bluuebunny/crossref_metadata_2025 huggingface dataset:
An Investigation Into the Analgesic Effects of Interferential Currents and Transcutaneous Electrical Nerve Stimulation on Experimentally Induced Ischemic Pain in Otherwise Pain-Free Volunteers
Authors: Johnson Mark I , Tabasam Ghazala
Published: February 2017

Background and Purpose. Interferential currents (IFC) and transcutaneous electrical nerve stimulation (TENS) are used for pain management. This study compared the analgesic effects of IFC and TENS on experimentally induced ischemic pain in otherwise pain-free subjects using a modified version of the submaximal-effort tourniquet technique. Subjects. The subjects were 30 volunteers (18 male, 12 female) without known pathology that could cause pain. Their mean age was 33.5 years (SD=9.9, range=21–54). Method. A single-blind, sham-controlled, parallel-group method was used. The primary outcome measure was the change in the self-report of pain intensity during 1 of 3 possible interventions: (1) IFC, (2) TENS, or (3) sham electrotherapy. The IFC and TENS were administered on the forearm, and the sham electrotherapy group received no current output via a dummy stimulator. Results. A 2-way repeated-measures analysis of variance revealed that there was no change in pain intensity during treatment when all 3 groups were considered together. Further analysis revealed that IFC reduced pain intensity when compared with sham electrotherapy but not when compared only with TENS. Discussion and Conclusion. There were no differences in the magnitude of analgesia between IFC and TENS. Interferential currents reduced pain intensity to a greater extent than sham electrotherapy.
A Qualitative Study of Clinical Decision Making in Recommending Discharge Placement From the Acute Care Setting
Authors: Jette Diane U , Grover Lisa , Keck Carol P
Published: February 2017

Background and Purpose. One of the roles of rehabilitation professionals in the acute care setting is making recommendations for patients' discharge placement. The purpose of this investigation was to explore the decision-making process of physical therapists and occupational therapists when recommending discharge destination for patients following acute care hospitalization. Subjects. Participants were 7 physical therapists and 2 occupational therapists in an acute care rotation at a large academic medical center. Methods. A grounded-theory strategy was used. Three interviews were conducted and guided by questions about participants' approaches to discharge decision making. Information from the interview transcripts was used to define constructs. A model was generated to explain the relationships among the constructs. Results. Decision making regarding discharge recommendations was guided by 4 constructs: patients' functioning and disability, patients' wants and needs, patients' ability to participate in care, and patients' life context. Information was filtered through therapists' experiences and modified by the health care team's opinions and by health care regulations. Discussion and Conclusion. The decision making of the rehabilitation professionals studied in recommending discharge placements for their patients reflects consideration of patients as individuals and the environments in which they live. Information about patients is filtered through the experience of therapists and influenced by health care regulations and opinions of other health care professionals, the patients, and their associates. The findings might be used in teaching clinical decision making to clinicians and students as they learn to make discharge recommendations.
A Physiological Profile Approach to Falls Risk Assessment and Prevention
Authors: Lord Stephen R , Menz Hylton B , Tiedemann Anne
Published: February 2017

The purpose of this perspective article is to describe the use of a physiological profile approach to falls risk assessment and prevention that has been developed by the Falls and Balance Research Group of the Prince of Wales Medical Research Institute, Sydney, Australia. The profile's use for people with a variety of factors that put them at risk for falls is discussed. The Physiological Profile Assessment (PPA) involves a series of simple tests of vision, peripheral sensation, muscle force, reaction time, and postural sway. The tests can be administered quickly, and all equipment needed is portable. The results can be used to differentiate people who are at risk for falls (“fallers”) from people who are not at risk for falls (“nonfallers”). A computer program using data from the PPA can be used to assess an individual's performance in relation to a normative database so that deficits can be targeted for intervention. The PPA provides valid and reliable measurements that can be used for assessing falls risk and evaluating the effectiveness of interventions and is suitable for use in a range of physical therapy and health care settings.
Use of Power Mobility for a Young Child With Spinal Muscular Atrophy
Authors: Jones Maria A , McEwen Irene R , Hansen Laura
Published: February 2017

Background and Purpose. Young children with severe motor impairments, such as spinal muscular atrophy, are often unable to move around their environment independently; therefore, they may be at risk for delays in areas of development not directly related to their motor limitations. Power mobility is an intervention that provides young children a means of independent movement and enables them to independently explore their environment. Case Description. The participant was a 20-month-old girl with type II spinal muscular atrophy. Intervention. The authors provided the child with a power wheelchair and gave her mother and physical therapist general guidelines to encourage her use of the power wheelchair. Outcomes. Within 6 weeks after receiving the power wheelchair, the child operated the wheelchair independently. She showed developmental gains in all domains of the Battelle Developmental Inventory and the Pediatric Evaluation of Disability Inventory over 6 months. The authors conducted an interview with the child's mother before and after intervention. She reported that the child was more independent after receiving the power wheelchair. Discussion. The power wheelchair may have been associated with the changes in the child's mobility and her developmental changes over 6 months.
Use of Clinical and Impairment-Based Tests to Predict Falls by Community-Dwelling Older Adults
Authors: Boulgarides Lois K , McGinty Susan M , Willett Jayne A , Barnes Carole W
Published: February 2017

Background and Purpose. Few tests have been found to be strongly predictive of falls in community-dwelling older adults. The purpose of this study was to determine whether data from 5 balance tests—combined with data regarding fall history, number of medications, dizziness, visual problems, use of an assistive device, physical activity level, sex, and age—could predict falls in community-dwelling older adults who were independent. Subjects. Ninety-nine community-dwelling older adults aged 65 to 90 years (X̄= 74.02, SD=5.64) were tested. Methods. Subjects were tracked for falls over a 1-year period following testing. Impairment-based tests, which are tests that attempt to specifically identify which sensory systems are impaired or how motor control is impaired (eg, speed, accuracy of movement), were the Modified Clinical Tests of Sensory Interaction for Balance (Modified CTSIB) and the 100% Limits of Stability Test, both of which were done on the Balance Master 6.1. Performance-based tests, which are functional tests that identify functional limitations without necessarily identifying their causes, were the Berg Balance Scale, the Timed “Up & Go” Test, and the Dynamic Gait Index. Demographic and health data included age, sex, number of medications, physical activity level, presence of dizziness, vision problems, and history of falls over the previous year. Logistic regression was used to determine which combinations of data from balance tests, demographics, and health factors were predictive of falls. Results. Two models—(1) the “standing on a firm surface with eyes closed” (FEC) condition of the Modified CTSIB and (2) the FEC combined with age and sex—were predictive of falls, but predicted only 1 and 2 subjects who were at risk for falling, respectively, out of 20 people who were at risk for falling. Discussion and Conclusion. Five balance tests combined with health and demographic factors did not predict falls in a sample of community-dwelling older adults who were active and independent.
Effects of Short Versus Long Bouts of Aerobic Exercise in Sedentary Women With Fibromyalgia: A Randomized Controlled Trial
Authors: Schachter Candice L , Busch Angela J , Peloso Paul M , Sheppard M Suzanne
Published: February 2017

Background and Purpose. The purposes of this study were: (1) to assess the effectiveness of a 16-week progressive program of home-based, videotape-based, low-impact aerobic exercise on physical function and signs and symptoms of fibromyalgia in previously sedentary women aged 20 to 55 years and (2) to compare the effects of 1 long exercise bout versus 2 short exercise bouts per training day (fractionation) on physical function, signs and symptoms of fibromyalgia, and exercise adherence. Subjects. One hundred forty-three sedentary women were randomly assigned to 1 of 3 groups: a group who trained using a long bout of exercise (LBE group, n=51), a group who trained using short bouts of exercise (SBE group, n=56), and a group who performed no exercise (NE group, n=36). Methods. The SBE group exercised twice daily, and the LBE group worked out once daily. Both groups progressed in total daily training duration from 10 to 30 minutes, 3 to 5 times a week, for 16 weeks. Physical and psychological well-being, symptoms, and self-efficacy were evaluated using a multivariate analysis of variance. Results. Dropout rates for the NE, SBE, and LBE groups were 14%, 38%, and 29%, respectively. The NE group differed from the LBE group in disease severity, self-efficacy, and psychological well-being (midtest, efficacy analysis) and from the SBE group in disease severity and self-efficacy (posttest, efficacy analysis). Exercise adherence was greater for the LBE group than for the SBE group between weeks 5 and 8 of the training program. No other differences between exercise groups were found. Discussion and Conclusion. Progressive, home-based, low-impact aerobics improved physical function and fibromyalgia symptoms minimally in participants who completed at least two thirds of the recommended exercise. Fractionation of exercise training provided no advantage in terms of exercise adherence, improvements in fibromyalgia symptoms or physical function. High attrition rates and problems with exercise adherence were experienced in both exercise groups.
Application of Constraint-Induced Movement Therapy for an Individual With Severe Chronic Upper-Extremity Hemiplegia
Authors: Bonifer Nancy (McNamara) , Anderson Kristin M
Published: February 2017

Background and Purpose. Constraint-induced movement therapy (CIMT) has been documented to improve motor function in the upper extremity of people with mild hemiparesis. The use of CIMT has not been documented for people with severe hemiparesis. This case report describes a CIMT program for an individual with severe upper-extremity deficits as a result of stroke. Case Description. The client was a 53-year-old woman who had a stroke 15 years previously and had no isolated movement in her right upper extremity. Methods. The client completed a 3-week CIMT program during which she restrained her left upper extremity and participated in intensive training of her right upper extremity. Task practice and shaping were the primary techniques used for training. Outcomes. Increased scores were noted from pretreatment to posttreatment on the Motor Activity Log, Graded Wolf Motor Function Test (GWMFT), and Fugl-Meyer Evaluation of Physical Performance. Further progress on the GWMFT was noted at the 6-month follow-up. Fugl-Meyer test scores remained higher than at pretreatment, but Motor Activity Log scores returned to near baseline by the 6-month follow-up. The speed of performance on the GWFMT did not change. Although some scores increased, the client reported and demonstrated no progress in functional use of the involved upper extremity at the end of the program. Discussion. This case report describes the use of CIMT with an individual who had severe chronic motor deficits as a result of stroke. Further investigation of CIMT, as well as investigation of CIMT in combination with other motor recovery interventions, is warranted.
Comparison of the Oxygen Cost of Breathing Exercises and Spontaneous Breathing in Patients With Stable Chronic Obstructive Pulmonary Disease
Authors: Jones Alice YM , Dean Elizabeth , Chow Cedric CS
Published: February 2017

Background and Purpose. The oxygen demand of breathing exercises and the clinical implications have not been studied in detail. In this study, the oxygen cost of 3 common breathing exercises believed to reduce oxygen cost (ie, work of breathing) was compared with that of spontaneous breathing in patients with chronic obstructive pulmonary disease (COPD). Subjects. Thirty subjects with stable, moderately severe COPD participated. Methods. Oxygen consumption (V̇o2) and respiratory rate (RR) during spontaneous breathing at rest (SB) were recorded for 10 minutes. Subjects then performed 3 breathing exercises in random order, with a rest between exercises: diaphragmatic breathing (DB), pursed-lip breathing (PLB), and a combination of DB and PLB (CB). Oxygen consumption and RR were measured. Results. Mean V̇o2 (±SD) was lower during the breathing exercises (165.8±22.3 mL O2/min for DB, 164.8±20.9 mL O2/min for PLB, and 167.7±20.7 mL O2/min for CB) compared with SB (174.5±25.2 mL O2/min). Correspondingly, mean RR (±SD) was higher during SB (17.3±4.23 breaths/min), followed by DB (15.0±4.32 breaths/min), PLB (12.8±3.53 breaths/min), and CB (11.2±2.7 breaths/min). Discussion and Conclusion. Given that patients do not spontaneously adopt the breathing pattern with the least V̇o2 and the lowest RR, the results suggest that determinants of the breathing pattern other than metabolic demand warrant being a primary focus in patients with COPD.
Medial Pontine Hemorrhagic Stroke
Authors: Ruhland Janet L , van Kan Peter LE
Published: February 2017

Background and Purpose. This case report documents a rare opportunity to observe the motor function of an individual for nearly 6 months following a primary pontine hemorrhage in the medial pontine tegmentum of the brain stem. The purpose of this report is to illustrate how knowledge of the location of the hemorrhage, in conjunction with knowledge of brain-stem structure-function relationships, informs physical therapist examination and intervention. Case Description. RM, a right-handed 81-year-old man with hypertension, had a hemorrhagic brain-stem stroke that severely compromised control of posture and whole-limb movements. Some residual ability to use the right hand and fingers remained, provided the trunk and right upper arm were stabilized. RM had undiminished intellectual abilities and unaltered memory because of sparing of cerebral cortices. RM's cognitive abilities, however, were obscured by severe impairments in interpersonal communication because of extensive damage to cranial nerve structures. Computed tomographic scans verified that the hematoma crossed the midline and was confined to the medial pontine tegmentum. Discussion. We interpret motor deficits resulting from stoke in the medial pontine tegmentum in terms of damage to brain-stem descending motor systems and ascending somatosensory systems. Recognition of cognitive and residual motor abilities following brain-stem stroke can aid in the development of rehabilitation strategies.
Manipulation of the Wrist for Management of Lateral Epicondylitis: A Randomized Pilot Study
Authors: Struijs Peter AA , Damen Pieter-Jan , Bakker Eric WP , Blankevoort Leendert , Assendelft Willem JJ , van Dijk C Niek
Published: February 2017

Background and Purpose. Lateral epicondylitis (“tennis elbow”) is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation of the wrist and (2) ultrasound, friction massage, and muscle stretching and strengthening exercises. Subjects and Methods. Thirty-one subjects with a history and examination results consistent with lateral epicondylitis participated in the study. The subjects were randomly assigned to either a group that received manipulation of the wrist (group 1) or a group that received ultrasound, friction massage, and muscle stretching and strengthening exercises (group 2). Three subjects were lost to follow-up, leaving 28 subjects for analysis. Follow-up was at 3 and 6 weeks. The primary outcome measure was a global measure of improvement, as assessed on a 6-point scale. Analysis was performed using independent t tests, Mann-Whitney U tests, and Fisher exact tests. Results. Differences were found for 2 outcome measures: success rate at 3 weeks and decrease in pain at 6 weeks. Both findings indicated manipulation was more effective than the other protocol. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. After 6 weeks of intervention, improvement in pain as measured on an 11-point numeric scale was 5.2 (SD=2.4) in group 1, as compared with 3.2 (SD=2.1) in group 2. Discussion and Conclusion. Manipulation of the wrist appeared to be more effective than ultrasound, friction massage, and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up. However, replication of our results is needed in a large-scale randomized clinical trial with a control group and a longer-term follow-up.
Determinants of Function After Total Knee Arthroplasty
Authors: Jones C Allyson , Voaklander Donald C , Suarez-Almazor Maria E
Published: February 2017

Background and Purpose. Decreasing hospital stays for patients with total knee arthroplasties (TKAs) have a direct effect on rehabilitation. The identification of modifiable determinants of postsurgical functional status would help physical therapists plan for discharge from hospitals. The purpose of this study was to identify preoperative determinants of functional status after a TKA. Participants. Using a community-based, prospective cohort study, data were collected from 276 patients who received a primary TKA in a Canadian health care region. Data were collected in the month before surgery and 6 months after surgery. Methods. Function was measured using the function subscale of a disease-specific measure—the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index—and a generic health status measure—the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Independent variables examined included demographic variables (eg, age, sex), medical variables (eg, diagnosis, number of comorbid conditions, ambulatory status), surgical variables (eg, type of implant, number of complications), and knee range of motion. Results. At 6 months after surgery, the average WOMAC physical function score was 70.5 (SD=18.2) and the average SF-36 physical function score was 44.8 (SD=25.3). Using multiple regression analyses, baseline function, walking device, walking distance, and comorbid conditions predicted 6-month function (WOMAC: R2=.20; SF-36 physical function: R2=.27). Discussion and Conclusion. Patients who have lower preoperative function may require more intensive physical therapy intervention because they are less likely to achieve functional outcomes similar to those of patients who have less preoperative dysfunction.
Phonophoresis Versus Topical Application of Ketoprofen: Comparison Between Tissue and Plasma Levels
Authors: Cagnie Barbara , Vinck Elke , Rimbaut Steven , Vanderstraeten Guy
Published: February 2017

Background and Purpose. Over the last few decades, application of ultrasound has been attempted to enhance transdermal transport of several drugs, a method referred to as “phonophoresis.” The purposes of this study were to examine the influence of ultrasound on the transdermal delivery of ketoprofen in humans and to compare the concentrations found after continuous and pulsed application. Subjects and Methods. Twenty-six patients with knee disorders requiring arthroscopy were randomly assigned to 1 of 3 groups. Just before surgery, phonophoresis of a ketoprofen gel (Fastum gel) was given to group A using continuous ultrasound (1 MHz, 1.5 W/cm2, for 5 minutes). Group B received the same treatment but with pulsed ultrasound (100 Hz, 20% duty cycle). Group C received 5 minutes of sham ultrasound with the ketoprofen gel. The ultrasound head was moved over a 10-cm2 area using small, continuous, circular movements. Biopsies of adipose tissue and synovial tissue were taken during surgery to evaluate the local penetration of the drug. Blood samples also were collected to determine whether ketoprofen entered the systemic circulation. Results. The concentration of ketoprofen in plasma was negligible in all 3 groups. The concentration of ketoprofen in synovial tissue differed from that in fat tissue. A difference in concentration of ketoprofen in synovial tissue was found between group C and groups A and B. The concentration of ketoprofen in fat tissue and synovial tissue was consistently higher in group B than in group A. Discussion and Conclusion. This study confirms that phonophoresis of ketoprofen allows the attainment of higher local concentrations, whereas systemic exposure is lower. The results indicate that, in contrast to sham phonopheresis, ultrasound can increase the transdermal delivery of ketoprofen.
Evidence-Based Practice: Beliefs, Attitudes, Knowledge, and Behaviors of Physical Therapists
Authors: Jette Diane U , Bacon Kimberly , Batty Cheryl , Carlson Melissa , Ferland Amanda , Hemingway Richard D , Hill Jessica C , Ogilvie Laura , Volk Danielle
Published: February 2017

Background and Purpose. Little research has been done regarding the attitudes and behaviors of physical therapists relative to the use of evidence in practice. The purposes of this study were to describe the beliefs, attitudes, knowledge, and behaviors of physical therapist members of the American Physical Therapy Association (APTA) as they relate to evidence-based practice (EBP) and to generate hypotheses about the relationship between these attributes and personal and practice characteristics of the respondents. Methods. A survey of a random sample of physical therapist members of APTA resulted in a 48.8% return rate and a sample of 488 that was fairly representative of the national membership. Participants completed a questionnaire designed to determine beliefs, attitudes, knowledge, and behaviors regarding EBP, as well as demographic information about themselves and their practice settings. Responses were summarized for each item, and logistic regression analyses were used to examine relationships among variables. Results. Respondents agreed that the use of evidence in practice was necessary, that the literature was helpful in their practices, and that quality of patient care was better when evidence was used. Training, familiarity with and confidence in search strategies, use of databases, and critical appraisal tended to be associated with younger therapists with fewer years since they were licensed. Seventeen percent of the respondents stated they read fewer than 2 articles in a typical month, and one quarter of the respondents stated they used literature in their clinical decision making less than twice per month. The majority of the respondents had access to online information, although more had access at home than at work. According to the respondents, the primary barrier to implementing EBP was lack of time. Discussion and Conclusion. Physical therapists stated they had a positive attitude about EBP and were interested in learning or improving the skills necessary to implement EBP. They noted that they needed to increase the use of evidence in their daily practice.
A Yoga-Based Exercise Program for People With Chronic Poststroke Hemiparesis
Authors: Bastille Julie V , Gill-Body Kathleen M
Published: February 2017

Background and Purpose. This was a preliminary investigation of the effects of a yoga-based exercise program on people with chronic (greater than 9 months) poststroke hemiparesis. Many people who have had a stroke report an impaired health status because of a reduced level of activity. Proponents of yoga contend that it offers a gentle alternative exercise program that can be easily adapted for people who have had a stroke. Subjects and Methods. Four subjects with chronic poststroke hemiparesis participated in this single-case study. The primary outcome measures were the Berg Balance Scale (BBS) and the Timed Movement Battery (TMB). A secondary outcome measure was the Stroke Impact Scale (SIS). The baseline testing phase varied for each subject and ranged from 4 to 7 weeks. The 8-week intervention phase consisted of 1.5-hour yoga sessions, 2 times per week, in the subject's home. The primary outcome data were collected each week, and the secondary outcome data were collected before the baseline testing phase and before and after the intervention phase. Results. Subjects 1, 2, and 4 had improved TMB scores, and subjects 3 and 4 had improved BBS scores. Discussion and Conclusion. The results suggest that yoga may be beneficial to people who have had a stroke. Further investigation is warranted to further examine the effects of yoga in this population.
Development and Validation of a Scale for Rating Motor Compensations Used for Reaching in Patients With Hemiparesis: The Reaching Performance Scale
Authors: Levin Mindy F , Desrosiers Johanne , Beauchemin Danielle , Bergeron Nathalie , Rochette Annie
Published: February 2017

Background and Purpose. Recent movement analysis studies have described compensatory movement strategies used by people with hemiparesis secondary to stroke during reaching and grasping tasks. The purpose of this article is to describe the development of a new scale—the Reaching Performance Scale (RPS)—for assessing compensatory movements for upper-extremity reaching in people with hemiparesis secondary to stroke. Subjects. Twenty-eight individuals with hemiparesis, with a mean age of 54.9 years (SD=18.6), participated. Methods. The study design involved scale development with expert panels and criterion standards for validity. Participants were evaluated on the new scale as well as other clinical tests for validity. They were videotaped while performing reaching and grasping movements. Results. The RPS scores correlated with measurements of grip force and Chedoke-McMaster Stroke Assessment and Upper Extremity Performance Test for the Elderly (TEMPA) scores. The RPS discriminated patients with different impairment levels according to the Chedoke-McMaster Stroke Assessment. Preliminary intrarater and interrater reliability coefficients were acceptable for the whole scale. Mean kappa values on individual scale components for 3 raters represented a mean of 67% (SD=13.5%) agreement. Discussion and Conclusion. Although the RPS shows some types of validity, more rigorous tests of reliability are needed for meaningful conclusions. This study is a first step in validating the scale to assess efficacy of intervention for motor recovery of the arm.
Reliability, Internal Consistency, and Validity of Data Obtained With the Functional Gait Assessment
Authors: Wrisley Diane M , Marchetti Gregory F , Kuharsky Diane K , Whitney Susan L
Published: February 2017

Background and Purpose. The Functional Gait Assessment (FGA) is a 10-item gait assessment based on the Dynamic Gait Index. The purpose of this study was to evaluate the reliability, internal consistency, and validity of data obtained with the FGA when used with people with vestibular disorders. Subjects. Seven physical therapists from various practice settings, 3 physical therapist students, and 6 patients with vestibular disorders volunteered to participate. Methods. All raters were given 10 minutes to review the instructions, the test items, and the grading criteria for the FGA. The 10 raters concurrently rated the performance of the 6 patients on the FGA. Patients completed the FGA twice, with an hour's rest between sessions. Reliability of total FGA scores was assessed using intraclass correlation coefficients (2,1). Internal consistency of the FGA was assessed using the Cronbach alpha and confirmatory factor analysis. Concurrent validity was assessed using the correlation of the FGA scores with balance and gait measurements. Results. Intraclass correlation coefficients of .86 and .74 were found for interrater and intrarater reliability of the total FGA scores. Internal consistency of the FGA scores was .79. Spearman rank order correlation coefficients of the FGA scores with balance measurements ranged from .11 to .67. Discussion and Conclusion. The FGA demonstrates what we believe is acceptable reliability, internal consistency, and concurrent validity with other balance measures used for patients with vestibular disorders.
A Home Program of Sensory and Neuromuscular Electrical Stimulation With Upper-Limb Task Practice in a Patient 5 Years After a Stroke
Authors: Sullivan Jane E , Hedman Lois D
Published: February 2017

Background and Purpose. This case report describes a person with upper-extremity (UE) hemiparesis who participated in a home program that included sensory amplitude electrical stimulation (SES) to his involved arm and performance of task-specific exercises with the assistance of neuromuscular electrical stimulation (NMES). Case Description. The patient was a 67-year-old man with stable sensory and motor deficits 5 years after a stroke. Sensory amplitude electrical stimulation was delivered for 2 hours per day. A daily, 15-minute course of NMES was used to help him perform UE tasks. This home program was carried out for 18 weeks and included 6 physical therapist home visits. Outcomes. The patient's UE score on the Stroke Rehabilitation Assessment of Movement (STREAM) improved from 10/20 to 17/20. The score on the Action Research Arm Test (ARAT) improved from 27/57 to 42/57. The patient reported that he was now able to button buttons, use a knife and fork, and tie simple fishing knots. Discussion. A home program combining SES and NMES may be an effective method to increase UE function even 5 years after a stroke.
Braving New Worlds: To Conquer, to Endure
Authors: Moffat Marilyn
Published: February 2017

Marilyn Moffat, PT, PhD, FAPTA, CSCS

Dr Moffat has had a tremendous impact on the physical therapy profession as a visionary leader, a distinguished educator, and an accomplished clinician, administrator, and researcher. She has served as editor of Physical Therapy and, as an elected member of APTA's House of Delegates, has been instrumental in providing direction for the future of the profession. She has served as a member of innumerable committees, task forces, and boards of directors at every level within the Association. In 1991, she was elected President of APTA for the first of 2 consecutive terms.

As President, Dr Moffat spearheaded the development of the Association's Guide to Physical Therapist Practice, and she later served as a project editor of the Guide's second edition and was heavily involved in the development of the Interactive Guide on CD-ROM. Dr Moffat has worked tirelessly since 1977, when she first spoke about the professional doctoral degree for physical therapists, to lead the profession through a process of redefining the role of the physical therapist for the future and ensuring that the highest level of practice would be achieved as a requisite for assuming the title “Doctor of Physical Therapy.”

As a delegate to the World Confederation for Physical Therapy, Dr Moffat has provided leadership to the international community of physical therapists. She served as APTA's voting delegate to the WCPT General Meeting, on the Executive Committee of the WCPT as the North America/Caribbean Region representative, and as a member of the Task Force on the International Definition of Physical Therapy. Dr Moffat has given more than 800 professional presentations worldwide and has taught and consulted in Taiwan, Thailand, Burma, Puerto Rico, Vietnam, Hong Kong, and Wuhan in China. For her demonstrated worldwide leadership in physical therapy, she was honored with WCPT's Mildred Elson Award for International Leadership in Physical Therapy.

Dr Moffat has been the recipient of many APTA honors and awards. She has been recognized with APTA's Lucy Blair Service Award and as a Catherine Worthingham Fellow. She has received 2 diversity awards from the Advisory Panel on Minority Affairs, the R Charles Harker Policy Maker Award from APTA's Health Policy and Administration Section, and the Robert Dicus Outstanding Service Award from APTA's Private Practice Section. The most significant acknowledgments of her lifelong commitment to service are the New York Chapter's Dr Marilyn Moffat Distinguished Service Award and APTA's newly created Marilyn Moffat Leadership Award.
Screening for Symptoms of Depression by Physical Therapists Managing Low Back Pain
Authors: Haggman Sonia , Maher Christopher G , Refshauge Kathryn M
Published: February 2017

Background and Purpose. Depression is a condition that worsens the prognosis of low back pain (LBP) and is under-recognized and undertreated in primary care. The purpose of this study was to evaluate the accuracy with which physical therapists screen for depressive symptoms among their patients with LBP. Subjects. Sixty-eight physical therapists and 232 patients with nonspecific LBP from 40 physical therapy clinics participated. Methods. Patients completed the reference standard (Depression Anxiety Stress Scales [DASS]) and a 2-item screening test for depression taken from the Primary Care Evaluation of Mental Disorders Procedure (PRIME-MD). Treating physical therapists used a 0 to 10 scale to judge whether each patient was depressed. Based on the short-form Depression Anxiety Stress Scales (DASS-21) depression scale score, each patient was categorized as exhibiting normal, mild, moderate, severe, or extremely severe depression symptoms, and receiver operating characteristic (ROC) curves were generated to describe test accuracy. Results. The 2-item screening test was more accurate in screening for depressive symptoms than the physical therapists' ratings were; for example, in detecting moderate depressive symptoms in the 2 areas under the ROC curve, values were 0.66 versus 0.79. Discussion and Conclusion. Because the therapists did not accurately identify symptoms of depression, even symptoms of severe depression, despite the common presentation in their clinics, we recommend that physical therapists managing patients with LBP use the 2-item depression screening test. Administration of this screening test would improve physical therapists' ability to screen for symptoms of depression and would enable referral for appropriate management.
Optimizing the Sensitivity of the Head Thrust Test for Identifying Vestibular Hypofunction
Authors: Schubert Michael C , Tusa Ronald J , Grine Lawrence E , Herdman Susan J
Published: February 2017

Background and Purpose. The head thrust test (HTT) is used to assess the vestibulo-ocular reflex. Sensitivity and specificity for diagnosing unilateral vestibular hypofunction (UVH) in patients following vestibular ablation is excellent (100%), although sensitivity is lower (35%–39%) for patients with nonsurgically induced UVH. The variability of the test results may be from moving the subject's head outside the plane of the lateral semicircular canals as well as using a head thrust of predictable timing and direction. The purpose of this study was to examine sensitivity and specificity of the horizontal HTT in identifying patients with UVH and bilateral vestibular hypofunction (BVH) when the head was flexed 30 degrees in attempt to induce acceleration primarily in the lateral semicircular canal and the head was moved unpredictably. Subjects. The medical records of 176 people with and without vestibular dysfunction (n=79 with UVH, n=32 with BVH, and n=65 with nonvestibular dizziness) were studied. Methods. Data were retrospectively tabulated from a de-identified database (ie, with health information stripped of all identifiers). Results. Sensitivity of the HTT for identifying vestibular hypofunction was 71% for UVH and 84% for BVH. Specificity was 82%. Discussion and Conclusion. Ensuring the head is pitched 30 degrees down and thrust with an unpredictable timing and direction appears to improve sensitivity of the HTT.
Relationship Between Spontaneous Kicking and Age of Walking Attainment in Preterm Infants With Very Low Birth Weight and Full-Term Infants
Authors: Jeng Suh-Fang , Chen Li-Chiou , Tsou Kuo-Inn , Chen Wei J , Luo Hong-Ji
Published: February 2017

Background and Purposes. Although early kicking differences have been reported for preterm infants without overt cranial sonographic abnormalities, their functional importance remains unclear because no outcomes have been measured. Therefore, the first purpose of this prospective study was to examine the age of walking attainment in preterm infants who had very low birth weight (VLBW) but no overt neurosonographic abnormalities and full-term infants without known impairments or pathology. The second purpose was to examine the relationship between spontaneous kicking and age of walking attainment in these infants. Subjects and Methods. Twenty-two preterm infants and 22 full-term infants were examined for kicking movements at 2 and 4 months corrected age and were followed up for age of walking attainment until 18 months corrected age. Results. Survival analysis showed that infants with VLBW attained walking ability at older ages than full-term infants after correction for prematurity. Cox proportional-hazards regression analyses for all infants revealed that a high hip-knee correlation at 2 months corrected age, a high kick frequency at 4 months corrected age, and a short intra-kick pause together with a low variability in interlimb coordination at 2 and 4 months corrected age were all associated with a decreased rate of walking attainment. Discussion and Conclusion. The results indicated that preterm infants who had VLBW but no overt neurosonographic abnormalities had an increased risk of delayed walking attainment compared with full-term infants. Alterations of spontaneous kicking may predict a decreased rate of walking attainment in both preterm and full-term infants.
Factors Related to the Inability of Individuals With Low Back Pain to Improve With a Spinal Manipulation
Authors: Fritz Julie M , Whitman Julie M , Flynn Timothy W , Wainner Robert S , Childs John D
Published: February 2017

Background and Purpose. Although spinal manipulation is one of the few interventions for low back pain supported by evidence, it appears to be underutilized by physical therapists, possibly due to therapists' concerns that a patient may not benefit from the intervention. The purpose of this study was to identify factors that are associated with an inability to benefit from manipulation. Subjects. Seventy-five people with nonradicular low back pain (mean age=37.6 years, SD=10.6, range=19–59; mean duration of symptoms=41.7 days, SD=54.7, range=1–252) participated. Methods. Subjects underwent a standardized examination that included history-taking; self-reports of pain, disability, and fear-avoidance beliefs; measurement of lumbar and hip range of motion; and use of various tests. All subjects received a spinal manipulation intervention for a maximum of 2 sessions. Subjects who did not show greater than 5 points of improvement on the modified Oswestry Low Back Pain Disability Questionnaire were considered to have shown no improvement with the manipulation. Baseline variables were tested for univariate relationship with the outcome of the manipulation. Variables showing a univariate relationship were entered into a logistic regression equation, and adjusted odds ratios were calculated. Results. Twenty subjects (28%) did not improve with manipulation. Six variables were identified as being related to inability to improve with manipulation: longer symptom duration, having symptoms in the buttock or leg, absence of lumbar hypomobility, less hip rotation range of motion, less discrepancy in left-to-right hip medial rotation range of motion, and a negative Gaenslen sign. The resulting logistic regression model explained 63% of the variance in manipulation outcome. Discussion and Conclusion. The majority of subjects improved with manipulation. Baseline variables could be identified that were predictive of which subjects would not improve.
Adding Ultrasound in the Management of Soft Tissue Disorders of the Shoulder: A Randomized Placebo-Controlled Trial
Authors: Gürsel Yeşim Kurtaiş , Ulus Yasemin , Bilgiç Ayşe , Dinçer Gülay , van der Heijden Geert JMG
Published: February 2017

Background and Purpose. There is still a lack of evidence about the beneficial effects of ultrasound (US) intervention for the management of soft tissue problems. Thus, this study was designed to assess the effectiveness of US over a placebo intervention when added to other physical therapy interventions and exercise in the management of shoulder disorders. Subjects and Methods. Forty patients who were diagnosed by ultrasonography or magnetic resonance imaging to have a periarticular soft tissue disorder of the shoulder were randomly assigned to either a group that received true US (n=20; mean time since onset of pain=8.7 months, SD=8.8, range=1–36) or a group that received sham US (n=20; mean time since onset of pain=8.1 months, SD=10.8, range=1–42). Besides true or sham US (10 minutes), superficial heat (10 minutes), electrical stimulation (15 minutes), and an exercise program (15–30 minutes) were administered to both groups 5 days each week for 3 weeks. Results. Subjects showed within-group improvements in pain, range of motion, Shoulder Disability Questionnaire scores, and Health Assessment Questionnaire scores with the intervention, but the differences did not reach significance when compared between the groups. Discussion and Conclusion. The results suggest that true US, compared with sham US, brings no further benefit when applied in addition to other physical therapy interventions in the management of soft tissue disorders of the shoulder.
Factors Related to Activity Limitations in a Group of Cuban Americans Before and After Hip Fracture
Authors: Kirk-Sanchez Neva J
Published: February 2017

Background and Purpose. Cuban Americans over the age of 50 years, like people from a number of other cultures, have been exposed to distinctive social and psychological aspects of their culture that may affect their recovery from a major health event. The purpose of this study was to determine factors related to activity limitations in a group of Cuban Americans recovering from hip fractures. Subjects. The subjects were 28 adults of Cuban-American origin with an average age of 79 years (SD=9, range=57–96) who were recovering from hip fracture. Subjects were followed for 2 months after discharge from a hospital-based inpatient rehabilitation facility. Methods. Subjects were interviewed at the time of discharge from the rehabilitation facility and 2 months after discharge, and they completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and a social support interview. Functional Independence Measure scores and information regarding rehabilitative care were obtained from the rehabilitation facility. Multilinear regression analysis was used to determine the factors related to activity limitations before and after hip fracture. Results. More premorbid activity limitations were related to poorer mental health status, older age, and male sex. More activity limitations at the time of discharge from the rehabilitation hospital were related to poorer mental health status prior to admission and partial or non–weight-bearing status after hip fracture. Older age and male sex were premorbid factors that appeared to relate to function after discharge. More activity limitations during the 2 months after discharge were related to the subjects reporting more social support in the form of physical assistance, less social support in the form of emotional assistance, less negative social support in the form of demand and criticism, status for weight bearing as tolerated at the time of discharge from the rehabilitation hospital, and older age. Discussion and Conclusion. In this group of Cuban Americans, mental health status was related to more activity limitations prior to admission to the rehabilitation facility and early in the recovery process, but not later in the recovery process. Conversely, social support was related to activity limitations later in the recovery process, but not prior to admission or early in the recovery process. Physical therapists should be aware of the psychosocial determinants of activity limitations during the process of recovery from disease or trauma.
The Role of Health Promotion in Physical Therapy in California, New York, and Tennessee
Authors: Rea Brenda L , Marshak Helen Hopp , Neish Christine , Davis Nicceta
Published: February 2017

Background and Purpose. As health care providers, physical therapists are in an ideal position to address health promotion issues with their patients; yet, little is known about actual health promotion practice patterns or the confidence of physical therapists in engaging in such activities. The purposes of this study were: (1) to investigate perceptions of practice patterns in 4 focus areas of Healthy People 2010 (disability and secondary conditions by assessing psychological well-being, nutrition and overweight, physical activity and fitness, and tobacco use) and (2) to identify related self-efficacy and outcome expectations in California, New York, and Tennessee. Subjects. A instrument was pilot tested and distributed in 2 waves to 3,500 randomly selected, licensed physical therapists from 3 states: California, New York, and Tennessee. Methods. Interviews were randomly conducted via telephone with 23 physical therapists in all 3 states until similar responses were identified in order to create the qualitative instrument, which was then pilot tested with 20 physical therapists in California. The total number of qualitative instruments used in the data analyses was 417 (145 from California, 127 from New York, and 145 from Tennessee) or 11.9%. Results. The health promotion behavior most commonly thought to be practiced by physical therapists was assisting patients to increase physical activity (54%), followed by psychological well-being (41%), nutrition and overweight issues (19%), and smoking cessation (17%). Self-efficacy predicted all 4 behaviors beyond the control variables. Minimal state-to-state differences were noted. Discussion and Conclusion. Physical therapists believe they are addressing health promotion topics with patients, although in varying degrees and in lower than desirable percentages based on Healthy People 2010 goals. This study demonstrated that a physical therapist's confidence in being able to perform a behavior (self-efficacy) was the best predictor of perceptions of practice patterns and is an area to target in future interventions.