Physical Therapy Commons^™

A Case Study: Adhesive Capsulitis After Breast Cancer Surgery, Kelsey Kratzke

Physical Therapy Scholarly Projects

Purpose: The purpose of this case report was to outline the physical therapy interventions and factors affecting rehabilitation of a patient with adhesive capsulitis following breast cancer surgery.

Case Description: A 65 year-old female, with limited range of motion in the right shoulder and right anterior chest pain, was seen at an outpatient physical therapy clinic. Past medical history included unilateral right mastectomy, right lymph node dissection, and chemotherapy. The physical therapy examination and patient history led to the diagnosis of adhesive capsulitis of the right shoulder and fibrosis of the anterior chest wall musculature.

Plan of Care …

Physical Therapy Treatment Of Upper Back, Neck, And Shoulder Pain: A Case Report, Lauren A. Graham

Physical Therapy Scholarly Projects

Background and Purpose. Neck, shoulder, and upper back pain may be caused by a number of different pathologies and can decrease a patient's functional ability and participation in their daily life. The purpose of this case study is to describe the use of strengthening, stretching, manual therapy, and neuroscience of pain education for decreasing pain in a patient with chronic neck, thoracic, and shoulder pain.

Case Description. The patient was a 69 year old female who had been experiencing neck, shoulder, and upper back pain for 8 months with an insidious onset. She was functionally limited and experienced …

Evaluation Of Fall Risk, Functional Mobility, And Quality Of Life Changes Of Community-Dwelling Older Adults With Parkinson's Disease Participating In A Community Exercise Program: Part Ii, Lauren Trudel, Courtney Mcdonald, Brittany Bleichner

Physical Therapy Scholarly Projects

Purpose/Hypothesis: As a person ages, the risk of a fall increases. Parkinson Disease (PD) is most commonly seen in the elderly population, which presents with symptoms such as bradykinesia, decreased balance, tremors, postural instability, and muscle weakness. These symptoms are associated with an increase in falls; therefore, a person with PD is more susceptible to falls than the average elderly individual. Exercise has been shown to combat those symptoms affecting people with PD. This study is an extension of a previous study, which examined the effect of a community based exercise program, for people with PD, on quality of …

Evaluation And Treatment Of Temporomandibular Joint Disorder: A Case Report, Melanie Fuller

Physical Therapy Scholarly Projects

Background and Purpose: Temporomandibular joint disorder (TMD) affects 40 to 60% of the US population and is primarily prevalent in 35 to 45 year old females. It involves a multitude of anatomical structures including bilateral temporomandibular joint (TMJ) and numerous muscles affecting the TMJ. Examination and treatment of TMD generally requires a whole person approach due to the complexity of involved structures. The purpose of this case study was to educate physical therapists in TMD and pro vide intervention options.

Case Description: The patient was a 36-year-old female referred to physical therapy by her oral surgeon. She presented …

Extension-Based Exercises In Conjunction With Manual Therapy And Strengtheing For Acute Low Back Pain With Associated Lumbar Radiculopathy: A Case Report, Marcé Schultz

Physical Therapy Scholarly Projects

Background and Purpose: The purpose of this case report is to describe a case in which extension-based exercises derived from the method of mechanical diagnosis and treatment (MDT) in correlation with manual therapy and strengthening were applied to a patient with acute low back pain and lumbar radiculopathy.

Case Description: I present the case of a female patient who worked as a certified nursing assistant and injured her back while attempting to transfer a patient. Workmen's compensation was filed and the patient was referred to physical therapy. Through an extensive historical intake and examination procedure, we determined that …

Effectiveness Of The Timed Up And Go (Tug) Test In Assessing Fall Risk In Community-Dwelling Elders Participating In The Stepping On Program, Megan Shanahan

Physical Therapy Scholarly Projects

Background: The Timed Up and Go (TUG) is intended to predict fall risk through assessment of balance, functional mobility, and gait in community-dwelling adults age 65 and older. The Stepping On program aims toward fall prevention through education, exercise, and shared experiences among participants. Previous evidence has displayed positive, significant results for Stepping On and the TUG, indicating use of the assessment to track participants' progress in the program.

Objective: The purpose of this study was: 1) to determine if the Stepping On program decreases fall risk in community-dwelling elderly individuals as measured by the TUG test, 2) …

Pulmonary Recovery Positions Increase Emg Activity In Accessory Respiratory Muscles, Shelby Carlson, William Hunt, Joshua Johnson

Physical Therapy Scholarly Projects

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States and is predicted to be the third leading cause of death worldwide between 2020 and 2030. Smoking continues to be the primary cause of this disease, which is associated with about 80% of all COPD deaths. Signs and symptoms of COPD can be debilitating; however pulmonary recovery positions may be taught to improve breathing capabilities in impaired individuals. Literature suggests techniques for pulmonary recovery may involve supporting the upper extremities, supporting the head, and leaning forward. The purpose of the current study was to …

Conservative Treatment Following Acl Rupture In An Older Individual, Wes Anderson

Physical Therapy Scholarly Projects

Background and Purpose. The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments in the knee. It is thought that reconstructive surgery of the ruptured ACL is the best way to return to functional activities, but not every patient wishes to have this surgery with the lengthy recovery. The purpose of this case report is to investigate the outcomes of conservative physical therapy treatment for an ACL rupture over the traditional reconstructive surgery.

Case Description. The patient fell off her bike on a gravel road and suffered a primary diagnosis of a ruptured ACL. She …

Electromyographic Activity Of Hamstrings And Quadriceps Muscles During Jumping And Landing: Pilot Study, Joseph Burckhard, Tyler Kemnitz, Mikaela Dick, Alexandria Sweeney

Physical Therapy Scholarly Projects

Background and Purpose. The purpose of this pilot study was to find if there was a difference in the activation and firing time of the quadriceps (vastus medialis and vastus lateralis) compared to activation times of the hamstrings (biceps femoris and semitendinosus) in active males and females.

Methods. Subjects consisted of two male and two female athletes in good physical condition with no previous knee pathologies. During each of the trials, the muscle activity of each muscle was recorded. The EMG activity recorded using a Noraxon TeleMy02400 G2 telemetry unit with a sampling rate of 1 kHz which …

Emg Of Serratus Anterior, Upper, Middle, And Lower Trapezius During Glenohumeral Abduction In A Patient With Scapular Dyskinesia: A Case Study, Tyler Bentrup, Byron Flett, Joshua Sorvig

Physical Therapy Scholarly Projects

Introduction. The purpose of this case study was to examine the differences in muscle activation between the right and left sided upper trapezius, middle trapezius, lower trapezius and serratus anterior in a participant with scapular dyskinesis.

Methods. EMG activity was recorded using a Noraxon TeleMyo2400 G2 telemetry unit with a sampling rate of 1 kHz on the aforementioned muscles.

Results. In comparing UE ratios of EMG activity, it appears that the left lower trapezius exerts a significant amount more of energy than the right lower trapezius.

Conclusion. This study may demonstrate the importance of bilateral lower …

Complex Regional Pain Syndrome Type I Treated With Active Release Technique, Kathleen Hughes, James M. Mckivigan

College of Health & Human Services (TUN) Publications and Research

This report describes the examination, intervention, and outcome for a patient with CRPS type I treated with ART®. The patient was diagnosed with CRPS following a grade II ATFL sprain. For two months, treatment consisted of weekly 45-minute sessions including ART® in combination with self-massage, desensitization, joint mobilization, gait training, therapeutic exercise, and patient education. A brief reexamination was performed weekly. A clinically significant increase of 13 points on the LEFS was measured after eight weeks of treatment, as were improvements in quality of gait and gait distance. In addition, the patient experienced the return of ankle range of motion …

The Effect Of One-On-One Intervention In Athletes With Multiple Risk Factors For Injury, Kathryn Schwartzkopf-Phifer

Theses and Dissertations--Rehabilitation Sciences

Background: Lower extremity (LE) musculoskeletal injuries in soccer players are extremely common. These injuries can result in many days of lost time in competition, severely impacting players and their respective teams. Implementation of group injury prevention programs has gained popularity due to time and cost-effectiveness. Though participation in group injury prevention programs has been successful at reducing injuries, programs often target a single injury and all players do not benefit from participation. Players with a greater number of risk factors are most likely to sustain an injury, and unfortunately, less likely to benefit from a group injury prevention program. …

What Does A Promis T-Score Mean For Physical Function?, Jeff Houck, Zane Wise, Amanda Tamanaha, Judith Baumhauer, Luke Skerjanec, Alexandra Wegner, Chris Dasilva, Michael Bass

Faculty Publications - College of Physical Therapy

Introduction/Purpose: The use of patient-reported outcomes (PRO) continues to expand beyond research to involve standard of care assessments. Although the PROMIS physical function (PF) is normalized to a T-score it is unclear how to interpret and apply this information in the daily care of patients. The T-score is abstract and unanchored to patient abilities impairing its clinical utility when shared with the patient. Patient questions are concrete such as “when will I be able to run again after this procedure?” The purpose of this research was to link PROMIS PF T-scores with physical function activities and provide a visual map …

Reading The Future: Predicting Who Will Benefit From Bunion Surgery, Ashlee Macdonald, Jeff Houck, Judith Baumhauer

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Hallux valgus is a common condition of the foot with 4.4 million patients seeking care yearly for this condition. A previous study suggested specific pre-operative cut-off scores based on Patient Reported Outcomes Measurement Information System (PROMIS) physical function (PF), pain interference (PI), and depression (D) values could predict post-operative outcomes in foot and ankle surgery. Though hallux valgus correction, among other procedures, were identified as one of the most common surgeries in the previous study, specific conditions were not considered separately. The purpose of this study was to evaluate the validity of applying a published comprehensive pre-surgical PROMIS profile …

Comparison Of Patient Reported Outcomes Using Promis In Patients With Shoulder Pain, Benjamin Strong, Raymond James Kennedy, Joseph Christopher Schaffer, Jon Hedgecock, Jeff Houck, Michael D. Maloney, Ilya Voloshin

Faculty Publications - College of Physical Therapy

Objectives: Compare a disease specific questionnaire (American Shoulder and Elbow Surgeons [ASES]) and a multidimensional global health scale (Patient reported outcome measurement system [PROMIS]) across a variety of shoulder conditions

Generalizability And Validation Of Promis Scores To Predict Surgical Success In Foot And Ankle Patients: A Tale Of Two Academic Centers, Judith Baumhauer, Michael Anderson, Charles Saltzman, Man Hung, Florian Nickisch, Alexej Barg, Timothy Beals, Jeff Houck

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Patient-reported outcomes are advancing clinical care by improving patient satisfaction and engagement. A recent publication reported preoperative PROMIS scores to be highly predictive in selecting patients who would and would not benefit from foot and ankle (F/A) surgery. Although this publication used the data from 5 fellowship trained foot and ankle surgeons at one institution, the generalizability to other patient populations and geographic areas is unknown. This validation study assesses the pre-operative PROMIS physical function (PF) and pain interference (PI) t-scores as a predictor of post-operative success from a separate geographic area.

Can Foot Exercises Alter Foot Posture, Strength, And Walking Foot Pressure Patterns In People With Severe Flat Foot?, Jeff Houck, Lacey Seidl, Austin Montgomery, Joshua Keefer, Miranda Walker

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Muscle training muscle control for barefoot running (i.e. doming seated[DS] and standing[DSt]) and post foot and ankle injury (i.e. seated plantar flexion and inversion[SPFI]) are common. Although studies demonstrated improvement in foot posture (validated foot posture index [FPI]) immediately following a 4-week exercise program this was not assessed in people with flatfoot. Also, more rigorous assessment of foot function is lacking (i.e. foot posture, strength, and plantar pressure during walking). There is clearly a need for more rigorous clinical data on the effect of foot exercises. The purpose of this pilot study was to assess the immediate effect of …

Clinical Utilization Of Patient Reported Outcome (Promis) Scores For Surgical Reconstruction Of Posterior Tibialis Tendon Dysfunction, Michael Anderson, Jeff Houck, Adolph Flemister, Judith Baumhauer, John Ketz, Benedict Digiovanni, David Ciufo, Irvin Oh

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Previous studies have demonstrated that preoperative Patient Reported Outcome Instrumentation System (PROMIS) scores effectively predict improvement in foot and ankle surgery. Adult acquired flatfoot deformity (AAFD) and Posterior Tibialis Tendon Dysfunction (PTTD) are a common surgical problem, but it is unclear if the specific thresholds for the physical function (PF), pain interference (PI) and depression published previously for all foot and ankle surgeries apply to a specific diagnosis. Furthermore, the interplay of PROMIS scores and clinical variables has not been evaluated. The purpose of this study was: 1) to investigate the change in PROMIS scales and radiographic measurements from …

The Road To Recovery For Bunion Surgery: Data Analytic Plots To Target Patient Progress, Ashlee Macdonald, Jeff Houck, Judith Baumhauer

Faculty Publications - College of Physical Therapy

Introduction/Purpose: Patient reported outcomes (PROs) can provide information on individual patient’s progress throughout a treatment course and additionally, with common surgeries, powerful numbers can be generated to provide data analytic curves to provide a recovery road map for patients and surgeons. Those who deviate negatively from the predicted path may have a complication and early intervention can be initiated. Those who deviate positively have the potential to need less physical therapy, early return to sports or work. Hallux valgus (HV) is a common condition of the foot with 4.4 million patients seeking care yearly and surgery is equally common. The …

Changes In Postural Sway Behavior Across The Life Span, Maria M B N R Santos

Graduate Student Theses, Dissertations, & Professional Papers

The present study aimed to investigate human balance control by assessing postural sway on three groups representing three stages of life (6-12, 19-40 and 65-74 years old). There were 14 individuals in each group and they were tested during upright bipedal stance with either eyes open or closed. Focus was given to multiple sway indices representing multi-dimensional features of postural sway in quiet stance and included: the center of pressure area, amplitude, root mean square (RMS), velocity, jerkiness, and sample entropy. Results confirmed that children and seniors swayed more (p<.004), faster (p<.001) and their body sway was shakier (p<.001) than young adults. Seniors also presented faster (p<.006) and shakier (p<.001) sway than children and a more unpredictable pattern of body sway in time (p<.002) than children and young adults. In addition, children presented a more random anterior-posterior sway (p<.034) and a more regular medio-lateral sway (p<.043) than young adults, and a higher synchronization between anterior-posterior and medio-lateral body sway (p<.012) than young adults and seniors. We also observed that postural control of children and young adults becomes relatively more challenged in experimental situations when eyes were closed for most postural indices. In conclusion, this study suggests that multi-dimension posturography is sensitive to detect subtle age-related changes in the postural behavior and each stage of life may have their own signature patterns of postural behavior. Therefore, we expect that quantifications of this nature may be used to assess not only postural instability and fall risk but also to aid the testing of the efficacy of balance interventional protocols.

Age-Related Differences In The Lumbopelvic Kinematics During The Trunk Motions In The Anatomical Planes, Milad Vazirian

Theses and Dissertations--Biomedical Engineering

Management and control of the low back pain as an important health problem in the industrial societies necessitates to investigate how the risk of this disease is affected by aging. Since the abnormalities of the lumbopelvic kinematics are related to the existence or risk of low back injuries, the objective of this dissertation was set to find the age-related differences in lumbopelvic kinematics when performing basic trunk motions reaching to range of motion in different anatomical planes.

A cross-sectional study was designed where sixty asymptomatic individuals between 20–70 years old with no confounding health condition, no current or previous highly …

Longitudinal Adaptations In Muscle Strength, Functional Performance, Gait Biomechanics, And Patient-Reported Function After Unilateral Total Knee Arthroplasty, Paul W. Kline

Theses and Dissertations--Rehabilitation Sciences

Objective: The aims of this research were to identify gaps in the literature related to impairments after total knee arthroplasty (TKA) (Aim 1) and define recovery between 3 and 6 months after TKA across four domains: 1) hip and knee muscle performance, 2) functional performance, 3) patient-reported function, and 4) biomechanics of walking and stair descent (Aim 2). Additionally, this project sought to explore the relationships between each domain (Aim 3) and establish predictive models to allow clinicians to use clinical measures to predict future gait biomechanics in patients after TKA (Aim 4). Ultimately, the results of this research would …

Physical Therapist Students’ Development Of Diagnostic Reasoning: A Longitudinal Study, Sarah Gilliland

Physical Therapy Faculty Articles and Research

Background and Purpose. Clinical reasoning is a complex problem-solving process that is necessary for effective clinical practice in physical therapy. Within the process of clinical reasoning, a physical therapist’s diagnostic reasoning should address the patient’s functional movement abilities and the impact of the patient’s condition on his or her ability to participate in life activities. This longitudinal study examined the development of entry-level physical therapist students’ diagnostic reasoning processes across time in their doctor of physical therapy education.

Methods. Qualitative methods were used to analyze participants’ diagnostic reasoning during a simulated patient case scenario. Six physical therapist students …

Occupational Therapy And Physiotherapy Education And Workforce In Anglophone Sub-Saharan Africa Countries, Augustine O. Agho, Emmanuel John

Physical Therapy Faculty Articles and Research

Background: Sub-Saharan Africa (SSA) countries are faced with the challenge of educating a critical mass of occupational therapists (OTs) and physiotherapists (PTs) to meet the growing demand for health and rehabilitation services. The World Federation of Occupational Therapy (WFOT) and World Confederation of Physical Therapy (WCPT) have argued for the need of graduate-level training for OTs and PTs for decades. However, very few studies have been conducted to determine the availability of OT and PT training programs and practitioners in SSA countries.

Methods: Initial data were collected and compiled from an extensive literature search conducted using MEDLINE and …

Differences In Trunk And Hip Flexion/Extension Strength, Jasmin Brown

College of Graduate Studies: Theses & Dissertations

Context: The definition of the “core” within the literature is misconstrued: some researchers believe the core only involves muscles of the trunk while others believe it also includes muscles of the hip. Core strength tests typically include exercises that activate hip flexors and extensors without a firm definition of the “core” including the muscles of the hip. Purpose: The purpose of this study was to differentiate between the strength of the trunk and hip during flexion and extension.

Methods: Participants included 28 Division I collegiate athletes from a single university (12 males, 16 females, height (in.) = 69.14 ± 4.81, …

Influence Of 4-Week Exercise Program On Clinical And Biomechanical Measures Of Foot Function, Lacey Seidl, Josh Keefer, Miranda Walker, Austin Montgomery, Jeff Houck

Student-Faculty Research - College of Physical Therapy

The significance of foot muscle function associated with flat feet is unclear. It is reported that flat feet have significantly decreased lateral forefoot pressure during ambulation with increased midfoot contact area and increased pressure under the big toe. There are passive mechanisms in the foot that support the arch during static standing, but cannot produce energy for dynamic activity. The two most plausible explanations for energy generation of the midfoot for dynamic activity are muscle contributions or recoil of stretched soft tissue (i.e. plantar fascia and other ligaments) or a combination. No studies to date evaluate the ability of foot …

Developing An Auditory And Visual Cross-Modal Continuous Performance Task For Evaluating Concussion, Chris Koch, Taylor Charbonnier, Kristin Dissinger, Steven Egeberg, Matthew Johnson, Lindsey Levanen, Matthew Scott

Student-Faculty Research - College of Physical Therapy

Neurocognitive tests like the SCAT3 and ImPACT have become standard concussion assessment tools. Although these tests have adequate sensitivity, specificity, and reliability, they are unimodal in nature. Consequently, the tests do not fully assess the range of processing that can be affected by concussion (Thompson, 2012). Therefore, we developed a cross-modal continuous performance task to examine cognitive processing post-concussion. Forty-three middle school school lacrosse players, college students, and physical therapy graduate students participated in the study. Twelve of these participants had been previously diagnosed with a concussion. Participants completed a symptom checklist from SCAT3 along with other demographic information (e.g., …

Sit-To-Stand Symmetry In Individuals With Hip Pathology, Andrew J. Meszaros, Stephen Block, Jake Edwards, Brittany Jones, Elizabeth Keeler, Christina Ridley, Ashley Yates

Student-Faculty Research - College of Physical Therapy

Why study hip fracture?

• Hip fractures occur in approximately 300,000 individuals over 65 years of age and is on the rise

• 53.3% of those who fall, fall again • 50% loss of function in involved lower extremity post fracture

• 25% increased mortality rate 1 year post hip fracture

An asymmetry in force production has been found to exist between fractured/non- fractured sides during a sit-to-stand task post hip fracture, despite having adequate

capacity to perform the task symmetrically.

Houck 2011 found the asymmetry is a result of weakness in the fractured lower extremity.

Briere 2013 found the …

Promis Physical Function Scale Bookmarking And Validation, Luke Skerjanec, Amanda Tamanaha, Alex Wegner, Zane Wise, Jeff Houck

Student-Faculty Research - College of Physical Therapy

• Quick, valid and responsive outcome measure are critical for physical therapists

• The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) is a universal, 124 item, computer adapted system (CAT) that evaluates various health domains including physical function without a ceiling or floor effect.

• PROMIS demonstrates good convergent validity with the Health Assessment Questionnaire Disability Index (HAQ-DI) and Short-form 36 (SF-36) physical function subscale1 and also with ‘gold standard' International Knee Documentation Committee (IKDC) scale. PROMIS score can also predict poor outcomes at various follow-up lengths ranging from 3-52 weeks2.

• The modified physical performance test (mPPT) is …

Pilot Study: What Measures Predict First Time Pass Rate On The National Physical Therapy Examination?, Jamie Bayliss, Rosanne M. Thomas, Marsha Eifert-Mangine

Internet Journal of Allied Health Sciences and Practice

Background: Research investigating predictors of success on licensure examination is useful for admission criteria as well as targeted intervention for identified at risk students in physical therapy programs. Predictors of success on the National Physical Therapy Examination (NPTE) have been explored but results are no longer current. This study assessed predictive variables including admission data, performance in identified key courses, and academic/clinical difficulty for Doctor of Physical Therapy (DPT) cohorts at Mount St Joseph University. Objective: Determine variables predicting success on the National Physical Therapy Examination. Design: A retrospective correlational study was done. Methods: Retrospective data of Mount St Joseph …