Rehabilitation and Therapy Commons^™

The Immediate Cardiovascular Response To Joint Mobilization Of The Neck - A Randomized, Placebo-Controlled Trial In Pain-Free Adults, Emmanuel Yung, Cheongeun Oh, Michael Wong, Jason K. Grimes, Erica M. Barton, Muhammad I. Ali, David A. Cameron

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Background: Some normotensive patients can have a spike in resting systolic blood pressure (SBP) in response to acute neck pain. Applying the typical dosage of mobilization may potentially result in a sympatho-excitatory response, further increasing resting SBP. Therefore, there is a need to explore other dosage regimens that could result in a decrease in SBP.

Objectives: To compare the blood pressure (BP) and heart rate (HR) response of pain-free, normotensive adults when receiving unilateral posterior-to-anterior mobilization (PA) applied to the neck versus its corresponding placebo (PA-P).

Study design: Double-Blind, Randomized Clinical Trial.

Development Of The Clinical Teaching Effectiveness Questionnaire In The United States, Michelle E. Wormley, Wendy Romney, Anna E. Greer

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The purpose of this study was to develop a single valid measure for assessing clinical teaching effectiveness within the field of physical therapy. Pilot testing with CIs from both universities were purposively sampled to complete the questionnaire. The CI databases yielded 1,001 potential respondents, recruited via e-mail. The questionnaire and two follow-up reminders were sent. Respondents consented by clicking a link which redirected them to the SurveyMonkey® questionnaire. Two hundred five CIs completed the questionnaire, a 20.5% response rate. The 205 respondents were mostly female (68.4%) with an average age of 40.54 years (SD=10.22). CI experience was distributed as follows: …

Improving Completeness And Transparency Of Reporting In Clinical Trials Using The Template For Intervention Description And Replication (Tidier) Checklist Will Benefit The Physiotherapy Profession, Tiê Yamato, Chris Maher, Bruno Saragiotto, Anne Moseley, Tammy Hoffmann, Mark Elkins, Shannon Petersen, Sean P. Riley, Jean-Michel Brismée

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Incomplete reporting of interventions in physiotherapy studies is an important problem and The Journal of Manual and Manipulative Therapy endorses the use of the TIDieR checklist as a potential solution.

Health-Related Fitness For Children And Adults With Cerebral Palsy, Yvette Blanchard, Mary E. Gannotti, Wendy Romney

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Position Statement of ACSM Sports Medicine Basics 2016: Health-related physical fitness for persons with Cerebral Palsy should be developed in the same model as fitness for all of us: start early, be easily available and continue throughout the life span.

Walking Speed: The Functional Vital Sign, Addie Middletown, Stacy Fritz, Michelle M. Lusardi

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Walking speed (WS) is a valid, reliable, and sensitive measure appropriate for assessing and monitoring functional status and overall health in a wide range of populations. These capabilities have led to its designation as the “sixth vital sign”. By synthesizing the available evidence on WS, this scholarly review article provides clinicians with a reference tool regarding this robust measure. Recommendations on testing procedures for assessing WS, including optimal distance, inclusion of acceleration and deceleration phases, instructions, and instrumentation are given. After assessing an individual's WS, clinicians need to know what this value represents. Therefore, WS cut-off values and the corresponding …

Validity And Usability Of A Professional Association’S Web-Based Knowledge Translation Portal: American Physical Therapy Association’S Ptnow.Org, Judith E. Deutsch, Wendy Romney, Jan Reynolds, Tara Jo Manal

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Background: PTNow.org is an evidence-based, on-line portal created by a professional membership association to promote use of evidence in practice and to help decrease unwarranted variation in practice. The site contains synthesis documents designed to promote efficient clinical reasoning. These documents were written and peer-reviewed by teams of content experts and master clinicians. The purpose of this paper is to report on the content and construct validity as well as usability of the site. Methods: Physical therapist participants used clinical summaries (available in 3 formats--as a full summary with hyperlinks, "quick takes" with hyperlinks, and a portable two-page version) on …

Cardiac Rehabilitation Programmes For Low-Risk Patients And Leisure Athletes: A Potential Paradox, Wendy Bjerke, Stu Steinman, Vincent Cotto

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Background: Athletes are enrolled in cardiac rehabilitation (CR) programmes in small numbers and require unique diagnostic testing and training considerations. Additionally, many physiotherapists, exercise physiologists, athletic trainers and physicians lack experience treating athletes in CR due to their limited exposure to these types of patients. Content: This analysis distinguishes athletes from typical CR patients within the context of diagnostic testing, assessment, exercise prescription, and management. Several case studies present unique challenges and approaches to the rehabilitation of athletes in a CR setting. Conclusions: Athletes enrolled in CR should be treated and trained according to their abilities and goals. Combining traditional …

Gait Analysis Of Teenagers And Young Adults Diagnosed With Autism & Severe Verbal Communication Disorders, Michael J. Weiss, Matthew F. Moran, Mary E. Parker, John T. Foley

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Both movement differences and disorders are common within autism spectrum disorders (ASD). These differences have wide and heterogeneous variability among different ages and sub-groups all diagnosed with ASD. Gait was studied in a more homogeneously identified group of nine teenagers and young adults who scored as “severe” in both measures of verbal communication and overall rating of Autism on the Childhood Autism Rating Scales (CARS). The ASD individuals were compared to a group of typically developing university undergraduates of similar ages. All participants walked a distance of 6-meters across a GAITRite (GR) electronic walkway for six trials. The ASD and …

Two-Legged Hopping In Autism Spectrum Disorders, Matthew F. Moran, John T. Foley, Mary E. Parker, Michael J. Weiss

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Sensory processing deficits are common within autism spectrum disorders (ASD). Deficits have a heterogeneous dispersion across the spectrum and multimodal processing tasks are thought to magnify integration difficulties. Two-legged hopping in place in sync with an auditory cue (2.3, 3.0 Hz) was studied in a group of six individuals with expressive language impaired ASD (ELI-ASD) and an age-matched control group. Vertical ground reaction force data were collected and discrete Fourier transforms were utilized to determine dominant hopping cadence. Effective leg stiffness was computed through a mass-spring model representation. The ELI-ASD group were unsuccessful in matching their hopping cadence (2.21 ± …

Service Learning In Higher Education Exercise Science Programs, Wendy Bjerke

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Introduction: Service learning (SL) describes teaching methods that incorporate student service activities with specific learning objectives. SL has been applied to allied health higher education programs.

Purpose: To determine the applicability of SL to exercise science courses. SL data associated with an undergraduate course in exercise physiology serving a local fire department is examined.

Use Of The Term "Elderly", Dale Avers, Marybeth Brown, Kevin Chui, Rita A. Wong, Michelle M. Lusardi

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Using the term elderly for a person who is robust and independent as well as for a person who is frail and dependent says little about the individual.

Exploring The Five Phases Of Physical Therapist Professional Development Advanced By The Clinical Doctorate Degree, Salome V. Brooks

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The American Physical Therapy Association (APTA) 2020 strategic plan mandated that the clinical doctor of physical therapy degree (DPT) will be the minimum practice standard. The APTA failed to articulate a functional practice description recognizing the varying levels of preparation. The current literature validates the existence of a stepwise pattern of professional development in similarly evolving disciplines. Applied nursing research by Benner (Benner model of professional development, 2001) identified five stages of professional development and characteristics that were useful in the discipline's advancement. The purpose of the study was to apply the structure of the Benner Model to physical therapy …

Are Scores On The Ppt Useful In Determination Of Risk Of Future Falls In Individuals With Dementia?, Mary K. Farrell, Richard A. Rutt, Michelle M. Lusardi, Ann K. Williams

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Individuals with dementia or Alzheimer’s disease (AD), exhibit both a progressive decline in cognitive function and accumulating difficulty with physical function.¹ As cognitive impairment begins, individuals will initially demonstrate difficulties with short-term memory and with instrumental activities of daily living. As the dementia progresses, individuals will increasingly demonstrate difficulties with long-term memory, communication, and basic activities of daily living.

Getting To Know You: Key Clinical Concepts In Relationship-Based Interventions And Neurobehavioral Observations With Young Infants, Yvette Blanchard

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The newborn infant is a social organism, pre-disposed to interact with his caregiver and able to elicit the kind of caregiving necessary for successful adaptation. The earliest developmental task of the newborn is to organize behavior to be able to play an active role in influencing the caregiving environment and eliciting the kind of support needed for development. This task is accomplished through the attainment of self-regulation or balanced neurobehavioral functioning of the infant's autonomic, motor, state, and responsivity behavioral dimensions as described by Als.

White Paper: Walking Speed: The Sixth Vital Sign, Stacy Fritz, Michelle M. Lusardi

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Walking speed is "almost the perfect measure." This review summarizes the strong psychometric properties of walking speed and robust evidence for using this clinical measurement. Walking speed is easily measurable, clinically interpretable, and a potentially modifiable risk factor. For these reasons, using WS as the sixth vital sign is both pragmatic and essential.

Applying Classification And Decision Rule To Predict Outcome Of Whiplash In An Ambulatory Patient Recovering From Incomplete Spinal Cord Trauma, Emmanuel Yung

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It is not known whether a clinical prediction rule or a whiplash associated disorder (WAD) classification may be applied effectively in a second traumatic event to predict the outcome in a patient recovering from cord trauma. Therefore, the purpose of this case was to apply a decision rule and a whiplash classification to predict the outcome of a second traumatic event in a recovering incomplete spinal cord injured (SCI) patient who was ambulatory.

Branched-Chain Amino Acid Supplementation And Indicators Of Muscle Damage After Endurance Exercise, Beau K. Greer, John L. Woodard, Jim P. White, Eric M. Arguello, Emily M. Haymes

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The purpose of this study was to determine whether branched-chain amino acid (BCAA) supplementation attenuates indirect indicators of muscle damage during endurance exercise as compared with an isocaloric, carbohydrate (CHO) beverage or a noncaloric placebo (PLAC) beverage. Nine untrained men performed three 90-min cycling bouts at 55% VO_2peak. Subjects, blinded to beverage selection, ingested a total of 200 kcal of energy via the CHO or BCAA beverage before and at 60 min of exercise, or they drank the PLAC beverage. Creatine kinase (CK), lactate dehydrogenase (LDH), isokinetic leg-extension and -flexion torque, and muscle soreness were assessed before and …

Functional Rehabilitation: Managing Low Back Pain Through Activities-Of-Daily-Living Education, Timothy E. Speicher, R. Daniel Martin, Robert M. Desimone

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After trauma to the low back, a decrease in intervertebral joint stiffness can occur, which can lead to inability of the motor-control system to compensate for the tasks imposed on the tissues, resulting in spinal instability. Intervertebral joint stiffness can be thought of as a tightening of a corset around a spine segment, facilitated through coactivation of small and large spinal muscles. The motor-control system might be able to adapt initially with cocontractions of the intrinsic muscles, but an unbalanced demand between the small and large muscles can lead to muscle fatigue and poor task performance. The inability of the …

Top 10 Positional-Release Therapy Techniques To Break The Chain Of Pain, Part 1, Timothy E. Speicher, David O. Draper

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Positional-Release Therapy (PRT) is a treatment technique that is gaining popularity. The purpose of this two-part column is to briefly explain the theory and application of PRT. Then, we will present our top 10 list of what we think are the most commonly treated tender points by athletic therapists, five in Part 1 and five in Part 2, along with general tips, patient self-treatments, and adjunctive techniques.

PRT, originally termed strain–counterstrain, is a therapeutic technique that uses tender points (TPs) and a position of comfort (POC) to resolve the associated dysfunction. Essentially, PRT is the opposite of stretching.

PRT is …

Top-10 Positional-Release Therapy Techniques To Break The Chain Of Pain: Part 2, Timothy E. Speicher, David O. Draper

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Positional-Release Therapy (PRT) is advocated as an effective indirect therapeutic treatment for acute, subacute, and chronic somatic dysfunction. Initial investigations have shown PRT to significantly reduce low back and hip pain and improve hip strength. The effects of PRT are thought to occur from placing a patient’s tissues in a position of comfort for an extended period of time.

Clinically, the practice of PRT and its therapeutic benefits have an established history. What is lacking is research into the neural and physiologic mechanisms of the process by which PRT alleviates somatic dysfunction. It can be tempting to view the technique …

The Influence Of Concurrent Cognitive Tasks On Postural Sway In Children, Yvette Blanchard, Shannon Carey, Jocelyn Coffey, Alison Cohen, Trisha Harris, Stephanie Michlik, Geraldine Pellecchia

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Purpose: The purpose of this study was to examine the influence of concurrent tasks on postural sway in children.

Methods: Nineteen fourth-grade students, while standing on a balance platform, were asked to stand still, count backward, and read second-grade level sentences. The AMTI Accusway System was used to calculate the length of center of pressure path (LCOP), sway range (SR), and variability (SV) in mediolateral (ML) and anteroposterior (AP) directions of sway.

Results: Analysis of variance revealed a main effect of cognitive task condition for SR-AP, SR-ML, SV-AP, and SV-ML. Post hoc comparisons revealed lower values of those four dependent …

A Comparison Of Hip Versus Ankle Exercises In Elders And The Influence On Balance And Gait, Laura Z. Gras, Pamela Levangie, Mary (Tina) Goodwin-Segal, Deborah A. Lawrence

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Purpose: Reductions in hip and ankle strength and range of motion (ROM) in elderly subjects have been associated with decreased functional mobility and risk of falls. The purpose of this research was to determine if short duration hip or ankle interventions designed to increase ROM and strength could improve ROM and strength of those joints, as well as improve balance and gait outcomes. Methods: Well elderly volunteers recruited from retirement communities and a senior citizen center were randomly assigned to a hip or ankle intervention group. Both groups performed a home exercise program (HEP) of stretching 5 days a week …

Determinants Of Balance Confidence In Community-Dwelling Elderly People, Janine Hatch, Kathleen M. Gill-Body, Leslie G. Portney

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Background and Purpose. The fear of falling can have detrimental effects on physical function in the elderly population, but the relationship between a persons' confidence in the ability to maintain balance and actual balance ability and functional mobility is not known. The extent to which balance confidence can be explained by balance performance, functional mobility, and sociodemographic, psychosocial, and health-related factors was the focus of this study.

Subjects. The subjects were 50 community-dwelling elderly people, aged 65 to 95 years (X̄=81.7, SD=6.7).

Methods. Balance was measured using the Berg Balance Scale. Functional mobility was measured using the Timed Up & …

Communication Apprehension And Interpersonal Skills In Physical Therapy Students : A Comparative Study Of Problem-Based Learning And Traditional Curricula, Beverly D. Fein

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Physical Therapy education has been challenged to prepare students to meet the increasing demands upon and changing needs of physical therapy practice in the evolving health delivery system. Today's practitioner needs strong interpersonal and collaborative skills for effective communication with patients, families, third party payers, community and other members of the health care team. The characteristics of problem-based learning (PBL) curricula appeared to offer greater potential for students to develop communication skills as compared to traditional curricula. Therefore, this study used available measures of communication apprehension and clinical performance of communication related behaviors to compare students educated in PBL curricula …

Effects Of Ibuprofen And Vicoprofen (R) On Physical Performance After Exercise-Induced Muscle Damage, Jaci L. Van Heest, Jim Stoppani, Tim P. Scheett, Valerie Wherley

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Objective: To determine the effects of Vicoprofen® and ibuprofen on aerobic performance, agility, and pain after exercise-induced muscle damage. Design: Double-blind randomized, placebo-controlled, repeated-dose clinical trial. Setting: Human-performance and sports-medicine laboratory. Participants: 36 healthy men. Methods and Measures: Baseline testing was performed, 72 hours after which subjects performed eccentric exercise to induce muscle damage. They were evaluated for pain 24 hours postdamage and placed randomly into 3 groups: Vicoprofen (VIC), ibuprofen, or placebo (P). Postdamage testing was performed every day for 5 days. Subjects performed an economy run and a t-agility test to determine exercise performance. Results: The drugs had …

Thoracic Pain In A Collegiate Runner (Case Report), Gary P. Austin, W. T. Benesky

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This case study describes the process of examination, re-examination, and intervention for a collegiate runner with mechanical thoracic pain preventing athletic participation and limiting daily function. Unimpaired function fully returned in less than 3 weeks with biweekly sessions to re-establish normal and painfree thoracic mechanics via postural hygiene, exercise, mobilization, and manipulation. The outcome of this case study supports the original hypothesis that the pattern of impairments was in fact responsible for the functional limitations and disability in this athlete. At the time of publication the athlete was without functional limitations and had fully returned to competitive sprinting for the …

A Problem-Based Learning Approach To Facilitate Evidence-Based Practice In Entry-Level Health Professional Education, Michelle M. Lusardi, Pamela Levangie, Beverly D. Fein

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This article will provide an overview of the problem-based learning process, and an illustration of how problem-based learning can facilitate development of critical appraisal necessary for evidence-based practice. It will trace the development of problem-based learning as an educational methodology for entry-level health professional education. The information seeking and appraisal themes common to both problem-based learning and evidence-based practice will be examined, along with the roles and responsibilities of faculty and tutors who are part of problem-based learning courses or curricula. Examples of strategies for student assessment will be discussed, for both mastery of didactic content and for contribution to …

Effect Of Added Mass On Human Unipedal Hopping, Gary P. Austin, Gladys E. Garrett, David Tiberio

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Although hopping is considered a children's activity, it can be used to provide insight into the neuromuscular and biomechanical performance of adults. This study investigated whether mass added during unipedal hopping altered the vertical stiffness, hopping period, and angular kinematics of the lower exteremity of adults. Measures of two-dimensional kinematics and vertical force were made from 10 healthy men during hopping at a preferred period under three conditions: Body Mass, Body Mass +10%, and Body Mass +20%. Adding mass significantly increased hopping period and hip flexion without significantly affecting vertical stiffness, ankle dorsiflexion, or knee flexion. Overall, the findings agreed …

Effect Of Frequency On Human Unipedal Hopping, Gary P. Austin, David Tiberio, Gladys E. Garrett

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All mature forms of locomotion involve periods of unilateral stance. Unipedal hopping may provide useful information about the neuromuscular and biomechanical capabilities of a single lower extremity in adults. This study investigated whether hopping influenced vertical stiffness and lower extremity angular kinematics during human unipedal hopping. Vertical force and two-dimensional kinematics were measured in 10 healthy males hopping at three frequencies: preferred, +20%, and -20%. At +20%, compared to preferred, vertical stiffness increased 55% as hip flexion, knee flexion, and ankle dorsiflexion decreased, while at -20%, vertical stiffness decreased 39.4% as hip flexion, knee flexion, and ankle dorsiflexion increased. As …

Preparing Students For Ebp, Pamela Levangie

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Describes one particular approach to teaching evidence-based practice in physical therapy. At Sacred Heart University students begin course work that is foundational to preparing them for evidence-based practice. In the first semester of study, they take a Concepts in Measurement unit. During the second semester, I teach a semester-long Clinical Research course that focuses on understanding concepts of clinical research and on critical review of physical therapy literature. During the third and fourth semesters of study, when they are doing their clinical coursework, the emphasis is on the concepts of validity and reliability of the tools they use. The students …