Rehabilitation and Therapy Commons^™

The Impact Of Visual Impairments On Mobility Performance In Community-Dwelling Older Adults, Lauren Andrew, Talia Davis, Christian Johnson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Falls are a major concern for elderly adults and can have a significant impact on overall health and well-being. Declines in vision with aging may be related to the development of fear of falling (FOF) and impaired mobility. It is possible that impaired vision due to common eye diseases can increase the FOF avoidance behavior and affect mobility function in this population. The purpose of this study was to investigate the relation among visual impairment, mobility performance, and FOF avoidance behavior in older adults. Methods: Inclusion criteria for eligible participants were: 50 years of age and older, …

The Effects Of Fatigue On Balance In Individuals With Parkinson's Disease: Influence Of Medication And Brain-Derived Neurotrophic Factor Genotype, Michael Baer, Bradley Klemetson, Diana Scott

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: The purpose was to investigate the effects of fatigue on balance in individuals with Parkinson’s disease (PD). Because falls in this population can have deleterious consequences, it is important to understand the influence of fatigue and PD medications on balance. Additionally, since brain-derived neurotrophic factor (BDNF) has been shown to be related to motor performance, we explored its role in balance fatigue. Participants: 27 individuals (age= 65.4±8.1; males= 14, females= 13) with neurologist-diagnosed PD. Of the 27, 13 were genotyped for BDNF as Val/Val, 11 as Val/Met, 2 as Met/Met, and one refused genotyping. Methods: Participants were …

Predictors Of Physical Therapy Non-Treatment Among Patients Scheduled For Treatment Two Times A Day In The Acute Hospital, Sara Bookout, Kyle Ozaki

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Consistent participation in physical therapy treatment is the key to the success of any physical therapy treatment program. Scheduled therapy sessions that do not result in treatment (non-treatment) may cause longer hospital stays and/or poor outcomes. A better understanding of the factors affecting non-treatment could allow proper adjustments to prevent non-treatment by hospital administration, improve patient-therapist interaction, and may result in improved care, greater patient satisfaction, and lower healthcare costs. The purpose of this study was to investigate characteristics of patients that affect physical therapy non-treatment events for patients scheduled for therapy twice a day (BID) in …

Gait And Balance In Alzheimer's Disease: A Retrospective Analysis Across Varying Levels Of Cognitive Impairment, Diana Contreras, Jessica Heim, Jun Nelson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: It was once thought that Alzheimer’s disease (AD) affected mostly cognition with minor motor impairment; however, it is becoming apparent that motor impairment may also be a prominent feature. Determining the extent of motor impairments throughout the continuum of cognitive impairment is critical in developing timely interventions for this population. Purpose/Hypothesis: The aim of this study was to gain a greater understanding of motor impairment in AD by exploring the relationships among gait, balance, and falls. Specifically, we explored the association of fall history to measures of cognition and performance-based balance measures in individuals with AD. We hypothesized that …

Fine-Wire Intramuscular Insertion To The Lumbar Paraspinal Muscles Does Not Affect Muscle Activation And Performance During High Exertion Spinal Extension Muscle Contractions, James Dimascio, Rebeka Hicks, Matthew Kimber, Kelsey Synder

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Low back pain (LBP) is associated with paraspinal muscle dysfunctions. A method to study the deep lumbar paraspinal muscle activation is with intramuscular electromyography (EMG). However, it is currently unknown how paraspinal muscle performance is affected by the invasive intramuscular insertion and the presence of the fine-wire electrode in the muscle. The purpose of this study was to analyze how insertion of fine-wire EMG into lumbar paraspinal muscle affects the lumbar paraspinal muscle fatigue, endurance, activation, and peak extension torque during high exertion spinal extension exercises. Participants: 20 individuals between the ages of 18-40 participated. The participants …

Measurement Of Anterior Translation Of The Mandibular Condyle Using Ultrasonography, Brooke Laskowski, Danielle Hahn, Christensen J. Hardy

UNLV Theses, Dissertations, Professional Papers, and Capstones

Study Design: Reliability of clinical measurement. Objectives: To establish a standardized ultrasonographic approach to quantify anterior translation of the mandibular condyle during mouth opening by examining the reliability of imaging acquisition and processing. Background: Restricted mouth opening is a common limitation in individuals with temporomandibular dysfunction (TMD), however the arthrokinematics of the temporomandibular joint (TMJ) during mouth opening have not been studied thoroughly. Furthermore, how anterior translation of the mandibular condyle contributes to mouth opening remains unclear. Methods: Twenty-eight subjects without TMD participated. During day 1 of data collection, all subjects performed maximal mouth opening while an examiner placed a …

Use Of Active Video Gaming In Children With Neromotor Dysfunction: A Systematic Review, Robert Manzanares, Lisa Popescu

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Active video games (AVG) are gaining popularity as a strategy for improving motor function in children with neurologically-based movement disorders, but there is no consensus regarding AVG’s utility or effectiveness in this population. The purpose of this systematic review was to examine current evidence on the use of AVG to improve motor function in children 2-17 years of age with neurologically-based movement disorders. Methods: Authors followed standard criteria for systematic review conduct and rating quality of evidence including the PRISMA checklist. Databases searched were Scopus, MEDLINE, Cochrane Library, EMBASE, and CINAHL. Systematic reviews, randomized control trials, or …

Acute Effects Of Walking On The Deformation Of Femoral Articular Cartilage, Jayson Mcclaren, Skyler Sudweeks

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Knee osteoarthritis (OA) is characterized by a progressive loss of the articular cartilage, increasing the amount of friction in the joint, resulting in pain and decreases in mobility and function. Additionally, it has been demonstrated that frontal plane lower extremity (LE) malalignment (e.g., varus, valgus) is associated with onset and progression of OA. Previous studies showed that static loading of 50% body weight at the knee results in more cartilage deformation in those with knee OA compared to healthy controls. As walking produces forces in the knee that are 2-3 times body weight, it may result in …

Disposition And Success Of Patients Following Discharge In The Acute Setting, Ciera Cortney, Kathryn Lutjens, Kristopher Raines

UNLV Theses, Dissertations, Professional Papers, and Capstones

Abstract: Background & Purpose: Many patients are seen in the hospital by physical therapists who also help decide where the patient will go after discharge (e.g., home, rehab hospital, skilled nursing facility) with the goal being the safest and best quality of life. Therapists may use different tests and measures along with their own professional judgment to help make a recommendation for a discharge location. The purpose of this study was to examine how PT’s recommendation for discharge location, POMA score, “6-clicks” score, age, diagnosis, and gender determine patient’s fall/readmission status after being discharged by hospital. Subjects: There were 113 …

Pressure Injury Assesment Comparison: Bedside Nurse Vs. Experts, Ali'itasi Kelemete, Brandi Hillock, Casey Snell

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure injury (PI) as, “A localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear.” PIs affect millions of people each year creating a substantial financial burden. Medicare has created policies for reimbursement and reporting of PIs making it financially important for hospitals to correctly assess PIs upon admission. A basic skin assessment to categorize PIs has not been standardized among facilities, resulting in inaccuracies, poor documentation, and gaps in the reporting and quality …

The Reliability Of The Thoracic Percussion Test, Casey Donaldson, Rey Veloz, Kaylee Waters

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: To investigate the reliability of the Thoracic Percussion Test (TPT), which is a quick screening tool used by manual therapists to assess hypomobility in the thoracic spine. Participants: 36 healthy subjects (18-60 years old), with or without back pain, and 10 therapists participated in the study. Six of the therapists with less than 5 years clinical experience were considered “novice” and 4 with at least 20 years experience were considered “expert” therapists. Methods: All participants were divided into a morning and an afternoon group. Both groups consisted of 18 subjects and a mix of novice and expert therapists. All …

Can Simple Postural Instructions Modify Running Forms In Recreational Runners, Casey Gray, Matthew Poggemiller, Ian Tracy

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: Recent research suggests that alteration of trunk angle and foot strike pattern during running may result in beneficial changes that prevent running related injuries due to reduction in vertical ground reaction forces (vGRF). For example, running form emphasizing a forward trunk lean and a midfoot or forefoot strike pattern has been shown to be effective in reducing knee stress and the risks of other impact-related running injuries. In clinical practice however, it is currently unknown if simple postural cues given to runners can elicit motor learning that leads to modification of running form. The purpose of this study was …

The Effects Of Locomotion-Induced Shock Loading On Tibiofemoral Bone Stress Response, Alexa Standerfer, Suzenna Ngo, Karen Daun

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: Knee osteoarthritis (Coats, Zioupos, & Aspden) is a degenerative joint disease that negatively impacts the quality of life. About 9.3 million people in the U.S. population are affected. It has been suggested via magnetic resonance imaging (MRI) studies that bone marrow edema (i.e., indicative of bone stress response) and joint structure changes may be the main contributing factors of pain in OA. Frontal plane lower extremity (LE) alignment has been a topic of much interest regarding development of OA in the knee joint. It is hypothesized that varus alignment increases forces through the medial compartment of the knee, thereby …

The Effect Of Dry Needling To The Multifidus Muscle On Resting And Contracted Thickness Of Transversus Abdominis In Subjects With Low Back Pain, Shane Collins, Abbay Dow, Daniel Rincon

UNLV Theses, Dissertations, Professional Papers, and Capstones

Study Design: Randomized, double-blinded, controlled clinical trial. Objective: To measure the effects of dry needling to the lumbar multifidus (MF) muscle for any change in resting and contracted thickness of the transversus abdominis (TrA) muscle as well as symptoms and disability in individuals with low back pain (LBP). Background: Recent studies have demonstrated that individuals with LBP have diminished co-activation of the lumbar MF and TrA muscles, which when working appropriately in healthy individuals, contributes to spinal stability and function. A significant change in the resting and contracted thickness of TrA has been found with dry needling to the lumbar …

Preventing Non-Contact Acl Injuries In Female Athletes: What Can We Learn From The Dancers?, Sarah Crow, Thomas Crowther, Trenton Saupan

UNLV Theses, Dissertations, Professional Papers, and Capstones

Study design: Cross-sectional case control.
 Objectives: The purpose of this study was to investigate the effects of dance experience and movement instruction on lower extremity kinematics and muscle activation during landing tasks Background/Aim: Current research demonstrates that dancers exhibit a much lower incidence of ACL injuries when compared to athletes of other sports despite the fact that dancers jump and land frequently in their training and performance. The mechanism that underlies this disparity is unclear.
 Methods: We analyzed lower extremity biomechanics during landing in 27 subjects (age 18-25 years, 12 dancers and 15 non-dancers). In the non-instructed (NI) conditions, participants …

The Effects Of Patellofemoral Taping On Patellofemoral Joint Alignment And Contact Area, Ryan Epstein, Ron Garcia, Nicole Riley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: It is widely accepted that patellofemoral pain (PFP) is the result of excessive stress between the retro-patellar surface and the femoral trochlea. Elevated patellofemoral joint (PFJ) stress may be associated with a reduction in PFJ contact area resulting from patellar malalignment (e.g., lateral displacement, lateral tilt, or patellar alta and/or quadriceps imbalance). McConnell and Kinesio taping techniques are commonly used to address PFP and improve PFJ alignment. It has been theorized that PFJ taping can alter the PFJ alignment which may increase the patella’s contact area within the femoral trochlea, thereby resulting in a reduction in PFP. To date, …

Influences Of Body Composition, Multimorbidity And Polypharmacy On Physical Mobility Of Older Adults, Chieh Chen, Linna Sestini, Rachel Wilde

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: The prevalence of falls, and the resulting injuries and complications reflect a key concern in the older adult population. An increased risk of falls is highly correlated with decreases in physical mobility and related functions. The Timed Up-and-Go test (TUG) has an established reliability and validity in assessing physical function and the risk of falling in the older adult population. With age, a person typically has an increased number of health morbidities, which may be reflected in changing body composition and the number of medications associated with diseases. However, the influence of these factors on physical mobility …

Thrust Joint Manipulation Utilization By Us Physical Therapists, Sean Reilly, Rebecca Slaughter, Erwin Ventura

UNLV Theses, Dissertations, Professional Papers, and Capstones

Study Design: Online survey study. Objective: To determine physical therapists’ utilization of thrust joint manipulation (TJM) and their comfort level in using TJM between the cervical, thoracic, and lumbar regions of the spine. We hypothesized that physical therapists who use TJM would report regular use and comfort providing it to the thoracic and lumbar spines, but not so much for the cervical spine. Background: Recent surveys of first professional physical therapy degree programs have found that TJM to the cervical spine is not taught to the same degree as to the thoracic and lumbar spines. Methods: We developed a survey …

Effects Of Simple Postural Instructions On Running Form Modification In Recreational Runners – Preliminary Findings, Elizabeth Billington, Scott Devries, Kenshin Scoggin

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and purpose: Running is one of the most popular exercises but it is also an activity with a high incidence of injury. Running form modification involving a forward lean of the trunk and forefoot strike pattern has been shown to be effective in attenuating the impact forces of the lower extremity. However, it is currently unknown how these changes can be most effectively instructed and learned by the runners. Previous studies have shown that practicing a motor task with an external focus can facilitate learning and retention when compared to the more common internal focus instructions. The purpose of …

Use Of A Mobile Application To Increase Patient Compliance To A Prescribed Home Exercise Program And Improve Outcomes, Ellie Cobb, Jed Hurst, Ethan Konshuk

UNLV Theses, Dissertations, Professional Papers, and Capstones

Methods: The creator of the app offered free use of their app to a physical therapy clinic. As the app is only compatible with Apple products, the clinic used the app with any patient that had an iPhone. Retrospective review was conducted to determine if differences in patient outcomes were observed. Patients who had access to an iPad or iPhone were considered part of the “app group” and used the mobile app to reference and report PT HEP compliance. Patients without access to an iPad or iPhone were considered part of the “non-app group” and received traditional PT HEP prescription …

Balance Confidence And Fear Of Falling Avoidance Behavior Are Most Predictive Of Falling In Older Adults: A Prospective Analysis, Sarrie Oscar, Jessica Sasaoka, Kyle Vaughn

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Evidence suggests that there are several fall predictors in the elderly population, including previous fall history and balance impairment. To date, however, the role of psychological factors has not yet been thoroughly vetted in conjunction with physical factors as predictors of future falls. Objective: The purpose of this study was to determine which measures, physical and psychological, are most predictive of falling in older adults. Design: This was a prospective cohort study. Methods: Sixty-four participants (mean age=72.2 years, SD=7.2; 40 women, 24 men) with and without pathology (25 healthy, 17 with Parkinson disease, 11 with cerebrovascular accident, 6 with …

Heel-Raised Foot Posture And Weightlifting Shoes Do Not Affect Trunk And Lowerextremity Biomechanics During A Barbell Back Squat, Javier Ibarra, Derek Oldroyd, Ryan Zane

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: It is claimed that wearing weightlifting shoes with a raised-heel can improve posture and leg muscle activation, and reduce the risk of back injuries during a barbell back squat. However, these proclaimed biomechanical effects have not been thoroughly investigated. The purpose of this study was to compare the thoracic, lumbar, and lower extremity biomechanics during barbell back squat in 3 foot posture conditions. Subjects: 14 healthy recreational weightlifters (7 male and 7 female) between the ages of 18-50 participated in the study. A minimum of 2 years weightlifting experience and regular training with the barbell back squat …

Comparing Functional Motor Control And Gait Parameters In Children With Autism To Those Of Age-Matched Peers Who Are Typically Developing, Patricia Stevenson, Samantha Novotny, Jillian May, Christopher Ancell

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to compare motor performance of children with Autism Spectrum Disorder (ASD) to that of age-matched peers who are typically developing (TD) on motor control tasks plus symmetry and variability of gait parameters across four walking conditions. A sample of convenience of children with ASD (n=6) and peers who are TD (n=6) were recruited. Motor control was assessed using initiation and completion times on the Timed Up and Go (TUG) test. Gait parameters were collected using a computerized walkway under four trial conditions: 1) walking at self-selected velocity (SSV); 2) walking during a tray-carrying task …

The Effects Of Instruction On Landing Strategies In Female College-Aged Dancers And Non-Dancers: A Pilot Study, Brittany Keating, Jason Pyfer, Kimberly Vialpando

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background Female athletic participation has increased over the past decade and with it the prevalence of knee injuries. Current research demonstrates an increased risk of anterior cruciate ligament (ACL) injury for female athletes. However, a number of studies have pointed out that ballet and modern dancers exhibit a lower incidence of ACL injuries despite the fact that they perform jumping and landing frequently.

Objective The objective of this study was to examine how dance experience and instruction affect the lower extremity biomechanics during drop landings. Specifically, lower extremity joint alignment and muscle activation of gluteus maximus and gluteus medius were …

The Effects Of Enhanced And Decreased Expectations On Balance Performance In Those With And Without Parkinson’S Disease, Joshua Ostrander, Granuaile Parrish, Jacob Blood

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: It has been reported individuals typically perform well on a task when enhanced expectancy was provided prior to task performance. It has also been reported people with Parkinson’s disease (PD) are especially susceptible to pre-task placebo cuing and suggestion. Evidence of this susceptibility has been previously demonstrated through brain imaging studies and with demonstration by individuals with PD improved balance performance.

Objective: This study was designed to further previous studies’ results for improved task performance with enhanced expectancy. The purpose of this study was to investigate if the pre-task verbal delivery of enhanced expectancy, decreased expectancy and no expectancy …

Comparing Usability And Variance Of Low- And High Technology Approaches To Gait Analysis In Health Adults, John Mcconnell, Brian Silverman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: The purpose of this study was to compare the usability, reliability, and objectivity of four tools that represented varying gait analysis technologies used in clinical practice and/or research. Low technology clinical tools included the Gait Abnormality Rating Scale (GARS-M) and the Rancho Los Amigos Observational Gait Analysis (Rancho OGA). High technology tools included the GAITRiteÒ computerized walkway, and the APDM Mobility LabÔ wearable sensor system.

Subjects: 74 healthy adults ages 18-41 years (mean = 24.82, SD = 4.39) 33 males and 40 females.

Methods: Subjects were instructed to walk at a self-selected speed for two minutes …

Four Weeks Of Minimalist Style Running Training Reduced Lumbar Paraspinal Muscle Activation During Shod Running, Stephanie Barton, David Brown, Talia Joyce

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Research has shown that the risk of low back dysfunctions in runners is related to the increased mileage of distance running. Repetitive shock loading of the spinal structures during running has been indicated as one of the important biomechanical mechanisms underlying such injury. Acute changes in foot strike pattern, like those seen during minimalist style running, have been shown to lead to modifications in lumbar range of motion. Minimalist style running could lead to changes in lumbar biomechanics and muscle activation, potentially reducing the loading on the musculoskeletal structures of the lower back. However, the long term …

Prevalence And Risk Factors For Neck And Shoulder Musculoskeletal Symptoms In Users Of Touch-Screen Tablet Computers, Betina Blair, Mariana Gama, Marissa Toberman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose:

Neck and upper extremity symptoms are common health complaints in the general population and cause a substantial financial burden to the health care system. Neck pain is known to be a multi factorial disorder, with head and spinal posture being one of the most important factors. Currently there is little evidence showing a relationship between touch-screen tablet computer usage and neck/upper extremity pathologies. However, it is fair to postulate that the incidence of neck/upper extremity pathologies is higher within touch-screen tablet computer users, considering how users maintain static postures while using the device. The primary purposes of …

Patient No-Show For Outpatient Physical Therapy: A National Survey, James Bokinskie, Payton Johnson, Trevor Mahoney

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Patients who fail to show for scheduled medical appointments (no-show) create a cascade of issues for the health care system, the provider, and themselves. No-show can affect clinical productivity, cost and quality of care, and treatment outcomes. There is an overwhelming lack of research on no-show as it relates to outpatient physical therapy in the United States. The purposes of this study were to report national no-show rates, describe the presence and characteristics of no-show policies, determine the relationship of these policies and other demographic information to no-show rates, and describe the most commonly perceived reasons for no-show.

Methods: …

Immediate Effects Of Cervical Spine Manipulation On Gait Parameters In Individuals With And Without Mechanical Neck Pain, Jordan Isom, Shaylyn Kennedy, Justin May, Samuel Moore

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: The purpose of this study was to determine 1) if there were any differences in gait parameters between participants with mechanical neck pain and those without and 2) if cervical spine manipulation has an immediate effect on these gait parameters.

Methods: Twenty participants with mechanical neck pain and twenty participants without neck pain were randomly assigned into either the sham or manipulation group. The two intervention groups participated in walking across a GAITRite Walkway that recorded gait parameters such as stride length, cadence and step width before and after cervical spine manipulation. The participants walked at their own cadence …