bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Explicit Information on Implicit Motor-Sequence Learning Following Middle Cerebral Artery Stroke
Authors: Boyd Lara A , Winstein Carolee J
Published: February 2017

Background and Purpose. Recovery of motor skills following stroke is supported, in part, by the implicit memory system. However, attempts to guide learning commonly use explicit instructions concerning “how to” perform a movement task. The purpose of this work was to systematically investigate the impact of explicit information (EI) on implicit motor-sequence learning using the ipsilesional arm in people with damage in the middle cerebral artery (MCA) distribution. Subjects and Methods. Ten people with unilateral stroke in the MCA distribution affecting the sensorimotor cortical areas and 10 people with no known pathology or impairment (control participants) were randomly divided into 2 groups. One group was provided with EI and one group was not (EI and No-EI groups, respectively) as the participants practiced an implicit motor-sequencing task over 3 days, with a retention test on day 4. Results. A 3-way interaction demonstrated that, across days of practice, EI had opposite effects on implicit motor-sequence performance for the 2 groups. Post hoc tests confirmed that EI facilitated the performance of the control participants in the EI group but interfered with the performance of the participants with stroke in the EI group. This interference effect persisted, and was evident during the retention test in the participants with stroke in the EI group. Discussion and Conclusion. Explicit information was detrimental for implicit motor-sequence learning following MCA stroke. Rehabilitation outcomes may benefit from consideration of stroke location when determining the degree to which EI can augment implicit motor skill learning.
Understanding and Treating “Pusher Syndrome”
Authors: Karnath Hans-Otto , Broetz Doris
Published: February 2017

“Pusher syndrome” is a clinical disorder following left or right brain damage in which patients actively push away from the nonhemiparetic side, leading to a loss of postural balance. The mechanism underlying this disorder and its related anatomy have only recently been identified. Investigation of patients with severe pushing behavior has shown that perception of body posture in relation to gravity is altered. The patients experience their body as oriented “upright” when the body actually is tilted to the side of the brain lesion (to the ipsilesional side). In contrast, patients with pusher syndrome show no disturbed processing of visual and vestibular inputs determining visual vertical. These new insights have allowed the authors to suggest a new physical therapy approach for patients with pusher syndrome where the visual control of vertical upright orientation, which is undisturbed in these patients, is the central element of intervention.
Effects of Iontophoresis Current Magnitude and Duration on Dexamethasone Deposition and Localized Drug Retention
Authors: Anderson Carter R , Morris Russell L , Boeh Stephen D , Panus Peter C , Sembrowich Walter L
Published: February 2017

Background and Purpose. Iontophoresis is a process that uses bipolar electric fields to propel molecules across intact skin and into underlying tissue. The purpose of this study was to describe and experimentally examine an iontophoresis drug delivery model. Subjects and Methods. A mechanistic model describing delivery was studied in vitro using agarose gels and was further tested in vivo by evaluation of cutaneous vasoconstriction following iontophoresis in human volunteers. Results. In vitro cathodic iontophoresis at 4 mA and 0.1 mA each delivered dexamethasone/dexamethasone phosphate (DEX/DEX-P) from a 4-mg/mL donor solution to a depth of 12 mm following a 40 mA·minute stimulation dosage. Delivery of DEX/DEX-P to at least the depths of the vasculature in humans was confirmed by observation of cutaneous vasoconstriction. This cutaneous vasoconstriction was longer lasting and greater in magnitude when using low-current, long-duration (∼0.1 mA) iontophoresis compared with equivalent dosages delivered by higher-current, shorter-duration (1.5–4.0 mA) iontophoresis. Discussion and Conclusion. From data gathered with the gel model, the authors developed a model of a potential mechanism of drug depot formation following iontophoresis. The authors believe this drug depot formation to be due to exchange of drug ions for chloride ions as the ionic current carriers. Furthermore, diffusion, not magnitude of current, appears to govern the depth of drug penetration. Although the authors did not address the efficacy of the drug delivered, the results of human experiments suggest that current magnitude and duration should be considered as factors in treating musculoskeletal dysfunctions with iontophoresis using DEX/DEX-P at a concentration of 4 mg/mL.
Musculoskeletal Deterioration and Hemicorporectomy After Spinal Cord Injury
Authors: Shields Richard K , Dudley-Javoroski Shauna
Published: February 2017

Background and Purpose. The long-term management following an hemicorporectomy (HCP) is not well documented in the scientific literature. The purpose of this case report is to describe the 25-year history of a man with a spinal cord injury who experienced severe musculoskeletal deterioration and hemicorporectomy. Case Description. The client sustained T10 complete paraplegia at age 18 years, developed severe decubitus ulcers, and required an HCP as a life-saving measure 13 years later. The authors describe the chronology of several rehabilitation and prosthetic strategies and speculate on factors that may have contributed to their successes and failures. Outcomes. The client survived 12 years after the HCP and returned to independent mobility, self-care, and schooling despite complications with continued skin breakdown. Over the 12 years following discharge from the hospital after the spinal cord injury, he spent 749 days in the hospital. During the 12 years he lived after discharge from the hospital following the HCP, he was hospitalized 190 days. Discussion. The authors discuss factors contributing to the client's musculoskeletal deterioration including chronic wounds, postural deviations, and incomplete adherence to pressure-relief recommendations and raise considerations for physical therapists who treat patients after HCP.
Construct Validation of a Model for Professional Behavior in Physical Therapist Students
Authors: Jette Diane U , Portney Leslie G
Published: February 2017

Background and Purpose. For physical therapist educators, professional behavior has been difficult to define. The purpose of this study was to test the construct validity of a model of professional behavior that was previously established through consensus and reported in the literature. Subjects and Methods. One hundred eighty-three students from 2 professional programs participated in the study. Using a self-administered questionnaire, students assessed how frequently they performed 152 behaviors on a 7-point Likert scale. Data were analyzed using principal components factor analysis. A Cronbach alpha was used to demonstrate internal consistency of items within each factor. Factor scores were submitted as dependent variables in analyses of variance to examine the differences in abilities according to amount of clinical education completed. Results. The analysis identified 7 factors that explained 52% of the variance. These factors were labeled Professionalism, Critical Thinking, Professional Development, Communication Management, Personal Balance, Interpersonal Skills, and Working Relationships. Cronbach alphas ranged from .81 to .95. Behaviors increased in frequency in 4 of the 7 areas identified according to the level of students' progress in the educational program. Discussion and Conclusion. The 7 factors corresponded fairly well to the 10 generic abilities previously identified. Although some behaviors may increase in frequency over the course of students' educational experience, others may be displayed at admission.
Psychometric Properties of the Dutch Chronic Fatigue Syndrome–Activities and Participation Questionnaire (CFS-APQ)
Authors: Nijs Jo , Vaes Peter , McGregor Neil , Van Hoof Elke , Meirleir Kenny De
Published: February 2017

Background and Purpose. The Chronic Fatigue Syndrome–Activities and Participation Questionnaire (CFS-APQ) is a recently developed disease-specific assessment tool for monitoring activity limitations and participation restrictions in patients with chronic fatigue syndrome (CFS). In this study, the convergent validity, content validity, and test-retest reliability of data obtained with the Dutch-language version of the questionnaire were examined. Subjects and Methods. One hundred eleven consecutive patients with CFS were enrolled, of whom 47 fulfilled all inclusion criteria. The subjects were first asked to rate their pain, fatigue, and ability to concentrate using 3 visual analog scales, to list at least 5 activities that had become difficult to perform due to their complaints, and to complete the CFS-APQ. Furthermore, subjects were asked to complete a modified version of the CFS-APQ at home and return it to the investigators. The content of the questionnaire was reviewed using the World Health Organization's International Classification of Impairments, Disability and Health (ICIDH) beta II draft. Spearman rank correlation coefficients (R) were used for the convergent validity analysis, and intraclass correlation coefficients were computed for the assessment of the test-retest data. Results. Overall scores on the CFS-APQ correlated with the scores from the visual analog scales for pain (R=.51, P<.001) and fatigue (R=.50, P<.001). The majority of the responses (157 out of 183 answers [85.8%]) to the request to “list difficult activities” matched the content of the CFS-APQ. Using the ICIDH beta II draft, 21 out of 26 questions were found to address activities, and the remaining 5 questions measured the participation level. The Cronbach alpha coefficient was .94, and intraclass correlation coefficients for test-retest reliability of the overall scores were ≥.95 (P<.001). Discussion and Conclusion. The results substantiate the convergent validity, content validity, and reliability of the CFS-APQ scores for patients with CFS.
The Hypothesis-Oriented Algorithm for Clinicians II (HOAC II): A Guide for Patient Management
Authors: Rothstein Jules M , Echternach John L , Riddle Daniel L
Published: February 2017

In this era of health care accountability, a need exists for a new decision-making and documentation guide in physical therapy. The original Hypothesis-Oriented Algorithm for Clinicians (HOAC) provided clinicians and students with a framework for science-based clinical practice and focused on the remediation of functional deficits and how changes in impairments related to these deficits. The HOAC II was designed to address shortcomings in the original HOAC and be more compatible with contemporary practice, including the Guide to Physical Therapist Practice. Disablement terminology is used in the HOAC II to guide clinicians and students when documenting patient care and incorporating evidence into practice. The HOAC II, like the HOAC, can be applied to a patient regardless of age or disorder and allows for identification of problems by physical therapists when patients are not able to communicate their problems. A feature of the HOAC II that was lacking in the original algorithm is the concept of prevention and how to justify and document interventions directed at prevention.
The Stroke Rehabilitation Assessment of Movement (STREAM): A Comparison With Other Measures Used to Evaluate Effects of Stroke and Rehabilitation
Authors: Ahmed Sara , Mayo Nancy E , Higgins Johanne , Salbach Nancy M , Finch Lois , Wood-Dauphinée Sharon L
Published: February 2017

Background and Purpose. The Stroke Rehabilitation Assessment of Movement (STREAM) is a relatively new measure of voluntary movement and basic mobility. The main objectives of this study were: (1) to examine the relationship of the STREAM to other measures of impairment and disability and (2) to compare its usefulness for evaluating effects of stroke and rehabilitation and for assessing change over time with that of other measures of impairment and disability. Subjects and Methods. The performance of 63 patients with acute stroke on the STREAM and other measures of impairment and disability was evaluated during the first week after stroke and 4 weeks and 3 months later. Results. Scores on the STREAM were associated with scores on the Box and Block test, Balance Scale, Barthel Index, gait speed, and the Timed “Up & Go” Test (with Pearson correlation coefficients ranging from .57 to .80) and were associated with categories of the Barthel Index and Balance Scale. The STREAM's ability to predict discharge destination from the acute care hospital, as well as to predict gait speed and Barthel Index scores at 3 months poststroke, was comparable to that of other commonly used measures. Standardized response mean estimates provided supporting evidence for the ability of the STREAM to reflect change over time. Discussion and Conclusion. The results obtained with the STREAM, as compared with other measures of impairment and disability in people with stroke, suggest that it may be useful in clinical practice and research.
Screening, Education, and Associated Behavioral Responses to Reduce Risk for Falls Among People Over Age 65 Years Attending a Community Health Fair
Authors: Ness Kirsten K , Gurney James G , Ice Gillian H
Published: February 2017

Background and Purpose. Because of the high risk of falling and the recognition that falling is a “geriatric syndrome,” screening for risk of falls has become popular at community health fairs. The purposes of this study were to determine whether health fair screening and educational intervention would result in behaviors that could reduce the risk of falls and to determine whether adoption of risk-reduction behaviors differed between people over age 65 years screened as being at high risk for falls and those screened as being at lower risk for falls. Subjects and Methods. The Berg Balance Test was used to classify fall risk in 68 individuals aged 57 to 89 years who were attending a community health fair. A score of 45 or lower led to a categorization of the person being at high risk for falls. All subjects were provided recommendations intended to reduce fall risk. Participants were interviewed by telephone 30 days after the screening to assess implementation of these recommendations. Results. Seventy-two percent of the participants reported implementing at least one risk-reduction behavior. The high-risk group was more likely to implement risk-reduction behaviors than the low-risk group. Discussion and Conclusion. Screening and education in a health fair setting appear to promote behaviors that could reduce fall risk among elderly people. Future study with a control group that does not receive an educational intervention is needed to draw more definite conclusions about the value of this health promotion activity for fall prevention.
Effect of Duration of a Moderate Exercise Program on Primary and Secondary Immune Responses in Mice
Authors: Kapasi Zoher F , Catlin Pamela A , Adams Meredith A , Glass Elizabeth G , McDonald Bart W , Nancarrow Alyson C
Published: February 2017

Background and Purpose. Moderate exercise conducted over a 4- to 8-week period enhances secondary antibody response and is mediated, in part, by endogenous opioids. Because changes in circulating levels of endogenous opioids occur after each exercise session, the researchers in this study tested the hypothesis that a shorter exercise program of 2 weeks may be sufficient to enhance secondary antibody response. Another purpose of this study was to examine the effects of a moderate exercise program completed prior to the primary immunization on the secondary antibody response in mice. Subjects and Methods. Young (8- to 10-week-old), syngeneic, female C57BL/6 mice were randomly assigned to exercise (2 or 8 weeks) and sedentary intervention protocols. Mice were immunized against human serum albumin (HSA), and serum anti-HSA antibody levels were measured (in micrograms per milliliter) using an enzyme-linked immunosorbent assay (ELISA). Results. The secondary antibody response was comparable in mice exercising for 2 or 8 weeks and was enhanced over sedentary controls. Discussion and Conclusion. A moderate exercise program of 2 weeks may be sufficient to improve secondary antibody production and may be a useful strategy to enhance antibody response to vaccinations in humans. Furthermore, an exercise program that includes exercise prior to the primary immunization in addition to exercise following primary immunization may not provide additional enhancement of secondary antibody response.
Reliability of the PEDro Scale for Rating Quality of Randomized Controlled Trials
Authors: Maher Christopher G , Sherrington Catherine , Herbert Robert D , Moseley Anne M , Elkins Mark
Published: February 2017

Background and Purpose. Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions. Method. In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]). Results. The kappa value for each of the 11 items ranged from .36 to .80 for individual assessors and from .50 to .79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was .56 (95% confidence interval=.47–.65) for ratings by individuals, and the ICC for consensus ratings was .68 (95% confidence interval=.57–.76). Discussion and Conclusion. The reliability of ratings of PEDro scale items varied from “fair” to “substantial,” and the reliability of the total PEDro score was “fair” to “good.”
Effect of Computer Keyboard Slope on Wrist Position and Forearm Electromyography of Typists Without Musculoskeletal Disorders
Authors: Simoneau Guy G , Marklin Richard W , Berman Joseph E
Published: February 2017

Background and Purpose. Positioning a computer keyboard with a downward slope reduces wrist extension needed to use the keyboard and has been shown to decrease pressure in the carpal tunnel. However, whether a downward slope of the keyboard reduces electromyographic (EMG) activity of the forearm muscles, in particular the wrist extensors, is not known. Subjects and Methods. Sixteen experienced typists participated in this study and typed on a conventional keyboard that was placed on slopes at angles of 7.5, 0, −7.5, and −15 degrees. Electromyographic activity of the extensor carpi ulnaris (ECU), flexor carpi ulnaris (FCU), and flexor carpi radialis (FCR) muscles was measured with surface electrodes, while the extension and ulnar deviation angles of the right and left wrists were measured with electrogoniometers. Results. Wrist extension angle decreased from approximately 12 degrees of extension while typing on a keyboard with a 7.5-degree slope to 3 degrees of flexion with the keyboard at a slope of −15 degrees. Although the differences were in the range of 1% to 3% of maximum voluntary contraction (MVC), amplitude probability distribution function (APDF) of root-mean-square EMG data points from the ECU, FCU, and FCR muscles varied across keyboard slopes. Discussion and Conclusion. Wrist extension decreased as the keyboard slope decreased. Furthermore, a slight decrease in percentage of MVC of the ECU muscle was noted as the keyboard slope decreased. Based on biomechanical modeling and published work on carpal tunnel pressure, both of these findings appear to be positive with respect to comfort and fatigue, but the exact consequences of these findings on the reduction or prevention of injuries have yet to be determined. The results may aid physical therapists and ergonomists in their evaluations of computer keyboard workstations and in making recommendations for interventions with regard to keyboard slope angle.
Identification of Individuals With Patellofemoral Pain Whose Symptoms Improved After a Combined Program of Foot Orthosis Use and Modified Activity: A Preliminary Investigation
Authors: Sutlive Thomas G , Mitchell Scott D , Maxfield Stephanie N , McLean Cynthia L , Neumann Jon C , Swiecki Christine R , Hall Robert C , Bare Anthony C , Flynn Timothy W
Published: February 2017

Background and Purpose. In patients with patellofemoral pain syndrome (PFPS), the authors determined which aspects of the examination could be used to identify those patients most likely to respond to off-the-shelf foot orthoses and instruction in activity modification. Participants and Methods. Fifty participants were enrolled in the study, and data for 5 individuals were excluded from analysis. Thirty-four men and 11 women completed the study. Participants were given foot orthoses and instructed in activity modification for 3 weeks. A 50% reduction in pain was considered a success. Likelihood ratios (LRs) were computed to determine which examination findings were most predictive of success. Results. The best predictors of improvement were forefoot valgus alignment of ≥2 degrees (+LR=4.0, 95% confidence interval [CI]=0.7–21.9), great toe extension of ≤78 degrees (+LR=4.0, 95% CI=0.7–21.9), and navicular drop of ≤3 mm (+LR=2.4, 95% CI=1.3–4.3). Discussion and Conclusion. The results suggest that patients with PFPS who have forefoot valgus alignment of ≥2 degrees, passive great toe extension of ≤78 degrees, or navicular drop of ≤3 mm are most likely to respond favorably to initial intervention with an off-the-shelf foot orthosis and instruction in activity modification.
Decision Making for Physical Therapy Service Delivery in Schools: A Nationwide Survey of Pediatric Physical Therapists
Authors: Kaminker Marcia K , Chiarello Lisa A , O'Neil Margaret E , Dichter Carol Gildenberg
Published: February 2017

Background and Purpose. A nationwide survey was conducted to explore decision making among school-based physical therapists and to examine recommendations regarding the models, contexts, frequency, and intensity of physical therapy service delivery. Factors that the therapists considered important in making clinical decisions also were examined. Subjects and Methods. A survey instrument using a clinical case format was sent to all members of the American Physical Therapy Association's Section on Pediatrics who identified themselves as school-based therapists (N=1,154); 626 respondents, from all 50 states, completed the survey. Four case descriptions were presented in the survey: 2 preschool girls with developmental delay (1 with and 1 without cognitive impairment) and a boy with cerebral palsy (at 6 and 12 years of age). Results. Individual direct services were recommended by 52% to 55% of the respondents for both 4-year-old girls and for the boy at 12 years of age; 92% of the respondents recommended them for the boy at 6 years of age. The most prevalent choice (48%-73%) for the context of service delivery (location or environment) was a combination of integrated and isolated contexts. For those respondents who selected direct services (individual or group, or both), the mean recommended monthly frequency for the boy at 6 years of age (5.8) was more than twice that for the boy at 12 years of age (2.4). The mean suggested direct frequency for the girl with cognitive impairment (4.5) was greater than that for the girl without cognitive impairment (4). The students' functional levels were considered very to extremely important in decision making by 87% to 90% of the respondents. Discussion and Conclusion. Survey responses were relatively consistent with current literature regarding school practice and principles of motor learning. Recommendations varied for each case, regarding the models, contexts, frequency, and intensity of physical therapy service delivery.
Motor Imagery for Gait Rehabilitation in Post-Stroke Hemiparesis
Authors: Dickstein Ruth , Dunsky Ayelet , Marcovitz Emanuel
Published: February 2017

Background and Purpose. Reports have described the contribution of motor imagery (MI) practice for improving upper-extremity functions in patients with hemiparesis following stroke. The purpose of this case report is to describe the use of MI practice to attempt to improve walking in an individual with hemiparesis. Case Description. A 69-year-old man with left hemiparesis received MI gait practice for 6 weeks. Intervention focused on task-oriented gait and on impairments of the affected lower limb. Preintervention, midterm, postintervention, and follow-up measurements of temporal-distance stride parameters and sagittal kinematics of the knee joint were taken. Main Outcomes. At 6 weeks postintervention, the patient had a 23% increase in gait speed and a 13% reduction in double-support time. An increase in range of motion of the knees also was observed. No changes in gait symmetry were noted. Discussion. The outcomes suggest that MI may be useful for the enhancement of walking ability in patients following stroke. Because improvement was mainly in temporal-distance gait variables and knee movement, imagery practice probably should focus on its specific impairments during gait in order to affect the performance of the paretic lower extremity.
Evidence Underlying Breathing Retraining in People With Stable Chronic Obstructive Pulmonary Disease
Authors: Dechman Gail , Wilson Christine R
Published: February 2017

The efficacy of pursed-lip breathing (PLB) and diaphragmatic breathing (DB) in the rehabilitation of people with chronic obstructive pulmonary disease (COPD) remains unclear. This review examines the evidence regarding the usefulness of these techniques in improving the breathing of people with stable COPD. The studies included in our review of the literature used either PLB or DB in isolation, contained a clear description of the methods, and used outcomes that were measured with what we considered to be appropriate procedures. Pursed-lip breathing slows the respiratory rate, and evidence suggests that this decreases the resistive pressure drop across the airways and, therefore, decreases airway narrowing during expiration. This decrease in airway narrowing may account for the decreased dyspnea some people experience when using this technique. Diaphragmatic breathing has negative and positive effects, but the latter appear to be caused by simply slowing the respiratory rate. Evidence supports the use of PLB, but not DB, for improving the breathing of people with COPD.
Leadership, Administration, Management, and Professionalism (LAMP) in Physical Therapy: A Delphi Study
Authors: Lopopolo Rosalie B , Schafer D Sue , Nosse Larry J
Published: February 2017

Background and Purpose. The knowledge and skills needed by physical therapists entering practice in the areas of leadership, administration, management, and professionalism (LAMP) are not known. Using the LAMP components identified by American Physical Therapy Association's Section on Administration, this study sought to define the range of LAMP content pertinent to physical therapy clinical management and to explore LAMP knowledge and skills required of physical therapists upon entry into the profession. Subjects and Methods. Thirty-four physical therapist managers participated in a Delphi study to (1) create a comprehensive list of defined LAMP components, (2) determine the perceived importance of each component in the management of clinical practices, and (3) identify the level of knowledge and skill for each component believed to be necessary for a new physical therapist graduate. Results. Respondents agreed that 178 items should be on the LAMP component list. They perceived that almost all LAMP components are important in the management of a clinical practice, and they indicated that new graduates needed moderate to extensive knowledge in 44% of them. They believed that new graduates needed no skill in 29% of the components, whereas they needed at least intermediate skill for 22% of them. Top-ranked component categories across the 3 scales (importance, knowledge, and skill) were communication, professional involvement and ethical practice, delegation and supervision, stress management, reimbursement sources, time management, and health care industry scanning. Discussion and Conclusion. This study provides a basis for further exploration of which LAMP components should be included in professional (entry-level) physical therapist curricula and which components should be learned after graduation.
Recovery of Ambulation During Inpatient Rehabilitation: Physical Therapist Prognosis for Children and Adolescents With Traumatic Brain Injury
Authors: Dumas Helene M , Haley Stephen M , Ludlow Larry H , Carey Tara M
Published: February 2017

Background and Purpose. Evidence to guide physical therapist prognosis for recovery of the ability to ambulate in children and adolescents with traumatic brain injury (TBI) is limited. The aim of this study was to delineate a predictive model and determine the value of key demographic and clinical variables in establishing a prognosis for ambulation without the assistance of a device or person over 15.24 m on a flat, level surface following inpatient rehabilitation. Subjects and Methods. For this retrospective study, a consecutive series of 95 children and adolescents with TBI (aged 2–18 years) admitted to an inpatient rehabilitation program was assessed using information from medical records. A multiple logistic regression analysis was conducted to identify predictors for ambulation at the time of discharge from the rehabilitation setting. Results. Fifty-six percent of the children achieved ambulation at discharge. Lower-extremity hypertonicity (measured on physical therapist examination as resistance to passive stretch), brain injury severity, and lower-extremity injury together were predictors of the ability to ambulate. Discussion and Conclusion. Impairment and injury-related variables were important in predicting a minimal level of unassisted ambulation after discharge from inpatient rehabilitation. Awareness of predictors of recovery of the ability to ambulate that are gathered as part of a physical therapist's examination may assist in developing a prognosis for ambulation and in establishment of an appropriate plan of care.
Clinical Reasoning Strategies in Physical Therapy
Authors: Edwards Ian , Jones Mark , Carr Judi , Braunack-Mayer Annette , Jensen Gail M
Published: February 2017

Background and Purpose. Clinical reasoning remains a relatively under-researched subject in physical therapy. The purpose of this qualitative study was to examine the clinical reasoning of expert physical therapists in 3 different fields of physical therapy: orthopedic (manual) physical therapy, neurological physical therapy, and domiciliary care (home health) physical therapy. Subjects. The subjects were 6 peer-designated expert physical therapists (2 from each field) nominated by leaders within the Australian Physiotherapy Association and 6 other interviewed experts representing each of the same 3 fields. Methods. Guided by a grounded theory method, a multiple case study approach was used to study the clinical practice of the 6 physical therapists in the 3 fields. Results. A model of clinical reasoning in physical therapy characterized by the notion of “clinical reasoning strategies” is proposed by the authors. Within these clinical reasoning strategies, the application of different paradigms of knowledge and their interplay within reasoning is termed “dialectical reasoning.” Discussion and Conclusion. The findings of this study provide a potential clinical reasoning framework for the adoption of emerging models of impairment and disability in physical therapy.
Diagnosing Suprascapular Neuropathy in Patients With Shoulder Dysfunction: A Report of 5 Cases
Authors: Walsworth Matthew K , Mills James T , Michener Lori A
Published: February 2017

Background and Purpose. Suprascapular neuropathy, resulting in shoulder pain and weakness, is frequently misdiagnosed. The consequences of misdiagnosis can include inappropriate physical rehabilitation or surgical procedures. The purpose of this case report is to describe the differential diagnosis of suprascapular neuropathy. Case Descriptions. Five patients were initially diagnosed with subacromial impingement syndrome and referred for physical therapy. Physical therapist examination findings were consistent with subacromial impingement syndrome and suprascapular neuropathy. Subsequent electrophysiologic testing confirmed the diagnosis of suprascapular neuropathy in all 5 patients. Discussion. The differential diagnosis of patients with suprascapular neuropathy includes subacromial impingement syndrome, rotator cuff pathology, C5–6 radiculopathy, and upper trunk brachial plexopathy. The diagnostic process and a table with key findings based on evidence and clinical experience is presented for differential diagnosis.
Vestibulo-ocular Physiology Underlying Vestibular Hypofunction
Authors: Schubert Michael C , Minor Lloyd B
Published: February 2017

The vestibular system detects motion of the head and maintains stability of images on the fovea of the retina as well as postural control during head motion. Signals representing angular and translational motion of the head as well as the tilt of the head relative to gravity are transduced by the vestibular end organs in the inner ear. This sensory information is then used to control reflexes responsible for maintaining the stability of images on the fovea (the central area of the retina where visual acuity is best) during head movements. Information from the vestibular receptors also is important for posture and gait. When vestibular function is normal, these reflexes operate with exquisite accuracy and, in the case of eye movements, at very short latencies. Knowledge of vestibular anatomy and physiology is important for physical therapists to effectively diagnose and manage people with vestibular dysfunction. The purposes of this article are to review the anatomy and physiology of the vestibular system and to describe the neurophysiological mechanisms responsible for the vestibulo-ocular abnormalities in patients with vestibular hypofunction.
Gross Motor Capability and Performance of Mobility in Children With Cerebral Palsy: A Comparison Across Home, School, and Outdoors/Community Settings
Authors: Tieman Beth L , Palisano Robert J , Gracely Edward J , Rosenbaum Peter L
Published: February 2017

Background and Purpose. Mobility of children with cerebral palsy (CP) has generally been examined in terms of capability (what a child can do) in a controlled environment, rather than performance (what a child does do) in everyday settings. The purpose of this study was to compare gross motor capability and performance across environmental settings in children with CP. Subjects. The subjects were 307 children with CP, aged 6 to 12 years, who were randomly selected across Ontario, Canada. Methods. Children were grouped by capability (the highest of 3 items achieved on the Gross Motor Function Measure). Performance was measured via a parent-completed questionnaire on usual mobility methods in the home, at school, and in the outdoors or community. Results. There were statistically significant differences in performance across settings for children in all capability groups. Children who were capable of crawling performed crawling more at home than at school or in the outdoors or community. Children who were capable of walking with support performed walking with support more at school than in the outdoors or community. Children who were capable of walking alone performed walking alone more at home than at school or in the outdoors or community, and more at school than in the outdoors or community. Discussion and Conclusion. The results provide evidence that children with CP with similar capability demonstrate differences in performance across settings. The results suggest that physical therapists should examine performance in the settings that are important to the child's daily life.
Psychometric Properties of 2 Simplified 3-Level Balance Scales Used for Patients With Stroke
Authors: Wang Chun-Hou , Hsueh I-Ping , Sheu Ching-Fan , Yao Grace , Hsieh Ching-Lin
Published: February 2017

Background and Purpose. To determine if the 3-level scales yield data as reliable and valid as data obtained for the original scales, 2 simplified 3-level measures of balance—a modified Berg Balance Scale (BBS-3P) and a modified Postural Assessment Scale for Stroke Patients (PASS-3P)—were proposed by the researchers, and psychometric properties of each were compared with those of the original measures (the Berg Balance Scale [BBS] and the Postural Assessment Scale for Stroke Patients [PASS], respectively) in patients with stroke. Subjects and Methods. The study consisted of 2 parts. The first part examined the reliability and concurrent and convergent validity of measurements obtained with these instruments. A total of 77 patients participated in this part of the study. The 3 levels in the center of the BBS were collapsed to a single level (ie, 0–2–4) to form the BBS-3P. Similarly, the 2 middle scores of the center of the PASS were averaged (ie, 0–1.5–3) to form the PASS-3P. In the second part of the study, the predictive validity and responsiveness of these measures were examined. The BBS and PASS scores of 226 patients were retrieved from the records of participants in the Quality of Life After Stroke Study, and these scores were converted into the proposed BBS-3P and PASS-3P scores. Results. The BBS-3P and PASS-3P showed high concurrent validity with the BBS and PASS, good predictive validity for disability, and moderate to high responsiveness. Importantly, the psychometric properties of the BBS-3P and PASS-3P were essentially identical to those of the original BBS and PASS. Discussion and Conclusion. The psychometric properties of both simplified 3-level balance measures were comparable to those of the full, nontruncated scales. Future study is needed to investigate how much meaningful utility can be gained from the scheme of simplification of scaling.
Childrearing Practices and Developmental Expectations for Mexican-American Mothers and the Developmental Status of Their Infants
Authors: Kolobe Thubi HA
Published: February 2017

Background and Purpose. The impact of parent education programs on early intervention programs is not thought to be uniform among children from majority and minority populations. This study examined the relationship between maternal childrearing practices and behaviors and the developmental status of Mexican-American infants. Subjects. Participants were 62 Mexican-American mother-infant pairs. The infants' mean adjusted age was 12 months (SD=1.7, range=9–14). A third of the children were diagnosed with developmental delays and referred for early intervention by physicians or therapists when the children received their medical follow-up. The group was stratified according to socioeconomic status and acculturation using the Bidimensional Acculturation Scale for Hispanics. This scale uses cutoff points to classify individuals into 3 levels of acculturation. Methods. Information on childrearing practices and behaviors was gathered using the Parent Behavior Checklist (PBC), the Home Observation for Measurement of the Environment (HOME) Inventory, and the Nursing Child Assessment Teaching Scale (NCATS). Infants' developmental status was assessed by use of the Bayley Scales of Infant Development II (BSID II). The Pearson product moment correlation, partial correlations, Fisher z transformation, and multiple regression analyses were used to examine the relationship between childrearing practices and parenting behaviors, demographic factors, and infants' developmental status. Results. Maternal nurturing behaviors, parent-child interaction, and quality of the home environment were positively correlated with the infants' cognitive development. Maternal years of education modified the observed relationship between PBC and BSID II scores but not the observed relationship between HOME Inventory and NCATS scores. The childrearing practices, maternal socioeconomic status (SES) and age, and infants' gestational age at birth (GA) explained 45% of the variance in infants' cognitive scores. The infants' GA, maternal SES and age, and NCATS scores accounted for 32% of the motor scores on the BSID II. Discussion and Conclusion. The findings partially support a link between aspects of the mothers' childrearing behaviors and their infants' cognitive developmental status. For motor developmental status, the association appeared stronger with the infants' characteristics than with maternal childrearing practices and behaviors tested in this study.
Challenges for Evidence-Based Physical Therapy: Accessing and Interpreting High-Quality Evidence on Therapy
Authors: Maher Christopher G , Sherrington Catherine , Elkins Mark , Herbert Robert D , Moseley Anne M
Published: February 2017

Although there is a growing awareness of evidence-based practice among physical therapists, implementation of evidence-based practice has proved difficult. This article discusses barriers to access and interpretation of evidence. Some solutions are offered, including facilitating the publication of all research, use of an optimum format for reporting research, maximizing the efficient use of electronic databases, improving physical therapists' skills in critical appraisal of published research, and fostering consumer access to evidence. These strategies and others discussed in the article might facilitate implementation of evidence-based physical therapy.
Passive Versus Active Stretching of Hip Flexor Muscles in Subjects With Limited Hip Extension: A Randomized Clinical Trial
Authors: Winters Michael V , Blake Charles G , Trost Jennifer S , Marcello-Brinker Toni B , Lowe Lynne , Garber Matthew B , Wainner Robert S
Published: February 2017

Background and Purpose. Active stretching is purported to stretch the shortened muscle and simultaneously strengthen the antagonist muscle. The purpose of this study was to determine whether active and passive stretching results in a difference between groups at improving hip extension range of motion in patients with hip flexor muscle tightness. Subjects and Methods. Thirty-three patients with low back pain and lower-extremity injuries who showed decreased range of motion, presumably due to hip flexor muscle tightness, completed the study. The subjects, who had a mean age of 23.6 years (SD=5.3, range=18–25), were randomly assigned to either an active home stretching group or a passive home stretching group. Hip extension range of motion was measured with the subjects in the modified Thomas test position at baseline and 3 and 6 weeks after the start of the study. Results. Range of motion in both groups improved over time, but there were no differences between groups. Discussion and Conclusion. The results indicate that passive and active stretching are equally effective for increasing range of motion, presumably due to increased flexibility of tight hip flexor muscles. Whether the 2 methods equally improve flexibility of other muscle groups or whether active stretching improves the function of the antagonist muscles is not known. Active and passive stretching both appeared to increase the flexibility of tight hip flexor muscles in patients with musculoskeletal impairments.
Differences in Quadriceps Femoris Muscle Torque When Using a Clinical Electrical Stimulator Versus a Portable Electrical Stimulator
Authors: Lyons Christian L , Robb Joel B , Irrgang James J , Fitzgerald G Kelley
Published: February 2017

Background and Purpose. There have been conflicting views and evidence reported in the literature concerning differences in muscle torque-generating capacities between clinical (“plug-in”) console devices whose power source is provided by an electrical outlet (60 Hz, alternating current-driven) and portable electrical muscle stimulators (smaller, battery-operated stimulators). The purpose of this study was to compare the torque-generating capacity of the quadriceps femoris muscle during neuromuscular electrical stimulation (NMES) between a clinical neuromuscular electrical stimulator (VersaStim 380) and a portable neuromuscular electrical stimulator (Empi 300PV). Subjects. Forty volunteer subjects with no known knee, neurological, or cardiovascular pathology (22 male, 18 female) participated in the study. Methods. All subjects were tested with the clinical and portable stimulators on 2 separate days. Peak isometric torque of the quadriceps femoris muscle was measured using a Biodex dynamometer. Peak isometric quadriceps femoris muscle torque achieved during NMES and the average quadriceps femoris muscle torque integral produced over 10 NMES contractions were measured for each stimulator. Subjects also rated the amount of pain they experienced during the 10 NMES contractions using a numeric pain scale. Paired t tests were used to compare mean differences in measured variables between stimulator conditions. Results. There were no differences in the peak torque or numeric pain ratings during the electrically stimulated contractions between stimulator conditions. The Empi 300PV produced a greater average torque integral compared with the VersaStim 380 during 10 electrically stimulated contractions (Empi 300PV=988.6±330.4 N·m-s, Versastim 380=822.7±292.6 N·m-s). Discussion and Conclusion. The portable Empi 300PV stimulator produced comparable levels of average peak torque at comparable levels of discomfort to those produced by the VersaStim 380 clinical stimulator. The Empi 300PV maintained greater amounts of torque production during a 10-contraction training session compared with the VersaStim 380. Based on these data, we believe that the Empi 300PV has the potential to produce adequate levels of torque production for NMES quadriceps femoris muscle performance training. Further study is needed to determine the effectiveness of using the Empi 300PV for quadriceps femoris muscle performance training.
Robotic-Assisted, Body-Weight–Supported Treadmill Training in Individuals Following Motor Incomplete Spinal Cord Injury
Authors: Hornby T George , Zemon David H , Campbell Donielle
Published: February 2017

Background and Purpose. Performance of therapist-assisted, body-weight–supported treadmill training (BWSTT) to enhance walking ability of people with neurological injury is an area of intense research. Its application in the clinical setting, however, is limited by the personnel and labor requirements placed on physical therapists. Recent development of motorized (“robotic”) rehabilitative devices that provide assistance during stepping may improve delivery of BWSTT. Case Description. This case report describes the use of a robotic device to enhance motor recovery and ambulation in 3 people following motor incomplete spinal cord injury. Interventions. Changes in motor impairment, functional limitations, and locomotor disability were monitored weekly during robotic-assisted BWSTT and following transition to therapist-assisted BWSTT with the assistance of one therapist. Outcomes. Following this training, 2 patients recovered independent over-ground walking and another improved his gait speed and endurance. Discussion. The use of robotic devices may assist physical therapists by providing task-specific practice of stepping in people following neurological injury.