Medicine and Health Sciences Commons^™

Spatial Characteristics Of Reactive Stepping Among People Living With Chronic Incomplete Spinal Cord Injury, Matthew G Heffernan, Jae Woung Lee, Katherine Chan, Janelle Unger, Susan Marzolini, Timothy N Welsh, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Objective: Compare the spatial characteristics of reactive stepping between individuals with chronic motor incomplete spinal cord injuries (iSCI) and able-bodied (AB) individuals.

Design: Cross sectional.

Setting: Lyndhurst Centre.

Participants: Twelve individuals with iSCI (3 males, 53.6 ± 15.2 years old) and 11 age- and sex-matched AB individuals (3 males, 54.8 ± 14.0 years old).

Interventions: The Lean-and-Release test was used to elicit reactive stepping. A horizontal cable, attached at waist height, was released when 8-12% body weight was supported in a forward lean position. Participants underwent up to 10 Lean-and-Release trials in a session. Kinematic and …

Association Between Measures Of Cognitive Function On Physical Function In Novice Users Of A Lower Limb Prosthesis, Humberto Omana, Courtney Frengopoulos, Manuel Montero-Odasso, Michael W. Payne, Ricardo Viana, Susan W. Hunter

Physical Therapy Publications

BACKGROUND: Cognitive impairment is prevalent in people with lower limb amputations (PLLA) and is associated with adverse outcomes, such as falls and worse rehabilitation outcomes. Physical function tests are essential to examine abilities; however, no research in PLLA has clarified the magnitude of cognitive demands amongst available tests in users novice at walking with a prosthesis.

METHODS: People from inpatient prosthetic rehabilitation were recruited. Inclusion criteria were: age ≥ 50 years, unilateral transtibial amputation and able to walk independently. Gait velocity and the L Test under single-task (usual) and dual-task (walking while counting backwards) conditions assessed functional mobility. The Four …

Co-Contraction Of Ankle Muscle Activity During Quiet Standing In Individuals With Incomplete Spinal Cord Injury Is Associated With Postural Instability, Kai Lon Fok, Jae W Lee, Janelle Unger, Katherine Chan, Kristin E Musselman, Kei Masani

Physical Therapy Publications

Previous findings indicate that co-contractions of plantarflexors and dorsiflexors during quiet standing increase the ankle mechanical joint stiffness, resulting in increased postural sway. Balance impairments in individuals with incomplete spinal cord injury (iSCI) may be due to co-contractions like in other individuals with reduced balance ability. Here we investigated the effect of co-contraction between plantar- and dorsiflexors on postural balance in individuals with iSCI (iSCI-group) and able-bodied individuals (AB-group). Thirteen able-bodied individuals and 13 individuals with iSCI were asked to perform quiet standing with their eyes open (EO) and eyes closed (EC). Kinetics and electromyograms from the tibialis anterior (TA), …

Functional Reach Test, Single-Leg Stance Test, And Tinetti Performance-Oriented Mobility Assessment For The Prediction Of Falls In Older Adults: A Systematic Review, Humberto Omaña, Kari Bezaire, Kyla Brady, Jayme Davies, Nancy Louwagie, Sean Power, Sydney Santin, Susan W. Hunter

Physical Therapy Publications

OBJECTIVE: The authors sought to systematically review the existing literature on the falls-related diagnostic test properties of the Functional Reach Test (FRT), single-leg stance test (SLST), and Tinetti Performance-Oriented Mobility Assessment (POMA) in older adults across settings and patient populations.

METHODS: The PubMed, EMBASE, and CINAHL databases were searched (inception-July 2020). Inclusion criteria were participants aged 60 years or more, prospectively recorded falls, and the reporting of falls-related predictive validity. Manuscripts not published in English were excluded. Methodological quality of reporting was assessed using the Tooth Scale.

RESULTS: Of 1071 studies reviewed, 21 met the inclusion criteria (12 POMA, 8 …

The Effect Of First-Time 4-Wheeled Walker Use On The Gait Of Younger And Older Adults, Humberto A. Omana, Edward Madou, Alison Divine, Walter Wittich, Keith D. Hill, Andrew M. Johnson, Jeffrey D. Holmes, Susan W. Hunter

Physical Therapy Publications

INTRODUCTION: The 4-wheeled walker is intended to enhance balance and gait for older adults. Yet, some research suggests that walking aids increase falls risk. An understanding of the influence of age with walker use on gait performance is required.

OBJECTIVE: To examine the effect of initial 4-wheeled walker use on spatiotemporal gait parameters between younger and older adults.

DESIGN: Cross-sectional, repeated-measures.

SETTING: Community-dwelling.

PARTICIPANTS: Twenty-five younger (age: 26.5 ± 4.1 years) and 24 older (age: 68.5 ± 10.5 years) adults participated. Younger adults were aged 18 to 35 years, whereas older adults were 50 years or older. Included were people …

Perspectives Of Individuals With Chronic Spinal Cord Injury Following Novel Balance Training Involving Functional Electrical Stimulation With Visual Feedback: A Qualitative Exploratory Study, David J Houston, Janelle Unger, Jae W Lee, Kei Masani, Kristin E Musselman

Physical Therapy Publications

BACKGROUND: Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during periods of walking or standing. We recently reported the findings of a novel intervention combining functional electrical stimulation with visual feedback balance training (FES + VFBT) on standing balance abilities among five individuals with motor iSCI. However, the previous publication did not report the perceived impact of the intervention on the participants' lives. In this report, the experiences of these five individuals with incomplete spinal cord injury (iSCI) who had recently completed the four-week balance training program are described.

METHODS: Five individuals with a motor …

Association Between Changes In Subjective And Objective Measures Of Mobility In People With Lower Limb Amputations After Inpatient Rehabilitation, Gabrielle Cieslak, Humberto Omana, Edward Madou, Courtney Frengopoulos, Ricardo Viana, Michael W Payne, Susan W. Hunter

Physical Therapy Publications

Functional recovery for people with lower limb amputations is quantified using objective or subjective measures of performance. In this brief report, the prospective relationship between objective and subjective mobility after rehabilitation was evaluated in people with lower limb amputations. Adults undergoing inpatient prosthetic rehabilitation for a first unilateral transtibial or transfemoral level lower limb amputation were recruited. Assessment times: discharge and 4-mo follow-up. Gait velocity and the L Test under single- and dual-task conditions measured objective mobility. The Prosthetic Evaluation Questionnaire (section 4 and question 5b) measured subjective mobility. Paired t tests and Pearson correlation analysis evaluated change over time …

The Β3-Adrenergic Receptor Agonist Mirabegron Improves Glucose Homeostasis In Obese Humans, Brian S. Finlin, Hasiyet Memetimin, Beibei Zhu, Amy L. Confides, Hemendra J. Vekaria, Riham H. El Khouli, Zachary R. Johnson, Philip M. Westgate, Jianzhong Chen, Andrew J. Morris, Patrick G. Sullivan, Esther E. Dupont-Versteegden, Philip A. Kern

Internal Medicine Faculty Publications

BACKGROUND. Beige adipose tissue is associated with improved glucose homeostasis in mice. Adipose tissue contains β3-adrenergic receptors (β3-ARs), and this study was intended to determine whether the treatment of obese, insulin-resistant humans with the β3-AR agonist mirabegron, which stimulates beige adipose formation in subcutaneous white adipose tissue (SC WAT), would induce other beneficial changes in fat and muscle and improve metabolic homeostasis.

METHODS. Before and after β3-AR agonist treatment, oral glucose tolerance tests and euglycemic clamps were performed, and histochemical analysis and gene expression profiling were performed on fat and muscle biopsies. PET-CT scans quantified brown adipose tissue volume and …

Prevalence And Risk Factors Of Falls In Adults 1 Year After Total Hip Arthroplasty For Osteoarthritis: A Cross-Sectional Study, Susan W. Hunter, Pavlos Bobos, Lyndsay Somerville, James Howard, Edward M Vasarhelyi, Brent Lanting

Physical Therapy Publications

Total hip arthroplasty is very successful in alleviating the pain from osteoarthritis. However, deficits in lower limb strength, gait, and balance after surgery has identified this group at risk of falls. Considering the high number of people annually receiving a total hip arthroplasty, further elaboration of factors associated with falls is needed to refine fall prevention guidelines. The objective was to examine the prevalence and circumstances of falling and the risk factors associated with falling in older adults in the first year after total hip arthroplasty surgery. This was a cross-sectional study involving 108 individuals (age of 72.4 ± 6.5 …

Executive Function As A Mediating Factor Between Visual Acuity And Postural Stability In Cognitively Healthy Adults And Adults With Alzheimer's Dementia, Susan W. Hunter, Alison Divine, Edward Madou, Humberto Omana, Keith D Hill, Andrew M Johnson, Jeffrey D Holmes, Walter Wittich

Physical Therapy Publications

BACKGROUND: Falls in older adults, notably those with Alzheimer's dementia (AD), are prevalent. Vision and balance impairments are prominent falls risk factors in older adults. However, recent literature in the cognitively impaired suggests that executive function (EF) is important for falls risk assessments. The study objectives were to: 1) to compare balance among people with AD, healthy older adults (OA), and healthy young adults (YA) and 2) to quantify the interaction of visual acuity and EF on postural stability.

METHODS: We recruited 165 individuals (51 YA, 48 OA, and 66 AD). Trail Making Tests (A and B) quantified EF and …

Effect Of Dual-Tasking On Walking And Cognitive Demands In Adults With Alzheimer's Dementia Experienced In Using A 4-Wheeled Walker, Susan W. Hunter, Humberto Omana, Edward Madou, Walter Wittich, Keith D Hill, Andrew M Johnson, Alison Divine, Jeffrey D Holmes

Physical Therapy Publications

BACKGROUND: Learning to walk with a 4-wheeled walker increases cognitive demands in people with Alzheimer's dementia (AD). However, it is expected that experience will offset the increased cognitive demand. Current research has not yet evaluated gait in people with AD experienced in using a 4-wheeled walker under complex gait situations.

RESEARCH QUESTION: What is the effect of dual-task testing on the spatial-temporal gait parameters and cognitive performance of people with AD experienced with a 4-wheeled walker?

METHODS: Twenty-three adults with mild to moderate AD (87.4 ± 6.2 years, 48 % female) and at least 6 months of walker use experience …

Reactive Stepping After A Forward Fall In People Living With Incomplete Spinal Cord Injury Or Disease, Katherine Chan, Jae Woung Lee, Janelle Unger, Jaeeun Yoo, Kei Masani, Kristin E Musselman

Physical Therapy Publications

STUDY DESIGN: Cross sectional.

OBJECTIVES: To compare the reactive stepping ability of individuals living with incomplete spinal cord injury or disease (SCI/D) to that of sex- and age-matched able-bodied adults.

SETTING: A tertiary SCI/D rehabilitation center in Canada.

METHODS: Thirty-three individuals (20 with incomplete SCI/D) participated. Participants assumed a forward lean position in standing whilst 8-12% of their body weight was supported by a horizontal cable at waist height affixed to a rigid structure. The cable was released unexpectedly, simulating a forward fall and eliciting one or more reactive steps. Behavioral responses (i.e., single step versus non-single step) were compared …

Quantifying Balance Control After Spinal Cord Injury: Reliability And Validity Of The Mini-Bestest, Katherine Chan, Janelle Unger, Jae Woung Lee, Gillian Johnston, Marissa Constand, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Context/Objective: Incomplete spinal cord injury (iSCI) causes deficits in balance control. The Mini-Balance Evaluation Systems Test (mini-BESTest) is a comprehensive measure; however, further testing of its psychometric properties among the iSCI population is needed. We evaluated the mini-BESTest’s test-retest reliability, and concurrent and convergent validity among individuals living with iSCI for more than one year.

Design: Cross-sectional study.

Setting: Rehabilitation hospital.

Participants: Twenty-one individuals with chronic motor iSCI (14 females, mean age 56.8 ± 14.0 years).

Interventions: None.

Outcome Measures: Participants completed the mini-BESTest at two sessions spaced two weeks apart. At the second session, participants …

Effect Of Learning To Use A Mobility Aid On Gait And Cognitive Demands In People With Mild To Moderate Alzheimer's Disease: Part I - Cane, Susan W. Hunter, Alison Divine, Humberto Omana, Walter Wittich, Keith D Hill, Andrew M Johnson, Jeffrey D Holmes

Physical Therapy Publications

BACKGROUND: People with Alzheimer's disease (AD) exhibit balance and walking impairments that increase falls risk. Prescription of a mobility aid is done to improve stability, yet also requires increased cognitive resources. Single-point canes require unique motor sequencing for safe use. The effect of learning to use a single-point cane has not been evaluated in people with AD.

OBJECTIVES: In people with AD and healthy adult controls: 1) examine changes in gait while using a cane under various walking conditions; and 2) determine the cognitive and gait costs associated with concurrent cane walking while multi-tasking.

METHODS: Seventeen participants with AD (age …

Risk Factors For Falls In Individuals With Lower Extremity Amputations During The Pre-Prosthetic Phase: A Retrospective Cohort Study, Kimberly Vu, Michael W C Payne, Susan W. Hunter, Ricardo Viana

Physical Therapy Publications

BACKGROUND: Falls in individuals with lower limb amputations (LLAs) pose significant health concerns. The literature is limited regarding falls during the preprosthetic phase of rehabilitation for persons with LLAs.

OBJECTIVE: To determine the incidence of falls and identify factors associated with falls during the preprosthetic recovery phase.

DESIGN: Retrospective chart audit.

SETTING: Inpatient rehabilitation program.

PARTICIPANTS: Four hundred forty individuals with LLAs (age ± SD = 61.93 ± 14.53 years, 73.18% male) who attended inpatient rehabilitation from 26 July 2011 to 21 August 2017.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASUREMENTS: The number of self-reported falls was recorded from the time …

Physical Therapy Treatment For A Patient With A Hip Fracture And Cognitive Impairments: A Case Report, Tracie Boehmlehner

Physical Therapy Scholarly Projects

Background and Purpose: As the population shifts to include higher numbers of people in the elderly population, diseases and pathologies associated with geriatric populations will also increase. Two of these conditions are cognitive impairment and hip fractures. Hip fractures can be costly and life altering injuries. Treating patients with both of these conditions can pose a unique challenge to healthcare workers.

Case Description: The patient in this case study is a 78 year-old female who suffered a hip fracture secondary to a fall with a hip herniarthroplasty completed. She had many co-morbidities that are typical of an aging person such …

Cognition Predicts Mobility Change In Lower Extremity Amputees Between Discharge From Rehabilitation And 4-Month Follow-Up: A Prospective Cohort Study., Susan W. Hunter, Pavlos Bobos, Courtney Frengopoulos, Austin Macpherson, Ricardo Viana, Michael W Payne

Physical Therapy Publications

OBJECTIVES: To assess (1) the effect of task (single and dual task), time (discharge and 4mo), and their interaction for mobility; (2) task prioritization during dual-task testing; and (3) the association between cognition on change in mobility between discharge from rehabilitation and 4 months' follow-up.

DESIGN: Prospective cohort study.

SETTING: Rehabilitation hospital.

PARTICIPANTS: People with lower extremity amputations (N=22) were consecutively recruited at discharge from an inpatient prosthetic rehabilitation program.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Gait velocity and the L Test of Functional Mobility, single and dual task (serial subtractions by 3), were the primary outcomes. Montreal Cognitive Assessment …

Reliability, Validity, And Agreement Of The Short-Form Activities-Specific Balance Confidence Scale In People With Lower Extremity Amputations., Katherine Fuller, Humberto Adolfo Omaña Moreno, Courtney Frengopoulos, Michael W Payne, Ricardo Viana, Susan W. Hunter

Physical Therapy Publications

BACKGROUND: Clinicians use the Activities-specific Balance Confidence Scale to understand balance confidence. A short-form Activities-specific Balance Confidence scale, was developed using the six most difficult tasks from the original Activities-specific Balance Confidence scale; however, short-form the short-form scale psychometrics and agreement with the original scale have yet to be explored in people with lower extremity amputations.

OBJECTIVE: To determine the relative and absolute reliability, construct validity, and agreement of the short-form Activities-specific Balance Confidence scale.

STUDY DESIGN: Test-retest with a 2-week interval.

METHODS: Analysis for relative reliability and internal consistency was intraclass correlation coefficient and Cronbach's

RESULTS: The short-form Activities-specific …

Effect Of Learning To Use A Mobility Aid On Gait And Cognitive Demands In People With Mild To Moderate Alzheimer's Disease: Part Ii - 4-Wheeled Walker., Susan W. Hunter, Alison Divine, Humberto Omana, Walter Wittich, Keith D Hill, Andrew M Johnson, Jeffrey D Holmes

Physical Therapy Publications

BACKGROUND: Cognitive deficits and gait problems are common and progressive in Alzheimer's disease (AD). Prescription of a 4-wheeled walker is a common intervention to improve stability and independence, yet can be associated with an increased falls risk.

OBJECTIVES: 1) To examine changes in spatial-temporal gait parameters while using a 4-wheeled walker under different walking conditions, and 2) to determine the cognitive and gait task costs of walking with the aid in adults with AD and healthy older adults.

METHODS: Twenty participants with AD (age 79.1±7.1 years) and 22 controls (age 68.5±10.7 years) walked using a 4-wheeled walker in a straight …

White Matter Biomarkers Associated With Motor Change In Individuals With Stroke: A Continuous Theta Burst Stimulation Study, K P Wadden, Sue Peters, M R Borich, J L Neva, K S Hayward, C S Mang, N J Snow, K E Brown, T S Woodward, S K Meehan, L A Boyd

Physical Therapy Publications

Continuous theta burst stimulation (cTBS) is a form of noninvasive repetitive brain stimulation that, when delivered over the contralesional hemisphere, can influence the excitability of the ipsilesional hemisphere in individuals with stroke. cTBS applied prior to skilled motor practice interventions may augment motor learning; however, there is a high degree of variability in individual response to this intervention. The main objective of the present study was to assess white matter biomarkers of response to cTBS paired with skilled motor practice in individuals with chronic stroke. We tested the effects of stimulation of the contralesional hemisphere at the site of the …

Standard And Cognitive Four Square Step Test (Fsst), Renee Hoffman, Hannah Bucholz

Physical Therapy Scholarly Projects

Background/Purpose: The Four Square Step Test (FSST) measures dynamic standing balance and agility and was developed to identify older adults at risk for falls. It has a cognitive component for remembering the stepping sequence but has never been tested with an additional cognitive task. The purpose of this study was to collect normative data for the FSST and Cognitive FSST in community dwelling adults for various age groups.

Materials/Methods: Eighty-seven community-dwelling adults (55 females, 32 males) between the age 21 and 86 (48.22 years) were included in the study. Participants completed a fall risk checklist and a cognitive screen prior …

Effects Of Pole Walking On Older Adults Following Six Weeks Of Training, Samantha Forsch, Raevyn Haugland

Physical Therapy Scholarly Projects

Introduction: Age-related changes in adults over 60 include reduced mobility and function as well as an increase in frailty. Conventional walking has been shown to be an effective physical activity to maintain mobility and improve function and overall health and fitness. Specifically, walking speed has been identified as a crucial predicting factor for fall risk and decreased functional mobility. For this reason, clinicians considered the element of walking speed as the sixth vital sign. Pole walking has gained popularity over the years and may provide additional benefits, when compared to conventional walking, such as improved stride and step length, faster …

A Framework For Secondary Cognitive And Motor Tasks In Dual-Task Gait Testing In People With Mild Cognitive Impairment., Susan W Hunter, Alison Divine, Courtney Frengopoulos, Manuel Montero Odasso

Physical Therapy Publications

BACKGROUND: Cognition is a key factor in the regulation of normal walking and dual-task gait assessment is an accepted method to evaluate the relationship. The objective of this study was to create a framework for task complexity of concurrent motor and cognitive tasks with gait in people with mild cognitive impairment (MCI).

METHODS: Community-dwelling people with MCI (n = 41, mean age = 76.20 ± 7.65 years) and cognitively normal controls (n = 41, mean age = 72.10 ± 3.80 years) participated in this study. Gait velocity was collected using an instrumented walkway under one single task and six combined …

Application Of Forced Use In A Traditional Acute Hospital Setting With A 77-Year-Old Female Post Left Cva, Jimmie Parten, Anne H. Boddy

St. Augustine, Summer 2018

The purpose of this case report is to look at the positive outcomes following the application of forced use physical therapy techniques in the traditional acute hospital setting with a 77-year-old female post left CVA.

Trunk Motion Visual Feedback During Walking Improves Dynamic Balance In Older Adults: Assessor Blinded Randomized Controlled Trial., Eric Anson, Lei Ma, Tippawan Meetam, Elizabeth Thompson, Roshita Rathore, Victoria Dean, John Jeka

Department of Physical Therapy Faculty Papers

BACKGROUND: Virtual reality and augmented feedback have become more prevalent as training methods to improve balance. Few reports exist on the benefits of providing trunk motion visual feedback (VFB) during treadmill walking, and most of those reports only describe within session changes.

RESEARCH QUESTION: To determine whether trunk motion VFB treadmill walking would improve over-ground balance for older adults with self-reported balance problems.

METHODS: 40 adults (75.8 years (SD 6.5)) with self-reported balance difficulties or a history of falling were randomized to a control or experimental group. Everyone walked on a treadmill at a comfortable speed 3×/week for 4 weeks …

Type-2 Diabetes Mellitus Reduces Cortical Thickness And Decreases Oxidative Metabolism In Sensorimotor Regions After Stroke., Jennifer K Ferris, Sue Peters, Katlyn E Brown, Katherine Tourigny, Lara A Boyd

Physical Therapy Publications

Individuals with type-2 diabetes mellitus experience poor motor outcomes after ischemic stroke. Recent research suggests that type-2 diabetes adversely impacts neuronal integrity and function, yet little work has considered how these neuronal changes affect sensorimotor outcomes after stroke. Here, we considered how type-2 diabetes impacted the structural and metabolic function of the sensorimotor cortex after stroke using volumetric magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). We hypothesized that the combination of chronic stroke and type-2 diabetes would negatively impact the integrity of sensorimotor cortex as compared to individuals with chronic stroke alone. Compared to stroke alone, individuals with …

Conservative Treatment Of A 58 Year-Old Male Referred To Physical Therapy With A Knee Sprain And Knee Osteoarthritis, Chase Pruitt

Physical Therapy Scholarly Projects

Background and Purpose: Knee osteoarthritis (OA) is a common condition in people over 50. Although there may be an association between acute knee injuries and knee OA later in life, the occurrence of acute knee injuries in patients with existing OA is less clear. The purpose of this case study is to evaluate the effectiveness of an impairment based therapy program in an individual with an acute knee injury and knee OA.

Case Description: This case follows a 57 year old male referred to physical therapy with an acute knee sprain and tri-compartmental knee OA. Treatment lasted 7 sessions …

The Attentional Demands Of Ambulating With An Assistive Device In Older Adults With Alzheimer's Disease, Susan W. Hunter, M Montero-Odasso

Physical Therapy Publications

Ambulation with a mobility aid is a unique real-life situation of multi-tasking. These simultaneous motor tasks place increased demands on executive function in healthy young and older adults, but the demands have not been evaluated in people with Alzheimer's disease (AD). Mobility problems are common among adults with AD, leading to provision of a mobility aid to optimize independent activity. The study objectives were: (i) to determine the dual-task cost (DTC) associated with the use of a mobility aid in straight and complex path walking, and (ii) to evaluate the association between executive function and ambulation with a mobility aid …

Training Of Anticipatory Postural Adjustments In An 83-Year-Old Female With Severe Anxiety Post-Femoral Fracture: A Case Report, Chandler Witt, Anne H. Boddy

St. Augustine, Spring 2017

The purpose of this case report is to present the outcomes of using APA training exercises in conjunction with conventional physical therapy to improve gait independence, and movement anxiety in older adult patients post femoral fracture secondary to a fall.

Visual, Verbal, And Tactile Cues On Improving Gait In A 71-Year Old Male With Dementia Of The Lewy Bodies, Symone Carter, Jackie Crossen-Sills

St. Augustine, Spring 2017

The purpose of the case report is to demonstrate how visual, verbal, and tactile cues can improve gait in a patient with DLB.