Rehabilitation and Therapy Commons^™

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 …

Effects Of Rucksack Military Accessory On Gait Dynamic Stability, Seong H. Moon, Christopher W. Frames, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Various factors are responsible for injuries that occur in the U.S. Army soldiers. In particular, rucksack load carriage equipment influences the stability of the lower extremities and possibly affects gait balance. The objective of this investigation was to assess the gait and local dynamic stability of the lower extremity of five subjects as they performed a simulated rucksack march on a treadmill. The Motek Gait Real-time Interactive Laboratory (GRAIL) was utilized to replicate the environment of the rucksack march. The first walking trial was without a rucksack and the second set was executed with the All-Purpose Lightweight Individual Carrying Equipment …

Different Biomechanical Variables Explain Within-Subjects Versus Between-Subjects Variance In Step Length Asymmetry Post-Stroke, Natalia Sánchez, Nicolas Schweighofer, James M. Finley

Physical Therapy Faculty Articles and Research

Step length asymmetry (SLA) is common in most stroke survivors. Several studies have shown that factors such as paretic propulsion can explain between-subjects differences in SLA. However, whether the factors that account for between-subjects variance in SLA are consistent with those that account for within subjects, stride-by-stride variance in SLA has not been determined. SLA direction is heterogeneous, and different impairments likely contribute to differences in SLA direction. Here, we identified common predictors between-subjects that explain within-subjects variance in SLA using sparse partial least squares regression (sPLSR). We determined whether the SLA predictors differ based on SLA direction and whether …

Using Biofeedback To Reduce Spatiotemporal Asymmetry Impairs Dynamic Balance In People Post-Stroke, Sungwoo Park, Chang Liu, Natalia Sánchez, Julie K. Tilson, Sara J. Mulroy, James M. Finley

Physical Therapy Faculty Articles and Research

Background. People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective. We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods. We performed clinical balance assessments and measured wholebody angular momentum during walking using a full-body marker set in a sample of 36 people with …

The Role Of Pre-Season Health Characteristics As Injury Risk Factors In Female Adolescent Soccer Players, Brent Harper, Adrian Aron, Emmanuel John

Physical Therapy Faculty Articles and Research

[Purpose] Determine if female adolescent soccer players with a history of concussion, impaired K-D scores, and pre-season subjective complaints of neck pain, dizziness, and headache were predisposed to additional risk of musculoskeletal or concussive injury during 10-weeks of competitive play. [Participants and Methods] Twenty-three female high school soccer athletes provided concussion history and reported pre-season subjective complaints. K-D testing was performed pre and postseason. During the 10-week season, all injuries, preventing participation in practice or game, were recorded. [Results] Six reported a history of concussion. Of those six, three injuries were reported, including two concussions and a hamstring strain. Baseline …

Lost In Translation: Simple Steps In Experimental Design Of Neurorehabilitation-Based Research Interventions To Promote Motor Recovery Post-Stroke, Natalia Sánchez, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Stroke continues to be a leading cause of disability. Basic neurorehabilitation research is necessary to inform the neuropathophysiology of impaired motor control, and to develop targeted interventions with potential to remediate disability post-stroke. Despite knowledge gained from basic research studies, the effectiveness of researchbased interventions for reducing motor impairment has been no greater than standard of practice interventions. In this perspective, we offer suggestions for overcoming translational barriers integral to experimental design, to augment traditional protocols, and re-route the rehabilitation trajectory toward recovery and away from compensation. First, we suggest that researchers consider modifying task practice schedules to focus on …

Comparison Of 360° Turn Cycles Among Individuals After Stroke And Healthy Older Adults, Rahul Soangra, Vennila Krishnan, Joby John, Ehsan Rashedi, Alison Mckenzie

Physical Therapy Faculty Articles and Research

Stroke survivors are at high risk of falling during turning. The kinematics of performing a 360° turn have not been fully analyzed among individuals after stroke. Quantitative differences in the parameters of turning between healthy older adults and those after stroke could provide detailed information on turning ability among these groups. The purpose of the current study was to characterize differences between healthy older adults and adults after stroke in 360° turn kinematics. Fourteen individuals with chronic stroke (mean age: 69 ± 8.4 years) and 14 healthy older adults (mean age: 74 ± 8.7 years) performed three trials of 360° …

Foot Contact Dynamics And Fall Risk Among Children Diagnosed With Idiopathic Toe Walking, Rahul Soangra, Michael Shiraishi, Richard Beuttler, Michelle Gwerder, Louanne Boyd, Venkateswaran Muthukumar, Mohamed Trabia, Afshin Aminian, Marybeth Grant-Beuttler

Physical Therapy Faculty Articles and Research

Children that are diagnosed with Idiopathic Toe walking (cITW) are characterized by persistent toe-to-toe contacts. The objective of this study was to explore whether typical foot contact dynamics during walking predisposes cITW to a higher risk of falling. Twenty cITW and agematched controls performed typical and toe walking trials. The gait parameters related to foot contact dynamics, vertical force impulses during stance, slip, and trip risk were compared for both groups. We found that cITW manifest less stable gait and produced significantly higher force impulses during push-off. Additionally, we found that cITW had a higher slip-initiation risk that was associated …

Smartphone-Based Prediction Model For Postoperative Cardiac Surgery Outcomes Using Preoperative Gait And Posture Measures, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Gait speed assessment increases the predictive value of mortality and morbidity following older adults’ cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h were …

Reliability Of A Barre-Mounted Dynamometer-Stabilizing Device In Measuring Dance-Specific Muscle Performance, Melissa Strzelinksi, Lori Thein Brody, Jo Armour Smith, Shaw Bronner

Physical Therapy Faculty Articles and Research

BACKGROUND: Hand-held dynamometry is considered an efficient, effective, and portable means of objectively measuring lower extremity strength; however, it has yet to be studied specific to dance-relevant muscle performance. Also, dynamometry is often criticized for variability in results based on tester strength and sex. Use of an external stabilizing device has been suggested to minimize differences in outcomes between male and female testers by reducing variability associated with tester strength limitations. Therefore, this study used a barre-mounted, portable dynamometer stabilizing device to improve consistency of results among different testers for assessing hip and lower extremity muscle performance in dance-relevant positions. …

Surface Inclination Influences Fall Risk And Lower Extremity Joint Moments During Walking, Rachel Kling, Alex Chung, Courtney Cox, Emily Kimbro, Jim Grodzielanek, Stephen Ayres, Shireen Hosseini, Michael Shiraishi, Rahul Soangra

Physical Therapy Faculty Articles and Research

Falls present a large danger to the geriatric population, with one in three individuals over the age of 65 experiencing at least one fall annually. With most falls occurring while walking, the relationship between inclined walking and fall risk has not been fully explored. In this study, 16 healthy young participants (age: 26.8 ±5.4 years, height: 175.0±11.0 cm, weight: 68.2 ±19.9 kg) walked on a treadmill with level surface and 10 degrees incline/decline in a virtual environment laboratory. We found that gait parameters and lower extremity joint moments were affected by surface inclination. These observed changes in joint moments and …

Effects Of Auditory Cueing On Cadence And Gait Pattern, Andrew Carballo, Matthew Chang, Brian Hirmiz, Nicolette Lambright, Vivian Lee, Marla Lewis, Martin Nguyen, Matthew Gothong, Rahul Soangra

Physical Therapy Faculty Articles and Research

A large portion of the population participate in gait rehabilitation, especially those with conditions such as increased fall risk such as stroke, or Parkinson’s Disease. Some studies have shown that auditory cues help improve gait and reduce fall risk, but relationship with gait patterns is missing. In this study, eight participants walked at their preferred cadence and at increased and reduced cadence by 20%. We found that step length and step width were not significantly different in all walking conditions. Decreased cadence resulted in an increase of swing time, stance time, stride time, and stance to swing ratio, and a …

Asymmetric Load Carriage At Shoulder Height Affects Temporal Gait Characteristics Among Food Service Workers, Christopher Espino, Robin Faustino, Tiffany Franco, Angel Reign Galvan, Matthew Gothong, Ennis Khaleq, Cody Occhino, Rahul Soangra

Physical Therapy Faculty Articles and Research

Slips and falls are common injuries among restaurant and food service workers. It is estimated that food service workers have 60% higher rate of occupational injury or illness than workers in other industry. This study investigates effects of asymmetric load carriage at shoulder level on gait characteristics. Each participant walked with a service tray held at shoulder height. Each participant’s gait was analyzed under 3 different load walking conditions, no load walking (NLW), intermediate load walking (ILW) (2.5% BW), and maximum load walking (MLW) (5% BW). We found that participants walked significantly slower with gait cycle time 1.125s versus 1.150 …

Load Carriage Affects Kinematics During Ingress And Egress On Simulated Travelators, Alex Charbonneau, Ben Garson, Fiona Bisoffi, Stephanie Esparza, Miral Bhakta, Luke Bailey, Rahul Soangra

Physical Therapy Faculty Articles and Research

Technology advancements has impacted the quality of life in the modern world. Nowadays travelators found popularly as conveyers in airports have been widely used but it is not known how load carriage affects Ingress/egress on travelators. Ten healthy young adults stepped off a metal platform onto a forward moving treadmill belt at a given speed and then stepped on to a second platform. Data was collected to understand how load carriage could influence ingress and egress in participants. Participants were tested for four conditions (load, No load, speed of 0.3 m/s and 0.6 m/s). Load carriage at speed 0.6 m/s …

A Feasibility Study Of Expanded Home-Based Telerehabilitation After Stroke, Steven C. Cramer, Lucy Dodakian, Vu Le, Alison Mckenzie, Jill See, Renee Augsburger, Robert J. Zhou, Sophia M. Raefsky, Thalia Nguyen, Benjamin Vanderschelden, Gene Wong, Daniel Bandak, Laila Nazarzai, Amar Dhand, Walt Scacchi, Jutta Heckhausen

Physical Therapy Faculty Articles and Research

Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program.

Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors …

Social Network Structure Is Related To Functional Improvement From Home-Based Telerehabilitation After Stroke, Archana Podury, Sophia M. Raefsky, Lucy Dodakian, Liam Mccafferty, Vu Le, Alison Mckenzie, Jill See, Robert J. Zhou, Thalia Nguyen, Benjamin Vanderschelden, Gene Wong, Laila Nazarzai, Jutta Heckhausen, Steven C. Cramer, Amar Dhand

Physical Therapy Faculty Articles and Research

Objective: Telerehabilitation (TR) is now, in the context of COVID-19, more clinically relevant than ever as a major source of outpatient care. The social network of a patient is a critical yet understudied factor in the success of TR that may influence both engagement in therapy programs and post-stroke outcomes. We designed a 12-week home-based TR program for stroke patients and evaluated which social factors might be related to motor gains and reduced depressive symptoms.

Methods: Stroke patients (n = 13) with arm motor deficits underwent supervised home-based TR for 12 weeks with routine assessments of motor function and …

Using Asymmetry To Your Advantage: Learning To Acquire And Accept External Assistance During Prolonged Split-Belt Walking, Natalia Sánchez, Surabhi N. Simha, J. Maxwell Donelan, James M. Finley

Physical Therapy Faculty Articles and Research

People can learn to exploit external assistance during walking to reduce energetic cost. For example, walking on a split-belt treadmill affords the opportunity for people to redistribute the mechanical work performed by the legs to gain assistance from the difference in belts’ speed and reduce energetic cost. Though we know what people should do to acquire this assistance, this strategy is not observed during typical adaptation studies. We hypothesized that extending the time allotted for adaptation would result in participants adopting asymmetric step lengths to increase the assistance they can acquire from the treadmill. Here, participants walked on a split-belt …

Effects Of Visual Referencing On Backward And Forward Treadmill Walking In Vr Environments, Rahul Soangra, Sivakumar Rajagopal

Physical Therapy Faculty Articles and Research

Backward walking is used increasingly as a rehabilitation exercise for stroke and diabetic peripheral neuropathy patients to improve strength and balance. However, it is unclear how visual referencing affects backward and forward walking. In this study, we evaluated spatiotemporal gait characteristics changes due to visual referencing while backward/forward walking. Sixteen healthy young participants were recruited in this study. All participants walked for 2 min with and without visual referencing in the virtual reality environment. While walking backward participants faced the virtual reality screen similar to forward walking, but their treadmill belt direction of movement was reversed. All participants walked at …

Proposing A New Algorithm For Premanipulative Testing In Physical Therapy Practice, Brent Harper, Daniel Miner, Harrison Vaughan

Physical Therapy Faculty Articles and Research

In the field of physical therapy, there is debate as to the clinical utility of premanipulative vascular assessments. Cervical artery dysfunction (CAD) risk assessment involves a multi-system approach to differentiate between spontaneous versus mechanical events. The purposes of this inductive analysis of the literature are to discuss the link between cervical spine manipulation (CSM) and CAD, to examine the literature on premanipulative vascular tests, and to suggest an optimal sequence of premanipulative testing based on the differentiation of a spontaneous versus mechanical vascular event. Knowing what premanipulative vascular tests assess and the associated clinical application facilitates an evidence-informed decision for …

Gains Across Who Dimensions Of Function After Robot-Based Therapy In Stroke Subjects, Jennifer Wu, Lucy Dodakian, Jill See, Erin Burke Quinlan, Lisa Meng, Jeby Abraham, Ellen C. Wong, Vu Le, Alison Mckenzie, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Background

Studies examining the effects of therapeutic interventions after stroke often focus on changes in loss of body function/structure (impairment). However, improvements in activities limitations and participation restriction are often higher patient priorities, and the relationship that these measures have with loss of body function/structure is unclear.

Objective

This study measured gains across WHO International Classification of Function (ICF) dimensions and examined their interrelationships.

Methods

Subjects were recruited 11 to 26 weeks after hemiparetic stroke. Over a 3-week period, subjects received 12 sessions of intensive robot-based therapy targeting the distal arm. Each subject was assessed at baseline and at 1 …

Mediolateral Damping Of An Overhead Body Weight Support System Assists Stability During Treadmill Walking, M. Bannwart, S. L. Bayer, Niklas König Ignasiak, M. Bolliger, G. Rauter, C. A. Easthope

Physical Therapy Faculty Articles and Research

Background

Body weight support systems with three or more degrees of freedom (3-DoF) are permissive and safe environments that provide unloading and allow unrestricted movement in any direction. This enables training of walking and balance control at an early stage in rehabilitation. Transparent systems generate a support force vector that is near vertical at all positions in the workspace to only minimally interfere with natural movement patterns. Patients with impaired balance, however, may benefit from additional mediolateral support that can be adjusted according to their capacity. An elegant solution for providing balance support might be by rendering viscous damping along …

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

Physical Therapy Faculty Articles and Research

Background

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

Methods

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

Automatic Detection Of Dynamic And Static Activities Of The Older Adults Using A Wearable Sensor And Support Vector Machines, Jian Zhang, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Although Support Vector Machines (SVM) are widely used for classifying human motion patterns, their application in the automatic recognition of dynamic and static activities of daily life in the healthy older adults is limited. Using a body mounted wireless inertial measurement unit (IMU), this paper explores the use of an SVM approach for classifying dynamic (walking) and static (sitting, standing and lying) activities of the older adults. Specifically, data formatting and feature extraction methods associated with IMU signals are discussed. To evaluate the performance of the SVM algorithm, the effects of two parameters involved in SVM algorithm—the soft margin constant …

Mini-Logger- A Wearable Inertial Measurement Unit (Imu) For Postural Sway Analysis, Michael Pollind, Rahul Soangra

Physical Therapy Faculty Articles and Research

Postural instability assessment is an important tool in fall risk analysis and for timely intervention of falls to reduce or prevent fall injuries. Traditionally fall risk is measured though postural sway assessment and is collected through forceplates by mapping Center of Pressure (COP) excursions or using motion analysis camera system for marker sway trajectories. However, both of these systems are expensive and lack portability to their usage in clinical environments. In this study, we developed a novel wearable low-cost MEMS inertial sensor and validated its usage for human postural sway assessment in standing posture with eyes open/closed, vibration/no vibration, and …

Development And Validation Of Wearable Inertial Sensor System For Postural Sway Analysis, Michael Pollind, Rahul Soangra

Physical Therapy Faculty Articles and Research

Postural sway is a fall risk assessment tool traditionally measured using forceplates. However, it is expensive and lack portability to usage in clinical environments. In this study, a wearable low-cost MEMS inertial sensor was developed and validated for sway assessment. This study had two principal objectives (1) To develop and validate an Inertial Measurement Unit (IMU) for sway analysis (2) To assess the feasibility of IMU in detecting slight balance impairments due to reduced proprioception or induced subthreshold vibrations on the feet. A total of 10 healthy young adults (five males and five females) participated in this study. We found …

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

Physical Therapy Faculty Articles and Research

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

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

Physical Therapy Faculty Articles and Research

Background

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

Research question

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

Methods

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

Anterior Talofibular Ligament And Superior Extensor Ankle Retinaculum Thicknesses: Relationship With Balance, Brooke Malloy, David Furrow, Haily Cook, Elizabeth Smoot, Lindsey Cash, Adrian Aron, Kristen Jagger, Brent Harper

Physical Therapy Faculty Articles and Research

Purpose

This study determined if anterior talofibular ligament (ATFL)/superior extensor ankle retinaculum (SEAR) thicknesses are related to dynamic balance in individuals with chronic ankle instability (CAI).

Materials and Methods

The subjects were 14 males and 15 females (age=24.52±3.46 years). Ankle instability was assessed using the Cumberland Ankle Instability Tool (CAIT) with a cut off score of 25 to define two groups. SonoSite MTurbo (Fugifilm Sonosite, Inc.) musculoskeletal ultrasound (MSKUS) unit was used to assess ATFL and SEAR thicknesses. Dynamic balance was measured with the Y Balance Test (YBT) and two NeuroCom balance tests.

Results

There were no significant differences in …

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

Physical Therapy Faculty Articles and Research

Objective

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

Design

Case‐control with randomization of conditions.

Setting

Clinical Research Laboratory.

Participants

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

Interventions

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

A Qualitative Study On The User Acceptance Of A Home-Based Stroke Telerehabilitation System, Yu Chen, Yunan Chen, Kai Zheng, Lucy Dodakian, Jill See, Robert Zhou, Renee Augsburger, Alison Mckenzie, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Objective: This paper reports a qualitative study of a home-based stroke telerehabilitation system. The telerehabilitation system delivers treatment sessions in the form of daily guided rehabilitation games, exercises, and stroke education in the patient’s home. The aims of the current report are to investigate patient perceived benefits of and barriers to using the telerehabilitation system at home.

Methods: We used a qualitative study design that involved in-depth semi-structured interviews with 13 participants who were patients in the subacute phase after stroke and had completed a six-week intervention using the home-based telerehabilitation system. Thematic analysis was conducted to analyze …