Physical Therapy Commons^™

Insertion And Presence Of Fine-Wire Intramuscular Electrodes To The Lumbar Paraspinal Muscles Do Not Affect Muscle Performance And Activation During Highexertion Spinal Extension Activities, Szu-Ping Lee, Jo Armour Smith, Matthew Kimber, Kelsey Houk

Physical Therapy Faculty Articles and Research

Background

Low back pain (LBP) is commonly associated with paraspinal muscle dysfunctions. A method to study deep lumbar paraspinal (i.e. multifidus) muscle function and neuromuscular activation pattern is intramuscular electromyography (EMG). Previous studies have shown that the procedure does not significantly impact muscle function during activities involving low-level muscle contractions. However, it is currently unknown how muscular function and activation are affected during high-exertion contractions.

Objective

To examine the effects of insertion and presence of fine-wire EMG electrodes in the lumbar multifidus on muscle strength, endurance, and activation profiles during high-exertion spinal extension muscle contractions.

Design

Single-blinded, repeated measures intervention …

Motor Subtypes Of Parkinson’S Disease Can Be Identified By Frequency Component Of Postural Stability, Saba Rezvanian, Thurmon Lockhart, Christopher Frames, Rahul Soangra, Abraham Lieberman

Physical Therapy Faculty Articles and Research

Parkinson’s disease (PD) can be divided into two subtypes based on clinical features—namely tremor dominant (TD) and postural instability and gait difficulty (PIGD). This categorization is important at the early stage of PD, since identifying the subtypes can help to predict the clinical progression of the disease. Accordingly, correctly diagnosing subtypes is critical in initiating appropriate early interventions and tracking the progression of the disease. However, as the disease progresses, it becomes increasingly difficult to further distinguish those attributes that are relevant to the subtypes. In this study, we investigated whether a method using the standing center of pressure (COP) …

Clinical Reasoning In Physical Therapy: A Concept Analysis, Karen Huhn, Sarah J. Gilliland, Lisa L. Black, Susan F. Wainwright, Nicole Christensen

Physical Therapy Faculty Articles and Research

Background

Physical Therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research.

Objective

The objective was to conceptualize a broad description of physical therapists’ clinical reasoning grounded in the published literature and to unify our understanding for future work related to teaching, assessment, and research.

Design/Methods

The design included a systematic concept analysis using Rodgers’ Evolutionary methodology. A concept analysis is a research methodology in which a concept's …

Virtual Reality As A Training Tool To Treat Physical Inactivity In Children, Adam W. Kiefer, David Pincus, Michael J. Richardson, Gregory D. Myer

Psychology Faculty Articles and Research

Lack of adequate physical activity in children is an epidemic that can result in obesity and other poor health outcomes across the lifespan. Physical activity interventions focused on motor skill competence continue to be developed, but some interventions, such as neuromuscular training (NMT), may be limited in how early they can be implemented due to dependence on the child’s level of cognitive and perceptual-motor development. Early implementation of motor-rich activities that support motor skill development in children is critical for the development of healthy levels of physical activity that carry through into adulthood. Virtual reality (VR) training may be beneficial …

Cortical Contribution To Linear, Non-Linear And Frequency Components Of Motor Variability Control During Standing, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Motor variability is an inherent feature of all human movements and reflects the quality of functional task performance. Depending on the requirements of the motor task, the human sensory-motor system is thought to be able to flexibly govern the appropriate level of variability. However, it remains unclear which neurophysiological structures are responsible for the control of motor variability. In this study, we tested the contribution of cortical cognitive resources on the control of motor variability (in this case postural sway) using a dual-task paradigm and furthermore observed potential changes in control strategy by evaluating Ia-afferent integration (H-reflex). Twenty healthy subjects …

The Influence Of Divided Attention On Walking Turns: Effects On Gait Control In Young Adults With And Without A History Of Low Back Pain, Jo Armour Smith, James Gordon, Kornelia Kulig

Physical Therapy Faculty Articles and Research

The cognitive control of gait is altered in individuals with low back pain, but it is unclear if this alteration persists between painful episodes. Locomotor perturbations such as walking turns may provide a sensitive measure of gait adaptation during divided attention in young adults. The purpose of this study was to investigate changes in gait during turns performed with divided attention, and to compare healthy young adults with asymptomatic individuals who have a history of recurrent low back pain (rLBP). Twenty-eight participants performed 90° ipsilateral walking turns at a controlled speed of 1.5 m/s. During the divided attention condition they …

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) …

The Motor Cortical Representation Of A Muscle Is Not Homogeneous In Brain Connectivity, Jo Armour Smith, Alaa Albishi, Sarine Babikian, Skulpan Asavasopon, Beth E. Fisher, Jason Kutch

Physical Therapy Faculty Articles and Research

Functional connectivity patterns of the motor cortical representational area of single muscles have not been extensively mapped in humans, particularly for the axial musculature. Functional connectivity may provide a neural substrate for adaptation of muscle activity in axial muscles that have both voluntary and postural functions. The purpose of this study was to combine brain stimulation and neuroimaging to both map the cortical representation of the external oblique (EO) in primary motor cortex (M1) and supplementary motor area (SMA), and to establish the resting-state functional connectivity associated with this representation. Motor evoked potentials were elicited from the EO muscle in …

The Use Of Emg As A Physical Therapy Learning Aid, Madeline L. Johnson, Rachel C. Cooklin, Erika N. Faria, Taylor M. Schavo, Eric Sternlicht

Student Scholar Symposium Abstracts and Posters

The purpose of this study was to compare the muscle recruitment of an agonist and antagonist muscle during the step up physical therapy exercise with and without visual electromyographic (EMG) biofeedback. 15 healthy, college-aged subjects were recruited to participate in the study. Subjects performed the step up with and without visual feedback in two separate sessions over a four week period. Muscle activity was recorded from the Vastus Medialis (VMO) of the target leg and Medial Gastrocnemius on the contralateral leg. EMG recordings were collected using a BTS FREEEMG system and data was processed using BTS SEMGanalyzer software (BTS Bioengineering, …

Efficacy Of Electromyography And The Dead Bug Exercise, Taylor M. Scavo, Rachel C. Cooklin, Erika N. Faria, Madeline L. Johnson, Eric Sternlicht

Student Scholar Symposium Abstracts and Posters

The Dead Bug exercise is performed in physical therapy clinics to restore lumbar spine stability and core strength in patients with lower back pain (LBP). The aim of this study was to evaluate the efficacy of using electromyography (EMG) feedback to enhance proper mechanics during the Dead Bug exercise. Sixteen healthy, college age students volunteered as subjects for the study. Subjects performed the Dead Bug (Fig. 1a.) with and without visual EMG cues and were given instructions on how to execute the exercise. Data was recorded using a BTS FREEEMG Analyzer and signal processed and data analyzed using the BTS …

Role Of Corpus Callosum Integrity In Arm Function Differs Based On Motor Severity After Stroke, Jill Campbell Stewart, Pritha Dewanjee, George Tran, Erin Burke Quinlan, Lucy Dodakian, Alison Mckenzie, Jill See, Steven C. Cramer

Physical Therapy Faculty Articles and Research

While the corpus callosum (CC) is important to normal sensorimotor function, its role in motor function after stroke is less well understood. This study examined the relationship between structural integrity of the motor and sensory sections of the CC, as reflected by fractional anisotropy (FA), and motor function in individuals with a range of motor impairment level due to stroke. Fifty-five individuals with chronic stroke (Fugl-Meyer motor score range 14 to 61) and 18 healthy controls underwent diffusion tensor imaging and a set of motor behavior tests. Mean FA from the motor and sensory regions of the CC and from …

What Is The Contribution Of Ia-Afference For Regulating Motor Output Variability During Standing?, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Motor variability is an inherent feature of all human movements, and describes the system‘s stability and rigidity during the performance of functional motor tasks such as balancing. In order to ensure successful task execution, the nervous system is thought to be able to flexibly select the appropriate level of variability. However, it remains unknown which neurophysiological pathways are utilized for the control of motor output variability. In responding to natural variability (in this example sway), it is plausible that the neuro-physiological response to muscular elongation contributes to restoring a balanced upright posture. In this study, the postural sway of 18 …

Dual-Task Does Not Increase Slip And Fall Risk In Healthy Young And Older Adults During Walking, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Dual-task tests can identify gait characteristics peculiar to fallers and nonfallers. Understanding the relationship between gait performance and dual-task related cognitive-motor interference is important for fall prevention. Dual-task adapted changes in gait instability/variability can adversely affect fall risks. Although implicated, it is unclear if healthy participants’ fall risks aremodified by dual-task walking conditions. Seven healthy young and seven healthy older adults were randomly assigned to normal walking and dual-task walking sessions with a slip perturbation. In the dual-task session, the participants walked and simultaneously counted backwards from a randomly provided number. The results indicate that the gait changes in dual-task …

Physical Therapist Students’ Development Of Diagnostic Reasoning: A Longitudinal Study, Sarah Gilliland

Physical Therapy Faculty Articles and Research

Background and Purpose. Clinical reasoning is a complex problem-solving process that is necessary for effective clinical practice in physical therapy. Within the process of clinical reasoning, a physical therapist’s diagnostic reasoning should address the patient’s functional movement abilities and the impact of the patient’s condition on his or her ability to participate in life activities. This longitudinal study examined the development of entry-level physical therapist students’ diagnostic reasoning processes across time in their doctor of physical therapy education.

Methods. Qualitative methods were used to analyze participants’ diagnostic reasoning during a simulated patient case scenario. Six physical therapist students …

Occupational Therapy And Physiotherapy Education And Workforce In Anglophone Sub-Saharan Africa Countries, Augustine O. Agho, Emmanuel John

Physical Therapy Faculty Articles and Research

Background: Sub-Saharan Africa (SSA) countries are faced with the challenge of educating a critical mass of occupational therapists (OTs) and physiotherapists (PTs) to meet the growing demand for health and rehabilitation services. The World Federation of Occupational Therapy (WFOT) and World Confederation of Physical Therapy (WCPT) have argued for the need of graduate-level training for OTs and PTs for decades. However, very few studies have been conducted to determine the availability of OT and PT training programs and practitioners in SSA countries.

Methods: Initial data were collected and compiled from an extensive literature search conducted using MEDLINE and …

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

Physical Therapy Faculty Articles and Research

Objectives

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

Design

Prospective cohort study.

Setting

University research laboratory.

Participants

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

Main outcome measures

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

Results

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

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

Physical Therapy Faculty Articles and Research

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

Can Gait Signatures Provide Quantitative Measures For Aiding Clinical Decision-Making? A Systematic Meta-Analysis Of Gait Variability Behavior In Patients With Parkinson’S Disease, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

A disturbed, inconsistent walking pattern is a common feature of patients with Parkinson's disease (PwPD). Such extreme variability in both temporal and spatial parameters of gait has been associated with unstable walking and an elevated prevalence of falls. However, despite their ability to discretise healthy from pathological function, normative variability values for key gait parameters are still missing. Furthermore, an understanding of each parameter's response to pathology, as well as the inter-parameter relationships, has received little attention. The aim of this systematic literature review and meta-analysis was therefore to define threshold levels for pathological gait variability as well as to …

How Should We Teach Lumbar Manipulation? A Consensus Study, Michael O'Donnell, Jo Armour Smith, Alex Abzug, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Background Spinal manipulation is an effective intervention for low back pain, yet there is little consistency in how this skill is taught.

Objectives The purpose of this study was to identify what educators and clinicians believe are important characteristics of the patient and operator position prior to side-lying lumbar manipulation and the patient position and operator motion during the manipulative thrust.

Design A multi-disciplinary correspondence-based Delphi method

Methods Three rounds of questionnaires were sent to physical therapists, osteopaths and chiropractors. Consensus was established in Round 3 if at least 75 % of respondents identified a characteristic as very important/extremely important …

Revealing The Quality Of Movement: A Meta-Analysis Review To Quantify The Thresholds To Pathological Variability During Standing And Walking, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Neuromotor processes are inherently noisy, which results in variability during movement and fluctu-ations in motor control. Although controversial, low levels of variability are traditionally considered healthy, while increased levels are thought to be pathological. This systematic review and meta-analysisof the literature investigates the thresholds between healthy and pathological task variability.

After examining 13,195 publications, 109 studies were included. Results from over 3000 healthy sub-jects and 2775 patients revealed an overall positive effect size of pathology on variability of 0.59 forwalking and 0.80 for sway. For the coefficient of variation of stride time (ST) and sway area (SA), upperthresholds of 2.6% …

Trunk-Pelvis Coordination During Turning: A Cross Sectional Study Of Young Adults With And Without A History Of Low Back Pain, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Background

During steady-state locomotion, symptomatic individuals with low back pain demonstrate reduced ability to modulate coordination between the trunk and the pelvis in the axial plane. It is unclear if this is also true during functional locomotor perturbations such as changing direction, or if this change in coordination adaptability persists between symptomatic episodes. The purpose of this study was to compare trunk-pelvis coordination during walking turns in healthy individuals and asymptomatic individuals with a history of low back pain.

Methods

Participants performed multiple ipsilateral turns. Axial plane inter-segmental coordination and stride-to-stride coordination variability were quantified using the vector coding technique. …

Altered Multifidus Recruitment During Walking In Young Asymptomatic Individuals With A History Of Low Back Pain, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Study Design

Cross sectional, laboratory study.

Background

Individuals with low back pain have impaired activation of multifidus during postural adjustments and increased activity of the erector spinae musculature during walking. However, it is unclear if these alterations in muscle activity are evident during locomotion in individuals with a history of low back pain when they are between symptomatic episodes.

Objectives

To compare paraspinal muscle activity in young healthy individuals and young individuals with a history of low back pain during walking turns.

Methods

14 asymptomatic individuals with a history of low back pain and 14 controls performed 90° walking turns …

Review Of The Pe Metrics Cognitive Assessment Tool For Fifth Grade Students, Michael Hodges, Chong Lee, Kent A. Lorenz, Daniel Cipriani

Physical Therapy Faculty Articles and Research

Study aim: this study examined the item difficulty and item discrimination scores for the HRFK PE Metrics cognitive assessment tool for 5th-grade students. Materials and methods: ten elementary physical education teachers volunteered to participate. Based on convenience, participating teachers selected two 5th grade physical education classes. Teachers then gave students (N = 633) a 28-question paper and pencil HRFK exam using PE Metrics Standards 3 and 4. Item difficulty and discrimination analysis and Rasch Modeling were used data to determine underperforming items. Results: analysis suggests that at least three items are problematic. The Rasch Model confirmed this …

Effects Of Pelvis Impact Angle And Hip Muscle Forces On Hip Fracture Risk During A Fall Using An Advanced Hip Impact Simulator, Woochol J. Choi, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

"Over 90% of hip fractures in older adults are caused by falls [1]. Whether a given fall will cause hip fracture depends on bone strength, and on the impact force and stress applied to the bone during impact [2]. Improved understanding is required on how peak bone stresses during a fall depend on the mechanics of a fall, and on the state of contraction at the moment of impact of the muscles spanning the hip. Recently, Choi et al showed that, for lateral impact to the hip, peak stresses decrease with increases in hip abductor muscle force [3]. In the …

Influence Of Pelvis Impact Angle During A Fall: On The Protective Benefit Of Hip Protectors, Woochol J. Choi, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

"Over 90% of hip fractures are due to falls [1]. Laboratory measures have shown that wearable hip protectors reduce impact forces to the proximal femur during a simulated sideways fall on the hip [2, 3]. However, clinical evidence suggests that hip fractures still occur when hip protectors are worn [4]. Furthermore, while falls in real life result in a variety of impact configurations, biomechanical tests to date have focused only on lateral impact to the pelvis. In the current study, we examined how the force reduction provided by wearable hip protectors is affected by pelvis impact configuration during simulated sideways …

Does Insertion Of Intramuscular Electromyographic Electrodes Alter Motor Behavior During Locomotion?, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Intramuscular electromyography (EMG) is commonly used to quantify activity in the trunk musculature. However, it is unclear if the discomfort or fear of pain associated with insertion of intramuscular EMG electrodes results in altered motor behavior. This study examined whether intramuscular EMG affects locomotor speed and trunk motion, and examined the anticipated and actual pain associated with electrode insertion in healthy individuals and individuals with a history of low back pain (LBP). Before and after insertion of intramuscular electrodes into the lumbar and thoracic paraspinals, participants performed multiple repetitions of a walking turn at self-selected and controlled average speed. Low …

Reliability Of Precision In Motion Software, Nicole Laura, Kristen Petrillo, Marybeth Grant-Beuttler, Richard Beuttler

Student Scholar Symposium Abstracts and Posters

Background: There is a current lack of affordable 3-D motion analysis systems available to physical therapists for documenting objective data.

Objective: Compare data from inexpensive 3-D motion capture system using the Kinect, to the Codamotion, a traditional active marker, motion analysis system. Determine data reliability.

Design: Reliability-method comparison study

Methods: Seventeen subjects (9 females, 8 males) were instructed to walk down marked runway, arms across chest while both systems recorded data. Data was collected with Kinect on the same and opposite side as the Coda. Kinect and Coda data were interpolated and normalized for comparison. A program for heel strike …

Hydatid Cyst Of Thoracic Spine: A Rare Cause Of Paraplegia, Rahul Soangra, Mool Chand Soangra

Physical Therapy Faculty Articles and Research

Primary spinal hydatid cysts are uncommon and extradural involvement is rare. We report an unusual case of Paraplegia due to hydatid disease of primary site of infection extra spinal muscles in thoracic region from T5 to T8 level extending into a daughter cyst at T9 level, is main cause of acute Paraplegia. Magnetic resonance imaging (MRI) showed an extradural round cystic lesion in the spinal canal filling the posterior and left postero-lateral expect at T9 level, markedly compressing the cord. The cyst was removed after laminectomy and opening of the dural sac, with excision of extraspinal mass in left paravertebral …

Innovative Evaluation Of Dexterity In Pediatrics, Susan V. Duff, Dorit H. Aaron, Gloria R. Gogola, Francisco J. Valero-Cuevas

Physical Therapy Faculty Articles and Research

Introduction

Hand dexterity is multifaceted and essential to the performance of daily tasks. Timed performance and precision demands are the most common features of quantitative dexterity testing. Measurement concepts such as rate of completion, in-hand manipulation and dynamic force control of instabilities are being integrated into assessment tools for the pediatric population.

Purpose

To review measurement concepts inherent in pediatric dexterity testing and introduce concepts that are infrequently measured or novel as exemplified with two assessment tools.

Methods

Measurement concepts included in common assessment tools are introduced first. We then describe seldom measured and novel concepts embedded in two instruments; …