Rehabilitation and Therapy Commons^™

Physical Therapy Management Of A Patient With Chronic Knee Pain: A Case Report, Mohamed Elsaid

Case Report Papers

Background and Purpose: Knee pain affects a large number of adults, and as a result limits their functional mobility and may induce participation restrictions. A number of risk factors may contribute to knee pain, with osteoarthritis (OA) being the most prevalent cause. The rate of knee replacement surgery among individuals 65 and older has increased significantly over the years. Physical therapy (PT) is a non-surgical option that offers individuals relief of their knee pain. Case Description: The patient was a 48-year-old Caucasian female referred to physical therapy with chronic right knee pain. She received PT twice a week for eight …

Management Of A Patient With Bronchiectasis Using Pulmonary Rehabilitation And Balance Training: A Case Report, Megan Witherow Quarles

Case Report Papers

Background and Purpose: Bronchiectasis is a chronic lung disease defined by permanent, abnormal dilation of the bronchi and accompanied by chronic airway infection which leads to airway inflammation. Bronchiectasis is progressive and leads to a cycle of worsening pulmonary damage. Pulmonary rehabilitation, including progressive gait training, cycling, and stair climbing, is often utilized as treatment for this condition. However, there has been little research conducted on its effectiveness for bronchiectasis. The purpose of this case report is to examine physical therapy (PT) management, utilizing pulmonary rehabilitation with incorporated balance training, for a geriatric patient with bronchiectasis. Description: The patient was …

E For Everyone: Strategic Plan, Lindsay Calcaterra, Kaela Fischer, Kelley Flahaven, Megan Witherow Quarles, Maria Stern, Christina Tilton

Physical Therapy Administration

‘E for Everyone’ is an innovative and unique inclusion program that equalizes the playing field among all people with and without disabilities by creating opportunities to build synergistic relationships through teamwork, fun, and physical activity. Created during the Fall 2016 semester of the course Physical Therapy Administration, this strategic plan summarizes the program.

E For Everyone: Implementation Guide, Lindsay Calcaterra, Kaela Fischer, Kelley Flahaven, Megan Witherow Quarles, Maria Stern, Christina Tilton

Physical Therapy Administration

‘E for Everyone’ is an innovative and unique inclusion program that equalizes the playing field among all people with and without disabilities by creating opportunities to build synergistic relationships through teamwork, fun, and physical activity. Created during the Fall 2016 semester, concurrent with the course Physical Therapy Administration, this implementation guide describes the step by step process for implementing the program.

Physical Therapy Management Of A Patient With Chronic Brainstem Stroke Syndrome To Improve Functional Mobility: A Case Report, Kelley Flahaven

Case Report Papers

Background and Purpose: Brainstem strokes are much less common and have a higher mortality rate than cortical strokes. Brainstem strokes can lead to several physical impairments, including gaze palsies, quadriplegia, ataxia, or cranial nerve deficits, leading to decreased balance and safety as well as decreased independence with functional activities. The purpose of this case report is to provide an overview of the physical therapy care plan created for a patient with chronic brainstem strokes. Case Description: The patient is a middle-aged man who had two brainstem strokes over two years ago. He initially received physical, occupational, and speech therapies, then …

Functional Training In A Patient With Middle Cerebral Artery Stroke With Multiple Comorbidities: A Case Report, Darien Lewis

Case Report Papers

Background and Purpose: Strokes affecting the middle cerebral artery (MCA) cause impairments of recovery affected by the patient’s premorbid status. Although there is a significant amount of research detailing physical therapy (PT) interventions for patients with hemiplegia, there is a lack of evidence supporting interventions for patients with hemiplegia following stroke that have multiple comorbidities. The purpose of this case report is to describe a progressive PT plan of care (POC) for a patient following MCA stroke with multiple comorbidities in the skilled nursing setting. Case Description: The patient was a 71-year-old male admitted to the skilled nursing facility (SNF) …

The Use Of Manual Therapy In The Treatment Of A Patient With Chronic Low Back Pain And Sciatica: A Case Report, Elia N. Darazi

Case Report Papers

Background: Chronic low back pain (CLBP) is one of the most common conditions encountered in an outpatient physical therapy (PT) setting. While there are many different approaches used in the treatment of CLBP, the purpose of this case report is to detail the successful utilization of a short-course of manual therapy (MT) for a patient with CLBP and sciatica. Case Description: The patient was a 60-year-old male who presented to PT with a medical diagnosis of nerve root compression-left sciatica. At the initial evaluation, he presented with radiating left sided low back and lower extremity pain of approximately six months …

Restoring Gait And Functional Mobility For A Patient With An Ischemic Stroke Through Physical Therapy: A Case Report, Colleen Kelly

Case Report Papers

Stroke is the primary cause of disability and care dependency in adults in the United States. Research has found that the risk of mortality post stroke can be greatly reduced through stroke rehabilitation. The purpose of this case report is to provide a framework of physical therapy rehabilitation that facilitated functional mobility and gait in a patient who experienced a stroke. The patient was a 50-year old male who was admitted to an inpatient rehabilitation hospital for physical therapy following a left middle cerebral artery ischemic stroke four days prior. The patient received three weeks of physical therapy after displaying …

Profiles Of Fatigue Severity And Variability Among Adolescents And Young Adults With Cerebral Palsy, Laura K. Brunton, Doreen J. Bartlett

Physical Therapy Publications

Background: Individuals with cerebral palsy (CP) experience progressive changes in functional status with the development of secondary impairments such as fatigue. Detailed accounts of the fatigue experience in CP are lacking.

Purpose: This study describes the severity and variability of fatigue in CP using the Fatigue Impact and Severity Self-Assessment.

Methods: This was a descriptive cross-sectional study surveying 130 (61 males) individuals (mean age 18 years, 11 months; SD four years, six months) with CP. Analyses comprised comparisons between two groups (Gross Motor Function Classification System (GMFCS) I and II-V), frequency counts and proportions.

Results: Significant differences exist between GMFCS …

Physical Therapy And Cognitive Behavioral Therapy In A Patient With Multiple Co-Morbidities – A Case Report, Jeanine Manubay

Case Report Papers

Background and Purpose: Cognitive behavioral therapy (CBT) is grounded in the premise that by altering a patient’s negative thought processes, one can improve functional and emotional health. When multiple co-morbidities limit traditional physical therapy interventions, CBT may be a consideration. While CBT has shown benefits in patients with cancer and others, there is a lack of research investigating its effectiveness in conjunction with physical therapy (PT) in the medically complex patient. The purpose of this case report was to document the outcomes of CBT along with traditional PT for a medically complex patient diagnosed with end stage renal disease and …

Use Of Functional Strengthening, Balance Training, And Stretching In The Treatment Of A Patient Following A T11-L5 Spinal Fusion: A Case Report, Anna Sidloski

Case Report Papers

Background and Purpose: Lumbar spinal fusion surgery has been utilized to manage levels of low back pain and instability. However, pain often persists post-operatively. Evidence supports the use of Transverse Abdominis recruitment in patients with LBP. Research demonstrates strengthening the hip musculature may allow for improved outcomes for those who experience LBP. There is limited research focusing on lower extremity strengthening, flexibility, and balance training in a patient following a T11-L5 spinal fusion. Case Description: The patient was a 68-year-old male presenting to physical therapy eight weeks’ status post T11-L5 spinal fusion with ~45 degrees forward-flexed posture, weak lower extremity …

Therapeutic Exercise In The Treatment Of Greater Trochanteric Pain Syndrome S/P Lumbar Discectomy: A Case Report, Sean Jeffrey

Case Report Papers

Background and Purpose: Greater trochanteric pain syndrome (GTPS) is a multifactorial cause of lateral hip pain, affecting between 1.8 and 5.6 patients per 1000 per year. The prevalence of GTPS is more common in patients with coexisting low back pain. Though discectomy is effective in the treatment of prolapsed lumbar intervertebral discs, it does not correct concurrent hip pathology. As GTPS in the setting of discectomy rehabilitation lacks defined treatment guidelines, the purpose of this case report is to display physical therapy (PT) treatment of GTPS in conjunction with simultaneous rehab from lumbar microdiscectomy.
Case Description: A 56-year-old male was …

Adaptations Of Lumbar Biomechanics After Four Weeks Of Running Training With Minimalist Footwear And Technique Guidance: Implications For Running-Related Lower Back Pain, Szu-Ping Lee, Joshua P. Bailey, Jo Armour Smith, Stephanie Barton, David Brown, Talia Joyce

Physical Therapy Faculty Articles and Research

Objectives

To investigate the changes in lumbar kinematic and paraspinal muscle activation before, during, and after a 4-week minimalist running training.

Design

Prospective cohort study.

Setting

University research laboratory.

Participants

Seventeen habitually shod recreational runners who run 10–50 km per week.

Main outcome measures

During stance phases of running, sagittal lumbar kinematics was recorded using an electrogoniometer, and activities of the lumbar paraspinal muscles were assessed by electromyography. Runners were asked to run at a prescribed speed (3.1 m/s) and a self-selected speed.

Results

For the 3.1 m/s running speed, significant differences were found in the calculated mean lumbar posture …

Physical Therapy Intervention For A Patient With Temporomandibular Joint Dysfunction Caused By Two Traumatic Events: A Case Study, Elyse Detweiler

Case Report Papers

Background and Purpose: Temporomandibular disorders (TMD) are pathoanatomical dysfunctions of the temporomandibular joint (TMJ) associated with symptoms throughout the head and neck.Limited information exists regarding conservative physical therapy (PT) and post-surgical management of TMD. The dental profession is the main source of published literature specific to TMD. This paper describes a conservative and post-surgical PT plan of care (POC) for TMD. Case Description: A 32-year old female experienced two separate traumatic events at work resulting in TMD. She was referred to PT after the second assault because of symptoms of severe pain, limited range of motion, and jaw locking. She …

Preseason Jump And Hop Measures In Male Collegiate Basketball Players: An Epidemiologic Report, Jason Brumitt, Amy Engilis, Dale Isaak, Amy Briggs, Alma Mattocks

Faculty Publications - College of Physical Therapy

Background: Injuries are inherent in basketball with lower extremity (LE) injury rates reported as high as 11.6 per 1000 athletic exposures (AEs); many of these injuries result in time loss from sport participation. A recent trend in sports medicine research has been the attempt to identify athletes who may be at risk for injury based on measures of preseason fitness.

Hypothesis/Purpose: The purpose of this prospective cohort study was to determine if the standing long jump (SLJ) and/or the single-leg hop (SLH) for distance functional performance tests (FPT) are associated with non-contact time loss lower quadrant (LQ, defined as lower …

Temporary Nerve Block At Selected Digits Revealed Hand Motor Deficits In Grasping Tasks, Aude Cateron, Kerry Mcpartlan, Christina Gioeli, Emily Reid, Matt Turturro, Barry Hahn, Cynthia Benson, Wei Zhang

Publications and Research

Peripheral sensory feedback plays a crucial role in ensuring correct motor execution throughout hand grasp control. Previous studies utilized local anesthesia to deprive somatosensory feedback in the digits or hand, observations included sensorimotor deficits at both corticospinal and peripheral levels. However, the questions of how the disturbed and intact sensory input integrate and interact with each other to assist the motor program execution, and whether the motor coordination based on motor output variability between affected and non-affected elements (e.g., digits) becomes interfered by the local sensory deficiency, have not been answered. The current study aims to investigate the effect of …

Influence Of Posture-Cuing Shirt On Tennis Serve Kinematics In Division Iii Tennis Players, Joseph Zappala, Caroline Orrego, Emily Boe, Heather Fechner, Derek Salminen, Daniel Cipriani

Physical Therapy Faculty Articles and Research

Objective: Injuries to the shoulder complex are common in overhead athletes, often related to kinematics of the shoulder complex. This study evaluated the influence of a posture-cuing shirt on internal rotation velocity of the shoulder during a tennis swing and to determine this influence on shoulder external rotation position. Methods: Nine healthy competitive college tennis players from a Division III college participated in this study. High speed motion capture allowed for 3-D analysis of shoulder kinematics during a tennis serve. Two conditions were evaluated while the athletes performed a high velocity tennis serve: standard tennis shirt and a …

Standing Balance And Spatiotemporal Aspects Of Gait Are Impaired Upon Nocturnal Awakening In Healthy Late Middle-Aged And Older Adults, Amanda L. Mcbean, Raymond P. Najjar, Ronald A. Schuchard, Courtney D. Hall, Cheng-Ann Wang, Ban Ku, Joseph M. Furman

ETSU Faculty Works

Study Objectives: Nocturnal awakenings may constitute a unique risk for falls among older adults. We describe differences in gait and balance between presleep and midsleep testing, and whether changes in the lighting environment during the midsleep testing further affect gait and balance.

Methods: Twenty-one healthy, late middle-aged and older (64.7 ± 8.0 y) adults participated in this repeated-measures design consisting of four overnight laboratory stays. Each night, participants completed baseline visual acuity, gait, and balance testing. After a 2-h sleep opportunity, they were awakened for 13 min into one of four lighting conditions: very dim white light (< 0.5 lux); dim white light (∼28.0 lux); dim orange light (∼28.0 lux); and white room-level light (∼200 lux). During this awakening, participants completed the same sequence of testing as at baseline.

Results: Low-contrast …

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

Physical Therapy Research Symposium

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

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

Physical Therapy Research Symposium

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

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

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

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

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

Physical Therapy Research Symposium

Theory:

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

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

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

Physical Therapy Research Symposium

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

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

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

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

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

Physical Therapy Research Symposium

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

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

Physical Therapy Research Symposium

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

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

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

Click Here! E-Learning Modules For Innovative Instruction And Learning, Nicole M. Sleddens, Betsy J. Becker, Sara E. Bills

Posters and Presentations: Physical Therapy

Purpose: Re-designing all or portions of a course with a fresh perspective can re-energize faculty and make the content more engaging for the learner. Teaching the millennial generation is also prompting faculty to revisit educational strategies. The use of electronic learning platforms, such as eLearning modules, is an innovative learning strategy with several reported benefits including flexibility and convenience for usage, ability for learners to study at their own pace and adaptability to different learning styles. Using technology that is free or already available to faculty, even the novice designer can begin development of these useful study tools. The key …

Same-Day Physical Therapy Consults In An Outpatient Neuromuscular Disease Physician Clinic, Evan M. Pucillo, Nancy Christensen-Mayer, Shelly D. Poole, Denise M. Whitten, Danielle Freeman, Blake R. Bohe, Brandon R. Swensen, A Gordon Smith, Nicholas E. Johnson

Physical Therapy Collection

Background: Team-based care has been shown to offer more comprehensive benefits to patients when compared to standard physician-based care alone in clinics for chronic conditions. However, apart from grant-funded multidisciplinary clinics, there are no reports on the usage of same-day physical therapy (PT) consults within a daily outpatient neuromuscular disease (NMD) physician clinic.

Objective: To determine the impact of same-day PT consults at the University of Utah’s outpatient Clinical Neurosciences Center.

Design: A qualitative assessment and survey of patient satisfaction.

Methods: An eight question Health Insurance Portability and Accountability Act-compliant patient satisfaction survey using a 5-point Likert scale was …

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

Physical Therapy Research Symposium

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

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

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

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

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

Physical Therapy Research Symposium

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

Evaluation Of The Healing Progress Of Pressure Ulcers Treated With Cathodal High-Voltage Monophasic Pulsed Current: Results Of A Prospective, Double-Blind, Randomized Clinical Trial, Anna Polak, Luther C. Kloth, Edward Blaszczak, Jakub Taradaj, Agnieszka Nawrat-Szoltysik, Lidia Bialek, Malgorzata Paczula, Andrzej Franek, Cezary Kucio

Physical Therapy Faculty Research and Publications

OBJECTIVE: To investigate the effectiveness of high-voltage monophasic pulsed current (HVMPC) as an adjunct to a standard wound care for the treatment of Stage II and III pressure ulcers (PrUs).

DESIGN: Prospective, randomized, double-blind, controlled clinical study.

SETTING: Two nursing and care centers.

PATIENTS: Patients with PrUs that did not respond to previous treatment for at least 4 weeks were randomly assigned to the electrical stimulation (ES) group (25 patients; mean age of 79.92 ± 8.50 years; mean wound surface area [WSA] of 10.58 ± 10.57 cm²) or to the control group (24 patients; mean age of 76.33 …

Role Of Vascular Reactive Oxygen Species In Regulating Cytochrome P450-4a Enzyme Expression In Dahl Salt-Sensitive Rats, Kathleen M. Lukaszewicz, Mahesh P. Paudyal, John R. Falck, Julian H. Lombard

Physical Therapy Faculty Research and Publications

Objective

The potential contribution of CYP4A enzymes to endothelial dysfunction in Dahl salt-sensitive rats was determined by comparison to SS-5^BN consomic rats having chromosome 5 carrying CYP4A alleles from the BN rat introgressed into the SS genetic background.

Methods

The following experiments were performed in cerebral arteries from HS-fed SS and SS-5^BN rats ± the SOD inhibitor DETC and/or the superoxide scavenger Tempol: (i) endothelial function was determined via video microscopy ± acute addition of the CYP4A inhibitor DDMS or Tempol; (ii) vascular oxidative stress was assessed with DHE fluorescence ± acute addition of DDMS, l-NAME, or PEG-SOD; …