Rehabilitation and Therapy Commons^™

Effects Of Load Carriage On Shoulder Neuromuscular Functions And Recovery, Muataz R. Almaddah

Theses and Dissertations--Rehabilitation Sciences

Load carriage is a primary source for injury occurrence among military personnel and recreational hikers affecting all body areas. The shoulder ranks as the second or third most common site of injuries among military personnel. Many studies report that elevations in self-reported fatigue, soreness, and discomfort in the shoulders accompany the load carriage. Almost 50% of military personnel experienced a load carriage injury during the first episode of training, and 75% of those injured suffered a second injury during their career. The goal of this research project is to investigate the components associated with load carriage shoulder symptoms to determine …

Biopsychological Predictors Of Pain And Function In Patients With Rotator Cuff Conditions, Nicole Cascia

Theses and Dissertations--Rehabilitation Sciences

Predicting worse patient-reported outcomes in those with Rotator Cuff (RC) conditions is dependent on examining both biological and psychological impairments. In order to help determine which biopsychological factors are associated with pain and function in patients with RC related conditions and to determine who may be at an increased risk for worse outcomes after Reverse Shoulder Arthroplasty (RSA), biopsychological associations between patient demographics, scapular motion, humeral motion, RC tear size, pain associated psychological distress, and function were clinically evaluated to investigate prediction models for pain and function. The central hypothesis is that in a group of patients with symptomatic Cuff …

Vestibular Function And Sports-Related Concussion: An Exploratory Investigation Of The Consequences Of Sports Related Concussion On Vestibular Function And Outcomes, Carolina Quintana

Theses and Dissertations--Rehabilitation Sciences

Sports-related concussions (SRC), or mild traumatic brain injuries that occur as a result of sports or athletic participation, are said to affect approximately 300,000 young adults and 1.4 million youth athletes in the United States on an annual basis. SRC create a significant burden on the health care system by generating an estimated $60 billion dollars in direct and indirect costs in 2000. In addition to the financial burden these injuries create, they additionally impose both short- and long-term effects for those effected and their overall health. Among the many effects of concussions are physical signs as symptoms such as …

Physical And Occupational Therapy For Young Children With Delayed Motor Development: Exploring Current Practices, Challenges, And Families’ Implementation Of Home Activities In Early Intervention, Afnan Gmmash

Theses and Dissertations--Rehabilitation Sciences

The literature supports the use of family-centered early intervention(EI) for young children with or at risk for cerebral palsy (CP) to promote the children’s motor development. Young children with or at risk for delayed motor development in their first three years of life are entitled to EI under Part C of The Individuals with Disabilities Education Improvement Act. Identifying current EI provided for young children with delayed motor development is essential to detect possible gaps and factors that could prevent therapists from providing the best EI. Understanding the parent’s perspective on the implementation of activities outside therapy to maximize the …

Influences Of Functional And Psychological Factors On Biomechanics Following An Anterior Cruciate Ligament (Acl) Reconstruction, Chelsey Roe

Theses and Dissertations--Rehabilitation Sciences

Objective: The aims of this research were to identify gaps in the literature related to return to sport (RTS) test batteries following primary anterior cruciate ligament reconstruction (ACLR) (Aim 1) and define recovery in athletes from 4-9 months after ACLR across three domains: 1) psychological recovery and biomechanics (Aim 2), 2) rehabilitation quantity and biomechanics (Aim 3), and 3) functional performance and biomechanics (Aim 4). Ultimately, the results of this research would quantify recovery following ACLR in athletes with a desire to RTS and identify objective criteria throughout rehabilitation prior to RTS.

Participants: Twenty-two post-ACLR athletes 17 females, 8 males, …

Knee Joint Loading Following Anterior Cruciate Ligament Reconstruction: Link To Patient Reported Outcomes And A Novel Method To Monitor With Wearable Sensors, Alex Spencer

Theses and Dissertations--Kinesiology and Health Promotion

Recovery from anterior cruciate ligament reconstruction (ACLR) commonly results in undesirable physical and patient-reported outcomes (PROs). Identification of modifiable factors such as knee contact force (KCF) early in rehabilitation that can improve these outcomes is important due to the rapid decrease in function, quality of life, and joint health in this population. Additionally, if noninvasive measurement of KCFs outside of a traditional laboratory were possible, clinicians could optimize patient treatment with personalized care. Therefore, there are two primary aims to this thesis: 1) quantify the link between KCF and PROs which measure pain, ability to perform activities of daily living, …

An Evaluation Of Postural Control And Balance After Anterior Cruciate Ligament Reconstruction, Kathryn Lucas

Theses and Dissertations--Rehabilitation Sciences

Over 100,000 anterior cruciate ligament reconstructions (ACLR) occur annually in the United States, with one in four individuals sustaining a second injury within the first two years after reconstruction. Due to the proprioceptive nature of the anterior cruciate ligament, the lack of regaining postural control and balance are likely large contributors to the rate of secondary injuries after ACLR. Recent literature has identified cerebral changes after anterior cruciate ligament injury and surgery, likely due to altered sensation and feedback loops. However, no study thus far has investigated the neurological feedback loops that may place this group at higher risk of …

Safety, Feasibility, And Efficacy Of Early Rehabilitation In Patients Requiring Continuous Renal Replacement: A Quality Improvement Study, Kirby P. Mayer, Amanda R. Hornsby, Victor Ortiz Soriano, Timothy C. Lin, Jennifer T. Cunningham, Hanwen Yuan, Caroline E. Hauschild, Peter E. Morris, Javier A. Neyra

Physical Therapy Faculty Publications

Introduction: Early rehabilitation in critically ill patients is associated with improved outcomes. Recent research demonstrates that patients requiring continuous renal replacement therapy (CRRT) can safely engage in mobility. The purpose of this study was to assess safety and feasibility of early rehabilitation with focus on mobility in patients requiring CRRT.

Methods: Study design was a mixed methods analysis of a quality improvement protocol. The setting was an intensive care unit (ICU) at a tertiary medical center. Safety was prospectively recorded by incidence of major adverse events including dislodgement of CRRT catheter, accidental extubation, bleeding, and hemodynamic emergency; and minor adverse …

Evaluation Of A Concussion Management And Discharge Education Training Module For Emergency Department Nurses, Carmen Frede

DNP Projects

Purpose: The purpose of this project was to improve the Emergency Department (ED) nurses’ knowledge on identifying patients at risk for concussions and delivering effective concussion discharge education using an educational training intervention.

Methods: This project used a descriptive, non-randomized pre-post survey design. Participation involved three stages: a pre-education survey to assess baseline concussion education knowledge, an educational intervention consisting of a narrated PowerPoint presentation, and a post-education survey to evaluate knowledge on concussion discharge education. The intervention was delivered online via the UK Canvas educational platform.

Results: The majority of nursing staff participants were female (97%) and had a …

Impact Of Motor Therapy With Dynamic Body-Weight Support On Functional Independence Measures In Traumatic Brain Injury: An Exploratory Study, Emily F. Anggelis, Elizabeth Salmon Powell, Philip M. Westgate, Amanda C. Glueck, Lumy Sawaki

Physical Medicine and Rehabilitation Faculty Publications

BACKGROUND: Contemporary goals of rehabilitation after traumatic brain injury (TBI) aim to improve cognitive and motor function by applying concepts of neuroplasticity. This can be challenging to carry out in TBI patients with motor, balance, and cognitive impairments.

OBJECTIVE: To determine whether use of dynamic body-weight support (DBWS) would allow safe administration of intensive motor therapy during inpatient rehabilitation and whether its use would yield greater improvement in functional recovery than standard-of-care (SOC) therapy in adults with TBI.

METHODS: Data in this retrospective cohort study was collected from patients with TBI who receive inpatient rehabilitation incorporating DBWS (n = …

Chronic Muscle Weakness And Mitochondrial Dysfunction In The Absence Of Sustained Atrophy In A Preclinical Sepsis Model, Allison M. Owen, Samir P. Patel, Jeffrey D. Smith, Beverly K. Balasuriya, Stephanie F. Mori, Gregory S. Hawk, Arnold J. Stromberg, Naohide Kuriyama, Masao Kaneki, Alexander G. Rabchevsky, Timothy A. Butterfield, Karyn A. Esser, Charlotte A. Peterson, Marlene E. Starr, Hiroshi Saito

Physiology Faculty Publications

Chronic critical illness is a global clinical issue affecting millions of sepsis survivors annually. Survivors report chronic skeletal muscle weakness and development of new functional limitations that persist for years. To delineate mechanisms of sepsis-induced chronic weakness, we first surpassed a critical barrier by establishing a murine model of sepsis with ICU-like interventions that allows for the study of survivors. We show that sepsis survivors have profound weakness for at least 1 month, even after recovery of muscle mass. Abnormal mitochondrial ultrastructure, impaired respiration and electron transport chain activities, and persistent protein oxidative damage were evident in the muscle of …

Development Of A Non-Invasive Device For Swallow Screening In Patients At Risk Of Oropharyngeal Dysphagia: Results From A Prospective Exploratory Study, Catriona M. Steele, Rajat Mukherjee, Juha M. Kortelainen, Harri Pölönen, Michael Jedwab, Susan L. Brady, Kayla Brinkman Theimer, Susan Langmore, Luis F. Riquelme, Nancy B. Swigert, Philip M. Bath, Larry B. Goldstein, Richard L. Hughes, Dana Leifer, Kennedy R. Lees, Atte Meretoja, Natalia Muehlemann

Neurology Faculty Publications

Oropharyngeal dysphagia is prevalent in several at-risk populations, including post-stroke patients, patients in intensive care and the elderly. Dysphagia contributes to longer hospital stays and poor outcomes, including pneumonia. Early identification of dysphagia is recommended as part of the evaluation of at-risk patients, but available bedside screening tools perform inconsistently. In this study, we developed algorithms to detect swallowing impairment using a novel accelerometer-based dysphagia detection system (DDS). A sample of 344 individuals was enrolled across seven sites in the United States. Dual-axis accelerometry signals were collected prospectively with simultaneous videofluoroscopy (VFSS) during swallows of liquid barium stimuli in thin, …

A Comprehensive Rehabilitation Program For Treating Lateral Elbow Tendinopathy, Joseph M. Day, Ann M. Lucado, Timothy L. Uhl

Physical Therapy Faculty Publications

Scapular muscle weakness in patients with lateral elbow tendinopathy is an identified impairment and is part of a multimodal rehabilitation approach. The published literature provides little information regarding specific rehabilitation guidelines that address both the proximal scapular muscle weakness and local elbow/ wrist dysfunctions common in patients with lateral elbow tendinopathy. The purpose of this clinical commentary is to describe a comprehensive rehabilitation strategy for individuals with lateral elbow tendinopathy. This program emphasizes a phased therapeutic strategy that addresses proximal and local dysfunction along the kinetic chain. This clinical protocol is currently being tested for efficacy as part of a …

Racial And Ethnic Disparities In Stroke Outcomes: A Scoping Review Of Post-Stroke Disability Assessment Tools, Suzanne Perea Burns, Brandi M. White, Gayenell Magwood, Charles Ellis, Ayaba Logan, Joy N. Jones Buie, Robert J. Adams

Health and Clinical Sciences Faculty Publications

Purpose: To identify how post-stroke disability outcomes are assessed in studies that examine racial/ethnic disparities and to map the identified assessment content to the International Classification of Functioning, Disability, and Health (ICF) across the time course of stroke recovery.

Methods: We conducted a scoping review of the literature. Articles published between January 2001 and July 2017 were identified through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion and exclusion criteria.

Results: We identified 1791 articles through database and hand-searching strategies. Of the articles, 194 met inclusion criteria for full-text review, and 41 met inclusion criteria for study inclusion. The …

Ethnic And Gender Disparities In The Uptake Of Transcatheter Aortic Valve Replacement In The United States, Ayman Elbadawi, Syed Yaseen Naqvi, Islam Y. Elgendy, Mohamed F. Almahmoud, Mohamed Hamed, Hesham Abowali, Gbolahan O. Ogunbayo, Hani Jneid, Khaled M. Ziada

Internal Medicine Faculty Publications

Introduction: Little is known about ethnic and gender disparities for transcatheter aortic valve replacement (TAVR) procedures in the United States.

Methods: We queried the Nationwide Inpatient Sample (NIS) database (2011–2014) to identify patients who underwent TAVR. We described the temporal trends in the uptake of TAVR procedures among various ethnicities and genders.

Results: Our analysis identified 39,253 records; 20,497 (52.2%) were men and 18,756 (47.8%) were women. Among all TAVRs, 87.2% were Caucasians, 3.9% were African Americans (AA), 3.7% were Hispanics, and 5.2% were of other ethnicities. We found a significant rise in the trend of TAVRs in all groups: …

Non-Fasting High-Density Lipoprotein Is Associated With White Matter Microstructure In Healthy Older Adults, Nathan F. Johnson, Brian T. Gold, Dorothy Ross, Alison L. Bailey, Jody L. Clasey, Vedant Gupta, Steve W. Leung, David K. Powell

Physical Therapy Faculty Publications

A growing body of evidence indicates that biomarkers of cardiovascular risk may be related to cerebral health. However, little is known about the role that non-fasting lipoproteins play in assessing age-related declines in a cerebral biomarker sensitive to vascular compromise, white matter (WM) microstructure. High-density lipoprotein cholesterol (HDL-C) is atheroprotective and low-density lipoprotein cholesterol (LDL-C) is a major atherogenic lipoprotein. This study explored the relationships between non-fasting levels of cholesterol and WM microstructure in healthy older adults. A voxelwise and region of interest approach was used to determine the relationship between cholesterol and fractional anisotropy (FA). Participants included 87 older …

Elastic Resistance Effectiveness On Increasing Strength Of Shoulders And Hips, Kelsey J. Picha, Muataz R. Almaddah, Jordan Barker, Tavis Ciochetty, W. Scott Black, Timothy L. Uhl

Physical Therapy Faculty Publications

Elastic resistance is a common training method used to gain strength. Currently, progression with elastic resistance is based on the perceived exertion of the exercise or completion of targeted repetitions; exact resistance is typically unknown. This study's objective is to determine if knowledge of load during elastic resistance exercise will increase strength gains during exercises. Participants were randomized into two strength training groups, elastic resistance only and elastic resistance using a load cell (LC) that displays force during exercise. The LC group used a Smart Handle (Patterson Medical Supply, Chicago, IL) to complete all exercises. Each participant completed the same …

Volleyball Overhead Swing Volume And Injury Frequency Over The Course Of A Season, Heather Wolfe, Katherine Poole, Alejandro G. Villasante Tezanos, Robert A. English, Timothy L. Uhl

Statistics Faculty Publications

Background: Overuse injuries are common in volleyball; however, few studies exist that quantify the workload of a volleyball athlete in a season. The relationship between workload and shoulder injury has not been extensively studied in women's collegiate volleyball athletes.

Hypothesis/Purpose: This study aims to quantify shoulder workloads by counting overhead swings during practice and matches. The purpose of the current study is to provide a complete depiction of typical overhead swings, serves, and hits, which occur in both practices and matches. The primary hypothesis was that significantly more swings will occur in practices compared to matches. The secondary hypothesis was …

The Relationship Between Pitching Volume And Arm Soreness In Collegiate Baseball Pitchers, Angel L. Lazu, Shawn D. Love, Timothy A. Butterfield, Robert A. English, Timothy L. Uhl

Physical Therapy Faculty Publications

Background: Excessive baseball pitch volume has been associated with increased risk of injury in adolescents. However, many collegiate athletes report non-time loss injuries over the course of the season. It is unknown how pitch volume throughout a collegiate baseball season affects arm soreness.

Purpose: The primary purpose of this study was to determine the relationship between pitch volume and self-reported arm soreness. A secondary purpose was to determine the relationship between change in pitch volume and change in arm soreness over the course of the season for collegiate baseball pitchers.

Study Design: Prospective Cohort.

Methods: Seven collegiate baseball …

Neuromuscular Adaptions Following A Daily Strengthening Exercise In Individuals With Rotator Cuff Related Shoulder Pain: A Pilot Case-Control Study, Amee L. Seitz, Lisa A. Podlecki, Emily R. Melton, Timothy L. Uhl

Physical Therapy Faculty Publications

Background: The goal of therapeutic exercise is to facilitate a neuromuscular response by increasing or decreasing muscular activity in order to reduce pain and improve function. It is not clear what dosage of exercise will create a neuromuscular response.

Purpose: The purpose of this study was to assess the effects following a three-week home program of a daily single exercise, the prone horizontal abduction exercise (PHA), on neuromuscular impairments of motor control as measured by scapular muscle EMG amplitudes, strength, and secondarily outcomes of self-reported pain and function between individuals with and without subacromial pain syndrome.

Study Design: Prospective Case-Control, …

Acute Treadmill Exercise Discriminately Improves The Skeletal Muscle Insulin-Stimulated Growth Signaling Responses In Mice Lacking Redd1, Cory M. Dungan, Bradley S. Gordon, David L Williamson

Physical Therapy Faculty Publications

A loss of the regulated in development and DNA damage 1 (REDD1) hyperactivates mechanistic Target of Rapamycin Complex 1 (mTORC1) reducing insulin‐stimulated insulin signaling, which could provide insight into mechanisms of insulin resistance. Although aerobic exercise acutely inhibits mTORC1 signaling, improvements in insulin‐stimulated signaling are exhibited. The goal of this study was to determine if a single bout of treadmill exercise was sufficient to improve insulin signaling in mice lacking REDD1. REDD1 wildtype (WT) and REDD1 knockout (KO) mice were acutely exercised on a treadmill (30 min, 20 m/min, 5% grade). A within animal noninsulin‐to‐insulin‐stimulated percent change in skeletal muscle …

A Comprehensive Assessment Of Crisis In Individuals With Intellectual Disabilities And Its Implications For Physical Therapy, Kathleen Sutton

Theses and Dissertations--Rehabilitation Sciences

Advancements in medicine, policy, and societal attitudes have improved life expectancy, socialization, and participation for individuals with intellectual and developmental disabilities (IDD). However, inconsistent or a lack of services may drive healthcare utilization toward expensive emergency care services. This can negatively impact health outcomes and disrupt physical therapy treatment plans, limiting their effectiveness and further placing individuals with IDD at risk for crisis episodes. Because of its subjective nature, quantifying crisis is challenging using current definitions. Rehabilitation professionals are often active members of the care team for individuals with IDD, however no evidence currently exists regarding how the profession can …

Prevalence Of Sports-Related Stress Urinary Incontinence In The Female Collegiate Athlete, Stacey Pagorek

Theses and Dissertations--Rehabilitation Sciences

Urinary incontinence is a health condition that is associated with involuntary leakage of urine. Stress urinary incontinence (SUI) describes involuntary leakage of urine on effort or exertion and can impact one’s ability to participate in activities and affect quality of life. Furthermore, clinical management of this health condition is challenging as individuals who experience urinary incontinence often do not report this concern to a health care provider.

Stress urinary incontinence is not typically a health concern associated with young, healthy athletes. However, researchers have begun to examine the presence of this health condition amongst both a younger population and in …

Connecting The Pieces: How Low Back Pain Alters Lower Extremity Biomechanics And Shock Attenuation In Active Individuals, Alexa Johnson

Theses and Dissertations--Rehabilitation Sciences

Low back pain in collegiate athletes has been reported at a rate of 37% from a wide array of sports including soccer, volleyball, football, swimming, and baseball. Whereas, in a military population the prevalence of low back pain is 70% higher than the general population. Compensatory movement strategies are often used as an attempt to reduce pain. Though compensatory movement strategies may effectively reduce pain, they are often associated with altered lower extremity loading patterns. Those who suffer from chronic low back pain tend to walk and run slower and with less trunk and pelvis coordination and variability. Individuals with …

Injury-Related Fear In Patients After Anterior Cruciate Ligament Reconstruction, Shelby Elyse Baez

Theses and Dissertations--Rehabilitation Sciences

Approximately 200,000 anterior cruciate ligament (ACL) injuries occur each year with about 100,000 of these injuries undergoing reconstruction (ACLR). The impetus of ACLR is to allow previously high functioning, physically active individuals to return to desired levels of sports participation and to engage in recommended levels of physical activity. However, 1 out of 3 patients after ACLR fail to return to competitive levels of sport and meet recommended levels of physical activity. Injury-related fear has been cited as the primary barrier for failure to return to sport. However, the research has been primarily qualitative in nature and limited research has …

A Brain-Computer Interface For Closed-Loop Sensory Stimulation During Motor Training In Patients With Tetraplegia, Sarah Helen Thomas

Theses and Dissertations--Biomedical Engineering

Normal movement execution requires proper coupling of motor and sensory activation. An increasing body of literature supports the idea that incorporation of sensory stimulation into motor rehabilitation practices increases its effectiveness. Paired associative stimulation (PAS) studies, in which afferent and efferent pathways are activated in tandem, have brought attention to the importance of well-timed stimulation rather than non-associative (i.e., open-loop) activation. In patients with tetraplegia resulting from spinal cord injury (SCI), varying degrees of upper limb function may remain and could be harnessed for rehabilitation. Incorporating associative sensory stimulation coupled with self-paced motor training would be a means for supplementing …

Leadership Development In Physical Therapy: Moving Toward A Community Of Transformative Practitioners, Kerry Cronin Mallini

Theses and Dissertations--Educational Leadership Studies

Physical therapy as an emerging profession is committed to establishing its identity and solidifying its role as a leader in health care. With expertise in human movement, wellness, and disease prevention, physical therapists possess invaluable knowledge and skill to influence public health and enhance patient recovery without increasing cost. Physical therapists have the opportunity to transform the delivery of public health services to meet current and future needs. A major challenge, however, is a dearth of leadership development in preparation programs. Because most physical therapists have not received formal education or explicit training in leadership, a problem of practice exists. …

Changes In Muscle Size, Quality And Power Are Related To Physical Function In Patients With Critical Illness, Kirby Mayer

Theses and Dissertations--Rehabilitation Sciences

Patients admitted to intensive care unit (ICU) are known to develop significant impairments in physical function. Patients with critical illness suffer up to 30% reductions in muscle size within the first ten days of admission to the ICU. Muscle strength testing, Medical Research Council-sum score, is current gold-standard to diagnosis ICU-acquired weakness and predicts risk of mortality and long-term physical function. Muscle power different from muscle strength in that it accounts for velocity of movement, is potentially a better independent predictor of function that has not been studied in this population. In addition, we hypothesize that muscle size and quality …

Walking With A Robotic Exoskeleton Does Not Mimic Natural Gait: A Within-Subjects Study, Chad Swank, Sharon Wang-Price, Fan Gao, Sattam Almutairi

Kinesiology and Health Promotion Faculty Publications

Background: Robotic exoskeleton devices enable individuals with lower extremity weakness to stand up and walk over ground with full weight-bearing and reciprocal gait. Limited information is available on how a robotic exoskeleton affects gait characteristics.

Objective: The purpose of this study was to examine whether wearing a robotic exoskeleton affects temporospatial parameters, kinematics, and muscle activity during gait.

Methods: The study was completed by 15 healthy adults (mean age 26.2 [SD 8.3] years; 6 males, 9 females). Each participant performed walking under 2 conditions: with and without wearing a robotic exoskeleton (EKSO). A 10-camera motion analysis system synchronized with 6 …

Patients' Perceptions And Patient-Reported Outcomes In Progressive-Fibrosing Interstitial Lung Diseases, Jeffrey J. Swigris, Kevin K. Brown, Rayid Abdulqawi, Ketan Buch, Daniel F. Dilling, Dirk Koschel, Krishna Thavarajah, Rade Tomic, Yoshikazu Inoue

Internal Medicine Faculty Publications

The effects of interstitial lung disease (ILD) create a significant burden on patients, unsettling almost every domain of their lives, disrupting their physical and emotional well-being and impairing their quality of life (QoL). Because many ILDs are incurable, and there are limited reliably-effective, life-prolonging treatment options available, the focus of many therapeutic interventions has been on improving or maintaining how patients with ILD feel and function, and by extension, their QoL. Such patient-centred outcomes are best assessed by patients themselves through tools that capture their perceptions, which inherently incorporate their values and judgements. These patient-reported outcome measures (PROs) can be …