bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental Practice Combined With Physical Practice for Upper-Limb Motor Deficit in Subacute Stroke
Authors: Page Stephen J , Levine Peter , Sisto Sue Ann , Johnston Mark V
Published: February 2017

Background and Purpose. This case report describes a patient with upper-limb hemiparesis (ULH) who received a program combining physical therapy for the affected side with mental practice. Case Description. The patient was a 56-year-old man with stable motor deficits, including ULH, on his dominant side resulting from a right parietal infarct that occurred 5 months previously. He received physical therapy for an hour 3 times a week for 6 weeks. In addition, 2 times a week the patient listened to an audiotape instructing him to imagine himself functionally using the affected limb. The patient also listened to the audiotape at home 2 times a week. Pretreatment and posttreatment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment (Fugl-Meyer Scale), the Action Research Arm Test (ARA), and the Stroke Rehabilitation Assessment of Movement (STREAM). Outcomes. The patient exhibited reduction in impairment (Fugl-Meyer Scale) and improvement in arm function, as measured by the ARA and STREAM. Discussion. Mental practice may complement physical therapy to improve motor function after stroke.
Effects of a Functional Therapy Program on Motor Abilities of Children With Cerebral Palsy
Authors: Ketelaar Marjolijn , Vermeer Adri , Hart Harm't , van Petegem-van Beek Els , Helders Paul JM
Published: February 2017

Background and Purpose. The purpose of this study was to determine whether the motor abilities of children with spastic cerebral palsy who were receiving functional physical therapy (physical therapy with an emphasis on practicing functional activities) improved more than the motor abilities of children in a reference group whose physical therapy was based on the principle of normalization of the quality of movement. Subjects. The subjects were 55 children with mild or moderate cerebral palsy aged 2 to 7 years (median=55 months). Methods. A randomized block design was used to assign the children to the 2 groups. After a pretest, the physical therapists for the functional physical therapy group received training in the systematic application of functional physical therapy. There were 3 follow-up assessments: 6, 12, and 18 months after the pretest. Both basic gross motor abilities and motor abilities in daily situations were studied, using the Gross Motor Function Measure (GMFM) and the self-care and mobility domains of the Pediatric Evaluation of Disability Inventory (PEDI), respectively. Results. Both groups had improved GMFM and PEDI scores after treatment. No time × group interactions were found on the GMFM. For the PEDI, time × group interactions were found for the functional skills and caregiver assistance scales in both the self-care and mobility domains. Discussion and Conclusion. The groups' improvements in basic gross motor abilities, as measured by the GMFM in a standardized environment, did not differ. When examining functional skills in daily situations, as measured by the PEDI, children in the functional physical therapy group improved more than children in the reference group.
Central Pattern Generation of Locomotion: A Review of the Evidence
Authors: MacKay-Lyons Marilyn
Published: February 2017

Neural networks in the spinal cord, referred to as “central pattern generators” (CPGs), are capable of producing rhythmic movements, such as swimming, walking, and hopping, even when isolated from the brain and sensory inputs. This article reviews the evidence for CPGs governing locomotion and addresses other factors, including supraspinal, sensory, and neuromodulatory influences, that interact with CPGs to shape the final motor output. Supraspinal inputs play a major role not only in initiating locomotion but also in adapting the locomotor pattern to environmental and motivational conditions. Sensory afferents involved in muscle and cutaneous reflexes have important regulatory functions in preserving balance and ensuring stable phase transitions in the locomotor cycle. Neuromodulators evoke changes in cellular and synaptic properties of CPG neurons, conferring flexibility to CPG circuits. Briefly addressed is the interaction of CPG networks to produce intersegmental coordination for locomotion. Evidence for CPGs in humans is reviewed, and although a comprehensive clinical review is not an objective, examples are provided of animal and human studies that apply knowledge of CPG mechanisms to improve locomotion. The final section deals with future directions in CPG research.
Use of a Static Adjustable Ankle-Foot Orthosis Following Tibial Nerve Block to Reduce Plantar-Flexion Contracture in an Individual With Brain Injury
Authors: Blanton Sarah , Grissom Samuel P , Riolo Lisa
Published: February 2017

Background and Purpose. Ankle plantar-flexion contractures are a common complication of brain injuries and can lead to secondary limitations in mobility. Case Description. The patient was a 44-year-old woman with left hemiplegia following a right frontal arteriovenous malformation resection. She had a left ankle plantar-flexion contracture of −31 degrees from neutral. After a tibial nerve block, an adjustable ankle-foot orthosis was applied 23 hours a day for 27 days. Adjustments of the orthosis were made as the contracture was reduced. The patient received physical therapy during the 27-day period for functional mobility activities and stretching the plantar flexors outside of the orthosis. Outcomes. The patient's dorsiflexion passive range of motion increased from −31 degrees to +10 degrees. Discussion. The application of an adjustable ankle-foot orthosis following a tibial nerve block, as an addition to a physical therapy regimen of stretching and mobility training, may reduce plantar-flexion contractures in patients with brain injury.
Self-Reported Measurement of Heart Rate and Blood Pressure in Patients by Physical Therapy Clinical Instructors
Authors: Frese Ethel M , Richter Randy R , Burlis Tamara V
Published: February 2017

Background and Purpose. The Guide to Physical Therapist Practice (Guide) recommends that heart rate (HR) and blood pressure (BP) measurement be included in the examination of new patients. The purpose of this study was to survey physical therapy clinical instructors to determine the frequency of HR and BP measurement in new patients and in patients already on the physical therapists' caseload. The use of information obtained from HR and BP measures in decision making for patient care and the effects of practice setting and academic preparation on the measurement and use of HR and BP also were examined. Subjects and Methods. A sample of 597 subjects was selected from a list of 2,663 clinical instructors at the clinical education sites of the 2 participating universities. Clinical instructors from a variety of practice settings were surveyed. A 26-item survey questionnaire was mailed to the clinical instructors. Results. Usable survey questionnaires were received from 387 respondents (64.8%); 43.4% reported working in an outpatient facility. The majority of the respondents strongly agreed or agreed (59.5%) that measurement of HR and BP should be included in physical therapy screening. When asked if routinely measuring HR and BP during clinical practice is essential, opinions were nearly split (strongly agree or agree=45.0%, strongly disagree or disagree=43.7%, no opinion=11.3%). More than one third (38.0%) of the respondents reported never measuring HR in the week before the survey as part of their examination of new patients. A slightly larger percentage (43.0%) reported never measuring BP of new patients in the week before the survey. Conversely, 6.0% and 4.4% of the respondents reported always measuring HR and BP, respectively, of new patients in the week before the survey. When given a list of reasons why HR and BP were not routinely measured in their clinical practice, respondents most frequently chose “not important for my patient population” (52.3%). Relationships were found between practice setting and frequency of HR and BP measurement in new patients. Discussion and Conclusion. Practices related to HR and BP measurement reported by this sample of clinical instructors do not meet the recommendations for physical therapy care described in the Guide.
Upper-Extremity Volume Measurements in Women With Lymphedema: A Comparison of Measurements Obtained Via Water Displacement With Geometrically Determined Volume
Authors: Sander Antoinette P , Hajer Nicole M , Hemenway Kristie , Miller Amy C
Published: February 2017

Background and Purpose. Upper-extremity (UE) swelling following breast cancer treatment is a frequent manifestation of lymphedema. In order to document outcomes from lymphedema treatments, reliable, valid, and practical measurements of UE swelling are necessary. The purpose of this study was to compare geometric methods of determining UE volumes with water displacement methods. Subjects. The edematous hand, forearm, and upper arm of 50 women with UE swelling secondary to lymphedema were measured. Methods. Upper-extremity volumes were determined by water displacement using arm and hand volumeters. Displaced water was weighed to determine volume. Circumferential girth measurements were taken. Width and depth measurements of the hand were taken with a tension-controlled caliper. Geometric volume formulas for a cylinder, frustum, rectangular solid, and trapezoidal solid were used to calculate volumes of the arm and hand at different measurement intervals. Results. Intraclass correlation coefficients [2,1] for interrater and intrarater reliability of all water and geometric measurements of the arm and hand were .91 to .99 and .92 to .99, respectively. Water displacement correlated with geometric measurements in the arm (r=.97–.98) and in the hand (r=.81–.91). The limits of agreement (LOA) indicated that water and geometric measurements of arm volume differed by 479 to 655 mL. Scatterplots of the LOA data indicated in that geometric volumes were either larger or smaller than water volumes. The smallest standard error of measurement for the arm measurements was for the 6-cm frustum method at 115 mL; for the hand measurements, the smallest standard error of measurement was for the frustum method at 16 mL. Discussion and Conclusion. Volume of an edematous UE calculated by geometric formulas correlated strongly with volume determined by water displacement. Although strongly correlated, the measurements obtained by the 2 methods did not agree.
Is Base of Support Greater in Unsteady Gait?
Authors: Krebs David E , Goldvasser Dov , Lockert Joyce D , Portney Leslie G , Gill-Body Kathleen M
Published: February 2017

Background and Purpose. We investigated dynamic interfoot distance (IFD) throughout the gait cycle in people with unsteady gait caused by vestibulopathy and in people without known neuromuscular pathology. We expected that the subjects with unsteady gait would use a greater IFD than subjects without neuromuscular pathology and that this IFD would be correlated with other measures of locomotor stability. Subjects and Methods. Simultaneous whole-body (11-segment) dynamic kinematic data were collected from 22 subjects with vestibulopathy and 22 subjects without known neuromuscular pathology who were matched for age, height, weight, and body mass index. Two trials each of the participants' gait at preferred speed and paced gait at 120 steps/min were analyzed with a repeated-measures design with multiple dependent variables. Quantitative data were analyzed descriptively and with inferential statistics. Results. Interfoot distance at preferred gait speed did not differentiate unsteady subjects with vestibulopathy from the comparison subjects. Paced gait IFD total range and IFD in single-limb support differed between groups, but IFD at heel-strike did not. However, IFD at heel-strike, the traditional measure of “base-of-support width,” was correlated with measurements of whole-body center-of-gravity stability (r=.32–.55). Discussion and Conclusion. Gait at preferred speed permitted the unsteady subjects and the comparison subjects to select similar IFD values, but at the cost of slower gait in the unsteady subjects. When required to walk at a “normal” pace of 120 steps/min, subjects with vestibulopathy increased their IFD. These data suggest that wide-based gait alone cannot differentiate between subjects with and without balance impairments. Base of support and other whole-body kinematic variables are mechanical compensations of vestibulopathic instability. Further studies are needed to determine whether development of active control of these whole-body control variables can occur after vestibular rehabilitation.
Voluntary Upper-Extremity Movements in Patients With Unilateral Peripheral Vestibular Hypofunction
Authors: Borello-France Diane F , Gallagher Jere D , Furman Joseph M , Redfern Mark S , Carvell George E
Published: February 2017

Background and Purpose. People with peripheral vestibular pathology demonstrate motor impairments when responding and adapting to postural platform perturbations and during performance of sit-to-stand and locomotor tasks. This study investigated the influence of unilateral peripheral vestibular hypofunction on voluntary arm movement. Subjects and Methods. Subjects without known neurological impairments and subjects with vestibular impairments performed 3 voluntary arm movements: an overhead reach to a target, a sideward reach to a target, and a forward flexion movement through 90 degrees. Subjects performed these tasks under precued and choice reaction time conditions. During all tasks, body segment motion was measured. Head velocity measurements were calculated for the side task only. Results. Subjects with vestibular loss restricted upper body segment motion within the frontal and transverse planes for the 90-degree and overhead tasks. Average angular head velocity was lower for the group with vestibular hypofunction. Task uncertainty (the introduction of a choice reaction time paradigm) differentially influenced the groups regarding head velocity at target acquisition. Discussion and Conclusion. Individuals with vestibular loss altered their performance of voluntary arm movements. Such alterations may have served to minimize the functional consequences of gaze instability.
Identifying Early Decline of Physical Function in Community-Dwelling Older Women: Performance-Based and Self-Report Measures
Authors: Brach Jennifer S , VanSwearingen Jessie M , Newman Anne B , Kriska Andrea M
Published: February 2017

Background and Purpose. The ability to identify early decline in physical function is important, but older people experiencing decline may fail to report the early changes in physical function. The purpose of this study was to compare the descriptions of physical function in community-dwelling older women obtained using performance-based and self-report measures. Subjects and Methods. One hundred seventy community-dwelling women with a mean age of 74.3 years (SD=4.3, range=56.6–83.6) completed the activities of daily living (ADL), instrumental activities of daily living (IADL), and social activity (SA) sections of the Functional Status Questionnaire (FSQ). They also completed performance-based measures of gait speed and the 7-item Physical Performance Test (PPT). Results. The majority of the women scored at the ceiling for the self-report measures of function (ADL=77%, IADL=61%, SA=94%), whereas only 7% scored at the ceiling for the PPT and 30% scored at the ceiling for gait speed (defined as >1.2 m/s). For 2 items of the FSQ, sensitivity was low (8% and 9%) and specificity was high (97% and 98%) compared with performance on the PPT. Discussion and Conclusion. In this sample of community-dwelling older women, performance-based measures identified more limitations in physical function than did self-report measures.
Tissue Adaptation to Physical Stress: A Proposed “Physical Stress Theory” to Guide Physical Therapist Practice, Education, and Research
Authors: Mueller Michael J , Maluf Katrina S
Published: February 2017

The purpose of this perspective is to present a general theory—the Physical Stress Theory (PST). The basic premise of the PST is that changes in the relative level of physical stress cause a predictable adaptive response in all biological tissue. Specific thresholds define the upper and lower stress levels for each characteristic tissue response. Qualitatively, the 5 tissue responses to physical stress are decreased stress tolerance (eg, atrophy), maintenance, increased stress tolerance (eg, hypertrophy), injury, and death. Fundamental principles of tissue adaptation to physical stress are described that, in the authors' opinion, can be used to help guide physical therapy practice, education, and research. The description of fundamental principles is followed by a review of selected literature describing adaptation to physical stress for each of the 4 main organ systems described in the Guide to Physical Therapist Practice (ie, cardiovascular/pulmonary, integumentary, musculoskeletal, neuromuscular). Limitations and implications of the PST for practice, research, and education are presented.
Work-Related Musculoskeletal Disorders and the Culture of Physical Therapy
Authors: Cromie Jean E , Robertson Valma J , Best Margaret O
Published: February 2017

Background and Purpose. Knowledge, skills, relationships, and attitudes of caring and working hard are all thought to be valued by physical therapists. This article explores how physical therapists see themselves, in light of some of these values, when they experience work-related musculoskeletal disorders (WMSDs). The article also explores the ways in which these values may compete with each other, and it suggests how this may contribute to the onset of WMSDs and to therapists' behavior following a WMSD. Subjects and Methods. Eighteen therapists who had made a career change after a WMSD participated in interviews that were designed to gain insight into the attitudes and beliefs of therapists who had had a WMSD. Results. Participants did not anticipate WMSDs, and they typically believed their physical therapy knowledge and skills would have prevented WMSDs from occurring. They saw themselves as knowledgeable and caring and indicated that these characteristics were highly valued by the profession. Their need to demonstrate these attributes sometimes resulted in behaviors that contributed to the development of their WMSDs and made them worse after their onset. Discussion and Conclusion. The cultural values of physical therapists may make it difficult for them to do their jobs in a way that minimizes the risk of WMSDs. The study identified a potential conflict between the therapists' need to (1) demonstrate their ability to work hard and care for their patients and (2) appear knowledgeable and skilled by remaining injury free.
Supported Treadmill Training for Gait and Balance in a Patient With Progressive Supranuclear Palsy
Authors: Suteerawattananon Monthaporn , MacNeill Betty , Protas Elizabeth J
Published: February 2017

Background and Purpose. Impaired balance, gait disturbances, and frequent falls are common problems in people with progressive supranuclear palsy (PSP). This case report describes the use of a modified body weight support treadmill training program to reduce falls and improve the balance and gait of a patient with PSP. Case Description. The patient was a 62-year-old man diagnosed with PSP. His major problems were impaired balance and frequent, abrupt falls. Methods. Physical therapy included walk training, balance perturbation, and step training using body weight support with a treadmill. Training sessions lasted 11/2 hours and occurred 3 days a week for 8 weeks. Fall incidence, balance, and gait were assessed before, during, and after the program. Outcomes. The patient reported fewer falls during and after training. Balance and gait improved after training. Discussion. This case report is the first to report fall reduction, improved gait, and improved balance following physical therapy for a person with PSP.
Neurogenic Bladder, Neurogenic Bowel, and Sexual Dysfunction in People With Spinal Cord Injury
Authors: Benevento Barbara T , Sipski Marca L
Published: February 2017

The purpose of this article is to review the literature related to the effects of spinal cord injuries on genitourinary, gastrointestinal, and sexual function. These important areas of function are profoundly affected by spinal cord injuries, with the effects of injury being dependent on the specific level and degree of neurologic dysfunction. Our ability to manage neurogenic bladder dysfunctions and neurogenic bowel dysfunctions has improved over the past few years; however, in general the techniques used have not significantly changed. In contrast, a significant amount of new information has been made available regarding the effects of specific neurologic injuries on sexual response, particularly female sexual response. Moreover, techniques to remediate erectile dysfunction and infertility in the male have vastly improved the fertility potential of men with spinal cord injuries. Further research is warranted in all of these areas.
Effect of Passive Range of Motion Exercises on Lower-Extremity Goniometric Measurements of Adults With Cerebral Palsy: A Single-Subject Design
Authors: Cadenhead Sherri L , McEwen Irene R , Thompson David M
Published: February 2017

Background and Purpose. People with spastic cerebral palsy often receive passive stretching that is intended to maintain or increase joint passive range of motion (PROM) even though the effectiveness of these exercises has not been definitively demonstrated. The purpose of this study was to determine the effect of PROM exercises on 6 adults with spastic quadriplegia and contractures. Participants. Four men and 2 women (X̄=31 years of age, range=20–44 years) who lived in an institution for people with mental retardation participated in the study. Methods. The authors used 2 multiple baseline designs. Three participants (group 1) received lower-extremity PROM exercises during phase A; PROM exercises were discontinued during phase B. Three participants (group 2) did not receive PROM exercises during phase A; PROM exercises were initiated during phase B. Data were analyzed using visual analysis and the C statistic. Results. Results varied with the method of analysis; however, phase A and phase B measurements, overall, did not differ for either group. Discussion and Conclusion. This study demonstrated use of a single-subject design to measure the effect of PROM exercises on adults with cerebral palsy. The authors concluded that the PROM exercise protocol did not have an effect on the lower-extremity goniometric measurements of the participants.
Scale to Measure Patient Satisfaction With Physical Therapy
Authors: Monnin Dominique , Perneger Thomas V
Published: February 2017

Background and Purpose. Patient satisfaction can be one indicator of quality of care. In this study, a patient satisfaction questionnaire for physical therapy was developed. Subjects. The subjects were a consecutive sample of 1,024 patients who received physical therapy between January and March 1999 at a teaching hospital in Geneva, Switzerland. Methods. A cross-sectional mail survey was conducted in which a structured questionnaire measuring patient satisfaction with various aspects of physical therapy followed by open-ended questions was sent to the subjects. Results. Overall, 528 of 1,024 patients (52%) responded (patient demographics for 501 respondents who provided demographic data: mean years of age=58.6, SD=18.9, range=15–95; 258 men, 243 women). Factor analysis was used to identify main domains of satisfaction, and a scale was constructed to measure satisfaction with each dimension: treatment subscale (5 items), admission subscale (3 items), logistics subscale (4 items), and a global assessment subscale (2 items). All subscales had good acceptability and small floor and ceiling effects. Internal consistency coefficients varied between .77 and .90, indicating good reliability for all subscales. Scale validity was supported by a logical grouping of items into subscales, according to their content, and by correlations of satisfaction scores with the patient's intention to recommend the facility and with the number of positive and negative comments to open-ended questions. Younger patients were less satisfied than older patients for 2 of the subscales (admission and logistics). Discussion and Conclusion. The 14-item instrument is a promising tool for the evaluation of patient satisfaction with physical therapy in both inpatients and outpatients.
Predictive Validity of the Test of Infant Motor Performance as Measured by the Bruininks-Oseretsky Test of Motor Proficiency at School Age
Authors: Flegel Judy , HA Kolobe Thubi
Published: February 2017

Background and Purpose. As the survival rate of infants who are born prematurely increases, the need for accuracy in early identification and prediction of developmental outcome in these infants is imperative. This study examined the predictive validity of the Test of Infant Motor Performance (TIMP) and the relationship between perinatal risk and motor performance in children who are of school age. Subjects and Methods. A stratified, random sample of 35 children was selected from subjects who had been examined using the TIMP and the Problem-Oriented Perinatal Risk Assessment System (POPRAS). The subjects were between 32 weeks gestational age and 4 months postterm (mean age=10 days postterm). The stratification was based on age at the time of TIMP administration (AGE) and on POPRAS scores. The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) was administered to the children at a mean age of 5.75 years. Predictive values were calculated and correlation and regression analyses were conducted to examine the relationship between the TIMP and POPRAS scores and the BOTMP score. Results. Using the receiver operating characteristic curve and a cutoff z score of −1.6, the TIMP's sensitivity, specificity, and positive and negative predictive values were .50, 1.00, 1.00, and .87, respectively. The correlation between TIMP and BOTMP scores, with AGE controlled, was .36, and the correlation between POPRAS and BOTMP scores was −.55. Thirty-seven percent of BOTMP variance was accounted for collectively by POPRAS scores, TIMP scores, and AGE. Discussion and Conclusion. The TIMP and POPRAS may be viable instruments that can be used together to identify infants who are at risk for poor long-term motor performance.
Impairment-Based Examination and Disability Management of an Elderly Woman With Sacroiliac Region Pain
Authors: Godges Joseph J , Varnum Denisa R , Sanders Kelly M
Published: February 2017

Background and Purpose. The purpose of this case report is to describe the use of a cluster of sacroiliac tests in conjunction with an impairment-based model of examination, diagnosis, and management of sacroiliac region pain. Case Description. The patient was a 74-year-old woman with an 18-month history of low back, left buttock, and groin pain following a misstep. The initial symptoms were intermittent. The symptoms became constant and limited her walking tolerance to 5 minutes, which affected her ability to care for her grandchildren. She was examined using a cluster of sacroiliac tests that examined: (1) innominate active mobility, (2) innominate positional symmetry, and (3) sacroiliac ligament tenderness. Outcomes. Following 4 treatments for identified impairments, the patient had unlimited walking tolerance and she resumed an active caregiving role for her grandchildren. Discussion. This case illustrates the use of an impairment-based model for examination and management of an elderly patient with what appeared to be sacroiliac joint dysfunction.
Dual Task Interference During Gait in People With Parkinson Disease: Effects of Motor Versus Cognitive Secondary Tasks
Authors: O'Shea Simone , Morris Meg E , Iansek Robert
Published: February 2017

Background and Purpose. Exacerbation of movement disorders while doing 2 tasks (dual task performance) is a characteristic feature of Parkinson disease (PD). The aim of this investigation was to identify whether the type of secondary task (motor or cognitive) determined the severity of dual task interference. Subjects and Methods. Footstep patterns for 15 people with PD and 15 comparison subjects without PD were compared when they walked: (1) at a self-selected speed, (2) while simultaneously performing a motor task (coin transference), and (3) while simultaneously performing a cognitive task (digit subtraction). Gait speed, stride length, cadence, and the percentage of the gait cycle in double-limb stance (DS) were examined with a computerized stride analyzer. Results. When there was no second task, the mean stride length was less in the group with PD (1.29 m) than in the comparison group (1.51 m), and the mean gait speed was less in the group with PD (71.47 m/min) than in the comparison group (87.29 m/min). The mean cadence was less in the group with PD (110.79 steps/min) than in the comparison group (115.81 steps/min). The percentage of the gait cycle in DS was greater in the group with PD (33.38%) than in the comparison group (31.21%). Both groups reduced their stride length and speed when they had to change from unitask performance to dual task performance and DS increased. For the group with PD, cadence also decreased. For both groups, the type of secondary task had a negligible effect on the performance decrement. Discussion and Conclusion. Although the performance of simultaneous motor or cognitive tasks compromised gait in people with PD, the type of secondary task was not a major determinant of the severity of dual task interference.
Use of Anabolic Steroids to Attenuate the Effects Glucocorticoids on the Rat Diaphragm
Authors: Eason Jane M , Dodd Stephen L , Powers Scott K
Published: February 2017

Background and Purpose. Administration of glucocorticoids results in atrophy and contractile dysfunction in the rat diaphragm. Anabolic steroids may be useful in preventing atrophy and contractile dysfunction. The purpose of this study was to assess the effects of simultaneous administration of testosterone and glucocorticoids on morphological and contractile properties of the rat diaphragm. Subjects. Eighty-eight adult female Sprague-Dawley rats were divided into 1 of 4 groups: a control group that was given sham injections for 13 days (CONT group, n=23), a group that was given prednisolone injections (0.5 mg/100 g) for 10 days (PRED group, n=23), a group that was given testosterone injections (0.5 mg/100 g) for 13 days (TEST group, n=18), and a group that was given a combination of prednisolone and testosterone injections (0.5 mg/100 g) for 10 and 13 days, respectively (COMBO group, n=23). Methods. The animals were weighed daily, and drug doses were adjusted to changes in body mass. Twenty-four hours following the final injection, animals were weighed and sacrificed and the diaphragm was removed and weighed. A small strip of diaphragm was attached to a force transducer to determine normalized maximal isometric tetanic tension (PO). Results. Body weights in the PRED group were decreased by 26% as compared with body weights in the CONT group, and body weights in the COMBO group were decreased by 11% as compared with body weights in the CONT group. Diaphragm weights in the PRED and COMBO groups were decreased by 22% and 12%, respectively, as compared with diaphragm weights in the CONT group. Normalized maximal isometric tetanic tension was decreased by 11% in the PRED group as compared with PO in both the CONT and TEST groups and was decreased by 13% as compared with PO in the COMBO group. There was no difference in PO among the CONT, TEST, and COMBO groups. Discussion and Conclusion. The results support the hypothesis that simultaneous administration of testosterone with glucocorticoids would prevent a decrease in PO. The results indicate that simultaneous administration of testosterone with glucocorticoids prevented the loss in body weight and partially attenuated the loss in diaphragm weight that is commonly observed when glucocorticoids are given alone. These data support the notion that testosterone may be useful in the prevention of glucocorticoid-induced atrophy.
Maximal Voluntary and Functional Performance Needed for Independence in Adults Aged 65 to 97 Years
Authors: Cress M Elaine , Meyer Mary
Published: February 2017

Background and Purpose. Age-related loss of muscle mass and cardiovascular endurance can lead to impairments in muscle force production and cardiac function that, in turn, limit performance in activities essential to everyday living. The purposes of this study were: (1) to identify the “breakpoint” or threshold of maximal voluntary performance and performance in ordinary daily function (2) to evaluate the predictive validity of the threshold to identify the ability independently without self-reported functional limitation. Subjects and Methods. Men and women (N=192; mean age=76 years, SD=7 were recruited from single-family community dwellings or retiremet communities with multiple levels of care. Physical function was measured with the Continuous-Scale Physical Functional Performance Test (CS-PFP). Maximal voluntary performance measures included peak oxygen consumption (V̇) and isokinetic knee extensor torque (KET). Segmented linear regression models of the CS-PFP on the physical performance measures were used to determine the threshold values and their confidence intervals. A logistic regression model was used to evaluate the ability of the CS-PFP scores to identify those living independently and to further illustrate the concepts of threshold and physical reserve. Results. Threshold values identified for V̇O2peak (20 mL·kg−1·min−1) and KET (2.5 N·m/[kgom-1]) were associated with an average of CS-PFP scoe of 57 units. The threshold accurately predicted individuals reporting functional limitations. Discussion and Conclusion. The thresholds provide a mechanism for easily estimating an individual's physical reserve, predicting dependency in living status, and providing unbiased guidance for intervention in late-life independence.
An Electromyographic Analysis of the Deep Cervical Flexor Muscles in Performance of Craniocervical Flexion
Authors: Falla Deborah , Jull Gwendolen , Dall'Alba Paul , Rainoldi Alberto , Merletti Roberto
Published: February 2017

Background and Purpose. This study evaluated an electromyographic technique for the measurement of muscle activity of the deep cervical flexor (DCF) muscles. Electromyographic signals were detected from the DCF, sternocleidomastoid (SCM), and anterior scalene (AS) muscles during performance of the craniocervical flexion (CCF) test, which involves performing 5 stages of increasing craniocervical flexion range of motion—the anatomical action of the DCF muscles. Subjects. Ten volunteers without known pathology or impairment participated in this study. Methods. Root-mean-square (RMS) values were calculated for the DCF, SCM, and AS muscles during performance of the CCF test. Myoelectric signals were recorded from the DCF muscles using bipolar electrodes placed over the posterior oropharyngeal wall. Reliability estimates of normalized RMS values were obtained by evaluating intraclass correlation coefficients and the normalized standard error of the mean (SEM). Results. A linear relationship was evident between the amplitude of DCF muscle activity and the incremental stages of the CCF test (F=239.04, df=36, P<.0001). Normalized SEMs in the range 6.7% to 10.3% were obtained for the normalized RMS values for the DCF muscles, providing evidence of reliability for these variables. Discussion and Conclusion. This approach for obtaining a direct measure of the DCF muscles, which differs from those previously used, may be useful for the examination of these muscles in future electromyographic applications.
Dermatomyositis: Evolution of a Diagnosis
Authors: Cleland Joshua A , Venzke Jane Walter
Published: February 2017

Background and Purpose. As direct access evolves, physical therapists will increasingly encounter patients with pathology that might have an underlying systemic origin. The purpose of this case report is to describe the diagnostic process that led a patient's physical therapist to recognize signs and symptoms of dermatomyositis. Case Description. The patient was an 18-year-old woman who was referred for physical therapy by her primary care physician on 3 occasions with 3 separate musculoskeletal diagnoses. During the third episode, the physical therapist recognized signs and symptoms that could be indicative of dermatologic disease and referred the patient to a dermatologist. Outcomes. A rheumatologist diagnosed the patient's condition as dermatomyositis and referred her for physical therapy. The physical therapy plan of care focused on strengthening and stretching, with an emphasis on a home exercise program. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) indicated that the patient continually made functional improvements over an 18-month period. Discussion. Although diagnosis of diseases such as inflammatory myopathies is not within a physical therapist's scope of practice, this case demonstrates the role a physical therapist can play in recognition of underlying systemic pathology by using the diagnostic process.
Using Clinical Outcomes to Identify Expert Physical Therapists
Authors: Resnik Linda , Hart Dennis L
Published: February 2017

Background and Purpose. Previous studies of expert physical therapists have sampled therapists based on years of clinical experience or reputation, not on their patients' clinical outcomes. The purposes of this study were to identify expert physical therapists by using patient self-reported outcomes and to describe the characteristics of clinicians whose patients with lumbar spine syndromes reported higher health-related quality of life (HRQL) following rehabilitation. Methods. Retrospective data were analyzed on 24,276 patients (mean age=47.8 years, SD=16, range=14–97) with lumbar spine syndromes treated by 930 physical therapists participating in the Focus On Therapeutic Outcomes database in 1999–2000. Physical therapists and staff answered questions concerning years of experience and practice setting when starting their participation in the outcomes system. Patient self-report HRQL data were collected at intake and discharge from outpatient rehabilitation. Discharge HRQL data were risk adjusted using patient characteristics. Data were aggregated by physical therapist. Risk-adjusted discharge HRQL scores were used to classify physical therapists whose patients reported mean HRQL improvement above the 90th percentile as experts and physical therapists whose patients reported mean HRQL improvement between the 45th and 55th percentiles as average. Results. Therapists classified as expert had fewer patients in the database than did therapists classified as average (X̄±SD) (19±17 versus 29±22). Mean treatment duration was different between groups (32±11 days for the expert group versus 31±8 days for the average group). Discussion and Conclusion. The results challenge assumptions that extensive clinical experience is necessary to achieve superior patient outcomes, and they provide information about the relationship between therapist characteristics and patient outcomes.
Determinants of Balance Confidence in Community-Dwelling Elderly People
Authors: Hatch Janine , Gill-Body Kathleen M , Portney Leslie G
Published: February 2017

Background and Purpose. The fear of falling can have detrimental effects on physical function in the elderly population, but the relationship between a persons' confidence in the ability to maintain balance and actual balance ability and functional mobility is not known. The extent to which balance confidence can be explained by balance performance, functional mobility, and sociodemographic, psychosocial, and health-related factors was the focus of this study. Subjects. The subjects were 50 community-dwelling elderly people, aged 65 to 95 years (X̄=81.7, SD=6.7). Methods. Balance was measured using the Berg Balance Scale. Functional mobility was measured using the Timed Up & Go Test. The Activities-specific Balance Scale was used to assess balance confidence. Data were analyzed using Pearson correlation, multiple regression analysis, and t tests. Results. Fifty-seven percent of the variance in balance confidence could be explained by balance performance. Functional mobility and subject characteristics examined in this study did not contribute to balance confidence. Discussion and Conclusion. Balance performance alone is a strong determinant of balance confidence in community-dwelling elderly people.
Physical Therapists Who Claimed Workers' Compensation: A Qualitative Study
Authors: Cromie Jean E , Robertson Valma J , Best Margaret O
Published: February 2017

Background and Purpose. Although most physical therapists experience work-related musculoskeletal disorders (WMSDs) at some time, only a small minority claim workers' compensation. This article describes the experiences of a group of therapists with WMSDs who made compensation claims. Methods. Interviews were used to document the experiences of physical therapists who reported that they had changed their career because of WMSDs. Results and Discussion. Therapists described their experiences in negative terms and found dealing with the workers' compensation system frustrating and unpleasant. They encountered attitudes that labeled them as malingerers and felt their credibility was questioned. Conclusions. Physical therapists' experiences of the workers' compensation system were negative, and they were keen to become independent of it. Those who claimed workers' compensation perceived that a compensable claim could limit their employment opportunities, making confidentiality an important issue when treating other health care professionals.
Using Clinical Outcomes to Explore the Theory of Expert Practice in Physical Therapy
Authors: Resnik Linda , Jensen Gail M
Published: February 2017

Background and Purpose. Theoretical models of physical therapist expertise have been developed through research on physical therapists sampled solely on the basis of years of experience or reputation. Expert clinicians, selected on the basis of their patients' outcomes, have not been previously studied, nor have the patient outcomes of peer-nominated experts been analyzed. The purpose of our study was to describe characteristics of therapists who were classified as expert or average therapists based on the outcomes of their patients. Subjects. Subjects were 6 therapists classified as expert and 6 therapists classified as average through retrospective analysis of an outcomes database. Methods. The study was guided by grounded theory method, using a multiple case study design. Analysis integrated data from quantitative and qualitative sources and developed a grounded theory. Results. All therapists expressed a commitment to professional growth and an ethic of caring. Therapists classified as expert were not distinguished by years of experience, but they differed in academic and work experience, utilization of colleagues, use of reflection, view of primary role, and pattern of delegation of care to support staff. Therapists classified as expert had a patient-centered approach to care, characterized by collaborative clinical reasoning and promotion of patient empowerment. Discussion and Conclusion. These findings add to the understanding of factors related to patient outcomes and build upon grounded theory for elucidating expert practice in physical therapy.
Treadmill Training for an Infant Born Preterm With a Grade III Intraventricular Hemorrhage
Authors: Bodkin Amy W , Baxter Ronda S , Heriza Carolyn B
Published: February 2017

Background and Purpose. Research has documented the feasibility and benefit of treadmill training in children with cerebral palsy and Down syndrome. The purposes of this case report are: (1) to determine the feasibility of treadmill training in an infant at high risk for neuromotor dysfunction and (2) to describe the child's treadmill stepping patterns following treadmill training. Case Description. The male infant, who had a grade III intraventricular hemorrhage following premature birth, began physical therapy and treadmill training at 5¼ months corrected age. Treadmill training was conducted 3 times weekly and videotaped weekly. Videotape analysis determined number of steps, step type, and foot position. Outcomes. Except for foot position, trends in treadmill stepping were similar to those of studies with infants not at high risk for neuromotor disabilities. Discussion. This case report shows that treadmill training is feasible for an infant at high risk for neuromotor disabilities and may be associated with more mature stepping characteristics. Future research should evaluate optimum treadmill training parameters and long-term developmental outcomes.
The Effect of Walking Aids on Balance and Weight-Bearing Patterns of Patients With Hemiparesis in Various Stance Positions
Authors: Laufer Yocheved
Published: February 2017

Background and Purpose. Standard and quad canes are often prescribed to patients with hemiparesis, yet their effect on postural control remains unclear. Thus, the objective of this study was to examine the effects of standard and quad canes on postural sway and on weight-bearing patterns in patients with hemiparesis. Subjects. Thirty subjects with a diagnosis of unilateral hemiparesis following a stroke (patient group; mean age=71.2 years, SD=7.0) and 20 age-matched, community-dwelling volunteers without hemiparesis (comparison group; mean age=72.1 years, SD=5.2) participated in the study. Methods. Postural sway and percentage of body weight (%BW) borne by each extremity were measured in 3 positions: with the heels aligned with each other (aligned position) and in staggered foot positions with either the affected or unaffected extremity placed forward (affected FW and unaffected FW positions). All subjects were tested in each position with no cane, a standard cane, and a quad cane. The order of tests was randomized, and analysis of data included use of an analysis of variance and adjusted Tukey-Kramer tests. Results. In both the aligned and unaffected FW positions, postural sway was reduced only with the quad cane. Both types of canes reduced postural sway in the affected FW position; however, the quad cane had a greater effect. An asymmetrical weight distribution between the lower extremities did not change in the patient group across positions, even with walking aids. Discussion and Conclusion. A quad cane appears to be more effective than a standard cane in decreasing postural sway in patients with moderate impairment secondary to hemiparesis during stance. The greatest effect on postural sway occurred when the assistive device was contralateral to the foot placed forward. The use of a cane does not appear to adversely affect the asymmetrical weight-bearing pattern during stance that is characteristic of patients with hemiparesis, even when balance is challenged by decreasing the base of support.