Physical Therapy Commons^™

Improvement In Overground Walking After Treadmill-Based Gait Training In A Child With Agenesis Of The Corpus Callosum, Gena Henderson, Matthew Beerse, Huaqing Liang, Diego Ferreira, Jianhua Wu

Physical Therapy Faculty Research

Background: Agenesis of the corpus callosum (ACC) is a rare congenital brain defect that produces a wide variety of cognitive and motor impairments. Literature regarding the response of pediatric populations with ACC to physical rehabilitation is scarce. Treadmill-based gait training (TT) has been shown to improve walking ability in some pediatric populations but has not been investigated in children with ACC.

Objective: The purpose of this study was to investigate the effect of a novel treadmill intervention paradigm on the gait parameters of a child with ACC.

Design: A single-participant design with 2 phases was used.

Methods: The settings were …

Calcium Pyrophosphate Deposition Disease In The Achilles Tendon, Kai-Yu Ho, Jing Nong Liang

Physical Therapy Faculty Research

The classic sonographic presentation of calcium pyrophosphate dihydrate crystal deposits in the Achilles tendon is reported.

Characteristics Of Medial-Lateral Postural Control While Exposed To The External Perturbation In Step Initiation, Yun-Ju Lee, Jing Nong Liang, Bing Chen, Alexander S. Aruin

Physical Therapy Faculty Research

Controllability of posture in the medial-lateral direction is critical for balance maintenance, particularly in step initiation. The objective of the current study was to examine the effects of external perturbation and landing orientation on medial-lateral control stability in step initiation. Eleven young healthy participants stood on the force platform and waited for the instruction of taking a step while experiencing a pendulum perturbation applied at the lateral side of the right shoulder. Eight experimental conditions were conducted by two levels of step side (right or left), two levels of perturbation (with or without), and two levels of landing orientation (forward …

Use Of Clinical Test Clusters Versus Advanced Imaging Studies In The Management Of Patients With A Suspected Slap Tear, Richard C. Clark, Chasiti C. Chandler, Andrew C. Fuqua, Kelly N. Glymph, Grayson C. Lambert, Katherine J. Rigney

Physical Therapy Faculty Research

Background and Purpose

The Magnetic Resonance Arthrogram (MRA) has served as the gold standard for identifying patients with possible Superior Labrum Anterior-Posterior (SLAP) lesions and are often required by orthopaedic surgeons prior to clinical evaluation. However, as the literature shows MRA sensitivity as 0.65-0.98, and specificity between 0.80-1.00, there is still room for misinterpretation of the imaging study, and potential mismanagement of a patient who may or may not exhibit a true SLAP lesion. It is proposed that by grouping a series of clinical special tests it may be possible to develop greater sensitivity in identifying a SLAP lesion, resulting …

Asymmetric Crying Facies Syndrome, Kai-Yu Ho Pt, Phd, Jing Nong Liang Pt, Phd

Physical Therapy Faculty Research

A female infant, born vaginally at 40 weeks of gestation with a birthweight of 3260 g had an Apgar score of 10 at 1 and 5 minutes. She presented with an asymmetric facial expression when crying, with the right side of her mouth deviating inferior-laterally (Figure, A and Video[available at www.jpeds.com]). At rest, her facial expression was symmetric and a thinner left lower lip was noted (Figure, B). A pediatricneurologist noted intact motor, reflex, and cranial nerve functions, and she was diagnosed with asymmetric crying facies, likely because of hypoplasia of the left depressor angularis oris muscle. Asymmetric crying facies …

A Resistance Exercise Set For A Total Body Workout For Adults With Intellectual Disabilities, A Pilot Study, Thessa Hilgenkamp, Stijn Weterings, Alyt Oppewal, Florien M. M. Van Eeden

Physical Therapy Faculty Research

Background: Resistance training has beneficial effects on fitness levels, cardiovascu‐lar disease risk, risk of sarcopenia and on performing activities of daily living. The focus of this study is to design a total body resistance exercise set for adults with intellectual disabilities (RESID) with minimal equipment required and to test its feasibility. Method: The RESID was selected in an expert meeting, and its feasibility was deter‐mined in a cross‐sectional pilot study. The feasibility was determined with comple‐tion rate, correct execution of exercises and the participant’s experience. Results: The expert group (n = 7) selected seven exercises for the RESID. The partici‐pants …

Adding Meaning To Physical Fitness Test Results In Individuals With Intellectual Disabilities, Thessa Hilgenkamp, Alyt Oppewal

Physical Therapy Faculty Research

Purpose:Evaluating physical fitness in individuals with intellectual disabilities (ID) is challenging, and a multitude of different versions of tests exist. However, psychometric properties of these tests are mostly unknown, and both researchers as clinical practitioners struggle with selecting appropriate tests for indi- viduals with ID. We aim to present a selection of field tests with satisfactory feasibility, reliability, and val- idity, and of which reference data are available. Methods:Tests were selected based on (1) literature review on psychometric properties, (2) expert meet- ings with physiotherapists and movement experts, (3) studies on population specific psychometric proper- ties, and (3) availability of …

Variability Of Spatiotemporal Gait Parameters In Children With And Without Down Syndrome During Treadmill Walking, Matthew Beerse, Gena Henderson, Huaqing Liang, Toyin Ajisafe, Jianhua Wu

Physical Therapy Faculty Research

Methods: Thirteen children with DS (aged 7–10 years) and thirteen age- and sex-matched typically developing (TD) children participated in this study. Subjects completed two bouts of 60-second treadmill walking at two different speeds (slow and fast) and two load conditions (no load and ankle load equaling to 2% bodyweight at each side). Kinematic data was captured using a Vicon motion capture system. Mean and coefficient of variance of spatiotemporal gait variables were calculated and compared between children with and without DS.

Results and significance: Across all conditions, the DS group took shorter and wider steps than the TD group, but …

Measurement Of Anterior Translation Of The Mandibular Condyle Using Sonography, Kai-Yu Ho, Brooke Laskowski, Danielle Garcia, Christensen J. Hardy, Emilio Puentedura

Physical Therapy Faculty Research

[Purpose] To establish a standardized sonographic approach to quantify anterior translation of the mandibular condyle during mouth opening by examining the reliability of image acquisition and processing, and to understand how anterior condylar translation contributes to mouth opening. [Participants and Methods] Twenty-eight participants without temporomandibular disorder (TMD) participated. During day 1 of data collection, all participants performed maximal mouth opening while an examiner recorded anterior condylar translation using sonography. The mouth opening range of motion was also obtained. On day 2 of data collection, the same procedure was performed on 6 participants that participated in day 1 of data collection. …

Transitioning From The Level Surface To Stairs In Children With And Without Down Syndrome: Motor Strategy And Anticipatory Locomotor Adjustments, Huaqing Liang, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Background: Children with Down syndrome (DS) show underdeveloped motor strategy and anticipatory locomotor adjustments (ALA) before crossing an obstacle. Stairs presents another important setting to study environment navigation and motor adaptation. Inclusion of external ankle load is often used to perturb the stability of a system and observe the emergence of new patterns.

Research question: How do stair height and external ankle load affect motor strategy and ALA in 5-to-11-year-old children with typical development (TD) and with DS when approaching the stairs?

Methods: Fourteen children with DS and 14 age- and sex-matched children with TD participated in the study. They …

An Electromyography Study Of Muscular Endurance During The Posterior Shoulder Endurance Test, Neil A. Evans, Emily Dressler, Tim Uhl

Physical Therapy Faculty Research

The primary purpose was to determine if there is a difference between the median frequency slopes of 5 posterior shoulder muscles during the initial portion of the Posterior Shoulder Endurance Test (PSET) at the 90⁰ and 135⁰ shoulder abduction positions.

Fifty-five healthy volunteers (31 females) participated. The median frequency of the posterior deltoid (PD), upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and infraspinatus (INF) was measured during the PSET at 90⁰ and 135⁰ of shoulder abduction. External torque of 13±1 Nm was used for females and 21±1 Nm for males. A fixed effect multi-variable regression model was used …

Locomotor Adjustments During Stair Ascent In Children With Down Syndrome: Comparison Between Walking And Crawling Strategies, Huaqing Liang, Jianhua Wu

Physical Therapy Faculty Research

Stair negotiation provides an important yet different paradigm to study environment navigation. As one has constantly move himself up while adjusting step length and foot placement due to the stair constraints, this paradigm is ideal to study motor strategy and adaptation in children with and without disabilities. Down syndrome (DS) is the most common genetic condition and causes significant delays in motor and cognitive development. Children with DS show poor postural control and less efficient gait patterns. When negotiating obstacles, they often select a more conservative strategy (i.e. crawling instead of walking). This study aimed to examine motor strategy and …

Characterizing The Recovery Trajectories Of Knee Range Of Motion For One Year After Total Knee Replacement, Saurabh Mehta, Andrew Rigney, Kyle Webb, Jacob Wesney, Paul W. Stratford, Franklin D. Shuler, Ali Oliashirazi

Physical Therapy Faculty Research

DESIGN: Retrospective analysis of routinely collected clinical data.

OBJECTIVE: This study modeled the recovery in knee flexion and extension range of motion (ROM) over 1 year after total knee replacement (TKR).

BACKGROUND: Recovery after TKR has been characterized for self-reported pain and functional status. Literature describing target knee ROM at different follow-up periods after TKR is scarce.

METHODS: Data were extracted for patients who had undergone TKR at a tertiary care hospital at 2, 8, 12, 26, and 52 weeks after TKR. A linear mixed-effects growth model was constructed that investigated the following covariates age, sex, pre-TKR range, body mass …

Transitioning From Level Surface To Stairs In Children With And Without Down Syndrome: Locomotor Adjustments During Stair Ascent, Huaqing Liang, Xiang Ke, Jianjia Wu

Physical Therapy Faculty Research

Background: Children with Down syndrome (DS) often show underdeveloped motor ability and adaptation. Stair ascent is a common task to examine locomotor function and external ankle load is often used to perturb the stability of a system and observe the emergence of new patterns.

Research question: How do stair height and external ankle load affect locomotor adjustments in 5-to-11-year-old children with typical development (TD) and with DS during stair ascent?

Methods: Fourteen children with DS and 14 age- and sex-matched children with TD participated in this study. They walked along a 5-m walkway and ascended 3-step staircases of different heights …

Motor Strategy And Locomotor Adjustments In Children With And Without Down Syndrome While Negotiating Stairs, Huaqing Liang, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Children with Down Syndrome (DS) often show impaired motor control, and walk with a slower speed and a shorter step length than typically developing (TD) children. When negotiating an obstacle, children with DS often stop for a longer duration, choose a more conservative crawling strategy and display a smaller toe clearance than their TD peers.

Center Of Mass Control And Multi-Segment Coordination In Children During And After Whole-Body Vibration, Huaqing Liang, Jianhua Wu

Physical Therapy Faculty Research

Maintaining upright posture under external perturbations requires the coordination between the nervous system and the musculoskeletal system, and it is a milestone of motor development in early childhood. Whole-body vibration (WBV) has acute effect on postural control and muscular activation during standing, resulting in an increased sway velocity and sway area of center-of-mass (COM), and the residual effect usually vanishes within 20 minutes after the vibration exposure. In quiet standing, a human body can be considered as a multi-segment linked system, and an uncontrolled manifold (UCM) approach has been used to examine how this multi-joint motor redundancy is utilized to …

Effect Of Whole-Body Vibration On Center-Of-Mass Movement During Standing In Children And Young Adults, Huaqing Liang, Matthew Beerse, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Whole body vibration (WBV) can affect postural control and muscular activation. The purpose of this study was to investigate the center-of-mass (COM) movement of children and young adults before, during, immediately after, and 5min after 40-s WBV in quiet standing. Fourteen young adults (mean age 24.5 years) and fourteen children (mean age 8.1 years) participated in the study. A full-body 35-marker set was placed on the participants and used to calculate COM. Forty-second standing trials were collected before, during, immediately after, and 5min after WBV with an frequency of 28Hz and an amplitude of <1mm. Two visual conditions were provided: eyes-open (EO) and eyes-closed (EC). COM variables included time-domain measures (average velocity, range, sway area and fractal dimension), frequency-domain measures (total power and median frequency), and detrended fluctuation analysis (DFA) scaling exponent in both anterior-posterior (AP) and medial-lateral (ML) directions. Results show that during WBV both children and adults increased average velocity and median frequency, but decreased range and the DFA scaling exponent. Immediately after WBV both groups increased the range, but showed pre-vibration values for most of the COM variables. Comparing to adults, children displayed a higher COM velocity, range, fractal dimension, and total power, but a lower DFA scaling exponent at all phases. The results suggest that both children and adults can quickly adapt their postural control system to WBV and maintain balance during and after vibration. Children display some adult-like postural control during and after WBV; however, their postural development continues into adolescence.

Spatiotemporal Gait Pattern In Children With And Without Down Syndrome While Walking From Level Surface To Stairs, Huaqing Liang, Xiang Ke, Jianhua Wu

Physical Therapy Faculty Research

Children with Down syndrome (DS) display a delayed motor development, and show clumsy and less coordinated gait pattern. Compared to typically developing children (TD), children with DS walk with a notably slower speed, a shorter stride length, a limited range of motion in ankle joint with increased plantar flexion, and reduced dorsal flexion throughout the gait cycle. When negotiating an obstacle, children with DS show shorter stride length and greater step length variability, and stop in front of the obstacle before stepping over it.

Effect Of Whole Body Vibration On Center Of Mass Movement In Children And Young Adults, Huaqing Liang, Jianhua Wu

Physical Therapy Faculty Research

Whole body vibration (WBV) has acute effects on postural control strategy. The degree of impact depends on the amplitude, frequency, and duration of WBV, and the difficult level of balance task as well as the reliability of sensory information to the individual [1, 2, 3]. Healthy young adults can return to the baseline level of postural sway for a simple balance task within 20 minutes after repeated exposure to WBV [4]. Little is known about the acute and residual effects of WBV on the center-of-mass (COM) movement after a single bout of WBV. This study aimed to understand the COM …

Children Display Adult-Like Kinetic Pattern In The Time Domain But Not In The Frequency Domain While Walking With Ankle Load, Jianhua Wu, Toyin Ajisafe, Matthew Beerse, Huaqing Liang

Physical Therapy Faculty Research

While external load is added during locomotion, humans increase the activation of extensors during stance and suppress the initiation of flexors during swing. External load at the ankles, rather than on the waist or thigh, elicits higher activities from ankle extensors, and increases stride length and decreases cadence in adults. Spatiotemporal and kinematic patterns become adult-like in children aged 5-8 years. However, little is known if children show adult like kinetic patterns while walking with external load This study aimed to investigate differences in kinetic patterns between children and adults while walking with external ankle load using both time and …

Walking Pattern In Children With And Without Down Syndrome Via A Force-Driven Harmonic Oscillator Model, Jianhua Wu, Matthew Beerse, Toyin Ajisafe, Huaqing Liang

Physical Therapy Faculty Research

Children with Down syndrome (DS) display poorer kinematic and kinetic patterns of walking than typically developing ( TD) children. However, little is known on neuromuscular control in children with DS during locomotion. A force driven harmonic oscillator (FDHO) model sheds light on general muscular activation with respect to the gravitational load of the thigh-shank-foot system. The K/G ratio derived from this model represents a scaling between the elastic restoring torque from muscles and soft tissues and the gravitational torque from the weight of the leg during walking. The K/G ratio has shown different muscular function in infant walkers and children …

Improving Outcomes By Implementing A Pressure Ulcer Prevention Program (Pupp): Going Beyond The Basics, Amparo Cano, Debbie Anglade, Hope Stamp, Fortunata Joaquin, Jennifer A. Lopez, Lori Lupe, Steven P. Schmidt, Daniel L. Young

Physical Therapy Faculty Research

A multidisciplinary process improvement program was initiated at the University of Miami Hospital (UMH) in 2009 to identify the prevalence of hospital-acquired pressure ulcers (HAPU) at the institution and to implement interventions to reduce the incidence of HAPU. This deliberate and thoughtful committee-driven process evaluated care, monitored results, and designed evidence-based strategic initiatives to manage and reduce the rate of HAPU. As a result all inpatient beds were replaced with support surfaces, updated care delivery protocols were created, and monitored, turning schedules were addressed, and a wound, ostomy, and continence (WOC) nurse and support staff were hired. These initial interventions …

Psychometric Properties Of The Hindi Version Of The Disabilities Of Arm, Shoulder, And Hand: A Pilot Study, Saurabh Mehta, Ramesh Tiruttani, Manraj N. Kaur, Joy Macdermid, Rania Karim

Physical Therapy Faculty Research

Objectives. To culturally adapt and translate the Disabilities of Arm, Shoulder, and Hand questionnaire into Hindi (DASH-H) and assess its reliability, validity, and responsiveness in adult patients with shoulder tendonitis.

Study Design. Descriptive methodological research, using longitudinal design.

Setting. Outpatient clinic. Participants. 30 adult patients aged 53.3 ± 6.9 y with shoulder tendonitis.

Data Analyses. DASH-H, visual analogue scales for pain (VAS-P) and disability (VAS-D), and shoulder active range of motion (AROM) were assessed at baseline, 2-3 days later, and 4-5 weeks after baseline. Intraclass correlation coefficients (ICC) assessed test-retest reliability of these scales and responsiveness …

Differences In Symptoms Among Adults With Canal Versus Otolith Vestibular Dysfunction: A Preliminary Report, Lisa Farrell, Rose Marie Rine

Physical Therapy Faculty Research

Despite the importance of symptomatology in the diagnosis of vestibular dysfunction, the qualitative nature of the symptoms related to semicircular canal (canal) versus otolith dysfunction is not fully understood. The purpose of this study was to compare symptoms, and their severity, in individuals with canal versus otolith peripheral vestibular dysfunction. A subjective tool, the Descriptive Symptom Index (DSI), was developed to enable categorization of symptoms as rotary, linear, imbalance or falls, and nondistinct. Fourteen adults were recruited and grouped based on vestibular function testing: canal only dysfunction, otolith only dysfunction, or canal and otolith dysfunction. Also, the Dizziness Handicap Inventory …

Home-Based Multidisciplinary Rehabilitation Following Hip Fracture Surgery: What Is The Evidence?, Kathleen Donohue, Richelle Hoevenaars, Jocelyn Mceachern, Erica Zeman, Saurabh Mehta

Physical Therapy Faculty Research

Objective. To determine the effects of multidisciplinary home rehabilitation (MHR) on functional and quality of life (QOL) outcomes following hip fracture surgery.

Methods. Systematic review methodology suggested by Cochrane Collaboration was adopted. Reviewers independently searched the literature, selected the studies, extracted data, and performed critical appraisal of studies. Summary of the results of included studies was provided.

Results. Five studies were included. Over the short-term, functional status and lower extremity strength were better in the MHR group compared to the no treatment group (NT). Over the long-term, the MHR group showed greater improvements in balance confidence, functional …

Predicting Risk For Adverse Outcomes Following Distal Radius Fracture, Saurabh Mehta Phd

Physical Therapy Faculty Research

Some individuals remain at risk for adverse outcomes such as chronic wrist/hand pain, falls, and fall-related osteoporotic fractures after distal radius fracture (DRF) remain. This thesis includes five studies that were conducted to establish prediction rules or assessing the risk of these adverse outcomes following DRF.

The first manuscript outlines a theoretical framework (RACE - Reducing pain, Activating, Cognitive reshaping, Empowering) for managing the risk of adverse outcomes, mainly chronic pain, in individuals with DRF. The RACE is one of the first frameworks to suggest a risk-based management approach for individuals with DRF.

The Patient-Rated Wrist Evaluation (PRWE) is a …

Proposal For A Clinic Based Model Of Physical Therapist Consultation In A Geriatric Outpatient Clinic, Rania Karim, Patricia A. Higgins, Thomas R. Hornick

Physical Therapy Faculty Research

Purpose: The purpose of this article is to describe the role of a certified geriatric physical therapist (PT) in a geriatric outpatient clinic.

Methods: This pilot study used a model in which a geriatric certified doctor of physical therapy (DPT) provided consultations one afternoon a week for patients in the Outpatient Geriatric Clinic at the Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC). Data collection included reason for referral, DPT’s interventions, and clinicians’ and patients’ perceptions.

Results: Over 7 months, the DPT consulted on 25 male patients ranging from 65 to 91 years, with a mean age …

Development Of A Statement On Autonomous Practice: Practice Committee, Section On Geriatrics, Jason Hardage, Stacey Zeigler, Jennifer Blackwood, Tamara Gravano, Greg Hartley, Jill Heitzman, Joe Libera, Ken Miller

Physical Therapy Faculty Research

Vision 2020 is the official vision statement of the American Physical Therapy Association (APTA). Drafted by the APTA House of Delegates in 2000, this statement contains 6 elements: autonomous physical therapist practice, direct access, Doctor of Physical Therapy and lifelong education, evidence-based practice, practitioner of choice, and professionalism. Autonomous practice has been operationally defined by the APTA primarily through its characteristics: “Physical therapists accept the responsibility to practice autonomously and collaboratively in all practice environments to provide best practice to the patient/client. Autonomous physical therapist practice is characterized by independent, self-determined, professional judgment and action.” The Section on Geriatrics has …

Cross-Cultural Adaptation And Psychometric Testing Of The Hindi Version Of The Patient-Rated Wrist Evaluation, Saurabh Mehta, Bhavna Mhatre, Joy C. Macdermid, Amita Mehta

Physical Therapy Faculty Research

The purpose of this study was to perform cross-cultural adaptation and Hindi translation of the patient-rated wrist evaluation (PRWE) and assess psychometric properties of the PRWE-Hindi. Cross-cultural adaptation and Hindi translation of the PRWE was performed using standardized guidelines. Intraclass correlation coefficient (ICC) was used for assessing test–retest reliability, and Cronbach’s alpha (CA) was used for assessing the internal consistency of the PRWE-Hindi. Construct validity was assessed by examining the correlations between the PRWE-Hindi and grip strength, wrist range of movements, and self-reported pain and disability. A total of 50 patients with distal radius fracture were recruited and assessed three …

A Systematic Review Of The Health-Related Quality Of Life Measures Following Total Knee Arthroplasty, Saurabh Mehta, Mary Law, Jean-Sebastian Roy

Physical Therapy Faculty Research

To perform systematic review and appraisal of common patient-reported outcomes (PROs) used in measuring aspects of health-related quality of life (HRQOL) following total knee arthroplasty (TKA). Especially, the study aimed to examine whether these common PROs assess the domains of HRQOL as described in the theoretical frameworks of the HRQOL.