bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Transcutaneous Electrical Stimulation on Spinal Motor Neuron Excitability in People Without Known Neuromuscular Diseases: The Roles of Stimulus Intensity and Location
Authors: Hardy SG Patrick , Spalding Thomas B , Liu Hao , Nick Todd G , Pearson Rebecca H , Hayes Antonio V , Stokic Dobrivoje S
Published: February 2017

Background and Purpose. The Hoffmann reflex (H-reflex) is widely acknowledged as an indirect indicator of spinal motor neuron excitability. The purpose of this study was to determine whether transcutaneous electrical stimulation (TES), applied over the dorsiflexors or plantar flexors of the ankle, would alter the soleus muscle's H-reflex. Attention was focused on the roles of stimulus intensity and location. Subjects. Thirty-two volunteers without known neuromuscular diseases (17 women [53%]; mean years of age=27, SD=7.3, range=21–48) were studied. Methods. Subjects were randomly assigned to 1 of 4 groups, and TES was administered for 15 minutes. Stimulation site and intensity varied according to group assignment. H-reflexes were recorded before and for 10 minutes after TES. Results. H-reflex amplitudes increased following TES at sensory threshold, whereas H-reflex amplitudes did not change following TES at 1.5 times motor threshold. The site of stimulation did not influence the resulting H-reflexes. Discussion and Conclusion. Low-intensity TES increases H-reflex amplitudes (and presumably the excitability of spinal motor neurons to Ia afferent input) in subjects without known neuromuscular diseases. High-intensity TES had little influence on H-reflex amplitudes.
Agility and Perturbation Training for a Physically Active Individual With Knee Osteoarthritis
Authors: Fitzgerald G Kelley , Childs John D , Ridge Tara M , Irrgang James J
Published: February 2017

Background and Purpose. People with knee osteoarthritis (OA) sometimes report episodes of knee instability that limit their activities of daily living. The episodes of instability are similar to those reported by people with knee ligament injuries. The authors believe that modifications of interventions that are used to promote knee stability in individuals with knee ligament injuries can be used to enhance knee stability and function in people with knee OA. The purpose of this case report is to describe the development and implementation of an agility and perturbation training program that was used in conjunction with traditional rehabilitation activities for a patient with knee OA. Case Description. The patient was a 73-year-old woman with a diagnosis of bilateral knee OA. Her chief complaints were knee pain and episodes of partial“giving way” at the knee during walking, stair climbing, and participation in tennis and golf. The patient participated in 12 treatment sessions at a frequency of 2 visits per week. The rehabilitation program consisted of lower-extremity stretching, strengthening and endurance exercises that were supplemented with a variety of walking-based agility training techniques, and perturbation training techniques. Outcome. At the completion of rehabilitation, the patient was able to walk on level surfaces and stairs and return to playing golf and tennis without episodes of instability and with reduced pain. Discussion. Supplementing rehabilitation programs for people with knee OA with a modified agility and perturbation training program may assist them in returning to higher levels of physical activity with less pain and instability following rehabilitation. Further research is needed to determine the role of agility and perturbation training in people with knee OA.
The Influence of a Move to Program Management on Physical Therapist Practice
Authors: Miller Patricia A , Solomon Patricia
Published: February 2017

Background and Purpose. The purpose of this qualitative study was to examine how a move to program management (PM) from a traditional department structure affected the professional practice of physical therapists in a large Canadian teaching hospital. Subjects. Twenty-five physical therapists participated in 1 of 5 focus groups, and 4 physical therapists participated in individual interviews. Methods. Focus groups and structured interviews were conducted by an experienced facilitator who was not a physical therapist. All focus groups and interviews were audiotaped and transcribed. Using an open-coding technique, 2 investigators undertook line-by-line analysis of each transcript to identify and code specific events related to the physical therapists' experiences. The investigators reached a consensus on all coding categories and then identified themes. Results. Seven themes that addressed issues of affect (a sense of loss, low morale, and positive coping), professional practice (loss of professional development activities, professional advantages, the assuming of multiple roles), and patient care were identified. Discussion and Conclusion. Physical therapists who were deployed from a department to a program described both positive and negative effects of the move to PM on their practice. There were reported influences on their personal affect, professional practice, and patient care. Staff and physical therapy administrators need to be aware of potential implications of an organization's move to PM on the professional practice of frontline staff.
Rehabilitation for Balance and Ambulation in a Patient With Attention Impairment Due to Intracranial Hemorrhage
Authors: Tappan Rachel S
Published: February 2017

Background and Purpose. The purpose of this case report is to describe physical therapy to improve the balance and ambulation of a 16-year-old patient with attention impairment following intracranial hemorrhage. Case Description. The patient initially had frequent losses of balance, especially in distracting environments, due in part to decreased attention. He was managed with a balance and ambulation training program that incorporated the principles of cognitive rehabilitation for attention impairments. Outcomes. Following 11 weeks of outpatient therapy, the patient returned to independent ambulation at school without losses of balance. Discussion. Research is needed to determine the interaction between balance and attention in patients with brain injury and effective treatment for patients with decreased balance related to attention impairments.
Patient Satisfaction With Outpatient Physical Therapy: Instrument Validation
Authors: Beattie Paul F , Pinto Mary Beth , Nelson Martha K , Nelson Roger
Published: February 2017

Background and Purpose. Patient satisfaction with physical therapy is used as an outcome variable. The purpose of this study was to develop and test an instrument used to determine which variables are associated with the satisfaction of patients receiving outpatient physical therapy. Subjects. During the pilot study, 191 patients participated, and 1,868 patients then participated in the main phase of this work. Methods. Using a survey instrument developed by the authors, subjects responded to global questions concerning overall satisfaction with physical therapy. Content validation of the instrument was investigated using item correlation, principal components analysis, and factor analysis. Reliability was measured using the standard error of measurement. Concurrent validity was investigated by correlating summary scores of the final survey instrument with global measures of satisfaction. Results. Reliability was best for a 10-item questionnaire. Patient satisfaction was most associated with items that reflected a high-quality interaction with the therapist (eg, time, adequate explanations and instructions to patients). Environmental factors such as clinic location, parking, time spent waiting for the therapist, and type of equipment used were not strongly correlated with overall satisfaction with care. Discussion and Conclusion. Because the time the therapist spent with patients and the behavior of the therapists are important for patient satisfaction, emphasis on cost-cutting, high patient volume, and the use of “care extenders” may jeopardize satisfaction.
Short-Term Effects of Workstation Exercises on Musculoskeletal Discomfort and Postural Changes in Seated Video Display Unit Workers
Authors: Fenety Anne , Walker Joan M
Published: February 2017

Background and Purpose. In recent years, a number of exercise programs have been developed for computer operators in order to promote movement and to reduce musculoskeletal discomfort. Tests of the effectiveness of these exercise programs, especially in field trials, are rare. The authors tested the hypothesis that doing regular, short-term (<10 days) exercises while at a workstation would decrease musculoskeletal discomfort and increase in-chair movement (ICM). Subjects. Eleven directory assistance operators (8 female, 3 male) with no recent history of musculoskeletal problems volunteered. Methods. In-chair movement was measured by tracking the center of pressure at the buttock-chair interface as subjects sat on a pressure-sensitive mat. Musculoskeletal discomfort was rated through the use of the Body Part Discomfort Scale (BPDS) and a body map. We used a revised Dataspan exercise program. Operators were tested for 2 hours, on 2 occasions: before and after doing exercises for 3- to 5-day shifts. During each test, ICM was measured during three 15-minute periods at the start of the test and at the end of hours 1 and 2. Subjects rated musculoskeletal discomfort per body part using the BPDS at 30, 60, and 120 minutes of each test. The effects of exercises on ICM and BPDS ratings were examined with a two-way repeated-measures analysis of variance with day (2) × time (3) designs. Results. When subjects were doing their exercises, ICM was higher at the start and hour 1, and perceived discomfort was lower during each test period (start, hour 1, and hour 2). When not exercising, subjects' musculoskeletal discomfort increased over time and was higher during all test periods. Discussion and Conclusion. Exercises done by video display unit operators while at a workstation resulted in short-term decreases in both musculoskeletal discomfort and postural immobility. These results suggest that workstation exercises may be beneficial.
Environmental Demands Associated With Community Mobility in Older Adults With and Without Mobility Disabilities
Authors: Shumway-Cook Anne , Patla Aftab E , Stewart Anita , Ferrucci Luigi , Ciol Marcia A , Guralnik Jack M
Published: February 2017

Background and Purpose. In this study, the influence of 8 dimensions of the physical environment on mobility in older adults with and without mobility disability was measured. This was done in order to identify environmental factors that contribute to mobility disability. Subjects. Subjects were 36 older adults (≥70 years of age) who were recruited from 2 geographic sites (Seattle, Wash, and Waterloo, Ontario, Canada) and were grouped according to level of mobility function (physically able [ability to walk ½ mile (0.8 km) or climb stairs without assistance], physically disabled). Methods. Subjects were observed and videotaped during 3 trips into the community (trip to grocery store, physician visit, recreational trip). Frequency of encounters with environmental features within each of the 8 dimensions was recorded. Differences in baseline characteristics and environmental encounters were analyzed using an analysis of variance or the Fisher exact test, as appropriate. Results. Mobility disability among older adults was not associated with a uniform decrease in encounters with environmental challenges across all dimensions. Environmental dimensions that differed between subjects who were physically able and those with physical disability included temporal factors, physical load, terrain, and postural transition. Dimensions that were not different included distance, density, ambient conditions (eg, light levels and weather conditions), and attentional demands. Discussion and Conclusion. Understanding the relationship of the environment to mobility is crucial to both prevention and rehabilitation of mobility disability in older adults. Among older adults, certain dimensions of the environment may disable community mobility more than others.
Treatment of Visual Neglect in Elderly Patients With Stroke: A Single-Subject Series Using Either a Scanning and Cueing Strategy or a Left-Limb Activation Strategy
Authors: Bailey Maggie J , Riddoch M Jane , Crome Peter
Published: February 2017

Background and Purpose. The presence of unilateral visual neglect (UVN) may adversely affect functional recovery, and rehabilitation strategies that are practical for use in clinical settings are needed. The purpose of this study was to evaluate the use of 2 approaches to reduce UVN in people who have had strokes. Subjects. Seven elderly patients with stroke and severe left UVN, aged 60 to 85 years, were recruited from a stroke rehabilitation unit. Methods. A nonconcurrent, multiple-baselines-across-subjects approach, with an A-B-A treatment-withdrawal single-subject experimental design, was used. Five subjects received a scanning and cueing approach, and 2 subjects received a contralesional limb activation approach, for 10 one-hour sessions. In the former approach, active scanning to the left was encouraged by the therapist, using visual and verbal cues and a mental imagery technique, during reading and copying tasks and simple board games. In the latter approach, functional and goal-oriented left upper-limb activities in neglected hemispace were encouraged. Unilateral visual neglect was examined by a masked (blinded) examiner throughout all phases using the Star Cancellation Test, the Line Bisection Test, and the Baking Tray Task. Data were analyzed using visual and inferential statistical techniques. Results. Both subjects who received limb activation and 3 of the 5 subjects who received scanning and cueing showed a reduction in UVN in one or more tests. This improvement was maintained during the withdrawal phase. Discussion and Conclusion. Both approaches had a positive effect of reducing aspects of UVN in some subjects relative to no-treatment baselines. However, causality cannot be assured in the absence of controls. The approaches are practical for use in rehabilitation settings. These procedures warrant further replication across subjects, settings, and therapists.
Balance Confidence Among People With Lower-Limb Amputations
Authors: Miller William C , Speechley Mark , Deathe A Barry
Published: February 2017

Background and Purpose. Confidence in a person's balance has been shown to be an important predictor of social activity among people with lower-limb amputations. The purposes of this study were to describe confidence in balance among people with transtibial or transfemoral lower-limb amputations and to compare people whose amputations were due to vascular and nonvascular causes. Subjects and Methods. A survey of a sample of 435 community-dwelling individuals from 2 regional clinics was conducted. The sample consisted of people with unilateral transfemoral (26.7%) and transtibial (73.3%) amputations who lost their limb for vascular (53%) and nonvascular (47%) reasons. The mean age of the primarily male (71%) sample was 62.0 years (SD=15.7). Results. Mean scores, using the Activities-specific Balance Confidence (ABC) Scale, were 63.8 for the total sample, 54.1 for the subjects with amputations due to vascular reasons, and 74.7 for the subjects with amputations due to nonvascular reasons. Given a maximum possible ABC Scale score of 100, the results suggest that confidence was low. A difference between the subjects with amputations due to vascular reasons and those with amputations due to nonvascular reasons was observed over each item of the ABC Scale. Variables that were statistically related to balance confidence included age, sex, etiology, mobility device use, the need to concentrate while walking, limitations in activities of daily living, depression, and fear of falling. Discussion and Conclusion. Balance confidence scores among the study sample were low when compared with values previously reported by other researchers. Confidence was particularly low among individuals who had their amputation for vascular reasons. Balance confidence might be an important area of clinical concern.
Prediction of Postoperative Pulmonary Complications on the Basis of Preoperative Risk Factors in Patients Who Had Undergone Coronary Artery Bypass Graft Surgery
Authors: Hulzebos Erik HJ , Van Meeteren Nico LU , De Bie Rob A , Dagnelie Pieter C , Helders Paul JM
Published: February 2017

Background and Purpose. Pulmonary complications are among the most frequently reported complications after coronary artery bypass graft (CABG) surgery. However, the risks of postoperative pulmonary complications (PPCs) are not equal for all patients. The aim of this study was to develop a model, based on preoperative factors, for classifying patients with high and low risks for PPCs in order to implement tailored interventions. Subjects and Methods. Postoperative pulmonary complications were examined in 117 adult patients who had undergone elective CABG surgery at the University Medical Centre Utrecht, Utrecht, the Netherlands. The presence of preoperative risk factors (N=12) that have been described in the literature was noted for each patient. A risk model was developed by use of logistic regression analysis. Results. Preoperative risk factors for developing PPCs were an age of ≥70 years, productive cough, diabetes mellitus, and a history of cigarette smoking. Protective factors against the development of PPCs were a predicted inspiratory vital capacity of ≥75% and a predicted maximal expiratory pressure of ≥75%. These risk and protective factors were included in the model (sensitivity=87% and specificity=56%), and a sum score for its clinical use was generated. Discussion and Conclusion. Six factors that can be determined easily before surgery, with need for only simple pulmonary testing, can provide a model for identifying patients at risk of developing PPCs after CABG surgery.
Establishing Minimal Clinically Important Differences for Scores on the Pediatric Evaluation of Disability Inventory for Inpatient Rehabilitation
Authors: Iyer Lakshmi V , Haley Stephen M , Watkins Mary P , Dumas Helene M
Published: February 2017

Background and Purpose. Standardized pediatric assessment tools such as the Pediatric Evaluation of Disability Inventory (PEDI) numerically quantify changes during rehabilitation through test scores, but they are unable to provide client-specific information regarding important changes in function. The purpose of this study was to identify the smallest change in PEDI scores during inpatient rehabilitation that was considered to be a minimal clinically important difference (MCID) by physical therapists and other clinicians. Subjects and Methods. A retrospective review was done of the medical charts of 53 children and youth (1–19 years of age) discharged from an inpatient rehabilitation hospital. Fifteen clinicians (5 physical therapists, 6 occupational therapists, and 4 speech and language pathologists) who were masked to the PEDI scores provided ratings of the magnitude of functional changes during inpatient rehabilitation using a Likert scale and a visual analog scale (VAS). Ratings by clinicians were reduced to 4 categories, including the MCID, and compared with PEDI change scores. Results. The MCIDs ranged from 6 to 15 points (X̄=11.5, 95% confidence interval=±2.8) for all PEDI scales. Likert scale and VAS ratings were correlated (τ=.73–.80). Discussion and Conclusion. Across all scales, PEDI change scores on the order of about 11% (0–100 scale) appear to be meaningful to clinicians during a child's or adolescent's inpatient rehabilitation. These data can serve as a starting point for interpreting group and individual changes on the PEDI during physical therapy intervention in inpatient rehabilitation.
One-Time Physical Therapist Consultation in Primary Health Care
Authors: Hendriks Erik JM , Kerssens Jan J , Dekker Joost , Nelson Roger M , Oostendorp Rob AB , van der Zee Jouke
Published: February 2017

Background and Purpose. One-time physical therapist consultation, prior to possible referral for physical therapy intervention, may enhance the quality of patient care, particularly if the referring physician is uncertain as to whether intervention by a physical therapist will be beneficial. The purpose of this study was to describe the use of consultation by a group of primary care physicians (PCPs) who could refer patients for a one-time consultation. Subjects and Methods. A 7-month observational study was conducted in the Netherlands with 59 pairs of randomly selected PCPs and physical therapists practicing in primary health care. Data were collected for the PCPs, the physical therapists, and the patients. Self-administered questionnaires (completed at the start and at the completion of the study), consultation request and report forms, and treatment referral records from health insurance agencies were used to obtain data. National reference data on patients referred by PCPs for intervention by a physical therapist were used to compare the data of patients referred by PCPs for a one-time consultation. The number and nature of consultation requests were determined as well as patient characteristics. The PCPs' satisfaction with the outcome and process of a one-time consultation and its impact on PCPs' management decisions also were described. Results. The number of referrals for a one-time consultation was 352 (X̄=5.9 per PCP, SD=5.4, range=0–20), resulting in a mean referral rate of 4.7 per 1,000 patients (SD=4.6). Characteristics of patients referred for a one-time consultation differed from national reference data of patients referred by their PCP for intervention by a physical therapist. Discussion and Conclusion. The results show that PCPs used the opportunity for a one-time physical therapist consultation and were satisfied with the outcome and process of consultation. The findings suggest that a one-time consultation is an appropriate and beneficial component of PCPs' patient management process.
A Quantitative Analysis of Research Publications in Physical Therapy Journals
Authors: Miller Patricia A , McKibbon K Ann , Haynes R Brian
Published: February 2017

Background and Purpose. Many physical therapists depend on their professional journals for high-quality evidence. The purpose of this study was to evaluate the rigor of research and review articles in 4 national physical therapy journals. Subjects and Methods. All articles in 6 consecutive issues of the Australian Journal of Physiotherapy, Physical Therapy, Physiotherapy, and Physiotherapy Canada, published between January 2000 and June 2001 (N=179), were reviewed. One trained reviewer identified the type and purpose of each article and assessed the rigor of treatment and review articles according to explicit criteria. Results. The majority of articles reviewed were original studies (56%). The majority of the research articles that dealt with human health care (66%) addressed topics that were not directly applicable to the provision of patient care such as measurement topics and studies on subjects without identified pathologies or impairments. Of the 179 journal articles, 19 met the standards for rigor (11%). The majority of these articles dealt with treatment. The pass rate per journal was as follows: Australian Journal of Physiotherapy, 10% (4/42); Physical Therapy, 15% (7/47); Physiotherapy, 12% (4/34); and Physiotherapy Canada, 7% (4/56). Discussion and Conclusion. Because such a small percentage of articles in these professional journals were identified as having direct application to patient care, physical therapists should attempt to access other sources of information to find additional high-quality evidence. A larger sample with a greater number of issues per journal may have yielded different results and indicated different trends, and further research appears to be warranted.
Concurrent Validity of Upper-Extremity Volume Estimates: Comparison of Calculated Volume Derived From Girth Measurements and Water Displacement Volume
Authors: Karges Joy R , Mark Beth E , Stikeleather S Jill , Worrell Teddy W
Published: February 2017

Background and Purpose. The volume of all limbs can be determined by water displacement methods or calculations derived from girth measurements. The purpose of this study was to determine the concurrent validity of calculated volume and water displacement volume measurements. Subjects. Both upper extremities of 14 women with lymphedema were measured. Methods. Volumetric measurements were taken with a volumeter, and circumferential measurements were taken with a tape measure. Calculated volume was determined by summing segment volumes derived from the truncated cone formula. Pearson product moment correlations, paired t tests, and linear regression tests were used to assess relative association and absolute differences between calculated and actual volumes. Results. The correlation coefficient for calculated volume versus upper extremity minus fingers (UE-F) water displacement volume was .99. Paired t tests showed differences between calculated volume and UE-F water displacement volume (t=−3.88, mean difference=−95.62 mL), and the linear regression slope was 0.83 with an intercept of 255.28 mL. Discussion and Conclusion. Calculated volume measurements were highly associated with measurements based on water displacement; therefore, clinicians should feel confident in using either calculated volume or water displacement volume. The differences, however, indicated that the measures were not interchangeable. Thus, clinicians should not mix or substitute measurement methods with a single patient or in a single study.
Use of Inspiratory Strength Training to Wean Six Patients Who Were Ventilator-Dependent
Authors: Sprague Samuel S , Hopkins Phillip D
Published: February 2017

Background and Purpose. Patients who are unable to wean from mechanical ventilation (MV) after resolution of critical illness or surgery risk increased morbidity and death and consume a disproportionate amount of intensive care unit resources. Decreased inspiratory muscle strength is often cited as a major factor contributing to prolonged MV. The purpose of this case report is to describe the rationale and application of inspiratory strength training (IST) as an adjunct to lengthen unassisted breathing trials and to ultimately wean patients with chronic mechanical ventilator dependency. Case Description. Six patients who had been ventilator-dependent for 18 to 221 days (mean of 72 days) after surgery and were diagnosed with “failure to wean” performed low-repetition, high-resistance breathing exercises that were coupled with increasing time off the ventilator. Outcomes. All 6 patients were weaned from the ventilator in 9 to 28 days (mean of 17 days). The patients' training pressure increased from a mean of 9.3 cm/H2O to 27.5 cm/H2O, for an increase of 195%. The volitional maximum inspiratory pressure (MIP) increased from a mean of 22.5 cm/H2O to 54 cm/H2O, for a 140% gain in pressure. Discussion. Although it is not clear why the patients appeared to benefit from IST, possible explanations include: (1) addressing inspiratory muscle pump dysfunction, (2) standardization of breathing patterns, 3) routinization of the patients' unassisted breathing trials, and (4) nonspecific training effects. Future research should address these possibilities when attempting to understand the effects of IST in the weaning of patients with chronic ventilator dependency.
Fatigability and Variable-Frequency Train Stimulation of Human Skeletal Muscles
Authors: Bickel C Scott , Slade Jill M , Warren Gordon L , Dudley Gary A
Published: February 2017

Background and Purpose. The quadriceps femoris (QF) and tibialis anterior (TA) muscles are often activated through the use of electrical stimulation by physical therapists. These 2 muscles are fundamentally different in regard to their fiber-type composition. Whether protocols developed using a given muscle can be applied to another muscle has seldom been questioned, even if they differ in fiber type. The purpose of this study was to test the hypothesis that torque augmentation during variable-frequency train (VFT) stimulation as compared with constant-frequency train (CFT) stimulation in the fatigued state would not differ between these muscles, even though the TA muscle has 50% relatively more slow fibers than the QF muscle relative to each muscle's overall composition. Subjects. Ten recreationally active men with no history of lower-extremity pathology participated in the study (mean age=25 years, SD=4, range=19–31; mean height=179 cm, SD=5, range=170–188; mean body mass=80 kg, SD=15, range=63–111). Methods. The subjects' TA and QF muscles were stimulated with CFTs (six 200-microsecond square waves separated by 70 milliseconds) or VFTs (first interpulse interval=5 milliseconds) that evoked an isometric contraction. Results. After potentiation, the torque-time integral and peak torque were not different for the VFT and CFT stimulation. Rise time was longer for the TA muscle than for the QF muscle and for CFT stimulation versus VFT stimulation (both approximately 40%). After 180 CFTs (50% duty cycle), peak torque decreased 56% overall, with no differences between muscles. Enhancement of the torque-time integral (25%) by VFT stimulation was not different between fatigued QF and TA muscles. Torque augmentation was due to the VFT stimulation evoking 27% greater peak torque and less slowing of rise time than the CFT stimulation (15% versus 30%). Discussion and Conclusion. The results indicate that the QF muscle may not necessarily fatigue more than the TA muscle. The results suggest that VFTs augment the force of fatigued, human skeletal muscle irrespective of fiber type.
Hypoalgesic and Sympathoexcitatory Effects of Mobilization With Movement for Lateral Epicondylalgia
Authors: Paungmali Aatit , O'Leary Shaun , Souvlis Tina , Vicenzino Bill
Published: February 2017

Background and Purpose. Mulligan has proposed the use of mobilization with movement for lateral epicondylalgia. In this study, mobilization with movement for the elbow was examined to determine whether this intervention was capable of inducing physiological effects similar to those reported for some forms of spinal manipulation. Participants. Seven women and 17 men (mean age=48.5 years, SD=7.2) with chronic lateral epicondylalgia participated in the study. Methods. A placebo, control, repeated-measures study was conducted to evaluate whether mobilization with movement at the elbow produced concurrent hypoalgesia and sympathoexcitation. Results. The treatment demonstrated an initial hypoalgesic effect and concurrent sympathoexcitation. Improvements in pain resulted in increased pain-free grip force and pressure pain thresholds. Sympathoexcitation was indicated by changes in heart rate, blood pressure, and cutaneous sudomotor and vasomotor function. Discussion and Conclusion. This study showed that a mobilization with movement treatment technique exerted a physiological effect similar to that reported for some spinal manipulations.
Application of the HOAC II: An Episode of Care for a Patient With Low Back Pain
Authors: Riddle Daniel L , Rothstein Jules M , Echternach John L
Published: February 2017

Background and Purpose. The HOAC II is a patient management algorithm designed, in part, to provide a conceptual framework for patient management for any type of patient seen by physical therapists. This case report illustrates how the HOAC II can be used in clinical practice. Case Description. The patient was a 47-year-old woman with low back pain. The report describes the patient's examination, evaluation, diagnosis, prognosis, intervention, and outcomes within the context of the HOAC II. Outcome. The patient had measurable improvements in impairments, functional limitation, and disability following an intervention designed to resolve her impairments and functional limitations. Discussion. This case report illustrates how the HOAC II can be used to assist in the management of a patient from admission to discharge. The report also demonstrates how use of a disablement model can add clarity to patient care.
Effectiveness of Supervised Physical Therapy in the Early Period After Arthroscopic Partial Meniscectomy
Authors: Goodwin Peter C , Morrissey Matthew C , Omar Rumana Z , Brown Michael , Southall Kathleen , McAuliffe Thomas B
Published: February 2017

Background and Purpose. Controversy exists about the effectiveness of physical therapy after arthroscopic partial meniscectomy. This randomized controlled trial evaluated the effectiveness of supervised physical therapy with a home program versus a home program alone. Subjects. Eighty-four patients (86% males; overall mean age=39 years, SD=9, range=21–58; female mean age=39 years, SD=9, range=24–58; male mean age=40, SD=9, range=21–58) who underwent an uncomplicated arthroscopic partial meniscectomy participated. Methods. Subjects were randomly assigned to either a group who received 6 weeks of supervised physical therapy with a home program or a group who received only a home program. Blinded test sessions were conducted 5 and 50 days after surgery. Outcome measures were: (1) Hughston Clinic questionnaire, (2) Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and EuroQol EQ-5D (EQ-5D) questionnaires, (3) number of days to return to work after surgery divided by the Factor Occupational Rating System score, (4) kinematic analysis of knee function during level walking and stair use, and (5) horizontal and vertical hops. Results. No differences between groups were found for any of the outcomes measured. Discussion and Conclusion. The results indicate that the supervised physical therapy used in this study is not beneficial for patients in the early period after uncomplicated arthroscopic partial meniscectomy.
Relationship of Knee Extension Force to Independence in Sit-to-Stand Performance in Patients Receiving Acute Rehabilitation
Authors: Eriksrud Ola , Bohannon Richard W
Published: February 2017

Background and Purpose. The ability to rise from a chair is important for independence in everyday life. This study was conducted to determine to what extent knee extension force (KEF) could explain independence in sit-to-stand (STS) performance from a standard chair. Subjects and Methods. This was a descriptive and correlational study of patients receiving acute rehabilitation (N=107). Measurements of KEF of both lower extremities were obtained using manual muscle testing (MMT) and hand-held dynamometers (HHDs). The HHD measurements were normalized based on body weight and age- and sex-specific reference values. Measurements of the ability to stand without using the upper extremities (STS [without hands]) and to stand using the upper extremities (STS [with hands]) were correlated with the force measurements. Results. The correlations (r) of the KEF measurements with STS success ranged from .652 to .708 for STS (without hands) and from .545 to .638 for STS (with hands). Body weight added to the explanation of STS (without hands) (R=.662) and STS (with hands) (R=.584) provided by KEF measured by HHD. The receiver operating characteristic curves showed that HHD (weight normalized) was the most sensitive and specific measure for explaining independence in STS. Discussion and Conclusion. Manual and dynamometric measurements of KEF are related to independence in STS. Measurements of KEF quantified with a dynamometer and normalized against body weight provided the most valid, specific, and sensitive cutoff point for explaining STS independence.
Measuring Functional Change in Children With Acquired Brain Injury (ABI): Comparison of Generic and ABI-Specific Scales Using the Pediatric Evaluation of Disability Inventory (PEDI)
Authors: Kothari Dhara H , Haley Stephen M , Gill-Body Kathleen M , Dumas Helene M
Published: February 2017

Background and Purpose. The Pediatric Evaluation of Disability Inventory (PEDI) subscales are hierarchic in nature, with item placements within each subscale reflecting the general order of skill attainment in children without disabilities. The purpose of this study was to determine whether a hierarchical subscale developed in this study for children with acquired brain injuries (ABIs) corresponds to the generic PEDI subscales, and, if not, whether condition-specific (ABI-specific) PEDI subscales are more sensitive for measuring change. Subjects. Eighty-seven children and adolescents (mean age=9.2 years, SD=5.2, range=1–20) with ABI during inpatient rehabilitation admissions were included. Methods. Data were collected by retrospective chart review. Rasch one-parameter analyses were conducted to construct the ABI-specific PEDI scale focusing on the Mobility and Self-care domains (content areas) only. Each domain consists of a Functional Skills subscale and a Caregiver Assistance subscale. Thus, in all, 4 scales were constructed within the ABI-specific PEDI scale. Differences in item hierarchies and sensitivity between generic and ABI-specific PEDI subscales for each domain were then examined. Results. Both generic and ABI-specific PEDI scales were sensitive for measuring functional changes during inpatient rehabilitation hospitalization. Even though the generic and ABI-specific item hierarchies differed substantially, only one of the 4 ABI-specific PEDI subscales (Caregiver Assistance Self-care subscale) was more sensitive for measuring change than the generic PEDI scale. Discussion and Conclusion. The ABI-specific scales added relatively little improvement in sensitivity compared with the generic PEDI scales of the Mobility and Self-care domains. Thus, for group analyses, the authors recommend use of the generic PEDI subscales for children with ABI. Future work with ABI-specific subscales may improve the physical therapist's ability to describe an individual's pattern of functional recovery.
Characteristics of Individuals Who Fell While Receiving Home Health Services
Authors: Lewis Cynthia L , Moutoux Mary , Slaughter Myra , Bailey Stephen P
Published: February 2017

Background and Purpose. Many patients receiving home health services are at risk for falling, but fall risk factors have not been previously investigated in this population. A retrospective record review was used to describe individuals who fell while being served by a home health agency. Subjects. The 98 individuals who fell while receiving home health services were compared with a random sample of 98 subjects served by the home health agency during the same period who did not report falling. Methods. Subjects were compared by age, sex, days of receiving home health services, number of falls prior to admission to the home health agency, diagnosis, medication category, home health services received, and type of health care coverage. In the group with falls, causes of falls and interventions were described. Results. The group with falls had comorbidities of neurological and cardiovascular impairment, took more medications associated with increased risk of falling, and had almost 3 times the number of falls prior to admission than the group without falls. Discussion and Conclusion. Home care providers should consider medical history, medication usage, and fall history as risk factors for falls in the home environment.
Evidence-Based Rating of Upper-Extremity Motor Function Tests Used for People Following a Stroke
Authors: Croarkin Earllaine , Danoff Jerome , Barnes Candice
Published: February 2017

Introduction. Tests of upper-extremity motor function used for people following a stroke have been described, but reliability and validity (psychometric properties) of measurements obtained with these tests have not been consistently established. This investigation was performed: (1) to review literature relative to upper-extremity motor function testing during rehabilitation following a stroke, (2) to develop selection criteria for identifying these tests in the literature, and (3) to rate the tests relative to their psychometric properties. Method. Literature searches were done using 2 databases. Reports of 4 psychometric properties were sought: interrater reliability, test-retest reliability, convergent validity or concurrent validity, and predictive validity. Results. Nine tests met the inclusion criteria of having psychometric properties reported in the literature. No test had evidence for all 4 psychometric properties. Only the Nine-Hole Peg Test was supported by 3 out of 4 properties. Most tests had 2 properties supported. Concurrent validity or convergent validity was most frequently described; test-retest reliability was least frequently described. Conclusions. More complete psychometric support is needed for upper-extremity motor function tests applied following a stroke. The absence of psychometric support, however, does not mean that a test has no value. Clinicians are cautioned not to generalize psychometric evidence.
Relationships Between Standing Balance and Symmetry Measurements in Patients Following Recent Strokes (≤3 Weeks) or Older Strokes (≥6 Months)
Authors: Pyöriä Outi , Era Pertti , Talvitie Ulla
Published: February 2017

Background and Purpose. The Functional Standing Balance (FSB) Scale was designed to obtain measurements of standing balance and to identify the problems typically faced by people with stroke. The purpose of this study was to investigate the validity of measurements obtained with the FSB Scale for use in the acute and chronic phases of stroke by comparing the measurements obtained with the FSB Scale with those obtained for postural sway and lateral symmetry by use of a force platform. Subjects and Methods. Measurements were obtained for 26 people with recent strokes (ie, strokes within 3 weeks of data collection) and for 28 people with long-standing strokes (ie, strokes of 6 months' duration or older). The FSB Scale consists of 3 components: weight distribution, balance without movement, and balance with movement. Measurements of balance performance were compared with measurements of anteroposterior and lateral sway velocity obtained on a force platform. The weight distribution on 2 digital scales was compared with the lateral symmetry measured on the force platform. Results. The highest correlations were found between the FSB Scale balance measurements and the measurements of anteroposterior sway velocity obtained on the force platform with feet apart and eyes open. The correlations (r) were −.68 and −.67 for the group with recent strokes and −.74 and −.91 for the group with long-standing strokes. The correlations (r) between weight distribution measured on the digital scales and lateral symmetry measured on the force platform were .44 for the group with recent strokes and .52 for the group with long-standing strokes. Discussion and Conclusion. The subjects whose results on the FSB Scale were poor had higher sway velocities on the force platform than the subjects whose results on the FSB Scale were good. The results of this study suggest that the FSB Scale provides the same kind of information as that obtained for sway velocity and lateral symmetry as measured with the use of force platforms in both patients with recent strokes and patients with long-standing strokes.
Categorizing Patients With Occupational Low Back Pain by Use of the Quebec Task Force Classification System Versus Pain Pattern Classification Procedures: Discriminant and Predictive Validity
Authors: Werneke Mark W , Hart Dennis L
Published: February 2017

Background and Purpose. Quebec Task Force Classification (QTFC) and pain pattern classification (PPC) procedures, including centralization and noncentralization, are common classification procedures. Classification was done to estimate validity of data obtained with QTFC and PPC procedures for differentiating patient subgroups at intake and for use in predicting rehabilitation outcomes at discharge and work status at 1 year after discharge from rehabilitation. Subjects. Patients (n=171, 54% male; mean age=37 years, SD=10, range=18–62) with acute work-related low back pain referred for physical therapy were analyzed. Methods. Patients completed pain and psychosocial questionnaires at initial examination and discharge and pain diagrams throughout intervention. Physical therapists classified patients using QTFC and PPC data at intake. Patients were classified again at discharge by PPC (time-dependent PPC). Results. Analysis of variance of showed QTFC and PPC data could be used to differentiate patients by pain intensity or disability at intake. Analysis of covariance showed that intake PPC predicted pain intensity and disability at discharge, but QTFC did not. Logistic regression showed that PPC predicted work status at 1 year, but QTFC did not. Classifying patients over time using time-dependent PPC data reduced the false positive rate by 31% and increased percentage of change in pretest-posttest probability of return to work by 16% compared with classifying patients at intake. Discussion and Conclusion. Results support the discriminant validity of the QTFC data at intake and predictive validity of the PPC data at intake. Tracking PPC over time increases predictive validity for 1-year work status.
Dynamic Resources Used in Ambulation by Children With Spastic Hemiplegic Cerebral Palsy: Relationship to Kinematics, Energetics, and Asymmetries
Authors: Fonseca Sérgio T , Holt Kenneth G , Fetters Linda , Saltzman Elliot
Published: February 2017

Background and Purpose. The atypical walking pattern in children with spastic cerebral palsy is assumed to involve kinematic and morphological adaptations that allow them to move. The purpose of this study was to explore how the requirements of the task and the energy-generating and energy-conserving capabilities of children with cerebral palsy relate to kinematic and mechanical energy patterns of walking. Subjects. Six children with hemiplegic cerebral palsy and a matched group of typically developing children participated in the study. Methods. Kinematic data were collected at 5 different walking speeds. Vertical stiffness, mechanical energy parameters, and landing angle were measured during the stance phase. Results. The affected side of the children with cerebral palsy showed greater vertical stiffness, a greater ratio of kinetic forward energy to potential energy, and a smaller landing angle when compared with those of the nonaffected lower extremity and with those of typically developing children. Discussion and Conclusion. Previous research has shown that children with cerebral palsy assumed a gait similar to an inverted pendulum on the nonaffected limb and a pogo stick on the affected limb. Our results indicate that asymmetries between lower extremities and differences from typically developing children in the landing angle of the lower extremity, vertical lower-extremity stiffness, and kinetic and potential energy profiles support the claim that walking patterns in children with spastic hemiplegic cerebral palsy emerge as a function of the resources available to them.
Individual and Societal Influences on Participation in Physical Activity Following Spinal Cord Injury: A Qualitative Study
Authors: Levins Stephen M , Redenbach Darlene M , Dyck Isabel
Published: February 2017

Background and Purpose. Despite evidence that physical activity, a tool of rehabilitation, affects health and improves functional ability in people following spinal cord injury (SCI), such people are often physically inactive. We used a qualitative method to explore the experiences of individuals with SCI during participation in physical activity. Subjects. The participants were 8 adults (5 male, 3 female), ranging from active to inactive, who were 2 to 27 years post-rehabilitation following SCI (paraplegic). Methods. We used semistructured ethnographic interviews to explore barriers and enablers to participation in physical activity following SCI. Emerging themes were derived from the participants' experiences. Results. Two themes were identified: (1) individual influences, defined as a period of loss of “able identity” and subsequent redefinition of self in which participation in physical activity may be a vehicle or an outcome, and (2) societal influences, which included environmental and attitudinal barriers. Discussion and Conclusion. The participants' experiences offer insight for therapists regarding physical activity following SCI.