Physical Therapy Commons^™

The Financial Stresses That Affect Athletic Training Students: A Qualitative Investigation, C Kuehner-Boyer, E León Zaragoza

Clinical Practice in Athletic Training

Introduction: A recent survey examining barriers that affect athletic training students found that financial-related barriers created significant stress for students in professional athletic training programs. The need to work while attending a professional athletic training program was the highest reported barrier with 54.82% of respondents indicating that this was a barrier for them during their program. Beyond the overall reporting rate, the need to work while completing a professional athletic training program was indicated by athletic training students to be the barrier that they encountered the most frequently with respondents reporting that this was a stress for them between monthly …

Musculoskeletal Tumors Disguised As Orthopedic Injuries: A Case Report, A Summers

Clinical Practice in Athletic Training

Background: Musculoskeletal tumors are relatively rare, accounting for only 0.2 to 0.5% of all malignancies across all age groups. More specifically, Pigmented Villonodular Synovitis, a type of musculoskeletal tumor, has an incidence rate of 1.8 cases per one million people in a population. This benign, proliferative disease is a type of tenosynovial giant cell tumor that can affect the soft tissue lining of joints, bursae, and tendon sheaths. These joint-related tumors often present with an insidious onset and non-specific physical exam findings. Therefore, they are often mistaken for other, more common orthopedic injuries, making them difficult to diagnose. Patient Information: …

Strength Assessment Protocol In Pre-Professional Ballet Dancers, Simona Di Nardo, Ivan Mascio

Clinical Practice in Athletic Training

Purpose: This research project aimed to investigate the effects, particularly regarding the ability to generate force, that could emerge following a ballet class. The purpose of the study was to support the thesis that low levels of fitness and performance in professional and amateur dancers, should be considered a significant gap that needs to be addressed. Larger will be the gap and bigger will be the demand of a dancer to be prepared athletically. While the shorter the gap and more efficient the artistic side of the dance performance will be. As a result, a stronger and healthier body will …

A Randomized, Double-Blind, Placebo-Controlled Trial Of Daxibotulinumtoxina For Injection For The Treatment Of Upper Limb Spasticity In Adults After Stroke Or Traumatic Brain Injury, Atul T Patel, Michael C Munin, Ziyad Ayyoub, Gerard E Francisco, Rashid Kazerooni, Todd M Gross

Faculty, Staff and Student Publications

Background: Intramuscular injection of botulinum toxin type A is a first-line pharmacotherapy for adults with upper limb spasticity (ULS). However, reemergence of symptoms within 12 weeks of treatment is common and longer-lasting treatments are needed.

Objective: To evaluate the efficacy and safety of three doses of DaxibotulinumtoxinA for Injection (DAXI) for treatment of ULS in adults with stroke or traumatic brain injury.

Intervention: Intramuscular injections of placebo (N = 24), DAXI 250 U (N = 22), DAXI 375 U (N = 19), or DAXI 500 U (N = 18) to the suprahypertonic muscle (SMG) and other muscle groups.

Design: Randomized, …

Two-Year Follow-Up Of Gait And Postural Control Following Initiation Of Recombinant Human Tripeptidyl Intracerebroventricular Enzyme Replacement Therapy In Two Atypical Cln2 Patients, Rahul Soangra, Marybeth Grant-Beuttler, Harriet Chang, Raymond Y. Wang

Physical Therapy Faculty Articles and Research

Neuronal ceroid lipofuscinosis type 2 (CLN2) is a rapidly progressive neurodegenerative disorder leading to premature mortality. Ambulatory CLN2 patients typically receive standard of care treatment through biweekly intracerebroventricular (ICV) enzyme replacement therapy (ERT) involving recombinant human tripeptidyl peptidase 1, known as cerliponase alfa (Brineura^®, Biomarin Pharmaceuticals). This study longitudinally assessed the impact of ICV cerliponase alfa ERT on gait, and postural control across a two-year span in two siblings diagnosed with atypical CLN2 disease. Both participants, ID01 (18 years and 8 months old at enrollment) and ID02 (13 years and 3 months old at enrollment), exhibited symptomatic characteristics …

Optimizing Decision-Making In A Cerebral Palsy Model Using Reinforcement Learning, Richard Ampah

Pitzer Senior Theses

This study presents an original interdisciplinary investigation into how reinforcement learning (RL) can model motor and cognitive defects and potentially improve motor and cognitive functions in individuals with cerebral palsy (CP), a non-progressive neurological disorder that impairs movement and adaptability. Integrating computational neuroscience and machine learning, the research applies policy gradient methods and Markov Decision Processes (MDPs) to simulate adaptive learning in agents with and without CP-related constraints.

The central aim is to compare the cumulative rewards of optimal policies, derived from value iteration, and human-like learning policies using the REINFORCE algorithm, both with and without the Bellman baseline. The …

The Interplay Between Pulse Width And Activation Depth In Tens: A Computational Study, Alexander Guillen, Dennis Q Truong, Yusuf O Cakmak, Sheng Li, Abhishek Datta

Faculty, Staff and Student Publications

Background: Transcutaneous electrical nerve stimulation (TENS) has been a commonly used modality to relieve aches and pain for over 40 years. Commercially available devices provide multiple therapy modes involving a different combination of frequency and pulse width with intensity. While frequency sets sensation, intensity helps determine tolerability, longer pulse width is reported to induce a feeling of deeper stimulation. In fact, longer pulse width has been empirically shown to deliver current into deeper tissues, but in context of other electrical stimulation modalities. The goal of this study was to unpack the relationship between pulse width and activation depth in TENS. …

Efficacy Of High-Definition Transcranial Alternating Current Stimulation (Hd-Tacs) At The M1 Hotspot Versus C3 Site In Modulating Corticospinal Tract Excitability, Hao Meng, Michael Houston, Nicholas Dias, Chen Guo, Gerard Francisco, Yingchun Zhang, Sheng Li

Faculty, Staff and Student Publications

Previous studies have shown that beta-band transcranial alternating current stimulation (tACS) applied at the M1 hotspot can modulate corticospinal excitability. However, it remains controversial whether tACS can influence motor unit activities at the spinal cord level. This study aims to compare the efficacy of applying tACS over the hotspot versus the conventional C3 site on motor unit activities and subsequent behavioral changes. This study used a randomized crossover trial design, where fifteen healthy participants performed a paced ball-squeezing exercise while receiving high-definition tACS (HD-tACS) at 21 Hz and 2 mA for 20 min. HD-tACS targeted either the flexor digitorum superficialis …

Pelvic Floor Physical Therapy In Pregnant And Postpartum Women, Madison G. Kaup

Senior Theses

This project had three main goals: 1) Explore how pregnancy and childbirth affect the female pelvic floor anatomy and physiology, 2) Examine current practices through a literature review and interviews conducted with pelvic floor physical therapists currently practicing in various clinical settings across the United States, and 3) Develop suggestions to mitigate the challenges currently faced in the field by patients and therapists.

The female pelvic floor undergoes extensive changes throughout pregnancy as its structures are targeted by laxity-inducing hormones and mechanical stress from the growing fetus. During childbirth, the system is stretched beyond its physiological limit, causing damage to …

Exploring The Use Of Bimodal Transcranial Direct Current Stimulation To Enhance Movement In Individuals With Patellofemoral Pain—A Sham-Controlled Double Blinded Pilot Study, Kai-Yu Ho, Connan Wallace, Jeno Aquino, Bryce Broadwell, Makenzie Whimple, Jing Nong Liang

Physical Therapy Faculty Research

Introduction: In individuals with patellofemoral pain (PFP), addressing increased knee valgus during weight-bearing activities typically involves strengthening weak hip muscles. However, recent literature highlights the role of altered descending central control in abnormal movements associated with PFP. While transcranial direct current stimulation (tDCS) has demonstrated the capacity to enhance neuroplasticity, its application targeting the corticomotor function of gluteal muscles in PFP remains unexplored. This study aimed to investigate the effects of combining bimodal tDCS with exercise on frontal plane kinematics in individuals with PFP. The hypothesis was that bimodal tDCS, specifically targeting the corticomotor function of the gluteal muscles, would …

Anxiety And Depression Amongst Female Athletes, Dp Golden, Re Obmann, Em Moore

Clinical Practice in Athletic Training

Context: Anxiety (categorized by a feeling of fear, dread, and uneasiness) and depression (mood disorder causing feelings of persistent sadness and loss of interest in things an individual once loved) are two major mental health disorders effecting females considerably who participate in sport. Females are more likely to present with anxiety (55-60%)1 and depression (1.844 times)2 compared to males. The purpose of this study was to examine the prevalence between mental health comorbidities (anxiety and depression), across female athletes aged 18-40. Methods: An anonymous survey was distributed via snowball sampling using social media. Demographic data, Generalized Anxiety Disorder-7 (GAD-7), validated …

Effects Of Sex Hormones And The Menstrual Cycle On Knee Joint Laxity In Physically Active Females: A Critically Appraised Topic, Ae Eicher, Rj Gage, K Park-Braswell

Clinical Practice in Athletic Training

Clinical Scenario: In recent years, females have exhibited increased physical activity and sport participation than ever before. Recent studies have identified a rising incidence rate of ACL injuries and indicate that the risk of ACL tears is greater in females than males. Knee laxity and physiological variation in women during the menstrual cycle have demonstrated increased ligament laxity, therefore, varying hormone concentrations may contribute to changes in ligamentous mechanical properties. Despite these findings, it remains unclear whether fluctuating sex hormone concentrations directly correlate to measurable changes in knee laxity. Clinical Question: How do fluctuations in sex hormones throughout the menstruation …

Individual Goal And Velocity Based Throwing Program For Collegiate Baseball Pitchers With Medial Elbow Injuries, Le Trail, Jm Cline, Ap Jacobsen

Clinical Practice in Athletic Training

Background: A 22-year-old male collegiate baseball pitcher experienced sudden pain in the medial left elbow following feeling a pop when pitching. The pitcher was removed from the competition and was evaluated with a point-of-care ultrasound at the conclusion of the competition. Ultrasound revealed an intact ulnar collateral ligament (UCL) and no edema. Differential Diagnosis: UCL sprain, Wrist flexor strain Treatment: The patient was referred to a primary care sports medicine physician for further evaluation. The physician found no tenderness or laxity at the UCL and ordered an MRI arthrogram for further diagnostic information. MRI revealed a grade II flexor digitorum …

Presentation Of An Accessory Navicular Bone In A Collegiate Women’S Field Hockey Player: A Type 3 Clinical Case Study, N Sutker, J Franco, K Mallory, B Hansberger

Clinical Practice in Athletic Training

Background: The accessory navicular is an extra bone located posterior and medial to the navicular tuberosity. The prevalence of accessory navicular has been reported to be 4 - 21% in the general population though this anatomical variant may often be overlooked during differential diagnosis. This case presents a female collegiate field hockey patient that was initially diagnosed with a midfoot sprain but was later determined to have an accessory navicular bone which required surgical removal. Patient: A 19-year-old female Division I collegiate field hockey patient presented to the athletic training clinic with pain in her left medial foot. The patient …

Changes In Neural Excitability Following 6-Week Of Balance Training In Individuals With Chronic Ankle Instability, Sh Chung, J Freeman, Rs Mccann

Clinical Practice in Athletic Training

Context: Individuals with chronic ankle instability (CAI) often struggle with balance issues due to changes in the central nervous system (CNS). Specifically, difficulties in modulating spinal reflexive excitability and enhancing corticospinal excitability contribute to poor balance, indicating challenges in transferring control to supraspinal centers. A recent study found that a single session of balance training could positively impact the CNS, improving spinal reflexive excitability modulation and corticospinal excitability in CAI patients. However, there is limited research on the effects of long-term balance training on neural excitability in CAI individuals. Therefore, this study aimed to investigate the effects of a 6-week …

Chronic Neck Pain, Vasculopathy, And Pre-Syncope In A Young Adult: A Type 4 Case Study, Tn Crane, K Moore, A Field

Clinical Practice in Athletic Training

Background: The patient is a 23-year-old college female presenting with chronic cervicalgia, bilateral upper extremity neurovascular symptoms, and insidious pre-syncope episodes over the past 3.5 years. Upper extremity neurovascular symptoms include bilateral numbness and tingling into the hands and bilateral throbbing arm pain originating proximal to the elbow and traveling to the fingers, which worsens with cervical rotation bilaterally. The patient has experienced 10 episodes of pre-syncope lasting less than 30 seconds that occur with cervical flexion, extension, or bilateral rotation. Pre-syncope symptoms include lightheadedness, blurry vision, increased neck/arm pain, headache, and malaise. Upon clinical evaluation, no obvious deformity, discoloration, …

Cyclops Lesion In A Collegiate Men’S Lacrosse Player: A Type 4 Clinical Case Study, K Powers, R Moen, G Siarkas

Clinical Practice in Athletic Training

Background: In late July 2023, a 20-year-old male division I lacrosse player reported to the Athletic Training clinic with pain, swelling, and an inability to fully extend his left knee. Evaluation revealed an extension deficit of 5 – 10° during active range of motion (ROM). The patient had previously undergone a double-bundle procedure to repair a torn anterior cruciate ligament (ACL) in his left knee in November 2022. Following this surgery, the patient completed a standard but conservative ACL reconstruction (ACLR) rehabilitation program as prescribed by the sports medicine team but switched to a light strength training regimen on his …

How Comorbidity With Adhd Impacts On Neurocognitive Performance In Adolescents After Sport-Related Concussions: A Scoping Review, T Chiba, Dm Emerson

Clinical Practice in Athletic Training

Context: The number of sport-related concussions (SRCs) is higher in adolescents than in other age groups and accounts for 32% of concussions. Athletes with attention-deficit hyperactivity disorder (ADHD) have a higher risk of previous history of concussion and future concussion risk compared with those without ADHD. People with ADHD present lower baseline scores of neurocognitive performances compared with those without ADHD. Neurocognitive deficits after SRC lead to increase risk of musculoskeletal injuries or another concussion after return to play (RTP) and affect RTP process. There is no consensus regarding the management of SRCs for those with ADHD. This scoping review …

A Qualitative Study Evaluating Athletic Trainers’ Self-Perceived Knowledge And Knowledge Acquisition Of Concussion Biomarkers, Kgs Swindell, T Mccormick, Jm Allen

Clinical Practice in Athletic Training

Context: Rapid movement of the brain caused by a concussion can damage brain cells and create chemical changes within the brain, which may cause lasting neurological, cognitive, and behavioral symptoms. It is suggested that following a trauma, biomarkers can be released which may be useful in accurately diagnosing concussions. Potential biomarkers being studied include β-amyloid peptide 42 [Aβ42], S100 calcium-binding protein B [S100B], glial fibrillation acidic protein [GFAB], microtubule-associated protein 2 [MAP2], and 2’,3’-cyclic-nucleotide 3'- phosphodiesterase [CNPase]. This study focuses on evaluating AT knowledge and awareness of biomarkers, with sub-analyses evaluating ATs’ perception of current knowledge of biomarkers, and the …

An Investigation Of Lower Extremity Injuries In Soccer Athletes Related To Their Playing Environment, Ak Whitlock, K Francis, H Maloney

Clinical Practice in Athletic Training

Context: The goal of this study was to investigate a connection between cleat type, surface type, and increased lower extremity injury rates in soccer athletes. Our hypothesis was that the cleat model, surface type, and facility affected the lower extremity injury rate among soccer athletes. Methods: A review of survey results distributed to the male and female soccer from an NCAA D-I program was completed. The survey investigated athlete injury history related to the specific shoe worn and the field surface information where the injury occurred. Measures of central tendency were calculated. Data was analyzed using a correlation analysis with …

Anaerobic Capacity And Lower Body Strength Deficits Related To Thermal Protective Gear In Rural Volunteer Firefighters, J Diggins, R Shagena, T Patrick, A Catanese

Clinical Practice in Athletic Training

Context: Firefighting is a dangerous job with occupational hazards, strenuous shifts, and increased work- related fatigue that contributes to risk of injury. The weight of thermal protective gear (TPG) may increase neuromuscular challenges while on-duty. The purpose of this study was to investigate the influence of TPG on volunteer firefighters’ anaerobic and lower body strength performance. Methods: Nine healthy males (mean±SD: age= 41±9.3 years; ungeared body mass= 96.47 ± 14.51kg; ungeared height=181.67 ± 4.48cm; VFF experience 8 years) participated in a cross-sectional correlation study during three visits to a university research laboratory. Participants’ TPG included thermal pants, jacket, boots, and …

Athletic Trainers’ Attitudes Towards Concussion Biomarkers And Their Future Use In Concussion Diagnosis, Jm Allen, T Mccormick, Kgs Swindell, T Campbell

Clinical Practice in Athletic Training

Context: Currently, concussions are diagnosed using subjective criteria that typically require baseline measurements to be considered accurate. In some cases, symptoms may not be immediately evident following a brain injury. Recently, studies have begun analyzing the possibility of using biomarkers as a means of objectively diagnosing concussions. However, more research and information on biomarkers are required before implementation of diagnostic methods are possible; therefore, the purpose of our study was to explore and analyze current practicing athletic trainers’ attitudes toward the future implementation of concussion biomarkers in clinical practices. Methods: A phenomenological qualitative research design was used to gather information …

Caffeine Consumption On Sports Performance Measures In College Athletes: A Critically Appraised Topic, Ja Wills, Al Fraley

Clinical Practice in Athletic Training

Focused Clinical Question: How does caffeine (CAF) consumption affect sports performance measures in healthy college athletes? Data Sources: In December 2023, PubMed was utilized to search key terms, including collegiate athlete, caffeine, and performance measures. A publication time frame from 2013-2023 was established. Study Selections: Inclusion criteria consisted of studies investigating collegiate athletes ingesting CAF and its impact on anaerobic, agility, and speed performance measures. Exclusion criteria consisted of participants with current injuries and ingredients consumed in addition to CAF. Data Extraction: Outcomes included sports performance measures such as: vertical jump test, 60- and 100-meter time trials, reaction time, maximum …

Citation Accuracy Of Scholarly Journal Articles In Sports Medicine, Lk Warner, Le Trail, Bj Warner, Sa Cage

Clinical Practice in Athletic Training

Context: Previous research has expounded on the importance of accurate use of references in scholarly manuscripts. A thorough and appropriate use of references allows authors to validate and lend credence to the position they are attempting to take on their subject matter.Reference errors have been well documented in multiple scholarly journals covering healthcare topics. To date, there does not appear to be a description of the accuracy of reference lists in sports medicine scholarly journal articles. Therefore, the purpose of this study was to describe the rate of reference errors in sports medicine literature. Methods: We examined four peer-reviewed sports …

Conflict Management In Athletic Training: The Influence Of Organizational Culture, Cc Emerson

Clinical Practice in Athletic Training

Context: Athletic trainers (ATs) face conflict within the social ecosystem of the organizations in which they practice and arises due to incompatibility of goals and interests. Within athletic departments, the ATs’ role to advocate for health and safety often comes at odds with an organizational culture directed towards maximizing performance and winning. ATs are often evaluated by dominant and powerful members of organizations who may not understand or respect the AT’s role. The purpose of this study was to examine the experience of managing conflict as an AT within the culture of athletics. Methods: This qualitative study explored experiences of …

Consistency In Patient-Reported Outcomes Survey Response, Me Beck, J Johnson, Wz Garrett, C Lavender

Clinical Practice in Athletic Training

Context: Patients returning from ACL or other knee injuries must be physically ready to return to activity and mentally. Patient-reported outcome measures are important means to evaluate the level of patient readiness. Many healthcare providers utilize multiple surveys as part of their intake process to determine current status. The distribution of multiple surveys related to one joint may be problematic. A question of completeness and consistency among participants is a limitation of most measures. The purpose of this study was 1) to determine the level at which people will persist in multiple surveys and 2) to determine the consistency in …

Continuing Education Seminar’S Impact On Knowledge And Retention Among Athletic Trainers., Brandon Warner, D Gill, S Shultz, W Karper, Sa Cage

Clinical Practice in Athletic Training

Context: The athletic training profession requires continuing education (CE) to maintain their national practice credential. Recent research has shown healthcare professionals to have knowledge and skill declines post-continuing education courses. Even with the CE mandate and available research, there is little evidence on the effectiveness of continuing education in the profession of athletic training. There is also a lack of research on the impact of a CE seminar assessing behavior change post-seminar. Therefore, the purpose of this study is to determine the impact of an educational seminar on participant knowledge gain, knowledge retention, and reported use of ES for pain …

Effects Of Concussion History On Risk Taking Behaviors In Collegiate Athletes, K Formey, Tr Campbell

Clinical Practice in Athletic Training

VirginiaContext: According to the literature, in the United States there are an estimated 1.6 to 3.8 million sport-related concussions annually with over 10,000 concussions among National Collegiate Athletic Association (NCAA) student-athletes1. The annual incidence of medically diagnosed pediatric concussions increased from 34 per 10,000 persons in 2003 to 150 per 10,000 persons in 20132. There has been an increase in research studied on the physiological mechanisms and causes of concussions among people of all ages with sports participation being the etiology of about half of all pediatric concussions2. Concussions occur from excessive forces being applied to the skull resulting in …

Effects Of Passive Heat Interventions On A Person’S Active Heat Acclimatization: A Critically Appraised Topic, Sl Dickstein, Dm Emerson, Al Fraley

Clinical Practice in Athletic Training

Focused Clinical Question: Does implementing a month-long passive heat protocol in a sauna affect a person’s active heat acclimatization by decreasing average heart rate (HR), decreasing internal body temperature, and increasing skin temperature (Tsk)? Data Sources: A comprehensive search was conducted in September 2023 through PubMed. The search terms used were passive heat therapy, heat acclimatization, and hypoxia. Manuscripts were limited to those published within the last 5 years. Study Selection: Inclusion criteria consisted of physically active participants, measures of HR and body temperature, and randomized-controlled trials and crossover studies using saunas as a passive heat intervention. Exclusion criteria consisted …

Enhancing Cultural Competency In Sports Medicine Resident And Fellowship Physicians Through The Coming Out Star Exercise., Sa Cage, Ap Jacobsen

Clinical Practice in Athletic Training

Context: Previous studies have reported that lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) healthcare providers and student-athletes encounter difficulties in their work or competition settings. Numerous medical professional associations have published statements affirming their commitment to providing equitable healthcare for patients from the LGBTQIA community. However, there is a paucity of research related to building cultural competency among healthcare professionals with regards to LGBTQIA patients. The purpose of this study was to describe the effects of the Coming Out Star exercise on giving sports medicine track resident and fellowship physicians a better understanding of the challenges faced by …