Rehabilitation and Therapy Commons^™

The Role Of Rehabilitation Following Autologous Chondrocyte Implantation: A Retrospective Chart Review, Jenny L. Toonstra, Jennifer Sebert Howard, Timothy L. Uhl, Robert A. English, Carl G. Mattacola

Physical Therapy Faculty Publications

PURPOSE/BACKGROUND: Clinical outcomes following autologous chondrocyte implantation (ACI) are influenced by multiple factors, including patient demographics, lesion characteristics, quality of the surgical repair, and post-operative rehabilitation. However, it is currently unknown what specific characteristics of rehabilitation have the greatest influence on clinical outcomes following ACI. The purpose of this study was to conduct a retrospective chart review of patients undergoing ACI with the intent to describe this patient population's demographics, clinical outcomes, and rehabilitation practices. This study aimed to assess the consistency of the documentation process relative to post-operative rehabilitation in order to provide information and guide initiatives for improving …

Reliability Of The Myotonometer For Assessment Of Posterior Shoulder Tightness, Caitlyn M. Kerins, Stephanie D. Moore, Timothy A. Butterfield, Patrick O. Mckeon, Timothy L. Uhl

Physical Therapy Faculty Publications

BACKGROUND/PURPOSE: The Myotonometer® is an electronic tissue compliance meter that has been used to quantify the compliance of soft tissues. The Myotonometer® may be a valuable tool to measure the effectiveness of interventions commonly used to increase tissue compliance in individuals with posterior shoulder tightness (PST). Limited data exist on reliability and responsiveness of the Myotonometer® for assessment of soft tissues about the shoulder; therefore, the purpose of this study is to determine the intra- and inter-session reliability and responsiveness of the Myotonometer® in measuring tissue compliance of the posterior shoulder musculature in asymptomatic subjects with PST.

METHODS: Fifteen asymptomatic …

Description And Service Innovation In Adolescent Transition Within Kentucky State Agency Education Programs, Amy C. Marshall

Theses and Dissertations--Rehabilitation Sciences

Of all Kentucky youth, state agency children are at the highest risk of making unsuccessful post-secondary transitions to adulthood. The intent of both studies comprising this dissertation was to understand and guide transition planning to make future improvements to transitions of adolescents in state agency programs.

The Kentucky Youth at Risk in Transition Study was a mixed methods study that identified and described the understandings of student transitions in state agency education programs from the perspectives of youth and administrators. The study included 105 nontraditional education programs funded and supervised by the Kentucky Educational Collaborative for State Agency Children (KECSAC). …

Developing The Rehabilitation Education For Caregivers And Patients (Recap) Model: Application To Physical Therapy In Stroke Rehabilitation, Megan M. Danzl

Theses and Dissertations--Rehabilitation Sciences

Patient and caregiver education is recognized as a critical component of stroke rehabilitation and physical therapy practice yet the informational needs of stroke survivors and caregivers are largely unmet and optimal educational interventions need to be established. The objective of this dissertation was to develop a theory and model of “Rehabilitation Education for Caregivers and Patients” (RECAP) in the context of physical therapy and stroke rehabilitation, grounded in the experiences and perceptions of stroke survivors, their caregivers, and physical therapists.

Qualitative research methods with a novel grounded theory approach were used. Potential constructs of RECAP were identified from existing research. …

A Comparison Of Upper Extremity Function Between Female Breast Cancer Survivors And Healthy Controls: Typical Self- Report Of Function, Motion, Strength And Muscular Endurance, Mary Insana Fisher

Theses and Dissertations--Rehabilitation Sciences

Many women who have experienced breast cancer (BC) report continued impairments in upper extremity (UE) function beyond the time required for normal healing after surgical treatment. Most research supporting this has not made comparisons between survivors of breast cancer (BCS) to a sample of healthy women. This lack of comparison to a healthy cohort prevents an understanding of whether continued deficits in UE function are due to normal aging or the BC treatment.

The purpose of this research was to compare quality of life (QOL) and UE function among long term breast cancer survivors and similar aged women without cancer. …

Predictors Of Outcome Following Standardized Rehabilitation For Patients With Shoulder Pain, Stephanie D. Moore

Theses and Dissertations--Rehabilitation Sciences

Shoulder dysfunction is frequently treated and persistent symptoms are common. Differential diagnosis of shoulder injuries can be challenging and knowledge of a diagnosis alone does not appear to be enough information to predict outcomes. Determination of a set of factors that predict outcome would assist clinicians in making the most effective treatment decision for patients with shoulder pain. The purposes of this dissertation were to investigate patient-clinician agreement in an orthopedic population of patients with shoulder pain and to determine what combination of factors best predicts positive patient-reported outcome following standardized rehabilitation in patients with shoulder pain.

In the first …

Experiences Of Speech-Language Pathology Graduate Students: An Exploratory Phenomenological Study, Anysia J. Ensslen

Theses and Dissertations--Educational Leadership Studies

Within the past decade little research has been conducted in the United States to examine the preparedness of beginning speech-language pathologists; the seminal article used for this research study comes from the United Kingdom (Horton, Byng, Bunning, & Pring, 2004). Literature from the past few decades indicates that there may be deficiencies in the way that beginning speech-language pathologists are being trained clinically.

The review of the literature suggests that the field may lack a clear and broadly supported learning theory or framework for the clinical supervision and training of speech-language pathology graduate students. The literature further supports the importance …

Development Of An Eeg Brain-Machine Interface To Aid In Recovery Of Motor Function After Neurological Injury, Elizabeth Salmon

Theses and Dissertations--Biomedical Engineering

Impaired motor function following neurological injury may be overcome through therapies that induce neuroplastic changes in the brain. Therapeutic methods include repetitive exercises that promote use-dependent plasticity (UDP), the benefit of which may be increased by first administering peripheral nerve stimulation (PNS) to activate afferent fibers, resulting in increased cortical excitability. We speculate that PNS delivered only in response to attempted movement would induce timing-dependent plasticity (TDP), a mechanism essential to normal motor learning. Here we develop a brain-machine interface (BMI) to detect movement intent and effort in healthy volunteers (n=5) from their electroencephalogram (EEG). This could be used in …

Alterations In Visual Processing And Its Impact On Upright Postural Stability In Athletes Following Sport-Related Concussion, Andrea E. Cripps

Theses and Dissertations--Rehabilitation Sciences

Athletes are at risk of sustaining a concussion in all sports and at all competitive levels which may lead to balance impairments. Balance results from the integration of visual, vestibular, and somatosensory information. The underlying pathophysiology for balance impairments is not well understood and visuo-motor processing impairments and how these impairments contribute to balance in concussed athletes has not been reported. Objectives: (1) to investigate the influence of visual perturbation on upright postural stability and balance in athletes who have recently suffered a sports-related concussion, (2) to establish the test-retest reliability of a simple visuo-motor processing task. Design: A longitudinal, …

Scapular Muscle Assessment In Patients With Lateral Epicondylalgia, Joseph M. Day

Theses and Dissertations--Rehabilitation Sciences

The role rehabilitation plays in the management of patients with lateral epicondylalgia (LE) remains elusive secondary to high recurrence rates. Addressing scapular muscle deficits may be important in the rehabilitation of patients with LE. However, it is unknown if scapular muscle impairments exist in a working population of patients with LE. The purpose of this dissertation was to assess scapular muscle strength and endurance in a working population of patients with LE.

Clinical scapular muscle assessment tools are limited in their ability to isolate specific muscles. Rehabilitative ultrasound imaging (RUSI) is a potentially useful tool but few studies have investigated …

What Keeps Us Well? Professional Quality Of Life And Career Sustaining Behaviors Of Music Therapy Professionals, Shane C. Swezey

Theses and Dissertations--Music

Self-care can be seen as not only critical for individual professionals, but also for the growth of the helping professions and the quality of care which clients receive. The purpose of this study was to investigate use of career-sustaining behaviors and the levels of professional quality of life in music therapy professionals. This study investigated research questions regarding use of career sustaining behaviors and levels of professional quality of life, the relationship between these variables, the differences in the use of career sustaining behavior by demographics, and the use of music as a self-care strategy.

An online survey was sent …

Longitudinal Documentation Of Serum Cartilage Oligomeric Matrix Protein And Patient-Reported Outcomes In Collegiate Soccer Athletes Over The Course Of An Athletic Season, Johanna M. Hoch, Carl G. Mattacola, Heather M. Bush, Jennifer M. Medina Mckeon, Timothy E. Hewett, Christian Lattermann

Physical Therapy Faculty Publications

BACKGROUND: Serum cartilage oligomeric matrix protein (sCOMP) is a biomarker for cartilage degradation. Patient-reported outcomes (PRO) are used to document postinjury recovery and may be used to prospectively identify changes in the course of a season. It is unknown what effect intense, continuous physical activity has on sCOMP levels and PRO values in athletes over the duration of a soccer season.

HYPOTHESIS/PURPOSE: The purpose of this study was to longitudinally document sCOMP levels and to determine whether changes in PROs occur in collegiate soccer athletes during a season. The hypotheses tested were that sCOMP levels and PRO scores would remain …

The Long-Term Impact Of Physical And Emotional Trauma: The Station Nightclub Fire, Jeffrey C. Schneider, Nhi-Ha T. Trinh, Elizabeth Selleck, Felipe Fregni, Sara S. Salles, Colleen M. Ryan, Joel Stein

Physical Medicine and Rehabilitation Faculty Publications

BACKGROUND: Survivors of physical and emotional trauma experience enduring occupational, psychological and quality of life impairments. Examining survivors from a large fire provides a unique opportunity to distinguish the impact of physical and emotional trauma on long-term outcomes. The objective is to detail the multi-dimensional long-term effects of a large fire on its survivor population and assess differences in outcomes between survivors with and without physical injury.

METHODS AND FINDINGS: This is a survey-based cross-sectional study of survivors of The Station fire on February 20, 2003. The relationships between functional outcomes and physical injury were evaluated with multivariate regression models …

Electromyographical Comparison Of Four Common Shoulder Exercises In Unstable And Stable Shoulders, Aaron Sciascia, Nina Kuschinsky, Arthur J. Nitz, Scott D. Mair, Tim L. Uhl

Physical Therapy Faculty Publications

This study examines if electromyographic (EMG) amplitude differences exist between patients with shoulder instability and healthy controls performing scaption, prone horizontal abduction, prone external rotation, and push-up plus shoulder rehabilitation exercises. Thirty nine subjects were categorized by a single orthopedic surgeon as having multidirectional instability (n = 10), anterior instability (n = 9), generalized laxity (n = 10), or a healthy shoulder (n = 10). Indwelling and surface electrodes were utilized to measure EMG activity (reported as a % of maximum voluntary isometric contraction (MVIC)) in various shoulder muscles during 4 common shoulder exercises. The exercises studied effectively activated the …

Bmi-1 Absence Causes Premature Brain Degeneration, Guangliang Cao, Minxia Gu, Min Zhu, Junying Gao, Ying Yin, Charles Marshall, Ming Xiao, Jiong Ding, Dengshun Miao

Physical Therapy Faculty Publications

Bmi-1, a polycomb transcriptional repressor, is implicated in cell cycle regulation and cell senescence. Its absence results in generalized astrogliosis and epilepsy during the postnatal development, but the underlying mechanisms are poorly understood. Here, we demonstrate the occurrence of oxidative stress in the brain of four-week-old Bmi-1 null mice. The mice showed various hallmarks of neurodegeneration including synaptic loss, axonal demyelination, reactive gliosis and brain mitochondrial damage. Moreover, astroglial glutamate transporters and glutamine synthetase decreased in the Bmi-1 null hippocampus, which might contribute to the sporadic epileptic-like seizures in these mice. These results indicate that Bmi-1 is required for maintaining …

Serum Cartilage Oligomeric Matrix Protein: A Biomarker For Acute Articular Cartilage Damage, Johanna M. Hoch

Theses and Dissertations--Rehabilitation Sciences

Bone bruise lesions (BBL) are documented on MRIs diagnosing acute knee ligament injury (AKLI). Recent evidence has indicated that a majority of patients that sustain an AKLI, especially anterior cruciate ligament (ACL) knee injury, will develop post-traumatic osteoarthritis (PTOA) 10-20 years following injury. It has been proposed that the initial damage sustained to the articular cartilage overlying BBL causes a cascade of events that may result in PTOA.

Researchers have proposed a modification to treatment protocols for more severe BBL, or have stressed the need for the development of protective therapies to protect the articular cartilage. However, there are limited …

Developing A Model Of Client Satisfaction With A Rehabilitation Continuum Of Care, Melba G. Custer

Theses and Dissertations--Rehabilitation Sciences

Client satisfaction is an important outcome indicator because it measures multiple domains of the quality of healthcare and rehabilitation service delivery. It is especially important in occupational therapy because it is also client-centered. There are multiple domains of satisfaction and findings described in previous research; however, there is no single standard of measuring client satisfaction or any single working model describing the relationship among variables influencing satisfaction. This research was designed to apply a measure of satisfaction in rehabilitation and to develop a working model of satisfaction.

This study was an exploratory and predictive study using a large existing dataset …

Use Of A Video Game Based Balance Training Intervention On The Balance And Function Of Children With Developmental Disabilities, Gina C. Siconolfi-Morris

Theses and Dissertations--Rehabilitation Sciences

Many children with developmental disabilities (DD) have physical impairments and limitations in their participation. Rehabilitation research often focuses on either physical impairments or participation restrictions, when both need to be investigated. The purposes of these two studies were to evaluate an at home therapist directed video game balance training intervention on balance, gait velocity (GV), hip strength and activities of children with DD. The pilot study was a single-subject non-concurrent multiple baseline design. Balance measures included: weight bearing symmetry; center of pressure area and velocity; time to boundary mean minima and standard deviation; and timed up and go. The participant’s …

The Development Of The Self-Efficacy Of Balance Scale (Sebs): Investigation Of Psychometric Properties In Female Basketball Players, Carrie Silkman Baker

Theses and Dissertations--Rehabilitation Sciences

Lower extremity injuries are the most common sports related injury. Many steps have been taken to attempt to identify individuals who might be at a higher risk for sustaining a lower extremity injury. Resource and time intensive screening techniques have been used previously to attempt to identify such individuals. However these techniques have focused heavily on postural control and landing mechanics in athletes, no psychological measure has been used to identify individuals who might be at a higher risk of lower extremity injury.

Self-efficacy of balance can be defined as how capable an individual feels he or she can balance …

The Use Of Explicit, Non-Evocative Print Referencing With Preschool Children At-Risk: Implications For Increasing Print Concept Knowledge, Susan Thomas Frank

Theses and Dissertations--Rehabilitation Sciences

The purpose of this research study was to investigate the learning of print concepts (PCs) by preschool children at risk for literacy problems using an experimental treatment: explicit, non-evocative print referencing. Children from low socio-economic status (SES) families have been determined to be at-risk for literacy learning problems including a reduced knowledge of print concepts.

The study incorporated a multiple group (experimental and control) time series design with persistent insertion of treatment to those subjects who were assigned to the experimental condition. Participants included 25 children at-risk, ages 4:0- 4:11 (years: months) who qualified for pre-school services and for subsidized …

Effects Of Proximal Stability Training On Sport Performance And Proximal Stability Measures, Thomas Gerard Palmer

Theses and Dissertations--Rehabilitation Sciences

Proximal stability, or the ability to stabilize and actively control the spine, pelvis and trunk, has been reported to influence sport performance. Traditional training practices for the proximal segments have had little success improving sport performance. The purpose of this dissertation was to investigate the effects a sport specific proximal stability training program can have on throwing velocity and measures of muscular endurance and power which target the proximal segments of the pelvis, spine and trunk.

A stratified randomized clinical trial was implemented with a pre- to post-intervention design. Forty-six healthy, Division III collegiate female softball (n=17) and male baseball …

Environmental Influences On Occupational Therapy Practice, Camille L. Skubik-Peplaski

Theses and Dissertations--Rehabilitation Sciences

Rehabilitation hospitals serve to foster a client’s independence in preparation to return home after an injury or insult. Having space in rehabilitation environments that is home-like and supportive for each client can facilitate participation in occupations and assist in learning and practicing the skills needed to transition to home. Yet, typically occupational therapists provide interventions to clients in therapy gyms with exercise and impairment based equipment. Currently the stroke population is changing and identifying the optimal rehabilitation environment is imperative to guide occupational therapy practice. This dissertation contains three studies relating to the rehabilitation environment and occupational therapy interventions. The …

Effect Of Lower Body Positive Pressure On Cardiovascular Response At Various Degrees Of Head Up Tilt, Vladimir Ilyich Kostas

Theses and Dissertations--Kinesiology and Health Promotion

Various models of simulated weightlessness and resulting cardiovascular effects have been researched in the last 50 years of space exploration. Examples of such models are the Alter-G (Alt-G) treadmill used for body unweighting and head-up-tilt (HUT) model each providing similar cardiovascular effects, but differing in their stimulation of vestibular centers . Advantages of using the Alt-G include: use of lower body positive pressure (LBPP) to simulate hypogravity, it acts as a countermeasure to alleviate negative cardiovascular effects of standing and provides a constant vestibular stimulus. In addition, the Alt-G shorts themselves may be providing a certain degree of LBPP, acting …

Effect Of Duration And Amplitude Of Direct Current When Lidocaine Is Delivered By Iontophoresis, Susan A. Saliba, Courtney L. Teeter-Heyl, Patrick O. Mckeon, Christopher D. Ingeroll, Ethan N. Saliba

Physical Therapy Faculty Publications

Dosage for the galvanic stimulation for iontophoresis varies. Clinicians manipulate the duration or the amplitude of the current, but it is not known which is more effective. We compared the anesthetic effect of lidocaine HCL (2%) by manipulating the current parameters on 21 healthy volunteers (age: 21.2 ± 4.2, height 170.7 ± 10.2 cm, mass 82.1 ± 19.2 kg). Three conditions were administered in a random order using a Phoresor II^® with 2 mL, 2% lidocaine HCL in an iontophoresis electrode. (1) HASD (40 mA_*min): High amplitude (4 mA), short duration (10 min); (2) LALD (40 mA.min): …

Comparison Of Hip And Knee Strength And Neuromuscular Activity In Subjects With And Without Patellofemoral Pain Syndrome, Lori Ann Bolgla, Terry R. Malone, Brian R. Umberger, Timothy L. Uhl

Physical Therapy Faculty Publications

Purpose/Background: Historically, patellofemoral pain syndrome (PFPS) has been viewed exclusively as a knee problem. Recent findings have suggested an association between hip muscle weakness and PFPS. Altered neuromuscular activity about the hip also may contribute to PFPS; however, more limited data exist regarding this aspect. Most prior investigations also have not concurrently examined hip and knee strength and neuromuscular activity in this patient population. Additional knowledge regarding the interaction between hip and knee muscle function may enhance the current understanding of PFPS. The purpose of this study was to compare hip and knee strength and electromyographic (EMG) …

Widespread Regulation Of Mirna Biogenesis At The Dicer Step By The Cold-Inducible Rna-Binding Protein, Rbm3, Julie Pilotte, Esther E. Dupont-Versteegden, Peter W. Vanderklish

Physical Therapy Faculty Publications

MicroRNAs (miRNAs) play critical roles in diverse cellular events through their effects on translation. Emerging data suggest that modulation of miRNA biogenesis at post-transcriptional steps by RNA-binding proteins is a key point of regulatory control over the expression of some miRNAs and the cellular processes they influence. However, the extent and conditions under which the miRNA pathway is amenable to regulation at posttranscriptional steps are poorly understood. Here we show that RBM3, a cold-inducible, developmentally regulated RNA-binding protein and putative protooncogene, is an essential regulator of miRNA biogenesis. Utilizing miRNA array, Northern blot, and PCR methods, we observed that over …

Sequential Alterations In Catabolic And Anabolic Gene Expression Parallel Pathological Changes During Progression Of Monoiodoacetate-Induced Arthritis, Jin Nam, Priyangi Perera, Jie Liu, Bjoern Rath, James Deschner, Robert Gassner, Timothy A. Butterfield, Sudha Agarwal

Physical Therapy Faculty Publications

Chronic inflammation is one of the major causes of cartilage destruction in osteoarthritis. Here, we systematically analyzed the changes in gene expression associated with the progression of cartilage destruction in monoiodoacetate-induced arthritis (MIA) of the rat knee. Sprague Dawley female rats were given intra-articular injection of monoiodoacetate in the knee. The progression of MIA was monitored macroscopically, microscopically and by micro-computed tomography. Grade 1 damage was observed by day 5 post-monoiodoacetate injection, progressively increasing to Grade 2 by day 9, and to Grade 3-3.5 by day 21. Affymetrix GeneChip was utilized to analyze the transcriptome-wide changes in gene expression, and …

Preferential Quadriceps Activation In Female Athletes With Incremental Increases In Landing Intensity, Kevin R. Ford, Gregory D. Myer, Laura C. Schmitt, Timothy L. Uhl, Timothy E. Hewett

Physical Therapy Faculty Publications

The purpose of this study was to identify alterations in preparatory muscle activation patterns across different drop heights in female athletes. Sixteen female high school volleyball players performed the drop vertical jump from three different drop heights. Surface electromyography of the quadriceps and hamstrings were collected during the movement trials. As the drop height increased, muscle activation of the quadriceps during preparatory phase also increased (p < .05). However, the hamstrings activation showed no similar increases relative to drop height. Female athletes appear to preferentially rely on increased quadriceps activation, without an increase in hamstrings activation, with increased plyometric intensity. The resultant decreased activation ratio of the hamstrings relative to quadriceps before landing may represent altered dynamic knee stability and may contribute to the increased risk of ACL injury in female athletes.

Clinical And Functional Assessment Following Autologous Chondrocyte Implantation To The Knee: The Role Of Patient Reported Outcomes, Performance Based Assessment, And Response Shift, Jennifer Sebert Howard

Theses and Dissertations--Rehabilitation Sciences

Autologous chondrocyte implantation (ACI) is a cell based therapy for the treatment of articular cartilage defects. Numerous studies have reported outcomes following ACI using a variety of patient reported outcomes (PROs), but no clear recommendations exist regarding which PRO is the most responsive to changes following ACI. Few studies have documented changes in performance based assessments (PBAs) following ACI. Response shift theory proposes that residual changes in self-report measures occur over time. Failing to account for response shift may result in over or under reporting of outcomes from which clinical decisions are made. The purposes of this dissertation were 1) …

The Effect Of Joint Mobilization On Functional Outcomes Associated With Chronic Ankle Instability, Matthew C. Hoch

University of Kentucky Doctoral Dissertations

Ankle sprains are among the most common injuries sustained by physically active individuals. Although ankle sprains are often considered innocuous in nature, a large percentage of individuals experience repetitive sprains, residual symptoms, and recurrent ankle instability following a single acute sprain; otherwise known as chronic ankle instability (CAI). In addition to repetitive ankle trauma, those with CAI experience reductions in functional capacity over the life span. This indicates that current intervention strategies for CAI are inadequate and require further investigation.

The objective of this dissertation was to explore differences in walking and running gait parameters between individuals with and without …