Rehabilitation and Therapy Commons^™

A Collaborative Approach To Decision Making Through Developmental Monitoring To Provide Individualized Services For Children With Cerebral Palsy., Doreen J Bartlett, Sarah W Mccoy, Lisa A Chiarello, Lisa Avery, Barbara Galuppi, On Track Study Team

Physical Therapy Publications

In this Perspective, we suggest a process to improve physical and occupational therapists’ and families’ collaboration to provide appropriate, efficient, and effective evidence-based services to improve motor function, self-care performance, and participation in family and recreation activities for children with cerebral palsy (CP). This process is informed by 2 multisite prospective cohort studies (Move & PLAY and On Track). The heterogeneity of children with CP is described, limiting the utility of evidence from randomized controlled trials and systematic reviews to inform service planning for children with CP. An evidence-based alternative using prospective cohort studies that produce knowledge of determinants of …

Stability Of The Gross Motor Function Classification System, Manual Ability Classification System, And Communication Function Classification System., Robert J Palisano, Lisa Avery, Jan Willem Gorter, Barbara Galuppi, Sarah Westcott Mccoy

Physical Therapy Publications

AIM: To determine the stability of the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) over 1-year and 2-year intervals using a process for consensus classification between parents and therapists.

METHOD: Participants were 664 children with cerebral palsy (CP), 18 months to 12 years of age, one of their parents, and 90 therapists. Consensus between parents and therapists on level of function was ≥92% for the GMFCS, MACS, and CFCS. A linearly weighted kappa coefficient of ≥0.75 was the criterion for stability.

RESULTS: Kappa coefficients varied from 0.76 to 0.88 for …

Core Stabilization And Pelvic Motility Training For A 28-Week Pregnant Female With Low Back Pain And Sciatic Nerve Pain, Jenna Belser, Anne H. Boddy

St. Augustine, Fall 2018

The purpose of this case study is to determine the effects of core stabilization and pelvis mobility training for a 28-week pregnant female to improve function and decrease pain.

Low back pain during pregnancy is a common occurrence that affects a majority of the population.¹ Over the five treatment sessions, the patient was able to tolerate a full ten-hour work shift and sleep through the night. She also showed improvements in muscle strength and flexibility. As seen in non-pregnant females, the patient was able to have a decrease in pain and improvement in function with these techniques.⁴

Fsm Restores Activity To Trapezius For 67 Y.O. Male, Marilyn Miller, Carolyn R. Mcmakin

San Marcos, Fall 2018

One session of frequency specific microcurrent (FSM) restored voluntary function and muscle definition for a 67 y. o. male DIY enthusiast after 18 mos of disuse.

Service Learning For Balance And Activity Promotion In The Older Adult, Christine Mary Childers

San Marcos, Summer 2018

Barr and Wong¹ challenged faculty to provide creative and innovative ways of teaching meaningful content related to care of the older adult population.¹ Service learning combines community service with learning objectives and reflection, meeting academic and community needs.² Service learning helps students manage the complex care of the older adult stroke population³ and intergenerational programs benefit both generations.⁴ The purpose of this study was to explore and compare student ideas and thoughts regarding balance and activity promotion in the older adult, both with and without a service learning opportunity Falls are a leading concern with …

A Different Instructional Model To Improve Student Learning Outcomes In Gross And Applied Anatomy For Physical Therapy Students, Cherie Peters-Brinkerhof, Christine Mary Childers

San Marcos, Fall 2018

Teaching and learning anatomy in a DPT program poses a challenge to students and faculty because of the volume of material needed as foundational information for a PT curriculum. The aim of this study was to determine if a round-robin model of instruction in anatomy and applied anatomy labs, is more effective to meet the course learning objectives compared to a more traditional, separate class instruction.

Guiding Questions:

1. What were the faculty and students’ perception of the teaching method used for anatomy and applied anatomy?

2. What were the faculty's perceptions of the students’ understanding of the material presented? …

Anti-Gravity Treadmill Training With 19-Year-Old Soccer Player Status Post-Leukemia, Britni Barber, Lisa Chase

St. Augustine, Fall 2018

The purpose of this case report was to describe the effects of anti-gravity treadmill training, in addition to standard treatment protocol, on endurance performance in a 19-year-old female collegiate soccer player following chemotherapy treatment for leukemia.

Physical therapy rehabilitation of patients who are experiencing chemotherapy-related fatigue may benefit from anti-gravity treadmill training. This case report not only identifies a successful outcoming using such intervention but also introduces a more aggressive approach to treatment for a patient whose goals included going back to play division one sports. The patient was not only able to reach her goals of being able to …

Inter-Institutional Collaboration To Benefit Student Learning: A Scenario In Graduate Education, Marilyn Miller, Linda Hill, Nicolas Van Den Heever

San Marcos, Fall 2018

Occupational and Physical Therapists are in a unique role, in which they can assist in the identification and rehabilitation of impairments. The collaboration between UCSD and USAHS is preparing students with the knowledge and skills to assess older persons for driving abilities.

The current content delivery allows the TREDS program to be available to the Gerontology course offering for other USAHS campus locations; and has the potential to be accessed by other institutions of higher education offering courses in Gerontology.

Conservative Therapy Of Patient With Dyspareunia In A Post-Menopausal State With Co-Morbidities Including Previous Breast Cancer And Valve Replacement: A Case Report, D. Ditoro, M. Mason-Cover, C. Hazelton, Annie Burke-Doe, Marilyn Miller

San Marcos, Fall 2018

Dyspareunia is defined as persistent pain in the vaginal area before, during, or after sexual intercourse.^1,2 The etiology is uncertain in the medical literature, but evidence proposes that pain and dysfunction of pelvic floor muscles (PFM) can contribute to dyspareunia and other forms of chronic pelvic pain.^1,2 The information contained in this case report is clinically relevant because it presents evidence that dyspareunia can be treated safely with physical therapy techniques on a patient with a complex medical history.

Soft Tissue Mobilization With Movement To Improve Cervical And Shoulder Range Of Motion Post-Thyroidectomy In A 36-Year-Old Male: A Case Report, Sarah Tomes, Megann Schooley

St. Augustine, Fall 2018

The purpose of this case report is to describe the effectiveness of soft tissue mobilization with movement (STMM) to improve cervical and shoulder range of motion status-post thyroidectomy in a 36-year-old male.

When addressing hypertrophic scarring and ROM restrictions after total thyroidectomy, a beneficial myofascial treatment may include STMM. A home program could incorporate STMM or self-myofascial release as well.

Power Up With Parkinson's: A Case Report, Sean Ekekwe, Anne H. Boddy

St. Augustine, Fall 2018

The purpose of this study is to highlight the use of power training in a patient with low back pain and Parkinson’s disease.

Power training demonstrated a more significant change in gait speed, mobility, and function compared to other phases in rehabilitation. After power training was implemented at visit 11, there was a dramatic increase gait speed with the 10-meter walk test, a reduction in Oswestry Disability Index score (ODI), and a decrease in Timed Up and Go (TUG) time. The increase in 10 MWT gait speed and reduction in ODI and TUG score were greater than their MDC values …

Are You Ready To Get High? High Repetition Exercise For Radial Nerve Palsy, Tayler Adams, Matthew L. Daugherty

St. Augustine, Fall 2018

Research suggests the need for early surgical nerve exploration for secondary radial nerve palsy based upon a 75% recovery rate with early exploration.⁵ In using typical conservative management plus high-repetition movement, the patient in this case report was able to avoid surgery for radial nerve exploration, attain complete recovery within 4 months of his initial injury, and fully return to work and daily function.

This case report offers the possibility of high-repetition movement being a beneficial treatment intervention. This is a simple, low-cost treatment and can be accomplished by the patient at home as part of a home exercise …

External Load On The Hemi-Paretic Lower Limb With Task-Oriented Training To Improve Gait Post Right Aca Stroke, Jacob France, Lindsey Perry

St. Augustine, Fall 2018

The purpose of this case report is to describe the treatment of a 77-year-old male post-stroke with the application of an external load to the paretic lower limb in conjunction with task-oriented training to improve gait.

Strength, balance, gait speed, and functional tasks all improved over the course of physical therapy. At the end of 2 weeks, the patient exceeded the minimal detectable change (MDC) for the TUG (2.9 sec) and achieved the minimal clinically important difference (MCID) for the FIM (22 points).^4-5 Although the MCID is not established for the Modified Ashworth Scale (MAS), the patient experienced improvements …

Incorporation Of Balance And Vestibular Exercises In A 45-Year-Old Female With Bell’S Palsy: A Case Report, Kelsey Andersson, Erica Kiernan

St. Augustine, Fall 2018

The purpose of this case report is to determine the effectiveness of balance and vestibular exercises in conjunction with facial strengthening exercises on a patient with Bell’s palsy.

By incorporating vestibular exercises into the patient’s therapy sessions, she was able to demonstrate improved single leg stance and self-reported decrease in onset of symptoms with a progression of vestibular exercises. Facial muscle strengthening exercises demonstrated significant improvements in eye closure and smiling but she exhibited little changes in facial symmetry, strength and self-perceived function. The patient reported she was starting to drive and participate in more social events by the 4th …

Sara Plus And Task Specific Training In A Patient With Anoxic Encephalopathy, Olivia Levi, Erica Kiernan

St. Augustine, Fall 2018

The purpose of this case report is to describe the benefits of using a task-specific approach and the SARA plus to improve balance and gait in a patient with anoxic encephalopathy.

This case demonstrated the positive results of incorporating repetitive, task-specific, and early use of the SARA plus for gait training. With these interventions, the patient was able to ambulate 25 ft and transfer from sit to stand with the use of a rolling walker and minimum assistance. He was also able to maintain static sitting balance for 32 seconds independently and reach 17 inches outside of his base of …

Proprioceptive Neuromuscular Facilitation In A Male Wrestler Post Type Ii Slap Lesion Surgical Repair, George Eskander, Matthew L. Daugherty

St. Augustine, Fall 2018

The primary purpose of this case report was to assess the effects of a specific progression of PNF and Rhythmic Stabilization Exercises (RSE) in conjunction with traditional physical therapy for a seventeen-year-old wrestler post Type II SLAP lesion surgical repair.

This case report indicated that the utilization of PNF and RSE is a beneficial component to physical therapy treatment of a seventeen-year-old wrestling athlete with a Type II SLAP lesion surgical repair. Designing a treatment plan with emphasis on PNF and RSE is cost-efficient, as it does not require expensive equipment or additional certifications. Also, physical therapists utilizing PNF and …

Scapulothoracic Mobility And Strengthening After A Posterior Capsular Reconstruction Of The Glenohumeral Joint With An Allograft: A Case Report, Kris Saunders, David Kempfert

St. Augustine, Fall 2018

The purpose of this case report is to emphasize the importance of scapular mobility and strengthening exercises in rehabilitation protocols for patients after a posterior capsular reconstruction surgery of the glenohumeral joint.

The objective outcomes by week three are displayed in Table 1.0. The patient was discharged after nine visits over a period of three weeks. During the final session, the patient was able to perform standing shoulder abduction to 90 degrees with a one-pound dumbbell pain-free. The patient was able to reach into a shelf at 120 degrees of shoulder flexion with a pain scale rating of 2/10. He …

Shall We Dance: A Parkinson’S Dance-Based Program, Rebecca Zawodny, Anne H. Boddy

St. Augustine, Fall 2018

This poster presents the implementation of a community-based dance program for individuals diagnosed with Parkinson’s disease.

Dance interventions for individuals with PD are shown to be superior to exercise for improving balance and mobility^5,6,7 thus, effectively addressing both motor as well non-motor symptoms such as depression, fear, anxiety, and declined self-efficacy.^8,9,10 Further positive effects include improved flexibility and coordination7^,11 and forced-use of the senses of sight, sound, and touch to assist with movement and balance.¹² The use of choreography further allows for the rehearsal of movement sequences, new motor skill learning, and improved cognitive functions.^{13 …}

Effects Of Weight Shifting And Heel Lift On Gait, Posture, And Balance In An Elderly Female With Backward Disequilibrium: A Case Report, Gilissa T. Schjang, Evan M. Pucillo

St. Augustine, Fall 2018

The purpose of this case report is to investigate how weight shifts and a heel lift affects a patient's center of mass in respect to their base of support to improve posture, balance, and gait which will aid in decreasing falls.

The patient demonstrated functional improvements by reducing the amount of assistance required from a caregiver for transfers and gait. Improvements in balance will allow the patient to sit on the toilet and edge of bed for toileting and dressing more independently.

Older adults with BD or other similar balance disorders are at risk for increased falls.⁵ This case …

Effectiveness Of Stretching And Arch Strengthening In A 10-Year-Old Male With Calcaneal Apophysitis, Hannah Hardesty, Catherine M. Andrea

St. Augustine, Fall 2018

The aim of this case report is to create an independent exercise program to minimize pain while allowing continued participation in recreational activities.

Calcaneal apophysitis is a common condition in children that often results in the cessation of physical activity and participation in social activities, which can have a negative effect on both physical and mental well-being.^2-5 This case demonstrates positive outcomes with the use of static/dynamic stretching combined with arch strengthening in the rehabilitation of a patient with bilateral calcaneal apophysitis without reducing the child’s participation in daily and recreational activities.

Effects Of Trigger Point Dry Needling In Conjunction With Intramuscular Electrical Stimulation For A Patient With Lumbar Radiculopathy: A Case Report, Mayur Patel, Todd Bourgeois

St. Augustine, Fall 2018

The purpose of this case was to see the benefits of Trigger Point Dry Needling in conjunction with Intramuscular Electrical Stimulation for the treatment of lumbar radiculopathy regarding the range of motion, strength, sensation, reduction of pain, improve functional ability, and quality of life.

Traditional interventions for this diagnosis include strengthening exercises, modalities such as transcutaneous electrical stimulation, and even surgery as a last resort. There is limited research available regarding Trigger Point Dry Needling in conjunction with Intramuscular Electrical Stimulation for lumbar radiculopathy.⁴ This case report supports the idea that this physical therapy treatment intervention has positive outcomes …

Transitioning From The Level Surface To Stairs In Children With And Without Down Syndrome: Motor Strategy And Anticipatory Locomotor Adjustments, Huaqing Liang, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Background: Children with Down syndrome (DS) show underdeveloped motor strategy and anticipatory locomotor adjustments (ALA) before crossing an obstacle. Stairs presents another important setting to study environment navigation and motor adaptation. Inclusion of external ankle load is often used to perturb the stability of a system and observe the emergence of new patterns.

Research question: How do stair height and external ankle load affect motor strategy and ALA in 5-to-11-year-old children with typical development (TD) and with DS when approaching the stairs?

Methods: Fourteen children with DS and 14 age- and sex-matched children with TD participated in the study. They …

Using Concept Mapping To Develop A Human Rights Based Indicator Framework To Assess Country Efforts To Strengthen Rehabilitation Provision And Policy: The Rehabilitation System Diagnosis And Dialogue Framework (Resyst), Dimitrios Skempes, John L. Melvin, Per Von Groote, Gerold Stucki, Jerome Bickenbach

Department of Rehabilitation Medicine Faculty Papers

Background: Rehabilitation is crucial for the realization of the right to health and a proper concern of global health. Yet, reliable information to guide rehabilitation service planning is unavailable in many countries in part due to the lack of appropriate indicators. To ensure universal health coverage and meet the central imperative of "leaving no one behind" countries must be able to assess key aspects of rehabilitation policy and provision and monitor how they have discharged their human rights responsibilities towards those most disadvantaged, including people with disability. This article describes the process of developing an expert guided indicator framework to …

Integration Of Therapies In Autistic Children; A Survey Based In Karachi, Pakistan, Masnoon Akhter, Mussarat Ashraf, Adnan Ali, Irum Rizwan, Rehana Rehman

Department of Biological & Biomedical Sciences

A cross-sectional study was conducted from January to June 2016 on autistic children at the Autism Unit of Dow University of Health Sciences to compare speech therapy, occupational therapy and combination of both for rehabilitation of autistic children in the selected population. A total of 55 children with autism age range from 1-12 years of both gender and all ethnic groups were recruited. All data was analysed in IBM-SPSS version 23.0. Pearson chi-square test was used to determine association of type of therapy with the diagnosed age of child, gender, mode of delivery, history of vaccination and parent's education. Educated …

Bringing Employment First To Scale: Support Coordination Strategies That Impact Employment Outcomes And Services For Individuals Served By State Intellectual/Developmental Disabilities Agencies, Barbara Brent, Rie Kennedy-Lizotte, Mary Lee Fay, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

Leadership from NASDDDS and ICI worked together to determine topics for a series of white papers on policies that influence employment outcomes for individuals with IDD. This white paper is the third in a series of five. It provides an overview of strategies that support coordinators, or case managers, use to influence employment outcomes for individuals with IDD who are receiving state funded services.

Bringing Employment First To Scale: Pushing The Integrated Employment Agenda: A Case Study Of Maryland’S High-Performing Employment System, Jean Winsor, Cady Landa, Allison C. Hall, Caro Narby, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

This brief summarizes data collected from key informants in Maryland about the state’s efforts to support integrated employment for people with intellectual and developmental disabilities (IDD). It highlights features that contribute to the effectiveness of Maryland’s collaborative structures that have resulted in the state’s success in achieving integrated employment outcomes for individuals with IDD across three state systems: IDD, vocational rehabilitation (VR), and education. Presentation of these features is organized by the seven elements of the Higher-Performing States Employment Framework. These elements have been found to be important in achieving higher rates of competitive integrated employment outcomes for people with …

Statedata: The National Report On Employment Services And Outcomes Through 2016, Jean Winsor, Jaimie Ciulla Timmons, John Butterworth, Alberto Migliore, Daria Domin, Agnes Zalewska, John Shepard, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

Recent legislation and regulation governing Medicaid Home and Community-Based Services (HCBS), the Workforce Innovation and Opportunity Act of 2014 (WIOA), and settlement agreements between states and the U.S. Department of Justice are clarifying federal intent and paving the way to supporting opportunities for people with disabilities to have meaningful jobs in their communities. With an increasing emphasis on integrated employment and an Employment First philosophy, the nation is poised for transformation that could put Americans with disabilities on a path out of poverty and towards self-sufficiency. However, there remains a significant gap in employment rates between people with and without …

Sustaining Daily Management With Gemba Walks: A Scheduling Model, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks

Operations Transformation

SUSTAINING DAILY MANAGEMENT WITH GEMBA WALKS: A SCHEDULING MODEL

At an academic tertiary care medical center, there are 110 Operational Excellence teams across 4 campuses. Every weekday, 10 GEMBA walks occur with the 11^th on Wednesdays. The expanding program has made daily leadership visits to all KPIs challenging. As a result, consideration of reduced gemba walks to departments who have met specific maturity/performance criteria.

The scope of the eight-week pilot consisted of 13 pre-identified teams that have weekly workflows. The teams must have met a baseline level of performance. Performance was scored for 9 variables measuring engagement, PDSA, use …

Generalist Versus Specialist Nurses' Knowledge, Attitudes, And Behavioral Intentions Toward Promoting Pulmonary Rehabilitation For Patients With Chronic Obstructive Pulmonary Disease: A Cross-Sectional Correlational Study, Su-Er Guo, Hsueh-Chen Shen, Chizimuzo T. C. Okoli, Yen-Chi Liao, Kuen-Daw Tsai, Ming-Shian Lin, Hsin-Tien Hsu

Nursing Faculty Publications

Pulmonary rehabilitation (PR) is an effective strategy to manage chronic obstructive pulmonary disease (COPD), though its utilization rate is low. One reason for this low utilization rate is that nurses do not provide COPD patients with enough health education to increase the patient's motivation for PR participation. This study examined knowledge, attitudes, and behavioral intention toward PR promotion. The study also investigated the correlates of behavioral intentions to promote PR among pulmonary nurses.

A cross-sectional correlational design was used. Overall, 284 nurses (all women) from chest medicine and general internal medicine wards in 3 hospitals within Midwest Taiwan were recruited. …

Experience Of Robotic Exoskeleton Use At Four Spinal Cord Injury Model Systems Centers, Allen W. Heinemann, Arun Jayaraman, Chaithanya K. Mummidisetty, Jamal Spraggins, Daniel Pinto, Susan Charlifue, Candy Tefertiller, Heather B. Taylor, Shuo-Hsiu Chang, Argyrios Stampas, Catherine L. Furbish, Edelle C. Field-Fote

Physical Therapy Faculty Research and Publications

Background and Purpose: Refinement of robotic exoskeletons for overground walking is progressing rapidly. We describe clinicians' experiences, evaluations, and training strategies using robotic exoskeletons in spinal cord injury rehabilitation and wellness settings and describe clinicians' perceptions of exoskeleton benefits and risks and developments that would enhance utility.

Methods: We convened focus groups at 4 spinal cord injury model system centers. A court reporter took verbatim notes and provided a transcript. Research staff used a thematic coding approach to summarize discussions.

Results: Thirty clinicians participated in focus groups. They reported using exoskeletons primarily in outpatient and wellness settings; 1 center used …