Physical Therapy Commons^™

Clinical Assessment Of The Infant And Child Following Perinatal Brachial Plexus Injury, Susan V. Duff, Carol Dematteo

Physical Therapy Faculty Articles and Research

Introduction

After perinatal brachial plexus injury (PBPI), clinicians play an important role in injury classification as well as the assessment of recovery and secondary conditions. Early assessment guides the initial plan of care and influences follow-up and long-term outcome.

Purpose

To review methods used to assess, classify and monitor the extent and influence of PBPI with an emphasis on guidelines for clinicians.

Methods

We use The International Classification of Functioning, Disability, and Health (ICF) model to provide a guide to assessment after PBPI for rehabilitation clinicians.

Discussion

With information gained from targeted assessments, clinicians can design interventions to increase the …

Choice Of Human–Computer Interaction Mode In Stroke Rehabilitation, Hossein Mousavi Hondori, Maryam Khademi, Lucy Dodakian, Alison Mackenzie, Cristina V. Lopes, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Background and Objective. Advances in technology are providing new forms of human–computer interaction. The current study examined one form of human–computer interaction, augmented reality (AR), whereby subjects train in the real-world workspace with virtual objects projected by the computer. Motor performances were compared with those obtained while subjects used a traditional human–computer interaction, that is, a personal computer (PC) with a mouse. Methods. Patients used goal-directed arm movements to play AR and PC versions of the Fruit Ninja video game. The 2 versions required the same arm movements to control the game but had different cognitive demands. With …

Interrater Reliability Of The Wolf Motor Function Test–Functional Ability Scale: Why It Matters, Susan V. Duff, Jiaxue He, Monica A. Nelsen, Christianne J. Lane, Veronica T. Rowe, Steve L. Wolf, Alexander W. Dromerick, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Background. One important objective for clinical trialists in rehabilitation is determining efficacy of interventions to enhance motor behavior. In part, limitation in the precision of measurement presents a challenge. The few valid, low-cost observational tools available to assess motor behavior cannot escape the variability inherent in test administration and scoring. This is especially true when there are multiple evaluators and raters, as in the case of multisite randomized controlled trials (RCTs). One way to enhance reliability and reduce variability is to implement rigorous quality control (QC) procedures. Objective. This article describes a systematic QC process used to refine …

A Multiple Degree Of Freedom Lower Extremity Isometric Device To Simultaneously Quantify Hip, Knee, And Ankle Torques, Natalia Sánchez, Ana Maria Acosta, Arno H. A. Stienen, Julius P. A. Dewald

Physical Therapy Faculty Articles and Research

Characterization of the joint torque coupling strategies used in the lower extremity to generate maximal and submaximal levels of torque at either the hip, knee, or ankle is lacking. Currently, there are no available isometric devices that quantify all concurrent joint torques in the hip, knee, and ankle of a single leg during maximum voluntary torque generation. Thus, joint-torque coupling strategies in the hip, knee, and concurrent torques at ankle and/or coupling patterns at the hip and knee driven by the ankle have yet to be quantified. This manuscript describes the design, implementation, and validation of a multiple degree of …

Identification Of Functional Parameters For The Classification Of Older Female Fallers And Prediction Of ‘First-Time’ Fallers, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Falls remain a challenge for ageing societies. Strong evidence indicates that a previous fall is the strongest single screening indicator for a subsequent fall and the need for assessing fall risk without accounting for fall history is therefore imperative. Testing in three functional domains (using a total 92 measures) were completed in 84 older women (60–85 years of age), including muscular control, standing balance, and mean and variability of gait. Participants were retrospectively classified as fallers (n = 38) or non-fallers (n = 42) and additionally in a prospective manner to identify first-time fallers (FTFs) (n = 6) within a …

Fall Risk Prediction Using Wearable Wireless Sensors, Thurmon Lockhart, Chris Frame, Rahul Soangra, John Lach

Physical Therapy Faculty Articles and Research

Wearable wireless sensors and nonlinear dynamics identify postural characteristics relevant to balance control and dynamic stability, revealing predictive risk of falls among older adults.

Classifying Lower Extremity Muscle Fatigue During Walking Using Machine Learning And Inertial Sensors, Jian Zhang, Thurmon Lockhart, Rahul Soangra

Physical Therapy Faculty Articles and Research

Fatigue in lower extremity musculature is associated with decline in postural stability, motor performance and alters normal walking patterns in human subjects. Automated recognition of lower extremity muscle fatigue condition may be advantageous in early detection of fall and injury risks. Supervised machine learning methods such as Support Vector Machines (SVM) have been previously used for classifying healthy and pathological gait patterns and also for separating old and young gait patterns. In this study we explore the classification potential of SVM in recognition of gait patterns utilizing an inertial measurement unit associated with lower extremity muscular fatigue. Both kinematic and …

Clinical Reasoning In First- And Third-Year Physical Therapist Students, Sarah Gilliland

Physical Therapy Faculty Articles and Research

Background and Purpose. The development of clinical reasoning skills is a crucial component of professional physical therapist education. Prior research has described reasoning patterns in novice and expert practitioners, yet little is known about how professional physical therapist (PT) students develop clinical reasoning skills. The purpose of this study was to explore how first-year PT students perform clinical reasoning in comparison to third year PT students in their final semester.

Subjects. A simple random sample of 6 first-year (mean age 23.1 years) and 6 third-year (mean age 27 years) Doctor of Physical Therapy students were recruited.

Methods. …

The Influence Of Hip Strength On Lower-Limb, Pelvis, And Trunk Kinematics And Coordination Patterns During Walking And Hopping In Healthy Women, Jo Armour Smith, John M. Popovich, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Study Design

Cross-sectional laboratory study.

Objectives

To compare peak lower-limb, pelvis, and trunk kinematics and interjoint and intersegmental coordination in women with strong and weak hip muscle performance.

Background

Persons with lower extremity musculoskeletal disorders often demonstrate a combination of weak hip musculature and altered kinematics during weight-bearing dynamic tasks. However, the association between hip strength and kinematics independent of pathology or pain is unclear.

Methods

Peak hip extensor and abductor torques were measured in 150 healthy young women. Of these, 10 fit the criteria for the strong group and 9 for the weak group, representing those with the strongest …

Agreement In Gait Speed From Smartphone And Stopwatch For Five Meter Walk In Laboratory And Clinical Environments, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Gait speed is suggested as an independent predictor of post-operative morbidity and mortality in elderly cardiovascular disease (CVD) patients. Society of thoracic surgeons has recently classified gait speed as the only important indicator of health for CVD patients. It has been seen that patients with slow gait speed above 70 years of age, taking more than 6 seconds to walk 5 meters are particularly at high risk for adverse outcomes. Twelve young participants walked in their self-selected, slow and fast speed with five reflective markers at sternum and heels and toes of both feet in laboratory environment. A smartphone was …

Impact Of Afo (Ankle Foot Orthosis) Design On Calf Circumference, Robert H. Meier, David C. Ruthsatz, Daniel Cipriani

Physical Therapy Faculty Articles and Research

Preliminary research suggests the use of a kinetic return ankle foot orthosis is associated with small but significant shortterm increases in calf circumference, which in turn suggests this type of device might reduce or protect against the risk of disuse muscle atrophy.

Trunk Coordination In Dancers And Non-Dancers, Danielle N. Jarvis, Jo Armour Smith, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Variability, or how a task changes across trials, may reveal differences between athletes of differing skill levels. The purpose of this study was to examine trunk and lower extremity (LE) single joint kinematic variability and inter-segmental coordination variability in dancers and non-dancers during bipedal vertical dance jumps (sautés). Twenty healthy females, ten with no formal dance training and ten professional dancers, performed 20 consecutive sautés. Single joint kinematic variability was assessed using mean standard deviation of angular displacement, and inter-segmental coordination variability was assessed using angular deviation of the coupling angle between segments. Within the context of the standard error …

Potential For Using Smartphone Accelerometers In Non-Laboratory Environments, Rahul Soangra, Thurmon Lockhart, Christopher W. Frames, Jian Zhang, Seong Hyun Moon, Jongsoon Park

Physical Therapy Faculty Articles and Research

In recent years, there has been rising interest in using accelerometers as an alternative instrument to measure the center of pressure. Accelerometers are inexpensive, small, sensitive, and can be readily used in non-laboratory environments. In addition to this, smartphones with built-in accelerometers add to their capability with real-time processing of data from sensors. Clinicians and researchers are currently in disagreement from whether these measurements provide the same physiological information about the participant’s balance. In this study, twelve participants were asked to wear smartphone on their right ASIS using a belt clip and stand still on the forceplate. The data was …

Age-Related Modifications To The Magnitude And Periodicity Of Neuromuscular Noise, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Background: Evaluation of task related outcomes within geriatric and fall-prone populations is essential not only for identification of neuromuscular deficits, but also for effective implementation of fall prevention strategies. As most tasks and activities of daily living are performed at submaximal force levels, restoration of muscle strength often does not produce the expected benefit in functional capacity. However, it is known that muscular control plays a key role in the performance of functional tasks, but it remains unclear to what degree muscular control and the associated neuromuscular noise (NmN) is age-related, particularly in the lower-extremities.

Objectives: The aim of this …

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.

Effects Of Hemodialysis Therapy On Sit-To-Walk Characteristics In End Stage Renal Disease Patients, Rahul Soangra, Thurmon Lockhart, John Lach, Emaad M. Abdel-Rahman

Physical Therapy Faculty Articles and Research

Patients with end stage renal diseases (ESRD) undergoing hemodialysis (HD) have high morbidity and mortality due to multiple causes; one of which is dramatically higher fall rates than the general population. In spite of the multiple efforts aiming to decrease the high mortality and improve quality of life in ESRD patients, limited success has been achieved. If adequate interventions for fall prevention are to be achieved, the functional and mobility mechanisms consistent with falls in this population must be understood. Human movements such as sit-to-walk (STW) tasks are clinically significant, and analysis of these movements provides a meaningful evaluation of …

Assessment Of Postural Stability Using Inertial Measurement Unit On Inclined Surfaces In Healthy Adults, Chris Frames, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Fatal and nonfatal falls in the construction domain remain a significant issue in today’s workforce. The roofing industry in particular, annually ranks amongst the highest in all industries. Exposure to an inclined surface, such as an inclined roof surface, has been reported to have adverse effects on postural stability. The purpose of this preliminary study was to investigate the intra-individual differences in stability parameters on both inclined and level surfaces. Postural Stability (PS) and Limit of Stability (LOS) were assessed in seven healthy subjects (aged 25-35 years) on inclined and level surfaces using embedded force plates and an Inertial Measurement …

Comparison Of Intra Individual Physiological Sway Complexity From Force Plate And Inertial Measurement Unit, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Center of Pressure (COP) is a clinical measure to investigate the effect of sensory input disturbances on postural stability in healthy, old population as well in people suffering from neuromuscular disease. Increased center of pressure velocity and sway area are interpreted as decreased stability or poor balance and are associated with fall risk. Body mounted inertial sensors have shown great promise as an easily implemented clinical measure of balance. The aim of the present study is to investigate if force plate and accelerometer measurements provide similar physiological information when approximate entropy (ApEn) are valuated from the time series. Seven Young …

Wavelet Based Automated Postural Event Detection And Activity Classification With Single Imu (Tempo), Thurmon E. Lockhart, Rahul Soangra, Jian Zhang, Xuefang Wu

Physical Therapy Faculty Articles and Research

Mobility characteristics associated with activity of daily living such as sitting down, lying down, rising up, and walking are considered to be important in maintaining functional independence and healthy life style especially for the growing elderly population. Characteristics of postural transitions such as sit-to-stand are widely used by clinicians as a physical indicator of health, and walking is used as an important mobility assessment tool. Many tools have been developed to assist in the assessment of functional levels and to detect a person’s activities during daily life. These include questionnaires, observation, diaries, kinetic and kinematic systems, and validated functional tests. …

Intramuscular Manual Therapy After Failed Conservative Care: A Case Report, Brent Harper

Physical Therapy Faculty Articles and Research

Background and Purpose: During intramuscular manual therapy (IMT), an acupuncture needle is inserted into the skin and muscle. The direct mechanical stimulation may interrupt the pathogenic mechanisms of myofascial trigger points (MTrPs). The purpose of this study was to demonstrate the application and efficacy of IMT on a patient suffering from right chronic elbow lateral epicondylalgia. Methods: A case study of a 26-year-old male presenting with a 6-month history of right elbow pain who failed 11 conservative physical therapy sessions and previous site-specific acupuncture. The patient received 5 IMT sessions over 4 weeks. Findings: The patient had …

Extreme Levels Of Noise Constitute A Key Neuromuscular Deficit In The Elderly, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Fluctuations during isometric force production tasks occur due to the inability of musculature to generate purely constant submaximal forces and are considered to be an estimation of neuromuscular noise. The human sensori-motor system regulates complex interactions between multiple afferent and efferent systems, which results in variability during functional task performance. Since muscles are the only active component of the motor system, it therefore seems reasonable that neuromuscular noise plays a key role in governing variability during both standing and walking. Seventy elderly women (including 34 fallers) performed multiple repetitions of isometric force production, quiet standing and walking tasks. No relationship …

Effect Of Stretch Frequency And Sex On The Rate Of Gain And Rate Of Loss In Muscle Flexibility During A Hamstring-Stretching Program: A Randomized Single-Blind Longitudinal Study, Daniel Cipriani, Megan E. Terry, Michelle A. Haines, Amir P. Tabibnia, Olga Lyssanova

Physical Therapy Faculty Articles and Research

This study evaluated the effects of four different weekly stretching protocols on the rate of gain and decline in hamstring flexibility over an 8-week period, across sex. Using a randomized single-blind design, 53 healthy subjects aged 18–46 years were assigned to 1 of 4 stretching protocols or a control group. The stretching protocols consisted of either daily or 3 times per week stretching and performed once or twice each day. These protocols differed in terms of frequency and total weekly stretching time. All the subjects stretched their hamstring muscles for 4 weeks and were measured weekly for their hip range …

Determination Of Stabilogram Diffusion Analysis Coefficients And Invariant Density Analysis Parameters To Understand Postural Stability Associated With Standing On Anti-Fatigue Mats, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Prolonged standing has been associated with loss of balance, onset of low back pain symptoms and development of fatigue in lower extremity muscles in working populations. Although so far, it is unknown how individuals’ postural stability is affected by standing on rigid versus cushioned platform but many industries are opting for anti-fatigue mats at workstations to reduce fall and injury related socio-economic cost. The goal of this study is to test SATECH's anti-fatigue mat for its effects on postural stability. A pilot test with seven healthy subjects (25–35 years old) has been conducted with a force plate to obtain kinetics …

Non-Invasive Fall Risk Assessment In Community Dwelling Elderly With Wireless Inertial Measurement Units, Thurmon E. Lockhart, Han T. Yeoh, Rahul Soangra, Manutchanok Jongprasithporn, Jian Zhang, Xuefang Wu, Arka Ghosh

Physical Therapy Faculty Articles and Research

Falls are among the most serious accidents among the elderly leading to increased injuries, reduced functioning and mortality. In 2009, about 2.2 million nonfatal fall injuries were reported among the elderly population (CDC, 2010). In this study, eleven community dwelling elderly (aged 65-84 years) participated in fall risk assessment camp at sterling senior center organized by Northern Virginia Fall Prevention Coalition (NVFPC). Three custom made wireless inertial measurement units (IMUs) were attached on trunk and both shanks. All participants performed postural and locomotor tasks such as sit-to-stand (STS) and timed up and go (TUG). Temporal and kinematic parameters were obtained. …

Rating Scale Analysis And Psychometric Properties Of The Caregiver Self-Efficacy Scale For Transfers, Daniel Cipriani, Francine E. Hansen, Danielle L. Mcpeck, Gina L.D. Kubec, Julie J. Thomas

Physical Therapy Faculty Articles and Research

Parents and caregivers faced with the challenges of transferring children with disability are at risk of musculoskeletal injuries and/or emotional stress. The Caregiver Self-Efficacy Scale for Transfers (CSEST) is a 14-item questionnaire that measures self-efficacy for transferring under common conditions. The CSEST yields reliable data and valid inferences; however, its rating scale structure has not been evaluated for utility. The aims of this study were to evaluate the category response structure of the CSEST, test the utility of a revised rating scale structure, and confirm its psychometric properties. The Rasch Measurement Model was used for all analyses. Subjects included 175 …

Shoulder-And Back-Muscle Activation During Shoulder Abduction And Flexion Using A Bodyblade Pro Versus Dumbbells, Joseph S. Parry, Rachel Straub, Daniel Cipriani

Physical Therapy Faculty Articles and Research

Context: The Bodyblade Pro is used for shoulder rehabilitation after injury. Resistance is provided by blade oscillations—faster oscillations or higher speeds correspond to greater resistance. However, research supporting the Bodyblade Pro’s use is scarce, particularly in comparison with dumbbell training. Objective: To compare muscle activity, using electromyography (EMG), in the back and shoulder regions during shoulder exercises with the Bodyblade Pro vs dumbbells. Design: Randomized crossover study. Setting: San Diego State University biomechanics laboratory. Participants: 11 healthy male subjects age 19–32 y. Intervention: Subjects performed shoulder-flexion and -abduction exercises using a Bodyblade Pro and …

Investigation Into The Functional Mobility Difference Between Obese And Non-Obese Elderly, Xuefang Wu, Han T. Yeoh, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Obese aging population is increasing in the United States, and obese elderly experience fall twice as frequent as their lean counterparts. However, the mechanisms of older obese adults fall are still not clear. It is not known whether the obese elderly has more functional mobility impairments than their lean counterparts, and consequently have increased risks of falls. It was hypothesized that obese elderly have more functional mobility impairments compared with their healthy weight counterparts. Six lean and six obese community-dwelling elderly participated in the study. “Timed up & go” test was used to quantify the functional mobility for both lean …

A Comparative Study For Performance Evaluation Of Sit-To-Stand Task With Body Worn Sensor And Existing Laboratory Methods, Rahul Soangra, Thurmon E. Lockhart

Physical Therapy Faculty Articles and Research

Human movement such as sit-to-stand (STS) is one of the most fundamental and essential movement among daily living activities. Elderly who are unable to stand are severely limited in daily activities and rely on others for their care. In the coming next two decades about 20% of US population will be above the age of 65 years, and considering ever-increasing elderly population and health care expenses, the rehabilitation of functionally limited elderly is becoming a topic of greater concern. Clinically STS movement is looked upon with great interest, such as its analysis is meaningful in order to evaluate motor control …

Pressure Distribution Over The Palm Region During Forward Falls On The Outstretched Hands, Woochol J. Choi, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

Falls on the outstretched hands are the cause of over 90% of wrist fractures, yet little is known about bone loading during this event. We tested how the magnitude and distribution of pressure over the palm region during a forward fall is affected by foam padding (simulating a glove) and arm configuration, and by the faller’s body mass index (BMI) and thickness of soft tissues over the palm region.

Thirteen young women with high (n=7) or low (n=6) BMI participated in a “torso release experiment” that simulated falling on both outstretched hands with the arm inclined either at 20° or …

An Approach For Identifying Gait Events Using Wavelet Denoising Technique And Single Wireless Imu, Rahul Soangra, Thurmon Lockhart, Nathalie Van De Berge

Physical Therapy Faculty Articles and Research

A new approach is proposed to identify gait events in non-laboratory environments with a single inertial measurement unit (IMU) embedded inside shoe. The aim of our work is to develop a useful clinical tool for monitoring individuals walking disability and detect specific pathological gait patterns. Temporal parameters of gait are determined by classification of accelerations and angular velocities. Wavelets denoising of IMU signals allows for an important amount of information that is exploited in different manners for event identification. It was found that wavelet denoising enhanced specific turning points which could effectively identify gait events. The method is verified by …