bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Quadriceps Femoris Muscle Strengthening Exercises on Spasticity in Children With Cerebral Palsy
Authors: Fowler Eileen G , Ho Teresa W , Nwigwe Azuka I , Dorey Fredrick J
Published: February 2017

Background and Purpose. The Bobath neurodevelopmental treatment approach advised against the use of resistive exercise, as proponents felt that increased effort would increase spasticity. The purpose of this study was to test the premise that the performance of exercises with maximum efforts will increase spasticity in people with cerebral palsy (CP). Spasticity, in the present study, was defined as a velocity-dependent hyperexcitability of the muscle stretch reflex. Subjects. Twenty-four subjects with the spastic diplegic form of CP (mean age=11.4 years, SD=3.0, range=7–17) and 12 subjects without known neurological impairments (mean age=11.6 years, SD=3.5, range= 7–17) were assessed. Methods. Knee muscle spasticity was assessed bilaterally using the pendulum test to elicit a stretch reflex immediately before and after 3 different forms of right quadriceps femoris muscle exercise (isometric, isotonic, and isokinetic) during a single bout of exercise training. Pendulum test outcome measures were: (1) first swing excursion, (2) number of lower leg oscillations, and (3) duration of the oscillations. Results. There were no changes in spasticity following exercise between the 2 groups of subjects. Discussion and Conclusion. These results do not support the premise that exercises with maximum efforts increase spasticity in people with CP.
The Impact of Social and Organizational Factors on Workers' Coping With Musculoskeletal Symptoms
Authors: Torp Steffen , Riise Trond , Moen Bente E
Published: February 2017

Background and Purpose. Workers with musculoskeletal symptoms are often advised to cope with their symptoms by changing their working technique and by using lifting equipment. The main objective of this study was to test the hypothesis that negative social and organizational factors where people are employed may prevent workers from implementing these coping strategies. Subjects and Methods. A total of 1,567 automobile garage workers (72%) returned a questionnaire concerning coping with musculoskeletal symptoms and social and organizational factors. Results. When job demands, decision authority, social support, and management support related to health, environment, and safety (HES) were used as predictor variables in a multiple regression model, coping as the outcome variable was correlated with decision authority, social support, and HES-related management support (standardized beta=.079, .12, and .13, respectively). When an index for health-related support and control was added to the model, it correlated with coping (standardized beta=.36), whereas the other relationships disappeared. Discussion and Conclusion. Decision authority and social support entail health-related support and control that, in turn, influences coping.
Material Properties of Thera-Band Tubing
Authors: Patterson Rita M , Stegink Jansen Caroline W , Hogan Harry A , Nassif Michael D
Published: February 2017

Background and Purpose. Thera-Band Tubing has been used in rehabilitation to provide resistance for exercise and splinting. However, the forces required to stretch the tubing have not been thoroughly quantified. Therefore, the therapist cannot assess, with certainty, how much force is applied when using a given length and type of Thera-Band Tubing. The purpose of this study was to quantify the material properties of Thera-Band Tubing. Methods. Force versus percentage of strain for all types of Thera-Band Tubing was measured during elongation in a mechanical testing machine. Results. The material is very compliant and displays nonlinear behavior in the initial stretching phase and linear behavior after 50% elongation. Discussion and Conclusion. From the data obtained in this project, plots that can provide the therapist with information about the forces needed for exercises with Thera-Band Tubing were generated. These data should allow therapists to make better choices about which size of tubing to use for each patient.
Level of Activities Associated With Mobility During Everyday Life in Patients With Chronic Congestive Heart Failure as Measured With an “Activity Monitor”
Authors: van den Berg-Emons Hendrika (Rita) , Bussmann Johannes (Hans) , Balk Aggie , Keijzer-Oster Dorinde , Stam Henk
Published: February 2017

Background and Purpose. Because of dyspnea and fatigue, patients with congestive heart failure (CHF) may be restricted in the performance of normal everyday activities. The aim of this study was to obtain a preliminary indication of the level of activities associated with mobility during everyday life and between-day variance in activities in patients with mild to moderate CHF as measured with an “Activity Monitor.” Subjects and Methods. The “Activity Monitor” is based on long-term (>24 hours) ambulatory monitoring of signals from accelerometers fixed to the subject's body during everyday activities with the aim of assessing the level of activities associated with mobility. Measurements were obtained over 3 days from 5 male subjects with CHF (mean age=64 years, SD=5, range=59–72) and over 2 days from 5 matched comparison subjects (mean age=65 years, SD=4, range=61–71). Results. Mean duration of movement-related activities (walking, cycling, or general movement) (expressed as a percentage of the duration of the measurement day) was lower in the subjects with CHF (X̄=3.9, SD=1.5, range=2.2–6.7) than in the comparison subjects (X̄=11.3, SD=3.0, range=6.6–14.1). In the patients, between-day variance was smaller for different weekdays (eg, Monday versus Tuesday) than for similar weekdays (eg, 2 Mondays) (1.11% and 7.28%, respectively). Discussion and Conclusion. The results show how activities associated with mobility during everyday life may be restricted in people with CHF.
The Effects of a Contoured Foam Seat on Postural Alignment and Upper-Extremity Function in Infants With Neuromotor Impairments
Authors: Washington Kathleen , Deitz Jean C , White Owen R , Schwartz Ilene S
Published: February 2017

Background and Purpose. Physical therapists and occupational therapists frequently use adaptive seating devices to improve stability in sitting for children with neuromotor impairments. The purpose of this study was to examine the effects of a contoured foam seat (CFS) on postural alignment and on the ability of infants with neuromotor impairments to engage with toys. Parental perceptions regarding the use and effects of the CFS also were assessed via semistructured interviews. Subjects. Subjects were 4 infants, ages 9 to 18 months, who were unable to sit independently. Method. A time-series, alternating-treatments design was used, with data collected under 3 conditions: (1) a regular highchair, (2) a regular highchair with a thin foam liner, and (3) a CFS used as an insert in a regular highchair. The primary dependent measures were postural alignment and engagement with toys. Engagement with toys was defined as percentage of intervals with 2 hands on a toy and percentage of intervals with no hands on a highchair tray and 1 or 2 hands on a toy. Results. Results showed a sustained effect of the CFS on improving postural alignment for all subjects. Effects of the CFS on increasing the number of intervals of bimanual play were not demonstrated for any subjects, although some improvement in the infant's ability to free the arms from support was observed for 2 subjects. Mothers reported acceptability of the CFS for everyday use and described benefits for themselves and their infants. Discussion and Conclusion. The results support the use of a CFS for improving postural alignment. Future research on adaptive seating should focus on interventions and outcomes that help children participate in functional activities relevant to them and their families.
Back Performance Scale for the Assessment of Mobility-Related Activities in People With Back Pain
Authors: Strand Liv Inger , Moe-Nilssen Rolf , Ljunggren Anne Elisabeth
Published: February 2017

Background and Purpose. Activities that require mobility of the trunk are often limited in patients with back problems. For this study, 5 tests (Sock Test, Pick-up Test, Roll-up Test, Fingertip-to-Floor Test, and Lift Test), all requiring sagittal-plane mobility, were performed, and the test scores were combined by the authors in a scale called the Back Performance Scale (BPS) to obtain a performance measure of mobility-related activities. Subjects. The participants were 288 patients with long-lasting musculoskeletal pain. Methods. The basis for constructing a sum scale (BPS), discriminative ability, and responsiveness to important change of the BPS were examined in patients with back pain. Results. Bivariate correlations (rs) of scores among tests ranged from .27 to .50, and correlations between separate tests and the BPS ranged from .63 to .73. The Cronbach alpha was .73. The BPS sum scores discriminated between patients with different return to work status and were higher for back pain than for other musculoskeletal pain. Responsiveness was high (effect size=1.33) in patients who had changed and low (effect size=0.31) in patients who had not changed, using return to work as an external indicator of important change. The BPS was more responsive than the separate tests. Discussion and Conclusion. The BPS appears to measure an aspect of physical performance that is of clinical importance to patients with back pain.
Pathophysiological Tissue Changes Associated With Repetitive Movement: A Review of the Evidence
Authors: Barr Ann E , Barbe Mary F
Published: February 2017

Work-related musculoskeletal disorders (WMSDs) represent approximately one third of workers' compensation costs in US private industry, yet estimates of acceptable exposure levels for forceful and repetitive tasks are imprecise, in part, due to lack of measures of tissue injury in humans. In this review, the authors discuss the scope of upper-extremity WMSDs, the relationship between repetition rate and forcefulness of reaching tasks and WMSDs, cellular responses to injury in vivo and in vitro, and animal injury models of repetitive, forceful tasks. The authors describe a model using albino rats and present evidence related to tissue injury and inflammation due to a highly repetitive reaching task. A conceptual schematic for WMSD development and suggestions for further research are presented. Animal models can enhance our ability to predict risk and to manage WMSDs in humans because such models permit the direct observation of exposed tissues as well as motor behavior.
Physical Therapists' Perceptions of Factors Influencing the Acquisition of Motor Abilities of Children With Cerebral Palsy: Implications for Clinical Reasoning
Authors: Bartlett Doreen J , Palisano Robert J
Published: February 2017

Background and Purpose. Evidence supporting factors predicting motor change for children with cerebral palsy is minimal. A consensus exercise using focus groups and survey methods was conducted to identify factors perceived to affect the acquisition of basic motor abilities among children with cerebral palsy from the time of diagnosis to 7 years of age. Subjects. Fifty-seven physical therapists participated in one of 12 focus groups, and 60 physical therapists participated in a follow-up questionnaire survey via mail. Methods. The nominal group technique was used to conduct the focus groups. Results. Participants reached consensus about 12 factors in 4 constructs, which we called: (1) primary impairments (muscle tone/movement patterns, distribution of involvement, balance, and sensory impairment), (2) secondary impairments (range of motion/joint alignment, force production, health, and endurance), (3) personality characteristics (motivation), and (4) family factors (support to child, family expectations, and support to family). Discussion and Conclusion. The recognition of potential determinants of motor change could assist in the clinical reasoning that physical therapists use when planning interventions for children with cerebral palsy. Participants identified a set of variables, some of which are found in the literature, that can provide foundation knowledge for decision making and research on factors that bring about change in motor ability among children with cerebral palsy.
Pediatric Constraint-Induced Movement Therapy for a Young Child With Cerebral Palsy: Two Episodes of Care
Authors: DeLuca Stephanie C , Echols Karen , Ramey Sharon Landesman , Taub Edward
Published: February 2017

Background and Purpose. This case report describes the use of “Pediatric Constraint-Induced Therapy (Pediatric CI Therapy)” given on 2 separate occasions for a young child with quadriparetic cerebral palsy. Case Description. The child was 15 months of age at the beginning of the first episode of care. She had previously received weekly physical therapy and occupational therapy for 11 months, but she had no functional use of her right upper extremity (UE), independently or in an assistive manner. She scored from 5 to 7 months below her chronological age on developmental assessments in gross motor, fine motor, and self-help skills. Intervention. Pediatric CI Therapy involved placement of a full-arm, bivalved cast on the child's less affected UE while providing 3 weeks of intensive intervention (6 hours a day) for the child's more affected UE (intervention 1). Therapy included activities that were goal oriented but broken down into progressively more challenging step-by-step tasks. Pediatric CI Therapy was administered again 5 months later to promote UE skills and independence (intervention 2). Outcomes. The child developed new behaviors throughout both interventions. During intervention 1, the child developed independent reach, grasp, release, weight bearing (positioned prone on elbows) of both UEs, gestures, self-feeding, sitting, and increased interactive play using both UEs. During intervention 2, she had increased independence and improved quality of UE movement, as supported by blinded clinical evaluations and parent ratings.
Accuracy and Reliability of Observational Gait Analysis Data: Judgments of Push-off in Gait After Stroke
Authors: McGinley Jennifer L , Goldie Patricia A , Greenwood Kenneth M , Olney Sandra J
Published: February 2017

Background and Purpose. Physical therapists routinely observe gait in clinical practice. The purpose of this study was to determine the accuracy and reliability of observational assessments of push-off in gait after stroke. Subjects. Eighteen physical therapists and 11 subjects with hemiplegia following a stroke participated in the study. Method. Measurements of ankle power generation were obtained from subjects following stroke using a gait analysis system. Concurrent videotaped gait performances were observed by the physical therapists on 2 occasions. Ankle power generation at push-off was scored as either normal or abnormal using two 11-point rating scales. These observational ratings were correlated with the measurements of peak ankle power generation. Results. A high correlation was obtained between the observational ratings and the measurements of ankle power generation (mean Pearson r=.84). Interobserver reliability was moderately high (mean intraclass correlation coefficient [ICC (2,1)]=.76). Intraobserver reliability also was high, with a mean ICC (2,1) of .89 obtained. Discussion and Conclusion. Physical therapists were able to make accurate and reliable judgments of push-off in videotaped gait of subjects following stroke using observational assessment. Further research is indicated to explore the accuracy and reliability of data obtained with observational gait analysis as it occurs in clinical practice.
Voluntary Activation and Decreased Force Production of the Quadriceps Femoris Muscle After Total Knee Arthroplasty
Authors: Mizner Ryan L , Stevens Jennifer E , Snyder-Mackler Lynn
Published: February 2017

Background and Purpose. Quadriceps femoris muscle weakness as manifested by a decrease in force-generating capability is a persistent problem after total knee arthroplasty (TKA). The authors hypothesized that (1) patients with a TKA would have decreased quadriceps femoris muscle performance (weakness) and impaired volitional activation when compared with a group of older adults without knee pathology, (2) pain and age would account for a large portion of the variability in volitional activation after surgery, and (3) volitional activation in the TKA group would account for a large portion of the variability in force production. Subjects. Comparison subjects were 52 volunteers (mean age=72.2 years, SD=5.34, range=64–85). The TKA group comprised 52 patients (mean age=64.9 years, SD=7.72, range=49–78) with a diagnosis of osteoarthritis who had undergone a tricompartmental, cemented TKA. Methods. Knee extension force was measured using a burst superimposition technique, where a supramaximal burst of electrical stimulation was superimposed on a maximal voluntary isometric contraction (MVIC). The amount of failure of volitional activation is determined by the amount of electrical augmentation of force beyond a person's MVIC at the instant of the application of the electrical burst. Results. The average normalized knee extension force of the TKA group was 64% lower than that of the comparison group. The average volitional activation deficit in the TKA group (26%) was 4 times as great as the comparison group's deficit (6%). Age did not correlate with quadriceps femoris muscle activation, and knee pain explained only a small portion of the variance in knee extension force (r2=.17). Volitional activation was highly correlated with knee extension force production (r2=.65). Discussion and Conclusion. Considerable quadriceps femoris muscle inhibition after surgery has several implications for recovery. Rehabilitation programs that focus on volitional exercise alone are unlikely to overcome this pronounced failure of activation. Early interventions focused at improving quadriceps femoris muscle voluntary activation may improve efforts to restore muscle force.
Treatment of Erectile Dysfunction by Perineal Exercise, Electromyographic Biofeedback, and Electrical Stimulation
Authors: Van Kampen Marijke , De Weerdt Willy , Claes Hubert , Feys Hilde , De Maeyer Mira , Van Poppel Hendrik
Published: February 2017

Background and Purpose. Only a few investigators have described the involvement of the perineal muscles in the process of human erection. The aim of this research was to evaluate a re-education program for men with erection problems of different etiologies. Subjects and Methods. Fifty-one patients with erectile dysfunction were treated with pelvic-floor exercises, biofeedback, and electrical stimulation. Results. The results of the interventions can be summarized as follows: 24 patients (47%) regained a normal erection, 12 patients (24%) improved, and 6 patients (12%) did not make any progress. Nine patients (18%) did not complete the therapy. On the basis of several variables, a prediction equation was generated to determine the factors that would predict the effect of the interventions. The outcome was most favorable in men with venous-occlusive dysfunction. Discussion and Conclusion. Comparison of the results of the physical therapy protocol reported here with those obtained for other interventions reported in the literature shows that a pelvic-floor muscle program may be a noninvasive alternative for the treatment of patients with erectile dysfunction caused by venous occlusion.
Acute Care Physical Therapist Evaluation and Intervention for an Adult After Right Hemispherectomy
Authors: Bates Alison L , Zadai Cynthia C
Published: February 2017

Background and Purpose. Hemispherectomy is performed to help control intractable seizures, yet little research quantifies and projects the clinical course of the impairments, functional limitations, and disabilities of patients who have undergone the procedure. This case report describes the physical therapist preoperative and postoperative examination, evaluation, and intervention during the acute hospitalization of an adult who underwent a right hemispherectomy. Case Description. The patient was a 27-year-old man who had intractable seizures despite having tried multiple drug regimens and undergoing several surgical interventions after a brain injury at age 5 years. He underwent a right functional hemispherectomy and then had 9 postoperative physical therapy sessions during his acute hospitalization. Outcomes. The patient made rapid gains, surpassing all initial goals. At discharge, the patient had distal left-sided sensorimotor impairments, but he was able to ambulate 121.9 m (400 ft) with assistance to maintain his balance. Discussion. The patient's posthemispherectomy recovery was rapid. His brain injury at a young age may have triggered preoperative transfer of function to the unaffected left hemisphere. The prognosis for this patient's improvements of impairments and functional limitations was better than initially expected, perhaps because of the redundant features and plasticity of the central nervous system.
Measurement Error in Grip and Pinch Force Measurements in Patients With Hand Injuries
Authors: Schreuders Ton AR , Roebroeck Marij E , Goumans Janine , van Nieuwenhuijzen Johan F , Stijnen Theo H , Stam Henk J
Published: February 2017

Background and Purpose. There is limited documentation of measurement error of grip and pinch force evaluation methods. The purposes of this study were (1) to determine indexes of measurement error for intraexaminer and interexaminer measurements of grip and pinch force in patients with hand injuries and (2) to investigate whether the measurement error differs between measurements of the injured and noninjured hands and between experienced and inexperienced examiners. Subjects. The subjects were a consecutive sample of 33 patients with hand injuries who were seen in the Department of Rehabilitation Medicine of Erasmus MC–University Medical Center Rotterdam in the Netherlands. Methods. Repeated measurements were taken of grip and pinch force, with a short break of 2 to 3 minutes between sessions. For the grip force in 2 handle positions (distance between handles of 4.6 and 7.2 cm, respectively), tip pinch (with the index finger on top and the thumb below, with the other fingers flexed) and key pinch force (with the thumb on top and the radial side of the index finger below) data were obtained on both hands of the subjects by an experienced examiner and an inexperienced examiner. Intraclass correlation coefficients (ICCs), standard errors of measurement (SEMs), and associated smallest detectable differences (SDDs) were calculated and compared with data from previous studies. Results. The reliability of the measurements was expressed by ICCs between .82 and .97. For grip force measurements (in the second handle position) by the experienced examiner, an SDD of 61 N was found. For tip pinch and key pinch, these values were 12 N and 11 N, respectively. For measurements by the inexperienced examiner, SDDs of 56 N for grip force and 13 N and 18 N for tip pinch and key pinch were found. Discussion and Conclusion. Based on the SEMs and SDDs, in individual patients only relatively large differences in grip and pinch force measurements can be adequately detected between consecutive measurements. Measurement error did not differ between injured and noninjured hands or between experienced and inexperienced examiners. Criteria for judging whether the measurement error does allow application of the measurements in individual patients are discussed.
Nonoperative Management of Functional Hallux Limitus in a Patient With Rheumatoid Arthritis
Authors: Shrader Joseph A , Siegel Karen Lohmann
Published: February 2017

Background and Purpose. Functional hallux limitus (FHL) is a condition that affects motion at the first metatarsophalangeal joint and may lead to abnormal forefoot plantar pressures, pain, and difficulty with ambulation. The purpose of this case report is to describe a patient with rheumatoid arthritis (RA) and FHL who was managed with foot orthoses, footwear, shoe modifications, and patient education. Case Description. The patient was a 55-year-old woman diagnosed with seropositive RA 10 years previously. Her chief complaint was bilateral foot pain, particularly under the left great toe. Her foot pain had been present for several years, but during the past 5 months it had intensified and interfered with her work performance, activities of daily living, and social life. Outcomes. Following 4 sessions of physical therapy over a 6-week time period, the patient reported complete relief of forefoot pain despite no change in medication use or RA disease pathophysiology. She was able to continuously walk for up to 4 hours. Left hallux peak plantar pressures were reduced from 43 N/cm2 to 18 N/cm2 with the foot orthoses. Discussion. Patients with RA who develop FHL may benefit from physical therapist management using semirigid foot orthoses, footwear, shoe modifications, and patient education.
Predicting Motor Outcome at Preschool Age for Infants Tested at 7, 30, 60, and 90 Days After Term Age Using the Test of Infant Motor Performance
Authors: Kolobe Thubi HA , Bulanda Michelle , Susman Louisa
Published: February 2017

Background and Purpose. Accurate and diagnostic measures are central to early identification and intervention with infants who are at risk for developmental delays or disabilities. The purpose of this study was to examine (1) the ability of infants' Test of Infant Motor Performance (TIMP) scores at 7, 30, 60 and 90 days after term age to predict motor development at preschool age and (2) the contribution of the home environment and medical risk to the prediction. Subjects and Methods. Sixty-one children from an original cohort of 90 infants who were assessed weekly with the TIMP, between 34 weeks gestational age and 4 months after term age, participated in this follow-up study. The Peabody Developmental Motor Scales, 2nd edition (PDMS-2), were administered to the children at the mean age of 57 months (SD=4.8 months). The quality and quantity of the home environment also were assessed at this age using the Early Childhood Home Observation for Measurement of the Environment (EC-HOME). Pearson product moment correlation coefficients, multiple regression, sensitivity and specificity, and positive and negative predictive values were used to assess the relationship among the TIMP, HOME, medical risk, and PDMS-2 scores. Results. The correlation coefficients between the TIMP and PDMS-2 scores were statistically significant for all ages except at 7 days. The highest correlation coefficient was at 90 days (r=.69, P=.001). The TIMP scores at 30, 60, and 90 days after term; medical risk scores; and EC-HOME scores explained 24%, 23%, and 52% of the variance in the PDMS-2 scores, respectively. The TIMP score at 90 days after term was the most significant contributor to the prediction. The TIMP cutoff score of − 0.5 standard deviation below the mean correctly classified 80%, 79%, and 87% of the children using a cutoff score of −2 standard deviations on the PDMS-2 at 30, 60, and 90 days, respectively. Discussion and Conclusion. The results compare favorably with those of developmental tests administered to infants at 6 months of age or older. These findings underscore the need for age-specific test values and developmental surveillance of infants before making referrals.
The Influence of Pathology, Pain, Balance, and Self-efficacy on Function in Women With Osteoarthritis of the Knee
Authors: Harrison Anne L
Published: February 2017

Background and Purpose. The determinants of function in people with osteoarthritis include both psychosocial and physiological variables. Studies that simultaneously integrate both domains are limited. The aim of this study was to determine the following in a sample of women with osteoarthritis (OA) of the knee: (1) the relationships among pathology (grade of OA of the knee), pain level, balance, and self-efficacy and (2) the relative effects of pathology, pain level, balance, and self-efficacy on function. Subjects. Fifty community-dwelling women, 50 to 84 years of age (X̅=69.2, SD=8.8), with symptoms of OA of the knee participated. Methods. Radiographs, standardized questionnaires (the Western Ontario and McMaster Universities Osteoarthritis Index, the Arthritis Self-Efficacy Scale, the Functional Reach Test, and timed performance tests were used to quantify the variables. Bivariate analyses and stepwise multiple regression modeling with analysis of variance calculations for beta weight testing were used in data analysis. Results. In regression analysis, functional self-efficacy and balance accounted for 42% of the variance in physical performance of function, whereas functional self-efficacy and pain accounted for 74% of the variance in self-report of functional difficulty. Discussion and Conclusion. Functional self-efficacy is an important factor affecting the functional performance outcome for people with OA of the knee. Suggestions are given to address self-efficacy in health care management.
Progressive Resistance Exercise in Physical Therapy: A Summary of Systematic Reviews
Authors: Taylor Nicholas F , Dodd Karen J , Damiano Diane L
Published: February 2017

Progressive resistance exercise (PRE) is a method of increasing the ability of muscles to generate force. However, the effectiveness and safety of PRE for clients of physical therapists are not well known. The purpose of this article is to review the evidence on positive and negative effects of PRE as a physical therapy intervention. Electronic databases were searched for systematic reviews on PRE and any relevant randomized trials published after the last available review. The search yielded 18 systematic reviews under major areas of physical therapy: cardiopulmonary, musculoskeletal, neuromuscular, and gerontology. Across conditions, PRE was shown to improve the ability to generate force, with moderate to large effect sizes that may carry over into an improved ability to perform daily activities. Further research is needed to determine the potential negative effects of PRE, how to maximize carryover into everyday activities, and what effect, if any, PRE has on societal participation.
Effect of Bracing and Other Conservative Interventions in the Treatment of Idiopathic Scoliosis in Adolescents: A Systematic Review of Clinical Trials
Authors: Lenssinck Marie-Louise B , Frijlink Astrid C , Berger Marjolein Y , Bierma-Zeinstra Sita MA , Verkerk Karin , Verhagen Arianne P
Published: February 2017

Background and Purpose. Many conservative treatments are available for adolescents with idiopathic scoliosis, but the evidence for their accepted use is still unclear. The purpose of this study was to evaluate the effectiveness of braces and other conservative treatments of idiopathic scoliosis in adolescents by systematically reviewing the literature. Methods. The literature was searched in the PubMed, CINAHL, Cochrane, and PEDro databases. Studies were selected if the design was a randomized clinical trial or a controlled clinical trial, if all patients had an idiopathic scoliosis, if all patients were less than 18 years of age during the intervention, and if the type of intervention was a conservative one. Two reviewers independently assessed the methodological qualityusing the Delphi list and performed data extraction. Analysis was based on the levels of evidence. Results. Thirteen studies met the final inclusion criteria, showing a wide range of interventions such as bracing, electrical surface stimulation, and exercises. Discussion and Conclusion. The authors conclude that the effectiveness of bracing and exercises is not yet established, but might be promising. They found no evidence of the effectiveness of electrical stimulation.
Reliability of a Measurement of Neck Flexor Muscle Endurance
Authors: Harris Kevin D , Heer Darren M , Roy Tanja C , Santos Diane M , Whitman Julie M , Wainner Robert S
Published: February 2017

Background and Purpose. Neck flexor muscle endurance has been negatively correlated with cervical pain and dysfunction. The purposes of this study were to determine rater reliability in subjects both withand without neck pain and to determine whether there was a difference in neck flexor muscle endurance between the 2 groups. Subjects. Forty-one subjects with and without neck pain were enrolled in this repeated-measures reliability study. Methods. Two raters used an isometric neck retraction test to assess neck flexor muscle endurancefor all subjects during an initial session, and subjects without neck pain returned for testing 1 week later. Results. For the group without neck pain, intrarater reliability was good to excellent (intraclass correlation coefficient [ICC(3,1)]=.82–.91), and interrater reliability was moderate to good (ICC[2,1]=.67–.78). The associated standard error of measurement (SEM) ranged from 8.0 to 11.0 seconds and from 12.6 to 15.3 seconds, respectively. For the group with neck pain, interrater reliability was moderate(ICC[2,1]=.67, SEM=11.5). Neck flexor muscle endurance test results for the group without neck pain (X̄=38.95 seconds, SD=26.4) and the group with neck pain (X̄=24.1 seconds, SD=12.8) were significantly different. Discussion and Conclusion. Reliability coefficients differed between the 2 groups and ranged from moderate to excellent and improved after the first test session. The interrater reliability of data obtained with the neck flexor muscle endurance test in people with neck pain must be improved in order for clinicians to distinguish a clinically meaningful change from measurement error. Neck flexor muscle endurance was both statistically and clinically greater for subjects without neck pain than for those with neck pain.
Factors Influencing Results of Functional Capacity Evaluations in Workers' Compensation Claimants With Low Back Pain
Authors: Gross Douglas P , Battié Michele C
Published: February 2017

Background and Purpose. Physical and psychosocial factors are hypothesized to influence performance-based assessment. The purpose of this study was to evaluate the association between performance on the Isernhagen Work System Functional Capacity Evaluation (IWS-FCE) and various clinical and psychosocial factors. Subjects. The sample consisted of 170 workers' compensation claimants who were undergoing functional capacity evaluations (FCEs) for low back injuries. Methods. In this cross-sectional study, claimants completed a battery of work-related measures, including the IWS-FCE, the Pain Disability Index (PDI), a workplace organizational policies and practices scale, and a recovery expectations questionnaire. Functional capacity evaluation performance indicators were the number of tasks in which subjects did not meet work demands and weight lifted on the floor-to-waist lift. Analysis included multivariable regression. Results. Only the PDI, pain intensity, age, and sex independently contributed to floor-to-waist lift performance. The PDI, pain intensity, and duration of injury contributed to the number of failed tasks. Discussion and Conclusion. The results indicate that performance on FCEs is influenced by physical factors, perceptions of disability, and pain intensity. However, perceptions of workplace organizational policies and procedures were not associated with FCE results for workers' compensation claimants with chronic back pain disability. Functional capacity evaluations should be considered behavioral tests influenced by multiple factors, including physical ability, beliefs, and perceptions.
Feasibility of Electromyography-Triggered Neuromuscular Stimulation as an Adjunct to Constraint-Induced Movement Therapy
Authors: Fritz Stacy L , Chiu Yi-Po , Malcolm Matthew P , Patterson Tara S , Light Kathye E
Published: February 2017

Background and Purpose. The purpose of this case report is to explore the feasibility of electromyography-triggered neuromuscular stimulation (EMG-stim) as an adjunct to constraint-induced movement therapy (CIMT). Case Description. The patient was a 72-year-old man, 10 years poststroke, who did not meet traditional CIMT criteria. The EMG-stim was applied to the wrist extensors of the patient's weaker arm for one half of the CIMT training hours. Outcomes. The intervention was feasible for this individual. Improvements were observed in motor behavior, quality and amount of use, muscle activity, wrist range of motion, and reaction time of the more-affected extremity. These improvements were paralleled by a change in the size and location of the extensor digitorum communis muscle representation in the primary motor cortex, as measured by transcranial magnetic stimulation mapping. Discussion. These changes suggest that using EMG-stim as an adjunct to CIMT should be further investigated in individuals who have low functional abilities following stroke.
Acrophobia and Pathological Height Vertigo: Indications for Vestibular Physical Therapy?
Authors: Whitney Susan L , Jacob Rolf G , Sparto Patrick J , Olshansky Ellen F , Detweiler-Shostak Gail , Brown Emily L , Furman Joseph M
Published: February 2017

Background and Purpose. Acrophobia (fear of heights) may be related to a high degree of height vertigo caused by visual dependence in the maintenance of standing balance. The purpose of this case report is to describe the use of vestibular physical therapy intervention following behavioral therapy to reduce a patient's visual dependence and height vertigo. Case Description. Mr N was a 37-year-old man with agoraphobia (fear of open spaces) that included symptoms of height phobia. Exposure to heights triggered symptoms of dizziness. Intervention. Mr N underwent 8 sessions of behavioral therapy that involved exposure to heights using a head-mounted virtual reality device. Subsequently, he underwent 8 weeks of physical therapy for an individualized vestibular physical therapy exercise program. Outcomes. After behavioral therapy, the patient demonstrated improvements on the behavioral avoidance test and the Illness Intrusiveness Rating Scale, but dizziness and body sway responses to moving visual scenes did not decrease. After physical therapy, his dizziness and sway responses decreased and his balance confidence increased. Discussion. Symptoms of acrophobia and sway responses to full-field visual motion appeared to respond to vestibular physical therapy administered after completion of a course of behavioral therapy. Vestibular physical therapy may have a role in the management of height phobia related to excessive height vertigo.
Incidence of and Risk Factors for Falls Following Hip Fracture in Community-dwelling Older Adults
Authors: Shumway-Cook Anne , Ciol Marcia A , Gruber William , Robinson Cynthia
Published: February 2017

Background and Purpose. Hip fracture is a major medical problem among older adults, leading to impaired balance and gait and loss of functional independence. The purpose of this study was to determine the incidence of and risk factors for falls 6 months following hospital discharge for a fall-related hip fracture in older adults. Subjects. Ninety of 100 community-dwelling older adults (≥65 years of age) hospitalized for a fall-related hip fracture provided data for this study. Methods. An observational cohort study used interviews and medical records to obtain information on demographics, prefracture health, falls, and functional status. Self-report of falls and performance-based measures of balance and mobility were completed 6 months after discharge. Results. A total of 53.3% of patients (48/90) reported 1 or more falls in the 6 months after hospitalization. Older adults who fell following discharge had greater declines in independence in activities of daily living and lower performance on balance and mobility measures. Prefracture fall history and use of a gait device predicted postdischarge falls. Discussion and Conclusion. Falls following hip fracture can be predicted by premorbid functional status.
Perturbation Training Improves Knee Kinematics and Reduces Muscle Co-contraction After Complete Unilateral Anterior Cruciate Ligament Rupture
Authors: Chmielewski Terese L , Hurd Wendy J , Rudolph Katherine S , Axe Michael J , Snyder-Mackler Lynn
Published: February 2017

Background and Purpose. Dynamic knee stabilization strategies of people who successfully compensate for the absence of an anterior cruciate ligament (ACL) (“copers”) are different from those of people who do not compensate well for the injury (“noncopers”). Early after injury, certain patients (“potential copers”) can increase the likelihood of successfully compensating for the injury by participating in 10 sessions of perturbation training. The purpose of this study was to determine how perturbation training alters muscle co-contraction and knee kinematics in potential copers. Subjects. Seventeen individuals with acute, unilateral ACL rupture who were categorized as potential copers and 17 subjects without injuries who were matched by age, sex, and activity level were recruited for this study. Methods. Motion analysis and electromyographic data were collected as subjects walked across a stationary or moving platform (horizontal translation) before and after perturbation training. Results. Before training, potential copers had higher co-contraction indexes and lower peak knee flexion angles than subjects without injuries. After training, potential copers' movement patterns more closely resembled those of subjects without injuries (ie, they showed reduced co-contraction indexes and increased peak knee flexion angles during stance). Discussion and Conclusion. Perturbation training reduced quadriceps femoris-hamstring muscle and quadriceps femoris-gastrocnemius muscle co-contractions and normalized knee kinematics in individuals with ACL rupture who were classified as potential copers. Findings from this study provide evidence for a mechanism by which perturbation training acts as an effective intervention for promoting coordinated muscle activity in a select population of people with ACL rupture.
Electromyographic Analyses of Global Synkinesis in the Paretic Upper Limb After Stroke
Authors: Hwang Ing-Shiou , Tung Li-Chen , Yang Jeng-Feng , Chen Yi-Ching , Yeh Chun-Yu , Wang Chun-Hou
Published: February 2017

Background and Purpose. Global synkinesis (GS), or motor irradiation, is an involuntary movement associated with the coactivation of numerous muscles in one limb when the opposite limb is active. The electromyographic (EMG) patterns of people with stroke and people who were healthy were analyzed to characterize GS development in relation to joint involvement and to attempt to relate these findings to clinical observations. Subjects and Methods. Twenty patients with stroke, divided into 2 groups with either greater levels of irradiation (SG, n=10) or lesser levels of irradiation (SL, n=10), and 20 subjects in a control group were studied. A dynamometer was used to provide resistance for voluntary isometric muscle contractions of the flexor muscle groups of the shoulder, elbow, and wrist. The summated and standardized net EMG amplitudes of 8 principal muscles of the unexercised (paretic) upper extremity were used to characterize intensity and spatial representation of GS. Clinical measurements included the Fugl-Meyer Assessment Scale (FMA), Barthel Index of Activities of Daily Living (BI), and the stage on the Brunnström Stages of Motor Recovery Scale (BR). Results. In the SG and control groups, a more substantial GS intensity was associated with muscle contractions of the flexor muscles of the opposite proximal joint than was the case for contractions of the flexor muscles of the distal joint, whereas such a gradient change was absent in the SL group. The corresponding spatial patterns of GS exhibited a predominant cross-excitation over the unexercised pectoralis major and extensor carpi radialis muscles in the control group, contrary to the enhanced activation of the brachioradialis and biceps brachii muscles noted in patients with stroke. The SG group had a better FMA score and a more satisfactory BR stage than did the SL group, and the 2 neurological scores were related to GS intensity for patients with stroke, depending on joint involvement. Discussion and Conclusion. Intensity of GS provided an affiliation with motor deficits and a promising window for poststroke recovery mechanisms.
Balance Disability After Stroke
Authors: Tyson Sarah F , Hanley Marie , Chillala Jay , Selley Andrea , Tallis Raymond C
Published: February 2017

Background and Purpose. Balance disability is common after stroke, but there is little detailed information about it. The aims of this study were to investigate the frequency of balance disability; to characterize different levels of disability; and to identify demographics, stroke pathology factors, and impairments associated with balance disability. Subjects. The subjects studied were 75 people with a first-time anterior circulation stroke; 37 subjects were men, the mean age was 71.5 years (SD=12.2), and 46 subjects (61%) had left hemiplegia. Methods. Prospective hospital-based cross-sectional surveys were carried out in 2 British National Health Service trusts. The subjects’ stroke pathology, demographics, balance disability, function, and neurologic impairments were recorded in a single testing session 2 to 4 weeks after stroke. Results. A total of 83% of the subjects (n=62) had a balance disability; of these, 17 (27%) could sit but not stand, 25 (40%) could stand but not step, and 20 (33%) could step and walk but still had limited balance. Subjects with the most severe balance disability had more severe strokes, impairments, and disabilities. Weakness and sensation were associated with balance disability. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability. Discussion and Conclusion. Subjects with the most severe balance disability had the most severe strokes, impairments, and disabilities. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability. [Tyson SF, Hanley M, Chillala J, et al. Balance disability after stroke. Phys Ther. 2006;86:30–38.]
Reliability and Validity of Arm Volume Measurements for Assessment of Lymphedema
Authors: Taylor Richard , Jayasinghe Upali W , Koelmeyer Louise , Ung Owen , Boyages John
Published: February 2017

Background and Purpose. Arm lymphedema following breast cancer surgery is a continuing problem. In this study, we assessed the reliability and validity of circumferential measurements and water displacement for measuring upper-limb volume. Subjects. Participants included subjects who had had breast cancer surgery, including axillary dissection—19 with and 22 without a diagnosis of arm lymphedema—and 25 control subjects. Methods. Two raters measured each subject by using circumferential tape measurements at specified distances from the fingertips and in relation to anatomic landmarks and by using water displacement. Interrater reliability was calculated by analysis of variance and multilevel modeling. Volumes from circumferential measurements were compared with those from water displacement by use of means and correlation coefficients, respectively. The standard error of measurement, minimum detectable change (MDC), and limits of agreement (LOA) for volumes also were calculated. Results. Arm volumes obtained with these methods had high reliability. Compared with volumes from water displacement, volumes from circumferential measurements had high validity, although these volumes were slightly larger. Expected differences between subjects with and without clinical lymphedema following breast cancer were found. The MDC of volumes or the error associated with a single measure for data based on anatomic landmarks was lower than that based on distance from fingertips. The mean LOA with water displacement were lower for data based on anatomic landmarks than for data based on distance from fingertips. Discussion and Conclusion. Volumes calculated from anatomic landmarks are reliable, valid, and more accurate than those obtained from circumferential measurements based on distance from fingertips. [Taylor R, Jayasinghe UW, Koelmeyer L, et al. Reliability and validity of arm volume measurements for assessment of lymphedema. Phys Ther. 2006;86:205–214.]