Rehabilitation and Therapy Commons^™

A Clinical Practice Guideline For The Management Of Acute Spinal Cord Injury: Introduction, Rationale, And Scope, Michael G. Fehlings, Lindsay A. Tetreault, Jefferson R. Wilson, Brian K. Kwon, Anthony S. Burns, Allan R. Martin, Gregory Hawryluk, James S. Harrop

Department of Neurosurgery Faculty Papers

Acute spinal cord injury (SCI) is a traumatic event that results in disturbances to normal sensory, motor, or autonomic function and ultimately affects a patient’s physical, psychological, and social well-being. The management of patients with SCI has drastically evolved over the past century as a result of increasing knowledge on injury mechanisms, disease pathophysiology, and the role of surgery. There still, however, remain controversial areas surrounding available management strategies for the treatment of SCI, including the use of corticosteroids such as methylprednisolone sodium succinate, the optimal timing of surgical intervention, the type and timing of anticoagulation prophylaxis, the role of …

International Society Of Sports Nutrition Position Stand: Nutrient Timing, Chad M. Kerksick, Shawn Arent, Brad J. Schoenfeld, Jeffrey R. Stout, Bill Campbell, Colin D. Wilborn, Lem Taylor, Doug Kalman, Abbie E. Smith-Ryan, Richard B. Krieder, Darryn Willoughby, Paul J. Arciero, Trisha A. Vandusseldorp, Michael J. Ormsbee, Robert Wildman, Mike Greenwood, Tim N. Ziegenfuss, Alan A. Aragon, Jose Antonio

Publications and Research

Position statement: The International Society of Sports Nutrition (ISSN) provides an objective and critical review regarding the timing of macronutrients in reference to healthy, exercising adults and in particular highly trained individuals on exercise performance and body composition. The following points summarize the position of the ISSN: 1. Nutrient timing incorporates the use ofmethodical planning and eating ofwhole foods, fortified foods and dietary supplements. The timing of energy intake and the ratio of certain ingestedmacronutrientsmay enhance recovery and tissue repair, augmentmuscle protein synthesis (MPS), and improvemood states following high-volume or intense exercise. 2. Endogenous glycogen stores are maximized by following …

Physiological Response To Firefighting Activities Of Various Work Cycles Using Extended Duration And Prototype Scba, Richard M. Kesler, Ipek Ensari, Rachel E. Bollaert, Robert W. Motl, Elizabeth T. Hsiao-Wecksler, Karl S. Rosengren, Bo Fernhall, Denise L. Smith, Gavin P. Horn

Exercise Science Faculty Research and Publications

Firefighters’ self-contained breathing apparatus (SCBA) protects the respiratory system during firefighting but increases the physiological burden. Extended duration SCBA (>30 min) have increased air supply, potentially increasing the duration of firefighting work cycles. To examine the effects of SCBA configuration and work cycle (length and rest), 30 firefighters completed seven trials using different SCBA and one or two bouts of simulated firefighting following work cycles common in the United States. Heart rate, core temperature, oxygen consumption, work output and self-reported perceptions were recorded during all activities. Varying SCBA resulted in few differences in these parameters. However, during a second …

Interprofessional Grand Rounds: Student Hotspotting Team 2016-2017, Caroline Komanecky, Peter Sacci, Danielle Mcfadden, Nuriya Neumann, Michaela Scotten, Melissa Murphy

Department of Occupational Therapy Posters and Presentations

No abstract provided.

Ventilation And Neurochemical Changes During Μ-Opioid Receptor Activation Or Blockade Of Excitatory Receptors In The Hypoglossal Motor Nucleus Of Goats, Thomas M. Langer, Suzanne E. Neumueller, Emma Crumley, Nicholas J. Burgraff, Sawan Talwar, Matthew R. Hodges, Lawrence Pan, Hubert V. Forster

Physical Therapy Faculty Research and Publications

Neuromodulator interdependence posits that changes in one or more neuromodulators are compensated by changes in other modulators to maintain stability in the respiratory control network. Herein, we studied compensatory neuromodulation in the hypoglossal motor nucleus (HMN) after chronic implantation of microtubules unilaterally (n = 5) or bilaterally (n = 5) into the HMN. After recovery, receptor agonists or antagonists in mock cerebrospinal fluid (mCSF) were dialyzed during the awake and non-rapid eye movement (NREM) sleep states. During day studies, dialysis of the µ-opioid inhibitory receptor agonist [d-Ala², N-MePhe⁴, Gly-ol]enkephalin (DAMGO; 100 µM) decreased …

Health Promotion And Wellness Strategies And Self-Regulation Interventions For Occupational Therapy Assistant Program Graduates Preparing For The Nbcot Exam, Marcia Hamilton

Occupational Therapy Collection

New graduates of Occupational Therapy Assistant (OTA) Programs are challenged with the preparation and successful completion of the National Board for Certification in Occupational Therapy (NBCOT) Certified Occupational Therapy Assistant (COTA) examination. The threat of not passing this exam is intensified due to the cost of the exam and lack of provisional licensing. Anecdotal experience of faculty in an OTA Program supports concern for new graduates as they report feelings of distress and anxiety, as they enter the one- to two-month period prior to the exam. An occupational role shift must occur during this transitional period, as the new graduates …

Strategies To Improve Interdisciplinary Communication In An Acute Care Inpatient Pediatric Unit, Sarah Thompson, Haley Pelletier, Barbara Bush Children's Hospital-Inpatient, Maine Medical Center, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

MaineHealth Maine Medical Center

Interdisciplinary patient rounding has been shown to improve patient and family satisfaction as well as reduce patient length of stay and readmission rates. In an acute care inpatient pediatric unit, baseline metrics demonstrated that 100% of the time, nursing was not included in these rounds thus resulting in sub optimal communication.

The goal of this performance improvement project was to attain increased nursing participation. Data collection demonstrated several reasons for lack of participation and corrective actions were instituted. After undertaking this KPI goal and utilizing operational excellence, 95% of the time, nurses were called to morning rounds with the medical …

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit, P6 Inpatient Geri-Med Psychiatry, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

MaineHealth Maine Medical Center

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted.

The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better …

Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

MaineHealth Maine Medical Center

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge.

In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant …

Patient Fall Prevention, R9 West Cardiovascular, Cathy Palleschi, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

MaineHealth Maine Medical Center

PATIENT FALL PREVENTION STRATEGIES IN AN ACUTE HOSPITAL

Every year in the United States, hundreds of thousands of patients fall resulting in injury. Injured patients often require prolonged hospital stays and a resultant increase in medical costs.

The purpose of this study was to identify the current state of fall prevention strategies on a hospital inpatient acute care cardiac unit. Through a root cause analysis, some deficiencies were identified and a process improvement plan was implemented.

Several positive outcomes were attained as a result of the countermeasures initiated. Patient falls per month and total waste in dollars saw a decline …

Implementing The Weefim System In Outpatient Pediatric Rehabilitation, Chelsea Ratilainen

Master's Projects and Capstones

Abstract

This project was designed to achieve an unmet criteria in the accreditation process for the outpatient pediatric rehabilitation program at a local, community hospital in the greater Bay Area. The clients range from 6 months old to 20 years old with functional disabilities. The Commission of Accreditation of Rehabilitation Facilities (CARF) requires that applicants demonstrate outcome measure data over a 6 month time period. During the self-evaluation process this was noted to be a deficiency in the department’s efforts. The WeeFIM system was chosen as the first tool to implement in the department. This is a functional improvement measurement …

Evidence Of Energetic Optimization During Adaptation Differs For Metabolic, Mechanical, And Perceptual Estimates Of Energetic Cost, Natalia Sánchez, Sungwoo Park, James M. Finley

Physical Therapy Faculty Articles and Research

The theory that the sensorimotor system minimizes energetic cost during locomotion has long been supported by both computational models and empirical studies. However, it has yet to be determined if the behavior to which people converge when exposed to a novel perturbation during locomotion is also energetically optimal. We address this issue in the context of adaptation to walking on a split-belt treadmill, which can impose a left-right asymmetry in step lengths. In response to this asymmetry, participants gradually adjust their foot placement to adopt steps of equal length. Here, we characterized metabolic, mechanical, and perceptual estimates of energetic cost …

Lower Extremity Motor Impairments In Ambulatory Chronic Hemiparetic Stroke: Evidence For Lower Extremity Weakness And Abnormal Muscle And Joint Torque Coupling Patterns, Natalia Sánchez, Ana Maria Acosta, Roberto Lopez-Rosado, Arno H. A. Stienen, Julius P. A. Dewald

Physical Therapy Faculty Articles and Research

Although global movement abnormalities in the lower extremity poststroke have been studied, the expression of specific motor impairments such as weakness and abnormal muscle and joint torque coupling patterns have received less attention. We characterized changes in strength, muscle coactivation and associated joint torque couples in the paretic and nonparetic extremity of 15 participants with chronic poststroke hemiparesis (age 59.6 ± 15.2 years) compared with 8 age-matched controls. Participants performed isometric maximum torques in hip abduction, adduction, flexion and extension, knee flexion and extension, ankle dorsi- and plantarflexion and submaximal torques in hip extension and ankle plantarflexion. Surface electromyograms (EMGs) …

Enhancing Value-Based Healthcare With Reconstructability Analysis: Predicting Risk For Hip And Knee Replacements, Cecily Corrine Froemke

Dissertations and Theses

Legislative reforms aimed at slowing growth of US healthcare costs are focused on achieving greater value, defined specifically as health outcomes achieved per dollar spent. To increase value while payments are diminishing and tied to individual outcomes, healthcare must improve at predicting risks and outcomes.

One way to improve predictions is through better modeling methods. Current models are predominantly based on logistic regression (LR). This project applied Reconstructability Analysis (RA) to data on hip and knee replacement surgery, and considered whether RA could create useful models of outcomes, and whether these models could produce predictions complimentary to or even stronger …

Conservative Treatment For Patients With Suspected Slap Tears: A Case Series, Stephanie D. Moore-Reed, Kelley A. Seekins, W. Ben Kibler, Aaron D. Sciascia, Timothy L. Uhl

Physical Therapy Faculty Publications

Objective: Outcome following non-operative management of superior labral anterior to posterior (SLAP) lesions has been under reported with little empirical data demonstrating the effectiveness of conservative treatment. Material and Methods: 10 patients, 5 matched pairs, presenting with symptoms consistent with a SLAP lesion performed a standardized phased rehabilitation program completing patient reported outcome (PRO) and pain measures before and following rehabilitation. Physical therapy notes and home exercise logs were reviewed and all exercises were recorded and coded using the phased rehabilitation protocol as a guide. At followup, patients were divided into two groups; responders and non-responders to treatment based on …

Identifying Themes When Using A Community-Based Participatory Research (Cbpr) Approach With Men Living In Abstinence-Based Recovery Housing, Rachel Morrison, Jade Sharrer, Jason Clements

Mental Health

This abstract will be available for download after an embargo period

Investigating The Needs Of Parents Of Premature Infants’ Interaction In The Neonatal Intensive Care Unit, Maureen A. Rinehimer

Seton Hall University Dissertations and Theses (ETDs)

Parents and/or caregivers of premature infants provide the interaction needed to promote better outcomes for these challenged infants at risk for developmental delays. This descriptive, exploratory study utilized convenience sampling. Inclusion criteria consisted of parents/caregivers who were at least 18 years of age and older with infants born 35 weeks gestation or less and currently in the NICU. This study focused on the research question: What do parents perceive they need in the NICU to enjoy interacting with their infant in the home? To collect the data needed to capture the perceptions of parent’s needs of infants in the NICU, …

Endothelial Function Is Associated With White Matter Microstructure And Executive Function In Older Adults, Nathan F. Johnson, Brian T. Gold, Christopher A. Brown, Emily F. Anggelis, Alison L. Bailey, Jody L. Clasey, David K. Powell

Physical Therapy Faculty Publications

Age-related declines in endothelial function can lead to cognitive decline. However, little is known about the relationships between endothelial function and specific neurocognitive functions. This study explored the relationship between measures of endothelial function (reactive hyperemia index; RHI), white matter (WM) health (fractional anisotropy, FA, and WM hyperintensity volume, WMH), and executive function (Trail Making Test (TMT); Trail B - Trail A). Participants were 36 older adults between the ages of 59 and 69 (mean age = 63.89 years, SD = 2.94). WMH volume showed no relationship with RHI or executive function. However, there was a positive relationship between RHI …

Motor Strategy And Locomotor Adjustments In Children With And Without Down Syndrome While Negotiating Stairs, Huaqing Liang, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Children with Down Syndrome (DS) often show impaired motor control, and walk with a slower speed and a shorter step length than typically developing (TD) children. When negotiating an obstacle, children with DS often stop for a longer duration, choose a more conservative crawling strategy and display a smaller toe clearance than their TD peers.

Center Of Mass Control And Multi-Segment Coordination In Children During And After Whole-Body Vibration, Huaqing Liang, Jianhua Wu

Physical Therapy Faculty Research

Maintaining upright posture under external perturbations requires the coordination between the nervous system and the musculoskeletal system, and it is a milestone of motor development in early childhood. Whole-body vibration (WBV) has acute effect on postural control and muscular activation during standing, resulting in an increased sway velocity and sway area of center-of-mass (COM), and the residual effect usually vanishes within 20 minutes after the vibration exposure. In quiet standing, a human body can be considered as a multi-segment linked system, and an uncontrolled manifold (UCM) approach has been used to examine how this multi-joint motor redundancy is utilized to …

Parents' Experiences And Perceptions When Classifying Their Children With Cerebral Palsy: Recommendations For Service Providers., Natalie V Scime, Doreen J Bartlett, Laura K Brunton, Robert J Palisano

Physical Therapy Publications

AIMS: This study investigated the experiences and perceptions of parents of children with cerebral palsy (CP) when classifying their children using the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS). The second aim was to collate parents' recommendations for service providers on how to interact and communicate with families.

METHODS: A purposive sample of seven parents participating in the On Track study was recruited. Semi-structured interviews were conducted orally and were audiotaped, transcribed, and coded openly. A descriptive interpretive approach within a pragmatic perspective was used during analysis.

RESULTS: …

The Effect Of Different Resistance Training Load Schemes On Strength And Body Composition In Trained Men, Charles Ricardo Lopes, Marcelo Saldanha Aoki, Alex Harley Crisp, Renê Scarpari De Mattos, Miguel Alves Lins, Gustavo Ribeiro Da Mota, Brad Jon Schoenfeld, Paulo Henrique Marchetti

Publications and Research

The purpose of this study was to evaluate the impact of moderate-load (10 RM) and low-load (20 RM) resistance training schemes on maximal strength and body composition. Sixteen resistance-trained men were randomly assigned to 1 of 2 groups: a moderate-load group (n = 8) or a low-load group (n = 8). The resistance training schemes consisted of 8 exercises performed 4 times per week for 6 weeks. In order to equate the number of repetitions performed by each group, the moderate load group performed 6 sets of 10 RM, while the low load group performed 3 sets of 20 RM. …

Lessons To Be Learned: How A Comprehensive Neurobiological Framework Of Atypical Reading Development Can Inform Educational Practice, Ola Ozernov-Palchik, Xi Yu, Yingying Wang, Nadine Gaab

Center for Brain, Biology, and Behavior: Faculty Publications

Dyslexia is a heritable reading disorder with an estimated prevalence of 5–17%. A multiple deficit model has been proposed that illustrates dyslexia as an outcome of multiple risks and protective factors interacting at the genetic, neural, cognitive, and environmental levels. Here we review the evidence on each of these levels and discuss possible underlying mechanisms and their reciprocal interactions along a developmental timeline. Current and potential implications of neuroscientific findings for contemporary challenges in the field of dyslexia, as well as for reading development and education in general, are then discussed.

Supported Employment For Veterans With Traumatic Brain Injury: Provider Perspectives, Terri K. Pogoda, Kathleen F. Carlson, Katelyn E. Gormley, Sandra Resnick

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: In 2006, 13 sites were provided with one-time pilot funding to provide supported employment (SE) to Veterans with traumatic brain injury (TBI) history. In 2014, we surveyed SE providers at pilot and non-pilot sites that did not receive this funding. Our objectives were to identify any pilot and non-pilot site differences regarding current: (1) provision of SE to Veterans with TBI; (2) staffing and communication between the SE and polytrauma/TBI teams; and (3) provider perceptions on facilitators and barriers to providing, and suggestions for improving, SE.

Design: Mixed methods cross-sectional survey study.

Participants: Providers included a …

Occupational Therapy Faculty Perspectives On The Use Of Telehealth As A Delivery Method For Healthcare Services, Holly Wasserman

All Theses And Dissertations

The use of telehealth for healthcare delivery is on the rise and is expected to increase due to the expansion of technological advances and the shortage of healthcare professionals to serve rural and remote communities. The use of telehealth by occupational therapists (OT) is relatively new, and it is unknown whether educational programs are adequately preparing OT students to practice in this context or if OT faculty members are adequately trained to deliver this content to their students. The purpose of this qualitative descriptive case study was to examine how faculty members teaching in a master’s level occupational therapy program …

Sex Differences In Spatial Accuracy Relate To The Neural Activation Of Antagonistic Muscles In Young Adults, Agostina Casamento-Moran, Sandra K. Hunter, Yen-Ting Chen, Min-Hyuk Kwon, Emily J. Fox, Basma Yacoubi, Evangelos A. Christou

Exercise Science Faculty Research and Publications

Sex is an important physiological variable of behavior, but its effect on motor control remains poorly understood. Some evidence suggests that women exhibit greater variability during constant contractions and poorer accuracy during goal-directed tasks. However, it remains unclear whether motor output variability or altered muscle activation impairs accuracy in women. Here, we examine sex differences in endpoint accuracy during ankle goal-directed movements and the activity of the antagonistic muscles. Ten women (23.1 ± 5.1 years) and 10 men (23 ± 3.7 years) aimed to match a target (9° in 180 ms) with ankle dorsiflexion. Participants performed 50 trials and we …

The Efficacy Of Pressure Ulcer Treatment With Cathodal And Cathodal-Anodal High-Voltage Monophasic Pulsed Current: A Prospective, Randomized, Controlled Clinical Trial, Anna Polak, Luther C. Kloth, Edward Blaszczak, Jakub Taradaj, Agnieszka Nawrat-Szoltysik, Tomasz Ickowicz, Ewa Hordynska, Andrzej Franek, Cezary Kucio

Physical Therapy Faculty Research and Publications

Background. Studies show that anode and cathode electrical stimulation (ES) promotes the healing of wounds, but specific protocols for both electrodes are not available.

Objective. To compare the effectiveness of cathodal versus cathodal+anodal ES in the treatment of Category II-IV pressure ulcers (PrUs).

Design. Prospective, randomized, controlled, clinical study.

Setting. Three nursing and care centers.

Patients. Sixty-three participants with PrUs were randomly formed into a cathodal ES group (CG: N = 23; mean age of 79.35; SD 8.48), a cathodal+anodal ES group (CAG: N = 20; mean age of 79.65; SD 11.44) and a placebo ES group (PG: N = …

Physical Activity Modulates Corticospinal Excitability Of The Lower Limb In Young And Old Adults, Hamidollah Hassanlouei, Christopher W. Sundberg, Ashleigh E. Smith, Andrew Kuplic, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Aging is associated with reduced neuromuscular function, which may be due in part to altered corticospinal excitability. Regular physical activity (PA) may ameliorate these age-related declines, but the influence of PA on corticospinal excitability is unknown. The purpose of this study was to determine the influence of age, sex, and PA on corticospinal excitability by comparing the stimulus-response curves of motor evoked potentials (MEP) in 28 young (22.4 ± 2.2 yr; 14 women and 14 men) and 50 old adults (70.2 ± 6.1 yr; 22 women and 28 men) who varied in activity levels. Transcranial magnetic stimulation was used to …

Ten Elements Of Organizational Transformation: Strategies For Moving Towards Integrated Employment, Jaimie Ciulla Timmons, John Butterworth, Jonathan Lucus, Thinkwork! At The Institute For Community Inclusion At Umass Boston

All Institute for Community Inclusion Publications

This session will share ten key organizational characteristics necessary to strengthen competitive integrated employment outcomes. Get a first-hand look at the RRTC’s Organizational Transformation Toolkit and explore our Provider Employment Leadership Network, a yearlong facilitated Community of Practice of provider leaders in employment. In conjunction with The Arc of the United States, this PowerPoint offers ten essential elements necessary for successful organizational transformation, along with strategies for implementing each element.

Use Of A Team Building Activity To Teach Clinical Decision-Making Concepts To Physical Therapy Students, Robert Fuchs, Betsy J. Becker

Posters and Presentations: Physical Therapy

PURPOSE : The purpose of this research was to find out if a team building exercise carried out by student groups will facilitate learning how to make clinical decision involving concepts from the International Classification of Function (ICF).

SIGNIFICANCE: Scant literature exists regarding the concept of integrating student and expert team case-based learning with the ICF to develop clinical decision-making skills.

SUBJECTS: Subjects were 213 first-year physical therapy students in the DPT program at UNMC in the first semester of the curriculum of years 2013-2016.

METHODS AND MATERIALS: A patient case was developed which included clinical decision-making steps using concepts …