bluuebunny/crossref_metadata_2025 huggingface dataset:
A Time to Harvest, a Time to Sow: Ethics for a Shifting Landscape
Authors: Purtilo Ruth B
Published: February 2017

Ruth B Purtilo, known to many physical therapist students and clinicians through her numerous publications in the area of ethics, has influenced the delivery of health care nationally and internationally. Throughout her long career, she has educated us about the moral issues and courses of direction that guide us in our daily lives as health care professionals.

Dr Purtilo has been a visiting professor or named lecturer to more than 30 different colleges and universities worldwide. Her publications, primarily on ethics in health care, include 8 books and more than 70 articles and chapters.

In addition to being involved in APTA, Dr Purtilo has served as President of the American Society of Law, Medicine, and Ethics and was a founding member of the Society of Bioethics Consultation. She is a member of many other professional organizations, including the American Association of Bioethics, the American Philosophical Association, the Society for Health and Human Values, and the World Confederation for Physical Therapy.

Dr Purtilo has been recognized by APTA as a recipient of the Golden Pen Award, the Helen Hislop Award for Outstanding Contributions to Professional Literature, and a Catherine Worthingham Fellowship.
Turning Difficulty Characteristics of Adults Aged 65 Years or Older
Authors: Thigpen Mary T , Light Kathye E , Creel Gwenda L , Flynn Sheryl M
Published: February 2017

Background and Purpose. Falls that occur while walking have been associated with an increased risk of hip fracture in elderly people. This study's purpose was to describe movement characteristics in older adults that serve as indicators of difficulty in turning while walking. Subjects. Three groups were assessed: young adults who had no difficulty in turning (age range=20–30 years, n=20) (YNDT group), elderly adults who had no difficulty in turning (age range=65–87 years, n=15) (ENDT group), and elderly adults who had difficulty in turning (age range=69–92 years, n=15) (EDT group). Methods. All subjects were videotaped performing a self-paced 180-degree turn during the Timed “Up & Go” Test. Movement characteristics of each group were identified. Four characteristics were used to identify difficulty in turning: (1) the type of turn, (2) the number of steps taken during the turn, (3) the time taken to accomplish the turn, and (4) staggering during the turn. Results. In general, the EDT group took more steps during the turn and more time to accomplish the turn than the YNDT and ENDT groups did. Although the only turning strategy used by the YNDT group was a pivot type of turn, there was an almost total absence of a pivot type of turn in the EDT group. No differences were found among the groups on the staggering item, yet the EDT group was the only group in which staggering was present. We believe these changes observed in the 4 characteristics only in the EDT group are indicators of difficulty in turning while walking. Conclusion and Discussion. These indicators of difficulty may be useful for the early identification of individuals aged 65 years or older who are having difficulty in turning and may well serve as the basis for the development of a scale for difficulty in turning in older adults. Preliminary findings indicate the need for further study into the reliability, validity, and sensitivity of measurements obtained with such a scale.
End-Range Mobilization Techniques in Adhesive Capsulitis of the Shoulder Joint: A Multiple-Subject Case Report
Authors: Vermeulen Henricus M , Obermann Wim R , Burger Bart J , Kok Gea J , Rozing Piet M , van den Ende Cornelia HM
Published: February 2017

Background and Purpose. The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis. Case Description. Four men and 3 women (mean age=50.2 years, SD=6.0, range=41–65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range= 3–12) were treated with end-range mobilization techniques, twice a week for 3 months. Indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment. Outcomes. After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=70–120) to 151 degrees (SD=22, range=110–170), mean flexion in the sagittal plane increased from 113 degrees (SD=17, range=90–145) to 147 degrees (SD=18, range=115–175), and mean lateral rotation increased from 13 degrees (SD=13, range=0–40) to 31 degrees (SD=11, range=15–50). There were also increases in passive range of motion: Mean abduction increased from 96 degrees (SD=18, range=70–125) to 159 degrees (SD=24, range 110–180), mean flexion in the sagittal plane increased from 120 degrees (SD=16, range=95–145) to 154 degrees (SD=19, range=120–180), and mean lateral rotation increased from 21 degrees (SD=11, range=10–45) to 41 degrees (SD=8, range=35–55). The mean capacity of the glenohumeral joint capsule (its ability to contain fluid) increased from 10 cc (SD=3, range=6–15) to 15 cc (SD=3, range=10–20). Four patients rated their improvement in shoulder function as excellent, 2 patients rated it as good, and 1 patient rated it as moderate. All patients maintained their gain in joint mobility at the 9-month follow-up. Discussion. There seems to be a role for intensive mobilization techniques in the treatment of adhesive capsulitis. Controlled studies regarding the effectiveness of end-range mobilization techniques in the treatment of adhesive capsulitis are warranted.
The Efficacy of Perturbation Training in Nonoperative Anterior Cruciate Ligament Rehabilitation Programs for Physically Active Individuals
Authors: Fitzgerald G Kelley , Axe Michael J , Snyder-Mackler Lynn
Published: February 2017

Background and Purpose. Treatment techniques involving perturbations of support surfaces may induce compensatory muscle activity that could improve knee stability and increase the likelihood of returning patients to high-level physical activity. The purpose of this study was to determine the efficacy of augmenting standard nonoperative anterior cruciate ligament (ACL) rehabilitation programs with a perturbation training program. Subjects. Twenty-six patients with an acute ACL injury or ruptures of ACL grafts participated in the study. Subjects had to have a unilateral ACL injury, be free of concomitant multiple ligament or meniscal damage requiring surgical repair, and pass a screening examination designed to identify patients who had the potential to return to high-level physical activity with nonoperative treatments. Subjects also had to be regular participants in level I activities (eg, soccer, football, basketball) or level II activities (eg, racquet sports, skiing, construction work). Methods. Subjects were randomly assigned to either a group that received a standard rehabilitation program (standard group) or a group that received the standard program augmented with a perturbation training program (perturbation group). Treatment outcome was determined from scores on the Knee Outcome Survey's Activities of Daily Living Scale (ADLS) and Sports Activity Scale, a global rating of knee function, scores on a series of single-limb hop tests, measurements of maximum isometric quadriceps femoris muscle force output, and the group frequency of unsuccessful rehabilitation. Unsuccessful rehabilitation was defined as the occurrence of an episode of giving way of the knee or failure to maintain the functional status of a rehabilitation candidate on retesting. Results. More subjects had unsuccessful rehabilitation in the standard group compared with the perturbation group. There was a within-group × time interaction for the ADLS, global rating of knee function, and crossover hop test scores. These scores decreased from posttraining to the 6-month follow-up for the standard group. Conclusion and Discussion. Although both the standard program and the perturbation training program may allow subjects to return to high-level physical activity, the perturbation training program appears to reduce the risk of continued episodes of giving way of the knee during athletic participation, and it allows subjects to maintain their functional status for longer periods.
Effects of Attentional Focus, Self-Control, and Dyad Training on Motor Learning: Implications for Physical Rehabilitation
Authors: McNevin Nancy H , Wulf Gabriele , Carlson Christine
Published: February 2017

In this article, the authors review recent studies on 3 factors that have been shown to affect the learning of motor skills—the performer's attentional focus, self-control, and practice in dyads—and discuss their implications for rehabilitation. Research has shown that directing learners' attention to the effects of their movements can be more beneficial for learning than directing their attention to the details of their own actions. Furthermore, giving learners some control over the training regimen has been found to enhance learning, unlike prescriptive training protocols that dictate when feedback will be delivered, how often, and the order that tasks will be practiced. Finally, not only can practice in dyads (or larger groups) reduce the costs of training, but it can also result in more effective learning than individual practice sessions. The incorporation of these factors into rehabilitation practice can potentially enhance the effectiveness and efficiency of rehabilitation.
Examination and Treatment of a Patient With Hypermobility Syndrome
Authors: Russek Leslie N
Published: February 2017

Background and Purpose. The purpose of this case report is to present the examination, evaluation/diagnosis/prognosis, intervention, and outcome of a patient with hypermobility syndrome (HMS). Hypermobility syndrome has been widely recognized in the rheumatology literature, but it has seldom been discussed in the orthopedic literature and has only recently been described in the physical therapy literature. The signs and symptoms of HMS are common among patients seen in orthopedic physical therapy clinics; however, the HMS may be overlooked while treating individual joints or tissues causing pain. Case Description. The patient was a 28-year-old woman with complaints of chronic, multiple-joint pain. After years without a diagnosis, a rheumatologist had recently diagnosed her as having HMS. Outcomes. Following intervention that emphasized patient education and activity modification, the patient's complaints decreased. Discussion. Recognition of HMS underlying common orthopedic problems may facilitate appropriate patient education and management.
Effectiveness of Wound Care Products in the Transmission of Acoustic Energy
Authors: Klucinec Brian , Scheidler Matthias , Denegar Craig , Domholdt Elizabeth , Burgess Sharon
Published: February 2017

Background and Purpose. Ultrasound is often recommended in the treatment of people with partial and full-thickness wounds. Many treatments are performed over a hydrogel sheet or semipermeable film dressing. The purpose of this in vitro study was to examine the effectiveness of 4 hydrogels (Nu-Gel, ClearSite, Aquasorb Border, and CarraDres) and 4 film dressings (CarraSmart Film, J&J Bioclusive, Tegaderm, and Opsite Flexigrid) in ultrasound transmission. Methods. The amount of sound energy transmitted through each product and interposed pig tissue was measured using an oscilloscope to display the intensity of sound energy delivered by the transducer. Five intensities at a frequency of 3.3 MHz were studied. Results. Results were expressed as the mean (±SD) percentage of voltage transmitted compared with a gel baseline. Nu-Gel was the most efficient hydrogel (77.2%±4.6%), followed by ClearSite (72.0%±2.2%), Aquasorb Border (45.3%±2.1%), and CarraDres (42.8%±5.9%). The 4 film dressings, in order of efficiency, were CarraSmart Film (60.5%±4.4%), J&J Bioclusive (53.2%±2.4%), Tegaderm (47.1%±2.3%), and Opsite Flexi-grid (31.5%±4.0%). Conclusion and Discussion. Transmissivity of wound care products used to deliver acoustic energy during ultrasound treatment of wounds varies greatly among dressing products. We believe that clinicians can use our findings as a part of the clinical reasoning process that they use to select an optimal wound dressing.
Spinal Cord Control of Movement: Implications for Locomotor Rehabilitation Following Spinal Cord Injury
Authors: Field-Fote Edelle Carmen
Published: February 2017

In recent years, our understanding of the spinal cord's role in movement control has been greatly advanced. Research suggests that body weight support (BWS) walking and functional electrical stimulation (FES), techniques that are used by physical therapists, have potential to improve walking function in individuals with spinal cord injury (SCI), perhaps long after the stage of spontaneous recovery. Walking is one of the most desired goals of people with SCI; however, we are obligated to be judicious in our claims of locomotor recovery. There are few controlled studies that compare outcomes of BWS training or FES with those of conventional interventions, and access to services using BWS training or FES may be restricted under managed care.
Effects of Squat Lift Training and Free Weight Muscle Training on Maximum Lifting Load and Isokinetic Peak Torque of Young Adults Without Impairments
Authors: Yeung Simon SM , Ng Gabriel YF
Published: February 2017

Background and Purpose. Manual lifting is a frequent cause of back injury, and there is no evidence as to which training mode can provide the best training effect for lifting performance and muscle force. The purpose of this study was to examine the effects of a squat lift training and a free weight muscle training program on the maximum lifting load and isokinetic peak torque in subjects without known neuro-muscular or musculoskeletal impairments. Subjects. Thirty-six adults (20 male, 16 female) without known neuromuscular or musculoskeletal impairments participated. The subjects' mean age was 21.25 years (SD=1.16, range=20–24). Methods. Subjects were divided into 3 groups. Subjects in group 1 (n=12) performed squat lift training. Subjects in group 2 (n=12) participated in free weight resistance training of their shoulder abductors, elbow flexors, knee extensors and trunk extensors. Subjects in group 3 (n=12) served as controls. The maximum lifting load and isokinetic peak torques of the trunk extensors, knee extensors, elbow flexors, and shoulder abductors of each subject were measured before and after the study. Training was conducted on alternate days for 4 weeks, with an initial load of 80% of each subject's maximum capacity and with the load increased by 5% weekly. Results. All groups were comparable for all measured variables before the study. After 4 weeks, subjects in groups 1 and 2 demonstrated more improvement in maximum lifting load and isokinetic peak torque of the back extensors compared with the subjects in group 3, but the 2 training groups were not different. Conclusion and Discussion. The findings demonstrate that both squat lift and free weight resistance training are equally effective in improving the lifting load and isokinetic back extension performance of individuals without impairments.
A Multivariate Model of Determinants of Motor Change for Children With Cerebral Palsy
Authors: Bartlett Doreen J , Palisano Robert J
Published: February 2017

The purpose of this article is to describe the development of a theory-and data-based model of determinants of motor change for children with cerebral palsy. The dimensions of human functioning proposed by the World Health Organization, general systems theory, theories of human ecology, and a philosophical approach incorporating family-centered care provide the conceptual framework for the model. The model focuses on relationships among child characteristics (eg, primary and secondary impairments, personality), family ecology (eg, dynamics of family function), and health care services (eg, availability, access, intervention options). Clarification of the complex multivariate and interactive relationships among the multiple child and family determinants, using statistical methods such as structural equation modeling, is necessary before determining how physical therapy intervention can optimize motor outcomes of children with cerebral palsy. We propose that the development and testing of multivariate models is also useful in physical therapy research and in the management of complex chronic conditions other than cerebral palsy. Testing of similar models could provide physical therapists with support for: (1) prognostic discussions with clients and their families, (2) establishment of realistic and attainable goals, and (3) interventions to enhance outcomes for individual clients with a variety of prognostic attributes.
Physical Therapy for a Patient in Acute Respiratory Failure
Authors: Wong Wai Pong
Published: February 2017

Background and Purpose. The main indications for physical therapy for patients in intensive care units (ICUs) are excessive pulmonary secretions or atelectasis. Timely physical therapy interventions may improve gas exchange and reverse pathological progression, thereby curtailing or avoiding artificial ventilation. The purpose of this case report is to illustrate 24-hour availability of physical therapy for a patient with acute respiratory failure. Case Description. The patient was a 66-year-old man who was admitted to an ICU for acute respiratory failure. Intensive physical therapy, based on Dean's physiologic treatment hierarchy for patients with impaired oxygen transport, consisted of upright body positioning, mobilization and exercise, and active cycles of breathing techniques every 2 hours for the first 12 hours he was in the ICU. Outcomes. In total, the patient received 11 physical therapy sessions over his 48-hour stay in the ICU (6 sessions on day 1 and 5 sessions on day 2). Arterial oxygenation improved markedly with radiographic resolution of infiltrates, and planned endotracheal intubation and mechanical ventilation were avoided. Discussion. This patient with acute respiratory failure received physical therapy in a timely manner afforded by 24-hour access to physical therapy. The intensive physical therapy might be more cost-effective than if the patient had been managed with intubation and mechanical ventilation. Patients in ICUs who have excessive pulmonary secretions or atelectasis may benefit from access to physical therapy 24 hours a day.
Vascular Events After Spinal Cord Injury: Contribution to Secondary Pathogenesis
Authors: Mautes Angelika EM , Weinzierl Martin R , Donovan Frances , Noble Linda J
Published: February 2017

Traumatic spinal cord injury results in the disruption of neural and vascular structures (primary injury) and is characterized by an evolution of secondary pathogenic events that collectively define the extent of functional recovery. This article reviews the vascular responses to spinal cord injury, focusing on both early and delayed events, including intraparenchymal hemorrhage, inflammation, disruption of the blood-spinal cord barrier, and angiogenesis. These vascular-related events not only influence the evolution of secondary tissue damage but also define an environment that fosters neural plasticity in the chronically injured spinal cord.
Relationship Among Balance Impairments, Functional Performance, and Disability in People With Peripheral Vestibular Hypofunction
Authors: Gill-Body Kathleen M , Beninato Marianne , Krebs David E
Published: February 2017

Background and Purpose. Physical therapy interventions are often based on assumed relationships among impairments, functional performance, and disability. The purposes of this study were (1) to describe balance impairments, functional performance, and disability in subjects with unilateral peripheral vestibular hypofunction (UVH) and bilateral peripheral vestibular hypofunction (BVH), (2) to examine the relationship among these factors, and (3) to determine whether disability can be explained by commonly used tests of balance and functional performance. Subjects. Participants were 85 subjects (mean age=62.5 years, SD=16.5) with UVH (n=41) or BVH (n=44) diagnosed by vestibular function tests and clinical examination. Methods. Each subject completed the Dizziness Handicap Inventory (DHI) to obtain a measure of disability. Functional performance was measured with a modified Timed Up & Go Test (TUG). Balance impairments were measured with computerized posturography and balance tests. Descriptive statistics, correlational analyses, and stepwise regressions were performed. Results. Subjects with BVH had poorer balance but similar TUG scores and perceived levels of disability, as compared with subjects with UVH. Weak to moderate correlations existed among balance measurements, TUG scores, and DHI scores. Balance impairments and TUG scores together explained 78% of the variance in DHI scores of the subjects with BVH, whereas balance impairments alone explained 13% of the variance in DHI scores of the subjects with UVH. Conclusion and Discussion. Balance impairments and functional performance appear to be more closely related to disability in individuals with BVH as compared with those with UVH. Clinical tests of balance impairments and functional performance appear to be useful in explaining disability.
The Role of Endogenous Opioids in Moderate Exercise Training-Induced Enhancement of the Secondary Antibody Response in Mice
Authors: Kapasi Zoher F , Catlin Pamela A , Beck Jon , Roehling Tamara , Smith Kathryn
Published: February 2017

Background and Purpose. Moderate exercise training (60%–80% of maximal oxygen uptake) enhances the secondary antibody response. The mechanism underlying this enhancement, however, has not been determined. In moderate doses, endogenous opioids such as enkephalins enhance antibody response. Furthermore, serum concentrations of endogenous opioids increase in response to exercise, and training programs augment this effect. Therefore, the enhancement of the secondary antibody response induced by moderate exercise may be brought about, in part, by endogenous opioids. The purpose of this study was to examine the effects of naltrexone (an opioid antagonist) on the enhancement of secondary antibody response induced by moderate exercise in young mice. Subjects and Methods. C57BL/6 mice immunized to human serum albumin (HSA) were randomly assigned to 1 of 3 groups: naltrexone, placebo, or control (received no intervention). Then, the mice in each group were randomly assigned to either an exercise group (treadmill running at 15 m/min, 0° slope, 5 days per week for 8 weeks) or a non-exercise group. At the end of 8 weeks, booster immunization was given, and the mice in the exercise group continued to exercise. Ten days later, when high levels of antibodies are produced in secondary antibody response, anti-HSA antibodies in serum were measured by enzyme-linked immunosorbent assay (ELISA). Results. With naltrexone implantation, mice that exercised showed a depression of secondary antibody response as compared with mice that exercised and either received a placebo or did not receive any intervention. Discussion and Conclusion. Endogenous opioids may play a role in the enhancement of the secondary antibody response observed after moderate exercise.
Relationships Among Selected Measures of Impairment, Functional Limitation, and Disability in Patients With Cervical Spine Disorders
Authors: Hermann Karl M , Reese C Shane
Published: February 2017

Background and Purpose. Little is known about the relationship among impairments, functional limitations, and disability in people with cervical spine disorders (CSD) despite the fact that these concepts are routinely used in clinical practice. The primary purpose of this study was to investigate the relationships among commonly assessed impairment, functional limitation, and disability measures in patients with CSD. A secondary purpose was to determine the influence of payment source and time since onset of symptoms on these same measures. Subjects. Eighty patients (mean age=45.7 years, SD=15.9, range= 20–88) with CSD who were referred for physical therapy participated in the study. Methods. Data were obtained for 3 measures of impairment, 2 measures of functional limitation, and 3 measures of self-reported disability during the initial visit. Results. All 3 sets of variables (ie, impairment, functional limitation, disability) correlated with each other, with the highest correlation occurring between the impairment measures and the functional limitation measures (r=.82). Other correlations were noted between individual variables. There was no effect of payment type or time since onset of symptoms on the variables. Conclusion and Discussion. Positive correlations were noted among the 3 sets of measures, which supports the assumption that impairments, functional limitations, and disability are related in patients with CSD.
Effects of Aerobic Exercise on Energy Metabolism in the Hypertensive Rat Heart
Authors: Kinney LaPier Tanya L , Rodnick Kenneth J
Published: February 2017

Background and Purpose. In order to explore the possible effects of physical therapy interventions on patients with hypertension, we evaluated the effects of aerobic exercise training on myocardial energy metabolism in an animal model of hypertension. Subjects. We used 36 female spontaneously hypertensive rats (rats with genetically induced hypertension) and 12 normotensive Wistar-Kyoto rats. Methods. The normotensive rats were sedentary and formed the CONsed group. The spontaneously hypertensive rats were randomly divided into 3 experimental groups (12 rats per group). Hypertensive rats that were sedentary formed the HTNsed group, those that received 8 weeks of exercise training formed the HTN×8 group, and those that received 16 weeks of exercise training formed the HTN×16 group. We measured systolic blood pressure, heart wet weight, maximal activities of cardiac energy metabolism enzymes, glucose transporter content, and total concentrations of protein, glycogen, and triglyceride. Results. Systolic blood pressure was greater than 200 mm Hg in the CONsed group at the time of testing. Exercise training modestly (∼11–18 mm Hg) lowered blood pressure in the HTN×8 and HTN×16 groups. Fatty acid enzyme activity was greater in the CONsed group than in the HTNsed and HTN×8 groups, but activity was roughly equivalent between the CONsed group and the HTN×16 group. Glucose enzyme activity was greater in the HTN×16 group than in the CONsed group and the HTNsed group. Intracellular glycogen concentration was greater in the HTN×8 group than in the HTNsed group. Discussion and Conclusion. Results of this study suggest that aerobic exercise training may help to normalize cardiac energy metabolism in mammals with hypertension.
Effect of Setup Configurations of Split Computer Keyboards on Wrist Angle
Authors: Marklin Richard W , Simoneau Guy G
Published: February 2017

Background and Purpose. Alternative computer keyboards whose halves can be slanted toward each other can reduce a risk factor (ulnar deviation) for work-related musculoskeletal disorders (WMSDs) affecting the upper limbs. Two questions that computer keyboard operators face when using keyboards that can be separated into halves (split keyboards) are: (1) At what angle should the keyboard halves be opened? and (2) At what distance apart should the keyboard halves be placed? The objective of this study was to investigate the effects of the opening angle and separation distance between halves of a split keyboard on wrist ulnar deviation and typing efficiency. Methods. Eleven experienced computer keyboard operators participated in this study and used a split keyboard that was set up in a conventional (nonsplit) format and also in 3 alternative configurations: (1) centers of keyboard halves were separated at 20-cm distance, (2) keyboard halves were separated half of the distance of shoulder width, and (3) keyboard halves were separated at shoulder width distance. Results. The 3 alternative configurations resulted in ulnar deviation of both wrists that were less than ulnar deviation from typing on a conventional setup. There were no differences in ulnar deviations among the 3 alternative configurations. Discussion and Conclusion. The results of this research provide physical therapists and ergonomists with a set of configurations of a split keyboard that they can recommend to their patients or clients. All of the alternative configurations of the split keyboard are beneficial in promoting a neutral wrist position, which theoretically would decrease exposure to WMSDs such as tenosynovitis in the wrist and carpal tunnel syndrome.
Quantification of the Differences in Electromyographic Activity Magnitude Between the Upper and Lower Portions of the Rectus Abdominis Muscle During Selected Trunk Exercises
Authors: Lehman Gregory J , McGill Stuart M
Published: February 2017

Background and Purpose. Controversy exists around exercises and clinical tests that attempt to differentially activate the upper or lower portions of the rectus abdominis muscle. The purpose of this study was to assess the activation of the upper and lower portions of the rectus abdominis muscle during a variety of abdominal muscle contractions. Subjects. Subjects (N=11) were selected from a university population for athletic ability and low subcutaneous fat to optimize electromyographic (EMG) signal collection. Methods. Controlling for spine curvature, range of motion, and posture (and, therefore, muscle length), EMG activity of the external oblique muscle and upper and lower portions of rectus abdominis muscle was measured during the isometric portion of curl-ups, abdominal muscle lifts, leg raises, and restricted or attempted leg raises and curl-ups. A one-way repeated-measures analysis of variance was used to test for differences in activity between exercises in the external oblique and rectus abdominis muscles as well as between the portions of the rectus abdominis muscle. Results. No differences in muscle activity were found between the upper and lower portions of the rectus abdominis muscle within and between exercises. External oblique muscle activity, however, showed differences between exercises. Discussion and Conclusion. Normalizing the EMG signal led the authors to believe that the differences between the portions of the rectus abdominis muscle are small and may lack clinical or therapeutic relevance.
Maximum Voluntary Activation in Nonfatigued and Fatigued Muscle of Young and Elderly Individuals
Authors: Stackhouse Scott K , Stevens Jennifer E , Lee Samuel CK , Pearce Karen M , Snyder-Mackler Lynn , Binder-Macleod Stuart A
Published: February 2017

Background and Purpose. Researchers studying central activation of muscles in elderly subjects (≥65 years of age) have investigated activation in only the nonfatigued state. This study examined the ability of young and elderly people to activate their quadriceps femoris muscles voluntarily under both fatigued and nonfatigued conditions to determine the effect of central activation failure on age-related loss of force. Subjects and Methods. Twenty young subjects (11 men, 9 women; mean age=22.67 years, SD=4.14, range=18–32 years) and 17 elderly subjects (8 men, 9 women; mean age=71.5 years, SD=5.85, range=65–84 years) participated in this study. Subjects were seated on a dynamometer and stabilized. Central activation was quantified, based on the change in force produced by a 100-Hz, 12-pulse electrical train that was delivered during a 3- to 5-second isometric maximum voluntary contraction (MVC) of the quadriceps femoris muscle. Next, subjects performed 25 MVCs (a 5-second contraction with 2 seconds of rest) to fatigue the muscle. During the last MVC, central activation was measured again. Results. In the nonfatigued state, elderly subjects had lower central activation than younger subjects. In the fatigued state, this difference became larger. Discussion and Conclusion. Central activation of the quadriceps femoris muscle in elderly subjects was reduced in both the fatigued and nonfatigued states when compared with young subjects. Some part of age-related weakness, therefore, may be attributed to failure of central activation in both the fatigued and nonfatigued states.
Effect of Burst-Mode Transcutaneous Electrical Nerve Stimulation on Peripheral Vascular Resistance
Authors: Sherry Julie E , Oehrlein Kristin M , Hegge Kristin S , Morgan Barbara J
Published: February 2017

Background and Purpose. Based on changes in skin temperature alone, some authors have proposed that postganglionic sympathetic vasoconstrictor fibers can be stimulated transcutaneously. Our goal was to determine the effects of low-frequency (2 bursts per second), burst-mode transcutaneous electrical nerve stimulation (TENS) on calf vascular resistance, a more direct marker of sympathetic vasoconstrictor outflow than skin temperature, in subjects with no known pathology. Subjects. Fourteen women and 6 men (mean age=31 years, SD=13, range=18–58) participated in this study. Methods. Calf blood flow, arterial pressure, and skin temperature were measured while TENS was applied over the common peroneal and tibial nerves. Results. Blood flow immediately following stimulation was not affected by TENS applied just under or just above the threshold for muscle contraction. Transcutaneous electrical nerve stimulation applied at 25% above the motor threshold caused a transient increase in calf blood flow. Regardless of stimulation intensity, TENS had no effect on arterial pressure; therefore, calf vascular resistance decreased only during the trial that was 25% above the motor threshold. Regardless of stimulation intensity, TENS failed to alter dorsal or plantar skin temperature. Discussion and Conclusion. These results demonstrate that the effects of TENS on circulation depend on stimulation intensity. When the intensity was sufficient to cause a moderate muscle contraction, a transient, local increase in blood flow occurred. Cooling of the dorsal and plantar skin occurred in both the stimulated and control legs, most likely because skin temperature acclimatized to ambient room temperature, rather than because of any effect of TENS on circulation. The data, therefore, call into question the idea that postganglionic sympathetic efferent fibers are stimulated when TENS is applied at clinically relevant intensities to people without symptoms of cardiovascular or neuromuscular pathology.
Development and Validation of a Telephone Questionnaire to Characterize Lymphedema in Women Treated for Breast Cancer
Authors: Norman Sandra A , Miller Linda T , Erikson H Bernadette , Norman M Frank , McCorkle Ruth
Published: February 2017

Background and Purpose. Accurate and economical characterization of lymphedema is needed for population-based studies of incidence and risk. The purpose of this study was to develop and validate a telephone questionnaire for characterizing lymphedema. Subjects. Forty-three women who were treated previously for breast cancer and who were recruited from physical therapy practices and a cancer support organization were studied. Methods. Questionnaire assessment of the presence and degree of lymphedema was compared with physical therapists' diagnoses, based primarily on circumferential measurements. Twenty-five of the 43 subjects were measured independently by 2 physical therapists to assess interobserver agreement. Results. Interobserver agreement on clinical assessments of the presence and degree of lymphedema was high (20/25, weighted kappa=.80); all of the disagreements were between judgments of whether there was no lymphedema or mild lymphedema. For the diagnosis of at least moderate lymphedema (differential in the circumferences of the upper extremities greater than 2 cm), sensitivity of the questionnaire varied from 0.86 to 0.92 and specificity was 0.90. However, sensitivity (varying from 0.93 to 0.96) was higher than specificity (varying from 0.69 to 0.75) for the diagnosis of any lymphedema. Discussion and Conclusion. A few straightforward questions exhibited excellent agreement with physical therapists' assessments for identifying at least moderate lymphedema.
Effect of Superficial Heat, Deep Heat, and Active Exercise Warm-up on the Extensibility of the Plantar Flexors
Authors: Knight Claudia A , Rutledge Carrie R , Cox Michael E , Acosta Martha , Hall Susan J
Published: February 2017

Background and Purpose. Warm-up prior to static stretching enhances muscle extensibility. The relative effectiveness of different modes of warm-up, however, is unknown. The purpose of this study was to evaluate the effectiveness of superficial heat, deep heat, and active exercise warm-up prior to stretching compared with stretching alone on the extensibility of the plantar-flexor muscles. Subjects. Ninety-seven subjects (59 women, 38 men) with limited dorsiflexion range of motion (ROM) were randomly assigned to 1 of 5 groups. Female subjects had a mean age of 27.6 years (SD=7.68, range=17–50), and male subjects had a mean age of 26.8 years (SD=6.87, range=18–48). Methods. The first group (group 1) was a control group and did not perform the stretching protocol. The 4 experimental groups (groups 2–5) performed a stretching protocol 3 days per week for 6 weeks. Group 2 performed the static stretching protocol only; group 3 performed active heel raises before stretching; group 4 received 15 minutes of superficial, moist heat to the plantar-flexor muscles before stretching; and group 5 received continuous ultrasound for 7 minutes before stretching. Dorsiflexion ROM measurements were taken initially and after 2, 4, and 6 weeks. Results. All experimental groups increased active and passive range of motion (AROM and PROM). The mean AROM/PROM differences at 6 weeks were 1.11/1.39 degrees for group 1, 4.10/6.11 degrees for group 2, 4.16/4.21 degrees for group 3, 4.38/4.90 degrees for group 4, and 6.20/7.35 degrees for group 5. The group receiving ultrasound before performing the stretching protocol (group 5) displayed the greatest increase in both AROM (6.20°) and PROM (7.35°). Discussion and Conclusion. Among the modalities tested, the use of ultrasound for 7 minutes prior to stretching may be the most effective for increasing ankle dorsiflexion ROM.
Examination Findings and Self-Reported Walking Capacity in Patients With Lumbar Spinal Stenosis
Authors: Iversen Maura D , Katz Jeffrey N
Published: February 2017

Background and Purpose. Spinal stenosis is a common, often disabling, condition resulting from compression of the cauda equina and nerve roots. This study was designed to: (1) characterize the impairments of patients with lumbar spinal stenosis (LSS) and (2) to identify predictors of self-reported walking capacity. Subjects. Forty-three patients with symptomatic LSS, from 3 specialty clinics, were evaluated. Twenty-eight subjects (65%) were female. The subjects' median age was 73.6 years (X̄=72.4, SD=10.3, range=45.–90.7), and the median duration of low back pain was 24 months (X̄=36.6, SD=41.6, range=0–216). Methods. Demographic data, medical history, and information about low back pain and symptoms (eg, numbness, tingling, and lower-extremity weakness) were collected using a standardized questionnaire and physical examination. Results. Twenty-two subjects (51%) had lower-extremity weakness, primarily of the extensor hallucis longus muscle. Thirty-five subjects (81%) had absent or decreased neurosensory responses (eg, pinprick, vibration, reflexes), and 28 subjects (66%) reported that they were unable to walk farther than 2 blocks. Women were more likely than men to report difficulties walking, as were subjects with abnormal Romberg test scores and those with greater pain during walking. Discussion and Conclusion. Pain and balance problems appeared to be the primary factors limiting ambulation in our subjects with LSS.
Quadriceps Femoris Muscle Torques and Fatigue Generated by Neuromuscular Electrical Stimulation With Three Different Waveforms
Authors: Laufer Yocheved , Ries Julie Deanne , Leininger Peter M , Alon Gad
Published: February 2017

Background and Purpose. Neuromuscular electrical stimulation is used by physical therapists to improve muscle performance. Optimal forms of stimulation settings are yet to be determined, as are possible sex-related differences in responsiveness to electrical stimulation. The objectives of the study were: (1) to compare the ability of 3 different waveforms to generate isometric contractions of the quadriceps femoris muscles of individuals without known impairments, (2) to compare muscle fatigue caused by repeated contractions induced by these same waveforms, and (3) to examine the effect of sex on muscle force production and fatigue induced by electrical stimulation. Subjects. Fifteen women and 15 men (mean age=29.5 years, SD=5.4, range=22–38) participated in the study. Methods. A portable battery-operated stimulator was used to generate either a monophasic or biphasic rectangular waveform. A stimulator that was plugged into an electrical outlet was used to generate a 2,500-Hz alternating current. Phase duration, frequency, and on-off ratios were kept identical for both stimulators. Participants did not know the type of waveform being used. Torque was measured using a computerized dynamometer: a maximal voluntary isometric contraction (MVIC) of the right quadriceps femoris muscle set at 60 degrees of knee flexion was determined during the first session. In each of the 3 testing sessions, torque of contraction and fatigue elicited by one waveform were measured. Order of testing was randomized. Torque elicited by electrical stimulation was expressed as a percentage of average MVIC. A mixed-model analysis of variance was used to determine the effect of stimulation and sex on strength of contraction and fatigue. Bonferroni-corrected post hoc tests were used to further distinguish between the effects of the 3 stimulus waveforms. Results. The results indicated that the monophasic and biphasic waveforms generated contractions with greater torque than the polyphasic waveform. These 2 waveforms also were less fatiguing. The torques from the maximally tolerated electrically elicited contractions were greater for the male subjects than for the female subjects. Discussion and Conclusion. Muscle torque and fatigue of electrically induced contractions depend on the waveform used to stimulate the contraction, with monophasic and biphasic waveforms having an advantage over the polyphasic waveform. All tested waveforms elicited, on average, stronger contractions in male subjects than in female subjects when measured as a percentage of MVIC.
A Review of Therapeutic Ultrasound: Biophysical Effects
Authors: Baker Kerry G , Robertson Valma J , Duck Francis A
Published: February 2017

Almost 2 decades ago, it was pointed out that physical therapists tended to overlook the tenuous nature of the scientific basis for the use of therapeutic ultrasound. The purpose of this review is to examine the literature regarding the biophysical effects of therapeutic ultrasound to determine whether these effects may be considered sufficient to provide a reason (biological rationale) for the use of insonation for the treatment of people with pain and soft tissue injury. This review does not discuss articles that examined the clinical usefulness of ultrasound (see article by Robertson and Baker titled “A Review of Therapeutic Ultrasound: Effectiveness Studies” in this issue). The frequently described biophysical effects of ultrasound either do not occur in vivo under therapeutic conditions or have not been proven to have a clinical effect under these conditions. This review reveals that there is currently insufficient biophysical evidence to provide a scientific foundation for the clinical use of therapeutic ultrasound for the treatment of people with pain and soft tissue injury.
Spinal Movement and Performance of a Standing Reach Task in Participants With and Without Parkinson Disease
Authors: Schenkman Margaret L , Clark Kevin , Xie Tony , Kuchibhatla Maggie , Shinberg Mindi , Ray Laurie
Published: February 2017

Background and Purpose. Evidence suggests that individuals with early and mid-stage Parkinson disease (PD) have diminished range of motion (ROM). Spinal ROM influences the ability to function. In this investigation, the authors examined available spinal ROM, segmental excursions (the ROM used) during reaching, and their relationships in community-dwelling adults with and without PD. Subjects. The subjects were 16 volunteers with PD (modified Hoehn and Yahr stages 1.5–3) and 32 participants without PD who were matched for age, body mass index, and sex. Methods. Range of motion of the extremities was measured using a goniometer, and ROM of the spine was measured using the functional axial rotation (FAR) test, a measure of unrestricted cervico-thoracic-lumbar rotation in the seated position. Motion during reaching was determined using 3-dimensional motion analysis. Group differences were determined using multivariable analysis of variance followed by analysis of variance. Contributions to total reaching distance of segmental excursions (eg, thoracic rotation, thoracic lateral flexion) were determined using forward stepwise regression. Results. Subjects with PD as compared with subjects without PD had less ROM (FAR of 98.2° versus 110.3°, shoulder flexion of 151.9° versus 160.1°) and less forward reaching (29.5 cm versus 34.0 cm). Lateral trunk flexion and total rotation relative to the ground contributed to reaching, with the regression model explaining 36% of the variance. Discussion and Conclusion. These results contribute to the growing body of evidence demonstrating that spinal ROM is impaired early in PD.
Relationship of Therapists' Attitudes, Children's Motor Ability, and Parenting Stress to Mothers' Perceptions of Therapists' Behaviors During Early Intervention
Authors: O'Neil Margaret E , Palisano Robert J , Westcott Sarah L
Published: February 2017

Background and Purpose. Federal law mandates family-centered care as the service delivery model in early intervention programs for children from birth to 36 months of age. This study investigated the relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of physical therapists' family-centered behaviors during early intervention. Subjects and Methods. Twenty-five physical therapists and 75 mother-child dyads (3 from each therapist's caseload) participated. The mean chronological age for the children was 21.2 months (SD=7.3, range=6–35). Mothers participated in a structured interview using the Measures of Processes of Care (MPOC-56), and they completed the Parenting Stress Index-Short Form (PSI-SF) and a questionnaire. The Bayley-II Motor Scale was administered to the children. Therapists completed a modified version of the Measures of Processes of Care for Service Providers (MPOC-SP) and a questionnaire. Results. Scores for mothers on the MPOC-56 and for therapists on the MPOC-SP indicated strong positive perceptions and attitudes toward family-centered behaviors. Hierarchical multiple regression analyses indicated that parenting stress explained a considerable amount of the variance in mothers' perceptions of family-centered behaviors, whereas therapists' attitudes explained a considerable amount of the variance in mothers' perceptions of respectful and supportive care. Children's motor ability was inversely related to parenting stress. Discussion and Conclusion. Findings suggest that mothers perceive that physical therapists are using family-centered behaviors in early intervention. Findings from the questionnaires suggest that some early intervention policies may be barriers for therapists and prevent them from actualizing attitudes toward family-centered behaviors.