bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome and Cost of Craniotomy Performed to Treat Tumors in Regional Academic Referral Centers
Authors: Long Donlin M. , Gordon Toby , Bowman Helen , Etzel Anthony , Burleyson Gregg , Betchen Simone , Garonzik Ira M. , Brem Henry
Published: February 2017

OBJECTIVE

Improved clinical and economic outcomes for high-risk surgical procedures have been previously cited in support of regionalization. The goal of this study was to examine the effects of regionalization by analyzing the cost and outcome of craniotomy for tumors and to compare the findings in academic medical centers versus community-based hospitals.

METHODS

Outcomes and charges were analyzed for all adult patients undergoing craniotomy for tumor in 33 nonfederal acute care hospitals in Maryland using the Maryland Health Service Cost Review Commission database for the years 1990 to 1996. A total of 4723 patients who underwent craniotomy for tumor were selected on the basis of Diagnostic Related Group 1 (craniotomy except for trauma, age 18 or older) and International Classification of Diseases–9th Revision diagnosis code for benign tumor, primary malignant neoplasm, or secondary malignant neoplasm (codes 191, 192, 194, 200, 225, 227, 228, 237, and 239). Hospitals were categorized as high-volume hospitals (>50 craniotomies/yr) or low-volume hospitals (≤50 craniotomies/yr). In-hospital mortality, length of stay, and charges were evaluated.

RESULTS

The mortality rate was 2.5% at high-volume centers and 4.9% at low-volume hospitals with an adjusted relative risk of 1.4 (P < 0.05), assuming equivalence of disease severity. Adjusted average length of stay in high-volume centers was 6.8, as compared with 8.8 days in low-volume hospitals (P < 0.001). Adjusted average total charges were $15,867 at high-volume centers and $14,045 at low-volume centers (P < 0.001). If all patients in the state had been treated at centers with survival rates equal to those achieved by the high-volume centers, then 46 patients would not have died of operation; that is, 48.6% fewer patients would have died, at an additional adjusted cost of $76,395 dollars per patient saved.

CONCLUSION

High-volume regional medical centers are capable of providing services with improved mortality rates and fewer hospital days, although with adjusted costs slightly higher than those at low-volume hospitals.
Alcohol Embolization of Carotid-Cavernous Indirect Fistulae
Authors: Koebbe Christopher J. , Horowitz Michael , Jungreis Charles , Levy Elad , Pless Misha
Published: February 2017

OBJECTIVE

Carotid-cavernous fistulae (CCFs) are abnormal communications between the carotid artery and cavernous sinus that may present with rapid visual deterioration and extraocular paresis as a result of increasing intraocular pressure requiring emergent treatment to preserve vision. We present a technique of balloon-assisted ethanol embolization of the cavernous carotid artery supply to indirect CCFs providing immediate reduction in intraocular pressure with symptomatic improvement.

METHODS

We reviewed clinical and angiographic data and present a retrospective case series illustrating six patients who underwent endovascular embolization because of worsening visual acuity and extraocular motility disorder caused by CCFs. Cerebral angiography revealed significant blood supply from the cavernous carotid artery to these CCFs. We performed ethanol embolization of these branches with distal balloon protection.

RESULTS

Five of the six patients experienced immediate and sustained (mean follow-up, 21 mo) decreases in intraocular pressure, with significant symptom improvement. One patient experienced cavernous sinus thrombosis after conclusion of embolization, which caused a temporary worsening of symptoms that improved gradually over time.

CONCLUSION

Many surgical and endovascular options are available to treat indirect CCFs. Absolute ethanol is a liquid agent that causes immediate vessel sclerosis and occlusion, which makes it a dangerous but potent liquid embolic agent. With distal temporary balloon protection to prevent migration of ethanol, we achieved excellent clinical and angiographic results using absolute ethanol to embolize the cavernous carotid supply to indirect CCFs. This represents a safe and effective method of endovascular management of this complex vascular anomaly.
Inferior Temporal Sulcus Approach for Amygdalohippocampectomy Guided by a Laser Beam of Stereotactic Navigator
Authors: Miyagi Yasushi , Shima Fumio , Ishido Katsuya , Araki Takehisa , Taniwaki Yoshihide , Okamoto Iku , Kamikaseda Kazufumi
Published: February 2017

OBJECTIVE

To describe a surgical technique for a minimally invasive transcortical transventricular amygdalohippocampectomy via the inferior temporal sulcus (ITS) using a stereotactic navigator.

METHODS

Seven patients with medically intractable mesial temporal lobe epilepsy underwent an amygdalohippocampectomy via the ITS. By use of a laser-guided navigation system, the epileptogenic foci of the mesial temporal lobe were resected through a small linear operative route that was made by a brain speculum inserted from the ITS to the anterolateral floor of the temporal horn in the lateral ventricle.

RESULTS

All patients completed at least a 1-year follow-up (range, 14–45 mo) after surgery and had improved neuropsychological parameters as a result of the operation. All patients became seizure-free after surgery. A Humphrey visual field perimeter detected no hemianopsia.

CONCLUSION

Combined with the stereotactic navigation system, the ITS approach provides the least invasive amygdalohippocampectomy that preserves optic radiation. This approach seems beneficial especially in patients in whom the epileptic lesions are limited to the anterior mesial temporal lobe.
A Surgical Technique for Safely Placing a Drug Delivery Catheter into the Pons of Primates: Preliminary Results of Carboplatin Infusion
Authors: Storm Phillip B. , Clatterbuck Richard E. , Liu Ya J. , Johnson Randolph M. , Gillis Edward M. , Guarnieri Michael , Carson Benjamin S.
Published: February 2017

OBJECTIVE

We sought to develop a neurosurgical procedure to access the pons with a drug delivery device for chronic therapy and collect preliminary data on the toxicity of direct infusions of carboplatin in primates.

METHODS

We made midline incisions on five cynomolgus monkeys, identified the inion, made a burr hole 2.5 cm below the inion, and inserted a catheter through the cerebellum into the roof of the pons. Pumps that infused saline for 90 days or carboplatin solutions for 30 to 35 days at 10 μl/d were placed subcutaneously in the low cervical/high thoracic region. Monkeys were assessed by computed tomography and magnetic resonance imaging, laboratory studies, daily neurological observation, postmortem examinations, and histopathology.

RESULTS

Monkeys infused with saline and 82 μg of carboplatin remained neurologically intact throughout the infusion periods. Serial imaging showed that the catheter tip was in the pons and revealed no evidence of hemorrhage, edema, or migration. Two monkeys infused with up to 850 μg of carboplatin showed hyperintense magnetic resonance imaging signals at Days 15 and 18 and neurological deficits at approximately Week 3. Platinum levels greater than 10 ng/mg tissue were detected over a distance of 1 cm in tissue slices. Histopathology demonstrated significant tissue necrosis around the tip of the catheter.

CONCLUSION

The pons of monkeys is safely accessed with a catheter for drug delivery by using a posterior midline approach. Clinical observations, radiographic imaging, and laboratory tests of animals infused with saline for 3 months or 0.26 mg/ml of carboplatin for 1 month were unremarkable. Neurotoxicity was seen with dose levels of 2.6 mg/ml of drug for 1 month. This procedure offers opportunities for examining the toxicity of brainstem antitumor therapy in primates.
Resection Followed by Radiosurgery for Advanced Juvenile Nasopharyngeal Angiofibroma: Report of Two Cases
Authors: Dare Amos O. , Gibbons Kevin J. , Proulx Gary M. , Fenstermaker Robert A.
Published: February 2017

OBJECTIVE AND IMPORTANCE

Experience with the management of juvenile nasopharyngeal angiofibroma (JNA) by gamma knife radiosurgery is limited. We report control of the disease in two patients with advanced-stage JNA treated with primary resection followed by gamma knife stereotactic radiosurgery of residual disease.

CLINICAL PRESENTATION

An 18-year-old man presented with chronic sinusitis, worsening headaches, diplopia, and left-sided facial numbness. A second patient, a 19-year-old man, presented with recurrent epistaxis and nasal congestion. Magnetic resonance imaging findings and endoscopic evaluation in each patient were consistent with advanced-stage JNA.

INTERVENTION

One patient underwent craniofacial resection with approximately 3.0 cm3of residual tumor in the region of the cavernous sinus. The other patient underwent preoperative embolization followed by a lateral rhinotomy for tumor resection with approximately 4.7 cm3of residual tumor in the right infratemporal fossa. In an attempt to limit radiation to surrounding normal brain, residual tumor in both patients was treated with gamma knife stereotactic radiosurgery. Control of disease was documented by magnetic resonance imaging more than 24 months after treatment.

CONCLUSION

Short-term control of late-stage JNA was achieved by use of a strategy of primary surgical resection followed by gamma knife radiosurgery of residual tumor in two patients. Establishing the effectiveness and safety of this strategy over conventional methods of managing advanced JNA will require future prospective studies.
Aneurysms at a Temporopolar Artery Origin from the Internal Carotid Artery: Report of Two Cases
Authors: Alkadhi Hatem , Schuknecht Bernhard , Imhof Hans-Georg , Yonekawa Yasuhiro
Published: February 2017

OBJECTIVE AND IMPORTANCE

Origination of the temporopolar artery (TPA) from the supraclinoid internal carotid artery (ICA) represents a rare anatomic variation, and the presence of aneurysms at this uncommon site has never before been reported.

CLINICAL PRESENTATION

Two patients presented with a sudden onset of headaches and meningism. Computed tomography demonstrated diffuse subarachnoid hemorrhage in both cases. Cerebral angiography revealed ruptured aneurysms originating at a TPA origin from the ICA.

INTERVENTION

The patients were surgically treated, and the aneurysms were successfully clipped. For technical reasons, the TPA was sacrificed in both cases.

CONCLUSION

These are the first reported cases of aneurysms originating at the TPA origin from the ICA. Awareness of the existence of this variation is necessary, particularly for the management of superior wall aneurysms of the ICA.
Preoperative Evaluation of Neural Tracts by Use of Three-dimensional Anisotropy Contrast Imaging in a Patient with Brainstem Cavernous Angioma: Technical Case Report
Authors: Kashimura Hiroshi , Inoue Takashi , Ogasawara Kuniaki , Ogawa Akira
Published: February 2017

OBJECTIVE AND IMPORTANCE

We describe a case of brainstem cavernous angioma in which the neural tracts were evaluated before surgery by three-dimensional anisotropy contrast (3-DAC) magnetic resonance imaging.

CLINICAL PRESENTATION

A 64-year-old man presented with a cavernous angioma located intrinsically in the brainstem and manifesting as gait ataxia. 3-DAC imaging demonstrated that the lesion was located outside the left inferior cerebellar peduncle and inside the middle cerebellar peduncle.

INTERVENTION

The intact brain surface was incised, and the lesion was removed successfully on the basis of the preoperative 3-DAC images. The patient exhibited temporary exacerbation of his gait ataxia, but the symptom improved 3 months after surgery. Postoperative 3-DAC imaging demonstrated resection of the lesion and preservation of the left inferior and middle cerebellar peduncles.

CONCLUSION

3-DAC imaging may provide essential information about the neural tracts for the planning of brainstem surgery.
Anterior Endoscopic Treatment of a Huge Anterior Sacral Meningocele: Technical Case Report
Authors: Jeon Byung-Chan , Kim Do-Heon , Kwon Ki-Young
Published: February 2017

OBJECTIVE AND IMPORTANCE

Anterior endoscopic treatment of a huge anterior sacral meningocele, a rare example of spinal dysraphism, is described.

CLINICAL PRESENTATION

A 43-year-old woman presented with severe headache and fever, increasing abdominal pain, and a several-year history of right lower-extremity radicular pain. She exhibited meningeal irritation signs and Currarino's triad. Lumbosacral myelograms and magnetic resonance imaging scans revealed a huge anterior sacral cyst connected with the spinal subarachnoid space.

INTERVENTION

A straight rigid endoscope was introduced into the meningocele through a small abdominal incision. The fistula between the meningocele and the spinal subarachnoid space was obliterated with multiple fat grafts harvested from the abdomen.

CONCLUSION

An anterior endoscopic procedure is an alternative for the treatment of a huge anterior sacral meningocele.
Simulated Lumbar Minimally Invasive Surgery Educational Model With Didactic and Technical Components
Authors: Chitale Rohan , Ghobrial George M. , Lobel Darlene , Harrop James
Published: February 2017

BACKGROUND:

The learning and development of technical skills are paramount for neurosurgical trainees. External influences and a need for maximizing efficiency and proficiency have encouraged advancements in simulator-based learning models.

OBJECTIVE:

To confirm the importance of establishing an educational curriculum for teaching minimally invasive techniques of pedicle screw placement using a computer-enhanced physical model of percutaneous pedicle screw placement with simultaneous didactic and technical components.

METHODS:

A 2-hour educational curriculum was created to educate neurosurgical residents on anatomy, pathophysiology, and technical aspects associated with image-guided pedicle screw placement. Predidactic and postdidactic practical and written scores were analyzed and compared. Scores were calculated for each participant on the basis of the optimal pedicle screw starting point and trajectory for both fluoroscopy and computed tomographic navigation.

RESULTS:

Eight trainees participated in this module. Average mean scores on the written didactic test improved from 78% to 100%. The technical component scores for fluoroscopic guidance improved from 58.8 to 52.9. Technical score for computed tomography—navigated guidance also improved from 28.3 to 26.6.

CONCLUSION:

Didactic and technical quantitative scores with a simulator-based educational curriculum improved objectively measured resident performance. A minimally invasive spine simulation model and curriculum may serve a valuable function in the education of neurosurgical residents and outcomes for patients.
Translating the Simulation of Procedural Drilling Techniques for Interactive Neurosurgical Training
Authors: Stredney Don , Rezai Ali R. , Prevedello Daniel M. , Elder J. Bradley , Kerwin Thomas , Hittle Bradley , Wiet Gregory J.
Published: February 2017

BACKGROUND:

Through previous efforts we have developed a fully virtual environment to provide procedural training of otologic surgical technique. The virtual environment is based on high-resolution volumetric data of the regional anatomy. These volumetric data help drive an interactive multisensory, ie, visual (stereo), aural (stereo), and tactile, simulation environment. Subsequently, we have extended our efforts to support the training of neurosurgical procedural technique as part of the Congress of Neurological Surgeons simulation initiative.

OBJECTIVE:

To deliberately study the integration of simulation technologies into the neurosurgical curriculum and to determine their efficacy in teaching minimally invasive cranial and skull base approaches.

METHODS:

We discuss issues of biofidelity and our methods to provide objective, quantitative and automated assessment for the residents.

RESULTS:

We conclude with a discussion of our experiences by reporting preliminary formative pilot studies and proposed approaches to take the simulation to the next level through additional validation studies.

CONCLUSION:

We have presented our efforts to translate an otologic simulation environment for use in the neurosurgical curriculum. We have demonstrated the initial proof of principles and define the steps to integrate and validate the system as an adjuvant to the neurosurgical curriculum.
The Development of a Virtual Simulator for Training Neurosurgeons to Perform and Perfect Endoscopic Endonasal Transsphenoidal Surgery
Authors: Rosseau Gail , Bailes Julian , del Maestro Rolando , Cabral Anne , Choudhury Nusrat , Comas Olivier , Debergue Patricia , De Luca Gino , Hovdebo Jordan , Jiang Di , Laroche Denis , Neubauer Andre , Pazos Valerie , Thibault Francis , DiRaddo Robert
Published: February 2017

BACKGROUND:

A virtual reality (VR) neurosurgical simulator with haptic feedback may provide the best model for training and perfecting surgical techniques for transsphenoidal approaches to the sella turcica and cranial base. Currently there are 2 commercially available simulators: NeuroTouch (Cranio and Endo) developed by the National Research Council of Canada in collaboration with surgeons at teaching hospitals in Canada, and the Immersive Touch. Work in progress on other simulators at additional institutions is currently unpublished.

OBJECTIVE:

This article describes a newly developed application of the NeuroTouch simulator that facilitates the performance and assessment of technical skills for endoscopic endonasal transsphenoidal surgical procedures as well as plans for collecting metrics during its early use.

METHODS:

The main components of the NeuroTouch-Endo VR neurosurgical simulator are a stereovision system, bimanual haptic tool manipulators, and high-end computers. The software engine continues to evolve, allowing additional surgical tasks to be performed in the VR environment. Device utility for efficient practice and performance metrics continue to be developed by its originators in collaboration with neurosurgeons at several teaching hospitals in the United States. Training tasks are being developed for teaching 1- and 2-nostril endonasal transsphenoidal approaches. Practice sessions benefit from anatomic labeling of normal structures along the surgical approach and inclusion (for avoidance) of critical structures, such as the internal carotid arteries and optic nerves.

CONCLUSION:

The simulation software for NeuroTouch-Endo VR simulation of transsphenoidal surgery provides an opportunity for beta testing, validation, and evaluation of performance metrics for use in neurosurgical residency training.
On the Horizon
Authors: Moffat Marilyn
Published: February 2017

Service to this wonderful profession and to this Association has been possible because of the love and support of so many. Many individuals have given their unflagging support for so many years. My thanks to all of the past and current members of our Board of Directors, who have truly been the driving force behind our activities; to the members of our House of Delegates, who set our course of action; to all at the component level, who help to steer much of our action and without whose support little would be possible; and to our Headquarters staff, without whose tireless efforts our accomplishments would, quite simply, not be possible. Countless others within the profession have been an integral part of my life, and to them I shall always be indebted for their mentorship, their expertise, their loyalty, and their friendship.
Visual-Vestibular Habituation and Balance Training for Motion Sickness
Authors: Rine Rose Marie , Schubert Michael C , Balkany Thomas J
Published: February 2017

Background and Purpose. This case report describes physical therapy for motion sickness in a 34-year-old woman. The purpose of the report is twofold: (1) to provide an overview of the literature regarding motion sickness syndrome, causal factors, and rationale for treatment and (2) to describe the evaluation and treatment of a patient with motion sickness. Case Description and Outcomes. The patient initially had moderate to severe visually induced motion sickness, which affected her functional abilities and prevented her from working. Following 10 weeks of a primarily home-based program of visual-vestibular habituation and balance training, her symptoms were alleviated and she could resume all work-related activities. Discussion. Although motion sickness affects nearly one third of all people who travel by land, sea, or air, little documentation exists regarding prevention or management.
Cough Threshold in People With Spinal Cord Injuries
Authors: Lin Kwan-Hwa , Lai Yih-Loong , Wu Huey-Dong , Wang Tyng-Quey , Wang Yen-Ho
Published: February 2017

Background and Purpose. The purpose of this study was to compare the cough threshold between people with and without spinal cord injury (SCI). The effect of smoking on cough threshold was also investigated. Subjects. The participants were 26 people with SCI (15 smokers, 11 nonsmokers) and 18 people without SCI (9 smokers, 9 nonsmokers). Methods. Aerosols of citric acid were delivered with incremental doubling concentration from 62.5 mmol to 2 mol. Cough threshold was defined as the first concentration of citric acid that induced at least 2 coughs, which is associated with large chest excursion and concurrently acoustic response. Results. The mean cough thresholds of smokers and nonsmokers with SCI (209 and 417 mmol, respectively) were lower than those of smokers and nonsmokers without SCI (467 and 1,072 mmol, respectively). The mean citric acid cough thresholds decreased in smokers with and without SCI when compared with nonsmokers with and without SCI. Conclusion and Discussion. The cough sensitivity increased in subjects with SCI, and smoking could also increase the cough sensitivity. Training about the frequency and technique of cough in patients with SCI should be carefully monitored.
Establishing the Reliability and Validity of Measurements of Walking Time Using the Emory Functional Ambulation Profile
Authors: Wolf Steven L , Catlin Pamela A , Gage Katherine , Gurucharri Karen , Robertson Renee , Stephen Kathleen
Published: February 2017

Background and Purpose. The Emory Functional Ambulation Profile (E-FAP) measures time to walk in different environments and accounts for use of assistive devices. This study assessed the reliability and validity of walking time measurements using these components. Subjects. Twenty-eight subjects who had strokes and 28 subjects without impairment were recruited. Methods. The E-FAP, Berg Balance Test, Functional Reach Test, and Timed 10-Meter Walk Test were administered in random order during a single data collection session. Results. Interrater reliability for the total E-FAP was ≥.997. Subjects without impairment performed better on all 4 tests than did subjects who had strokes. Increased times on the E-FAP correlated with poor performance on the Berg Balance Test and slow gait speeds on the Timed 10-Meter Walk Test in the subjects who had strokes. The E-FAP scores and the Functional Reach Test scores were not correlated. Conclusion and Discussion. The E-FAP can be administered easily and inexpensively. Because the E-FAP scores differentiated subject groups and correlated with known measures of function, the E-FAP may be a clinically useful measure of ambulation.
An Electromyographic Study of the Hip Abductor Muscles as Subjects With a Hip Prosthesis Walked With Different Methods of Using a Cane and Carrying a Load
Authors: Neumann Donald A
Published: February 2017

Background and Purpose. Certain methods of carrying handheld loads or using a cane can reduce the demands placed on the hip abductor (HA) muscles and the loads on the underlying prosthetic hip. In certain conditions, unusually large forces from the HA muscles may contribute to premature loosening of a prosthetic hip. The purpose of this study was to examine HA use by measuring the amplitude of the electromyographic (EMG) signal from the HA muscles as subjects carried a load and simultaneously used a cane. Subjects. Twenty-four active subjects (mean age=63.3 years, SD=10.7, range=40–86) with a unilateral prosthetic hip were tested. Methods. The HA muscle surface EMG activity was analyzed as subjects carried loads weighing 5%, 10%, or 15% of body weight held by either their contralateral or ipsilateral arm relative to their prosthetic hip. They simultaneously used a cane with their free hand. Results. The contralateral cane and ipsilateral load conditions produced HA muscle EMG activity that was approximately 40% less than the EMG activity produced while walking without carrying a load or using a cane. Conclusion and Discussion. People who are in danger of premature loosening of their prosthetic hip should, if possible, avoid carrying loads. If a load must be carried, however, then the contralateral cane and ipsilateral load condition appears to minimize the loads placed on the prosthetic hip due to HA muscle activity.
Lower-Extremity Muscle Force and Balance Performance in Adults Aged 65 Years and Older
Authors: Daubney Marguerite Elizabeth , Culham Elsie G
Published: February 2017

Background and Purpose.Measures of postural control may be useful for determining fall risk in older people and for determining the outcomes of treatments aimed at improving balance. Commonly used tools measure the output of the postural control system. The purpose of this study was to determine the degree to which one component of postural control (muscle force) contributes to scores on 3 functional balance measures. Subjects. Fifty community-dwelling volunteers between 65 and 91 years of age (X̄=74.82, SD=6.11) participated. Based on their histories, 11 subjects were classified as being at risk for falling. Methods. Measures were the Berg Balance Scale (BBS), the Functional Reach Test (FRT), and the Timed Get Up & Go Test (GUG). The force generated by 12 lower-extremity muscle groups was measured using a handheld dynamometer. Results. In the group reporting no falls, dorsiflexor and subtalar evertor force accounted for 58% of the score on the BBS, ankle plantar-flexor and subtalar invertor force accounted for 48.4% of the score on the GUG, and ankle plantar-flexor force accounted for 13% of the score on the FRT. Ankle dorsiflexor and hip extensor forces were lower in subjects reporting falls, and force of the ankle dorsiflexors predicted fall status. Conclusion and Discussion. Distal muscle force measures may be able to contribute to the prediction of functional balance scores; however, the muscles involved in the prediction differ depending on the measure of balance.
Hospital Restructuring and the Changing Nature of the Physical Therapist's Role
Authors: Lopopolo Rosalie B
Published: February 2017

Background and Purpose. This study was conducted to identify role behavior changes of acute care physical therapists and changes in the organizational and professional context of hospitals following restructuring. Methods. A Delphi technique, which involved a panel of 100 randomly selected acute care physical therapy managers, was used as the research design for this study. Responses from rounds 1 and 2 were synthesized and organized into exhaustive and mutually exclusive categories for round 3. Data obtained from round 3 were used to develop a comprehensive perspective on the changes that have occurred. Results. Changed role behaviors in patient care and professional interaction, including increased emphasis on evaluation, planning, teaching, supervising, and collaboration, appeared to be extensions of unchanged role behaviors. Reported changes in the structural and professional context of physical therapy services included using critical pathways to guide care, providing services system-wide, and using educational activities and meetings to maintain a sense of community. The importance of professionalism to physical therapists' work was identified and related to specific role behavior changes. Conclusion and Discussion. The changing role of physical therapists in acute care hospitals includes an increased emphasis on higher-level skills in patient care and professional interaction and the continuing importance of professionalism.
Effect of Number of Home Exercises on Compliance and Performance in Adults Over 65 Years of Age
Authors: Henry Kristin D , Rosemond Cherie , Eckert Lynn B
Published: February 2017

Background and Purpose. There is limited research on the effects of the number of exercises a person is told to perform on compliance and performance, as defined by cueing requirements, correct alignment, and quality of movement. Some studies of medication suggest that compliance decreases as the number of medications increases. The purpose of this study was to determine whether older adults comply and perform better (ie, requiring less cueing, exhibiting correct alignment, and exhibiting controlled, coordinated, and continuous movements) when they are asked to do 2, 5, or 8 exercises. Subjects. Subjects were 11 women and 4 men, aged 67 to 82 years (X̄=72.8), who were living independently in their communities. Methods. Subjects were randomly prescribed 2, 5, or 8 general strengthening home exercises. They were instructed on their exercises at an initial session and asked to record the number of repetitions performed each day in a self-report exercise log. At a return session 7 to 10 days later, subjects were scored on their performance of the prescribed exercises using a newly designed assessment tool. Results. The group that was prescribed 2 exercises performed better, as defined by their performance tool score, than the group that was prescribed 8 exercises. The group that was prescribed 5 exercises was not different from the groups that performed 2 or 8 exercises. No differences were found among groups regarding the self-report measurement of compliance. There was a moderate correlation between performance scores and the self-report percentage rates. Conclusion and Discussion. Subjects who were prescribed 2 exercises performed better than subjects who were prescribed 8 exercises. The question of an optimal number of exercises to prescribe to elderly people warrants further study.
Hip Moments During Level Walking, Stair Climbing, and Exercise in Individuals Aged 55 Years or Older
Authors: Kirkwood Renata Noce , Culham Elsie G , Costigan Patrick
Published: February 2017

Background and Purpose. Low bone mass of the proximal femur is a risk factor for hip fractures. Exercise has been shown to reduce bone loss in older individuals; however, the exercises most likely to influence bone mass of the proximal femur have not been identified. Net moments of force at the hip provide an indication of the mechanical load on the proximal femur. The purpose of this study was to examine various exercises to determine which exercises result in the greatest magnitude and rate of change in moments of force at the hip in older individuals. Subjects and Methods. Walking and exercise patterns were analyzed for 30 subjects (17 men, 13 women) who were 55 years of age or older (X̄=65.4, SD=6.02, range=55–75) and who had no identified musculoskeletal or neurological impairment. Kinematic and kinetic data were obtained with an optoelectronic system and a force platform. Results. Of the exercises investigated, only ascending stairs generated peak moments higher than those obtained during level walking and only in the transverse plane. Most of the exercises generated moments and rate of change in moments with magnitudes similar to or lower than those obtained during gait. Conclusion and Discussion. Level walking and exercises that generated moments with magnitudes comparable to or higher than those obtained during gait could be combined in an exercise program designed to maintain or increase bone mass at the hip.
Kinematic and Qualitative Analysis of Lower-Extremity Movements in Preterm Infants With Brain Lesions
Authors: van der Heide Jolanda C , Paolicelli Paola B , Boldrini Antonio , Cioni Giovanni
Published: February 2017

Background and Purpose. The purposes of this study were to evaluate the effects of preterm birth, severe brain lesions, and postterm age on kicking movements of young infants and to compare the prognostic value of kinematic analysis of kicking with a qualitative assessment of infants' spontaneous movements. Subjects. The subjects were 12 full-term infants without brain injury, 12 low-risk preterm infants without brain injury, and 11 preterm infants with severe brain lesions (periventricular leukomalacia). Methods. Videotape recordings of each infant's motor behavior in a supine position were made at 1 and 3 months postterm age. Kicking frequency, temporal organization of the kick cycle, coordination among different joints, and interlimb coordination were measured. A qualitative assessment for lower-extremity movements and a Gestalt judgment of general movement quality according to Prechtl's method were made from the same videotape recordings. Results. Kinematic analysis showed only mild differences among the 3 groups of infants. Qualitative assessment of the lower-extremity movements, however, showed that preterm infants with brain lesions, and particularly those who later were found to have cerebral palsy, consistently had fewer segmental movements of the foot and abnormal general movements at both ages. Conclusion and Discussion. The data suggest that the mechanisms responsible for kicking movements in newborns and young infants do not appear to be influenced by the extrauterine environment or by brain lesions, at least at the ages studied. Qualitative assessment of lower-extremity and general movements seems to be more appropriate for clinical purposes.
Cause, Prevalence, and Response to Occupational Musculoskeletal Injuries Reported by Physical Therapists and Physical Therapist Assistants
Authors: Holder Nicole L , Clark Holly A , DiBlasio John M , Hughes Carol L , Scherpf John W , Harding Linn , Shepard Katherine F
Published: February 2017

Background and Purpose. Physical therapists (PTs) and physical therapist assistants (PTAs) are susceptible to occupational musculoskeletal injuries. The purpose of this study was to examine the reported causes and prevalence of occupational musculoskeletal injuries to PTs and PTAs during a 2-year period. Subjects. A questionnaire was mailed to 500 PTs and 500 PTAs randomly selected from the American Physical Therapy Association 1996 active membership list. Six hundred sixty-seven questionnaires were returned, giving a response rate of 67%. Method. Based on a literature review and a pilot study, an occupational injury questionnaire was constructed and mailed. Self-reports of injuries were obtained. Results. Thirty-two percent of the PTs and 35% of the PTAs reported sustaining a musculoskeletal injury. The highest prevalence of injury was to the low back (62% of injured PTs and 56% of injured PTAs). The PTs reported the upper back and the wrist and hand as having the second highest prevalence (23%). The PTAs reported the upper back as having the second highest prevalence (28%). The PTs and PTAs reported making changes in their work habits of improved body mechanics, increased use of other personnel, and frequent change of work position. The majority of PTs and PTAs reported they did not limit patient contact time or area of practice after sustaining an injury. Conclusion and Discussion. Although PTs and PTAs are recognized to knowledgeable in prevention and treatment of musculoskeletal injuries, they are susceptible to sustaining occupational musculoskeletal injuries because of performing labor-intensive tasks.
Association of Low Back Pain With Self-Reported Risk Factors Among Patients Seeking Physical Therapy Services
Authors: Levangie Pamela K
Published: February 2017

Background and Purpose. This study investigated the magnitude of association between low back pain (LBP) and self-reported factors thought to increase the risk of LBP. Subjects and Methods. Questionnaires were completed by 150 patients who were receiving physical therapy for LBP and by 138 patients who were being treated for other reasons. The solicited information was used to estimate odds ratios and 95% confidence intervals for the LBP-risk factor association. Results. Low back pain was positively associated with smoking status, pregnancy, industrial vibration exposure, and time spent in a car (odds ratios ≥ 2.21). Daily lifting, body mass index, activity level, and time sitting or standing showed at most a weak positive association with LBP. Comparisons with estimated associations from other studies were made. Conclusion and Discussion. Data from this study support a statistically significant association between LBP and some factors found in other research to increase the risk of LBP. Study findings may have implications for targeting at-risk groups for back care education or intervention programs.
Treatment of Neuropathic Pain in a Patient With Diabetic Neuropathy Using Transcutaneous Electrical Nerve Stimulation Applied to the Skin of the Lumbar Region
Authors: Somers David L , Somers Martha F
Published: February 2017

Background and Purpose. Diabetic neuropathy can produce severe pain. The purpose of this case report is to describe the alteration of pain in a patient with severe, painful diabetic neuropathy following application of transcutaneous electrical nerve stimulation (TENS) to the low back. Case Description. The patient was a 73-year-old woman with pain in the left lower extremity over the lateral aspect of the hip and the entire leg below the knee. The pain prevented sound sleep. The intensity of pain was assessed with a visual analog scale. Intervention. The TENS (80 Hz) was delivered 1 to 2 hours a day and during the entire night through electrodes placed on the lumbar area of the back. Outcomes. Following 20 minutes of TENS on the first day of treatment, the patient reported a 38% reduction in intensity of pain. After 17 days, the patient reported no pain following 20 minutes of TENS and that she could sleep through the night. Application of TENS to the skin of the lumbar area may be an effective treatment for the pain of diabetic neuropathy.
Balance and Ankle Range of Motion in Community-Dwelling Women Aged 64 to 87 Years: A Correlational Study
Authors: Mecagni Chiara , Smith Janet Pulliam , Roberts Kay E , O'Sullivan Susan B
Published: February 2017

Background and Purpose. This study investigated the relationship between balance measures and ankle range of motion (ROM) in community-dwelling elderly women with no health problems. Identification of modifiable factors associated with balance may enable clinicians to design treatments to help reduce the risk of falls in elderly people. Subjects. The sample consisted of 34 women between the ages of 64 and 87 years (X̄=74.7, SD=6.0). Methods. Goniometry was used to determine bilateral ankle active-assistive range of motion (AAROM) and passive range of motion. Balance capabilities were measured with the Functional Reach Test (FRT) and the Tinetti Performance-Oriented Mobility Assessment (POMA). Balance data for the FRT, POMA balance subtest, POMA gait subtest, and POMA total score were correlated with ankle ROM using the Pearson product moment correlation coefficient (PCC). Results. Correlations between ROM and balance scores were found, ranging from .29 to .63. The POMA gait subtest and FRT resulted in higher correlations with ROM than did the POMA balance subtest (left total AAROM PCC=.63, .51, and .31). Correlations using composite ankle ROM scores were higher than individual motions. The strongest correlation existed between bilateral, total ankle AAROM and the POMA gait subtest scores (PCC=.63) Conclusion and Discussion. Correlations exist between ankle ROM and balance in community-dwelling elderly women. Additional research is needed to determine whether treatment directed at increasing ankle ROM can improve balance.
Patellar Kinematics, Part II: The Influence of the Depth of the Trochlear Groove in Subjects With and Without Patellofemoral Pain
Authors: Powers Christopher M
Published: February 2017

Background and Purpose. A shallow intercondylar groove has been implicated as being contributory to abnormal patellar alignment. The purpose of this study was to assess the influence of the depth of the intercondylar groove on patellar kinematics. Subjects. Twenty-three women (mean age=26.8 years, SD=8.5, range=14–46) with a diagnosis of patellofemoral pain and 12 women (mean age=29.1 years, SD=5.0, range=24–38) without patellofemoral pain participated. Only female subjects were studied because of potential biomechanical differences between sexes. Methods. Patellar kinematics were assessed during resisted knee extension using kinematic magnetic resonance imaging. Measurements of medial and lateral patellar displacement and tilt were correlated with the depth of the trochlear groove (sulcus angle) at 45, 36, 27, 18, 9, and 0 degrees of knee flexion using regression analysis. Results. The depth of the trochlear groove was found to be correlated with patellar kinematics, with increased shallowness being predictive of lateral patellar tilt at 27, 18, 9, and 0 degrees of flexion and of lateral patellar displacement at 9 and 0 degrees of flexion (r=.51–.76). Conclusions and Discussion. The results of this study indicate that bony structure is an important determinant of patellar kinematics at end-range knee extension (0°–30°).
Development of an Activity Scale for Individuals With Advanced Parkinson Disease: Reliability and “On-Off” Variability
Authors: Nieuwboer Alice , De Weerdt Willy , Dom René , Bogaerts Kris , Nuyens Godelieve
Published: February 2017

Background and Purpose. Functional mobility in people with advanced Parkinson disease, some of whom have a variable response to drug treatment, is often difficult to evaluate. The objectives of this study were to investigate the interrater reliability of measurements obtained with a scale designed to measure mobility and to determine the impact of self-rated dyskinesias and fluctuations on the measure. Subjects. Twenty-nine people with Parkinson disease and with disability and considerable disease duration (X̄=11.7 years, SD=4.9, range=6–22) took part in the study. Methods. The subjects' performance on a 10-item scale was videotaped. The videotapes were then scored by 2 independent raters, and the scores were used to determine interrater reliability. The stability of 6 repeated measurements was examined in the home situation, taking into account self-rated fluctuations of motor performance. Results. Weighted Kappa values of agreement (.86–.98) confirmed the reliability between testers. Measurement during the “on” phase (when medication was working optimally) and the “off” phase (when the action of medication was strongly decreased or absent) led to different measurements. Measuring frequently within “on” and “off” phases gave relatively stable measurements for total function, bed transfers, and gait akinesia, the latter during the “off” phase only (intraclass correlation coefficients [ICCs]=.70–.93). However, more modest repeatability applied to transfers from a chair (ICC=.65–.67). Conclusion and Discussion. To ensure valid results in future effect studies, clinical differentiation between “on” and “off” phase measurements is proposed on the basis of patients' own perception of their medication status.
Lower-Extremity Compensations Following Anterior Cruciate Ligament Reconstruction
Authors: Ernst Gregory P , Saliba Ethan , Diduch David R , Hurwitz Shepard R , Ball Donald W
Published: February 2017

Background and Purpose. Several studies have demonstrated that patients with knee injury scored within a normal range during one-legged hop tests yet showed quadriceps femoris muscle weakness with non–weight-bearing isokinetic testing. This study evaluated lower-extremity kinetics while subjects performed a single-leg vertical jump (VJ) and a lateral step-up (LSU) in an attempt to explain this phenomenon. Subjects and Methods. Using a motion analysis and force platform system, hip, knee, and ankle extension moments of 20 subjects with anterior cruciate ligament (ACL) reconstructions and 20 matched subjects were measured while they performed an LSU and a VJ. Results. An analysis of variance revealed that the knee extension moment of the ACL-reconstructed extremity was lower than that of the uninjured and matched extremities during the LSU, VJ take-off, and VJ landing. However, there was no difference in summated extension moment (hip + knee + ankle) among extremities during the LSU and VJ take-off. The summated extension moment of the ACL-reconstructed extremity during VJ landing was less than that of the uninvolved and matched extremities. Conclusions and Discussion. These results suggest that the hip or ankle extensors may compensate for the knee extension moment deficit. The decrease in summated extension moment in the ACL-reconstructed extremity during VJ landing represents inadequate attenuation of landing forces, which may expose the skeleton and joint structures to injury.
Lumbar Lordosis and Pelvic Inclination in Adults With Chronic Low Back Pain
Authors: Youdas James W , Garrett Tom R , Egan Kathleen S , Therneau Terry M
Published: February 2017

Background and Purpose. The causes of lumbopelvic imbalances in standing have been widely accepted by physical therapists, but there is a lack of scientific evidence available to support them. We examined the association between 9 variables and pelvic inclination and lumbar lordosis during relaxed standing. Subjects. Thirty men and 30 women with chronic low back pain (CLBP) for at least 4 months were examined (mean age=54.9 years, SD=9, range=40.4–69.8). Methods. Multiple linear regression modeling was used to assess the association of pelvic inclination and the magnitude of lumbar lordosis in standing with age, sex, body mass index (BMI), Oswestry Back Pain Disability Questionnaire (ODQ) scores, physical activity level, hip flexor muscle length, abdominal muscle force, and range of motion (ROM) for lumbar flexion and extension. Results. In women, age, BMI, and ODQ scores were associated univariately and multivariately with pelvic inclination. In men, lumbar extension ROM was related univariately to pelvic inclination; age, lumbar extension ROM, and ODQ scores were associated multivariately. Lumbar lordosis was associated univariately with only lumbar extension ROM for women and men. A weak correlation was found between angle of pelvic inclination and magnitude of lumbar lordosis in standing (r=.31 for women, r=.37 for men). Conclusion and Discussion. The odds ratio of having CLBP is increased if the score on the double-leg lowering test for abdominal muscles exceeds 50 degrees for men and 60 degrees for women. In patients with CLBP, the magnitude of the lumbar lordosis and pelvic inclination in standing is not associated with the force production of the abdominal muscles.