Medicine and Health Sciences Commons^™

Pediatric Burn Management: Examining Efficacy And Affordability, Grace Bouker, Gabrielle Golinvaux, Kaytie Ridle, Makayla Stahl

Occupational Therapy Evidence Projects

Our research was led by Kelly Culhane, OTR/L, at California Children Services (CCS), in searching for efficacious and cost-effective occupational therapy treatments, or sequences of treatments, in chronic pediatric (ages 3-21) burn scar management. The primary outcomes following burn scar treatment are to increase functionality, mobility, well-being, and to improve the physical appearance of the scars. Research suggests that exercise, massage, silicon gel, and silicon patches can all be used as occupational therapy treatment for burn scars. Unstructured massages and silicon patches were found to be the most cost-effective solutions, resulting in less itch and scar vascularity, and increased range …

The Short-Term Effects Of Thoracic Transverse Mobilization In Patients With Subacromial Shoulder Pain, Hannah Descoteaux Spt, Kyle Morris Spt, Sarah Taketa Spt, Robert Boyles Pt, Dsc, Ocs, Faaompt

Physical Therapy Research Symposium

Background: There is evidence that thoracic manipulation is effective for treating subacromial shoulder pain (SSP). However, evidence is limited for thoracic mobilization. Manipulation is not safe for all patients; therefore, effects of thoracic mobilization on SSP needs to be researched further.

Purpose: To measure the effects of thoracic spine transverse mobilization (TSTM) and a home exercise in patients with SSP immediately after treatment, and 48 hours later. Shoulder range of motion (ROM), shoulder pain, and patient perception of treatment effects were assessed.

Methods: This is a single treatment pretest/posttest design consisting of eight patients (five females, three males; mean age …

Motor Competency And Physical Activity In Elementary School Aged Children Who Participate In Nontraditional Sports, Courtney Norman, Wesley Geer, Julia Looper

All Faculty Scholarship

One after school program, Youth Ambassadors of Physical Education (YA), is designed to promote physical activity in school age children to help combat the growing levels of childhood inactivity. However, this program utilizes skills that are vastly different from the locomotor and object control skills assessed with the Test of Gross Motor Development. Purpose: The purpose of this study it to determine whether the TGMD-2 can identify the children in YA as competent in their motor skills. This study also examines if there is a link between the overall physical activity level of the children in YA and their motor …

Challenges Facing Young Adults With Complex Communication Needs Entering The Adult Health Care System, Molly Stark, Christabelle Francis

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Barbara Abbott, PhD, OTR/L is a school-based occupational therapist currently working with students grades K-12 in four schools in Kent, WA. The purpose of our project was to identify the most effective service delivery models and/or components of interventions for young adults with complex communication needs to understand their health information. We conducted a systematic review to critically appraise literature published between the years of 1990-2018 to address our research question. Our research yielded a total of seven qualitative and 12 quantitative studies to address our research question. Qualitative data found that individuals with complex communication needs (CCN) experience significant …

Outcomes Of Service Delivery Models In School-Based Therapies, Nicholas Kasovac, Daniel Krupicka, Katherine Woodworth, Maryann Zmuda

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Kristin Brubaker, a licensed occupational therapist in the University Place School District, proposed the following question to a student research team: “What are the student, therapist, and teacher outcomes of different school-based service delivery models?” Following a review of 22 articles with qualitative and quantitative methods, studies were grouped into three categories of school-based service delivery models: collaborative-consultative, mixed, and direct. Research demonstrated that collaborative-consultative service delivery models provide positive outcomes such as stronger relationships between therapists and teachers, opportunities for therapists to implement and adapt intervention techniques within the classroom, increased effectiveness in teaching strategies, and improved academic skills …

Efficacy Of Evidence-Based Exercise As A Treatment For Breast Cancer Related Lymphedema, Eric Kartevold, Katrina Maañao Perez, Malcolm Reed

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Breast cancer related lymphedema (BCRL) of the upper extremity is a frequent sequela following axillary node dissection (AND). A recent meta-analysis by Gillespie et al. (2018), suggested a 21.4% incidence of chronic arm edema post breast cancer intervention. Gillespie et al. (2018) explained that because of a lack of diagnostic criteria for BCRL, incidence reports varied widely from less than 5% to over 50%.

The purpose of this review was to determine the efficacy of exercise in the self-management of BCRL, including the types and frequency of exercise. Protocols from 24 articles on the self-management of BCRL, including exercise as …

Biopsychosocial Factors That Hinders And/Or Facilitate Successful Return To Work: A Review Of Literature And Knowledge Of Translation, Natacha Chimenti, Lianna Wong

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Two community practitioners collaborated with the University of Puget Sound Occupational Therapy program and submitted the following clinical question: “What bio/psycho/social factors have been identified to hinder and/or facilitate successful return to work in addition to traditional work hardening/conditioning intervention for adults?” A literature review discovered 47 articles ranging from systematic reviews, descriptive, qualitative, outcome, and experimental studies. Evidence was synthesized by two reviewers into a critically appraised topic (CAT). Numerous facilitating (job satisfaction, employment accommodation, social support, multidisciplinary approach) and hindering factors (social isolation, depression, pain, self-perceived disability) were identified affecting one’s ability to return to work after various …

Emerging Opportunities: Lymphedema Management And The Potential For Surveillance Methods In A Primary Care Model, Claire Brummet, Nicole Chang, Kayleigh Odgear

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Heidi Shaffer, OTR/L, MSM, CLT-LANA at MultiCare-Gig Harbor was interested in how early intervention, namely intervening at Stage 0, related to better outcomes for oncology patients at risk of lymphedema. This question was developed from a desire to follow-up prior student research relating to the usefulness of the LDEX in lymphedema management, however current literature did not indicate the LDEX as an early intervention method. Although the authors did not exclude other types of cancer, the research only reflected breast cancer outcomes. Overall, strong evidence was found that exercise is not contraindicated for clients at risk of breast cancer related …

Comparing The Effectiveness Of Activity-Based Interventions And Rote Exercises In Skilled Nursing Facilities, Loren Burnett, Kelsey Tasoe, Kirsten Woodard

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Joette Jindra, OTR/L and director of rehabilitation at ManorCare in Tacoma, WA was interested in learning what type of interventions should be utilized by the therapists on her team. Therefore, the purpose of this critically appraised topic (CAT) was to examine the current literature on the effectiveness of activity-based intervention (meaningful or nonmeaningful) and rote exercise for improving physical performance outcomes in patients residing in skilled nursing facilities (SNF). The student researchers examined the literature on articles comparing the outcomes of activity-based interventions to those of rote exercise. Articles describing the outcomes of the two interventions independently were also examined. …

Efficacy Of Myofascial Release, Michelle Chait Ots, Erin Eaton Ots, Tiffany Farley Ots

School of Occupational Therapy Master's Capstone Projects (2016-2021)

In collaboration with Tomi Johnson and Domonique Herrin, hand therapists working in a MultiCare rehabilitation clinic, we sought to answer the question: In adults with upper extremity and cervical spine orthopedic and peripheral nerve conditions, does myofascial release (MFR) lead to functional outcomes (such as decreased pain or disability, or increased range of motion etc.), compared to therapeutic exercises, other manual therapeutic techniques, and/or modalities? Twenty-three research articles, systematic reviews and meta-analyses were included in our evaluation of the research. Based on our findings, moderate evidence exists to support the use of MFR in the upper extremity and its effectiveness …

Mirror Visual Feedback Therapy For Treatment Of Phantom Limb Pain: A Clinical Practice Guideline, Erick Moon, Roger Allen, Garret Hoskins

Physical Therapy Research Symposium

Authors: Garrett B Hoskins, SPT; Erick T Moon, SPT; Roger J. Allen, PT, PhD

Mirror visual feedback therapy for treatment of phantom limb pain: a clinical practice guideline.

Purpose: A growing number of recent controlled studies report mirror visual feedback therapy (MT) holds promise for treatment of phantom limb pain (PLP) following amputation, via facilitation of neuroplastic cortical remodeling. However, available research reports typically do not contain sufficient detail regarding the MT components utilized to allow clinicians to implement protocols found to be effective. The purpose of this study was to synthesize a clinical practice guideline, based on a systematic …

International Service Learning: An Overview, Kaitlynn L.C. Mckirgan Spt, Daniel Murty Spt, Dr. Holly Roberts Pt, Dpt, Gcs, Ncs

Physical Therapy Research Symposium

International Service Learning: An Overview

Kaitlynn McKirgan, SPT; Daniel Murty, SPT; Dr. Holly Roberts, PT, DPT, GCS, NCS

Affiliation: 1. The School of Physical Therapy, University of Puget Sound

Abstract

Purpose

A wide range of healthcare disciplines including nursing, public health, occupational therapy, and physical therapy (PT) now recognize global health participation and education as a necessary component of healthcare education. Increasingly, students applying to and choosing which PT program to attend must now consider the design, purpose, benefits, and potential drawbacks of such a program in their education. The purpose of this report is to provide an overview of …

Gender Dysphoria And The Role Of Occupational Therapy, Melanie Murphy, Julie Tinsley Schaefer, Enjoli Washington

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Prompted by Kristin Brubaker, a licensed pediatric occupational therapist who works at the Center for Therapeutic Intervention (CTI) in Gig Harbor, WA, the researchers set out to answer the following question: “What evidence supports the use of occupational therapy (OT) interventions in improving the psychosocial health of children and youth between the ages of 0 to 25 experiencing gender dysphoria (GD)?” After reading and evaluating 29 articles from qualitative and quantitative research, systematic reviews, and additional evidence, the researchers concluded that occupational therapists can assist this population by affirming the experience of GD, encouraging exploration of gender identity, providing a …

A Review Of Health Related Quality Of Life Assessments For Patients With Lymphedema, Bonnie C. Blair, Gina M. Dellino, Jennifer E. Thomas

School of Occupational Therapy Master's Capstone Projects (2016-2021)

In collaboration with Heidi Shaffer, one of the occupational therapists on staff at the MultiCare lymphedema clinic in Gig Harbor, Washington, we sought to answer the question “Which patient-reported outcome assessments are most valid and reliable in measuring health-related quality of life (HRQoL) in patients with lymphedema?” We conducted a systematic literature review to answer this question. In reviewing selected databases, 19 articles were chosen to appraise the evidence supporting psychometric properties and clinical utility of 10 HRQoL assessments used for patients with lymphedema. The Disability of the Arm, Shoulder and Hand (DASH) and Lymphedema Life Impact Scale (LLIS) assessments …

Orthotic Intervention For Children With Down Syndrome: A Review Based On The Icf Model, Emily Burman, Vanessa Thompson, Monica Finney, Julia Looper

Physical Therapy Research Symposium

Down Syndrome (DS), which occurs in 1 out of every 691 live births, is the most common genetic disorder in the United States. It is characterized by multiple physical and cognitive impairments that impact development and typically persist into adulthood. Due to the prevalence of musculoskeletal impairments such as ligamentous laxity, hypotonia, and abnormal bony alignment in the foot, medical providers frequently prescribe foot or ankle orthoses for children with DS. The International Classification of Functioning, Disability, and Health (ICF) provides a unique framework to clarify the impact of orthotic intervention on three domains of human function: body structure and …

Change In Function, Pain And Quality Of Life Following Structured Nonoperative Treatment In Patients With Degenerative Cervical Myelopathy: A Systematic Review, Ian Andersson, Anna Dembek

Physical Therapy Research Symposium

Title: Change in Function, Pain and Quality of Life following Structured Nonoperative Treatment in Patients with Degenerative Cervical Myelopathy: A Systematic Review

Authors: Lindsay Tetreault¹, Mohammed Shamji¹, John Rhee², Heidi Prather³, Jeff Wilson¹, Ian B. Andersson⁴, Anna H. Dembek⁴, Krystle Pagarigan⁵, Joseph R. Dettori⁵, Michael G. Fehlings¹

Affiliations: 1. Toronto Western Hospital, Toronto 2. Emory clinic, Atlanta 3. School of Medicine, Washington University at St. Louis 4. School of Physical Therapy, University of Puget Sound 5. Spectrum Research, Tacoma …

Does Patient Self-Efficacy At Intake Predict The Therapeutic Outcome?, Molly J. Geiger, Stephanie Juhnke, Ellen Maloney, Danny Mcmillian

Physical Therapy Research Symposium

Title: Does Patient Self-Efficacy at Intake Predict the Therapeutic Outcome?

Authors: Molly Geiger SPT¹, Stephanie Juhnke SPT¹, Ellen Maloney SPT¹, Danny McMillian DSc.¹

Affiliation: 1. School of Physical Therapy, University of Puget Sound

Purpose: Several studies have linked psychosocial factors, such as depression, self-efficacy, and fear-avoidance to poor outcomes, increased disability, and the development of chronic pain. In a primary care setting, Foster has shown self-efficacy to be the most important for determining outcomes. The aim of this study is to examine the relationship between self-efficacy (SE) levels and physical therapy (PT) outcomes. …

Episodic Versus Continuous Care In Outpatient Pediatric Clinics, Rebecca Newman, Kimberly Mcgarvey, Laura Hoppe

School of Occupational Therapy Master's Capstone Projects (2016-2021)

UW Medicine Valley Medical Center, Children’s Therapy (VMC-CT) has experienced difficulties with consistent service delivery schedules for their clients. Long waitlists, absences, and scheduling and insurance constraints have impeded client ability to receive standard, continuous therapy. Thus, this critically appraised topic (CAT) paper addresses a research question developed in conjunction with Kari Tanta, PhD, OTR/L, FAOTA, the Rehabilitation Manager at VMC-CT, to understand the most effective methods of service delivery: episodic therapy (i.e. high frequency over a short duration) or continuous therapy (i.e., low frequency over a longer duration). The following research question was developed: Is episodic pediatric care as …

Seeing Relief: Mirror Box Therapy As A Treatment For Chronic Regional Pain Syndrome, Danielle Watson, Mel Velsher

School of Occupational Therapy Master's Capstone Projects (2016-2021)

In collaboration with an occupational therapist who works in a physical therapy private practice as a hand therapist, the following clinical questions were identified: Is mirror box therapy (MT) effective in reducing pain for patients with complex regional pain syndrome (CRPS); secondary to orthopedic injury or peripheral nerve damage in the upper extremity (UE)? What protocols and dosages are the most effective? A structured review of the literature identified 18 studies that focus on the use of MT for CRPS of the UE: one meta-analysis of systematic reviews, five systematic reviews (SR) and 12 individual studies of which four are …

Four Effective And Feasible Interventions For Hemi-Inattention Post Cva: Systematic Review And Collaboration For Knowledge Translation In An Inpatient Rehab Setting., Elizabeth Armbrust, Domonique Herrin, Christi Lewallen, Karin Van Duzer

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Purpose: To locate, evaluate, and summarize the evidence for effective and feasible interventions to treat hemi-inattention in inpatient rehabilitation settings and ensure knowledge translation with a collaborating clinician Timothy Rich, OTR/L and his team at Harborview Medical Center. Design: Systematic literature review, participatory active research with a collaborating clinician, and knowledge translation. Methods: Included studies that tested effectiveness of mirror therapy (MT), transcutaneous electric nerve stimulation (TENS), limb activation therapy (LAT), and visual scanning therapy (VST). 11 databases were searched to yield 31 articles included in a critically appraised topic (CAT) table. A concise protocol for each …

Effects Of Desensitization On Pain Distribution And Normalization Of Somatosensation In A Patient With Quadrilateral Complex Regional Pain Syndrome, Lisa Cook, Kristen Dullen, Jacob Hoffman, Megan Vento, Roger Allen

Physical Therapy Research Symposium

Background and Purpose:

Complex regional pain syndrome (CRPS) is a chronic condition affecting at least one extremity that can develop after injury, involving allodynia, constant limb pain, and hyperpathic autonomic and somatic symptoms.¹ One essential CRPS treatment is somatosensory desensitization (SD), yet efficacy evidence remains limited.² This study aimed to assess changes in pain distribution and intensity in treated and untreated limbs, as well as possible somatosensory normalization of proximal non-painful limb regions, after 10 weeks of SD.

Case Description:

The 54 y.o. male patient had an incomplete C5 SCI. Prior to SD, the patient experienced constant searing …

Effect Of Early Mobilization Programs In The Intensive Care Unit (Icu). A Review Of Systematic Reviews, Rondamarie Smith, Stephanie Pelham, Nicholas Higa, Ann M. Wilson

Physical Therapy Research Symposium

Title: Effect of Early Mobilization Programs in the Intensive Care Unit (ICU). A Review of Systematic Reviews

Authors: Nicholas C. Higa, SPT1; Stephanie J. Pelham, SPT1; Rondamarie B. Smith, SPT1; Ann Wilson, PT, M.Ed., GCS.1

Affiliation(s): 1. Physical Therapy Program, University of Puget Sound;

Purpose: To determine the effect of early mobilization on reducing the side effects associated with prolonged bed rest of patients in the ICU.

Materials & Methods: CINAHL, The Cochrane Library, PEDro and PubMed were searched between April 2015 to August 2015 to identify systematic reviews published from 2000 to 2015 with the keywords “ambulation,” “critical care,” …

Reliability Of A United States Version Of The Nottingham Sensory Assessment, Amy Kaestner, Rebecca Miller

School of Occupational Therapy Master's Theses (2010-2015)

Many stroke survivors experience somatosensory deficits and there is currently no “gold standard” reliable standardized assessment commonly used by clinicians in the United States. In the present study, the authors modified the Nottingham Sensory Assessment (NSA) into a U.S. version to provide therapists with a standardized multimodal sensory assessment for use with clients post-stroke. Six licensed rehabilitation practitioners and one occupational therapy student administered the United States-NSA (US-NSA) on 17 older adults with chronic stroke (i.e., at least six months post-stroke) to evaluate its inter-rater reliability. The authors used an intraclass correlation coefficient (ICC) to analyze the inter-rater reliability of …

The Effectiveness Of Desensitization Therapy For Individuals With Complex Regional Pain Syndrome: A Systematic Review, Lauryn M. Helmers, Kira L. Donnelly, Olivia M. Verberne, Roger J. Allen

Physical Therapy Research Symposium

Authors: Kira L, Donnelly, SPT; Lauryn M. Helmers, SPT; Olivia M. Verberne, SPT; Roger J. Allen, PT, PhD

Title: The Effectiveness of Desensitization Therapy for Individuals with Complex Regional Pain Syndrome: A Systematic Review

Purpose: Systematically review evidence supporting the use of desensitization therapy to treat Complex Regional Pain Syndrome (CRPS).

Subjects: This systematic review evaluated 10 studies from peer-reviewed journals fitting research criteria.

Materials/Methods: Databases were searched between Mar and Aug of 2014 with the following search terms: complex regional pain syndrome, CRPS, allodynia, desensitization, neuropathic pain, physical therapy, tactile desensitization, pressure desensitization, hydrotherapy, physiotherapy, capsaicin and somatosensory.

Results: …

Hippotherapy As A Tool For Improving Motor Skills, Postural Stability, And Self Confidence In Cerebral Palsy And Multiple Sclerosis, Sarah A. Long

Sound Neuroscience: An Undergraduate Neuroscience Journal

Hippotherapy utilizes the three dimensional movement of the horse to improve balance, strength, coordination, and postural symmetry in those with cerebral palsy, multiple sclerosis, or related neuromuscular disorders. The forward, side-to-side, and rotational movement of the horse provides the rider with different sensory cues to help improve gait. While this therapy is a passive exercise for the patient, the individual must engage the core muscles to sit upright along with making small corrections due to the constant movement of the horse to help with postural stability and strengthening. Ultimately, understanding how affected brain areas lead to symptoms in those with …

Latent Modulation Of Neuropathic Pain Intensity Via Hypothalamus-Pituitary-Thyroid Axis Of Psychogenic Stress, Roger J. Allen

All Faculty Scholarship

Background: In patients with complex regional pain syndrome (CRPS) delayed pain flares consistently occur ten days following salient psychogenic stress episodes. Timing of latent flares suggests pain modulation via hypothalamus-pituitary-thyroid (HPT) axis hormones.

Objective: To determine if thyroxine (T₄) may modulate latent stress-related neuropathic pain flare intensity, temporal relationships between daily stress, serum T₄ levels, and perceived pain intensity in patients with CRPS were investigated.

Patients and Methods: Daily, for ten weeks, three patients with type I CRPS and no thyroid pathology Hx provided blood samples for T₄ assay and ratings of stress and pain. Measures …

Considering Client And Caregiver Experience After Stroke: A Systematic Review Of Qualitative Studies To Enhance Quantitative Research, Theresa Ryan

School of Occupational Therapy Master's Theses (2010-2015)

Objective: The purpose of this study was to examine the literature on the process of recovery through the perspective of both clients who have experienced stroke and their informal caregivers, in order to discover to what extent the findings of qualitative research enrich those of the quantitative type as to rehabilitation effectiveness.

Method: A systematic review of the salient qualitative research within EBSCOHOST, MEDLINE, AJOT, BJOT, and CJOT resulted in 50 articles identified. Of the articles initially identified, 41 met the inclusion criteria for further examination and critical appraisal. Themes that emerged from this review were compared with the …

Client Adherence To Discharge Recommendations From An Occupational Therapy Teaching Clinic Based On Activity Type: Occupation-Based, Purposeful, Or Preparatory, Jennie White

School of Occupational Therapy Master's Theses (2010-2015)

Research has shown full adherence to occupational therapy home program recommendations varies between 40 and 70%. Considering many clients have chronic conditions and are not completely recovered at discharge, this rate of adherence is far less than ideal and has been associated with poor overall health outcomes. Previous research has also suggested that people respond better to activities that have a goal-embedded component than they do to traditional or rote exercise. The current study examined client adherence based on the type of discharge recommendation given to adult clients at an on-campus clinic. Recommendations were categorized into those which were goal-embedded: …

Client Adherence To Discharge Recommendations From A Campus Occupational Therapy Student Clinic, Nancy Fuller

School of Occupational Therapy Master's Theses (2010-2015)

Eighteen adults with chronic medical conditions who participated in a university occupational therapy clinic were surveyed about adherence to home program discharge recommendations. Adherence rates for discharge recommendations that were occupation-based or purposeful activities were compared to preparatory activities, including rote exercise. Reported adherence rates were not statistically different. The study also examined barriers and supports that impacted adherence. Statistically significant negative correlations were found between age and adherence to preparatory activity recommendations and between the number of discharge recommendations and adherence to preparatory activities. In order to achieve better adherence, and therefore improve outcomes, occupational therapists should carefully consider …

Secondary Lymphedema Due To Breast Cancer: A Look At The Quality Of Life And Psychosocial Treatment Approaches Used By Occupational Therapy Practitioners, Hannah Baldwin

School of Occupational Therapy Master's Theses (2010-2015)

This study examined the degree to which occupational therapy practitioners address psychosocial and quality of life (QOL) sequelae in adult clients with lymphedema resulting from breast cancer treatment. An original survey was sent to 268 practitioners who were listed on the open source contact list on the website of the Lymphology Association of North America. When promoting QOL, respondents indicated that inquiry was the most frequently used assessment and therapeutic exercise was the most commonly reported therapeutic activity. When assessing for psychosocial well-being practitioners reported most commonly using interview, with conversation the most frequently reported therapeutic activity. For both QOL …