Rehabilitation and Therapy Commons^™

Trunk-Pelvis Coordination During Turning: A Cross Sectional Study Of Young Adults With And Without A History Of Low Back Pain, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Background

During steady-state locomotion, symptomatic individuals with low back pain demonstrate reduced ability to modulate coordination between the trunk and the pelvis in the axial plane. It is unclear if this is also true during functional locomotor perturbations such as changing direction, or if this change in coordination adaptability persists between symptomatic episodes. The purpose of this study was to compare trunk-pelvis coordination during walking turns in healthy individuals and asymptomatic individuals with a history of low back pain.

Methods

Participants performed multiple ipsilateral turns. Axial plane inter-segmental coordination and stride-to-stride coordination variability were quantified using the vector coding technique. …

Altered Multifidus Recruitment During Walking In Young Asymptomatic Individuals With A History Of Low Back Pain, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Study Design

Cross sectional, laboratory study.

Background

Individuals with low back pain have impaired activation of multifidus during postural adjustments and increased activity of the erector spinae musculature during walking. However, it is unclear if these alterations in muscle activity are evident during locomotion in individuals with a history of low back pain when they are between symptomatic episodes.

Objectives

To compare paraspinal muscle activity in young healthy individuals and young individuals with a history of low back pain during walking turns.

Methods

14 asymptomatic individuals with a history of low back pain and 14 controls performed 90° walking turns …

Review Of The Pe Metrics Cognitive Assessment Tool For Fifth Grade Students, Michael Hodges, Chong Lee, Kent A. Lorenz, Daniel Cipriani

Physical Therapy Faculty Articles and Research

Study aim: this study examined the item difficulty and item discrimination scores for the HRFK PE Metrics cognitive assessment tool for 5th-grade students. Materials and methods: ten elementary physical education teachers volunteered to participate. Based on convenience, participating teachers selected two 5th grade physical education classes. Teachers then gave students (N = 633) a 28-question paper and pencil HRFK exam using PE Metrics Standards 3 and 4. Item difficulty and discrimination analysis and Rasch Modeling were used data to determine underperforming items. Results: analysis suggests that at least three items are problematic. The Rasch Model confirmed this …

Effects Of Pelvis Impact Angle And Hip Muscle Forces On Hip Fracture Risk During A Fall Using An Advanced Hip Impact Simulator, Woochol J. Choi, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

"Over 90% of hip fractures in older adults are caused by falls [1]. Whether a given fall will cause hip fracture depends on bone strength, and on the impact force and stress applied to the bone during impact [2]. Improved understanding is required on how peak bone stresses during a fall depend on the mechanics of a fall, and on the state of contraction at the moment of impact of the muscles spanning the hip. Recently, Choi et al showed that, for lateral impact to the hip, peak stresses decrease with increases in hip abductor muscle force [3]. In the …

Influence Of Pelvis Impact Angle During A Fall: On The Protective Benefit Of Hip Protectors, Woochol J. Choi, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

"Over 90% of hip fractures are due to falls [1]. Laboratory measures have shown that wearable hip protectors reduce impact forces to the proximal femur during a simulated sideways fall on the hip [2, 3]. However, clinical evidence suggests that hip fractures still occur when hip protectors are worn [4]. Furthermore, while falls in real life result in a variety of impact configurations, biomechanical tests to date have focused only on lateral impact to the pelvis. In the current study, we examined how the force reduction provided by wearable hip protectors is affected by pelvis impact configuration during simulated sideways …

Connectivity Measures Are Robust Biomarkers Of Cortical Function And Plasticity After Stroke, Jennifer Wu, Erin Burke Quinlan, Lucy Dodakian, Alison Mckenzie, Nikhita Kathuria, Robert J. Zhou, Renee Augsburger, Jill See, Vu H. Lee, Ramesh Srinivasan, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Valid biomarkers of motor system function after stroke could improve clinical decision-making. Electroencephalography-based measures are safe, inexpensive, and accessible in complex medical settings and so are attractive candidates. This study examined specific electroencephalography cortical connectivity measures as biomarkers by assessing their relationship with motor deficits across 28 days of intensive therapy. Resting-state connectivity measures were acquired four times using dense array (256 leads) electroencephalography in 12 hemiparetic patients (7.3 ± 4.0 months post-stroke, age 26–75 years, six male/six female) across 28 days of intensive therapy targeting arm motor deficits. Structural magnetic resonance imaging measured corticospinal tract injury and infarct volume. …

Does Insertion Of Intramuscular Electromyographic Electrodes Alter Motor Behavior During Locomotion?, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Intramuscular electromyography (EMG) is commonly used to quantify activity in the trunk musculature. However, it is unclear if the discomfort or fear of pain associated with insertion of intramuscular EMG electrodes results in altered motor behavior. This study examined whether intramuscular EMG affects locomotor speed and trunk motion, and examined the anticipated and actual pain associated with electrode insertion in healthy individuals and individuals with a history of low back pain (LBP). Before and after insertion of intramuscular electrodes into the lumbar and thoracic paraspinals, participants performed multiple repetitions of a walking turn at self-selected and controlled average speed. Low …

Hydatid Cyst Of Thoracic Spine: A Rare Cause Of Paraplegia, Rahul Soangra, Mool Chand Soangra

Physical Therapy Faculty Articles and Research

Primary spinal hydatid cysts are uncommon and extradural involvement is rare. We report an unusual case of Paraplegia due to hydatid disease of primary site of infection extra spinal muscles in thoracic region from T5 to T8 level extending into a daughter cyst at T9 level, is main cause of acute Paraplegia. Magnetic resonance imaging (MRI) showed an extradural round cystic lesion in the spinal canal filling the posterior and left postero-lateral expect at T9 level, markedly compressing the cord. The cyst was removed after laminectomy and opening of the dural sac, with excision of extraspinal mass in left paravertebral …

Innovative Evaluation Of Dexterity In Pediatrics, Susan V. Duff, Dorit H. Aaron, Gloria R. Gogola, Francisco J. Valero-Cuevas

Physical Therapy Faculty Articles and Research

Introduction

Hand dexterity is multifaceted and essential to the performance of daily tasks. Timed performance and precision demands are the most common features of quantitative dexterity testing. Measurement concepts such as rate of completion, in-hand manipulation and dynamic force control of instabilities are being integrated into assessment tools for the pediatric population.

Purpose

To review measurement concepts inherent in pediatric dexterity testing and introduce concepts that are infrequently measured or novel as exemplified with two assessment tools.

Methods

Measurement concepts included in common assessment tools are introduced first. We then describe seldom measured and novel concepts embedded in two instruments; …

Clinical Assessment Of The Infant And Child Following Perinatal Brachial Plexus Injury, Susan V. Duff, Carol Dematteo

Physical Therapy Faculty Articles and Research

Introduction

After perinatal brachial plexus injury (PBPI), clinicians play an important role in injury classification as well as the assessment of recovery and secondary conditions. Early assessment guides the initial plan of care and influences follow-up and long-term outcome.

Purpose

To review methods used to assess, classify and monitor the extent and influence of PBPI with an emphasis on guidelines for clinicians.

Methods

We use The International Classification of Functioning, Disability, and Health (ICF) model to provide a guide to assessment after PBPI for rehabilitation clinicians.

Discussion

With information gained from targeted assessments, clinicians can design interventions to increase the …

Neural Function, Injury, And Stroke Subtype Predict Treatment Gains After Stroke, Erin Burke Quinlan, Lucy Dodakian, Jill See, Alison Mackenzie, Vu Le, Mike Wojnowicz, Babak Shahbaba, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Objective

This study was undertaken to better understand the high variability in response seen when treating human subjects with restorative therapies poststroke. Preclinical studies suggest that neural function, neural injury, and clinical status each influence treatment gains; therefore, the current study hypothesized that a multivariate approach incorporating these 3 measures would have the greatest predictive value.

Methods

Patients 3 to 6 months poststroke underwent a battery of assessments before receiving 3 weeks of standardized upper extremity robotic therapy. Candidate predictors included measures of brain injury (including to gray and white matter), neural function (cortical function and cortical connectivity), and clinical …

Choice Of Human–Computer Interaction Mode In Stroke Rehabilitation, Hossein Mousavi Hondori, Maryam Khademi, Lucy Dodakian, Alison Mackenzie, Cristina V. Lopes, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Background and Objective. Advances in technology are providing new forms of human–computer interaction. The current study examined one form of human–computer interaction, augmented reality (AR), whereby subjects train in the real-world workspace with virtual objects projected by the computer. Motor performances were compared with those obtained while subjects used a traditional human–computer interaction, that is, a personal computer (PC) with a mouse. Methods. Patients used goal-directed arm movements to play AR and PC versions of the Fruit Ninja video game. The 2 versions required the same arm movements to control the game but had different cognitive demands. With …

Interrater Reliability Of The Wolf Motor Function Test–Functional Ability Scale: Why It Matters, Susan V. Duff, Jiaxue He, Monica A. Nelsen, Christianne J. Lane, Veronica T. Rowe, Steve L. Wolf, Alexander W. Dromerick, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Background. One important objective for clinical trialists in rehabilitation is determining efficacy of interventions to enhance motor behavior. In part, limitation in the precision of measurement presents a challenge. The few valid, low-cost observational tools available to assess motor behavior cannot escape the variability inherent in test administration and scoring. This is especially true when there are multiple evaluators and raters, as in the case of multisite randomized controlled trials (RCTs). One way to enhance reliability and reduce variability is to implement rigorous quality control (QC) procedures. Objective. This article describes a systematic QC process used to refine …

A Multiple Degree Of Freedom Lower Extremity Isometric Device To Simultaneously Quantify Hip, Knee, And Ankle Torques, Natalia Sánchez, Ana Maria Acosta, Arno H. A. Stienen, Julius P. A. Dewald

Physical Therapy Faculty Articles and Research

Characterization of the joint torque coupling strategies used in the lower extremity to generate maximal and submaximal levels of torque at either the hip, knee, or ankle is lacking. Currently, there are no available isometric devices that quantify all concurrent joint torques in the hip, knee, and ankle of a single leg during maximum voluntary torque generation. Thus, joint-torque coupling strategies in the hip, knee, and concurrent torques at ankle and/or coupling patterns at the hip and knee driven by the ankle have yet to be quantified. This manuscript describes the design, implementation, and validation of a multiple degree of …

Identification Of Functional Parameters For The Classification Of Older Female Fallers And Prediction Of ‘First-Time’ Fallers, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Falls remain a challenge for ageing societies. Strong evidence indicates that a previous fall is the strongest single screening indicator for a subsequent fall and the need for assessing fall risk without accounting for fall history is therefore imperative. Testing in three functional domains (using a total 92 measures) were completed in 84 older women (60–85 years of age), including muscular control, standing balance, and mean and variability of gait. Participants were retrospectively classified as fallers (n = 38) or non-fallers (n = 42) and additionally in a prospective manner to identify first-time fallers (FTFs) (n = 6) within a …

Fall Risk Prediction Using Wearable Wireless Sensors, Thurmon Lockhart, Chris Frame, Rahul Soangra, John Lach

Physical Therapy Faculty Articles and Research

Wearable wireless sensors and nonlinear dynamics identify postural characteristics relevant to balance control and dynamic stability, revealing predictive risk of falls among older adults.

Classifying Lower Extremity Muscle Fatigue During Walking Using Machine Learning And Inertial Sensors, Jian Zhang, Thurmon Lockhart, Rahul Soangra

Physical Therapy Faculty Articles and Research

Fatigue in lower extremity musculature is associated with decline in postural stability, motor performance and alters normal walking patterns in human subjects. Automated recognition of lower extremity muscle fatigue condition may be advantageous in early detection of fall and injury risks. Supervised machine learning methods such as Support Vector Machines (SVM) have been previously used for classifying healthy and pathological gait patterns and also for separating old and young gait patterns. In this study we explore the classification potential of SVM in recognition of gait patterns utilizing an inertial measurement unit associated with lower extremity muscular fatigue. Both kinematic and …

Impact Of Afo (Ankle Foot Orthosis) Design On Calf Circumference, Robert H. Meier, David C. Ruthsatz, Daniel Cipriani

Physical Therapy Faculty Articles and Research

Preliminary research suggests the use of a kinetic return ankle foot orthosis is associated with small but significant shortterm increases in calf circumference, which in turn suggests this type of device might reduce or protect against the risk of disuse muscle atrophy.

Clinical Reasoning In First- And Third-Year Physical Therapist Students, Sarah Gilliland

Physical Therapy Faculty Articles and Research

Background and Purpose. The development of clinical reasoning skills is a crucial component of professional physical therapist education. Prior research has described reasoning patterns in novice and expert practitioners, yet little is known about how professional physical therapist (PT) students develop clinical reasoning skills. The purpose of this study was to explore how first-year PT students perform clinical reasoning in comparison to third year PT students in their final semester.

Subjects. A simple random sample of 6 first-year (mean age 23.1 years) and 6 third-year (mean age 27 years) Doctor of Physical Therapy students were recruited.

Methods. …

Potential For Using Smartphone Accelerometers In Non-Laboratory Environments, Rahul Soangra, Thurmon Lockhart, Christopher W. Frames, Jian Zhang, Seong Hyun Moon, Jongsoon Park

Physical Therapy Faculty Articles and Research

In recent years, there has been rising interest in using accelerometers as an alternative instrument to measure the center of pressure. Accelerometers are inexpensive, small, sensitive, and can be readily used in non-laboratory environments. In addition to this, smartphones with built-in accelerometers add to their capability with real-time processing of data from sensors. Clinicians and researchers are currently in disagreement from whether these measurements provide the same physiological information about the participant’s balance. In this study, twelve participants were asked to wear smartphone on their right ASIS using a belt clip and stand still on the forceplate. The data was …

Trunk Coordination In Dancers And Non-Dancers, Danielle N. Jarvis, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Variability, or how a task changes across trials, may reveal differences between athletes of differing skill levels. The purpose of this study was to examine trunk and lower extremity (LE) single joint kinematic variability and inter-segmental coordination variability in dancers and non-dancers during bipedal vertical dance jumps (sautés). Twenty healthy females, ten with no formal dance training and ten professional dancers, performed 20 consecutive sautés. Single joint kinematic variability was assessed using mean standard deviation of angular displacement, and inter-segmental coordination variability was assessed using angular deviation of the coupling angle between segments. Within the context of the standard error …

The Influence Of Hip Strength On Lower-Limb, Pelvis, And Trunk Kinematics And Coordination Patterns During Walking And Hopping In Healthy Women, Jo Armour Smith, John M. Popovich, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Study Design

Cross-sectional laboratory study.

Objectives

To compare peak lower-limb, pelvis, and trunk kinematics and interjoint and intersegmental coordination in women with strong and weak hip muscle performance.

Background

Persons with lower extremity musculoskeletal disorders often demonstrate a combination of weak hip musculature and altered kinematics during weight-bearing dynamic tasks. However, the association between hip strength and kinematics independent of pathology or pain is unclear.

Methods

Peak hip extensor and abductor torques were measured in 150 healthy young women. Of these, 10 fit the criteria for the strong group and 9 for the weak group, representing those with the strongest …

Agreement In Gait Speed From Smartphone And Stopwatch For Five Meter Walk In Laboratory And Clinical Environments, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Gait speed is suggested as an independent predictor of post-operative morbidity and mortality in elderly cardiovascular disease (CVD) patients. Society of thoracic surgeons has recently classified gait speed as the only important indicator of health for CVD patients. It has been seen that patients with slow gait speed above 70 years of age, taking more than 6 seconds to walk 5 meters are particularly at high risk for adverse outcomes. Twelve young participants walked in their self-selected, slow and fast speed with five reflective markers at sternum and heels and toes of both feet in laboratory environment. A smartphone was …

Age-Related Modifications To The Magnitude And Periodicity Of Neuromuscular Noise, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Background: Evaluation of task related outcomes within geriatric and fall-prone populations is essential not only for identification of neuromuscular deficits, but also for effective implementation of fall prevention strategies. As most tasks and activities of daily living are performed at submaximal force levels, restoration of muscle strength often does not produce the expected benefit in functional capacity. However, it is known that muscular control plays a key role in the performance of functional tasks, but it remains unclear to what degree muscular control and the associated neuromuscular noise (NmN) is age-related, particularly in the lower-extremities.

Objectives: The aim of this …

Applying Principles Of Motor Learning And Control To Upper Extremity Rehabilitation, Lisa M. Muratori, Eric M. Lamberg, Lori Quinn, Susan V. Duff

Physical Therapy Faculty Articles and Research

The purpose of this article is to provide a brief review of the principles of motor control and learning. Different models of motor control from historical to contemporary are presented with emphasis on the Systems model. Concepts of motor learning including skill acquisition, measurement of learning, and methods to promote skill acquisition by examining the many facets of practice scheduling and use of feedback are provided. A fictional client case is introduced and threaded throughout the article to facilitate understanding of these concepts and how they can be applied to clinical practice.

Effects Of Hemodialysis Therapy On Sit-To-Walk Characteristics In End Stage Renal Disease Patients, Rahul Soangra, Thurmon Lockhart, John Lach, Emaad M. Abdel-Rahman

Physical Therapy Faculty Articles and Research

Patients with end stage renal diseases (ESRD) undergoing hemodialysis (HD) have high morbidity and mortality due to multiple causes; one of which is dramatically higher fall rates than the general population. In spite of the multiple efforts aiming to decrease the high mortality and improve quality of life in ESRD patients, limited success has been achieved. If adequate interventions for fall prevention are to be achieved, the functional and mobility mechanisms consistent with falls in this population must be understood. Human movements such as sit-to-walk (STW) tasks are clinically significant, and analysis of these movements provides a meaningful evaluation of …

Assessment Of Postural Stability Using Inertial Measurement Unit On Inclined Surfaces In Healthy Adults, Chris Frames, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Fatal and nonfatal falls in the construction domain remain a significant issue in today’s workforce. The roofing industry in particular, annually ranks amongst the highest in all industries. Exposure to an inclined surface, such as an inclined roof surface, has been reported to have adverse effects on postural stability. The purpose of this preliminary study was to investigate the intra-individual differences in stability parameters on both inclined and level surfaces. Postural Stability (PS) and Limit of Stability (LOS) were assessed in seven healthy subjects (aged 25-35 years) on inclined and level surfaces using embedded force plates and an Inertial Measurement …

Comparison Of Intra Individual Physiological Sway Complexity From Force Plate And Inertial Measurement Unit, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Center of Pressure (COP) is a clinical measure to investigate the effect of sensory input disturbances on postural stability in healthy, old population as well in people suffering from neuromuscular disease. Increased center of pressure velocity and sway area are interpreted as decreased stability or poor balance and are associated with fall risk. Body mounted inertial sensors have shown great promise as an easily implemented clinical measure of balance. The aim of the present study is to investigate if force plate and accelerometer measurements provide similar physiological information when approximate entropy (ApEn) are valuated from the time series. Seven Young …

Intramuscular Manual Therapy After Failed Conservative Care: A Case Report, Brent Harper

Physical Therapy Faculty Articles and Research

Background and Purpose: During intramuscular manual therapy (IMT), an acupuncture needle is inserted into the skin and muscle. The direct mechanical stimulation may interrupt the pathogenic mechanisms of myofascial trigger points (MTrPs). The purpose of this study was to demonstrate the application and efficacy of IMT on a patient suffering from right chronic elbow lateral epicondylalgia. Methods: A case study of a 26-year-old male presenting with a 6-month history of right elbow pain who failed 11 conservative physical therapy sessions and previous site-specific acupuncture. The patient received 5 IMT sessions over 4 weeks. Findings: The patient had …

Wavelet Based Automated Postural Event Detection And Activity Classification With Single Imu (Tempo), Thurmon E. Lockhart, Rahul Soangra, Jian Zhang, Xuefang Wu

Physical Therapy Faculty Articles and Research

Mobility characteristics associated with activity of daily living such as sitting down, lying down, rising up, and walking are considered to be important in maintaining functional independence and healthy life style especially for the growing elderly population. Characteristics of postural transitions such as sit-to-stand are widely used by clinicians as a physical indicator of health, and walking is used as an important mobility assessment tool. Many tools have been developed to assist in the assessment of functional levels and to detect a person’s activities during daily life. These include questionnaires, observation, diaries, kinetic and kinematic systems, and validated functional tests. …