bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simulation-Based Neurosurgical Training for the Presigmoid Approach With a Physical Model
Authors: Jabbour Pascal , Chalouhi Nohra 
Published: February 2017

Abstract

BACKGROUND:
In recent years, there has been growing interest in the use of simulation to supplement conventional surgical training. Simulation remains, however, in its infancy in neurosurgery.

OBJECTIVE:
To report on and assess the utility of a simulation physical model for the presigmoid approach.

METHODS:
The Congress of Neurological Surgeons created a Simulation Committee to explore and develop simulation-based models. The current model involves drilling of the presigmoid cranial base under image guidance. Each time the drill touches the dura, facial nerve, or sigmoid sinus, a beeping and a warning sound are emitted.

RESULTS:
Nine neurosurgery residents participated in and completed the presigmoid approach simulation module. All residents successfully completed the simulation procedure within the allocated time period (20 minutes). The mean number of hits to the dura, facial nerve, and sigmoid sinus decreased from 4.2 in the first test to 3.1 in the second test (P &lt; .05). The facial nerve was the most likely structure to be injured, followed by the sigmoid sinus and finally the dura. All 9 participants had an improvement in their technical scores.

CONCLUSION:
The presigmoid approach simulation model is a useful tool in resident education that may improve surgical proficiency while minimizing risk to patients. More studies with standardized end points for technical proficiency and clinical outcomes are needed.
Reliability of Scores on the Stroke Rehabilitation Assessment of Movement (STREAM) Measure
Authors: Daley Kathy , Mayo Nancy , Wood-Dauphinée Sharon 
Published: February 2017

Abstract
Background and Purpose. The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinical measurement tool for evaluating the recovery of voluntary movement and basic mobility following stroke. This article presents the results of 3 substudies examining the reliability (interrater and intrarater) and internal consistency of STREAM scores.Subjects and Methods. A “direct-observation reliability study” was conducted on 20 patients who had strokes and were in a rehabilitation setting. Pairs of raters from a group of 6 participating therapists provided data to judge interrater agreement. A “videotaped assessments reliability study” was done to assess intrarater and interrater agreement on the scoring of videotaped performances using the STREAM measure and involved 4 videotaped assessments that were viewed and rated on 2 occasions by 20 physical therapists. The internal consistency of the STREAM scores was evaluated for 26 patients who had strokes and who demonstrated the full range of motor ability.Results. The reliability of the STREAM scores was demonstrated by generalizability correlation coefficients of .99 for total scores and of .96 to .99 for subscale scores. The internal consistency of the STREAM scores was demonstrated by Cronbach alphas of greater than .98 on the subscales and overall.Conclusion and Discussion. These high levels of reliability support the use of the STREAM instrument for the measurement of motor recovery following stroke. Further work on the validity and responsiveness of the STREAM measure is in progress.
Four Clinical Tests of Sacroiliac Joint Dysfunction: The Association of Test Results With Innominate Torsion Among Patients With and Without Low Back Pain
Authors: Levangie Pamela K 
Published: February 2017

Abstract
Background and Purpose. The purpose of this study was to assess the association between innominate torsion (asymmetric anteroposterior positioning of the pelvic innominates) and the Gillet, standing forward flexion, sitting forward flexion, and supine-to-sit tests. Subjects. A sample of 21- to 50-year-old patients with low back pain (n=150) and a comparison group of patients with upper-extremity impairments (n=138) were recruited from outpatient physical therapy facilities. Methods. The association of single and combined test results with innominate torsion (calculated from pelvic landmark data) and with presence or absence of low back pain were estimated via odds ratios, sensitivities, specificities, and predictive values. Results. Individual test sensitivities were low (8%-44%), as were negative predictive values (28%-38%), for identifying the presence of innominate torsion. Combining tests and controlling for sex, age group, leg-length difference, or iliac crest level did not improve performance characteristics. The associations of test results with low back pain were weak, with the exception of the Gillet test (odds ratio=4.57). Conclusion and Discussion. The data do not support the value of these tests in identifying innominate torsion, although the use of these tests for identifying other phenomena (eg, sacroiliac joint hypomobility) cannot be ruled out. Further exploration of the association of Gillet test results with low back pain is warranted.
Postural Synergies Associated With a Stepping Task
Authors: Mercer Vicki Stemmons , Sahrmann Shirley A 
Published: February 2017

Abstract
Background and Purpose. Synergistic relationships among multiple muscle components are thought to exist to simplify control of posture and movement. The purpose of this study was to examine the extent to which children, young adults, and older adults exhibit consistent sequences of postural muscle activation when lifting the right foot onto a step from a standing position. Subjects. Twenty subjects without known impairments of the neuromuscular system (10 male, 10 female) in each of 3 age groups—children (8–12 years), young adults (25–35 years), and older adults (65–73 years)—participated. Methods. A pressure switch taped to the subject's right foot was used to determine movement onset and offset. Latencies of muscle activation were determined using surface electromyography. A preferred postural synergy was defined as the sequence of postural muscle activation observed during the majority of trials for each subject. Results. Mean movement times did not differ among age groups. Although the left tibialis anterior (TA) muscle was the first of the postural muscles activated in 93% of the trials, subjects displayed considerable variability in the subsequent order of postural muscle activation. Across subjects, a total of 14 different preferred postural synergies were observed. Age groups did not differ in the number of different synergies. Conclusion and Discussion. Early TA activation may reflect biomechanical constraints of the stepping task, producing forward displacement of the center of mass over the changing base of support. The fact that subjects of all ages were quite variable in the specific sequences of muscles activated subsequent to the TA suggests that, for this type of task, therapists should not focus their interventions on facilitating execution of particular synergy patterns.
The Sock Test for Evaluating Activity Limitation in Patients With Musculoskeletal Pain
Authors: Strand Liv I , Wie Solveig L 
Published: February 2017

Abstract
Background and Purpose. Assessment within rehabilitation often must reflect patients' perceived functional problems and provide information on whether these problems are caused by impairments of the musculoskeletal system. Such capabilities were examined in a new functional test, the Sock Test, simulating the activity of putting on a sock. Subjects and Methods. Intertester reliability was examined in 21 patients. Concurrent validity, responsiveness, and predictive validity were examined in a sample of 337 patients and in subgroups of this sample. Results. Intertester reliability was acceptable. Sock Test scores were related to concurrent reports of activity limitation in dressing activities. Scores also reflected questionnaire–derived reports of problems in a broad range of activities of daily living and pain and were responsive to change over time. Increases in age and body mass index increased the likelihood of Sock Test scores indicating activity limitation. Pretest scores were predictive of perceived difficulties in dressing activities after 1 year. Conclusion and Discussion. Sock Test scores reflect perceived activity limitations and restrictions of the musculoskeletal system.
Energy Cost of Propulsion in Standard and Ultralight Wheelchairs in People With Spinal Cord Injuries
Authors: Beekman Claire E , Miller-Porter Leslie , Schoneberger Marion 
Published: February 2017

AbstractBackground and Purpose. Wheelchair- and subject-related factors influence the efficiency of wheelchair propulsion. The purpose of this study was to compare wheelchair propulsion in ultralight and standard wheelchairs in people with different levels of spinal cord injury. Subjects. Seventy-four subjects (mean age=26.2 years, SD=7.14, range=17-50) with spinal cord injury resulting in motor loss (30 with tetraplegia and 44 with paraplegia) were studied. Method. Each subject propelled standard and ultralight wheelchairs around an outdoor track at self-selected speeds, while data were collected at 4 predetermined intervals. Speed, distance traveled, and oxygen cost (V̇o2 mL/kg/m) were compared by wheelchair, group, and over time, using a Bonferroni correction. Results. In the ultralight wheelchair, speed and distance traveled were greater for both subjects with paraplegia and subjects with tetraplegia, whereas V̇o2 was less only for subjects with paraplegia. Subjects with paraplegia propelled faster and farther than did subjects with tetraplegia. Conclusion and Discussion. The ultralight wheelchair improved the efficiency of propulsion in the tested subjects. Subjects with tetraplegia, especially at the C6 level, are limited in their ability to propel a wheelchair.
The Prevalence of Low Back Pain in Adults: A Methodological Review of the Literature
Authors: Loney Patricia L , Stratford Paul W 
Published: February 2017

Abstract
The prevalence of low back pain (LBP) has been reported in the literature for different populations. Methodological differences among studies and lack of methodological rigor have made it difficult to draw conclusions from these studies. A systematic review was done for adult community prevalence studies of LBP published from 1981 to 1998. The technique of capture-recapture was performed to estimate the completeness of the search strategy used. Established guidelines and a methodological scoring system were used to critically appraise the studies. Thirteen studies were deemed methodologically acceptable. Differences in the duration of LBP used in the studies appeared to affect the prevalence rates reported and explain much of the variation seen. It was estimated that the point prevalence rate in North America is 5.6%. Further studies using superior methods are needed, however, before this estimate can be used with confidence to make health care policies and decisions relating to physical therapy.
Physical Therapy for Facial Paralysis: A Tailored Treatment Approach
Authors: Brach Jennifer S , VanSwearingen Jessie M 
Published: February 2017

AbstractBackground and Purpose. Bell palsy is an acute facial paralysis of unknown etiology. Although recovery from Bell palsy is expected without intervention, clinical experience suggests that recovery is often incomplete. This case report describes a classification system used to guide treatment and to monitor recovery of an individual with facial paralysis. Case Description. The patient was a 71-year-old woman with complete left facial paralysis secondary to Bell palsy. Signs and symptoms were assessed using a standardized measure of facial impairment (Facial Grading System [FGS]) and questions regarding functional limitations. A treatment-based category was assigned based on signs and symptoms. Rehabilitation involved muscle re-education exercises tailored to the treatment-based category. Outcomes. In 14 physical therapy sessions over 13 months, the patient had improved facial impairments (initial FGS score=17/100, final FGS score=68/100) and no reported functional limitations. Discussion. Recovery from Bell palsy can be a complicated and lengthy process. The use of a classification system may help simplify the rehabilitation process.
Effects of Repetitive Handgrip Training on Endurance, Specificity, and Cross–Education
Authors: Shields Richard K , Leo Ken C , Messaros Andrew J , Somers Virend K 
Published: February 2017

Abstract
Background and Purpose. Exercise programs are more likely to be successful when they are based on research that predicts the outcomes of such training. This study determined the effect of submaximal rhythmic handgrip training on rhythmic handgrip endurance or work (RHW), isometric handgrip endurance time (IHE), and maximal voluntary isometric contraction for the handgrip force (MVIC) (in newtons). Subjects. Twenty–four male subjects (mean age=26.2 years) with right–hand dominance were randomly assigned to a regular training group (n=8), a low–level training group (n=8), or a control group (n=8). Methods. Rhythmic handgrip work, IHE, and MVIC were determined bilaterally before and after 6 weeks of a rhythmic right handgrip training program using 30% of MVIC. The low-level training group performed daily training with a near–zero load (&lt;0.005% of MVIC). Results. There was a 1,232% increase in RHW and an 8% decrease in IHE after the training program using 30% of MVIC for the right hand. The left hand showed a 43% increase in RHW after training, whereas the low–level training group showed a 35% increase in RHW. No differences were found between the change in the left=hand RHW of the regular training group and the change in the right–hand RHW of the low–level training group, but both measurements were greater than the change in the control group (6.4%). Conclusion and Discussion. Submaximal handgrip endurance training at 30% of MVIC had a minimal effect on submaximal IHE and MVIC of the handgrip, but it had a large effect on RHW of the trained extremity. The regular training group and the low–level training group showed similar increases in cross–education, suggesting that cross–education during endurance training is not intensity–dependent.
The Clinical Doctorate: A Framework for Analysis in Physical Therapist Education
Authors: Threlkeld A Joseph , Jensen Gail M , Royeen Charlotte Brasic 
Published: February 2017

Abstract
This article explores major considerations for analysis and discussion of the role of the clinical doctorate as the first professional degree in physical therapist education (DPT). A process for this analysis is posed based on a conceptual framework developed by Stark, Lowther, Hagerty, and Orczyk through grounded theory research on professional education. External influences from society and the profession, institutional and programmatic influences, and articulation of critical dimensions of professional competence and professional attitudes as major categories are discussed in relation to the DPT. A series of questions generated from the application of the model are put forth for continued discussion and deliberation concerning the DPT. We conclude that the DPT provides the best pathway to serve society, the patient, and the profession.
Effect of Positioning on Recorded Lung Sound Intensities in Subjects Without Pulmonary Dysfunction
Authors: Jones Alice , Jones R Douglas , Kwong Kevin , Burns Yvonne 
Published: February 2017

Abstract
Background and Purpose. Physical therapists often use positioning to assist in the reexpansion of collapsed lung segments. An increase in lung sound intensity on auscultation is considered indicative of lung expansion. This study was designed to examine whether clinical interpretation of auscultatory findings is warranted. Subjects. The subjects (5 male, 6 female) were young physical therapist students without pulmonary dysfunction (mean age=20.4 years, mean height=166.3 cm, mean weight=57.5 kg). Subjects with lung disease were excluded because pulmonary pathology is difficult to standardize. Methods. Lung sounds electronically recorded over the posterior chest wall of subjects in sitting and side-lying positions were compared. Measures included peak intensity, frequency at maximum power, and median frequency. Results. In the sitting position, inspiratory sounds recorded over the left posterior chest wall were louder than those recorded on the right side. In the side-lying positions, the sound intensity recorded from the dependent chest wall was louder than that recorded from the nondependent chest wall. In side-lying positions, the upper hemithorax is “nondependent,” and the side in contact with the bed is “dependent.” Sound intensities recorded over both posterior chest walls in the sitting position were louder than those recorded over the same lung area in the nondependent side-lying position. There was no difference in the sound intensity recorded between the sitting and dependent side-lying postures. Conclusion and Discussion. When comparative auscultation of the chest wall is used by physical therapists to assess the adequacy of pulmonary ventilation, patient posture and regional differences in breath sound intensity can influence clinical interpretation.
Effects of Length on the Catchlike Property of Human Quadriceps Femoris Muscle
Authors: Lee Samuel CK , Gerdom Michelle L , Binder-Macleod Stuart A 
Published: February 2017

AbstractBackground and Purpose. Recent reports have suggested that electrical stimulation trains that take advantage of the catchlike property of skeletal muscle can produce higher forces from skeletal muscle than traditionally used constant-frequency trains. This study investigated the effects of catchlike-inducing trains on human quadriceps femoris muscles while the knee joint was held at 15 degrees of flexion. Subjects and Methods. Subjects (N=12) were tested with constant-frequency trains that had interpulse intervals ranging from 10 to 160 milliseconds and comparable catchlike-inducing trains. Data were collected during the control condition (1 train every 10 seconds) and during repetitive contractions (1 train per second). Results. During control and repetitive activation conditions, catchlike-inducing trains produced approximately 5% to 110% greater peak forces than comparable constant-frequency trains, depending on the frequencies being compared. Total forces produced (ie, force-time integrals) were increased up to 59% and 49% during the control and repetitive activation conditions, respectively. Conclusion and Discussion. These results support earlier findings that catchlike-inducing trains may be advantageous in functional electrical stimulation applications.
Expert Practice in Physical Therapy
Authors: Jensen Gail M , Gwyer Jan , Shepard Katherine F , Hack Laurita M 
Published: February 2017

Abstract
Background and Purpose. The purpose of this qualitative study was to identify the dimensions of clinical expertise in physical therapy practice across 4 clinical specialty areas: geriatrics, neurology, orthopedics, and pediatrics. Subjects. Subjects were 12 peer-designated expert physical therapists nominated by the leaders of the American Physical Therapy Association sections for geriatrics, neurology, orthopedics, and pediatrics. Methods. Guided by a grounded theory approach, a multiple case study research design was used, with each of the 4 investigators studying 3 therapists working in one clinical area. Data were obtained through nonparticipant observation, interviews, review of documents, and analysis of structured tasks. Videotapes made during selected therapist-patient treatment sessions were used as a stimulus for the expert therapist interviews. Data were transcribed, coded, and analyzed through the development of 12 case reports and 4 composite case studies, one for each specialty area. Results. A theoretical model of expert practice in physical therapy was developed that included 4 dimensions: (1) a dynamic, multidimensional knowledge base that is patient-centered and evolves through therapist reflection, (2) a clinical reasoning process that is embedded in a collaborative, problem-solving venture with the patient, (3) a central focus on movement assessment linked to patient function, and (4) consistent virtues seen in caring and commitment to patients. Conclusion and Discussion. These findings build on previous research in physical therapy on expertise. The dimensions of expert practice in physical therapy have implications for physical therapy practice, education, and continued research.
Circulatory Responses to Voluntary and Electrically Induced Muscle Contractions in Humans
Authors: Miller Benjamin F , Gruben Kreg G , Morgan Barbara J 
Published: February 2017

Abstract
Background and Purpose. Transcutaneous electrical nerve stimulation (TENS) increases regional blood flow when applied at intensities sufficient to cause skeletal muscle contraction. It is not known whether increases in blood flow elicited by TENS differ from those caused by voluntary muscle contraction. The purpose of this study, therefore, was to compare the hemodynamic effects of these 2 types of muscle contraction. Subjects and Methods. Fourteen people with no known pathology, aged 18 to 49 years (X̄=28, SD=8), served as subjects. Calf blood flow (venous occlusion plethysmography), heart rate (electrocardiogram), blood pressure (automated sphygmomanometry), and force (footplate transducer) were measured during electrically induced and voluntary contractions. Results. Both modes of exercise caused rapid, but short-lived vasodilation (calf vascular resistance [X̄±SEM]: −53%±3% for voluntary contractions versus −57%±4% for electrically induced contractions). The vasodilation caused by electrically induced contractions persisted for at least 15 seconds in the postexercise period, whereas the vasodilation elicited by voluntary contractions had resolved by this time point. Conclusion and Discussion. The hemodynamic changes elicited by voluntary and electrically induced muscle contractions are similar in magnitude but different in duration.
Reliability and Responsiveness of Two Physical Performance Measures Examined in the Context of a Functional Training Intervention
Authors: King Mary B , Judge James O , Whipple Robert , Wolfson Leslie 
Published: February 2017

Abstract
Background and Purpose. The reliability and responsiveness of 2 physical performance measures were assessed in this nonrandomized, controlled pilot exercise intervention. Subjects. Forty-five older individuals with mobility impairment (mean age=77.9 years, SD=5.9, range=70–92) were sequentially assigned to participate in an exercise program (intervention group) or to a control group. Methods. The intervention group performed exercise 3 times a week for 12 weeks that targeted muscle force, endurance, balance, and flexibility. Outcome measures were the 8-item Physical Performance Test (PPT-8) and the 6-minute walk test. Test-retest reliability and responsiveness indexes were determined for both tests; interrater reliability was measured for the PPT-8. Results. The intraclass correlation coefficient for interrater reliability for the PPT-8 was .96. Intraclass correlation coefficients for test-retest reliability were .88 for the PPT-8 and .93 for the 6-minute walk test. The intervention group improved 2.4 points and the control group improved 0.7 point on the PPT-8, as compared with baseline measurements. There was no change in 6-minute walk test distance in the intervention group when compared with the control group. The responsiveness index was .8 for the PPT-8 and .6 for the 6-minute walk test. Conclusion and Discussion. Measurements for both the PPT-8 and the 6-minute walk test appeared to be highly reliable. The PPT-8 was more responsive than the 6-minute walk test to change in performance expected with this functional training intervention.