Rehabilitation and Therapy Commons^™

Integrating The Development Of Children And Gestalt Therapy, Jennifer J. Thompson

Loma Linda University Electronic Theses, Dissertations & Projects

There are many theories that have contributed to what we know about the development of children; for instance, theoretical diversity supports the complexities of human nature. A child's developmental level will impact his ability to relate. Gestalt theory supports the child's phenomenological view by focusing on the here-and-now of what is happening in the therapeutic environment. Most of what a child will do is in response to a need or want. The child will work toward fulfilling that need. The child may develop maladaptive ways to fulfill his needs based on the environment in which he lives. Gestalt play therapy …

Aerobic Exercise And Bone Turnover In Trained And Untrained Premenopausal Women, Michelle Prowse

Loma Linda University Electronic Theses, Dissertations & Projects

Regular weight-bearing exercise is recommended for healthy young adults to optimize bone mineral density (BMD) (Physical Activity Guidelines Advisory Committee, 2008). BMD alone however, is not a significant predictor of osteoporosis or fracture risk. While bone turnover markers are used clinically to assess efficacy of pharmacological intervention in individuals diagnosed with osteoporosis, they may also have a role in evaluating acute responses to exercise. The purpose of this dissertation was to compare two groups of premenopausal women, those which are sedentary (low fitness) versus those that are well-trained (high fitness), by BMD and bone turnover markers at rest and the …

Effect Of 3-Electrode Electrical Stimulation On Current Delivery And Healing In Chronic Wounds, Hyejin Suh

Loma Linda University Electronic Theses, Dissertations & Projects

Chronic wounds have been an enormous burden on the healthcare system due to their prevalence and the lack of efficacy of current treatment modalities. Over the years, electrical stimulation (ES) has been widely used in the treatment of wounds. Unfortunately, the effectiveness of this treatment is under scrutiny, since many studies have failed to report successive and/or consistent effects of ES on wound healing. This inconsistency may be due to the uneven current produced by the conventional 2-electrode delivery system (2-channel ES) and the reduced resting blood flow resulting from thermally cool treatment rooms. In this study, a new approach …

Response Of Endothelial Cells To Stressors: The Impact Of Aging And Diabetes, Katie Mclellan

Loma Linda University Electronic Theses, Dissertations & Projects

Preliminary research indicates there is some impairment of the endothelial cells to respond to single stressors such as local heat, shear stress, and global heat in older people and people who have diabetes. The response of the skin blood flow to local heat is an indicator of the endothelial cells ability to cope with stress. In addition, factors such as thicker subcutaneous fat and skin moisture may impair the skin’s ability to dissipate heat. For older people and people with diabetes, this endothelial dysfunction may cause an even more diminished response to multiple stressors. However, no studies have examined the …

Is Electrical Stimulation A Predictive Tool For Autonomic Dysfunction In Males With Diabetes?, Susan Dorothy Rand

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to examine whether electrical stimulation can be used as a predictive tool to assess autonomic dysfunction in males with diabetes. The study was designed to better understand the extent of autonomic nervous system (ANS) dysfunction in the diabetic population.

Controls and patients with diabetes were recruited from the community at large and the Loma Linda University Diabetes Treatment Center and were managed by a physician. Twelve (12) people with diabetes and thirteen (13) control subjects participated. Mean age (years) for people with diabetes was 52.4 +/- 6.1 and 47.2 +/-11.1 for controls (p =0.05). …

Physiological Effects Of Vibration In Select Populations, Colleen S. Maloney-Hinds

Loma Linda University Electronic Theses, Dissertations & Projects

Recently, researchers have demonstrated that Whole Body Vibration results in significant increases in skin blood flow. No study has determined if there is an optimal frequency or duration for optimizing this response. In addition, there is no known mechanism for the increase in skin blood flow. It is hypothesized that nitric oxide (NO) is responsible for the increase in skin blood flow due to its ability to vasodilate the smooth muscle in response to shear stress. Therefore, the purpose of this research was to determine the optimal frequency and duration of vibration and determine if NO is the mechanism for …

A Qualitative Study Of Inpatient Rehabilitation Client Perceptions Of The Semi-Fixed Environment, Liane Hewitt

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. Literature supports the importance of the environment on promoting or compromising health. However, little is known about how the semi-fixed environment affects client perceptions and recovery from a debilitating condition. The purpose of this study was to investigate beliefs about control within the semi-fixed environment and client perceptions of the rehabilitation process.

Design and Method. This study utilized a basic qualitative research design with 10 rehabilitation clients whose average inpatient length of stay was 14 days. Data were collected in two phases. Phase I included two inpatient visits involving semi-structured interviews on the rehabilitation process and …

Factors That Influence The Blood Flow Response Of Skin To Electrical Stimulation, Abdul-Majeed Raja Al-Malty

Loma Linda University Electronic Theses, Dissertations & Projects

Female reproductive hormones, aging, global heating and local heating are factors affecting skin blood flow (SBF), but their effect on electrical stimulation (ES) has never been examined until the present investigation. To investigate female reproductive hormones, nine women (age= 25.6±3.5 years) with a normal menstrual cycle (MC) underwent ES in thermoneutral (25°±0.5°C) and warm environments (35°±0.5°C). To investigate aging, ES was applied on active young (n=15, age=32.1±8.3 years) and old (n=8, 64.5±6.2 years) groups in thermoneutral and warm environments. To investigate the effect of global and local heating, groups of 15 and 18 subjects (age= 18-40 years) experienced ES under …

Isokinetic Knee Strength In Females With Fibromyalgia, Flora F. Shafiee

Loma Linda University Electronic Theses, Dissertations & Projects

Objectives: To compare knee flexors and extensors muscle strength, total work, and power between females with fibromyalgia (FM) and matched healthy controls.

Methods: This is the first study to measure knee muscle power and total work in females with FM. Thirty-one females with FM and thirty-one healthy females completed isokinetic testing of knee flexors and extensors of their dominant leg using a Cybex Norm Isokinetic Dynamometer. Two knee muscle groups (flexors and extensors) at two angular velocities (607sec and 1807sec) were tested for both groups. Both muscle groups were assessed continuously using five reciprocal concentric-concentric cycles, followed by five eccentric-eccentric …

The Effect Of Positioning On Pelvic Floor Muscle Activity As Evaluated With Surface Electromyography In Normals, Karen R. Whitter-Brandon

Loma Linda University Electronic Theses, Dissertations & Projects

Physical therapists who treat patients with urinary incontinence commonly utilize sEMG biofeedback. Practitioners compare resting tone, maximal contraction, and muscle endurance measures before and after pelvic floor exercise instruction to determine intervention and demonstrate progress. There is little research that supports the use of biofeedback in positions other than supine. The purpose of this study was to examine the effect of positioning on pelvic floor muscle activity as measured by surface electromyography (sEMG) in supine, sitting, and standing. Subjects were healthy nulliparous and multiparous women, 23-74 years old, with no symptoms, history, diagnosis, or treatment of incontinence. Subjects were randomized …

The Effect Of Posterior Versus Anterior Glide Joint Mobilization On External Rotation Range Of Motion Of Patients With Shoulder Adhesive Capsulitis, Andrea J. Johnson

Loma Linda University Electronic Theses, Dissertations & Projects

Study Design: Repeated measures, randomized comparison of two treatment groups.

Objective: To compare effectiveness of two manual therapy procedures, posterior and anterior glide joint mobilization, for improving external rotation in patients with adhesive capsulitis of the shoulder.

Background: Joint mobilization procedures are often used by physical therapists to treat the accessory motion impairments associated with shoulder adhesive capsulitis. However opinions differ regarding the value of posterior versus anterior glide mobilization. especially for improving external rotation.

Methods and Measures: Subjects with idiopathic adhesive capsulitis exhibiting a specific external rotation range deficit, were randomly assigned to one of two treatment groups. For …

The Effect Of Electrical Stimulation On Blood Flow In Chronic Wounds In Patients With And Without Diabetes, Daryl J. Lawson

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. Only 3% of the U S population is afflicted by diabetes, yet one of the most common chronic wounds is the diabetic ulcer. Decrease in blood flow may be one reason why only 31% of neuropathic diabetic ulcers heal in 20-weeks. The purpose of this investigation was to compare healing rates and blood flow of chronic stage III and IV wounds in people with diabetes and those without diabetes over four weeks of treatment. Blood flow was measured before, during, and after stimulation using one of two different electrical stimulation waveforms in a 32°C room.

Subjects …

Difference In Transverse Plane Scapular Position Of Professional Baseball Players Relative To Baseball Field Position, James M. Syms

Loma Linda University Electronic Theses, Dissertations & Projects

The objective of this study was to identify the variation of the scaption angle of professional baseball players among field position played. Subjects consisted of 109 minor league professional baseball players reporting for the 2002 spring training season, who were under contract with the Anaheim Angels professional baseball organization. Subjects reported to a sports medicine/physical therapy clinic for their 2002 spring training pre-participation physical examination. The scaption measurements were taken as a component of the examination.

Goniometric measurements were taken with the players in a relaxed standing position. Players were instructed to remain looking forward, roll their shoulders forward three …

Orthopedic Treatment Outcomes And Physical Therapists' Orthopedic Clinical Specialist Status, Karin Granberg

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. Orthopedic Clinical Specialist (OCS) certification has been available since 1989, however, no prospective studies exist demonstrating better patient outcomes with OCS certification. The purpose of this study was to prospectively explore if there are differences in effectiveness as measured by health, work status and patient satisfaction; efficiency, as measured by visits, treatment duration, number of treatment codes and cost; value (unit of functional improvement per dollar charged), and utilization (unit of functional improvement per visit) depending on OCS status of PTs working in orthopedic outpatient settings.

Subjects. Six PTs with OCS certification and 11 PTs without …

The Effectiveness Of A Physical Therapy Intervention For Children With Hypotonia And Flatfeet, Charmayne G. Ross

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The purpose of this study was to determine the effectiveness of physical therapy using Cascade orthotics and an exercise program for children with hypotonia and flatfeet. Subjects: Thirty-seven children, aged 18 months to 5 years, who demonstrated developmental delays and hypotonia with flatfoot dysfunction, participated in this study. Methods: Three groups (control, orthotic, and orthotic-exercise) were studied. The orthotic- exercise group practiced bilateral heel lifts besides wearing the orthoses. An arch index was used to assess the width of the medial longitudinal arch (MLA) pre/post interventions. Gait parameters (velocity, step-length, single-limb support, and cadence) were assessed four times in …

Diabetes: The Interrelationship Between Vascular, Nervous Systems And Avandia, Salameh Bweir

Loma Linda University Electronic Theses, Dissertations & Projects

Diabetes Mellitus has been linked to vascular and neurological impairments. The purpose of this study was to assess the relationship between vascular endothelial dysfunction, autonomic and somatic nervous systems impairment in diabetic patients. These studies also evaluated the effects of rosiglitazone (Avandia) on the vascular, autonomic, and somatic nervous systems.

Fourteen diabetic subjects and fourteen control subjects (age matched) participated in three series of experiments. Using Whitney volume plesythmography to assess post occlusion blood flow in the subject’s forearm did assessment of vascular endothelial function. Evaluating skin blood flow, orthostatic tolerance, heart rate, and thermal responses under thermal and postural …

The Role Of Health Promotion In Physical Therapy, Brenda L. Rea

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The purpose of this study was to investigate physical therapy practice patterns in four focus areas of Healthy People 2010 (focus area #6, disability and secondary conditions by looking at psychological well-being; focus area #19, nutrition and overweight; focus area #22, physical fitness and activity; focus area #27, tobacco use) and identify self-efficacy and outcome expectations related to those practice patterns across California, New York and Tennessee using Bandura’s Social Cognitive Theory as a framework. It was hypothesized that physical therapists’ self-efficacy and outcome expectations in the four focus areas of Healthy People 2010 would be significantly associated with …

Predicting Sacroiliac Syndrome: The Association Between Noninvasive Sacroiliac Joint Tests And Sacroiliac Joint Injections, Lorraine D. Webb

Loma Linda University Electronic Theses, Dissertations & Projects

Study Design. A prospective single sample observational design was performed. Sacroiliac tests that predicted ≥ 75% pain relief after sacroiliac joint (SIJ) injection were considered valid diagnostic tests for SIJ syndrome.

Objectives. To identify valid noninvasive sacroiliac tests that can be used to diagnose SIJ syndrome.

Summary of Background Data. The criterion standard for diagnosing SIJ syndrome is with SIJ intraarticular injections under fluoroscopy. This procedure is costly, invasive, and impractical for routine use. Clinicians need practical ways to diagnose SIJ syndrome; however, few studies have been performed to validate existing sacroiliac tests against SIJ Injections.

Methods. Nineteen subjects …

Effect Of Electrode Size, Shape, And Placement On Electrical Current And Subject Comfort During Electrical Stimulation, Bonnie J. Forrester

Loma Linda University Electronic Theses, Dissertations & Projects

Six healthy subjects were studied to determine the optimal size, shape and placement of stimulating electrodes during the application of electrical stimulation (ES) to the biceps, quadriceps, and tibialis anterior muscles. Subjects were recruited to allow for diversity in age, sex, and skin pigmentation. Subjects sat in a custom designed multi-positional chair, which allowed precise positioning of each extremity. After determining the maximal voluntary contraction (MVC) of the muscle and careful determination of the motor point, ES, with a biphasic square wave of 300 ms duration and a frequency of 30 Hz, was used to bring the muscle to 10% …

Patterns Of Scholarly Productivity In Physical Therapy Faculty, Ardith L. Williams-Meyer

Loma Linda University Electronic Theses, Dissertations & Projects

Due to the proliferation of entry-level doctorate physical therapy programs (DPT), there are two important qualifications for current physical therapy educators: 1) they should hold academic doctorate degrees and 2) they need to conduct scholarly activity, such as research, to increase the scientific base for physical therapy practice. In order to determine current faculty preparation for the increasing number of DPT programs, this descriptive study compared the current percentage of doctorally prepared faculty teaching in entry-level doctorate and masters degree programs, and determined their contributions through original research, publications as first or contributing authors or presentations, during the last five …

Prevalence Of Various Upper Extremity Disorders In Patients With Carpal Tunnel Syndrome Versus Patients Without Carpal Tunnel Syndrome, Daniel C. Buda

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose: Increasingly larger numbers of patients present with repetitive strain injuries of the upper extremities, especially carpal tunnel syndrome (CTS). A large number of these patients appear to have more than one upper extremity condition. The purpose of this study was to determine the probability that a patient diagnosed with carpal tunnel syndrome will also be diagnosed with other upper extremity and/or cervical spine disorders.

Subjects: A group of 188 subjects diagnosed with carpal tunnel syndrome and a group of 203 subjects without carpal tunnel syndrome were selected through a chart review of patients at Loma Linda …

A Practice Analysis Survey: Defining The Clinical Practice Of Primary Care Physical Therapy, Edsen Bermudez Donato

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. Due to changes in the health care delivery systems, physical therapy services have moved toward a primary care model of practice. The purpose of this study was to identify the professional responsibilities, procedures, and knowledge areas of physical therapists practicing in primary care settings.

Subjects. A sample of 212 physical therapists practicing in primary care settings, and a control group of 250 physical therapists not practicing in primary care settings were surveyed.

Methods. The survey instrument was developed with the assistance of a National Advisory Committee (NAC) consisting of 12 subject matter experts. A modified Delphi …

The Effects Of Education On Fear-Avoidance Behavior Of Subjects With Work-Related Low Back Pain, Marie A. Anger

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. Fear-avoidance behavior contributes to chronic low back pain. The purpose of this study was to determine whether patient education on fear-avoidance behavior added to conventional physical therapy would have significant effects on return to work status in contrast to a comparison group with only physical therapy intervention. Return to work status was measured by the length of time from the initial injury to the subject’s return to work on regular duty.

Subjects. Thirty-four workers’ compensation subjects with low back pain who exhibited fear-avoidance behavior, according to their responses to the Fear- Avoidance Beliefs Questionnaire, were alternately assigned …

Disability Self-Assessment And Upper Quarter Muscle Balance In Females, Eric Glenn Johnson

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. This study compared upper quarter muscle balance of working female dental hygienists and non-dental hygiene females who had no history of upper quarter pathology. The upper quarter was operationally defined as the shoulder and neck region; and muscle balance, as muscular flexibility and muscular performance. Muscular performance was operationally defined as a combination of strength and endurance.

Subjects. The study group consisted of 41 working dental hygienists between the ages of 22 and 60 years with a mean age of 38 years. The control group consisted of 46 non-dental hygienists between the ages of 20 and 54 …

Factors In Predicting The Number Of Home Care Physical Visits, Bruce D. Bradley

Loma Linda University Electronic Theses, Dissertations & Projects

There has been a significant increase in the utilization of home health care during the past decade. Medicare has attempted to control home care costs by 1) allowing Medicare beneficiaries to join Health Maintenance Organizations, and 2) requiring the use of the Outcome and Assessment Information Set (OASIS) for all patients admitted to home care services. These changes have challenged the home care physical therapist to be a better predictor of the total number of visits needed to complete the rehabilitation process. This was a retrospective study of 335 patients who received home health care physical therapy. The first part …

Toward The Optimal Waveform For Electrical Stimulation, Scott Douglas Bennie

Loma Linda University Electronic Theses, Dissertations & Projects

Electrical stimulation (ES) is used to strengthen muscle, improve abnormal tone, and improve the healing rate of pressure sores. Four male and three female research subjects received four minute bouts of electrically stimulated isometric contractions equal to 10% of the maximal voluntary contraction (MVC) of their right quadriceps muscle to study subjective comfort and physiological responses to different waveforms, including Russian, interferential, sine, and square. Frequency remained constant at 30pps. The pulse width for the Russian waveform was 200ps, while the sine, square, and interferential waveforms used a lOOps pulse width. The amplitude of stimulation was adjusted to maintain the …

Comparison Of Elderly Non-Fallers And Fallers On Performance Measures Of Functional Reach, Sensory Organizations, And Limits Of Stability, Harvey W. Wallmann

Loma Linda University Electronic Theses, Dissertations & Projects

OBJECTIVE: The purpose of this study was to compare elderly non-fallers and fallers for differences in the following: (1) mean functional reach (FR), (2) mean anterior limits of stability (LOS), (3) mean posterior LOS, and (4) mean sensory organization test (SOT) composite score. The following correlations were tested for significance separately in the sample of non-fallers and the sample of fallers: (1) FR and anterior LOS, (2) FR and posterior LOS, (3) FR and SOT composite score, (4) anterior LOS and the SOT composite score, and (5) posterior LOS and the SOT composite score.

DESIGN: Two group comparison design.

SETTING: …

Patient Participation In Physical Therapy Goal-Setting, Susan M. Baker

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. An important part of treatment planning in physical therapy is effective goal-setting. The Guide to Physical Therapist Practice recommends that therapists identify the patient’s goals and objectives during the initial evaluation as a way to maximize treatment outcomes. The purpose of this study was to examine whether therapists seek patient participation in goal-setting and, if so, with what methods. We also examined therapists’ attitudes toward participation and patient satisfaction with the evaluation encounter.

Subjects and Methods. Twenty-two physical therapists audiotaped the initial evaluation of 73 elder patients. The audiotaped evaluations were then scored using the Participation …

Prediction Of Discharge Destination From Initial Physical Therapy Assessment Using The Physical Assessment Key (Pak), Wendy L. Chung, Kimberly A. Vieten

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to determine if a patient’s discharge destination could be predicted by information available upon the physical therapy initial evaluation using the Physical Assessment Key (PAK). There were 141 subjects (58 male, 83 female) included in this study and their ages ranged from 19 to 89 years (mean age=57.1 years). Each subject was given a PAK score on the day of the initial physical therapy evaluation and on the day of discharge from the hospital. The PAK evaluates a patient in the areas of transfer activities, self-care activities, locomotion and excretion management. A patient was …

Does The Oswestry Or Sf-36 Help A Therapist To Predict Treatment Classification, Amy Crawford, Denese D. Kaufeldt-Soliz

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to determine the relationship of two disability questionnaires, the Oswestry Low Back Pain Disability Questionnaire (Oswestry) and the Medical Outcome Study Short Form-36 (SF-36), and a standardized physical examination and diagnostic classification system. The physical examination was performed by the evaluating therapists from the clinic and classification was determined by the evaluating therapists and the investigators to ensure correct subject placement into treatment Stages la, lb, or II. Data collection occurred at an outpatient physical therapy clinic in a metropolitan area health maintenance organization, where a sample of 221 subjects with low back pain …