Rehabilitation and Therapy Commons^™

Blood Flow Restriction Therapy: A Review Of Physiology, Clinical Application, And Guidelines For Implementation, Nathan Schuliger

Senior Honors Theses

Blood flow restriction (BFR) therapy is an emerging clinical modality utilizing the metabolic stress of a hypoxic state to induce hypertrophic and strength adaptations in a manner allowing for reduced external loading. BFR has a variety of applications in rehabilitation settings, showing great potential for patients seeking the benefits of high intensity training without the associated degrees of mechanical stress. This literature review details the proposed mechanisms of BFR, along with various clinical applications of BFR including active and aerobic BFR. Concerns and contraindications for BFR usage are discussed regarding certain clinical populations, with risk stratification recommendations provided. Current BFR …

Assessments Used By Athletic Trainers To Decide Return-To-Activity Readiness In Patients With An Ankle Sprain, Ryan S. Mccann, Cailee E. Welch Bacon, Ashley M. B. Suttmiller, Phillip A. Gribble, Julie M. Cavallario

Rehabilitation Sciences Faculty Publications

Context: Athletic trainers (ATs) often care for patients with ankle sprains. Expert consensus has been established for rehabilitation-oriented assessments (ROASTs) that should be included in ankle-sprain evaluations. However, the methods ATs use to determine return-to-activity readiness after an ankle sprain are unknown.

Objectives: To identify ATs' methods for determining patients' return-to-activity readiness after an ankle sprain and demographic characteristics of the ATs and their methods.

Setting: Online survey.

Design: Cross-sectional study.

Patients or Other Participants: We recruited 10 000 clinically practicing ATs. A total of 676 accessed the survey, 574 submitted responses (85% completion rate), and 541 respondents met the …

Lifelong Fitness In Ambulatory Children And Adolescents With Cerebral Palsy I: Key Ingredients For Bone And Muscle Health, Noelle G. Moreau, Kathleen M. Friel, Robyn K. Fuchs, Sudarshan Dayanidhi, Theresa Sukal-Moulton, Marybeth Grant-Beuttler, Mark D. Peterson, Richard D. Stevenson, Susan V. Duff

School of Allied Health Professions Faculty Publications

Physical activity of a sufficient amount and intensity is essential to health and the prevention of a sedentary lifestyle in all children as they transition into adolescence and adulthood. While fostering a fit lifestyle in all children can be challenging, it may be even more so for those with cerebral palsy (CP). Evidence suggests that bone and muscle health can improve with targeted exercise programs for children with CP. Yet, it is not clear how musculoskeletal improvements are sustained into adulthood. In this perspective, we introduce key ingredients and guidelines to promote bone and muscle health in ambulatory children with …

The Effect Of Running On The Onset And Development Of Osteoarthritis, Jordan Hekman

Senior Honors Theses

Osteoarthritis is a prominent and debilitating form of joint disease characterized by pain and deterioration of the articular cartilage and other tissues in the affected joint. Research has identified a variety of risk factors for osteoarthritis, including age, obesity, gender, previous injury, and occupation. The relationship between running and osteoarthritis is a topic of particular interest because of the prevalence of running as a simple and physiologically beneficial form of exercise. Increasing evidence suggests that recreational running has at worst no effect and at best a protective effect on joint and articular cartilage health in contrast to high-intensity professional/elite-level running …

Duchenne’S Muscular Dystrophy & Occupational Therapy, Vanessa Sagredo, Meagan C. Romero

Client Educational Handouts

No abstract provided.

Knowledge Of Red-S Among Collegiate Athletes, Becca Goldman

Graduate Research Showcase

Knowledge of Relative Energy Deficiency Among Collegiate Athletes

Low energy availability (LEA) can produce negative health and performance effects for collegiate athletes. It is defined as a deficit between the athlete’s caloric intake and the energy expended during competition or training. The body is then unable to support certain physiological functions that are needed to maintain optimal health. One component of the female athlete triad is disordered eating which can result in low energy availability. Relative Energy Deficiency in Sport is an extension of the female athlete triad, created to take a more holistic approach and include male athletes as …

Do People With Low Back Pain Walk Differently? A Systematic Review And Meta-Analysis, Jo Armour Smith, Heidi Stabbert, Jennifer J. Bagwell, Hsiang-Ling Teng, Vernie Wade, Szu-Ping Lee

Physical Therapy Faculty Articles and Research

Background

The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain (LBP). Despite substantial research, it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP. The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls.

Methods

A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020. Studies were included …

Corticospinal Activity During A Single-Leg Stance In People With Chronic Ankle Instability, Masafumi Terada, Kyle B. Kosik, Ryan S. Mccann, Colin Drinkard, Phillip A. Gribble

Rehabilitation Sciences Faculty Publications

Purpose: The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls.

Methods: Twenty-three participants with CAI, 23 lateral ankle sprain copers, and 24 healthy control participants volunteered. Active motor threshold (AMT), normalized motor-evoked potential (MEP), and cortical silent period (CSP) were evaluated by transcranial magnetic stimulation while participants performed a single-leg standing task.

Results: Participants with CAI had significantly longer CSP at 100% of AMT and lower normalized MEP at 120% of AMT compared to …

The Effect Of Concussion History On Lower Extremity Injury Risk In College Athletes: A Systematic Review And Meta Analysis, Vanessa Ramirez, Ryan Mccann, Eric Schussler, Jessica Martinez

Rehabilitation Sciences Faculty Publications

INTRODUCTION: Collegiate athletes who suffer a concussion may possess prolonged impairments even after clearance for return-to-participation, which may place them at an increased risk of lower extremity injury.

OBJECTIVE: To conduct a systematic review and meta-analysis of studies examining risk of lower extremity musculoskeletal injury following a concussion in collegiate athletes.

METHODS: A literature search was performed using the following databases: PubMed, CINAHL, SPORTDiscus. The following search terms were used to identify relevant articles, ["concussion" OR "brain injury" OR "mild traumatic brain injury" OR "mTBI"] AND ["lower extremity injury" OR "musculoskeletal injury"]. Articles were included if they were published between …

Kinematic Assessment Of Turning And Walking Tasks Among Stroke Survivors By Employing Wearable Sensors And Pressure Platform, Masoud Abdollahi, Pranav Madhav Kuber, Christopher Hoang, Michael Shiraishi, Rahul Soangra, Ehsan Rashedi

Physical Therapy Faculty Articles and Research

Stroke survivors often experience reduced movement capabilities due to alterations in their neuromusculoskeletal systems. Modern sensor technologies and motion analyses can facilitate the determination of these changes. Our work aims to assess the potential of using wearable motion sensors to analyze the movement of stroke survivors and identifying the affected functions. We recruited 10 participants (5 stroke survivors, 5 healthy individuals) and conducted a controlled laboratory evaluation for two of the most common daily activities: turning and walking. Among the extracted kinematic parameters, range of trunk and sacrum lateral bending in turning were significantly larger in stroke survivors (p-value<0.02). However, no statistical difference in mean angular velocity and range of motion for trunk/sacrum/shank flexion-extension were obtained in the turning task. Our results also indicated that during walking, while there was no difference in swing time, double support portion of gait among the stroke group was significantly larger (p-value = 0.001). Outcomes of this investigation may help in designing new rehabilitation programs for stroke and other neurological disorders and/or in improving the efficacy of such programs.Clinical Relevance— This study may provide a better insight on the detailed functional differences between stroke survivors and healthy individuals which in turn could be used to develop a more efficient rehabilitation program for stroke community.

Lumbopelvic Stability And Trunk Muscle Contractility Of Individuals With Chronic Ankle Instability, Ryan S. Mccann, Kelly Johnson, Ashley M.B. Suttmiller

Rehabilitation Sciences Faculty Publications

BACKGROUND: Chronic ankle instability (CAI) results in hip neuromuscular impairments that can perpetuate dysfunction through reduced lumbopelvic stability and subsequent malpositioning of the lower body during functional movement. Lumbopelvic stability might be further impaired through changes in trunk muscular contractility. However, lumbopelvic stability and trunk muscle morphology have not been compared between individuals with and without CAI.

PURPOSE: To compare lumbopelvic stability and trunk muscle contractility between individuals with and without chronic ankle instability (CAI) and determine if lumbopelvic stability and trunk muscle contractility are associated with self-reported function.

STUDY DESIGN: Case-control study.

METHODS: Ten individuals with CAI, 10 …

Wearing Knee Sleeves During Back Squats Does Not Improve Mass Lifted Or Affect Knee Biomechanics, Hunter J. Bennett, Alexandria Trypuc, Kevin A. Valenzuela, Zachary A. Sievert

Human Movement Sciences Faculty Publications

Purpose:
Knee sleeves have become widely popular in the exercise realm, especially for knee support during back squats. Knee sleeves are successful in providing frontal plane knee support during functional tasks, but have not been investigated in back squats. Knee wraps, a somewhat similar elastic material, provide elastic energy that increases weight lifted during back squats. Thus, it is possible the thick neoprene knee sleeves could prove advantageous for back squats. The purpose of this study was to examine the effects of knee sleeves on weight lifted, knee biomechanics, and muscle activations during back squats.

Methods:
Fifteen resistance trained men …

Diagnostic Accuracy Of Mcmurry’S Test In The Diagnosis Of Meniscal Tears, Jessica Smyth, Hartwell Rainey

Physician Assistant Capstones, 2020-current

No abstract provided.

Lower Extremity Kinetics And Muscle Activation During Gait Are Significantly Different During And After Pregnancy Compared To Nulliparous Females, Jennifer J. Bagwell, Nicholas Reynolds, Michelle Walaszek, Hannah Runez, Kristina Lam, Jo Armour Smith, Dimitrios Katsavelis

Physical Therapy Faculty Articles and Research

Background

Low back, pelvic, and lower extremity pain are common during and after pregnancy. Understanding differences in mechanics between pregnant and non-pregnant females is a first step toward identifying potential pathological mechanisms. The primary purpose of this study was to compare joint kinetics and muscle activation during gait between females during and after pregnancy to nulliparous females.

Methods

Twenty pregnant females completed testing on three occasions (second trimester, third trimester, and post-partum), while 20 matched, nulliparous controls were tested once. Motion capture, force data, and surface electromyography were averaged across seven trials during gait. Lower extremity kinematics, lower extremity moments …

A Comparison Of Denoising Methods In Onset Determination In Medial Gastrocnemius Muscle Activations During Stance, Jian Zhang, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

One of the most basic pieces of information gained from dynamic electromyography is accurately defining muscle action and phase timing within the gait cycle. The human gait relies on selective timing and the intensity of appropriate muscle activations for stability, loading, and progression over the supporting foot during stance, and further to advance the limb in the swing phase. A common clinical practice is utilizing a low-pass filter to denoise integrated electromyogram (EMG) signals and to determine onset and cessation events using a predefined threshold. However, the accuracy of the defining period of significant muscle activations via EMG varies with …

Comparison Of Pre- And Post-Operative Shoulder Muscle Emg Profiles In Reverse Total Shoulder Arthroplasty Patients, Emily Lau, Sreten Franovic, Noah Kuhlmann, Eric C. Makhni Md, Stephanie Muh Md

Medical Student Research Symposium

Background: Deltoid muscle function is central in reverse total shoulder arthroplasty (RTSA) function; however, there is limited information available regarding changes in deltoid activity before and after surgery. Few tests exist to evaluate specific muscle metrics pre and post operatively. Surface Electromyographic (EMG) is non-invasive and allows for observation of motions with multifaceted analysis of movement with minimal patient demand. Understanding the changes in shoulder muscle activation, namely in the deltoid, in patients pre and post-RTSA can further advance understanding of the procedure and rehabilitation efforts.

Methods: Nine individuals were recruited for this study: all patients underwent RTSA by a …

Syllabus For Clinical Exercise Physiology (Kine 4700), Phillip Drouet

Q2S Enhancing Pedagogy

The syllabus has newly developed learning objectives that will prepare students entering the field of clinical exercise physiology. This course will cover the etiology and pathophysiology of many chronic diseases that plague the population. Assessments of chronic diseases include but are not limited to understanding symptomology will also be covered. Due to the limitations in time the most prevalent chronic disease will be covered and students will have to present on a disease that was not presented in class. The practical application portion of this course will take place during a lab section. Here students will have the opportunity to …

Task-Invariance And Reliability Of Anticipatory Postural Adjustments In Healthy Young Adults, Jo Armour Smith, Niklas König Ignasiak, Jesse V. Jacobs

Physical Therapy Faculty Articles and Research

Background

Anticipatory postural adjustments (APAs) occur in the trunk during tasks such as rapid limb movement and are impaired in individuals with musculoskeletal and neurological dysfunction. To understand APA impairment, it is important to first determine if APAs can be measured reliably and which characteristics of APAs are task-invariant.

Research question

What is the test-retest reliability of latency, amplitude and muscle activation patterns (synergies) of trunk APAs during arm-raise and leg-raise tasks, and to what extent are these APA characteristics invariant across tasks at the individual and group levels?

Methods

15 young adults (mean age: 23.7 (±3.2) years) performed six …

Individuals With Recurrent Low Back Pain Exhibit Significant Changes In Paraspinal Muscle Strength After Intramuscular Fine Wire Electrode Insertion, Szu-Ping Lee, Vincent Dinglasan, Anthony Duong, Russell Totten, Jo Armour Smith

Physical Therapy Faculty Articles and Research

Objective

To examine how insertion and presence of intramuscular fine‐wire electromyography electrodes (IFWE) in lumbar multifidus affect paraspinal muscle strength, endurance, and activation in persons with and without recurrent lower back pain (RLBP) during activities that require high levels of muscle contraction.

Design

Case‐control with randomization of conditions.

Setting

Clinical Research Laboratory.

Participants

Forty participants age 18‐40 were recruited (18 female; mean age = 25.5 yr); 20 with a history of RLBP were compared to a matching control group of 20 without RLBP.

Interventions

Each participant was tested under three conditions over three sessions. On Session 1, the baseline condition, …

Effects Of Obesity And Fall Risk On Gait And Posture Of Community-Dwelling Older Adults, Thurmon E. Lockhart, Christopher W. Frames, Rahul Soangra, Abraham Lieberman

Physical Therapy Faculty Articles and Research

Epidemiological studies link increased fall risk to obesity in older adults, but the mechanism through which obesity increases falls and fall risks is unknown. This study investigates if obesity (Body Mass Index: BMI>30 kg/m2) influenced gait and standing postural characteristics of community dwelling older adults leading to increased risk of falls. One hundred healthy older adults (age 74.0±7.6 years, range of 56-90 years) living independently in a community participated in this study. Participants’ history of falls over the previous two years was recorded, with emphasis on frequency and characteristics of falls. Participants with at least two falls in the …

A Method To Concatenate Multiple Short Time Series For Evaluating Dynamic Behaviour During Walking, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Gait variability is a sensitive metric for assessing functional deficits in individuals with mobility impairments. To correctly represent the temporal evolution of gait kinematics, nonlinear measures require extended and uninterrupted time series. In this study, we present and validate a novel algorithm for concatenating multiple time-series in order to allow the nonlinear analysis of gait data from standard and unrestricted overground walking protocols. The fullbody gait patterns of twenty healthy subjects were captured during five walking trials (at least 5 minutes) on a treadmill under different weight perturbation conditions. The collected time series were cut into multiple shorter time series …

Does Variability Of Footfall Kinematics Correlate With Dynamic Stability Of The Centre Of Mass During Walking?, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

A stable walking pattern is presumably essential to avoid falls. Stability of walking is most accurately determined by the short-term local dynamic stability (maximum Lyapunov exponent) of the body centre of mass. In many studies related to fall risk, however, variability of step width is considered to be indicative of the stability of the centre of mass during walking. However, other footfall parameters, in particular variability of stride time, have also been associated with increased risk for falling. Therefore, the aim of this study was to investigate the association between short-term local dynamic stability of the body centre of mass …

The Pairing Of Trigger Point Dry Needling With Rehabilitation Techniques, Karle Kotze

Senior Honors Theses

Trigger point dry needling is a manual treatment modality used for individuals experiencing tightness, pain, and inhibited range of motion in any region of the body. Dry needling can be described as the insertion of a blunt, microfilament non-medicated needle into the skin for the purpose of targeting specific muscles, which contain tight bands known as trigger points. When the needle is inserted into the trigger point the muscle contracts, holds tight to the needle, and elicits a neural twitch response. This ultimately causes the muscle to relax, allowing for reduction in pain and improvements in range of motion. Although …

Walking Biomechanics And Energetics Of Individuals With A Visual Impairment: A Preliminary Report, Hunter J. Bennett, Kevin A. Valenzuela, Kristina Fleenor, Steven Morrison, Justin A. Haegele

Human Movement Sciences Faculty Publications

Purpose.

Although walking gait in sighted populations is well researched, few studies have investigated persons with visual impairments (VIs). Given the lack of physical activity in people with VIs, it is possible that reduced efficiency in walking could adversely affect activity. The purposes of this preliminary study were to (1) examine the biomechanics and energetics utilized during independent and guided walking in subjects with VIs, and (2) compare gait biomechanics between people with VIs and sighted controls.

Methods.

Three-dimensional motion capture and force platforms were used during independent and guided walking at self-selected speeds. Joint angles, moments, external work, and …

Anticipatory Postural Adjustments And Spatial Organization Of Motor Cortex: Evidence Of Adaptive Compensations In Healthy Older Adults, Jo Armour Smith, Beth E. Fisher

Physical Therapy Faculty Articles and Research

During anticipated postural perturbations induced by limb movement, the central nervous system generates anticipatory postural adjustments (APAs) in the trunk and hip musculature to minimize disturbances to equilibrium. Age-related changes in functional organization of the nervous system may contribute to changes in APAs in healthy older adults. Here we examined if altered APAs of trunk/hip musculature in older adults are accompanied by changes in the representation of these muscles in motor cortex. Twelve healthy older adults, 5 with a history of falls and 7 nonfallers, were compared with 13 young adults. APAs were assessed during a mediolateral arm raise task …

Immunohistochemical Identification Of Human Skeletal Muscle Macrophages, Kate Kosmac, Bailey D. Peck, R. Grace Walton, Jyothi Mula, Philip A. Kern, Marcas M. Bamman, Richard A. Dennis, Cale A. Jacobs, Christian Lattermann, Darren L. Johnson, Charlotte A. Peterson

Physical Therapy Faculty Publications

Macrophages have well-characterized roles in skeletal muscle repair and regeneration. Relatively little is known regarding the role of resident macrophages in skeletal muscle homeostasis, extracellular matrix remodeling, growth, metabolism and adaptation to various stimuli including exercise and training. Despite speculation into macrophage contributions during these processes, studies characterizing macrophages in non-injured muscle are limited and methods used to identify macrophages vary. A standardized method for the identification of human resident skeletal muscle macrophages will aide in the characterization of these immune cells and allow for the comparison of results across studies. Here, we present an immunohistochemistry (IHC) protocol, validated by …

Insertion And Presence Of Fine-Wire Intramuscular Electrodes To The Lumbar Paraspinal Muscles Do Not Affect Muscle Performance And Activation During Highexertion Spinal Extension Activities, Szu-Ping Lee, Jo Armour Smith, Matthew Kimber, Kelsey Houk

Physical Therapy Faculty Articles and Research

Background

Low back pain (LBP) is commonly associated with paraspinal muscle dysfunctions. A method to study deep lumbar paraspinal (i.e. multifidus) muscle function and neuromuscular activation pattern is intramuscular electromyography (EMG). Previous studies have shown that the procedure does not significantly impact muscle function during activities involving low-level muscle contractions. However, it is currently unknown how muscular function and activation are affected during high-exertion contractions.

Objective

To examine the effects of insertion and presence of fine-wire EMG electrodes in the lumbar multifidus on muscle strength, endurance, and activation profiles during high-exertion spinal extension muscle contractions.

Design

Single-blinded, repeated measures intervention …

Cortical Contribution To Linear, Non-Linear And Frequency Components Of Motor Variability Control During Standing, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Motor variability is an inherent feature of all human movements and reflects the quality of functional task performance. Depending on the requirements of the motor task, the human sensory-motor system is thought to be able to flexibly govern the appropriate level of variability. However, it remains unclear which neurophysiological structures are responsible for the control of motor variability. In this study, we tested the contribution of cortical cognitive resources on the control of motor variability (in this case postural sway) using a dual-task paradigm and furthermore observed potential changes in control strategy by evaluating Ia-afferent integration (H-reflex). Twenty healthy subjects …

Differential Requirement For Satellite Cells During Overload-Induced Muscle Hypertrophy In Growing Versus Mature Mice, Kevin A. Murach, Sarah H. White, Yuan Wen, Angel Ho, Esther E. Dupont-Versteegden, John J. Mccarthy, Charlotte A. Peterson

Physical Therapy Faculty Publications

Background: Pax7+ satellite cells are required for skeletal muscle fiber growth during post-natal development in mice. Satellite cell-mediated myonuclear accretion also appears to persist into early adulthood. Given the important role of satellite cells during muscle development, we hypothesized that the necessity of satellite cells for adaptation to an imposed hypertrophic stimulus depends on maturational age.

Methods: Pax7^CreER-R26R^DTA mice were treated for 5 days with vehicle (satellite cell-replete, SC+) or tamoxifen (satellite cell-depleted, SC-) at 2 months (young) and 4 months (mature) of age. Following a 2-week washout, mice were subjected to sham surgery or 10 day …

The Motor Cortical Representation Of A Muscle Is Not Homogeneous In Brain Connectivity, Jo Armour Smith, Alaa Albishi, Sarine Babikian, Skulpan Asavasopon, Beth E. Fisher, Jason Kutch

Physical Therapy Faculty Articles and Research

Functional connectivity patterns of the motor cortical representational area of single muscles have not been extensively mapped in humans, particularly for the axial musculature. Functional connectivity may provide a neural substrate for adaptation of muscle activity in axial muscles that have both voluntary and postural functions. The purpose of this study was to combine brain stimulation and neuroimaging to both map the cortical representation of the external oblique (EO) in primary motor cortex (M1) and supplementary motor area (SMA), and to establish the resting-state functional connectivity associated with this representation. Motor evoked potentials were elicited from the EO muscle in …