Rehabilitation and Therapy Commons^™

Postural Responses To Perturbations Of The Vestibular System During Walking In Healthy Young And Older Adults, Jung Hung Chien

Theses & Dissertations

It has been shown that approximate one-third of US adults aged 40 years and older (69 million US citizens) have some type of vestibular problems. These declining abilities of the vestibular system affect quality of life. Difficulties in performing daily activities (dressing, bathing, getting in and out of the bed and etc.) have been highly correlated to loss of balance due to vestibular disorders. The exact number of people affected by vestibular disorders is still difficult to quantify. This might be because symptoms are difficult to describe and differences exist in the qualifying criteria within and across studies. Thus, it …

The Feedforward And Feedback Controls On Gait In Adults With Diabetes, Chun-Kai Huang

Theses & Dissertations

There are nearly 26 million people with diabetes mellitus (DM) in the US, and half of chronic DMs develop somatosensory deficits due to diabetic polyneuropathy or diabetic peripheral neuropathy (DPN). The absence or impaired somatosensory feedback (e.g. touch sensation or joint proprioception) resulted from the damage of large nerve fiber, and motor deficits such as attenuated muscle strength and abnormal plantar pressure of lower extremity have been identified in DPN, and these sensorimotor impairments lead to an increased number of falls. To reduce the risk of falling, a well-coordinated and adapted limb movement driven by the feedforward (anticipatory) and feedback …

Humeral Retrotorsion In Developing Children And Its Relationship To Throwing Sports, Elliot M. Greenberg

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Baseball players exhibit a more posteriorly oriented humeral head or humeral retrotorsion (HRT) in the dominant arm, likely representing an adaptive response to the stress of throwing. This adaptation is thought to occur while skeletally immature, however there is limited research detailing how throwing while young influences the development HRT. In addition, it is currently unclear how this changing osseous orientation influences shoulder motion within young athletes. Purpose: To determine the influence of throwing and age on the development of asymmetry in HRT and shoulder range of motion (ROM); and analyze the relationship between HRT and ROM. Study Design: …

Effect Of Vestibular Adaptation Exercises On Chronic Motion Sensitivity, Danah Alyahya

Loma Linda University Electronic Theses, Dissertations & Projects

Dizziness is one of the most common complaints reported to primary care physicians. It is often associated with vestibular dysfunction and typically impacts postural stability. Motion sickness, or motion sensitivity, is stimulated by abnormal spatial orientation and is a common symptom related to dizziness and postural instability. The main cause of the motion sensitivity is aberrant sensory input from the visual, vestibular and somatosensory systems. The aim of this study was to measure the effect of vestibular adaptation exercises on postural stability in young healthy adults with subjective awareness of chronic motion sensitivity.

Methods: Fifty healthy male and female …

Inter-Rater Reliability Of The Mckenzie System Of Mechanical Diagnosis And Therapy In The Examination Of The Knee, Sean Willis

Electronic Thesis and Dissertation Repository

Objective: The purpose of this thesis was to investigate the inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy (MDT) when classifying patients with musculoskeletal knee pain using clinical vignettes. Methods: This study was divided into two phases. First, ten clinicians experienced in the use of MDT were randomly recruited to write a total of 60 clinical vignettes based upon the initial assessment of past patients with knee pain. Second, six different MDT raters were recruited to rate 53 selected vignettes and reliability was determined using Fleiss Kappa. Results: There was “substantial agreement” among six MDT raters …

Developmental Coordination Disorder: The Relationship Between Gait And Attention With Possible Implications For Early Identification And Intervention, Yocheved Bensinger-Brody

Dissertations, Theses, and Capstone Projects

The aim of this research was to evaluate how increased levels of challenge to attentional capacity would affect the motor planning and coordination in the gait of children at risk of Developmental Coordination Disorder (DCD) across developmental ages. The study incorporated a dual task paradigm requiring both motor and attention performance, with the primary hypothesis that children who are at risk of DCD across different ages (3- to 8 yrs.-of-age) would demonstrate an alteration in their motor strategies if they were simultaneously engaging in an attention task. A secondary hypothesis of this study was that there is an underlying deficit …

A Randomized Clinical Trial To Compare The Effect Of Non Operative Treatment With And Without Autologous Conditioned Plasma (Acp) On Healing And Function In Patients With Achilles Tendon Ruptures, Tyler M. Pratt

Electronic Thesis and Dissertation Repository

The purpose of this study was to determine whether there is evidence to support conducting a larger randomized control trial (RCT) to compare the non-operative treatment of Achilles tendon (AT) ruptures with or without Autologous Conditioned Plasma (ACP®). Twenty-four patients were randomized to receive an ACP® or saline injection within seven days and again at two weeks post-rupture. Tendon healing was longitudinally evaluated using ultrasound (US) and magnetic resonance imaging (MRI). Functional and patient-reported quality of life measures were also assessed. A small sample size limited our ability to detect statistically significant differences. The mean rankings of healing were slightly …

Physical Therapy After Triangular Fibrocartilage Injuries And Ulnar Wrist Pain, Mohamed A. Abdelmegeed

Loma Linda University Electronic Theses, Dissertations & Projects

Background: The ulnar side of the wrist has been referred to as the “black box” of the wrist because of its complex structures and sophisticated anatomy, disorders at this anatomical site have been compared to those of low back pain

Purposes: The purpose of this study was to apply the Brief International Classification of Functioning (ICF) Core Set for Hand Conditions to the physical therapy outcome measures, and to evaluate the contribution of these measures to overall health in subjects with ulnar wrist pain. A secondary purpose was to investigate the effect of wrist orthotics and strengthening exercise on …

Cross-Cultural Adaption And Psychometric Properties Testing Of The Arabic Anterior Knee Pain Scale, Abdullah S. Alshehri

Loma Linda University Electronic Theses, Dissertations & Projects

Patellofemoral pain syndrome (PFP) is a common condition affecting the musculoskeletal system and has a tendency of becoming chronic and is problematic in the affected people. It is the commonest cause of anterior knee pain. In over 2/3 of the patients affected it has been successfully treated through the use of rehabilitation protocols which are designed in pain reduction and returning the functionality to an individual. Many cases of patellofemoral pain syndrome can be avoided only if a clinician can make a pre-diagnosis. Preparation Screening Evaluation testing done by a certified athletic trainer can also help in prevention of this …

The Effects Of A Novel Therapeutic Intervention In Diabetic Peripheral Neuropathy Patients, Adel M. Alshahrani

Loma Linda University Electronic Theses, Dissertations & Projects

Diabetes mellitus (DM) is a common disorder affecting individuals in the United States and in the world. The prevalence of DM has increased noticeably over the last three decades with an estimated 380 million people currently diagnosed with this disease. DM is associated with numerous systemic complications that affect the retina, heart, brain, kidneys, and nerves. The most common complication of DM is diabetic peripheral neuropathy. Diabetic peripheral neuropathy causes reduced sensation, reflexes, proprioception, and strength in lower limbs that leads to balance problems. Various manual therapy techniques have not approached a pilot study for the efficacy of a manual …

Stability Study: A Multicentre Rct Comparing Acl Reconstruction With And Without Lateral Extra-Articular Tenodesis For Individuals At High Risk Of Graft Failure, Christopher Eric Hewison

Electronic Thesis and Dissertation Repository

Seventy patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) were randomly assigned to receive ACLR alone or ACLR plus a lateral extra-articular tenodesis (LET). Our primary outcome was Limb Symmetry Index (LSI) calculated using a series of four hop tests at six months postoperative. Secondary outcomes measures included pain, subjective function and isokinetic strength testing. We found no statistically significant difference between the two groups in LSI calculations. We found statistically significant differences favouring the ACLR alone group in quadriceps average power and peak torque symmetry measurements at six-months postoperative when we adjusted for baseline measurements. No other statistically significant …

Differences In Balance And Muscle Activation Strategies During Gait Initiation At Different Speeds Between Young And Middle-Aged Adults, Lynn Curtis-Vinegra

Seton Hall University Dissertations and Theses (ETDs)

Middle-age adults’ (MA) self-report of falls are greater compared to younger adults (YA) during ambulation. A previous study found that MA compared to YA use different strategies taking one-step forward at a fast speed. No other studies have compared the effect of two different speeds on balance variables and muscle activity during gait initiation in the MA compared to YA using an instrumented walkway. The objectives of this study were to assess the effects of age and speed on balance by measuring a) the Center of Pressure (COP) in two planes: COPx (sagittal) and COPy (frontal) and the Center of …

The Effect Of A Multiple Modality Mind-Motor Exercise Intervention On Single And Dual-Task Gait, Balance, And Executive Function, In Community Dwelling Older Adults With A Subjective Cognitive Complaint: A Randomized Controlled Trial., John P. Bocti

Electronic Thesis and Dissertation Repository

Cognitive decline disorders are becoming increasingly prevalent, with older adults at increased risk. Combined exercise has been recently explored as an intervention to help to prevent the decline, however cognitive activation in combination with physical activity has yet to be explored. Therefore, the purpose of the study is to determine the effects of multiple modality exercise programs in combination with a mind-motor task and their effects on mobility and cognitive variables. A total of (n=89) older adults (55+ yrs), with subjective cognitive complaints participated in a multiple modality exercise class, three days a week over six months, with the intervention …

Stability Of Isometric Strength Asymmetry And Its Relationship To Sprint And Change-Of-Direction Performance Asymmetry In Division-I Collegiate Athletes, Benjamin H. Gleason

Electronic Theses and Dissertations

The purpose of this dissertation was to evaluate the stability of strength asymmetry over a long-term period (1 year) and investigate the relationship of strength asymmetry to field test performance asymmetry in NCAA division-1 athletes. Isometric mid-thigh pull (IMTP) peak force asymmetry, ground contact time and finish time asymmetries on 10m sprint and 505 agility test performances were also observed. The impact of strength was also investigated in these studies to determine its effect on the magnitude of asymmetry.

In the second study, peak force asymmetry over a one-year period was observed to be a rather volatile quality, with ranges …

The Effect Of Cervical Muscle Fatigue On Postural Stability During Immersion Virtual Reality, Mazen M. Alqahtani

Loma Linda University Electronic Theses, Dissertations & Projects

The visual system is part of the nervous system that enables an individual to scan their environment and assess distance to and from objects. The information captured form our navigating environment is communicated to the brain, which in turn makes the decision on how we respond to spatial orientation. This is particularly useful in helping with balance and determining direction of movement. Our posture and visual stability rely heavily on an efficient and processing of visual, vestibular, and proprioception afferent input. Erroneous sensory information from defective sensory organs may cause a person to experience feelings of lightheadedness, spinning and whirling …

Effect Of Tactile Feedback On Reducing Body Sway In Elderly, Faris Shuleih Alshammari

Loma Linda University Electronic Theses, Dissertations & Projects

Context: Body sway increases in the elderly due to normal aging and a high incidence of disease such as diabetes. Increased body sway is associated with an elevated risk of falling. Falling is one of the major causes of morbidity and mortality in the elderly. Objectives: The purpose of this study was to examine the effect of 6 minutes training of tactile feedback (novel intervention) compared to visual feedback on body sway in the elderly with or without diabetes to develop a new technique for balance training. Design: A single blinded randomized controlled trial. Setting: Loma Linda University, Loma Linda, …

Use Of The Bioness L300® Functional Electrical Stimulator In Acute Stroke Rehabilitation, Christine Flanigan, Colleen M. Martinez, Beth N. Terranova, Nicholas Wildi

Dissertations, Theses, and Capstone Projects

Purpose. Over 150,000 people in the U.S. every year experience foot drop following a stroke, slowing their ambulation and increasing their falls risk. We explore whether the use of functional electrical stimulation (FES) to the common fibular nerve during acute rehabilitation can maximize ambulation gains. Methods. Five in-patients admitted at Burke Rehabilitation Hospital experiencing foot drop participated. While receiving conventional physical therapy, four subjects wore the Bioness L300® device, and one subject used an elastic figure-8 wrapped elastic bandage. Gait parameters were evaluated at initial evaluation, an intermittent evaluation, and discharge. Results. During their stay, subjects significantly improved in gait …

Retrospective Chart Review Of Patients Following Unilateral Total Knee Replacement To Assess Achievement Of Functional Milestones Based On Type Of Anesthetic Used Intra-Operatively, William S. Benish, Lolline Chong, Elana Kram, Danielle Krieger

Dissertations, Theses, and Capstone Projects

PURPOSE: Given the large number of Total Knee Replacements (TKR) performed annually in the US and the prediction that those numbers will increase, providing optimal analgesia during TKR is an important strategy for reducing cost and improving patient outcomes. Currently, no standard analgesia protocol for TKR exists and facilities in the US and world-wide use varied methods of analgesia. The purpose of the present study is to determine which analgesic technique; femoral nerve block (FNB), saphenous nerve block (SNB) or periarticular injection (PAI), within the context of a multi-modal pain management regimen, results in optimal TKR patient outcomes and achievement …

Investigating The Effects Of Combining Treadmill Training With Trans-Spinal Direct Current Stimulation On Motor Skill Recovery After Spinal Cord Injury, Jennifer Blake, Rebecca Bullen, Jeremy Pahl, Samantha Scicchigno

Dissertations, Theses, and Capstone Projects

This study assessed the effect of treadmill training with or without trans-spinal direct current stimulation on motor recovery following a T13/L1 spinal cord hemi section in CD-1 mice. Mice all received the same spinal cord injury, which resulted in left hind limb paralysis, and were assigned to one of three groups. Control animals received no treatment. Treadmill only mice were treated with 5 sessions of treadmill training. Treadmill + stimulation animals were treated with concurrent treadmill training and trans-spinal direct current stimulation. Progress was assessed by analyzing each subject’s steps on a horizontal ladder test, which the animals performed both …

Implications Of Muscle Activation Patterns On Balance In The Elderly, Arielle Bailey, Goldie Baum, Hadassa Radzik, Aruna Woods

Dissertations, Theses, and Capstone Projects

More than one third of adults ages 65 years old and older fall each year in the United States. This can result in trauma, hospital admissions, and potential death. The purpose of this study was to investigate the effects of waist-pull perturbation training on balance in the elderly. There were two experimental groups, elderly non-fallers (n=9) and elderly fallers (n=5) between ages 65-86, and a control group comprised of young, healthy subjects (n=10) ages 21-31. All subjects underwent baseline and post-training measurements using EMG recordings of the tibialis anterior, gastrocnemius, vastus lateralis and semimembranosus. Training was performing using repeated waist-pull …

An Electromyographic Comparison Of The Functional Performance Of The Gluteus Maximus Muscle In Prolonged Sitting Versus Standing Populations, Kerry Campagnola, Giusi Gerbino, Erica Johnson, Adrienne O’Keefe

Dissertations, Theses, and Capstone Projects

PURPOSE: A common clinical concern of Physical Therapists is the inexplicably weak gluteus maximus (GM) muscle; we hypothesized that this may be linked to the popular habit of prolonged sitting. The purpose of this study was to determine if surface electromyography (sEMG) output and timing of the GM and hamstrings muscles differed between people who sit for prolonged periods of time and people who stand for prolonged periods of time. METHODS: The design of our study was a single session case-control study. Subjects were 22 healthy adults (23-36 years old) who either sat or stood for 8-10 hours a day …

The Influence Of Forward Head Posture On Suprahyoid Activity During Oropharyngeal Swallowing: A Surface Electromyographic Analysis, Brianne Carroll, Sierra Hunt, Katherine Sheeleigh, Mark Wnukowski

Dissertations, Theses, and Capstone Projects

STUDY DESIGN: Within subjects repeated measures design.

OBJECTIVE: The aim of this research is to explore the effect that Forward Head Posture has on the mylohyoid muscle during swallowing in a healthy population.

BACKGROUND: Forward Head Posture (FHP) is the most common deviation from ideal head posture, and has become more prominent due to the rise of smart phones and the prevalence of computers in the household and workplace. FHP is associated with a variety of detrimental effects on the musculoskeletal system that arise from the abnormal positioning of the cranial and cervical bones and joints. In particular, the muscles …

Assessment Of Physical Performance In Adolescents Of Varying Body Weight, Nicholas Dalonzo, Nicole Liquori, Nicole Savarese

Dissertations, Theses, and Capstone Projects

Fifty-one healthy adolescents of both gender without any neuromuscular, musculoskeletal or cardiopulmonary disorders and between the ages of 12 and 17 with a mean age of 14.09 years (SD: 1.45 years) were recruited to participate in the 6-minute walk test. Several measurements such as height, weight and leg length were taken before testing, along with heart rate, blood pressure and oxygen saturation (SPO2) before, after and 10 minutes post 6-minute walk test. Walk distance was also quantified and used as an outcome measure. The adolescents were divided into two groups prior to statistical testing. The first group was classified as …

Dancer Performance On The Lower Quarter Y Balance Test: A Longitudinal Study, Megan Dehey, Kelly Kaems, Molly Saunders, Gabrielle Schneider

Dissertations, Theses, and Capstone Projects

Purpose: There is a need in the current literature for further information regarding dancer performance on the Y Balance Test (YBT). This study tracked the test scores of a group of dancers to assess change over time and relationship of balance scores to injury risk. It is hoped that clinicians may be able to use the information found in this study to more accurately screen dancers for asymmetries, deficits, and changes over time using the YBT. Such screenings would allow for more effective care and better assessment of readiness to return to dance. Method: A group of 12 dancers between …

The Effects Of Cooling During Gait On Gait Endurance In Persons With Multiple Sclerosis Using The Six Minute Walk Test, Meghan Higgins, Esther Sosowsky, Elisheva Zinberg

Dissertations, Theses, and Capstone Projects

Background: Persons with MS (pwMS) are limited in their mobility due to thermosensitivity. Exercising at a sufficient volume and intensity to increase mobility can result in increased core temperatures and resultant worsening of symptoms. The use of cooling garments to lower core temperature has been found to be a successful means of allowing pwMS to exercise for longer periods. Previous studies have relied on precooling for an extended period of time prior to activity, to achieve improved exercise performance. Cooling during the performance itself, or pericooling, may allow for similar performance gains to be realized without spending the time needed …

The Effects Of Maximal Strength Training On Gait And Balance In Persons With Multiple Sclerosis: A Pretest Posttest Pilot Study, Janet Klein, David Park, Charles Wright, Michael Zervas

Dissertations, Theses, and Capstone Projects

Background: Physical Therapy strength training programs utilizing mild to moderate intensity are commonly prescribed to address many of the deficits found in multiple sclerosis, but studies examining the effectiveness of higher intensity strength training in gait and balance have not been performed. Maximal strength training (MST), which involves lifting nearly maximal weights (85-95% of an individual’s one repetition maximum [1RM]) with low repetitions, has been shown to improve functional abilities in both healthy and non-MS impaired populations. The higher intensity training used in MST may result in greater activation of the CNS, providing a greater stimulus to improvement than …

Interactions Between Descending And Somatosensory Inputs In Humans, Lisa Krivis, Ann Mackey, Maureen Mcdonough, Denise Uttaro

Dissertations, Theses, and Capstone Projects

In this study, we assessed the corticospinal integration in healthy people while seated. Corticospinal integration was assessed by establishing the latency and amplitude of motor evoked potentials (MEPs) evoked following transcranial magnetic stimulation (TMS) of the primary motor cortex area representing the leg muscles, and the latency and amplitude of spinally-mediated reflex responses. Further, the modulation pattern of the spinally-mediated reflex responses were determined following subthreshold and suprathreshold TMS. All compound muscle action potentials, descending motor or spinally-mediated reflexes were recorded from the leg muscles through surface electromyography. Both subthreshold and suprathreshold TMS induced a similar modulation pattern on the …

Effect Of Absent Tactile Sensation On Multi-Digit Coordination Underlying Hand Control, Michael P. Alcorn, Bruce Faulkner, Matthew Macina, Brian Sherman

Dissertations, Theses, and Capstone Projects

We investigated the effect of anesthesia, causing absent tactile sensation feedback, on multi-digit coordination underlying hand control. The purpose of the study is to expand our understanding on the essential role of tactile sensation feedback in the sensorimotor integration process by examining the motor coordination patterns during multi-digit forces production tasks. We hypothesized that absent tactile sensation feedback would interrupt the force sharing pattern at local and non-local digits. Twelve participants were utilized for data collection and statistical analysis (25.6 ± 4.1 years old, 6 males and 6 females), right-handed (according to their preferred hand use for writing and eating) …

Evaluating Physical Therapy For Adolescent Patients With Low Back Pain, Kelly Denise Gonzales

Doctor of Nursing Practice Final Manuscripts

Background: Low back pain is a condition affecting many people worldwide. The age of onset is variable, affecting all patient populations from childhood throughout the lifespan. Aims/Purpose: The efficacy of physical therapy for adolescent patients with back pain seen in a pediatric orthopedic clinic was evaluated through comparison of pre and post-intervention pain scores. Patient compliance with physical therapy was monitored and evaluated against outcomes.

Design: A six-month retrospective chart review of adolescent patients with a diagnosis of low back pain. Patients with a diagnosis of low back pain were referred for physical therapy and provided with a home exercise …

Functional Recovery: A Mixed Methods Study Of The Specific Variables Within A Post-Hospital Inter-Disciplinary Brain Injury Rehabilitation - Residential Program, Victoria Harding

Dissertations, 2014-2019

The mixed methods explanatory design study examined specific constructs of Post Hospital Interdisciplinary Brain Injury Rehabilitation – Residential (PHIDBIR-R) programs that positively influenced gains in function. The investigation involved exploring the phenomenon of individuals’ experiences while participating in a PHIDBIR-R program as part of recovery from brain injury. The study’ primary purpose was to understand individuals who make the greatest gains in function while participating in these programs, as measured by the Mayo-Portland Adaptability Inventory-4 (MPAI-4) change scores from admission to discharge and what are the components of these programs that may contribute to individuals’ gains in function.

Data were …