Physical Therapy Commons^™

Horizontal Ladder Task: Assessing The Effect Of A Walking Intervention On Mobility In People With Lower Limb Amputation, Chelsea Domingo

Undergraduate Research Symposium Posters

Hundreds of thousands of people struggle with mobility due to lower limb amputation. Learning how to do something you have never done is a difficult task for anyone. Practice is important when person with amputation uses a prosthesis because each environment they encounter could vary. Across settings, different textures such as even and uneven terrain require different skills to maintain balance. The purpose of this research is to determine if practicing walking on uneven terrain will help people with amputation improve their ability to walk in different environments. We will use a horizontal ladder task (Christie et al., 2020) to …

Effects Of Patellofemoral Pain On Central Activation And Function Of The Gluteus Medius Muscle In Physically Active Females, Michelle Samuel

UNLV Theses, Dissertations, Professional Papers, and Capstones

Patellofemoral pain (PFP) is the most common knee injury among runners, military personnel, adolescents and recreationally active persons. PFP commonly presents as diffuse pain across the anterior knee that increases with activities such as running, squatting, and walking up and down stairs. Nearly 75% of patients with PFP either alter or completely stop physical activity as a result of the pain. There are numerous mechanisms that contribute to PFP symptoms; such as muscle weakness, abnormal joint mechanics and abnormal joint stress, which make it difficult to successfully treat. In addition, PFP may lead to patellofemoral joint (PFJ) osteoarthritis, a debilitating …

Direction Of Attentional Focus In Prosthetic Training: Current Practice And Potential For Improving Motor Learning In Individuals With Lower Limb Loss, Szu-Ping Lee, Alexander Bonczyk, Maria Katrina Dimapilis, Sarah Partridge, Samantha Ruiz, Lung-Chan Chien, Andrew Sawers

Physical Therapy Faculty Research

Objective:

Adopting an external focus of attention has been shown to benefit motor performance and learning. However, the potential of optimizing attentional focus for improving prosthetic motor skills in lower limb prosthesis (LLP) users has not been examined. In this study, we investigated the frequency and direction of attentional focus embedded in the verbal instructions in a clinical prosthetic training setting.

Methods:

Twenty-one adult LLP users (8 female, 13 male; 85% at K3 level; mean age = 50.5) were recruited from prosthetic clinics in the Southern Nevada region. Verbal interactions between LLP users and their prosthetists (mean experience = 10 …

Direction Of Attentional Focus In Prosthetic Training: Current Practice And Potential For Improving Motor Learning In Individuals With Lower Limb Loss, Alexander Bonczyk, Maria Katrina Tillada Dimapilis, Sarah Partridge, Samantha Ruiz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: Adopting an external focus of attention has been shown to benefit motor performance and learning. However, the potential of optimizing attentional focus for improving prosthetic motor skills in lower limb prosthesis (LLP) users has not been examined. In this study, we investigated the frequency and direction of attentional focus embedded in the verbal instructions in a clinical prosthetic training setting.

Methods: Twenty-one adult LLP users (8 female, 13 male; 85% at K3 level; mean age=50.5) were recruited from prosthetic clinics in the Southern Nevada region. Verbal interactions between LLP users and their prosthetists (mean experience=10 years, range=4-21 years) during …

Essential Tools For Sustainability Of A Student-Led, Pro-Bono Back School, Cory Brown, Rosalie Gutierrez, Jennifer Montes, Rondale Scruggs

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: In 2018, University of Nevada Las Vegas Doctor of Physical Therapy (DPT) students and faculty, in cooperation with a community partner, created a student-led pro bono Back School to address a gap in healthcare for underinsured individuals with low back pain in Southern Nevada. To support the sustainability of the Back School, the authors of this paper set out to develop a student club to recruit and train DPT students to volunteer in the program using a specifically designed electronic training manual. Overall, the aim was to encourage students to join the new club's leadership team to prepare future …

Increasing Utilization Of Otago Fall Prevention Program By Nevada Physical Therapists: A Service-Learning Project, Jared Apostol, Erica Mooy Brown, Danielle Uptain

UNLV Theses, Dissertations, Professional Papers, and Capstones

Otago is an evidence-based program that is designed to reduce falls in community dwelling older adults by individualizing an exercise program with three key components: strength, balance, and a walking program. Unfortunately, Nevada clinicians do not utilize the program frequently or entirely with patients in outpatient and/or home health physical therapy. Evidence shows it reduces fall risk, but it has barriers to implementation in the United States. The barriers to integration are primarily due to the plan of care that stems from a 12-month timeframe and several phone call appointments which does not fit well in the American healthcare system. …

Effects Of A Remote Exercise Intervention On Aerobic Endurance In Individuals With Down Syndrome, Andrew Murata, Elena Wolf, Jonathan Crimm, Benjamin Lee

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: Down syndrome (Ds) or Trisomy 21 is a common genetic birth condition, and those with Ds typically display decreased cardiorespiratory fitness compared to those without Ds, potentially leading to an increased risk for cardiovascular conditions and mortality. Low cardiorespiratory fitness is partially caused by low physical activity levels in this population. The COVID-19 pandemic caused community-based activity programs to shut down, as individuals with Ds are at increased risk for COVID-19 hospitalization and death. Thus, it was vital to explore alternatives of in-person exercise during the pandemic. The purpose of this study was to investigate the effects of a …

Perceived Value Of Acute Care Physical Therapy, Juliana Amenta, Andrew Falcinelli, Erin Heenan, Hannah Kendall

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background/Significance/Objective: Although there is some research regarding physical therapy in the acute hospital setting, much of it is focused on the role physical therapists play with specific patient populations or diagnoses. By understanding more about how physical therapy services can add value in the acute hospital, their skills could be better utilized to maximize benefit for both individual patients and the hospital. The purpose of this study was to investigate the perceived value that physical therapists bring to the acute care hospital from the perspective of both physical therapists and their supervisors in Southern Nevada.

Methods: This study used an …

Walking With Poles Improves Step Length Of Simulated Prosthetic Gait, Marissa Elquist, Daniel Perez, Jonathan Garcia, Brady Owens

UNLV Theses, Dissertations, Professional Papers, and Capstones

Individuals with lower limb loss often demonstrate gait deviations which cause instability and asymmetry. Walking with poles has been shown to improve stride length and stability in older adult and other patient populations. The enhanced arm involvement in bipedal walking with poles has the potential to facilitate interlimb coordination among arms and legs, and therefore is likely to improve prosthetic gait. The purpose of this study was to examine the effect of walking poles on temporal gait parameters and the center of mass (COM) displacement during prosthetic and simulated prosthetic gait. It was hypothesized that walking with poles would improve …

Effects Of A 12-Week Telehealth Exercise Intervention On Gait Speed And Gait Deviations In Adults With Down Syndrome, Robert Lum, Taylor Souza, Christopher Roys, Daniel Stopka

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Down syndrome (Ds) is associated with impairments affecting overall motor development including gait pattern and speed. Research on the effects of exercise on adults with Ds is lacking. The purpose of this study is to evaluate the effects of a 12-week telehealth exercise program on gait impairments in adults with Ds.

Methods: Twenty participants performed a 12-week telehealth exercise program based upon a diagnosis-specific procedure developed by Sarah Mann, PT, DPT. Gait deviations were assessed with the Ranchos Los Amigos Observational Gait Analysis. Comfortable gait speed was evaluated with the 4-meter walk test.

Results: Improvements in comfortable gait speed …

Factors Predicting Fear Of Falling Avoidance Behavior In Parkinsonisms, Kameron Eckard, Franjo Vukojevic, Ryan Hammar

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Fear of falling avoidance behavior (FFAB) is common in parkinsonisms and results in potentially mitigable downstream consequences.

Objective: Determine the characteristics of individuals with parkinsonisms most associated with FFAB.

Methods: A retrospective, cross-sectional study was conducted from medical records data of 142 patients with parkinsonisms. These data included: demographics (age, sex), disease characteristics (Movement Disorders Society – Unified Parkinson’s Disease Rating Scale Part III (MDS-UPDRS III), years since diagnosis), fall history (number of fall injuries in previous year), and gait and balance function (five times sit to stand, MiniBESTest, Timed Up and Go (TUG), dual-task TUG, ten-meter walk test …

Efficacy And Benefits Of Providing A Screening Clinic For Performing Arts Students, Shaun Bean, Joanna Centeno, Elizabeth Williams

UNLV Theses, Dissertations, Professional Papers, and Capstones

In past years, University of Nevada, Las Vegas physical therapy students (UNLVPT) have provided UNLV dance students with screening clinics, injury evaluations, and treatment sessions to help address their need for direct and specialized services. Through this project, UNLVPT has worked to help reduce injury risk in dancers and provided treatment and rehabilitation for injuries that have occurred. Due to the COVID-19 pandemic, our group was unable to treat dancers in person over the course of the 2020-2021 school year. In response to these limitations, we worked to reformat our screening process to make it practical in a virtual setting. …

The Effects Of A Telehealth Exercise Intervention On Balance In Adults With Down Syndrome, Mark Barton, Kristina Guerrero, Andrew Martinez, Alexandria Umagat

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: People with Down syndrome (Ds) often present with balance deficits, which compromise their safety during daily activity. While evidence shows that exercise can improve balance in the Ds population, it is unclear if a telehealth method will elicit similar benefits. We aimed to examine the effects of a virtual exercise program on balance in adults with Ds.

Methods: Twenty participants completed a 12-week telehealth exercise program based on the Mann Method. Balance testing took place before and after the intervention, which included: Timed Up and Go (TUG), Modified Clinical Test of Sensory Interaction in Balance (MCTSIB), Frailty and Injuries: …

Diagnostic Ultrasound As A Reliable Tool To Measure Multifidus Thickness, Katherine Shigemoto, Valeria Garcia Arteaga, Jessie Peterson, Nathan Gentry

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Lower back pain (LBP) is a recurrent issue in the general population, though it is generally seen 2-3 times more frequently in those who undergo transfemoral amputations, being considered worse than phantom limb or residual pain. It is suggested that LBP is more common in those who have a transfemoral amputation than those who have a transtibial amputation. Research thus far has seemed to focus on identifying links between unilateral amputation and LBP rather than bilateral.

The multifidus muscle is the most important dynamic stabilizer of the lumbar spine, accounting for two- thirds of lower lumbar segmental stability. A …

Physical Therapy Alumni Rural Employment Assessment, Karen Aleyda Santos, Nikkita Jacob Crozier

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction and Purpose: The University of Nevada, Las Vegas Doctor of Physical Therapy program (UNLVPT) encourages rural and underserved employment by requiring students to complete one clinical experience in either a rural or underserved setting. Students who participate in rural clinical experiences may be more likely to practice in rural settings. UNLVPT also assesses rural interest level during each student’s education. The purpose of this study was to determine if relationship exists between students’ pre- or post-clinical experience rural interest level and their practice location within the first two years after graduation. We hypothesized that an interest in rural practice …

Brain And Spinal Cord Adaptations Associated With Patellofemoral Pain: A Systematic Review And Meta-Analysis, Kara Meske, Savanna Budge Huerta, Austin Madriaga, Derrick Nguyenton

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: To evaluate the evidence for altered cortical and spinal cord functions in individuals with patellofemoral pain (PFP).

Methods: We conducted a comprehensive search of databases to appraise and analyze the studies published prior to December 10, 2021 that examined spinal reflex excitability measured using Hoffmann reflex (H-reflex) amplitudes, corticospinal excitability measured using transcranial magnetic stimulation (TMS)-elicited motor evoked potential (MEP) amplitudes, motor threshold (MT), or stimulus-response (SR) curves, cortical reorganization assessed using TMS cortical mapping or structural magnetic resonance imaging (MRI), or functional changes of the brain assessed using functional MRI (fMRI) in individuals with PFP.

Results: Eight studies …

Biomechanical Evaluation Over Level Ground Walking Of User-Specific Prosthetic Feet Designed Using The Lower Leg Trajectory Error Framework, Victor Prost, W. Brett Johnson, Jenny A. Kent, Matthew J. Major, Amos G. Winter V.

Physical Therapy Faculty Research

The walking pattern and comfort of a person with lower limb amputation are determined by the prosthetic foot’s diverse set of mechanical characteristics. However, most design methodologies are iterative and focus on individual parameters, preventing a holistic design of prosthetic feet for a user’s body size and walking preferences. Here we refined and evaluated the lower leg trajectory error (LLTE) framework, a novel quantitative and predictive design methodology that optimizes the mechanical function of a user’s prosthesis to encourage gait dynamics that match their body size and desired walking pattern. Five people with unilateral below-knee amputation walked over-ground at self-selected …

Do People With Low Back Pain Walk Differently? A Systematic Review And Meta-Analysis, Jo Armour Smith, Heidi Stabbert, Jennifer J. Bagwell, Hsiang-Ling Teng, Vernie Wade, Szu-Ping Lee

Physical Therapy Faculty Research

Background

The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain (LBP). Despite substantial research, it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP. The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls.

Methods

A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020. Studies were included …

Brain And Spinal Cord Adaptations Associated With Patellofemoral Pain: A Systematic Review And Meta-Analysis, Kai-Yu Ho, Jing Nong Liang, Savanna Budge, Austin Madriaga, Kara Meske, Derrick Nguyenton

Physical Therapy Faculty Research

Objective: To evaluate the evidence for altered cortical and spinal cord functions in individuals with patellofemoral pain (PFP).

Methods: We conducted a comprehensive search of databases to appraise and analyze the studies published prior to December 10, 2021 that examined spinal reflex excitability measured using Hoffmann reflex (H-reflex) amplitudes, corticospinal excitability measured using transcranial magnetic stimulation (TMS)-elicited motor evoked potential (MEP) amplitudes, motor threshold (MT), or stimulus-response (SR) curves, cortical reorganization assessed using TMS cortical mapping or structural magnetic resonance imaging (MRI), or functional changes of the brain assessed using functional MRI (fMRI) in individuals with PFP.

Results: Eight studies …

Patient Engagement In Cosmetic Designing Of Prostheses: Current Practice And Potential Outcome Benefits, Szu-Ping Lee, Cailin Mitchell, Kenneth Repayo, Matthew Tillitt, Collin Weber, Lung-Chang Chien, Chris Doerger

Physical Therapy Faculty Research

Background: Making a prosthesis for an individual with limb loss is a highly personalized process. A currently unexplored area is whether there are tangible benefits in greater patient engagement during the cosmetic designing of their prostheses. We examined the current clinical practice of engaging patients in prosthetic cosmetic designing and identified factors associated with patient outcomes.

Methods: One hundred and four prosthetists and 28 prosthesis users were surveyed in this cross-sectional study. The question- naires covered aspects of prosthetic prescription and fabrication, users’ perceived level of engagement, and self-reported outcomes.

Regression analyses were used to examine the associations between patients’ …

Neurophysiological Changes Of Brain And Spinal Cord In Individuals With Patellofemoral Pain: A Systematic Review And Meta-Analysis Protocol, Jing Nong Liang, Savanna Budge, Austin Madriaga, Kara Meske, Derrick Nguyenton, Kai-Yu Ho

Physical Therapy Faculty Research

Introduction: Reduced neuromuscular control due to altered neurophysiological functions of the central nervous system has been suggested to cause movement deficits in individuals with patellofemoral pain (PFP). However, the underlying neurophysiological measures of brain and spinal cord in this population remain to be poorly understood. The purpose of this systematic review is to evaluate the evidence for altered cortical and spinal cord functions in individuals with PFP.

Methods and analysis: The protocol for conducting the review was prepared using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will systematically search the literature that examines cortical and …

Asymmetries In Dynamic Valgus Index After Anterior Cruciate Ligament Reconstruction: A Proof-Of-Concept Study, Kai Yu Ho, Andrew Murata

Physical Therapy Faculty Research

Individuals with anterior cruciate ligament reconstruction (ACLR) are at a higher risk for subsequent anterior cruciate ligament (ACL) tears. Risk factors for ACL injuries likely involve a combination of anatomical, biomechanical, and neuromuscular factors. Dynamic knee valgus has been indicated as a possible biomechanical factor for future ACL injuries. Given that knee valgus is often accompanied by contralateral pelvic drop during single-leg activities, a dynamic valgus index (DVI) that quantifies combined kinematics of the knee and hip in the frontal plane has recently been developed. As the premise of asymmetrical DVI between limbs in the ACLR population has not been …

Dancer Screening Clinic, Kristen Manaloto, John Lencioni, Laura Nguyen

UNLV Theses, Dissertations, Professional Papers, and Capstones

Dance students at the University of Nevada, Las Vegas (UNLV) do not have access to sports medicine specialists, thus a pro-bono dance clinic was created as a service-learning project by the UNLV Department of Physical Therapy (UNLVPT) in 2018. In the second year of the service-learning project, three graduate students from the UNLVPT program, under the supervision of a clinical faculty member, have continued to provide free dance specific injury prevention screenings and management to students within the UNLV Department of Dance. To improve clinic operation and services, the group emphasized communication and accessibility as areas of growth. Injury prevention …

Quality Assurance Of Service Learning Back School, Eric Bashaw, Vu Pham, Tyler Parvin, Ryan Pauly

UNLV Theses, Dissertations, Professional Papers, and Capstones

Project Execution: Back School: During the 2019-20 academic year, two University of Nevada, Las Vegas Physical Therapy (UNLVPT) core faculty members, along with eight doctor of physical therapy students, provided three student-led, pro-bono back school classes at Volunteers in Medicine of Southern Nevada (VMSN). Each back school class consisted of two, 2-hour sessions where participants were screened for red flags, educated on pain management strategies and common causes of back pain, and given an individual home exercise program. Quality Assurance Surveys: Patient’s and VMSN staff were all given questions in the form of Likert-scale and open-ended questions via printed handouts …

Recruitment And Advocacy For Clinician Involvement In Pro Bono Physical Therapy Service-Learning Program, Gilberto Carrillo, Gavin Brady, Felicia Doblado, Alyssa Woo Hatch

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Service-learning allows Doctor of Physical Therapy (DPT) students to develop important professional skills and addresses community-based needs. When integrated into physical therapy education, it can be a powerful tool for increasing students' altruism and social responsibility. Many clinicians desire to participate in pro bono physical therapy (PT) services. Therefore, the responsibility of promoting and advertising these programs falls upon the student. This paper describes various methods for recruiting clinician involvement to improve the sustainability of a student led pro bono clinic, as well as how the students advocated for pro bono services in the state of Nevada …

Is Decreased Trunk Flexion Angle A Contributing Factor To Patellofemoral Joint Loading In Runners With Patellofemoral Pain?, Christine Duvall, Zachary Clark, Tavin Fox, Caitlin Howden

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: Reduced trunk flexion during running is theorized to be a contributing factor of elevated patellofemoral joint (PFJ) stress in runners with patellofemoral pain (PFP); thus, the primary purpose of this research study was to determine if runners with PFP would exhibit differences in PFJ stress and trunk flexion angle during running as compared to pain-free runners across three speeds. We hypothesized that runners with PFP would exhibit higher PFJ stress and decreased trunk flexion while running compared to the pain- free runners. Number of Subjects: 7 runners with PFP and 5 similar pain-free control runners. Materials/Methods: Kinematics and kinetics …

A Vicious Cycle Of Fear Of Falling Avoidance Behavior In Parkinson’S Disease: A Path Analysis, Kameron Jacobson, Nicole Matsunami, Hannah Mccarl, Michelle Regis

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Postural instability (PI) in Parkinson’s disease (PD) is associated with several negative down- stream consequences. Objective: The purpose was to explore the validity of a theoretical model of these downstream consequences arranged in a vicious cycle wherein PI leads to decreased balance con!dence, which in turn leads to increased fear of falling (FOF) avoidance behavior, which in turn leads to decreased physical conditioning, which then feeds back and negatively affects PI. Methods: A path analysis of cross!sectional data from 55 participants with PD was conducted. The four con- structs in the model connected in succession were: 1. PI (principal …

Effects Of Bimodal Transcranial Direct Current Stimulation On Modulation Of Spinal Circuitry In People With Chronic Post-Stroke Hemiparesis, John Patrick Gan, Rafael Cabrera, Lana Laudermilch, Benjamin Wolkenhauer

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Stroke can lead to gait abnormalities such as foot drop. Foot drop can result from decreased corticospinal tract input to the ankle dorsiflexors and/or from exaggerated stretch reflexes on the soleus due to reduced reciprocal inhibition from spinal reflex pathways. Transcranial direct current stimulation (tDCS) attempts to modulate corticospinal tract input and spinal reflex pathways by delivering electrical signals to parts of the brain. The degree of neuromodulation from tDCS can be measured through the Hoffman Reflex (H-reflex)—a tool used to estimate alpha motor neuron excitability which is increased in individuals post-stroke. Purpose: The primary purpose of this study …

Patient Engagement In Cosmetic Designing Of Prostheses: Current Practice And Potential Outcome Benefits, Kenneth Repayo, Cailin Mitchell, Matthew Tillitt, Collin Weber

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: Making a prosthesis for an individual with limb loss is a highly personalized process. A currently unexplored area is whether there are tangible benefits in greater patient engagement during the making of their prostheses. We examined the current practice of engaging patients in prosthetic cosmetic designing and identified factors associated with patient outcomes. Methods: This cross-sectional study surveyed 104 prosthetists and 25 prostheses users. The questionnaires covered aspects of prosthetic prescription, users’ perceived level of engagement, and self-reported outcomes. Regression analyses were used to examine the associations between perceived level of engagement, satisfaction, and other outcomes. Results: Among prosthesis …

Effects Of Altered Somatosensory Input On Lower Limb Mechanics Via Different Shoes And Barefoot Walking In Individuals With Chronic Post-Stroke Hemiparesis, Aaron Abraham Simon, Jynelle Marie Guerrero Arches, Megan Leigh Keohane, Wee Jin Jed Lee

UNLV Theses, Dissertations, Professional Papers, and Capstones

[Purpose/Hypothesis] Stroke is a leading cause of disability that results in various neurological deficits. Stroke can cause impaired somatosensory input, which results in decreased balance and gait speed, ultimately increasing fall risks. Therapies to increase somatosensory input have shown promise for people with stroke as well as other neurological populations. However, few studies have systematically investigated varying somatosensory input via different footwear to improve walking in people post-stroke. The purpose of this study was to investigate the effects of altering somatosensory input via different types of footwear (i.e., barefoot, self-selected shoes, and memory foam shoes) on gait kinetics and ankle …