Musculoskeletal System Commons^™

Effects Of Obesity And Fall Risk On Gait And Posture Of Community-Dwelling Older Adults, Thurmon E. Lockhart, Christopher W. Frames, Rahul Soangra, Abraham Lieberman

Physical Therapy Faculty Articles and Research

Epidemiological studies link increased fall risk to obesity in older adults, but the mechanism through which obesity increases falls and fall risks is unknown. This study investigates if obesity (Body Mass Index: BMI>30 kg/m2) influenced gait and standing postural characteristics of community dwelling older adults leading to increased risk of falls. One hundred healthy older adults (age 74.0±7.6 years, range of 56-90 years) living independently in a community participated in this study. Participants’ history of falls over the previous two years was recorded, with emphasis on frequency and characteristics of falls. Participants with at least two falls in the …

A Method To Concatenate Multiple Short Time Series For Evaluating Dynamic Behaviour During Walking, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Gait variability is a sensitive metric for assessing functional deficits in individuals with mobility impairments. To correctly represent the temporal evolution of gait kinematics, nonlinear measures require extended and uninterrupted time series. In this study, we present and validate a novel algorithm for concatenating multiple time-series in order to allow the nonlinear analysis of gait data from standard and unrestricted overground walking protocols. The fullbody gait patterns of twenty healthy subjects were captured during five walking trials (at least 5 minutes) on a treadmill under different weight perturbation conditions. The collected time series were cut into multiple shorter time series …

Does Variability Of Footfall Kinematics Correlate With Dynamic Stability Of The Centre Of Mass During Walking?, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

A stable walking pattern is presumably essential to avoid falls. Stability of walking is most accurately determined by the short-term local dynamic stability (maximum Lyapunov exponent) of the body centre of mass. In many studies related to fall risk, however, variability of step width is considered to be indicative of the stability of the centre of mass during walking. However, other footfall parameters, in particular variability of stride time, have also been associated with increased risk for falling. Therefore, the aim of this study was to investigate the association between short-term local dynamic stability of the body centre of mass …

The Pairing Of Trigger Point Dry Needling With Rehabilitation Techniques, Karle Kotze

Senior Honors Theses

Trigger point dry needling is a manual treatment modality used for individuals experiencing tightness, pain, and inhibited range of motion in any region of the body. Dry needling can be described as the insertion of a blunt, microfilament non-medicated needle into the skin for the purpose of targeting specific muscles, which contain tight bands known as trigger points. When the needle is inserted into the trigger point the muscle contracts, holds tight to the needle, and elicits a neural twitch response. This ultimately causes the muscle to relax, allowing for reduction in pain and improvements in range of motion. Although …

The Effects Of Saddle Alignment And Pedal Stroke Training On A Competitive Cyclist With Anterior Knee Pain: A Case Report, Tim Evens, Jerome Danoff

Internet Journal of Allied Health Sciences and Practice

Background: Among competitive cyclists, anterior knee pain is a common overuse injury. Alignment of the rider on the bicycle and the loading pattern on the pedals are proposed as factors in this pain. The patient was a 23-year-old competitive female cyclist who was riding up to 200 miles weekly and had developed bilateral anterior knee pain within the 3 months preceding our examination. The purpose of this case report is to demonstrate the effectiveness of adjusting this patient’s static alignment (ie. position while seated on bicycle, but not actively pedaling) on the bike and modifying her habitual pedaling pattern. Methods …

Anticipatory Postural Adjustments And Spatial Organization Of Motor Cortex: Evidence Of Adaptive Compensations In Healthy Older Adults, Jo Armour Smith, Beth E. Fisher

Physical Therapy Faculty Articles and Research

During anticipated postural perturbations induced by limb movement, the central nervous system generates anticipatory postural adjustments (APAs) in the trunk and hip musculature to minimize disturbances to equilibrium. Age-related changes in functional organization of the nervous system may contribute to changes in APAs in healthy older adults. Here we examined if altered APAs of trunk/hip musculature in older adults are accompanied by changes in the representation of these muscles in motor cortex. Twelve healthy older adults, 5 with a history of falls and 7 nonfallers, were compared with 13 young adults. APAs were assessed during a mediolateral arm raise task …

Insertion And Presence Of Fine-Wire Intramuscular Electrodes To The Lumbar Paraspinal Muscles Do Not Affect Muscle Performance And Activation During Highexertion Spinal Extension Activities, Szu-Ping Lee, Jo Armour Smith, Matthew Kimber, Kelsey Houk

Physical Therapy Faculty Articles and Research

Background

Low back pain (LBP) is commonly associated with paraspinal muscle dysfunctions. A method to study deep lumbar paraspinal (i.e. multifidus) muscle function and neuromuscular activation pattern is intramuscular electromyography (EMG). Previous studies have shown that the procedure does not significantly impact muscle function during activities involving low-level muscle contractions. However, it is currently unknown how muscular function and activation are affected during high-exertion contractions.

Objective

To examine the effects of insertion and presence of fine-wire EMG electrodes in the lumbar multifidus on muscle strength, endurance, and activation profiles during high-exertion spinal extension muscle contractions.

Design

Single-blinded, repeated measures intervention …

Muscle Synergy During A Single Leg Standing Test In Ambulatory Children With Cerebral Palsy, Brennan L. Smith

Theses and Dissertations--Kinesiology and Health Promotion

INTRODUCTION: Cerebral Palsy (CP) is a sensorimotor disorder characterized by dysfunctional motor coordination, balance problems, and loss of selective motor control. Motor coordination exhibited as co-contraction, has been subjectively quantified using gait analysis, but recent studies have begun to objectively analyze the amount of co-contraction by collecting electromyography (EMG) data. Center of pressure excursion (COPE) measurements collected during a single leg standing test (SLST) have shown to be more valid measurements of balance in populations with motor disabilities than a SLST alone. A recent study has correlated increased COPE velocity with a lower fall risk as determined by reported fall …

Using Foot Pressure Analysis To Predict Reoccurrence Of Deformity For Children With Unilateral Clubfoot, Juanita Jean Wallace

Theses and Dissertations--Kinesiology and Health Promotion

Reoccurrence of deformity can affect upwards of 64% of children with clubfoot. The ability to use foot function as a measure of reoccurrence has not been previously assessed. The purpose of this investigation was to utilize foot pressure analysis to predict the probability of reoccurrence in children with unilateral clubfoot. Retrospective foot pressure data revealed predictive algorithms detecting the probability of experiencing any type of reoccurrence (overall reoccurrence) and for experiencing a tibialis anterior tendon transfer (TATT). The equation for overall reoccurrence reported sensitivity and specificity of 0.82 and 0.81 and the equation for TATT reported values of 0.81 and …

Effects Of Lower Extremity Aerobic Exercise And Conditioned Pain Modulation On Evoked Shoulder Pain, Logan Lumpkins, Craig Wassinger

Undergraduate Honors Theses

Background: Emerging evidence suggests that aerobic exercise and conditioned pain modulation may be advocated in treating patients with musculoskeletal pain. The effects of lower extremity aerobic exercise and conditioned pain modulation on evoked shoulder pain are not known.

Purpose: To determine the acute effects of lower extremity aerobic exercise and conditioned pain modulation on outcomes of evoked shoulder pain from pain pressure threshold measurements.

Study Design: Repeated measures.

Methods: Thirty (30) healthy volunteers were tested over the course of two sessions. Session 1 consisted of collecting pain pressure threshold measurements over the infraspinatus before and immediately following a conditioned pain …

Cortical Contribution To Linear, Non-Linear And Frequency Components Of Motor Variability Control During Standing, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Motor variability is an inherent feature of all human movements and reflects the quality of functional task performance. Depending on the requirements of the motor task, the human sensory-motor system is thought to be able to flexibly govern the appropriate level of variability. However, it remains unclear which neurophysiological structures are responsible for the control of motor variability. In this study, we tested the contribution of cortical cognitive resources on the control of motor variability (in this case postural sway) using a dual-task paradigm and furthermore observed potential changes in control strategy by evaluating Ia-afferent integration (H-reflex). Twenty healthy subjects …

Neuromuscular Function In Women Postpartum, Rita Deering

Dissertations (1934 -)

Efficient abdominal muscle function is important for functional mobility in men and women, and dysfunction of these muscles has been associated with impaired function such as low back pain. This dissertation explored abdominal muscle function in healthy young men and young women who have never been pregnant (nulligravid). As pregnancy and child birth also impact the tissues of the abdominal wall, this dissertation will also explore abdominal muscle function in postpartum women. This dissertation involved three primary aims. Aim1 compared abdominal muscle function and experimental pain perception in males and nulligravid females. Maximal strength over a range of trunk angles, …

The Motor Cortical Representation Of A Muscle Is Not Homogeneous In Brain Connectivity, Jo Armour Smith, Alaa Albishi, Sarine Babikian, Skulpan Asavasopon, Beth E. Fisher, Jason Kutch

Physical Therapy Faculty Articles and Research

Functional connectivity patterns of the motor cortical representational area of single muscles have not been extensively mapped in humans, particularly for the axial musculature. Functional connectivity may provide a neural substrate for adaptation of muscle activity in axial muscles that have both voluntary and postural functions. The purpose of this study was to combine brain stimulation and neuroimaging to both map the cortical representation of the external oblique (EO) in primary motor cortex (M1) and supplementary motor area (SMA), and to establish the resting-state functional connectivity associated with this representation. Motor evoked potentials were elicited from the EO muscle in …

Efficacy Of Electromyography And The Dead Bug Exercise, Taylor M. Scavo, Rachel C. Cooklin, Erika N. Faria, Madeline L. Johnson, Eric Sternlicht

Student Scholar Symposium Abstracts and Posters

The Dead Bug exercise is performed in physical therapy clinics to restore lumbar spine stability and core strength in patients with lower back pain (LBP). The aim of this study was to evaluate the efficacy of using electromyography (EMG) feedback to enhance proper mechanics during the Dead Bug exercise. Sixteen healthy, college age students volunteered as subjects for the study. Subjects performed the Dead Bug (Fig. 1a.) with and without visual EMG cues and were given instructions on how to execute the exercise. Data was recorded using a BTS FREEEMG Analyzer and signal processed and data analyzed using the BTS …

Toward A Research Agenda For Oncology Physical Therapy, Lucinda Pfalzer, Nicole L. Stout, Shana Harrington, Mary Insana Fisher

Physical Therapy Faculty Publications

Research Round-up: Cancer survivors frequently experience cancer treatment–related functional impairments and disability. While a growing body of evidence supports the effectiveness of rehabilitation interventions for these individuals, there are significant gaps in the existing literature and no interdisciplinary agreement on the priorities for cancer rehabilitation research. In 2016, the Oncology Section revised its strategic plan and set an objective to create an oncology rehabilitation research agenda for the physical therapy (PT) profession. To achieve this goal, the scope of the agenda, a development and review process, and dissemination plan need to be developed.

What Is The Contribution Of Ia-Afference For Regulating Motor Output Variability During Standing?, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Motor variability is an inherent feature of all human movements, and describes the system‘s stability and rigidity during the performance of functional motor tasks such as balancing. In order to ensure successful task execution, the nervous system is thought to be able to flexibly select the appropriate level of variability. However, it remains unknown which neurophysiological pathways are utilized for the control of motor output variability. In responding to natural variability (in this example sway), it is plausible that the neuro-physiological response to muscular elongation contributes to restoring a balanced upright posture. In this study, the postural sway of 18 …

Dual-Task Does Not Increase Slip And Fall Risk In Healthy Young And Older Adults During Walking, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Dual-task tests can identify gait characteristics peculiar to fallers and nonfallers. Understanding the relationship between gait performance and dual-task related cognitive-motor interference is important for fall prevention. Dual-task adapted changes in gait instability/variability can adversely affect fall risks. Although implicated, it is unclear if healthy participants’ fall risks aremodified by dual-task walking conditions. Seven healthy young and seven healthy older adults were randomly assigned to normal walking and dual-task walking sessions with a slip perturbation. In the dual-task session, the participants walked and simultaneously counted backwards from a randomly provided number. The results indicate that the gait changes in dual-task …

Pattern Of Alteration In Foot Mechanics When Carrying Loads Unilaterally In Hand, Deepashini Harithasan, Baharudin Omar, Aatit Paungmali

Internet Journal of Allied Health Sciences and Practice

PURPOSE: Carrying weight in one hand is a common functional activity. This study investigated the effects of incremental loads carried in one hand unilaterally and its influence on the foot mechanics [plantar pressure, maximum force and contact area]. METHOD: Twenty healthy individuals were tested, in standing and walking, while carrying different weights (no load, 5 kg, 7.5 kg and 10 kg) using their right hand. ANCOVA was conducted separately for the right and left leg to address the effect of incremental loads on the foot mechanics within each leg with navicular drop index and Q angle as covariates. Paired t …

Adaptations Of Lumbar Biomechanics After Four Weeks Of Running Training With Minimalist Footwear And Technique Guidance: Implications For Running-Related Lower Back Pain, Szu-Ping Lee, Joshua P. Bailey, Jo Armour Smith, Stephanie Barton, David Brown, Talia Joyce

Physical Therapy Faculty Articles and Research

Objectives

To investigate the changes in lumbar kinematic and paraspinal muscle activation before, during, and after a 4-week minimalist running training.

Design

Prospective cohort study.

Setting

University research laboratory.

Participants

Seventeen habitually shod recreational runners who run 10–50 km per week.

Main outcome measures

During stance phases of running, sagittal lumbar kinematics was recorded using an electrogoniometer, and activities of the lumbar paraspinal muscles were assessed by electromyography. Runners were asked to run at a prescribed speed (3.1 m/s) and a self-selected speed.

Results

For the 3.1 m/s running speed, significant differences were found in the calculated mean lumbar posture …

Can Gait Signatures Provide Quantitative Measures For Aiding Clinical Decision-Making? A Systematic Meta-Analysis Of Gait Variability Behavior In Patients With Parkinson’S Disease, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

A disturbed, inconsistent walking pattern is a common feature of patients with Parkinson's disease (PwPD). Such extreme variability in both temporal and spatial parameters of gait has been associated with unstable walking and an elevated prevalence of falls. However, despite their ability to discretise healthy from pathological function, normative variability values for key gait parameters are still missing. Furthermore, an understanding of each parameter's response to pathology, as well as the inter-parameter relationships, has received little attention. The aim of this systematic literature review and meta-analysis was therefore to define threshold levels for pathological gait variability as well as to …

How Should We Teach Lumbar Manipulation? A Consensus Study, Michael O'Donnell, Jo Armour Smith, Alex Abzug, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Background Spinal manipulation is an effective intervention for low back pain, yet there is little consistency in how this skill is taught.

Objectives The purpose of this study was to identify what educators and clinicians believe are important characteristics of the patient and operator position prior to side-lying lumbar manipulation and the patient position and operator motion during the manipulative thrust.

Design A multi-disciplinary correspondence-based Delphi method

Methods Three rounds of questionnaires were sent to physical therapists, osteopaths and chiropractors. Consensus was established in Round 3 if at least 75 % of respondents identified a characteristic as very important/extremely important …

Revealing The Quality Of Movement: A Meta-Analysis Review To Quantify The Thresholds To Pathological Variability During Standing And Walking, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Neuromotor processes are inherently noisy, which results in variability during movement and fluctu-ations in motor control. Although controversial, low levels of variability are traditionally considered healthy, while increased levels are thought to be pathological. This systematic review and meta-analysisof the literature investigates the thresholds between healthy and pathological task variability.

After examining 13,195 publications, 109 studies were included. Results from over 3000 healthy sub-jects and 2775 patients revealed an overall positive effect size of pathology on variability of 0.59 forwalking and 0.80 for sway. For the coefficient of variation of stride time (ST) and sway area (SA), upperthresholds of 2.6% …

Trunk-Pelvis Coordination During Turning: A Cross Sectional Study Of Young Adults With And Without A History Of Low Back Pain, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Background

During steady-state locomotion, symptomatic individuals with low back pain demonstrate reduced ability to modulate coordination between the trunk and the pelvis in the axial plane. It is unclear if this is also true during functional locomotor perturbations such as changing direction, or if this change in coordination adaptability persists between symptomatic episodes. The purpose of this study was to compare trunk-pelvis coordination during walking turns in healthy individuals and asymptomatic individuals with a history of low back pain.

Methods

Participants performed multiple ipsilateral turns. Axial plane inter-segmental coordination and stride-to-stride coordination variability were quantified using the vector coding technique. …

Altered Multifidus Recruitment During Walking In Young Asymptomatic Individuals With A History Of Low Back Pain, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Study Design

Cross sectional, laboratory study.

Background

Individuals with low back pain have impaired activation of multifidus during postural adjustments and increased activity of the erector spinae musculature during walking. However, it is unclear if these alterations in muscle activity are evident during locomotion in individuals with a history of low back pain when they are between symptomatic episodes.

Objectives

To compare paraspinal muscle activity in young healthy individuals and young individuals with a history of low back pain during walking turns.

Methods

14 asymptomatic individuals with a history of low back pain and 14 controls performed 90° walking turns …

Hip Flexor Extensibility And Its Correlation To Hip Hyperextension And Lower Back Pain In Dancers, Tessa Richards

Undergraduate Theses, Professional Papers, and Capstone Artifacts

In the world of ballet, flexibility and strength are the keys to success. A leg extended to extraordinary heights is equated with beauty and expertise, whereas a lower height is seen as lesser quality. Dancers are trained from their first ballet lesson to reach their toes to the utmost end of their range of motion, and push themselves beyond the regular restrictions of the human body. Despite the pressure put on dancers to be extremely flexible, tight hip flexor muscles (the rectus femoris and the iliopsoas group) are a common complaint, restricting hip hyperextension (called an arabesque). To compensate for …

Effects Of Pelvis Impact Angle And Hip Muscle Forces On Hip Fracture Risk During A Fall Using An Advanced Hip Impact Simulator, Woochol J. Choi, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

"Over 90% of hip fractures in older adults are caused by falls [1]. Whether a given fall will cause hip fracture depends on bone strength, and on the impact force and stress applied to the bone during impact [2]. Improved understanding is required on how peak bone stresses during a fall depend on the mechanics of a fall, and on the state of contraction at the moment of impact of the muscles spanning the hip. Recently, Choi et al showed that, for lateral impact to the hip, peak stresses decrease with increases in hip abductor muscle force [3]. In the …

Influence Of Pelvis Impact Angle During A Fall: On The Protective Benefit Of Hip Protectors, Woochol J. Choi, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

"Over 90% of hip fractures are due to falls [1]. Laboratory measures have shown that wearable hip protectors reduce impact forces to the proximal femur during a simulated sideways fall on the hip [2, 3]. However, clinical evidence suggests that hip fractures still occur when hip protectors are worn [4]. Furthermore, while falls in real life result in a variety of impact configurations, biomechanical tests to date have focused only on lateral impact to the pelvis. In the current study, we examined how the force reduction provided by wearable hip protectors is affected by pelvis impact configuration during simulated sideways …

Does Insertion Of Intramuscular Electromyographic Electrodes Alter Motor Behavior During Locomotion?, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Intramuscular electromyography (EMG) is commonly used to quantify activity in the trunk musculature. However, it is unclear if the discomfort or fear of pain associated with insertion of intramuscular EMG electrodes results in altered motor behavior. This study examined whether intramuscular EMG affects locomotor speed and trunk motion, and examined the anticipated and actual pain associated with electrode insertion in healthy individuals and individuals with a history of low back pain (LBP). Before and after insertion of intramuscular electrodes into the lumbar and thoracic paraspinals, participants performed multiple repetitions of a walking turn at self-selected and controlled average speed. Low …

A Comparison Of The Scapular Flip Test Between Women With Breast Cancer And Healthy Controls, Mary Insana Fisher, Lucinda Pfalzer, Ellen W. Levy, Shana Harrington, Lynn H. Gerber, Nicole L. Stout

Physical Therapy Faculty Publications

Presentation at the World Confederation for Physical Therapy Congress, held May 1-4, 2015, in Singapore.

Background: The Scapular Flip test was designed to screen for spinal accessory nerve palsy. The spinal accessory nerve can be damaged in breast cancer surgery and treatment, resulting in scapular dyskinesis and upper limb (UL) impairment in women with breast cancer (BC). This test could be useful to screen for UL impairment in BC.

Purpose: The purpose of this study was to describe shoulder impairments as defined by a positive Flip Test in a group of women with BC at baseline, 1-3 months, and 12+ …

Hydatid Cyst Of Thoracic Spine: A Rare Cause Of Paraplegia, Rahul Soangra, Mool Chand Soangra

Physical Therapy Faculty Articles and Research

Primary spinal hydatid cysts are uncommon and extradural involvement is rare. We report an unusual case of Paraplegia due to hydatid disease of primary site of infection extra spinal muscles in thoracic region from T5 to T8 level extending into a daughter cyst at T9 level, is main cause of acute Paraplegia. Magnetic resonance imaging (MRI) showed an extradural round cystic lesion in the spinal canal filling the posterior and left postero-lateral expect at T9 level, markedly compressing the cord. The cyst was removed after laminectomy and opening of the dural sac, with excision of extraspinal mass in left paravertebral …