bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Ultrasound and Diclofenac Phonophoresis on Inflammatory Pain Relief: Suppression of Inducible Nitric Oxide Synthase in Arthritic Rats
Authors: Hsieh Yueh-Ling
Published: February 2017

Background and Purpose. The direct effects of ultrasound (US) and phonophoresis of a nonsteroidal anti-inflammatory drug (NSAID) on injured peripheral tissue have been widely investigated, but evidence concerning the effects of central spinal nociceptive modulation seems to be lacking. The purpose of this study was to investigate the peripheral influences of US and phonophoresis on the modulation of spinal inducible nitric oxide synthase (iNOS) expression elicited by hind paw stimulation with an ankle injection of complete Freund adjuvant (CFA). Subjects and Methods. Inflammatory arthritis was induced in 18 male Wistar rats with intra-articular tibiotarsal injections of CFA. Serial changes in inflammatory pain reactions, including hind-limb edema, and the locomotor activity of the arthritic animals were measured. Arthritic rats underwent US (n=6), diclofenac phonophoresis (n=6), or sham treatment (n=6) on the CFA-injected leg at 18 hours after injection. At 20 hours after injection, spinal inducible nitric oxide synthase–like immunoreactive (iNOS-LI) cells were examined. Results. Following the CFA injection, all animals’ paw diameters and ankle circumferences ipsilateral to the injected leg were significantly increased compared with the values prior to injection. The rearing behavior of arthritic animals had improved significantly after US and diclofenac phonophoresis treatments. The mean total number (±SD) of iNOS-LI cells per section of segments L1 and L2 of the bilateral spinal cord of the sham treatment, US, and phonophoresis groups were 531.20±6.11, 124.20±4.09, and 114.80±3.23, respectively. The total numbers of iNOS-LI cells in rats treated with US and diclofenac phonophoresis were significantly smaller than in those receiving sham treatment. There were no significant differences in the total number of iNOS-LI cells ipsilateral to the injected leg between the US and diclofenac phonophoresis groups. Discussion and Conclusion. Ultrasound and phonophoresis treatments probably modulate and prevent the CFA-insult–induced increase in total and regional iNOS-LI neurons. Peripheral use of diclofenac phonophoresis offers little advantage over US alone in affecting the central mechanisms of nociception. The peripheral influences of US and phonophoresis on the central modulation of the spinal nociceptive processing system are important and may reflect the work being done through the neuroplasticity of spinal cord in response to peripheral input of US and phonophoresis. [Hsieh YL. Effects of ultrasound and diclofenac phonophoresis on inflammatory pain relief: suppression of inducible nitric oxide synthase in arthritic rats.]
A Psychosocial Risk Factor–Targeted Intervention for the Prevention of Chronic Pain and Disability Following Whiplash Injury
Authors: Sullivan Michael JL , Adams Heather , Rhodenizer Trina , Stanish William D
Published: February 2017

Background and Purpose. The objective of this study was to determine whether the addition of a psychosocial intervention improved return-to-work rates beyond those associated with participation in a functional restoration physical therapy intervention. Subjects who had sustained whiplash injuries participated in the Progressive Goal Attainment Program (PGAP), which is a 10-week psychosocial intervention program that aims to increase activity involvement and minimize psychological barriers to rehabilitation progress. Subjects and Methods. A sample of 60 subjects enrolled in a functional restoration physical therapy intervention were used as a historical cohort comparison group. Subjects who received the functional restoration physical therapy intervention were compared with a sample of 70 subjects who received PGAP in addition to physical therapy. Results. Participation in PGAP plus physical therapy resulted in a higher return-to-work rate (75%) than participation in physical therapy alone (50%). Differences between treatment conditions were most pronounced for the subgroup of subjects who had the largest number of psychosocial risk factors. Discussion and Conclusion. The findings suggest that a psychosocial risk reduction intervention can be an effective means of improving function and facilitating return to work in people who are at risk for prolonged pain-related disability. [Sullivan MJL, Adams H, Rhodenizer T, Stanish WD. A psychosocial risk factor–targeted intervention for the prevention of chronic pain and disability following whiplash injury.
Effectiveness of Continuous Passive Motion and Conventional Physical Therapy After Total Knee Arthroplasty: A Randomized Clinical Trial
Authors: Denis Madeleine , Moffet Hélène , Caron France , Ouellet Denise , Paquet Julien , Nolet Lucie
Published: February 2017

Background and Purpose. This randomized clinical trial was conducted to compare the effectiveness of 3 in-hospital rehabilitation programs with and without continuous passive motion (CPM) for range of motion (ROM) in knee flexion and knee extension, functional ability, and length of stay after primary total knee arthroplasty (TKA). Subjects. Eighty-one subjects who underwent TKA for a diagnosis of osteoarthritis were recruited. Methods. All subjects were randomly assigned to 1 of 3 groups immediately after TKA: a control group, which received conventional physical therapy intervention only; experimental group 1, which received conventional physical therapy and 35 minutes of CPM applications daily; and experimental group 2, which received conventional physical therapy and 2 hours of CPM applications daily. All subjects were evaluated once before TKA and at discharge. The primary outcome measure was active ROM in knee flexion at discharge. Active ROM in knee extension, Timed “Up & Go” Test results, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire scores, and length of stay were the secondary outcome measures. Results. The characteristics of and outcome measurements for the subjects in the 3 groups were similar at baseline. No significant difference among the 3 groups was demonstrated in primary or secondary outcomes at discharge. Discussion and Conclusion. The results of this study do not support the addition of CPM applications to conventional physical therapy in rehabilitation programs after primary TKA, as applied in this clinical trial, because they did not further reduce knee impairments or disability or reduce the length of the hospital stay. [Denis M, Moffet H, Caron F, et al. Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial.
Effects of Long-Term Gait Training Using Visual Cues in an Individual With Parkinson Disease
Authors: Sidaway Ben , Anderson Jennifer , Danielson Garth , Martin Lucas , Smith Garth
Published: February 2017

Background and Purpose. In an attempt to improve the gait of people with Parkinson disease (PD), researchers have examined the effect of visual cues placed on the floor. These studies typically have used a single session of training with such cues and have not examined the long-term carryover of such training. In the present study, therefore, gait was analyzed during uncued, cued, and retention phases, each lasting 1 month. Subject. A 78-year-old woman who had been diagnosed with PD 12 years previously (Hoehn and Yahr classification of disability, stage III) volunteered for the study. Methods. During the initial uncued gait phase, the subject was required to walk a distance of 10 m as many times as she could in 30 minutes, 3 times per week for 4 weeks. During the 4-week cued gait phase, visual cues were placed on the floor along the 10-m walkway. The cues were initially 110% of the uncued step length and were later increased to 120%. Following this cued gait phase, the subject’s gait was recorded periodically for 1 month without cues available. Step length, gait speed, and 2-dimensional lower-limb kinematics were compared within and across the 3 experimental phases. Celeration lines were calculated for the initial uncued phase and then extrapolated across the cued training and uncued retention phases. Binomial tests were used to analyze the significance of changes from the initial phase of the experiment. Results. Step length (0.53–0.56 m) and gait speed (0.77–0.82 m·s−1) were essentially unchanged during uncued gait training after the first day; however, during the cued gait phase, gait speed improved, from 0.87 m·s−1 to 1.13 m·s−1, as step length was increased with visual cues. Improvements in step length (0.68 m) and gait speed (1.08 m·s−1) were still evident 1 month following the removal of the cues. Analyses of angle-angle diagrams and phase-plane portraits revealed that training with visual cues increased hip and knee range of motion and engendered more stable motor control of the lower limb. Discussion and Conclusion. In contrast to previous studies in which the benefits of visual cueing were relatively short-lived, in this study, 1 month of gait training with visual cues was successful in establishing a lasting improvement in gait speed and step length while increasing the stability of the underlying motor control system. [Sidaway B, Anderson J, Danielson G, et al. Effects of long-term gait training using visual cues in an individual with Parkinson disease.
Rehabilitation Medicine Summit: Building Research Capacity— Executive Summary
Authors: Frontera Walter R , Fuhrer Marcus J , Jette Alan M , Chan Leighton , Cooper Rory A , Duncan Pamela W , Kemp John D , Ottenbacher Kenneth J , Peckham P Hunter , Roth Elliot J , Tate Denise G ,   Rehabilitation Medicine Summit Program Committee
Published: February 2017

The general objective of the Rehabilitation Medicine Summit: Building Research Capacity was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were: (1) researchers, (2) research environment, infrastructure, and culture, (3) funding, (4) partnerships, and (5) metrics. The [approximately] 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small-group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report.
Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial
Authors: Vermeulen Henricus M , Rozing Piet M , Obermann Wim R , le Cessie Saskia , Vliet Vlieland Thea PM
Published: February 2017

Background and Purpose. In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobilization techniques are an important part of the intervention. The purpose of this study was to compare the effectiveness of high-grade mobilization techniques (HGMT) with that of low-grade mobilization techniques (LGMT) in subjects with adhesive capsulitis of the shoulder. Subjects. One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a ≥50% decrease in passive joint mobility relative to the nonaffected side were enrolled in this study. Methods. Subjects randomly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint, and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone. The duration of treatment was a maximum of 12 weeks (24 sessions) in both groups. Subjects were assessed at baseline and at 3, 6, and 12 months by a masked assessor. Primary outcome measures included active and passive range of motion and shoulder disability (Shoulder Rating Questionnaire [SRQ] and Shoulder Disability Questionnaire [SDQ]). An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year, respectively. Results. Overall, subjects in both groups improved over 12 months. Statistically significant greater change scores were found in the HGMT group for passive abduction (at the time points 3 and 12 months), and for active and passive external rotation (at 12 months). A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation, SRQ, and SDQ with greater change scores in the HGMT group. Discussion and Conclusion. In subjects with adhesive capsulitis of the shoulder, HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs, with the overall differences between the 2 interventions being small. [Vermeulen HM, Rozing PM, Obermann WR, et al. Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial.]
Motor Learning of a Dynamic Balancing Task After Stroke: Implicit Implications for Stroke Rehabilitation
Authors: Orrell Alison J , Eves Frank F , Masters Rich SW
Published: February 2017

Background and Purpose. After a stroke, people often attempt to consciously control their motor actions, which, paradoxically, disrupts optimal performance. A learning strategy that minimizes the accrual of explicit knowledge may circumvent attempts to consciously control motor actions, thereby resulting in better performance. The purpose of this study was to examine the implicit learning of a dynamic balancing task after stroke by use of 1 of 2 motor learning strategies: learning without errors and discovery learning. Participants and Methods. Ten adults with stroke and 12 older adults practiced a dynamic balancing task on a stabilometer under single-task (balance only) and concurrent-task conditions. Root-mean-square error (in degrees) from horizontal was used to measure balance performance. Results. The balance performance of the discovery (explicit) learners after stroke was impaired by the imposition of a concurrent cognitive task load. In contrast, the performance of the errorless (implicit) learners (stroke and control groups) and the discovery learning control group was not impaired. Discussion and Conclusion. The provision of explicit information during rehabilitation may be detrimental to the learning/relearning and execution of motor skills in some people with stroke. The application of implicit motor learning techniques in the rehabilitation setting may be beneficial. [Orrell AJ, Eves FF, Masters RSW. Motor learning of a dynamic balancing task after stroke: implicit implications for stroke rehabilitation. Phys Ther. 2006;86:369–380.]
High-Level Mobility Assessment Tool (HiMAT): Interrater Reliability, Retest Reliability, and Internal Consistency
Authors: Williams Gavin P , Greenwood Kenneth M , Robertson Val J , Goldie Patricia A , Morris Meg E
Published: February 2017

Background and Purpose. The High-Level Mobility Assessment Tool (HiMAT) assesses high-level mobility in people who have sustained a traumatic brain injury (TBI). The purpose of this study was to investigate the interrater reliability, retest reliability, and internal consistency of data obtained with the HiMAT. Subjects. Three physical therapists and 103 people with TBI were recruited from a rehabilitation hospital. Methods. Three physical therapists concurrently assessed a subset of 17 subjects with TBI to investigate interrater reliability. One physical therapist assessed a different subset of 20 subjects with TBI on 2 occasions, 2 days apart, to investigate retest reliability. Data from the entire sample of 103 subjects were used to investigate the internal consistency of this new scale. Results. Both the interrater reliability (intraclass correlation coefficient [ICC]=.99) and the retest reliability (ICC=.99) of the HiMAT data were very high. For retest reliability, a small systematic change was detected (t=3.82, df=19), indicating a marginal improvement of 1 point at retest. Internal consistency also was very high (Cronbach alpha=.97). Discussion and Conclusion. The HiMAT is a new tool specifically designed to measure high-level mobility, which currently is not a component of existing scales used in TBI. This study demonstrated that the HiMAT is a reliable tool for measuring high-level mobility. [Williams GP, Greenwood KM, Robertson VJ, et al. High-Level Mobility Assessment Tool (HiMAT): interrater reliability, retest reliability, and internal consistency. Phys Ther. 2006;86:395–400.]
A High-Intensity Functional Weight-Bearing Exercise Program for Older People Dependent in Activities of Daily Living and Living in Residential Care Facilities: Evaluation of the Applicability With Focus on Cognitive Function
Authors: Littbrand Håkan , Rosendahl Erik , Lindelöf Nina , Lundin-Olsson Lillemor , Gustafson Yngve , Nyberg Lars
Published: February 2017

Background and Purpose. Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments. The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities. A second aim was to analyze whether cognitive function was associated with the applicability of the program. Subjects. The subjects were 91 older people (mean age=85.3 years, SD=6.1, range=68–100) who were dependent in personal activities of daily living and randomly assigned to participate in an exercise intervention. Their mean score for the Mini-Mental State Examination (MMSE) was 17.5 (SD=5.0, range=10–29). Methods. A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists. There were 29 exercise sessions over 13 weeks. Attendance, intensity of lower-limb strength and balance exercises, and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program. Results. The median attendance rate was 76%. Lower-limb strength exercises with high intensity were performed in a median of 53% of the attended exercise sessions, and balance exercises with high intensity were performed in a median of 73% of the attended exercise sessions. The median rate of sessions with adverse events was 5%. All except 2 adverse events were assessed as minor and temporary, and none led to manifest injury or disease. No significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, there was no significant correlation between applicability and the MMSE score. Discussion and Conclusion. The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use, regardless of cognitive function, among older people who are dependent in activities of daily living, living in residential care facilities, and have an MMSE score of 10 or higher. [Littbrand H, Rosendahl E, Lindelöf N, et al. A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: evaluation of the applicability with focus on cognitive function. Phys Ther. 2006;86:489–498.]
Reporting Ethical Protections in Physical Therapy Research
Authors: Henley Lesley D , Frank Denise M
Published: February 2017

Background and Purpose. Efforts to make physical therapy more evidence based have increased demand for human participants, raising concerns for their safety and welfare. This study examined how often research articles in physical therapy journals report basic ethical protections. Methods. We carried out a retrospective audit of research articles in 6 physical therapy journals between 1996 and 2001. Results. Of 806 articles reviewed, 48% documented both research ethics committee approval and informed consent. Articles reporting clinical interventions had the highest reported rate (64%) of both protections. Articles reporting qualitative methods, chart reviews, and case reports had the lowest rates of documentation of both requirements: 30%, 17%, and 11%, respectively. Reported rates of both requirements in vulnerable populations were 55% for children, 48% for students, and 33% for employees. Twenty-six percent of articles included confidentiality assurances. Case reports were most likely and chart reviews were least likely to mention confidentiality: 88% and 8%, respectively. Discussion and Conclusion. There is no uniform editorial policy among physical therapy journals for reporting basic ethical requirements. Physical therapy journals should standardize ethical protections and make documentation of compliance a prerequisite of publication. [Henley LD, Frank DM. Reporting ethical protections in physical therapy research.
Time Dependency of Walking Classification in Stroke
Authors: Kollen Boudewijn , Kwakkel Gert , Lindeman Eline
Published: February 2017

Background and Purpose. To facilitate optimal stroke rehabilitation, valid interpretation of observed functional recovery is required. The purpose of this study was to examine the longitudinal relationship between comfortable walking speed and Functional Ambulation Categories (FAC) scores for physically independent gait. Subjects. This study was a prospective cohort study with 73 subjects who were severely affected by acute stroke. Methods. Functional Ambulation Categories classification and walking speed were measured between weeks 4 and 26 after stroke. The responsiveness of walking speed measurements for detecting clinically important speed changes was determined, and the longitudinal association between walking speed and FAC scores and its time dependency were established. This relationship subsequently was scrutinized for possible speed changes occurring within specific FAC scores. Responsiveness ratios, random coefficient analysis, paired Student t tests, and the Cohen kappa statistic were used for statistical analyses. Results. Responsiveness ratios exceeded the smallest detectable differences. Random coefficient analysis demonstrated a significant between- and within-subject coefficient and a significant negative interaction between timing of measurements and FAC scores. Paired Student t tests revealed mostly significant pretest-posttest differences in walking speeds, and all kappa values for pretest-posttest FAC scores were significant. Discussion and Conclusion. Walking speed measurements are sensitive for detecting clinically important changes. Functional Ambulation Categories scores are dependent on the timing of comfortable walking speed measurements after stroke. Moreover, there are indications that, in this relationship, repeated FAC appraisals are not only based on steady walking speeds, but that the walking speeds related to a specific FAC appraisal also change and, over time, may shift gradually from higher to lower speeds.
Transcutaneous Electrical Nerve Stimulation for the Management of Neuropathic Pain: The Effects of Frequency and Electrode Position on Prevention of Allodynia in a Rat Model of Complex Regional Pain Syndrome Type II
Authors: Somers David L , Clemente F Richard
Published: February 2017

Background and Purpose. Complex regional pain syndrome type II (CPSII) is a painful condition that develops following a nerve injury. Although transcutaneous electrical nerve stimulation (TENS) relieves the pain of CPSII, the stimulation parameters that would best prevent the development of the condition are not known. The purpose of this study was to compare the ability of several different stimulation strategies to reduce the development of allodynia. Subjects. Sprague-Dawley rats were used in the study. Methods. A chronic constriction injury (CCI) to the right sciatic nerve was used to induce allodynia. Two groups of CCI rats received high-frequency TENS to the lumbar paravertebral region with electrodes positioned on the skin overlying either the right or left paraspinal musculature. Two additional groups of CCI rats received low-frequency TENS to acupuncture points in the right or left hind limbs. A fifth group of CCI rats received no TENS intervention. Thermal and mechanical pain thresholds were assessed in the right hind paw before and 12 days after the CCI surgery. The TENS was delivered 1 hour per day beginning on the day of surgery. Results. Daily high-frequency TENS reduced the development of mechanical allodynia in CCI rats, and low-frequency TENS reduced the development of thermal allodynia, but only when TENS was delivered on the left side. Discussion and Conclusion. The results indicate that TENS delivered contralateral to a nerve injury best reduces allodynia development. Comprehensive reduction of allodynia development would require a combination of high- and low-frequency TENS intervention.
A Systematic Review of the Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders
Authors: McNeely Margaret L , Armijo Olivo Susan , Magee David J
Published: February 2017

Background and Purpose. The purpose of this qualitative systematic review was to assess the evidence concerning the effectiveness of physical therapy interventions in the management of temporomandibular disorders. Methods. A literature search of published and unpublished articles resulted in the retrieval of 36 potential articles. Results. Twelve studies met all selection criteria for inclusion in the review: 4 studies addressed the use of therapeutic exercise interventions, 2 studies examined the use of acupuncture, and 6 studies examined electrophysical modalities. Two studies provided evidence in support of postural exercises to reduce pain and to improve function and oral opening. One study provided evidence for the use of manual therapy in combination with active exercises to reduce pain and to improve oral opening. One study provided evidence in support of acupuncture to reduce pain when compared with no treatment; however, in another study no significant differences in pain outcomes were found between acupuncture and sham acupuncture. Significant improvements in oral opening were found with muscular awareness relaxation therapy, biofeedback training, and low-level laser therapy treatment. Discussion and Conclusion. Most of the studies included in this review were of very poor methodological quality; therefore, the findings should be interpreted with caution.
Contractile Properties and the Force-Frequency Relationship of the Paralyzed Human Quadriceps Femoris Muscle
Authors: Scott Wayne B , Lee Samuel CK , Johnston Therese E , Binkley Jennifer , Binder-Macleod Stuart A
Published: February 2017

Background and Purpose. Following spinal cord injury (SCI), paralyzed muscles undergo physiological changes that alter their force responses to electrical stimulation. The purpose of this study was to investigate the effects of SCI on the contractile properties and force-frequency relationship (FFR) of the paralyzed human quadriceps femoris muscle of adolescents and young adults. Subjects. Thirteen subjects (11 male, 2 female; age range=11–24 years) with motor complete SCIs and 13 matched control subjects (11 male, 2 female; age range=9–23 years) without SCI participated in the study. Methods. Both groups of subjects underwent the same testing protocol using similar equipment. Results. The paralyzed muscles of the subjects with SCI produced 62% of the peak twitch force and had a fatigue ratio that was 65% of that of the control subjects. The paralyzed muscles contracted 14% and 25% faster and relaxed 38% and 46% faster than the nonparalyzed muscles in nonfatigued and fatigued conditions, respectively. Compared with the control subjects, the subjects with SCI had twitch-to-tetanus ratios that were 84% and 127% greater in nonfatigued and fatigued conditions, respectively. Relative to the control subjects, the FFR of the subjects with SCI was shifted to the left in the fatigued condition. Relative to their respective nonfatigued conditions, the FFR of both groups of subjects shifted to the right with fatigue. Discussion and Conclusion. These findings may have important implications for designing stimulation strategies to reduce the rapid fatigue that limits the clinical efficacy of functional electrical stimulation. [Scott WB, Lee SCK, Johnston TE, et al. Contractile properties and the force-frequency relationship of the paralyzed human quadriceps femoris muscle. Phys Ther. 2006;86:788–799.]
Physical Therapist Examination, Evaluation, and Intervention for a Patient With West Nile Virus Paralysis
Authors: Miller Nancy H , Miller David J , Goldberg Joanna L
Published: February 2017

Background and Purpose. The incidence of West Nile virus (WNV) has increased in the United States since 1999. A small percentage of people with WNV develop West Nile neuroinvasive disease (WNND) with encephalitis and flaccid paralysis. The purpose of this report is to describe the physical therapist management and outcomes for a patient with WNND and the therapist’s efforts to use an evidence-based practice approach in the management of a patient with this disease. Case Description. The patient was an active 55-year-old woman in excellent health who became acutely ill with asymmetrical lower-extremity weakness. The physical therapist reviewed the available literature, consulted with medical and physical therapist experts and the patient, and elected to use a poliovirus “period of recovery” approach combining intensive strengthening and monitoring of fatigue. Outcomes. The patient progressed from an initial nonambulatory status to ambulation with a single-point cane at week 18 after onset of symptoms. She began to ambulate without an assistive device by week 20. The patient returned to work part-time by week 22 and full-time by week 43. Discussion. These outcomes demonstrate the recovery of a patient with WNND after an intensive strengthening program.[Miller NH, Miller DJ, Goldberg JL. Physical therapist examination, evaluation, and intervention for a patient with West Nile virus paralysis. Phys Ther. 2006;86:843– 856.]
Effects of a Multimodal Exercise Program for People With Ankylosing Spondylitis
Authors: Ince Gonca , Sarpel Tunay , Durgun Behice , Erdogan Seref
Published: February 2017

Background and Purpose. Few randomized controlled studies have examined the effects of exercise in patients with ankylosing spondylitis (AS). This study investigated the effects of a 12-week, multimodal exercise program in patients with AS. Subjects. A convenience sample of 30 patients with AS (18 male, 12 female), with a mean age of 34.9 years (SD=6.28), participated in the study. Twenty-six subjects were classified as having stage I AS and 4 subjects were classified as having stage II AS according to the modified New York Criteria. Methods. This study was a randomized controlled trial. Subjects were assigned to either a group that received an exercise program or to a control group. The exercise program consisted of 50 minutes of multimodal exercise, including aerobic, stretching, and pulmonary exercises, 3 times a week for 3 months. Subjects in both groups received medical treatment for AS, but the exercise group received the exercise program in addition to the medical treatment. All subjects received a physical examination at baseline and at 12 weeks. The examinations were conducted under the supervision of a physician who specialized in physical medicine and rehabilitation and included the assessment of spinal mobility using 2 methods: clinical measurements (chin-to-chest distance, Modified Schober Flexion Test, occiput-to-wall distance, finger-to-floor distance, and chest expansion) and inclinometer measurements (gross hip flexion, gross lumbar flexion, and gross thoracic flexion). In addition, vital capacity was measured by a physiologist, and physical work capacity was evaluated by a doctorally prepared exercise instructor. Results. The measurements of the exercise group for chest expansion, chin-to-chest distance, Modified Schober Flexion Test, and occiput-to-wall distance were significantly better than those of the control group after the 3-month exercise period. The spinal movements of the exercise group improved significantly at the end of exercise program, but those of the control group showed no significant change. In addition, the results showed that the posttraining value of gross thoracic flexion of the exercise group was significantly higher than that of the control group. Physical work capacity and vital capacity values improved in the exercise group but decreased in the control group. Discussion and Conclusion. In this study, a multimodal exercise program including aerobic, stretching, and pulmonary exercises provided in conjunction with routine medical management yielded greater improvements in spinal mobility, work capacity, and chest expansion.
Clinimetric Properties of the Performance-Oriented Mobility Assessment
Authors: Faber Marjan J , Bosscher Ruud J , van Wieringen Piet CW
Published: February 2017

Background and Purpose. The Performance-Oriented Mobility Assessment (POMA) is a widely used instrument that provides an evaluation of balance and gait. It is used clinically to determine the mobility status of older adults or to evaluate changes over time. To support the use of the POMA for these purposes, the clinimetric properties (in particular, responsiveness) were determined. Subjects. Participants (78% female; mean age=84.9 years) were living in either self-care or nursing-care residences. Concurrent and discriminant validity were assessed with the total group (N=245), whereas reliability and responsiveness were determined with a subsample (n=30). Fall-related predictive validity was assessed with a subsample of 72 participants. Methods. In addition to the POMA, several reference performance tests were administered. The POMA was assessed on 2 consecutive days by 2 raters (observers). The analyses included the calculation of Spearman rank correlation coefficients (R), limits of agreement (LOA) with Bland-Altman plots, minimal detectable changes at the 95% confidence level (MDC95), and sensitivity and specificity with regard to predicting falls. When possible, findings for the total scale (POMA-T) were complemented by findings for its balance subscale (POMA-B) and its gait subscale (POMA-G). Results. The interrater and test-retest reliability for the POMA-T and the POMA-B were good (R=.74–.93), whereas for the POMA-G, the reliability values, although high as well, were systematically slightly lower (R=.72–.89). The Spearman correlations with the reference performance tests (R=|.64|–|.68|) indicated satisfactory concurrent validity for the POMA-T and the POMA-B, but the corresponding findings for the POMA-G (R=|.52|–|.56|) were less convincing. The discriminant validity values of the 3 scales were about the same. The LOA for the POMA-T were on the order of –4.0 to 4.0 for test-retest agreement and –3.0 to 3.0 for interrater agreement. On the basis of the MDC95 values, it was concluded that changes in POMA-T scores at the individual level should be at least 5 points and that those at the group level (n=30) should be at least 0.8 point to be considered reliable. Even when optimal cutoff points were used, sensitivity and specificity values (varying between 62.5% and 66.1%) for the POMA-T as well as for its 2 subscales indicated poor accuracy in predicting falls. Discussion and Conclusion. The POMA-T and its subscale POMA-B have adequate reliability and validity for assessing mobility in older adults. The POMA-T is useful for demonstrating intervention effects at the group level. Changes within subjects, however, should be at least 5 points before being interpreted as reliable changes. The accuracy of the POMA-T in predicting falls is poor.
Shoulder Dysfunction Assessment: Self-report and Impaired Scapular Movements
Authors: Lin Jiu-jenq , Hanten William P , Olson Sharon L , Roddey Toni S , Soto-quijano David A , Lim Hyun K , Sherwood Arthur M
Published: February 2017

Background and Purpose. Shoulder dysfunction is common in various patient populations. This investigation was performed to assess shoulder dysfunction with self-report and performance-based functional measures. Subjects. Fifty men (25 with shoulder dysfunction and 25 without shoulder dysfunction) participated in this study. Methods. Self-report functional disabilities were assessed with the Flexilevel Scale of Shoulder Function (FLEX-SF), and electromagnetic tracking sensors were used to monitor 3-dimensional scapular movements during 4 functional tasks. Results. Relative to the control group, the group with shoulder dysfunction showed significant alterations in scapular movements (averages of 6.9° less posterior tipping, 5.7° less upward rotation, and 2.3 cm more elevation). Scapular kinematics correlated significantly (r) with the Self-report FLEX-SF measure during functional tasks (posterior tipping=.454 to .712, upward rotation=.296 and .317, and elevation=−.310). Discussion and Conclusion. Functional disabilities were identified with self-report and performance-based functional measures. The inadequate scapular posterior tipping and scapular upward rotation as well as the excessive elevation may have implications in planning intervention strategies for people with shoulder dysfunction.
Shoulder Function and 3-Dimensional Scapular Kinematics in People With and Without Shoulder Impingement Syndrome
Authors: McClure Philip W , Michener Lori A , Karduna Andrew R
Published: February 2017

Background and Purpose. Several factors such as posture, muscle force, range of motion, and scapular dysfunction are commonly believed to contribute to shoulder impingement. The purpose of this study was to compare 3-dimensional scapular kinematics, shoulder range of motion, shoulder muscle force, and posture in subjects with and without primary shoulder impingement syndrome. Subjects. Forty-five subjects with impingement syndrome were recruited and compared with 45 subjects without known pathology or impairments matched by age, sex, and hand dominance. Methods. Shoulder motion and thoracic spine posture were measured goniometrically, and force was measured with a dynamometer. An electromagnetic motion analysis system was used to capture shoulder kinematics during active elevation in both the sagittal and scapular planes as well as during external rotation with the arm at 90 degrees of elevation in the frontal plane. Results. The impingement group demonstrated slightly greater scapular upward rotation and clavicular elevation during flexion and slightly greater scapular posterior tilt and clavicular retraction during scapular-plane elevation compared with the control group. The impingement group demonstrated less range of motion and force in all directions compared with the control group. There were no differences in resting posture between the groups. Discussion and Conclusion. The kinematic differences found in subjects with impingement may represent scapulothoracic compensatory strategies for glenohumeral weakness or motion loss. The decreased range of motion and force found in subjects with impingement support rehabilitation approaches that focus on strengthening and restoring flexibility.
Reliability and Validity of Data for 2 Newly Developed Shuttle Run Tests in Children With Cerebral Palsy
Authors: Verschuren Olaf , Takken Tim , Ketelaar Marjolijn , Gorter Jan Willem , Helders Paul JM
Published: February 2017

Background and Purpose. The purpose of this study was to examine the reliability and validity of data obtained with 2 newly developed shuttle run tests (SRT-I and SRT-II) to measure aerobic power in children with cerebral palsy (CP) who were classified at level I or II on the Gross Motor Function Classification System (GMFCS). The SRT-I was developed for children at GMFCS level I, and the SRT-II was developed for children at GMFCS level II. Subjects. Twenty-five children and adolescents with CP (10 female, 15 male; mean age=11.9 years, SD=2.9), classified at GMFCS level I (n=14) or level II (n=11), participated in the study. Methods. To assess test-retest reliability of data for the 10-m shuttle run tests, the subjects performed the same test within 2 weeks. To examine validity, the shuttle run tests were compared with a GMFCS level–based treadmill test designed to measure peak oxygen uptake. Results. Statistical analyses revealed test-retest reliability for exercise time (number of levels completed) (intraclass correlation coefficients of .97 for the SRT-I and .99 for the SRT-II) and reliability for peak heart rate attained during the final level (intraclass correlation coefficients of .87 for the SRT-I and .94 for the SRT-II). High correlations were found for the relationship between data for both shuttle run tests and data for the treadmill test (r=.96 for both). Discussion and Conclusion. The results suggest that both 10-m shuttle run tests yield reliable and valid data. Moreover, the shuttle run tests have advantages over a treadmill test for children with CP who are able to walk and run (GMFCS level I or II). [Verschuren O, Takken T, Ketelaar M, et al. Reliability and validity of data for 2 newly developed shuttle run tests in children with cerebral palsy. Phys Ther. 2006;86:1107–1117.]
Ultrasound Produced by a Conventional Therapeutic Ultrasound Unit Accelerates Fracture Repair
Authors: Warden Stuart J , Fuchs Robyn K , Kessler Chris K , Avin Keith G , Cardinal Ryan E , Stewart Rena L
Published: February 2017

Background and Purpose. A recent novel application of ultrasound therapy is the treatment of bone fractures. The aim of this study was to investigate the effect on fracture repair of ultrasound produced by a conventional therapeutic ultrasound unit as used by physical therapists. Subjects and Methods. Bilateral midshaft femur fractures were created in 30 adult male Long-Evans rats. Ultrasound therapy was commenced on the first day after fracture and introduced 5 days a week for 20 minutes a day. Each animal was treated unilaterally with active ultrasound and contralaterally with inactive ultrasound. Active ultrasound involved a 2-millisecond burst of 1.0-MHz sine waves repeating at 100 Hz. The spatially averaged, temporally averaged intensity was set at 0.1 W/cm2. Animals were killed at 25 and 40 days after fracture induction, and the fractures were assessed for bone mass and strength. Results. There were no differences between fractures treated with active ultrasound and fractures treated with inactive ultrasound at 25 days. However, at 40 days, active ultrasound-treated fractures had 16.9% greater bone mineral content at the fracture site than inactive ultrasound-treated fractures. This change resulted in a 25.8% increase in bone size, as opposed to an increase in bone density, and contributed to active ultrasound-treated fractures having 81.3% greater mechanical strength than inactive ultrasound-treated fractures. Discussion and Conclusion. These data indicate that ultrasound produced by a conventional therapeutic ultrasound unit as traditionally used by physical therapists may be used to facilitate fracture repair. However, careful interpretation of this controlled laboratory study is warranted until its findings are confirmed by clinical trials. [Warden SJ, Fuchs RK, Kessler CK, et al. Ultrasound produced by a conventional therapeutic ultrasound unit accelerates fracture repair. Phys Ther. 2006;86:1118–1127.]
Twice-Weekly Complete Decongestive Physical Therapy in the Management of Secondary Lymphedema of the Lower Extremities
Authors: Holtgrefe Karen M
Published: February 2017

Background and Purpose. This case report describes the physical therapist examination, evaluation, and intervention for a patient with bilateral lower-extremity lymphedema who received complete decongestive physical therapy 2 days per week instead of the recommended daily frequency. Case Description. The patient was a 55-year-old woman who developed bilateral lower-extremity grade II lymphedema 3 years after surgery and radiation for cervical cancer. She had impairments in hip and knee flexion range of motion and functional limitations in transfers, gait, and activities of daily living. Intervention. A twice-weekly intervention program was implemented consisting of education in skin care, manual lymph techniques, compression, and exercise. Outcomes. Outcomes related to the lymphedema were measured using the sum of the circumference of each limb. At discharge, the patient had reductions in lymphedema of 9% for the left lower extremity and 10% for the right lower extremity. Her hip flexion range of motion increased from 95 degrees to 110 degrees, and her knee flexion range of motion increased from 95 degrees to 130 degrees. She had resumed all premorbid activities and was independent in self-management. Discussion. Twice-weekly management of lymphedema using a program of skin care, manual lymph techniques, compression, and exercise was followed by reduction of the impairments and functional limitations in a patient with bilateral lower-extremity lymphedema.
Reprint—AACVPR/ACCF/AHA 2010 Update: Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation/Secondary Prevention Services
Authors: Thomas Randal J. , King Marjorie , Lui Karen , Oldridge Neil , Piña Ileana L. , Spertus John , Masoudi Frederick A. , DeLong Elizabeth , Erwin John P. , Goff David C. , Grady Kathleen , Green Lee A. , Heidenreich Paul A. , Jenkins Kathy J. , Loth Ann R. , Peterson Eric D. , Shahian David M.
Published: February 2017

Endorsed by the American College of Chest Physicians, the American College of Sports Medicine, the American Physical Therapy Association, the Canadian Association of Cardiac Rehabilitation, the European Association for Cardiovascular Prevention and Rehabilitation, the Inter-American Heart Foundation, the National Association of Clinical Nurse Specialists, the Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons.

This document was approved by the American College of Cardiology Foundation Executive Committee in April 2010, by the American Heart Association Science Advisory and Coordinating Committee in April 2010, and by the AACVPR Document Oversight Committee and Board of Directors in June 2010.

The American College of Cardiology Foundation requests that this document be cited as follows: Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J. AACVPR/ACC/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services. J Am Coll Cardiol 2010;56:1159–1167.

This article is copublished in Circulation and the Journal of Cadiopulmonary Rehabilitation and Prevention.

Copyright ©2010 by the American Association of Cardiovascular and Pulmonary Rehabilitation, American College of Cardiology Foundation, and American Heart Association, Inc. Published by Elsevier Inc.

CPT™ contained in the online data supplement is ©2009 American Medical Association.