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Full-Text Articles in Physical Therapy

African American Students In Physical Therapy: Enhancing Diversity, Kimberly Renee Willis Jan 2019

African American Students In Physical Therapy: Enhancing Diversity, Kimberly Renee Willis

Electronic Theses and Dissertations

African Americans are motivated by early exposure to the profession and future expectations for their personal career path including stability work-life balance and helping others. The elimination of barriers such as finances lack of support and cultural microaggressions influences their career path. Following statistical analysis of admissions data conclusions were made that the current admissions criteria does not successfully predict first year success for any students including African American students. Lastly African American physical therapy graduates from UMMC reported excitement upon admission concerns over quotas lack of African American faculty students and physical therapists and the presence of microaggressions while …


African American Students In Physical Therapy: Enhancing Diversity, Sherry T. Colson Jan 2019

African American Students In Physical Therapy: Enhancing Diversity, Sherry T. Colson

Electronic Theses and Dissertations

African Americans are motivated by early exposure to the profession and future expectations for their personal career path including stability work-life balance and helping others. The elimination of barriers such as finances lack of support and cultural microaggressions influences their career path. Following statistical analysis of admissions data conclusions were made that the current admissions criteria does not successfully predict first year success for any students including African American students. Lastly African American physical therapy graduates from UMMC reported excitement upon admission concerns over quotas lack of African American faculty students and physical therapists and the presence of microaggressions while …


African American Students In Physical Therapy: Enhancing Diversity, Melanie H. Lauderdale Jan 2019

African American Students In Physical Therapy: Enhancing Diversity, Melanie H. Lauderdale

Electronic Theses and Dissertations

African Americans are motivated by early exposure to the profession and future expectations for their personal career path including stability work-life balance and helping others. The elimination of barriers such as finances lack of support and cultural microaggressions influences their career path. Following statistical analysis of admissions data conclusions were made that the current admissions criteria does not successfully predict first year success for any students including African American students. Lastly African American physical therapy graduates from UMMC reported excitement upon admission concerns over quotas lack of African American faculty students and physical therapists and the presence of microaggressions while …


Application Of Theory To Guide Development Of A Rehabilitation Service-Learning Project In Guatemala, Mary Zadnik, Suzanne Trotter, Cindy Mathena Jan 2019

Application Of Theory To Guide Development Of A Rehabilitation Service-Learning Project In Guatemala, Mary Zadnik, Suzanne Trotter, Cindy Mathena

Journal of Occupational Therapy Education

International community-based rehabilitation service-learning projects in physical and occupational therapy education programs may impact underserved communities internationally. The intentional inclusion of learning in service activities has been identified as service-learning. Extending the impact and education beyond the service project is necessary in order to provide a sustainable outcome for the community. Faculty at the University of St. Augustine for Health Sciences partnered with Potter’s House Association International to develop an interprofessional program to address the rehabilitation needs and continuity of care following a one-week project serving the community members of the Guatemalan City Garbage Dump. The purpose of this article …


Thrust Joint Manipulation To The Cervical Spine In Participants With A Primary Complaint Of Temporomandibular Disorder (Tmd): A Randomized Clinical Trial, Breanna C. Reynolds Jan 2019

Thrust Joint Manipulation To The Cervical Spine In Participants With A Primary Complaint Of Temporomandibular Disorder (Tmd): A Randomized Clinical Trial, Breanna C. Reynolds

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Temporomandibular disorder (TMD) is a common and costly problem often leading to chronic pain. There exists moderate evidence for physical therapy (PT) interventions in the management of TMD. A known relationship between TMD and the cervical spine exists with some evidence to support cervical intervention treatments. Cervical spine thrust joint manipulation (TJM) is an effective PT intervention explored in a limited fashion for this population. Objectives: To determine the immediate and short term (1 and 4 week) effects of cervical TJM on pain, dysfunction, and perception of change in individuals with a primary complaint of TMD. Methods: In this …


Effectiveness Of A Manual Therapy Approach In Treatment Of Patients With Lumbar Spinal Stenosis, Haitham Ramadan Jan 2019

Effectiveness Of A Manual Therapy Approach In Treatment Of Patients With Lumbar Spinal Stenosis, Haitham Ramadan

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: The use of manual therapy for the management of lumbar spinal stenosis (LSS) has not been adequately systematically reviewed in an attempt to determine its effectiveness on patients with LSS. The lack of evidence in support ofcommonly used conservative interventions continues to result in a lack of clarity regarding what interventions should be used to manage patients with LSS. Objective: To use a randomized comparative trial to compare the functional clinical outcomes achieved by patients with LSS receiving two different physical therapy interventions. Methods: In this randomized controlled trial, a total of40 participants diagnosed with LSS were randomized into …


Influence Of Clinical Instructor And Physical Therapist Student Characteristics On The Use Of Standardized Tests And Measures In Clinical Practice, Vicki Lafay Jan 2019

Influence Of Clinical Instructor And Physical Therapist Student Characteristics On The Use Of Standardized Tests And Measures In Clinical Practice, Vicki Lafay

Department of Physical Therapy Student Theses, Dissertations and Capstones

Problem Statement: Physical therapist (PT) students report discord between what they learn in the academic environment and what they experience in clinical practice. Despite increasing reporting requirements, standardized tests and measures (STMs) are not well integrated into routine clinical practice. The primary purposes of this study were to (1) examine clinical instructor (CI) and PT student characteristics and beliefs that influence the use of STMs in clinical practice, and (2) explore alignment between the STMs students learn during academic preparation to those commonly reported in clinical practice. Procedures/Methodology: In this mixed method sequential explanatory study, participant demographic characteristics, perceived STM …


Inside Outsourcing: Experiences Of Outsourced Physical Therapy Services In Dutch Hospitals, Rudi A. Steenbruggen Pt, Mba, Hannah Boven Msc Jan 2019

Inside Outsourcing: Experiences Of Outsourced Physical Therapy Services In Dutch Hospitals, Rudi A. Steenbruggen Pt, Mba, Hannah Boven Msc

Internet Journal of Allied Health Sciences and Practice

Over the past years, it has become more common in Dutch hospitals to outsource allied healthcare services to the private sector. This development has affected hospital-based physical therapy significantly. And as a result, there is an increasing need for guidance in this new situation. In response to this, the Dutch Association of Physical Therapy in Hospitals (NVZF) conducted a comprehensive study into the process of outsourcing with the objective to inform and advise physical therapy services in hospitals about outsourcing developments. Eight Dutch hospitals where physical therapy services had been outsourced or where this option was explored, were interviewed. The …


Early Career Physical Therapy Faculty Networking And Scholarly Productivity: A Mixed-Methods Study, Betsy J. Becker Dec 2018

Early Career Physical Therapy Faculty Networking And Scholarly Productivity: A Mixed-Methods Study, Betsy J. Becker

Theses & Dissertations

While it is well-known that physical therapist (PT) faculty must retain a scholarly agenda, few report being activity engaged and many programs have low scholarly dissemination. There is evidence that knowledge of the make-up of a faculty network leads to improved performance and innovation. The purpose of this explanatory sequential mixed methods study was to explore agency (behaviors and perspectives about career advancement) and the professional network structure and composition of early career PT faculty as they relate to scholarly activity. This dissertation research study included 50 early career faculty who worked in accredited entry-level physical therapy programs.

The quantitative …


The Effect Of Patterned Sensory Enhancement On Balance And Ambulation In Persons Diagnosed With Parkinson’S Disease, Brittany Barko Dec 2018

The Effect Of Patterned Sensory Enhancement On Balance And Ambulation In Persons Diagnosed With Parkinson’S Disease, Brittany Barko

Masters Theses

One rehabilitation protocol effective in delaying the symptoms of Parkinson’s Disease (PD) is Lee Silverman Voice Training BIG (LSVT BIG), comprising pre-gait exercises and gait training. This study seeks to determine if combining Patterned Sensory Enhancement (PSE), a music therapy intervention, with LSVT BIG will improve quality of movement. During physical therapy sessions with three participants, a music therapist adapted the PSE stimuli to support each patient’s motor needs, which were then recorded on CD and sent with patients to exercise with at home. Results showed improved balance and ambulation comparing pre- and post- measures of the BERG balance scale …


Shoulder-Specific Patient Reported Outcome Measures For Use In Patients With Head And Neck Cancer:An Assessment Of Reliability, Construct Validity, And Overall Appropriateness Of Test Score Interpretation Using Rasch Analysis, Melissa Michelle Eden Dec 2018

Shoulder-Specific Patient Reported Outcome Measures For Use In Patients With Head And Neck Cancer:An Assessment Of Reliability, Construct Validity, And Overall Appropriateness Of Test Score Interpretation Using Rasch Analysis, Melissa Michelle Eden

Department of Physical Therapy Student Theses, Dissertations and Capstones

Context: Medical management for head and neck cancer (HNC) often includes neck dissection surgery, a side effect of which is shoulder dysfunction. There is no consensus for which patient-reported outcome measure (PRO) is most appropriate to quantify shoulder dysfunction in this population.

Objective: The aims of this research study were to: (1) use Rasch methodologies to assess construct validity and overall appropriateness of test score interpretation of Disability of the Arm, Shoulder and Hand (DASH), QuickDASH, Shoulder Pain and Disability Index (SPADI) and Neck Dissection Impairment Index (NDII) in the HNC population; (2) determine appropriateness of use of University of …


Optimizing Physical Therapy Sessions Among Patients Undergoing Elective Lumbar Surgery, Ellina Hattar, Md, Kelly Hufford, Dpt, Marie Wilson, Rn, James Harrop Jun 2018

Optimizing Physical Therapy Sessions Among Patients Undergoing Elective Lumbar Surgery, Ellina Hattar, Md, Kelly Hufford, Dpt, Marie Wilson, Rn, James Harrop

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

Physical therapy is imperative in achieving early mobilization, thereby reducing morbidity of immobility such as venous thrombolic events, improving postoperative pain, and facilitating appropriate disposition among patients who have recently undergone spine surgery. At TJUH, patients undergoing elective spine surgery are planned to engage in physical therapy (PT) twice a day. There are however several impediments that may limit the ability of patients to adequately participate in PT.


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 May 2018

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 …


Successful Patient Participation In Acute Hospital Physical Therapy, Jesse Kim, Joseph Fertitta, Patrick Williams May 2018

Successful Patient Participation In Acute Hospital Physical Therapy, Jesse Kim, Joseph Fertitta, Patrick Williams

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: Research has demonstrated that physical therapy plays a crucial role in patient recovery in the acute hospital setting. Despite known benefits, scheduled sessions do not always occur and are called nontreatment (NT) events. Reported NT ranges from 15% to 26% of scheduled sessions. Previous studies have found an association between NT and patient diagnosis as well as between NT and day of the week on which treatment was scheduled. Identifying additional factors that affect NT is important if therapists and administrators are to make improvements. The purpose of this study is to determine if an association exists between physical …


Neuromuscular Adaptations Following Slope Walking In Individuals Post-Stroke, Eric Akoopie, Brooke Conway Kleven, Trisha Koch May 2018

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 …


Physical Therapy Review Of Best Practices Based On Psychology, Bethany Painter May 2018

Physical Therapy Review Of Best Practices Based On Psychology, Bethany Painter

Honors Projects

Physical therapy is a field that is growing and changing constantly. For so long, it was assumed that physical healing should be the sole focus of physical therapy. While this is an important aspect of the rehabilitation process, there is so much more to it than that. The psychological trauma a person may experience following an injury can be just as challenging, if not more challenging to overcome than the physical repercussions of the injury. For this reason, it is important to take psychological healing into consideration, as well as physical healing when creating best practices for physical therapists. The …


Manual Therapy Interventions In A Complex Case Of Upper Quarter Symptoms In A Professional Violinist, Paul Howard, Pt, Dpt, Phd, Ocs, Faaompt Feb 2018

Manual Therapy Interventions In A Complex Case Of Upper Quarter Symptoms In A Professional Violinist, Paul Howard, Pt, Dpt, Phd, Ocs, Faaompt

Department of Pathology, Anatomy, and Cell Biology Posters

This poster illustrates how knowledge of clinical anatomy, biomechanics, and orthopaedic manual therapy can be applied to the examination and treatment of a violinist.


Physical Therapy Considerations For Chronic Kidney Disease And Secondary Sarcopenia, Michael O. Harris-Love, Haniel J. Hernandez, Gideon Obamwonyi Jan 2018

Physical Therapy Considerations For Chronic Kidney Disease And Secondary Sarcopenia, Michael O. Harris-Love, Haniel J. Hernandez, Gideon Obamwonyi

Exercise and Nutrition Sciences Faculty Publications

Chronic kidney disease (CKD) is a progressive condition that may negatively affect musculoskeletal health. These comorbidities may include malnutrition, osteoporosis, and decreased lean body mass. Secondary sarcopenia due to CKD may be associated with mobility limitations and elevated fall risk. Physical therapists are well-positioned among the health care team to screen for secondary sarcopenia in those with CKD and for the treatment of musculoskeletal comorbid conditions that may affect functional performance. Given the consequences of both low muscle mass and low bone mineral density, appropriate and timely physical therapy is important for fall risk assessment and intervention to minimize the …


Diagnostic Musculoskeletal Imaging: How Physical Therapists Utilize Imaging In Clinical Decision-Making, Hilmir Agustsson Jan 2018

Diagnostic Musculoskeletal Imaging: How Physical Therapists Utilize Imaging In Clinical Decision-Making, Hilmir Agustsson

Department of Physical Therapy Student Theses, Dissertations and Capstones

This qualitative study describes how physical therapist experts in musculoskeletal disorders evaluate and interpret imaging studies and how they employ imaging in clinical decision-making. The informants are physical therapists who are certified orthopedic clinical specialists (OCS) and/or fellows of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). The study employed web conferencing to display patient cases, record screen-capture videos, and to conduct interviews. Informants were observed and their activity video-captured as they evaluated imaging studies and, afterwards, interviews were employed to explore the processes they utilized to evaluate and interpret the images and to discuss imaging-related clinical decision-making, including …


Can Patient Reported Outcomes Guide Therapy Needs In Foot And Ankle Patients?, Jeff Houck, Jillian Santer, Judith Baumhauer Jan 2018

Can Patient Reported Outcomes Guide Therapy Needs In Foot And Ankle Patients?, Jeff Houck, Jillian Santer, Judith Baumhauer

Faculty Publications - College of Physical Therapy

Introduction/Purpose: The patient acceptable symptom state (PASS) is a validated question establishing if patients activity and symptoms are at a satisfactory low level for pain and function. Surprisingly, ~20% of foot and ankle patients at their initial visit present for care with an acceptable symptom state (i.e. PASS yes). These patients are important to identify to prevent over treatment and avoid excessive cost. It is also unclear what health domains (Pain Interference (PI), Physical Function (PF), or Depression (Dep)) influence a patients judgement of their PASS state (i.e. why they are seeking treatment). The purpose of this analysis is to …


Physical Therapists’ Beliefs About Preparation To Work In Special Care Nurseries And Neonatal Intensive Care Units, Joyce Lammers Jan 2018

Physical Therapists’ Beliefs About Preparation To Work In Special Care Nurseries And Neonatal Intensive Care Units, Joyce Lammers

Department of Physical Therapy Student Theses, Dissertations and Capstones

BACKGROUND: Physical therapists (PTs) may care for full-term or premature newborns in all levels of hospital nurseries. There is some endorsement in the published physical therapy literature for restricting practice in the nursery setting to only those PTs with specialized training.1-4 PURPOSE: The purpose of this study was to understand the experiences of becoming and being a physical therapist in a special care nursery (SCN) or neonatal intensive care unit (NICU) from the therapists’ perspective. METHODS: The participants were physical therapists who have practiced in a SCN or NICU in the United States. A phenomenological approach was used and data …


Small Business Marketing Strategies For Physical Therapy Practice Owners, Matthew Lane Daugherty Jan 2018

Small Business Marketing Strategies For Physical Therapy Practice Owners, Matthew Lane Daugherty

Walden Dissertations and Doctoral Studies

The United States economy depends on small businesses, which represent 99% of all businesses in the United States, yet approximately 50% of small businesses cease operations in the first 5 years. The purpose of this multiple case study was to explore the marketing strategies used by owners of small businesses to develop and maintain their organization through the initial 5 years of business operation. The population included 5 physical therapy business owners in northeastern Florida who had sustained their business for a minimum of 5 years. The conceptual framework for this study was the brand equity model, and data were …


Effectiveness Of Intermittent Mechanical Traction In Cervical Radiculopathy: A Systematic Review, Gilmour Gregory, James M. Mckivigan Jan 2018

Effectiveness Of Intermittent Mechanical Traction In Cervical Radiculopathy: A Systematic Review, Gilmour Gregory, James M. Mckivigan

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

The aim of this review was to assess the effectiveness of intermittent mechanical traction (IMT) in treating cervical radiculopathy (CR). A literature search was conducted electronically, and the data were extracted from the available papers that evaluated IMT and its combination with other therapies. The risk of bias was assessed using the criteria recommended by the Cochrane Back Review Group. The quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation method (GRADE). Nine of the articles met the inclusion criteria and were included in the review. Results showed that four studies with very low level …


Using Virtual Reality To Improve Sitting Balance, Alice Kay Barnes Dec 2017

Using Virtual Reality To Improve Sitting Balance, Alice Kay Barnes

Graduate Theses/Dissertations

This thesis focuses on using virtual reality (VR) to enhance sitting balance and core strength. It is a study in how to create a VR exercise program which is interesting enough to keep players/patients motivated, but comfortable to play and not overwhelming to the senses. The software used for this study was written with the hope that a later version of it might be used with occupational/physical therapy patients one day. For this master’s thesis, the initial testing has been done with healthy volunteers. The software incorporates what developers know thus far about designing for VR, and it is hoped …


Motor Strategy And Locomotor Adjustments In Children With And Without Down Syndrome While Negotiating Stairs, Huaqing Liang, Xiang Ke, Jianhua Wu Aug 2017

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.


Motor Learning And Adaptation In People With Knee Osteoarthritis And Chronic Pain, Heather Turcotte, Katherine S. Rudolph Jul 2017

Motor Learning And Adaptation In People With Knee Osteoarthritis And Chronic Pain, Heather Turcotte, Katherine S. Rudolph

Osteopathic Medicine Student Research Posters

Osteoarthritis (OA) affects an estimated 50 million people in the US, and approximately 43% have limitations in daily function due to arthritis pain.3 Individuals with knee osteoarthritis (OA) have heightened sensitization to pain2,5 as well as reduced strength, diminished function and quality of life1 that prompts them to seek care from health care providers. Physical therapists commonly work with patients to improve function and quality of life by helping them learn to move without pain. Unfortunately, chronic pain causes changes to the nervous system that may impact the ability to learn new ways but the extent to which chronic pain …


Disposition And Success Of Patients Following Discharge In The Acute Setting, Ciera Cortney, Kathryn Lutjens, Kristopher Raines May 2017

Disposition And Success Of Patients Following Discharge In The Acute Setting, Ciera Cortney, Kathryn Lutjens, Kristopher Raines

UNLV Theses, Dissertations, Professional Papers, and Capstones

Abstract: Background & Purpose: Many patients are seen in the hospital by physical therapists who also help decide where the patient will go after discharge (e.g., home, rehab hospital, skilled nursing facility) with the goal being the safest and best quality of life. Therapists may use different tests and measures along with their own professional judgment to help make a recommendation for a discharge location. The purpose of this study was to examine how PT’s recommendation for discharge location, POMA score, “6-clicks” score, age, diagnosis, and gender determine patient’s fall/readmission status after being discharged by hospital. Subjects: There were 113 …


Use Of Active Video Gaming In Children With Neromotor Dysfunction: A Systematic Review, Robert Manzanares, Lisa Popescu May 2017

Use Of Active Video Gaming In Children With Neromotor Dysfunction: A Systematic Review, Robert Manzanares, Lisa Popescu

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Active video games (AVG) are gaining popularity as a strategy for improving motor function in children with neurologically-based movement disorders, but there is no consensus regarding AVG’s utility or effectiveness in this population. The purpose of this systematic review was to examine current evidence on the use of AVG to improve motor function in children 2-17 years of age with neurologically-based movement disorders. Methods: Authors followed standard criteria for systematic review conduct and rating quality of evidence including the PRISMA checklist. Databases searched were Scopus, MEDLINE, Cochrane Library, EMBASE, and CINAHL. Systematic reviews, randomized control trials, or …


Gait Analysis Following Total Knee Arthroplasty During Inpatient Rehabilitation: Can Findings Predict Los, Ambulation Device, And Discharge Disposition?, Janet Anne Herbold Jan 2017

Gait Analysis Following Total Knee Arthroplasty During Inpatient Rehabilitation: Can Findings Predict Los, Ambulation Device, And Discharge Disposition?, Janet Anne Herbold

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis. Growth in the number of procedures performed annually in the United States is expected to increase steadily. Post-operative rehabilitation settings vary and include both institutional and community based physical therapy (PT) services. Despite access to PT, deficits in gait often persist for months and even years after surgery. Slow gait speed, asymmetrical walking patterns, and prolonged time in double-limb support following the TKA often lead to the need for an assistive device for walking and prolong the rehabilitation phase. Purpose: The purpose of this study is …


Complex Regional Pain Syndrome Type I Treated With Active Release Technique, Kathleen Hughes, James M. Mckivigan Jan 2017

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 …