Rehabilitation and Therapy Commons^™

The Nature Of Movement Symmetry: Implications For Function And Injury Risk, Laura Broudy, Spt, Aerie Glowka, Spt, Katie Schaner, Spt, Michelle Wrigley, Spt, Danny Mcmillian, Dsc, Mpt, Cscs

Physical Therapy Research Symposium

Human movement requires an equipoise of mobility, strength, and neuromuscular control for optimal performance and injury protection. When certain movement asymmetries are present they create functional impairments that can negatively impact an individual’s performance and increase the likelihood for injury. This results in decreased quality of life due to missed time from work, sport, or social interaction and increased financial burden. There is limited evidence addressing what degree of asymmetry impacts functional performance or increases injury risk. Some activities such as throwing are naturally asymmetrical, thus asymmetry of the upper extremity may be beneficial in specific occupations or sporting professions. …

The Safety And Efficacy Of Physical Agents On Cancer Survivors: An Update, Katelyn Ratliff Spt, Gentry Ensign Spt, Kathryn Flyte Spt, Michael Moore Spt, Ann Wilson Pt, M.Ed., Gcs

Physical Therapy Research Symposium

Title: The Safety and Efficacy of Physical Agents on Cancer Survivors: An Update

Authors: Gentry Ensign, SPT¹; Kathryn Flyte, SPT¹; Michael Moore, SPT¹; Katelyn Ratliff, SPT¹; Ann Wilson, P.T., M.Ed., GCS¹

Affiliations: 1. School of Physical Therapy, University of Puget Sound

Theory: Cancer patients are often referred to physical therapy to treat impairments associated with cancer, its treatment, and the disease progression. Physical therapists sometimes use physical agents as part of a complete rehabilitation program for the purpose of decreasing pain, increasing strength, and facilitating tissue healing while avoiding possible malignant …

Lymphedema Therapy For The Treatment Of Complex Regional Pain Syndrome, Sarah Armstrong, Jake Look, L. Fletcher Christie, Roger Allen

Physical Therapy Research Symposium

Theory:

This proposal presents the theory that the use of early lymphatic management techniques for patients who suffer from complex regional pain syndrome (CRPS) can limit CNS remodeling, preventing progression of the disorder. In absence of high quality evidence, we interviewed multiple lymphedema therapists to assist in the generation of a lymphatic management protocol for use with patients experiencing CRPS-associated pain and edema.

The pathophysiology of CRPS-associated edema is not fully understood. Potential causes may include vasomotor dysregulation or neurogenic inflammation. Regardless of its cause, edema and pain may lead to excessive muscle guarding and kinesiophobia. Targeting edema early may …

Defending The Art Of Physical Therapy: Expanding Inquiry And Crafting Culture In Support Of Therapeutic Alliance, Nicole Brun-Cottan Spt, Jennifer Hastings Pt, Ph.D, Ncs, Danny Mcmillian Pt, Dsc, Ocs

Physical Therapy Research Symposium

Title: Defending the Art of Physical Therapy: Expanding Inquiry and Crafting Culture in Support of Therapeutic Alliance

Authors: Nicole Brun-Cottan¹, SPT, Danny McMillian PT DSc.¹, Jennifer Hastings, PT PhD. ,NCS.¹

Affiliations 1. School of Physical Therapy, University of Puget Sound, Tacoma WA, USA.

Theory/Body: The successful practice of physical therapy within the biopsychosocial construct requires a professional culture that places value on the interpersonal relationships that foster healing and the face time required to build those relationships. The unfortunate truth is that pressures on current practice are not facilitating this dynamic approach. The drive for …

Orthotic Intervention For Children With Down Syndrome: A Review Based On The Icf Model, Emily Burman, Vanessa Thompson, Monica Finney, Julia Looper

Physical Therapy Research Symposium

Down Syndrome (DS), which occurs in 1 out of every 691 live births, is the most common genetic disorder in the United States. It is characterized by multiple physical and cognitive impairments that impact development and typically persist into adulthood. Due to the prevalence of musculoskeletal impairments such as ligamentous laxity, hypotonia, and abnormal bony alignment in the foot, medical providers frequently prescribe foot or ankle orthoses for children with DS. The International Classification of Functioning, Disability, and Health (ICF) provides a unique framework to clarify the impact of orthotic intervention on three domains of human function: body structure and …

Change In Function, Pain And Quality Of Life Following Structured Nonoperative Treatment In Patients With Degenerative Cervical Myelopathy: A Systematic Review, Ian Andersson, Anna Dembek

Physical Therapy Research Symposium

Title: Change in Function, Pain and Quality of Life following Structured Nonoperative Treatment in Patients with Degenerative Cervical Myelopathy: A Systematic Review

Authors: Lindsay Tetreault¹, Mohammed Shamji¹, John Rhee², Heidi Prather³, Jeff Wilson¹, Ian B. Andersson⁴, Anna H. Dembek⁴, Krystle Pagarigan⁵, Joseph R. Dettori⁵, Michael G. Fehlings¹

Affiliations: 1. Toronto Western Hospital, Toronto 2. Emory clinic, Atlanta 3. School of Medicine, Washington University at St. Louis 4. School of Physical Therapy, University of Puget Sound 5. Spectrum Research, Tacoma …

Does Patient Self-Efficacy At Intake Predict The Therapeutic Outcome?, Molly J. Geiger, Stephanie Juhnke, Ellen Maloney, Danny Mcmillian

Physical Therapy Research Symposium

Title: Does Patient Self-Efficacy at Intake Predict the Therapeutic Outcome?

Authors: Molly Geiger SPT¹, Stephanie Juhnke SPT¹, Ellen Maloney SPT¹, Danny McMillian DSc.¹

Affiliation: 1. School of Physical Therapy, University of Puget Sound

Purpose: Several studies have linked psychosocial factors, such as depression, self-efficacy, and fear-avoidance to poor outcomes, increased disability, and the development of chronic pain. In a primary care setting, Foster has shown self-efficacy to be the most important for determining outcomes. The aim of this study is to examine the relationship between self-efficacy (SE) levels and physical therapy (PT) outcomes. …

The Temporal Relationship Between Stress And Spasticity, A Comparison Between Subjects With And Without Intact Thyroid Function, Dr. Roger Allen, Benjamin L. Hannula, Benjamin T. Gilksion, Caitlin A. Turner

Physical Therapy Research Symposium

Purpose/Hypothesis: Stress has been studied as a credible trigger of spasticity, but evidence is limited concerning temporal relationships. Case studies of complex regional pain syndrome (CRPS) and fibromyalgia (FM) have established a ten-day delay between psychogenic stress and episodic pain flares. This is explained by a stress induced release of thyroxine (T4) from the thyroid gland via the hypothalamus-pituitary-thyroid (HPT) axis, which reaches its peak effect by day 10. Models suggest that T4 may increase peripheral nerve excitability, which could increase sensitivity in 1A fibers from muscle spindles, leading to hyper-excitability in motor neuron pools. The purpose of our study …

Episodic Versus Continuous Care In Outpatient Pediatric Clinics, Rebecca Newman, Kimberly Mcgarvey, Laura Hoppe

School of Occupational Therapy Master's Capstone Projects (2016-2021)

UW Medicine Valley Medical Center, Children’s Therapy (VMC-CT) has experienced difficulties with consistent service delivery schedules for their clients. Long waitlists, absences, and scheduling and insurance constraints have impeded client ability to receive standard, continuous therapy. Thus, this critically appraised topic (CAT) paper addresses a research question developed in conjunction with Kari Tanta, PhD, OTR/L, FAOTA, the Rehabilitation Manager at VMC-CT, to understand the most effective methods of service delivery: episodic therapy (i.e. high frequency over a short duration) or continuous therapy (i.e., low frequency over a longer duration). The following research question was developed: Is episodic pediatric care as …

Anxiety In Children: Intervention Strategies, Nina Handojo, Christine Hsu-Nazzal, Nadia Kabbani

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Three occupational therapy graduate students at the University of Puget Sound partnered with a practicing pediatric occupational therapist to investigate effective interventions for anxiety in children in the literature. A Critically-Appraised-Topic (CAT) was performed on the research question: Which interventions geared towards school-aged children between 5 and 18 with anxiety and related disorders are effective in reducing symptoms and increasing participation in school and meaningful occupations as compared to no intervention?

Cognitive Behavioral Therapy (CBT) was found to have the strongest research base and the strongest positive outcomes. Gains were maintained following CBT even 10-26 weeks post-treatment. Other promising interventions …

Identifying And Implementing Assessments Of Upper Extremity Motor Control For Patients With Stroke Or Parkinson’S Disease, Julia Albright, Kayla Karelsen, Allison Lucas

School of Occupational Therapy Master's Capstone Projects (2016-2021)

The authors collaborated with a team of clinicians at a skilled nursing facility (SNF) in Gig Harbor, WA to identify the need for measures of UE functional use that are most appropriate to utilize with the two largest client populations at their facility, stroke and Parkinson’s disease (PD). In order to meet the clinical utility characteristics identified as important by the clinicians, the authors searched two databases that contain overviews of assessments. This search identified five stroke assessments and two PD assessments that met the clinical utility parameters outlined by the clinicians. The authors then conducted a systematic literature search …

Seeing Relief: Mirror Box Therapy As A Treatment For Chronic Regional Pain Syndrome, Danielle Watson, Mel Velsher

School of Occupational Therapy Master's Capstone Projects (2016-2021)

In collaboration with an occupational therapist who works in a physical therapy private practice as a hand therapist, the following clinical questions were identified: Is mirror box therapy (MT) effective in reducing pain for patients with complex regional pain syndrome (CRPS); secondary to orthopedic injury or peripheral nerve damage in the upper extremity (UE)? What protocols and dosages are the most effective? A structured review of the literature identified 18 studies that focus on the use of MT for CRPS of the UE: one meta-analysis of systematic reviews, five systematic reviews (SR) and 12 individual studies of which four are …

Four Effective And Feasible Interventions For Hemi-Inattention Post Cva: Systematic Review And Collaboration For Knowledge Translation In An Inpatient Rehab Setting., Elizabeth Armbrust, Domonique Herrin, Christi Lewallen, Karin Van Duzer

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Purpose: To locate, evaluate, and summarize the evidence for effective and feasible interventions to treat hemi-inattention in inpatient rehabilitation settings and ensure knowledge translation with a collaborating clinician Timothy Rich, OTR/L and his team at Harborview Medical Center. Design: Systematic literature review, participatory active research with a collaborating clinician, and knowledge translation. Methods: Included studies that tested effectiveness of mirror therapy (MT), transcutaneous electric nerve stimulation (TENS), limb activation therapy (LAT), and visual scanning therapy (VST). 11 databases were searched to yield 31 articles included in a critically appraised topic (CAT) table. A concise protocol for each …

Comparison Of Four Cognitive Screening Tools: Clinical Utility In A Skilled Nursing Setting And Relationship To Discharge Location, Liliya Bachinskaya, Alina Muller

School of Occupational Therapy Master's Capstone Projects (2016-2021)

A systematic review of 34 articles was conducted to answer the following clinical questions posed by Joette Jindra, the Director of Rehabilitation, at ManorCare of Tacoma: “Which cognitive screen, out of the four we are currently using, most accurately measures a patient's functional cognitive performance?” and “How well do cognitive tools and measures predict a client’s discharge setting from a skilled nursing facility (SNF)?”. Results indicate the Montreal Cognitive Assessment (MoCA) to be the most clinically useful tool for detecting mild cognitive impairment (MCI) as it demonstrated the greatest sensitivity across studies and diagnoses. The evidence did not support the …

A Critical Appraisal And Participatory Action Research Project On Effectiveness Of Weighed Vests For Early Elementary Children With Asd, Luna Blossom, Arielle Langworthy, Sarah Steckel

School of Occupational Therapy Master's Capstone Projects (2016-2021)

A Tacoma Public School clinician approached the University of Puget Sound with a research question regarding the effectiveness of weighted vests to increase on-task behaviors and decrease problem behaviors (such as self-injurious behaviors) of students ages 3-12 with ASD. A structured literature review produced eleven studies (six single subject experimental studies and five systematic reviews) published on or after 2005 and presented evidence ranging from no evidence of effectiveness, to inconclusive results, to some rare positive effect results with weighted vest usage related to increasing on-task and decreasing self-injurious behaviors within the target population. Of the six single subject experimental …

Clinical Utility Of The Weefim As A Mandated Outcome Measure: Navigating The Needs Of The Organization, Client And Clinician, Elise Brown, Andrea Hokanson, Tricia Turner

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Local outpatient pediatric occupational therapists expressed a need for evidence to support the use of the Functional Independence Measure for Children (WeeFIM) as a universal measure for evaluations in their facility. We summarized the evidence addressing the psychometrics of the WeeFIM and a comparison instrument, the Pediatric Evaluation of Disability Inventory (PEDI). We ultimately made a recommendation for the PEDI based on its better evidence history for children with autism. The collaborating clinicians received an organizational mandate to implement use of the WeeFIM. We surveyed them to better understand their knowledge translation process. Themes from surveys were inserted into the …

Sensory Interventions In Schools: A Literature Review And Knowledge Translation Project, Cordelia Nwogu, Kelly Peterson

School of Occupational Therapy Master's Capstone Projects (2016-2021)

A literature review of sensory interventions that are possible in a school setting by occupational therapists was completed based on Jennifer Burke’s, a Franklin Pierce Public Schools occupational therapist, question. Her question was what sensory interventions have been shown to be effective for decreasing negative behaviors and/or increasing participation that could be used in a school setting. Most sensory based interventions (SBI) had only weak evidence in support. Sensory integration therapy (SIT) showed more promise for achieving individual goals. Because of the mix of evidence it was recommended that if a clinician chooses to use SBI or SIT they should …

Cognition In Clients With Acute Tetraplegia: Why Assessment Matters, Olivia Allen, Michael Dewilde, Jon-Erik Golob

School of Occupational Therapy Master's Capstone Projects (2016-2021)

The authors of this research project collaborated with Sarah Bicker, OTR/L, an acute care therapist working at Harborview Medical Center in Seattle, WA to investigate two clinical questions: [1] “What is the correlation between high-level (C1-C7) spinal cord injury (SCI) and cognitive impairment?” [2] “Which assessments are most effective for evaluating cognition in adult clients who have very limited motor and/or verbal abilities and could potentially be used with clients who have acute high-level spinal cord injuries?” A review of the research revealed that common comorbidities, including orthostatic hypotension, sleep apnea, and traumatic brain injury, often affect cognition in clients …

Impact Of Garden Spaces On Dementia Residents: Translating Evidence-Based Research Into Clinical Practice, Angela Ko, Jenna Williams

School of Occupational Therapy Master's Capstone Projects (2016-2021)

The research addressed the following focused question: “Do garden spaces decrease the incidence of behaviors such as combativeness and agitation, psychiatric medication use, depression, falls, cognitive decline, and sleep disturbance in clients with dementia in a residential facility?” The research team collaborated with staff at a skilled nursing facility in an urban area of the Pacific Northwest. Appraisal of existing research revealed multiple potential benefits of residents’ with dementia utilizing garden spaces for wandering and/or therapeutic activities. Based on these findings, the research team recommended implementation of an on-site garden. To support the implementation of these findings, the research team …

Musculoskeletal Imaging Education In A Doctor Of Physical Therapy Program, William Chaz Sak-Ocbina, Rebecca Lancaster, Travis Muraoka, Robert Boyles

Physical Therapy Research Symposium

Title: Musculoskeletal Imaging Education in a Doctor of Physical Therapy Program

Authors: Rebecca Lancaster, SPT¹; Chaz Sak-Ocbina, SPT¹; Travis Muraoka, SPT¹; Robert Boyles, PT, DSc, OCS, FAAOMPT¹

Affiliation: 1. The School of Physical Therapy, University of Puget Sound

Purpose: Physical Therapists (PTs) are commonly referred to as the musculoskeletal experts in the medical field. As direct access laws have passed, PTs now must demonstrate appropriate clinical decision making and select suitable patients to refer for imaging services. Evidence suggests that, with adequate imaging education, PTs decrease imaging and overall health care costs compared …

Effects Of Desensitization On Pain Distribution And Normalization Of Somatosensation In A Patient With Quadrilateral Complex Regional Pain Syndrome, Lisa Cook, Kristen Dullen, Jacob Hoffman, Megan Vento, Roger Allen

Physical Therapy Research Symposium

Background and Purpose:

Complex regional pain syndrome (CRPS) is a chronic condition affecting at least one extremity that can develop after injury, involving allodynia, constant limb pain, and hyperpathic autonomic and somatic symptoms.¹ One essential CRPS treatment is somatosensory desensitization (SD), yet efficacy evidence remains limited.² This study aimed to assess changes in pain distribution and intensity in treated and untreated limbs, as well as possible somatosensory normalization of proximal non-painful limb regions, after 10 weeks of SD.

Case Description:

The 54 y.o. male patient had an incomplete C5 SCI. Prior to SD, the patient experienced constant searing …

The Influence Of A Supine Kicking Intervention On Infants With Down Syndrome Compared To Typically Developing Infants, Kara Schimke, Bryana Pardo, Kaylee Redmann, Kimberly Mahoney, Julia Looper

Physical Therapy Research Symposium

Title: The Influence of a Supine Kicking Intervention on Infants with Down Syndrome Compared to Typically Developing Infants

Authors: Kara Schimke, SPT¹; Bryana Pardo, SPT¹; Kaylee Redmann, SPT¹; Kimberly Mahoney, SPT¹; Julia Looper, PT, PhD¹

Affiliation(s): 1. School of Physical Therapy, University of Puget Sound

Purpose: Without intervention, infants with Down syndrome (DS) initiate walking one year later than their typically developing peers (TD). Supine kicking is an essential foundation for the development of walking due to similarities between the movement patterns. The purpose of this study was to investigate the …

Balance-Related Outcome Measures Of Acquired Brain Injury Patients In A Student-Led Onsite Physical Therapy Clinic: A Retrospective Records Review, Lauren M. Wilson, Corey R. Kaleshnik, Parke K. Humphrey, Ann M. Wilson

Physical Therapy Research Symposium

Title: Balance-Related Outcome Measures of Acquired Brain Injury Patients in a Student-Led Onsite Physical Therapy Clinic: A Retrospective Records Review

Authors: Parke Humphrey, SPT; Corey Kaleshnik, SPT; Lauren Wilson, SPT; Ann Wilson, PT, MEd, GCS

Affiliation(s): 1. Physical Therapy Program, University of Puget Sound

Purpose: Individuals with Acquired Brain Injury (ABI) often have balance impairments. Interventions targeting these impairments may improve balance and thus increase overall societal participation. The purpose of this review was to identify the types of balance-related outcome measures used to assess balance impairments in patients with ABI in a student-led onsite physical therapy clinic.

Subjects: 13 …