Physical Therapy Commons^™

Joint Mobilizations And Paraplegia: A Curious Pairing, Preston Tam, Matthew L. Daugherty

St. Augustine, Summer 2018

The purpose of this case report is to explore the effectiveness of joint mobilizations at the knee on gait and pain in a patient with ambulatory paraplegia.

Canalith-Repositioning Maneuvers And Balance Interventions On A Patient With Multiple-Canal Bppv: A Case Study, Nicole Knights, Kerry C. Mallini

St. Augustine, Summer 2018

The purpose of this case report is to demonstrate using canalith-repositioning maneuvers and balance training as interventions to reduce vertigo and improve balance and gait in a patient with multiple-canal BPPV.

Immediate Effects Of Cervical Spine Thrust Joint Manipulation On Gait Parameters In Individuals With Neck Pain, Marc Anthony D. Albano, Emily Blok, Beau Gronert, Ryan Masuda

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypotheses: 1. To investigate for any change in gait parameters in individuals with neck pain while walking with different functional neck conditions immediately following cervical thrust joint manipulation (TJM) versus a sham intervention. 2. To investigate any association between Global Rating of Change (GROC) scores and gait parameters immediately following cervical thrust joint manipulation versus a sham intervention. The hypotheses were that, a) cervical TJM would have an immediate effect on gait parameters during walking with the neck in at least one of three conditions (neutral, flexion/extension and rotation) among individuals with neck pain; and b) higher scores on the …

Neuromuscular Adaptations Following Slope Walking In Individuals Post-Stroke, Eric Akoopie, Brooke Conway Kleven, Trisha Koch

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: The excitability of the H-reflex pathway in the non-impaired nervous system can be augmented by altering the different parameters of a walking task, specifically slope. We sought to examine the adaptations in soleus H-reflex excitability and foot force control following an acute bout of upslope or downslope treadmill walking in people post-stroke compared to those who are non- impaired. Methods: We recruited 12 individuals with chronic post-stroke hemiparesis and 9 age-similar non- neurologically impaired individuals. Each subject was tested over 2 sessions separated by at least 7 days. For each session, subjects walked at a self-selected walking speed on …

Walkin’ On Air: Alter-G Gait Training In A Male With Hereditary Spastic Paraplegia, Kimberly Richardson, Evan M. Pucillo

St. Augustine, Spring 2018

The purpose of this case report is to determine the effectiveness of LBPPS treadmill training, using the Alter-G, to improve the spatiotemporal parameters of gait for a patient with HSP.

Walk It Like You Talk It, Like A Champ With Some Amp, Sam Chukwuma, Anne H. Boddy

St. Augustine, Spring 2018

The purpose of this case report is to measure the effectiveness of amplified movement therapy to improve functional balance and gait in a post-stroke patient.

Six-Minute Walk Test Performance In Persons With Multiple Sclerosis While Using Passive Or Powered Ankle-Foot Orthoses, Morgan K. Boes, Rachel E. Bollaert, Richard M. Kesler, Yvonne C. Learmonth, Mazharul Islam, Matthew N. Petrucci, Robert W. Motl, Elizabeth T. Hsiao-Wecksler

Exercise Science Faculty Research and Publications

Objective

To determine whether a powered ankle-foot orthosis (AFO) that provides dorsiflexor and plantar flexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS).

Design

Short-term intervention.

Setting

University research laboratory.

Participants

Participants (N=16) with a neurologist-confirmed diagnosis of MS and daily use of a prescribed custom unilateral passive AFO.

Interventions

Three 6-minute walk tests (6MWTs), 1 per footwear condition: shoes (no AFO), prescribed passive AFO, and portable powered AFO (PPAFO). Assistive devices were worn on the impaired limb.

Main Outcome Measures

Distance walked and metabolic cost of transport were recorded during each 6MWT and …

Differences In Walking Mechanics Between A Traditional Walker And The Kb Balance Trainer, Silvia Zanini

Electronic Theses and Dissertations

INTRODUCTION: Millions of individuals with ambulatory difficulties rely on walking aids to maintain independence and mobility. However, users of traditional walkers typically exhibit increased forward lean of their trunk while using the assistive device. The KB Balance Trainer is a new posterior walker designed to facilitate a more erect position during gait. PURPOSE: To compare gait mechanics across three walking conditions: unassisted, using a traditional walker, and using the KB Balance Trainer. METHODS: Seven adults with experience using walkers due to ambulatory difficulties participated in the study. The study consisted of one training session and one gait analysis session. The …

Effects Of Functional Electrical Stimulation Cycling Versus Cycling Only On Walking Performance And Quality Of Life In Individuals With Multiple Sclerosis: A Randomized, Clinical Pilot Study, Lori Hochman

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Functional Electrical Stimulation (FES) stimulates peripheral nerves via electrical current to evoke muscle contractions and when combined with lower extremity cycling (LE), creates patterned leg movements. Previous studies demonstrated FES cycling is safe and effective in the spinal cord injury and stroke populations with improvements seen in walking speed, muscle mass, and bone density. Few studies have applied FES cycling to a neurodegenerative disorder, such as multiple sclerosis (MS). The aim of this study is to assess the effect of an 8-week training program using FES cycling, compared to Cycling Only, in people with MS (PWMS). Methods: Using a …

The Attentional Demands Of Ambulating With An Assistive Device In Older Adults With Alzheimer's Disease, Susan W. Hunter, M Montero-Odasso

Physical Therapy Publications

Ambulation with a mobility aid is a unique real-life situation of multi-tasking. These simultaneous motor tasks place increased demands on executive function in healthy young and older adults, but the demands have not been evaluated in people with Alzheimer's disease (AD). Mobility problems are common among adults with AD, leading to provision of a mobility aid to optimize independent activity. The study objectives were: (i) to determine the dual-task cost (DTC) associated with the use of a mobility aid in straight and complex path walking, and (ii) to evaluate the association between executive function and ambulation with a mobility aid …

The Effects Of Fatigue On Balance In Individuals With Parkinson's Disease: Influence Of Medication And Brain-Derived Neurotrophic Factor Genotype, Michael Baer, Bradley Klemetson, Diana Scott

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: The purpose was to investigate the effects of fatigue on balance in individuals with Parkinson’s disease (PD). Because falls in this population can have deleterious consequences, it is important to understand the influence of fatigue and PD medications on balance. Additionally, since brain-derived neurotrophic factor (BDNF) has been shown to be related to motor performance, we explored its role in balance fatigue. Participants: 27 individuals (age= 65.4±8.1; males= 14, females= 13) with neurologist-diagnosed PD. Of the 27, 13 were genotyped for BDNF as Val/Val, 11 as Val/Met, 2 as Met/Met, and one refused genotyping. Methods: Participants were …

Visual, Verbal, And Tactile Cues On Improving Gait In A 71-Year Old Male With Dementia Of The Lewy Bodies, Symone Carter, Jackie Crossen-Sills

St. Augustine, Spring 2017

The purpose of the case report is to demonstrate how visual, verbal, and tactile cues can improve gait in a patient with DLB.

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 …

Altering A Runner’S Foot Strike Using A Modified Elliptical Trainer, Daniel Shull

Theses and Dissertations

One possible solution to common running related injuries is to transition runners from a rearfoot strike during initial contact to a midfoot strike. Natural rearfoot strike runners were studied to see if a modified elliptical trainer could be used to alter their running pattern to that of a midfoot strike runner. Their results were compared to subjects who ran on a non-modified elliptical trainer. After training on the modified elliptical trainer, subjects demonstrated a decrease in foot angle at initial contact when attempting to run with a midfoot strike. Training did not affect all kinetic metrics or stride frequency. However, …

Standing Balance And Spatiotemporal Aspects Of Gait Are Impaired Upon Nocturnal Awakening In Healthy Late Middle-Aged And Older Adults, Amanda L. Mcbean, Raymond P. Najjar, Ronald A. Schuchard, Courtney D. Hall, Cheng-Ann Wang, Ban Ku, Joseph M. Furman

ETSU Faculty Works

Study Objectives: Nocturnal awakenings may constitute a unique risk for falls among older adults. We describe differences in gait and balance between presleep and midsleep testing, and whether changes in the lighting environment during the midsleep testing further affect gait and balance.

Methods: Twenty-one healthy, late middle-aged and older (64.7 ± 8.0 y) adults participated in this repeated-measures design consisting of four overnight laboratory stays. Each night, participants completed baseline visual acuity, gait, and balance testing. After a 2-h sleep opportunity, they were awakened for 13 min into one of four lighting conditions: very dim white light (< 0.5 lux); dim white light (∼28.0 lux); dim orange light (∼28.0 lux); and white room-level light (∼200 lux). During this awakening, participants completed the same sequence of testing as at baseline.

Results: Low-contrast …

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.

Mobility Of Individuals With Multiple Sclerosis And The Influence Of Physical Therapy, Brenda L. Davies

Theses & Dissertations

One main purpose was to explore the compensatory gait strategies of individuals with multiple sclerosis (MS). To address this purpose, we quantified the mechanical work generated by the lower extremity joints during walking. The outcomes from this investi­gation suggested that individuals with MS redistribute positive mechanical work during walking to the hip in order to compensate for a reduced ability of the ankle to generate positive mechanical work. Additionally, we also explored the motor control of the ankle as a potential contributing factor to the mobility limitations of individuals with MS. The outcomes from this investigation indicated that individuals with …

Influence Of Visual Feedback On Dynamic Balance Control In Chronic Stroke Survivors, Eric R. Walker, Allison S. Hyngstrom, Brian D. Schmit

Physical Therapy Faculty Research and Publications

Chronic stroke survivors have an increased incidence of falls during walking, suggesting changes in dynamic balance control post-stroke. Despite this increased incidence of falls during walking, balance control is often studied only in standing. The purpose of this study was to quantify deficits in dynamic balance control during walking, and to evaluate the influence of visual feedback on this control in stroke survivors. Ten individuals with chronic stroke, and ten neurologically intact individuals participated in this study. Walking performance was assessed while participants walked on an instrumented split-belt treadmill with different types of visual feedback. Dynamic balance control was quantified …

Stepping On: Gait Velocity And Fall Risk Assessment, Brittney Herbst

Physical Therapy Scholarly Projects

Purpose: To identify fall risk and determine if the Stepping On program is effective at reducing the risk of falls in participants by increasing gait speed to greater than or equal to 1 m/s. Step and stride length were also compared to age related norms to determine if they correlated to fall risk. Gait speed of less than I m/s has been shown to increase the risk for falls in elderly.

Methods: Fourteen female participants over the age of 65 (mean age of 87) were recruited from a local Stepping On class conducted at an assisted living facility …

Postural Responses To Perturbations Of The Vestibular System During Walking In Healthy Young And Older Adults, Jung Hung Chien

Theses & Dissertations

It has been shown that approximate one-third of US adults aged 40 years and older (69 million US citizens) have some type of vestibular problems. These declining abilities of the vestibular system affect quality of life. Difficulties in performing daily activities (dressing, bathing, getting in and out of the bed and etc.) have been highly correlated to loss of balance due to vestibular disorders. The exact number of people affected by vestibular disorders is still difficult to quantify. This might be because symptoms are difficult to describe and differences exist in the qualifying criteria within and across studies. Thus, it …

Church Pew Exercise Integrated With Conventional Physical Therapy Following Total Knee Arthroplasty (Tka): Case Report, Randell Gonzales, Jerome Danoff

Internet Journal of Allied Health Sciences and Practice

Background and Purpose: Physical therapy treatment following Total knee Arthroplasty (TKA) consists of a combination of strengthening and range of motion exercises. The exercise technique, church pew exercise (CPE), has been proposed to enhance quadriceps facilitation and improve function. This is a technique that has the patient standing and rocking forward/back. The backward motion is arrested by engagement of the upper calf against a solid object, creating a sudden flexion torque at the knee and a sudden extension torque at the hip. The combination of CPE with standard physical therapy is claimed to provide better quadriceps control and faster walking …

The Effect Of Balance-Based Torso-Weighting On Mobility, Gait, Balance, Postural Control, And Falls Efficacy In Mobility Limited Older Adults, Jennifer L. Vincenzo

Graduate Theses and Dissertations

Exercise is a known intervention to prevent fall risk among older adults; however, adherence is poor. Therefore, it is of interest to determine if other interventions improve function and decrease fall risk among older adults. Balance-Based Torso-Weighting (BBTW) is a non-exercise intervention that improves functional measures among adults with multiple sclerosis, yet the effectiveness of BBTW has not been assessed among older adults without progressive neurological disorders. We conducted a double-blind, randomized study to analyze the effect of BBTW on functional measures and falls efficacy among community-dwelling, mobility limited older adults after 5 days of wearing BalanceWear® for 4 hours …

Effect Of Dual Tasking On Walking Over Even And Uneven Surfaces In Functionally Independent Community Older Adults, Olajide L. Kolawole

Seton Hall University Dissertations and Theses (ETDs)

While several studies have reported a decrement in performance by older adults while walking and concurrently performing a dual task on even surfaces, to date the effects of dual tasking while walking on uneven surfaces commonly found in the community has received less attention. Thus, we sought to test the hypothesis that an incremental decrement in gait parameters will be observed, when walking on an uneven versus an even surface and furthermore, that this decrement would be dependent upon the concurrent performance of a secondary cognitive and/or motor task in functionally independent-living-community older adults.

Dynamic Gait Index assessed the subject’s …

Identification Of Functional Parameters For The Classification Of Older Female Fallers And Prediction Of ‘First-Time’ Fallers, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Falls remain a challenge for ageing societies. Strong evidence indicates that a previous fall is the strongest single screening indicator for a subsequent fall and the need for assessing fall risk without accounting for fall history is therefore imperative. Testing in three functional domains (using a total 92 measures) were completed in 84 older women (60–85 years of age), including muscular control, standing balance, and mean and variability of gait. Participants were retrospectively classified as fallers (n = 38) or non-fallers (n = 42) and additionally in a prospective manner to identify first-time fallers (FTFs) (n = 6) within a …

Stride Length-Speed Relationship During Body Weight Supported Running, Carmen Chona

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to determine if body weight support influences the stride length-speed relationship. Additionally, the purpose was to determine if impact characteristics of running are influenced by body weight support and speed. Subjects (n=10; 6 female, 4 male) volunteered to participate in this study. All subjects were injury free and were comfortable running on a treadmill for 30 minutes. Subjects ran on a lower body positive (LBPP, Alter-G, G-Trainer) treadmill for 4 conditions of body weight (100, 40, 30 and 20% of body weight) and 4 running speeds (100, 110, 120 and 130% of the preferred …

The Stroke-Related Effects Of Hip Flexion Fatigue On Over Ground Walking, Megan M. Rybar, Eric R. Walker, Henry Kuhnen, Daniel R. Ouellette, Reivian Berrios, Sandra K. Hunter, Allison S. Hyngstrom

Exercise Science Faculty Research and Publications

Individuals post stroke often rely more on hip flexors for limb advancement during walking due to distal weakness but the effects of muscle fatigue in this group is not known. The purpose of this study was to quantify how stroke affects the influence of hip flexor fatigue on over ground walking kinematics and performance and muscle activation. Ten individuals with chronic stroke and 10 without stroke (controls) participated in the study. Maximal walking speed, walking distance, muscle electromyograms (EMG), and lower extremity joint kinematics were compared before and after dynamic, submaximal fatiguing contractions of the hip flexors (30% maximal load) …

Classifying Lower Extremity Muscle Fatigue During Walking Using Machine Learning And Inertial Sensors, Jian Zhang, Thurmon Lockhart, Rahul Soangra

Physical Therapy Faculty Articles and Research

Fatigue in lower extremity musculature is associated with decline in postural stability, motor performance and alters normal walking patterns in human subjects. Automated recognition of lower extremity muscle fatigue condition may be advantageous in early detection of fall and injury risks. Supervised machine learning methods such as Support Vector Machines (SVM) have been previously used for classifying healthy and pathological gait patterns and also for separating old and young gait patterns. In this study we explore the classification potential of SVM in recognition of gait patterns utilizing an inertial measurement unit associated with lower extremity muscular fatigue. Both kinematic and …

Concurrent Validity Of Accelerations Measured Using A Tri-Axial Inertial Measurement Unit While Walking On Firm, Compliant, And Uneven Surfaces, Michael H. Cole, Wolbert Van Den Hoorn, Justin K. Kavanagh, Steven Morrison, Paul W. Hodges, James E. Smeathers, Graham K. Kerr

Rehabilitation Sciences Faculty Publications

Although accelerometers are extensively used for assessing gait, limited research has evaluated the concurrent validity of these devices on less predictable walking surfaces or the comparability of different methods used for gravitational acceleration compensation. This study evaluated the concurrent validity of trunk accelerations derived from a tri-axial inertial measurement unit while walking on firm, compliant and uneven surfaces and contrasted two methods used to remove gravitational accelerations; i) subtraction of the best linear fit from the data (detrending); and ii) use of orientation information (quaternions) from the inertial measurement unit. Twelve older and twelve younger adults walked at their preferred …

The Influence Of Hip Strength On Lower-Limb, Pelvis, And Trunk Kinematics And Coordination Patterns During Walking And Hopping In Healthy Women, Jo Armour Smith, John M. Popovich, Kornelia Kulig

Physical Therapy Faculty Articles and Research

Study Design

Cross-sectional laboratory study.

Objectives

To compare peak lower-limb, pelvis, and trunk kinematics and interjoint and intersegmental coordination in women with strong and weak hip muscle performance.

Background

Persons with lower extremity musculoskeletal disorders often demonstrate a combination of weak hip musculature and altered kinematics during weight-bearing dynamic tasks. However, the association between hip strength and kinematics independent of pathology or pain is unclear.

Methods

Peak hip extensor and abductor torques were measured in 150 healthy young women. Of these, 10 fit the criteria for the strong group and 9 for the weak group, representing those with the strongest …

Changes In The Dynamics Of Postural And Locomotor Control As A Result Of Varying Task Demands, Kathleen Sherry Thomas

Human Movement Studies & Special Education Theses & Dissertations

The aim of this study was to examine changes in postural and locomotor control under varying task demands. Three experiments were designed to address the impact that fast walking had on standing posture over time, slow walking had on gait dynamics over time, and the extent to which gait speed interacts with the ability to walk randomly.

For experiment I, the aim was to identify the time course in which postural adaptation occurred while walking at faster than preferred speeds. Postural motion was assessed at specific intervals over a 35-min walking trial. Findings revealed that walking at a faster speed …