Physical Therapy Commons^™

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 …

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 …

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 …

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 …

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. …

Stepping On Fall Prevention Project, James P. Gaddi, Jordan T. Bowers, Lea M. K. Fung

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Falls are a major problem in the United States among the older adult population and provide opportunity for community outreach via student-led physical therapy projects. Objective: The purpose of this project was to investigate the relationship between fall related outcome measures and questionnaires with the completion of the Stepping On Fall Prevention program along with evaluating the benefits of Physical Therapy student development with participation in service learning projects. Methods: The research quantified the fall risk of 13 participants with assessment of: gait speed (Timed Up and Go), lower extremity strength (30-Second Chair Stand), balance (4-Stage Balance Test), and …

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 …

Inter And Intra-Rater Reliability Of Dance Screening Tool, Kathleen Stone, Braden Waters

UNLV Theses, Dissertations, Professional Papers, and Capstones

Previous literature has indicated that injury rates of ballet and modern dancers are among the highest of any physical activity. These injuries can be detrimental to the athlete and can also result in financial burden for dance companies due to time loss related to injuries. Preventative intervention aimed at those who are most at risk for injury can be effective at reducing the cost associated with lost time due to injury. An effective approach to identifying those most at risk for dance related injuries is to administer a functional movement screen. One such movement screen is the ballet-based Dance Technique …

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 …

Am-Pac Basic Mobility Inpatient Short Form (Low Function) Psychometrics/Clinimetrics, Meghan Wonderling, David Miller, Selena Soria

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: To determine whether the Activity Measure for Post-Acute Care® Basic Mobility Inpatient Short Form (Low Function) (6-clicks LF) has increased responsiveness for patients with lower levels of physical function compared to the Activity Measure for Post-Acute Care Basic Mobility Inpatient Short Form (6-clicks). Design: Retrospective cohort study using original scores and simulated scores for assessment of internal responsiveness of the 6-clicks LF compared to the 6-clicks. Simulated 6-clicks and 6-clicks LF scores were created as a hypothetical future AM-PAC® score. Results: We found a statistically significant difference between the 6-clicks and simulated 6-clicks, t=24.8, p < 0.00 [two-tailed]. The effect size was large (d=1.2, r=0.51).There was a statistically significant difference between the 6-clicks LF and simulated 6-clicks LF, t=19.7, p < 0.00 [two-tailed]. The effect size was medium (d=0.91, r=0.41). Finally, for patients with a 6-clicks score in the bottom five-percentile (n=27), we found a statistically significant difference between the 6-clicks and 6-clicks LF, t=11.9, p < 0.00 [two-tailed]. Conclusion: Among patients scoring less than 15, the 6-clicks LF has greater internal responsiveness than the 6-clicks and thus demonstrates that the new low-level questions in the 6-clicks LF better quantify low-level patients’ functional level. Research using non-simulated data should be completed in the future to confirm these findings.

Development Of A Novel Cognitive-Motor Dual Task Assessment Battery In Neurodegenerative Disease, Jason Longhurst

UNLV Theses, Dissertations, Professional Papers, and Capstones

Automaticity --- the ability to perform a task with directing attentional resources to its completion --- is commonly reduced among individuals with neurodegenerative diseases. These automaticity deficits result in impaired functional and daily activities and are sensitive to subtle, subclinical impairments. However, current measurement of automaticity by dual task paradigms is methodologically limited. In order to gain insight into the current state of the literature regarding cognitive-motor interference in symptomatic and prodromal neurodegenerative disease, the author of this dissertation conducted a scoping review (Chapter 1). To address the methodological limitations of current measurement of automaticity, a new measurement tool was …

Examining The Experiences Of Lgbtq Dpt Students: A Critical Ethnography, Catherine Turner

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to examine the experiences of LGBTQ Doctor of Physical Therapy (DPT) students at a large public university in the south-western United States, as it relates to the culture and climate of the program and campus. The LGBTQ community faces its own unique health disparities. Research in medicine suggests improving the diversity of the healthcare profession is a vital component in improving access to care, and this requires the creation of inclusive and supportive educational environments for LGBTQ identifying healthcare students. However, minimal research exists examining the experiences of LGBTQ physical therapy students.

The study …

Association Between Patient Ability In Activities Of Daily Living At Hospital Admission And Key Indicators, Stephanie Rosen, Amber Steele

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Illness and inactivity in the hospital frequently leads to disability that can reduce quality of life and increase costs. Early identification of people with limitations in activities of daily living (ADL) who are at risk for poor outcomes such as increased length of stay (LOS), hospital acquired conditions (i.e., falls and pressure injuries (PIs)), and discharge away from home can facilitate appropriate intervention. The Activity Measure for Post-Acute Care Inpatient Activity Short Form (AM-PAC IASF), a reliable and valid tool to measure ADL limitations, is scored at admission for all patients in our hospital. The purpose of this study …

Reliability Of The Lateral Reach Test In People With Unilateral Transfemoral Amputations, Stephen Hill, Samantha Leonard, Elizabeth Vianey Trujillo

UNLV Theses, Dissertations, Professional Papers, and Capstones

Lateral reach testing has been established as useful in quantifying stability and fall-risk for older populations without limb loss,1 and has potential for providing useful information about fall-risk, recovery, and rehabilitation of individuals after unilateral trans-femoral amputation. Investigators sought to determine the feasibility and reliability of the Lateral Reach Test (LRT) in people with unilateral trans-femoral amputations. Nine individuals, aged 20-68, with a unilateral trans-femoral amputation were recruited for this study. Two females and seven males participated, and the average height and weight for the group was 167cm and 76kg, respectively. Three participants had right trans-femoral amputations while six had …

Physical Therapy After Amputation In Community Dwelling Older Adults: A Quantitative And Qualitative Interview Study, Amanda Ferraro, Jennifer Gorton, Lindsey Horn, Michaela Kubo

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: To investigate participation in physical therapy in older adults after lower extremity limb loss. The secondary objective was to examine the associations between physical therapy attendance, fear of falling avoidance behavior, self-perceived prosthetic mobility, and mental well-being. Number of Subjects: 64 Materials and Methods: Community-dwelling older adults with amputation were recruited and individually interviewed. The data collection consisted of four surveys (Physical Therapy after Amputation Patient Perception Survey, Short-Form Health Survey [SF-36v2], Prosthetic Evaluation Questionnaire [PEQ, mobility group], and Fear of Falling Avoidance Behavior Questionnaire [FFABQ]). Participants' demographic characteristics were analyzed using descriptive statistics. Participant comments were qualitatively categorized. …

Dosage, Mode, And Timing Of Acute Care Physical Therapy: A Scoping Review, Brendan Acosta, Bradley Goins

UNLV Theses, Dissertations, Professional Papers, and Capstones

Aims and Objectives: 1) To synthesize available evidence for mode, dosage, and timing of physical therapy in the acute care hospital setting. 2) To report the evidence about the effects of mode, dosage, and timing of physical therapy in the acute care hospital setting on LOS, associated costs, and PT-related outcomes. Background: Hospital based physical therapy quality depends on providing evidence-based interventions, however, the research regarding dosage, mode, and timing of physical therapy in the acute care hospital setting has not been synthesized for patient populations except for total joint arthroplasties or patients in the ICU. Design: A systematic search …

Patient And Facility Perceptions On The Feasibility Of A Student-Run Pro-Bono Back-School For Uninsured Patients With Low Back Pain, Javier Ascanio-Pellon, Sofia Cruz, Lauren Liebert, Trevor Pacuk

UNLV Theses, Dissertations, Professional Papers, and Capstones

A. Background of Knowledge: Nevada ranks 8th highest in uninsured population in the United States. People who are uninsured may be more affected by low back pain (LBP) than their insured counterparts. Volunteers in Medicine of Southern Nevada (VMSN), a non-profit organization, serves uninsured people in Nevada. VMSN partnered with UNLV Physical Therapy (UNLVPT) to provide a back-school for patients. UNLVPT proposed a service-learning model to provide both education and treatment for VMSN patients with LBP. B. Purpose: The purpose of this community-based research project is to create and implement a student-run pro-bono back-school for uninsured individuals with LBP in …

Brain Volumes And Dual-Task Performance Correlates Among Individuals With Cognitive Impairment: A Retrospective Analysis, Jon Basterrechea, Daniel Krist, Caitlin Moreland, Morgan Wise

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Cognitive impairment (CI) is a prevalent condition characterized by loss of brain volume and changes in cognition, motor function, and dual-tasking ability. Objective: To examine associations between brain volumes, dual task performance, and gait and balance in those with CI to elucidate the mechanisms underlying loss of function. Methods: We performed a retrospective analysis of medical records of patients with CI and compared brain volumes, dual task performance, and measures of gait and balance. Results: Greater cognitive function and combined dual task effect (DTE) is associated with smaller brain volumes. In contrast, greater motor DTE is associated with larger …

Partnering With The Nevada Physical Therapy Association To Improve Pt/Pta Engagement, Rachel Cooklin, Joshua Cooper, Madison Luna

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: The American Physical Therapy Association (APTA) is the professional organization that represents Physical Therapy and exists to promote the needs of society by advocating access and availability of all Physical Therapy services. The Nevada Physical Therapy Association (NVPTA) is a chapter of the APTA that represents the Physical Therapy profession in Nevada. In 2017, only 38.9% of licensed Physical Therapists (PTs) and 7.9% of licensed Physical Therapy Assistants (PTAs) practicing in Nevada were members of the NVPTA. Objective: The purpose of this service-learning project was to explore membership trends in the NVPTA, explore why membership amongst PTAs is low, …

Comparisons Of Patellar Bone Mineral Density Between Individuals With And Without Patellofemoral Pain, Chris Khuu, Allina Cummins, Steven Shepherd

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Although bone stress injuries have been reported in individuals with patellofemoral pain (PFP), especially within the lateral patella, it remains unclear whether persons with PFP exhibit altered patellar regional bone mineral density (BMD). The primary purpose of this study was to compare BMD of the patella (lateral, medial, and total regions) between individuals with and without PFP using quantitative computed tomography (QCT). The secondary aim was to examine the associations between patellar regional BMD and patellofemoral joint (PFJ) alignment. Methods: Ten individuals with retropatellar pain and 10 sex, age, weight, height, and activity matched pain-free controls underwent a QCT …

Fall Prevention Service-Learning Project, Alexis Mansoor, Kendra Morrison, Jeremy Nordfelt, Cheng Yang Tu

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: The purpose of this service-learning project was to: 1) reduce falls in the Las Vegas, Nevada community by implementing the Stepping On fall prevention program and 2) to investigate the effect of planning and implementing a service learning project (SLP) on physical therapy (PT) students’ education and professional development. Description: Under the supervision of our advisor, we planned and organized this SLP, became certified leaders of Stepping On, recruited and screened older adults using the STEADI fall risk screening tool, and facilitated the program at a local community hospital. We facilitated group discussion and instructed the exercises outlined in …

Patient, Student, And Faculty Perceptions Of A Student Led Pro-Bono Education And Treatment Based Back School For Uninsured Nevadans, James Tingey, Daniel Tiano, Rebecca Templeton, Meagan Duncan

UNLV Theses, Dissertations, Professional Papers, and Capstones

Importance: To determine feasibility and benefits of student led back school in an underserved population. Perceptions were positive support benefits for all participants. Objective: To evaluate perceived benefits for uninsured participants, students, and faculty with implementation of an evidence based, student led back school. Design: Eight DPT students created curriculum delivered over two days of two-hour classes, one week apart including screening and abbreviated evaluation of LBP, group education, specific exercise selection, and home exercise program assignment. Following first session, analysis performed to improve subsequent sessions. Setting: Cooperative effort between the pro bono clinic, Volunteers in Medicine of Southern Nevada, …

Effects Of Transcranial Direct Current Stimulation On Gait And Balance Post-Stroke, Leonard Ubalde, Jordon Jacklin, Peyton Hobson, Sara Wright-Avila

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Non-invasive brain stimulation is effective in combination with traditional physical therapy to facilitate motor performance in patients who recently survived a stroke. Current literature has focused on transcranial direct current stimulation and transcranial magnetic stimulation efficacy for improving the completion of fine motor tasks in the upper extremities. However, there is a lack of current evidence regarding the efficacy of this therapy in the lower extremities. Objective: To measure the effects of transcranial direct current stimulation on lower extremity clinical outcomes in patients who had a stroke including gait speed, functional reach, and balance. Methods: Randomized control trial in …