Physical Therapy Commons^™

Applying Principles Of Motor Learning And Control To Upper Extremity Rehabilitation, Lisa M. Muratori, Eric M. Lamberg, Lori Quinn, Susan V. Duff

Physical Therapy Faculty Articles and Research

The purpose of this article is to provide a brief review of the principles of motor control and learning. Different models of motor control from historical to contemporary are presented with emphasis on the Systems model. Concepts of motor learning including skill acquisition, measurement of learning, and methods to promote skill acquisition by examining the many facets of practice scheduling and use of feedback are provided. A fictional client case is introduced and threaded throughout the article to facilitate understanding of these concepts and how they can be applied to clinical practice.

Atropine Microdialysis Within Or Near The Pre-Bötzinger Complex Increases Breathing Frequency More During Wakefulness Than During Nrem Sleep, Clarissa Muere, Suzanne E. Neumueller, Justin Robert Miller, Samantha Olesiak, Matthew R. Hodges, Lawrence Pan, Hubert V. Forster

Physical Therapy Faculty Research and Publications

Normal activity of neurons within the medullary ventral respiratory column (VRC) in or near the pre-Bötzinger Complex (preBötC) is dependent on the balance of inhibitory and excitatory neuromodulators acting at their respective receptors. The role of cholinergic neuromodulation during awake and sleep states is unknown. Accordingly, our objective herein was to test the hypotheses that attenuation of cholinergic modulation of VRC/preBötC neurons in vivo with atropine would: 1) decrease breathing frequency more while awake than during non-rapid-eye-movement (NREM) sleep and 2) increase other excitatory neuromodulators. To test these hypotheses, we unilaterally dialyzed mock cerebrospinal fluid (mCSF) or 50 mM atropine …

Assessing Tactile Acuity In Musculoskeletal Medicine: How Good Are Two Point Discrimination Tests At The Neck, Hand, Back And Foot?, M Catley, A Tabor, Benedict Wand, G L. Moseley

Physiotherapy Conference Papers

No abstract provided.

Crawling Kinematics In An Early Knee Protocol For Pediatric Prosthetic Prescription, Mark Geil

Faculty Articles

No abstract provided.

A Comparison Of Upper Extremity Function Between Female Breast Cancer Survivors And Healthy Controls: Typical Self- Report Of Function, Motion, Strength And Muscular Endurance, Mary Insana Fisher

Theses and Dissertations--Rehabilitation Sciences

Many women who have experienced breast cancer (BC) report continued impairments in upper extremity (UE) function beyond the time required for normal healing after surgical treatment. Most research supporting this has not made comparisons between survivors of breast cancer (BCS) to a sample of healthy women. This lack of comparison to a healthy cohort prevents an understanding of whether continued deficits in UE function are due to normal aging or the BC treatment.

The purpose of this research was to compare quality of life (QOL) and UE function among long term breast cancer survivors and similar aged women without cancer. …

Physiotherapists Have Accurate Expectations Of Their Patients’ Future Health-Related Quality Of Life After First Assessment In A Subacute Rehabilitation Setting, Steven M. Mcphail, Emily Nalder, Anne-Marie Hill, Terry P. Haines

Physiotherapy Papers and Journal Articles

Background.

Expectations held by health professionals and their patients are likely to affect treatment choices in subacute inpatient rehabilitation settings for older adults. There is a scarcity of empirical evidence evaluating whether health professionals expectations of the quality of their patients’ future health states are accurate.

Methods.

A prospective longitudinal cohort investigation was implemented to examine agreement (kappa coefficients, exact agreement, limits-of-agreement, and intraclass-correlation coefficients) between physiotherapists’ (n=23) prediction of patients’ discharge health-related quality of life (reported on the EQ-5D-3L) and the actual health-related quality of life self-reported by patients (n=272) at their discharge assessment (using the EQ-5D-3L). The mini-mental …

Cost Effectiveness Of Patient Education For The Prevention Of Falls In Hospital: Economic Evaluation From A Randomized Controlled Trial, Terry P. Haines, Anne-Marie Hill, Keith D. Hill, Sandra G. Brauer, Tammy Hoffmann, Christopher Etherton-Beer, Steven M. Mcphail

Physiotherapy Papers and Journal Articles

Background

Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventing falls in hospitals. Hospital-based falls prevention interventions tested in randomized trials have not yet been subjected to economic evaluation.

Methods

Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and …

Circumstances Of Falls And Falls-Related Injuries In A Cohort Of Older Patients Following Hospital Discharge, Anne-Marie Hill, Tammy Hoffman, Terry P. Haines

Physiotherapy Papers and Journal Articles

Background:

Older people are at increased risk of falls after hospital discharge. This study aimed to describe the circumstances of falls in the six months after hospital discharge and to identify factors associated with the time and location of these falls.

Methods:

Participants in this randomized controlled study comprised fallers (n = 138) who were part of a prospective observational cohort (n = 343) nested within a randomized controlled trial (n = 1206). The study tested patient education on falls prevention in hospital compared with usual care in older patients who were discharged from hospital and followed for six months …

Measurement Of Localized Tissue Water - Clinical Application Of Bioimpedance Spectroscopy In Wound Management, L C. Ward, K Sharpe, Dale Edgar, V Finlay, F Wood

Physiotherapy Papers and Journal Articles

Wound healing is a complex process which can be impeded by the presence of accumulated cell fluid or oedema. A simple and convenient method for the assessment of wound oedema would aid improvement in patient care. In this proof of concept study we investigated whether bioelectrical impedance spectroscopy has the potential to provide such a tool. A number of important observations were made. Firstly, the method was highly reproducible and data can be obtained from electrodes located at different positions around the region of interest; important given the highly variable topography of surface wounds, e.g. burns. Secondly, the method was …

Tailored Education For Older Patients To Facilitate Engagement In Falls Prevention Strategies After Hospital Discharge—A Pilot Randomized Controlled Trial, Anne-Marie Hill, Christopher Etherton-Beer, Terry P. Haines

Physiotherapy Papers and Journal Articles

Background

The aims of the study were to evaluate the effect of providing tailored falls prevention education in hospital on: i) engagement in targeted falls prevention behaviors in the month after discharge: ii) patients’ self-perceived risk and knowledge about falls and falls prevention strategies after receiving the education.

Methods

A pilot randomized controlled trial (n = 50): baseline and outcome assessments conducted by blinded researchers. Participants: hospital inpatients 60 years or older, discharged to the community. Participants were randomized into two groups. The intervention was a tailored education package consisting of multimedia falls prevention information with trained health professional follow-up, …

Changes In Neurochemicals Within The Ventrolateral Medullary Respiratory Column In Awake Goats After Carotid Body Denervation, Justin Robert Miller, Suzanne E. Neumueller, Clarissa Muere, Samantha Olesiak, Lawrence Pan, Matthew R. Hodges, Hubert V. Forster

Physical Therapy Faculty Research and Publications

A current and major unanswered question is why the highly sensitive central CO₂/H⁺ chemoreceptors do not prevent hypoventilation-induced hypercapnia following carotid body denervation (CBD). Because perturbations involving the carotid bodies affect central neuromodulator and/or neurotransmitter levels within the respiratory network, we tested the hypothesis that after CBD there is an increase in inhibitory and/or a decrease in excitatory neurochemicals within the ventrolateral medullary column (VMC) in awake goats. Microtubules for chronic use were implanted bilaterally in the VMC within or near the pre-Bötzinger Complex (preBötC) through which mock cerebrospinal fluid (mCSF) was dialyzed. Effluent mCSF was collected …

Kinesio Taping On Short-Term Changes In Shoulder Strength In Healthy Adults: A Randomized Clinical Trial, Dario A. Callegari, Cristobal E. Cordova, Julia R. Dunievitz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Study Type: A Randomized Clinical Trial

Introduction:

Kinesio tape is an elastic tape used in various settings and it is purported to assist in strengthening weakened muscles. The mechanism behind this claim is neuromuscular facilitation. The purpose of this study was to determine if the claims of Kinesio tape would be supported in its role in strength enhancing properties.

Methods:

Twenty-nine healthy, untrained male and female college-aged individuals participated in this study. Two baseline measurements assessing shoulder external rotation (ER) strength were collected using isokinetic dynamometry. Subjects were then randomized into two groups, Kinesio tape with ER strengthening (KT-Ex) and …

Attentional Focus During Balance Training In Idiopathic Parkinson’S Disease (Pd): A Randomized Clinical Trial, Alyssa Davis, Rebecca Hatlevig, Amanda Richards, Leslee Rosenlof

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to compare the effects of various attentional focus strategies on balance in people with PD. Forty-nine adults with idiopathic PD were randomized into one of four groups (internal focus, external focus, no focus, and control). The three intervention groups participated in a month-long balance program. The outcomes measured were the Sensory Organization Test, Berg Balance Scale, self selected gait velocity, Dynamic Gait Index, Activities-specific Balance Confidence Scale and obstacle course completion time. These outcomes were measured at baseline, post intervention, 2-weeks post intervention, and 8-weeks post intervention. Statistical analyses yielded no significant differences among …

Duration Of The Effects Of Three Static Stretching Conditions With Or Without A Dynamic Warm-Up In College Age Adults, Spencer Blackwell, Andrew Blomberg, Jonathan Griffith

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose. The purpose of this study was to determine the stretching duration (15, 30, 60 seconds) with or without a dynamic warm-up that resulted in the longest lasting acute effects in hamstring flexibility.

Subjects. Forty subjects (17 male, 23 female) (age: 20-35 years) were selected to participate in this study using a sample of convenience from university graduate students.

Methods. This study contained 7 treatment conditions in which each subject completed in random order. Three groups consisted of a 5-minute treadmill warm-up at a self-selected velocity (SSV) followed by one of three stretching durations (15, 30, or 60 sec). …

Chronic Lower Back Pain: A Maladaptive Perceptions Model, Benedict M. Wand

Physiotherapy Conference Papers

High quality evidence suggests that current approaches to the management of CLBP show only limited effectiveness; one explanation of this finding is that current models of management are misdirected or incomplete. This talk proposes a model of CLBP underpinned by data on the psychological contributors to the LBP experience and recent evidence of neuroplastic changes in the brains of people with CLBP (see below). The model suggests that maladaptive cognitive perception about the nature of the back problem and future consequences drive behaviours that might bring about maladaptive neuroplastic changes. These central nervous system changes may enhance sensitivity, influence normal …

Moving In An Environment Of Induced Sensory-Motor Incongruence Does Not Influence Pain Sensitivity In Healthy Volunteers: A Randomised Within-Subject Cross-Over Experiment, Benedict M. Wand, Lareina Szpak, Pamela George, Max Bulsara, Neil E. O'Connell, G Lorimer Moseley

Physiotherapy Conference Papers

A mismatch between the brain's motor control and sensory systems has been suggested as one mechanism whereby maladaptive neuroplastic changes contribute to the experience of chronic pain. Several studies have investigated this hypothesis by artificially inducing a state of sensory-motor incongruence using mirrors. The data to date appear to suggest that creating an environment of sensori-motor incongruence induces various sensory changes and feeling of peculiarity, however the effect on pain is less clear. The aim of this study was to test the hypothesis that healthy participants would demonstrate reduced pain thresholds and report greater intensity of pain in a condition …

Treatment-Based Classification Of Low Back Pain – Who Are The Unclear Classifications?, T R. Stanton, J M. Fritz, A T. Apeldoorn, Benedict M. Wand, M J. Hancock

Physiotherapy Conference Papers

A recent focus in low back pain research has been to identify patient subgroups that respond best to certain treatments. To integrate these subgroup findings into a useable form, a treatment-based classification algorithm for LBP was created.^1,2 To allow the algorithm to be comprehensive – eg, provide a classification for all patients – additional criteria are provided to assist therapists’ decisions for patients who do not clearly meet a treatment subgroup (unclear classifications).

Recent research found that approximately 34% of patients will receive unclear classifications using the algorithm.³ It has also been shown that the reliability of the …

Functional Changes In The Primary Somatosensory Cortex In Complex Regional Pain Syndrome (Crps): A Systematic Review, Flavia Di Pietro, Tasha R. Stanton, Luke Parkitny, James H. Mccauley, Martin Lotze, Benedict M. Wand, G Lorimer Moseley

Physiotherapy Conference Papers

The brain plays a key role in CRPS. A widely-studied brain region in pain research is the primary somatosensory cortex (S1), a somatotopic map of our body’s surface which functionally reorganises in pain [1]. Changes in the S1 representation of the CRPS-affected body part have contributed to new CRPS treatments, e.g. graded motor imagery. This systematic review and meta-analysis aimed to determine whether CRPS is associated with: a) a change in the size of the S1 representation of the affected body part; b) altered S1 activity, in terms of activation levels and latency of responses.

Discovering Which Experiences Physiotherapy Students Identify As Learning Facilitators In Practical Laboratories: An Action Research Project, J Francis-Coad, A Hill

Physiotherapy Conference Papers

Purpose: Students enrolled in courses that focus on patient contact participate in practical laboratories to learn clinical skills but this can be challenging in a pre-clinical environment. A simulated case based format using role play in small groups is commonly undertaken. Students may find it difficult to actively engage in learning and effective role playing without prior clinical experience. The aim of this study was to discover what type of experiences facilitated student learning in practical laboratory sessions.

Method: Design: Action research study.

Participants: Thirty two undergraduate second year physiotherapy students who were engaging in practical laboratories.

Data …

Low Back Pain-Related Beliefs And Self-Reported Practice Behaviours Among Final-Year Cross-Discipline Health Students, A Briggs, H Slater, A Smith, A Parkin-Smith, K Watkins, Benedict Wand, J Chua

Physiotherapy Conference Papers

No abstract provided.

Low Dose Ct Vs Plain Abdominal Radiography For The Investigation Of The Acute Abdomen, Long K. Nguyen, Daniel D. Wong, Daniel M. Fatovich, Justin M. Yeung, Jennifer Persaud, Christopher J. Wood, David De Vos, Richard M. Mendelson

Physiotherapy Papers and Journal Articles

Background: To compare low-dose abdominal computed tomography (LDCT) with plain abdominal radiography (AR) in the primary investigation of acute abdominal pain to determine if there is a difference in diagnostic yield, the number of additional investigations required and hospital length of stay (LOS).

Methods: This randomized controlled trial was approved by the institutional review board, and informed consent was obtained. Patients presenting to the emergency department with an acute abdomen and who would normally be investigated with AR were randomized to either AR or LDCT. The estimated radiation dose of the LDCT protocol was 2–3 mSv compared to 1.1 mSv …

Tactile Thresholds Are Preserved Yet Complex Sensory Function Is Impaired Over The Lumbar Spine Of Chronic Non-Specific Low Back Pain Patients: A Preliminary Investigation, Benedict M. Wand, Flavia Di Pietro, Pamela George, Neil E. O'Connell

Physiotherapy Conference Papers

Evidence indicates that chronic non-specific low back pain (CNSLBP) is associated with alteration in the brain’s cortical representation of the back, resulting in body perception disturbance and contributing to the condition [1,2]. This study investigated perception via ‘cortical’ sensory tests, in this case two-point discrimination and graphaesthesia—whose results partly depend on the integrity of cortical representation [2]. The hypothesis was dysfunction in these higher-order tasks, with simple tactile thresholds remaining unchanged. Furthermore a relationship between cortical sensation and severity of the condition was predicted.

Patient Satisfaction With Musculoskeletal Physiotherapy Care In Australia Is High, Vivian Yung, Martin Mackey, Benedict M. Wand, Roger Adams, Roger Nelson, Paul Beattie, Julia Hush

Physiotherapy Conference Papers

Patient satisfaction is an important outcome of care and is intrinsically valuable to clinicians. The level of patient satisfaction with musculoskeletal physiotherapy care in Australia is unknown. Increased understanding of patient satisfaction will benefit patients by facilitating clinicians to optimise clinical service delivery.

Non-Invasive Brain Stimulation Techniques For Chronic Pain. A Cochrane Systematic Review And Meta-Analysis, Neil E. O'Connell, Louise Marston, Benedict M. Wand, Sally Spencer, Lorraine H. De Souza

Physiotherapy Conference Papers

Poster Presentation

Non-invasive brain stimulation techniques aim to induce an electrical stimulation of the brain in an attempt to reduce chronic pain by directly altering brain activity. They include repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES) and transcranial direct current stimulation (tDCS). These approaches to pain treatment are relatively novel. It is important to assess the existing literature robustly to ascertain the current level of supporting evidence and to inform future research and potential clinical use.

Evaluation Of A Treatment-Based Classification Algorithm For Low Back Pain, Tasha R. Stanton, Julie Fritz, Mark J. Hancock, Jane Latimer, Chris G. Maher, Benedict M. Wand, Eric Parent

Physiotherapy Conference Papers

Poster Presentation

Theme: How can we better translate evidence into clinical practice?

Background: Several studies have investigated criteria for classifying patients with low back pain into treatment-based subgroups. A comprehensive algorithm was recently created to translate these criteria into a clinical decision-making guide. This study investigated the translation of the individual subgroup criteria into a comprehensive algorithm by studying the prevalence of patients meeting each treatment subgroup, more than one treatment subgroup, and none of the treatment subgroups. The reliability of the classification decision was also investigated.

Transcranial Direct Current Stimulation Of The Motor Cortex In The Treatment Of Chronic Non-Specific Low Back Pain. A Randomised, Double-Blind Exploratory Study, Neil E. O'Connell, John Cossar, Louise Marston, Benedict M. Wand, David Bunce, Lorraine H. De Souza, David W. Maskill, Andrew Sharp, G Lorimer Moseley

Physiotherapy Conference Papers

This exploratory study aimed to test the proof of principle that active anodal transcranial direct current stimulation (tDCS) applied to the motor cortex reduces pain significantly more than sham stimulation in a group of participants with chronic non-specific low back pain.

What Factors Determine Patient Satisfaction With Musculoskeletal Physiotherapy Care In Australia?, Julia Hush, Vivian Yung, Martin Mackey, Benedict M. Wand, Roger Adams, Roger Nelson, Paul Beattie

Physiotherapy Conference Papers

Patient satisfaction is an important patient-focussed indicator of the quality of physiotherapy care. We have completed an evaluation of patient satisfaction with musculoskeletal physiotherapy in Australia using the 20-item MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS). In this paper we report on factors that influence patient satisfaction in this cultural context.

Treating Chronic Nonspecific Low Back Pain With A Sensorimotor Retraining Approach: An Exploratory Multiple-Baseline Study Of 3 Participants, Benedict M. Wand, Neil E. O'Connell, Flavia Di Pietro, Max Bulsara

Physiotherapy Conference Papers

Chronic nonspecific low back pain (CNSLBP) is a common healthcare problem for which current interventions are only moderately successful [1]. There is growing evidence of extensive cortical reorganisation and perceptual disturbances which may contribute to the condition [2]. The aim of this study was to test whether a graded sensorimotor retraining program, aimed at influencing cortical representation, would reduce pain intensity, interference of pain on daily life and self reported disability.

Factors Associated With Older Patients' Engagement In Exercise After Hospital Discharge, Anne-Marie Hill, Tammy Hoffmann, Steven Mcphail, Christopher Beer, Keith D. Hill, Sandra G. Brauer, Terrence P. Haines

Physiotherapy Papers and Journal Articles

Objectives: To identify factors that are associated with older patients' engagement in exercise in the 6 months after hospital discharge.

Design: A prospective observational study using qualitative and quantitative evaluation.

Setting: Follow-up of hospital patients in their home setting after discharge from a metropolitan general hospital.

Participants: Participants (N=343) were older patients (mean age ± SD, 79.4±8.5y) discharged from medical, surgical, and rehabilitation wards and followed up for 6 months after discharge.

Interventions: Not applicable.

Main Outcome Measures: Self-perceived awareness and risk of falls measured at discharge with a survey that addressed elements of the Health Belief Model. Engagement and …

Falls After Discharge From Hospital: Is There A Gap Between Older Peoples’ Knowledge About Falls Prevention Strategies And The Research Evidence?, Anne-Marie Hill, Tammy Hoffmann, Christopher Beer, Steven Mcphail, Keith D. Hill, David Oliver, Sandra G. Brauer, Terry P. Haines

Physiotherapy Papers and Journal Articles

Purpose: The aim of this study was to examine whether older people are prepared to engage in appropriate falls prevention strategies after discharge from hospital.

Design and Methods: We used a semi-structured interview to survey older patients about to be discharged from hospital and examined their knowledge regarding falls prevention strategies to utilize in the post-discharge period. The study was part of a prospective cohort study, nested within a larger, randomized controlled trial. Participants (n = 333) were asked to suggest strategies to reduce their falls risk at home after discharge, and their responses were compared with current reported …