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Volume 4, Number 1
Case Study
The Effects of an Independent Exercise Program on an Adolescent with Cerebral Palsy
Kathryn L. Chambers SPT, Jenny R. Kemp SPT, and Daryl Lawson PT, DSc.
Elon University – Elon, NC
Journal of Student Physical Therapy Research. 2011:4(1)1-9. [PDF]
Introduction: The purpose of this case report was to examine a 4-week independent, community exercise program and the outcome measures on a person with Cerebral Palsy. This case study follows a repeated measures design. Case Description: The participant was assessed at baseline for all outcome measures (aerobic capacity, anaerobic capacity, flexibility, strength, body composition and quality of life). She was given an independent exercise program designed based on the impairments found at the initial evaluation. She performed the program independently at her local gym. Outcomes: Four week follow-up demonstrated increases in health related quality of life for both the parent and the teen, lower extremity showed an increase in strength except right hip extension and all upper extremity motions showed an increase in strength. Conclusion: A person with CP can continue their own independent exercise program, which may provide more long-term improvements in strength, quality of life and life-long increases in function.
Cross Section Survey
Public Perception of Physical Therapist Scope of Practice
Kacie Rognlie PT and Yvonne Searls PT, PhD
University of Kansas Medical Center - Kansas City, Kansas
Journal of Student Physical Therapy Research. 2011:4(1)10-17. [PDF]
Objective: The purpose of this study is to investigate the public’s knowledge about accessing a physical therapist and the services they provide. Background: With states across the country moving towards consumers having direct access to physical therapists, there is a need to investigate consumers’ knowledge of the profession. Currently, there is a lack of studies examining what the public knows about the scope of physical therapy (PT) practice. Methods and Measures: A survey was designed to collect information from the public on their exposure to PT, knowledge of the level of education required by physical therapists, understanding of access to physical therapists, and awareness of 22 various interventions. 115 people over the age of 18 were randomly selected for survey in seven community events and locations. Analysis was performed using SPSS 16.0. Analysis of variance for simple linear regression and Pearson’s correlation coefficients were calculated to discern if there were predictability, associations and differences respectively, between awareness of interventions, physician referral and perceived level of physical therapist education to the surveyed person’s age, gender, exposure to PT, or level of education. Numerical frequency analysis was done to understand the public’s experience with PT and correct recognition of the scope of PT practice. Results: Pearson’s correlation revealed respondent level of education is associated to knowledge of the scope of PT. Level of education was identified as a significant predictor of the ability to recognize PT scope of practice with higher educational levels being more knowledgeable. Education level contributed 4.8% of the variability in responses. The highest knowledge of PT was in the practice areas of musculoskeletal (90.0%), functional mobility (88.4%), neurological (79.9%), and pain management (75.7%). The public was less aware of areas such as cardiopulmonary (64.3%), pediatrics (53.9%) and integument care (18.7%). The highest level of exposure to PT was through second hand information (57.9%) presented by the media, physicians, acquaintances who were patients or common knowledge. Interestingly, 30.5% of respondents reported having received PT. Conclusion: The results show the public lacks complete knowledge about PT. The lack of knowledge is multi-factorial, but education level is associated with awareness of the profession. Additionally, potential patients are unsure how to access physical therapists. The profession could benefit from better educating the public on its entire scope of practice.
Case Study
Necrotizing Fasciitis and Physical Therapy Management
Andrea T. Konja, SPT
Wayne State University – Detroit, MI
Journal of Student Physical Therapy Research. 2011:4(1)18-27. [PDF]
Necrotizing fasciitis is a life threatening infection resulting in radical loss of tissue. The immediate management of the infection involves aggressive surgical debridement of the infected region. Understanding the management of the infection is needed to assist with the immediate wound management and determine appropriate precautions during early rehabilitation. This paper describes the implications of tissue healing for post radical surgical debridement secondary to necrotizing fasciitis. A patient case is presented to illustrate and discuss infection control, tissue recovery from a major infection, and the implications for prognosis and goal setting. The patient was informed and gave consent to have the information from this case used for research purposes. Currently, there is limited literature regarding necrotizing fasciitis and rehabilitation.
North Carolina Physical Therapy Poster Presentation Abstracts
The following are abstracts from the North Carolina Physical Therapy Association Fall Conference Student Research Poster Presentation Session in Greensboro, NC
The Effect of Foot Orthose on Hip Joint Kinematics During Drop Jump Landings in Healthy Females and Males
Hefner J, Davis J, Stallings D, Waggoner K, Williams DS, Jenkins W
Human Motion Laboratory, Department of Physical Therapy, College of Allied Health Sciences, East Carolina University
1st Place Award Winner
Purpose: Female athletes injure their anterior cruciate ligament (ACL) between three and eight times more frequently as compared to male athletes. Landing from a jump has been implicated as one mechanism of injury for the ACL in female athletes. It has been observed that female athletes have greater hip internal rotation motion and less knee and hip flexion motion than males when landing from a jump. During running it has been observed that when the hip joint is adducted the femur internally rotates placing the ACL in a compromised position. It has been suggested that the rationale for prevention of ACL injuries is a change in lower extremity kinematics. Foot orthotic devices are commonly used to decrease motion within lower extremity joints when lower extremity pathology and dysfunction are present. The purpose of this study is to investigate the amount of hip joint internal rotation when landing from a jump between genders and to determine if foot orthotic devices influence transverse plane kinematics at the hip joint. Subjects: 36 healthy physical therapy students, 18 male and 18 female (µ age = 25.3, 24.3), with no history of lower extremity injury. Methods: Subjects performed a unilateral drop landing from a 30cm platform. Prior to the experimental trials retroreflective markers were bilaterally placed on the rearfoot, shank, thigh and pelvis. Subjects were randomly assigned to perform 10 consecutive trials in each of the foot orthoses conditions (over-the-counter orthoses and without) with 20 total jumps. Kinematic data were collected using a 8-camera Qualisys motion analysis system. Data analysis for hip excursion and peak movement in the transverse plane was carried out. Comparisons between gender and condition were made with a mixed model ANOVA. Results: There was a significant difference in transverse plane peak hip motion within the female group (p= 0.047) when comparing the foot orthoses conditions. There were no differences within the female group between the conditions for hip transverse plane excursion and no difference in transverse plane hip movement within the male group between conditions. There was no interaction between genders for transverse plane hip motion. Conclusion: Foot orthotic devices significantly reduced peak hip internal rotation in females, but had no effect on transverse hip plane motion in males during a single limb drop landing. Clinical Relevance: When landing from a jump females have significantly more hip internal rotation which places ligaments in the knee at an increased risk. Foot orthoses significantly decrease hip internal rotation in females during a single leg landing.
Aberrant Primary Afferent Sprouting and Sensory Abnormalities Following Spinal Cord Injury Correlate with Altered Glycogen Synthase Kinase-3b Activity
Kristin Hernandez SPT, Tiffany Lee, Mackenzie Tuzzolo, Kori Brewer Ph.D, Sonja Bareiss PT, Ph.D.
Departments of Physical Therapy and Emergency Medicine, East Carolina University, Greenville, NC
2nd Place Award Winner
Background and Purpose: Neuropathic pain and sensory abnormalities are an important secondary consequence of spinal cord injury (SCI), partially resulting from aberrant primary afferent sprouting into the spinal cord. A potential mechanism controlling primary afferent sprouting involves glycogen synthase kinase-3b (GSK-3b), an intracellular mediator of neuronal growth and survival. The purpose of this study was to correlate changes in GSK-3b activity with peripheral neuronal sprouting and development of pain/ sensory abnormalities. Methods: Male, Long-Evans rats underwent excitotoxic SCI through intramedullary injection of quisqualic acid (QUIS; n=6) or an equal volume of saline for controls (n=6), into the dorsal gray matter. Animals were examined daily for overgrooming behavior and at 2, 7, and 14 days after injury for changes in thermal sensitivity. After 14 days, spinal cords and dorsal root ganglia (DRG) were removed from the level of injury. DRG ipsilateral to the site of injury were cultured and analyzed for overall branching and neurite length. Results: Spinal cord injured animals demonstrated a significant increase in thermal sensitivity changes from baseline (p=0.04), compared to saline controls (p= 0.30). The extent of neurons with branching was 16.4% for saline controls while QUIS-injected animals showed a significant (p < 0.001) increase in the number of branching neurons (39.5%). Average maximum length of neurites in QUIS animals (48.0 m) was significantly greater (p < 0.05) than saline animals (19.7 m). GSK-3b activity was examined using Western blot analysis. Compared to saline controls, spinal cords of QUIS-injected animals showed a significant increase in percent phosphorylated GSK-3b (p-GSK-3b/GSK-3b) (p=0.05). A similar, but non-significant trend was observed in DRG tissues. Conclusion: Our results show that excitotoxic SCI resulted in DRG neuronal sprouting and enhanced GSK-3 phosphorylation correlated with pain related behavior. Clinical Relevance:Up to 90% of persons with SCI report experiencing neuropathic pain, which is typically refractory to standard therapeutic and pharmacologic interventions. This study demonstrates that SCI is associated with peripheral primary afferent spouting and provides information on a potential therapeutic target for SCI pain.
The Training Effects of Body Weight Support Treadmill Training on an Individual with Cerebral Palsy: A Case Report
Stacy Anderson SPT, Alyssa Bajdas SPT, Renee Delamarter SPT, Jenna Valaer SPT, Cynthia Lewis PT, PhD, Paula DiBiasio PT, DPT, MS
Elon University Center for Human Movement Studies at Alamance Regional Hospital
3rd Place Award Winner
Purpose: The purpose of this study was to examine the effects of body weight support treadmill training (BWSTT) as a form of exercise on energy cost of gait [energy expenditure index (EEI), 3-minute walk distance, function (PEDI) and quality of life (PEDs-QL) in an adolescent with CP who is functionally a non-ambulatory. Case Description: Subject’s characteristics: Subject was an 18 year old male with CP who is functionally a non-ambulatory. He was able to follow verbal cues and communicate with the research team. He has a high school special certificate and attends adapted classes at Alamance Community College. Currently, he is unable to receive physical therapy services previously provided by the public school system. Procedures: The initial evaluation (week 1) included the PEDI, PEDs-QL, and a 3-Minute Walk Test with calculation of EEI. BWSTT took place twice weekly for 6 weeks (weeks 2-7) with a body weight support of 40%, target heart rate (HR) of 70-80% of predicted maximum HR calculated from the Ball State Formula, and perceived rate of exertion (PRE) of moderately hard-hard (6-8). Initial BSWTT consisted of three 3-minute bouts of treadmill walking at 0.7 mph (18.76 meters/min) followed by 3-minute rest periods. Training progressed to five 3-min bouts (week 7) at 1.0 mph (26.82 meters/ min). All pre-test measures were repeated (week 8). Outcomes: Resting HR: Pre: 85, Post: 77. Average Training HR range: Pre: 178, Post: 172. Treadmill Speed: Pre: 0.7 mph (18.76 meters/min); Post: 1.0 mph (26.8 m/min). Number of training sets: Pre: 3, Post: 5. Treadmill EEI: Pre: 5.38 beats/meter, Post: 3.54 b/min. 3-Minute Walk Distance: Pre: 195 ft (59 m), Post: 176. Ft (53 m). 3-min EEI: Pre: 5.69 b/m, Post: 5.49 b/m. PEDI: Self care domain, items J,K,L,M: Pre 9, Post 10, Item improved: K Pants: removes pants including unfastening, Mobility Domain: A,B,C,D,E: Pre 13, Post 14, Item improved: C Car Transfers: gets in and out of car with no assistance or instruction. PEDs-QL Parent Report*: Physical Function: Pre 34.3, Post 40.7; Emotional Function: Pre 75, Post 85; Social Function: Pre 55, Post 60; School Function: Pre 85, Post 100. Discussion: Cardiac Response and Endurance: BWSTT Progression and EEI: Subject demonstrated improvements in BWSTT endurance as indicated by decreased HR, increased sets, and decreased EEI. 3-Minute Walk Test: changed little in distance and EEI. While the purpose of this study was not to quantify the subject’s gait, it was observed, however, that the subject performed the final walk test with a more upright, controlled gait pattern which may have slowed subject’s gait speed. Functional Outcome Measures: PEDI: Parent and subject goals of increased ease with toileting and car transfers were achieved. Quality of Life: PedsQL: Parent, as primary caregiver, indicated improvements in all domains. Conclusion: BWSTT was a feasible and effective form of exercise for this adolescent with CP. Future research is needed in this area
The Effect of Infant Positioning on the Attainment of Gross Motor Milestones
DiBiasio, Paula A.; Garcia, Maria; Smid, Jennifer; Vincent, Tracy
Physical Therapy Education, Elon University, Elon, NC, United States.
Purpose/Hypothesis: In 1992, the American Academy of Pediatric Medicine implemented the “Back to Sleep” program encouraging parents to position infants supine while sleeping. This program came in response to research correlating a decrease in Sudden Infant Death Syndrome (SIDS) with sleeping in the supine position. Research suggests awake and play time spent in prone may influence the age at which infants attain gross motor skills. In particular, skills that contain activities of arm extension and reaching seem most affected. Majnemer and Barr demonstrated that typically developing infants who slept in supine and had decreased exposure to prone positioning had significant delays in the attainment of motor milestones. Jantz et. al showed that infants who slept in prone were more likely to roll over before those who slept supine or side-lying. The purpose of this study was to examine the relationship between infant positioning and gross motor skills in infants. Materials/Methods: A sample of convenience was used to recruit a goal of 30 subjects from the local community. In total 27 subjects met the following inclusion criteria: age 3 to 9 months, full term, typically developing, and English or Spanish speaking families.A 15 item questionnaire was completed by the caregiver who was blinded to the purpose. Data collection teams included one licensed physical therapist (PT) and one PT student. The Alberta Infant Motor Scale (AIMS) was administered by the PT during typical infant play. Results: One-way ANOVAs were used to compare positioning to AIMS percentile scores. The influence of sleep position (F(3,23)= 1.94, p=.15) revealed statistically insignificant results with infants that slept in prone (67.3% with a standard deviation of 25.5%), supine (23.5±20.8%), side-lying (37.5±41.7%) or a combination of positions (56.7±35.7%). The influence of play positioning (F(8,18)= 2.28, p=.07) also revealed insignificant results with amount of play time spent in prone. Although statistically insignificant, infants who spent longer time in prone had greater AIMS percentile scores. Regression analysis revealed that sleep position was the only variable which influenced motor milestone development (R^2 =.19). Conclusions: Infants’ sleep or play positioning may influence their attainment of gross motor milestones. This study demonstrated a positive relationship between time spent prone and gross motor development. A larger study population may have resulted in statistically significant findings. Although results were not statistically significant, there were trends in AIMS percentile scores which appeared to correlate with sleep positioning and prone play time. Limitations to this study include the small sample size, sample demographics, and lack of blinding by the researchers. In addition, the questionnaire had no established reliability and validity. This study strongly supports further research into the influence of position on the attainment of gross motor milestones. Clinical Relevance: Currently accepted measures for gross motor skills normed prior to the implementation of the “back to sleep” program may now be inaccurate. These measures, often utilized by health care providers as screening and diagnostic tools, may not account for the influence of current sleep and play positioning recommendations. Establishing whether an infant is delayed in attaining gross motor skills or is typically developing based on a revision of the current norms is a valuable distinction. This updated information would be a useful resource to pediatric physical therapists, medical professionals, and caregivers.
The Relationship of Static Balance and Gait Parameters Among Hypertensive Elderly African Americans
Emerson, B.1, Piper, M.1, Long, B1,2, Foxworth, J1,2
1Winston Salem State University, Physical Therapy Department, Winston-Salem, NC
2Winston Salem State University/Wake Forest University Human Performance and Biodynamics Laboratory, Winston-Salem, NC.
Purpose: Falls result in significant morbidity and mortality among the elderly. While hypotension has been strongly linked to impaired balance and increased risk of falls, so too has hypertension, though this relationship is less clear.Poor performance in functional gait assessments have been linked with balance deficits as measured by Tinneti Balance Scale. The increased prevalence of hypertension among African Americans raises many questions concerning balance and falls in this medically underserved population. The purpose of this study was to examine the relationship between static balance and temporal and spatial gait parameters among elderly African Americans with hypertension. Methods: Thirty-five elderly adults (68.6 ± 3.6 years) from the surrounding area volunteered to participate in this study. To be included in the study participants were African-American, 65 years or older at the time of testing, and diagnosed with hypertension. Volunteers were excluded from the study if they reported neuromuscular disease, dementia, or history of head trauma or stroke. Participants walked over a 14 foot pressure-sensor mat (the GAITRite® mat) four times at self-selected and fast speed. Participants also performed the Sensory Organization Test (SOT) on the NeuroCom Smart Balance Manager (NeuroCom International, Clackamas, Oregon). A non-dimensional equilibrium score (%) was calculated during the SOT from the participants’ peak amplitude of Anterior-Posterior sway to the theoretical Anterior-Posterior limits of stability. Equilibrium scores near 100% reflect little sway; equilibrium scores near 0% reflect that the sway is approaching the limits of stability.Correlational analysis (Pearson correlation) was performed to examine the relationship of the spatio-temporal measures of gait (gait velocity (m/s), base of support (cm.), double-support (% stance.), single-support (% stance.) and single leg stance time (sec.) to the equilibrium composite score as measured by the SOT. Statistical Package for the Social Sciences (SPSS) software (ver. 16.0) was utilized for data analysis. Results: Thirty-two participants demonstrated vestibular dysfunction on the SOT compared to age-matched norms. No significant relationship was found between GaitRite outcome measures in either self-selected (gait velocity r = .02, p =.892; base of support r = -.08, p = .612; double-support r = .-.14, p = 416; single-support r = .070, p = .691; stride length r = .158, p =.364) or fast walk (gait velocity r = .16, p = .348; base of support r = .-.076, p =.665; double-support r = -.26, p = .135; single-support r = .25, p =.148; stride length r = .23, p = .191) and the equilibrium composite score. Conclusion: There is no relationship between the selected spatio-temporal gait parameters in either self-selected or fast pace walking andbalance deficits in this population. Clinical Relevance: These results suggest that spatio-temporal gait parameters are a poor predictor of vestibular function and static balance in African Americans with hypertension. Further research is needed to compare this data with gait and balance measures in normotensive African-Americans.
Volume 3, Number 1
Case Report
Examining Dance Therapy as an Adjunct Therapy for Selected Measures of Postural Stability, Gait, and Sensory Processing for Children with Mild to Moderate Cerebral Palsy
Dana B McCarty, PT, DPT; Bruce McClenaghan, PED, PT; Erika Blanck DPT, ATC; Stacy Fritz, PhD, PT
University of South Carolina, Columbia, SC
Journal of Student Physical Therapy Research. 2010:3(1)1-13. [PDF]
Study Design: This case report examined benefits of dance therapy to improve static and dynamic balance, gait, and sensory processing in children with cerebral palsy. Subjects were two 4 year-olds with Level I cerebral palsy based on the Gross Motor Function Classification Scale. Background: Cerebral palsy (CP) is one of the most common pediatric neurological disorders and has been of interest in research for many years. Physical therapists help children improve dynamic and static stability to normalize gait and reactive balance. Children with CP may also process sensory information with difficulty. Case Description: The intervention consisted of three 45-minute dance lessons weekly over five weeks (15 sessions). Sessions included stepping, jumping, skipping, and swaying to promote core stability while engaging the limbs. Proper mechanics were reinforced through verbal and tactile cues and demonstration. Baseline, pre-test, and post-test measures were taken. Static balance was measured using an AMTI force platform. Dynamic balance and gait components were assessed using the GAITRite mat. Peabody Developmental Motor Scales – 2nd Edition (PDMS-2) and Sensory Profile were administered to quantify gross motor skills and sensory processing changes, respectively. Outcomes: PDMS-2 and the Sensory Profile noted small improvements. GAITRite and force platform data exhibited high variability among and within testing sessions making drawing definitive conclusions difficult. Conclusion: Dance therapy is an alternative treatment for children with CP that may provide multi-sensory stimulation as indicated by the Sensory Profile improvements. Results from the PDMS-2 suggest increased exposure to dance therapy provides opportunities to practice gross motor skills. GAITRite and force platform results are somewhat inconclusive and may not be appropriate or reliable testing instruments for this population.
Case Report
Outcomes Following Treadmill Training with Partial Body Weight Support of an Individual with a Traumatic Brain Injury and Multiple CVAs
Shannon Gray SPT; Danielle Poli SPT; Sara Schwartz SPT; Jessica Sommer SPT; Gabriele Moriello PT, PhD, MS, GCS
The Sage Colleges, Troy, NY
Journal of Student Physical Therapy Research. 2010:3(1)14-30. [PDF]
Purpose: The purpose of this case report was to document outcomes of 16 weeks of body weight supported treadmill training (BWSTT) on range of motion, muscle strength, cardiovascular parameters, trunk control, quality of movement, functional mobility, and weight loss in a single participant. Methods: The participant was a 38 year old, Caucasian female with a chronic traumatic brain injury and multiple cerebral vascular accidents. The participant received BWSTT two times per week for a total of 16 weeks. Outcome measures included passive range of motion, manual muscle testing, heart rate, the Trunk Impairment Scale, video analysis of transfers, functional assessments, Motor FIM, and body weight. Outcomes: The participant showed some improvements on all outcomes measures, most noticeably in her lower extremity extensor strength, and trunk control. The participant lost on average 1.5 pounds per month more during the intervention than she did prior to the intervention. Anecdotal improvements were made in the participant’s quality of life. Discussion: The participant’s improvements suggest that BWSTT may be beneficial in improving overall functional abilities even when recovery of walking ability is not achieved. Improvements in balance and upper extremity function, along with reduced effort required to complete transfers, suggests that the intervention may have had a positive effect on her trunk control. The participant was able to respond to the cardiovascular demands of BWSTT which increased her energy expenditure enough to stimulate greater weight loss. Further research is needed to determine whether the use of BWSTT can improve other parameters besides gait.
Case Report
Conservative Physical Therapy Management of an Adult with Cerebral Palsy and Severe Upper and Lower Extremity Contractures: A Case Report
Amanda Cope Hooper, SPT
Elon University - Elon, NC
Journal of Student Physical Therapy Research. 2010:3(1)31-39. [PDF]
Background and Purpose: Physical therapists often treat patients with joint contractures that are a result of chronic immobility. There is no consensus on the most effective treatment strategy for managing an immobile patient with multiple joint contractures. The purpose of this case report is to describe the intervention strategies used with an adult patient with cerebral palsy, profound developmental disabilities and both upper and lower extremity contractures affecting the patient’s daily function. Case Description: A 62-year-old female with profound developmental and intellectual disabilities who presented with severe contractures of the left hip, knee, and upper extremity was referred to physical therapy. During initial evaluation, significantly decreased upper and lower extremity range of motion and strength, and no visible signs of pain were observed. The patient was treated for 21 visits over a seven-week period with an individualized program including manual therapy, therapeutic exercise, wheelchair modifications, and relaxation techniques. Outcomes: Moderate improvements, based on visual observation and goniometric measurements, in lower and upper extremity range of motion and in function were noted. Direct care staff reported greater ease with activities of daily living such as dressing and feeding. Discussion: Currently, there is very little research focusing on older individuals with cerebral palsy and the impairments these individuals present with. Minimal research is available on the most appropriate management of an adult with cerebral palsy having joint contractures. The intervention strategies used with this patient aimed to address these impairments. This patient demonstrated functional improvements; however, a direct cause-effect relationship cannot be concluded from a single subject case report. Further research is warranted to determine the effectiveness of using this approach to treat individuals with decreased range of motion and strength secondary to joint contractures obtained from long-term wheelchair use. Conclusion: This patient demonstrated actual improvements in joint range of motion based on goniometric measurements, as well as apparent improvements in her sitting posture in her wheelchair following a program of aggressive joint mobilizations and stretching. Further research is necessary to investigate the evolution of abilities and limitations in individuals with cerebral palsy across the lifespan, as well as the most appropriate management of impairments associated with those limitations.
Methodological Study
Using Tai Chi to Improve Balance and Mobility among Community-Dwelling Elders
Richard J Call, SPT; Frank Lai, SPT; Carol A. Maritz, PT, EdD, GCS
University of Sciences in Philadelphia–Philadelphia, PA
Journal of Student Physical Therapy Research. 2010:3(1)40-46. [PDF]
Objectives: The purpose of this study was to examine the effectiveness of a 10-week long Tai Chi exercise program in decreasing the risk of fear and falling in the community-dwelling elderly population. Background: A prevalent concern for the elderly population is the risk of falling. With falls accounting for a majority of medical complications affecting this population, exercise programs have been developed to decrease the risk of falling. Tai Chi focuses on balance, coordination, and endurance, providing increases in overall health and wellness, and a possible decrease in the risk of falling. Methods and Measures: This one-group pretest-posttest design involved a sample of 9 community-dwelling elderly female subjects that voluntarily participated in a Tai Chi program for 45 minutes, twice a week (one live session and one using a DVD per week) for 10 weeks. The primary outcome tools, Timed Up and Go (TUG) and Tinetti were administered before the start of the program and at the conclusion of the program. Results: Statistical analysis using a dependent t-test revealed that the elderly subjects significantly achieved better scores on both the TUG (p = 0.01) and Tinetti test (p = 0.001) after 10 weeks of the program. Conclusions: The above findings suggest that a 10-week long Tai Chi exercise program may improve functional balance and overall quality of life in the community-dwelling elderly population.
Case Study
A Case Study Examining The Recovery of Gait Using Treadmill Training Followed by Overground Ambulation in a Patient with a Middle Cerebral Artery Stroke
Michelle Gorman DPT and Dr. A. Williams Andrews, PT, MS, EdD, NCS.
Mission Hospital – Asheville, NC and Elon University – Elon, NC
Journal of Student Physical Therapy Research. 2010:3(1)47-56. [PDF]
Study Design: Body weight support treadmill training (BWSTT) has been shown to increase gait speed and improve balance in patients suffering from a stroke. The purpose of this case study is to describe a specific treadmill training exercise program in conjunction with an overground walking program to demonstrate improvements in function and quality of life in a middle-aged patient having had a stroke. The patient in this case study received 12 sessions of treadmill intervention followed by overground ambulation with a focus on improving gait speed. Each “session” consists of ambulating on a treadmill for three to four bouts at increasing speeds, duration, and decreasing amount of need for manual assist followed by overground walking up to patient tolerance. Background: The patient is a 54 year old male having suffered a stroke five months ago. The patient’s heart rate (HR), blood pressure (BP), and rate of perceived exertion (RPE) are assessed. Case Description: The patient is given verbal, visual (mirror) and tactile cues during treadmill training to facilitate a normal, reciprocal gait pattern followed by overground walking. Outcomes: Following 12 sessions of intervention and a home exercise program of daily walking, the patient statistically improved in gait speed (Ten Meter Walk), distance walked (Six Meter Walk), and balance abilities (Berg Balance Scale). Conclusion: The use of a standard treadmill followed by overground ambulation in an outpatient facility may be effective intervention for patients with gait deficits following a stroke or other neurological infarct.
Volume 2, Number 1
Systematic Review
The Effectiveness of Virtual Reality in Controlling Pain in Patients with Burns: A Systematic Review
Stephanie Koenke, SPT
Temple University – Philadelphia, PA
Journal of Student Physical Therapy Research. 2010:2(1)1-11. [PDF]
Study Design: Systematic review of the literature. Objectives: To determine if virtual reality (VR) with standard analgesics is more effective at improving patients’ reports of pain during wound dressing changes, passive stretching, and range of motion (ROM) exercises than standard analgesics alone. Background: People with burn injuries experience significant pain during rehabilitation. VR may be a means to enhance pain control during the rehabilitation period. There are no previous systematic reviews of this topic. Methods and Measures: The following databases were searched for studies applying VR in the treatment of patients with burns; Ovid Medline, Cinahl, PEDro, and Pubmed. The PEDro1 scale was used to assess methodological quality of included studies. Included studies were then synthesized for a best-level of evidence using the qualitative scale from Van Tulder.2 Results: Seven randomized controlled trials and quasi-experimental studies were included in the review. All seven studies were of moderate level quality. Six out of seven articles showed a statistically significant effect of VR on pain scores. Of the statistically significant results, two articles used the Faces Scale and demonstrated a mean reduction in pain from 4.1 to 1.39, and 5.38 to 2.8112 respectively. Two articles used a Visual Analog Scale and indicated a mean pain reduction from 69.00mm to 28.29mm6 and from 36.33mm to 14.67mm.10 Additionally, one study used a Graphic Rating Scale and showed a mean reduction in pain from 7.6 to 5.111, and the last study used a Visual Analog Thermometer and showed a mean reduction in pain from 5.52 to 2.83. 13 Moderate level evidence indicates that VR results in lower pain scores during dressing changes and physical therapy compared to analgesics alone. Conclusions: The available data suggests that VR in adjunct with standard pharmacologic analgesics produces lower pain scores during wound dressing changes and physical therapy compared to standard pharmacologic analgesics alone. Further research should address the use and effect of VR in a physical therapy specific setting, as well as the cost-effectiveness of such an intervention.
Clinical Report
Feasibility and Benefit of Using the Nintendo Wii Fit for Balance Rehabilitation in an Elderly Patient Experiencing Recurrent Falls
Tony Pigford, DPT
Director of Outpatient Physical Therapy, Duplin General Hospital – Kenansville, NC
A. Williams Andrews, PT, EdD, NCS
Associate Professor, Department of Physical Therapy Education, Elon University – Elon, NC
Journal of Student Physical Therapy Research. 2010:2(1)12-20. [PDF]
Introduction: The purpose of this case report was to examine whether a balance training program utilizing the Nintendo Wii Fit platform could improve dynamic balance control in an elderly patient with balance impairments. Also, the investigators sought to determine whether the motivational aspect of the video games would stimulate the patient’s desire to participate in the balance rehabilitation program. Case Description: An elderly patient with a recent history of falls underwent two weeks of balance training utilizing the Wii Fit platform along with other traditional therapeutic interventions. Pre-intervention and post-intervention outcome measures were recorded. For this report, the selected outcome measures were: Berg Balance Scale, Activities-specific Balance Confidence Scale, Timed Up and Go, and gait speed. Outcomes: Post-intervention, the patient demonstrated improvements in all of the selected balance outcome measures. During the intervention, the patient demonstrated a high level of cooperation resulting in increased time spent performing balance activities. Conclusions: This case report gives insight on how the Wii Fit was combined with more traditional physical therapy interventions to enhance an elderly patient’s participation in the interventions and improve balance performance.
Methodological Study
Reliability and validity of the sit-to-stand navicular drop test: Do static measures of navicular height relate to the dynamic navicular motion during gait?
Juli Deng, PT, DPT
Senior Physical Therapist, Rusk Institute of Rehabilitation Medicine, New York; University Langone Medical Center – New York, NY
Rita Joseph, PT, DPT
Physical Therapist, Mount Sinai Medical Center – New York, NY
Christopher Kevin Wong, PT, PhD, OCS
Assistant Professor in Clinical Physical Therapy, Program in Physical Therapy, Columbia University – New York, NY
Journal of Student Physical Therapy Research. 2010:2(1)21-28. [PDF]
Study Design: A methodological study. Objectives: To be a useful assessment of gait, a static measure should be reliable and also demonstrate predictive validity of dynamic gait function. To date, predictive validity has not been established for any static arch height measure. This study sought to examine the relationship between the sit-to-stand navicular drop test (SSNDT) and dynamic navicular drop (DND) during gait as measured with motion analysis. Background: Reliable measures of midfoot function that correlate with the dynamic navicular drop during gait remain elusive. The navicular drop test (NDT) measures change in static navicular height (NH), but has variable reliability. Reliability has been affected by inconsistencies when finding subtalar joint neutral (STJN) and percent weight bearing through the lower extremity. The SSNDT addresses some issues that may negatively affect the reliability of the NDT. Currently there is no gold standard for a static measurement used within the clinic for NH. Methods and Measures: The study included 102 feet of 51 healthy volunteers (22 men, 29 women) with mean age 28.1 ± 7.1 years. Intra- and inter-rater reliability of the SSNDT was established in preliminary testing before the SSNDT was compared to DND. The reliability was established using the first six participants. Navicular height was measured in three positions: sitting with foot flat and 5% body weight on a scale, standing with 70-80% body weight, with the other foot stabilized to avoid balance reactions and STJN position in standing evenly on both legs. Results: Measures of NH in standing or sitting for all testers demonstrated good intra- and inter-rater reliability (ICC = 0.83 to 0.95). SSNDT had moderate intra- (ICC = 0.68 to 0.78) and inter-rater reliability (ICC = 0.72). Discussion: The mean navicular drop obtained using the SSNDT was consistent with previous findings reported in the literature and was more reliable than those obtained with the NDT. The SSNDT had moderate reliability and no predictive validity for the digital motion analysis of gait. Conclusions: There was no correlation between SSNDT and DND, suggesting that static measures of NH change may not predict dynamic navicular motion in gait.
Methodological Study
The Effects of a Combination of Live and Videotaped Exercise Sessions on Functional Mobility and Falls Prevention Among Community-Dwelling Elders
Anuja H. Gandhi, SPT
University of Sciences in Philadelphia–Philadelphia, PA
Richard Cipoletti, SPT
University of Sciences in Philadelphia–Philadelphia, PA
Carol A. Maritz, PT, EdD, GCS
University of Sciences in Philadelphia–Philadelphia, PA
Journal of Student Physical Therapy Research. 2010:2(1)29-35. [PDF]
Study Design: Longitudinal study. Objectives: The purpose of this program was to measure the effects of a combination of both live and videotaped exercise sessions on functional mobility and falls prevention among community-dwelling elders. Background: African American female subjects (mean age 78) who attend a local senior center participated in one 45-minute exercise class per week for ten weeks over two consecutive years. The program was based on ACSM guidelines for older adults and included 45 minutes of a combination of seated conditioning and strengthening exercises. Methods and Measures: The exercise program was designed with various levels of challenges, enabling participants to choose based on their comfort level and physical ability. The group of elders was videotaped both at the beginning and at the mid-points of the program as they gradually progressed. This videotape, which featured the program participants, was edited and copied for use at home as a supplement to the live classes. Results: To measure the effectiveness of this program, a pretest-posttest approach was used for the assessment of functional mobility using the timed up and go test (TUG) and the performance oriented mobility assessment (POMA). Data was analyzed using the paired, dependent t-test in three stages. After the first program, the POMA scores increased significantly from pretest to posttest, but TUG scores showed no significant change; however, there was a trend towards decreased performance time among participants. POMA and TUG scores measured prior to the start of the second program showed no significant differences when compared with the same measures taken at the conclusion of the first program. This suggests that participants were maintaining gains made following participation in the first session. However, the results from the third stage revealed significant differences with POMA and TUG. Conclusions: The group dynamics proved to be a strong motivator for participants to exercise, and the use of a video as a supplement to live group sessions was found to be beneficial in the short term. Perhaps the provision of ongoing support via telephone would have enabled the video to continue to serve as an adjunct to a live group-based program thereby serving as a falls prevention strategy. Future research is needed to assess the effectiveness of the telephone support.
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.
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