bluuebunny/crossref_metadata_2025 huggingface dataset:
Chance and Determinism
Authors: Frigg Roman
Published: February 2017

Determinism and chance seem to be irreconcilable opposites: either something is chancy or it is deterministic, but not both. Yet there are processes which appear to square the circle by being chancy and deterministic at once, and the appearance is backed by well-confirmed scientific theories, such as statistical mechanics, which also seem to provide us with chances for deterministic processes. Is this possible, and if so how? In this chapter is a discussion of this question for probabilities as they occur in the empirical sciences. Particular attention is paid to broadly Humean approaches and to the method of arbitrary functions, which seem to offer the most promising accounts of deterministic chance.
Probabilities in Statistical Mechanics
Authors: Myrvold Wayne
Published: February 2017

This chapter reviews selected aspects of the terrain of discussion of the role of probabilities in statistical mechanics. Among the topics addressed are the reasons for introduction of probabilities into statistical mechanics, the status of the standard equilibrium distribution, and the question of interpretation of statistical mechanical probabilities. The chapter starts with a brief history of probabilities in physics and the evolution of statistical mechanics therefrom. The approaches of Boltzmann and Gibbs are presented, and then some approaches to justifying choice of probability measures. The chapter closes with a presentation of possible resolutions to some puzzling aspects of the use of standard probability measures.
Probability in Epistemology
Authors: Kotzen Matthew
Published: February 2017

In recent years, probabilistic approaches to epistemological questions have become increasingly influential. This chapter surveys a number of the most significant ways in which probability is relevant to contemporary epistemology. Topics surveyed include: the debate surrounding the connection between full and partial beliefs; synchronic rational constraints on credences including probabilism, regularity, reflection, and the principal principle; diachronic rational constraints on credences including conditionalization and de se updating; the application of the requirement of total evidence; evidential probability, focusing on the theories of Henry Kyburg and Timothy Williamson; sharp and fuzzy credences; likelihood arguments, including the fine-tuning argument for Design; dogmatism and its critics; and transmission failure, focusing on the work of Crispin Wright.
Criminal Law and the Evolving Technological Understanding of Behaviour
Authors: Claydon Lisa
Published: February 2017

This chapter examines the claims made by science and technology that have impacted upon criminal law. It looks at issues of legitimacy in criminal law and in particular at claims based upon new scientific and technological explanations of human behaviour. It considers how the criminal law has responded to these challenges. It considers whether there are areas of the criminal law where a greater understanding of the relevant science would assist the criminal justice system. It also looks at the present legal approaches to those issues and considers how the Criminal Procedure Rules 2015 may provide a framework for the courts when dealing with science and technology.
Population, Reproduction, and Family
Authors: McLean Sheila A.M.
Published: February 2017

Both at national and international level, the right to reproduce and form a family has considerable personal and social implications. The policies that underpin the regulatory approach in this area need careful consideration for their supporting values and principles. While regulation of reproductive decisions may be direct or indirect, it is virtually universal. Reflection on the importance of the decision whether or not to reproduce, irrespective of the sophistication (or not) of the techniques used to effect it, demands attention to the human rights guaranteed by national laws and international agreements. This remains the case whether or not the decision concerns an individual, a couple, or a nation. Thus, both individual reproductive choices and policies on population control must be measured against human rights norms. As regulation is generally based on policy decisions, it is also important to explore how policy is made and the assumptions that underpin it.
Law, Responsibility, and the Sciences of the Brain/Mind
Authors: Morse Stephen J.
Published: February 2017

This chapter considers whether the new sciences of the brain/mind, especially neuroscience and behavioural genetics, are likely to transform the law’s traditional concepts of the person, agency, and responsibility. The chapter begins with a brief speculation about why so many people think these sciences will transform the law. It reviews the law’s concepts of the person, agency and responsibility, misguided challenges to these concepts, and the achievements of the new sciences. It then confronts the claim that the brain/mind sciences prove that we are not agents who can guide our conduct by reason and thus cannot be responsible. It argues that this claim cannot be supported empirically or conceptually, and that no revolution in legal thinking is foreseeable. The chapter concludes by suggesting that the new sciences have little to offer the law at present, but in the future, they may contribute modestly to reforming doctrine, policy, and practice.
The Micropolitics of Exchange
Authors: Elswit Kate
Published: February 2017

Exile has received relatively little attention in dance studies, although forced migration in the mid-twentieth century reconfigured artistic and intellectual landscapes on multiple continents. This chapter turns to German dance during and after the Third Reich, while drawing on theoretical and historical treatments of exile developed in other disciplines, as well as constructions of national identity. Such perspectives on displacement suggest that it is not the place of exiled artists, which needs to be reassessed within national dance histories; rather, these artists offer an opportunity to assess the contours of the historical narrations themselves and, with them, other forms of belonging. The case studies of Valeska Gert and Kurt Jooss highlight the micropolitics of exile’s transnational exchange. These intricate, personalized crosscurrents were catalyzed by survival strategies that registered in the work itself and left traces in history, which can only be seen by engaging with multiple forms of otherness.
Modern Dance in the Third Reich, Redux
Authors: Manning Susan
Published: February 2017

This chapter reviews the literature on modern dance in Germany under National Socialism (1933–1945). In the current consensus, three interrelated explanations are advanced for why so many modern dancers collaborated with the National Socialists: shared roots in the life reform and physical culture movement at the turn of the twentieth century; crises during the Weimar Republic that culminated in the Great Depression; and the changing cultural policy of Goebbels’s Cultural Ministry. This chapter probes varied interpretations of how and why Mary Wigman, Rudolf Laban, and other modern dancers adapted their mode of Ausdruckstanz as Deutscher Tanz (“German dance”) and poses new research questions. The complex question of modern dance in the Third Reich is viewed in relation to changing historiographic models for understanding Germany between the two world wars.
Samuel Daniel
Authors: Pitcher John
Published: February 2017

This article discusses current research on the Elizabethan poet and historian Samuel Daniel (1562–1619) and looks at future archival and critical directions for work on him. It sets out details of Daniel’s life in Somerset and offers new evidence of his outlook as a man of letters and the income he made from writing. The connections between his work and that of Spenser, Jonson, and Shakespeare are considered, as is his relationship with elite patrons, including Sir Edward Dymoke, Lord Keeper Egerton, Baron Mountjoy, and Lady Anne Clifford. The article examines the considerable reputation Daniel had at court and at Oxford and closes with a discussion of his ideas about civilized life.
An Analysis of the Relationship Between the Utilization of Physical Therapy Services and Outcomes for Patients With Acute Stroke
Authors: Freburger Janet K
Published: February 2017

Background and Purpose. Little research has been conducted on the outcomes of care for people who have had a stroke. In this study, the relationship between physical therapy utilization and outcomes of care for patients with acute stroke was examined. Subjects. The sample consisted of 6,342 patients treated in US academic health center hospitals in 1996 who survived their inpatient stay and received physical therapy. Methods. The primary data source was the University HealthSystem Consortium Clinical Data Base. Physical therapy use was assessed by examining physical therapy charges. Outcomes of care were assessed in terms of the total cost of care (ie, whether the cost of care was more costly or less costly than expected, taking into account patient characteristics) and in terms of discharge destination (ie, whether the patient was discharged home or elsewhere). Regression analyses were conducted to examine the relationship between physical therapy use and outcomes. Results. Physical therapy use was directly related to a total cost of care that was less than expected and to an increased probability of discharge home. Conclusion and Discussion. The results of this study provide preliminary evidence to support the use of physical therapy in the acute care of patients with strokes and indicate the need for further study of this topic.
Head Stability in Walking in Children With Cerebral Palsy and in Children and Adults Without Neurological Impairment
Authors: Holt Kenneth G , Ratcliffe Robert , Jeng Suh-Fang
Published: February 2017

Background and Purpose. The location of several sensory systems in the head implies that maintenance of head stability may be a potentially important part of locomotor activity. A limited amount of research, however, has been conducted to measure stability or to compare head stability among different groups. The purpose of this study was to determine whether a method for measuring head stability during walking could differentiate among 3 groups: (1) children with cerebral palsy, (2) children without neurological impairment, and (3) adults without neurological impairment. Subjects. Eight adults without known neurological impairment, 6 children without known neurological impairment, and 6 children with cerebral palsy and mild spastic hemiplegia were compared. Methods. Subjects walked on a treadmill at their preferred speed at a number of frequencies. Head stability was characterized by fluctuations in period and amplitude of head motion in the sagittal plane across walking cycles. Results. Mean period fluctuation was lower for the adults than for the children, and it was lower for the children without neurological impairments than for the children with cerebral palsy. Conclusion and Discussion. The method can be used to differentiate head stability among different groups during functional activities.
Statistical Inference by Confidence Intervals: Issues of Interpretation and Utilization
Authors: Sim Julius , Reid Norma
Published: February 2017

This article examines the role of the confidence interval (CI) in statistical inference and its advantages over conventional hypothesis testing, particularly when data are applied in the context of clinical practice. A CI provides a range of population values with which a sample statistic is consistent at a given level of confidence (usually 95%). Conventional hypothesis testing serves to either reject or retain a null hypothesis. A CI, while also functioning as a hypothesis test, provides additional information on the variability of an observed sample statistic (ie, its precision) and on its probable relationship to the value of this statistic in the population from which the sample was drawn (ie, its accuracy). Thus, the CI focuses attention on the magnitude and the probability of a treatment or other effect. It thereby assists in determining the clinical usefulness and importance of, as well as the statistical significance of, findings. The CI is appropriate for both parametric and nonparametric analyses and for both individual studies and aggregated data in meta-analyses. It is recommended that, when inferential statistical analysis is performed, CIs should accompany point estimates and conventional hypothesis tests wherever possible.
Toward Sensitive Practice: Issues for Physical Therapists Working With Survivors of Childhood Sexual Abuse
Authors: Schachter Candice L , Stalker Carol A , Teram Eli
Published: February 2017

Background and Purpose. The high rates of prevalence of childhood sexual abuse in the United States and Canada suggest that physical therapists work, often unknowingly, with adult survivors of childhood sexual abuse. The purposes of this qualitative study were to explore the reactions of adult female survivors of childhood sexual abuse to physical therapy and to listen to their ideas about how practitioners could be more sensitive to their needs. The dynamics and long-term sequelae of childhood sexual abuse, as currently understood by mental health researchers and as described by the participants, are summarized to provide a context for the findings of this study. Subjects and Methods. Twenty-seven female survivors (aged 19–62 years) participated in semistructured interviews in which they described their reactions to physical therapy. Results. Survivors' reactions to physical therapy, termed “long-term sequelae of abuse that detract from feeling safe in physical therapy,” are reported. Participant-identified suggestions that could contribute to the sense of safety are shared. Conclusions and Discussion. Although the physical therapist cannot change the survivor's history, an appreciation of issues associated with child sexual abuse theoretically can increase clinicians' understanding of survivors' reactions during treatment. We believe that attention by the physical therapist to the client's sense of safety throughout treatment can maximize the benefits of the physical therapy experience for the client who is a survivor. [Schachter CL, Stalker CA, Teram E. Toward sensitive practice: issues for physical therapists working with survivors of childhood sexual abuse.
Effects of Side Lying on Lung Function in Older Individuals
Authors: Manning Fiona , Dean Elizabeth , Ross Jocelyn , Abboud Raja T
Published: February 2017

Background and Purpose. Body positioning exerts a strong effect on pulmonary function, but its effect on other components of the oxygen transport pathway are less well understood, especially the effects of side-lying positions. This study investigated the interrelationships between side-lying positions and indexes of lung function such as spirometry, alveolar diffusing capacity, and inhomogeneity of ventilation in older individuals. Subjects and Methods. Nineteen nonsmoking subjects (mean age=62.8 years, SD=6.8, range=50–74) with no history of cardiac or pulmonary disease were tested over 2 sessions. The test positions were sitting and left side lying in one session and sitting and right side lying in the other session. In each of the positions, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), single-breath pulmonary diffusing capacity (DLCO/VA), and the slope of phase III (DN2%/L) of the single-breath nitrogen washout test to determine inhomogeneity of ventilation were measured. Results. Compared with measurements obtained in the sitting position, FVC and FEV1 were decreased equally in the side-lying positions, but no change was observed in DLCO/VA or DN2%/L. Conclusion and Discussion. Side-lying positions resulted in decreases in FVC and FEV1, which is consistent with the well-documented effects of the supine position. These findings further support the need for prescriptive rather than routine body positioning of patients with risks of cardiopulmonary compromise and the need to use upright positions in which lung volumes and capacities are maximized.
Health Promotion for People With Disabilities: The Emerging Paradigm Shift From Disability Prevention to Prevention of Secondary Conditions
Authors: Rimmer James H
Published: February 2017

The premise of this article is that, until recently, health promotion for people with disabilities has been a neglected area of interest on the part of the general health community. Today, researchers, funding agencies, and health care providers and consumers are leading an effort to establish higher-quality health care for the millions of Americans with disabilities. The aims of a health promotion program for people with disabilities are to reduce secondary conditions (eg, obesity, hypertension, pressure sores), to maintain functional independence, to provide an opportunity for leisure and enjoyment, and to enhance the overall quality of life by reducing environmental barriers to good health. A greater emphasis must be placed on community-based health promotion initiatives for people with disabilities in order to achieve these objectives.
Accuracy of Digitization Using Automated and Manual Methods
Authors: Wilson Daniel J , Smith Bryan K , Gibson J Kyle , Choe Byung K , Gaba Brenda C , Voelz John T
Published: February 2017

Background and Purpose. Computerized 3-dimensional (3-D) motion measurement systems are used by those interested in human motion. The purposes of this study were (1) to determine the limits of accuracy in determining intersegmental angles during pendular motion at varying speeds and (2) to determine changes in accuracy introduced by autodigitization and digitization by experienced manual raters. Methods. Angular speed of a T-shaped pendulum was systematically increased by releasing the pendulum from 4 angles (0° [no movement], 45°, 90°, and 120°). Twelve reference angles calculated from markers placed on the pendulum were estimated over 20 frames for 10 trials at each release position. Results. Mean errors across trials and frames for intersegmental angles reconstructed by a 3-D motion measurement system were within ±1 degree across all release positions. An analysis of variance and a post hocTukey test revealed that the mean error for the autodigitized trials was larger than that for the manually digitized trials. For the autodigitized trials, the static trials (release position=0°) produced less mean error than the trials with movement produced. The ICCs showed a high degree of consistency among all raters, ranging from .707 to .999. Conclusion and Discussion. Our findings support the conclusion that under carefully controlled conditions, a 3-D motion measurement system can produce clinically acceptable measurements of accuracy across a range of angular speeds. Furthermore, acceptable accuracy is possible regardless of the digitization method.
Effects of Testing Context on Ball Skill Performance in 5-Year-Old Children With and Without Developmental Delay
Authors: Doty Antonette K , McEwen Irene R , Parker Donald , Laskin James
Published: February 2017

Background and Purpose. Physical therapists often test ball-playing skills of children with disabilities using standardized testing, which may not predict performance of ball skills in games with peers. This type of testing is used by physical therapists to determine whether children have delays in ball-handling skills. The purpose of this study was to compare ball skill performance of children with and without developmental delay in a one-to-one testing situation and in a structured game with peers. Subjects. Five-year-old children with developmental delay (n=20) and 5-year-old children without disabilities (n=20) participated in the study. Methods. We used the Peabody Developmental Motor Scales receipt and propulsion scale to test children one-to-one with a therapist and during a structured game with peers. Results. Subjects without developmental delay performed better than subjects with developmental delay under both testing conditions. Children with developmental delay performed better in the one-to-one testing condition than in the game with peers. The performance of children without developmental delay did not differ under the 2 conditions. Boys performed better than girls. Conclusions and Discussion. Physical therapists should consider the potential effect of environment on the ball-handling skills of children with disabilities.
Influence of Age on Length and Passive Elastic Stiffness Characteristics of the Calf Muscle-Tendon Unit of Women
Authors: Gajdosik Richard L , Vander Linden Darl W , Williams Ann K
Published: February 2017

Background and Purpose. Therapeutic stretching of the calf muscle-tendon unit is used to increase its length and to ameliorate decreased dorsiflexion range of motion (ROM), but the influence of age on the passive properties of the calf muscle-tendon unit has not been studied adequately. The purpose of this study was to examine the influence of age on length and passive elastic stiffness (PES) characteristics of the calf muscle-tendon unit when stretched through the full, available dorsiflexion ROM. Subjects. Twenty-four younger women (aged 20–39 years), 24 middle-aged women (aged 40–59 years), and 33 older women (aged 60–84 years) participated. Methods. An isokinetic dynamometer was used to passively stretch the right calf muscle-tendon unit from relaxed plantar flexion to the maximal angle of available dorsiflexion at 5°·s−1. The maximal passive resistive torque was measured, and passive angle-torque curves were constructed for a full ROM from an initial angle of passive resistive torque to the maximal dorsiflexion angle. The full ROM represented length extensibility. The average PES was calculated for this full stretch ROM and for the first half and the last half of this stretch ROM. The maximal passive dorsiflexion angle, maximal passive resistive torque, angular change for the full stretch ROM, and average PES for the full stretch ROM and the first half and the last half of the full stretch ROM were examined for group differences and their relationships with age. Results. The maximal passive dorsiflexion angle, maximal passive resistive torque, angular change for the full stretch ROM, and average PES within the last half of the full stretch ROM were less for the older women than for the younger women. Age was negatively associated with these variables. Conclusion and Discussion. Decreased maximal passive dorsiflexion ROM in older women was associated with decreased maximal passive resistive torque, decreased calf muscle-tendon unit length extensibility, and decreased average PES within the last half of their available passive dorsiflexion ROM.
Bactericidal Effect of 0.95-mW Helium-Neon and 5-mW Indium-Gallium-Aluminum-Phosphate Laser Irradiation at Exposure Times of 30, 60, and 120 Seconds on Photosensitized Staphylococcus aureus and Pseudomonas aeruginosa In Vitro
Authors: DeSimone Noelle A , Christiansen Cory , Dore David
Published: February 2017

Background and Purpose. Studies have demonstrated a bactericidal effect of laser irradiation when lasers with power outputs of ≥6 mW are directed toward pathogenic or opportunistic bacteria previously treated with a photosensitizing agent. The purpose of this study was to determine the bactericidal capabilities of irradiation from lasers with power outputs of less than 6 mW on photosensitized microorganisms. Methods. Two bacteria that commonly infect skin lesions, Staphylococcus aureus and Pseudomonas aeruginosa, were used. The 2 lasers used, the 0.95-mW helium-neon laser and the 5-mW indium-gallium-aluminum-phosphate laser, emit light at a wavelength close to the absorption maxima of the sensitizing agent chosen, toluidine blue O. This agent was used because of its proven effectiveness in sensitizing bacteria. For each bacterial strain, toluidine blue O was added to a 108 cells/mL solution until a 0.01% weight/volume ratio was obtained. These mixtures were spread on agar-coated petri dishes, which were then exposed to 1 of the 2 lasers for 30, 60, and 120 seconds. The cultures were then grown overnight and examined for one or more visible zones of inhibition. The areas surrounding the irradiated zone provided a control for the effects of toluidine blue O alone. To determine the effects of laser irradiation without prior toluidine blue O sensitization, separate plates were established using unsensitized bacteria. Results. Although inconsistencies between plates were noted, both lasers produced at least one zone of inhibition in both bacterial species at all 3 time periods. The 5-mW laser, however, produced a greater number of these zones. Conclusion and Discussion. Laser-induced microbial killing of photosensitized organisms could have clinical applications in the treatment of infected skin lesions, pending in vivo studies.
Use of a Classification System to Guide Nonsurgical Management of a Patient With Chronic Low Back Pain
Authors: Maluf Katrina S , Sahrmann Shirley A , Van Dillen Linda R
Published: February 2017

Background and Purpose. This case report describes the use of a classification system in the evaluation of a patient with chronic low back pain (LBP) and illustrates how this system was used to develop a management program in which the patient was instructed in symptom-reducing strategies for positioning and functional movement. Case Description. The patient was a 55-year-old woman with a medical diagnosis of lumbar degenerative disk and degenerative joint disease from L2 to S1. Rotation with extension of the lumbar spine was found to be consistently associated with an increase in symptoms during the examination. Instruction was provided to restrict lumbar rotation and extension during performance of daily activities. Outcomes. The patient completed 8 physical therapy sessions over a 3-month period. Pretreatment, posttreatment, and 3-month follow-up modified Oswestry Disability Questionnaire scores were 43%, 16%, and 12%, respectively. Discussion. Daily repetition of similar movements and postures may result in preferential movement of the lumbar spine in a specific direction, which then may contribute to the development, persistence, or recurrence of LBP. Research is needed to determine whether patients with LBP would benefit from training in activity modifications that are specific to the symptom-provoking movements and postures of each individual as identified through examination.
Writing Patient-Centered Functional Goals
Authors: Randall Kenneth E , McEwen Irene R
Published: February 2017

Motor learning research, health care policies, reimbursement practices, and the standards of accrediting bodies all support writing patient-centered functional goals of physical therapy. This article defines patient-centered functional goals within the context of the Guide to Physical Therapist Practice and provides a rationale for incorporating functional goals into physical therapy for patients in all areas of practice. The article also describes how physical therapists can collaborate with patients to identify functional goals that are meaningful to them and describes a 5-step process for writing functional goals that are measurable.
Alberta Infant Motor Scale: Reliability and Validity When Used on Preterm Infants in Taiwan
Authors: Jeng Suh-Fang , Yau Kuo-Inn Tsou , Chen Li-Chiou , Hsiao Shu-Fang
Published: February 2017

Background and Purpose. The goal of this study was to examine the reliability and validity of measurements obtained with the Alberta Infant Motor Scale (AIMS) for evaluation of preterm infants in Taiwan. Subjects. Two independent groups of preterm infants were used to investigate the reliability (n=45) and validity (n=41) for the AIMS. Methods. In the reliability study, the AIMS was administered to the infants by a physical therapist, and infant performance was videotaped. The performance was then rescored by the same therapist and by 2 other therapists to examine the intrarater and interrater reliability. In the validity study, the AIMS and the Bayley Motor Scale were administered to the infants at 6 and 12 months of age to examine criterion-related validity. Results. Intraclass correlation coefficients (ICCs) for intrarater and interrater reliability of measurements obtained with the AIMS were high (ICC=.97–.99). The AIMS scores correlated with the Bayley Motor Scale scores at 6 and 12 months (r=.78 and .90), although the AIMS scores at 6 months were only moderately predictive of the motor function at 12 months (r=.56). Conclusion and Discussion. The results suggest that measurements obtained with the AIMS have acceptable reliability and concurrent validity but limited predictive value for evaluating preterm Taiwanese infants.
Work-Related Musculoskeletal Disorders in Physical Therapists: Prevalence, Severity, Risks, and Responses
Authors: Cromie Jean E , Robertson Valma J , Best Margaret O
Published: February 2017

Background and Purpose. Physical therapists are at risk for work-related musculoskeletal disorders (WMSDs). Little is known of how therapists respond to injury or of what actions they take to prevent injury. The purpose of this study was to investigate the prevalence and severity of WMSDs in physical therapists, contributing risk factors, and their responses to injury. Subjects. As part of a larger study, a systematic sample of 1 in 4 therapists on a state register (n=824) was surveyed. Methods. An 8-page questionnaire was mailed to each subject. Questions investigated musculoskeletal symptoms, specialty areas, tasks and job-related risk factors, injury prevention strategies, and responses to injury. Results. Lifetime prevalence of WMSDs was 91%, and 1 in 6 physical therapists moved within or left the profession as a result of WMSDs. Younger therapists reported a higher prevalence of WMSDs in most body areas. Use of mobilization and manipulation techniques was related to increased prevalence of thumb symptoms. Risk factors pertaining to workload were related to a higher prevalence of neck and upper-limb symptoms, and postural risk factors were related to a higher prevalence of spinal symptoms. Conclusion and Discussion. Strategies used to reduce work-related injury in industry may also apply to physical therapists. Increased risk of thumb symptoms associated with mobilization techniques suggests that further research is needed to establish recommendations for practice. The issues for therapists who move within or leave the profession are unknown, and further research is needed to better understand their needs and experiences.
Passive Ankle Stiffness in Subjects With Diabetes and Peripheral Neuropathy Versus an Age-Matched Comparison Group
Authors: Salsich Gretchen B , Mueller Michael J , Sahrmann Shirley A
Published: February 2017

Background and Purpose. Patients with diabetes mellitus and peripheral neuropathy (DM and PN) often complain of joint stiffness. Although stiffness may contribute to some of the impairments and functional limitations found in these patients, it has not been quantified in this population. The purpose of this study was to quantify and compare passive ankle stiffness and dorsiflexion (DF) range of motion in subjects with DM and PN versus an age-matched comparison group. Subjects. Thirty-four subjects were tested (17 subjects with DM and PN and 17 subjects in an age-matched comparison group). There were 10 male subjects and 7 female subjects in each group. Methods. A Kin-Com dynamometer was used to measure passive plantar flexor torque as each subject's ankle was moved from plantar flexion into dorsiflexion at 60°/s. The following variables were compared using a Student t test: initial angle (angle of onset of plantar flexor torque), maximal dorsiflexion angle, plantar flexor muscle excursion (difference between initial angle and maximal dorsiflexion angle), slope of the first half of the plantar flexor torque curve (stiffness 1 measurement), and slope of the second half of the plantar flexor torque curve (stiffness 2 measurement). Results. The subjects with DM and PN group had smaller maximal dorsiflexion angles and less plantar flexor muscle excursion than the comparison group. There was no difference in initial angle, stiffness 1 measurement, or stiffness 2 measurement. Conclusion and Discussion. Although the subjects with DM and PN had less dorsiflexion range of motion than did the comparison group, there was no difference in stiffness between the groups. This finding suggests that people with DM and PN have “short” versus “stiff” plantar flexor muscles.
Muscle Force and Range of Motion as Predictors of Function in Older Adults
Authors: Beissner Katherine L , Collins Jennifer E , Holmes Heidi
Published: February 2017

Background and Purpose. Musculoskeletal impairments and functional limitations are linked to disability in older adults. The purposes of this study were to identify the extremity musculoskeletal impairments that best predict functional limitations in older adults and to assess the validity of measurements obtained for the Physical Performance Test (PPT) as a predictor of disability. Subjects and Methods. Eighty-one older adults residing in independent and dependent care facilities were tested for extremity muscle force, range of motion, and function. Data were analyzed using multiple regression analysis to identify extremity impairments that predicted function scores and logistic regression analysis to determine whether PPT scores predicted subjects' living situation as dependent versus independent. Results. Subject age, lower-extremity muscle force, and lower-extremity range of motion explained 77% of the variance in function as measured by the PPT. Results differed when analysis was done by the subjects' living situation, with a higher percentage of the variance in function scores explained by musculoskeletal measures for the dependent living group as compared with the independent living group. Conclusion and Discussion. Extremity musculoskeletal impairments have a strong relationship to function, especially in older adults living in dependent care settings. The results of this study can be used to design interventions to address the musculoskeletal disorders most related to function in the older population.
Use of The Blue MACS: Acceptance by Clinical Instructors and Self-Reports of Adherence
Authors: Hrachovy Julie , Clopton Nancy , Baggett Kristi , Garber Tamara , Cantwell Jennifer , Schreiber Jennifer
Published: February 2017

Background and Purpose. The purpose of this study was to evaluate clinical instructors' (CIs') acceptance of and self-reported adherence to instructions for use of The Blue MACS (5th edition) for evaluating the clinical performance of physical therapist students. Subjects and Methods. One hundred twenty-four usable survey instruments were returned by CIs. Results. Twenty-two items from The Blue MACS were collapsed into a score representing acceptance, and 10 items were collapsed into a score representing reported adherence to instructions. Ninety-six percent of the CIs surveyed expressed a positive opinion of the instrument. Ninety-eight percent of the CIs reported at least moderately consistent adherence to instructions. Conclusion and Discussion. The instrument was regarded as a useful tool, and most CIs reported using the instrument according to the instructions. A positive opinion of the clinical performance assessment instrument is desirable to facilitate its use by CIs. Consistent use by different CIs is desirable to promote accurate communication among students, CIs, and the educational institution.
Submaximal Exercise Testing: Clinical Application and Interpretation
Authors: Noonan Vanessa , Dean Elizabeth
Published: February 2017

Compared with maximal exercise testing, submaximal exercise testing appears to have greater applicability to physical therapists in their role as clinical exercise specialists. This review contrasts maximal and submaximal exercise testing. Two major categories of submaximal tests (ie, predictive and performance tests) and their relative merits are described. Predictive tests are submaximal tests that are used to predict maximal aerobic capacity. Performance tests involve measuring the responses to standardized physical activities that are typically encountered in everyday life. To maximize the validity and reliability of data obtained from submaximal tests, physical therapists are cautioned to apply the tests selectively based on their indications; to adhere to methods, including the requisite number of practice sessions; and to use measurements such as heart rate, blood pressure, exertion, and pain to evaluate test performance and to safely monitor patients.
Effect of 15% Body Weight Support on Exercise Capacity of Adults Without Impairments
Authors: MacKay-Lyons Marilyn , Makrides Lydia , Speth Stephanie
Published: February 2017

Background and Purpose. External support of body weight, a technique used for the gait training of patients with neurologic conditions, may also be beneficial for tests of exercise capacity in people whose impairments in motor function and balance have traditionally precluded such testing. The purpose of this study was to investigate the effect of using external support of 15% of body mass during treadmill exercise testing of adults without impairments. Subjects and Methods. Seven men and 8 women (mean age=55.2 years, SD=11.3, range=43–82) performed 3 treadmill tests with random assignment of testing condition: (1) no body weight support (BWS)—standard test, (2) 0% BWS—harness in place but no use of external support, and (3) 15% BWS—use of external support for 15% of body mass. Expired gas was analyzed to determine oxygen uptake, carbon dioxide production, minute ventilation, tidal volume, heart rate, and respiratory exchange ratio. Results. Use of external support for 15% of body mass did not affect the end-expiratory gas exchange variables, although the time to achieve peak values was lengthened. Maximal tidal volume was lower in the 15% BWS test, but maximal minute ventilation was not different. Discussion and Conclusion. Because 15% BWS did not affect the exercise capacity of adults without known impairments, future study of its application to testing of patients with neurologic injuries is warranted.
Relationships Between Walk/Run Performance and Cardiorespiratory Fitness in Adolescents Who Are Overweight
Authors: Drinkard Bart , McDuffie Jennifer , McCann Serena , Uwaifo Gabriel I , Nicholson Jennifer , Yanovski Jack A
Published: February 2017

Background and Purpose. Little is known about the methods used to assess the physical fitness of adolescents who are overweight. We investigated the relationship between walk/run performance and cardiorespiratory fitness in adolescents who are overweight. Subjects. Eight African-American adolescents (5 female, 3 male) and 10 Caucasian adolescents (5 female, 5 male) who were overweight (mean age=14.5 years, SD=2.0, range=12–17; mean body mass index [BMI]=42.9 kg/m2, SD=11.5) participated in this study. Methods. Subjects performed a 12-minute walk/run test. The distances traveled at both 9 minutes (D9) and 12 minutes (D12) were recorded, and the distance traveled between 9 and 12 minutes (D9–12) was calculated. Subjects also completed a maximal cycle ergometry test, during which peak oxygen uptake (V̇o2peak), anaerobic threshold (AT), peak power (Wpeak), and power at the anaerobic threshold (Wat) were determined. Body composition was determined by air displacement plethysmography. Results. The mean percentage of body fat was 48.6% (SD=5.3%, range=40.3%–60.4%). Percentage of body fat and BMI were each inversely related to D9, D12, and V̇o2peak (all P<.005). Peak oxygen uptake (r=.72, P=.0001), V̇o2peak/kg lean body mass (r=.60, P<.005), Wpeak (r=.88, P<.0001), and Wat (r=.72, P=.0007) were all related to D12, with greater r values than for D9. If D9–12was included in regression analyses, D9 did not account for additional variance in any of the cycle ergometry variables. Discussion and Conclusion. These results suggest that an easily obtained measurement of physical performance (distance traveled during a 12-minute walk/run test) is related to cardiorespiratory fitness and to body composition in adolescents who are overweight. The 12-minute walk/run distance is more predictive of cycle ergometry test results than the 9-minute distance.
Concurrent and Construct Validity of Scores on the Timed Movement Battery
Authors: Creel Gwenda L , Light Kathye E , Thigpen Mary T
Published: February 2017

Background and Purpose. The Timed Movement Battery (TMB) is a new assessment tool designed to measure mobility in elderly individuals. “Mobility” was defined as a person's ability to maneuver his or her body independently in order to accomplish everyday tasks. The purpose of this study was to assess the concurrent and construct validity of scores obtained with the TMB as a measure of mobility in a group of elderly individuals who reported moderate or no difficulty in performing either basic or instrumental activities of daily living (BADL or IADL). Subjects. Thirty community-dwelling elderly people, with a mean age of 77.5 years (SD=7.0, range=65–92), participated in this study. Methods. Subjects responded to 2 questionnaires regarding their activities of daily living (ADL) (ie, Barthel Index and an 18-item ADL/IADL scale) and completed 3 assessments of mobility (ie, Berg Balance Scale, Timed “Up & Go” Test, and the TMB). Subjects were asked to perform the items on the TMB at a “self-selected” speed (their normal speed) and at a “maximum-movement” speed (as quickly as they could safely perform the items). Subjects' scores on the TMB were cross-correlated with data for 4 criterion tests (ie, Berg Balance Scale, Timed “Up & Go” Test, Barthel Index, and the 18-item ADL/IADL scale) using Spearman rank correlations and Pearson product moment correlations. Results. Composite scores of the TMB performed at self-selected speeds correlated highly with data for the criterion tests and differentiated between those subjects reporting difficulty with ADL and those reporting no difficulty. Conclusion and Discussion. These results support the validity of scores obtained with the TMB as a measure of mobility in this sample of elderly individuals with moderate or no reported difficulty with ADL.
Application of Passive Stretch and Its Implications for Muscle Fibers
Authors: De Deyne Patrick G
Published: February 2017

To increase range of motion, physical therapists frequently use passive stretch as a means of gaining increased excursion around a joint. In addition to clinical studies showing effectiveness, thereby supporting evidence-based practice, the basic sciences can explain how a technique might work once it is known to be effective. The goal of this article is to review the potential cellular events that may occur when muscle fibers are stretched passively. A biomechanical example of passive stretch applied to the ankle is used to provide a means to discuss passive stretch at the cellular and molecular levels. The implications of passive stretch on muscle fibers and the related connective tissue are discussed with respect to tissue biomechanics. Emphasis is placed on structures that are potentially involved in the sensing and signal transduction of stretch, and the mechanisms that may result in myofibrillogenesis are explored.
Student Performance and Perceptions of a Lecture-based Course Compared With the Same Course Utilizing Group Discussion
Authors: Lake David A
Published: February 2017

Background and Purpose. Self-directed learning is believed to be an important aspect of the reflective clinical practitioner. This study was a comparison of student learning and student perceptions of course and instructor effectiveness, course difficulty, and amount learned between the active learning and lecture sections of a course. Subjects. Participants in this study were 170 physical therapist students in 3 sections of a physiology course in the first year of their professional program. Methods. Course grades and the results of teacher-course evaluations were compared between a lecture section and an active learning section. The students in the original active learning section were reassessed 1 year later to determine their perceptions of the course. The differences were analyzed using Kruskal-Wallis and Mann-Whitney U tests. Results. Course grades were higher in both active learning sections than in the lecture section. However, the students in both active learning sections perceived that they had learned less than students in the lecture section. Students' perceptions of course and instructor effectiveness were lower in the active learning sections than in the lecture section. There were no differences between the lecture and active learning sections on the students' perceptions of course difficulty. Conclusion and Discussion. Although they did better in the active learning environment, physical therapist students in a basic sciences course (physiology) in the first year of their professional program perceived that they had learned less in active learning courses. They also had lower perceptions of course and instructor quality.
Patients in General Practice in Denmark Referred to Physiotherapists: A Description of Patient Characteristics Based on General Health Status, Diagnoses, and Sociodemographic Characteristics
Authors: Jørgensen Carsten Krogh , Fink Per , Olesen Frede
Published: February 2017

Background and Purpose. Both musculoskeletal illness and mental illness characterized by somatic symptoms are common in primary care, and it is hypothesized that many patients with musculoskeletal illness have relatively poor mental health. The purpose of this study was to describe the characteristics of patients in general practice in Denmark who are referred to physiotherapists with signs and symptoms of musculoskeletal illness. Subjects and Methods. One hundred ninety-four general practitioners, representing 124 practices, participated in a survey of 2,042 consecutive patients with musculoskeletal illness. Results. The diagnoses were generally poorly defined. Compared with the general population, patients with musculoskeletal illness had markedly poorer physical health and poorer mental health. Patients with poorly defined diagnoses did not differ from patients with well-defined diagnoses in terms of physical health, but they scored lower on the mental health component summary scale of the Danish version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Conclusion and Discussion. Of the patients referred to physiotherapists by general practitioners in Denmark, the subgroup with poorly defined diagnoses had lower mental health scores than those with well-defined diagnoses, suggesting that a biopsychosocial approach to care may be appropriate for this group of patients.
Exercise in 94°F Water for a Patient With Multiple Sclerosis
Authors: Peterson Colleen
Published: February 2017

Background and Purpose. The purpose of this case report is to describe the examination, intervention, and outcome of a patient with multiple sclerosis (MS) who participated in a comprehensive rehabilitation program that included aquatic therapy with a pool temperature of 94°F. There are few descriptions of aquatic exercise programs on muscle force, exercise tolerance, and functional outcomes in individuals with MS, and most authors recommend a water temperature of less than 85°F to prevent an exacerbation of symptoms. Description. The patient was a 33-year-old woman. Before, during, and after the aquatic program, she was monitored for body temperature, heart rate, blood pressure, and perceived exertion. She was also assessed for muscle force and functional abilities. Outcomes. The patient did not experience heat sensitivity or fatigue throughout the program, and her manual muscle test grades and mobility improved. Discussion. This patient's participation in aquatic therapy, in conjunction with land-based interventions, may have been associated with the improvement in functional abilities.