Physical Therapy Commons^™

Total Quality Management In Physical Therapy: A Primer For Physical Therapists In Search Of Quality, Brian C. Kittelson

Physical Therapy Scholarly Projects

Total quality management (TQM), a management system first successfully utilized in the manufacturing industry, has gained much popularity in the healthcare industry over the past few years. Books, articles, conferences, workshops, and video tapes that teach health care executives how to utilize TQM in their organizations abound. Unfortunately, resources which specifically apply the TQM philosophy and tools to the practice of physical therapy are few. The purpose of this project is to provide a resource that introduces the philosophy, methods, and tools of TQM with applications to the physical therapy setting.

Chapter one briefly discusses the general history of TQM …

Parkinson's Disease: An Exercise Approach To Treatment, Kara Lynn Klosterman

Physical Therapy Scholarly Projects

Parkinson's Disease (PO) is a common neurological disorder affecting elderly people. Patients suffering from PO typically display three cardinal signs: tremor, rigidity, and bradykinesia. As the disease progresses, secondary symptoms develop. These cardinal signs and secondary symptoms decrease the patient's abilities to function during normal daily activity.

Physical therapists are specially trained in the evaluation and treatment of persons with movement disorders such as PD. Research demonstrates success in the treatment of PO when physical therapy services are utilized. Physical therapists educate patients and their families about PD. Via exercise, physical therapists prevent the onset of complications and improve the …

Patient Compliance With Medical Regimens, Stacie R. Lund

Physical Therapy Scholarly Projects

Patient compliance is defined as the patients' following a request, wish, or demand that a health care provider has decided is necessary and beneficial for the improvement of the health of the patient. Oftentimes, though suggestions by providers are in the patient's best interest, patients will instead either disregard what has been told to them or actively go against the suggestions. Certainly, the patient is the manager of his/her own health care program, however, noncompliance is a very common problem. There are several reasons for noncompliance, including the psychological make-up of the patient, the patient's social environment, the nature of …

Fibromyalgia: Diagnosis And Management, Janet Mckinnon Rasmusson

Physical Therapy Scholarly Projects

Fibromyalgia is a nonarticular rheumatic disease of unknown origin. It is diagnosed by the presence of widespread pain of more than three months duration and tenderness at 11 or more of 18 tender point sites. Typical symptoms of this syndrome are generalized pain, stiffness, and chronic fatigue due to sleep disturbances. Other uncommon symptoms include headaches, anxiety, depression, irritable bowel syndrome, and numbness. These symptoms become worse with the presence of modulating factors such as weather, stress, fatigue, overexertion, or inactivity.

The purposes of this independent study are to examine the prevalence and demographics of this disorder, discuss the etiology …

A Review Of Chronic Lateral Ankle Instability, Marcy K. Narum

Physical Therapy Scholarly Projects

Ankle injuries constitute one of the most common and most frequent injuries affecting the lower extremities, with lateral ligament sprains comprising the majority of the ankle injuries. The development of chronic lateral ankle instability is a relatively common occurrence following an acute ankle sprain. Previously the treatment of chronic lateral ankle instability has been primary surgical intervention, but more recently the initial treatment is shifting toward a conservative approach emphasizing functional rehabilitation of the unstable ankle. Frequently the treatment of recurrent sprains and chronic instability addresses only the symptoms; however, a treatment program addressing the underlying causes of instability needs …

Hippotherapy: A Survey Of Therapists Nationwide, Yvette J. Normandin

Physical Therapy Scholarly Projects

The purpose of this study was to survey physical therapists nationwide who are involved with North American Riding for the Handicapped Association (NARHA) certified centers to obtain their perspectives regarding the need for more empirical research and outcome studies, benefits of Therapeutic Horseback Riding, and methods of objective evaluation utilized when determining patient improvement. Of the 261 surveys mailed, 125 (48.8%) were returned with 110 utilized for data interpretation.

Respondents indicated a large need for more empirical research to support therapeutic horseback riding as a treatment method and to facilitate increased acceptance by the medical field in general. Only a …

Overview Of The Flaccid Hemiplegic Shoulder Following A Stroke, Tricia R. Pederson

Physical Therapy Scholarly Projects

Stroke may cause long-term disability and impairment in the hemiplegic shoulder. Problems may develop early in the flaccid phase of recovery and complicate the entire rehabilitation process. The etiology and treatment of shoulder complications remains uncertain. Contributing factors include inappropriate handling and positioning, abnormal muscle tone, impaired sensation, and musculoskeletal pathology.

Prevention and treatment of shoulder dysfunction begins with positioning, early range of motion, and education. Physical therapists play an important role in stroke management by administering therapeutic positioning programs, teaching appropriate exercise regimens, and instructing in proper handling techniques.

The purpose of this paper is to review methods being …

Multiple Sclerosis: A Literature Review, Jody E. Price

Physical Therapy Scholarly Projects

Multiple Sclerosis (MS), a demyelinating disease of the Central Nervous System (CNS), is the most common cause of nontraumatic disability affecting young adults in the United States. The resultant lesions lead to a variety of symptoms which include: weakness, sensory disturbances, visual problems, spasticity, fatigue, and paralysis. There are also a number of psychological and emotional issues that the MS patient must face. The cause of MS remains unknown and the diagnosis is often difficult. The course and severity of the disease varies from patient to patient. There is no known cure or prevention.

Current treatments include drug therapy, physical …

Diagnostic Criteria And Management Of Carpal Tunnel Syndrome, Holly Rogers

Physical Therapy Scholarly Projects

Carpal tunnel syndrome (CTS) is an entrapment neuropathy involving the median nerve as it passes through the carpal tunnel. CTS is widely recognized as the most common of all nerve entrapment syndromes. CTS develops when irritation causes the tendon sheaths passing through the carpal tunnel to swell, constricting the tunnel and compressing the median nerve. Manifestations of CTS are varied, but usually include pain, numbness and weakness of the hand. Incidence of CTS has risen sharply in the past five years. Prevention of CTS and reduction of it's effects appears to be the best solution for this disorder. Physical therapists …

A Detailed Look At The Innovative Manual Therapy Technique: Strain/Counterstrain, Rochelle Skarperud

Physical Therapy Scholarly Projects

The purpose of the following literature review is to provide the reader with information regarding the manual therapy technique of strain/counterstrain. The review will describe the origin, theory, rationale, and methods associated with the treatment technique of strain/counterstrain. The role of the muscle spindle and trigger point as utilized in the technique are discussed in detail, along with a comparison of strain/counterstrain to similar manual therapy techniques. Several of the techniques discussed are: acupressure, acupuncture, osteopathic manipulation, and muscle energy techniques. To further support the authors' viewpoints, several case studies are presented and reviewed. The general treatment techniques and guidelines …

The Effects Of Supramalleolar Orthoses On The Biomechanics Of The Knee, Foot, And Ankle During Gait: A Single-Subject Design, Jennifer Ruth Stauffer

Physical Therapy Scholarly Projects

Gait deviations are a common problem associated with disorders of movement and posture such as cerebral palsy (CP). Inhibitive casts and ankle-foot orthoses have been used to treat gait deviations in children with CP, but they have not satisfied the needs of children who are able to achieve active dorsiflexion and plantarflexion but lack stability at the subtalar joint. Supramalleolar orthoses (SMOs) were developed to address that need. SMOs, along with physical therapy, have been used to treat children with CP, but little research has been conducted to determine the actual effects of the SMO on lower extremity biomechanics during …

Occupational Cumulative Trauma Disorders: Prevention And Treatment, Michelle Uyeno

Physical Therapy Scholarly Projects

Cumulative Trauma Disorders (CTDs) consist of a group of musculoskeletal injuries caused by overuse or repetitive strain. The purpose of this Independent Study was to review the literature concerning occupational CTDs, the methods of prevention, and treatment as it related to physical therapy. The most beneficial means of controlling CTDs appear to be taking preventative measures with jobsite analysis and employee education. Treatment is varied and dependent upon the actual diagnosis and causative factor. Therapists may attempt heat or cold modalities, work hardening programs, or manual therapy such as strain-counterstrain. An important aspect to treatment is early intervention. Due to …

A Literature Review On Wheelchair Products And Fitting, Lee M. Werchau

Physical Therapy Scholarly Projects

Physical therapists are often involved in wheelchair prescription. An important factor when recommending or prescribing a wheelchair is proper fit. Proper wheelchair fitting is critical when attempting to get maximum independence, normalize tone in spastic or low tone clients, as well as decreasing bony deformities and pressure ulcers. Crucial measurements for wheelchair fitting include backrest height and seat width, depth, and height. To assure ultimate independence an individuals mental competence, ROM in upper extremities, cardiopulmonary health, and coordination must be evaluated prior to prescribing a wheelchair. Options to consider are the type of seat cushion, wheelchair frame, peripherals, and safety. …

Assessment Of Physical Therapy Needs At Third Street Clinic, Susan Wheeldon

Physical Therapy Scholarly Projects

Health care is being provided free of charge at the Third Street Clinic in Grand Forks, North Dakota, for those people who are uninsured or who do not qualify for Medicare or Medicaid. Physical Therapy is not presently offered as a service at the Clinic.

Physical Therapy is part of comprehensive health care. Therapists provide caring and expertise in the areas of neurological rehabilitation, orthopedic/musculoskeletal problems, pediatrics, and work hardening. As volunteers, therapists are involved in providing care at free clinics across the nation.

The Third Street Clinic agreed to have a needs assessment performed to identify those clients who …

A Review Of Noninvasive Tools Used For Measuring Flexion Of The Lumbar Spine, Mary E. Johnson

Physical Therapy Scholarly Projects

The purpose of this study is to compare the reliability, validity, and ease of administration for various noninvasive tools used for measuring flexion of the lumbar spine. A synopsis of several clinical techniques is offered: Schober's technique, modified Schober, modified modified Schober, fingertip to floor, modified fingertip to floor, goniometer, single inclinometer, double inclinometer, and flexicurves. The results were variable for the different techniques with each having its own inherent advantages and disadvantages. Ultimately, the clinician can weigh the information presented when choosing a technique. It appears that a true gold standard has yet to be described. Therefore, it is …

Poststroke Depression, Colleen Frohberg

Physical Therapy Scholarly Projects

Depressed mood is the most common psychiatric disorder following stroke with estimated prevalence rates ranging anywhere from 20% to 60%. It has been reported that effective and rapid treatment of poststroke depression may enhance stroke rehabilitation and speed up functional recovery. The potential reversibility of depression emphasizes the importance of early identification of poststroke depression. Yet, poststroke depression remains largely untreated as part of the rehabilitation process. Therefore, it is important that health professionals, such as physical therapists, who often work with patients who have suffered a stroke are aware of the signs and symptoms of poststroke depression to ensure …

The Effects Of Microcurrent Stimulation In The Treatment Of Lateral Epicondylitis, Justin G. Feeser

Physical Therapy Scholarly Projects

Microcurrent Electrical Neuromuscular Stimulation (MENS) is a modality that is quickly gaining popularity in the treatment of various musculoskeletal disorders. At this time, there is a lack of literature, especially well controlled clinical studies, to support its use. The purpose of this study, therefore, is to examine the effects of MENS in the treatment of a common musculoskeletal dysfunction, lateral epicondylitis. Approximately ten subjects with a diagnosis of lateral epicondylitis were assigned either to group A, receiving MENS and conservative treatment (education, home exercise program, ice, and counterforce bracing), or group B, receiving sham MENS and conservative treatment. Subjects were …

Burn Care: The Use Of Cpm, Electrical Stimulation And Lasers, Jennifer Walter

Physical Therapy Scholarly Projects

p>The treatment of patients with burns has always been a tedious venture. The burn team may devote many long and painful hours to the patient's rehabilitation. Physical therapists play an important part on this team, especially in the areas of wound care and pain control. The purpose of this literature review is to analyze the physiological mechanisms of continuous passive motion, electrical stimulation, and lasers in regard to wound healing and pain perceptions.

In relation to wound healing, electrical stimulation and lasers were found to enhance the actual healing process, mostly in the early phases of healing. Continuous passive …

A Literature Review Of The Team Approach In The Cardiac Rehabilitation Process, Kristin Nelson

Physical Therapy Scholarly Projects

Teamwork is a term that is now commonplace in the provision of health services for all people. Variations of this team are widely used, such as multidisciplinary teams and inter-disciplinary teams. A health care team is a group of persons, each possessing particular expertise, who have a common purpose and goal. Teams including professionals, such as nurses, doctors, physical therapists, social workers, and other staff, depending on needs and local resources, are now commonplace in hospital and community services. The purpose of this independent study is to review the literature regarding collaborative team approaches to cardiac rehabilitation. Included in this …

Chinese Medicine: An Effective Alternative For Physical Therapists, Nancy Palumbo

Physical Therapy Scholarly Projects

Acupressure is a technique that has been used for thousands of years in China, and has gained popularity in the United States since the 1960's. Research shows a high correlation between trigger points and acupuncture points, though discovered independently and labeled differently, the same phenomenon of can be explained by the same neural mechanisms. The purpose of this study was to provide an overview of Chinese medicine and its use in physical therapy. First, a literature review consisting of a brief history of Chinese medicine and traditional Western medicine is compared. Next, the results of a survey distributed to 47 …

Regaining Control: Emotional Adjustment After A Myocardial Infarction, Angela J. Bryl

Physical Therapy Scholarly Projects

Cardiac rehabilitation is the process of the development and maintenance of a desirable level of physical, social, occupational, and psychological functioning after the onset of cardiovascular illness. The scope of cardiac rehabilitation has evolved from what first began as strict bed rest to now a complete multidimensional approach including many health disciplines. The psychological aspects of rehabilitation have become just as integral as the physical components. Regaining a sense of control through a process of emotional adjustment is one of the important factors of psychological rehabilitation after a myocardial infarction.

The purpose of this study is to first examine different …

Resistance Training In Children, Debra L. Cutner

Physical Therapy Scholarly Projects

Strength training in the child and adolescent has been a controversial topic for quite a few years. Current research has changed the thoughts of many professionals regarding strength gains or the possibility of strength gains in the prepubertal and adolescent age groups. Part of the controversy lies with the fact that some believe it is not safe for a child to do resistance training as it may cause various injuries such as musculoskeletal sprains and strains and epiphyseal fractures.

A review of the literature indicates that strength gains can occur in prepubertal children and that training with weights can be …

Closed Kinetic Chain Exercises Of The Shoulder Joint: Biomechanics And Clinical Implications, Todd L. Gentzler

Physical Therapy Scholarly Projects

The shoulder is a complex joint with many structures located in a small area. The purpose of this paper is to first analyze the shoulder joint mechanics and allow for a more complete understanding of this structure. The anatomical features are defined, including muscles, tendons and ligaments, their attachments and innervations. These structures are often predisposed to injury or pathology.

The second part of this paper introduced a new treatment concept: Closed Kinetic Chain Exercises of the shoulder joint. Closed kinetic chain exercises are defined, including the purpose and rationale behind this new treatment. Closed kinetic chain exercises add variability …

Critical Overview Of Wound Care Modalities, Keith W. Hartnett

Physical Therapy Scholarly Projects

The purpose of this independent study is to explore Physical Therapy modalities used in adjunct to traditional wound management. There are many factors that influence the healing rate. A basic knowledge of the body's healing process is needed in order to understand the affects modalities have on the wound.

The key to wound management is the initial and constant assessment. The patient history, subjective information, and objective measure are critical to the etiology and progression of the wound, and will be discussed.

Modalities can accelerate wound healing. Mechanical and physiological effects of the different modalities will be explored. This study …

Physical Therapy And Internal Derangement Of The Temporomandibular Joint, Kathy Johnson

Physical Therapy Scholarly Projects

In orthopedic literature, internal derangement is considered to be one of the main predisposing factors in the development of temporomandibular joint dysfunction and subsequent arthrosis. Internal derangement can be defined as the abnormal relationship of the articular disc to the condyle and consists of a multitude of disorders.

Physical therapy is well-recognized as an effective, conservative method of treatment for temporomandibular disorders. Early treatment to correct symptomatic internal derangement decreases the possibility of disc deformation and further joint degeneration. However, much of the physical therapy literature consists of uncontrolled case studies and focal clinical technique articles. For this reason, there …

Low Back Pain, Jeff Large

Physical Therapy Scholarly Projects

Low back pain (LBP) is one of the most common disorders seen in the health care setting today. The cost of rehabilitation of LBP makes up a significant proportion of today's health care economy. Both physical and social factors have been associated with the etiology of LBP. Today's advanced diagnostic equipment has allowed the underlying pathologies of LBP to be better understood. In the past, different theories and techniques for rehabilitation have been utilized. Current rehabilitation of LBP has emphasized effective, cost-efficient prevention and education.

The purpose of this independent study is to research current theories of risk factors, pathologies …

The Use Of Lower Extremity Functional Electrical Stimulation In Spinal Cord Injured Patients, Michelle Mccrory

Physical Therapy Scholarly Projects

Spinal cord injury (SCI) is a devastating, life-altering injury that presents a variety of rehabilitative and long-term medical management challenges. Not only must the inability to ambulate, which is generally of primary concern to the patient, be addressed, but also the inherent degenerative and deconditioning effects of SCI which may ultimately lead to various secondary complications.

Recently, functional electrical stimulation (FES) has been the subject of a variety of research concerning the rehabilitation of individuals with SCI. FES is a means of activating alpha motor neurons to stimulate muscular contraction and elicit a therapeutic or functional effect.

The purpose of …

Nonoperative Treatment Of Shoulder Instability In The Throwing Athlete, Whitney A. Meier

Physical Therapy Scholarly Projects

An increase interest of the shoulder complex has led to additional knowledge through research and enhancement of rehabilitation for various shoulder disorders. Shoulder injuries are common for overhead sporting activities, such as pitching. The pitching mechanism combines a high level of neuromuscular coordination between the glenohumeral and scapulothoracic muscles. The intricate balance and timing of these muscles is necessary to allow full mobility and to maintain the dynamic stability throughout the entire throwing motion. Any deficiency in muscular strength or timing can affect shoulder function and potentially cause shoulder instability.

Rehabilitation and nonoperative management of shoulder pain due to instability …

A Literature Review Of Strengthening And Injury Prevention Techniques As Related To High School Athletes, Matthew Miller

Physical Therapy Scholarly Projects

In the U.S. an estimated 20-25 million youths participate in high school athletics yearly. Of these, nearly 30% will be forced to miss part or all of the season due to injury. It has been speculated that through proper training, many of the injuries seen may be reduced or eliminated. However, most coaches do not have an extensive anatomical and physiological background to provide athletes with these correct training techniques. Although athletic trainers have expertise in this area, they are only employed in approximately 10% of the high school systems in the U.S.

Much of the research to date on …

Functional Knee Bracing: Effects And Efficacy, Lisa A. Philion

Physical Therapy Scholarly Projects

Functional knee braces are intended to provide stability to the unstable knee joint. The purpose of this literature review is to examine available research on functional knee braces in order to summarize their effects and efficacy.

Research indicates that the most effective brace for controlling abnormal knee motions would be a custom designed shell brace with rigid straps and a polycentric hinge. However, individual characteristics of the wearer must also be considered.

Subjective research indicates that functional knee braces improve function and provide support for the unstable knee. However, these findings do not correlate with objective findings.

Results of biomechanical …