Rehabilitation and Therapy Commons^™

Neurophysiological Changes Of Brain And Spinal Cord In Individuals With Patellofemoral Pain: A Systematic Review And Meta-Analysis Protocol, Jing Nong Liang, Savanna Budge, Austin Madriaga, Kara Meske, Derrick Nguyenton, Kai-Yu Ho

Physical Therapy Faculty Research

Introduction: Reduced neuromuscular control due to altered neurophysiological functions of the central nervous system has been suggested to cause movement deficits in individuals with patellofemoral pain (PFP). However, the underlying neurophysiological measures of brain and spinal cord in this population remain to be poorly understood. The purpose of this systematic review is to evaluate the evidence for altered cortical and spinal cord functions in individuals with PFP.

Methods and analysis: The protocol for conducting the review was prepared using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will systematically search the literature that examines cortical and …

Knowledge, Attitude, And Practice Of Orthopedic Manual Physical Therapists Toward Lifestyle Screening And Education: A Descriptive Study, Jillian M. Zollinger, Sozina Katuli

Faculty Publications

Introduction. Lifestyle-focused rehabilitation plans need to become part of the standard system of care for the treatment of chronic diseases. To achieve this goal, the KAP of rehabilitation professionals toward lifestyle medicine needs to be understood. This study investigated the niche of orthopedic manual physical therapy and is purposed as a foundational model for continued research. Method. A survey instrument was designed to investigate the KAP of orthopedic manual physical therapists toward lifestyle screening and education. Results. There were 155 participants of which 58.1-72.3% reported frequently talking to their patients about lifestyle topics, while 78.1-80.6% felt highly confident and competent …

Myonuclear Transcriptional Dynamics In Response To Exercise Following Satellite Cell Depletion, Yuan Wen, Davis A. Englund, Bailey D. Peck, Kevin A. Murach, John J. Mccarthy, Charlotte A. Peterson

Physical Therapy Faculty Publications

Skeletal muscle is composed of post-mitotic myofibers that form a syncytium containing hundreds of myonuclei. Using a progressive exercise training model in the mouse and single nucleus RNA-sequencing (snRNA-seq) for high-resolution characterization of myonuclear transcription, we show myonuclear functional specialization in muscle. After 4 weeks of exercise training, snRNA-seq reveals that resident muscle stem cells, or satellite cells, are activated with acute exercise but demonstrate limited lineage progression while contributing to muscle adaptation. In the absence of satellite cells, a portion of nuclei demonstrates divergent transcriptional dynamics associated with mixed-fate identities compared with satellite cell replete muscles. These data provide …

Asymmetries In Dynamic Valgus Index After Anterior Cruciate Ligament Reconstruction: A Proof-Of-Concept Study, Kai Yu Ho, Andrew Murata

Physical Therapy Faculty Research

Individuals with anterior cruciate ligament reconstruction (ACLR) are at a higher risk for subsequent anterior cruciate ligament (ACL) tears. Risk factors for ACL injuries likely involve a combination of anatomical, biomechanical, and neuromuscular factors. Dynamic knee valgus has been indicated as a possible biomechanical factor for future ACL injuries. Given that knee valgus is often accompanied by contralateral pelvic drop during single-leg activities, a dynamic valgus index (DVI) that quantifies combined kinematics of the knee and hip in the frontal plane has recently been developed. As the premise of asymmetrical DVI between limbs in the ACLR population has not been …

The Why, Where, And How Clinical Reasoning Model For The Evaluation And Treatment Of Patients With Low Back Pain, Sean P. Riley, Brian T. Swanson, Joshua Cleland

Physical Therapy Faculty Publications

Objective

The objective of this theoretical clinical reasoning model is to provide a framework to help clinicians integrate linear and non-linear clinical reasoning approaches to minimize clinical reasoning errors related to logically fallacious thinking and cognitive biases.

Methods

This masterclass proposes a hypothesis-driven and probabilistic approach that uses clinical reasoning for managing LBP that seeks to eliminate the challenges related to using any single diagnostic paradigm.

Conclusions

This model integrates the why (mechanism of primary symptoms), where (location of the primary driver of symptoms), and how (impact of mechanical input and how it may or may not modulate the patient's …

Muscle Force Contributions To Ankle Joint Contact Forces During An Unanticipated Cutting Task In People With Chronic Ankle Instability, Hoon Kim, Rianna M. Palmieri-Smith, Kristof Kipp

Exercise Science Faculty Research and Publications

The purpose of this study was to compare muscle force contributions to ankle joint compression and anteroposterior shear forces between people with chronic ankle instability (CAI) and healthy controls (CON) during an unanticipated cutting task. Eleven people with CAI and 11 CON performed an unanticipated cutting task as three-dimensional motion capture, ground reaction force (GRF), and muscle activation data were collected. A musculoskeletal modeling was used to calculate talocrural joint compression and anteroposterior shear forces and parse out the contributions to these forces from ankle-spanning muscles and from GRF. Independent t-tests were used for statistical analysis. People with CAI exhibited …

Gait Mechanics Are Influenced By Quadriceps Strength, Age, And Sex After Total Knee Arthroplasty, Jesse C. Christensen, Jacob J. Capin, Lauren A. Hinrichs, Moiyad Aljehani, Jennifer E. Stevens-Lapsley, Joseph A. Zeni

Physical Therapy Faculty Research and Publications

Although most patients are satisfied with outcomes after total knee arthroplasty (TKA), many retain preoperative altered gait mechanics. Identifying patient characteristics associated with gait mechanics will improve rehabilitation strategies and enhance our understanding of movement disorders. Therefore, the purpose of this study was to identify which patient characteristics are related to gait mechanics in the surgical limb during walking post-TKA. Patient characteristics included age, body mass, sex, quadriceps strength, self-reported function, and knee pain. General linear regression was used to compare patient characteristics associated with gait mechanics, after controlling for gait speed, functional capacity and time from surgery. We tested …

Different Biomechanical Variables Explain Within-Subjects Versus Between-Subjects Variance In Step Length Asymmetry Post-Stroke, Natalia Sánchez, Nicolas Schweighofer, James M. Finley

Physical Therapy Faculty Articles and Research

Step length asymmetry (SLA) is common in most stroke survivors. Several studies have shown that factors such as paretic propulsion can explain between-subjects differences in SLA. However, whether the factors that account for between-subjects variance in SLA are consistent with those that account for within subjects, stride-by-stride variance in SLA has not been determined. SLA direction is heterogeneous, and different impairments likely contribute to differences in SLA direction. Here, we identified common predictors between-subjects that explain within-subjects variance in SLA using sparse partial least squares regression (sPLSR). We determined whether the SLA predictors differ based on SLA direction and whether …

Interprofessional Education And Practice: Perspectives From Students In Speech-Language Pathology And Recreational Therapy, David Hajjar, Jan Elich-Monroe, Susan Durnford

Teaching and Learning in Communication Sciences & Disorders

Interprofessional education and practice (IPE/IPP) are important components for undergraduate and graduate students to experience during their programs of study in speech-language pathology and related health professions. The American Speech-Language Hearing Association (ASHA) is a member organization of the Interprofessional Education Collaborative (IPEC) which promotes four core competencies required for effective practice: values/ethics, roles/responsibilities, interprofessional communication, and teams and teamwork. The purpose of this study was to gather the lived experiences from eight pre-professional students, four from speech-language pathology (SLP) and four from recreational therapy(RT), during focus groups and discussion forums conducted before, during, and after a 14-week IPE/IPP clinical …

Development And Feasibility Of A Modified Fugl-Meyer Lower Extremity Assessment For Telerehabilitation: A Pilot Study., Sue Peters, Marcela Botero, Allison Evers, Brianna Fong, Botond Jakab, Emily Petter, Janice J Eng

Physical Therapy Publications

BACKGROUND: The majority of stroke survivors experience motor impairment which benefits from rehabilitation treatment. Telerehabilitation, remote delivery of rehabilitation services, is a possible solution providing access to rehabilitation for stroke survivors living in rural areas or in situations like the COVID-19 pandemic where face-to-face treatment may be risky. However, valid and reliable motor impairment measures have not yet been established over a telerehabilitation platform. The Fugl-Meyer (FM) lower extremity assessment is widely used clinically and in research. Thus, the aim was to develop a modified FM for telerehabilitation (FM-tele) and assess the feasibility and preliminary agreement of FM-tele scores with …

Evaluating The Effects Of Physical Activity On The Cognitive Functions And Motor Skills Of The Special Needs Population And Testing A Different Teaching Style To Maximize The Efficiency Of Special Needs Programs, Oren Nedjar

BIO4960: Practicum in Biology I

This study aimed to analyze the effects of physical activities on the motor and cognitive functions of participants with special needs and compare these results with a similar program but organized online because of the health precautions that have been applied due to the COVID-19 pandemic. An intervention consisting of sending an educational brochure aiming to increase high school volunteers' health literacy was then tested and results showed that it improved participants' health outcomes and also could increase the program's effectiveness in the long term.

Generalizing The Predictive Relationship Between 1-Month Motor Skill Retention And Rey–Osterrieth Delayed Recall Scores From Nondemented Older Adults To Individuals With Chronic Stroke: A Short Report, Jennapher Lingo Vangilder, Andrew Hooyman, Pamela R. Bosch, Sydney Y. Schaefer

Physical Therapy Faculty Articles and Research

Motor learning is fundamental to motor rehabilitation outcomes. There is growing evidence from non-neurological populations supporting the role of visuospatial memory function in motor learning, but current predictive models of motor recovery of individuals with stroke generally exclude cognitive measures, thereby overlooking the potential link between motor learning and visuospatial memory. Recent work has demonstrated that a clinical test of visuospatial memory (Rey–Osterrieth Complex Figure Delayed Recall) may predict 1-month skill learning in older adults; however, whether this relationship persists in individuals with chronic stroke remains unknown. The purpose of this short report was to validate previous findings using Rey–Osterrieth …

Trunk And Lower Extremity Muscle Activity During The Y Balance Test In Healthy Adults, Navpreet Kaur, Kunal Bhanot, Germaine Ferreira

Physical Therapy Collection

Y balance test kit^TM (YBT) is used to measure dynamic balance. YBT is an instrumented version of the Star Excursion Balance test that has Anterior (A), Posteromedial (PM), and Posterolateral (PL) directions. PURPOSE: To determine electromyographic (EMG) activity of the trunk and lower extremity (LE) muscles during YBT performance. METHODS: Surface EMG was collected on 10 males and 10 females healthy adults for the erector spinae (ES), external oblique (EOB), and rectus abdominis (RA) for both ipsilateral (i) and contralateral (c) sides of the stance leg, and gluteus medius (GMED), gluteus maximus (GMAX), Rectus Femoris (RF), Vastus Lateralis (VL), …

The Time For Translation Of Mobile Brain And Body Imaging To People With Stroke Is Now, Brian Greeley, Grant Hanada, Lara A Boyd, Sue Peters

Physical Therapy Publications

No abstract provided.

Using Biofeedback To Reduce Spatiotemporal Asymmetry Impairs Dynamic Balance In People Post-Stroke, Sungwoo Park, Chang Liu, Natalia Sánchez, Julie K. Tilson, Sara J. Mulroy, James M. Finley

Physical Therapy Faculty Articles and Research

Background. People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective. We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods. We performed clinical balance assessments and measured wholebody angular momentum during walking using a full-body marker set in a sample of 36 people with …

Navigator Role For Promoting Adaptive Sports And Recreation Participation In Individuals With Disabilities, Moriah Iverson, Alexander V. Ng, Alice F. Yan, Kimberley Zvara, Michael Bonk, Deb Falk-Palec, Cherri Sylla, Maurine Strickland, Rachel Preston, Diane W. Braza

Exercise Science Faculty Research and Publications

Objective

The aims of the study were to gain a better understanding of the resources, barriers, and facilitators of participation in adaptive sport and recreational activities as a means of achieving physical activity recommendations in individuals with disability and to understand preferences for a patient navigator service to help mitigate the barriers.

Design

Clinical, academic, and community stakeholders applied a community-engaged research approach to develop online surveys and focus group questions for adults with a disability or parents of a child with a disability to meet study objectives.

Results

One hundred ninety-eight adults and 146 parents completed the online surveys. …

Weight Reduction Motivation In Osteoarthritis Patients Through Nurse Practitioner Driven Education And Follow-Up: A Pilot Project, Caoilfhionn Mulvey, Martha Fuller Phd

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: The ultimate goal of this short-term pilot project is for

overweight or obese osteoarthritis patients to increase their knowledge on the benefits of

weight loss and physical activity. Research shows that for every kilogram of weight lost,

2.2–4.0 kilograms of weight is taken off of the joint and could reduce joint pain up to

thirty to fifty percent and improve quality of life. Following education from the provider,

patients will understand the correlation of osteoarthritis symptom management with

weight loss.

EBP Model/Frameworks: This project utilizes the Iowa Model of Evidence-Based

Practice to Promote Quality Care. This addresses …

The Use Of Mindfulness Meditation To Increase The Efficacy Of Mirror Visual Feedback For Reducing Phantom Limb Pain In Amputees, Nicolas Sebastian Mills

Doctoral Dissertations

Phantom limb pain is a chronic pain condition that negatively impacts the lives of over half of amputees, and results in considerable morbidity. Currently, there is no gold standard for treatment for phantom limb pain. However, a frequently used intervention is the use of mirror visual feedback, in which the amputee watches the reflection of the adjacent non-amputated limb move and exercise. In the last few decades, mindfulness-based interventions have been increasingly used with individuals living with different types of chronic pain. This study attempts to discover if the addition of a mindfulness-based intervention, such as guided meditation, will augment …

The Effects Of The Mckenzie Method And Strengthening/Stabilization Exercises In Patients With Chronic Nonspecific Low Back Pain., Lufei Harder

Honors College Theses

Background & objective: Low back pain is a frequent problem that the majority of people will face at some point in their lifetime. Exercise has been advocated as an effective treatment for chronic nonspecific low back pain; however, there is a lack of consensus on the best form of exercise treatment. This review was designed to compare the effectiveness of the McKenzie Method against stabilization/strengthening exercises in patients with chronic nonspecific low back pain.

Methods: A literature review examining McKenzie and stabilization exercises for chronic nonspecific low back pain were identified from three databases.

Results: A total of nine articles …

Icf Linking Of Patient-Reported Therapy Goals For Children With Acquired Upper Extremity Impairment, Jenny M. Dorich, Roger Cornwall, Timothy L. Uhl

Physical Therapy Faculty Publications

BACKGROUND: Patient reported outcome measures are used to evaluate hand therapy outcomes. Yet, limited evidence is available regarding the outcomes children desire from hand therapy.

PURPOSE: To determine the desired treatment outcomes of children with acquired upper extremity impairments.

STUDY DESIGN: Descriptive case series METHODS: Two raters independently applied International Classification of Function, Disability and Health (ICF) linking rules to the Canadian Occupational Performance goals of 151 children, age 6-18, receiving occupational therapy for acquired upper extremity impairments. Prevalence of the linked ICF codes was examined using frequency distributions. Kappa and the proportion of positive agreement assessed inter-rater agreement of …

Dancer Screening Clinic, Kristen Manaloto, John Lencioni, Laura Nguyen

UNLV Theses, Dissertations, Professional Papers, and Capstones

Dance students at the University of Nevada, Las Vegas (UNLV) do not have access to sports medicine specialists, thus a pro-bono dance clinic was created as a service-learning project by the UNLV Department of Physical Therapy (UNLVPT) in 2018. In the second year of the service-learning project, three graduate students from the UNLVPT program, under the supervision of a clinical faculty member, have continued to provide free dance specific injury prevention screenings and management to students within the UNLV Department of Dance. To improve clinic operation and services, the group emphasized communication and accessibility as areas of growth. Injury prevention …

Quality Assurance Of Service Learning Back School, Eric Bashaw, Vu Pham, Tyler Parvin, Ryan Pauly

UNLV Theses, Dissertations, Professional Papers, and Capstones

Project Execution: Back School: During the 2019-20 academic year, two University of Nevada, Las Vegas Physical Therapy (UNLVPT) core faculty members, along with eight doctor of physical therapy students, provided three student-led, pro-bono back school classes at Volunteers in Medicine of Southern Nevada (VMSN). Each back school class consisted of two, 2-hour sessions where participants were screened for red flags, educated on pain management strategies and common causes of back pain, and given an individual home exercise program. Quality Assurance Surveys: Patient’s and VMSN staff were all given questions in the form of Likert-scale and open-ended questions via printed handouts …

Recruitment And Advocacy For Clinician Involvement In Pro Bono Physical Therapy Service-Learning Program, Gilberto Carrillo, Gavin Brady, Felicia Doblado, Alyssa Woo Hatch

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Service-learning allows Doctor of Physical Therapy (DPT) students to develop important professional skills and addresses community-based needs. When integrated into physical therapy education, it can be a powerful tool for increasing students' altruism and social responsibility. Many clinicians desire to participate in pro bono physical therapy (PT) services. Therefore, the responsibility of promoting and advertising these programs falls upon the student. This paper describes various methods for recruiting clinician involvement to improve the sustainability of a student led pro bono clinic, as well as how the students advocated for pro bono services in the state of Nevada …

Is Decreased Trunk Flexion Angle A Contributing Factor To Patellofemoral Joint Loading In Runners With Patellofemoral Pain?, Christine Duvall, Zachary Clark, Tavin Fox, Caitlin Howden

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: Reduced trunk flexion during running is theorized to be a contributing factor of elevated patellofemoral joint (PFJ) stress in runners with patellofemoral pain (PFP); thus, the primary purpose of this research study was to determine if runners with PFP would exhibit differences in PFJ stress and trunk flexion angle during running as compared to pain-free runners across three speeds. We hypothesized that runners with PFP would exhibit higher PFJ stress and decreased trunk flexion while running compared to the pain- free runners. Number of Subjects: 7 runners with PFP and 5 similar pain-free control runners. Materials/Methods: Kinematics and kinetics …

A Vicious Cycle Of Fear Of Falling Avoidance Behavior In Parkinson’S Disease: A Path Analysis, Kameron Jacobson, Nicole Matsunami, Hannah Mccarl, Michelle Regis

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Postural instability (PI) in Parkinson’s disease (PD) is associated with several negative down- stream consequences. Objective: The purpose was to explore the validity of a theoretical model of these downstream consequences arranged in a vicious cycle wherein PI leads to decreased balance con!dence, which in turn leads to increased fear of falling (FOF) avoidance behavior, which in turn leads to decreased physical conditioning, which then feeds back and negatively affects PI. Methods: A path analysis of cross!sectional data from 55 participants with PD was conducted. The four con- structs in the model connected in succession were: 1. PI (principal …

Effects Of Bimodal Transcranial Direct Current Stimulation On Modulation Of Spinal Circuitry In People With Chronic Post-Stroke Hemiparesis, John Patrick Gan, Rafael Cabrera, Lana Laudermilch, Benjamin Wolkenhauer

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Stroke can lead to gait abnormalities such as foot drop. Foot drop can result from decreased corticospinal tract input to the ankle dorsiflexors and/or from exaggerated stretch reflexes on the soleus due to reduced reciprocal inhibition from spinal reflex pathways. Transcranial direct current stimulation (tDCS) attempts to modulate corticospinal tract input and spinal reflex pathways by delivering electrical signals to parts of the brain. The degree of neuromodulation from tDCS can be measured through the Hoffman Reflex (H-reflex)—a tool used to estimate alpha motor neuron excitability which is increased in individuals post-stroke. Purpose: The primary purpose of this study …

Patient Engagement In Cosmetic Designing Of Prostheses: Current Practice And Potential Outcome Benefits, Kenneth Repayo, Cailin Mitchell, Matthew Tillitt, Collin Weber

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: Making a prosthesis for an individual with limb loss is a highly personalized process. A currently unexplored area is whether there are tangible benefits in greater patient engagement during the making of their prostheses. We examined the current practice of engaging patients in prosthetic cosmetic designing and identified factors associated with patient outcomes. Methods: This cross-sectional study surveyed 104 prosthetists and 25 prostheses users. The questionnaires covered aspects of prosthetic prescription, users’ perceived level of engagement, and self-reported outcomes. Regression analyses were used to examine the associations between perceived level of engagement, satisfaction, and other outcomes. Results: Among prosthesis …

Effects Of Altered Somatosensory Input On Lower Limb Mechanics Via Different Shoes And Barefoot Walking In Individuals With Chronic Post-Stroke Hemiparesis, Aaron Abraham Simon, Jynelle Marie Guerrero Arches, Megan Leigh Keohane, Wee Jin Jed Lee

UNLV Theses, Dissertations, Professional Papers, and Capstones

[Purpose/Hypothesis] Stroke is a leading cause of disability that results in various neurological deficits. Stroke can cause impaired somatosensory input, which results in decreased balance and gait speed, ultimately increasing fall risks. Therapies to increase somatosensory input have shown promise for people with stroke as well as other neurological populations. However, few studies have systematically investigated varying somatosensory input via different footwear to improve walking in people post-stroke. The purpose of this study was to investigate the effects of altering somatosensory input via different types of footwear (i.e., barefoot, self-selected shoes, and memory foam shoes) on gait kinetics and ankle …

Inter And Intra-Rater Reliability Of Dance Screening Tool, Kathleen Stone, Braden Waters

UNLV Theses, Dissertations, Professional Papers, and Capstones

Previous literature has indicated that injury rates of ballet and modern dancers are among the highest of any physical activity. These injuries can be detrimental to the athlete and can also result in financial burden for dance companies due to time loss related to injuries. Preventative intervention aimed at those who are most at risk for injury can be effective at reducing the cost associated with lost time due to injury. An effective approach to identifying those most at risk for dance related injuries is to administer a functional movement screen. One such movement screen is the ballet-based Dance Technique …

Am-Pac Basic Mobility Inpatient Short Form (Low Function) Psychometrics/Clinimetrics, Meghan Wonderling, David Miller, Selena Soria

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: To determine whether the Activity Measure for Post-Acute Care® Basic Mobility Inpatient Short Form (Low Function) (6-clicks LF) has increased responsiveness for patients with lower levels of physical function compared to the Activity Measure for Post-Acute Care Basic Mobility Inpatient Short Form (6-clicks). Design: Retrospective cohort study using original scores and simulated scores for assessment of internal responsiveness of the 6-clicks LF compared to the 6-clicks. Simulated 6-clicks and 6-clicks LF scores were created as a hypothetical future AM-PAC® score. Results: We found a statistically significant difference between the 6-clicks and simulated 6-clicks, t=24.8, p < 0.00 [two-tailed]. The effect size was large (d=1.2, r=0.51).There was a statistically significant difference between the 6-clicks LF and simulated 6-clicks LF, t=19.7, p < 0.00 [two-tailed]. The effect size was medium (d=0.91, r=0.41). Finally, for patients with a 6-clicks score in the bottom five-percentile (n=27), we found a statistically significant difference between the 6-clicks and 6-clicks LF, t=11.9, p < 0.00 [two-tailed]. Conclusion: Among patients scoring less than 15, the 6-clicks LF has greater internal responsiveness than the 6-clicks and thus demonstrates that the new low-level questions in the 6-clicks LF better quantify low-level patients’ functional level. Research using non-simulated data should be completed in the future to confirm these findings.