bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Prolonged Static and Cyclic Stretching on Ankle Joint Stiffness, Torque Relaxation, and Gait in People With Stroke
Authors: Bressel Eadric , McNair Peter J 
Published: February 2017

Abstract
Background and Purpose. Continuous passive motion (cyclic stretching applied to the subject's limb) has been used for the rehabilitation of some orthopedic impairments; however, few researchers have considered its application in the management of neurological disorders such as stroke. The purpose of this study was to examine the short-term effects of prolonged static and cyclic calf stretching on passive ankle joint stiffness, torque relaxation, and gait in people with ischemic stroke. Subjects. Ten community-dwelling people (mean age=64.6 years, SD=8.76, range=53–76) who were diagnosed with a cerebrovascular accident volunteered to be subjects. Methods. Participants engaged in one 30-minute static stretch and one 30-minute cyclic stretch of the calf muscle, using an isokinetic dynamometer that also collected torque and angle measurements. Before and after treatments, 10-m walking times were collected. Ankle joint stiffness was calculated from the slope of the torque and angle curves before and immediately after treatments, and torque relaxation was calculated as the percentage of decrease in peak passive torque over the 30-minute stretch durations. Results. Ankle joint stiffness decreased by 35% and 30% after the static and cyclic stretches, respectively. Stiffness values and 10-m walk times were not different between conditions. The amount of torque relaxation was 53% greater for static stretching than for cyclic stretching. Discussion and Conclusion. These preliminary data from a very small sample of people with stroke indicate that ankle joint stiffness decreases after both prolonged static and cyclic stretches; however, neither technique appears to be better at reducing stiffness in people with stroke. Torque relaxation is greater after static stretching than after cyclic stretching, and walking speed does not appear to be influenced by the stretching treatments used in our study.
Virtual Reality–Augmented Rehabilitation for Patients Following Stroke
Authors: Merians Alma S , Jack David , Boian Rares , Tremaine Marilyn , Burdea Grigore C , Adamovich Sergei V , Recce Michael , Poizner Howard 
Published: February 2017

Abstract
Background and Purpose. Recent evidence indicates that intensive massed practice may be necessary to modify neural organization and effect recovery of motor skills in patients following stroke. Virtual reality (VR) technology has the capability of creating an interactive, motivating environment in which practice intensity and feedback can be manipulated to create individualized treatments to retrain movement. Case Description. Three patients (ML, LE, and DK), who were in the chronic phase following stroke, participated in a 2-week training program (3½ hours a day) including dexterity tasks on real objects and VR exercises. The VR simulations were targeted for range of motion, movement speed, fractionation, and force production. Outcomes. ML's function was the most impaired at the beginning of the intervention, but showed improvement in the thumb and fingers in range of motion and speed of movement. LE improved in fractionation and range of motion of his thumb and fingers. DK made the greatest gains, showing improvement in range of motion and strength of the thumb, velocity of the thumb and fingers, and fractionation. Two of the 3 patients improved on the Jebsen Test of Hand Function. Discussion. The outcomes suggest that VR may be useful to augment rehabilitation of the upper limb in patients in the chronic phase following stroke.
Effect of Electrical Stimulation on Chronic Leg Ulcer Size and Appearance
Authors: Houghton Pamela E , Kincaid Cynthia B , Lovell Marge , Campbell Karen E , Keast David H , Woodbury M Gail , Harris Kenneth A 
Published: February 2017

Abstract
Background and Purpose. Electrical current has been recommended for use on chronic pressure ulcers; however, the ability of this modality to improve healing of other types of chronic ulcers is less well established. The purpose of this study was to examine the effect of high-voltage pulsed current (HVPC) on healing of chronic leg ulcers. Subjects. Twenty-seven people with 42 chronic leg ulcers participated in the study. Methods. The subjects were separated into subgroups according to primary etiology of the wound (diabetes, arterial insufficiency, venous insufficiency) and then randomly assigned to receive either HVPC (100 microseconds, 150 V, 100 Hz) or a sham treatment for 45 minutes, 3 times weekly, for 4 weeks. Wound surface area and wound appearance assessed during an initial examination, following a 1- to 2-week period during which subjects received only conventional wound therapy, after 4 weeks of sham or HVPC treatment, and at 1 month following treatments. Results The results indicated that HVPC applied to chronic leg ulcers reduced the wound surface area over the 4-week treatment period to approximately one half the initial wound size (mean decrease=44.3%, SD=8.8%, range=2.8%-100%), which was over 2 times greater than that observed in wounds treated with sham units (mean decrease=16.0%, SD=8.9%, range=-30.3%-83.7%). Discussion and Conclusion. The results of the study indicate that HVPC administered 3 times a week should be considered to accelerate wound closure of chronic leg ulcers.
The Relationship of Lower-Extremity Muscle Torque to Locomotor Performance in People With Stroke
Authors: Kim C Maria , Eng Janice J 
Published: February 2017

AbstractBackground and Purpose. Improved walking is a common goal after stroke. The purpose of this study was to examine the relationship between the torque generated by the muscles of both lower extremities and 2 locomotor tasks: gait on level surfaces and stair climbing in people who had strokes. Subjects. Twenty community-dwelling individuals (mean age=61.2 years, SD=8.4, range=52-82) who had strokes and who were able to walk independently participated in the study. The mean time since stroke was 4.0 years (SD=2.6, range=1.5-10.0). Methods. Pearson correlations and multiple regression were used to measure the relationship between concentric isokinetic torque of the flexor and extensor muscles of the hip, knee, and ankle bilaterally and locomotor performance (gait on level surfaces and stair-climbing speed). Results. The isokinetic torques of the paretic ankle plantar flexors, hip flexors, and knee flexors had moderate to high correlations (r=.5-.8) with gait and stair-climbing speeds. Muscle force could explain 66% to 72% of the variability in gait and stair-climbing speeds. Correlations for the nonparetic side were as high as or higher than those for the paretic side for some muscle groups. Discussion and Conclusion. Muscle performance measurements of both limbs should be included in the evaluation of locomotion and treatment of people following a stroke.
Occupational Rehabilitation Following Open Mesh Surgical Repair of an Inguinal Hernia
Authors: Pesanelli Kelly E , Cigna Joseph A , Basu Shantanu G , Morin Andrew R 
Published: February 2017

Abstract
Background and Purpose. The purpose of this case report is to describe an occupational rehabilitation program for a person whose work-related inguinal hernia was surgically repaired. Case Description. A 35-year-old baggage service attendant acquired an inguinal hernia while lifting at work. Postoperatively, the patient had discomfort in the groin, weakness of the lower extremities and trunk, limited ability to walk, and a decreased ability to work due to impaired tolerance.Outcomes. Following postoperative rehabilitation, the patient was able to return to full-time, full-duty work. Discussion. This case report describes occupational rehabilitation as a method to treat patients with work-related inguinal hernias following surgical repair.
Lumbar Posture—Should It, and Can It, Be Modified? A Study of Passive Tissue Stiffness and Lumbar Position During Activities of Daily Living
Authors: Scannell Joan P , McGill Stuart M 
Published: February 2017

Abstract
Background and Purpose. Physical therapists commonly attempt to reduce and prevent low back pain by “improving” individuals' lumbar posture. To investigate the physical therapy clinical practice of attempting to “improve” lumbar posture, measures of passive tissue stiffness and angular deformation during activities of daily living were used. Participants. The lumbar spine posture of 150 university students was measured as the inclinometer angle difference between L1 and S1. Eighteen female participants (6 with hypolordosis, 6 with hyperlordosis, and 6 controls without lumbar spine impairment) were recruited from this lumbar posture database. Hypolordosis and hyperlordosis were clinically classified by physical therapists. Methods. Lumbar passive tissue stiffness was measured during sitting, standing, and walking before and after a 12-week exercise program, and estimates of lumbar passive tissue strain were calculated from those measurements. Results. The neutral zone (NZ), a range of lumbar positions of low passive tissue stiffness, was identified. Prior to training, the subjects with hypolordosis had more passive tissue strain during sitting than the subjects with hyperlordosis, and the subjects with hyperlordosis stood in extension relative to their NZs while the control subjects and subjects with hypolordosis stood within their NZs. Before and after training, subjects in all 3 groups walked with lumbar spine positions within their NZs. After training, the lumbar posture of the subjects with hypolordosis and the subjects with hyperlordosis changed toward a “mean” (mid-range) lumbar posture. After the exercise program, subjects in all 3 groups stood and walked with their lumbar spines in positions within their NZs, and they sat with their lumbar spines flexed relative to their NZs. Discussion and Conclusion. Knowing that tissue failure can be related to passive tissue strain, the results of this study support the clinical practice of attempting to change individuals' posture-related lumbar spine positions during activities of daily living. Lumbar passive tissue strain, as estimated from the NZ and angular deformation during activities of daily living, can be decreased, but can also be increased, by an exercise program.
One Grip a Little Stronger
Authors: Duncan Pamela W 
Published: February 2017

Abstract
Pamela W Duncan, PT, PhD, FAPTA
Dr Duncan has actively participated in and contributed to physical therapist practice, physical therapist professional education, professional preparation of other health care providers, national policy development related to rehabilitation after stroke and aging, and scientific investigation. She has served several government appointments and provides leadership within several organizations. She served as co-chair of the Consensus Panel on Establishing Guidelines for Stroke Rehabilitation for the Agency for Health Care Policy, Research, and Education. She was a panel member on the National Institutes of Health's Total Hip Replacement Consensus Conference and served on the Strategic Planning Group for Stroke Research for the National Institute of Neurological Disorders and Stroke. She recently was appointed to serve on the Steering Committee of the Department of Education's National Institute on Disability and Rehabilitation Research and is currently on the Executive Leadership Council of the American Stroke Foundation and the Advisory Committee of the Canadian Stroke Network. She has served on committees and panels for the American Heart Association and was president of APTA's Neurology section.
Dr Duncan's research activities focus on geriatric rehabilitation, stroke rehabilitation, and health outcomes measurement. She developed the Functional Reach Test, used to assess balance in older adults. In the past 20 years, she has received $13 million in research awards as principal investigator or co-investigator from agencies such as the National Institutes of Health, National Institute on Aging, American Heart Association, Department of Veteran's Affairs, and National Center for Medical Rehabilitation Research and from multiple private funding sources. Dr Duncan has disseminated her research findings in more than 80 peer-reviewed articles in 20 different journals, and she has written a book and 12 book chapters.
Dr Duncan's work has influenced the care and rehabilitation of patients in the United States and worldwide. Physical therapy education programs across the country incorporate her findings and professional vision into the preparation of the next generation of physical therapists.
APTA has awarded Dr Duncan the Marian Williams Award for Research in Physical Therapy, the Catherine Worthingham Fellowship Award, and the Mary McMillan Scholarship Award. She has also received research awards from the APTA Neurology Section, Sports Physical Therapy Section, and Section on Geriatrics, as well as a service award from the Neurology Section. She is an elected fellow of the Stroke Council of the American Heart Association and has given 8 invited lectureships at universities across the United States.
Impact of Explicit Information on Implicit Motor-Sequence Learning Following Middle Cerebral Artery Stroke
Authors: Boyd Lara A , Winstein Carolee J 
Published: February 2017

Abstract
Background and Purpose. Recovery of motor skills following stroke is supported, in part, by the implicit memory system. However, attempts to guide learning commonly use explicit instructions concerning “how to” perform a movement task. The purpose of this work was to systematically investigate the impact of explicit information (EI) on implicit motor-sequence learning using the ipsilesional arm in people with damage in the middle cerebral artery (MCA) distribution. Subjects and Methods. Ten people with unilateral stroke in the MCA distribution affecting the sensorimotor cortical areas and 10 people with no known pathology or impairment (control participants) were randomly divided into 2 groups. One group was provided with EI and one group was not (EI and No-EI groups, respectively) as the participants practiced an implicit motor-sequencing task over 3 days, with a retention test on day 4. Results. A 3-way interaction demonstrated that, across days of practice, EI had opposite effects on implicit motor-sequence performance for the 2 groups. Post hoc tests confirmed that EI facilitated the performance of the control participants in the EI group but interfered with the performance of the participants with stroke in the EI group. This interference effect persisted, and was evident during the retention test in the participants with stroke in the EI group. Discussion and Conclusion. Explicit information was detrimental for implicit motor-sequence learning following MCA stroke. Rehabilitation outcomes may benefit from consideration of stroke location when determining the degree to which EI can augment implicit motor skill learning.
Effects of Iontophoresis Current Magnitude and Duration on Dexamethasone Deposition and Localized Drug Retention
Authors: Anderson Carter R , Morris Russell L , Boeh Stephen D , Panus Peter C , Sembrowich Walter L 
Published: February 2017

Abstract
Background and Purpose. Iontophoresis is a process that uses bipolar electric fields to propel molecules across intact skin and into underlying tissue. The purpose of this study was to describe and experimentally examine an iontophoresis drug delivery model. Subjects and Methods. A mechanistic model describing delivery was studied in vitro using agarose gels and was further tested in vivo by evaluation of cutaneous vasoconstriction following iontophoresis in human volunteers. Results. In vitro cathodic iontophoresis at 4 mA and 0.1 mA each delivered dexamethasone/dexamethasone phosphate (DEX/DEX-P) from a 4-mg/mL donor solution to a depth of 12 mm following a 40 mA·minute stimulation dosage. Delivery of DEX/DEX-P to at least the depths of the vasculature in humans was confirmed by observation of cutaneous vasoconstriction. This cutaneous vasoconstriction was longer lasting and greater in magnitude when using low-current, long-duration (∼0.1 mA) iontophoresis compared with equivalent dosages delivered by higher-current, shorter-duration (1.5–4.0 mA) iontophoresis. Discussion and Conclusion. From data gathered with the gel model, the authors developed a model of a potential mechanism of drug depot formation following iontophoresis. The authors believe this drug depot formation to be due to exchange of drug ions for chloride ions as the ionic current carriers. Furthermore, diffusion, not magnitude of current, appears to govern the depth of drug penetration. Although the authors did not address the efficacy of the drug delivered, the results of human experiments suggest that current magnitude and duration should be considered as factors in treating musculoskeletal dysfunctions with iontophoresis using DEX/DEX-P at a concentration of 4 mg/mL.
Musculoskeletal Deterioration and Hemicorporectomy After Spinal Cord Injury
Authors: Shields Richard K , Dudley-Javoroski Shauna 
Published: February 2017

Abstract
Background and Purpose. The long-term management following an hemicorporectomy (HCP) is not well documented in the scientific literature. The purpose of this case report is to describe the 25-year history of a man with a spinal cord injury who experienced severe musculoskeletal deterioration and hemicorporectomy. Case Description. The client sustained T10 complete paraplegia at age 18 years, developed severe decubitus ulcers, and required an HCP as a life-saving measure 13 years later. The authors describe the chronology of several rehabilitation and prosthetic strategies and speculate on factors that may have contributed to their successes and failures. Outcomes. The client survived 12 years after the HCP and returned to independent mobility, self-care, and schooling despite complications with continued skin breakdown. Over the 12 years following discharge from the hospital after the spinal cord injury, he spent 749 days in the hospital. During the 12 years he lived after discharge from the hospital following the HCP, he was hospitalized 190 days. Discussion. The authors discuss factors contributing to the client's musculoskeletal deterioration including chronic wounds, postural deviations, and incomplete adherence to pressure-relief recommendations and raise considerations for physical therapists who treat patients after HCP.
Construct Validation of a Model for Professional Behavior in Physical Therapist Students
Authors: Jette Diane U , Portney Leslie G 
Published: February 2017

Abstract
Background and Purpose. For physical therapist educators, professional behavior has been difficult to define. The purpose of this study was to test the construct validity of a model of professional behavior that was previously established through consensus and reported in the literature. Subjects and Methods. One hundred eighty-three students from 2 professional programs participated in the study. Using a self-administered questionnaire, students assessed how frequently they performed 152 behaviors on a 7-point Likert scale. Data were analyzed using principal components factor analysis. A Cronbach alpha was used to demonstrate internal consistency of items within each factor. Factor scores were submitted as dependent variables in analyses of variance to examine the differences in abilities according to amount of clinical education completed. Results. The analysis identified 7 factors that explained 52% of the variance. These factors were labeled Professionalism, Critical Thinking, Professional Development, Communication Management, Personal Balance, Interpersonal Skills, and Working Relationships. Cronbach alphas ranged from .81 to .95. Behaviors increased in frequency in 4 of the 7 areas identified according to the level of students' progress in the educational program. Discussion and Conclusion. The 7 factors corresponded fairly well to the 10 generic abilities previously identified. Although some behaviors may increase in frequency over the course of students' educational experience, others may be displayed at admission.
Psychometric Properties of the Dutch Chronic Fatigue Syndrome–Activities and Participation Questionnaire (CFS-APQ)
Authors: Nijs Jo , Vaes Peter , McGregor Neil , Van Hoof Elke , Meirleir Kenny De 
Published: February 2017

Abstract
Background and Purpose. The Chronic Fatigue Syndrome–Activities and Participation Questionnaire (CFS-APQ) is a recently developed disease-specific assessment tool for monitoring activity limitations and participation restrictions in patients with chronic fatigue syndrome (CFS). In this study, the convergent validity, content validity, and test-retest reliability of data obtained with the Dutch-language version of the questionnaire were examined. Subjects and Methods. One hundred eleven consecutive patients with CFS were enrolled, of whom 47 fulfilled all inclusion criteria. The subjects were first asked to rate their pain, fatigue, and ability to concentrate using 3 visual analog scales, to list at least 5 activities that had become difficult to perform due to their complaints, and to complete the CFS-APQ. Furthermore, subjects were asked to complete a modified version of the CFS-APQ at home and return it to the investigators. The content of the questionnaire was reviewed using the World Health Organization's International Classification of Impairments, Disability and Health (ICIDH) beta II draft. Spearman rank correlation coefficients (R) were used for the convergent validity analysis, and intraclass correlation coefficients were computed for the assessment of the test-retest data. Results. Overall scores on the CFS-APQ correlated with the scores from the visual analog scales for pain (R=.51, P&lt;.001) and fatigue (R=.50, P&lt;.001). The majority of the responses (157 out of 183 answers [85.8%]) to the request to “list difficult activities” matched the content of the CFS-APQ. Using the ICIDH beta II draft, 21 out of 26 questions were found to address activities, and the remaining 5 questions measured the participation level. The Cronbach alpha coefficient was .94, and intraclass correlation coefficients for test-retest reliability of the overall scores were ≥.95 (P&lt;.001). Discussion and Conclusion. The results substantiate the convergent validity, content validity, and reliability of the CFS-APQ scores for patients with CFS.
The Hypothesis-Oriented Algorithm for Clinicians II (HOAC II): A Guide for Patient Management
Authors: Rothstein Jules M , Echternach John L , Riddle Daniel L 
Published: February 2017

Abstract
In this era of health care accountability, a need exists for a new decision-making and documentation guide in physical therapy. The original Hypothesis-Oriented Algorithm for Clinicians (HOAC) provided clinicians and students with a framework for science-based clinical practice and focused on the remediation of functional deficits and how changes in impairments related to these deficits. The HOAC II was designed to address shortcomings in the original HOAC and be more compatible with contemporary practice, including the Guide to Physical Therapist Practice. Disablement terminology is used in the HOAC II to guide clinicians and students when documenting patient care and incorporating evidence into practice. The HOAC II, like the HOAC, can be applied to a patient regardless of age or disorder and allows for identification of problems by physical therapists when patients are not able to communicate their problems. A feature of the HOAC II that was lacking in the original algorithm is the concept of prevention and how to justify and document interventions directed at prevention.