The Feigned Annoyance And Frustration Test To Activate The Sympathoadrenal Medullary System, Ted W. Gehrig Iii, Lee S. Berk, Robert I. Dudley, Jo A. Smith, Lida Gharibvand, Everett B. Lohman Iii

Physical Therapy Faculty Articles and Research

When perceived as threatening, social interactions have been shown to trigger the sympathoadrenal medullary system as well as the hypothalamic-pituitary-adrenal axis resulting in a physiologic stress response. The allostatic load placed on human health and physiology in the context of acute and chronic stress can have profound health consequences. The purpose of this study was to develop a protocol for a lab-based stress stimulus using social-evaluative threat. While several valid, stress-stimulating protocols exist, we sought to develop one that triggered a physiologic response, did not require significant lab resources, and could be completed in around 10 min. We included 53 …

Correlation Enhanced Distribution Adaptation For Prediction Of Fall Risk, Ziqi Guo, Teresa Wu, Thurmon Lockhart, Rahul Soangra, Hyunsoo Yoon

Physical Therapy Faculty Articles and Research

With technological advancements in diagnostic imaging, smart sensing, and wearables, a multitude of heterogeneous sources or modalities are available to proactively monitor the health of the elderly. Due to the increasing risks of falls among older adults, an early diagnosis tool is crucial to prevent future falls. However, during the early stage of diagnosis, there is often limited or no labeled data (expert-confirmed diagnostic information) available in the target domain (new cohort) to determine the proper treatment for older adults. Instead, there are multiple related but non-identical domain data with labels from the existing cohort or different institutions. Integrating different …

Running Biomechanics Differ During And After Pregnancy Compared To Females Who Have Never Been Pregnant, Jennifer J. Bagwell, Elizabeth Avila, Nicholas Reynolds, Jo Armour Smith, Kevin Valenzuela, Dimitrios Katsavelis

Physical Therapy Faculty Articles and Research

Background

Perinatal running participation has increased recently; however, pregnancy related symptoms can limit activity. Perinatal running biomechanics could inform interventions to help perinatal individuals maintain an active lifestyle.

Research question

Are perinatal running biomaechanics and muscle activation different compared to nulligravida females?

Methods

Sixteen pregnant participants completed self-selected velocity running during second trimester (2 T), third trimester (3 T), and postpartum (PP) and 16 matched controls completed these procedures once in this case control study. Kinematic, kinetic, and electromyography (EMG) data were collected using a motion capture system, force plates, and EMG electrodes. Peak trunk, pelvis, hip, knee, and ankle …

Multi-Site Identification And Generalization Of Clusters Of Walking Behaviors In Individuals With Chronic Stroke And Neurotypical Controls, Natalia Sanchez, Nicolas Schweighofer, Sara J. Mulroy, Ryan T. Roemmich, Tricia M. Kesar, Gelsy Torres-Oviedo, Beth E. Fisher, James M. Finley, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Background

Objectives

Methods

Multi-Site Identification And Generalization Of Clusters Of Walking Behaviors In Individuals With Chronic Stroke And Neurotypical Controls, Natalia Sánchez, Nicolas Schweighofer, Sara J. Mulroy, Ryan T. Roemmich, Trisha M. Keshar, Gelsy Torres-Oviedo, Beth E. Fisher, James M. Finley, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Background

Objectives

Methods

Integrating Glenohumeral Range Of Motion With Dynamic Postural Control For Early Detection Of Elbow Injury Risk In Collegiate Baseball Pitchers: A Preliminary Prospective Case Series, Brent A. Harper, Luke J. Bailey, Mikayla N. Jones, Joseph Bradley

Physical Therapy Faculty Articles and Research

Introduction: Medial elbow ulnar collateral ligament (UCL) injuries are common in baseball with increased surgical incidence in pitchers. There is no consensus on which modifiable injury risk metrics or performance screening tools to use to identify at risk collegiate baseball pitchers. Current literature on UCL injury risk has focused on local passive glenohumeral rotational motion with limited forays into more global movement patterns. The aim of this study was to assess possible relationships involving UCL injuries and modifiable local and global motor control performance risk factors. Material and Methods: An observational single cohort case series involving 15 collegiate …

Novice Inter-Rater Reliability On The Selective Functional Movement Assessment (Sfma) After A 4-Hour Training Session, Brent Harper, Adrian Aron

Physical Therapy Faculty Articles and Research

Background

The Selective Functional Movement Assessment (SFMA) is a whole-body movement classification system that identifies non-optimal movement performance requiring further assessment. There needs to be more evidence specifying the training time required to obtain SFMA reliability for entry-level health care practitioners.

Purpose

The primary intent of this study was to determine SFMA inter-rater reliability between two third-year physical therapy students following an in-person three-hour training and one-hour follow-up training with a certified SFMA physical therapist. The secondary purpose was to compare rater scores of the composite criterion 50-point checklist and rater categorization using the top-tier movements in real-time assessments of …

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

Physical Therapy Faculty Articles and Research

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 …

Lifelong Fitness In Ambulatory Children And Adolescents With Cerebral Palsy Ii: Influencing The Trajectory, Susan V. Duff, Justine D. Kimbel, Marybeth Grant-Beuttler, Theresa Sukal-Moulton, Noelle G. Moreau, Kathleen M. Friel

Physical Therapy Faculty Articles and Research

Physical activity of at least moderate intensity in all children contributes to higher levels of physical and psychological health. While essential, children with cerebral palsy (CP) often lack the physical capacity, resources, and knowledge to engage in physical activity at a sufficient intensity to optimize health and well-being. Low levels of physical activity place them at risk for declining fitness and health, contributing to a sedentary lifestyle. From this perspective, we describe a framework to foster a lifelong trajectory of fitness in ambulatory children with CP (GMFCS I–III) as they progress into adolescence and adulthood, implemented in conjunction with a …

Habitual Exercise Evokes Fast And Persistent Adaptation During Split-Belt Walking, Sasha A. Brinkerhoff, Natalia Sánchez, Jaimie A. Roper

Physical Therapy Faculty Articles and Research

Changing movement patterns in response to environmental perturbations is a critical aspect of gait and is related to reducing the energetic cost of the movement. Exercise improves energetic capacity for submaximal exercise and may affect how people adapt movement to reach an energetic minimum. The purpose of this study was to determine whether self-reported exercise behavior influences gait adaptation in young adults. Young adults who met the optimal volume of exercise according to the Physical Activity Guidelines for Americans (MOVE; n = 19) and young adults who did not meet the optimal volume of exercise (notMOVE; n = 13) walked …

Implementation Of Post-Covid Conditions Management Utilizing Interprofessional Collaboration In A Multi-Facility Healthcare Organization, Jocelin Friedman, Christina Dhesi-Bawa, Kathleen Kennedy, Stephen Lee, Leona Hidalgo

Physical Therapy Faculty Articles and Research

Background: The prevalence of Post-Covid Conditions (PCC) is estimated to affect 10-35% of infected individuals, with upwards of 85% of previously hospitalized individuals reporting prolonged effects. Literature indicates deficiencies in communication between healthcare providers which can negatively affect patients. Due to limited interprofessional communication, there was a scarcity of individuals with PCC receiving comprehensive therapy treatment on an outpatient basis. The multi-system nature of PCC was an indication for interprofessional collaboration and the development of workflows facilitating access to care.

Purpose: This qualitative study investigates the Post-COVID-19 Rehabilitation Program (PCRP) at a California, USA multi-facility healthcare system. The …

Soccer Heading Drills And Concussion-Related Deficits In High School Female Athletes, Brent Harper, Adrian Aron, Rahul Soangra

Physical Therapy Faculty Articles and Research

Repetitive head impacts from soccer heading may result in concussions in female athletes. Problem Statement: Concussion assessments exist with efforts to limit headers. Heading drills performed in different environments have conflicting results regarding influences on assessments. Approach: To evaluate, within an ecological realsetting environment with unpredictable conditions reflective of game situations, a heading drill’s effect on the King-Devick (K-D) and Biodex Biosway Balance Assessment (CTSIB-M). Preseason and post-heading metrics were taken for eleven female high school varsity soccer players (16 ± 1.4 years old) using K-D and CTSIB-M. K-D and CTSIB-M tests were repeated following a heading drill …

Identifying The Neural Correlates Of Anticipatory Postural Control: A Novel Fmri Paradigm, Jo Armour Smith, Rongwen Tain, Kelli G. Sharp, Laura M. Glynn, Linda R. Van Dillen, Korinne Henslee, Jesse V. Jacobs, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Altered postural control in the trunk/hip musculature is a characteristic of multiple neurological and musculoskeletal conditions. Previously it was not possible to determine if altered cortical and subcortical sensorimotor brain activation underlies impairments in postural control. This study used a novel fMRI-compatible paradigm to identify the brain activation associated with postural control in the trunk and hip musculature. BOLD fMRI imaging was conducted as participants performed two versions of a lower limb task involving lifting the left leg to touch the foot to a target. For the supported leg raise (SLR) the leg is raised from the knee while the …

Dense & Attention Convolutional Neural Networks For Toe Walking Recognition, Junde Chen, Rahul Soangra, Marybeth Grant-Beuttler, Y. A. Nanehkaran, Yuxin Wen

Physical Therapy Faculty Articles and Research

Idiopathic toe walking (ITW) is a gait disorder where children’s initial contacts show limited or no heel touch during the gait cycle. Toe walking can lead to poor balance, increased risk of falling or tripping, leg pain, and stunted growth in children. Early detection and identification can facilitate targeted interventions for children diagnosed with ITW. This study proposes a new one-dimensional (1D) Dense & Attention convolutional network architecture, which is termed as the DANet, to detect idiopathic toe walking. The dense block is integrated into the network to maximize information transfer and avoid missed features. Further, the attention modules are …

The Effect Of Spinal Muscle Fatigue And Psychosocial Factors On Pressure-Pain Threshold In Healthy Adults, Susan Mais, Jo Armour Smith

Physical Therapy Faculty Articles and Research

Objective. Pain sensitivity decreases following isometric exercise. It is not clear whether this exercise-induced hypoalgesia (EIH) occurs to the same extent in men and women. It is also unclear if the effect is systemic or local to the exercised musculature. The aim of our study was to investigate whether fatiguing isometric exercise of the spinal and hip extensors would result in increased pressure pain threshold (PPT) at sites local to and remote from the exercised muscles in healthy men and women and whether there is a relationship between central sensitization, psychosocial factors, and PPT. Subjects. 35 healthy adults …

Comparison Of Clinical And Biomechanical Characteristics Between Individuals With Lower Limb Amputation With And Without Lower Back Pain: A Systematic Review And Meta-Analysis, Szu-Ping Lee, Shawn Farrokhi, Jenny A. Kent, Jason Ciccotelli, Lung-Chang Chien, Jo Armour Smith

Physical Therapy Faculty Articles and Research

Background

Lower back pain is a debilitating condition common to individuals with lower limb amputation. It is unclear what risk factors contribute to the development of back pain. This study systematically reviewed and analyzed the available evidence regarding the clinical and biomechanical differences between individuals with amputation, with and without lower back pain.

Methods

A literature search was conducted in PubMed, Web of Science, Scopus, and CINAHL databases in November 2020 and repeated in June 2021 and June 2022. Studies were included if they reported comparisons of demographic, anthropometric, biomechanical, and other clinical variables between participants with and without LBP. …

Reliability And Validity Of Inertial Sensor Assisted Reaction Time Measurement Tools Among Healthy Young Adults, Brent Harper, Michael Shiraishi, Rahul Soangra

Physical Therapy Faculty Articles and Research

The assessment of movement reaction time (RT) as a sideline assessment is a valuable biomarker for mild TBI or concussion. However, such assessments require controlled laboratory environments, which may not be feasible for sideline testing during a game. Body-worn wearable devices are advantageous as being cost-effective, easy to don and use, wirelessly transmit data, and ensure unhindered movement performance. This study aimed to develop a Drop-stick Test System (DTS) with a wireless inertial sensor and confirm its reliability for different standing conditions (Foam versus No Foam) and task types (Single versus Dual), and postures (Standing versus sitting). Fourteen healthy young …

Bruce Protocol Test Affects Postural Stability In Healthy Young Adults, Andreas Germanos, Tessa Heiberg, Annie Jeon, Emi Heisterkamp, Hao Giang, Jessica Cota, Laura Corona, Thomas Loi, Vincent Bovino, Shayce Cordero, Sunny Kim, Michael Shiraishi, Rahul Soangra

Physical Therapy Faculty Articles and Research

Maintaining balance is key in avoiding falls and injury. However, little is known on how increased cardiac activity may affect postural stability. This study investigated if increase in cardiac activity to 85% maximal heart rate (HR) when exercising with standard Bruce Protocol Test (BPT) influence postural sway. Ten young adults were tested for three postural stances, quiet bilateral standing with i) eyes open, ii) eyes closed, and iii) tandem stance, before and after performing the BPT. Resting Heart Rate (HR) and HR variability along with standard postural sway parameters like sway velocity, sway area, turn index, and power frequency in …

Classifying Toe Walking Gait Patterns Among Children Diagnosed With Idiopathic Toe Walking Using Wearable Sensors And Machine Learning Algorithms, Rahul Soangra, Yuxin Wen, Hualin Yang, Marybeth Grant-Beuttler

Physical Therapy Faculty Articles and Research

Idiopathic toe walking (ITW) is a gait abnormality in which children’s toes touch at initial contact and demonstrate limited or no heel contact throughout the gait cycle. Toe walking results in poor balance, increased risk of falling, and developmental delays among children. Identifying toe walking steps during walking can facilitate targeted intervention among children diagnosed with ITW. With recent advances in wearable sensing, communication technologies, and machine learning, new avenues of managing toe walking behavior among children are feasible. In this study, we investigate the capabilities of Machine Learning (ML) algorithms in identifying initial foot contact (heel strike versus toe …

An Exploratory Analysis Of Gait Biomechanics And Muscle Activation In Pregnant Females With High And Low Scores For Low Back Or Pelvic Girdle Pain During And After Pregnancy, Jennifer J. Bagwell, Nicholas Reynolds, Jo Armour Smith, Michelle Walaszek, Hannah Runez, Kristina Lam, Julie Peterson, Dimitrios Katsavelis

Physical Therapy Faculty Articles and Research

Background

The purpose of this study was to compare gait kinematics, kinetics, and muscle activation between pregnant females with high and low scores for low back and/or pelvic girdle pain during and after pregnancy.

Methods

Twenty participants tested during second trimester, third trimester, and again post-partum. At each session, motion capture, force plates, and surface electromyography data were captured during self-selected velocity over-ground walking. Participants completed the Quebec Back Pain Disability Scale (QBPDS) and were assigned to high (QBPDS ≥15) or low pain groups (QBPDS

Findings

Nine participants met the high pain group criteria and 11 were low pain. During …

General Variability Leads To Specific Adaptation Toward Energy Optimal Policies, Sabrina J. Abram, Katherine L. Poggensee, Natalia Sánchez, Surabhi N. Simha, James M. Finley, Steven H. Collins, J. Maxwell Donelan

Physical Therapy Faculty Articles and Research

Our nervous systems can learn optimal control policies in response to changes to our bodies, tasks, and movement contexts. For example, humans can learn to adapt their control policy in walking contexts where the energy-optimal policy is shifted along variables such as step frequency or step width. However, it is unclear how the nervous system determines which ways to adapt its control policy. Here, we asked how human participants explore through variations in their control policy to identify more optimal policies in new contexts. We created new contexts using exoskeletons that apply assistive torques to each ankle at each walking …

Quantifying Intra- And Interlimb Use During Unimanual And Bimanual Tasks In Persons With Hemiparesis Post-Stroke, Susan V. Duff, Aaron Miller, Lori Quinn, Gregory Youdan Jr., Lauri Bishop, Heather Ruthrauff, Eric Wade

Physical Therapy Faculty Articles and Research

Background

Individuals with hemiparesis post-stroke often have difficulty with tasks requiring upper extremity (UE) intra- and interlimb use, yet methods to quantify both are limited.

Objective

To develop a quantitative yet sensitive method to identify distinct features of UE intra- and interlimb use during task performance.

Methods

Twenty adults post-stroke and 20 controls wore five inertial sensors (wrists, upper arms, sternum) during 12 seated UE tasks. Three sensor modalities (acceleration, angular rate of change, orientation) were examined for three metrics (peak to peak amplitude, time, and frequency). To allow for comparison between sensor data, the resultant values were combined into …

Test-Retest Reliability Of Postural Control Assessment On Biodex Biosway™, Daniel Miner, Brent A. Harper, Stephen M. Glass, Brooke Martin, Molly Polizotto, S. Montana Hearl, Ellen Turner

Physical Therapy Faculty Articles and Research

Background. Recent protocols for posturographic assessment of postural control and balance have included head shake test conditions to challenge the vestibular contributions of postural control in an effort to increase the diagnostic accuracy of identifying individuals with impaired balance. However, evidence is limited regarding the test-retest reliability of such assessment protocols. Purpose. The purpose of this study was twofold: to determine the test-retest reliability of postural control assessment on the Biodex Biosway™, an accessible and field expedient tool for posturographic assessment, and to determine the test-retest reliability of the Head Shake Sensory Interaction and Balance Test (HS-SIB), an …

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 …

Visualization-Driven Time-Series Extraction From Wearable Systems Can Facilitate Differentiation Of Passive Adl Characteristics Among Stroke And Healthy Older Adults, Joby John, Rahul Soangra

Physical Therapy Faculty Articles and Research

Wearable technologies allow the measurement of unhindered activities of daily living (ADL) among patients who had a stroke in their natural settings. However, methods to extract meaningful information from large multi-day datasets are limited. This study investigated new visualization-driven time-series extraction methods for distinguishing activities from stroke and healthy adults. Fourteen stroke and fourteen healthy adults wore a wearable sensor at the L5/S1 position for three consecutive days and collected accelerometer data passively in the participant’s naturalistic environment. Data from visualization facilitated selecting information-rich time series, which resulted in classification accuracy of 97.3% using recurrent neural networks (RNNs). Individuals with …

Kinematic Analysis Of 360° Turning In Stroke Survivors Using Wearable Motion Sensors, Masoud Abdollahi, Pranav Madhav Kuber, Michael Shiraishi, Rahul Soangra, Ehsan Rashedi

Physical Therapy Faculty Articles and Research

Background: A stroke often bequeaths surviving patients with impaired neuromusculoskeletal systems subjecting them to increased risk of injury (e.g., due to falls) even during activities of daily living. The risk of injuries to such individuals can be related to alterations in their movement. Using inertial sensors to record the digital biomarkers during turning could reveal the relevant turning alterations. Objectives: In this study, movement alterations in stroke survivors (SS) were studied and compared to healthy individuals (HI) in the entire turning task due to its requirement of synergistic application of multiple bodily systems. Methods: The motion of 28 participants (14 …

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.

Prediction Of Fall Risk Among Community-Dwelling Older Adults Using A Wearable System, Thurmon Lockhart, Rahul Soangra, Hyunsoo Yoon, Teresa Wu, Christopher W. Frames, Raven Weaver, Karen A. Roberto

Physical Therapy Faculty Articles and Research

Falls are among the most common cause of decreased mobility and independence in older adults and rank as one of the most severe public health problems with frequent fatal consequences. In the present study, gait characteristics from 171 community-dwelling older adults were evaluated to determine their predictive ability for future falls using a wearable system. Participants wore a wearable sensor (inertial measurement unit, IMU) affixed to the sternum and performed a 10-m walking test. Measures of gait variability, complexity, and smoothness were extracted from each participant, and prospective fall incidence was evaluated over the following 6-months. Gait parameters were refined …

Self-Paced Treadmills Do Not Allow For Valid Observation Of Linear And Nonlinear Gait Variability Outcomes In Patients With Parkinson’S Disease, Maryam Rohafza, Rahul Soangra, Jo Armour Smith, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Background

Due to the imposed constant belt speed, motorized treadmills are known to affect linear and nonlinear gait variability outcomes. This is particularly true of patients with Parkinson’s Disease where the treadmill can act as an external pacemaker. Self-paced treadmills update the belt speed in response to the subject's walking speed and might, therefore, be a useful tool for measurement of gait variability in this patient population. This study aimed to compare gait variability during walking at self-paced and constant treadmill speeds with overground walking in individuals with PD and individuals with unimpaired gait.

Methods

Thirteen patients with Parkinson’s Disease …

Does Subthalamic Deep Brain Stimulation Impact Asymmetry And Dyscoordination Of Gait In Parkinson’S Disease?, Deepak K. Ravi, Christian R. Baumann, Elena Bernasconi, Michelle Gwerder, Niklas K. Ignasiak, Mechtild Uhl, Lennart Stieglitz, William R. Taylor, Navrag B. Singh

Physical Therapy Faculty Articles and Research

Background. Subthalamic deep brain stimulation (STN-DBS) is an effective treatment for selected Parkinson’s disease (PD) patients. Gait characteristics are often altered after surgery, but quantitative therapeutic effects are poorly described. Objective. The goal of this study was to systematically investigate modifications in asymmetry and dyscoordination of gait 6 months postoperatively in patients with PD and compare the outcomes with preoperative baseline and to asymptomatic controls without PD. Methods. A convenience sample of thirty-two patients with PD (19 with postural instability and gait disorder (PIGD) type and 13 with tremor dominant disease) and 51 asymptomatic controls participated. Parkinson patients …