Rehabilitation and Therapy Commons^™

Effects Of Hemodialysis Therapy On Sit-To-Walk Characteristics In End Stage Renal Disease Patients, Rahul Soangra, Thurmon Lockhart, John Lach, Emaad M. Abdel-Rahman

Physical Therapy Faculty Articles and Research

Patients with end stage renal diseases (ESRD) undergoing hemodialysis (HD) have high morbidity and mortality due to multiple causes; one of which is dramatically higher fall rates than the general population. In spite of the multiple efforts aiming to decrease the high mortality and improve quality of life in ESRD patients, limited success has been achieved. If adequate interventions for fall prevention are to be achieved, the functional and mobility mechanisms consistent with falls in this population must be understood. Human movements such as sit-to-walk (STW) tasks are clinically significant, and analysis of these movements provides a meaningful evaluation of …

Comparison Of Intra Individual Physiological Sway Complexity From Force Plate And Inertial Measurement Unit, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Center of Pressure (COP) is a clinical measure to investigate the effect of sensory input disturbances on postural stability in healthy, old population as well in people suffering from neuromuscular disease. Increased center of pressure velocity and sway area are interpreted as decreased stability or poor balance and are associated with fall risk. Body mounted inertial sensors have shown great promise as an easily implemented clinical measure of balance. The aim of the present study is to investigate if force plate and accelerometer measurements provide similar physiological information when approximate entropy (ApEn) are valuated from the time series. Seven Young …

Assessment Of Postural Stability Using Inertial Measurement Unit On Inclined Surfaces In Healthy Adults, Chris Frames, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Fatal and nonfatal falls in the construction domain remain a significant issue in today’s workforce. The roofing industry in particular, annually ranks amongst the highest in all industries. Exposure to an inclined surface, such as an inclined roof surface, has been reported to have adverse effects on postural stability. The purpose of this preliminary study was to investigate the intra-individual differences in stability parameters on both inclined and level surfaces. Postural Stability (PS) and Limit of Stability (LOS) were assessed in seven healthy subjects (aged 25-35 years) on inclined and level surfaces using embedded force plates and an Inertial Measurement …

Wavelet Based Automated Postural Event Detection And Activity Classification With Single Imu (Tempo), Thurmon E. Lockhart, Rahul Soangra, Jian Zhang, Xuefang Wu

Physical Therapy Faculty Articles and Research

Mobility characteristics associated with activity of daily living such as sitting down, lying down, rising up, and walking are considered to be important in maintaining functional independence and healthy life style especially for the growing elderly population. Characteristics of postural transitions such as sit-to-stand are widely used by clinicians as a physical indicator of health, and walking is used as an important mobility assessment tool. Many tools have been developed to assist in the assessment of functional levels and to detect a person’s activities during daily life. These include questionnaires, observation, diaries, kinetic and kinematic systems, and validated functional tests. …

Intramuscular Manual Therapy After Failed Conservative Care: A Case Report, Brent Harper

Physical Therapy Faculty Articles and Research

Background and Purpose: During intramuscular manual therapy (IMT), an acupuncture needle is inserted into the skin and muscle. The direct mechanical stimulation may interrupt the pathogenic mechanisms of myofascial trigger points (MTrPs). The purpose of this study was to demonstrate the application and efficacy of IMT on a patient suffering from right chronic elbow lateral epicondylalgia. Methods: A case study of a 26-year-old male presenting with a 6-month history of right elbow pain who failed 11 conservative physical therapy sessions and previous site-specific acupuncture. The patient received 5 IMT sessions over 4 weeks. Findings: The patient had …

Extreme Levels Of Noise Constitute A Key Neuromuscular Deficit In The Elderly, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Fluctuations during isometric force production tasks occur due to the inability of musculature to generate purely constant submaximal forces and are considered to be an estimation of neuromuscular noise. The human sensori-motor system regulates complex interactions between multiple afferent and efferent systems, which results in variability during functional task performance. Since muscles are the only active component of the motor system, it therefore seems reasonable that neuromuscular noise plays a key role in governing variability during both standing and walking. Seventy elderly women (including 34 fallers) performed multiple repetitions of isometric force production, quiet standing and walking tasks. No relationship …

Determination Of Stabilogram Diffusion Analysis Coefficients And Invariant Density Analysis Parameters To Understand Postural Stability Associated With Standing On Anti-Fatigue Mats, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Prolonged standing has been associated with loss of balance, onset of low back pain symptoms and development of fatigue in lower extremity muscles in working populations. Although so far, it is unknown how individuals’ postural stability is affected by standing on rigid versus cushioned platform but many industries are opting for anti-fatigue mats at workstations to reduce fall and injury related socio-economic cost. The goal of this study is to test SATECH's anti-fatigue mat for its effects on postural stability. A pilot test with seven healthy subjects (25–35 years old) has been conducted with a force plate to obtain kinetics …

Shoulder-And Back-Muscle Activation During Shoulder Abduction And Flexion Using A Bodyblade Pro Versus Dumbbells, Joseph S. Parry, Rachel Straub, Daniel Cipriani

Physical Therapy Faculty Articles and Research

Context: The Bodyblade Pro is used for shoulder rehabilitation after injury. Resistance is provided by blade oscillations—faster oscillations or higher speeds correspond to greater resistance. However, research supporting the Bodyblade Pro’s use is scarce, particularly in comparison with dumbbell training. Objective: To compare muscle activity, using electromyography (EMG), in the back and shoulder regions during shoulder exercises with the Bodyblade Pro vs dumbbells. Design: Randomized crossover study. Setting: San Diego State University biomechanics laboratory. Participants: 11 healthy male subjects age 19–32 y. Intervention: Subjects performed shoulder-flexion and -abduction exercises using a Bodyblade Pro and …

Rating Scale Analysis And Psychometric Properties Of The Caregiver Self-Efficacy Scale For Transfers, Daniel Cipriani, Francine E. Hansen, Danielle L. Mcpeck, Gina L.D. Kubec, Julie J. Thomas

Physical Therapy Faculty Articles and Research

Parents and caregivers faced with the challenges of transferring children with disability are at risk of musculoskeletal injuries and/or emotional stress. The Caregiver Self-Efficacy Scale for Transfers (CSEST) is a 14-item questionnaire that measures self-efficacy for transferring under common conditions. The CSEST yields reliable data and valid inferences; however, its rating scale structure has not been evaluated for utility. The aims of this study were to evaluate the category response structure of the CSEST, test the utility of a revised rating scale structure, and confirm its psychometric properties. The Rasch Measurement Model was used for all analyses. Subjects included 175 …

Effect Of Stretch Frequency And Sex On The Rate Of Gain And Rate Of Loss In Muscle Flexibility During A Hamstring-Stretching Program: A Randomized Single-Blind Longitudinal Study, Daniel Cipriani, Megan E. Terry, Michelle A. Haines, Amir P. Tabibnia, Olga Lyssanova

Physical Therapy Faculty Articles and Research

This study evaluated the effects of four different weekly stretching protocols on the rate of gain and decline in hamstring flexibility over an 8-week period, across sex. Using a randomized single-blind design, 53 healthy subjects aged 18–46 years were assigned to 1 of 4 stretching protocols or a control group. The stretching protocols consisted of either daily or 3 times per week stretching and performed once or twice each day. These protocols differed in terms of frequency and total weekly stretching time. All the subjects stretched their hamstring muscles for 4 weeks and were measured weekly for their hip range …

Investigation Into The Functional Mobility Difference Between Obese And Non-Obese Elderly, Xuefang Wu, Han T. Yeoh, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Obese aging population is increasing in the United States, and obese elderly experience fall twice as frequent as their lean counterparts. However, the mechanisms of older obese adults fall are still not clear. It is not known whether the obese elderly has more functional mobility impairments than their lean counterparts, and consequently have increased risks of falls. It was hypothesized that obese elderly have more functional mobility impairments compared with their healthy weight counterparts. Six lean and six obese community-dwelling elderly participated in the study. “Timed up & go” test was used to quantify the functional mobility for both lean …

A Comparative Study For Performance Evaluation Of Sit-To-Stand Task With Body Worn Sensor And Existing Laboratory Methods, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Human movement such as sit-to-stand (STS) is one of the most fundamental and essential movement among daily living activities. Elderly who are unable to stand are severely limited in daily activities and rely on others for their care. In the coming next two decades about 20% of US population will be above the age of 65 years, and considering ever-increasing elderly population and health care expenses, the rehabilitation of functionally limited elderly is becoming a topic of greater concern. Clinically STS movement is looked upon with great interest, such as its analysis is meaningful in order to evaluate motor control …

Non-Invasive Fall Risk Assessment In Community Dwelling Elderly With Wireless Inertial Measurement Units, Thurmon E. Lockhart, Han T. Yeoh, Rahul Soangra, Manutchanok Jongprasithporn, Jian Zhang, Xuefang Wu, Arka Ghosh

Physical Therapy Faculty Articles and Research

Falls are among the most serious accidents among the elderly leading to increased injuries, reduced functioning and mortality. In 2009, about 2.2 million nonfatal fall injuries were reported among the elderly population (CDC, 2010). In this study, eleven community dwelling elderly (aged 65-84 years) participated in fall risk assessment camp at sterling senior center organized by Northern Virginia Fall Prevention Coalition (NVFPC). Three custom made wireless inertial measurement units (IMUs) were attached on trunk and both shanks. All participants performed postural and locomotor tasks such as sit-to-stand (STS) and timed up and go (TUG). Temporal and kinematic parameters were obtained. …

Pressure Distribution Over The Palm Region During Forward Falls On The Outstretched Hands, Woochol J. Choi, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

Falls on the outstretched hands are the cause of over 90% of wrist fractures, yet little is known about bone loading during this event. We tested how the magnitude and distribution of pressure over the palm region during a forward fall is affected by foam padding (simulating a glove) and arm configuration, and by the faller’s body mass index (BMI) and thickness of soft tissues over the palm region.

Thirteen young women with high (n=7) or low (n=6) BMI participated in a “torso release experiment” that simulated falling on both outstretched hands with the arm inclined either at 20° or …

An Approach For Identifying Gait Events Using Wavelet Denoising Technique And Single Wireless Imu, Rahul Soangra, Thurmon Lockhart, Nathalie Van De Berge

Physical Therapy Faculty Articles and Research

A new approach is proposed to identify gait events in non-laboratory environments with a single inertial measurement unit (IMU) embedded inside shoe. The aim of our work is to develop a useful clinical tool for monitoring individuals walking disability and detect specific pathological gait patterns. Temporal parameters of gait are determined by classification of accelerations and angular velocities. Wavelets denoising of IMU signals allows for an important amount of information that is exploited in different manners for event identification. It was found that wavelet denoising enhanced specific turning points which could effectively identify gait events. The method is verified by …

Pressure Distribution Over The Palm During Falls On The Outstretched Hands, Woochol J. Choi, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

"Over 90% of wrist fractures are caused by falls on the outstretched hands (Palvanen et al., Osteoporos Int, 2000). Along with bone strength, fracture risk depends on the magnitude and distribution of force to soft and hard tissues during impact. In the current study, we examined how pressure distribution over the palm during a fall is affected by impact configuration, body mass index (BMI), palmer soft tissue thickness, and a 5 mm thick foam pad (simulating a protective glove)."

Portable, Non-Invasive Fall Risk Assessment In End Stage Renal Disease Patients On Hemodialysis, Thurmon Lockhart, Adam T. Barth, Xiaoyue Zhang, Rahul Soangra, Emaad Abdel-Rahman, John Lach

Physical Therapy Faculty Articles and Research

Patients with end stage renal diseases (ESRD) on hemodialysis (HD) have high morbidity and mortality due to multiple causes, one of which is dramatically higher fall rates than the general population. The mobility mechanisms that contribute to falls in this population must be understood if adequate interventions for fall prevention are to be achieved. This study utilizes emerging noninvasive, portable gait, posture, strength, and stability assessment technologies to extract various mobility parameters that research has shown to be predictive of fall risk in the general population. As part of an ongoing human subjects study, mobility measures such as postural and …

The Impact Of Left Hemisphere Stroke On Force Control With Familiar And Novel Objects: Neuroanatomic Substrates And Relationship To Apraxia, Amanda M. Dawson, Laura J. Buxbaum, Susan V. Duff

Physical Therapy Faculty Articles and Research

Fingertip force scaling for lifting objects frequently occurs in anticipation of finger contact. An ongoing question concerns the types of memories that are used to inform predictive control. Object-specific information such as weight may be stored and retrieved when previously encountered objects are lifted again. Alternatively, visual size and shape cues may provide estimates of object density each time objects are encountered. We reasoned that differences in performance with familiar versus novel objects would provide support for the former possibility. Anticipatory force production with both familiar and novel objects was assessed in six left hemisphere stroke patients, two of whom …

Performance Of A Hip Protector Depends On Its Position During A Fall, Woochol J. Choi, Joaquin A. Hoffer, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

"Hip protectors are designed to attenuate and redistribute the force applied to the hip region during a fall, and thereby reduce risk for hip fracture [1]. However, little information exists on the effectiveness of hip protectors in achieving these goals, and how this is altered by displacement of the hip protector relative to the greater trochanter (GT). In the current study, we tested these issues."

Author Response To Invited Commentary By Heathcock [Commentary For: Gastrocnemius/Soleus Muscle Tendon Unit Changes Over The First 12 Weeks Of Adjusted Age In Infants Born Preterm], Marybeth Grant-Beuttler, Robert J. Palisano, Debra P. Miller, Barbara Reddien Wagner, Carolyn B. Heriza, Patricia A. Shewokis

Physical Therapy Faculty Articles and Research

"We thank Heathcock for taking the time to write her commentaryregarding our study. Her comments are interesting, and our subsequent investigation into these ideas has led us to uncover some enlightening evidence in relation to the topics raised in the commentary. We will attempt to review each of the topics raised and the evidence associated with these topics."

Gastrocnemius-Soleus Muscle Tendon Unit Changes Over The First 12 Weeks Of Adjusted Age In Infants Born Preterm, Marybeth Grant-Beuttler, Robert J. Palisano, Debra P. Miller, Barbara Reddien Wagner, Carolyn B. Heriza, Patricia A. Shewokis

Physical Therapy Faculty Articles and Research

Background and Purpose: Differences in the gastrocnemius-soleus muscle and tendon have been documented shortly after birth in infants born preterm compared with infants born at term. Knowledge of muscle tendon unit lengths at term age to 12 weeks of age in infants born preterm may be useful in understanding motor development.

Participants and Method: Gastrocnemius-soleus muscle tendon unit lengths were compared at term age, at 6 weeks of age, and at 12 weeks of age (preterm adjusted age) in 20 infants born full term and 22 infants born preterm.

Results: Significant differences were found between the 2 groups on taut …

Nonlinear Time Series Analysis Of Knee And Ankle Kinematics During Side By Side Treadmill Walking, Jeff A. Nessler, Charles J. De Leone, Sarah Gilliland

Physical Therapy Faculty Articles and Research

Nonlinear time series analysis was used to estimate maximal Lyapunov exponents of select ankle and knee kinematics during three different conditions of treadmill walking: independent, side by side, and side by side with forced synchronization of stepping. Stride to stride variability was significantly increased for the condition in which individuals walked side by side and synchronized unintentionally when compared to the conditions of forced synchronization and independent walking. In addition, standard deviations of three kinematic variables of lower extremity movement were significantly increased during the condition in which unintentional synchronization occurred. No relationship was found between standard deviation and estimates …

Electromyographic Data Do Not Support A Progressive Recruitment Of Muscle Fibers During Exercise Exhibiting A Vo2 Slow Component, Daniel T. Cannon, Fred W. Kolkhorst, Daniel Cipriani

Physical Therapy Faculty Articles and Research

The origin of the slow component (SC) of oxygen uptake kinetics, presenting during exercise above the ventilatory threshold (VT), remains unclear. Possible physiologic mechanisms include a progressive recruitment of type II muscle fibers. The purpose of this study was to examine alterations in muscle activity through electromyography (EMG) and mean power frequency (MPF) analysis during heavy cycling exercise. Eight trained cyclists (mean±S.E.; age=30±3 years, height=177±4 cm, weight=73.8±6.5 kg, VO2max=4.33±0.28lmin−1) completed transitions from 20 W to a workload equaling 50% of the difference between VT and VO2max. VO2 was monitored using a breath-by-breath measurement system, and EMG data were gathered from …

Influence Of A Functional Knee Brace And Exercise On Lower Extremity Kinematics During Jogging, Brian M. Campbell, Daniel Cipriani, James A. Yaggie

Physical Therapy Faculty Articles and Research

ABSTRACT Context: Functional knee braces (FKB) are used prophylactically and in rehabilitation to aide in the functional stability of the knee joint. Objective: To determine if alterations in sagittal plane lower extremity kinematics remain evident throughout a one hour period in healthy individuals. Design: 2X5 repeated measures design. Setting: Biomechanics Laboratory. Subjects: Twenty subjects (14 male and 6 female, mean age 26.5±7 yrs; height 172.4±13 cm; weight 78.6±9 kg), separated into braced (B) and no brace (NB) groups. Intervention: A one-hour exercise program divided into three 20 minute increments. Main Outcome Measures: Synchronized three-dimensional …

Does Motor Lateralization Have Implications For Stroke Rehabilitation?, Robert L. Sainburg, Susan V. Duff

Physical Therapy Faculty Articles and Research

Recent findings on motor lateralization have revealed consistent differences in the control strategies of the dominant and nondominant hemisphere/limb systems that could have implications for hemiplegic stroke patients. Studies in stroke patients have demonstrated deficiencies in the ipsilesional arm that reflect these distinctions; patients with right-hemisphere damage tend to show deficits in positional accuracy, and patients with left-hemisphere damage show deficits in trajectory control. Such deficits have been shown to impede functional performance; yet patients with severe dominant-side hemiplegia must often use the nondominant arm as the primary manipulator for activities of daily living. Nevertheless, the nondominant arm may not …

The Role Of Lower Leg Muscle Activity In Blood Pressure Maintenance Of Older Adults, Michelle M. Masterson, Amy L. Morgan, Christine E. Multer, Daniel Cipriani

Physical Therapy Faculty Articles and Research

Purpose. Age-associated muscle weakness, postural instability, and orthostatic hypotension have been identified as contributing factors to falls , but the relationships among them are not clear. Therefore, the purpose of this study, a two-way factorial design, was to investigate the differences in lower extremity (LE) muscle activity, blood pressure (BP), and heart rate (HR) between young and older individuals in an upright position. Methods. Ten young males (20-24 yrs.) and 10 older males (65-82 yrs.) stood for 15 minutes while BP, HR, and LE electromyography (EMG) were recorded at one minute intervals . A two-way ANOVA was used …

Safe At The Shoulder, Daniel Cipriani

Physical Therapy Faculty Articles and Research

The key to preventing shoulder injuries is understanding the anatomy of the shoulder complex and how the body's other muscles affect the throwing motion