PREVIOUS ISSUES Volume 1, Number 1 Case Report Application of a Clinical Prediction Rule for Thoracic Spine Thrust Manipulation on a Patient with Acute Neck Pain Following a Motor Vehicle Accident Craig Swisher PT, DPT Elon University, Elon, NC Journal of Student Physical Therapy Research. 2009:1(1)1-11. [PDF] Study Design: Case Report. Background: Neck pain is one of the most commonly seen impairments in the physical therapy clinic. The purpose of this study is to report a case of a patient with neck pain secondary to a motor vehicle accident who met the criteria for and benefited from a clinical prediction rule (CPR) for thoracic thrust manipulation of patients with acute neck pain. Case Description: The patient was a seventeen year old female with acute mechanical neck pain and decreased cervical active range of motion (AROM) secondary to a motor vehicle accident. The patient’s signs and symptoms met the criteria for a CPR for thoracic spine thrust manipulation for patients with acute neck pain. Intervention: Intervention focused on the thrust manipulation techniques described by Cleland and colleagues, and a home exercise program for cervical AROM and scapular stabilization. Outcomes: Significant improvements were noted at discharge, four-week and six-week follow-up for cervical AROM, pain, self-reported medication usage and the Fear Avoidance Beliefs Questionnaire Physical Activity Subscale. Significant improvements for the Neck Disability Index were noted at discharge and six-week follow-up, but not at twelve-week follow-up. Conclusion: This case represents application of a CPR for patients with acute neck pain who should benefit from thoracic spine thrust manipulation techniques. The results confirm the findings that if a patient meets the criteria outlined in the CPR then significant improvements can be anticipated. Case Report Use of the NeuroCom Balance Master™ Training Protocols to Improve Functional Performance in a Person with Multiple Sclerosis Jordan Larsen-Merrill SPT; Rolando Lazaro PT, DPT, GCS Samuel Merritt College, Oakland, CA Journal of Student Physical Therapy Research. 2009:1(1)12-27. [PDF] Study Design: Case Report. Background: Decreased functional abilities such as impaired balance, transfers and ambulation and are common problems for people with Multiple Sclerosis (MS). Previous studies have shown that the use of high technology equipment such as the NeuroCom Balance Master™ may be beneficial in examining and improving a patient’s functional performance. However, research on the use of the training protocols in people with multiple sclerosis is lacking. The purpose of this Case Report is to investigate the use of NeuroCom Balance Master™ training protocols as an intervention for a patient with Multiple Sclerosis presenting with decreased balance, transfers and ambulation. Case Description: A 30-year-old man with an acute exacerbation of relapsing-remitting MS presented with impaired strength, balance, transfers and gait. His goal was to independently ambulate community distances. A physical therapy intervention was designed using the following NeuroCom Balance Master™ training programs: weight bearing squat, sit to stand, limits of stability and rhythmic weight shifting to improve balance, sit to stand transfers, weight bearing thru right lower extremity and gait. Patient underwent physical therapy three times per week for eight weeks. Outcomes: Patient demonstrated improvements in dynamic sitting balance, static and dynamic standing balance, transfers, gait and functional performance. Conclusions: The use of the NeuroCom Balance Master™ training protocols included a variety of task goals that require propulsive movements of the body’s center of gravity, narrowed base of support and high velocity movements and movements on unstable surfaces. The use of the protocols resulted in the improvement of the patient’s balance, transfers and gait. Research Report Physical Therapists’ Experiences with Patients with Traumatic Spinal Cord Injury Esther Smith SPT; Maria Newton Ph.D University of Utah, Salt Lake City, Utah. Journal of Student Physical Therapy Research. 2009:1(1)28-38. [PDF] Study Design: Qualitative design including inductive analysis. Objectives: Understand the experience of physical therapists (PT) when treating individuals with traumatic spinal cord injury. Background: Spinal cord injury (SCI) affects 12,000 Americans each year. Individuals with SCI spend an average of eighteen days hospitalized in the acute care unit, and, on average, an additional thirty-nine days are spent in the rehabilitation unit.1 The relationship that develops between the physical therapist and the individual with SCI is both physical and psychological in nature. Little is known about how physical therapists interpret and experience their interactions with individuals with SCI. Methods: Interviews were conducted with four licensed physical therapists (two males and two females) with an average of 13.25 years experience working with individuals with SCI. The interviews were transcribed and evaluated for similar and unique clusters of statements. The clusters were grouped into similar categories. The categories were collapsed into themes. Results: Three themes emerged relative to the physical therapists’ experience treating individuals with SCI: (1) Multifaceted nature of SCI and the inherent challenges it presents to PT and patient; (2) benefits and barriers; and (3) strategies physical therapists use to facilitate recovery. Conclusions: The findings from this study highlight the components of the experience of physical therapists who work with individuals with SCI. Greater knowledge about the complex relationship that exists between the PT and the individual with SCI may help to foster a more effective rehabilitation. Research Report The Effect of Acupuncture in the Management of Myofascial Pain: A Systematic Review of the Literature Eun Ha Park SPT Temple University, Philadelphia, PA Journal of Student Physical Therapy Research. 2009:1(1)39-49. [PDF] Study Design: Systematic Literature Review. Background: Even though local injections have been preferred as the most effective treatment for MP, there is conflicting evidence as to the superiority of local injection versus dry needling. Methods: The search was conducted in 3 computerized databases in September 2008, and hand searching of potentially relevant articles was also performed. Randomized controlled trials (RCTs) and quasi RCTs that fulfilled 6 inclusion criteria were selected. The methodological quality of each included study was assessed using the PEDro scale. Pain intensity was extracted as the primary outcome measure. The pain intensity measurements were grouped into immediate term, short term, intermediate term, or long term effects. A best-evidence synthesis was used to perform a qualitative analysis. Results: Five different trials (3 RCTs and 2 quasi RCTs) were included. Two studies dealt with the comparisons of real acupuncture with sham acupuncture, and other three studies the comparisons of dry needling with local injections. The quality assessment resulted in 3 high-quality and 2 low-quality studies. There is limited evidence for effectiveness in favor of the acupuncture at immediate term. At short and intermediate term, there is conflicting evidence for difference in effectiveness between treatment groups. At long term, there is limited evidence of no difference in effectiveness between treatment groups. Conclusions: Even though there is limited evidence to support the effect of real acupuncture compared to that of sham acupuncture, the retrieved data failed to demonstrate a clear effect of acupuncture or dry needling over local injections in the management of myofascial pain. In the future, additional high-quality RCTs are needed that are appropriately designed and reported. ____________________________________________________________________________________________ | 