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RMUoHP Dissertations

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Athletic Training

    Epidemiological Aspects of Community Associated Methicillin Resistant Staphylococcal Aureus (CA-MRSA) Infections Within Northeastern Intercollegiate and High School Athletics

    Published Year: 2015
    Specialization: Athletic Training

    Braun, Timothy

    Context: Community Associated Methicillin Resistant Staphylococcus Aureus (CA-MRSA) infections continue to impose an annual multi-billion cost on society with athletes being an at risk population. With the focus of sports medicine CA-MRSA research centered on retrospective outbreaks and environmental studies, recommendations and position statements spawned from the results. Although these recommendations offer effective solutions to controlling and managing these infections, they have not served to eliminate the problem. Few studies have attempted to examine infection rates, referral practices and physician management steps for CA-MRSA infections within student-athletes. Objective: To retrospectively and prospectively assess the rate of CA-MRSA infections, sport risk, management protocol and referral practices within high school and intercollegiate athletic programs. Design: Two descriptive epidemiological studies. One review of current literature. Retrospective Patients or Other Participants: 156 certified athletic trainers (ATs) from intercollegiate and high school programs within National Athletic Trainers Association (NATA) District Two. Retrospective Main Outcome Measures: Frequencies, analysis of variance, prevalence and relative risk were calculted to determine differences between settings and sports for CA-MRSA infections. Retrospective Results: The overall infection prevalence was 15.5 per 10,000 athletes. The prevalence and relative risk were significantly higher in wrestling and football compared to the general athletic population. The majority of referrals occurred to general or primary physicians. The majority of respondents indicated proper decontamination. Approximately half the respondents were unsure of physician management steps. Prospective patients or Other Participants: Eight-seven certified athletic trainers (ATs) responded to the first survey request. Over the course of the competitive academic year, sixty-one participants responded to every survey. Prospective Main Outcome Measures: Frequencies, analysis of variance, incidence rates and relative risk were calculated to determine differences between settings and sports for CA-MRSA infections. Prospective Results: The overall CA-MRSA infection incidence was 16.3 per 10,000 athletes. The incidence and relative risk were significantly higher in wrestling and football compared to the general athletic population. The majority of the suspicious bacterial lesions were referred to either primary care or general physicians with patients most likely to receive antibiotic coverage for CA-MRSA regardless of diagnostic confirmation. Conclusions: Athletes, particularly contact athletes, suffer a higher rate of CA-MRSA infections compared to the general population. Despite successful preventative meaures and recommendations, the rate of CA-MRSA infection among athletes remains high. Upon referral, many cases of suspicious bacterial lesions are issued antibiotics to treat CA-MRSA. As CA-MRSA strains begin to display resistance to antibiotic mainstays, it is critical that certified athletic trainers stay abreast of the eve changing standards of medical care.

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    Red Bull® vs Red Bull® Total Zero’s Affect on Performance and Perceived Exertion in Collegiate Soccer Players

    Published Year: 2013
    Specialization: Athletic Training

    Brown, Christopher D.

    Purpose: This study is presented as an effort to provide more information on the effects of energy drinks (ED) on intermittent exercise, and add to the published research in Caffeine (CAF) combined with Carbohydrate (CHO) as an ergogenic aid compared to CAF alone. Methods: In three trials, each separated by seven days, seven healthy male and seven healthy female collegiate soccer players randomly ingested an ED, a sugar-free ED, or a placebo beverage 40 minutes before performing a Loughborough Intermittent Shuttle Test (LIST). Rate of perceived exertion (RPE) and heart rate (HR) were measured through the LIST. Results: There were significant differences in weight, height, estimated VO, and daily CAFintake between males and females. TTE during was 16.18 plus or minus 8.26, 17.71 plus or minus 11.64, and 12.43 plus or minus 5.99 for the ED, sugar-free ED, and placebo respectively. No significant differences were found between the trials after an ANCOVA with CAF intake, gender, and weight as covariates. There were no significant differences between RPE scores for the ED, sugar-free ED, and placebo trials. An ANCOVA with CAF intake, gender, and weight as covariates did no result in significant differences. A significant correlation between RPE and HR was found throughout the trials. Conclusions: These results demonstrate no significant improvements in collegiate soccer players for performance of extended duration intermittent exercise or RPE after ingesting an ED or sugar-free ED when compared with a placebo.

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    Athletic Training Students’ Knowledge and Attitudes of Transgender Athletes

    Published Year: 2021
    Specialization: Athletic Training

    Carmosino, Jordan

    Objective: This study aimed to determine athletic training students’ (ATS) knowledge of and attitudes toward transgender athletes. Method: The study followed a mixed-method design. Phase I was a quantitative survey instrument. Commission on Accreditation of Athletic Training Education (CAATE) Accredited Professional Athletic Training Programs were contacted during the quantitative phase. Program Director (PD) and Clinical Education Coordinator (CEC) e-mail addresses were collected from instructional websites. An estimated sample of 11, 856 ATS enrolled in CAATE Accredited Professional Athletic Training Programs were contacted through their PD or CEC. We meaured knowledge using the Athletic Training Student Transgender Knowledge Survey (ATSTKS) and measured attitudes using the Attitudes Towards Transgender Patients (ATTP) Scale. Phase II used qualitative interviews. A convenience sample of 9 ATS currently enrolled in CAATE Accredited Professional Athletic Training Programs participated in the qualitative interviews. Semi-structured interviews were conducted to identify ATS’s current knowledge, education, and training on the transgender population using a phenomenological approach. Results: ATS with previous education or training on transgender populations had higher knowledge scores than those who did not. We also found differences among groups for gender, sexual orientation, ethnicity, religious importance, and having interpersonal contact with LGBT family members or friends or LGB athletes. Those who had a family member or friend who identified as LGBT and those who worked with student-athletes identifying as LGB had higher knowledge scores than those who did not. Contact with transgender student-athletes did not impact knowledge scores. Additionally, ATS who had a family member or friend who identified as LGBT had more positive attitudes than those who did not. Six themes in the qualitative interviews were identified. Themes included 1) comfort levels, 2) preparedness, 3) participation policy knowledge, 4) lack of experience and knowledge, 5) personal factors, and 6) education. Conclusion: Although differences existed among various demographic considerations, ATS generally had a positive view of treating transgender athletes. In terms of comfort, most ATS agreed they would be comfortable treating a patient whose gender identity is unclear. They would also be comfortable treating someone they know to be on hormone therapy. ATS indicated a desire for more training and education on the specific needs of the transgender population, as very few felt they had the skills to confidently discuss medical conditions, psychosocial concerns, or athletic policies that concern the transgender community. Athletic training curricula should consider including transgender-specific healthcare content to better prepare ATS to provide quality care for transgender athletes, including healthcare needs, hormone interventions, psychosocial factors, and athletic participation policies.

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    The Effect of Kinesio Taping Combined with a Scapular Exercise Program in Overhead Athletes with Shoulder Impingement Symptoms

    Published Year: 2020
    Specialization: Athletic Training

    Chin, Willesley V.

    Purpose: To investigate the effectiveness of Kinesio Tex tape combined with a scapula exercise program in the strengthening of the serratus anterior (SA) and lower trapezius (LT) muscles in overhead (OH) athletes with shoulder impingement. The reduction of shoulder impingement symptomology in (OH) athletes were also investigated. Hypothesis: OH athletes with shoulder impingement will demonstrate a greater increase in the strength of the SA muscle with the combination of Kinesio taping and a scapular strengthening exercise program (experimental group) when comared to individuals who receive the exercise program along with placebo taping. Also, three exploratory questions were asked, which looked at the strength of LT, along with changes in pain and function. Study Design: Randomized, single-blinded placebo-controlled trial. Subjects/Methods: Twenty-nine OH athletes male and female with shoulder impingement between the ages of 15-25 participated in the study. Subjects were divided into two groups. The experimental group received Kinesio taping to the SA and LT muscles while performing a scapula strengthening exercise program for six weeks. The placebo group also performed the strengthening program but had placebo taping applied. The outcome measures include (1) strength of SA and LT muscles, (2) Visual analog scale (VAS) pain rating taken for each orthopedic special test (OST) along with the change in impingement symptomology, (3) Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score. Results: The mean change of SA muscle strength was positive, indicating increased SA strength for both the treatment and control groups; however, the difference between the treatment and control groups from pre-test to post-test was small. Similarly, for the LT muscle strength, the difference between groups was small. The mean change of KJOC scores was positive for both groups but the difference between groups was small. For the four-pain variables (OST), the standard deviations were as large as, or larger than, the means, suggesting that there were not major differences between groups. Conclusion: Both groups demonstrated improvements in SA and LT muscle strength, pain during OST, and the KJOC functional assessment tool. However, there was no statistical difference between the two groups. Further studies with a larger sample size that explore the long-term effects of Kinesio taping in OH athletes with shoulder impingement symptoms are needed to assist clinicians in the treatment of this population.

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    Effectiveness of Mobile Learning on Athletic Training Psychomotor Skill Acquisition and Retention

    Published Year: 2013
    Specialization: Athletic Training

    Davie, Emily E.

    Objective: To introduce and present techniques for incorporating mobile learning into athletic training education. Background: The matriculation of digital natives into college has stimulated the identification and development of new teaching and learning strategies. Electronic learning (e-learning), including the use of learning management systems, has been combined with traditional classroom lectures and lab activities to address the needs of these technologically savvy students. Learning management systems offer valuable options to students, but still rely on a computer terminal to interface with the material. Restrictions on when and where a student can “plug-in”: to learn places limitations on e-learning. Mobile learning (m-learning) is a sub-set of e-learning that uses hand-held devices to allow flexibility in learning at any time and any place. M-learning involves the use of mobile devices such as mobile phones, personal digital assistants (PDAs), and portable media players for the purposes of acquiring and disseminating knowledge. A variety of methods have been identified for incorporating m-learning into higher education. Articles regarding the use of m-learning, specifically in health care education, are limited. Description: Descriptions of m-learning applications in higher education are presented. Examples of techniques are offered to aid the athletic training instructor in implementing the m-learning principles into the classroom and clinical settings. Application: Athletic training education lends itself well to m-learning. Athletic training students can utilize mobile devices to prepare for an upcoming class session, participate during class, review and study course materials, communicate with teachers and peers, enhance clinical education, and document clinical experiences.

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    Athletic Training Educators’ Attitudes Toward and Use of Technology in Education: Barriers to Course Design and Instruction Delivery

    Published Year: 2019
    Specialization: Athletic Training

    Davis, Ryan

    Context: To date, no research examines athletic training educators’ (ATE) attitudes, or perceived barriers, toward technology use in course design and instructional delivery. Objective: To investigate relationships between ATE attitude toward, and use of, technology and to explore barriers of technology use in course design and instructional delivery. Design: A two-phase sequential, explanatory, mixed-methods design was used. Phase I included quantitative survey procedures. Phase II involved qualitative interview preocedures. Setting: Participants were ATEs affiliated with accredited athletic training programs in the United States. Participants: 224 ATEs participated. 12 participants were interviewed. Intervention: Participants completed a 48-item online survey regardingl attitudes and perceived barriers toward the use of technology in course design and instructional delivery. Semi-structured phone interviews were conducted with a subset of participants. Main Outcome Measures: Spearman correlations were used to examine relationships among dependent factors with an a priori alpha level set at p<.05. Results: A positive relationship exists between ATE use of technology and instructional delivery. No significant findings were observed for ATE attitude toward, and use of, technology as it relates to course design. Qualitative analysis exposed barriers to technology use including time needed to learn technology and lack of budget and institutional support for technology integration. Data revealed varied attitudes toward, and use of, technology relative to course design and instructional delivery. Conclusions: ATEs’ attitude toward, and use of, technology vary widely as it relates to course design and instructional delivery. Educators should seek professional development opportunities to better meet student expectations for technology use in course design and instructional delivery.

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    The Usage of Active Video Games as a Tool for Therapeutic Interventions Among Certified Athletic Trainers Practicing in a Clinical Setting

    Published Year: 2021
    Specialization: Athletic Training

    Deans, Sabrina M.

    Research indicates that video gaming usage among health care professionals such as physical therapists and occupational therapists is beneficial. However, healthcare professionals’ intentions for usage and perceptions, such as athletic trainers (ATs) are underrepresented.

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    The Efficacy of Neurodynamic Mobilization on the Range of Motion and Performance Measures in Individuals with Short Hamstring Syndrome

    Published Year: 2021
    Specialization: Athletic Training

    Dicriscio, Vincent J.

    Background: Hamstring stain injuries remain a common occurrence in sport and a challenging issue for the health care clinicians to adequately manage while minimizing the risk of re-injury and time to return to play. One of the factors identified in reccurrent hamstring strain injuries is the presence of adverse neurodynamics. Adverse neurodynamics is a disfunction within the nervous system. It may play a signficant role in the recovery due to the hamstring muculature’s close proximity to the sciatic nerve. However, the efficacy of neurodynamics in the treatment of hamstring strains is unclear. Purpose: The purpose of these studies is the identify neurodynamics’ effectiveness on hamstring flexibility and performance measures through changes in the range of motion (ROM) and maximal voluntary isometric strength (MVIC). Methods: A systematic review and meta-analysis were conducted to identify and assess literature that examined the effect of neurodynamics on hamstring flexibility and performance measures. Additionally, a case series was performed to assess the use of neurodynamic tensioner treatment on individuals with short hamstring syndrome. The efficacy of the neurodynamic tensioners treatment was measured through changes in ROM and MVIC strength. Results: The results of the systematic review and meta-analysis demonstrates a benefit of neurodynamics of improving hamstring ROM. Eighteen articles were included in the review and assessed via the PEDro scale, while five of those eighteen were input for a meta-analysis. Additionally, in the case series it was illustrated that neurodynamic tensioners produced a significant increase in passive straight leg raise while not influencing MVIC performance. Conclusion: Neurodynamic techniques are effective interventions in improving hamstring flexbility. It remains unclear on neurodynamics’ efficacy in assessments of performance meaures. The case series illustrated that neurodynamics might be a superior option compared to traditional stretching methods as it did not diminish MVIC post-intervention.

     

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    Evaluation of the Functional Movement Screen as an Injury Prediction Tool

    Published Year: 2015
    Specialization: Athletic Training

    Dorrel, Bryan Scott

    Context: The Function Movement Screen (FMS) is an assessment tool to assess quality of human movement. Research reports a significant difference between FMS scores of subjects who later experienced inury and those uninjured. Objective: The objective of this study was to systematically review literature related to predictive validity of the FMS. From the aggragated data, meta-analysis was conducted to determine prognostic accuracy of the FMS. Data Sources: PubMed, Ebscohost, Google scholar, and the Cochrane Review databases were searched between 1998 and Feb 20th, 2014. Study selection: Identified studies were reviewed in full detail to validate inclusion criteria. Seven of the elven identified studies were included. Articles were reviewed for inclusion criteria then bias assessment and critical analysis was conducted. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 1. Data Extraction: Data extracted included: study type, methodology, study subjects, number of subjects, injury classification definition, FMS cut core, sensitivity, specificity, odds ratios, likelihood ratios, predictive values, Receiver Operator Characteristic (ROC) analysis, and Area Under the Curve (AUC). Results: Overall bias for the included seven studies was low in respect to patient selection and flow and timing. Study quality assessement scored one study 5/7, two studies were scored 3/7 and four studes were scored 2/7 for quality. The meta-analysis indicated the FMS to be more specific than sensitive with a positive predictive value of 42.8% and a negative predictive value of 72.5%. AUC was determined to be 0.587, LR+ 1.7, LR- .87, CI=0.6-6.1 and effect size was determined to be 0.68. Conclusion: Based upon analysis of the current literature, findings do not support the predictive validity of the FMS. Methodological and statistical limitations identified by this study threaten the ability of the research to determine the predictive validity of FMS.

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    Examining the Effects of Three Soft Tissue Treatments on Functional Movement and Functional Performance Enhancement

    Published Year: 2017
    Specialization: Athletic Training

    Doyle, Andrew T.

    Strength and conditioning specialists, as well as rehabilitation professionals, continue to seek understanding of the acute human performance effects of pre-event soft tissue treatment among athletes. The purpose of this study was to investigate the effects of three soft tissue treatment protocols on lower extremity dynamic balance, power, and overall perceived lower extremity function as measured by a Y-Balance Lower Quarter Test (YBLQT), vertical jump (VJ), and Perceived Lower Extremity Function Score (PLEFS) respectively. Forty-eight college aged basketball and volleyball athletes participated in the study and were randomly assigned to either Astym treatment (AT), The Stick treatment (ST), or sham Astym treatment (SAT). The suject’s outcomes were measured at baseline and again immediately following the treatment. A 3×2 mixed model analysis of variance (ANOVA) and a Bonferroni post hoc test were used to detect between group and within group differences. For data that were not normally distributed, the Kruskal-Wallis test and Mann-Whitney U post hoc tests were used. No significant group and time interaction were found for the VJ or YBLQT. The Stick significantly reduced VJ over time while all treatments improved YBLQT over time. Significant group and time interaction for PLEFS occurred at baseline. The Stick may decrease VJ and should be used with caution prior to explosive events.

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    Effects of 6-Week Individualized and Group Interventions on Functional Movement Screen Scores in NCAA Division III Athletes

    Published Year: 2016
    Specialization: Athletic Training

    Edsall, Jason R.

    Background: The Functional Movement Screen (FMS) is a full body assessment tool found to be predictive of injury in competitive athletes by identifying predisposing asymmetries and dysfunctional movements. Objective: To determine ability of 6-week individualized and mass training interventions in increasing composite FMS score in an NCAA division III college athlete population and determine inter-rater and intra rater reliability of the FMS tool. Study Design: Experimental, randomized controlled, single blind study utilizing pretest/posttest and intervention. Setting: Small NCAA division III institution. Subejcts: 132 NCAA division III college athletes. Data Collection and Analysis: Participants were pretested utilizing the Functional Movement Screen and assigned to one of three intervention groups: individualized, mass or placebo. Intervention exercises were performed during 12 exercise sessions over a period of no longer than six-weeks followed by a posttest FMS. FMS testing was conducted by 2 FMS certified clinicians for the secondary purpose of this study to assess inter-rater and intra rater reliability of the FMS tool. Results: A one-way repeated measures ANOVA found statistically significant change in composite FMS score between groups, between pretest and posttest, and for interaction between group x test for group vs. placebo. The mass group and the placebo group differed significantly at post intervention testing with clinically relevant difference between individualized and placebo groups. Similar changes were found in mass and individualized group mean composite FMS scores between pretest and posttest. A very high intra-rater reliability and inter-rater reliability were demonstrated. Conclusion: A mass intervention protocol was found to increase composite FMS score better than the time intensive recommended individualized intervention protocol proposed by the FMS creator.

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    The Validity and Reliability of the Titan 1+ 10 Hz Global Positioning System for Assessing Measures of Athletic Movement

    Published Year: 2021
    Specialization: Athletic Training

    Elia, Victoria Colleen

    Global Positioning System (GPS) wearable technology has become commonplace throughout many team sports and is used to measure athletic movement patterns and physical demands during training and competition. However, a barrier exists between budget-conscious teams who wish to integrate this technology into their programs and the availability of affordable options. The implementation of GPS monitoring comes with a large price tag for purchasing and subscription costs. Titan Sensor, a startup company in Houston, Texas, offers a 10 Hz GPS device at a fraction of the cost of other popular GPS devices yet lacks research in the device’s validity or reliability. The purpose of this study is to establish device comparability, accuracy, and reliability for the Titan 1+ 10 Hz GPS device against the Catapult PlayerTEK 10 Hz GPS device and criterion measures for time, total distance, top speed, and distance covered in specific speed zones.

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    The Effects of the Use of Versa Gripps on Surface Electromyographic Signal Amplitude of Selected Muscles During Pull-ups in Strength Trained Participants and on Maximal Pull-Up Performance in Women

    Published Year: 2012
    Specialization: Athletic Training

    Escalante, Guillermo

    This study compared surface electromyographic (sEMG) amplitude during pull-ups with Versa Gripps to those without grips on the dominant side wrist flexors (WF), wrist extensors (WE), latissimus dorsi (LAT), and infraspinatus (INF) muscles among strength trained males and females. The effects of the use of grips on the maximum number of pull-ups performed by females were also studied. Thirty health males and 17 healthy females voluteered to participate. Due to significant differences between males and females in pull-up performance, the groups were analyzed independently. Surface EMG was computed using the root-mean-suqare (RMS) of the signal intensity, integrated over 500 milliseconds, and normalized to the maximum voluntary contraction (MVC) for each muscle investigated. Female pull-up performance was determined by counting the number of full pull-ups completed. EMG data from each muscle for males and females, and the number of pull-ups performed by the females, were analyzed using an ANOVA repeated measures, for each group. The overall ANOVA repeated measures for the males revealed a difference between the grip conditions for the muscles being investigated. Separate comparisons of the Grip-to-No Grip conditions for each muscle for the males, with Bonferroni corrections, revealed that only WE sEMG were significantly less for the Grip than for the No Grip condition. There were no significant differences between the Grip and No Grip conditions for the WF, LAT, and INF. Data for the females demonstrated no differences between the Grip conditions for sEMG activation in any of the muscles or for the maximum number of pull-ups performed. These results suggest that the effort required by the WE can be reduced with the use of Versa Gripps in males while performing a pull-up without inhibiting the LAT and/or the INF. This finding could be beneficial for males suffering or recovering from lateral epincondylitis because the grips could decrease the load on the WE during a pull-up.

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    Athletic Training Students’ Transfer of Learning During Their Clinical Education Experience: A Grounded Theory Study

    Published Year: 2013
    Specialization: Athletic Training

    Franek, Thomas B.

    Transfer of learning refers to how previous learning influences current and future learning and how past or current learning is applied or adapted to similar or novel situations. Athletic training students enrolled in accredited programs are exposed to didactic theory and clinical practice in the form of educational competencies and clinical proficiencies. The learner progresses through established coursework in which he or she must successfully transfer their learning to clinical practice. This transfer is necessary to ensure the learner matriculates from the level of a student learner to that of an independent practitioner. A variety of supervised clinical rotations are provided to give students the opportunity to apply previously learned knowledge and skills in “real world” situations. These rotations must include controlled problem solving/critical thinking situations that allows for the utilization of knowledge and skills learned from course content. In this sense, the goals of clinical education include authenticating student knowledge, interpreting theoretical and applied knowledge, developing and refining skills, familiarizing students with the workplace, and developing problem-solving and time management skills. Transfer of learning is at the heart of this development. Assessments of transfer of learning will assist athletic training educators authenticate the development of the athletic training student as a learner in the clinical setting.

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    Assessment of Taekwondo Athletes’ Knowledge of and Attitude Toward Sport-Related Concussions

    Published Year: 2018
    Specialization: Athletic Training

    Freer, Scott M.

    Sports-related concussions have been recongized as a public health concern among athletes. Previous literature indicates that contact or collision sports have a higher incidence of concussions than non-contact sports. Taekwondo (TKD), a combat sport, has been reported to have a concussion rate, per 1000 A-E, to range from 1.0 to 55.2 in males and from 2.4 to 49.3 in females. The overall purpose of this study was to assess the current knowledge of and attitude toward sport-related concussions (SRC) in a population of TKD athletes. The present study used a mixed methodological design which included a modified Rosenbaum Concussion Knowledge and Attitude Survey (RoCKAS) and a semi-structured interview. The population usable for data analysis consisted of 97 males and 73 females. Eight males and seven females completed the interview at an average of 20.93 minutes per interview. The overall mean scores for the CKI and CAI were 18.71 plus or minus 3.93 and 56.25 plus or minus 8.70, respectively. Educational format was shown to have a significant effect on athlete’s knowledge and attitudes. Between-group comparisons concluded that athletes educated by a health care provider were more knowledgeable than those that had not receive any formal concussion education. Conversely, athletes, regardless of the education format. had similar attitudes toward concussions. During the interview, participants endorsed a number of accurate signs and symptoms of concussions; however, responses identified discrepancies in risks both safe and risky attitudes towards concussion. Overall, the results of the current study indicated moderate concussion knowledge with potentially risky attitudes. Most TKD athletes had a good general sense and practical understanding of signs and symptoms of concussions. However, there are some deficiencies in concussions knowledge and risks along with misconceptions towards concussions bringing their attitude into question. These findings are capable of providing the groundwork for TKD governing bodies to develop education materials, regarding injury risks, symptomology, assessment, and the consquences of mismanaging a concussion, for TKD athletes and competitors.

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    Utilization of Clinical Teaching Models in Athletic Training Clinical Education

    Published Year: 2021
    Specialization: Athletic Training

    Graham, Jason

    Context : Clinical education comprises over half the time students spend in an athletic training program. Preceptors are tasked with overseeing these clinical experiences and mentoring students while simultaneously engaging in patient care. Preceptors have a limited training in clinical education or background in andragogy. Preceptors have previously reported teaching and learning as their highest topic of interest in preceptorship professional development. Objective: The purpose of this study is to examine the awareness of and how often preceptors use specific clinical teaching models within athletic training clinical education. This study also examines the preceptor’s perceptions of the benefits and barriers to using specific clinical teaching models and the perceptions of preceptor training in educating them on clinical teaching models. Design: Sequential mixed methods. Setting: Online qualitative survey and virtual qualitative semi-structured interviews. Patients or Other Participants: 165 preceptors affiliated with masters and bachelors level accredited athletic training programs participated in the survey and 10 participants completed follow-up interviews. Data Collection and Analysis: Surveys were administered via Qualtrics, and interviews were completed using Zoom. Frequency tables and chi square tests of independence were used to analyze the survey data. A phenomenological approach of inquiry was used to analyze the interview data. Trustworthiness was established with member checking, triangulation using 2 data collection methods and independent data analysts, and external peer review. Results: The Supervision, Questioning, Feedback (SQF) model was used by most preceptors. The One-Minute Preceptor (OMP) or the SNAPPS model were less common. Components related to the SQF model were used more frequently, on a daily or weekly basis over components unique to the OMP or SNAPPS models. Participants described using teaching techniques similar to the SQF model but acknowledge they are generally unaware of clinical teaching models that exist. Participants report perceptor training focuses more on programmatic administration rather than clinical teaching. Only 68% of preceptors reported completing any institutional preceptor training related to clinical teaching, and 24% have completed the Master Preceptor Level I training program. Participants would like to have consistent and ongoing training that incorporates experiential learning to educate them on clinical teaching models as they did display enthusiasm towards improving their clinical teaching abilities. Participants report clinical teaching models are beneficial in helping students build confidence in clinical reasoning, providing a structured teaching strategy, and fostering a positive learning environment. However, the biggest barier reported is balancing role strain in the simultaneous role of being a healthcare provider and educator. Conclusions: Preceptors are largely unaware that clinical teaching models exist. Most preceptors believe preceptor training does not adequately prepare them how to teach in the clinical setting. The context and frequency of institutional preceptor training needs to be reassessed to ensure preceptors are being adequately educated on clinical teaching. Enhancing their clinical teaching practices will reduce preceptor role strain, improve their professional growth, and improve student learning.

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    Identification of Lower Leg Injury Risk Factors and Longitudinal Tear-Drop Arch Taping Effectiveness in an Active Adult Population

    Published Year: 2019
    Specialization: Athletic Training

    Grahovec, Nicholas E.

    Context: Arch tapings have been used by athletic trainers to support the arch in patients with increased pronation and/or increased navicular drop. The arch taping assists in increasing the navicular height, decreasing the amount of navicular drop, and altering foot biomechanics of an individual during weight bearing activity. Several studies have observed the initial effects of taping interventions, but few have researched clinically relevant effectiveness in these taping interventions. Objective: The objective of this study is three-fold: 1. Determine the presence of known modifiable risk factors in an active adult population; 2. Determine the immediate effectiveness of a longitudinal tear-drop arch tape on navicular drop, plantar flexion, dorsiflexion, and center of pressure; 3. Determine the effectiveness of the longitudinal tear-drop arch taping during a treadmill performance test. Design: Quasi-Experiment. Setting: Athletic Training research laboratory. Patients or Other Participants: Fifty-nine participants were involved in the study with thirty-five young active adults having a navicular drop of more than 8mm. Interventions: All individuals who met inclusion criteria received longitudinal tear-drop arch tape. Navicular height, plantar flexion, dorsiflexion, and center of pressure was measured at multiple intervals: baseline, post-tape, and in 5 minute intervals until failure or to a max of 30 minutes. Main outcome measure(s): The dependent variables were navicular height in millimeters, ankle range of motion in degrees, and center of pressure deviation. Center of pressure deviations were divided into 4 sections and analyzed for differences between time points. Results: There was a significant difference in dorsiflexion between navicular drop <10mm and navicular drop >10mm on the right side. No significant difference was found with plantar flexion range of motion. Navicular drop was significantly reduced immediately following intervention application. Differences were observed from no intervention to intervention application in both plantar flexion. Average duration of effectiveness was 12.29 minutes. Significant differences in navicular drop remained for 25 minutes and plantar flexion for 5 minutes. Conclusions: Longitudinal tear-drop arch taping intervention effectively changed navicular drop, plantar flexion range of motion, and dorsiflexion range of motion, but these changes did not last the entire 30 minute duration of the exercise. The inability of the longitudinal tear-drop arch taping to perform beyond 30 minutes leads one to reconsider its use during clinical application. This intervention may be useful for short duration tasks such as sprints and rehabilitation exercises as there was an initial change in risk factors, but long term use is not proven to be effective.

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    An Assessment of the Provisions of Appropriate Medical Care in Secondary School Athletics in South Carolina

    Published Year: 2019
    Specialization: Athletic Training

    Greenleaf, Christopher D.

    This study utilized the 134-item AMCAT, or the Appropriate Care Assessment Tool, which includes the 119 items assessing medical care found within the Appropriate Medical Care for Secondary-School Aged Athletes (AMCSSAA) consensus statement and monograph. The AMCAT assessed the comprehensive medical care provided by a secondary school/high school for athletes participating in all sports within the athletic program. Also included were items assessing the potential influences on medical care presence and number of Athletic Trainers (AT), source of AT, meaning the source of their employment, school district or clinic/hospital; school size, distance of school to the nearest medical center, athletic training supply budget, and football regional championships, these are anecdotal factors that schools claim makes a difference in the level of medical care given within an institution; these served as explanatory variables. While school setting, meaning rural, urban, or small town; region of the state, and rate of free and reduced lunch qualifiers served as the control variables.

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    Challenges and Coping Strategies of Athletic Training Students Participating in an Immersive Clinical Experience

    Published Year: 2022
    Specialization: Athletic Training

    Hackett, Craig M.

    Context: With the mandate of a clinical immersion for athletic training students (ATSs) by the Commission on Accreditation of Athletic Training Education (CAATE) for accedited athletic training programs, a need exists to identify problems and concerns experienced by stakeholders. Current research identifies issues and concerns related to many aspects of clinical education, but few have addressed issues specific to the newly mandated clinical immersion. Furthermore, the issues addressed by research related to clinical immersion are from the perspective of program administrators and not students. Objective: The purposes of this study were to examine the perceived challenges ATSs faced during an immersive clinical experience (ICE), the extent of the effect of those challenges, investigate the coping strategies were the same regardless of demographics and clinical placements, and the ATSs overall impression of their ICE. Design: A mixed-methods research inquiry. Setting: Online survey, individual virtual interviews. Participants: Professional masters ATSs (N=2356) who had completed an ICE. 415 responded to the survey. Ten participants participated in individual interviews. Participants represented programs from all regions of the contiguous United States and completed an average of 2.5 ICEs lasting an average of 8.4 weeks. Data Collection and Analysis: A survey containing demographic questions and the Carver Brief COPE Instrument and one-on-one interviews were used to gather information. Demographic data and coping strategies ATSs used during their ICE were analyzed using a mixed model analysis of variance. Transcripts from the one-on-one interviews were analyzed to determine the perceived challenges ATSs faced during their ICE and whether those challenges affected their total experience. Interview transcripts were also analyzed to determine whether clinical placement factors influenced challenges faced by ATSs and students’ overall impression of their ICE. Results: The most frequent challenges ATSs faced during their ICE included interpersonal communication, intrapersonal communication, and work-life interface. One hundred percent of interviewees described challenges experienced during the ICE as opportunities for growth or learning as long as ATSs utilized an appropriate coping strategy. The most frequent coping strategies ATSs used included Problem-Focused, Emotion-Focused, and Avoidant. Clinical placement factors had no significant influence on the overarching coping strategies used by ATSs and included the number of terms ATSs completed; the number of contacts ATSs had with their home institution; region of the ICE; the term the ICE was completed; ATSs familiarity with the area of the ICE; region of the student’s home institution, and ATS gender. One-hundred percent of ATSs interviewed felt their ICE was a positive learning experience. Conclusions: ATSs participating in ICEs encountered various challenges and opportunities to develop and apply coping strategies. ATSs demonstrated using different coping strategies regardless of the source of the challenge.

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    An Examination of Collegiate Student-Athletes’ Mental Toughness Following Rehabilitation for a Non-Surgical Injury

    Published Year: 2022
    Specialization: Athletic Training

    Harris, April

    Objective: The purpose of this study is to examine and measure mental toughness during the rehabilitation process with a mental imagery intervention using an electronic digital script. Participants: Based on a power analysis for a 2-tailed within-subjects test design using alpha=0.05, 57 orthopedic non-surgical participants were needed for this study. Setting: This study took place at an NCAA Division 1 and Division III University with male and female athletes who had sustainted a non-surgical orthopedic injury that required a rehabilitation porgram with an athletic trainer. Design: The study design was pre-posttest using the Mental Toughness Questionnaire (MTQ-48) to quantitatively measure mental toughness of the participants before beginning the non-surgical injury rehabilitation program and at the completion of the rehabilitation program while using an electronic mental imagery intervention. Intervention: An electronic digital mental imagery script was used as the intervention. Participants used during the application of cryotherapy at the end of each their rehabilitation sessions. Main Outcome Measures: The IBM SPSS Statistics for Windows, Version 26.0 Armonk, NY : IBM Corp. was used to calculate the Wilcoxon Signed Rank for the mental toughness and the various subscales of the MTQ-48 data analysis. A one way ANOVA was used to analyze mental toughness between genders. Results: There were no significant differences in mental toughness changes with a mental imagery intervention over a minimum of 6 day rehabilitation program. There were no significant differences in the effects of mental toughness on the level of non-surgical injury rehabilitation adherence in collegiate aged student-athletes. There were no significant differences in mental toughness between genders of collegiate aged student-athletes when participating in a non-surgical injury rehabilitation. There were no sigificant differences in rehabilitation adherence between genders: Conclusion: The results of this study suggest athletic trainers, physical therapists, and physicians must continue to work to develop longer mental toughness intervention treatment programs to help athletes’ improve their levels of mental toughness and sustain the improvements over time while maintaining success throughout a rehabilitation program.

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    The Effects of Computer-based Written Simulations on Critical Thinking Skills of Pre- Professional Athletic Training Students

    Published Year: 2011
    Specialization: Athletic Training

    Harrison, Kelly A.

    Context: The ability of practitioners to engage in critically appraising patient information, making clinical judgements, assessing treatment efficacy and effectiveness, and ultimately seeking improvement of clinical practices are paramount to ensuring quality health care. Objective: To evaluate the effects of two computer-based instructional modalities, computer simulation (SIM) or case study (CS), on critical thinking skills and self-efficacy of undergraduate athletic training students. Design: Pretest-Posttest Study. Setting: University Computer Classroom. Patients or Other Participants: Subjects included 49 pre-clinical level students pursuing a Bachelor of Science degree in Athletic Training from a CAATE-accredited undergraduate athletic training education program. Intervention: Subject received an 8-week computer-based instructional interventions consisting of either 5 written simulations or 5 traditional case studies covering the Acute Care and Assessment and Evaluation of Athletic Injuries and Illnesses Injuries and Illness content areas. Main Outcome: Subjects’ critical thinking skills were measured using the Health Science Reasoning Test (HSRT). A Self-Efficacy Questionnaire (SEQ) was utlized to assess the subjects’ perceptions of their ability to learn and perform clinical problem solving. Results: There was no significant change measured in critical thinking or self-efficacy for either the SIM or CS groups over the 8-week study. There were no statistical differences in HSRT Total Score or SEQ scores found between groups. Conclusion: The 8-week stand-alone computer-based interventions assessed in this study did not yield statistically significant improvements in critical thinking of self efficacy as measured by the HSRT and SEQ. However, these interventions may be a valuable mechanism for providing students with multiple context-rich experiences in which to practice connecting basic content knowledge in higher cognitive applications. Furthermore, these simulations may provide guided opportunities for students to collect and reflect on clinical data, practice core critical thinking skills, and receive feedback on their performances in preparation for clinical field experiences.

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    Effects of Varying Body Composition on Glucose and Insulin Response Following Seven Weeks of Progressive Resistance Training in Young, Healthy Females

    Published Year: 2010
    Specialization: Athletic Training

    Hinnerichs, Kristi R.

    Little information exists on the benefit of resistance exercise on glucose tolerance and insulin sensitivity in women. The purpose of this study was to determine the effect of body composition on glucose tolerance and insulin sensitivity response to 7 weeks of resistance training (RT) in young, healthy women. Subjects were randomly assigned to the lower body fat Group 1, higher body fat Group II or the control group. Experimental groups completed 7 weeks RT. Oral glucose tolerance tests with concomitant insulin assays were completed before and after 7 weeks of RT. Body fat %, android fat % and gynoid fat % were determined by dual-energy x-ray absorptiometry. Glucose measurements did not change after 7 weeks of RT. A modified Composite-Insulin Sensitivity Index (C-ISI) estimated insulin sensitivity. C-ISI improved after 7 weeks of RT in Group I but not Group II or the control group. RT did not affect fat distribution in any group, and reduced BF only in Group II. Higher BF in women attenuates C-ISI improvement in response to RT.

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    Use of Squat Based Gradable Movement Screens by Certified Athlete Trainers

    Published Year: 2019
    Specialization: Athletic Training

    Hipp, George Ryan

    Context: Injuries related to physical activity contribute to rising annual medical costs in the United States. Gradable movement screens (GMS) have been developed to identify the presence of contributing factors associated with injury in order to target dysfunctional movements and mitigate injury risk through corrective exercise and targeted treatment. There is little evidence available to determine how clinicians learn about and use GMS in their practices. Some GMS focus on balance or a jumping and landing component while others employ a non-weighted squat based gradable movement screen (SBGMS). Incorporation of SBGMS has not been widely researched in the field of athletic training. Objective: To discover the current use, popularity of, and exposure to SBGMS by athletic trainers in the university and collegiate setting. Main Outcome Measure: Participants answered a questionnaire concerning their use of squat based gradable movement screens (SBGMS). The primary questions utilized include 1) Are ATs using SBGMS, and if so, how are ATs utilizing SBGMS? 2) How to do ATs learn about SBGMS? 3) What type of impression/attitude will ATs have concerning the use of SBGMS in clinical practice? Results: Chi-Square tests were used to analyze the majority of the data, which is nominal in nature. Scheffe, Mann Whitney U Rank Sum, and ANOVA were used in select analyses. Statistically significant differences exist when comparing participants’ clinical use of SBGMS and the participants’ gender with more males using SBGMS and athletic division with Division 1 athletic trainers reporting more clinical use of SBGMS. Participants with previous instruction of GMS or credentialing of GMS used SBGMS more than participants that did not have previous instruction or credentialing in SBGMS. The majority of participants that have not earned an additional professional credential, other than athletic training, also did not use SBGMS clinically. Additionally, the majority of participants without previous experience at various clinical settings also did not use SBGMS clinically. Mann-Whitney U test was used for Likert style questions related to attitudes regarding clinical use of SBGMS; participants who do use SBGMS clinically show statistically significant differences in positive attitudes regarding SBGMS as compared to participants that do not use SBGMS clinically. Conclusions: Athletic trainers that work at the collegiate and university setting are more like to use SBGMS in their clinical practice if they are male, work at the NCAA Division I level, have previously learned or are credentialed in a specific SBGMS, and have previously earned another professional credential. Positive responses from participants suggest that SBGMS use should be considered by all athletic trainers.

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    A Comparison of Hip Musculature, Knee Extensor, and Hip Musculature and Knee Extensor Exercises for the Management of Patellofemoral Pain Syndrome: A Randomized Clinical Trial

    Published Year: 2012
    Specialization: Athletic Training

    Howard, Donald L.

    Context: Therapeutic exercise is a recommended treatment for patellofemoral pain syndrome (PFPS). However, the literature is not clear as to which muscle groups to target for this intervention. Objective: To compare the effects of strengthening exercise targeting knee extensors, hip lateral rotators and abductors, or both on pain and function in those with PFPS. Design: Randomized controlled clinical trial. Setting: University sports medicine clinic and biometrics laboratory. Patients: Twenty-four patients with PFPS. Intervention: We randomly assigned the patients to participate in strengthening exercises targeting the knee extensor (QE), hip lateral rotators and abductors (HE), or both (HQE). The patients participated in both supervised and home exercises for 4-weeks. Main Outcome Measures: We measured perceived pain and perceived function before and after intervention using the visual analogue scale (VAS) and the Lower Extremity Functional Scale (LEFS) respectively. We also obtained isokinetic torques before and after intervention. Results: The three groups were Homogenous at baseline. We observed significant improvements in perceived pain and perceived function from pre to post intervention within the groups regardless of assignment. Our study found no statistically significant differences between the three groups for perceived pain or perceived function at the end of the 4-week intervention. Improvements in perceived pain and perceived function were largely independent of changes in strength. Conclusion: In the treatment of PFPS, targeting only the hip external rotators and abductors is equally effective as targeting only the quadriceps or a combination of the two protocols. We found improvements in perceived pain and perceived function were not attributed to improvements in strength.

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    Comparison of a Personalized Corrective Exercise Warm-Up Protocol Versus a General Corrective Exercise Warm-Up Protocol on Functional Movement Screen and Y Balance Test Scores in College Athletes

    Published Year: 2012
    Specialization: Athletic Training

    Hoyt, Peter L.

    Purpose: To compare the effect of a personalized corrective exercise warm-up protocol based on an individual’s Functional Movement Screen (FMS) score and the effect of a general corrective exercise warm-up protocol that addresses overall movement deficits, on scores of the FMS and the Y Balance Test (YBT) in college athletes and dancers. Introduction: The FMS and the YBT are used as instruments to manage and identify injury risk in the physically active. Both have been previously reported to be a predictive tool for injury risk. Exercise strategies to target risk factors that the FMS and YBT identify have been reported to improve the scores of the FMS. These exercise strategies are closely related to the protocols reported to also improvement YBT scores, in that they involve neuromuscular control, flexibility, and core stability. It is important to determine if these exercise strategies can improve both FMS and YBT scores as compared to a control. Methods: Athletes and dancers from an NCAA Division III institution participated in an exercise intervention program. FMS scores and YBT scores were collected before and after a 6 week exercise intervention protocol. The FMS consists of seven movements to be evaluated: deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push-up and rotary stability. The YBT consists of two tests with three reach patterns for the upper quarter and three reach patterns for the lower quarter.The YBT-UQ consists of reach patterns with the upper extremity in medial, inferolateral, and superolateral reach directions and the YBT-LQ consist of reach patterns with the lower extremity in anterior, posteromedial, and posterolateral reach directions. The experimental and control groups received a corrective exercise protocol that lasted approximately 15 minutes and was incorporated into their regular exercise schedules. The experimental group underwent a personalized corrective exercise warm-up of 3 to 4 exercises, based on their lowest score of the seven movement patterns and/or asymmetry on the FMS. The control group received a general corrective exercise warm-up protocol prescribed to improve overall movement deficits from the seven patterns of the FMS. Results: Pre-test and post-test measurement did significantly differ for the FMS 21 point scores, FMS 100 point scores, and YBT-LQ composite, but did not differ for the YBT-UQ composite and YBT-UQ, as well as the interaction of group and time for the FMS on the 21 point scores, FMS 100 point scores, YBT-LQ composite and YBT-UQ. Scores did not differ significantly between sport categories in the FMS on the 21 point scale, FMS on the 100 point scale, YBT-LQ and YBT-UQ. Conclusion: A personalized 3 to 4 corrective exercise warm-up protocol did not significantly improve scores of the FMS and YBT among athletes and dancers as compared to a general corrective exercise warm-up protocol. However, it did support the hypothesis that there will be no signficant difference in improvement in scores of the FMS and YBT among various athletes and dancers. It was also determined that the results of this study were inconclusive due to the study being underpowered. Future studies should be conducted to examine if adding individualized manual techniques and specific exercises targeting mobility and stability to a personalized corrective exercise protocol improves FMS and YBT scores compared to a general movement oriented warm-up protocol.

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    The Effect of an 8 Week Neuromuscular Training Program on Neuromechanics in African American Female Athletes

    Published Year: 2012
    Specialization: Athletic Training

    Hughley, Timothy Wayne

    The purpose of this study was to examine the effects of an 8 week neuromuscular training program on lower extremity knee valgus angle in African American athletes. We hypothesized a neuromuscular training program would signficantly decrease lower extremity knee valgus angles during a drop vertical jump at landing compared to a control group. Fifteen female volleyball, track, softball players underwent an 8 week intervention neuromuscular training program that included three main components. While eleven controls underwent the resistance training protocol for eight weeks. With this directional hypothesis we used a T-Test on the difference between tests. Intervention athletes pre- and posttest 2-dimensional analysis demonstrated decreased knee valgus angles during a drop vertical jump landing maneuver. Intervention mean was a 9.4 degree decrease in valgus from pretest and control mean was 0.6 degree decrease in valgus from pretest. The subjects undergoing the neuromuscular training program demonstrated a significantly greater decrease in knee valgus angle compared to controls. Measurements taken from the suibjects with 2-dimensional motion analysis were used to calculate the knee flexion range of motion during landing from a drop box vertical jump. Maximum knee flexion range of motion increased fro 74.7 plus or minus 1.9 to 78.5 plus or minus 1.6. Control subjects did not demonstrate significant changes in knee valgus or knee flexion anlges during the 8 week protocol. The results of this study support the hypothesis that an 8 week neuromuscular training program that combines injury prevention-training components can decrease an injury risk factor such as knee valgus in African American female athletes.

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    Effects of Case-Based Learning on Athletic Training Students’ Confidence with Diabetic Emergency

    Published Year: 2018
    Specialization: Athletic Training

    Isaac, Kimberly B.

    Context: Confidence or self-efficacy may be linked to critical thinking, increased knowledge, and the ability to effectively manage high-stress clinical situations. Therefore, it is crucial to better understand how the utilization of clinical case scenarios within a case-based teaching method may affect learner confidence through experiential learning. Objective: It was three fold: 1) to examine the effects of using clinical case scenarios within case-based learning on the confidence level of pre-professional novice athletic training students in the management of a diabetic emergency, 2) determine the effects of case-based learning on knowledge acquisition, 3) to explore learners’ perceptions on the use and benefits of case-based learning and how this teaching technique influenced their confidence. Design: A two-phase, sequential explanatory mixed methods design was used in this study. Phase I included experimental methods and involved a pre-test, post-test. Phase II involved qualitative methods using interview procedures. Setting: The participants were undergraduate novice athletic training students (ATS’) in four CAATE accredited athletic training programs, located in the Midwest United States. Participants: 93 athletic training students ages 20 plus or minus 2 years participated in this sequential explanatory mixed methods study, 47 in the control groups, 46 in the intervention group. 18 of those participants in the intervention group were interviewed. Intervention: Both the control and intervention groups were present for the same traditional teaching method that consisted of a PowerPoint-facilitated lecture on diabetic emergency provided by the same instructor. Those students selected in the intervention group received one, single case-based scenario for the educational experience. Main Outcome Measures: Confidence levels measured through C Scale, knowledge through scored knowledge quiz and qualitative interviews for students’ perspectives of educational method. Results: To achieve research purpose 1, a paired sample t-test was performed to compare the confidence scale taken after the PowerPoint lecture to the confidence scale taken after the intervention. Although the total sample for the intervention group was n=46, some of the data were removed for this analysis because of researcher error. The Pre-C-Scale was omitted at one institution. Therefore, the participant number for this within-group analysis was n=21. There was a significant difference in the scores for the pre C Scale and Post C Scale. An Independent t-test was conducted to compare the control group confidence scale versus the Intervention group confidence scale. There was a significant difference in the scores for the control group pre C Scale and intervention group post C Scale. To Achieve research purpose 2, an independent t-test was conducted to compare quiz scores for the control group and intervention group knowledge quiz. There was no significant difference in the scores for the control group and intervention group. The overall qualitative findings were that the students found the intervention to be beneficial in increasing knowledge, increasing confidence, facilitating student engagement, and connecting theory to practice. Conclusion: Athletic training education programs are where future clinicians are developed. In order for the profession to thrive and continue in the current direction, educators must help develop competent and knowledgeable clinicians. Therefore, it is critical that athletic training students transfer knowledge from the classroom to the clinical setting, engage with the content in a way that expands their knowledge, and have confidence in their clinical practice. Case-based scenarios integrated into curriculums is possibly to enhance student learning.

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    Evidence-Based Practice: Beliefs and Behaviors among Athletic Trainers

    Published Year: 2013
    Specialization: Athletic Training

    Keeley, Kimberly

    Evidence-Based Practice (EBP) has been a popular topic in healthcare over the last two decades and has recently become an area of focus in athletic training. Benefits of EBP in athletic training include promotion of critical thinking by clinicians, opportunity for third party reimbursement, growth and enhanced reputation of the athletic training profession, support for treatments and interventions, improved patient care, and remaining current with healthcare trends. Limited information is known about the clinical practice of athletic trainers as it pertains to EBP. By understanding the beliefs and behaviors of athletic trainers it will help to establish the necessary intervention strategies to help athletic trainers successfully implement EBP. The purpose of this study is to examine athletic trainer’s beliefs and perceived implementation of EBP; as well as, provide an outline of current EBP clinical practice methods utilized in athletic training.

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    A Holistic Investigation of Clinical Reasoning in Athletic Training

    Published Year: 2015
    Specialization: Athletic Training

    Kicklighter, Taz H.

    Context: The cognitive process of making a clinical decision lies somewhere on a continuum between novices utilizing hypothetico-deductive reasoning and experts relying more on case pattern recognition and has not been explicitly measured in athletic training. Factors thought to enhance or hinder clinical reasoning ability must be investigated and compared to current medical literature to ensure that appropriate strategies for developing sound clinical reasoning skills are being developed and utilized. Objective: To determine differences in clinical reasoning ability of athletic trainers and students and factors perceived to enhance or hinder individual clinical reasoning abilities. Design: Original qualitative and quanitative research. Setting: Online inventory and interviews. Participants: 103 athletic trainers and senior level undergraduate athletic training students were randomly selected to participate in the DTI-AT. 23 randomly selected participants conducted the follow up interviews. Data Collection and Analysis: Randomly selected athletic trainers and athletic training students completed an online version of the DTI-AT which rated clinical reasoning tendencies on a 6 point Likert-type scale. ANOVA with Scheffe’s post hoc was conducted to determine differences between participant groups. Randomly selected participants were interviewed face to face in an on-line format in order to determine their understanding of their cognitive processing ability and perceived factors that enhance and hinder clinical reasoning ability utilizing a general inductive approach. Results: A significant effect was found for total DTI-AT score, FIT subset, and SOM subset. Post hoc analysis revealed no significant differences within the participant groups of total DTI-AT, FIT subset or SOM subset scores. Qualitative analysis confirmed DTI-AT finding that AT and ATS participants utilized expert and novice level cognitive reasoning strategies, respectively. Professional socialization, and metacognitive activities were the main themes thought to enhance individual clinical reasoning abilities. Lack of professional socialization, lack of time, limited experience, and educational setting were the main barriers thought to detract from developing higher level thinking abilities.

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    Utilization of Hybrid Simulation: Effectiveness in Preparing Athletic Training Students for the Assessment and Treatment of Exertional Heat Stroke

    Published Year: 2017
    Specialization: Athletic Training

    Kinslow, Beth L.

    Context: Athletic training education can continue to move towards more evidence-based teaching through establishing effective instructional methods of providing authentic learning opportunities. Objective: To examine the effectiveness of two different instructional methods impact on pre-athletic training students’ assessment and treatment of a patient with exertional heat stroke (EHS). Design: A pretest, posttest randomization control trial study design was utilized. Setting: Five undergraduate athletic training programs. Participants: Thirty-six pre-athletic training students volunteered to participate. Thirty-two participants completed the research study. Interventions: All participants received an educational packet and classroom presentation regarding EHS. Participants then completed the pre-intervention Knowledge, Preferences, and Practices of Certified Athletic Trainers Regarding Recognition and Treatment of Exertional Heat Stroke survey. Approximately 2-3 weeks after receiving the educational material, the participants completed HS or CBL intervention protocol and completed the post-intervention KPP-EHS survey. The HS intervention consisted of a clinical scenario utilizing a standardized patient and rectal thermometer task trainer. The CBL intervention utilized completing a case-study worksheet regarding a clinical scenario. At the 6-week follow-up time point participants completed the KPP-EHS survey. Main Outcome Measures: Composite and subscale scores from the KPP-EHS survey. Results: A factorial repeated measure 2×3 ANOVA revealed a statistically significant main effect for time of the total composite score of both groups. Bonferroni post-hoc testing revealed a statistically significant difference between time points 1 and 2 and time points 1 and 3. Conclusions: Athletic training educators should consider the use of HS and CBL in conjunction with didactic course work to prepare students to approximately manage EHS. Both interventions were shown to improve and maintain an increase in knowledge at the 6-week follow-up time point.

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    Attitudes and Behaviors of Athletic Trainers Toward Exercise Following Sport-Related Concussion

    Published Year: 2021
    Specialization: Athletic Training

    Kosderka, Emily M.

    Objective: Management of sport-related concussion (SRC) has undergone significant changes over the past decade. Recommendations have shifted from a rest only approach during recovery to incorporating exercise as a therapeutic intervention. Athletic trainers (AT) are health care professionals who are often responsible for the recognition, evaluation, and manangement of these injuries. While previous research has investigated multiple aspects of athletic trainers’ knowledge and utilization of best practice recommendations, no study has examined their use of exercise. This study aimed to explore the experiences of collegiate ATs who regularly prescribe exercise to their patients as part of their concussion management protocol. Method: A phenomenological approach to qualitative inquiry was used. Through purposive sampling, athletic trainers known to the researchers were invited to participated. Eight ATs who were identified as implementers participated in semi-structured interviews. A thematic analysis approach was used to analyze the collected data. Results: Six major themes emerged from our analysis of the experiences of athletic trainers: 1) Considerations for exercise; 2) Barriers & Concerns; 3) The exercise prescription; 4) Outcomes; and 5) Resouces. Conclusion: Participants faced both extrinsic and intrinsic challenges when shifting their concussion management protocols to include exercise during the symptomatic period. There were few negative experiences and the ATs in our study felt their patient outcomes were overwhelmingly positive. Perceived benefits of exercise included improved mood, quicker symptom resolution, and potentially improved recovery time. Team physician involvement was critical to the implementation of using exercise as a therapeutic intervention.

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    Interprofessional Collaborative Practice: Athletic Trainers’ Perceptions and Experiences

    Published Year: 2017
    Specialization: Athletic Training

    Kraemer, Ellanora

    Context: Athletic trainers (ATs) play a central role in collaborating with health care professionals to provide patient care. However, this collaboration is not well-documented in the literature. Little is known regarding the benefits of interprofessional collaborative practice (IPCP) in athletic training (AT), barriers to implementing IPCP, ATs’ experiences with IPCP and strategies for improving IPCP in clinical practice. Objective: The purpose of this study was to examine ATs’ perceptions of, experiences with and methods for facilitating IPCP in AT. Design: Mixed methods study using a quantitative survey and qualitative interviews. Setting: Online survey instrument and telephone interviews. Participants: The survey was sent to 4500 ATs from the National Athletic Trainers’ Association Member Services database. Three hundred fourteen participants completed the online survey. A total of 36 individuals participated in telephone interviews. All participants provided direct patients care in the United States. Main Outcome Measure(s): Demographic information as well as perceptions, experiences and strategies associated with IPCP in AT were obtained. Descriptive statistics were used to examine ATs’ perceptions and experiences associated with IPCP. Kruskal-Wallis and Mann-Whitney U tests were used to determine the differences in scores among the demographic variables. The significance level was set at p=< 0.05. Data for the open-ended questions were coded, organized and grouped into themes and subthemes. Results: Athletic trainers believed collaboration was beneficial to health care providers and patients. Working interprofessionally improved understanding of each other’s work with patient care. Additionally, ATs believed collaboration improved the quality and comprehensiveness of patient care. Participants were neutral on statements regarding barriers to IPCP. The majority of ATs believed they were typically the point person for the sports medicine team and they should be the point person of the team. Athletic trainers interacted with other ATs and orthopedic physicians either frequently or all the time; however the frequency of interactions was much lower with other healthcare providers. Through qualitative analysis four themes emerged: 1) benefits to IPCP; 2) barriers to IPCP; 3) exerpiences with IPCP; and 4) strategies to implement IPCP in AT. Specialized care and professional growth were the main benefits of collaboration. Barriers to IPCP included: 1) negative attitudes toward providers and IPCP; 2) misunderstanding of scope of practice; and 3) varying provider work schedules. Athletic trainers collaborate with a variety of health care professionals, however ATs have received limited education on IPCP and providers’ scopes of practice. Strategies to improve implementation of IPCP included: 1) initiated and developing relationships; 2) meeting face-to-face with providers; and 3) educating providers on IPCP and each other’s scope of practice. Conclusions: Athletic trainers had a positive attitude toward IPCP and believed IPCP improved patient outcomes and relationships between providers. To counteract ATs’ limited education on collaboration and other providers’ scopes of practice, ATs should find ways to implement education on collaboration and providers’ scopes of practice at the professional level. Faced with barriers such as negative attitudes, clinicians should seek out and initiate conversations with providers to improve understanding of each other’s scope of practice and build positive relationships.

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    The Epidemiology of Musculoskeletal Injuries Among Brazilian Jiu Jitsu Athletes

    Published Year: 2012
    Specialization: Athletic Training

    Kreiswirth, Ethan M.

    Objective: To determine incidence of injury and to identify risk factors among Brazilian Jiu Jitsu (BJJ) fighters at an international level tournament. Design: Prospective Observational Cohort Design. Setting: 2011 World Brazilian Jiu Jitsu Championships. Patients: A cohort of 2165 BJJ male and female fighters were prospectively monitored during the 2011 World Brazilian Jiu Jitsu Championships. Data collected were injury incidence of belt rank level and baseline characteristics of previous history of injury, prior years’ experience, number of days training, injury experience, injury severity, and subsequent time-loss. Incidence rates (IR) per 1000 Athletic Exposures (AEs) were captured of belt rank and injury location, in addition to relative risk (RR) to gather comparisons of fighter previous history, injury joint location, and gender. Main Outcomes: Injury Incidence and Relative Risk. Results: The cumulative injurty incidence rate for BJJ during the championships was 31.8/1000AEs. Blue belt level had highest injury incidence; 34.1/1000 AEs followed by white belt 35.1, purple belt 21.2, brown belt 20.2, and black belt 19.3. The elbow joint was the higest reported incidence of injury; 10.4/1000 AEs. Injury rates did not differ significantly by gender; IRR 1.04. Fighters who reported a previous history of injury were three times more likely to be injured during the event RR 3.1. Additionally, fighters who reported a previous history of elbow joint trauma were two times more likely to sustain another elbow injury during the event; RR2.2. Conclusions: Findings suggest that previous history of injury is a risk factor among fighters at an international BJJ competition. Specifically, elbow joint previous history may increase risk of sustaining an additional elbow injury at a large scale BJJ event. Lastly, there were no significant differences among injury between gender.

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    Perceptions of Exertional Heat Stroke Policy: The Insights of High School Athletic Directors: A Mixed Methods Study

    Published Year: 2017
    Specialization: Athletic Training

    Lawler, Racheal

    As the number of participants in high school football rise annually, exertional heat stroke deaths continue to plague the high school football athlete. Exertional heat stroke policy guidelines are available, but are being underutilized for creation and implementation at the high school setting. Athletic administrators have the task of researching, developing, and executing exertional heat policy for their coaches, parents, and athletes. Athletic directors need to be informed and encouraged to infiltrate the help of athletic trainers. Athletic trainers are educated and trained to prevent, recognize and treat exertional heat stroke and should be used for the development of exertional heat stroke policy. The purpose of this study is to look at the athletic director’s perceptions of exertional heat stroke and the development of policy to prevent injury and death.

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    Structure versus Function: Exploring the Relationship between Lumbar Multifidus Morphology and Activation among Individuals with Low Back Pain

    Published Year: 2012
    Specialization: Athletic Training

    Le Cara, Edward C.

    Study Design: A cross-sectional study. Objectives: To examine the relationship between fatty inflitration (morphology) of the lumber multifidus (LM) and changes in LM thickness during contraction using ultrasound imaging in patients with lower back pain (LBP). Background: LBP provides a substantial burden on our healthcare system. The LM muscles appear to play a unique role in lumbar stability and may relate to clinical outcomes if made a priority with rehabilitation programs for patients who experience lumbar spine pain. The purpose of this research was to explore the relationship between LM morphology (structure) and LM activation (function). Confounding factors that may influence patients with LBP were also investigated and compared to the percentage of fat in the LM at each level, including age, gender, disability, BMI, physical-activity level, pain intensity, and clinical signs of instability. Method: Sixty-five subjects filled out the Oswestry Low Back Disability Questionnaire (ODI), the Numeric Pain Rating Scale (NPRS), and the International Physical Activity Questionnaire (IPAQ). A physical exam, lumbar spine MRI, and bilateral rehabilitative ultrasound imaging of the LM at the L4/L5 and L5/S1 level, both at rest and at submaximal contraction were performed. Results: The mean percentage fat content of the multifidus muscle was 16 at L4/L5 and 17 at L5/S1 on the right and on the left 17 L4/L5 and and 16 at L5/S1. The mean percentage change of the LM from rest to activation of L4/L5 and L5/S1, respectively, was 25% and 22% on the right and 21% and 18% on the left. Separate multiple linear regressions were performed with the dependent variable being the percentage of intramuscular fat within the LM. The independent variable was the percentage of LM activation at L4/L5 and L5/S1, bilaterally, and variance associated with age and gender was controlled for. Age was statistically significant for increases in LM at fatter infiltration at each level and side. Percent change of LM thickness was not associated with LM fatty infiltration. Conclusion: No relationship between the fat percentage of the LM at L4/L5 and L5/S1 and the muscles ability to contract was found in this population at these vertebral levels.

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    The Longitudinal Metabolic and Cardiovascular Effects of Weighted Vest Training in Females

    Published Year: 2023
    Specialization: Athletic Training

    Mallett, Gregg S.

    Background: Weighted vests (WV) worn during training can improve strength, endurance, and minimize the need for separate additional resistance training sessions. A WV provides external mass across the upper body and the chest while training. Due to the high versatility, WVs can be worn during a wide variety of exercises such as running and plyometric activities. Weighted vests are commonly incorporated by runners not only to complete running and restiance training together but improve performance. Extra demands placed on the muscular, respiratory, and cardiovascular systems when running with a WV can increase lower-body strength and endurance. Purpose: This study investigated the effects of weighted vest training (WVT) on maximal oxygen uptake (VO2max), non-invasive estimated cardiac output (CO), lactate threshold, (LT) concentration, and running economy (RE). Methods: Participants were screened for inclusion/exclusion criteria using the PAR-Q+/ePARmed-X+ questionnaires. Eighteen young female participants were randomly assigned into one of two groups, a 10% body mass weighted vest group or 2) a nonweighted vest control. Both groups completed two laboratory endurance training (ET) trials at pre- and post-, which consisted of three training sessions per week. Participants performed the two testing trials separated by >24 hours without using a WV. Laboratory test one (LT1) was an incremental treadmill test that determined VO2max and non-invasive estimated CO. Laboratory test two (LT2) consisted of a maximal lactate steady state (MLSS) treadmill protocol that determined LT concentration. Results: The covariate pre-VO2max had a statistically significant influence on post-VO2max, however there was no significance among the WV or non-WV groups. The covariate pre-CO had a statistically significance effect on post-CO, but no significance among the WV or non-WV groups was observed. The covariate pre-BL had a statistically significant result on post-BL, yet there was no signficance between the WV or non-WV groups. For RE, the main effect for the within-subjects was significant, indicating differences were observed between the values of pre-, mid-, and post-RE. A post hoc Tukey comparison for within-subject effects observed that pre-RE was significantly greater than mid-RE, pre-RE was significantly greater than post-RE, and mid-RE was significantly greater than post-RE. Conclusion: A structured endurance training program at a minimum of 3x per week at 30 minutes for 6 weeks, is adequate to elicit cardiovascular and metabolic adaptions as determined by VO2max, CO, and BL, and RE.

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    Can Preseason Y-Balance Test Upper Quarter Composite Scores Identify Collegiate Football Players at Risk of Injury? A Prospective and Normative Data Study

    Published Year: 2021
    Specialization: Athletic Training

    Matte, Dan

    Context of the Problem: Football (FB) has the highest injury rates of all collegiate sports injury surveillance studies estimated collegiate football has an injury rate of 9.7 per 1000 athlete exposures (AE). There are typically 80 to 100 FB players per collegiate football team, and with limited resources it may be difficult for athletic trainers (ATs) to identify all those who may be at risk of injury in the preseason. There are limited tests in football that examine upper body risk and use baseline measurements for return to play. The tests that exist in the research for the upper body, do not use allometric scaling to adjust for body size. The Y-Balance Test uses arm length to normalize composite score data. This functional test has been proposed to identify athletes with dysfunctional movement, pain or limited reach in one of the three directions. If this test is associated with increased risk, ATs may be able to identify those at risk, implement established injury prevention programs, and have a more reliable and quantifiable return to play tool. Objective: The objective of this study was to investigate the Y-Balance Test upper quarter composite scores, risk factors, and normative data. Design: Prospective & Cross-sectional design. Setting: Two Northeast United States National Collegiate Athletic Association (NCAA) FB teams. Participants: Eighty male collegiate FB players with an age range of 18 to 23, and a mean age of 19.5. Main Outcome Measure(s): The Y-Balance Test upper quarter (YBT-UQ) was initiated during the 2018 preseason. The variables consisted of height, weight, age dominant arm, and in-season injury were also recorded. Results: In this sample population the YBT-UQ average composite scores (ACS) identified FB players at risk of an in-season upper body injury sensitivity 84%, specificity 68.7%, p < 0.001. Reach distance differences/asymmetries were not able to to identify at risk FB players, area under the curve 0.367. The mean ACS for those who suffered upper body musculoskeletal injury was 80.1%. The reach distance differences mean for all in-season injury was 4.03 cm and for no in-season injury was 4.13 cm. Individual composite score reaches were not associated with in-season upper body injury. There was a high correlation between individual right-to-left composite scores. Conclusion: Right and Left CS were similar and may be considered to compare the contralateral side. ACS were able to identify FB players at risk for an in-season upper body injury in this population.

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    Running Biomechanics, Quadriceps Strength and Knee Function of Military Service Members at Clearance to Return to Run Following Anterior Cruciate Ligament Reconstruction

    Published Year: 2020
    Specialization: Athletic Training

    Miller, Erin

    Background: Less than half of military service members return to full day following anterior cruciate ligament reconstruction (ACLR). Differences in running biomechanics and strength are commonly observed when comparing the involved lower limb to the uninvolved lower limb following ACLR. In the general population, asymmetrical gait biomechanics and quadriceps strength have been shown to contribute to poorer self-reported disability, greater risk of ACL re-injury and the progression of knee osteoarthritis. Little is known of the running biomechanical and strength characteristics of military service members following ACLR. Purpose: The purpose of this study was to compare lower extremity running biomechanics, and quadriceps strength of the involved limbs with the uninvolved limbs of military service members at clearance to return to run (RTR) following unilateral ACLR. Additionally, we investigated the relationships between these measures of interest and patient-reported outcome measures of knee function and pain. Methods: Participants completed the Knee Injury of Osteoarthritis Outcome Score (KOOS) and Single Assessment Numeric Evaluation (SANE). Hip and knee kinematics (KFE), peak hip adduction angle (HADA), the horizontal distance from the center of mass (COM) to the heel at IC, kinetics, and GRFs were assessed during treadmill running. Bilateral isokinetic knee extensor peak torque (EPT) was assessed at 180 degrees and 300 degrees. Two-tailed paired t-tests, and two-tailed bivariate correlations were performed to compare means and assess relationships among the measures of interest. Results: Ten individuals volunteered to participate an average of 5.0 plus or minus 1.9 months following ACLR. Conclusion: We observed significant between-limb differences in peak KFA, KFA at IC, heel-to-COM distance at IC, peak iKEM, peak vGRF, braking impluse, and EPT at 180 degrees and 300 degrees. These preliminary results suggest that there continues to be unresolved running biomechanical asymmetries at approximately 70% strength LSI post-ACLR. Military clinicians should be aware of these deficits and their potential implication on long-term knee joint health and risk of re-injury. We observed a large magnitude deficit in peak iKEM LSI which was strongly related to peak KF and KFE LSI’s. This results suggests additional guidelines focused on restoring neuromuscular function before initiating RTR are needed to mitigate potentially harmful knee biomechanics asymmetries.Measures of self-reported knee function and pain were not related to knee joint biomechanics symmetry or knee strength symmetry and may be weak clinical indicators of these measures.

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    Pre- and Post- Season Changes in Modified Clinical Test of Sensory Interaction in Balance and Y Ballance-Lower Quarter Test Performance Among High School Lacrosse and Rugby Athletes

    Published Year: 2023
    Specialization: Athletic Training

    Mills, William J., Jr.

    Sports-related concussion (SRC) is a complex injury impacting brain function, as well as balance. It is estimated that up to 3.8 million SRCs occur each year, and as many as 50% go unreported in high school because the symptoms are unrecognized or minimized by the athlete. The incidence of SRC can be as high as 38.4% of all injuries in some sports. To date, no objective biomarker has been identified to help diagnose a concussion, therefore clinicians are forced to rely on the following: observed mechanism of injury, signs identified by the medical practitioner, and/or symptoms self-reported by the athlete. Given the lack of objective testing and standardization for SRC management, identifying reliable and valid assessment is warranted. Specifically, the role of balance testing within a comprehensive concussion management program may have clinical utility in this complex condition. Reliable and valid balance measures could be utilized ad repeated within the athlete at pre-season (pre-injury), during rehabilitation, and used to assist with return-to-play decisions.

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    Critical Thinking: The Relationship Between Years of Experience as an ATC and the Level of Critical Thinking

    Published Year: 2009
    Specialization: Athletic Training

    Monaco, Michele Jane

    Little is known concerning critical thinking abilities of certified athletic trainers (ATs). Critical thinking is used by ATs during clinical decision making, diagnostic reasoning and patient problem solvilng. To date, research in athletic training and critical thinkinging has focused on athletic training students and thier matriculation through their educational programs. The level of critical thinking of practicing ATs is unknown.

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    Effectiveness of Soleus Specific Stretching to Increase Dorisflexion in Athletes and Relationship of Soleus and Gastrocnemius Flexibility by Sport Type

    Published Year: 2018
    Specialization: Athletic Training

    Morris, Kimberly S.

    Context: Lacking ankle flexibility or dorsiflexion range of motion (DFROM) has been postulated to be a primary risk factor in lower extremity injuries. The soleus has not been well investigated for stretching to gain DFROM or for its relation to DFROM in sport. Objective: The purpose of this research is to investigate soleus and gastrocnemius length and their relationship to DFROM in a two-pronged approach: 1) the effect of soleus specific stretching on increasing DFROM as compared to traditional gastrocnemius/soleus stretching; and 2) an exploration of whether a relationship exists between shortening of the gastrocnemius or soleus and the sport type an athlete engages in. Design: 1) Randomized controlled clinical trial; 2) Cross sectional study. Setting: 1) Collegiate athletes during in-season, 2) Collegiate pre-season physical examination records. Patients or Other Participants: 1) Final measures on 132 ankles, 61 male and 71 female, from six teams each separately randomly assigned to knee flexed (soleus) stretching, knee-extended (gastrocnemius/soleus) stretching and control groups; 2) Physical examination records reviewed on 339 athletes or 678 ankles after exclusions, 178 males and 161 females. Interventions: 1) The two stretching groups were asked to perform three 30-second stretches on each leg twice a day beyond the teams’ usual stretching protocol for four weeks. The control group continued to perform the team stretching protocol. Main Outcome Measures: Non-weight-bearing DFROM with the knee extended (KE) and with the knee flexed to 90 degrees (KF). Results: 1) Soleus stretching caused a statistically significant gain on the KE measurement as compared to the control group. The traditional gastrocnemius/soleus-stretching group had a gain but this did not reach significance. There was no statistically significant difference in the two stretching groups. 2) Basketball had statistically significant less DFROM on both KE and KF as compared to Endurance and Non-endurance sport types respectively. No statistically significant difference between the Endurance and Non-endurance groups. Conclusions: 1) Soleus specific (knee-flexed) stretching for four weeks during the competitive season for collegiate athletes caused a statistically significant gain in DFROM compared to a control group and greater gains as compared to traditional knee-extending stretching. 2) Basketball had significant DFROM flexibility restrictions both KE and KF compared to the other sports on a robust set of measures. The mean DFROM for all teams is very restricted compared to norms, classifications, and cut-off point for risk studies.

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    Development and Validation of a Clinic-Based ACL Injury Risk Prediction Algorithm for Use in Targeted Neuromuscular Injury Prevention Training

    Published Year: 2010
    Specialization: Athletic Training

    Myer, Gregory D.

    Prospective measzures of high knee abduction moment (KAM) during landing have identified female athletes at increased risk for ACL injury. However, dedicated biomechanical laboratories, which require costly measurement tools and labor intensive data collection sessions, are necessary to ascertain the measurements. The purpose of this study was to develop and validate a clinic-based ACL injury risk prediction algorithm. The hypothesis was that clinically obtainable correlates derived from highly predictive 3D motion analysis models would demonstrate high accuracy for determination of high KAM status.

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    Professional Master’s Athletic Training Students’ Career Influences

    Published Year: 2020
    Specialization: Athletic Training

    Nokes, Ryan D.

    Context: As athletic training education continues its transition to a professional master’s degree, it is essential to understand how professional master’s athletic training students’ professional experiences influence their perceptions of athletic training and their career intentions after graduation. Objective: 1) To examine second-year professional master’s athletic training students’ perceptions of athletic training and identify the factors that influenced their perceptions. 2) To examine the career intentions of second-year professional master’s athletic training students and identify the factors that influenced their intentions. Design: Convergent mixed-methods. Setting: Online surveys and individual phone interviews. Patients or Other Participants: A total of 80 second-year professional master’s students who graduated in 2019 completed the online survey. Ten survey respondents elected to participate in the follow-up phone interviews. Data Collection and Analysis: We created an online survey and semi-structured interview guide to answer the research questions. We validated the instruments using a content validity index tool. The data from both methodological approaches were blended. As a result, we displayed our findings in one comprehensive results section. We established trustworthiness through triangulation, member checks, memos, and peer debriefing. Results: Five higher-order themes emerged from the data. 1) Perceptions of the athletic training profession: lack of appreciation and awareness for the profession from others, rewarding profession, and dynamic profession. 2) Perceptions of a career in athletic training: low pay, long hours and inconsistent schedules, and inability to have work-life balance. 3) Factors influencing perceptions: clinical experience, interactions with athletic trainers, interactions with the general public, and interactions with other healthcare professionals. 4) Career progression: short-term career plans, concerns over lack of experience, and long-term career plans. 5) Factors influencing career intentions: clinical experience and mentorship. Conclusions: Second-year professional master’s athletic training students developed positive and negative perceptions of the athletic profession and a career in the professional during their professional education experiences. Additionally, their professional education experiences allowed them to develop career paths and career goals after graduation. The factors identified were all key socializing agents to the profession and had a profound impact on how they developed their perceptions of athletic training and career paths. The mentorship they received from their clinical preceptors and faculty members were also influential to the development of their career goals and career intentions after graduation.

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    California Community College Preparatory Athletic Training Programs: Relevance to Athletic Training Education and Student Success

    Published Year: 2017
    Specialization: Athletic Training

    Ohkubo, Monica A.

    With the transition to the professional Master’s degree for Commission on Accreditation of Athletic Training Education (CAATE) athletic training education programs, it is important to examine best pre-athletic training preparation. Currently some pre-athletic training Bachelor’s degrees are offered at the university level, but there are also community college program that exist to prepare pre-athletic training students for transfer to CAATE athletic training programs. Specifically, little is known about the California community college athletic training preparation (CCCPAT) programs in regards to athletic training education overall, and no previous research has been conducted on the topic. The purpose of this study was to describe and explore the relevance of CCCPAT programs to athletic training education and student success from the perspective of athletic training graduates who had transferred from CCCPAT programs as well as program directors of California CAATE accredited athletic training programs (ATPs). Using a phenomenological qualitative approach, semi-structured interviews with California ATP program directors and graduates were conducted. A total of 18 interviews were completed, 9 program directors and 9 graduates. Interviews were transcribed, and data were analyzed using an interpretive thematic approach. Results revealed the same 3 themes for each group: CCCPAT programs foster student success, CCCPAT programs can improve and the CCCPAT role in the move to the professional Master’s degree. Study findings suggest that CCCPAT role in the move to the professional Master’s degree. Study findings suggest that CCCPAT programs have a positive effect on student success including: 1) mentorship 2) networking 3) being part of a cohort 4) hands-on clinical experience 5) exposure and understanding of athletic training 6) communication and confidence enhancement 7) a good athletic training foundation and 8) financial savings. Areas of improvement revealed the need 1) to refine CCCPAT program curriculum to improve transfer efficiency 2) to improve the focus o academic performance 3) for more supervision of CCCPAT program students and 4) for more CCCPAT program student support with the transfer to University process and University adjustment. Concerns regarding the role of CCCPAT programs in the shift to the professional Master’s ATPs included financial hardship, a gap in clinical exposure from CCCPAT programs to Master’s programs, and the worry that CCCPAT program roles may decrease. Participants agreed that CCCPAT programs will continue to provide an athletic training foundation, hands on clinical experience, a place to complete prerequisite courses and may possibly play a role in bridging the gap of the upper division junior and senior years of Bachelor’s programs by providing a place to continue hands on clinical experience. University ATP programs and administrators, CCCPAT programs and administrator and students can utilize study findings to better understand CCCPAT programs and refine and improve their programs accordingly.

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    Awareness and Perceptions of Parents Regarding the Recognition and Treatment of Exertional Heat Stroke

    Published Year: 2019
    Specialization: Athletic Training

    Okayama, Michelle L.

    It is estimated that approximately 9,000 secondary school athletes are treated for exertional heat illness (EHI) annually. Many of these cases can be easily managed without concern; however exertional heat stroke (EHS) is classified under the umbrella of heat illness. Unlike other heat illnesses, EHS can be fatal and is one of the leading causes of death in secondary school sports. Secondary school student-athletes have been assessed as the highest risk EHS athlete population. Awareness of EHS and proper recognition and treatment strategies is imperative to the prevention of EHS death. Awareness of EHS is important not only for medical staff and coaches but athletes and parents as well. It is unknown whether adolescent athletes and their parents are aware of the signs, symptoms and prevention techniques for EHS, therefore an increased awareness and better preventive measures are needed. This study analyzed secondary school parents’ awareness and perceptions regarding EHS recognition and treatment procedures. A total of 378 out of 417 parent surveys were collected in southern California from thirteen football booster club meetings; eight semi-structured follow-up interviews were conducted to provide further insight into the attitudes and perceptions of the parents of football secondary school student athletes. Based on the results of the survey, it was determined that many of the parent respondents believed themselves to have an adequate knowledge of concepts related to EHS. However, the scores of knowledge test indicated the highest possible score on the knowledge test was 31 points, the median score was an average score of 36.6% of the highest possible score. Despite a lack of knowledge regarding EHS, parents were supportive of the use of rectal temperature assessment and cold-water immersion as diagnosis and treatment procedures for EHS. Among the possible factors that influence parents’ attitudes towards EHS treatments; gender, education and whether a parent was a healthcare provider were the most common. It was determined that having an athletic trainer at the child’s school was significantly associated with support for cold-water immersion and rectal temperature assessment. The findings of the qualitative analysis helped demonstrate the tendency of participants to prioritize the safety and well-being of the secondary student athletes. The data implies there is an understanding for the importance and necessity of rectal temperature procedures for EHS assessment. Parents as well as coaches, athletic trainers, and administrators should be educated about the importance of proper preparation and planning regarding EHI and other emergencies in high school sports.

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    Cervical Spine Range of Motion Pre and Post Concussion

    Published Year: 2022
    Specialization: Athletic Training

    Ottie, Kelly E.

    Objective: To evaluate the changes in the active range of motion (AROM) of the cervical spine (c-spine) pre-and-post concussion.

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    Policies, Procedures, and Practices Regarding Sport-related Concussions in California Community College Athletics

    Published Year: 2012
    Specialization: Athletic Training

    Paddack, Michael E.

    The primary purpose of this study was to assess and describe current policies and practices regarding assessment, management, and return to play (RTP) criteria for sport-related concussions (SRCs) in the California community colleges (CCC) setting. Secondary purposes of the study included: 1) determine whether these policies were in compliance with the National Athletic Trainer’s Association (NATA) and National Collegiate Athletic Association (NCAA) position statements and “best practice” guidelines, 2) determine if there are institutional policies in place regarding academic accommodations for athletes suffering from the symptoms of SRCs and identify the most common practices, 3) examine the relationship of continuing education and training to policies and practices in the assessment, management RTP criteria for SRCs, 4) examine the perceptions of sports medicine staff regarding SRC assessment and management practices and policies, and 5) identify relevant issues regarding SRC policies and practices in the CCC system for future evaluation and enhancement.

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    Low Back Pain In Alpine Ski Instructors

    Published Year: 2002
    Specialization: Athletic Training

    Peacock, Nola

    Low back pain in the adult population is a common and often costly condition. Athletes also experience low back pain. The lifetime prevalence for low back pain is up to 60% among some athletes. It has been my observation in the physical therapy setting that many alpine ski instructors suffer from low back pain. Published literature documents back pain among athletes participating in many sports. However, the prevalence of low back pain among alpine ski instructors has not been established. Surveys were mailed to 500 randomly selected members of the Professional Ski Instructors of America. The lifetime and point prevalences were determined by subjects’ report regarding history of low back pain and current low back pain. Two hundred seventy-two subjects (54%) of the sample responded to the survey. Two hundred-four subjects (75%) reported a history of low back pain. Eighty-five subjects (31%) reported current low back pain. A history of low back pain was reported most often among 41 to 50 year old subjects. The largest group with current low back pain was the 51 to 60 year old group. Seventy-six percent of the sample reported they had not missed any days of work due to low back pain. Nearly 8% of subjects with a history of back pain stated that they had missed ten or more days of work as a ski intructor because of low back pain. The lifetime prevalence of back pain among ski instructors in this survey was similar to the general population. The subjects reported more lifetime prevalence of back pain than athletes of many other sports. Lifetime prevalence of low back pain among the subjects in this survey was higher than among physical laborers such as bricklayers, carpenters, mechanics and machine operators. The high prevalence of back pain among alpine ski instructors may increase cost and decrease renevue for the employer. Prevention training in this population may decrease the prevalence of low back pain and lesson costs to the employer ad the alpine ski instructor.

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    Attitudes and Perceptions of Environmental Sustainability in Athletic Training

    Published Year: 2012
    Specialization: Athletic Training

    Potteiger, Kelly

    Environmental sustainability efforts have become a critical and noteworthy issue in the health professions. Like other health professions, the practice of athletic training necessitates a large quantity of resources that are both natural and manufactured. Presently, there is no published evidence regarding how much waste if produced by the practice of athletic training or how to best conserve the materials used. To facilitate a philosophy of environmental sustainability, one must first understand the attitudes and perceptions of practice athletic trainers. Only then can tactics be executed to encourage environmentally friendly practices. The purpose of this study was to examine certified athletic trainers’ attitudes, perceptions, and current practices of environmental sustainability techniques within their professional role. A secondary focus was to determine what types of waste are of biggest concern to athletic trainers.

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    Utilization of Bodyblade Training in Athletes with Traumatic Anterior Shoulder Instability

    Published Year: 2021
    Specialization: Athletic Training

    Pulido, Victor

    Background: The Bodyblade (Bb) has the potential of enhancing the traditional conservative management approach to Traumatic Anterior Shoulder Instability (TASI) by delivering higher muscle activation levels to multiple muscle groups in a single exercise greater than traditional rehabilitation tools. This improved efficiency may allow athletes to return to their sport in an optimal timeframe. Bodyblade has been shown to produce kinetic chain activation with the upper body and lower body as well. There is a lack of research in the conservative management of TASI for in-season athletes. Furthermore, little is known about the rehabilitation benefits of the Bb and how it might improve subjective and objective functional measurements. This study’s primary purpose was to investigate the utilization of the Bb on athletes with TASI and develop an efficient and effective exercise program to improve quality of life and functional outcome measures compared to traditional protocols.

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    Effect of Ankle Support on Performance, Range of Motion, and Perception

    Published Year: 2012
    Specialization: Athletic Training

    Ramirez, David A.

    In order to prevent ankle related injuries, ankle supports have been used for many years. However, the use of ankle supports should not be at the expense of athletic performance, range of motion or mental perception. Ankle range of motion (ROM), athletic performance and mental perception were measured under three conditions of tape (T), brace (B) and control (C). Twenty-four healthy males and fourteen healthy females who were recreational athletes participated. Any subject with current or past injury to the lower extremity within the last 6 months was excluded. All participants were tested on three separate days under a different randomized condition. The C condition had no ankle support while the T condition used a modified basket-weave technique and the B condition utilized the Zoom Ankle brace by Ultra Athlete. Following a five minute warm-up on a cycle ergometer and three sub-max efforts, participants completed three maximal efforts in the VJ, 20m and PA. Ankle ROM was assessed four times each day: pre-condition (PreC), post-condition (PostC), post-warm-up (PostW) and post-performance (PostP). Prior to and following each performance, all subjects answered a three question perception survey pertaining to the comfort, support and effect of each condition on performance measure. All measurements and support applications were administered by a certified athletic trainer and certified strength and conditioning specialist. Results demonstrated that ankle supports statistically decreased VJ height and clinically increased the 20m and PA times. Similarly, ankle supports decreased ROM before, during and after performance. Mentally, perceived comfort, support and performance were affected differently. While, comfort was perceived negatively with ankle support, support was perceived positively. During the VJ and 20m, ankle supports were perceived to negatively affect performance, while during the PA, ankle supports were perceived to positively affect performance. In conclusion, while injury prevention must be addressed, athletic performance, necessary range of motion and mental perception should not be compromised.

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    Beliefs and Behaviors of Strength and Conditioning Coaches at the NCAA Division I Level: An Investigation of Evidence Based Practice Concepts

    Published Year: 2016
    Specialization: Athletic Training

    Ramirez, Richard

    Context: Investigation of the Evidence Based Practice Beliefs and Implementation practices of Srength and Conditioning Coaches at the NCAA Division I Level. Objective: To examine the NCAA Division-I Strength and Conditioning Coaches EBP beliefs and use of EBP for the purpose of gaining knowledge about their practice behaviors. Design: Quantitative Survey Research Design. Setting: Online survey instrument. Patients or Other Participants: A total of 165 of 800 NCAA Division I SCC’s invited to participate in the study completed the EBP Beliefs and EBP Implementation Scales. Main Outcome Measure(s): The EBP Beliefs and EBP Implementation Scales were administered. The surveys collected demographic information in addition to information about participants’ beliefs regarding EBP and implementation of EBP in strength and conditioning practice. Results: Strength and Conditioning coaches did not demonstrate an overall high level of agreement concerning importance of EBP using the EBP-Beliefs Scale, but did show higher “agreeability” or an “agree score” on total sum score for individual items. SCC’s EBP Implementation subscale scores demonstrated “low or infrequent” use or implementation of EBP with a total sum score of 2.45 for individual items. A One Way ANOVA on Educational Level showed statistically significant or approaching statistically significant differences in EBP-Beliefs between subjects who had a Doctorate compared to those with a Bachelor’s Degree, and a Master’s Degree but not those with a Master’s Degree, and EBP-Implementation was also higher in subjects with a Doctorate as compared to the other 3 groups. A One Way ANOVA on Experience Years showed EBP Beliefs were higher and statistically different between SCC’s with 20+ years and coaches with 11-20 years but no significant difference was seen in EBP-Implementation, and a One Way ANOVA on Certification did not have a statistically significant effect on EBP Beliefs, or EBP Implementation. A One Way ANOVA for Age and EBP-B, and EBP-I results were also statistically significant. SCC’s in the Age group 20+ held higher scores in both scales as compared to other groups. Practical Applications: This study may provide SCC’s awareness of current state of EBP concepts, and guidance for implementation of its concepts. Discussion: An SCC’s age, educational level, years of experience and certification type all affect EBP Beliefs and Implementation to some degree. Conclusion: SCC’s have positive EBP Beliefs, but lack EBP Implementation. Future research should be aimed at strengths and barriers, organizational culture, leadership and educational strategies to help promote implementation in strength and conditioning.

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    Mechanism of Persistence in Students Enrolled in Professional Master’s Athletic Training Programs

    Published Year: 2020
    Specialization: Athletic Training

    Reyes, Christine Dara

    This mixed-methods study aims to address the existing gap of knowledge relating to persistence factors of students enrolled in Professional Master’s Athletic Training Program (PM-ATP) and determine whether self-identified qualitative coping mechanisms utilized by these students are, or are not, reflective of the student’s quantitatively assessed resiliency and burnout potential.

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    Management of the Injured Baseball Player Utilizing a Postural Restoration Approach

    Published Year: 2018
    Specialization: Athletic Training

    Robey, Jason H.

    Treatment of the overhead throwing athlete is a very involved process that has multiple components to consider. Having an understanding of throwing mechanics and the forces the shoulder goes through are beneficial for diagnosis and treatment. Pain and shoulder dysfunction may be a result of scapular dysfunction, repetitive stress or micro-trauma to joint capsule and musculature, improper throwing mechanics, and lower extremity asymmetries. The purpose of this case series is to demonstrate whether a Postural Restoration based approach is effective in the management of injured baseball players. The Postural Restoration exercises focused on obtaining proper respiration, rib cage and scapular position, increased glenohumeral motion, and addressed asymmetries at the pelvis and lower extremities. These exercises demonstrated significant changes in shoulder ranges of motion, an average increase in the subjects ASES scores by 30.6 points, and an average increase in the VAS scores by 4.9 points. However, one patient had a two point improvement in his VAS score which does not demonstrate clinical significance. The Postural Restoration exercises seem to be a very effective treatment approach for baseball players with shoulder conditions and pain. It also demonstrated significant change in shoulder ranges of motion that may be beneficial in reducing further risk of injury.

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    Mexican American Adolescents’ Knowledge of Health Issues

    Published Year: 2013
    Specialization: Athletic Training

    Rodriguez, Maritza

    Obesity and diabetes have been increasing at an alarming rate in the United States in both the adolescent and adult population. Lack of physical activity has been determined to be a primary cause of these two diseases. Additionally, the Centers for Disease Control and Prevention estimates the prevalence of obesity and diabetes to be higher among Mexican Americans compared to other ethnic groups. The objective was to explore health issues that concern Mexican American adolescents, determine the level of knowledge Mexican American adolescents have regarding health issues, and how they learn about these general health issues.

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    Student Athlete Perceptions of Athletic Trainers’ Competence Based on Appearance and Dress

    Published Year: 2014
    Specialization: Athletic Training

    Rogers, Jennifer J.

    Individuals often make judgements of others based upon first impressions. Physica appearance can be a major influence on a person’s snap judgement of another individual, leading to a perception of that individual’s intellectual competence. The primary purpose of this study was to determine if physical appearance and dress of an Athletic Trainer (AT) influences student athletes’ perception of an AT’s competence. The secondary purpose was to elucidate the influence of physical appearance and dress on student athletes’ perception of AT competence. Research with a mixed-methods design was conducted via an electronically distributed quantitative survey. Student athletes who competed at colleges or universities within NATA District 5 were contacted via e-mail and asked to participate in an electronic survey. One hundred fifty-six student athletes completed the demographic information and the Student Athlete Response Form (SAR Form) that contained questions in reference to an image of a male or female AT who was underweight, normal weight, overweight, or obese and dressed in either business casual or athletic attire. Students athletes were also asked to select the BMI of an AT that would best demonstrate competency. After completing the electronic survey, eighteen student athletes volunteered to be interviewed to fulfill the qualitative portion of this study. The results supported the primary hypothesis that student athletes scored obese ATs as less competent than normal and underweight ATs. A One-way ANOVA was conducted and a significant main effect was found for AT BMI. The Scheffe post-hoc test revealed that the AT BMI category of obese differed significantly in composite SAR mean score from underweight and normal weight AT BMI categories. A significant main effect was also found for AT dress: business casual or athletic attire. Business casual attire was perceived as more competent than athletic attire dress. The BMI Silhouette Scale Data was analyzed using a paired t-test which resulted in a significant difference between the perceived ideal male BMI and female BMI at p<0.001. The overall AT BMI that was perceived as the most competent was a BMI of 25.59 plus or minus 4.07. The main theme that emerged from the qualitative data analysis was that physically fit and knowledgeable athletic trainers are perceived as competent. In conclusion, this research indicates that student athletes perceive a relationship between an AT’s physical appearance and competence. More specifically, student athletes perceived a non-obese and professionally dressed AT as more competent than the alternative.

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    Role Strain in Athletic Trainers Working in Professional Sports: A Mixed Method Study

    Published Year: 2015
    Specialization: Athletic Training

    Romero, Manuel G.

    The demands and expectations of athletic trainers working in the professional sport setting have increased over the years. Meeting these demands and expectations may predispose the athletic trainer to workplace stress and ultimately role strain. Role strain issues have been studied in a variety of health care professionals, such as nurses, physicians, and physical therapists. In athletic training, role strain has been studied in the collegiate and secondary school settings, but the organizational factors of the professional sport setting are different from those in the settings where role strain has been studied. The purpose of this study is to investigate the concept of role strain among athletic trainers working in the professional sports setting.

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    Celiac Disease: College Athletes’ Perspectives on Accommodations and Support for Nutritional Needs and Challenges Encountered

    Published Year: 2017
    Specialization: Athletic Training

    Sandvik, Jodi

    This phenomenological study expored the experience of collegiate student-athletes with celiac disease (CD) to better understand the challenges encountered, as well as the accommodations and support provided by their university to assist in maintaining a gluten free lifestyle. Data was collected via semi-structured individual interviews, reflective journals, and a focus group interview. Participants included 11 current student-athletes with CD, who participated in a variety of sports at a NCAA school. An interpretive thematic analytic approach was used to analyze data. The student-athletes identified challenges directly related to lack of university accommodations and support included both the athletic department and campus dining halls. Challenges indirectly related to the lack of university accommodations and support were also encountered, such as emotional issues, financial issues, social issues, and time management issues. Despite the many challenges experienced by athletes with CD, participants identyified present-day accommodation and support, in the areas of university support, social support, athletic department support, and self-support. Participants also identified areas of needed or desired accommodations and support including gluten-free options through athletic department and dining halls, education for the university/athletics staff regarding celiac disease, and financial assistance. This information will provide educational institutions with support/accommodation strategies to assist with Americans with Disabilities Act (ADA) compliance as well as assist athletic trainers in caring for athletes with dietary considerations.

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    Exploring the Socialization of Athletic Trainers in the Performing Arts, Military, and Physician Extender Setting

    Published Year: 2017
    Specialization: Athletic Training

    Sax, Misty A.

    Context: National Athletic Trainer’s Association (NATA) employment setting statistics indicate growing numbers of athletic trainers (ATs) are seeking employment in practice settings of performing arts, military, and physician extender (emergent setting); and while ATs employed in the industrial setting have been studied, little data is available regarding socialization processes experienced by ATs entering aforementioned settings. Objective: Understanding the experiences of ATs regarding socialization experiences upon entering emergent practice setting. Design: Inductive qualitative research study using a grounded theory approach. Setting: Emergent practice settings. Participants: Six male and eleven female athletic trainers in emergent practice settings averaging 38 plus or minus 11 years of age. Average years of AT experience was 15 plus or minus 10 across all settings. Data Collection and Analysis: Telephone interviews following semi-structured interviews were recorded and transcribed verbatim. Data analysis processes rooted in grounded theory were used to analyze data. Trustworthiness was established using researcher triangulation, member checks and peer debriefing. Results: Analyses revealed three major themes: 1) anticipatory socialization, 2) organizational socialization and 3) challenges to socialization. Anticipatory socialization revealed how educational experiences generated a foundation to gage organizational socialization experiences. Organizational socialization included naturally occurring informal experiences. Formal experiences were related to human resources interactions. Challenges to socialization, lack of understanding of AT role and ATs contributions to standing organizational structure, both impacted induction into employment role. Conclusions: Athletic trainers in emergent practice settings experience benefits of anticipatory socialization when preparing to enter a non-traditional setting. Challenges to socialization are present but, naturally occurring informal processes provided ATs the organizational socialization required to understand their employment role in their chosen setting.

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    The Use of the Selective Functional Movement Assessment on Athletes Who Experience Low Back Pain

    Published Year: 2017
    Specialization: Athletic Training

    Shaffer, Joseph D.

    Movement is the result of a complex interaction between the individual, environment, and the task they are engaged with. Health professionals recognize the importance of understanding the construct of movement and are constantly seeking innovative ways to objectively assess and breakdown movement patterns into more manageable parts. Complex motor patterns have been studied by health professional in an attempt to better serve their patients/clients in regards to their functional activities. The selective funtional movement assessment is one tool that has been growing in popularity due to its ability to discriminate functional and dysfunctional movement patterns in the context of pain. However, little research has been conducted to understand the reliability and validity of the tool. Therefore, the purpose of this study was to investigate the use of the Selective Functional Movement Assessment, along with the Oswentry Disability Index and the Tampa Scale of Kinesiophobia on NCAA division II collegiate athletes who have a recent history of low back pain. 73 Division II collegiate men and women athletes were purposefully selected and placed into two groups. All participants complete the TSK and ODI questionnaires as well as the SFMA. Poor to excellent reliability was established for intra- and inter- rater reliability for both composite and categorical data from the SFMA with the upper extremity pattern two being the most predictive category of someone with low back pain. A small correlation was found between the SFMA and TSK and a moderate correlation was found between the SFMA and ODI. In conclusion, this study is consistent with previous research indicating the SFMA is reliable and valid. However, future research is needed to address reliability and validity on different populations and settings.

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    Collegiate Wrestler’s Compliance and Institutional Perceptions to the National Wrestling Coaches Association (NWCA) Weight Loss Plan

    Published Year: 2013
    Specialization: Athletic Training

    Shotwell, Colleen A.

    In 1998, the National Collegiate Athletic Association’s (NCAA) Committe on Competitive Safeguards and Medical Aspects of Sports implemented more stringent rules and guidelines regarding its wrestling weight class certification program. These change were the results of the deaths of three young apparently healthy collegiate athletes. These wrestlers were engaged in similar rapid weight loss (RWL) programs to qualify themselves for competition. This protocol for RWL promoted dehydration. Consequently, the NCAA mandates wrestlers descend to minimum wrestling weight at a rate of 1.5% of body weight loss per week; but few researchers have examined wrestler’s compliance to this 1.5% decent rule prior to the first competition. To evaluate intercollegiate wrestler’s compliance and institution’s perceptions to the National Wrestling Coaches Association’s (NWCA) Optimal Performance Calculator (OPC) weight loss plan.

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    Utilizing Alternative Planes of Motion for Hamstring Stretching: Can it Reduce Pain, Improve Range of Motion, Increase Muscle Strength, and Facilitate Early Return to Performance in Recreational Athletes With Acute Exercise-Induced Muscular Damage?

    Published Year: 2017
    Specialization: Athletic Training

    Smith, Darrin M.

    Stretching treatments associated with muscle injury that re-creates pain or mechanism of injury is contraindicated. To date, no studies have explored the efficacy of treating a damaged muscle group utilizing flexibility protocols that are based on selectively single or combined planes of motion. The objective is to determine if daily stretching, utilizing alternative planes of motion for exercised-induced hamstring muscl damage (EIMD), would result in pain reduction, improved range of motion, increased muscle strength, and facilitation of early return to performance over 96 hours.

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    The Effects of Simulation Education on Athletic Training Students Self Confidence When Performing Rectal Thermometry

    Published Year: 2023
    Specialization: Athletic Training

    Stedge, Hannah L.

    Performing rectal thermometry to recognize exertional heat stroke (EHS) has been best practice in athletic training since 2015. Despite this and other research, certified athletic trainers show low compliance with implementing best practices for recognizing and managing exertional heat stroke. Among the barriers reported, athletic trainers state one of the reasons for not utilizing rectal thermometry is a lack of self-confidence and athentic practice opportunities. This study aimed to determine the effect of a standardized patient encounter vs. high-fidelity simulation on self-confidence and explore athletic training students’ perceptions of using standarized patients or high-fidelity simulation techniques to learn rectal thermometry. A secondary purpose was to identify any differences between different genders in self-confidence.

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    Critically Appraising Evidence Within the Literature: Perceptions of Athletic Training Preceptors

    Published Year: 2017
    Specialization: Athletic Training

    Stokes, Lindsey

    Evidence-based practice (EBP) has aided clinicians with utilizing the best available evidence to guide clinical decision-making. Critical appraisal, a tenet of EBP, is a mechanism for the evaluation of medical literature to determine its appropriateness in patient care. Critical appraisal and pre-appraised resources assist clinicians with identifying quality information that is relevant, reliable, and applicable in patient care. Pre-appraised resources, such as point-of-care resources, clinical prediction rules, clinical practice guidelines, critically appraised topics, and CASE reports encourage the use of EBP and critical appraisal within clinical practice.

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    Relative Risk of Concussions in Youth, Female Soccer Players

    Published Year: 2011
    Specialization: Athletic Training

    Strand, Sarah L.

    Determining the relative risk of concussions in young, female soccer players is important for a number of reasons. There has been little research, however, regarding the estimated incidence of concussions in this age/gender group. The objective was to determine the relative risk of concussions in young, female soccer players. Data were gathered from a survey that assessed the presence of concussions in 11-13 year old girls.

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    A Determination if Total Hip Arthroplasty (Anterior Approach) Improves Early Functional Outcomes

    Published Year: 2012
    Specialization: Athletic Training

    Toma, Megan

    Total hip arthroplasty (THA) is one of the most commonly performed and successful operations in orthopedic. The efficacy of this surgical technique has been reported for over forty years in the literature providing patients with pain relief and functional improvement with minimal complication rates. Many modifications have been made to the original technique, including minimal incision approaches that are promising less tissue damage, decreased post-operative pain and a rapid rehabilitation potential with none of the dislocation precautions that are needed for the traditional total hip replacement approach. The efficacy of minimal incision THA has been questioned in the literature and studies have shown conflicting data on the rapid recovery benefits when compared to the traditional approach. The purpose of this study is to determine patient physical function and pain outcomes 6 weeks post total hip arthroplasty with an anterior approach compared to pre-operative function. This study also compared post-surgical improvements at 6 weeks post-operatively with published estimates for patients undergoing traditional THA surgery and compared the subjects modified functional movement screen scores pre and post-surgery results to established measures.

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    Effects of Short-Term, Intermittent Cryotherapy on Velocity, Accuracy, Perceived Exertion, and Perceived Recovery in Collegiate Softball Pitchers

    Published Year: 2017
    Specialization: Athletic Training

    Ulrich, Bethany J.

    The windmill pitch is perceived by coaches and players to be a natural movement and a low risk for injury. However, high levels of force act upon the upper extremity due to the dynamic nature of the motion. There is a paucity of research examining the windmill pitch and strategies for attenuating the effects of fatigue. While short-term, intermittent cryotherapy has demonstrated the potential to delay the onset of fatigue in baseball pitchers, there are no studies invesigating these effects in the fast-pitch softball pitcher. This study investigated the effects of upper extremity cryotherapy intervention on ptich velocity, pitch accuracy, percieved exertion, and perceived recovery in collegiate softball pitchers. Trained collegiate female fast-pitch softball pitchers threw 15 fastball pitches over seven innings, totalling 105 pitches, during a game simulation. In a crossover study design, participants received four minutes of a cryotherapy application to the shoulder and elbow between innings in one game simulation or no cryotherapy application in the other fame simulation in random order. Pitch velocity and pitch accuracy were recorded for each pitch as well as perceived exertion (RPE) after each inning and perceived recovery (PRS) after each intervention between innings. Following each game simulation, participants completed the PRS for three days to observe continued recovery. There were no statistical differences between conditions for pitch velocity, pitch accuracy, perceived exertion, perceived recovery, and perceived recovery, three-day post. Short-term, intermittent cryotherapy demonstrated no difference compared with no intervention on pitch velocity, pitch accuracy, perceived exertion, and perceived recovery in the collegiate fast-pitch softball pitcher. This study shows that while a short application of cryotherapy between innings may not attenuate the effects of fatigue, cryotherapy may be utilized for the analgesic effect between innings without performance deficits in collegiate softball pitchers.

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    Burnout and Seasonality in Rural Medicine

    Published Year: 2022
    Specialization: Athletic Training

    Warfel, Alison

    Purpose of Study: The purpose of this study is to develop an understanding of how staff working in rural healthcare organizations experience burnout and seasonality and the perceived effectiveness of organizational interventions employed to mitigate or prevent the occurrence of burnout.

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    Minority Enrollment and Retention in Athletic Training Programs: An Exploratory Study

    Published Year: 2015
    Specialization: Athletic Training

    Warren, Karlita L.

    Minorities are underrepresented in the health professions. Presently, research regarding race and ethnicity, student enrollment, and retention in athletic training programs is unknown. The objective is to explore the demographic composition of accredited entry-level undergraduate athletic training programs (AT programs) and to examine the factors affecting minority student enrollment, retention, and academic success in AT programs.

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    Epidemiology of Collegiate Rodeo

    Published Year: 2017
    Specialization: Athletic Training

    Watts, Melinda

    Context: Little is known about the frequency and nature of collegiate rodeo because few studies, have focused on the college rodeo population. In addition, most college rodeo athletes do not have medical professionals, like athletic trainers (ATs), readily available to provide care. The lack of available medical professionals can leave athletes to make their own participation decisions when injured and may affect athletic performance and the health of the college athlete.. Therefore, more research is needed regarding the types of injuries occurring in college rodeo and the available healthcare. Objective: The purpose of this study was to describe the frequency and nature of both time loss (TL) and non-time loss (NTL) injuries in men’s and women’s collegiate rodeo. Design: Descriptive Epidemiology. Setting: Eleven National Intercollegiate Rodeo Association (NIRA) member institutions across the United States. Participants: There were 264 male and female college athletes who competed in the National Intercollegiate Rodeo Association (NIRA). Main Outcome Measure: Injuries and athlete exposures (AE) from practices and competititions during one college rodeo season were analyzed. Injury rates and rate ratios were reported for time loss and non-time loss injuries with 95% confidence intervals (CI). Frequencies and proportions for type of injury, injury location, and injury severity were also reported. Results: Athletic trainers reported a total of 98 TL and NTL injuries and 23122 AEs, with one athlete receiving a repeat MCL sprain, resulting in an injury rate of 4.24/1,000 athlete-exposures. TL and NTL injury rates were 2.47/1,000 AE and 1.77/1,000 AE, respectively. Males accounted for more injuries than females. More injuries occurred in practices than competitions. The injury rate was higher in competition than practice. The bull riding event had the most AT reported injuries. The most AT reported injuries were sprains, strains, and contusions. Conclusions: TL injuries accounted for more injuries than NTL injuries. The TL injury rate was higher than the NTL injury rate, but not significantly. Male athletes had a higher injury rate than females, and may be attributed to male athletes competing in rough stock events. More research with college rodeo is needed to illustrate how frequent injuries occur and the need for available healthcare for college rodeo athletes.

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    The Relationship Of Hip Internal Rotation To Non-Contact Anterior Cruciate Ligament Injury In Females

    Published Year: 2018
    Specialization: Athletic Training

    Welch, Lark A.

    Determining any relationships of hip internal rotation ranges of motion, actively and passively, in healthy 14-25 year old females compared to 14-24 year old females with an anterior cruciate ligament (ACL) injury. The objective is to analyze, with the simple clinical measurement of a hand held goniometer, bilateral hip ranges of motion symmetries in a healthy female basketball players ages 14-24 years of age. Within a case control study, hip internal rotation ranges of motion were measured, both actively and passively, to determine if they were greater in the participants’ injured lower extremity hips, compared to their uninjured lower extremity hips. Hip internal rotation excess (HIRE) may be present in females 14-24 years old with a non-contact anterior cruciate ligament (ACL) injury, as this transverse plane hip movement is associated with dynamic knee valgus which occurs during this type of knee injury.

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    Workplace Bullying in Athletic Training: Perceptions and Experiences of Collegiate Certified Athletic Trainers

    Published Year: 2012
    Specialization: Athletic Training

    Weuve, Celestine M.

    Workplace bullying (WPB) is a series of persistent negative interactions that can affect a health care professional’s ability to perform his/her role. Workplace bullying has been associated with many personal and professional life disturbances. Although workplace bullying has been studied in health professions such as nursing, there is a dearth of information pertaining to this phenomenon in other health care disciplines, including athletic training. The objective is to determine the prevalence of workplace bullying among certified athletic trainers in the collegiate setting and explore the experiences and perceptions of those athletic trainers.

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    Sport Specialization Behaviors, Influences, and Self-Reported Throwing Arm Health in College Baseball Athletes

    Published Year: 2021
    Specialization: Athletic Training

    Wilkins, Samuel

    Early sport specialization has been shown to increase the risk of overuse injuries in several sports, including baseball. Overuse injury can be challenging to define; therefore, a patient-reported outcome measure may be useful in determining throwing arm health over time. Major League Baseball and USA Baseball established the Pitch Smart guidelines related to pitching volume, rest, and participation to promote safe practices in youth baseball. However, compliance with these guidelines is not required. Qualitative research methodologies may provide additional insight into athlete motivation by learning about lived experiences of playing sports during an athlete’s formative years. Therefore, the purpose of this study was to determine differences in Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow scores in college baseball athletes based on their age of specialization, as well as whether the athlete was compliant or non-compliant with the various Pitch Smart guidelines while pitching in high school. Another purpose of this study was to learn more about athletes motivations and sports experiences using qualitatrive methodologies.

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    Effects of Verbs Versus Nouns in Intensive Language Action Therapy in Persons with Chronic, Expressive Aphasia

    Published Year: 2021
    Specialization: Athletic Training

    Yoder-Black, Deanna L.

    This study incorporated Intensive Language Action Therapy (ILAT) targeting anomia across two linguistic classes, or parts of speech (POS): nouns and verbs. The participant was a person with aphasia (PWA) who sustained an acquired brain injury resulting in moderate expressive aphasia. The environment was a South Dakota city public access space. An Alternating Treatment Design (ATD) was used to compare ILAT treatment of nouns versus verbs over four weeks. Stimuli were chosen based on prior work from Alyahya. Nouns were chosen with the restriction that a verb in the list could not prime them. Verbs were chosen with semantic, phonological, and orthographic restrictions. The initial session included five rounds of naming each class. Stimuli included those which were achieved 40% or less correct naming across all five trial sets. Multiple statistical analyses were run to compare the results across dependent variable. As expected, nouns returned a steady, relatively shallow, increasing trajectory. Verbs demonstrated a much more volatile response in their increasing trajectory. This study demonstrated that the use of ILAT resulted in improving naming abilities across POS as both nouns and verbs resonded to the ILATprotocol. The Discussion section of this paper hypothesizes possible reasons why the null hypothesis of verb recovery increasing over nouns was rejected. The Discussion section also briefly explores that using verbs suggests future exploration in comparing transitive and intratransitive verbs and highlights an increase in mean length of utterance for all responses.

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Cardiopulmonary

    Comparison Of Two Formats For Teaching Diagnostic Reasoning Skills To Experienced Physical Therapists

    Published Year: 2004
    Specialization: Cardiopulmonary

    Michel, Theresa H.

    The purpose of this perspective is to describe an approach to teaching diagnostic reasoning using a Web-based course. To elucidate this we describe how we match the learning needs of practicing clinicians in the realm of diagnostic reasoning with specific teaching methods used in an online course format. We use 3 principles of teaching and learning diagnostic reasoning skills to frame the discussion: 1) ready access to information 2) active participation of all students; and 3) self appraisal and metacognition. These three principles guided the method of developing and conducting this online course called: Diagnostic Screening for Physical Therapists: When to Treat? When to Refer? Experienced physical therapists are adult learners. They pursue their own areas of interest; find their own resources for learning, and pace themselves according to their own learnging needs. The Web-based format lends itself to this type of teaching and learning, using Web-based access to information, and collaborative learning groups engaged in constructing new knowledge by integrating what they have stored in memory with new insights they gain from others. Adult learners come to the course with knowledge and inferences arrived at by their own clinical experiences. By interacting with other students and teachers, they engage in an analytical approach to solving patient problems which requires them to reflect on their own practice and share their thinking strategies with others. This enables them to learn more deeply than simply memorizing facts, or strategically trying to perform all of the course requirements as quickly as possible. They learn by solving real clinical problems using cases that present confusing and complex signs and symptoms and by doing this in an ongoing threaded discussion with fellow physical therapists. The online format permits them flexibility of scheduling and much more time to engage with each other in discussion than a traditional classroom would provide.

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Clinical Electrophysiology

    Physical Therapist Compliance with Electroneuromyography Guidelines

    Published Year: 2007
    Specialization: Clinical Electrophysiology

    Armantrout, Elaine Ann

    Background: There is debate on who is qualified to practice electroneuromyography (ENMG). Purpose: ENMG reports performed by physical therapists were examined to determine how well they complied with clinical practice guidelines developed for three upper extremity conditions; carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow, and cervical radiculopathy. Methods: ENMG reports were collected and compared to the clinical practice guidelines. Results: The mean scores for CTS, ulnar neuropathy at the elbow, and cervical radiculopathy were 84%, 71%, and 83%, respectively. The reliability calculations for the performance measurement tools were 0.74, 0.75, and 0.57, respectively. Discussion: The compliance rates of the ENMG reports were high. The performance measurement tools developed for CTS, ulnar neuropathy at the elbow, and cervical radiculopathy were moderately reliable. Conclusion: This study suggested that physical therapists adequately perform ENMG studies by following established clinical practice guidelines. The performance measurement tools may be useful for quality improvement projects in individual ENMG laboratories.

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    Electromyographic Amplitude Comparison of the First Dorsal Interosseous of the Feet of Chronologically Diverse Subjects

    Published Year: 2004
    Specialization: Clinical Electrophysiology

    Baker, Robert D.

    Background and Purpose: The clinical electromyographer routinely performs an analysis of motor unit potentials (MUPs), consisting of isolating a waveform, recording phases and the peak-to-peak height of the responseor amplitude. Selecting a muscle that will assist in determining whether a chronic condition is present in an anatomical distribution requires analysis of established criteria. Sampling of the first dorsal intereosseous muscle of the foot (FDI) as a distal muscle to survey in chronic neuropathy involvement, has not been address in the literature. The purpose of this study is to determine (1) if there are any age related changes in MUP amplitudes of the FDI of the foot that can be used for clinical analysis, and (2) to determine if there is an appropriate sampling methodology for the FDI muscle of the foot. Methods: The research design was descriptive and normative, reporting data from each foot sample of 90 asymptomatic volunteer subjects, ranging in age from 18 to 84 years old. MUP peak amplitudes were recorded from the FDI muscles of subjects with a monopolar needle electrode and analyzed using manual measurement from the positive to the negative peak. The sampleing method was standardized. Two trials of 6 MUPs were recorded and compared on the same foot. Results: One hundred seventy-five peak MUP amplitude values were recorded from subjects ranging in age from 18 to 84 years old. Five subjects were unable to produce a FDI muscle contraction with one of their feet. The peak amplitude of 175 feet obtained from subjects 18 to 84 years old ranged from 0.8 to 25 mV. The upper limit calculated as the mean plus 2 S.D.=17.7 mV. The peak amplitude of 139 feet obtained from subjects less than 60 years of age ranged from 0.8 to 25 mV. The peak amplitude of 36 feet obtained from subjects greater than 60 years of age ranged from 0.2 to 19.4 mV. Linear regression analysis was performed to assess the ability of age to predict the largest MUP amplitude. No significant relationship was found between age and amplitude. Differences between the mean amplitudes of the first trial of 6 MUPs sampled in comparison to the second trial of 6 MUPs indicated no statistical difference between the two groups:t. The peak MUP amplitude value occurred 58% of the time in the first trial. Discussion and Conclusion: This study found no relationship between age and the ability to predict peak amplitude values. Caution with interpretation of FDI peak amplitude values is recommended due to widespread variability across age groups. Secondly, there is no statistical difference between the mean of the first and second trials of 6 MUPs. The peak MUP occurred in the first set of sampling 58% of the time. Therefore, small muscles such as the FDI may require less motor unit sampling than that recommended in the literature. Reference values for the mean peak MUP amplitude of the FDI are 9.3 mV � 4.2; upper limit 17.7 mV.

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    Effect of Age and Limb Length on Median Nerve H-Reflex Latency Recorded from the Flexor Carpi Radialis in Healthy Subjects

    Published Year: 2006
    Specialization: Clinical Electrophysiology

    Brooks, Mark E.

    Objectives: To establish a reliable standardized technique for recording median H-reflexes from the flexor carpi radialis using surface electrodes; to establish normal values for H-reflex latency and side-to-side latency difference; to explore the effect of age and limb length on H-reflex latency; and to construct a three-variable nomogram to allow prediction of H-reflex latency, given age and limb length. Design: Quantitative, cross-sectional, descriptive, and normative study. Setting: Electromyography laboratory at a private outpatient office. Participants: Convenience sample of 123 healthy adult volunteers who met all inclusion and exclusion criteria. Intervention: The median H-reflex was obtained in 115 of 123 subjects. The mean median H-reflex latency was 15.88 � 1.56 ms. The mean side-to-side latency difference was 0.45 � .39 ms. Using two standard deviations, the upper limit of normal for latency was 19.00 ms, and the upper limit of normal for side-to-side difference was 1.23 ms. A weak correlation existed between H-refles latency and age, and a moderate correlation existed betwen H-relfex latency and arm length. Using the regression of H-reflex latency on age and arm length, a three-variable nomogram was constructed. Conclusions: The median H-relfex can be reliabley obtained from the flexor carpi radialis without facilitation. A normative value database was established, and a clinical prediction tool for calculating H-reflex latency was developed. Thus, the clinician is provided with a useful diagnostic technique in the assessment of radiculopathy and neuropathy.

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    Normative Data for Trans-Tarsal Conduction Velocity of the Medial and Lateral Plantar Nerves Recorded from the Flexor Hallucis Brevis and First Dorsal Interosseous

    Published Year: 2014
    Specialization: Clinical Electrophysiology

    Casciere, C. Bruce

    Medial plantar and lateral plantar neuropathy, also known as posterior tarsal tunnel syndrome (PTTS), is a common lower extremity entrapment neuropathy that most individuals performing electrophysiological examinations will encounter with some frequency. However, few studies actually assess the primary area of entrapment located within the posterior tarsal tunnel (PTT). The purpose of this study was to establish a set of normative data for trans-tarsal motor nerve conduction velocity (MNCV) through the PTT for the medial plantar nerve (MPN) and lateral plantar nerve (LPN) when recording from the flexor hallucis brevis (FHB) and first dorsal interosseous (FDI) muscles respectively. Normative conduction velocity through the PTT using hte FHB and FDI as recording sites may allow the clinician to better assess for focal slowing over this smaller potential entrapment site. These recording sites of the FHB and FDI have shown a consistent clear initial negative deflection from the baseline that is sometimes not seen using the abductor hallucis (AH) and abductor digiti minimi (ADM) recording sites. The development of this normative data may be useful to clinicians who routinely test for PTTS during their electrodiagnostic examinations. Conventional PTT testing methods using the AH and ADM muscles for the MPB and LPN motor nerves do not assess the conduction velocity through the PTT. A secondary purpose of this study was to establish a set of normative data for motor latencies and compound motor action potential (CMAP) amplitudes proximal and distal to the posterior tarsal tunnel and to demontrate that normative trans-tarsal conduction velocitiescan be obtained when stimulating the tibial nerve and the MPN and LPN and recording from the FHB and FDI.

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    Position Dependent Changes in Tibial Motor Conduction Velocity Across the Tarsal Tunnel

    Published Year: 2001
    Specialization: Clinical Electrophysiology

    DePasquale, Lisa V.

    Precise measurement of nerve length across joints or irregular bony surfaces is critical for accurate determination of nerve conduction velocity (NCV). Recording techniques should be standardized to improve nerve conduction study reliability. The correlation between surface measurement of the tibial nerve segment through the tarsal tunnel, based on the distance between certain anatomical landmarks, and the true length of this segment, has not been previously studied. As a result, calculations of conduction velocity through this region may be inaccurate, leading to false interpretation. The purpose of this investigation was a) to determine, in a cadaver model, the ankle position where surface measurements of the tibial nerve segment through the tarsal tunnel most closely approximate the true length of the segment, and b) to then determine the reliability of conduction velocity measurements, in normal subjects, using this, (and other) ankle positions.

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    The Effect of Carpal Tunnel Syndrome on Flexor Carpi Radialis H-reflex Latency

    Published Year: 2006
    Specialization: Clinical Electrophysiology

    Downs, William James Jr.

    Background and Purpose: Although the Flexor Carpi Radialis (FCR) H-reflex is recommended as a screening tool for proximal nerve disfunction, there has been concern that Carpal Tunnel Syndrome (CTS) might affect FCR reflex latency values. The purpose of this study was to determine if the FCR H-reflex latency is altered by the presence of CTS. Subjects and Methods: An exploratory design with a retrospective, observational approach was used. CTS subjects were former patients with CTS classified on each side into levels of severity. Control subjects were a volunteer sample of convenience with no evidence of CTS. Subjects were categorized into 4 groups by severity of CTS between the two arms with 14 subjects assigned to each group. The side-to-side mean latency difference of the FCR H-reflex for each subject was used to compute a single factor ANOVA. Results: There were no statistically significant differences among group means. The power of the F-test was adequate as determined by 95% CI analyses of the between-group differences relative to the minimal clinically important difference. Discussion and Conclusion: The FCR H-reflex latency is not altered by the presence of CTS.Therefore, an FCR H-reflex latency abnormality in a limb with CTS will be as likely to indicate disfunction along its neural pathway as the FCR H-reflex latency in a limb without CTS.

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    Comparison of Two Methods of Tibial H-Reflex Acquisition and Predictive Value of an Abnormal H/H Ratio in Unilateral S1 Radiculopathy

    Published Year: 2013
    Specialization: Clinical Electrophysiology

    Eisner, William D.

    The primary objective of this study was to compare a novel method of bilateral simultaneous tibial H-relfex acquisition (Hbil) with the traditional method of unilateral acquisition (Huni). Secondary objectives included assessing the reliability of H-relfex measures obtained via the Hbil method and determining the predictive value of an abnormal H/H Ratio obtained with the Hbil method compared with an abnormal side-to-side H-reflex latency difference (Hlat Diff) in the context of unilateral S1 radiculopathy. Tertiary objectives included exploring if any demographic or clinical examination items can predict an abnormal H/H Ratio and determining the ideal upper limit of normal for H/H Ratio in the clinical context of unilateral S1 radiculopathy.

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    Prediction of the Abnormality of the Medial and Lateral Plantar Mixed Nerve Action Potential by Combining Vibration Perception Threshold and Semmes Weinstein Monofilament in Adult Onset Diabetes

    Published Year: 2008
    Specialization: Clinical Electrophysiology

    Elsayed, Gamal Ramadan Hamed

    Background and Purposes: The primary purpose of this study is to determine the effect of combining the measurements of Vibration Perception Threshold (VPI) and Semmes Weinstein Monofilament (SWM), on predicting the abnormality of the Mixed Sensorimotor Potential (MSP) of the medial and lateral plantar nerves in patients with type two diabetes mellitus. The secondary purpose is to determine the segments at the terminal branches of both nerves where combining VPT and SWM highly predict MSP of both nerves. Methods: Two age-matched (40 to 75 years of age) study groups were formed; group A (mean age of 51 years) participants were healthy volunteers with normal MSP of the medial and lateral plantar nerves, and group B (mean age 59 years) participants were patients with type two diabetes mellitus with abnormal medial and lateral plantar MSP. 30 subjects were included in each group. VPT as measured by the Biothesiometer and touch perception threshold as measured by SWM were obtained on six points in the sole of the foot. These points correspond to the dermatomal distribution of the medial and the lateral plantar nerves as follows; the plantar surface of the 1st and 5th toes, the plantar surface of 1st an 5th metatarsals, and the plantar surface of the lateral and medial areas just distal to the heel. The sensitivity, specificity, and the postitive and negative predictive values were obtained for the VPT and SWM in all points both individually and combined. ROC curves were established for VPT and SWM individually and combined to determine the best cutoff points to predict the abnormality of the MSP. Results: Combining VPT and SWM improved the sensitivity to predict the abnormal electrophysiologic response of the MSP of the medial and lateral plantar nerves in all points in both feet. The increased sensitivity was accompanied by little diminution in their corresponding specificity. The points of highest combined sensitivity were the right first and fifth metatarsals with 83.3% and 87%, respectively. The corresponding combined specificity for the right first and fifth metatarsal were 90% and 90%, respectively. The left medial and lateral heel areas sensitivity were 83.3% and 83.3%, respectively, and with corresponding combined specificity of 93.3% and 93.3%, respectively. The plantar aspect of the first and fifth toes combined sensitivity were 80% and 70%, respecitvely with corresponding specificity of 90% and 100%, respectively. The increased sensitivity when both tests are combined is not statistically significant among the terminal segments of both nerves. Conclusions: Combining VPT and SWM on the plantar surface of the foot significantly increases the sensitivity to predict the abnormality of MSP of the medial and lateral plantar nerves.

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    Innovative Procedure for Measuring Motor Nerve Conduction Velocity Across the Carpal Tunnel

    Published Year: 2005
    Specialization: Clinical Electrophysiology

    Elskenidy, Naglaa

    Background: Stimulation of the median nerve in the palm may be a useful addition to the conventional method of stimulation above the carpal tunnel for assessing a lesion of the media nerve through the carpal tunnel. It may be particularly beneficial in cases where the median sensory nerve action potential (SNAP) cannot be obtained because of advanced sensory deficits or in cases of acute carpal tunnel syndrome (CTS). It may also lead to the adoption of new normal values for amplitude measurements of the media nerve compound muscle action potential(CMAP) recorded from the abductor pollicis brevis muscle (APB). Currently, normal values vary from as low as a few millivolts (mV) to as high as 20 mV. Purpose: This primary purpose of this study is to establish a technique for stimulating the motor branch of the median nerve in the palm. In addition, we will report normal values for latency and amplitude and calculate the motor nerve conduction velocity (MNCV) across the carpal tunnel in the wrist to palm segment. Hypothesis: Our hypothesis was that there would be no statistical significant difference in the amplitude of the CMAP recorded from the APB between the stimulation site of the median nerve above the carpal tunnel and at the palmer site. Sample and Method: Healthy subjects with no history of injury or disease that may have affected the median nerves were recruited for the study. Subject’s age ranged between 26-44 years old. A single supramaximal stimulus to the median nerve was applied at the wrist at a point 8 cm proximal to the recording electrode located over the anatomic center of the abductor pollicis brevis muscle. A second stimulation site on the palm was identified at the point where the tip of the ring finger flexes to contact the thenar crease. The thrid stimulation site was located 8 cm proximal from the palm site along the course of the median nerve. The reference electrode was placed on the distal phalanx of the thumb and the ground electrode was firmly positioned over the dorsum of the hand. Both hands were stimulated in a random order. Results: Paired t-test showed no statistical difference in the amplitude of the CMAP between the stimulations of the median nerve at the wrist and at the palm. There was no statistical significance difference in amplitude, latency and MNCV between right and left hand of the subjects. Test re-test reliability was also determined for the stimulation sites. Interclass correlations coefficient (ICC) values were 0.98 for amplitude at the wrist, 0.96 for amplitude at the palm, 0.8 for latency at the wrist, 0.67 for latency at the palm and 0.79 for MNCV. Discussion: Palmar stimulation of the recurrent motor branch of the median nerve can be easily and rapidly performed with little discomfort to the patient. Adding palmer stimulation to the conventional testing procedures may demonstrate cases of acute CTS that have only conduction block and minimal slowing of median motor nerve fibers. Additional studies will be necessary to determine the extent to which these data are similar for individuals with CTS. Conclusion: Adding the palmer stimulation to the typical median nerve assessment through the carpal tunnel can provide valuable information. The testing procedures are reliable and aid in providing a more detailed description of median nerve function through the carpal tunnel.

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    Electrophysiological Response Recorded in the First Dorsal Inerosseous Muscle with Stimulation of the Tibial and Deep Fibular Nerves

    Published Year: 2002
    Specialization: Clinical Electrophysiology

    Galloway, Kathleen Mary

    Foot intrinsic muscle innervation may demonstrate some variability. The first dorsal interosseous muscle (FDI) is innervated by the deep branch of the lateral plantar nerve (LPN) from the main trunk of the tibial nerve. Contribution from the deep fibular nerve (DFN) may also play a role in the supply of the FDI. Thirty healthy adult volunteers were studied to determine the presence and type of response in the FDI, with stimulation of the tibial nerve/LPN and DFN. Both nerves were stimulated at the ankle and knee, with a surface and needle recording from the FDI. Latency, amplitude and conduction values were recorded and preliminary normative data was established. The incidence of deep branch LPN/tibial nerve supply to the FDI was 100% with a mean ankle amplitude of 5.11 mV. The superficial branch of the LPN is most often studied when evaluating for tarsal tunnel syndrome, since the standard recording site is the abductor digiti minimi (ADM). It is possible that selective deep branch involvement may occur, and if so, recording from the FDI may prove valuable.

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    Effect of Reference Electrode Position on Normal Distal Motor Latency and Action Potential Amplitude of the Ulnar Nerve

    Published Year: 2008
    Specialization: Clinical Electrophysiology

    Gomaa, Hala

    There are many conflicting opinions regarding the placement of the reference electrode in ulnar nerve conduction studies. The purpose of this study is ato investigate the effect of reference electrode position on the distal motor latency (DML) and compound muscle action potential (CMAP) amplitude of the ulnar nerve. This study also investigates the effect of gender and dominant versus non-dominant hand (arm) on DML and CMAP amplitude. Methods: Thirty healthy individuals (fifteen males and fifteen females) between twenty-five to fifty years old volunteered for the study. Each participant was screened for ulnar nerve deficits. A Cadwell Sierra II electroneuromyography machine was used to measure the ulnar DML and CMAP amplitude following the testing guidelines of the National Institute for Occupational Safety and Health (NIOSH). Both the dominant and non-dominant upper extremities were tested for both reference electrode distances. The order of testing was randomized. Results: Ulnar distal motor latency was not significantly different between the two tested distances P=0.1675. The mean DML at 3cm was 2.94 mSec and at 5cm was 2.99 mSec, with an absolute difference of 0.0463mSec. CMAP amplitude on the other hand showed statistically significant difference between the two distances P=0.0024. The mean CMAP amplitude for 3cm position was 8.3790mv and for the 5cm position was 9.0432mV, with an absolute difference of 0.6642. Also, the CMAP amplitude measured on the dominant hand was significantly larger than the non-dominant hand (P<0.0001). In male participant there was a significant difference in CMAP amplitude between the dominant and non-dominant hand with means of 9.969mV and 7.3953mV, respectively, and an absolute difference of 2.5737mV. Conclusion: Our study showed that the reference electrode distance of 3 or 5cm from active electrode, did not have and effect on ulnar distal motor latency readings. CMAP amplitude however was reduced at 3cm compared to 5cm. In addition the CMAP amplitude was greater when measured on the dominant hand versus the non-dominant hand. Also, CMAP amplitude was greater on the dominant hand of male participants when compared to the non-dominant hand of male participants.

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    Reliability of Upper Arm Median and Ulnar Motor Nerve Conduction Results in Children and Youth with Cervical Spinal Cord Pathology

    Published Year: 2011
    Specialization: Clinical Electrophysiology

    Hutchinson, David

    Objectives: To investigate the reliability of median and ulnar motor nerve conduction velocity (NCV) results in subjects with mid cervical spinal cord pathology. Secondarily, to investigate the reliability of NCV results in subjects with C5 and C6 motor level classifications as defined by the International Standards for Neurological Classification of Spinal Cord Injury.

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    Sensitivity and Specificity of Tinel’s, Phalen’s and the Hand Diagram in Electrodiagnostically Confirmed Carpal Tunnel Syndrome

    Published Year: 2010
    Specialization: Clinical Electrophysiology

    James, Eric D.

    Objective: To determine the individual and combined specificities and sensitivities of Tinel’s and Phalen’s tests and a Hand Symptom Diagram relative to the widely accepted Criterion Standard Nerve Conduction Studies (NCS) testing for Carpal Tunnel Syndrome (CTS). Design: Correlation study with blind comparison of three clinical examination findings to a Criterion Standard. Setting: Single center, out-patient orthopedic electrodiagnostic laboratory in eastern North Carolina, with patients referred from primary care physicians, orthopedic and specialty physicians. Participants: One hundred three patients, referred for electrodiagnostic examination for any of the following referral diagnoses; CTS, hand numbness or weakness, or arm pain, numbness or weakness. Interventions: Not applicable. Main Outcome Measures: Sensitivity, specificity. Results: Sensitivities and specificities were calculated for the following seven combinations of clinicla tests vs. NCS: Hand Diagram/Tinel’s/Phalen’s, Hand Diagram/Tinel’s Hand Diagram/Phalen’s, Tinel’s/Phalen’s, Hand Diagram alone, Tinel’s alone, and Phalen’s alone. The range of sensitivities and specificities was from .26 to .62, and from .42 to .88 respecitvely. When compared with NCS, the most sensitive tests were the Hand Diagram and the Phalen’s test alone. The combination of the Hand Diagram/Phalen’s/Tinel’s and the combination of the Hand Diagram with Tinel’s test were found to have the highest agreement. No individual clinical test or combination of clinical tests provided specificity and sensitivity equivalent to NCS confirmed CTS. Conclusions: No single clinical examination or combination of clinical examinations is found to be both as specific and as sensitive as electrodiagnostically confirmed CTS. The combination of Tinel’s, Phalen’s and a Hand Diagram was found to be highly specific, but not as sensitive in diagnosing CTS. Both sensitivity and specificity results diminish as individual’s age and provide minimal value for patients over 69 years old. Therefore, electrodiagnostic testing is the recommended procedure for the diagnosis and management of suspected CTS.

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    The Effects of Ischemic Compression and Passive Stretching on Spontaneous Electrical Activity and Participants’ Pain Perception of Myofascial Trigger Points in the Upper Trapezius Muscle

    Published Year: 2005
    Specialization: Clinical Electrophysiology

    Kostopoulos, Dimitrios

    A major goal of physical therapy is to reduce pain associated with trauma. Massaging tender spots to provide relief has been practiced since time immemorial. Ancient and traditional Chinese and Japanese medicine that emphasized acupuncture have documented sensitive areas and tender points on the human body. Over the centuries a body of lore has developed about the various kinds of pain and how they can be treated. The purpose of this investigator is to examine the effects of ischemic compression technique (IC) and stretching in isolation and in combination on the reduction of spontaneous electrical activity (SEA) and perceived pain in myofascial trigger points located in the upper trapezius muscle.

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    The Lumbrical/Interossei Specific Examination of Median/Ulnar Motor Distal Latency, a New Method for Placement of the Recording Electrode

    Published Year: 2003
    Specialization: Clinical Electrophysiology

    LaPlante, Michael Darren

    Introduction: Many techniques and tests are utilized when attempting to evaluate possible carpal tunnel syndrome (CTS), but few seem to have stirred as much controversy as the second lumbrical-interossei examination (2L-INT). In an attempt to shed light on these incongruities among researchers, a study of the test utilizing a new method was completed on normal subjects. Methods: Sixty-three normals subjects (103 hands), meeting inclusion criteria were tested using the recognized 2L-INT examination, although a different method was used for establishing recording electrode placement. This data set was analyzed for statistical similarity to standard tests used for electrophysiologic evaluation of carpal tunnel syndrome. Results: Results of testing are as follows: mean 2L-INT delta, standard deviation, 95% confidence interval, t-test 3.09 to 5.89 with a critical value of 2.093 comparing 2L-INT to standard tests. ANOVA for age group variance at 0.05 significance level, Calculated F=1.34 with a critical F=2.46. Summary and Conclusion: This data set suggests that among normals, the 2L-INT method showed no statistical similarity to standard nerve conduction tests. There was no age decrement when using the 2L-INT examination, though the high mean and high standard deviation also indicate that the acceptable range is too wide for use as a sensitive indicator of carpal tunnel syndrome. This data set is on parity with a number of researchers who have concluded that this exam suffers from many variables that may effect its reliability. Other standardized testing techniques may be nedded to make this test reliable and sensitive in the evaluation of carpal tunnel syndrome.

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    Distal Motor Latency in Hand Intrinsic Muscles: Effects of Less Commonly Considered Sources of Variance

    Published Year: 2008
    Specialization: Clinical Electrophysiology

    Lord, David R.

    Title: Distal motor latency in hand intrinsic muscles: effects of less commonly considered sources of variance. Study Design: A repeated measures within subjects design. Objectives: This study evaluated the effects of six extrinsic examiner or technique-related factors on distal motor latency (DML) of hand intrinsic muscles. Summary of Background Data: DML is an important component in the electrodiagnosis of peripheral neuropathic changes, particularly compression neuropathy. Both extrinsic and intrinsic factors can potentially cause variability in DML. Methods: The study population was compromised of 30 adults, 16 men and 14 women, representing 60 hands. The mean age was 46.7 (plus or minus) 15.9 years (range 24 to 84 years); 96.5% (28/30) of subjects were right-hand dominant. A rapid test-retest protocol was used to study effects of intra-rater reliability, recording electrode replacement, hand posture, recording sensitivity, reference recording electrode site, and presence of premotor waves or initial positive deflections on DML in the abductor pollicis brevis (APB), abductor digiti quinti (ADQ), second lumbrical (SL), second interossei (SI), and the SL – SI Differential. Repeated measures ANOVA and paired t Tests with Bonferroni Correction were used to compare findings and detect significant differences. Descriptive statistics were reported for the premotor waves and initial positive deflections. Results: Intra-class Correlation Coefficients showed excellent intra-rater reliability across two DML measurement trials for the SL, SI, and SL – SI Differential. Removal and replacement of electrodes caused no significant effect on DML or the SL-SI Differential. Significant effects were detected for changes related to hand posture in the SLand SL-SI Differential, for recording sensitivities in all muscles and the SL-SI Differential, and for different reference recording sites in the SI and SL-SI Differential. The incidence of premotor waves and initial positive deflections was greater in the SL and SI than in the APB and ADQ, and their presence appeared to shorten DML using the particular measurement protocol described. Conclusions: In this study, DML in hand intrinsic muscles could be reliabily measured and replicated. Hand posture, recording sensitivities, and reference recording sites, were demonstrated to significantly affect DML in specific muscles. These effects were clinically relevant and should be carefully controlled during DML testing. The origins of disruptions of the baseline preceding the main motor response need to be identified and controlled.

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    The Effect of Carpal Tunnel Syndrome on the Median Mixed Nerve Forearm Potential

    Published Year: 2013
    Specialization: Clinical Electrophysiology

    McKibben, Richard J.

    Objectives: The purpose of this study was to report the differences in the wrist – elbow median mixed nerve forearm evoked potential (WEmix) in subjects with carpal tunnel syndrome (CTS) and a control sample; identifiy correlations and predictive relationships between traditional nerve conduction (NCS) measures of CTS and WEmix; highlight methodological considerations for varying reports in the existing literature pertaining to WEmix; and discuss implications for the clinical use of WEmix and opportunities for further research. Background: The literature is clear that induced axon loss in animals and not demyelination result in RAA which is also time depenedent. There is controversy regarding WEmix as a measure of retrograde axonal atrophy (RAA) in CTS and there are several methodological considerations that may explain this debate. Subjects and Methods: A convenience sample of 38 subjects with electrophysiological evidence of CTS and 31 control volunteers who met the inclusion criteria comprised the sample. Standard NCS used to determine CTS as well as direct and indirect mixed NCS in the forearm were obtained in all subjects. Two-way analysis of variance, Pearson’s correlation coefficients and multiple regressions were used to evaluate the data. Results: There were significantly different findings between groups in all traditional NCS, WEmix and Altmix parameters. There were mild to moderate correlations between WEmix parameters and some traditional NCS measures of CTS. There were significant regressions in WEmix amplitude and velocity with median sensory and motor amplitude. Conclusions: There is a difference in WEmix amplitude and velocity between control and CTS subjects. Measures of axon integrity are predictive of RAA as measured by WEmix, which is consistent with the animal literature. Future research should consider severity and duration of CTS as well as multivariate statistics in the evaluation of WEmix as a measure of RAA. WEmix has potential clinical utility. Normative studies and use of WEmix in the differential assessment of a variety of clinical conditions is suggested.

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    The Relationship between Skin Temperature and Neuronal Characteristics in the Median, Ulnar and Radial Nerves of Non-Impaired Individuals

    Published Year: 2005
    Specialization: Clinical Electrophysiology

    Moses, Babu

    The purpose of this study was to evaluation the relationship between the nerve conduction characteristics in the median, ulnar and radial nerves and presenting skin temperature in non-impaired individuals as they were subjected to electrophysiological testing. Previous researchers artificially manipulated the skin temperature and demonstrated that there was a positive relationship between temperature and nerve conduction velocity and a negative correlation between distal latency and evoked motor action potential (EMAP). The sample population was 50 non-impaired individuals derived from a venue in the New York City and Long Island region. The independent variable was skin temperature. The dependent variables were: motor nerve conduction velocity, motor distal latency, EMAP of median and ulnar nerves, sensory distal latency and sensory nerve action potential (SNAP) of median, ulnar and radial nerves. The data were analyzed using descriptive statistics, the Bonferroni correction factor and correlation statistics. The study showed significant correlation in median motor distal latency, ulnar motor distal latency, ulnar sensory distal latency, median sensory amplitude, and ulnar sensory amplitude. The NCV, the distal latency and the amplitude of the median, ulnar and radial nerves were similar in value to other researchers’ normal values.

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    Normative Values for Ulnar Motor Nerve Conduction to the Adductor Pollicis (AP) Compared to the First Dorsal Interosesous (FDI) and Abductor Digiti Minimi (ADM) Muscles in Asymptomatic Normal Adults

    Published Year: 2006
    Specialization: Clinical Electrophysiology

    Palazzo, John J.

    Ulnar neuropathy across the elbow (UNE) is a type of upper extremity mononeuropathy commonly referred for electrodiagnostic testing (EDX). The purpose of this descriptive normative study on healthy adults was to determine normal ulnar motot nerve conduction values across the elbow using the adductor pollicis (AP) muscle as a recording technique. The AP recording site was selected as the focus of this study based on frequent clinical observation of weakness of this muscle in suspected cases of UNE and the lack of information about recording from this muscle. Comparisons were also made to standard recording techniques using the abductor digiti minimi (ADM) and first dorsal interosseous (FDI) muscles. Methods: After signed consent 88 upper limbs in 44 healthy subjects were studied with a standardized battery of ulnar NCV tests performed when using surface stimulation and recording from the AP, FDI and ADM muscles. Conduction velocity was computed for the across elbow and forearm segments and amplitudes were recorded from three stimulation sites; wrist, below elbow and above elbow. A pain history and a battery of clinical tests were administered to measure hand strength and point tenderness. Results: The AP muscle recording site yielded compound muscle action potentials (CMAP) with consistent and reproducible amplitudes and waveforms. Normal values were computed for ulnar motor conduction velocity across the elbow and amplitude measurements for each of the three muscle sites. The null hypothesis was accepted as no statistical difference was found comparing elbow conduction velocity values recorded from the three muscles. Mean (SD) elbow conduction velocity for the AP, FDI and ADM recording sites was 60.9 (6.1), 61.1 (7.0) and 61.8 (7.0) m/s, respectively. Using the traditional mean – 2 SD method for computing the absolute lower limits of normal (LLN) determined cutoff values for elbow conduction velocity of 48,47 and 48 m/s using the AP, FDI and ADM, respectively. The 95th percentile method for the LLN produced higher cut off value for each muscle site at 51, 50 and 51 M/S for the AP, FDI and ADM, respectively. Higher CMAP amplitudes recorded on wrist compared to elbow stimulation correlated with the presence of an MGA innervation patter. This pattern appeared most often when recording from the AP muscle. Pain history and clinical tests of hand strength and elbow and hand tenderness revealed no correlation to elbow conduction velocity. Conclusion: Ulnar motor nerve conduction velocity across the elbow and forearm is the same when recording from the AP, FDI and ADM muscles. The normal values for ADM and FDI were comparable to those of prior reports. Conduction velocity and amplitude reference normals were determined for the AP muscle. Use of the alternate AP muscle site in clinically positive cases of UNE, particularly in the presence of AP muscle weakness, may help to identify conduction defects at the elbow in the case of selective ulnar motor fiber involvement and when traditional tests using the ADM muscle are normal. In addition to the AP muscle technique may enhance identification of the MGA anomalies with or without elbow conduction defects. A future study on a patient population with confirmed UNE is suggested to determine the sensitivity and specificity of the AP muscle recording technique and to assess its clinical utility in early identification of UNE pathology.

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    A Comparison of the Intra-Subject Differences in the Bilateral Compound Muscle Action Potential Maximal Amplitudes for the Upper Trapezius Muscle Responses in Asymptomatic Subjects

    Published Year: 2004
    Specialization: Clinical Electrophysiology

    Read, Richard L.

    Background: Electrophysiologic tests are utilized in the evaluation of patients reporting pain and/or sensory changes in peripheral nerve distributions. Nerve conduction studies reporting latency, compound muscle action potential (CMAP) maximal amplitude, and conduction velocity are useful components of that evaluative process. Latency and CMAP maximal amplitude values are reported in the literature as revealing no significant side-to-side differences. Changes in the CMAP maximal amplitude are associated with either partial or complete axonal loss (conduction block). The side-to-side differences in CMAP maximal amplitude, when reported, are usually reported as a percentage difference. A percentage difference greater than 50% has been reported as significant. The need to attain such a large percentage difference may lead to an increased risk of failing to identify a conduction block when in fact one exists. The ability to identify a conduction black of the Spinal Accessory Nerve (SAN) is useful in evaluating patients with shoulder girdle, neck, and craniofacial pain. In order to identify a conduction block involving the SAN, it is necessary to know the normal numeric range (mV) of the side-to-side difference of the CMAP maximal amplitude of the SAN. Purpose: The purposes of this research project were to (1) analyze the intr-subject side-to-side CMAP maximal amplitudes of response recorded from the upper trapezius muscles for significant difference and (2) perform a simple linear regression analysis in order to determine if there was a linear relationship between the left and right side responses and if the ipsilateral response could be used to predict the contralateral response with both a 95% confidence interval and 95% prediction interval plotted for the population mean. Methods: The study design was descriptive research, reporting on normative data from a sample of 25 asymptomatic volunteer subjects, ranging in age from 24 to 69 years of age. Measurements of the CMAP maximal amplitudes for the ipsilateral and contralateral upper trapezius muscles were recorded. Informed consent was obtained from all subjects. The Internal Review Board of Rocky Mountain University of Health Professions approved this study. Data Analysis: Data analysis was performed using a two-tailed, dependent Student’s t test with an a=.05 and a 95% confidence interval for the population mean. A linear regression analysis was performed in order to determine if there was a linear relationship between the left and right side responses with both a 95% confidence interval and 95% prediction interval for the population mean. Results: Paired, dependent Student’s t-test for the mean of the absolute difference for the left and right CMAP maximal amplitudes revealed no significant difference. Linear regression analysis revealed a linear relationship between the variables with the points clustered about the fitted lines and a strong positive correlation for predicting the contralateral response based upon the ipsilateral response. Conclusion: In a asymptomatic adult population, the mean of the absolute difference between the ipsilateral and contralateral CMAP maximal amplitudes of response for the upper trapezius muscle is not significant. The side-to-side mean of the absolute difference, carried to 2 standard deviations, should not exceed 2.07 mV with 95% confidence. Linear regression analysis revealed a strong positive correlation for predicting the contralateral response based upon the ipsilateral response. These results may be useful in evaluating a patient with a suspected SAN neuropathy.

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    The Sensitivity and Specificity of Short Segment Transcarpal Median Motor Testing in Carpal Tunnel Syndrome

    Published Year: 2016
    Specialization: Clinical Electrophysiology

    Romero, Leon Constantine

    The purpose of this study was to explore the clinical utility of short segment wrist-to-palm median motor velocity testing (WPM) in subjects with carpal tunnel syndrome (CTS), to determine the best WPM cutoff value for CTS detection and to compare the statistical characteristics of WPM to other standard nerve conduction tests.

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    Electrophysiologic Measures of Ulnar Sensory Nerve Function: Reference Values and Reliability of the Measure

    Published Year: 2008
    Specialization: Clinical Electrophysiology

    Ruediger, Thomas Mark

    Objective: This was a descriptive and exploratory study. The purpose was to determine reliability and clinical reference values computed with approriate statistical methods for electrophysiologic measures of ulnar sensory nerve function using data from healthy subjects obtained with the recommended elbow testing position. Methods: Antidromic sensory nerve conduction studies of the ulnar nerve using surface electrodes were performed on 100 disease free volunteers. Sensory nerve evoked potentials were elicited from stimulation at the wrist, below-elbow, and above-elbow sites in all subjects. Sensory distal latency (SDL) and sensory nerve conduction velocity (SNCV) were calculated to both the onset and to the peak of the evoked potentials; sensory nerve action potential (SNAP) amplitude was measured from onset to negative peak of the evoked potential. Thirty subjects were tested a second time to collect data for intrarater reliability analyses. Multiple linear regression models were constructed to examine the use of age, body mass index, gender, and finger girth to predict forearm and across-elbow SNCV and SNAP amplitude. Results: Responses were obtained from all subjects. Intraclass correlation coefficients were greater than 0.85 for all paired measures of SDL, SNCV, and SNAP amplitude. Reference values were computed from data optimally transformed to minimize skew. Reference values were: SDL measured to onset and peak 2.34 msec and 3.11 msec; forearm SNCV measured to onset and peak 54 m/sec and 53 m/sec; across-elbow SNCV measured to onset and peak 47 m/sec and 5 m/sec; SNAP amplitude from wrist, below elbow, and above elbow stimulation 10.79uV, 4.66uV, and 3.33uV respectively; SNAP amplitude decrement across the elbow 46%. No independent variable accounted for more than 5% of the variance in across-elbow SNCV; finger girth accounted for approximately 28% of the variance in above-elbow SNAP amplitude. Conclusion: Ulnar SDL, SNCV, and SNAP amplitude are reliable measures. Reference values for SNCV and SNAP amplitude were computed using recommended statistical methods and elbow position. No strong statistical models for prediction of SNCV or SNAP amplitude could be derived from the limited set of predictor variables. The reliability analyses in the current study, combined with relatively low level of measurement error, suggest that these ulnar sensory reference values computed using the recommended elbow position and appropriate statistical methodology may be used with confidence.

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    Effect of Recording Electrode Size on Median Motor Nerve Conduction in Healthy Subjects

    Published Year: 2007
    Specialization: Clinical Electrophysiology

    Sadek, Azza Ahmed

    The use of recording disposable electrodes of different sizes has recently become an increasingly popular practice. Determining the appropriate size of recording disposable electrodes is essential to have accurate nerve conduction study measures. The purpose of this study is to determine if there is a liner trend between the recording disposable electrodes by measuring distal motor latency (DML) and compound motor action potential (CMAP) of the median nerve when recording with three different disposable electrode sizes. Large electrodes have the capability to pick up more motor unit potentials during testing. It was hypthothesized that the greater the electrode size, the greater the significant difference in median DML and CMAP that is detected compared to a small size electrode. Twenty-two adult volunteers within the age range of 19-49 years old participated in the study. The Sierra II-a four Channel electromyograph (EMG) machine with a laptop computer and two channel amplifier was used in the study. Disposable electrodes of different sizes by Cadwell Laboratoraties, Inc. were used with Sierra II. The testing electrodes used in the study were Silver/ Silver chloride disposable tabs self-adhering electrodes of 1.61 cm (squared) surface area, Silver/ Silver chloride disposable tabs self-adhering electrodes of 5.65 cm (squared) surface area, and disposable disc self-adhering electrodes of 3.63 cm (squared) surface area. The Silver/ Silver chloride disposable electrodes of 14.11 cm (squared) surface were used as ground electrodes. A metal disc electrode of 1.03 cm (squared) surface area was also used in the study as a control measure to record median DML and median CMAP. This commonly used electrode in the clinical field is known to obtain recording with less artifact and with less evoked potential bias. Each test was applied to the dominant hand using supramaximal stimulation and following National Institute of Occupational Safety and Health (NIOSH) guidelines. General linear models regression analysis and repeated measures analysis of variance test (ANOVA) were used to determine if the mean readings for the four electrodes differed significantly. The results revealed no significant difference between the four disposable recording electrode sizes in detecting median DML and significant difference in detecting median CMAP when used electrode of 5.65 cm (squared) surface area in normal subjects. The results of this study rejected the predicted the hypothesis for DML and accepted the hypothesis for CMAP. Electrode size has no significance on median DML while it has significance on median CMAP recording. Recording electrodes with a surface area between 1.61 to 3.63 cm (squared) are recommended to be used for routine nerve conduction studies in order to have accurate measurements.

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    Nitrous Oxide With Propofol Reduces Somatosensory Evoked Potential Amplitude in a Pediatric Population

    Published Year: 2002
    Specialization: Clinical Electrophysiology

    Schaney, C. Raymond

    Somatosensory evoked potential amplitude measurements are used to determine spinal cord function during surgery to correct idiopathic scoliosis, as well as other surgry around the spinal cord. A significant decrease in amplitude of the corticol response may indicate that neural conduction in the spinothalamic tracts is compromised. However, if the amplitude decrease is caused by anesthesia, it represents an innocuous event. Nitrous oxide is known to significantly reduce the corticol somatosensory evoked potential amplitude in adults, but little is known regarding its effect on children. This study evaluates the effect of nitrous oxide combined with propofol on the amplitude of the corticol response in children. The hypothesis is that the corticol amplitude would decrease 50% when nitrous oxide is combined with propofol compared with propofol alone.

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    Therapeutic Continuous Ultrasound as a Diagnostic Tool for Median Neuropathy At or Distal to the Wrist

    Published Year: 2004
    Specialization: Clinical Electrophysiology

    Schrank, Edward C.

    Study Design: Prospective cohort design. Objective: To determine the diagnostic accuracy (sensitivity, specificity, positive and negative likelihood ratio) of 1 MHz conintuous therapeutic ultrasound in identifying median neuropathy at or distal to the wrist in a patient population. Background: Diagnosis and management of median neuropathy at or distal to the wrist (carpal tunnel syndrome) remains and expensive and often times perplexing endeavor. Diagnosis of median neuropathy at or distal to the wrist is primarily accomplished via clinical presentation, provacative tests and electrophysiological testing. While the senistivity and specificity of electrophysiological testing is relatively high, the monetary cost of performing these types of tests can be prohibitive as well as uncomfortable for the patient. A test that would provide for ease of use, patient comfort and provide high diagnostic accuracy would save money and time for both the patient and clinician. Therapeutic ultrasound applied to the median nerve at 1 megahertz has been proposed as a provacative test to elicit symptoms consistent with median neuropathy at or distal to the wrist. Methods: Forty two subjects with symptoms of pain, weakness, numbness or tingling that involved the hands, upper extremity or neck participated in this study. Continuous, 1 megahertz, therapeutic ultrasound was applied to the involved distal wrist over the margins of the carpal tunnel at four intensities for a duration of 5 seconds at each intensity. Subjects’ response to the ultrasound was recorded at each level. A postive response was recorded if the subject indicated any of the following: reproduction of their symptoms, numbness, tingling, pain/discomfort at the wrist or pain/discomfort radiating to the fingers. The diagnostic accuracy (sensitivity, specificity, positive and negative likelihood ratios) of the ultrasound test to detect median neuropathy at the wrist was calculated using nerve conduction velocity testing as the criterion standard. Conclusions: The diagnostic accuracy (sensitivity, specificity, positive and negative likelihood ratio) of 1 MHz continuous therapeutic ultrasound in identifying median neuropathy at or distal to the wrist in a patient population was found. The primary finding of this study was that a protocol utilizing therapeutic continuous ultrasound at 1 MHz was at least as effective in identifying subjects with median neuropathy at or distal to the wrist as common clinically utilized physical examination signs, but not as accurate as nerve conduction testing.

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    The Use of Electrophysiological Evaluation in Peripheral Nerve Injuries in Thoroughbred Foals and Yearlings

    Published Year: 2001
    Specialization: Clinical Electrophysiology

    Sellin, Robert A.

    Background and purpose: Electromyography (EMG) is an important diagnostic toll in the study of Thoroughbred foals, and other horses with neurologic disorders. This case study was designed to follow, in a serial manner, a Thoroughbred foal with an isolated peripheral lesion of the axillary nerve. Subject: A Thoroughbred foal with a suspected lesion of the axillary nerve. Methods: Serial electromyographic analysis was performed on a monthly basis for six months. Electromyographic findings were correlated with the phyisical exam and functional progress of the subject. Results: Electromyographic testing revealed a severe isolated lesion of the left axillary nerve. Serial testing revealed a slow neural regeneration process. The return of muscle girth is less likely in muscles with severe atrophy, and little EMG evidence of neural regeneration, three months post injury. In this case, a foal with severe isolated unilateral loss of the deltoid muscle showed little electrophysiologic, or muscle girth improvement, but returned to full function. Conclusions and Discussion: Electromyography is of great benefit in the differential diagnosis of peripheral nerve injuries in horses. By isolating the location and severity of a nerve lesion, the EMG data can be valuable in developing a prognosis for neurologic improvement. Additional EMG research may be clinicians develop patterns of functional return in horses with specific peripheral nerve lesions.

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    The Effects of Latent Myofascial Trigger Points on Muscle Activation Patterns During Prone Hip Extension

    Published Year: 2009
    Specialization: Clinical Electrophysiology

    Silver, Herbert L.

    Purpose: Alterations in lower extremity muscle activation patterns (MAPs) of the gluteal, hip abductors, and erector spinae muscles have been associated with the presence of myofascial trigger points (TPs). TPs are focal tender areas in muscles and are associated with musculoskeletal pain. Latent myofascial TPs (Latent TPs) are tender areas in the muscle that do not cause familiar pain when palpated but have been shown to contribute to altered MAPs in scapular muscles and gluteal muscles. This study compared changes in MAPs under three test conditions in subjecets who present with latent TPs in the gluteus medius muscle. Methods: A single blind, randomized controlled block design with subjects stratified based on gender was used to compare changes in MAPs in three groups of subjects who presented with Latent TPs. Group 1 received no treatment, Group 2 was treated with a stretch of the gluteus medius muscle and Group 3 was treated with dry needling of Latent TPs in the gluteus medius muscle. This study quantified, using surface electromyography (sEMG), changes in MAPs during prone leg lift. MAPs were collected at two points in time: immediately before and after the intervention. For the dry needling group, qualitative data were gathered including subjective responses of the sensation experienced and descriptions of referral patterns. Subjects: Using a sample of convenience, 64 volunteers, ages 22-43, were recruited from the Georgia State University Division of Physical Therapy and assessed for the presence of gluteus medius latent TP(s). From that pool of eligible participants, 47 were randomly selected in a consecutive manner until all 3 groups were filled. Outcomes: Repeated measures analysis of variance with the Greenhouse-Geisser correction was used. No changes were found in MAPS from before to after the three interventions of rest, gluteus medius stretch, and dry needling during the prone leg raise, and there were no between group effects. The relative prevalence of latent trigger points in the non-symptomatic sample was similar to that presented in other studies. Subjective responses to dry needline were consistent with published reports of referral patterns. The lead researchers observed local twitch responses with dry needling, an unexpected finding given that a local twitch response is more commonly associated with active TPs rather than latent TPs. Relevance: Latent TPs are associated with movement dysfunction. The results may help in the design of future studies of latent TPs using sEMG as a measurement.

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    Median Nerve Transcarpal Motor Conduction Normative Amplitudes and Velocities Using a Unique Approach

    Published Year: 2013
    Specialization: Clinical Electrophysiology

    Sweet, Jeffrey A.

    Rationale: Electrodiagnostic assessment of the median nerve is one of the most commonly used parameters in clinical electrophysiology and is routinely used to assess for carpal tunnel syndrome (CTS). However, few studies have looked at the velocity and amplitude changes of the median motor nerve when stimulating at the wrist and palm. Purpose: The purpose of this study was to establish normative values for palm and wrist amplitudes and conduction velocity across the wrist for median motor nerve transcarpal testing using a unique technique. Compound muscle action potentials (CMAPs) were recorded at the palm and wrist from normal subjects and were analyzed to established the normative data for transcarpal velocities and amplitudes. Research Goals: The goal of this research was to determine normative CMAP latencies, amplitudes and conduction velocities for transcarpal median motor nerve conduction using a unique approach. We also determined if there was a difference in amplitudes between the palm and wrist sides in normal subjects. Population: 70 hands from 35 healthy, symptom free, volunteer subjects betwen the ages of 24 to 49 without history or signs/symptoms of pathology to the median nerve. Method: While recording from the abductor pollicis brevis (APB) muscle, supramaximal stimulation was first applied in the mid-palm where the tip of the flexed ring finger touches the thenar crease. A second, supramaximal stimulation was applied at the wrist, 8cm proximal to the palm site along the course of the median nerve. Results: An independent t-test showed no statistical difference in the amplitude of the compound muscle action potentials from the palm and wrist. Normal palm latency was 2.07 msec plus or minus .60. Normal wrist latencywas 3.66 msec plus or minus .66. Normative values for palm and wrist amplitude as well as conduction velocity across the wrist were also determined using the mean plus or minus 2 SD. Normal palm amplitude was determined to be 10.18 plus or minus 4.48mV. Normal wrist amplitude was 9.63 plus or minus 4.08 mV. Normal conduction velocity between wrist and palm is 50.40 plus or minus 7.16 m/sec. The technique used was found to have a desired intrarater reliability based on the results of the intraclass correlation coefficient (ICC) testing, amplitude ICC=.94 and conduction velocity IC=.92. Conclusions: This paper provided a new and unique approach to transcarpal median motor nerve testing and provided a set of normative data.

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Geriatrics

    Correlational Study of the National Institutes of Health Stroke Scale with Older African Americans with Acute Stroke

    Published Year: 1
    Specialization: Geriatrics

    Burnett, Carole Campbell

    Background and Purpose: Stroke or cerebrovascular accident is a leading cause of neurological impairment and long term disability in the older adult. Projections of the elderly indicate they are more vulnerable to stroke than in the general population. African Americans experience not only a higher stroke incidence than whites, but also higher stroke mortality and, among stroke survivors, worse residual physical impairments. Because of these impairments, a valid and reliable measure of stroke impairment is needed that can be utilized in an acute hospital setting to determine the most appropriate rehabilitation plan for African American patients. The National Institutes of Health Stroke Scale (NIHSS) has been determined to be a valid and reliable tool for patients with an acute stroke. However, few data exist about the appropriateness of this instrument for African American stroke survivors. Therefore, the purpose of this study was to determine the reliability of the National Institutes of Health Stroke Scale (NIHSS) for African Americans with an acute stroke. Methods: This study was a reliability/correlational study of African Americans who were admitted to the hospital with the diagnosis of a cerebrovascular accident. On admission to an acute, urban hospital, patients with the diagnosis with an acute CVA were referred to physical therapy by the primary physician, and within 48 hours of referral underwent a physical therapy examination. Part of the initial examination included the National Institutes of Health Stroke Scale (NIHSS) and patients were re-examined three months post discharge with the NIHSS. The main outcome measures were the comparison of the initial score and the score 3 months post discharge. Results: The study included a cohort of 35 older African Americans between 60 and 92 years of age. Sixty percent of the subjects were under 80 years of age; 77% women; 23% men; 57% had a left cerebral insult and 43% had a right; 83% had a thrombus. A Pearson product correlation, Spearman rho correlation and Chi Square were done to determine level of significance and test of independence. A significant relationship was found between the initial score and the repeat score and discharge destination at p<.01. There was a less significant relationship found between the intitial score and gender at the p<.05. There was no relationship found between the initial score and repeat score for side of lesion, patient age or type of CVA. Conclusions: The test-retest reliability coefficient for the initial raw score and the repeat raw score was strong. The NIHSS identified the severity level of neurological involvement in this cohort of African American subjects with an acute stroke. The NIHSS appears to be a useful tool for physical therapy clinicians in determining destination and rehabilitation planning for African American patients after an acute stroke, but more study is needed.

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    Reliability and Predictive Validity of the Physical Performance Test in People with Dementia

    Published Year: 2008
    Specialization: Geriatrics

    Farrell, Mary K.

    Purpose: Approximately 30% of older adults have dementia. Disease progression has been found to be the largest predictor of function, and dementia has been found to influence fall risk. In order to identify individuals with dementia that may benefit from interventions to increase function and decrease fall risk, assessment tools for these domains that are validated in this population are necessary. The 7-item physical performance test (PPT) is a valid measure of balance and function in older adults; however its reliability has not been established in those with dementia. The purpose of this study was to establish intra-tester, inter-tester, and test-retest reliability of the 7-item PPT in people with dementia. Methods: Thirty-three subjects with a diagnosis of dementia and a Mini Mental State Exam (MMSE) score between 10 and 24 were tested with the PPT on two separate days with performance on the second day videotaped. One tester scored the videotaped performance on two separate occasions and intra-tester reliability was determined using an ICC. Two testers independently scored the videotaped performances and inter-tester reliability was determined using an ICC. Scores from the first and second testing days were compared and test-retest reliability was determined using an ICC. Results: All subjects completed both testing sessions and reliability was established for intra-tester, inter-tester, and test-retest with ICCs of .99, .96, and .90 respectively. Conclusion: The 7-item PPT is reliable for use in people with mild to moderate dementia as defined by MMSE scores between 10 and 24.

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    Utilization of a Screening Tool to Identify Homebound Older Adults at Risk for Falls: Validity and Reliability

    Published Year: 2003
    Specialization: Geriatrics

    Flemming, Patricia Johnson

    Purpose: This study examined the reliability and validity of a Falls Risk Assessment (FRA) tool developed to identify risk factors associated with falls in homebound older adults. Design and Methods: FRA scores of 307 Medicare-eligible adults over 65 admitted sequentially to a home health agency (HHA) were analyzed retrospectively using a case-control design. 18 subjects participated prosepctively in assessment of criterion-related validity and rater reliability. Results: Mean FRA scores of “fallers” were significantly higher than “non-fallers”. The FRA and Performance Oriented Mobility Assessment (POMA) demonstrated a strong negative correlation, utilizing a Pearson correlation. Using percent agreement, FRA scores of nine raters yielded 94.74% agreement. Kuder-Richardson (KR)-20 anlysis yielded internal consistency of .98, .97, and .98 within subjects scored, indicating high consistency among raters. An intraclass correlation coefficient of .83 supports intra-rater reliability. “History of recurrent falls” was the only significant predictor in logistic regression. Implications: Data support use of the FRA in screening for fall-related risk factors in homebound older adults.

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    Functional Recovery Following Hip Fracture In the Subacute Setting

    Published Year: 2005
    Specialization: Geriatrics

    Ganz, Sandy B.

    Background: Over 250,000 hip fractures occur in the United States annually. Three out of five hospitalizations attributable to injury among persons over 75 were for fractures. Greater than 50% were hip fractures. Purpose: The purpose of this study is to describe the functional recovery following hip fracture in the sub acute setting utilizing performance based measures. Method: This is a prospective observational cohort. Data Analysis: Descriptive statistics were used for baseline characteristics. Repeated measures analysis using a Bonferroni correction were utilized to compare admission and discharge performance based measure scores. Results: Eighty residents were enrolled in the study, of which seven were withdrawn due to medical complications and 1 subject expired within one week of admission. Data were analyzed for 72 subjects. There were 59 females and 13 males ranging in age from 63-99. Mean age was 85.3. The patient profile was as follows: 53% lived alone, 63% were Medicare recipients, 50% used an assistive device prior to hip fracture, 46% sustained a femoral neck fracture, 57% underwent a bipolar hemiarthroplasty, 90% received epidural anesthesia, and 90% had a weight bearing status as weight bearing as tolerated. Conclusion: The results of this study demonstrated that objective measures of physical performance utilizing the timted up and go test, Tinetti gait and balance test, and the six minute walk test has been described in a sub-acute setting. There was a significant improvement between admission and discharge performance based measure scores in those who underwent surgical repair of a hip fracture following a fall.

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    Comparison of Work Injuries for Younger Versus Older Workers in the Health Care Industry in North Dakota

    Published Year: 2003
    Specialization: Geriatrics

    Johnson, Beverly Jane

    Background and Purpose: Billions of dollars are spent annually for medical costs and indirect costs associated with work injury. The current economic climate and discussion of raising the retirement age may necessitate the worker to continue in the work force to an older age. The purpose of this study was to define similarities and differences in the prevalence, cost, length of time off work, and cause of work injuries common to the older worker as compared to the younger worker. Subjects and Methods: All injured employees in the state of North Dakota working in health care facilities during the fiscal year July 1, 1999, to June 30, 2000, were considered for inclusion in the data analysis. Subjects were categorized according to age: less than 40 years, 40-59 years of age, and over 60 years of age. Descriptive and analytical statistics were used to investigate differences among age groups relative to the prevalence of injury, cost of injury, cause of injury, and body part injured. Results: The largest number of injuries occured in the youngest age group. There was no significant differences in totoal cost between the younger and older age group; however, a Kruskal-Wallis ANOVA demonstrated a significant difference in total cost between the youngest and middle-aged group with the middle-aged group experiencing the highest total cost. There were no significant differences in days off work among the groups. A Chi-square Test of Independence demonstrated a significant relationship between age and cause of injury and between age and body part injured. Conclusion: The total cost of a work injury, body part injured, and cause of work injury were related to age. Time off work following injury was not related to age. The middle-aged health care worker experienced the highest work injury costs. The older worker was more likely to sustain an injury as a result of a slip or fall and the younger worker was more likely than the older worker to sustain an injury due to a strain. Even though the upper extremity was the most common body part injured across age groups, the older workers were more likely to sustain an injury to the lower extremity, while the younger worker was more likely to sustain an injury to the spine. An understanding of the injury profile is necessary to develop and injury prevention program to meet the needs of the employee and the work setting.

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    Incontinence as a Fall Risk Factor in Older Adults: A Qualitative Study

    Published Year: 2008
    Specialization: Geriatrics

    Lookabaugh-deur, Holly J.

    Background and Purpose: While urinary incontinence is considered and intrinsic fall risk factor, there is a paucity of descriptive research on the relationship between urinary incontinence and falling. The purpose of this qualitative study was to investigate fall episodes and urinary incontinence from the perspective of the older adult. Methods: A phenomenologic approach to inquiry was used to explore the life experiences of individuals over age 65 diagnosed with urinary incontinence, who reported a fall within the previous 6 months. Nine semi-structured interviews were analyzed using an inductive, constant-comparative approach. Results: Five primary themes were identified. The most prevalent theme was the distraction/focus factor, described as a change in behavior as the participant focused on mobility skills to negotiate toileting facilities. The second theme was the urgency/rushing factor, with marked changes in gait patterns reported during toileting activities. Theme three, the fear/safety factor, emerged as participants described methods for avoiding the consequences of falls, such as limiting activity or under-reporting falls to family members. Discussion: Insights into the fall experience relating to urinary incontinence management are described. An expanded understanding of the role of urinary incontinence as a risk factor for falling is presented, directing recommendations for potential assessment and intervention strategies as well as future research in the important field of fall prevention.

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    Fall Risk Assessment in Home Care: A Description of Clinical Decision Making, Knowledge, and Practice of Physical Therapists in One Florida Agency

    Published Year: 2009
    Specialization: Geriatrics

    Ronis, Deborah L.

    The purpose of this study was to describe physical therapists use of fall risk assessments in their home care examinations. It is not known if, or how often, physical therapists assess fall risk in older adults with diagnoses of muscle weakness and/or abnormality of gait in the home care setting.

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    Increasing Patient Participation: The Effects of Training Physical and Occupational Therapists to Involve Geriatric Patients in Treatment Planning

    Published Year: 2005
    Specialization: Geriatrics

    Tripicchio, Robert J.

    Context: Physical and occupational therapists fail to involve patients to the optimal extent possible during the concerns clarification and goal setting process. Objective: Can training physical and occupational therapists in the Ozer Payton Nelson Model improve their ability to seek patient participation in the concerns clarification and goal setting process? Design: Quasi-experimental pretest-posttest one-shot own control group. Setting: Home health and skilled nursing facilities environments. Patients or Other Participants: Thirty-five emplyees of a subcontract company were approached to participate in the study. Convenience sampling was used. Twenty-four subjects completed all phases of study. Inclusion criteria of subjects: full time or part time employees of company, all speak English as their primary language, all have a license to practice in Illnois. Intervention: Treatment Planning for Rehabilitation: A Patient-Centered Approach. Not diagnosis dependent and can be used for physical and occupational therapists. Five 90-minute time spaced experiential training sessions conducted by researcher. Outcome: A twenty-three criterion-based assessment tool that measures the ability of therapists to seek patient participation in concerns clarification and goal setting process. Results: Ten criteria items demonstrated statistically significant differences in frequencies from pretest to posttest scoring. Conclusion: The study validates the premise that the Ozer Payton Nelson Model can have a positive effect on ten of the critical skill dimensions that therapists need in order to effectively involve patients in a higher level of patient participation within three weeks post training.

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    Understanding Exercise Behavior Change in Older Women

    Published Year: 2006
    Specialization: Geriatrics

    Weddle, Mary Lee

    Purpose: Levels of physical activity in the United States population are inadequate. Since women generally live longer than men, and are less apt to engage in physical activity than men, it is important to understand how older women can successfully change their physical behavior. The purposes of this study were to 1) review the literature published on exercise behavior in older women and 2) to describe the experience and meaning of exercise behavior change of healthy women who began exercising after 50 years of age. Method: A literature review on physical activity or exercise in older women was conducted. The review was limited to studies that reported on healthy, community dwelling women, 65 years of age or older. Additionally, a study was conducted that used the phenomenological method in which participants were interviewed about their experience of exercise and exercise behavior change. Interview transcripts were analyzed to reveal the structure and essense of women’s lived experience of exercise behavior change. Results: Most studies in the literature were found to use cross-sectional designs. Static descriptions of older women who are, or are not, physically active, provide little insight into how inactive women become active. The phenomenological study found that the essence of adopting exercise for the women was an experience of exercise resonance. Establishing a habit of exercise occurred via mechanisms that that were not overtly evident to the participants and their descriptions of the exercise behavior change process were murky. Conclusions: A better understanding of exercise behavior in women is needed. Further, it is necessary to critically examine the models currently driving much of the research in exercise behavior change.

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    The Effect of Behavioral Contract on Adherence to a Walking Program in Postmenopausal African American Women

    Published Year: 2005
    Specialization: Geriatrics

    Williams, Bernadette Rene

    Purpose: This study examined the effect of a behavioral contract on adherence to a walking program in post-menopausal African American women. Participants: A convenience sample of 43 post-menopausal African American women was used. Methods: Participants were randomly assigned to an experimental or control groupo. Those in the experimental group signed a behavioral contract. A pedometer, daily log, 7-day physical activity recall, and qualitative analysis were used during a 7-week program. Results: The contract group adhered more to the brisk walking goal. Conclusions: A behavioral contract is effective in increasing exercise adherence in postmenopausal African American women.

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    A Comparison of Hip versus Ankle Exercises in Elders and the Influence on Balance and Gait

    Published Year: 2003
    Specialization: Geriatrics

    Zacharewicz, Laura

    Purpose: Falls are commonly in the elderly, with hip or ankle impairments as potentially contributing causes. The purpose of this research was to determine if short duration hip or ankle interventions designed to increase range of motion (ROM) and strength, could improve range and strength of those joints, as well as impact balance and gait outcomes. Methods: Well elderly vounteers recruited from retirement communities and senior citizen centers were randomly assigned to a hip or ankle intervention group. Both groups performed a home exercise program (HEP) of stretching 5 days a week and strengthening 3 times a week for 8 weeks consisting or either hip or ankle stretching and strengthening dependent upon their group assignment. Strength and range measures were repeated twice and ICCs calculated. The upper limit of the 95% confidence interval (CI) of the standard error of the measurement (SEM) of the pretest data was set as the criterion for improvement. Wilcoxon Signed-Ranks Test was used to determined if there were differences between pretest and posttest measurements within each group. Mann Whitney-U tests were used to determine if there were differences between groups on change scores. Post hoc analyses of subgroups were also done. Results: Thirty-five subjects completed the exercise program. None of the group outcomes met the criterion for clinically relevant change.

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Hand Rehabilitation

    Examining the Impact of Sensory Rehabilitation Methods on Fingertip Dexterity and Participation in Activities of Daily Living in Adults with Allodynia of the Hand

    Published Year: 2023
    Specialization: Hand Rehabilitation

    Bennett, Amy

    This capstone project will cover peripheral nerve injuries (PNIs) in the upper extremity and the consequences that they pose to adult which can impair their activities of daily living (ADLs). Interventions for individuals with PNIs, such as sensory rehabilitation methods (SRMs) and tactile stimulation, will be explored to improve hand allodynia and fingertip dexterity for enhanced participation in daily activities. The majority of research articles on tactile stimulation interventions focus on pain reduction. To inform the best evidence-based practice of occupational therapy, it is critical to establish the relationship between tactile stimulation interventions and their impact on dexterity and discover how that measure correlates with an improved ability to participate in ADLs. The purpose of this manuscript is to review the current literature and explore the impact of various SRMs interventions to treat patients with PNIs, such as utilizing desensitization approaches and graded motor imagery, and how those interventions may be used not only to reduce pain but also to increase dexterity for improved daily functional performance.

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    Effect of Portability to the Jebsen Hand Function Test on Scores: Implications for Use in Home Health Care

    Published Year: 2009
    Specialization: Hand Rehabilitation

    Bentzel, Karen S.

    Objective: This study sought to determine whether published normative data may be used to interpret test scores following portability modifications to four subtests of the Jebsen Hand Function Test (JHFT). A portable version of the JHFT increases the convenience and ease of use for home health therapists. Methods: Four JHFT subtests were slightly modified by substituting a legal-size clipboard placed on the subject’s lap for a 30″ high table, and by using a small wooden attachment to the clipboard instead of the large wooden testing board. Thirty-five male and 35 female subjects ages 60 to 94 without medical diagnoses that would influence hand fuction were tested. Subjects were videotaped as they completed both the standardized version and the modified “clipboard” version of the test. A blinded reviewer determined each subtest completion time from the video recorded performance. Differences between scores on the two test versions were analyzed using t-tests and equivalence testing. Results: The portable versions of the Small Objects and Simulated Feeding subtests passed the equivalence test. The minor changes to achieve portability did not result in significant differences for these two subtests. The Writing and Card Turning subtests failed to pass the equivalence test, indicating that the portable versions are different from the standard versions of these subtests. Conclusion: The portable versions of the Small Objects and Simulated Feeding JHFT subtests may be used in place of the standard test to evaluate hand function.

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    Development and Validation of the Hand Assessment Tool

    Published Year: 2007
    Specialization: Hand Rehabilitation

    Panchik, Daniel

    Purpose: The objective of this study was to develop a self-administered outcome measurement tool for individuals with hand and wrist injuries, and to evaluate the reliability and validity of the new instrument, te Hand Assessment Tool (HAT). Methods: Questionnaire items were generated by review and modification of existing instruments, expert opinion, and a pilot study. Factor analysis identified 7 factors and reduced the instrument from 30 to 14 questions. The final version of the HAT-, the SF12, and Disabilities of Arm, Shoulder, and Hand Questionnaire (DASH) were administered to 94 consecutive new hand clinic patients with a variety of of hand and wrist problems. Participants responded to the questionnaire items by comparing their current performance to how they would have usually performed the task. Statistical analyses were conducted to determine internal consistency, test re-test reliability, and construct validity. Pearson correlations were contructed to correlate the HAT with the DASH, SF12 physical score, and SF12 mental health score. Results: Statistical analyses indicated excellent internal consistency with Cronbach’s alpha of 0.91. Test re-test reliability of the HAT indicated good agreement. The concordance correlation coefficient was 0.73, with 95% confidence interval. The Pearson correlation coefficient of 0.91 with 95% confidence interval showed a strong positive correlation between the HAT and DASH. This indicates that the HAT is a very good representation of the DASH. Robustness of the instrument was evaluated by removing the data fomr the 4 functional questions that are similar on the HAT and DASH. The Pearson correlation was 0.89 still indicating a strong positive correlation. A modest agreement existed to the SF12 physical score. The Pearson correlation coefficient was 0.52, with 95% confidence interval . The HAT did not correlate to the SF12 mental health score. The Pearson correlation coefficient was 0.35, with 95% confidence interval. Conclusion: The HAT correlates well to the DASH and SF12 physical score and proves to be a reliable and valid instrument for evaluation of functional outcome for individuals that sustain wrist or hand injury. As expected the HAT does not correlate well with the SF12 mental health score. There are notable differences between the HAT and DASH. The HAT does not ask the respondents to rate pain or weakness nor does it ask them to rate the impact of their injury to their work. The HAT does however ask respondents to rate the impact of the appearance of their injured hand. More than fifty percent of the functional questions in the HAT are different from the DASH nevertheless there was excellent agreement. Unlike the DASH, the HAT takes the approach of basing the comparison on performance without compensatory strategies or the use of adaptive equipment. It is hoped that this new instrument will be particularly useful when examining intervention or disease process of wrist and hand pathology and its impact to usual functional activity. Functional activities in the HAT are notably different from the DASH. The researchers believe that the HAT will provide for a more specific instrument to measure hand and wrist outcome.

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Health Professions Education

    Athletic Training Students’ Mental Health Recognition and Referral Skills : A Sequential, Explanatory Mixed-Methods Study

    Published Year: 2022
    Specialization: Health Professions Education

    Anderson, Alyssa S.

    Context: Increased prevalence of mental health conditions has exposed gaps in the educational preparation of athletic training students. Identifying effective pedagogical strategies to increase knowledge and confidence in the recognition and referral of mental health conditions is imperative. A standardized curriculum, such as Mental Health First Aid (MHFA) training, is promising, as is the use of standardized patient (SP) encounters and case-based learning (CBL); however, there is a lack of evidence to determine best practice for achieving these learning goals. The purpose of this study was to examine the effect of MHFA training on students’ knowledge and confidence and compare the use of CBL and SP encounters following MHFA training. Further, we sought to explore students’ perceptions of the CBL and SP encounters. Methods: This study used a sequential, explanatory mixed-methods design with 2 phases: 1) randomized controlled trial with pre-test, post-test design, and 2) individual interviews. The study was set in an online learning environment using Zoom. A convenience sample of 70 students from graduate level CAATE-accredited professional athletic training programs participated in this study. Twenty-two participants were interviewed. All participants completed MHFA training followed by no intervention, and SP encounter, or CBL activity. A validated electronic knowledge assessment and self-reported confidence scale measured knowledge and confidence with mental health recognition and referral at the study’s commencement and after intervention. A mixed-model ANOVA with an a priori alpha level set a p<.05 was used to analyze differences between groups. Analyses were conducted with Intellectus Statistics. Interviews were recorded using Zoom and then transcribed. The Qualitative Analysis Guide of Leuven (QUAGOL) method was used to identify emergent themes. Strategies to enhance trustworthiness included an audit trail, member checks, and peer debriefing. Results: A mixed-model ANOVA showed significant improvement between pre-test and post-test scores for knowledge and confidence. This result was similar among all three groups. No significant change in knowledge or confidence was found between the control, SP and CBL groups. Five higher order themes emerged from the interview data: 1) perceived value of MHFA training, 2) engaged learning and facilitated feedback, 3) capability, 4) comfort/confidence, and 5) authentic experience. These were organized into three overarching dimensios: knowledge, skills, pedagogy. Participants described how the opportunity to apply their knowledge and practice their skills with an athletic training specific scenario helped them feel more equipped future patient care. In line with the significant difference in knowledge and confidence scores following the training, students perceived MHFA training as a beneficial method to acquire knowledge as it provded a valuable strategy for approaching mental health challenges and distinguishing crises from noncrises. Simulation activities (SP and CBL) were perceived to increase students’ capability, comfort and confidence in mental health recognition and referral. Engaged learning via peer interactions and facilitated feedback through real-time debriefing were key facilitators of student learning in these simulated activities. Conclusions: In order to meet the 2020 CAATE Standards for behavioral and mental health content, programs should incorporate MHFA training to improve student content knowledge and confidence in skills. While this study showed no numerical difference between the groups, the opportunity to practice via simulation with CBL or SP influenced participants’ knowledge and feelings of confidence and capability. To better prepare students for clinical practice, MHFA training should be followed by athletic training specific simulated encounters.

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    Understanding Potential : An Investigation of Personal Attributes, Diversity, and Academic Performance in Doctor of Physical Therapy Students

    Published Year: 2023
    Specialization: Health Professions Education

    Reynolds, Kelly Braden

    The primary purpose of this study was to examine personal attributes, including differences among more and less diverse students and thir relationship of academic performance. Currently, it is not known if more diverse students differ from less diverse students in personal attributes that may be considered in holistic admissions. It is also not known which personal attributes may be predictive of academic performance in DPT students and if the same prediction approach holds true for students with more or fewer diversity characteristics. This study examined the number of diversity characteristics for each subject, their self-report ratings on six personal attributes, and their academic performance at two time points in the curriculum and on a standardized test. We explored the relationship between 2 catagories of non-academic factors: 1) number of diversity characteristics, and 2) personal attributes. Additionally, we examine if these non-academic factors predicted academic performance. The overarching goal of this project was to further understand the relationship of diversity, personal attributes, and academic performance with the goal of providing data-driven evidence to inform equitable admissions practices.

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Health Promotion and Wellness

    Comparisons of Body Composition and Self-Perception of Body Type in Racially and Ethnically Diverse Male and Female College Students

    Published Year: 2011
    Specialization: Health Promotion and Wellness

    Baldis, Mark W.

    Previous research suggests that individual perception of body size varies by gender and ethnicity and that some sub-cultures are more accepting of overweight body types. Particular groups of individuals who positively value a body type that is deemed clinically overweight or obese may be unreceptive to weight management techniques aimed to decrease the risk for development of obesity-related chronic diseases. The purpose of this study was to examine the relationship between perceived body image and actual body composition, across race and gender, in a group of 240 college-aged students. Participants underwent skinfold body composition assessment and completed a questionnaire designed to elicit perceptions of body image and body weight status. Data summary of this cross-sectional study design included comparative descriptive statistics, frequencies, and relative frequencies. Results suggested that one in four females, regardless of race, categorized as in the acceptable range for body fat percentage, identified themselves as overweight. Over half of all Asian, Black, and Hispanic males, categorized as in the acceptable range for body fat percentage, identified themselves as overweight. Over half of White males and females, and Black females, categorized as overweight, perceived themselves to be of “about the right weight”.

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    Implementing a Modified Otago Exercise Program for Fall Prevention Using the Health Belief Model for Community-Dwelling Seniors in the Senior Center Setting

    Published Year: 2018
    Specialization: Health Promotion and Wellness

    Barenholtz, Theodora

    In this study, the implementation of a fall prevention exercise program for community-dwelling seniors based on a behavior change component using the Health Belief Model (HBM) was studied. The Otago Exercise Program (OEP) was administered to groups of seniors in three senior center settings for five sessions over eight weeks with a follow-up at 12 weeks. The study design was a quasi-experimental, nonrandomized control group with blinded pre-test and post-test. The primary outcome was balance ability, measured using the Berg Balance Scale (BBS). The secondary outcomes were attitudes toward fall prevention using a survey based on the HBM constructs. The study hypothesis was that the OEP with behavior change based on the HBM would yield a more significant increase in the BBS score than the OEP group without the behavior change component. The results retained the null hypothesis, and there was not a significant difference between the groups. Both the OEP group and the OEP + HBM group experienced a significant improvement in balance as measured by the BBS. There was no significant change in attitudes as measured by the survey for the intervention group. The clinical importance of this study was the investigation of a novel approach to implementing a fall prevention exercise program. The study indicates that as few as five sessions of group fall prevention exercises can achieve significant improvements in balance for community-dwelling seniors.

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    Improving Health Perceptions to Increase Physical Activity Among Community Members of Diverse Ethnicity and Religious Beliefs: A Faith-Based Intervention

    Published Year: 2020
    Specialization: Health Promotion and Wellness

    Black, Byron K.

    Purpose: The purposes of this study were two-fold: First, measure pre- and post-intervention physical activity levels and health perceptions of physically inactive individuals of an ethnically and religiously diverse community. Second, develop, implement, and investigate a six-week, faith-based intervention design to increase physical activity and improve health perception by combining physical activity information with correlating scriptures. Methods: This study was a two-group, pretest-posttest design for which thirty-four participants were recruited from a local county in Central Texas using social media platforms Facebook and NextDoor. Both groups received handouts from the VA MOVE! program while only the intervention group received the faith-based handouts. Health perceptions and physical activity levels were assessed pre- and post-intervention using Physical Activity-Stages of Change (PA-SOC), Self-Efficacy for Exercise (SEE), Helpless Inevitability Subscale (HIS), Nutrition Self-Efficacy Scale (NSES). Participants wore a FitBit Inspire to record Week one and Week six-step totals. Study outcomes were measured using Independent samples t-test and Chi-square. Results: An examination of the pre, post, and difference mean scores of the SEE, HIS, NSES, and weekly step counts using independent sample t-tests revealed no significant differences. An examination of the pre, post, and direction of change of the PA-SOC using the Pearson Chi-Square revealed no significant difference. Conclusion: The limitations had a heavy impact on the findings of this faith-based intervention. However, while the study results were not statistically significant, the faith-based intervention did have a minimal impact on the physical activity level and health perceptions. Future research evaluating the effectiveness of this faith-based intervention affecting the physical activity and health perceptions should address pastor buy-in and church attendees’ use to improve outcomes.

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    Personal Health Behaviors and Role-Modeling Attitudes of Physical Therapists and Student Physical Therapists

    Published Year: 2010
    Specialization: Health Promotion and Wellness

    Black, R. Elizabeth

    Background: To support the goals of Healthy People 2010, health professionals have been encouraged to discuss healthy lifestyle behaviors with their patients. Health professionals who engage in health promoting behaviors themselves are more likely to initiate these discussions with their patients, and be credible role-models for healthy behaviors. Objective: The purpose of this study was to describe the personal health behaviors and role-modeling attitudes of physical therapists and student physical therapists, and to examine the relationship between role-modeling attitudes and personal health behaviors. Design: This study was a cross-sectional survey. Methods: A national sample of 405 physical therapists and 329 student physical therapists participated in the survey. The survey collected sociodemographic information, measured attitudes towards role-modeling and measured subjects’ self-reported stage of change for health behaviors related to physical activity, fruit and vegetable consumption, abstention from smoking, and maintenance of a healthy weight. Wilcoxon rank sum tests were used to examine differences between physical therapists and student physical therapists in personal health behaviors and role-modeling attitudes. Kruskal-Wallis tests were conducted to examine differences in role-modeling attitudes based on stage of change for each of the four health behaviors. Results: A majority of study subjects reported they engage in regular physical activity, eat adequate servings of fruit and vegetables, do not smoke, and maintain a healthy weight. There were no statistically significant differences between physical therapists and student physical therapists in the four health behaviors, but there were statistically significant differences in a number of role-modeling attitudes. Student physical therapists were more likely to believe that role-modeling is a powerful teaching tool, that physical therapist professionals should practice what they preach, that physical activity is a desirable behavior, and that physical therapist professionals should role-model the behaviors of non-smoking, and maintaining a healthy weight. Role-modeling attitudes differed among stage of change groups for regular physical activity, fruit and vegetable consumption, and healthy weight management. Conclusions: Physical therapists and student physical therapists engage in the health-promoting behaviors of regular physical activity, maintaining a healthy weight, eating fruits and vegetables, and abstaining from smoking at similarly high rates but differ in attitudes towards the need to role-model healthy behaviors. Attitudes towards the need to role-model are associated with personal health behaviors.

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    Investigating Labyrinth Walking as a Tool for Stress Relief in the Workplace

    Published Year: 2017
    Specialization: Health Promotion and Wellness

    Boardman, Paula

    Background: Workplace stress is a risk factor for physical and psychological ill-health. Mindfulness meditation programs are effective in reducing stress but may not always be appropriate for the workplace. Objective: To investigate whether walking a labyrinth would be an appropriate and effective tool for stress relief in office workers. Design: Mixed-methods research study with a quantitative experimental design using pretest and posttest measures. Setting and Participants: Employees at a medical office in S.E. Michigan. Interventions: Subjects were randomly allocated to one of three groups. The experimental group practiced mindfulness meditation as they walked a labyrinth. The active-control group practiced mindfulness mediation as they walked in the neighborhood. Group three was a waitlist control. Primary Outcome Measures. The Perceived Stress Scale (PSS10), Copenhagen Psychosocial Questionnaire (COPSOQ II), and diurnal cortisol slope measured self-reported and physiological levels of stress. Qualitative data were collected from the Labyrinth Walk Questionnaire, diaries, and group interview. Results: No statistically significant interactions were recorded for the effect of labyrinth walking on PSS10, COPSOQ II, or diurnal cortisol slope. A large effect size was noted for the interaction of labyrinth walking on workplace stress and a moderate effect size for perceived stress. A large effect size was recorded for the change in PSS10 from pretest to posttest in the labyrinth walking group compared to a small effect size in the waitlist control group. Qualitative analysis provided strong support for labyrinth walking in the workplace. Reported benefits included enjoying time away from the stressors of work. Odds ratio of being less/much less stressed was 5.49. Odds ratio of being more-much more relaxed was 51.33. Conclusions: Walking the labyrinth was accepted by employees as a place for a time out from the stress of work. Self-reported measures of stress and statistical effect sizes trended in a positive direction for the effect of labyrinth walking on stress. A larger sample size is recommended to determine if this trend is statistically significant.

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    Engagement in Gait- and Balance-Enhancing Behaviors in Persons with Multiple Sclerosis After Out-Patient Physical Therapy

    Published Year: 2015
    Specialization: Health Promotion and Wellness

    Bradford, Elissa Held

    Purpose: The overarching aim of this research was to better understand what persons with multiple sclerosis (pwMS) chose to do and what physical therapists recommended to maxmize gait and balance (G&B) after discharge from out-patient physical therapy (OP-PT), and the factors influencing those decisions. Methods: A descriptive, exploratory case series design with multiple methods was used. Data was collected from pwMS at two time points and PT at one time point following pwMS discharge from OP-PT. All interviews were audio recorded and transcribed verbatim. Stake’s case series and Brewer’s multi-methods guidelines were used to direct both within and across case content and constant comparative analysis of both pwMS and PT and narrative and numeric data. Results: Seven matched pwMS – PT pairs participated, n=12, because one PT participated three times. Exercise was the most important behavior used by pwMS and recommended by PTs to maximize G&B, although pwMS used a wider variety of behaviors, ranging from lifestyle physical activity to stress management. The key themes were challenging self by pushing but respecting limits for pwMS and finding the right fit for PTs with both aiming to maximize pwMS engagement in meaningful activities and life roles. The four key factors impacting engagement decisions were importance, confidence, support, and resilience. Facilitators had to outweigh barriers for engagement to occur. To optimize PT practice, key recommendations from these combined analyses for further discussion, analysis, and testing were: 1) focus but be comprehensive and long-term in planning, 2) support pwMS by developing and refining knowledge, attitude, and skills, for not only valued behaviors and how to challenge and monitor self, but how to make self-management decisions and develop routines that can become flexible habits, 3) seek, understand, and value the expertise and uncertainty pwMS bring to decision making 4) assess and address importance, confidence, support and resilience to individual behaviors, and 5) self-reflect on personal toolbox and beliefs and how they may impact decisions and recommendations. Conclusion: Better understanding of the valued behaviors, decision making processes, and underlying influential factors of both pwMS and PTs towards maximizing G&B, has potential to optimize the pwMS-PT experience, engagement rates, and, ultimately, meaningful G&B outcomes for pwMS.

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    The Holistic Influence of Participation in Military Adaptive Sport Programming on the Overall Quality of Life of Wounded, Ill, and Injured Veterans as Part of Their Transition Process

    Published Year: 2021
    Specialization: Health Promotion and Wellness

    Campbell, Mark A.

    Purpose: The purpose of this research study is to explore the lived experiences of recently transitioned veterans of the U.S. Military who have wounds, illnesses, or injuries, who participated in a military adaptive sports program as part of the healing and transition process. An experiential study looking at the service members’ interpretation of these specific programs has not been conducted, leaving a gap in research, specifically within this population. Understanding participant experiences could assist in recommendations for further support, development, and implementation of adaptive sports programming to assist in a complete transition into the veteran status and beyond. Methods: A phenomenological approach using a semi-structured interview protocol was used to investigate the lived experiences of ten (10) recent U.S. Veterans. They used adaptive sports programming as part of their healing and transition process. The participants described their “lived experiences,” providing details regarding their military service and transition processes. Results: Three overarching themes emerged with implications on the quality of life of the participants. These were (a) camaraderie and connection, (b) growth after adversity, and (c) barriers to participation. Study participants reported positive effects across multiple dimensions of their quality of life, supporting the foundational design of the DoD’s programming. Conclusion: The findings portray a group of veterans who benefitted from adaptive sports participation as part of their healing and military transition processes. According to the data collected from all study participants, the military adaptive sports programming provided the infrastructure required to foster holistic growth and development following adversity.

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    Winning the Challenge: The Interaction of Conscientiousness and Perceived Autonomy

    Published Year: 2013
    Specialization: Health Promotion and Wellness

    Curtis, Jason McCreary

    Background: Understanding determinants for weight-loss is a national priority. Obesity is an epidemic with serious health consequences. Most of today’s obesity and overweight problems are being attributed to poor diets and not enough physical activity. These problems show no signs of slowing down with the behaviors of most Americans. The phenomenon of “The Biggest Loser” has spawned many variants in commercial health clubs. This prospectus study examined the direct and interactive or moderated effects of known determinants of healthy behaviors. Those determinants were conscientiousness and perceived autonomy support. Thus, the purpose of this prospective study was to examine these two determinants of adhering to a variant of “The Biggest Loser” to gain more scientific knowledge of predictors of those that are successful in such commercial programs. Methods: Participants were 64 adults who completed measures of conscientiousness and perceived autonomy support along with a number of other measures being taken such as weight, attendance, and relative autonomy for exercise prior to and during the 12-week Weight-loss program. Participant’s attendance was kept based on participating in five scheduled weight and body fat percentage measurements time points during the 12-week program. At final weigh-in, the participants completed the measure of perceived autonomy support from their group exercise leader. Results: Overall, conscientiousness appeared to be the most influencial variable in the prospective study. It correlated with relative autonomy, perceived leader autonomy support, attendance, and change in weight. Results from the moderated regression analyses, one set for attendance and the other for change in weight, suggested that conscientiousness was the major determinant in this prospective study though admitted the correlations were small in magnitude. Conclusions: As hypothesized, the interaction of autonomy support and conscientiousness yielded the greatest amount of weight loss. Thus, for the sample in this prospective study, best results were found in highly conscientiousness participants that perceived their group exercise leader to provide a great deal of autonomy support. Future, studies should investigate environmental factors to increase both participant conscientiousness and leader provided autonomy support.

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    Competencies Required for Physical Therapy Telerehabilitation : A Delphi Study

    Published Year: 2022
    Specialization: Health Promotion and Wellness

    Daisy, Denise A.

    Background: Telehealth has been emerging in health care as new technologies are becoming part of patient care. Most recently, the COVID-19 pandemic has been a catalyst for telehealth growth. While some physical therapists have begun practicing rehabilitation via telehealth, termed as telerehabilitation, the level of knowledge, skills, and attitudes necessary to demonstrate competency in effective, evidence-based telerehabilitation is lacking in the profession. Purpose: The purpose of this study is to establish competencies for physical therapists performing telerehabilitation. Methods: In a 3-round Delphi study, physical therapists from a variety of practice settings were surveyed rating their agreement on telerehabilitation competency statements using a 5-point Likert scale of agreement. In round 1 of the study, subject matter experts (SME) with more than 9 months experience were asked to rate agreement on statements adapted from previously published literature. In addition, 2 open-ended questions to were used to generate additional competencies. Following a thematic analysis of the responses received from open-ended questions, new statements were included in round 2 for all participants. The threshold for consensus was set at 75%. Statements with 20%-75% consensus were included in each subsequent rounds while statements with less than 20% agreement were excluded. Results: Consensus was achieved on 83 competency statements across 3 domains: knowledge, skills, and attitudes. Conclusions: Identification of telerehabilitation competencies for physical therapists has been identified in this study. Further research into the implementation of telerehabilitation in specific speciality practice areas may be beneficial; however, clinicians with minimal to no expertise in telerehabilitation and those involved in physical therapy education can use this as a suggestion for the knowledge and skills required to provide care effectively in a virtual manner. As we advance in our understanding of the best uses of telerehabilitation, it would be important to consider all aspects of provision of physical therapy and understand where telerehabilitation may be most advantageous in providing care, and where face to face treatment may remain superior to virtual treatment.

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    The Association Between Wellness and Academic Performance in College Students

    Published Year: 2011
    Specialization: Health Promotion and Wellness

    Droppa, Marjorie M.

    Objective: Part 1. To develop a wellness tool that assesses college student health-risk behaviors. Part 2. To examine whether there is an association between college student wellness status and academic performance. Participants and Methods: A retrospective design with secondary analysis of cross-sectional data from the American College Health Association National College Health Assessment (ACHA-NCHA) was used to build the new tool. Results: Principle components analysis of several ACHA-NCHA datasets identified a consistent set of 4 wellness dimensions which were labeled drug/alcohol awareness, physical, emotional, and sexual awareness. To evaluate content and face validity, the 23-item survey tool was administered to students at 2 colleges in the U.S. Reliability analysis of the tool was also performed. Conclusions: The new survey is a valid and innovative wellness tool developed specifically for college students. It includes individual facets of student health for intervention purposes, and combines the facet scores into a single, multidimensional wellness score for research purposes. College administrators and health professionals can use the tool to identify health-risk behaviors unique to their campuses; practitioners can use the data to design and implement interventions that promote wellness; and researchers can use the tool to assess student health risk outcomes.

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    Identifying Determinants to Predict Intention to Complete a Health Risk Assessment: A Questionnaire Development and Implementation

    Published Year: 2013
    Specialization: Health Promotion and Wellness

    Ettinger, Michael Locke

    The health risk assessment (HRA) has become a widely accepted assessment tool used to help mitigate the rise in chronic disease. However, HRA completion rates are reported to be low to moderate with very limited research focused on factors predicting HRA participation. The purpose of this study was to determine which constructs will significantly predict and influence the intention to complete an HRA in a hospital employee population. Participants of the study included hospital employeeswho had previously had the opportunity to complete an HRA. A cross-sectional design using the Theory of Planned Behavior (TBP) was used to design a questionnaire to determine the variables associated with intention to complete an HRA. From a sample of those who completed and those who did not complete the HRA, elicitation inquiry was used to determine the leading factors associated with the intention to complete an HRA. The responses from this inquiry were used to develop a questionnaire that was sent to a hospital population. A total of 503 hospital employees completed and returned this questionnaire. Using the returned questionnaire data, logistic regression analysis was used to determine the best fit model for predicting intention to complete an HRA. The predictive model was statistically significant at the p<0.001 level. Discriminant analysis correctly verified the predictive model classified intenders and non-intenders the majority of the time. These study results indicated that perceived behavioral control factors such as having time to complete the HRA, confidence in completing the HRA and trust that the information divulged in the HRA would be kept confidential had the strongest influence in predicting participation in taking an HRA. These results help to identify key behavioral-related factors predicting employee participation to complete an HRA. Drawing upon these findings, adminstrators of worksite health promotion programs can systematically explore means of addressing identified participation barriers for the purpose of increasing overall HRA participation success.

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    Perceived Wellness in Mothers of Children with Special Needs

    Published Year: 2010
    Specialization: Health Promotion and Wellness

    Ewoniuk, Jane Harris

    Background: Mothers of children with special needs report higher incidences of physical, psychological, and emotional burden and illness than typical parents. While numerous theoretical models exist to describe parenting wellness that encompasses the subjective responses to stress as it affects health. The main purpose of this study was to examine perceived wellness in mothers of children with special needs. Several suprising results suggest that maternal perceived wellness is affected by stress. Methods: Relationships between stress and perceived wellness in mothers of young children without special needs and mothers of children with special needs were examined. Measures used included the Perceived Wellness Survey (PWS), the Parenting Stress Index-Short Form (PSI-SF), as well as questionnaire on demographics. Empirical data was analyzed using ANOVA, correlation and frequencies to determine the relationship between stress and perceived wellness in this population. Results: No significant difference was found between groups for parenting stress measures or perceived wellness. A statistically significant relationship was established between the parenting distress subscale of the PSI-SF and perceived emotional wellness of the PWS. Additionally, in the regression equations, two dimensions of the PWS produced signficance in relation to the overall total stress score of the PSI-SF. However, although a relationship was determined to exist, it is difficult to determine the exact relationship as no strong correlations were found among the covariates in the model. Conclusions: Research shows that mothers of children with special needs require on-going and substantial support. Thus, a better understanding of the mother’s perceived wellness, allow professionals to better target maternal support needs.

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    Dimensions of Health and Wellness Individuals with Relapsing-Remitting Multiple Sclerosis Perceive as Essential for Improving Quality of Life

    Published Year: 2021
    Specialization: Health Promotion and Wellness

    Faraclas, Erin

    Overview: Multiple sclerosis (MS) is a chronic progressive neurological disease with millions of people affected worldwide. Currently, MS is the most common non-traumatic neurological disease affecting young adults in the United States today, with an estimated 1 million individuals with MS nationwide. Recent evidence has established that the quality of life (QOL) for those with MS is lower than the general population. Futher exploration into the dimensions of health that are contributing to this diminished QOL is needed. Purpose: Identifying and describing the health and wellness needs individuals with relapsing-remitting multiple schlerosis (RRMS) report as essential to their QOL. Additional aims investigate why these needs are essential to the individual’s overall health and wellness and the perceived barriers to meeting these identified needs. Methods: Adults with a self-reported diagnosis of RRMS were recruited for this explanatory sequential mixed-method study guided by the phenomenological approach. Study participants completed the SF-36v2 survey along with demographic information. One-sample z-tests were completed for all subscales and component means. Semi-structured interviews were then conducted until data saturation was reached. Interview data were analyed using a thematic content analysis approach. Results: All values of z were statistically significant, p < .01. Social function and physical function subscales and the mental health component score had the lowest mean scores compared to the general population. A first stage depression screen revealed that 49% of the surveyed population were at risk for depression, compared to 18% in the general population. For years since MS diagnosis, stratification of data revealed 61% of the ‘0-3 years since diagnosis’ group was at risk for depression. Lifestyle behaviors and social engagement followed as the next most frequent themes emerging from the data. While a decrease in physical function is prevalent in the RRMS population, addressing this was a low priority for optimizing QOL. Conclusions: Overall, the mental health of individuals with RRMS was shown to influence QOL as much as physica health. However, early in the disease course, mental health affected QOL more than physical health. Mental health and lifestyle behaviors were perceived as significant contributors to QOL and the areas reported as having the greatest need. Access to dietary information, exercise guidance, and general education about living with MS were also identified as essential factors to improving QOL. Individuals with RRMS perceive mental, emotional, and social health as essential components to their QOL.

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    The Relationship Of Emotional Intelligence Among Graduate Students In Combined Master Of Science/Dietetic Internship Programs

    Published Year: 2017
    Specialization: Health Promotion and Wellness

    Frazier, Heather

    Emotional intelligence (EI) is often associated with perceived stress and academic performance in health professions such as nursing and medicine, but not typically dietetics. Students in health profession fields with higher EI have lower perceived stress and better ability to cope with stressors. This study aimed to explore the relationship between emotional intelligence, perceived stress and academic performance of graduate dietetic students completed measures of EI, perceived stress, sociodemographic and program information. EI and perceived stress were collected using the Schutte Emotional Intelligence Scale and Perceived Stress Scale-10, respectively. Students self-reported demographic and program information. Statistical significance was p<= 0.05. A statistically significant negative correlation was found between EI score and perceived stress. No statistically significant correlation was found between EI ansd academic performance. When evaluating factors of EI, total EI was positively associated with “appraisal of emotions”, “optimism and regulation of emotions”, and “intrapersonal and interpersonal utilization of emotions”. Perceived stress was negatively associated with “optimism and regulation of emotions” and not associated with the other two EI factors. The findings suggest that graduate dietetic students with higher EI scores have lower self-perceived stress and are more optimistic. Development of EI in graduate dietetic students might help reduce perceived stress levels and create better coping of stressors. There is a need for futher research on EI among dietetic students as it relates to college health and professional competence.

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    Impact of Electronic Cigarette Use on Physiological Outcomes, Perceived Health Effects, and Quality of Life Among Adults

    Published Year: 2020
    Specialization: Health Promotion and Wellness

    Fretti, Sarah

    Background: The understanding of electronic cigarettes (ECs) and their potentially deleterious effects on health outcomes are lacking compared to the increasing use and evolvement of these devices. Research that explores determinants of health effects such as acute physiological responses, individual expectations, social factors, and emotional well-being may address issues that will likely arise with long-term EC use. Examining characteristics, motivations, and health-risk behaviors may also provide valuable insights into behavioral trends and conditions associated with EC use and identify groups in need of targeted interventions. Study Design: there were two separate arms for this study: quasi-experimental pretest-posttest control design involving vascular and pulmonary testing and a cross-sectional, Internet-based survey. Purpose: The purposes of Arm I include 1) to examine baseline vascular and pulmonary health differences between tobacco-na�ive controls and chronic EC users, and 2) to examine the acute vascular and pulmonary health effects of a single vaping session in chronic EC users. The purposes of Arm 2 include 1) to explore associations among EC use, health-related quality of life, and perceived health effects in a diverse sample of adults in the United States, 2) to examine the association between sociodemographic factors and EC use, and 3) to examine motivations and patterns of use within EC users. Methods: Eight healthy EC users and eight age-matched controls recruited from the university campus and the surrounding area participated in Arm 1 of this study. All subjects completed assessments of spirometry and flow-mediated dilation (FMD) of the brachial artery, respectively. EC users wer assessed before and after a single, ad libitum, vaping session. Targeted social media advertising was used to collect a convenience, respondent-driven sample of EC users for for Arm 2. Subjects completed an online questionnaire that included measures of EC use and perceptions, tobacco use, HRQoL assessed using the brief version of World Health Organization Quality of Life, perceived health effects, and sociodemographic factors. A series of t-tests were conducted to assess for signifiant differences in Arm 1. Chi-square Test of Independence, Fisher’s exact test, Man-Whitney U, MANOVA, and ordinal logistic regressions were performed, as appropriate for the level of data, to determine associations between the outcome measures in Arm 2. Results: Arm 1. A single vaping session significantly affected lung function, placing the experimental group into the category of moderate chronic obstructive pulmonary disease. EC users also experienced increased central cardiovascular burden pre- to post-vaping. Microvascular and macrovascular function decreased after a single vaping session in EC users. There were no differences in FMD%, time to peak dilation, or FMD-AUC. Arm 2. Survey respondents were predominantly young adults, 67% of whom identified as former cigarette smokers. Former smokers reported perceiving EC use as less harmful than tobacco cigarettes, compared to 30% of current smokers. The majority of participants reported at least one adverse health effect attributable to EC use. WHOQOL-BREF scores were as follows: overall QOL, physical health, psychological well being, social relationships, and environment. The linear combination of QOL scores was significantly different based on smoking status. Conclusions: The results of this study demonstrate that EC users demonstrate poorer baseline pulmonary and vascular health parameters. Also, a single session of vaping causes decreases in pulmonary and cardiovascular function among regular EC users. Considering the critical role microcirculation plays in modulating vascular tone, these physiological responses may have long-term implications. In addition, the significant associations among EC use, HRQoL, and other health-risk behaviors provide valuable insights into lifestyle factors and conditions linked to EC use. These associations may also identify groups most likely in need of targeted interventions to reduce health-related inequalities.

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    Fitness Professionals Working in Healthcare: History, Perceptions, and Barriers

    Published Year: 2021
    Specialization: Health Promotion and Wellness

    Fried, Aaron M.

    Considerable research demonstrates the positive outcomes of physical activity on chronic diseases. Fitness professionals are experts in physical activity and are absent in healthcare. This study aimed to discover the history of and perceived barriers of fitness professionals’ absence from healthcare. A group of 24 fitness professionals and healthcare decision-makers were interviewed to learn about their perceptions of fitness professionals working in healthcare. The findings revealed that barriers exist to patients getting the highest quality, evidence-based care they need. Healthcare providers need education on the benefits of physical activity and who can provide exercise programming. Fitness professionals need to clarfiy their certifications, regulation, and scope of practice. Fitness professionals also need training in behavior modification and lifestyle interventions to treat patients with chronic medical conditions. Our healthcare system makes the cost for fitness services a barrier, opening the potential for Health and Wellness Coaches,

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    The Association Between Bodyage and the Perceptions of Wellness Among Employees of a Worksite Wellness Facility

    Published Year: 2013
    Specialization: Health Promotion and Wellness

    Gaines, Chayla Harris

    Many working adults throughout the United States spend a large portion of their day in sedentary occupations, making the workplace an ideal setting for cultivating positive health behaviors. Despite the well-known benefits of leading a physical active lifestyle, most American adults are physically inactive. Given this dilemma, it is important to understand why some people remain physically inactive, particularly in the work environment, where many structural barriers and resources are eliminated by companies who invest in worksite wellness programs and fitness centers. The purpose of this study was to examine the relationship between physical activity behavior, its impact on one’s BodyAge and perceptions of wellness among employees of a worksite wellness facility.

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    The Effects of Synchronized Music on Heart Rate, Distance, Rate of Perceived Exertion, and Motivation During 30 Minutes of Two Different Types of Physical Activity: A Prospective Community Fitness Center Intervention Study

    Published Year: 2016
    Specialization: Health Promotion and Wellness

    Gammill, Eddie

    The purpose of this study was to investigate the effects of synchronized music on heart rate, rate of perceived exertion (RPE), and motivation during 30 minutes of walking and running on a treadmill. Walking participants and running participants walked or ran four days, over a two week period while listening to predetermined and randomized slow, medium, and fast tempo music. On the fourth day they completed their activity on the treadmill without any music. During the trials for both walking and running, each participant’s heart rate was recorded every minute, and their RPE was recorded at 5-minute intervals. After the 3 days of testing with music, each participant completed a motivational music-rating inventory, the Brunnel Music Rating Inventory-3. Distance completed during each day of running and walking was also recorded. Multi-level modeling was used to conduct the data analysis. The music motivational results indicated that among runners, the mean scores were significantly higher for medium and fast music compared to slow music. Pairwise comparison showed that motivation was higher for medium when compared to slow tempo, 95% CI = 2.41-12.59. Pairwise comparison showed that heart rate was higher for slow tempo compared to no music, 95% CI + 1.83-4.94, heart rate was higher for medium tempo music compared to slow music 95% CI -4.22-1.11, and heart rate was higher for fast tempo than slow temp 95% CI -3.67-0.56. The pairwise comparison results for the running group indicated statistically significant differences among all comparison groups except runners with fast tempo music and runners with medium tempo music, with the greatest difference between fast music and the no music condition. In comparing the RPE for the walking conditions, there were significant differences between all walking conditions except for the medium and fast tempo music when compared to the slow music condition. The comparison of the RPE for runners was significant when comparing medium tempo to slow music, and fast tempo to slow tempo music. There was a significant difference in distance run between all pairwise comparisons except for between fast and medium tempo music. the results suggest that fast and medium tempo music may be beneficial for running and that medium tempo music may have some benefit during walking. Practitioners should consider the application of slow and medium tempo music as part of a walking regimen and medium and fast music as part of a running regimen to achieve optimal results.

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    A Mixed Methods Investigation of Physical Activity Levels in Community College Students

    Published Year: 2017
    Specialization: Health Promotion and Wellness

    Googins, Lori J.

    Purpose: This mixed methods study investigated physical activity (PA) levels of community college students (CC) in order to understand factors that influenced PA behaviors in this population. Methodology: An explanatory sequential mixed methods design was used. An ecological model provided the framework and a general qualitative approach using grounded theory data analysis process provided the focus of the qualitative phase. Matriculated students aged 18 years or older, carrying a course load of 9 credits or more at a CC in a northeastern state were eligible to participate in this study. Results: PA was examined using the following quantitative and qualitative research aims: Quantitative Aim (1): Identify PA levels in CC students in 4 domains: job-related; transportation; domestic and garden; and leisure-time. Significant multiple regression analyses indicated: job-related PA was explained by academic major Trades, employed part-time (EPT), and employed full-time (EFT); transportation PA was explained by EPT, EFT, and residence location; domestic and garden PA was explained by martial status; and leisure -time PA was explained by residence location, never smoked, and have smoked, but not in 30 days. Quantitative Aim (2): Identify total PA levels in CC students. Significant multiple regression equation found total PA was explained by academic major Trades and EFT. Quantitative Aim (3): Directly measure accelerometer steps/minute, time standing, and time sedentary in CC students. One-way multivariate analysis of variance (MANOVA) steps revealed: significant between groups interaction for number of credit hours, with combined variables of sedentary time weekday and number of steps/minute weekday; and significant interaction between number of credit hours with combined variables of standing time weekday and number of steps/minute weekday. Quantitative Aim (4): Identify measured steps of PA during the week and the weekend in CC students. One-way MANOVA revealed: significant difference between the variable “does participate have children,” with combined variables of sedentary time weekend and number of steps weekend; and for the entire week a significant difference between credit hours and combined variables of sedentary time weekly and number of steps weekly. Qualitative Aim (1): Understand experiences, factors, and values that influence CC students’ PA levels and Aim (2): Explore relationship of ecological factors impacting CC students’ PA levels: public policy, community, institutional, intrapersonal, and interpersonal. Focus group inquiry provided awareness to enablers and barriers, factors and values that influenced PA in CC students. Five emergent themes arose from focus group discussions: being healthy, improved self-esteem, ease of being active, difficulties in being active, and desirable resources. Mixed Method Results: Integration of data sets provided insight into PA levels of this population within the context of the ecological model. Interrelationships were revealed and programming suggestions were offered. Conclusions: CC students struggle with the demands of school, work, and family. They wan opportunities to be active, within a supportive environment, that fits their schedule, fits their level of fitness, and are fun.

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    Is Health Philosophy Associated With Life Satisfaction Among Registered Dietitian Nutritionists?

    Published Year: 2017
    Specialization: Health Promotion and Wellness

    Grace-Farfaglia, Patricia

    Studies of health providers suggest that satisfaction with life is related to a health professional’s values and sense of purpose which is best achieved when their professional role and private behaviors are in harmony with their personal philosophy. This study sought to describe the philosophy, lifestyle behaviors, and professional practices of dietitians, and evaluate their relationship with life satisfaction. The study recruited a randomly selected group of 520 Registered Dietitian Nutritionists to take a survey containing measures for health conception, integrative care orientation, healthy lifestyles, and satisfaction with life (SWL).

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    Examining the Change in Physical Activity, Fitness and Self-Efficacy Of African American Adolescent Girls following an 8-Week Intervention Cultural Moves

    Published Year: 2011
    Specialization: Health Promotion and Wellness

    Griffin, Angela Farr

    Examining the Change in Physical Activity, Fitness and Self-Efficacy of African American Adolescent Girls following an 8-Week Intervention “Cultural Moves” Physical activity (PA) has decrease among adolescents in the United States in the past 20 years and reportedly the lowest rates are among African American females. Lack of PA has been identified as a major risk factor for overweight, obesity and poor fitness levels which can lead to numerous health issues including cardiovascular disease. The purpose of this study was to examine the change in PA and fitness in African American girls following an 8-week educational curriculum and PA intervention that used the Trans-theoretical Model (TTM) with cultural sensitivity to promote an increase in PA. Fifty-nine 15-18 year old African American girls were randomized into an intervention group or a control group. The intervention group participated in an 8-week program called “Cultural Moves” that used TTM to promote higher level of PA. Both groups wore an activity monitor for one week prior to the intervention, and were assessed at baseline, three and six month intervals for changes in PA, cardiorespiratory fitness, and self-efficacy for exercise. A repeated meaures analysis of variance showed a statistically significant increase in PA via step counts, however, cardiorespiratory fitness and self-efficacy for exercise were not statistically significant. An intervention specifically designed for this population, “Cultural Moves”, shows promise as an intervention to increase PA with sedentary African American girls.

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    Back Squat Assessment Movement Competency: Maturity-Related Differences and Associations with Countermovement Jump Kinetics in Young Athletes and Motor Performance Variables Affecting Athleticism in Youth: A Narrative Review

    Published Year: 2020
    Specialization: Health Promotion and Wellness

    Howard, Rick

    Back squat assessment movement competency as a screening tool can identify biomechanical deficits that may reduce movement pattern compentence. The Back-Squat Assessment (BSA) was developed to quanitfy movement quality and identify functional deficits in the squat movement. The ICC for BSA novel three-point total score revealed excellent intrarater agreement for both maturity groups. The ICC also revealed excellent interrater agreement for both maturity groups, with good strength of aggreement for pre-PHV and very good strength of aggreement for post-PHV. The Mann Whitney U test showed that the pre-PHV group had a significantly higher total BSA score than the post-PHV group. Wilcoxon r test showed no signifiant between group differences between the two scores for the pre-PHV group z=1.897 and the post-PHV group z=0.816. The current study has established both intra-rater reliability and inter-rater reliability for the three-level BSA for pre-PHV and post-PHV male athletes. The pre-PHV group had significantly higher median score on the BSA than the post-PHV group. BSA performance did not predict CMJ performance.

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    Cognitive Mapping in Persons with Type 2 Diabetes

    Published Year: 2011
    Specialization: Health Promotion and Wellness

    Hughes, Lynne C.

    The purpose of this study was to explore the thoughts of persons newly diagnosed with type 2 diabetes using cognitive mapping and to compare the map of the same individuals 6 months later after living with this chronic disease. Change in biometrics, lifestyle habits, diabetes management practices, perceived wellness, as well as importance, confidence, and seriousness rulers were examined for trends and relationships among measures.

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    The Association Between Physical Activity and Quality of Life in Adults After Bariatric Surgery

    Published Year: 2011
    Specialization: Health Promotion and Wellness

    Ingman, MarySue

    The most commonly measured outcome following bariatric surgery is weight loss. Incorporating measures such as health related quality of life (HRQOL) in addition to weight loss provides outcome data that represent what is most important and meaningful to the individual and captures a more broad perspective of surgical success. HRQOL is improved in individuals who lose weight with bariatric surgery and HRQOL is enhanced by regular physical activity. It is expected that HRQOL could be maintained at a higher level, even after the period of initial weight loss, with regular physical activity. The purposes of this study were to examine the association of HRQOL with self-reported levels of physical activity and to compare HRQOL and physical activity levels in individuals following bariatric surgery with population norms.

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    A Validation Study of a Sleep Disorders Screening Questionnaire (SDS-CL-25) in College Students

    Published Year: 2019
    Specialization: Health Promotion and Wellness

    Johnson, Sandra

    Quality sleep for everyone has proven mental, physical, and emotional health benefits. Common sleep disorders, inattention to achieving adequate sleep, and other wide-ranging reasons for poor sleep hygiene often lead to adverse health outcomes, interpersonal maladjustment, and decreases in work productivity and academic performance. There are a variety of sleep disorder screening tools, and among them is the Sleep Disorders Symptoms Checklist-25 developed by Jungquist and colleagues. It was designed to be a quick screening instrument for sleep disorders across an adult U.S. population. There is a lack of self-report tools that can screen a more limited college-age sample quickly and conveniently for common sleep disturbance and disorders. Therefore, this study examined the self-administered SDS-CL-25 to determine whether it is a reliable and valid tool for use with a U.S. college sample. The convenience type sample consisted of 312 traditional college students from a small U.S. liberal arts college in the Northeast with 76 students participating in the validation process. The internal consistency of the SDS-CL-25 was high while the test-retest intraclass correlations were between 0.678 and 0.939. The principal component analysis revealed seven components with factor loadings falling between 0.439 and 0.917. Using a discriminant function analysis, the SDS-CL-25 was able to correctly classify 84.2% of the original groups with a specificity of 81.8% and a sensitivity of 85.2%. These results indicate that the SDS-CL-25 is a reliable instrument for the sample measured in this study. It is recommended that a more statistically robust college sample of participants with more sleep disorder diagnoses is needed to confirm the instrument’s validity. Within the limitation of this study, such as small sample size, low number of participants with sleep disorders, and anomalies, the validity of the SDS-CL-25 was not established.

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    An Analysis of Key Performance Metrics in Collegiate Ice Hockey Players

    Published Year: 2023
    Specialization: Health Promotion and Wellness

    Kizer, IV, Victor William

    Performance testing is used in most sports settings to provide coaching staff and scouts information on the physical capabilities of players. In ice hockey, key off-ice performance metrics have been correlated to an increase in on-ice game performance, especially anaerobic power. However, limited baseline descriptive data exists and as has previously focused on NCAA Division I players. A lack of studies directed at lower levels of collegiate play has left a data gap for coaches to compare their athletes against peers in American Collegiate Hockey Association (ACHA) leagues. The Wingate 30-second Anaerobic Threshold test (WAnT) is commonly used to determine a player’s anaerobic power. Given the interval nature of an ice hockey shift, a novel Wingate test was conducted for the first time at the 2018 NHL Scouting Combine in Buffalo, NY. This novel Wingate anaerobic test, the NHL 45s Wingate, has been proposed as a valid and reliable replacement for the more traditionally used 30s Wingate test to assess ice hockey players due to the interval-based structure of the 45s test, which more closely replicates a typical ice hockey shift. The purpose of this study was to provide descriptive satistics on key performance metrics and American Collegiate Hockey Association (ACHA) ice hockey players to explore the validity and reliability of the NHL 45s Wingate protocols.

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    Self-Reflection Behavior as a Support to Evidence-based Practice Implementation

    Published Year: 2019
    Specialization: Health Promotion and Wellness

    Krueger, Robert B.

    Objective: Evidence-based practice (EBP) has been associated with quality health care outcomes, yet only a small proportion of occupational therapists implement EBP. This study aimed to clarify factors from the literature associated with EBP, and to explore the thinking experiences of occupational therapists to determine how reflection behavior may act as a support to EBP implementation. Method: This study used a sequential explanatory mixed-method design. Phase I was a national online survey measuring EBP implementation, skill and knowledge, self-reflection behavior, and practice demographics. A total of 578 surveys were included in the final analysis. Phase II used a telephone interview of thirty participants selected based on aspects of the survey results. A grounded theory approach was used to analyze the collected data. Results: Scores on the EBP Implementation Scale indicated participants implemented EBP less than one time over the past 8 weeks. Implementation was higher for those with a doctoral degree, organizational support, time allotted for EBP, access to full articles, and high reflection behavior. Triggers to reflection included challenges to knowledge, challenges to communication, challenges to safety, and challenges to ethics. Actions taken by participants aligned with steps of the EBP cycle. Depth of reflection indicated high reflectors were more likely to engage in critical analysis and take action to correct practice. Conclusion: Participants infrequently implemented EBP in practice and in relation to steps of the EBP cycle. Organizational supports, doctorate level education, and engagement in the deepest levels of reflection acted as supports to EBP implementation. Future models of professional thinking and EBP should incorporate the full construct of reflective practice.

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    The Acute Effects of Attentional Focus on Muscular Strength

    Published Year: 2019
    Specialization: Health Promotion and Wellness

    Larson, Rachel

    Guiding a client or athlete through the performance of a motor skill requires verbal instruction. The instruction provided can cause the athlete or client to focus their attention internally or externally. Internal is a focus on body parts or body movements whereas external is a focus on an external object or end result of the movement. Limited evidence exists regarding attentional focus effects on muscular strength. A majority of the studies have tested isolated joint movements at submaxmimal loads. Therefore, the purpose of this study was to address the gaps in research by investigating the influence of attentional focus on muscular strength and surface electromyographic amplitude during a free-weight bench press exercise. Twenty three resistance-trained males, following a familiarization session, performed a one-repetition max bench press and completed 3 repititions at loads of 65%RM, 75%RM, and 85%RM under internal (INT), external (EXT), and control (CONT) conditions on 3 separate occasions. The order of attentional focus was randomized and counterbalanced. One-repitition max scores and electromyographical data from five muscles of the eupper body were recorded for analysis. Subsequently, the mean and peak EMG amplitudes were computed. A repeated-measures ANOVA comparing IRM relative strength scores found no statistical differences between conditions F(2,44)=.197, p=.822, np2=.009. There were also no statistically signficant differences in the peak EMG values under three attentional focus instructions for any muscle under any load according to the repeated-measures ANCOVA, with sphericity assumed. In conclusion, the performance of a resistance-trained individual does not appear to be affected by attentional focus instructions when performing a bench press at max and near max loads.

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    The Effects of Reducing Sedentary Behavior and Increasing Light Intensity Physical Activity on Total Wellness and Vascular Health in Adults with Asymptomatic Peripheral Arterial Disease: A 12-week Randomized Controlled Trial

    Published Year: 2018
    Specialization: Health Promotion and Wellness

    Laslovich, Steven Matthew

    Peripherla arterial disease, (PAD) a common, often progressive systematic vascular disease results in reduced blood flow capactity to the limbs. Impaired blood flow to lower limb musculature, depending on severity, is associated with reduced tolerance to ambulatory activity, restricted daily mobility, and promotes higher levels of sedentary behaviors. Importantly, the presence of PAD is associated with increased cardiovascular morbidity and mortality and lower quality of life. While the cardiovascular benefits from repeated bouts of moderate or greater intensity physical activity are fairly well established for older sedentary adults, far less is presently understood regarding the roles of daily lifestyle light to moderate intensity physical activity and sedentary behaviors in individuals with PAD. The consequences of low levels of physical activity in combination with high levels of sedentary behavior involving older adults with PAD are posited to negatively influence cardiovascular health. Additionally, reduced ambulatory capacities and reduced mobility may negatively influence quality of life. The magnitudes of lower limb complications and physical symptoms associated with PAD vary but a significant percentage of older adults with PAD are completely asymptomatic. However, similar to PAD who experience lower limb symptoms, those who are asymptomatic, (APAD) demonstrate significant increases in cardiovascular mortality along with increased sedentarism, lower levels of physical activity, and lower health related quality of life. To improve out understanding surrounding the associations of arterial health and wellness in individuals with APAD an interventional study was completed. Thirty-eight subjects with APAD were randomized to an attention control group or a physical activity and sedentary behavior reduction intervention for 12 weeks. Physical activity behaviors were measured for seven continuous days pre- and post-intervention using the ActivPAL device and through self-report using the 7-day Sedentary and Light Intensity Physical Activity instrument. Arterial health was also measured pre- and post-intervention using the EndoPAT system for measures of arterial compliance and endothelial reactivity. Additionally, all subjects underwent measurement of perceived wellness using the Wellness Evaluation of Life instrument at baseline and following the intervention.

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    Body Composition and Peak VO2 of Major League Baseball Players: 1991 2007

    Published Year: 2012
    Specialization: Health Promotion and Wellness

    Lewis, Lisa A.

    Major League Baseball (MLB) continues to be a popular national sport. While much attention has been given to performance issues in MLB players, few studies have reported on their physiological characteristics, fitness levels and training patterns of thses professional athletes. The purpose of this study was to examine physiological data that were systematically and consistently collected over a 17-year period from MLB players to: 1) describe the trends in height, weight, percent body fat, fat mass, lean mass, and peak VO2 and to 2) compare these characteristics by player position.

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    Effects of a Defecation Posture Modification Intervention on Bowel Elimination Quality in Overweight and Obese Adolescents

    Published Year: 2019
    Specialization: Health Promotion and Wellness

    Malt, Jacklyn M.

    Functional Constipation (FC) is a common complaint for which pediatric patients present for medical management. Existing research shows a greater prevalence of FC in the overweight pediatric population. Lifestyle modification is showing inconsistent results. One conservative strategy with sparse information is that of defecation posture modification. Objectives: The purpose of this investigation is to explore the effect of an educational intervention, including DPM, on the bowel elimination patterns of overweight and obese adolescents using a mixed-method approach. Study Design: Concurrent Embedded Mixed Methods. Methods: One hundred eighty-nine overweight/ obese adolescents ranging in age from 9 to 18 years attending a lifestyle modification camp participated in this study. Data collection consisted of completion of a series of Rome IV questionnaires along with a collection of a Bristol Stool Form Scale stool diary at multiple points during the camp for all subjects along with a questionnaire exploring the intention to use DPM outside of the study environment. The experimental group received the educational intervention, including instruction in defecation posture modification (DPM) followed by an opportunity to use the technique while still at camp. Two focus groups and eight individual interviews were conducted with members of the experimental group, during the final week of camp, for qualitative data. Three additional questions were added to the final experimental group survey to further clarify qualitative findings. Result: Control group N=55; Experimental grou N=64. No changes reached significance in the control group, but the improvement was noted in increased bowel movement frequency, reduced reports of incomplete emptying, and reduced FC rate. However, there was a recorded increase in reported straining. Experimental group findings showed the same pattern with statistical significance reached with improvements noted in bowel frequency and worsening in reported of straining. Results on FC prevalence in the population were varied with Rome IV showing FC prevalence within normal limits, but BSFS straining and incomplete emptying reports creating a statistically signficant elevated FC prevalence. Statistical significance was also reached when evaluating the subjects’ intention to use DPM upon returning home from camp with the experimental group showing a greater intention. Qualitative reports demonstrated significant benefits with the DPM specifically the report of faster and easier bowel movements. The main barriers identified were those of DPM discomfort and feelings of embarrassment or awkwardness with use. Conclusion: Quantitative results demonstrate modest support for the effectiveness of the educational intervention on positively impacting bowel movement quality in this population, specifically with regards to reduced evidence of delaying bowel movements and recognizing straining. Qualitative results demonstrate that DPM holds a promise as a helpful intervention in managing FC symptoms and potentially prevention of FC relapses. One-on-one patient/family instruction has a strong likelihood to solicit compliance with this technique at home without adding significant additional family burden. Additional research into the effectiveness of DPM as a tool for the management of FC needs to be performed so that DPM can be considered for addition to clinical practice guidelines for FC. Rome IV needs to be further evaluated for its sensitivity to readilty identify FC.

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    An Intervention Enhances Resilience in Physical Therapy Students

    Published Year: 2016
    Specialization: Health Promotion and Wellness

    Mejia-Downs, Anne M.

    Introduction: Physical therapy (PT) students experience high levels of psychological stress during their education. Individuals with higher levels of resilience are better equipped to handle stress. The purpose of this study was to assess the impact of an 8-hour resilience curriculum on stress levels, resilience, protectice factors, and illness among PT students during a period of academic stress. Review of Literature: Students in PT programs experience high levels of stress. Resilience is the ability to recover more quickly from stressful circumstances, to realize positive growth after a traumatic experience, and the capacity to sustain positive actions in order to achieve life goals. College students benefit from programs to increase resilience against stress; however, there is a lack of research examining the effect of resilience interventions in PT students. Subjects: Forty-three students enrolled in a DPT program at two universities volunteered to participate. Methods: Students were randomized to an intervention group that received the resilience curriculum prior to midterm examinations, or a waitlist control group. The curriculum included components of resilience, skills-building, and homework exercises. Baseline and follow-up assessments measured stress levels, resilience, coping flexibility, optimism, positive and negative emotions, social support, and symptoms of illness. Effects of the curriculum were assessed by group by time mixed model ANOVA, or nonparametric tests for data not normally distributed. Associations were explored between demographic characteristics and stress and resilience scores, and between baseline survey data and resilience scores. Multiple linear regression analysis was used to find predictors of resilience. Results: There was a significant difference in group by time interaction, showing increased resilience, and positive emotions in the intervention group compared to the control group. There were no significant differences in group by time interaction in stress, coping flexibility, negative emotions, optimism, social support, or illness symptoms. Less perceived stress, greater coping flexibility, and higher positive mood scores predicted greater resilience, accounting for 56% of the variance. Discussion and Conclusion: DPT students who received a resilience curriculum had significantly increased resilience and positive emotions compared to the students in the control group. Providing physical therapy students with tools to improve psychological resilience may better prepare them to meet the demands inherent in physical therapy educational programs.

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    The Timed Up From Floor Test: A Reliability And Validity Study

    Published Year: 2017
    Specialization: Health Promotion and Wellness

    Moffett, Marilyn A.

    Background: Identifying mobility disability as early as possible in the aging process allows interventions to be introduced before signifcant strength and mobility are lost, leading to better outcomes by delaying the physical deadline which deprives individuals of their independence. The Timed Up From Floor (TUFF) test is a screening test in which the individual is timed transitioning from supine on the floor to the stable, upright stance. The TUFF is functional and quick, yet challenging enough to identfy signs of impending mobility disability potentially earlier than many tests currently in use. To be of use, however, reliability and validity must be established. Objective: To determine reliability and validity of the TUFF test as a screening test to identify early signs of mobility disability in community-dwelling older females. Methods: In this prospective methodological study, 62 community-dwelling females, 55 years of age and older, consented to participate in this study. Inter-rater reliability of the TUFF test was established by comparing the timing results of three raters observing the same videotaped performances. Test-retest reliability was determined by having the same three raters time videos of the same participants performing the TUFF test during session approximately 1 week apart. Participants unable to get up from the floor unassisted had the option of performing a modified TUFF test (mTUFF) which permitted use of a chair to assist with the transition from supine to standing. To establish validity, the association of TUFF test times with the SF-36 questionnaire scores, usual and fast gait speeds, and 30-second sit-to-stand test repetitions was examined. Results: Both TUFF and mTUFF tests were determined to have excellent inter-rater reliability. Test-retest reliability was acceptable with an ICC=0.91 for the TUFF and ICC=0.82 for the mTUFF. The TUFF correlated with the physical function component of the SF-36, usual gait speed, fast gait speed, and the 30-second sit-to-stand test. Limitations: The study was limited to females; therefore, generalizability to males cannot be assumed. Statistical analysis of the mTUFF was underpowered, therefore conclusions cannot be drawn regarding the validity of the mTUFF in this study. Conclusions: The TUFF test is a reliable and valid screening test to identify early signs of mobility disability in community-dwelling female older adults. It is arguably a more physically demanding test than gait speed, suggesting it may identfiy signs of impending mobility disability earlier in the process. The mTUFF will require further testing with a greater number of participants in order to determine validity.

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    The Acute Chronic Workload Ratio: Related to but not Predictive of Injuries in the National Basketball Association

    Published Year: 2018
    Specialization: Health Promotion and Wellness

    Nijem, Ramsey

    The purpose of this investigation is to determine the relationship between in-game workload and injury in National Basketball Association (NBA) athletes. SportVU historical data for the 2013-2017 seasons were analyzed to determine the relationship between in-game workload variables and injury as well as if the selected variables could predict injury. Specifically, the acute, chronic, and acute: chronic workload ratio (ACWR) groupings of less than 0.8, between 0.8 and 1.3, and greaater than 1.3 and Area Under Receiver Operator Curve (AUROC) analysis were performed to determine predictive accuracy. For each of the selected workload variables, results revealed proportions of injury were higher when ACWR exceeded 1.3, while the AUROC resulted in poor prediction ability. These data suggest a relationship exists between in-game workload variables and injuries in the NBA, however this relationship is a poor predictor of injury. The results provide insight into the relationship between in-game workload and injury in NBA athletes and utlimately improves the ability of NBA practitioners to manage athletes away from injury risk.

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    Relationships between Perceived Wellness, Self-efficacy, Body Mass Index, and Illness Experienced by College Freshman

    Published Year: 2008
    Specialization: Health Promotion and Wellness

    Nustad, Jill K.

    Objective: The purpose of this study was to determine if perceived wellness predicted susceptibility to common infectious illness (CII). Participants: College freshmen participated. Methods: Students completed a health history questionnaire (HHQ), general self-efficacy (SE), and Perceived Wellness Survey (PWS) at the beginning and end of their first academic semester. Body mass index (BMI) was also measured. A survey assessing CII experienced throughout the semester was completed at the end of the semester. Spearman’s correlation coefficients and binary logistic regression analysis were used to determine relationships among all predictors of CII. Results: Students with high perceived wellness were 33% less likely to be in the High CII group compared to those with low perceived wellness. Those with higher physical wellness were 21% less likely to be in the High CI group than those with low physical wellness scores. Conclusions: The PWS was associated with CII, where those with high PWS scores were about one third less likely to experience infectious illness.

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    Effectiveness of a Group-Based Culturally Tailored Lifestyle Intervention Program on Changes in Risk Factors for Type 2 Diabetes Among Asian Indians in the United States

    Published Year: 2016
    Specialization: Health Promotion and Wellness

    Patel, Rupal M.

    This study used an experimental, pretest-posttest control group repeated measures design to evaluate the effectiveness of a community-based culturally appropriate lifestyle intervention program to reduce the risk for type 2 diabetes (T2DM) among Gujarati Asian Indians (AIs) in an urban community in the U.S. Participants included 70 adults AIs in the greater Houston A1c (HbA1c) and improvement in physical activity. Participants were screened for risk factors and randomly assigned to a 12 week group-based lifestyle intervention program or a control group that received standard print material on diabetes prevention. Participants also completed clinical measures and self-reported questionnaires about physical activity, social and lifestyle habits at 0, 3 and 6 months. No significant baseline differences were noted between groups. While a significant decline in weight and increase in physical activity was observed in all participants, the intervention group lowered their HbA1c and waist circumference signficantly as compared to the control group. Findings demonstrated that participation in a culturally tailored, lifestyle intervention program in a community setting can be effectively reduce weight, waist circumference, and HbA1c and Gujarati AIs living in the US.

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    Do the Coping Strategies used by Physical Therapists working in Acute Care Influence their Experience of Burnout Syndrome?

    Published Year: 2019
    Specialization: Health Promotion and Wellness

    Randa, Jacqueline

    This study examined the prevalence of Burnout Syndrome among acute care physical therapist, the coping strategies used to manage a stressful event, and the ability of coping strategy to predict Burnout Syndrome. An anonymous electronic survey including the Maslach Burnout Inventory-Human Services Survey and the Ways of Coping Questionnaire was deployed to acute care PTs. Structural equation modeling was used to examine whether coping strategies may help predict Burnout Syndrome. Many PTs in this study had Emotional Exhaustion, Depersonalization, and low levels of Personal Accomplishment, all dimensions of burnout, but only 10% had Burnout Syndrome. The coping strategies used most often were Planful Problem Solving, Self-Controlling, and Seeking Social Support. By contrast, Positive Reappraisal, Accepting Responsibility, and Escape-Avoidance were used least often. AR was a positive indicator of both EE, and DP. Both AR and EA were positive indicators of Burnout Syndrome. The results of this study suggest that PTs demonstrate Emotional Exhaustion, but do not show high levels of Burnout Syndrome. Accepting Responsibility and Escape-Avoidance contributed to Burnout Syndrome by increasing levels of Emotional Exhaustion and Depersonalization. PTs in this study used Accepting Responsibility and Escape-Avoidance least often. It is possible that the PTs were proteted from Burnout Syndrome by their choice of coping strategies.

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    Efficacy of a Community- and Group-based Intervention to Reduce Fall Risk among Older People

    Published Year: 2011
    Specialization: Health Promotion and Wellness

    Ratliff, Patricia Lynn Ritter

    Background: Systematic reviews and meta-analyses of fall prevention programs support the use of exercise as an effective intervention to improve strength and balance, thus decreasing fall risks. The Arthritis Foundation Exercise Program (AFEP) has not been evaluated for its potential to improve measures of physical functioning relating to falls risk management. Objective: To analyze the effect of an 8-week, 16 session AFEP intervention on performance-based measures of balance, functional fitness and self-rated health-related quality of life measures for senior adults. Design: A quasi-experimental pretest-posttest group design study, with each subject serving as her or his own control. Setting: An Alabama senior residential and wellness facility. Subjects: Forty-five senior volunteers. Methods: Balance and functional fitness measures were assessed using the Berg Balance Scale (BBS) and the Senior Fitness Test (SFT), which consists of six validated performance tests and assessment of Body Mass Index (BMI). Self-reported health-related quality of life was assessed using the RAND 36-Item Health Survey, Version 1.0. Results: Paired-sample t-test analyses identified the AFEP intervention as significantly associated with improvements in BB, SFT measures for arm curl strength, chair sit-and-reach and back scratch flexibility, and six-minute walk distance. There was no significant effect on SFT measures for BMI, 8-foot up-and-go, or any of the RAND-36 subgroups. Conclusion: The AFEP is a potentially effective fall prevention exercise intervention strategies for seniors.

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    Effects of Resistance Training on Smoking Behavior and Self-Efficacy

    Published Year: 2017
    Specialization: Health Promotion and Wellness

    Richardson, Scott

    Purpose/Hypothesis: This study examined the effects of resistance training (RT) on smoking behavior and self-efficacy. It was hypothesized that participation in a RT program would decrease withdrawal symptoms, improve self-efficacy of smoker attempting to quit, and decrease smoking behavior. Subjects: 40 subjects were randomized into either an exercise or control group. Materials/Methods: Exercise group subjects completed an eight-week progressive supervised RT program formalized via baseline strength testing. Control group subjects received smoking cessation self-help materials. All subjects completed the Smoking Abstinence Self Efficacy (SASE) survey and the Mood and Physical Symptoms Scale (MPSS) every two weeks and weekly smoking behavior was gathered. Results: Exercise subjects presented with decreased smoking behavior compared to control and decreased withdrawal symptoms compared to control as well as increased self-efficacy compared to control. Significance was found with self-efficacy results. Discussion: RT reduced withdrawal symptoms and smoking behavior and significantly improved smoking abstinence self-efficacy. Large SD in smoking behavior results likely due to lack of control for smoking levels at study entry. This provides evidence to support utilization of RT to assist efforts to overcome barriers associated with quitting smoking. Clinical Relevance: Cigarette smoking is prevalent with 40 million Americans smoking and one in five deaths attributed to this behavior. Studies of aerobic exercise as an intervention for smoking cessation are well documented, with sprase research examining effects of RT. This study demonstrates the effectiveness of RT as an aid for smokers attempting to quit.

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    Effects of Different Volume-Equated Resistance Training Loading Strategies on Muscular Adaptations in Well-Trained Men

    Published Year: 2014
    Specialization: Health Promotion and Wellness

    Schoenfeld, Brad

    Regimented resistance training has been shown to promote marked increases in skeletal muscle mass. Although muscle hypertrophy can be attained through a wide range of resistance training programs, the principle of specificity, which states that adaptations are specific to the nature of the applied stimulus, dictates that some programs will promote greater hypertrophy than others. Research is lacking, however, as to the best combination of variables required to maximize hypertrophic gains. The purpose of this study was to investigate muscular adaptations to a bodybuilding-type training program versus a powerlifting-type routine in well-trained subjects. 17 young man were randomly assigned to either an HT group that performed 3 sets of 10RM with 90 seconds rest or an ST group that performed 7 sets of 3RM with 3 minutes rest. After 8 weeks, no significant differences were noted in muscle thickness of the biceps brachii or quadriceps femoris. Significant strength differences were found in favor of ST for the 1RM bench press and a trend was found for greater increases in the 1RM squat. In conclusion, this study showed both bodybuilding- and powerlifting-type training promote similar increases in muscular size, but powerlifting-type training is superior for enhancing maximal strength in well-trained young men.

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    Exploring Mental Health Help-Seeking Behaviors in Student-Athletes: A Mixed-Methods Approach

    Published Year: 2021
    Specialization: Health Promotion and Wellness

    Shemak, Geana R.

    Introduction: Adolescents and young adults experience a high level of mental health conditions.These disorders appear to be increasing in number and severity. The prevalence rate for 18-25-years-olds is 8.7% in 12 months. Mental health conditions are treatable, yet many people do not seek professional help. Seeking help from a professional source is particularly important for preventing, early detection, treatment, and recovery from mental health conditions. Purpose: The purpose of this mixed-methods study is to demonstrate the prevalence of depression, explore student-athletes attitudes towards seeking mental health help, understand what factors may influence help-seeking behaviors, and explore the athlete’s perceptions of the role that athletic trainers play in the assessment and referral process. Methods: An exploratory, concurrent mixed methods design was used. Survey data from the ATSPPH-SF and PHQ-9 were collected from collegiate student-athletes. A phenomenological approach will guide the qualitative research process. Semi-structured interviews will be audiotaped, transcribed, and analyzed using an interpretive thematic analytical approach. Study Participants: National Collegiate Athletic Association (NCAA) student-athletes participating at the Divsion III (DIII) level. Results: The prevalence of depression was almost 42% in the study population. There was no relationship between PHQ-9 scores and sex. Attitudes towards seeking help were generally positive. Females tend to have more favorable attitudes than males, but this finding was not statistically significant. There was no relationhship between PHQ-9 scores and ATSPPH-SF scores. Barriers to help-seeking included perceived seriousness, stigma, lack of time, accessibility, prefer to handle issues on own, and cost. Facilitators to help-seeking included perceived and nee-problems that were serious enough to warrant help and a supportive network. Clinical Importance: As we continue to address the mental health crisis, it is imperative to understand what prevents student-athletes from seeking professional psychological help and develop supportive programs to help them overcome these barriers. Certified athletic trainers, coaches, and other athletic personel need to understand the seriousness of untreated mental health conditions and be educated to recognize when an athlete may be struggling with issues beyond their control. Knowing when to refer a student-athlete to a professional is essential in preventing potential unnecessary and irreversible consequences.

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    Impact of Yoga on Undergraduate Freshman Resilience and Academic Persistence

    Published Year: 2022
    Specialization: Health Promotion and Wellness

    Skorupski, Kayle

    Stress and mental health issues are widespread in college students, and they may benefit from increased resilience. The objective of this study was to determine the impact of Hatha yoga on resilience and determine the relationship between resilience and academic persistence. This study was a quantitative, prospective controlled trial using a pretest and posttest design with a convenience sample. Participants included first-year University students who participateed in weekly 1-hour yoga sessions, practiced progressive muscle relaxation (PMR) for 10 minutes daily, 6 times per week, or continued with activity as usual (wait list control). The intervention length was shortened from 6 weeks to 4 weeks due to the start of the COVID-19 Pandemic. Outcome measures included Brief Resilience Score (BRS), Connor-Davidson Resilience Scale (CD-RISC 25), Academic Resilience Scale (ARS-30), and persistence to sophmore year. Results included significant post-score increases compared to pre- for the PMR group in the BRS and CD-RISC 25 scales, demonstrating increased resilience. Significant changes were found for yoga and PMR in ARS-30 Factor 3 scores, showing a decrease in negative thoughts regarding academics. No relationship between resilience and academic persistence was found. This study demonstrates that Hatha yoga and PMR can positively impact resilience in first-year college students.

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    Examining Self-Reported Adult Physical Activity Levels in an Integrated Health Care System

    Published Year: 2017
    Specialization: Health Promotion and Wellness

    Smith, Trevor Quintin

    This study aims to define the characteristics of the patient population in which the physical activity vital sign (PAVS), physical activity (PA) advice, a combination of both PAVS and PA advice, as well as standard care were provided and documented within an electronic health record (EHR). Methods: Retrospective clinical data captured through the EHR was examined. A focus was placed on the characteristics of individuals who received different levels of PA assessment and/or advice. Data on ages, genders, and body mass index (BMI) numbers was abstracted from the EHR over 20 months. Results: Characteristics examined included: gender, age, and BMI. Providers were more likely to provide PA advice to males, but less likely to receive both the PAVS and PA advice. Compared to younger patients, older patients were more likely to receive the PAVS and PA advice. Similar findings were observed in patients with high BMIs. Conclusion: Females and older patients are more likely to receive the PAVS; whereas, males,older adults, and patients with high BMIs are more likely to receive PA advice. Patients receiving both the PAVS and PA advice are more commonly older females with high BMIs.

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    The Effects of Sit-Stand Equipment and Hourly Prompting on Occupational Sitting Time

    Published Year: 2014
    Specialization: Health Promotion and Wellness

    Sternburgh, Lucille E.

    A growing body of literature has recently brought attention to the idea that prolonged sitting time is a deleterious and independent risk factor for chronic disease and all-cause mortality. The purpose of this dissertation was to assess the effects of sit-stand equipment and hourly prompting on occupational sitting time. The primary hypothesis of this study was that sit-stand office equipment would decrease occupational sitting time in call center employees compared to a control group. Secondarily, sit-stand office equipment would also increase the amount of time spent standing and stepping, as well as self-reported productivity and mood compared to a control group.

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    Obesity in Female Adolescents: Influence on Fitness, Health Literacy, and Engagement in a Fitness and Health Promotion After-School Program

    Published Year: 2016
    Specialization: Health Promotion and Wellness

    Taylor, Mary Jean

    Determine fitness level in female adolescents and relationship with body mass index (BMI) and participation in school athletics. Fitness was determined using the President’s Challenge Physical Fitness Test. Percentage of subjects who scored =< 90th percentile was calculated for each fitness measures based on comparison with age and gender-specific, norma-referenced data. Greater than 50% of subjects scored =< 10th percentile on the timed mile, shuttle run, and number of push-ups and sit-ups performed in one minute. Fitness was significantly corelated with BMI. Those classified as “thin” and “obese” demonstrated the greatest compromise. Fitness was greater in athletes compared to non-athletes. This study provides preliminary evidence of compromised fitness status in ethnically diverse female adolescents from an economically challenged community. Engagement in athletics may serve as a catalyst to maintain and improve fitness in female adolescents.

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    Job Satisfaction in Physical Therapy and its Relationship with Debt Load

    Published Year: 2019
    Specialization: Health Promotion and Wellness

    Timpson, Misti L.

    Background: Job satisfaction is important for life satisfaction as well as for quality of patient care. There are many identified factors that are correlated with both satisfaction and dissatisfaction in physical therapy (PT). One of the factors creating dissatisfaction in the field of PT may be educational debt load. As the requirements for degree confirmation and the cost of education have increased, students graduate with greater amounts of debt. Evidence in the medical literature suggestes that physicians and other health care professionals pursue specialties often because of the influence of salary potential. Working in higher paying settings may not produce the same degree of satisfaction, if the decision is based primarily on financial considerations only. Purpose: To explore job satisfaction in the field of physical therapy and investigate if an how much educational debt load is factor. Methods: This study was a mixed method, two-party study design. Phase I was an electronic survey, 1,060 surveys were completed and analyzed. Phase II was qualitative study consisting of a telephone interview, in which 24 PTs from acute care, skilled nursing, and outpatient orthopedics were interviewed. Individuals with either high debt or low debt, high satisfaction or low satisfaction were all represented. The Job Satisfaction Survey (JSS) and a visual analog scale (VAS) were used to assess satisfaction levels. Results: JSS and VAS were found to have a strong correlation with each other. Demographic factors, including debt, showed little correlation or predictive ability with either satisfaction measure. Qualitatively, all PTs interviewed were highly concerned with the increasing educational debt load students assume. Several primary and lower order themes emerged as satisfaction related to debt: education, work, and financial. Conclusions: Educational debt load was a major concern for all interviewed, whether they had debt or not. Experienced therapists that may have had very little initial debt or more significant amounts of debt but have paid it off were often more concerned than newer therapists that have significantly large amounts of debt. Debt did not appear to significantly influence choice of specialty or location of work for most people. Debt was not a strong indicator or greater or lesser degrees of satisfaction.

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    Effects of Common Interventions at the Workplace on Sedentary Behavior, Physical Activity and Perceived Wellness

    Published Year: 2015
    Specialization: Health Promotion and Wellness

    Urda, Joyan L.

    The purpose was to determine whether an alert to get up and move once per hour, while at work would reduce sedentary time, change the number of sit-to-stand transitions and change perceived wellness. A secondary purpose was to determine whether subjective recall of physical activity (PA) and sedentary time were related to objective measures. Participants were office staff and admininstrators working in occupations primarily consisting of sitting at a desk. Participants were randomly assigned to one of two groups: the control – control group (CC), or the control – intervention group (CI).Both groups wore a triaxial accelerometer for two weeks. The CC group was instructed to maintain normal behaviors, whereas the CI group was instructed to maintain behaviors during week 1, but responded to the alerts during week two, The alert was an hourly reminder on their phone or computer to get up and move for a short duration in the workday. Both groups provided subjective recall and objective measures of sedentary and PA behaviors at the end of week one and week two. Both groups completed a perceived wellness survey at the beginning of the study, and again after weeks one and two. A factorial/mixed design repeated measures Analysis of Variance (ANOVA) revealed no differences in any of the variables over time. There was a between groups difference, and a post hoc independent t-test revealed that sedentary time at work was different between groups in week 2. Perceived wellness was not different between groups at day 0, day 8, or day 16, nor was it different between groups between day 0 and day 8. However, there was a significant increase in perceived wellness from day 0 to day 16 ion both groups. A positive, weak correlation was found between subjective and objective sedentary time at work. There was also a positive, weak correlation between subjective and objective sedentary time over a 24 hour period. It was concluded that the intervention had no effect on sitting time or sit-to-stand transitions during working hours or sedentarytime outside of work. Perceived wellness scores over the two week protocol improved for both groups. Subjective recall was only weakly related to objective measures of sedentary time.

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    The Conceptualization and Measurement of Wellness : The Perceived Wellness Survey-2

    Published Year: 2023
    Specialization: Health Promotion and Wellness

    Ward, Alisa

    The Perceived Wellness Survey (PWS), introduced to the academic world in 1997, has been cited 723 times in published sutdies. Despite its popularity, it exhibits comprised loading properties as a multidimensional model upon psychometric analysis. The purpose of this study was to develop an updated version of the original 25-year-old PWS to offer valid and reliable responses to measure perceptions of wellness of current traditional college students. This current study may contribute to existing literatrue, providing a more contemporary understanding of college students’ perceptions and understanding of wellness, and to identify the dimensions of wellness most relevant for assessment and intervention among this demographic.

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    Soft Tissue Mobilization in Treatment of Chronic Pain Following Caesarean Section

    Published Year: 2017
    Specialization: Health Promotion and Wellness

    Wasserman, Jennifer B.

    This dissertation’s primary aim was to determine if soft tissue mobilization will reduce chronic pain and improve function and mobility resulting from C-section surgery. Secondary aims were to examine the existing evidence for manual treatment of adhesion-related abdominal symptoms and to demonstrate the reliability of the digital pressure algometer and the modified adheremeter when used in abdominal tissues.

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    The Effect of the Exosym Care Program on Physical Performance, and Association with Psychosocial Status and Health-Related Quality of Life Among Adults with Major Lower Extremity Disabilities

    Published Year: 2021
    Specialization: Health Promotion and Wellness

    Williamson, Jared

    Millions of Americans suffer from chronic lower extremity pain and disability. Prosthetic and orthotic (P & O) devices, particularly ankle-foot orthoses, are widely used to restore mobility and reduce pain. Successful P&O interventions integrate device delivery, physical training, and psychosocial strategy, particularly when treating individuals with chronic pain and disability.

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    The Effect of Attentional Focus on Sprint Performance

    Published Year: 2015
    Specialization: Health Promotion and Wellness

    Winkelman, Nicklaas

    Two experiments evaluated the influence of attentional focus on 10-meter sprint time and start kinetics in a group of collegiate soccer players and highly experienced sprinters. In Experiment 1, the collegiate soccer players were asked to perform 10-meter spints under an external focus condition, an internal focus condition and a control condition. For the 10-meter sprint time, the results showed that both the external focus and control conditions resulted in significantly faster sprint times than the internal focus condition. There were no differences observed across any of the conditions for a select set of kinetic variables. In Experiment 2, the highly experienced sprinters performed the same 10-meter sprint task using the same instructional conditions as in Experiment 1. For the 10-meter sprint time and kinetic variables, there were no differences observed across any of the conditions. These results provide new evidence that experience level mediates the influence of attentional focus on sprint performance.

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    Exercise Knowledge and Behavior: Former Athletes Compared to the General Population

    Published Year: 2017
    Specialization: Health Promotion and Wellness

    Wludyga, Joshua

    Previous research suggested former athletes exhibit no differences in exercise habits as the general population. However, the extent of knowledge of the American College of Sports Medicine (ACSM) exercise recommendations as an influence of exercise habits is not fully demonstrated. The purpose of this study was to determine the exercise behaviors and level of exercise knowledge or former athletes compared to members of the general population. Additionally, the potential influences a health education course provided in maintaining health and exercise habits once community college athletes terminate their competitive career was examined. A total of 454 participants consisting of former community college athletes of various sports, as well as non-athlete graduates submitted a brief survey that assessed level of knowledge regarding current exercise recommendations, as well as comparing current aerobic exercise habits. Athletes and non-athletes were then separated into groups based on their previous enrollment in a freshmen level health education course. Chi-square analyses were utilized to assess comparisons of accuracy of the ACSM exercise recommendations, while a one-way Aanlysis of Covariance assessed differences in current exercise behaviors. Results indicated no differences in accuracy of the ACSM recommendations regardless of athletes or health education background. Significant differences in exercise frequency were demonstrated between former athletes with health education and non-athletes with no health education. Significant differences in exercise duration were shown between former athletes with no health education background and both non-athletes with health education and no health education. An a posteriori t-test revealed accurate responders had higher exercise volumes than inaccurate responders. In conclusion, the health education course had no apparent long-term impact on exercise behaviors. Athletic background had a statistically significant impact on current exercise habhits more so than educational background. However, future reseearch is warranted to evaluate the impact of other educational opportunities as well as trends in declining exercise habits over time among all groups.

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Health Science

    Return to Sport after ACL Reconstruction using Hamstring Autografts: A Comparison of Factors Associated with Failure

    Published Year: 2008
    Specialization: Health Science

    Nesseth, Jennifer R.

    Context: Female athletes returning to sports after being reconstructed with hamstring autografts has not been widely discussed in the literature. Objective: To evaluate reconstructed anterior cruciate ligament failures in a population of female athletes returning to competitive sports. Design: Restrospective Study. Setting: A private orthopaedic clinic. Patients or Other Participants: Female atheletes ranging in age from 13-25 that participated in sports before and after anterior cruciate ligament reconstruction using only hamstring autografts. Two groups were compared, a Non-Failure Group to a Failure Group. The sports were divided into Level 1 and Level 2 soprts for this study. Data Collection and Analysis: Data collection was performed by one practitioner. Demographic factors were collected from medical records with IRB approval. All factors that may have lead to the failure of the reconstructed anterior cruciate ligament in female athletes were collected. Statistical significance was set at p (less than or equal to) 0.05. Results: The mean follow-up time was 24 (plus or minus) 6 months on all the participants. Return to pre-injury status and athletics took the Non-Failure Group 158 days from surgery compared to the Failure Group who took 141 days to return to athletic competition. Sports returned to after reconstructive surgery using the hamstring autograft compared between the two groups was statistically significant. Conclusions: Repeat ACL injury occured in 14% of the athletes in the first 8 months after the index reconstruction. The factors that increased the risk of repeat ACL injury included a return to competitive sports and the days between surgery and return to pre-injury status. Factors such as age, meniscal, and other knee ligament injuries during the index ACL rupture are believed to increase the risk of injury, but were not found to influence ACL graft ruptures.

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    Utilization and Perceptions of Patient-Reported Outcome Measures and Health-Related Quality of Life in Pediatric Inpatient Physical Therapy : A Mixed-Methods Study

    Published Year: 2023
    Specialization: Health Science

    Tischler, Dana

    Patient-reported outcome measures (PROMs) are important assessments to gain the patient’s or caregiver’s perspective. Pediatric physical therapists (PTs) report barriers to using outcome measures, such as lack of time, difficulty selecting measures, and difficulty interpreting results. While professional standards recommend using PROMs, there is a paucity of evidence regarding PROM trends among acute care pediatric PTs. The purpose of this study was to describe the current use of and perceived benefits and barriers to using PROMs by pediatric PTs in the acute care setting and to explore therapists’ perceptions and experiences of the influence of PROMs, including those measuring HRQOL, on their clinical decision-making and the plan of care.

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Healthcare Leadership and Administration

    Fall Prediction In inpatient Rehabilitation Facilities

    Published Year: 2023
    Specialization: Healthcare Leadership and Administration

    Wright, Jonathan Robert

    Falls in inpatient rehabilitation facilities (IRFs) complicate patient recovery and generate a substantial financial burden. Identifying with patients are likely to fall is an important step to reducing falls. The Morse Fall Scale (MFS), a traditional acute care assessment tool, has been used in IRFs, but research suggests it is not predictively accurate in that setting. Retrospective studies indicate Activity Measure for Post-Acute Care (AM-PAC) subscales and Quality Indicators (QI) may be used to enhance fall prediction accuracy in rehabilitation facilities, but further prospective investigation is needed. Using QI codes to identify fall risk would reduce assessment burden as they are already part of required IRF documentation. Therefore, the purpose of this dissertation was to 1) analyze the associations between QI codes and falls, 2) calculate the predictive accuracy of a QI-based fall risk assessment called the IRF Scale, and 3) compare the accuracy of the IRF Scale with a 2-Item QI scale, the MFS, and AM-PAC in predicting which patients would fall in a prospective sample.

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Neurology

    The Effects of Synchronized Timing Training on Timing, Attention, Motor Function, and Self-perception in Children with Dyscoordination

    Published Year: 2008
    Specialization: Neurology

    Bartscherer, Melinda L.

    Background and Purpose: Children who are dyscoordinated have difficulty with successfully performing activities of daily living at school and at home. When performing activities they exhibit timing impairments, notably inaccuracy and inconsistency. Additionally, an estimated 50% of children with DCD also exhibit cooccurring attention deficit hyperactivity disorder (ADHD). The purposes of this study were to determine if children who are dyscoordinated are able to improve accuracy and consistency in a timing task and attention and to examine if, following synchronized motor timing training (STT), they are able to maintain accuracy and consistency and selective attention even after an interval without practice. Thirteen participants ages 9-12 identified by their parents as having coordination difficulties consistent with those with Developmental Coordination Disorder were recruited. Methods/design/results: Thirteen participants ages nine to twelve were identified by their parents as having coordination difficulties consistent with developmental coordination disorder were recruited. All participants were randomly assigned to 1 of 2 groups: an experimental group which received STT via a computerized metronome program 2-3 times weekly for 6 weeks; or a control group which received weekly correspondence from the researcher for 6 weeks. All participants were evaluated before randomization and then again at 6 weeks and 3 months post training. The outcome measures were timing error and sustained and selective attention. Following STT, children exhibited significantly improved accuracy and consistency and had significantly fewer inattentive errors. Discussion: This paper presents the rationale, design, and protocol for examining the effect of synchronized timing training on timing and attention and provides evidence that STT enhances timing and attention in children with discoordination.

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    Effect of Group Delivery of Feldenkrais Awareness Through Movement on Balance, Functional Mobility, and Quality of Life in Adults Post-Stroke

    Published Year: 2006
    Specialization: Neurology

    Batson, Glenna

    Background and Purpose: The Feldenkrais Method (FM) is a complimentay movement therapy approach to motor learning that shares tenets with dynamic systems theory. The approach purports to enhance movement awareness and efficiency. FM efficiency on balance has been reported in only one controlled trial with people with multiple sclerosis. The purpose of this study was to determine if a group-delivered program of Feldenkrais Awareness through Movement (ATM) would improve balance and functional mobility in adults post-stroke. Methodology: The study used a double base-line pre-test post-test design. Subjects included 7 men and 3 women, 1 to 3 years post-stroke. Primary outcomes of balance and functional mobility were the Berg Balance Scale (BBS) and the Timed Movement Battery (TMB), respectively. Secondary outcomes were quality of life and imagery ability measured with the Stroke Impact Scale (SIS), and the Movement Imagery Questionnaire (MIQ), respectively. Subjects received 18 ATM sessions (1.5 hours each) over a 6-week period. Eight subjects were included in the final analysis using the Wilcoxon Signed Ranks Test and Spearman Rank Correlation Coefficient to measure differences and associations, respectively. Results: The group improved an average of 5 points on the BBS, with 5 out of 8 subjects improving 6 or more points. Eight out of 10 subjects improved on the TMB 20′ at walk a normal and fast speed. Most subjects improved on TMB stair ascension and left side stepping at normal and fast speeds. There was no significant difference on the SIS pretest-posttest scores. MIQ scores improved significantly for both the entire test as well as individual visual and kinesthetic subscales. There was a positive association between pre-test MIQ kinesthetic scores with posttest BBS. Discussion and Conclusion: For select individuals post-stroke, a group-delivered, exploratory method of perceptuo-motor learning resulted in functional gains in complex measures of balance and movement efficiency. Additionally subjects improved their imagery ability. Pre-testing kinesthetic imagery ability was related to post-test balance improvements suggesting that pre-test MIQ scores could be used to select for individuals that may benefit from this type of intervention.

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    Effects of Neonatal Physical Therapy Instruction on Parent Competency and Anxiety in a Neonatal Intensive Care Setting

    Published Year: 2010
    Specialization: Neurology

    Byrne, Eilish M.

    Survival of an increasing number of infants born preterm requires the healthcare community to focus on quality of life issues for both the child and the family. In one effort to enhance quality of life, hospitals have adopted a patient-centered, family-focused approach to medical and health related care. Findings from research have demonstrated that familial involvement in infant care is critical and that improved infant outcome relies on both the physical capabilities of the infant and on parent-infant interaction. Furthermore, the quality of parent-infant interaction has been shown to be a better predictor of improved outcome than traditional perinatal physical assessments. The primary purpose of this study was to investigate the effectiveness of three methods for delivering instruction to parents regarding handling of their infants who were born preterm and admitted to the Neonatal Intensive Care Unit (NICU). A secondary purpose was to examine the effect of instruction on reported parental anxiety regarding infant handling.

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    The Use of Taoist Meditation on the Reduction of Heart Rate, Blood Pressure, Fatigue and Depression in Persons with Multiple Sclerosis: A Single Subject Design

    Published Year: 2005
    Specialization: Neurology

    Csiza, Linda

    Background and Purpose: This feasibility study determined the effect of Taoist meditation on heart rate (HR), blood pressure (BP), depression, and perceived fatigue in persons with Multiple Sclerosis (MS). Fatigue is one of the first and most often reported symptoms in persons with MS. Depression and fatigue appear to be closely related in individuals with MS. Studies also have shown a connection between stressful events and exacerbation of symptoms of MS and lesions in the brain. Meditation has been successfully used in the treatment of conditions such as cardiac disease, skin disease, anxiety, asthma, fibromyalgia and other chronic problems that have stress as a component of the disease. Therefore the purpose of this study is to study the effect of meditation on stress, fatigue and depression in persons with MS. Subjects and Methods: The study, a single subject, multiple baseline design with varying baselines and intervention periods, included 6 individuals recruited from the local community. The participants were randomly assigned to 1 of 3 protocols. Outcome measures were: Expanded Disability Status Survey (EDSS), Functional Assessment of Multiple Sclerosis (FAMS), Beck Depression Inventory (BDI), Fatigue Severity Scale (FSS), Fatigue Visual Analogue (FVA), HR, and BP. The measures were completed during baseline, end of baseline, 8 weeks, and of the intervention period, and at 4 week post study. HR and BP were recorded before and after each meditation class. The 8-12 week intervention was a 90 minute weekly Taoist meditation class. Visual analysis was performed on the FAMS, FSS and FVA. The C-statistic was utilized to analyzed HR, systolic and diastolic BP. Results: No change occurred on the EDSS. Participants demonstrated improvement on the FAMS, and the FSS, and the FVA. Ten of 18 HR and BP data were statistically significant at a p<.05. Discussion and Conclusion: This study suppors the need for a definitive study of meditation for persons with MS to help combat the effects of stress, depression, and fatigue.

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    Surviving to Living: The Transition from Rehabilitation to Community Participation after Spinal Cord Injury

    Published Year: 2005
    Specialization: Neurology

    Davidson, Carol Ann

    The intended outcome of rehabilitation is that people with spinal cord injury return to the highest level of function possible and participate in community life. However, little is known about the process of achieving participation from the perspectives of the individuals with SCI who have experienced rehabilitation. The purpose of this study was to describe experiences of rehabilitation after spinal cord injury and the influence of the rehabilitation experiences on the ability to achieve community reintegration from the individuals’ perspectives. A qualitative phenomenological approach was used. Six participants who were six months to one year post discharge from initial rehabilitation for an acute spinal cord injury participated in a series of semistructured interviews and confirmatory discussions. Participants described the process of community integration as a transition from surviving to living. Four major themes related to this transition emerged from narrative descriptions: support, psychological adjustment, physical adjustment, and education. Although the intended outcome of rehabilitation is that people with SCI return to the highest level of cummunity participation possible, rehabilitation focuses on support and education that assists people with skills necessary for day to day survival of SCI. Under the traditional continuum of care, support and education to facilitating living skills are lacking. Home and cummunity rehabilitation or other transition programs may better enhance individuals’ abilities to participate in community life after discharge from inpatient rehabilitation.

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    The Relationship Between Postural Control, Gait Variability and Cognition, and Their Association to Falls Risk

    Published Year: 2009
    Specialization: Neurology

    Dewane, Judith A.

    Falls and injuries related to falls constitute a large problem in the United States with 25-30% of adults over the age of 65 yrs falling annually. Of these, greater than 50% occurred during walking or some type of locomotion. The purposes of this study were to characterize the relationship between postural control and gait variability in older adults with and without a falls history, and to explore how executive function affects both postural control and gait variability as it relates to falling. Methods: Cross sectional design. Subjects: Participants included community dwelling older adults aged 65 to 85 yrs who were able to walk a minimum of 5 min without an assistive device. Measurements: Stride time variability was recorded using pressure-sensitive foot switches during usual and dual task walking. Postural control was measured with the Sensory Organization Test (SOT) and Limits of Stability Test (LOS) using the NeuroCom Smart Balance System. Clinical measures included the Dynamic Gait Index (DGI) and Activities Specific Balance Confidence Scale (ABC). Executive function measures included the Clock Drawing Test and the Trial Making Tests (TMT) part A and B. Known risk factors for falls were identified from the literature and calculated for each subject. Results: All postural control measures, ABC, DGI and Trial Making Test A and B were able to differeniate non-fallers and fallers, with fallers scoring worse in all testing. Stride time variability was consistent between groups during both walking conditions. The SOT composite score was inversely related to stride time variability under both conditions for fallers only. The DGI was the strongest in predicting stride time variability during usual and dual task conditions. The DGI cut score of 19.5 had a sensitivity of 68% and specificity of 72% in differentiating fallers from non-fallers. DGI < 19.5 combined with TMT B>74 s enhanced the ability to identify individuals not at risk for falls, but results in more false positives. Odds ratios (OR) for falling were: TMT B>74 s=4.1; DGI <19.5=5.4;8 or more risk factors =7.3; and combined TMT B>74 s and DGI< 19.5 =17.8. However, if 8 risk factors and TMT <74 s were present the OR was 0.2. Clinical relevance: Falls are multifactorial: it is important to not only identify impairments, but to also identify problems with postural control strategies. Psturography, specifically the SOT and LOS-MXE, is a valuable tool to identify fallers and to specify the type of postuyral control problem. The DGI appears to be an essential tool in the identification of those at risk of falling especially during gait activities, and should be considered part of the standard of care when examining older adults with risk for falls. Executive function, specifically flexibility of thought, appears to be used in the management of postural instability and related impairments. As demonstrated in this study, the slowing of cognitive flexibility substantially increases the odds of falling. Therefore, clinical use of the TMT test may enhance the discrimination power of postural control measures. Clinicians need to consider interventions aimed at remediating neuromuscular impairments, as well as those designed to enhance cognitive flexibility to better manage the impairments that persist.

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    Changes in Muscle Activity Patterns During Forward Pedaling after Backward Pedaling in Persons with Post-Stroke Hemiplegia

    Published Year: 2009
    Specialization: Neurology

    Gallichio, Joann

    Impaired locomotion in individuals with post-stroke hemiplegia is due, in part, to abnormal muscle activation patterns with respect to amplitude and phasing. It can be theorized that interventions that improve muscle activation patterns may decrease disability in persons with hemiplegia following stroke. The purpose of this study was to determine the change in muscle activation patterns of three lower extremity muscles during forward pedaling after 15 minutes of backward pedaling training on a modified ergometer in persons with post-stroke hemiplegia. Previous studies have shown that during backward pedaling, there is a large reduction in inappropriately prolonged vastus medialis (VM) and soleus (SL) activity that is present during forward pedaling. Therefore, we hypothesized that, after 15 minutes of backward pedaling, inappropriate activation of the VM and SL during foward pedaling would be reduced. In contrast, since biarticular muscles, particularly the rectus femoris (RF), do not show altered phasing during backward pedaling, we hypothesized that the RF would not change its inappropriate phasing during forward pedaling after backward pedaling training. Eleven participants with a single unilateral stroke and lower extremity paresis greater than six months duration were tested. EMG was recorded for the paretic and nonparetic lower extremity muscles as a 1-minute baseline measurement of muscle activation patterns during forward pedaling. Participants performed both a 15-minute bout of backward pedaling and a 15-minute bout of forward pedaling followed by a post-training 5-minute bout of forward pedaling. Contrary to expectations, inappropriate VM activation in the paretic lower extremity was increased rather than reduced during forward after backward pedaling training. Consistent with our hypothesis, inappropriate RF phasing did not change after backward pedaling training. We conclude that, even though muscl activity patterns are changed with changes in task mechanics, those chnges are not transferable to the original task. In addition, there may be some evidence to support inappropriate phasing enhancement training to reduce post-training error.

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    A Comparison of Actual and Perceived Balance Abilities in Patients with Stroke

    Published Year: 2004
    Specialization: Neurology

    Ibrahim, Mohamed Attia Abbas

    Purpose: The purpose of this study was to investigate the relationship between perceived confidence in the ability to perform certain activities that challenge balance and the actual performance of some of those activities in subjects with chronic stroke. Background: Patients who have had a stroke are at high risk for a wide range of secondary complications such as recurrent stroke, epileptic seizure, infectio and mobility-related falls. Falls after stroke are one of the major complications, and of all complications in people with chronic stroke, falls constitute 25%. The causes and prevention of falls are still under investigation in this population. Subjects: Thirty volunteers (14 male and 16 female) with chronic stroke (6-30 months post-stroke) participated in the study. The mean age was 64.7 years. Methods: The primary ourcome measures were the Activities specific Balance Confidence scale (ABC) scale (perceived confidence), the Berg Balance Scale (BBS) (actual abilities), Stroke-Adapted SIP-30, Stroke Severity Index, and Charlson’s Comorbidity Index. The ABC and SA-SIP30 were self administered by each participant. The Berg Balance Scale, Stroke Severity Index, and Charlson’s Comorbidity Index were administered and recorded by the researcher. Analyses: A Spearman rank correlation coefficient was used to determine if a significant correlation exists between the ABC and the BBS. Results: Scores revealed significant moderate correlations between actual and perceived balance abilities in patients with chronic stroke. Further data analysis revealed that there were no significant correlations between fallers and non-fallers actual and/or perceived balance abilities among patients with chronic stroke. Conclusion: Perceived confidence of balance abilities might be an indicator of actual balance abilities when performing certain activities that challenge balance in patients with chronic stroke. However, no relationship was established between the BBS and the ABC between fallers and non-fallers in patients with chronic stroke.

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    Effect of a Single Bout of Intermittent vs. Continuous Walking on Perceptions of Fatigue in Persons With Multiple Sclerosis

    Published Year: 2009
    Specialization: Neurology

    Karpatkin, Herbert I.

    Fatigue is a symptom commonly seen in individuals with MS that may limit their ability to benefit from physical therapy. A exercise program that decreases the amount of fatigue a person with MS experiences as a result of the exercise may lead to a greater amount of exercise performed and a greater likelihood of realizing the benefits of exercise. The purpose of this study was to determine whether subjective feelings of fatigue are different in persons with MS depending on whether they engage in intermittent or continuous exercise. Using a repeated-measures, crossover, within-subejcts design, a sample of 30 ambulatory persons with EDSS scores between two and four performed 6 minutes of either continuous or intermittent walking. Fatigue was measured of the Visual Analog Scale of Fatigue. It was expected that persons with MS who performed the 6-minute walk in an intermittent manner would have lower scores on the VASF compared to persons who performed the 6-minute walk continuously. Results showed the subjects found the intermittent walking to be significantly less fatiguing than the continuous walking. There was no effect noted for disease severity, duration, or subject mood. Clinicians are often reluctant to treat persons with MS due to the lack of an established protocol as compared to those available for other neurological disorders. This study provides evidence to support the use of intermittent exercise in persons with MS, which may be tolerated better than continuous exercise based on subjective reporting.

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    The Relationship Between the Activities-Specific Balance Confidence (ABC) Scale and the Dynamic Gait Index (DGI) in Peripheral Vestibular Dysfunction

    Published Year: 2002
    Specialization: Neurology

    Legters, Kristine S.

    Persons wit vestibular dysfunction experience dizziness, vertigo, and postural instability. The persistence of these symptoms may result in decreased balance confidence. The purpose of this study is to examine the relationship between decreased balance confidence and gait dysfunction in patients with unilateral peripheral vestibular dysfunction. A retrospective review of 137 charts with Activities-specific Balance Confidence (ABC) Scale ad Dynamic Gait Index (DGI) scores was completed. Speannan rank order correlation analysis was performed of the total sample, by age group and by degree of vestibular weakness. A moderate correlation of r = .58 (p < 0.001) was found between the ABC Score and DGI in the total sample. Those with mild/moderate vestibular weakness had a correlation of .72 (p < 0.001), compared to a correlation of .48 in those with severe/total vestibular weakness. Decreased balance confidence and increased fall risk are crucial issues for persons with vestibular dysfunction. The effects of aging did not have a significant impact on the relationship, however, those with mild/moderate vestibular weakness were more disabled by their vestibular symptoms than those with severe/total vestibular weakness.

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    In Individuals with Parkinson’s Disease What is the Feasibility of Clinical Vestibular Testing and What is the Relationship of Vestibular Function with Balance and Falls?

    Published Year: 2020
    Specialization: Neurology

    Lesko, Rebekah F.

    With a growing population of individuals with Parkinson’s disease (PD) and the high impact of falls in this population, effective and efficient treatment is required to minimize falls and enhance life quality. Currently, little research has been done on the impact of vestibular dysfunction on balance and falls for individuals with PD. The purpose of this study was to determine for individuals with PD the feasibility of conducting a clinical vestibular test battery and to determine the relationship of vestibular dysfunction with balance and falls.

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    Does Static Trunk Rotation Range of Motion Contribute to Trunk Rotation Range of Motion During Wwalking in People with Parkinson’s Disease?

    Published Year: 2021
    Specialization: Neurology

    Madsen, Jackie

    Parkinson’s disease (PD) is a common age-related neurodegenerative disease affecting the dopamine-producing cells of the substantia nigra pars compacta of the basal ganglia, in turn impacting widespread networks within the central nervous system. The neurodegeneration associated with PD manifests in may motor and nonmotor impairments, which negatively affects movement and quality of life (QOL) The motor impairments inherent to PD have a negative impact on walking. People with PD exhibit reduced speed, step length, foot clearance, arm swing, and trunk rotation during walking. Dynamic trunk rotation range of motion (TRROM) contributes to stability during walking by dissapating forces, generated by the lower extremities, as they are transferred up the kinetic chain. Adequate force dissipation serves to keep the head stable thus optimizing critical vestibular and visual inputs to maintain balance while walking. Decrease dynamic TRROM during walking is a discriminating factor in people with PD who fall compared to people with PD who do not fall. While dynamic TRROM is decreased during walking in people with PD, the underlying cause is unclear. Research has shown that rigidity and passive constraints in muscle and connective tissue extensibility may contribute to decreased dynamic TRROM during walking. Currently, little is known about how decreased static TRROM relates to dynamic TRROM during walking in people with PD. A more precise understanding of the impact of static TRROM on dynamic TRROM during walking may improve the specificity of physical therapy treatment interventions aimed to improve walking performance and reduce the frequency of falls in people with PD. Measurement of static TRROM in people with PD is problematic. A valid, reliable, and clinically feasible method of measuring static TRROM has not been established in people with PD. While the goniometer is a standard measurement tool used clinically to measure joint ROM, measurement of static TRROM using a goniometer has not been validated in people with PD. A valid and reliable measurement technique is needed to objectively assess treatment effectiveness, quantify change in ROM over time, and monitor patient progress towards their functional goals. The aims of the present study are to 1) determine the reliability (inter and intrarater) and concurrent validity of a goniometer for measuring static TRROM in people with PD and 2) determine the degree to which static TRROM contributes to dynamic TRROM during walking in people with PD.

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    The Effect of Airway Control on Postural Stability

    Published Year: 2011
    Specialization: Neurology

    Massery, Mary P.

    Maintaining upright posture is a complex neuromotor process involving control of multiple factors including thoracic and abdominal pressures. Control of airflow by glottal structures, a primary determinant of thoracic pressure, should therefore be important for efficient control of postural stability. This study aimed to investigate the effect of modulation of airway control on upright postural stability during postural perturbations. Standing balance was gently perturbed in the sagittal plane during 7 breathing/voicing tasks that ranged from completely closed, to partially opened or completely open glottal conditions in 11 health adult participants. Dependent measures were peak amplitude of displacement of the thorax and center of pressure (CoP). When the glottis was completely open, thoracic displacement in response to the perturbation was greater than in all other conditions, regardless of direction of perturbation. The absolute amplitude of CoP displacement was greater with backward perturbation across airway conditions and was greater at both extremes of glottal modulation. Perturbation of CoP was least during the partially opened glottal condition.These results show that airway modulation effects postural control during upright perturbations. The thorax was most stable with a static breath-holding maneuver, but optimal control of CoP displacement was during the natural dynamic mid-range airway modulation of voicing. This study suggests that glottal control may be a relevant considertation during balance training.

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    Responsiveness of Five Times Sit to Stand Test as an Indicator of Improvement in Balance After Vestibular Rehabilitation in People with Balance and Vestibular Disorders

    Published Year: 2005
    Specialization: Neurology

    Meretta, Bridget M.

    Objective: The purpose of this study was to determine if patients with balance and vestibular disorders would demonstrate clinically meaningful improvement in the Five Times Sit to Stand Test (FTSST) score as a result of vestibular rehabilitation. Design: Retrospective chart review of 351 people who underwent individualized outpatient vestibular rehabilitation programs. Setting: Outpatient tertiary balance and vestibular clinic. Subjects: One hundred and seventeen patients, mean age 62.7 years, with peripheral, central or mixed vestibular dysfunction. Main Outcome Measures: FTSST, gait speed, Timed Up and Go Test (TUG), Dynamic Gait Index (DGI), Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC). Results: The mean change in FTSST scores was 2.7 seconds. The paired t-test and Wilcoxon signed rank test results for the FTSST, gait speed, ABC, DHI, DGI and TUG were all significant at p<0.01 pre versus post rehabilitation. The responsiveness-treatment coefficient (RT) was calculated to be 0.58 for the FTSST indicating moderate responsiveness. The linear regression demonstrated that the change in FTSST score after rehabilitation was independent of age, gender, diagnosis, and number of physical therapy visits. The univariate linear regression model for baseline FTSST predicting FTSST change was significant and predicted 49% of the change variance. Conclusion: The FTSST was moderately responsive to change over time and was independent of age, gender, diagnosis, and number of physical therapy visits.

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    Reliability and Validity of the Activities-Specific Balance Confidence Scale in Individuals with Traumatic Brain Injury

    Published Year: 2023
    Specialization: Neurology

    Meyer, Jennifer

    Background and Purpose: The Activities-specific Balance Confidence (ABC) Scale is recommended as the primary outcome measure to measure and track changes in balance confidence for individuals with neurological conditions. However, there is a lack of psychometric data when used for individuals with traumatic brain injury (TBI). The purpose of this study was to determine if the ABC Scale is correlated with performance-based measures of balance and walking, if the ABC Scale is reliable with repeated administration, and if the ABC Scale can identify individuals at risk for falls or near-falls.

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    Effects of Chemotherapy on Balance in Women with Stage I, II or IIIA Breast Cancer

    Published Year: 2009
    Specialization: Neurology

    Nordon-Craft, Amy

    Background and Purpose: Radiation, chemotherapy, and hormonal therapy are common treatments for breast cancer and result in side effects, many of which may decrease balance. The primary purpose of this study was to compare changes in balance over four month in women treated with a taxane-based chemotherapy regimen. Subjects and Methods: Sixteen women diagnosed with breast cancer and treated with taxane-based chemotherapy and 18 women without history of breast cancer or chemotherapy treatments underwen balance and function testing at baseline (T1) and four months later (T2). the primary outcome measure was the Modified Clinical Test of Sensory Integration and Balance (Modified CTSIB). Secondary outcome measures included the Timed Up and Go (TUG), Berg Balance Scale (BBS), Activities Balance Confidence Scale (ABC) and the Physical Performance Test (PPT). Results: Breast Cancer participants had significantly lower scores on the Modified CTSIB at T1. Four of sixteen women treated with chemotherapy reported falls during the later chemotherapy cycles. Three women reported three falls each. The four-month change scores for the PPT were significantly different between groups. Group differences in the TUG and BBS were not significantly different. Conclusion: Women treated with taxane-based chemotherapy had significant balance impairements one month following treatments and reported falls during later cycles. By recognizing individuals at risk for falls, health care providers can implement screening tools and treatment strategies to decrease risk of falls during chemotherapy, maintain or improve functional status, and reduce the risk for chronic physical impairments.

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    Relationship Between Fear of Falling and Balance Performance in Community-Dwelling Older Adults

    Published Year: 2020
    Specialization: Neurology

    Roberts, Holly J.

    Background and Purpose: Fear of falling is highly prevalent in community-dwelling older adults and is associated with low health-related quality of life. However, screening for fear of falling does not identify domains in which the clinician should target intervention. Many outcome measures have ceiling effects and do not detect subtle changes in mobility. This study aimed to determine whether there is a correlation among balance confidence, fear of falling avoidance behaviors, and performance on high-level mobility tests in community-dwelling older adults and whether peformance on high-level mobility tests is a dicriminator between fallers and non-fallers. Methods: 89 community-dwelling older adults completed the World Health Organization Quaility of Life-BREF (WHOQOL-BREF), Activities-specific Balance Confidence Scale (ABC), Fear of Falling Avoidance Behavior Questionnaire (FFABQ), Functional Gait Assessment (FGA), and Community Balance and Mobility Scale (CB&M). Receiver operating characteristic curves were calculated to determine the ability of the ABC, FFABQ, FGA, and CB&M to discriminate between fallers and non-fallers. Correlation analyses were calculated to determine the relationship between the outcome measures. Multiple regression analyses were used to determine if there was a relationship between scores on the FGA, CB&M, ABC, and FFABQ and the WHOQOL-BREF. Results and Discussion: The ABC, FFABQ, FGA, and CB&M did not distinguish among fallers and non-fallers. There were significant correlations between the CB&M and ABC, FGA and ABC, CB&M and FFABQ, and FGA and FFABQ and between all outcome measures and QOL. Conclusion: Scores on performance-based outcome measures were correlated with patient-reported balance confidence and fear of falling avoidance behavior in community-dwelling older adults, but did not discriminate between fallers and non-fallers. Individuals who scored higher on the CB&M and FGA had higher QOL scores. These findings suggest that clinicians should test high-level mobility performance in older adults who report activity avoidance or low balance confidence.

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    Loss of Trunk Repositioning Sense and Its Relation To Postural Control Functions in People Post Stroke

    Published Year: 2006
    Specialization: Neurology

    Ryerson, Susan J.

    Purpose: To determine whether trunk repositioning sense is impaired and related to loss of postural functions in people with post-stroke hemiparesis. Background/significance: Good trunk control is essential for functional activities. Deficits of trunk anticipatory postural control have been identified in people post-stroke. One conceptual model suggests that postural control requires an internal model for accurate orientation. Proprioceptive feedback provides part of the information for internal modeling. Trunk repositioning sense is one aspect of proprioception. If trunk repositioning sense is impaired post-stroke, it may be an underlying contributing element of altered trunk postural control. Altered trunk postural control would adversely effect trunk-limb linked movement sequences and ultimately interfere with the performance of daily activities. If rehabilitation clinicians have a clearer understanding of trunk postural impairment, they may refocus their intervention techniques to include trunk position sense retraining. Subjects: 21 subjects with chronic stroke and 21 age/sex matched non-neuologically impaired subjects. Methods: Trunk repositioning error was assessed in sitting while the subject performed forward felxion movements. Subjects were instructed to move to a prespecified flexion position during which trunk position was recorded from a tracking marker placed on the skin over the spinous process of T1. An electromagnetic movement analysis system, ‘Flock of Birds’, was used to track the position of the trunk and document errors. Analysis: Mean repositioning error in people post-stroke and non-neuologically impaired people was compared using a two-tailed independent t-test. Spearman correlation coefficient analyses were used to determine the strength of the relationship between absolute repositioning error and clinical measures of balance, postural control, and stroke severity. Conclusions: This study is an important first step towards a more complete understanding of the role of trunk repositioning sense in subjects with post-stroke hemiparesis. Position sense, with and emphasis on sagittal and transverse movements should be integrated into intervention strategies to improve trunk postural control in sitting for patients post-stroke.

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    A Comparison of Position-, Velocity-, and Acceleration-Dependent Mechanical Loads on Muscle Recruitment and Activation Patterns During Reaching in People with Hemiparesis

    Published Year: 2007
    Specialization: Neurology

    Stoeckmann, Tina M.

    Objectives: To determine the effects of load type (elastic, viscous, mass) on muscle activation and co-activity during research in individuals with spastic hemiparesis, post-stroke. Design: single session, mixed repeated measures. Setting: Marquette University’s Neuromotor Control lab – Participants: Cross-sectional sample of 10 right-handed individuals with chronic hemiplegia and 10 neurologically intact matched controls. Interventions: Upper extremity reaching against elastic, viscous, mass loads. Outcome measures: Agonist muscle activation (triceps, anterior deltoid) and co-activation at the shoulder and elbow from normalized EMG impulses during reaching. Results: For each load, muscle activation and co-activation were generally greater in both arms post-stroke. Whereas load type did not affect activation or co-activation levels in the paretic arm, shoulder muscles did respond differentially across loads in the non-paretic arms. In comparison, healthy adults demonstrated stronger shoulder muscle activity with elastic and viscous loads, and little evidence of co-contraction regardless of load type. Conclusions: Despite the fact that elastic and viscous loads require only agonist activity, and mass loads required approximately timed agonist and antagonist, hemiparetic arms demontrated high levels of muscle activation and co-contraction regardless of the load type. The non-paretic arm also demonstrated increased muscle activation and co-contraction, albeit with some load differentiation at the shoulder. Clinical significance: For resisted reaching with the non-paretic limb, viscous loads may be a more effective form of resistance than mass or elastic loads since it elicited greater muscle activation wihout increased co-contraction at the shoulder. For the paretic limb, all loads were equally effective in recruiting muscle activity, although co-activity was substantial for each of them. Further research is needed to determine whether trainig with one or more of the different loads may promote normalization of muscle activation patterns post stroke.

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    Postural Sway Characteristics of Low and High Fall Risk Community Dwelling Older Adults

    Published Year: 2011
    Specialization: Neurology

    Thompson, Marcia Jeanne

    Older adults have increased incidence of falls. A key intrinsic risk factor for falls is the presence of balance impairment. Studies have shown that as people age, their balance control declines. However, not all individuals over the age of 65 will experience a serious balance problem or fall. Those health adults dwelling independently within the community, who would not be assumed at risk by themselves or society, provide a great opportunity for investigation given that one-third of the individuals are projected to fall each year. The long term goal of this investigation is to contribute to the body of understanding of the sensory and motor aspects of balance that contribute to falls in the elderly, the ability to identify those at risk, and the possible ways to mitigate that risk in the aging population. Through discrimination and classification, more effective treatments and outcome measurements can be designed, applied, and studied.

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    The Effects of Tai Chi on Persons with Parkinson’s Disease

    Published Year: 2004
    Specialization: Neurology

    Venglar, Mollie Cooper

    Tai Chi is an exercise form that has been shown to improve flexibility, strength, balance, cardiovascular response, and depression in older adults as well as in some individuals with neurologic or orthopedic dysfunction. Persons with Parkinson’s desease, due to the nature of the disease, present with progressively worsening flexibility, strength, and balance. This study was designed to assess the effects of an 8-week Tai Chi class on balance, balance confidence, functional activity, and quality of life in persons with Parkinson’s disease. Eleven subjects were recruited to participate in the study. Each subject was tested with the Activity-specific Balance Confidence Scale, the Parkinson’s Disease Questionnaire-39, the Multi-directional Reach Test, and the Timed Up and Go one-month prior to the Tai Chi class, immediately prior to the class, immediately following the 8-week class, one-month following the class, and two-months following the class. Six of the eleven subjects were unable to complete the study for issues unrelated to the intervention. Of the remaining five subjects, two showed trends toward improvement in most of the outcome measures over the course of the study. None of the subjects made measurable improvements on the outcome measures used; however, most of the subjects (4/5) reported subjective improvements in balance or balance confidence in the follow-up questionnaires. Possible reasons for lack of measurable improvements were that the intervention duration, intensity or choice of outcome measures may not have been optimal to produce a measurable change. An 8-week session (1x/wk) of Tai Chi did not alter measurable balance, balance confidence, or quality of life.

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    The Effect of Ice Skating versus Overground Walking on the Lower Extremity EMG Activation and Energy Expenditure Index of Children With Cerebral Palsy

    Published Year: 2007
    Specialization: Neurology

    Walsh, Sharon Fleming

    Multiple studies have documented that children with cerebral palsy display significant deficits in function, muscle strength and muscle activation. Anecdotal reports of children with cerebral palsy involved in ince-skating suggest gains in function, endurance, and mobility. The purpose of this study was to examine the differences seen in the lower extremity surface electromyographic (SEMG) activation and the Energy Expediture Index (EEI) during ice-skating compared to overground ambulation on level surfaces in children with cerebral palsy.

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    An Investigation of Abnormal Vestibular and Oculomotor Function in Individuals with Visual Motion Hypersensitivity

    Published Year: 2005
    Specialization: Neurology

    Winkler, Patricia R.

    Context: A subgroup of individuals with vestibular dysfunction and visual motion hypersensitivity (VMH) become dizzy and imbalanced in response to movement of the visual environment. Objective: The purpose of this study was to investigate ocular fixational stability while bifixating on a small midline target with and without visual background movement. Binocular visual functions were also examined as possible confounding factors. Design: The study was a quasi-experimental three-group comparison design with a control group. Assignment to the experimental group was by symptoms of VMH as diagnosed by a physical therapist or neuro-otologist. Subjects: Twenty-four individuals with VMH, 20 with vestibular disorders without VMH, and 20 healthy subjects were tested. Outcome measures: Electrooculogram recordings (vertical an horizontal) were examined for refixation eye movements, and 4 binocular visual functions were assessed. The DHI for measuring level of dizziness were also used. Results: Subjects with VMH had significantly more refixation eye movements and higher levels of dizziness than found in the other two groups. There were abnormalities in binocular function in bothe the VMH group and vestibular dysfunction group compared to the control group. Conclusions: Individuals with VMH are unable to use bifixation to inhibit eye movements to background motion. Binocular vision dysfunctions may contribute to this problem.

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Nursing

    Phenomenological Inquiry into the Decision-Making Process of the Older Adult Who Has Elected to Receive Electroconvulsive Therapy

    Published Year: 2007
    Specialization: Nursing

    Amazon, Jody

    Although there is extensive literature on Electroconvulsive Therapy (ECT) there is little documentation about how an individual makes the decision to receive a course of ECT. This study is an exploratory examination of the decision-making process of the mentally ill older adult who elects to receive ECT. This study provides a basis to plan clinical practice and build further research. A phenomenological design was chosen to explore the question: “What is the decision-making process of the older adult who has elected to receive ECT?” Study participants were seven non-demented older adults in a suburban geriatric medicine/psychiatry practice who elected to receive treatment with ECT. The lived experience of decision-making as perceived by these seven participants was a process that moved them toward wellness. The data showed four significant themes: Support, Trust, Past Experience, and Desperation. An overriding substative theme identified as an obstacle was the Stigma of Mental Illness.

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    Association of Adherence to Follow-up Recommendations from Community Health Blood Pressure Screening Clinics to Healthy Lifestyles: Results from a Rural Cohort

    Published Year: 2010
    Specialization: Nursing

    Backus, Debra

    This mixe-method study examined the impact of recommendations made by blood pressure screening clinic personnel to participant adherence in seeking medical provider care and adherence to healthy lifestyle recommendations. The subjects were 31 blood pressure screening clinic participants, 4 individual interviews, 60 medical providers and 1199 community residents. Community and clinic participants completed a Behavioral Risk Factor Surveillance System survey and medical providers a prehypertension treatment survey. Medical providers ranked prehypertension treatment according to the greatest impact on blood pressure reduction, yet participants with prehypertension were not counseled on lifestyle changes more than the general public. However, participants reported a diastolic BP significantly lower than those who did not report a follow-up BP. Lifestyle changes at 3 months post BP screening clinic included less consumption of foods with sugar. Parental fat intake was associated with partiicipant fat intake. Regression analyses showed those who are older and unemployed were more likely to participate in healthy lifestyle behaviors. Qualitative analyses reflected a lack of mindful and healthy selection of food, regular consumption of fast food, general satisfaction with their health care provider, and comorbidities of high blood pressure, high cholesterol and obesity. Implications for practice and research are offered for public health consideration.

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    Changing to Concept-Based Curricula: The Process for Nurse Educators

    Published Year: 2014
    Specialization: Nursing

    Baron, Kristy A.

    Purpose: The complexity of health care today requires nursing graduates to use high-level thinking skills. Many nursing programs are revising curricula to include concept-based learning that encourages problem-solving, high-level thinking, and the ability to transfer knowledge to a variety of situations – requiring nurse educators to modify their teaching styles and methods to promote student-centered learning. Changing from teacher-centered learning to student-centered learning requires a major shift in thinking and application. The focus of this qualitative study was to understand the process of changing to concept-based curricula for nurse educators who previously taught in traditional curriculum designs. The specific aims of this study explored the educators’ behaviors and their perceptions of the change, teaching practices, and the teaching-learning process. Methodology: The researcher recruited a purposive sample of nurse educators with a minimum of a master’s degree in nursing and over two years of teaching experience for in-depth interviews about their experiences of changing to a concept-based curriculum. The sample included eight educator from two institutions in one Western state. The researcher used a grounded theory design to guide this study and analyzed and interpreted interview transcripts using Charmaz’s methods. Results: The grounded theory is constructed from the participants’ experiences and consists of the overarching concept, support for change, and central concept, finding meaning. Related to finding meaning are four concepts: (a) refining change, (b) constructing learning, (c) fostering authenticity, and (d) reinforcement benefits. Data indicate educators must find meaning in the processes of a concept-based curriculum. These processes include (a) designing conceptual curricular structure, (b) implementing conceptual teaching, and (c) evaluating teaching-learning methods through a conceptual lens. Conclusions: Finding meaning, or understanding the processes of a concept-based curriculum, is proportional of refinind the change: the greater the understanding, the more refinement of curricular structures, teaching techniques, and teaching-learning methods. Concept-based teaching requires educators to construct learning that reflects conceptual understanding using a student-centered learning approach with authentic experiences. Fostering authenticity requires provision of real experiences in class for students to apply to their nursing practice. Educators practicing the processes of a concept-based curriculum discovered intrinsic rewards that reinforced the benefits of a nursing education career.

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    The Sexual Assault Nurse Examiner: A Descriptive Study

    Published Year: 2017
    Specialization: Nursing

    Boyle, Cathy

    The purpose of this descriptive study was to understand the profile of SANEs involved in forensic nursing and motivations that led them to continue to practice in this specialty area. Determining commonalities related to characteristics of SANEs with career longevity of five years or more enable targeted recruiting and retention strategies, and education programs can be developed to increase the number of nurses selecting this nursing practice speciality.

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    The Process of Transition of Care of the Neurogenic Bowel in the Preadolescence with Spina Bifida: The Primary Caregiver’s Perspective

    Published Year: 2007
    Specialization: Nursing

    Braun, Patricia Gail

    Bowel management toward continence has been identified as one of the most challanging self-care behaviors to transition for children and their families. Developmental transition periods from birth through high school are especially demanding for children with spina bifida and their caregivers. Furthermore, obtaining bowel continence, which includes bowel management, has been difficult for health-care providers in their efforts to support primary caregivers and their child in promoting independence. The effort becomes increasingly challenging when the child with spina bifida reaches the developmental milestone for achieving bowel-management care and, yet, has not obtained it. A qualitative study using grounded theory was performed to investigate the process of transitioning neurogenic-bowel-continence management from the primary caregiver to the child. The transitional process was examined from the perspective of the primary caregiver. The study’s sample included 10 primary caregivers of preadolescents (8-13 years old) with spina bifida. The present investigation was the first step in a three-part study to explore how primary caregivers, children, and professionals can work together to promote neurogenic-bowel continence. Subsequent studies will focus on the perspective of the child with spina bifida and of health-care providers prompting bowel management. Primary caregivers in the present study were recruited from parent participation at Illinois Spina Bifida Association activities. Guided interviews were conducted with the primary caregivers in their homes or, when possible, an informal environment to investigate factors in the process of transitioning neurogenic-bowel management from the primary caregiver to the preadolescent’s self-care continence practices. Sample size was determined by saturation of information received in the interviews. All interviews were audiotaped. Content analysis was completed to identify themes and concepts. By studying the primary caregivers’ perspectives, the researcher identified factors that either promote or hinder the efforts of primary caregivers and their preadolescents in transitioning neurogenic-bowel management to the children. Identified themes and categories may be helpful in determining supportive interventions for children and their primary caregivers.

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    Evaluation of a Tool Kit for Safe Patient Handling in the Home Care Setting

    Published Year: 2010
    Specialization: Nursing

    Capewell, Roberta A.

    A review of literature supported the finding that where equipment has been introduced to inpatient and long-term care facilities with ergonomics education and leadership support, a dramatic reduction in injury and work absenteeism was documented. There is a lack of studies that investigate the use of equipment in the home care setting where a large amount of dependent patient care is conducted by home health aides. Therefore the purpose of this study was to provide safe patient handling equipment and classes in ergonomics for home health care workers.

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    A Phenomenological Study of Barriers to Nursing Care Experienced by Nurses Working in Medicare Certified Home Care Agencies

    Published Year: 2010
    Specialization: Nursing

    DalPezzo, Nancy K.

    During the last ten years, poor patient outcomes and unnecessary patient deaths have generated major concern regarding the quality and safety of the American health care system. Compounding this concern is a critical shortage of registered nurses. As a results of these problems, there is increasing interest in establishing the relationship between professional nursing care and patient outcomes in all care settings. However, while evidence mounts linking nursing care to patient outcomes in hospitals, little is known about the relationship between nursing care and patient outcomes in home health care. The home environment is unpredictable and uncontrolled, and often presents barriers to the delivery of care. Therefore, the purpose of this study was to develop an understanding of barriers that interfere with the delivery of nursing care in Medicare-certified home care agencies. Using a descriptive pheonemological approach, nine expert home care nurses were interviewed, and the narrative accounts were analyzed using Giorgi’s method. Analysis fo the narrative data revealed that the livid experience of encountering barriers when delivering nursing care in the home is a complex, multi-dimensional phenomenon involving the patient, the caregiver, the nurse, the physician, the clinical agency, the insurance company, and the health care system itself.

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    Do Levels Of General Self-Efficacy And The Knowledge Of And Use Of University Resources Impact Success In A Semester For BSN Nursing Students?

    Published Year: 2016
    Specialization: Nursing

    Edwards, Faith T.

    This correlation study investigated the relationship between nursing students’ level of general self-efficacy and knowledge of and use of university resources with their success in a traditional baccalaureate nursing program. Nursing students in the first three semesters of a traditional baccalaureate program responded to the General Self-Efficacy scale and a questionnaire to identify their knowledge of and use of university-specific resources. The researcher correlated the data with the student’s final course grade in a nursing theory course. The researchers identified the final course grade as the indicator of success. Parametric statistical analysis was used to determine if there was a correlation between the independent variables of score of general self-efficacy and knowledge and utilization of campus resources and the dependent variable of success in the nursing course. The findings indicated that there was no significant relationship between self-efficacy and students’ knowledge of and use of university resources. Post hoc analysis indicated there was a significant relationship between levels of self-efficacy and academic success among the three groups of nursing students. Success in the nursing program, as well as success in college, is a concern to both the nursing program and the university. Optimally, the graduation rates will increase and the number of nurses entering the profession will increase, as well. This study attempted to identify indicators which may increase the success rate in a traditional baccalaueate nursing program. The findings of this study amy contribute to the current knowledge base and research, which focuses on university resources addressing the student’s needs, both academically and non-academically.

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    The Effect of Cranial Electrotherapy Stimulation on Anxiety in Interventional Pain Management Procedures

    Published Year: 2012
    Specialization: Nursing

    Fink, Gerry E.

    Mild anxiety may be beneficial in coping with stress; however, anxiety prior to invasive procedures in healthcare in generally regarded as undesirable and maladaptive. Although the use of anxiolytic medication reduces the anxiety associated with surgical procedures, the need is not ubiquitous and the side effects are often undesirable. As minimally invasive procedures are utilized, the necessity of anesthesia for patients has been replaced by the need for temporary relief of anxiety and pain. Cranial electrotherapy stimulation, the passing of electrical currents transcranially using ear clip electrodes, has been established for use of a regular basis for anxiety in psychiatric and substance abuse populations. However, its effectiveness when used as a one-time intervention to decrease state anxiety has only recently been examined in several studies, however; the studies have lacked power. This study contributes to the developing body of knowledge regarding the one-time use of CES prior to and during interventional pain management procedures. This study aimed to assess the efficact of a single, cranial electrotherapy stimulation intervention to reduce anxiety prior to and during fluoroscopically-guided spinal and pelvic injections for pain management.

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    Learning to Teach: The Lived Experience of Peer-Nominated Effective Nurse Educators

    Published Year: 2010
    Specialization: Nursing

    Gardner, Susan Smart

    The United States faces a significant shortage of nurses and nurse faculty resulting in an increased demand for new nurse educators. Nurses with graduate degrees are considered qualified to teach although many have little or no educational preparation for the teaching role. Proficiency in teaching develops over time and little is understood about this process. An extensive literature review found few publications that explored how nurses as clinicians became effective educators, or how nurse educators dveleoped competence as they moved along their career trajectory. Specific aims for this phenomenological study included: Understanding the lived experience of nurse educators in higher education who were peer-nominated as effective teachers, and understanding the characteristics, traits, practices, and experiences that influenced and shaped their development and competence.

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    The Lived Experience of Heart Transplant Patients: Post-Operative Initial Awareness

    Published Year: 2012
    Specialization: Nursing

    Hermann, Eileen M.

    Heart transplants are a major event for patients and their significant others. According to the U.S. Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR), 11,469 heart transplants have occurrred from January through May 2012. The purpose of this study was to explore the lived experience of a heart transplant recipient’s initial conscious awareness post-surgery, to better understand the emotional impact of receiving a heart from a another person. The focus was the patient’s recall of their first conscious awareness that another person’s heart is in their body.

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    Voices from the Bedside: Registered Nurse Perceptions of the Work Environment

    Published Year: 2013
    Specialization: Nursing

    Jett, Katherine

    Registered Nurse turnover is a costly and disruptive problem occuring in acute care hospitals today. Turnover may results in lost revenue and inadequate staffing which in turn affects the quality of patient care. A literature search revealed that nurses’ engagement with their work predicts job contentment or happiness which reduces the risk of turnover thus improving consistency in patient care. Significant relationships exist between work engagement and overall job contentment or happiness, thinking about leaving a position and seeking out other employment opportunities. A positive connection has been found between the amounts of time spent in the presence of patients, caring behaviors and job contentment or happiness. The purpose of this study was to gain a deeper understanding of the work environment from the staff nurse perspective. This researcher sought to explore the realities of the lived experienced of registered nurses caring for patients in an acute care hospital with multiple clinical settings. A qualitative phenomemological research method was utilized. Registered Nurses were interviewed to obtain perceptions of the work environment from the perspective of the bedside nurse administering care. Experiences shared by 16 nurses caring for patients in their current work environment were captured through interviews. The respondents were randomly chosen based on availability and interest. Themes from the transcripts of the interviews were coded. Narrative accounts were individually analyzed using Colaizzi’s procedural steps for interpreting qualitative research. An effort was made to define experiences of the bedside nurse and the influence clinical experiences have on behavior and decisions. Feelings and thoiughts were solicited. Results of the interviews indicating that inadequate staffing is the number one concern, followed by inadequate support from administration, patient to nurse ration too high, inadequate support from unit supervisor, environmental stress, and finally abuse of power by charge nurses, administrators and supervisors. Findings were consistent with the review of the literature. Recommendations include hiring nurturing supervisors with good communication skills and placing 95% of all full time equivalents touching the patient. Also, development of an organizational chart giving RNs authority to direct lesser skilled care givers is imperative to patient safety. Conducting a comparison study by interviewing administrators and unit supervisors to obtain perceptions regarding staff nurse issues could give further insight into the situation at this facility. This investigator also recommends that further research be conducted to identify specific issues with pay, benefits, policies, rules regulations and opportunities for advancement.

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    Exploring the Influences of Homelessness on the Single-parent Family: A Grounded Theory Approach

    Published Year: 2010
    Specialization: Nursing

    Langemeier, Jane

    Background: Families with children are one of the largest subgroups of the homeless population. Limited literature addresses the impact of homelessness on the single-parent families’ abilities to function. Community and public health nurses have opportunities to care for single-parent families struggling with the plight of homelessness. Purpose: The purpose of this study was to explore the influences of homelessness on the process of family life from the perspective of the single-parent. A gap in knowledge supported an additional aim to discover how the homeless single-parent perceives the impact of homelessness on the present and future life of the family. Lastly, the study aimed to conceptualize the influences of homelessness for the single-parent family. Methodology: This qualitative study utilized a semi-structured, face-to-face interview approach to collect data. Glaser’s qualitative grounded theory methodology guided data collection and analysis. Constant comparative analysis with open and axial coding identified emergent themes and categories until data saturation was achieved. A letter was distributed at two Midwestern homeless shelters to recruit homeless single-parents. Thus, this purposive approach led to 15 participants meeting the inclusion criteria for the study. The results of this study examined the complexity of homelessness for a single-parent family through the interpretive nature and analysis of their narratives. Themes identified include: action, reaction, and interaction, wake-up calls, paradox of influences, parental dichotomy, self-awareness, and resourcefulness. The principle findings of the study identified homelessness as a dynamic and fluid phenomenon for the single-parent family. The multifaceted influence the single-parent homeless families offer explanations for their needs, which can enhance appropriate interventions and policy development.

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    An Exploratory Study of Compassion Scores in Nursing Students

    Published Year: 2019
    Specialization: Nursing

    Larsen, DeAnne

    Compassion, needed to elevate care beyond technical an academic expertise, has been identified as an important quality for nurses yet currently little is known about how, when, or if nurses develop compassion. Nurse educators assess nursing students and graduates primarily by grade point average (GPA) and the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Nursing programs may not assess compassion. This research explores compassion scores in various nursing and non-nursing student groups.

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    Direct Care Registered Nurse Perceptions of the Healthy Work Environment

    Published Year: 2011
    Specialization: Nursing

    Longo, M. Anne

    The purpose of the qualitative mixed method study was to understand the perceptions of direct care registered nurses (RMs) regarding their work environment. Patricia Benner applied the Dreyfus Model of Skill Acquisition to describe and interpret skill acquisition and clincal judgement in nursing practice. Benner’s operational definitions for the five levels of her Novice to Expert Practice Model were used by the study participants to self-identify their level of practice. Action research (AR) using Cooperrider’s Model of Appreciative Inquiry guided the researchers in understanding the study participants’ perception of The American Association of Critical Care Nurses (AACN) six standards of the healthy work environment (HWE) within their own work setting. An additional aim was to determine if the clinical manager’s perception of their direct reports was the same as the RN.

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    Maine Nurses Ability and Willingness to Work during Pandemic Influenza

    Published Year: 2010
    Specialization: Nursing

    Martin, Sharon Dezzani

    Studies of health care worker unwillingness or inability to work during hypothetical flu pandemics have been reported but none has focused soley on nurses, the largest proportion of health care providers, and few were conducted during a pandemic. This study reports variables affecting nurses’ ability and willingness to work during the 2009 A/H1N1 flu pandemic.

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    Perceptions Of Caring Behaviors In Associate Degree Male Nursing Students

    Published Year: 2017
    Specialization: Nursing

    McDermott, Michelle C.

    Although women still make up the majority of those who choose nursing as a profession, the representation of men in this field has increased as the demand for nurses has grown and more adults choose nursing as a second career. Caring behaviors, an integral part of nursing related to better patient outcomes, has traditionally been associated with women. This survey study explored male and female nursing students’ perceptions of caring behaviors and investigated whether stages of nursing education, age, previous health care work experience, parenthood, sibling status, length of nursing program, or ethnic category influence perceptions of caring behaviors in these students. Participants were associate degree nursing (ADN) students at three western US universities. Students responded anonymously online to an open-ended question as to how they demonstrated caring behaviors and completed the Caring Dimensions Inventory (CDI). Score for total CDI, individual CDI factor subscales regarding the technical, intimacy, support, unnecessary, and inappropriate aspects of nursing, and the Mokken subscale were evaluated. Of 160 responses, 147 were evaluable. Content analysis of responses to the open-ended question revealed seven interrelated categories: 1) competence, 2) communication, 3) patient education, 4) giving the best care possible, 5) nursing actions and interventions, 6) mode of behavior, and 7) miscellaneous. No significant effects of gender, number of semesters in an ADN program or demographic variables such as student age, years of previous health care experience, parenthood, sibling status, length of nursing program, or ethnic category were observed in perceptions of caring as measured by the total CDI and subscales. However, free-text question responses appeared to fit stereotypes of women as being more attuned to personal relationships and emotions, with more verbal skills and nuanced thinking, and of men as being more assertive, action-oriented, and more abstract in their thinking. These tendencies should be considered in designing nurse education programs to foster effective caring behaviors in both men and women.

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    Phenomena of Inner Strength in Women Post-Myocardial Infarction Coronary Stent Placement: A Grounded Theory Study

    Published Year: 2009
    Specialization: Nursing

    Mendes, Beverly A.

    Purpose: The phenomenon of inner strength has been identified as a factor of health and spiritual well-being. Inner strength has not been fully explored in relation to the leading cause of death in women, coronary artery disease. The purpose of this qualitative descriptive study was to explore the phenomenon of inner strength in women recovering from a coronary intervention following an acute cardiac event. The choice of grounded theory was based on the desire to develop a theoretical understanding of the nature of inner strength in the context of factors affecting the healthcare recovery of women following myocardial infarction. Methods: Grounded theory methodology was used to answer the research question, “How do women experience inner strength during their recovery from coronary stent placement following an acute coronary event?” Data analysis was based on qualitative methodology informed by grounded theory and the constant comparative method. Interviews were conducted until saturation of data was achieved. A literature review enhanced theoretical sensitivity. A literature rview enhanced theoretical sensitivity. Findings from this study were compared to previous research on inner strength. The components of Lincoln and Guba’s trustworthiness criteria were applied to generate an accurate and consistent meaning to the data. Results: Twelve women ranging in ages between 41 and 81 years old and with a confirmed diagnosis of a myocardial infarction participated in the study. The conflict termed as “changing patterns of fear” was the basic psychological problem faced by the women as they recovered from post-myocardial infarction coronary stent placement. The basic psychosocial process to form the theoretical model that the women utilized to resolve the problem of fear was identified as “living a new normal.” Five distinct stages emerged to resolve the conflict: (1) uncertainty in seeking help, (2) rapid changing, (3) evolving patterns, (4) reminiscing the past, and (5) spiritual solace. Conclusion: Although all humans possess inner strength, the experience of a challenging life event often acts as a catalyst for the expansion and expression of strength. The present study’s findings can assist health professionals to enhance the well-being of and support for women living with chronic health conditions. The current study contributes to the growing research about the phenomenon of inner strength, advanicing theory generation.

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    Shifting Paradigms: Development of a Nursing Identity in Paramedics Educated as Nurses

    Published Year: 2018
    Specialization: Nursing

    Petersen, Tiffany L.

    The United States (U.S.) faces an ongoing shortage of registered nurses. This shortage had led to a proliferation of new nursing programs and new pathways for transitioning into nursing from other professions such as emergency medical services (EMS). This increase in pathways has enabled paramedics to transition to registered nursing (RN) practice in greater numbers. While the increased number of paramedics entering nursing could be seen as beneficial to address the nursing shortage, this is only true if these newly educated paramedic-RNs are well prepared to practice and do not experience excessive turnover in the first few years. Formation of a professional identity has been specifically linking to higher nurse retention rates and job satisfaction. The purpose of this study was to explore the current role perception of paramedics who were educated as RNs through various different educational programs, and those influences and experiences that facilitated or hindered role perception as nurses.

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    A Qualitative Descriptive Study of Women in a Transitional Living Facility

    Published Year: 2015
    Specialization: Nursing

    Reveles, Kathryn

    Background: Pediatric obesity is escalating and predisposes children to a multiple of health risks. These risks are magnified in the poor and predominantly Hispanic population residing along the US-Mexico border where health disparities are rampant. Foreground: Many low-income families rely on school meals – breakfast, lunch, and after-school snacks – to feed their children. An analysis of a typical lunch at a local charter school (EPCS) found unacceptable low vegetable, fruit, and whole grain. Because children eat what is available, healthier school meals will help build life-long eating habits and school-age children receiving school meals are prepared onsite. Methods: The administrator of the community organization that ran the charter school and associated clinic championed the change project. Healthier school meals were implemented by a multidisciplinary team of stakeholders, including parents and children. Clinic staff measured indices of weight pre- and post-implementation. EBP Framework: An integrative model was utilized to guide this change process. The Prochaska model for change enhanced Team Strategies and Toold for Enhancement Performance and Patient Safety (TSTEPPS) by identifying behaviors over the change process that influenced outcome. Findings/Results: External funding provided the means to build a state-of-the-art kitchen at the school. Faculty and students from a local community college culinary arts program staffed the kitchen. Students, parents, and team members enjoyed the taste of school meals prepared on-site using AHA guidelines. No difference in indices of obesity changed over the 14-week school meal program. As expected, weight circumference-to-height ratio predicted central adiposity across all grades. The rate of obesity tripled between pre-kindergarten and third grade. Conclusion/Recommendations: Continued monitoring of the EPCS students BMI and wc:ht needs to occur to document future changes in the overweight and obese percentages, especially with the addition of increased physical activity. In addition, continuing to utilize wc:ht ratios will assist in establishing pediatric standards for the measurement. One school, one meal at a time is a small but important step toward reducing pediatric obesity rates.

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    Journaling Scrapbooks in the Treatment of Women with Posttraumatic Stress Disorder (PTSD): A Grounded Theory Approach

    Published Year: 2007
    Specialization: Nursing

    Robison, Barbara J.

    Purpose: To generate theoretical insights into the concepts that emerge through observation, narratives, and scrapbooking intervention of experiences that led to PTSD in the women participants. Design: A triangulated (mixed method) research design including a Grounded Theory approach as defined by Glaser and Strauss was used to provide a framework for the study and a systematic review of the literature was performed to compare findings with previous research. Methods: Open-ended, in-depth interviews before and after scrapbooking sessions were conducted with 9 women with diagnoses of PTSD. Emerging qualitative data were handled with the use of NVivo 7, while quantitative assessments were measured on the Posttraumatic Stress Diagnostic Scale. Findings: Participants reported that their number of PTSD symptoms and severity were reduced following the scrapbooking sessions, In addition, scores on the pre-intervention Posttraumatic Stress Diagnostic Scale were significantly decreased on the same post-intervention scale. Conclusions: For this sample women, scrapbooking served as an effective intervention in reducing the symptoms of PTSD.

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    Long-Term Effects Of Baccalaureate Students’ International Nursing Experiences On Practicing Nurses

    Published Year: 2018
    Specialization: Nursing

    Sewell, Gale

    In the 21st century, change has affected all levels of society and culture. In the United States, shifts in demographics, industry focus, technology, and international travel have contributed to the increased need for cultural competence. These changes affect healthcare and the profession of nursing, challenging nurses to incorporate culturally appropriate care to provide optimal care to all clients. Findings from an extensive literature review indicated international nursing exeriences provided positive short-term effects; however, little research addressed long-term effects of international nursing experiences on nurses’ beliefs and practice. The purpose of this descriptive study was to investigate the long-term effects of baccalaureate students’ international nursing experiences. Research questions were: 1. What do practicing nurses describe as the effect of international nursing experiences during baccalaureate nursing education on the following aspects of their personal views and nursing career: understanding culture; relationships with others; personal and career decision-making; emotional effects; cultural desire; and professional development and practice? 2. What is the relationship of demographic variables and stated effects of international experiences on nurses’ views about culture and aspects of nursing practice?

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    Sleep Issues in Children Adopted from China: A Qualitative Study

    Published Year: 2015
    Specialization: Nursing

    Spencer, Cara S.

    Management of sleep challenges in children adopted from China has not been thoroughly addressed in literature, but it is one of the most important issues to parents after adoption. Although sleep issues in adopted children from China appear to be more prevalent than in non-adopted children, there is limited research providing parents with an understanding of how these sleep problems manifest or suggestions to manage the problem. The purpose of this study was to describe what sleep issues look like in children after being adopted from China and to identify the most successful management techniques. The primary research question was: What were the effective techniques for managing sleep problems in children adopted from China? The interview began “tell me about the sleep issues in you child”?

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    Professional Role Growth Experienced by Graduates of an On-Site RN to BSN Program

    Published Year: 2010
    Specialization: Nursing

    Tierney, Carol C.

    This non-experimental, phenomenological study identifed the professional role growth experienced by graduates of an RN to BSN completion program occurring at four hospitals in the Greater Cincinnati area. One hundred and forty-two subjects completed a professional growth activity profile survey which measured professional growth activities at three points in time, before starting the RN to BSN program, during the RN to BSN program, and after graduation from the RN to BSN program. Repeated measures ANOVA conducted on the survey results revealed a significant multivariate effect of the RN to BSN education on the professional growth experienced by the study participants. Professional growth activities having the highest mean scores were: Served as a preceptor to a nursing student or new nurse on your unit; Assumed a leadership role; Participants in a mentoring relationship; and Participated in an evidence-based practice project, research, project, or quality improvement project. Focus groups participants identified external and internal influences impacting their decision to return to school, manifestations of their personal growth, their manner of growing as a professional nurse, the symbiosis of their professional growth to others, and their role in enhancing the profession of nursing as a results of their RN to BSN education. These data are significant because they show that study participants engaged in more professional activities, which is a benefit to their organization.

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    Effect of Collaborative Testing on Long-Term Knowledge Retention Among Baccalaureate Nursing Students

    Published Year: 2016
    Specialization: Nursing

    Vietz, Karen Kay

    Nursing faculty are being called to review and revise curricula and nursing strategies to incorporate collaboration. One nursing strategy for faculty to consider is the use of collaboratively writing exams. Writing exams individually have been the tradition in nursing education as many nurse educators believe that students must gain knowledge individually to be able to pass the licensing exam. However, with the increased calls for nursing faculty to revise curricula to include collaboration, some nurse educators are researching the strategy of gaining knowledge by working together on exams. Limited studies conducted with nursing students collaboratively writing exams, results in mixed findings as to improvement in test scores, the ability to explain rationale and critically think, and increased knowledge retention. The purpose of this study was to examine whether collaborative unit testing was more effective than individualized unit testing on long-term knowledge retention as measured by scores on individual comprehensive final exams. The sample population was comprised of 57 senior nursing students concurrently enrolled in Critical Care and Mental Health or Critical Care and Community health courses in Midwest baccalaureate nursing program. A quantitative non-randomized quasi-experimental within group control study design was used to answer the question of whether baccalaureate nursing students participating in collaborative, multiple choice unit testing in Critical Care would have higher retention of course content compared to individualized unit testing in Mental Health or Community Health. Results indicated collaborative unit testing was not more effective than individualized unit testing on long-term knowledge retention of nursing course content for students concurrently enrolled in Critical Care and Mental Health or Critical Care and Community Health. There was no significant increase in short-term knowledge retention of nursing course content with collaborative testing compared to individualized unit testing for students concurently enrolled in Critical Care and Mental Health or Critical Care and Community Health. There was also no significant increase in long-term knowledge retention of nursing course content with collaborative unit testing compared to individualized unit testing for students concurrently enrolled in Critical Care and Mental Health or Critcial Care and Community Health. The results of this study did not indicate an increase in knowledge retention using collaborative testing.

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Orthopaedics

    The Occurrence Of Positive Sacroiliac Screening Tests In Asymptomatic Adults

    Published Year: 2002
    Specialization: Orthopaedics

    Awad, Ahmed

    Diagnosis of sacroiliac joint (SIJ) dysfunction is made primarily by clinical examination using various special tests as preliminary diagnostic tools. These screening tests are used to assess the asymmetry of sacroiliac motion, which is thought to be due to a relative, unilateral hypomobility of one side of the SIJ. The occurence of positive tests has not been thoroughly investigated in an asymptomatic population. The purpose of the study is two fold: 1) to determine if commonly used SIJ screening tests may be positive in asymptomatic individuals, and 2) to determine if a relationship exists between rectus femoris and hamstring muscle tightness and results of the SIJ tests. Subject: A sample of convenience consisted of 50 asymptomatic adults from 18 to 50 years of age. Methods: A prospective study that investigated the occurence of positive sacroiliac joint screening tests including the standing flexion test, the supine to long sitting test, and the prone knee flexion test in asymptomatic individuals. The primary examiner performed the three SIJ tests on all subjects. A secondary tester tested the hamstring and rectus fermoris muscles length. Data analysis: Chi-square values and P values were calculated using a one-sample test to determine the association between the hamstring and rectus femoris muscle tightness and the presence of positive SIJ screening tests. Results: Overall, 18% of subjects were judged to have a positive test for at least one of the 3 SIJ screening tests. There was no relationship between hamstrings or rectus femoris muscle tightness and positive SIJ screening tests. Discussion and Conclusion: Positive sacroiliac screening tests can occur in asymptomatic individuals. Clinicians need to be aware of thsi during routine physical therapy assessment. There appears to be no relationship between hamstrings or rectus femoris muscle tightness and positive SIJ screening tests.

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    The Effects of Lumbar Spine Position on Shoulder Range of Motion in Asymptomatic Subjects

    Published Year: 2005
    Specialization: Orthopaedics

    Bishop, Dianna Lynn

    Background and Purpose: Active shoulder flexion in sitting is sometimes accompanied by thoracolumbar extension, along with cervical side-flexion and rotation, which may result in inconsistent documentation of shoulder range motion values. The purposes of this study are to examine intra-rater and inter-rater reliability of a method for measuring active shoulder flexion range of motion in the sitting position, and to determine if different lumbar spine positions will results in a change in subjects’ active shoulder flexion range of motion in sitting. Subjects: Twenty-five healthy subjects volunteered to participate in a reliable study for active shoulder flexion in neutral sitting. Twenty-six subjects with fifty asymptomatic shoulders volunteered to have shoulder flexion measured while sitting in lumbar kyphosis and lumbar lordosis. Methods: Active shoulder flexion was measured with each subject sitting with a neutral spine three times by three physical therapists for the reliability study. Active shoulder flexion was measured with each subject sitting in lumbar kyphosis and lumbar lordosis for ANOVA comparisons. Results: Intra-rater reliability for the primary therapist was .98, for the second therapist was .95, and for the third therapist was .94. Inter-rater reliability was .91. One-way ANOVA results revealed that active shoulder flexion with the lumbar spine in lordosis is significantly greater than active shoulder flexion with the lumbar spine in kyphosis. Discussion and Conclusion: Intra-rater and inter-rater reliability for measuring active shoulder flexion range of motion in sitting was high. Lumbar spine position does significantly affect healthy subjects’ active shoulder flexio range of motion. This difference may be caused by postural variations that occur at the thoracic spine, cervical spine, scapula, acromioclavicular joint, and sternoclavicular joint when the lumbar spine is in lordosis versus kyphosis.

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    The Immediate Effects of Manual Massage on Power Grip Performance Following Maximal Exercise in Healthy Adults

    Published Year: 2004
    Specialization: Orthopaedics

    Brooks, Carol P.

    Purpose: Massage is often used as an adjunct to exercise in sports and therapeutic settings, but its effects on muscle performance have not been conclusively determined. The purpose of this study was to assess the effects of using manual massage to improve power grip performance immediately following maximal exercise in health adults. Methods: Fifty-two volunteer massage school client, stadd, faculty, and students were randomized to receive either a 5-minute forearm/hand massage of effleurage and friction (to either the dominant hand or non-dominant hand side), 5 minutes of passive shoulder and elbow range of motion, or 5 minutes of non-intervention rest. Power grip measurements – baseline, post-exercise, and post-intervention – were performed on both hands using a commercial hand dynamometer. These measurements preceded and followed 3 minutes of maximal exercise using a commercial isometric hand exerciser that produced fatigue to 60% of baseline strength. Results: After 3 minutes of isometric exercise, power grip was consistently fatigued to at least 60% of baseline with recovery occuring over the following 5 minutes. Statistical analyses involved single-factor repeated measures analyses of variance with Bonferroni a priori tests that demonstrated statistically significant differences in intervention and natural muscle recovery effects between groups. Massage had a greater effect than no massage or placebo on grip performance after fatigue, especially in the non-dominant hand group. Natural muscle recovery was shown to be a a significant factor in grip performance after exercise, with less natural muscle recovery occuring in the massage groups, and thus, suggesting that massage had a greater effect on overall grip performance in these two groups. Conclusions: Manual massage to the forearm and hand after maximal exercise produced greater effects than non-massage on post-exercise grip performance. At five minutes post-exercise, massage was shown to have the greater effect on grip performance, and this supported the hypothesis that manual massage to the muscles of grip would have an immediately positive and greater effect on performance, as shown by the physiological response. In this sample of health adults natural muscle recovery of grip strength was not equal on both sides, a finding that suggests that natural muscle recovery is not the same between the dominant and non-dominant hand; however, neither the results of this study, nor a review of the literature provides a basis for any definitive conclusion regarding the imbalance. The present data do support the use of a five minute manual massage to assist immediate grip performance after fatigue in healthy subjects. The recommendation is made that future studies be done to determine the differences in natural muscle recovery between an individual’s dominant and non-dominant hands following exercise, and the effects of response to massage.

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    Specific Stabilization Exercises to Medical Diagnoses of Lumbar Segmental Instability

    Published Year: 2006
    Specialization: Orthopaedics

    Bull, Eric C.

    Study Design: Test re-test methodological design using a sample of convenience. Objectives : Examine the effects of a 6-week criterion-based stabilization program on subjects with surgical and non-surgical medical diagnoses of lumbar segmental instability. Dependent variables assessed included Oswentry Low Back Pain Disability Questionnaire and cross sectional area of the lumbar multifidus. Background: Lumbar segmental instability has emerged as a characteristic finding in many phases of spinal pain. Onset of lumbar segmental instability may be insidious in cases of isthmic spondylolisthesis of acute in cases of disc herniation. Surgical treatment of these conditions produces specific atrophy. Lumbar multifidus atrophy persists if specific interventions are not performed. Correlations between cross sectional area of the lumbar multifidis and disability questionnaires have not been demonstrated in these two medical diagnoses. Methods and Measures: All subjects completed the Oswestry Low Back Pain Disability Questionnaire and received real-time ultrasound measurements to their lumbar multifidis at pre and post-test. A convenience sample fo the first 21 subjects participated in the intervention group, while the next 17 subjects participated in the control group. Results: Odds ratios demonstrate a 49:1 chance of improvement with this program. Speaman’s rank correlations revealed no correlation between change in cross sectional area and improvement in self-report questionnaire. Conclusion: This specific stabilization program produces improvements in self-report of disability after six-weeks. During the study timeframe, no measurable change in cross sectional area of the lumbar multifidis was correlated with improvements in Oswestry Low Back Pain Disability Questionnaire scores.

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    Electromechanical Delay and Pre-Motor Time in Quadriceps Following ACL Reconstruction from 2 Weeks to 3 Months Post-Operatively

    Published Year: 2006
    Specialization: Orthopaedics

    Carling, Jon M.

    Objectives: The purpose of this study was to investigate the electromechanical properties of muscle after ACL reconstruction and examine the changes in these properties during the post surgical recovery period. Background: Post surgical subjects demonstrate delayed response to volitional muscle contraction. This causes decreased neuromuscular coordination which makes coordinated movement difficult, delays rehabilitation and may predispose the subject to further injury. It is not known if the prolonged reaction time to stimulus is a results of central nervous system delay, impaired proprioception, or as a result of increased muscle elasticity in the series of elastic component, muscle fiber alterations, or excitation/contraction coupling of the effected muscle, or perhaps both. Methods: Measuring PMT, and EMD during both volitional and electrically stimulated muscle contractions in patients having undergone surgery provides one method of determining the cause of the delayed neuromuscular response because it allows measurement of the variables with and without central nervous system input. In order to determine the cause of the documented neuromuscular delay, 26 subjects participated in serial measurement of EMD and PMT of the involved Vastus Lateralis (VL) during volitional contractions, and via femoral nerve stimulation at 6 different times. ACL subjects were measured at 2, 3, 4, 6, 8 and 12 wks post operatively, and control’s dominant VL was measured at identical time periods beginning at a convenient test time. Circumference measurements at 5 cm above joint line and 15 cm above joint line were also recorded at each test time. Results: Repeated measures analysis of variance was used to document any statistical differences between groups. No differences in PMT were seen between controls and the ACL group for the voluntary test or for the involuntary test. The EMD during the voluntary test demonstrated no statistically significant differences between the two groups, Student-Newman-Keuls post-hoc analysis revealed that EMD during the voluntary tests performed at 3 wks and 6 wks post operatively were significantly longer than the other tests. This is unexplained since test before, between and after weeks 3 and 6 were similar and thus different from weeks 3 and 6, for both ACL and control groups. Circumference measures did not change significantly throughout the study for the control group. Slight increases in muscle circumference were noted during the 8 and 12 wk test times for the ACL group. Conclusions: PMT is not increased in post ACL reconstructed patients compared to non-surgical patients. Central response to simple stimulus and nerve conduction seem to be unaffected in ACL reconstructed patients. EMD during involuntary contraction appears to be increased compared to controls for at least 12 wks postoperatively. This may be due to decreased stiffness in the series elastic component of the muscle-tendon unit, changes in fiber type composition, or delays in the excitation/contraction coupling of the affected muscle. The lack of statistical significance during voluntary testing may be related to variations in the ability to recruit motor units in an identical manner between tests for subjects within both groups. This may be related to preferential recruitment of type II motor units in an unsychronized manner. Current emphasis on rehabilitation techniques designed to progressively load the series elastic component, affect muscle fiber composition, or improve excitation-contraction coupling of the involved muscle is supported by these findings, and appears likely to be more effective treatment than focusing on central processes related to muscle recruitment.

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    The Effect of Ankle Bracing on Knee Joint Kinematics and Kinetics during Repeated Single Leg Hop and Drop Vertical Jump in High School Aged Girls

    Published Year: 2009
    Specialization: Orthopaedics

    Christensen, Virginia Norene

    Background: Ankle bracing has not been studied for its effects of knee joint kinematics and kinetics in the adolescent female athlete. Hypothesis: A) A statistically significant mean increase of knee joint valgus and extensor moments and valgus angles would be found in the braced group during the drop vertical jump and the single log hop tests and B) A statistically significant mean decrease in knee joint varus and extensor moments and valgus angles will be found between pre- and post-test acclimation periods in the braced condition. Study Design: Randomized Controlled Trial. Methods: Fifteen adolescent female athletes performed Drop Vertical Jump (DVJ) and Single Leg Hop (SLH) tests without ankle bracing and with a lace-up style ankle brace. Subjects wore braces over a 1 week period and retested. Results: During the DVJ, bracing increased knee extensor moments during the first 50 ms of landing but had no affect on knee frontal plane moments. Bracing increased vertical ground reaction force (vGRF) within the first 50ms of landing, and peak vGRF with less time to achieve peak vGRF. During the SLH, bracing increased knee flexion at IC and decreased knee frontal plane displacement into valgus. Ankle bracing increased vGRF within the first 50ms of landing and decreased stance time. Conclusions: Ankle bracing increased vGRF and knee extensor moments during the first 50ms of landing. Clinical Relevance: The adolscent female athlete may be at risk for knee injury during the initial landing phse when wearing a lace-up style ankle brace.

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    EMG Analysis Of Selected Muscles Of The Shoulder During Open And Closed Chain Exercises

    Published Year: 2007
    Specialization: Orthopaedics

    Christoff, Ryan

    Purpose: The purpose of this study is to compare a closed chain activity using the Fitter device to open chain activities. Methods: Sixteen subjects participated in the study. Surface electromyographic analysis was used to measure muscle activity for each of the muscles studied including the Upper, Middle and Lower Trapezius Muscles, and Pectoralis Major muscles. Manual Muscle Testing was peformed of all muscles. Open chain and Fitter exercises were performed randomly. Open chain exercises performed were scaption, flexion, abduction, and scapular retraction utilizing Thera-Band. Data Analysis: The data was analyzed for peak root mean square. The t-test was utilized to analyze the data at the .05 level. Results: The Upper, Middle and Lower Trapezius Muscles all produced greater muscle activity with open chain exercises than closed chain exercises. The Pectoralis Major Muscle produced greater muscle activity while performing closed chain exercises utilizing the Fitter. Conclusion: Strengthening the Upper, Middle and Lower Trapezius Muscles is more effective performing open chain exercises versus the Fitter. Strengthening the Pectoralis Major utilizing the Fitter may be an appropriate closed chain exercise.

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    The Lateral Scapular Slide Test: A Reliability Study of Subjects With and Without Shoulder Pathology

    Published Year: 2002
    Specialization: Orthopaedics

    Curtis, Thomas J.

    There is evidence that scapular motion and position is related to shoulder pathology and therefore an important component of shoulder evaluation. The Lateral Scapular Slide Test (LSST) is used to determine scapular position with the arm abducted to 0, 45, and 90 degrees in the coronal plane. There are conflicting results from previous studies investigating the reliability of the LSST. 33 male subjects with ages ranging from 18 to 34 years participated in this study. One group (n = 15) had shoulder pathology and the other group (n = 18) did not have pathology. Two measurements were taken in each test position bilaterally. A coefficient of determination and standard error of the measurement (SEM) was calculated was as well as a repeated-measures analysis of variance and intraclass correlation coefficient (ICC). To determine the interrater reliability between raters, a model ICC (2,3) was used. Subjects without pathology in position 1 and 2 revealed high coefficients ranging from .80 to .92 whereas position 3 revealed moderate to high ranging from .64 to .81 Subjects with pathology were similar. ICC(2,2) was likewise good for positions 1 and 2 with ICC ranging from .87 to .95 while moderate to good for position 3 with ICC ranging from .70 to .82 in both groups with and without pathology. Overall good agreement for both subject groups were determined with ICC(2,3) and ranged from .83 to .96. The results of our investigation demonstrate that measurements obtained with the LSST can be reliable in screening scapular position or symmetry.

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    Effects of ASTM AdvantEDGE TM on Tendon Morphology Related to Functional Outcomes in Patients with Patellar Tendinopathy

    Published Year: 2004
    Specialization: Orthopaedics

    Cutrone, Guillermo

    Title: Effects of ASTM AdvantEDGETM on Tendon Morphology Related to Functional Outcomes in Patients with Patellar Tendinopathy. Study Design: Prosepective, randomized, controlled, blind clinical trial. Objectives: The purposes of the present study were to evaluate the effects of ASTM AdvantEDGE on morphological changes in tendon morphology and its relationship with functional outcomes and perception of pain in cases of patellar tendinopathy. Background: Patellar tendinopathies have been traditionally treated as an inflammatory process. ASTM AdvantEDGE constitutes an alternative approach that treats these conditions degenerative processes. ASTM AdvantEDGE triggers a localized inflammatory response, which is hypothesized to facilitate the resorption of degenerative or excessive connective tissue creating a window of opportunity to align new collagen fibers when therapeutic exercises before cross linking occurs. Methods and Measures: Sixteen knees of 9 patients with bilateral or unilateral degenerative patellar tendinopathy who completed this study were randomly assigned either to ASTM or exercise only groups. They underwent repeated testing with ultrasonograms for tendon thickness, hypoechoic areas and blood flow, along with functional assessment tests. In addition, all patients rated their pain before and during functional testing using a visual analogue scale. Results: Paired T-test for pre-post treatment perception of pain, tendon thickness, and hypoechoic area, and a pre mid-post term multivariate analysis of variance nested in each group with repeated measures for functional testing showed no significant difference, except for single leg jump test for time in favor of the ASTM group, although with unusual observations. Conclusions: ASTM AdvantEDGE appears to be as effective as therapeutic exercises only for the treatment of patellar tendinopathy in the young adult and the teenage patient population with sonographic edivences of patellar degeneration without inflammation. Further investigation with larger samples and longer treatment periods with different age groups to determine a potential difference in the approaches presented in this study are recommended.

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    The Effectiveness of Mobilization with Exercise and Sacroiliac Belts in the Treatment of Pelvic Pain and Disability in Pregnant Patients

    Published Year: 2007
    Specialization: Orthopaedics

    Dodge, Cheryl

    Background and Purpose: Back pain is common among pregnant women with a prevalence as high as 76% with 47% who cannot perform their daily activities. The purpose of this study was to determine if pelvic mobilization and pelvic support belts are effective treatments for posterior pelvic pain during pregnancy. Secondly, this study aimed to determine whether applying a sacroiliac belt after pelvic alignment correction was more effective than applying a belt alone. Subjects: Eighteen pregnant women complaining of lower back pain who met criteria for pain originating from the pelvis were consecutively assigned to one of 3 treatment groups. Methods: A mixed design, repeated measures prospective experimental clinical trial was conducted. Each subject attended four visits. Each group received examination and identical education on the first visit. On the second visit, treatment group 1 received mobilization of the pelvis by the physical therapist and an exercise to carryover the mobilization correction for home. The second group received a sacroiliac belt. The third group received both interventions. On visit three, groups 1 and 2 received both interventions and group 3 was brought back for retesting and review. Each group was brought back for visit 4 for retesting. At each visit, a 100mm pain visual analogue scale and the revised Oswestry Low Back Disability Questionnaire were given to each group to serve as the dependent variables. Results: There was strong support for the first hypothesis that mobilization of the pelvis and the use of a pelvic belt would decrease reported pain and disability in pregnant women. VAS scores and Oswestry scores dropped significantly when all subjects received mobilization and belt interventions. There was some support for the second hypothesis that mobilization of the pelvis prior to belt application would be more effective than applying a belt alone. There was a steep drop in VAS scores from the second visit to the third visit for subjects who were provided with mobilization treatment and a pelvic belt, but only a minimal drop in VAS when the subjects were provided with a pelvic belt alone. Discussion and Conclusion: The results of this study suggest that mobilization and sacroiliac belts are effective treatments for pelvic pain and disability during pregnancy. In addition, correcting pelvic alignment prior to applying a sacroiliac belt may add further reduction in pain and disability in pregnant women.

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    Validity and Reliability Study of a Multi-Dimensional Computerized Pain Assessment Tool (ComPAT)

    Published Year: 2007
    Specialization: Orthopaedics

    Dodson, William H.

    The complex nature of the pain experience suggests that measurements obtained by a numeric rating scale and other solitary dimension scales may not always show high concordance. Pain assessment is an essential part of pain management in lumbar spine pain as in other pain syndromes, but pain is subjectively perceived and a complex sensation. It is recognized that the patient’s perception of his/her pain is essential in making medical decisions and judging the results of treatment interventions. Many patients are unable to give a precise verbal description of their discomfort due to the lack of anatomical knowledge and/or possible difficulties in expressing their pain. It can be time consuming for the care provider to acquire a complete pain description during the assessment of the patient. Additionally, many errors in communication of pain are made with respect to location, type and intensity. This research study used a test-retest comparison design utilizing the Computerized Pain Assessment Tool (ComPAT) and the paper pain mapping (PPM) methods to measure pain. The aims of this papaer are to determine the validity and reliability of the ComPAT software program. The ComPAT is a multi-dimensional pain assessment tool that allows the clinician to assess the area, intensity, type, and depth of pain that a patient is experiencing. One hundred fifty-nine patients participated in the test-retes of the ComPAT compared to the PPM. They then received moist heat and manual therapy and then performed the ComPAT and PPM. Analysis of data was performed using the repeated measures analysis of variance (ANOVA) and the Pearson’s correlation coefficient. Also, descriptive statistics were used to describe the subjects. In order to show agreement between the types of pain both pre and post interventions, percent agreement evaluation was performed along with the Chi-square. The results show that the ComPAT is a valid and reliable tool in measuring pain area, intensity, depth and type.

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    Comparison Of High School Football And Soccer Injuries On Fieldturf Versus Natural Grass

    Published Year: 2008
    Specialization: Orthopaedics

    Garlock, Patrick G.

    Background: Few studies have compared injury rates on natural grass and FieldTurf surfaces, especially in interscholastic populations. No prior studies have reported if injury rates are different during practice and games in football and soccer on these two surfaces. Hypothesis: We theorized that there would be no difference in injury rates for football and soccer players when playing on natural grass or FieldTurf surfaces. Objective: To compare the incidence of injury of high school football players on natural grass and FieldTurf surfaces. Study Design: Retrospective study. Setting: Natural grass and FieldTurf surfaces at a high school in Western Washington. Sample Population: A total of 539 boy and girl athletes who participated in eight football and sixteen soccer teams during 1998 to 2001 interscholastic seasons. All injuries were reported and verified by an athletic trainer/physical therapist. Injury rates were determined per 1,000 athletic exposures. Main Outcome Measure: Reportable injuries occuring from participation as a varsity or junior varsity football or soccer athlete. Results: Injury rates on natural grass were significantly higher on FieldTurf for football and girls’ soccer. Injury rates on natural grass were significantly higher on natural grass than FieldTurf for practices and games for boys’ football and girls’ soccer. No significant differences were found between natural grass and FieldTurf in head related trauma for football players. For other body locations, higher rates of knee injury for football and ankle injuries for girls’ soccer occurred on natural grass compared to FieldTurf. By injury type, higher rates of spains for girls’ soccer and strains for football occurred on natural grass compared to FieldTurf. By position, for football, we found higher rates of injury on natural grass than FieldTurf for lineman and defensive backs. For girls’ soccer defenders had higher rates on natural grass than FieldTurf. Conclusion: The results of this study suggest that a new generation of synthetic turf, FieldTurf, may lower the risk of injury in football and girls’ soccer at the high school level. Further studies are needed to compare the risk of injury between the two surfaces in other high school sports like field hockey or lacrosse that also play on these surfaces.

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    Effect Of Exercise On Index Of Kyphosis, Trunk Strength, Shoulder Flexion And Functional Disability Scores In Postmenopausal Women With Low Bone Mass

    Published Year: 2003
    Specialization: Orthopaedics

    Grafa, Colleen Shepperd

    An exaggerated thoracic kyphosis is physically disfiguring and a physiological and psychological consequence of declining bone mass. Previous investigators have correlated trunk strength and kyphosis, but have not demonstrated an exercise program effective at reducing the index of kyphosis. The purpose of this study was to determine the effect of trunk and scapular strengthening exercises on I/K, trunk and lower trapezius muscle performance, shoulder flexation range of motion (ROM) and self-perceived functional disability in postmenopausal women with low bone mass. Thirty-three postmenopausal women with low bone mass and a “clinically apparent” index of kyphosis were randomly allocated to 1 of 2 groups. Subjects in the control group continued their usual routine while subjects in the experimental group received a supervised program of 9 progressive trunk-strengthening exercises 3 times a week within 12 weeks. I/K was calculated from flexicurve measures. Trunk extensor and lower trapezius muscle performances were measured in gravity-minimized positions using a hand-held dynamometer. Shoulder flexion was measured with a goniometer. Functional disability was measured using the activities of daily living (ADL) component score from the Osteoporosis Functional Disability Questionnaire (OFDQ). Measurements were taken prior to and following the intervention by an examiner blinded to group assignment. The design was a prospective randomized controlled trial. Multivariate analyses of covariance (MANCOVA), using pre-treatment trunk strength, shoulder ROM and I/K as covariates, was used to test post-treatment differences between the groups. Between group differences in ADL scores were tested using the Mann Whitney U. The overall MANCOVA demonstrated a difference between groups and follow-up analysis revealed significant increases in shoulder flexion and muscle performances while decreasing the I/K. The Mann Whitney test demonstrated an increase in ADL scores in the treatment group. Clinical improvements in the exercise group compared to the control group ranged from 4 to 28% with a 12% decrease in the I/K. A 24-session, supervised program of progressive trunk strengthening exercises can reduce thoracic kyphosis and increase shoulder flexion, trunk muscle performance, and ADL in postmenopausal women with low bone mass.

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    The Impact of Custom Semi-Rigid Foot Orthotics on Lower Extremity Function and Pain in a Patellar-Femoral Population

    Published Year: 2005
    Specialization: Orthopaedics

    Grundman, Donna Muir

    Study Design: Experimental and control group design utilizing randomized clinical trials using pre-post intervention repeated measures. Objectives: To determine the effects of foot orthotics on quadriceps angle (Q-angle), knee pain and function in a patellar-femoral population with pronated feet, and whether a Merchant view patellar congruence angle can predict the effectiveness of an orthotic. Background: Foot orthotics are commonly used for correction of alignment in a foot pronation population with patellofemoral pain. It is unclear if custom semi-rigid foot orthotics alter knee pain, change standing Q-angle, improve knee function, or if there is a correlation between Merchant x-ray views of the patella and the ability to predict the orthotic’s effectiveness. Methods and Measures: Sixty volunteer experiencing anterior knee pain were randomly assigned to treatment group receiving bilateral custom semirigid foot orthotics plus home exercise program, and control group HEP only. Pre/post intervention repeated measures were used for: (1) Q-angle measurement in standing; (2) pain as assessed by visual analogue scale (VAS); (3) Lower Extremity Function Scale (LEFS) questionnaire; and, (4) Merchant view patellar x-ray angles when available. Results: Paired t-test showed the custom orthotic group had significantly less pain and significantly higher function than the non-orthotic group after the 28 day trial. Significant changes in Q-angle were measured between barefoot and athletic shoes plus orthotics. No correlations were noted between Merchant view x-rays and orthotic success. Conclusions: Custom semirigid orthotics diminish pain and Q-angle, and improve function for patients who experience patellar-femoral pain and foot pronation.

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    Effect of a Graded Exercise Program with Manual Physical Therapy on Supraspinatus Tendinopathy in Primary Compressive Disease: A One Group Pretest-Posttest Repeated Measures Design

    Published Year: 2010
    Specialization: Orthopaedics

    Himel, Eddie J.

    Rotator cuff problems are a common occurrence in the general public and can lead to long term disability and/or surgical intervention.There appears to be no consensus of opinion or experimental evidence that definitively determines the most effective conservative intervention for primary compressive disease. The objective is to observe the effect of an eight week graded exercise program on individuals clinically diagnosed with stage II primary compressive disease of the shoulder and who also exhibit a positive MRI find of supraspinatus tendinitis/tendinosis.

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    The Effectiveness of Extracorporeal Shock Wave Therapy for Patients with Plantar Fasciitis Who Satisfy a Clinical Prediction Rule

    Published Year: 2008
    Specialization: Orthopaedics

    Ibrahim, Mahmoud Ibrahim

    Introduction: Plantar fasciitis is a common cause of heel pain, affecting 10% of the general population. Extracorporeal shock wave therapy (ESWT) has been recommended as treatment for chronic plantar fasciitis in patients unresponsive to conservative treatment. The primary goal of this study was to determine the effectiveness of extracorporeal shock wave therapy compared with placebo in the treatment of chronic plantar fasciitis. Methods: A prospective, randomized, blinded, controlled study with two groups of subjects each was proposed. 50 patients (50 heels), including 25 patients (25 heels) in the shockwave treatment group and 25 patients (25 heels) in the control group. All patients had been suffering from plantar fasciitis for at least 6 months. Pre-treatment measurements including a visual analog pain scale (VAS) and the modified Roles and Maudsley scale (R&M). In the shockwave group, Therapy was applied once a week for two weeks at an air pressure of 3.5 bars and frequency of 8 Hz were given at each sitting. The patients in the placebo group received treatment with the clasp on the heel. ESWT was performed without local anaesthesia. At the fourth week the subject were again completed a VAS and R&M. Results: At 4 weeks, there was a mean VAS decrease of 7.88 for the experimental group; there was a mean decrease of 1.36 for the control group. There was a statistically significant ANOVA group by time interaction indicating the experimental group had a greater decrease in pain when compared to the control group p < .001. At 4 weeks, there was a mean decrease of 2.56 in R&M for the experimental group; there was a mean decrease of 0.24 for the control group. There was a statistically significant ANOVA group by time interaction indicating the experimental group had a greater increase in quality of life when compared with the control group p < .001. Discussion: Extracorporeal shock wave therapy has a statistically significant decrease in pain scores than placebo for patients with plantar fasciitis. Extracorporeal shock wave therapy has a statistically significant increase in functional outcome (better quality of life) than placebo on patients with plantar fasciitis. Conclusion: Shock wave therapy is effective and safe for the treatment of chronic plantar fasciitis.

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    Frequency, Severity and Mechanism of Injury in Beginner, Intermediate and Expert Kiteboarders

    Published Year: 2006
    Specialization: Orthopaedics

    Kemp-Smith, Kevin

    In the past decade participation in kiteboarding has increased in popularity. However, limited knowledge exists on the frequency, severity and mechanism of injury in kiteboarders by skill level. Certain experience levels, types of equipment, and landing abilities from high jumps will identify individuals at increased risk of injury during kiteboarding. Our results indicate that the risk of injury is high among kiteboarders, especially in the lower extremity. Most injuries appear to cause 7 or fewer days lost from kiteboarding. Kiteboarders are at increased risk for injury when their feet are caught in the kiteboard bindings when landing from aerial maneuvers. Our study’s findings may provide kiteboarding instructions, healthcare professionals and kiteboarding manufacturers with information on where educational and prevention efforts should be targeted to help minimize injuries associated with kiteboarding.

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    Use of a Wrist Extension Inhibition Brace to Increase Velocity and Accuracy of a Baseball Pitch

    Published Year: 2008
    Specialization: Orthopaedics

    King, Tertia

    Objective: The aim of the study was to evaluate the pitching performance of subjects wearing a wrist extension inhibition brace, specifically the velocity and accuracy of the pitch. Background: A wrist brace has been proposed as having potential for teaching proper pitching technique and thereby preventing elbow and shoulder injury in youth baseball. A dynamic extensor wrist has been demonstrated to have an effect on wrist proprioception, a necessary component of an effective pitch. Thus, an objective assessment of the brace is warranted in youth baseball pitchers. Study Design: A randomized pretest-posttest two-group design was used to study the effect of a wrist extension inhibition brace on pitching a baseball for boys, ages 9 to 17. Throw velocity and pitch accuracy were measured in pitchers who were trained with or without a wrist brace. Methods: Throw velocity was assessed with a jugs radar gun. Target pitch accuracy, and pitching technique were recorded with a camcorder and evaluated by two coach raters. Measurements were made at baseline and at 4 weeks posttest. Pitchers also filled out a pain questionnaire weekly. Results: The throw velocity increase was significantly greater for pitchers wearing the brace. There was a mean increase of 2.39 mph for the brace group; there was a mean decrease of 0.46 mph for the non-brace group. Conclusion: This randomized control group study suggests that there are potential performance benefits of a wrist extension inhibition brace for youth pitchers.

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    Predictors of Physical Therapy Outcomes in Patients with Lower Extremity Musculoskeletal Dysfunction

    Published Year: 2008
    Specialization: Orthopaedics

    Klein, Aimee Beth

    Background and Purpose: The purpose of this study was to explore factors related to physical therapy outcomes in patients with lower extremity (LE) muscoluskeletal dysfunction, using the Lower Extremity Functional Scale (LEFS) and the Medical Rehabilitation Follow Along (MRFA). Subjects: Data were collected from 188 patients with a mean age 47 years. Methods: Five physical therapists were involved in the study, providing data for their outpatients referred for LE problems at the hips, knee of ankle/foot from January 2005 through January 2006. Demographic and medical variables, including comorbidities, number of medications, acuity and physician referral, and initial MRFA and LEFS scores were used to predict discharge MRFA and LEFS scores using stepwise regression analysis. Results: Regression analyses showed that the demographic and medical variables provided limited explanation for only one of the MRFA subscales, the Placcid subscale, or emotional health, with and R (squared) of .58, with initial Placcid score the most important variable, followed by time since onset. Prediction of the discharge LEFS score was also limited, with and R (squared) of .41. The predictive variables included initial Pain score on the MRFA, initial LEFS score, and being employed. Discussion and Conclusion: Findings suggest that a region-specific functional measure provides important information for understanding factors that influence successful physical therapy outcomes. The initial score of the LEFS, along with the patient’s pain level, acuity level and employment status can assist the therapist in their clinical decision-making regarding prognostication of patient outcome.

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    A Comparison of a McKenzie Approach to a Specific Spine Stabilization Program for Chronic Low Back Pain

    Published Year: 2002
    Specialization: Orthopaedics

    Miller, Eric R.

    Chronic low back pain has been associated with specific patterns of muscle dysfunction. Recent studies have examined effects of a stabilization program directed at the retraining muscles for the management low back pain. The McKenzie approach is a widely utilized treatment approach for low back pain that emphasizes the performance of repeated end range movements and patient self-treatment. A stabilization approach directed at specific muscle deficiencies may be a more effective treatment for patients with chronic low back pain.

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    An Epidemiological Investigation of Lower Extremity Injury Among High School Cross Country Runners

    Published Year: 2005
    Specialization: Orthopaedics

    Plisky, Melody S.

    Background: Medial tibial stres syndrome (MTSS) is a common injury among runners. Biomechanical factors, including navicular drop, have been suggested to increase the risk for MTSS. However, few researchers have examined this association, especially is adolescent runners. Thus, the purpose of this study was to determine if navicular drop is associated with the occurrence of MTSS in high school cross country runners. Methods: A prospecftive cohort of 105 high school runners was followed in eight Indiana high schools during the 2004 cross country season. Bilateral navicular drop and foot length were measured on each runner prior to the start of the season. Additional data collected included a baseline history form on previous running injury, running experience, orthotic use, height and weight. The runners were followed throughout the cross country season for occurrence of MTSS. Coaches and certified athletic trainers completed the Athletic Health Care System Daily Injury Report to document MTSS and other running-related injuries, time lost from injury, and athletic exposures (AEs) daily. The baseline history, navicular drop, and foot length measurements were tested for an association to injury using logistic regression analysis. Results: Incidence rates for MTSS were 2.7/1,000 AEs, 3.9/1,000 AEs, and 1.7/1,000 AEs for all subjects, girls, and boys, respectively. After logistic regression modeling, only gender was found to be significantly related with the occurrence of MTSS, as girls were 3.3 times more likely than boys to develop MTSS during the cross country season. No significant associations were found between MTSS and either navicular drop or foot length. Conclusions: The results of this study reveal that the incidence of MTSS is greater among female runners than male runners. Furthermore, our findings indicate that navicular drop may not be an appropriate measure to identify runners who may develop MTSS during a cross country season. Clinical Relevance: Similar to other sports, female cross country runners experience a greater incidence of injury than male runners. Current training programs aimed at reducing the risk of injury to female athletes may prove useful among cross country runners. As navicular drop was not useful in predicting the occurrence of MTSS, additional studies are needed to identify appropriate preseason screening tools.

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    Relationship Between Risk of Lower Extremity Injury and Star Excursion Balance Test Reach Distance in Boys and Girls High School Basketball Players

    Published Year: 2005
    Specialization: Orthopaedics

    Plisky, Phillip J.

    Objective: To examine the injury rates for boys and girls high school basketball players. Study Design: Prospective cohort. Setting: Seven Indiana high schools during the 2004-05 basketball season. Participants: 160 male and 129 female athletes from rosters of the freshmen, junior varsity, and varsity basketball teams. Main Outcome Measurements: Coaches and Certified Athletic Trainers maintained the Daily Injury Report and documented the number of athletic exposures, injuries, and time lost due to injury. Results: The total number of injuries was 128 for an overall injury rate of 6.4/1,000 AEs. Girls had a significantly higher overall injury rate than boys. Girls were 1.5 times more likely than boys to sustain an initial injury, and two times more likely to sustain a subsequent injury. Conclusions: This study found greater injury rates than other studies. Previous studies may have underestimated injury rates in high school basketball due to lack of accurate exposure data, incomplete or inaccurate injury reporting, or missed time loss injuries that could have been captured by an end of season questionnaire. Our study supports previous work that girls have higher injury rates than boys. Further, this study highlights the need for consistent reporting of injury data.

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    A Comparison Of Pilates Mat Exercise And Swiss Ball Exercise Training On Trunk Endurance And Lower Extremity Strength In Older Women

    Published Year: 2007
    Specialization: Orthopaedics

    Ramsey, Katrin L.

    Background and Purpose: Pilates mat and Swiss Ball exercise are complementary alternative medicine (CAM) therapies currently utilized as preventative health and fitness measures as well as methods of rehabilitation. Minimal evidence based information exists regarding the efficacy of most CAM therapies. The purpose of this study was to compare the effects of Pilates mat and Swiss ball exercise training upon trunk endurance and lower extremity strength of older healthy females. Subjects: One hundred eleven women were randomly assigned to Pilates mat, Swiss ball and control groups. Methods: Subjects participated in 10 weekly of biweekly exercise training. Outcome measures included assessment of trunk endurance (trunk flexion and extension) and lower extremity (gluteus medius and quadriceps) strength via hand-held dynamometry. Results: Eighty-three subjects completed the study. Both Pilates mat and Swiss ball participants exhibited statistically significant improvement in rectus abdominus endurance. Initial ANOVA results for pre/post rectus abdominus endurance deltas among Pilates. Swiss and control groups was p=.03, but post-hoc Tukey’s tests indicated that only the rectus abdominus endurance changes between Swiss ball and control participants differed. A subsequent ANOVA of only beginner (deconditioned) fitness level participants results for pre/post rectus abdominus endurance deltas among Pilates, Swiss and control groups was p= .02 and post-hoc Tukey’s indicated that only the rectus abdominus endurance changes between Pilates and control group participants differed. Swiss ball participants exhibited statistically significant improvement in trunk extensor endurance. Initial ANOVA results for pre/post trunk extensor endurance deltas among Pilates, Swiss and control groups was p=.04 and post-hoc Tukey’s tests indicated that the only trunk extensor endurance changes between Swiss ball and control group participants differed. No statistically significant improvement in lower extremity strength was observed in either Pilates mat or Swiss ball participants. Discussion and Conclusion: The results suggest that Pilates mat and Swiss ball exercise participation effectively improve trunk endurance in healthy older females.

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    Lapse Time, Patient Satisfaction and Utilization of Physical Therapy Services in Episodes of Care with Non-surgical Spinal Conditions

    Published Year: 2003
    Specialization: Orthopaedics

    Rauh, James G.

    Purpose: The purpose of this study was to determine whether there was a difference in time from onset of condition to access of care for patients who had non-surgical spinal conditions and were satisfied or not satisfied with the physical therapy services they received. Also examined was whether there was a difference in initial health index scores, duration of care and number or physical therapy interventions for patients who are considered to have non-surgical spinal conditions of an acute, sub acute, or chronic stage, at the initial presentation to physical therapy. Patient encounter data for episodes of care involving physical therapy services was extracted for 301 non-surgical spinal cases that met all criteria for review. The encounter data included the time from onset of conditionto access of physical therapy, the patient’s initial SF-12 health index score, the duration of care, the number of visits, and post treatment satisfaction survey obtained following discharge. Mann Whitney-U tests were used to determine if there were significant differences between satisfied and unsatisfied patients and their lapse time from onset of condition and access to care. ANOVA procedures were performed to determine if there were significant differences in initial SF-12 scores, duration of care and number of visits for the three patient groups of acute, sub acute and chronic for the non-surgical spinal conditions. Results: There was a significant difference in the lapse time in days from onset of condition to treatment for those patients who reported being satisfied versus not satisfied with the: outcome of their treatment, overall results of their treatment and level of services received. There was no significant difference in the mean lapse time for those patients who reported being satisfied or not satisfied with the technical skill of their provider. ANOVA results showed a significant difference in the duration of care between groups of acute, sub-acute and chronic lapse time. There were however, no significances between any two groups found with Tukey’s honestly significant difference for pairwise comparisons of duration of care and the three lapse time groups. Conclusions: The less the lapse time between onset of the condition and access to physical therapy the more likely the patient will be satisfied with the results and outcome of their care. They are also more likely to be satisfied with the level of services they receive. However the satisfaction with the technical skill of the provider is not significantly affected by lapse time. There is no difference in initial SF-12 health index scores, the duration of the episode of care or the number of services received based on the patient groups of acute, sub acute, or chronic.

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    Effects of Exercise Induced Muscular Fatigue on the Kinetics and Electromyographic Activity of a Single-Leg Vertical Jump in Healthy Men

    Published Year: 2004
    Specialization: Orthopaedics

    Robinson, Thomas Kevin

    Purpose/Hypotheses: The knee is the most commonly injured major joint, with approximately 80,000 anterior cruciate ligament (ACL) injuries annually. Epidemiological studies of sporting events show that knee injury frequency increases during during the latter portion of the game, thus injury may be associated with biomechanical changes induced by fatigue. We investigated the bilateral effects of unilateral lower extremity (LE) extensor muscle fatigue on electromyographic (EMG) patterns, kinematics, and kinetics of the single-leg vertical jump. Subjects: 15 healthy males, 22-29 years old. Methods: Subjects performed 5 maximal single-leg vertical jumps with each leg. Bilateral EMG (gluteus medius, vastus medialis and lateralis, medial and lateral hamstrings, gastroc/soleus), 3D lower extremity motion and ground reaction forces (GRF) from the jumping/landing leg were collected simultaneously. Subjects exercised the dominant LE (plant leg when kicking a ball) on a leg press machine to fatigue (unable to perform a complete leg press against resistance of 30% of body weight), then single-leg vertical jumps were repeated. Data were exracted in relation to landing events – initial force plate contact and the peak vertical GRF. EMG data were averaged across 5 trials and normalized as a percentage of the pre-exercise value for each muscle. Data analysis used repeated measures ANOVA and MANOVA. Results: There were significant interactions between limb dominance and fatigue for frontal plane knee valgus/varus moment (p=.035; larger on the dominant knee after exercise) and peak vertical GRF (p=.013; lower on the dominant leg after exercise). There was also a main effect of fatigue on peak anterior shear ground reaction force (p=.008; greater for the dominant leg after exercise). The dominant leg had significantly greater EMG activity of the gluteus medius and medial hamstring muscle groups. Conclusion: Despite reduced vertical and anterior GRF following exercise, landing from a single-leg vertical jump produced greater knee valgus moments and more EMG activity in the gluteus medius ad medial hamstring muscle groups in the dominant (exercised) leg and greater lateral hamstring and gastroc/soleus EMG activity in the non-dominant leg. Clinical Relevance: The change in post-fatigue forces in the dominant limb, particularly increased knee valgus moments, may increase the risk of ACL injury. The post-fatigue increase in gluteus medius and medial hamstring activity may be compensatory strategies to counteract the potentially damaging forces.

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    Physical Therapists Inclusion of Advising/Teaching Future Health Problem Avoidance and Injury Prevention in Outpatient Care

    Published Year: 2009
    Specialization: Orthopaedics

    Samuelson, Penelope E.

    Physical therapists are well placed to provide primary, secondary and tertiary prevention information to their patients to help them avoid future health problems and injuries. Results of satisfaction surveys utilizing the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care suggest that patients do not see physical therapists as effective in this role as in other roles such as provider of direct care. Previous studies have indicated that patient education on prevention is minimal in practice. The purpose of this study was to examine the extent that physical therapists value and include teaching all levels of prevention to their patients.

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    Prospective Examination of Closed Versus Open Kinetic Chain Exercise For Symptoms and Disability Associated with Subacromial Impingement Syndrome

    Published Year: 2007
    Specialization: Orthopaedics

    Smith, Jay A.

    Purpose: The purpose of this study was to determine if either open or closed kinetic chain exercises were clearly superior in terms of decreasing pain or disability related to shoulder impingement. Hypothesis: There will be no significant difference in outcomes as measured by pain and disability caused by shoulder impingement between subjects who participate in either an open kinetic chain (OKC) or a primarily closed kinetic chain (CKC) exercise program to improve rotator cuff and scapular strength and endurance (Null Hypothesis). Subjects: Participants were drawn from a convenience sample of patients who presented to physical therapy for treatment of pain and/or decreased shoulder function at one (1) of five (5) physical therapy clinics in the state of Washington. Methods: After potential subjects were identified and met all inclusion criteria, informed consent was obtained and subjects were randomly assigned to one of two exercise groups. One group performed exclusively open kinetic chain exercises for rotator cuff and scapular strengthening and endurance. The second group performed primarily closed kinetic chain exercises targeting the same muscle groups. Exercise frequency was established at four (4) sessions per week for six (6) weeks. To ensure exercises were performed and progressed correctly, all subjects were scheduled for two (2) sessions per week for three (3) weeks then once weekly for two (2) weeks with a therapist who was trained in the exercise programs and progression. Home exercise flow sheets were used to track at home exercise compliance for the remained of the sessions. Data was collected regarding the changes in activities of daily living, pain levels via the Shoulder Performance and Disability Index (SPADI) and a medication usage form before a subject’s first exercise session and again at the completion of all scheduled exercise sessions. Results: A total of forty-five (45) subjects completed all exercise sessions. There were six (6) subjects who dropped out. Twenty-two (22) completed the OKC exercise protocol and twenty-three (n=23) the primarily CKC program. The two (2) groups were compared regarding age, gender, baseline pain and baseline function sub scales of the SPADI and acuity (duration of symptoms). There were no significant differences (p=0.05) between the groups prior to beginning the exercise protocols. After completion of all exercise sessions, both groups showed a significant (p=0.05) decrease in disability and pain subscale scores. The differences were, however, not significant from each other. (Accept the Null Hypothesis). Between-group comparisons were made using Wilcoxon rank sum tests and confirmed using two sample t-tests. Conclusion: There were no significant differences between the two (2) exercise groups related to decreased disability or pain as measured by the SPADI. There was, however, a significant improvement noted in both groups from pre to post exercise scores. Due to the small sample size there might be minor differences between the groups post exercise scores that were not identified by this study.

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    Derivation of a Clinical Prediction Rule for Identifying a Sub-Group of Patients with Low Back Pain Likely to Benefit from Pilates Exercise

    Published Year: 2011
    Specialization: Orthopaedics

    Stolze, Lisa

    Study Design: Prospective cohort study of subjects with non-specific low back pain (LBP) Objective: The purpose of this study was to derive a preliminary clinical prediction rule for identifying a sub-group of patients with LBP likely to benefit from Pilates exercise therapy. Background: Pilates has been shown to be effective for patients with LBP, however no work has previously been done to characterize patient attributes for those most likely to have a successful outcome from treatment. Methods: Treatment response was cataegorized based on changes inthe Oswestry Disability Questionnaire Scores (ODQ) after 8 weeks. An improvement of 50% or greater was categorized as achieving a successful outcome. Thirty seven variables measured at baseline were analyzed with univariate and multivariate methods to derive a clinical prediction rule for successful outcome with Pilates exercise. Accuracy Statistics, ROC curves and regression analyses were used to determine the association between standardized examination variables and treatment response ststus. Results: 96 subjects participated; 95 completed the study. 51 subjects achieved a successful outcome. A preliminary clinical prediction rule with 5 variables was identified: total trunk flexion ROM <= 70 degrees, duration of current symptoms <= 6 months, no leg symptoms in the last week, BMI >=25, and positive active sit up test. If 3 of the 5 attributes were present, the probability of experiencing a successful outcome increased from 54% to 91%. Conclusion: These data provide preliminary evidence to support that the response to Pilates exercise therapy in patients with LBP can be predicted from variables collected from the clinical examination. If subsequently validated in a randomized clinical trial, this prediction rule may be useful to improve clinical decision-making in determining which patients are most likely to benefit from Pilates exercise therapy.

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    Effect of Anchoring and Object Symmetry on Visual Estimates of Angles

    Published Year: 2007
    Specialization: Orthopaedics

    Torres, Edgar

    Purpose: To test the effect of anchoring and object symmetry on the accuracy of visual estimates of angles by physical therapists. Method: Sixty licensed physical therapists estimated eight angles in each of the following groups: anchored symmetrical, anchored non-symmetrical, non-anchored symmetrical, and non-anchored non-symmetrical. A two way analysis of variance (ANOVA) was used to assess error associated with symmetry of objects and anchoring of angles. Correlation coefficients were calculated to evaluate the association between total error and years of experience, and between error and frequency of estimation in clinical practice. Results: The total mean absolute error for all angles was 9.9 (plus or minus) 8.1 degrees with a range of 0 to 47 degrees. There was a main effect for both symmetry and anchoring and a fair relationship was found between error and years of experience. There was virtually no correlation between error and visual estimation frequency in clinical practice. Estimates of near-orthogonal angles had the smallest errors. Conclusion: These findings suggest that physical therapists are slightly better at estimating angles with one anchored side. They also suggest that angles formed by symmetrical objects are estimated more accurately than nonsymmestrical objects. Because of the magnitude of effects from anchoring and symmetry were small, they may not be clinically meaningful. These findings are consistent with the findings of others who also found errors to be smaller for near-orthogonal angles. They differ in that we found a statistically significant decrease in error for anchored angles, whereas others found no anchoring effect. It is recommended that clinicians limit their visual estimation of joint angles to near-orthogonal angles, practice to gain experience, and assess their visual estimation accuracy prior to using it in clinical practice.

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    Physical Trauma and Posttraumatic Stress Disorder (PTSD): An Investigation of PTSD in an Outpatient Physical Therapy Population

    Published Year: 2004
    Specialization: Orthopaedics

    Vittone, Danielle

    Purpose: Psychological effects of a traumatic experience may emerge during the acute post injury period through any of the rehabilitative phases. PTSD is the most frequently cited problem connected to trauma. Limited research exists on PT and PTSD. The purposes of this study were to investigate the: occurence of psychological sequelae following physical trauma, the relationship between psychological sequelae and perceived level of function, and to explore the possible risk factors associated with PTSD. Methods: A sequential sample of 94 subjects completed a structured interview for PTSD (CAPS and SCID-MDE) and received a survey packet (Demographic Survey, Beck Depression Inventory, Brief Symptom Inventory, State Trait Anxiety Inventory, SF36, and an Adapted Oswestry Questionnaire) to be returned one week later. Severity of injury was assessed by Abbreviated Injury Scale and Injury Severity Score. Seventy-four subjects completed both the initial interview and survey packet. Results: According to DSM-IV criteria prevalence of 24.5% PTSD and 18.1% subsyndromal was found. No significant differences were found between those who completed all surveys and those who only completed the initial interview. The PTSD group was significantly different from the No PTSD group on all measures. No correlations were found between severity of injury and the development of PTSD symptom, depression, or anxiety. Several risk factors that were associated with the development of PTSD symptoms and PTSD diagnosis were identified. Conclusion: Psychological impairement is common in an outpatient PT population. Screening for risk factors associated with PTSD as part of the PT examination and Implications for treatment were discussed.

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    The Utilization Of E-Mail By OCS Physical Therapists In Clinical Practice

    Published Year: 2002
    Specialization: Orthopaedics

    Volansky, Kerry

    Purpose: The purpose of this investigation was: to establish a baseline of current e-mail usage by orthopedic clinical specialists, to profile a “typical” physical therapist who uses e-mail in clinical practice, to explore e-mail use/non use in clinical practice including rationale, to state therapists’ self perceptions of computer skill level, and to report therapists’ opinions regarding the use of e-mail in clinical practice. Subjects: The subjects consisted of the entire population of physical therapists with the credentials of orthopedic clinical specialist as designed by the APTA. Methods: A survey questionnaire was administered using the United States Postal Service with a response rate of 68% The survey instrument was divided into four main categories. Section one gatherered information about the respondents’ demographics. Section two containe questions regarding computer accessibility, location of Internet access, Internet provider, and if e-mail was used in clinical practice. Section three gathered information related to specific e-mail usage. Section four solicited personal opinions related to perceived computer skill level and reasons for using/not using e-mail in clinical practice. Analysis: Data was compiled and analyzed using SPSS version 9.0.0 for Windows. Descriptive statistics were used to examine the data. Cross-tabulations were used to compare data. Chi-Square analysis was used to calculate statistically significant differences between users and non-users of e-mail. Results: The majority of physical therapists have computer access and many are using e-mail in clinical practice. The most common use for e-mail is to communicate with other physical therapist, to request information from the APTA, to communicate with other health care professionals, and to communicate with employers or employees. The majority of physical therapists are using e-mail to eliminate phone tag or to save time. Conclusion: The majority of physical therapists are using e-mail as a communication medium. Profiles of therapists who use e-mail and who do not use e-mail in clinical practice were similar in demographics but differed in gender, practice environment, number of e-mail accounts, and perceived computer skill level. Most therapists are using e-mail to save time and money. Therapists who are not using e-mail report lack of time, limited computer access at work, and patient populations not comfortable with the technology. Clinical Implications: As society moves towards increasing computer literacy, the future of using technology to enhance the way healthcare is delivered is inevitable. The use of e-mail is growing rapidly in all areas of health care. This was the first survey to report on physical therapists use of e-mail in clinical practice. Physical therapists who use e-mail will be able to provide improved communication and monitoring of their patients. Patients will have the opportunity to ask questions and provide information about compliance with home exercise programs. Future research is recommended to further clarify the role of e-mail in physical therapy clinical practice.

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    Comparison of Three Training Protocols for Trunk Extensor Endurance

    Published Year: 2006
    Specialization: Orthopaedics

    Williams, Billie J.

    Assessment of the pathology involving injury and dysfunctions of the spine has led to numerous philosophies and methodologies of assessment and treatment intervention to improve clinical outcomes. Varying the exercise protocols and prescriptions is a common method to influence muscle stabilization of the spine. Trunk extensor endurance tests are one method of objectifying low back function. The purpose of this study was to examine the effects of three different endurance exercise protocols on isometric holding time of the trunk extensor muscles in a normal group of subjects. The null hypothesis was that there will be no significant differences in the mechanical endurance of the trunk extensor muscles in the experimental groups compared to the control group. The methods included 52 healthy volunteer subjects who were randomly assigned to one of the four groups comprised of active individuals without a recent history of low back pain or pathology. There was 1 control group and 3 exercise groups targeting various trunk and lower extremity muscles groups and combinations at specific exercise frequencies and intensities. The self-directed home exercise training was performed at a frequency of three times per week, ranging fro 35 to 90 minutes for each exercise session, depending upon group assignment. The exercise prescription emphasized relative perceived exertion (RPE) grading of muscle contractions during exercises in an effort to optimize muscle recruitment. Tests were performed every two weeks for 8 weeks and emphasis was placed on an EMG monitored trunk extensor test to failure. The RPE scale was also used to determine perceptual fatigue during testing, as well as to rate the intensity of each muscle contraction during home exercises. Results of this study indicate that 8 weeks of training in all three trunk exercise protocols promoted statistically signifiant changes in trunk extensor endurance. Gender and somatotoype were found to be statistically significant in association with the modified Sorensen Test scores. Most of the endurance gains by the exercise groups were acquired in weeks 2-8. No significant differences were observed when the 3 exercise protocols were compared with each other. Group #1 exercised the extensors of the hip and spine, group #2 added the abdominals and quadratus lumborum and group #3 added a resistance exercise in standing to integrate trunk and lower extremity extensor muscles. Expressed as a percentage, the changes in mean holding time via the modified Sorensen Test indicated the control group improved .55%, exercise group #1 improved by 22.7%, exercise group #2 improved by 24.8%, and exercise group #3 improved by 26.4%. The exercise protocol and prescription used in this study was observed to significantly increase spine extensor endurance. Further studies regarding modifications of the protocol or exercise prescription may be appropriate.

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    Alternative Methods for Measuring Scapular Protraction and Retraction Maximal Isometric Forces

    Published Year: 2008
    Specialization: Orthopaedics

    Williams, Duane A.

    Background: Movement dysfunction of the scapula has been recognized as a contributor to many shoulder disorders. The strength of the scapular stabilizing muscles has been determined to be a factor in controlling the position and movements of the scapula. However, few reports are available on the realiability of objective measures for scapular muscle strength. Objective: To determine the reliability of four new methods of measuring the maximal isometric strength of key scapular stabilizing muscles for the actions of protraction and retraction, both with and without the involvement of the glenohumeral (GH) joint. Methods: The Isobex stationary tension dynamometer was used to measure the maximal isometric force on thirty healthy females. Three measures were taken for each method that was sequentially randomized for three separate testing sessions on three non-consecutive days. Results: Intraclass correlations for intrasession reliability and for intersession reliability ranged from 0.95 to 0.98, and 0.94 to 0.96 respectively. The standard errors of measurement were narrow. Scatter grams for both protraction and retraction testing methods demonstrated a signficant relationship, 0.92 for protraction, and 0.93 for retraction. The Bland-Altman plots indicated good agreement between the two methods for measuring protraction strength but a weaker agreement for the two methods measuring retraction strength. Conclusion: The four new methods assessed in this study indicate reilable options for measuring scapular protraction or retraction isometric strength with or without involving the GH joint for young healthy females.

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Orthopaedics and Sports Science

    Reliability and Range of Motion Characteristics of Shoulder Internal Rotation in the Sidelying Position in Collegiate Overhead and Non-Overhead Athletes

    Published Year: 2011
    Specialization: Orthopaedics and Sports Science

    Ames, Peter S.

    Objective: First, to compare the reliability of measuring shoulder internal rotation (IR) range of motion (ROM) using three different techniques: sidelying, or sleeper stretch position (SSP), scapular stabilization (SS), and visual inspection (VI). Second, to establish and compare shoulder IR ROM characteristics using SSP, SS, and VI in the dominant and non-dominant arms of overhead and non-overhead athletes. Background: Many studies have reported that decreased shoulder IR ROM is associated with shoulder pathology. However, no single method for measuring shoulder IR ROM has demonstrated consistently high levels of reliability. The sleeper-stretch is often used to increase shoulder IR ROM yet there are no known studies presenting shoulder IR ROM characteristics in athletes as measured with the SSP. Method: Twenty male subjects asymptomatic of upper extremity injury were recruited for the reliability phase. Shoulder IR passive ROM was measured on both arms by two examiners using three techniques: SSP, SS, and VI. In the second phase, 25 overhead and 25 non-overhead collegiate athletes were recruited. Shoulder IR passive ROM values were obtained on the dominant and non-dominant arms of each athlete using the three techniques. Results: Intrarater reliability was good for SSP, good for SS and fair to good for VI. Interrater reliability for SSP was excellent, good for SS and good for VI. The dominant arm of non-overhead athletes had significantly lower IR ROM tha overhead athletes using SSP. In both overhead and non-overhead athletes, IR ROM was signficantly less using SSP and SS compared to VI in the dominant and non-dominant arms. Conclusion: When measuring shoulder IR passive ROM, SSP had better interrater reliability compared to SS or VI. Significantly lower IR was found in the dominant arm of non-overhead athletes versus overhead athletes. Internal rotation in the dominant arm of overhead athletes was significantly lower than their non-dominant side.

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    Ability to Perform Floor Transfer as a Measure of Readiness for Independent Living Among Older Adults

    Published Year: 2016
    Specialization: Orthopaedics and Sports Science

    Ardali, Gunay

    The ability to get up from the floor after a fall is a basic functional skill required for autonomy. Accordingly, the inability to safely get down and up from the floor or to perform a floor transfer (FT) may indicate decreased mobility and/or increased frailty. Since one in three community-dwelling senior citizens aged 65 years or older will fall at least once each year, a valid test of FT ability is critical to guide interventions that promote optimal functional mobility. The FT test is a simple, performance-based test that can be administered quickly and easily in clinical and home-care settings to determine the patient’s ability to safely and successfully get down and up from the floor using any movement strategy and without time restriction. The primary purpose of this cross-sectional study was to determine the intra-rater reliability and validity of the FT test as an alternative to several widely used but time-consuming measures of physical disability, frailty, and functional mobility. The secondary purpose was to provide descriptive data for the FT test outcome groups.

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    Balanced Abdominal Wall Activation Effects on Thoracic Spine Stiffness and Physiological Scapulo-Thoracic Articulation Kinematics

    Published Year: 2018
    Specialization: Orthopaedics and Sports Science

    Axner, Mary Ellen

    Design: Blocked, counter-balanced repeated measures. Background: Altered scapular kinematics have been documented in many shoulder injuries and pathologies. Assessing faulty movement of the scapulae on the thorax and retraining activation of periscapular and spinal intrinsic musculature should enhance a neuromuscular pattern’s quality to establish a punctum fixum at the thoracic spine and physiological scapula-thoracic articulation (PSTA). Establishing proper fixation of the scapulae on the thorax requires a stiffening of the thoracic spine. Optimal muscle activation pattern from the scapula’s stabilization on the thorax establishes a point of fixation from which the scapula glide, tilt, and rotate about the shoulder girdle axes. This is accomplished by a “stiffening” of the thoracic spine. A specific muscle activation pattern creates an ideal intra-abdominal pressure, stiffening not only the lumbar spine, but also the thoracic spine. This activity establishes a point of fixation and determines the direction of muscle pull of muscles that centrate the PSTA position on the thorax, allowing for an optimal mechanical advantage for upper extremity motion and support functions. Aims: This study aims to 1) determine if a balanced abdominal wall activation augments mechanical support of the thoracic spine and 2) determine if a balanced abdominal wall activation affects scapula-thoracic kinematics, specifically scapular upward rotation on the thorax. Method: Healthy males and females who met the criteria for the study were recruited from the local community. Thoracic spine stiffness to posteroanterior (PA) glides, electromyography (EMG) activity of the abdominal wall regions and simultaneous kinematic motion analysis of the scapulae were recorded pre- and post-balanced adbominal wall activation training. Results: All participants, regardless of age or gender, were able to increase thoracic spine stabilization, as measured by EMG activity and spinal stiffness measure, through a neuromuscular activity or proportional, synchronized abdominal wall activation pattern during bilateral upper extremity (UE) reach task in sagital, scapular, and frontal planes. This reach in multiple planes. Conclusion: A balanced abdominal wall muscle activation pattern stiffens the thoracic spine, creating a punctum fixum, altering neuromuscular control of the scapula, resulting in decreased upward rotation on the thorax during bilateral reaching activities. Ideal stabilization of the shoulder girdle requires preparatory muscle activity in the abdominal wall, and it is part of a neuromuscular pattern necessary to achieve a punctum fixum at the thorax and the PTSA. This central mechanism of neuromuscular adbominal wall activity on the quality of scapular fixation on the thorax should be considered when describing ideal kinematics at the PSTA.

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    Surface Electromyography of the Gluteus Maximus, Gluteus Medius and Tensor Faciae Latae Muscles and Kinematic Assessment of the Hip and Knee in Runners with and Without Iliotibial Band Syndrome: A Controlled Study with Flexibility and Functional Assessment

    Published Year: 2016
    Specialization: Orthopaedics and Sports Science

    Baker, Robert L.

    Motion capture and surface electromyography was performed on 15 runners with iliotibial band syndrome and 15 gender, age and body mass index matched controls. Average muscle activation was compared for the gluteus medius, gluteus maximus and tensor fasciae latae muscles. Kinematics were compared for hip adduction and knee adduction. Modified Thomas test was used to assess rectus femoris length. The six-inch step down test was performed to assess eccentric control in lowering of the body on one leg. Injured runners demonstrated increased knee adduction compared to control runners at 30 minutes. Tensor Fasciae Latae muscle activation in injured runners was increased compared to control runners at three minutes. Step down test performance was signficantly worse in the injured runner. The research contributed kinematic, electromyography and function test findings in combination as possible factors related to iliotibial band syndrome. In conclusion, runners with iliotibial band syndrome exhibited both increased knee adduction and increased muscle activation int eh tensor fasciae latae muscle. This finding establishes a connection between neuromuscular control of a hip muscle and abnormal kinematics in the knee runners with iliotibial band syndrome.

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    The Relationship Between Isotonic Plantar Flexor Endurance, Navicular Drop, and Exercise-Related Leg Pain in a Cohort of Collegiate Cross-Country Runners

    Published Year: 2011
    Specialization: Orthopaedics and Sports Science

    Bennett, Jason E.

    Purpose: The purpose of this study was to examine the relationships between isotonic ankle joint plantar flexor endurance (PFE), foot pronation, and exercise-related leg pain (ERLP). Background: Exercise-related leg pain is aq common occurrence in competitive and recreational runners.The identification of factors contributing to the development of ERLP may help guide methods for the prevention and management of overuse injuries. Methods: Seventy-seven competitive runners from five collegiate cross-country teams consented to participate in the study. Isotonic ankle joint PFE and foot pronation were measured using the standing high-rise and navicular drop (ND) tests, respectively. Demographic information, anthropometric measurements, and ERLP history were also recorded. Subjects were then prospectively tracked for occurrence of ERLP during the 2009 intercollegiate cross-country season. Multivariate logistic regression analysis was used to examine the relationships between isotonic ankle joint PFE and ND and the occurrence of ERLP. Results: While no significant differences were identified for isotonic ankle joint PFE between groups of collegiate XC runners with and without ERLP, runners with a ND>10 mm were almost 7 times more likely to incur medial ERLP than runners with ND <= 10mm. Runners with a history of ERLP in the previous month were significantly 12 times more likely to develop season occurrence of ERLP. Conclusion: While PFE did not appear to be a risk factor in the development of ERLP in this group of collegiate XC runners, those with a ND greater than 10 mm may be at greater odds of incurring medial ERLP. Our study suggests that ND measurement and previous history of ERLP be included in pre-participatory exams for ERLP.

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    Hip and Trunk Muscle Activity During the Star Excursion Balance Test in Healthy Adults

    Published Year: 2013
    Specialization: Orthopaedics and Sports Science

    Bhanot, Kunal

    Study Design: Experimental, within-subject repeated measures. Objective: To determine electromyographic (EMG) activity of the hip and the trunk muscles during the Star Excursion Balance Test (SEBT) performance in 8 reach directions. Background: Dynamic balance (DB) is a measure of core stability. Deficits in DB have been related to injuries in athletic populations. The SEBT is suggested to measure DB by assessing the functional strength of core muscles and lower extremity muscles. Methods: Surface EMG data was collected in 22 healthy adults for the erector spinae (ES), external oblique (EOB), and rectus abdominis (RA) bilaterally, and gluteus medius (GMED) and gluteus maximus (GMAX) muscles of the stance leg. A 2 way repeated measures ANOVA was used to determine the interaction between percentage maximal voluntary isometric contraction and reach directions. The %MVIC for each muscle was compared across 8 reach directions using the Sidak post hoc test. Alpha level was set a-priori at 0.05. Results: Significant differences were observed for all 8 muscles across reach directions of the SEBT. Highest EMG activity was found for the tested muscles in the following reach directions ipsilateral EOB: anterolateral, contralateral EOB: medial, ipsilateral RA: anterior, contralateral RA: anteromedial, ipsilateral ES: posterolateral, contralateral RA: anteromedial, ipsilateral ES: posterolateral, contralateral ES: posteromedial, GMAX: posterior, and GMED: medial direction. Conclusion: Trunk and hip muscle activation is direction dependent during the SEBT. The EMG activity during the 8 reach directions of the SEBT can be used to either evaluate functional strength or to rehabilitate the trrunk and the hip muscles.

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    The Effects of Elliptical Cross Training of Patellofemoral Pain

    Published Year: 2011
    Specialization: Orthopaedics and Sports Science

    Bost, Bryan C.

    Study Design: Pilot Study. Objectives: To determine if the Elliptical Cross Trainer has a role in the rehabilitation of patellofemoral pain. Background: Abnormal patellofemoral joint compressive forces and gluteal muscle weakness have been proposed to be associated with patellofemoral joint pain. The elliptical exercise machines can commonly be found in physical therapy clinics and gyms. The elliptical cross trainer may add another form of therapeutic exercise in the rehabilitation for patients with pattelofemoral pain. Methods: Ten subjects that met inclusion criteria entered into the study. Subjects were randomly assigned into one of three groups. All subjects completed the Knee Outcomes Survey, Visual Analog Scale after a 15 centimeter step down test, and hand held dynamometry testing of the knee extensors, hip abductors and extensors. All subjects participated in standardized stretching and strengthening exercises for twelve sessions. Additionally, two of the groups participated in elliptical exercise in either a forwards or reverse mode. Results: Five subjects completed all twelve sessions. Minimal detectable levels of change were reviewed for the KOS, VAS with step down, and strength. Conclusions: As a pilot study, elliptical cross training exercise may have a role in rehabilitation of patellofemoral pain. Further recommendations have been suggested.

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    Can Functional Testing Identify Division III Collegiate Athletes Who Are At Risk for a Lower Extremity or Low Back Injury?

    Published Year: 2011
    Specialization: Orthopaedics and Sports Science

    Brumitt, Jason

    Functional tests have been primarily used as a measure to assess an athlete’s readiness to return to sport. The purpose of this prospective cohort study was to determine if the following tests; the standing long jump (SLJ), the single leg hop (SLH) for distance, and the lower extremity functional test (LEFT) could be used as a pre-season screening tools to identify collegiate athletes at risk for a time-loss sport-related low back or lower extremity injury. It was expected that athletes with shorter jump and hop distances and slower LEFT scores would be at greater risk for injury. A secondary purpose of this study was to examine relationships between each test and preseason training activities in a collegiate athletic population.

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    Development of a Valid and Reliable Musculoskeletal Imaging Competency Examination

    Published Year: 2018
    Specialization: Orthopaedics and Sports Science

    Burley, Troy

    Medical imaging aids in the diagnosis and management of many musculoskeletal conditions. As physical therapist practice evolves, imaging becomes more essential to patient care. While some physical therapists have shown competency with imaging privileges, the known level of competency and knowledge is generally lacking within the profession. The objective was to develop a valid and reliable musculoskeletal imaging competency examination for physical therapists.

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    The Relationship Between Iliac Crest Height Difference And Running Injury

    Published Year: 2018
    Specialization: Orthopaedics and Sports Science

    Cahanin, Richard L.

    At least 50% of the U.S. population has a leg-length inequality (LLI) >= 5mm. LLI can be defined by both type and magnitude. There are two types of LLI, structural and functional. Magnitude of LLI has been classified as either mild, moderate, or severe. LLI is a common condition that has been associated with various spinal, pelvic, and lower extremity dysfunctions. Diagnosis of LLI with imaging tests, which is the gold standard, can be expensive, potentially harmful, and may be contraindicated for some patient populations. Non-imaging tests for LLI are inexpensive, innocuous, and pragmatic. However, evidence reveals high variability in validity and reliability of non-imaging tests for LLI. Iliac crest height difference (ICHD) has been demonstrated to be a good estimate for LLI and may be a useful measure for identifying individuals who are at risk for injury. If ICHD is a risk factor for injury, there is a paucity of evidence guiding conservative treatment. The purpose of our study was three-fold: First, to investigate the validity and reliability of ICHD, innominate rotation difference (IRD), and LLI measurements. Second, to investigate whether ICHD is a risk factor for injury among runners; if so, then to determine an optimal cutoff ICHD magnitude associated with increased injury risk. Third, to observe changes in pain and function among individuals with running-related low back, pelvic or lower extremity pain who receive LLI correction.

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    An Electromyographic Analysis of Trunk and Hip Muscles During Bridging Exercises Using Two Different Ankle Positions

    Published Year: 2012
    Specialization: Orthopaedics and Sports Science

    Carinci, Joseph M.

    The objectives were to determine if dorsiflexion (DF) or plantar flexion (PF) of the ankle affects the electromyographic (EMG) signal pattern of the core musculature during 6 different bridging exercises: 2-leg bridge (2LB), 2-leg bridge with hip abduction (2LB-Abd), 2-leg bridge with hip adduction (2LB-Add), 1-leg bridge on right leg with left knee to chest (RLB-LKC), 1-leg bridge on right leg with left knee extended (RLB-LKE) and 1-leg bridge on left leg with right knee extended (LLB-RKE). Compare core EMG activity during 1-leg and 2-leg bridging exercises and determine if gender affects core EMG during 1-leg and 2-leg bridging exercises in DF and PF.

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    Relationship Between Functional Tests And Injury Occurrence In Male Soldiers Undergoing Special Forces Assessment And Selection

    Published Year: 2016
    Specialization: Orthopaedics and Sports Science

    Christopher, Greer M. Evans

    High levels of injury have caused a significant decrement in mission readiness and a high taxation on medical resources in the military. There is an immediate need to identify valid and cost effective tools for identifying military personnel at increased risk of being injured as a first step in mitigating injury and implementing prevention mechanisms. The Functional Movement Screen (FMS), the Lower Quarter Y-Balance Test (YBT-LQ), and the Landing Error Scoring System – Real Time (LESS-RT) are screening tools that have been used in athletic and military populations to indentify individuals at risk for injury. The purposeof this study was to evaluate and compare functional screening tools for validity in a military population. The hypothesis of this study was that poor movement patterns identified by low FMS scores, low YBT-LQ scores, and high LESS-RT scores would be associated with greater injury occurrence among soldiers during training and selection for Special Forces. A total of 690 participants were recruited from soldiers undergoing Special Forces Assessment and Selection (SFAS) at Fort Bragg, NC. Students were screened during in-processing, and injury data was collected througout the three week SFAS period. Descriptive statistics were calculated and t-tests used to compare mean (SD) differences between groups. Odds ratios and their corresponding 95% confidence intervals (CI) were calculated to examine the likelihood associations between the functional screening tools and injury. No statistically significant mean differences of the composite FMS, the YBT-LQ, and the LESS-RT scores were found between injured and non-injured soldiers. By individual subtests, the mean Rotary Stability score on the FMS was signficantly higher among the injured than non-injured soldiers. A signficant difference was found between injured and non-injured groups for Posterior Medial Reach subtest with the right lower extremity of the YBT-LQ. A significant relationship was also found between groups on the Total Sagittal Plane Motion subtest of the LESS-RT. The overall test scores for FMS, YBT-LQ, and LESS-RT were not associated with injury occurrence in a military population during a 3-week Special Forces training and assessment course.

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    The Influence Of Healthcare Seeking Behavior On Health Services Utilization For Musculoskeletal Conditions

    Published Year: 2018
    Specialization: Orthopaedics and Sports Science

    Clewely, Derek

    Objective: The purpose of this systematic review was to examine the association between health seeking behavior (HSB) and healthcare outcomes associated with musculoskeletal disorders. Data Sources/ Study Setting: Studies were identified through a sensitive systematic literature search to articles published from inception to 2017 in the PubMed, EMBASE, and CINAHL databases. Study Design: We conducted a systematic review of studies that investigated the association between HSB and musculoskeletal outcomes. We operationally defined HSB according the Andersen behavior model of health services utilization. Principal Findings: The search strategy yielded 7,103 papers. After screening against eligibility criteria, only five heterogeneous studies were retained for review. Outcomes were variable and included recovery factors or new diagnostic label of fibromyalgia. All studies included in this review suggest that health seeking behavior was associated with the outcome of interest. The limited number of studies identified indicate that there is some association between HSB, as defined for this review, and health outcomes. High health seeking behavior predicted a diagnosis of fibromyalgia. Furthermore, high health seeking behavior was predictive of condition severity and recovery, including sickness absence and return to work. Conclusions: The construct of health seeking behavior is limited, demonstrated by a paucity of evidence exists regarding the association of health seeking behavior and health related outcomes. Emerging evidence suggests that health seeking behavior may influence musculoskeletal outcomes. Future research is necessary to directly investigate the construct of health seeking behavior and its predictive capacity.

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    Soft Tissue Mobilization or Therapeutic Ultrasound for Subjects with Neck and Arm Pain with Evidence of Neural Mechanical Sensitivity: A Randomized Clinical Trial

    Published Year: 2012
    Specialization: Orthopaedics and Sports Science

    Costello, Michael J.

    Study Design: Randomized clinical trial. Objectives: To investigate the immediate and short term treatment effects of soft tissue mobilization versus therapeutic ultrasound in subjects with neck and arm pain who demonstrate signs of neural mechanical sensitivity. Background: Neck and arm pain may be associated with several factors, including neural tissue mechanical sensitivity and soft tissue dysfunction. While experts have suggested that individuals with neck and arm pain and neural mechanical sensitivity may benefit from soft tissue mobilization, there has been little research to investigate this hypothesis. Methods: Twenty subjects with neck and arm pain and a positive supper limb neurodynamic test with median nerve bias (ULNT) were randomly assigned to 1 of 2 treatments provided during a single session: soft tissue mobilization or therapeutic ultrasound. Outcome measures were collected immediately before and after treatment, and at a 2-4 day follow up. Primary outcomes were the Global Rating of Change, range of motion during the ULNT, and pain rating during the ULNT. Secondary measures included the Neck Disability Index, Patient-Specific Functional Scale, Numeric Pain Rating Scale, Body Pain Diagram, active range of should abduction motion, and shoulder abduction combined with wrist extension active range of motion. Results: A greater proportion of subjects in the soft tissue mobilization group reported a significant improvement on the Global Rating of Change Scale, and demonstrated a statistically significant change of 7.5 degrees of the ULNT at immediate follow up, but not at 2-4 day follow up. Subjects who received soft tissue mobilization demonstrated greater improvements in range of motion during ULNT, Patient-Specific Functional Scale, and shoulder combined with wrist extension active range of motion. Both groups reported improvements in Numeric Pain Rating Scale, but there was no significant difference in pain ratings between groups. There were no significant changes in pain rating during the ULNT in either group. Conclusion: Subjects with neck and arm pain demonstrated greater improvements in ULNT range of motion, Global Rating of Change, and Patient-Specific Functional Scale following soft tissue mobilization than after receiving therapeutic ultrasound. Clinicians should consider utilizing soft tissue mobilization in the management of individuals with neck and arm pain. Future research should investigate the use of soft tissue mobilization within multimodal management for neck and arm pain with evidence of neural mechanical sensitivity.

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    High Velocity Quadriceps Exercises Compared to Slow Velocity Quadriceps Exercises Following Total Knee Arthroplasty

    Published Year: 2013
    Specialization: Orthopaedics and Sports Science

    Doerfler, Deborah

    Background: Despite improvement in pain and perceived function in patients who have undergone total knee arthroplasty (TKA), objective outcome measures of muscular impairment and ambulatory function demonstrate significant deficits compared to the univolved side and to age-matched healthy adults. Some evidence suggests that quadriceps power may play a greater role in ambulatory function than measures of strength following TKA. Objective: The purpose of this sudy was to compare the effect of high velocity (HV) to slow velocity (SV) quadriceps exercises on functional outcomes and quadriceps power following knee arthroplasty. Design: This study used a double-blinded randomized controlled clinical trial design and was conducted in a university hospital outpatient physical therapy clinic in patients who underwent TKA. Methods: Nineteen patients between the ages of 50 and 85 years old and four to six weeks out from unilateral TKA were randomly assigned to a HV group or SV group. Subjects performed an evidence-bsed standard progressive exercise program in addition to either HV quadriceps exercises or SV quadriceps exercises. Subjects attended two sessions per week for eight weeks. Before and after the eight-week exercise intervention, subjects completed a functional questionnaire, health survey, functional testing, and underwent quadriceps strength and power testing. Results: Both groups demonstrated improvement in ambulatory outcome measures, strength, speed and power. The HV group demonstrated significantly greater improvement in distance walked and perceived physical function, compared to the SV group. Limitations: Limited subject numbers may be responsible for a Type I error. There was no control for the amount of exercise workload between groups. The eight-week intervention may not have been sufficient to maximize differences. Conclusion: HV quadriceps exercises are an effective rehabilitation strategy in conjunction with a standardized progressive resistance exercise program beginning four to six weeks after total knee arthroplasty.

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    Electromyographic Analysis of Manual Muscle Testing Positions and Exercises for the Trapezius and Serratus Anterior Muscles

    Published Year: 2001
    Specialization: Orthopaedics and Sports Science

    Ekstrom, Richard

    The trapezius and serratus anterior are very important muscles of the shoulder girdle in that they perform upward rotation and stabilized of the scapula. Any weakness of these muscles is believed to affect the scapulohumeral rhythm that may cause secondary problems at the glenohumeral joint. There is very little information in the literature regarding electromyography analysis of muscle testing or exercises for the trapezius and serratus anterior muscles. The purposes of this study were to: 1) perform an electromyographic analysis of manual muscle testing positions for the trapezius and serratus anterior muscles to help identify which tests are optimal for clinical muscle testing and for normalization procedures during EMG studies, 2) perform an electromyographic study during strengthening exercises for the trapezius and serratus anterior muscles to determine which exercises produce maximum electromyographic activity, and 3) compare the torque measurements obtained during hand-held dynamometry muscle testing of the trapezius and serratus anterior muscles of the dominant and non-dominant shoulders and identify which muscle tests can be reliably performed with a hand-held dynamometer.

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    Short-Term Effects of Thoracic Spine Thrust Manipulation for Individuals with Low Back Pain: A Randomized Controlled Trial

    Published Year: 2018
    Specialization: Orthopaedics and Sports Science

    Fisher, Laura

    Study Design: Randomized controlled trial with blind assessor. Background: Low back pain (LBP) is one of the most prevelant and costly musculoskeletal conditions in the United States (US) resulting in more global disability than any other condition. Most patients with acute LBP will improve over a short time, but many patients will proceed to chronicity resulting in a reduced quality of life and a high societal burden. The treatment of LBP has been studied extensively, yet the most effective treatment strategies remain to be elucidated. Objective: The purpose was to determine the short-term effectiveness of thoracic manipulation when compared to sham thoracic manipulation. Methods: Consecutive patients in a large health care ssytem with LBP were stratified based on symptom duration and randomly assigned to one of two groups. The intervention group received three visits of thoracic manipulation and core strengthening exercises. The control group received core strengthening and sham manipulative therapy. Both groups received education regarding LBP. Factorial repeated measures ANCOVA was completed for pain, disability, and fear-avoidance with duration of symptoms as the covariate. Mann Whitney-U test was used for GROC at follow up. Multiple regression was used to determine follow up scores, with duration of symptoms and baseline scores as covariates. Results: Ninety participants completed the study. The overall group-by-time interaction for the ANCOVA was not significant for MODQ, NPRS, FABQ. GROC was not significantly different between the groups. Disability, pain, FABQ-PA and FABQ-total were significantly reduced from initial to final; however, there was no significant difference between groups. Intervention group did significantly differ in the multiple regression when baseline scores were accounted for with manipulation having lower disability. Time and duration of symptoms were the primary factors in predicting outcomes of disability and pain. Conclusion: The current study did not show improved outcomes in individuals with LBP receiving the thoracic manipulation. Patient education regarding nature of pain and impact on activity remain crucial in the management of this disabling condition. This trial was prospectively registered.

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    Changes in Kinematic and Muscle Firing Patterns from Forefoot Wedges at the Shoe-Pedal Interface in Competitive Female Cyclists

    Published Year: 2017
    Specialization: Orthopaedics and Sports Science

    Fitzgibbon, Sinead Aisling

    Competitive cyclists have a high incidence of patellofemoral (PF) pain. Deviation of the knee from an optimal pedaling pattern is a contributor to PF pain, but such deviation can be altered by correctly fitting the cyclist to the bicycle. Wedges are used at the shoe-pedal interface (SPI) to alter specific cycling kinematics, but the efficacy of such intervention has not been established. Moreover, determination of efficacy often requires high-cost 3D motion analysis equipment. This study examined cycling kinematics in response to SPI wedges and the morphological differences between cyclists with and without patella-femoral pain. The reliability and precision of Retul, a lower-cost cycling-specific motion capture system, was compared to that of the the “gold standard” Vicon 3D system. Nineteen competitive female cyclists pedaled on a computer-controlled cycle ergometer at 85rpm and 70% of their peak power output. Wedges were 2 and 4 in size, inclined laterally and then medially and were bolted to the SPI. Kinematics were captured using a 10-camera Vicon MX system and then compared with the Retul system. Electromyographic (EMG) output was captured using a wireless 16-electrode surface EMG system. Knee morphology was measured using standing tibiofemoral angle (sTFA) from Vicon data, and foot morphology using the foot posture index (FPI-6) and foot mobility magnitude (FMM) scores. Influence of wedge condition, PF pain history, and morphology on cycling kinematics and EMG were examined with multivariate tests. Regression tests examined the predictive capability of frontal plane knee measurements and knee/foot morphology to determine presence of PF pain.Comparison of Vicon and Retul systems indicated acceptable agreement for hip, knee and ankle joint angle, range of motion and knee distance measurements. Wedges at the SPI altered cycling kinematics, reduced hip flexion, hip extension, and ankle ROM, increased knee range of motion (ROM), and reduced knee distance from bicycle centerline, but did not alter vastus medialis (VM) or vastus lateralis (VL) EMG. The presence of pain was predicted by knee distance to bicycle centerline, knee frontal angle while cycling and FMM score. There were significant differences between those with and without PF pain for the temporal aspects of EMG and foot/lower limb morphology. Cycling with the knee farther from the bicycle and with a more valgus knee angle predicted PF pain group classification. Overall, wedges at the SPI alter knee kinematics and the temporal characteristics of VM and VL muscles of competitive female cyclists. Cyclists with PF pain demonstrate different morphologic, kinematic and EMG patterns than those with no pain. These data support the use of the wedges at the SPI for altering cycling kinematics and support the use of Retul as a low-cost 3D motion analysis system for measuring cycling kinematics.

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    Immediate Effects of Kinesio Taping on Pain, Function, and Predictors of Effectiveness in Patients with Patellofemoral Pain Syndrome

    Published Year: 2013
    Specialization: Orthopaedics and Sports Science

    Freedman, Scott

    Patellar taping is a commonly used adjunct to physical therapy management of patellofemoral pain syndrome (PFPS). Kinesio taping (KT) is an alternative type of taping technique that has gained significant popularity in recent years. Currently there exists limited published research investigating the effects of KT in patients with PFPS and its use by clinicians is largely anecdotal. The aim of this study was to determine the efficacy if patellar KT in improving pain and single-leg hop function in patients with PFPS and to identify predictors associated with a positive outcome to determine what subgroups of patients are most likely to benefit from patellar KT.

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    Anterior Cruciate Ligament Reconstruction and Dynamic Stability at Time of Release for Return to Sport

    Published Year: 2019
    Specialization: Orthopaedics and Sports Science

    Head, Penny L.

    With an elevated risk of a second anterior cruciate ligament (ACL) injury following ACL reconstruction (ACLR), determining when an athlete can safely return to sport (RTS) is a challenging task for rehabilitation professionals. Lack of dynamic postural control has been associated with ACL injury and reinjury and should therefore be included in the assessment for readiness to RTS. The primary purpose of this investigation was to examine dynamic stability using the Dynamic Postural Stability Index (DPSI) in athletes following ACLR at the time of release for RTS compared to healthy, matched controls. A secondary purpose was to examine how dynamic postural stability is affected in athletes following ACLR when performing a jump-landing task in three different directions. We hypothesized that 1) athletes with ACLR would demonstrate decreased dynamic postural stability at time of release for RTS compared to matched controls, and 2) dynamic stability for athletes with ACLR would significantly differ among the three jump-landing tasks.

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    Investigating the Psychometric Properties of the King-Devick Test in Healthy 14 to 24 Year Olds

    Published Year: 2015
    Specialization: Orthopaedics and Sports Science

    Heick, John Duane

    The purpose of the current study was to examine learning effects in the King-Devick (K-D) test and to determine whether K-D scores differed across age and sex in young adolescents and adults. Composite and trial scores of the K-D test were evaluated in 60 health participants. The K-D composite scores revealed main effects for trial order, card number, age, and sex. Post-hoc comparisons showed faster times across trials. Females took longer than males to complete the test. Participants were faster across trials within each card except for card 3, from trial 2 to trial 3. As reported in other studies, participants demonstrated a learning effect that varied across the 3 cards of the K-D test. Our findings suggest that an additional practice trial of the K-D test should be completed before recording a baseline composite score.

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    Relevance of the Flexion-Relaxation Response Test on the Management of Acute Low Back Pain Treated with Spinal Manipulation

    Published Year: 2021
    Specialization: Orthopaedics and Sports Science

    Janke, Kirby C.

    Objective: The purpose of this study was to investigate the clinical usefulness of the flexion relaxation response test (FRT) in subjects undergoing an episode of acute nonspecific low back pain (LBP). Specifically, it determined if the flexion relaxation ratio (FRR), derived from components of the FRT, can be an effective and reliable measure of therapeutic benefit to the intervention of spinal manipulation (SM). This study explored the relationship between the FRR, left and right paraspinal muscles individually, and the patient self-reported outcome measures of Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI). Methods: Thirty consecutive subjects with LBP underwent repeated measures testing in an outpatient physical therapy clinical setting. Pre-intervention measures before sessions #1, 3, 6, 9, and 12 included NPRS, ODI, surface electromyography (EMG), as well as post-intervention EMG. A cycle of three repetitions was perfomed, repositioning slowly from standing erect to full trunk flexion, holding for 3 seconds, then extending back to the starting upright positiion. FRR was then determined. Each subject receieved tow interventions of SM per session, minimum of 3 to a maximim of 12 sessions within six weeks. Results: By analyzing FRR values through treatment, this study found a statistically significant increase in the FRR. Mean NPRS and ODI scores did decrease throughout treatment. We had hypothesized that clinicians would be able to reliably use the FRR as an objective measure in association with patient self-reported outcome measures in assessing the response to the treatment intervention of SM during an episode of acute LBP. However, this study did not find a statistically significant correlation between the FRR and patient outcome measures. Clinical Relevance/Conclusion: This study of acute LBP subjects found that the increase in FRR was responsive to multiple SM interventions, inferring benefit. Despite this finding, there was no significant correlation found between the FRR and patient-reported outcome measures. These conclusions encourage further investigation into the use of EMG as an objective measure in assessing LBP response to SM intervention.

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    Subjective and Electrophysiologic Findings During Provocation Tests for the Ulnar Nerve in Asymptomatic Individuals

    Published Year: 2010
    Specialization: Orthopaedics and Sports Science

    Jefferson, John Robert

    Assessment of neural tissue irritability and extensibility is an accepted component of the orthopedic physical therapy examination process. While some tests for neural irritability, such as straight leg raising, have well-documented sensitivities and specificities, others have little or no data to support their usefulness. In particular, no studies have examined the use of the upper limb neurodynamic test for the ulnar nerve (ULNT3) in either patients or asymptomatic individuals. The lack of normative data on the (ULNT3) limits interpretation of both subjective responses and neurophysiologic findings. The purpose of this study was to determine the effect of provacative tests for the ulnar nerve on subjective responses, nerve conduction parameters and distal perfusion in an asymptomatic population.

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    Effects of Lower Exremity and Trunk Muscle Recruitment on Serratus Anterior Muscle Activation in Healthy Male Adults

    Published Year: 2013
    Specialization: Orthopaedics and Sports Science

    Kaur, Navpreet

    Study Design: Experimental, within-subject repeated measures. Objective: To determine the influence of lower extremity (LE) and trunk muscle (TM) recruitment on the serratus anterior (SA) muscle activity during the forward punch plus (FPP). Background: Poor activation of the SA muscle may result in abnormal shoulder rhythm, and secondarily contribute to imingement and rotator cuff tears. Sequential activation of the trunk, pelvis, and LE muscles is required to facilitate the transfer of appropriate forces from these body segments to the upper extremity. Myofascial connections exist in the body, and LE and TM activity may influence scapular and upper limb activity. Methods: Surface electromyography (EMG) activity of the SA, latissimus dorsi, and external oblique muscles on the dominant side, bilateral gluteus maximus muscles, and contra-lateral femoral adductor muscles were analyzed in FPP and six variations in twenty one healthy male adults. The percentage of maximum voluntary isometric contraction for each muscle was compared across various exercises using a 1-way repeated – measures analysis of variance with Sidak pair wise comparison as post-hoc test. Results: Pairwise comparisons found that the EMG activity of the SA during the FPP with contralateral closed chain leg extension (CCLE), FPP with ipsilateral closed chain leg extension (ICLE), FPP with closed chain serape effect (CS), and FPP with open chain serape effect (OS) showed significantly higher EMG activity than the FPP. The CS and OS exercises produced the greatest amount of EMG activity for the SA, followed by CCLE and ICLE. Conclusions: Simultaneous recruitment of the LE muscles and TM does increase the activation of the SA muscle during the FPP exercise.

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    Validation of Diagnostic Ultrasound in the Measurement of Supraspinatus and Infraspinatus Cross-Sectional Area

    Published Year: 2019
    Specialization: Orthopaedics and Sports Science

    Kokmeyer, Dirk J.

    Background: Diagnostic ultrasound (US) offers a cost-effective and accessible means of evaluating the cross-sectional area (CSA) of muscles as compared to the gold standard of Magnetic Resonance Imaging (MRI). Muscle CSA is directly related to the amount of force a muscle can produce. Rotator cuff CSA is especially important when considering the strength and function of the shoulder joint. The present study aims to test the validity, same-day and between day intra-rater reliability of US CSA measures of the supraspinatus (SS) and infraspinatus (IS) muscles of the shoulder compared to MRI. Methods: Thirty-two, right-hand dominant subjects were prospectively enrolled and completed this study. A protocol was developed using previous research to measure the SS and IS CSA with US. US images were compared to corollary MRI images to test validity. Same-day intra-rater reliability was tested on all 32 subjects. Fourteen subjects were asked to return for follow up US imaging in order to test between-day intra-rater reliability. Twelve subjects with right shoulder pain referred for an MRI and 12 case-matched healthy controls were used to test criterion validity. Results: US demonstrated acceptable criterion validity when compared to MRI and acceptable same-day and between-day intra-rater reliability. Conclusion: This present study showed that US is a valid and reliable tool in measuring the CSA of the SS and IS muscles of the shoulder. Ultrasound CSA measures of the SS and IS muscles demonstrate acceptable criterion validity and same-day and between-day intra-rater reliability.

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    The Effect Of Video Feedback On Physical Therapist Student Performance Of A Low Back Manipulation Intervention: A Randomized Controlled Trial

    Published Year: 2017
    Specialization: Orthopaedics and Sports Science

    Lau, Jeffery D.

    The purpose of this study was to examine whether video feedback would improve entry-level physical therapy students’ ability to perform the psychomotor skill of lumbar spine manipulation (LSM). A convenience sample of 32 male and female first year Doctor of Physical Therapy (DPT) students was randomized to one of two groups: the experimental group and the control group. Any student having a physical condition that would preclude ability to perform the manipulation technique was excluded. A pilot study was conducted prior the main study to examine reliability, validity, and internal consistency of the Manipulation Performance Rating Tool (MPRT). The main study used a prospective, randomized experimental design. Examiners/raters were clinded to group assignment. All subjects were instructed in the performance of LSM. Participant performance of the manipulation technique was video recorded three times for all participants: once at baseline (VI), once after instruction and practice (V2 or “acquisition”), and once after a week of no practice (V3 or “retention”). Each participant in the experimental group viewed the video recording of his/her individual baseline performance as a part of the practice session; those in control group did not. Two raters scored each LSM performance two separate times in random sequence using the MPRT. A 2×3 repeated measures ANOVA was performed to analyze any differences within or between groups at each time point. Interobserver and intra-observer reliability was determined using intraclass correlation coefficients. Educationally meaningful raw effect size was predetermined as a 15% change in MPRT score from baseline. Pilot study results establish face validity, moderate to high intra and interrater reliability, and high internal consistency for the MPRT. The effect of time showed that both groups improved from baseline to acquisition and retention. The main effect of group was non-significant. The group x time interaction effect was not significant, although the experimental group improved by 8% from baseline to acquisition compared to a smaller improvement of 4% over the same interval for the control group. Instruction in spinal manipulation techniques with and without video feedback resulted in statistically significant learning effects, with average performance meeting a “passing” score above 80% on the MPRT, and acquisition scores being higher than retention scores in both groups. There was not a significant or educationally meaningful difference in performance scores between students who used video feedback compared to those who did not.

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    The Reliability and Validity of Gluteal Endurance Measures (GEMs)

    Published Year: 2018
    Specialization: Orthopaedics and Sports Science

    Lehecka, Bryan Jason

    Background: The gluteals have unique morphology related to muscle endurance, including moderate fiber sizes and a majority of Type I endurance fibers. Evidence suggests gluteal endurance is related to several classifications of low back pain, work-related musculoskeletal disorders, running kinematics, balance, and pelvic posture. However, there exists a lack of reliable and valid measures specific to gluteal endurance. Purpose: This study aims to examine the intra- and inter-rater reliability of two gluteal endurance measures (GEMs) convenient for clinical use. It also aims to provide validity for the two measures by using electromyography, recording subjective reasons for task failure, and analyzing the differences between subjects with and without recurrent low back pain (LBP). Study Design: Cross-Sectional. Methods: Sixty-eight males and females aged 18–35 years were recruited from a university population. Electromyography electrodes were placed on subjects’ dominant gluteus maximus and gluteus medius, and each subject performed three trials of each of the two GEMs, GEM-A and GEM-B. Hold times, EMG median frequency (MF) data, and subjective reasons for task failure were analyzed. Results: Bot GEMs demonstrated high intra-rater reliability and inter-rater reliability. The MF slopes of both GEMs were also highly reliable. Mean hold times were 104.83 plus or minus 34.11 seconds for GEM-A and 81.03 plus or minus 24.79 seconds for GEM-B. No statistically significant difference was found between subjects with and without LBP. Median frequency data validated gluteus maximus and gluteus medius fatigue during both measures. Posterolateral hip fatigue was reported as the primary reason for task failure in 93% and 86% of subjects for GEM-A and GEM-B, respectively. Conclusion: This seminal study of GEM-A and GEM-B found both measures to be reliable and valid measures of gluteal endurance. Further examination of the GEMs in samples with different types of LBP or hip pain is recommended.

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    Influence of Step Rate on Shin Injury and Anterior Knee Pain in High School Cross Country Runners

    Published Year: 2016
    Specialization: Orthopaedics and Sports Science

    Luedke, Lace E.

    High school cross country runners have a high incidence of overuse injury, particularly at the shin and knee. An increased step rate during running has been shown to reduce impact forces and loading of the lower extremity joints. While step rate manipulation is presently used in the treatment of running injury, there has been no prospective evidence reported on the risk relationship between step rate and injury. The primary purpose of this prospective study was to examine step rate as a risk factor for shin injury and anterior knee pain (AKP) occurrence in high school cross country runners. Secondary aims were to determine 1) if a relationship existed between isometric hip abductor, knee extensor and flexor strength and the incidence of shin injury and AKP; and 2) if running experience, selected anthropometric factors, muscle strength, and prior injury were related with preferred step rate. We hypothesized that 1) runners with lower step rates would have a higher incidence of shin injury and AKP, and 3) runners with more running experience, shorter leg length or greater hamstring strength would demonstrate higher step rates.

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    Effectiveness of Physical Therapy Treatment in Addition to Usual Podiatry Management of Plantar Heel Pain

    Published Year: 2017
    Specialization: Orthopaedics and Sports Science

    McClinton, Shane

    Many patients will seek care from a podiatrist for plantar heel pain (PHP), while few of these patients will also be seen be a physical therapist. Physical therapists can provide treatment that is not a part of usual podiatric care and may provide additional improvement in function and pain in individuals with PHP. To examine the additional benefit of physical therapy treatment to usual podiatric care and describe individualized multimodal physical therapy treatment for varied PHP presentations.

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    Eccentric Exercise versus Eccentric Exercise and Astym in the Management of Insertional Achilles Tendinopathy: A Randomized Controlled Trial

    Published Year: 2015
    Specialization: Orthopaedics and Sports Science

    McCormack, Joshua R.

    Study Design: Prospective, randomized, controlled intervention trial. Objectives: Compare outcomes between eccentric exercise and eccentric exercise plus Astym for subjects with insertional Achilles tendinopathy (AT). Background: Eccentric exercise is commonly used in the management of AT but its effectiveness for insertional AT has been quesioned. Manual soft tissue interventions, such as Astym, have been proposed to be beneficial in the treatment of AT, and it is plausible that Astym combined with eccentric exercise could result in better outcomes than eccentric exercise alone. Methods: Sixteen subjects were randomly assigned to either an Astym and eccentric exercise group or an eccentric exercise only group. Intervention was completed over a 12-week period with outcomes assessed at baseline, 4, 8, and 12 weeks. Outcomes included the Victorian Institute of Sport Assessment Achilles Specific Questionnaire (VISA-A), the numeric pain rating scale (NPRS), and the global rating of change (GROC). Results: A significant group x time interaction effect was found for the VISA-A with greater improvements noted in the Astym group. A significant main effect of time was found for the NPRS with both groups improving over the 12-week period. A significantly greater number of subjects in the Astym grou achieved a successful outcome as measured by the GROC. Conclusion: Astym plus eccentric exercise was more effective than eccentric exercise only at improving function while both groups experienced similar improvements in pain. The combined treatment group was more likely to obtain a successful outcome.

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    The Effect of Chronic Low Back Pain and Trunk Stablization on Gluteus Medius Activiation During Hip Abduction and Hip Abduction-Lateral Rotation

    Published Year: 2020
    Specialization: Orthopaedics and Sports Science

    Meekins, Myra Marie

    People with lower extremity and low back injury often demonstrate altered muscle recruitment patterns in the lumbopelvic region and hip. These altered recruitment patterns can result in dysfunctional movement, decreased stability, and pain. Clinicians frequently prescribe hip movements that target gluteal muscle activation to improve lumbopelvic stabilization. These dynamic lower limb movements are typically performed with cues to keeping the lumbopelvic region still. These exercises are effective at increasing lumbopelvic muscluature activation. However, their effect on gluteal muscl activation during hip movement is unclear. The purpose of these studies is to identify effective methods of lumbopelvic stability during hip movement on gluteal recruitment and determine the specific effect of the abdominal draw-in maneuver (ADIM) on gluteus medius recruitment during side-lying hip abduction (SHA) and side-lying hip abduction-lateral rotation (SHALR) in people with and without chronic low back pain (LBP).

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    A Comparison of Quadriceps and Gluteal Muscle Activity Between Two Types of Pre-Activation Super Sets and Control Amongst Health Adults

    Published Year: 2021
    Specialization: Orthopaedics and Sports Science

    O'Connor, Joseph S.

    Study Design: An experimental design using repeated measures within subjects. Purposes: Determine if pre-activation techniques enhance quadricep and gluteus maximus muscle activity during a leg press exercise set more than a leg press exercise done without pre-activation, and to assess if similar muscle activity can be achieved during a leg press exercise set using less resistance using the same techniques. Background: Exercise intensity is an important exercise component. It has been demonstrated that certain exercise combinations may enhance or activate muscle groups more efficiently than would normally be required. How best to use this technique has not been established. Subjects and Methods: Twenty healthy adult males between the ages of 20 to 40 years without a history of lower extremity injuries were recruited. Five exercise conditions and 4 muscles were analyzed using both average and peak muscle activity as the dependent variable. Data was assessed using a repeate measures ANOVA. If the data violated the sphericity assumption, the Friedman rank sum test was substituted. Post hoc analysis was used to explore any significant findings. Results: EMG activity of the gluteus maximus and quadriceps muscles at 60% of 1RM was not significantly greater during the leg press exercise when the pre-activation exercises were first employed compared to the leg press exercise without the pre-activation exercises. Less resistance was required to achieve appropriate intensity in the quadriceps and/or gluteus maximus muscles during the leg press exercise when employing the pre-activation techniques. Conclusions: This study did not support the hypothesis that pre-activation supersets of the quadriceps and gluteus maximus muscles would enhance activation of those same muscles in a subsequent leg press exercise using the same resistance but did not support the hypothesis that similar effects can be achieved with less resistance. Expected Outcome: EMG activity of the gluteus maximus and quadriceps muscles at 60% of 1RM was not significantly greater during the leg press exercise when the pre-activation exercises were first employed compared to the leg press exercise without the pre-activation exercises. Less resistance was required to achieve appropriate and significantly equal intensity in the quadriceps and/or gluteus maximus muscles during the leg press exercise when employing the pre-activation techniques. Relevance: The results may contribute to the exercise recommendations in the the rehabilitation, conditioning, and aging specialty professions.

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    Relationship Between Dynamic Lower Extremity Biomechanics and Single Leg Postural Stability and a Second Anterior Cruciate Ligament Injury in a Population of Athletes Returning to Sport After Unilateral Anterior Cruciate Reconstruction

    Published Year: 2010
    Specialization: Orthopaedics and Sports Science

    Paterno, Mark V.

    The incidence rate and factors that may predict a second anterior cruciate ligament (ACL) injury to the ipsilateral or contralateral knee after ACL reconstruction (ACLR) have seldom, if ever, been reported. Therefore, impairments that increase risk of future injury may persist in athletes who return to sport after ACLR. The purpose of this study was to determine the incidence of subsequent ACL injury following ACLR and identify modifiable factors predictive of a second ACL injury.

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    Overactive Bladder in Female Graduate and Health Professions Students: Prevalence, Effect on Quality of Life, and Risk Factors

    Published Year: 2014
    Specialization: Orthopaedics and Sports Science

    Reisch, Rebecca A.

    Introduction and Purpose: The prevalence of overactive bladder (OAB) in young women has not been fully described. The purpose of this study was to identify the prevalence of OAB and associated symptoms in female graduate and health professions students. Study design and Methods: The study was a cross-sectional design. All female graduate and health professions students from Pacific University’s College of Health Professions were invited to participate, and 210 students participated. Study participants filled out the Overactive Bladder Questionnaire (OAB-q), a 4-day bladder diary, and a demographic information questionnaire. Results: Response rate was 21.2%. The average age of participants was 25.53 plus or minus 3.71. Prevalence of OAB was 21.6%, prevalence of frequency was 29.9%, prevalence of nocturia was 43.1%, and prevalenceof urinary incontinence was 4.4%. Discussion and Conclusion: Because of differences in study design, it is difficult to compare these results with results reported in other studies. However, the results indicate that many young women suffer from OAB and its associated symptoms of frequency, nocturia, and incontinence. Future research should be done to verify the ideal mechanism for identifying OAB, and to compare prevalence rates among different groups.

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    Myofascial Trigger Points in the Hip as a Contributing Factor in Patellofemoral Pain

    Published Year: 2009
    Specialization: Orthopaedics and Sports Science

    Roach, Sean

    Background: Patellofemoral pain (PFP) is a common orthopedic problem, accounting for 25-40% of all knee problems addressed in sports medicine clinics. Improvement of treatment outcomes requires a better understanding of the condition’s etiology and the various treatment strategies. Recent literature on PFP has drawn attention to the importance of hip strength, in particular for the hip abductor and external rotator muscles, in controlling excessive valgus forces at the knee. Muscle damage associated with unaccustomed eccentric exercise can result in the formation of a myofascial trigger point (MTrP) and may cause muscle weakness. The purpose of this study was to: 1) determine the prevalence of MTrPs in the gluteus medius (GMe) for subjects with PFP, as compared to control, 2) examine the relationship between MTrPs and force production of the examined muscles, and 3) determine if trigger point pressure release therapy (TPPRT) and self-management techniques for MTrPs and GMe muscles will result in increased hip abduction strength in subjects with and without PFP. Methods: 60 subjects participated in this study, 30 with PFP and 30 non-PFP controls. All subjects were evaluated for the presence of MTrPs in the GMe muscles and hip abduction strength. Additionally, PFP subjects’ strength was measured after either a sham treatment or trigger point pressure release therapy (TPPRT). PFP subjects were reevaluated after a two-week interval for MTrPs and hip abduction strength. Results: Prevalence of bilateral GMe MTrPs for the PFP group was significantly higher compared to controls. The prevalence of MTrPs in bilateral GMe muscles in the PFP group made it difficult to determine if direct relationships existed between MTrPs and force production, however subjects in the PFP group displayed significantly less hip abduction force production between PFP treatment and sham groups were noted. Conclusions: Subjects with PFP have a higher prevalence of MTrPs in bilateral GMe muscles. PFP subjects demonstrate less hip abductor strength with strength compared to controls. No difference was found in hip abductor strength with TPPRT and sham at a two-weel follow-up.

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    The Impact of Physical Therapy Residency or Fellowship Education on Clinical Outcomes for Patients with Common Musculoskeletal Impairments

    Published Year: 2013
    Specialization: Orthopaedics and Sports Science

    Rodeghero, Jason R.

    Background and Purpose: There is an increasing focus on physical therapy specialization through postprofessional residency and/or fellowship training. Scant evidence exists that evaluates the influence of postprofessional education on patient outcomes. The purpose of this study was to compare the outcomes of patients with musculoskeletal impairments between physical therapists who have completed a residency or fellowship program and therapists who have not completed either. Methods: A retrospective chohort design was conducted using data from a survey and an existing commercial database. Physical therapsts using the database were surveyed to determine what level of education they completed. Musculoskeletal outcome data for 25,843 patients treated by these physical therapists was extracted from the database for the timeframe of June 2012-June 2013. Data were analyzed with ANCOVA to identify differences between groups in the functional status change, number of visits, duration of care, and efficiency. Logistic regression was used to determine the odds of achieving various magnitudes of improvement between groups. Results: Patients treated by physical therapists who completed residency or fellowship training demonstrated significantly greater improvement in their functions fellowship-trained group had significantly fewer visits than the residency trained group but no the group without training. The fellowship trained group and the group without training had significantly shorter episode durations than the residency trained group. Physical therapists who had completed a fellowship program had significantly greater efficiency, defined as change per visit, than the other groups. Patients ere 40% more likely to achieve outcomes 4-5 times greater than MCID values when they were treated by a physical therapist with fellowship training. Discussion & Conclusion: The data analyzed in this observational study demonstrate that physical therapists with fellowship training may achieve greater outcomes for patients with musculoskeletal impairments. There may be a benefit from postprofessional fellowship training that positively influences patient outcomes. No definitive conclusions about residency or fellowship training can be made due to the observational nature of this study.

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    Characteristics Of Adolescent Baseball Pitchers And Their Relationship To Throwing Velocity

    Published Year: 2001
    Specialization: Orthopaedics and Sports Science

    Schulte, Robert A.

    Throwing is a complex biomechanical feat that requires a balance between mobility and stability of the human kinetic chain. Shoulder muscle weakness and adaptive tissue changes have been proposed as a possible risk for developing injury. Objective quantification of anthropometric characteristics has been identified in a population of professional baseball pitchers, but there is a paucity in the literature regarding the adolescent pitcher. The purpose of this study was to identify characteristics of healthy adolescent pitchers and determine the relationships between shoulder passive range of motion, eccentric strength, field-testing performance and other anthropometric data to pitching velocity. Thirty-seven healthy Babe Ruth baseball players age 14-15 were tested bilaterally for selected anthropometric and field testing measurements to determine if the throwing side differed in strength, range of motion, and various performance measures from the nonthrowing side. Passive internal and external range of motion was bilaterally measured at 90� of abduction. Muscle strength of the supraspinatus, handgrip, and internal and external glenohumeral rotators were measured with a hand-held dynamometer. Field-testing consisted of the following tests: sit-ups, medicine ball throw, standing long jump, and Davies Closed Kinetic Chain Upper Extremity Stability Test. Correlational statistics were used to determine if any of these characteristics were significant predictors for pitch velocity in adolescent pitchers. No significant strength difference existed between extremities in external rotator, internal rotator, or supraspinatus strength. However, a significant difference of handgrip strength existed in the pitching arm as compared to the nonpitching arm. When compared to the nonpitching arm, the bilateral glenohumeral passive range of motion tests demonstrated greater passive external rotation in 90� of abduction in the pitching arm of adolescent players. Results demonstrated significantly greater distance by the nonpitching side during the single-leg hop test. Furthermore, this study identified external rotation strength and the single-leg hop test (stride leg) distance as two significant predictors for pitch velocity in adolescent pitchers. The strength, range of motion, and performance characteristics identified in this study can assist the practitioner in evaluating and treating adolescent athletes who use overhead throwing motions.

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    An Epidemiological Investigation of Injury Among High School Windmill Softball and Baseball Players

    Published Year: 2011
    Specialization: Orthopaedics and Sports Science

    Shanley, Ellen

    Few studies have prospectively examined injury rates in high school softball and baseball players. While many descriptive studies have been conducted to determine the risk of injury in competitive baseball, particularly upper extremity injury, none have prospectively assessed the risk of injury in softball athletes. While prior retrospective studies have found an association between overhead athletes’ arm injuries, and range of motion (ROM) deficits in shoulder external rotation (ER), internal rotation (IR), total rotation ROM (ER+IR)m and horizontal adduction (HA), few prospective studies have examined these and other risk factors in youth softball and baseball.

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    Effect of Performing the Standing Pilates Repertoire on Balance in an Aging Female Population

    Published Year: 2011
    Specialization: Orthopaedics and Sports Science

    Staples, Karyn

    Background: The ability to maintain balance directly affects an individual’s capacity to function independently or with confidence. Research shows that balance declines with aging based on many factors. Poor balance can lead to injury, which may further compromise independence, making balance not just an immediate safety concern, but a broader quality of life issue. Objective: To determine if performing the Standing Pilates repertoire would significantly improve balance compared with a standard exercise program as determined by the Timed Up an Go (TUG) and Berg Balance Scale (BBS) for women aged 65-85 years. Design: Single-blinded randomized controlled trial. Setting: Community senior facility. Participants: Fifty-two community dwelling healthy women. Intervention: Standing Pilates protocol versus standard exercise protocol, performed for three 45 minute exercise sessions each week for a 4-week time period. Measurements: Modified Falls Efficacy Scale, TUG, BBS, and abdominal circumference. Results: Forty-one women completed a minimum of 10 exercise sessions and partipated in the post-assessment. The MFES tool showed no difference pre- an post-assessment and no difference between groups. Statistical significance was found on the pre- and post-assessment for all participants independent of group assignment on the TUG and BBS. Statistical significance was found pre- and post-assessment as well as between groups on the abdominal circumference measurement. Limitations: Small sample size, unequal drop out rate between intervention and standard group, ceiling effect on balance measures used, and no interactive control comparison. Conclusions: The Standing Pilates repertoire was no more effective at improving balance scores than the standard exercise group.

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    The Efficacy of Low Frequency Electrical Stimulation for the Treatment of Plantar Fasciitis

    Published Year: 2008
    Specialization: Orthopaedics and Sports Science

    Stratton, Michael

    More than two million Americans receive treatment for plantar fasciitis annually. The plantar fasciitis is a ligamentous structure that requires proper vascularization to heal. A review of the literature indicates that numerous treatment protocols have been proposed for plantar fasciitis but with varying rates of success. Researchers and clinicians agree that specific plantar fascia stretches have a significant effect in the recovery of patients diagnosed with plantar fasciitis. Additionally, it is widely accepted that an increase in circulation is pivotal to aide in tissue healing. Electrical stimulation may increase blood flow by eliciting muscular contraction. Previous research demonstrates that low-frequency electrical stimulation (LFES) of four to eight Hertz stimulates a significant amount of blood flow for the healing of soft tissue pathology. The purpose of this study will examine the efficacy of LFES in combination with non-weight bearing plantar fascia stretching exercises and prefabricated basic foot orthoses. The study hypothesized that LFES, specific plantar fascia stretching and prefabricated basic foot orthoses would decrease pain levels and improve functional activity levels in patients diagnosed with plantar fasciitis after four weeks of treatment and at a three-month follow up. Twenty-six subjects, 18 to 65 years of age and diagnosed with plantar fasciitis, participated in a true randomized clinical trial. A repeated measures design was used to assess the following functional outcome measures: the Visual Analogue Scale and the Activities of Daily Living subscale of the Foot and Ankle Ability Measure. A repeated measures two-way ANOVA was used to examine differences in pain and function. The study established significant decreases in pain level in all subjects at both four weeks and three months. All subjects also demonstrated improvement in functional activity levels after four weeks and three months. Interestingly, out of the three measures of pain, the VAS-current scores for the experimental group after four weeks of treatment significantly decreased as compared to the control group, These results indicate that LFES when used in conjunction with stretching and prefabricated orthoses may be an effective intervention to reduce pain levels in the early stages of plantar fasciitis.

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    The Influence of Hip Pain on Muscle Performance in Dancers

    Published Year: 2018
    Specialization: Orthopaedics and Sports Science

    Strzelinski, Melissa

    This manuscript outlines the 2-phase study conducted to evaluate the influence of hip pain on muscle performance in dancers. Study I evaluated the reliability of a new handheld dynamometry (HHD) stabilizing device in measuring dance relevant muscle force production, core endurance, and hip range of motion in dancers who experience hip pain while dancing and dancers without hip pain.

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    Foot Morphology and Musculoskeletal Injury: Regional Interdependence the Missing Link?

    Published Year: 2018
    Specialization: Orthopaedics and Sports Science

    Tedaldi, Ann-Maree

    The foot is the base of the musculoskeletal system and much attention has been given to its role in lower extremity injuries. Unfortunately, there is great disparity in existing literature. Arch height of the foot, is reported to effect injury risk and it is suggested that if an individual has a high, low or either extreme of arch height individuals are at an increased risk of injury. Conversely, there are numerous reports that refute any such association, Reports on arch mobility are scarce and provide little help in clarfiying the role of toot morphology as an injury risk factor. Although there is great debate regarding the role of the foot and incidence of injury, looking at both arch height and mobility may provide a better understanding of the role of the arch of the foot has with injury. Therefore, the purpose of this doctoral dissertation is three-fold: 1, to develop a functional arch score representing arch height and mobility; 2. to determine the predictive value of this functional arch score; and 3. to determine if foot morphology influences function. 1143 active duty US Army Soldiers were enrolled in this investigation. Two arch height and nine arch mobility measures were assessed; sitting arch height index and relative arch mobility were selected to calculate a functional arch score on categorical and continuous scales. The catagorical scale was deemed most appropriate and defined by nine arch types: 1. Low-Hypo, 2. Normal-Hypo, 3. High-Hypo, 4. Low-Normal. 5. Normal-Normal, 6. High-Normal, 7. Low-Hyper, 8.Normal-Hyper, 9. High-Hyper. Using this categorical version of the functional arch score, if injured, a subject’s odd of a lower extremity injury were greatest for High-Hypo or a Low-Hyper foot. Lastly, specific foot types influenced function as measured by ankle mobility and dynamic balance on the Y balance test. Subjects with Normal-Hypo had statistically less maximum closed chain dorsilfexion than Normal-Hyper and High-Hypo. Normalized to leg length, anterior reach distances were the shortest among Normal-Hypo arches than both Low-Normal and Normal-Hyper arches. Maximum composite scores are greater among subjects with Low-Normal than Normal-Hypo and High-Normal arches. The outcome of this research demonstrate the value of a comprehensive objecitve measure of foot morphology. These findings demonstrate the combination of extreme arch height and mobility are most highly associated with lower extermity injury. Lastly, differences in functional measures, ankle mobility and postural control, demonstrate the appropriateness in applying principles of regional interdependence to investigate foot morphology. This research brings a new perspective to the discussion table regarding the interaction of arch height and mobility on injury and function and will serve as a platform for future research.

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    Associations Between Disordered Eating, Menstrual Dysfunction, and Musculoskeletal Injury in Female High School Athletes

    Published Year: 2009
    Specialization: Orthopaedics and Sports Science

    Thein-Nissenbaum, Jill M.

    Study Design: Retrospective. Objectives: To determine the prevalence and associations of disordered eating (DE), menstrual dysfunction (MD), and musculoskeletal injury (MI) among high school female athletes. Background: The female athlete triad (Triad) is a syndrome concerning the interrelatedness of DE, MD and low bone mass. Few studies have examined two or more Triad components simultaneously, or their relationship to injury, among female high school athletes. Methods: The subject sample consisted of 334 surveys completed by female athletes competing on 33 interscholastic high school teams during the 2006-2007 school year. Athletes completed the Eating Disorder Examination Questionnaire (EDE-Q) and Health Wisconsin High School Female Athletes Survey (HWHSFAS). Athletes were classified by sport type as aesthetic (AES), endurance (END), or team/anaerobic (T/A). Results: Of the athletes surveyed, 34.7% reported DE, 18.9% reported MD and 64.7% sustained a sports-related musculoskeletal injury. Athletes reporting DE were two times more likely to incur an injury than those reporting normal eating behaviors. Multivariate logistic regression analyses revealed that athletes who reported a history of DE or prior injuriy were more likely to report an injury during the sports season. Conclusion: Our findings indicate a high prevalence of DE and MD among female athletes at the high school level. In addition, athletes with disordered eating are over 2 times more likely to sustain a sports-related injury during the current sports season. Therefore, screening and intervention programs designed to identify and decrease the prevalence of DE should be implemented at the high school level.

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    Dehydration Reduces Posterior Leg And Trunk Flexibility And Increases Stiffness In Male Collegiate Age Runners

    Published Year: 2014
    Specialization: Orthopaedics and Sports Science

    Ullucci, Paul A.

    Context: The importance of maintaining a euhydrated state for human survival has been well documented. Researchers have also sought to describe the effects dehydration has on muscular endurance, strength and power in varying climactic conditions. There is a paucity of published works exploring the impact dehydration plays on the physiological and mechanical properties of muscle and connective tissues which may affect athletic performance and injury risk. Objective: To measure the effects dehydration has on the mechanical properties of the muscles and connective tissues of teh posterior leg. It was hypothesized that when dehydrated, the mechanical properties of the connective and muscular tissues of the posterior leg would be negatively affected. Design: A crossover design. Setting: Laboratory. Patients or Other Participants: Nineteen male collegiate runners between the ages of 18-25 years old with no history of lower leg injury in the past 6 months. Main Outcome Measure(s): Each subject attended three sessions: baseline, dehydration and euhydration conditions. The order of testing, eurhydrated vs. dehydrated, was randomly assigned and the lead researcher was blinded to the testing conditions. Sit and reach (SnR) scores and terminal leg raise (TSLR) measurements were analyzed using a MANOVA. Posterior leg stiffness (PLS) was analyzed using a repeated measures ANOVA for each of the three tesing conditions. Results: Dehydrated 18-25 year old male runners demonstrated statistically significant decreases in mean SnR scores, P=0.001, and mean TSLR, P=0.001, with a concurrent increase in mean PLS, P=0.001, as compared to when they were euhydrated. Conclusions: The observed increase in stiffness combined with decreased flexibility may be linked to an increase in risk for lower extremity injury.

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    The Efficacy of Muscle Energy Technique in Patients with Acute Low Back Pain: A Randomized, Controlled, Double-Blind, Sequential Clinical Trial

    Published Year: 2001
    Specialization: Orthopaedics and Sports Science

    Wilson, Eric

    Acute low back pain is treated by a variety of health care providers utilizing an array or treatment approaches. In 1995, acute low back pain was the 5th most common reason for all physician visits in the United States over 13 billion dollars of medical expenses per year are attributed to low back pain affecting from 5 to 10% of the adult population annually with a prevelance from 60 to 90% over a ltfetime. Acute low back pain occurs in people with a wide variety of professions including those involving heavy labor, repetitive work activities and extended sedentary postures. Half of the population will have experienced a significant incidence of low back pain by age thirty. There is much controversy in the literature in regards to how to best manage patients with acute low back pain. Much of this controvery stems from two distinctly different philosophies: medical management and physical therapy management. Standard medical management most often emphasizes the need for the patient to remain as active as possible while prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) and/or muscle relaxants to assist in symptom control/relief. Some advocates of medical management believe that physical therapy, especially exercise-based interventions, are contraindicated for patients with acute low back pain. Others feel that the “limited” benefits attained with exercise-based or manual therapy interventions are not worth the increased cost of care. Many proponents of medical management believe that 80 to 90% of all patients with acute low back pain will “spontaneously” improve within three months. However, recent reports in the literature demonstrate that 75% of the patients medically managed for acute low back pain will have recurrent episodes of low back pain within one year after intial onset of symptoms. Clearly, there must be a more efficient method of managing this patient population. Physical therapists attempt to manage patients with acute low back pain by utilizing a wide variety of interventions including exercise and manual therapy. One of the key exercise approaches that can counter the potentially long-term effects of acute low back pain is strength training. Deyol stated that failure to strength train could cause increased severity and frequency of low back pain. According to Twomey and Taylor properly implemented resistance-exercise regimes play a vital role in the treatment of acute low back pain and are crucial for a patient’s successful return to function. The Mayo Foundation for Medical Education and Research advocated the use of a comprehensive, dynamic strengthening program to stabilize the trunk and spine. Unfortunately, the literature is incomplete on issues involving how to best strength train patients with acute low back pain and which specific populations will have the best outcomes with this intervention. Another common treatment for acute low back pain is the use of manual therapy. Manual therapy is a broad term that encompasses numerous techniques with many subcategories. Two of the more popular sub-categories of manual therapy are manipulation and mobilization. DiFabio defined spinal manipulation as a “high velocity thrust momentarily exceeding the available ROM”. While under the broad umbrella of “manual therapy”, muscle energy technique (MET) does not fall into either the manipulation or mobilization sub-categories. Muscle energy technique is an active technique in that the patient supplies the corrective force instead of the care provider. Greenman defined muscle energy technique as a “manual medicine treatment procedure that involves the voluntary contraction of patient muscle in a precisely controlled direction, at varying levels of intensity, against a distictly executed counterforce applied by the operator.” It has been hypothesized that muscle energy technique can be used to lengthen and strengthen muscle(s), increase fluid mechanics and decrease local edema, and to mobilize a restricted articulation. Muscle energy technique has become more popular over the past several years. While originally considered an osteopathic treatement, muscle energy technique has found increased favor with physiatrists, physical therapists, and chiropractors in the treatment of acute and chronic spinal disorders. One of the reasons for this is that it requires active participation on the part of the patient, both in performing and maintaining the effects of the treatment – thus decreasing the risk of patient dependency. DeRosa and Porterfield advocated the use of muscle energy technique as one of the preferred methods to apply “nondestructive forces” in order to facilitate movement at the site of impairment. If the patient is able to tolerate forces into the impaired joint area and more normal motion is restored, the patient should be able to improve spinal mobility with greater ease. Enhanced spinal mobility should lead to improved activity levels, which is imperative for the successful long-term management of low back pain. While muscle energy technique has found an increased audience with clinicians, very little has been published in the peer-reviewed literature on this intervention. Its wide-spread use in the clinic makes it imperative that we determine if this technique is viable procedure for the treatment of acute low back pain. The purpose of this randomized, double-blind, sequential clinical trial was to determine whether patients with acute low back pain would demonstrate a more rapid return to function, as assessed by the Oswestry Disability Index, after being treated with muscle energy technique treatment coupled with supervised strengthening exercises as compared to patients treated with supervised strengthening exercises alone. The following research hypothesis was investigated: There will be a statistically significant difference (p<O.05) between patients diagnosed with acute low back pain with a concomitant diagnosis of an extended lumbar dysfunction treated with muscle energy technique combined with supervised strengthening exercises (experimental group), than patients treated with supervised strengthening exercises alone (control group), in that the experimental group will have a greater percent change in Oswestry Disability Index scores after four weeks of treatment.

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    Use of a Script Concordance Test to Discriminate Between Physical Therapist Clinical Decisions in Conditions of Uncertainty Regarding Patients with Lumbar Spine Disorders

    Published Year: 2018
    Specialization: Orthopaedics and Sports Science

    Windsor, Brett Andrew

    Diagnostic Clinical Reasoning (DxR) is a strong focus within pre- and post-professional physical therapy (PT) training programs. However there is no consistency regarding what DxR is, how it is taught, or how PT measures progressive development of these skills. Further, there is little evidence correlating the development of DxR and expertise in practice. In particular, there is little distinction in the PT literature between diagnostic reasoning and therapeutic reasoning. The purposes of this srticle are two-fold: 1) to describe the construction of a novel Script Concordance Test (SCT) which proves capable of measuring the hypothetical clinical decisions of PT clinicians treating patients with lumbar spine disorders, and 2) to demonstrate the SCT’s validity and reliability as an indirect instrument for assessing clinical decision making.

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    Subscapularis Syndrome: Clinical Testing, Magnetic Resonance Imaging, and Should Impingement

    Published Year: 2002
    Specialization: Orthopaedics and Sports Science

    Zazzali, Michael S.

    The purpose of this study was to investigate the relationship between clinical findings and abnormal changes within the subscapularis muscle as found on magnetic resonance imaging in patients with subacromial impingement.

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Pediatric Science

    Relationships Among Age, Gender, Anthropometric Characteristics, And Dynamic Balance In Children 5 To 12 Years Of Age

    Published Year: 2011
    Specialization: Pediatric Science

    Butz, Sarah M.

    Dynamic balance is an important component of development in children and of safety with functional activities. With increasing age, the postural control systems of children progress toward using adult-like strategies; however, the postural strategies for balance develop at different ages. The purpose of this study was to examine the relationship among age, gender, various anthropometric variables, and dynamic balance measured by three balance tests. It was hypothesized that increasing age in children would be significantly related to scores on the Timed Up & Go (TUG), the Pediatric Reach Test (PRT), and the Pediatric Balance Scale (PBS).

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    The Effect Of Physical Activity On Parental-Reported Health-Related Quality Of Life, Sleep, And Pain In Non-Ambulatory Children With Multiple Disabilities

    Published Year: 2011
    Specialization: Pediatric Science

    Dodds, Cynthia Brown

    Participation in physical activity for children with motor disability is limited and progressively becomes more restricted as the severity increases. Lack of physical activity affects the health status of children with disabilities. The purpose of this study was to investigate health-related quality of life (HRQL), sleep characteristics, and pain in non-ambulatory children with multiple disabilities exposed to a community-based physical activity intervention. Twenty-nine children at GMFCS, MACS, and CFCS levels III, IV, and V between 1 and 14 years-of-age participated. A pre- and post-test quasi-experimental design examined the impact of a 5 week physical activity day camp on the parental report of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD), Children’s Sleep Habits Questionnaire (CSHQ), sleep diary, and Faces Pain Scale-Revised (FPS-R). Additional analyses explored the relationship between catagories of physical activity and HRQL, sleep durations, and pain. Participants demonstrated significant improvements in HRQL, sleep durations, and pain scores. One thousand minutes of physical activity over 5 weeks predicted a 5 to 8 point increase in total HRQL scores. Short-term, intensive, and supported physical activity enhanced parental report of HRQL, sleep duration, and pain in non-ambulatory children with multiple disabilities. It appears forty minutes of daily physical activity enhances parental report of HRQL, but not sleep duration and pain.

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    Short-Term Intensive Neurodevelopmental Treatment (NDT) Program Experiences Of Parents And Their Children With Disabilities

    Published Year: 2012
    Specialization: Pediatric Science

    Evans-Rogers, Debbie L.

    While numerous pediatric theray decisions are made by parents, minimal research has been conducted on parents’ perspectives regarding their experiences during high intensity interventions of neurodevelopmental treatment (NDT). The purposes of this study were to: 1. investigate the perceptions of parents of children with disabilities regarding their child’s participation in an intense pediatric therapy program (NDT); and 2. examine if differences occur in functional skills of children with motor disability after an intensive NDT program.

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    The Effectiveness Of A Dynamic Orthotic And Strapping System On Trunk Postural Control In Gait And Gross Motor Function In Children With Cerebral Palsy

    Published Year: 2011
    Specialization: Pediatric Science

    George, Kristiane Walter

    The purpose of this study was to examine the effectiveness of a soft, dynamic orthotic device, TheraTogs, on functional movement and posture in children with cerebral palsy (CP).

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    Congenital Muscular Torticollis: Infant Characteristics And Clinical Outcomes

    Published Year: 2017
    Specialization: Pediatric Science

    Greve, Kelly R.

    Congenital muscular torticollis (CMT) is a common musculoskeletal diagnosis in infants. Muscular CMT with and without a sternocleidomastoid mass are the two most restrictive types of CMT resulting in postural abnormalities and impairments in range of motion (ROM) and strength. Postural preference is the third type of CMT that does not limit ROM but results in a visible head tilt. Physical therapy (PT) is the first line, conservative intervention to resolve signs of CMT, yet not all infants complete a course of treatment. The purposes of this dissertation were first to describe demographic patterns, baseline clinical characteristics, and PT recommendations for 3 groups of infants with CMT when discharge criteria were (1) met following direct PT; (2) unmet following direct PT; (3) unmet following home program instruction. The second purpose was to examine cervical range range and strength in infants with CMT when discharge criteria were met or unmet at least 6 months after initial PT examination.

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    Family-Professional Partnership Dynamics, Transition To Preschool, And Physical Therapy: A Mixed Methods Study

    Published Year: 2017
    Specialization: Pediatric Science

    Hall, Jamie B.

    The purpose of this mixed methods study was to explore the dynamics of relationships between families and physical therapy providers (PTP) during the transition of children with disabilities and developmental delays from early intervention (EI) to early childhood special education (ECSE).

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    The Relationship Of Temperament And Sensory Processing To Social Participation In Young Children With Developmental Delays

    Published Year: 2016
    Specialization: Pediatric Science

    Hiranaka, Chana

    Objective: To examine the temperament and sensory processing factors related to the social participation of 3 year olds with developmental delays. Method: This is cross-sectional, descriptive study. Parent responses on questionnaires for temperament and sensory processing were correlated with measures of social participation. Predictors for social participation were explored. Results: The temperament factor of Effortful Control was found to be moderately related to social participation. The total sensory score was significantly and strongly related to social participation. The sensory scale score of Body Awareness had a correlation of .535 and Planning Ideas .593 with social participation. The total sensory score was the strongest predictor of social participation. Conclusion: Young children wit developmental delays have temperament and sensory processing vulnerabilities that place them at high risk for difficulties in social skill development and their social participation at home, school, and community. Pediatric therapists can provide interventions to support the foundations of social participation to include sensory integration therapy, cognitive approaches to learning social skills, and parental behavioral management to modify difficult temperament responses.

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    Variability Of Foot Movements During Spontaneous Leg Movements In Infants Born Full Term

    Published Year: 2011
    Specialization: Pediatric Science

    McElroy, Jan. J.

    Identification of very young infants with motor dysfunction is inadequate in early intervention programs due to lack of clinical tools that are easily administered and highly prognostic for infants under 3 months of age. Observation and assessment of spontaneous movements is a promising tool for this population. Spontaneous movements are described as highly coordinated as well as variable and complex, and may differentiate between infants developing typically and those with movement disorders. Kinematic studies were used to quatitatively describe coordination of hip, knee, and ankle movements. Qualitative studies employed “gestalt” methodology to identify overall variability/complexity of movement. Clinicians often have difficulty observing and describing spontaneous movements due to the presence of both coordination and variability/complexity in young infants. With expanded specific descriptions of infant spontaneous lower extremity movements, new tools may become available for improved clinical identification of movement dysfunction in very young infants. The purpose of this study was to describe foot movements of eversion/inversion and abduction/adduction during spontaneous lower extremity movement in newborn (NB) and 3 month (3M) old infants. Movements were examined for spatial and temporal coordination of hip, knee, ankle and foot using joint pair correlation coefficients and phase lag computation. Twenty-four joint combinations were identified to assist in the clinical description of movement variation necessary for future adaptability of movement for function. Comparisons were made between ages on all measures to examine developmental changes.

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    Relationship Between Balance And Motor Skills In Young Children With Developmental Coordination Disorder

    Published Year: 2016
    Specialization: Pediatric Science

    Rowland, Phyllis O.

    The purpose of this dissertation were to a) describe and compare performance of children with typical motor development (TMD) and with probable Developmental Coordination Disorder (pDCD) on clinical measures of sensory orientation to balance b) examine differences in clinical balance measures to discriminate between children with and without motor problems.

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    Adults With Cerebral Palsy: Independent Community Living Factors And Perceived Quality Of Life

    Published Year: 2012
    Specialization: Pediatric Science

    Shen, Eunice Yu Chiu

    Cerebral palsy (CP) is the most common physical ability in childhood that impacts an individual across lifespan. As the lifespan of individuals with CP increases, there is a need to understand the impact of disease and disability on the quality of life and to explore the challenges of their changing needs in community living. The purposes of this study were: 1) to explore and identify the lived experience of adults with CP living in their communities, and 2) to examine factors influencing activity level and participation and how these factors influence perceived quality of life. The specific aims of this study were: Specific aim #1. Determine the relationship between the Gross Motor Function Classification System (GMFCS) levels of motor function and the World Health Organization Disability Assessment II (WHODAS II) physical domain in adults with CP. Specific aim #2. Compare the domains of the WHODAS II and World Health Organization Quality of Life-BREF (WHOQOL-BREF) instruments in adults with CP. Specific aim #3. Examine the relationship among physical and social demographic factors and the domains of the WHOQOL-BREF in adults with CP. The qualitative inquiry included in-depth information gathered through semi-structured individual interviews, using the WHOQOL-BREF to guide open ended questions. The primary qualitative research question was: For adults with CP, which factors influence living independently in the community and affect their perceived quality of life?

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    Effects Of Swaddling On Infants Born Preterm During Bottle Feeding: A Randomized Crossover Study

    Published Year: 2016
    Specialization: Pediatric Science

    Smith, Allison P.

    Infants born preterm have difficulty with coordinated feeding skills due to fragile physiological stability, immature state regulation, and maturation-related low muscle tone. Feeding difficulties often affect length of hospital display for these infants. Swaddling has been found to reduce pain and stress responses and improve neurobehavioral state regulation and physiological stability in infants born preterm in the Neonatal Intensive Care Unit (NICU). Swaddling is used inconsistently during feeding in the NICU and has not been critically examined as an intervention to improve quality of preterm infant’s feeding skills. The purpose of this research was to examine the effects of body swaddling during bottle feeding on feeding efficiency and feeding quality in infant’s born preterm.

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    The Validity Of Accelerometer Measurements To Assess Physical Activity In Infants

    Published Year: 2018
    Specialization: Pediatric Science

    Snarski, Kristen

    Introduction: The impact of infant physical activity (PA) on development is of particular interest to pediatric physical therapists who are tasked with supporting the acquisition of motor skills. In order to determine the role of infant PA on development, valid measurement of infant PA must be established. Purpose: The purpose of this study was to determine the validity of accelerometry to measure lower extremity PA in infants. Methods: Lower extremity PA was measured in twenty-three infants ages 2-4 months using a triaxial accelerometer placed on the infants’ ankle. Kinematic information was simultaneously collected via motion capture. Correlation coefficients were calculated to determine if a relationship existed between accelerometer measurement of infant PA and any of the kinematic variables. Results: No significant correlations were found between accelerometer of infant PA and kinematic descriptors of infant movement. Conclusions: Accelerometry may not be a valid measure of lower extremity infant PA. Future studies are necessary to determine if alternative data processing decisions would result in different results.

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    Pain, Walking Activity, and Participation in Children with Sickle Cell Disease: A Cross-Sectional Descriptive Study

    Published Year: 2019
    Specialization: Pediatric Science

    Tankersley, Janet B.

    Purpose: The purpose of this cross-sectional descriptive study was to determine the relationship between pain frequency, walking activity, and participation with sickle cell disease (SCD). Methods: A cross-sectional descriptive study observed a cohort of 50 children with SCD, ages 6-13 years, who attend school. Participants wore the Fitbit Flex wireless activity monitor to track step counts for four weeks. They completed pain diaries and testing with the Beery-Buktenica Developmental Test of Visual-Motor Integration, and the Assessment of Life Habits. Descriptive statistics representative of the study sample were summarized relative to data type. Correlation analysis of data was used to measure the strength of association beteween pain frequency, walking activity, and participation. Results: The negative relationship between pain frequency and participation was moderately correlated and statistically significant. The positive relationship between walking activity and participation was moderately correlated and statistically significant. No significant relationship was found between pain frequency and walking activity. Conclusion: Pain frequency and walking activity influence ability to participate in life habits for children with SCD. Future pediatric physical therapy research to examine interventions to modulate pain and increase walking activity could have implications for participation in life habits among children with SCD.

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    Predictive Validity Of The Matching Assistive Technology To Child-Augmentative Communication Evaluation Simplified (Match-Aces) Assessment Protocol

    Published Year: 2012
    Specialization: Pediatric Science

    Zapf, Susan Ann

    The purpose of this quantitative study was to measure the predictive validity, internal consistency, and clinical utility of the Matching Assistive Technology to CHild & Augmentative Communication Evaluation Simplified assessment & toolkit process used in the educational setting. A secondary purpose was to measure the effectiveness of the recommended assistive technology through quantitative analysis using student pre-post-scores.

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Pediatrics

    Effects of Soft Shoe Inserts on Foot Alignment and Falls in Toddlers with Moderate to Severe Flat Feet

    Published Year: 2009
    Specialization: Pediatrics

    Agee, Ruth

    Purpose: The purpose of this study was to determine the effects of soft shoe inserts on foot alignment and falls in toddlers with moderate to severe flat feet. Methods: An experimental design with each subject as her own control as well as a separate group of toddlers with less than moderate flat feet was used in this study. Data were collected from each subject in two separate trials on two different days approximately one week apart. Falls, loss of balance, time to walk, and number of steps were assessed on videos of each subject walking on five laps of fifteen feet of uneven mats. Foot alignment was documented through photographs of the subject standing on a mat with a grid of one inch blocks printed on it. Results: Repeated measures analysis showed the measures to be reliable for all measures. The only significant effect of the inserts on the dependent variables was on the distance between the first metatarsophalangeal joints of the subjects’ feet. Trends were documented in decreased falls, loss of balance occurrences, heel distance, and knee distance. Conclusions: The measures used i this study are reliable across subjects adn across trials. The significant decrease in the distance between the first metatarsophalangeal joints of the subjects’ feet with less heel and knee change indicates decreased eversion in subjects wearing the inserts. Trends of decreased heel distance, and knee distance indicate a trend of narrower base of support with the inserts. Trends of decreased falls and loss of balance occurrences indicate a trend of improved motor function in gait. The use of soft shoe inserts to decrease eversion in toddlers’ feet with moderate to severe flat feet is supported.

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    Neuro-Developmental Treatment versus Parent-Infant-Playgroup for Infants With Posture and Movement Dysfunction – Effects on Gross Motor Function

    Published Year: 2007
    Specialization: Pediatrics

    Arndt, Sherry Lynn Wilson

    Purpose/Hypothesis: This efficacy study was used to evaluate a Neuro-Developmental Treatment (NDT) protocol during age-appropriate, functional activities in infants 4 to 12 months of age. The NDT protocol focused on developing efficient movement and posture in response to gravity and to the body’s contact with the support surface using facilitated, actively balanced and specifically sequenced trunk movements. The hypotheses were: (1) infants receiving an NDT-based protocol will make greater gains in gross motor function than infants receiving a parent-infant playgroup (PIP) when evaluated immediately after intervention, and (2) the NDT group will maintain gains at the 3-week follow-up evaluation (FU). Subjects: Ten infants, 4 to 12 months of age with identified posture and movement dysfunction. Materials/Methods: A repeated measures, randomized block design was used. Infants scoring at or below the 5th percentile rank on the Alberta Infant Motor Scale, and demonstrating delayed head and trunk-orienting behaviors, measured by the Movement Assessment of Infants, were randomized into groups after controlling for severity of disability. After attrition, 10 of 19 participants completed the study: 5 in the experimental group; 5 in the comparison group. The NDT group received an infant NDT-based protocol of active, sequential trunk activities delivered by pediatric therapists during a post-professional 3-week training course. The PIP group received enriched play activities delivered by parents, with guidance from a Child-Life Specialist. Both groups received a block of intervention consisting of 10 hours over a 15-day-period. A reliable exminer, blind to group assignment, assessed infants before, immediately after, and 3 weeks following intervention using the Gross Motor Function Measure (GMFM). Both groups continued to receive pre-established therapeutic interventions throughout the duration of the study. Data Analysis: The differences in GMFM total percentage scores (pretest to posttest, posttest to 3-week follow-up, and pretest to 3-week follow-up) were analyzed using nonparametric, one-tailed, repeated measures analysis of variance (Friedman two-way analysis of variance by ranks) and Mann-Whitney U-test. Results: The NDT group made significantly more progress than the PIP group on the GMFM at the end of the intervention. The gros motor skills of the NDT group were maintained at 3-week follow-up. Only the NDT group demonstrated significant change in GMFM scores over time (pretest-posttest-3-week follow-up). No significant change in gross motor skills occurred in the PIP group. Conclusions: A NDT-based protocol of 10 consecutive 1-hour sessions improved motor function, and less robust motor gains were maintained at a 3-week follow-up evaluation. Clinical Relevance: Infants with posture and movement dysfunction made greater motor gains from direct service by NDT trained pediatric therapists with specialization in infant intervention than from a playgroup coordinated by a child-life specialist. A short duration, high frequency, individualized NDT-based protocol intervention may produce clinically important changes for infants at 4 to 12 months of age. The variability of application of an individualized NDT-based infant protocol can be reduced when treatment practicums are supervised within the context of a continuing education course. An evaluative outcome measure, GMFM, validated for the infant population, can be used to document change in motor skills over time.

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    Effects of a Motor Control Intervention in Two-and-a-Half to Six Year Old Children Diagnosed with Idiopathic Toe Walking

    Published Year: 2008
    Specialization: Pediatrics

    Clark, Elaine

    Background and Purpose: Best practice in physical therapy management of idiopathic toe walking (ITW) has not been established, and a valid system to measure toe walking gait is unavailable for clinicians. Purposes of this two-phase project were to 1) develop and test measurement properties of the gait event detector (GED), a device to measure the frequency of heel strike with gait in the natural environment; and 2) evaluate the effect of motor control intervention on gait in preschool age children diagnosed with ITW. Methods: Two designs were used: 1) Non-concurrent single system multiple baseline design (A, B) with two post-intervention measurements. Outcome measures were the GED and a parent visual analogue scale (VAS) estimate of percent heel-toe walking. 2) Repeated measures design. Outcome measures were the gross motor subtests of the Peabody Developmental Motor Scales (PDMS-2) and ankle dorsiflexion range of motion. Results: Gross motor skills, measured by the PDMS-2, were significantly increased at the immediate follow-up examinations but not at the 30-day follow-up examinations. Ankle dorsiflexion improved at the immediate follow-up examinations and improvement was maintained at the 30-day follow-up examinations. Gait results varied. Heel strike frequency, as measured by the GED in the intervention phase, showed a significant upward trend for 1 subject, slight upward trends for 3 subjects, and no change for 1 subject. Two subjects showed a 50% improvement in heel strike frequency between phases. Of these, one retained the slight upward trend of heel strike from the intervention phase at the 30-day follow-up session, signifying a gait change. No participant changed to a consistent heel-toe gait pattern with daily living based on parent perception from the VAS. Comparisons by individual subject of the longitudinal VAS estimates and GED measures on the same day showed correlations that ranged from 0.417 to 0.633. For the 5 subjects, the mean of the correlation scores was 0.057. Conclusions: Following motor control intervention for children diagnosed with ITW, gross motor skills improved and ankle ROM increased, but most gait measures did not meet a criterion of consistent, spontaneous heel-toe progression. Demonstration of marginal gait improvement may be due to inadequacy of the 1) measurement system or study design; 2) administration of intervention using pre-planned protocol and pre-set time period; or 3) match of motor control intervention to various musculoskeletal or neurological pathology associated with ITW. If structural stability within the foot has failed to develop, orthotic support may be needed to improve the base of support for persistent toe walking in preschool age children.

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    Functional and Kinematic Advantages of Providing Knee Components in the First Prosthesis of Infants and Toddlers with High Level Lower Limb Amputations

    Published Year: 2009
    Specialization: Pediatrics

    Coulter-O’Berry, Colleen

    Infants and toddlers with amputations who require a prosthetic knee joint present a unique rehabilitation challenges to clinicians. Historicaly, infants and young toddlers with lower extremity loss at or proximal to the knee disarticulation level have been prescribed with a prosthesis with no prosthetic knee or a prosthetic knee unit locked in full extension. Two factors have contributed to acceptance of this treatment protocol: assumption that young children lack the strength and neural control to prevent the prosthetic knee from buckling, and lack of appropriately-sized pediatric prosthetic knee components. Most recently, pediatric prosthetic knees have been developed appropriate for infants and young toddlers and some centers have revised treatment protocols in order to fit very young children with a passively flexing prosthetic knee component. A gap remains in the evidence concerning the appropriate age for the introduction of an articulated knee in infants and toddlers. In addition, motor control research have identified mobility adaptations in crawling infants when their movements were restricted and when their environment was changed. The purpose of this study was to demontrate the kinematic and functional advantages of providing knee components in the first prosthesis of infants and toddlers with high level lower limb amputations. The working hypothesis is that infants and toddlers with knee disarticulation or trans-femoral amputation levels will demonstrate knee flexion functions paralleling their non amputee peers if provided with a free flexing prosthetic knee at first prosthetic fitting compared to diminished knee flexion functions if fitted with a non-articulating knee unit. In addition, the subject’s parents will report greater satisfaction in fit, function, and appearance of their child’s prosthesis in the unlocked condition.

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    Partial Weight Bearing Treadmill Training in the Home with Young Children with Cerebral Palsy: A Study of Feasibility and Motor Outcomes

    Published Year: 2004
    Specialization: Pediatrics

    Dannemiller, Lisa A.

    Purpose: The purpose of this study was to document feasibility, motor outcomes and parent reports of participation for young children with cerebral palsy (CP) who received parent-administered partial weight bearing treadmill training (PWBTT). Methods: Three nonambulatory children under the age of 3, participated in this single-system, multiple baseline study. All children had quadriplegic CP, one was Level III and 2 were Level IV using the Gross Motor Function Classification System (GMFCS). Parents were trained to administer PWBTT 5 days/wk for 8min/day. Participants received 2, 3, or 4 months of PWBTT. Study duration was 6 months including baseline phase, intervention phase, and follow-up probe. Outcomes included: (1) % alternating and parallel steps, (2) Supported Walker Ambulation Performance Scale (SWAPS) scores, (3) the Gross Motor Function Measure (GMFM) 88 and 66 scores, and (4) a participation questionnaire. Results: Parents of the 3 participants averaged 92% of the expected minuntes of PWBTT. One child had significant changes in alternating and parallel steps on the treadmill and a significant increase in SWAPS scores. All participants made greater changes on GMFM-88 scores for a 6-month periodm compared to published GMFM-88 data for children of similar ages and GMFCS levels. One participant made greater change on the GMFM-66, compared to published GMFM-66 data for children of a similar age and GMFCS level. Two of the 3 families reported a positive moderate change in their child’s participation in their family and communty. Conclusions: Although outcomes varied for the individual children, parent-administered PWBTT may be a feasible intervention to improve motor and participation outcomes for children with quadriplegic CP.

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    A Longitudinal Study of Outcome Measures and the Use and Impact of Environmental Modifications for Children Receiving Early Intervention Services

    Published Year: 2008
    Specialization: Pediatrics

    Eigsti, Heidi Johnson

    The purposes of this study were: (1) to compare the Pediatric Evaluation of Disability Inventory (PEDI) and the Mullen Scales of Early Learning (MSEL) as measures of change in children who have received Part C early intervention services; and (2) to compare the use and impact of environmental modifications on mobility, self-care, and social function in young children with and without gross motor delays. Thirty-four children who received early intervention services were stratified into 2 groups according to the severity of motor delay. The PEDI adn MSEL were administered 3 times; at an average age of 18, 31, and 53 months. Data were analyzed using a repeated-measures multi-variate analysis of variance. Effect size indices were compared within and between subjects on all scales. Between group comparisons were analyzed for the use of environmental modifications in PEDI activity areas and linear regression was used to determine if the use of environmental modifications was a significant predictor of function. The findings suggest that PEDI Functional Skills scaled scores are capable of measuring change in children with and without motor delays. The PEDI Functional Skill Social scale was found to be more sensitive to change than the MSEL Receptive and Expressive Language scales for children with motor delays. A higher proportion of children with motor delays used environmental modifications for eating, bed transfers and safety. A significant negative predictive relationship was found between the use of environmental modifications and PEDI scores. Using PEDI scaled scores may be an effective tool for measuring functional change at the group and individual level in children receiving Part C early intervention services. More research is needed to determine the impact of rehabilitative and child-based modifications on function in children receiving early intervention services.

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    Guatemalan Caregivers Perceptions of the Experience of Receiving and Using Wheelchairs Donated for their Children

    Published Year: 2006
    Specialization: Pediatrics

    Glumac, Lorraine Kathleen

    Although thousands of new and refurbished wheelchairs are donated each year to children with disabilities (CWD) in developing countries, there is currently no evidence base in the literature to support this practice. The purposes of this qualitative research study were to: 1) explore, from the perspective of caregivers, the experience of receiving and using a wheelchair donated for a non-ambulatory child in Guatemala; and 2) identify local services perceived by caregivers as needed or desired to support the use of the wheelchairs. A phenomenological research design was employed for this study. Evidence was derived from the first person accounts of fourteen purposively selected caregivers of non-ambulatory children in Guatemala who had received donated wheelchairs less than three years earlier. Data collected included record review, observations, photographs, and open-ended interviews using an interview guide. Qualitative data analysis generated themes including positive effects of the wheelchairs on the health and well-being of the caregivers, children’s ability to participate in typical age-expected activities, children’s physical state and activity performance, children’s emotional state and demonstration of learning, family relationships, and community attitudes and awareness of disability issues. The impact of contextual barriers on wheelchair use, desire for changes in the delivery of rehabilitation services, and effects of specific wheelchair features and wheelchair receipt variables were also uncovered. A composite description was constructed of the meanings and essences of the experience for the group of participants as a whole. Community-based services perceived by caregivers as needed or desired to support use of the donated wheelchairs included the ability to maintain and repair the wheelchairs locally, community outreach to caregivers, disability education for community members, an accessible environment including the ability to use public bus transportation, and education and rehabilitation opportunities for their children. Donated wheelchairs can have multiple positive effects on CWD and their caregivers in a Third World context. The knowledge generated from this study provides essential evidence derived from caregivers’ own perspectives on the effects of wheelchairs donated for CWD in a developing country. By incorporating this evidence into practice patterns, therapists can help wheelchair providers give more appropriate wheelchairs and higher quality support services to non-ambulatory children and their caregivers in varied international settings. In a developing country, matching a child and caregiver with a wheelchair that best meets their needs is a complex practice. Both the wheelchair and local services to support use of the wheelchair should be considered when determining effectiveness of wheelchair provision. Outcomes are more likely to be successful when persons providing wheelchairs have a thorough understanding of the complexities of the issues and a sound knowledge base to address these issues in varied and challenging contexts. A unique role exists for pediatric physical and occupational therapists in this area of practice to help achieve the “ultimate” goal of the provision of wheelchairs to CWD in international settings – a more typical life for child and caregiver.

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    Linking Family and Community Ecology With Child Development Outcomes Among Nevada Early Head Start Enrollees

    Published Year: 2007
    Specialization: Pediatrics

    Hickman, Robbin A. Britt

    Introduction: While motor development may be affected by various factors intrinsic and extrinsic to the child, studies have reported that the child’s task-specific experience or practice of the developmental motor skill being acquired is the single most important factor that influences this process. To our knowledge, the specific environmental variables that may influence the child’s ability to obtain this experience have not previously been identified. This information may be very important if physical therapists and other early interventionists are to provide effective support-based interventions. Additionally, it is important to identify which children may be most vulnerable to potential risk factors that may result in delayed or dysfunctional acquisition of development motor skills. Purpose: The purposes of this two-part study were to 1) explore familial and community-level mechanisms that influence developmental experience and outcomes of young children in University of Nevada, Reno Early Head Start, and 2) to examine concurrence among screening and examination tools regarding identification of children who may be most vulnerable to those risks. Discussion: Public health and administrative implications of the study include recommendations to consider broadening EI eligibility criteria to include children with demographic and environmental risk factors in addition to biologic risk and delayed skills; consider allowing children with multiple risk factors to be eligible for EI services rather than monitoring their development; and consider whether the ASQ is an appropriate tool to use for screening motor development of young children living in poverty. Clinical implications include increasing attention to family education and provision of anticipatory guidance related to development skill acquisition, advocating for multi-risk children to receive an IFSP and services, and connecting families to resources that facilitate safe outdoor play and to public, low-cost enrichment opportunities.

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    The Effects of Rigid, Hinged, and Supramalleolar Orthoses on the Characteristics of Gait in Children with Cerebral Palsy

    Published Year: 2005
    Specialization: Pediatrics

    Hobbs, Laurie A.

    Purpose: The purpose of this retrospective pilot study was to identify the effect(s) that rigid, hinged, and supramalleolar othoses had on characteristics of gait in children with cerebral palsy (CP). Subjects: Twenty-five patients with CP and who had prior gait analyses were included. They were assigned to three groups, characterized by the orthoses worn during the gait study; six wore rigid ankle foot orthoses (AFO) and walked with assistive devices, 12 wore hinged AFOs and were independent of assistive devices, and 6 wore supramalleolar orthoses (SMO) and were independent of assistive devices. Methods: Gait data collected from these three groups included: ipsilateral hip, knee and ankle sagittal plane kinematics in swing and stance periods, as well as ipsilateral step length. Conclusion: The rigid AFO group in this study experienced benefits from the orthosis in both swing and stance periods. The hinged AFO and SMO groups displayed clinically desirable effects of the orthosis in the stance period and clincially undesirable effects of the orthosis in the swing period. Prospective research with larger sample sizes is needed to determine if these findings can be generalized to the population of children with CP. Relevance: Orthoses are frequently prescribed for children, based on their intended effects in stance. A detailed assessment of orthoses in both stance and swing periods of gait pre- and post-fitting will enhance the prescription of orthoses and improve the functional effects of orthoses on mobility of children with CP.

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    Standing Postural Control in Children with Cerebral Palsy: Effects of Distal Stabilization

    Published Year: 2020
    Specialization: Pediatrics

    Leonard, Rebecca

    Postural control is fundamental to participation in activities of daily living. Children with Cerebral Palsy (CP) have limited postural control secondary to neuromuscular, biomechanical alignment, sensory processing and perception impairments. The purpose of this study was to examine the influence of three ankle-foot conditions (barefoot [BF], participant’s own prescribed orthoses [AFO], and distal control orthoses [DCO] on standing postural control of participants with CP compared to two ankle-foot conditions (BF and simulated DCO) of participants with typical development (TD).

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    Effects of Sensory Level Electrical Stimulation on Muscle Cross-Sectional Area, Strength and Metabolite Production in Children with Cerebral Palsy

    Published Year: 2010
    Specialization: Pediatrics

    Logan, Lynne Romeiser

    Our team proposes to determine if TES has an effect on muscle structure or function in children wit mild to moderate spastic cerebral palsy. Directly measuring cross-sectional area and metabolic output of treated and untreated muscle groups in the same child will give clinicians information about the effect of TES on muscle structure. Isometric strength measurement and estimates of recruitment will yield information about the fuction of treated and untreated muscles. Understanding the relative contributions of muscl and neural influences on any strength increases will assist in designing the most efficient methods of improving strength for children with cerebral palsy. Measures of hypertonia will provide information about the influence (if any) of TES on spasticity as well as help us understand if spasticity influences the effect of TES on strength or muscle structure and function. Measurement of Health Locus of Control will provide information on the influence of health beliefs on adherence to a long term electrical stimulation protocol in children with cererbral palsy.

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    Comparison of Two Support Walkers on the Gait Parameters of School-Aged Children with Cerebral Palsy

    Published Year: 2008
    Specialization: Pediatrics

    Low, Sheryl A.

    Purpose: Children with severe disabilities are unable to use handheld walkers because they lack postural and pelvic control. A support walker (SW) provides increased trunk or pelvic support. The purpose of this study was to investigate clinical decision making and use of SWs for children by pediatric physical therapists (PTs). Participants: Twenty-five hundred surveys were mailed randomly selected members of the Section on Pediatrics of the American Physical Therapy Association. Five hundred and thirteen PTs responded. Methods: Using a Likert scale and open ended questions, frequencies were calculated using SPSS. Comments were analyzed descriptively. Results: The Rifton Pacer and Kaye SW are the most commonly used SWs. These SWs are used equally posterior and anterior to the child and usually including trunk and forearm supports. Pediatric PTs report using SWs to address weakness, poor motor control, hip development and respiratory status. SWs are used primarily for children with spastic cerebral palsy, for at least a one month trial before purchase, in at least nine sessions of physical therapy to train a child for use in the school setting. The most common factors considered for SW prescription are participation with peers in school and clinical assessment by the PT. Conclusions: Sws are used in pediatric PT for increasing postural control, mobility and a child’s participation in school. Most clinicians select a SW based on the individual needs and clinical presentation of the child.

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    Effects of an Early Intervention on Bone Health: Knowledge, Perceived Efficacy of Behaviors, and Behavioral Risk Factors in Adolescent Females

    Published Year: 2004
    Specialization: Pediatrics

    Magee, Julie A.

    Study Design: Pre-test/post-test control group research design to test the effectiveness of an osteoporosis educational in-service program with female high school students. Background: Peak bone mass and density occur at critical critical periods primarily during adolescence. Girls developmentally start off with a lesser peak bone mass than boys and suffer more osteoporosis consquences as adult women. Purpose: To determine if adolescent girls who participate in an in-service educational program about osteoporosis and bone density development will have improved knowledge about osteoporosis and improved confidence in health behaviors for bone density development as well as improved bone-health lifestyle behaviors compared to adolescents who do not participate in an in-service educational program. Methods and Measures: Eighty four girls from two high schools in a north eastern city school district participated. One school was randomly determined as the treatment and the other as the control group. Pretests on knowledge, self-efficacy, calcium intake, and previous day physical activity were collected in the treatment and control groups. Two to three days after the initial testing, an educational in-service program about osteoporosis and osteoporosis prevention was presented to the treatment group during a 50-minute class-time block. Time was allowed for planned discussion and a calcium-rich snack. No educational in-service program was given to control group participants. Approximately a week after the educational in-service, the four test instruments were again given to all students. The differential effects of intervention vs. no intervention were determined using 2 x 2 analyses of variance. Seven dependent variables from the four test instruments were analyzed. Results: 1) Significant differences were found for the main effect of time and the main effect of group on all measures of the Osteoporosis Knowledge Test: total scores, exercise subscale scores, and calcium subscale scores. The scores were much higher at posttest for the treatment group while posttest scores remained similar to pretest scores for the control group. 2) Scores for improved confidence for conducting activities related to osteoporosis prevention were encouraging. While there were no main effects for group or time of testing, there was a significant interaction of the two. The treatment group showed significantly greater increases for self-efficacy from pretest to posttest compared to participant scores in the control group. 3) Although the interaction analyses for the behavioral tests were also significant, both for calcium consumption and metabolic equivalent task (MET) values of physical activity, performance trends did not exhibit patterns like that of the OKT and OSES, and may be misleading. Conclusion: An osteoporosis educational in-service can significantly improve overall knowledge in high school girls as well as their confidence for exercising and calcium consumption; however, it is not clear that an educational in-service alone is an adequate intervention to change nutrition or exercise lifestyle behaviors.

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    Sensitivity and Specificity of a Two Step Screening Procedure For Four to Six Month Old Infants

    Published Year: 2007
    Specialization: Pediatrics

    Meade, Vickie A.

    The federal government recognized the importance of early and accurate identification of children with developmental delay or disability through legislation, the Individuals with Disabilities Education Improvement Act (IDEIA), which requires states to set up methods to find eligible children. Epidemiologists suggest that 10% to 17% of the pediatric population could benefit from early intervention, yet less than half are identified by elementary school age. Physical and occupational therapists have the vision, knowledge, and skills to be actively involved in community child find efforts to identify these children. The purpose of this dissertation was to create a screening procedure, combining Dworkin’s model of surveillance with detection, and determine efficacy. The model used two steps, parent concerns and an observational screening tool, to identify children with developmental delay. An observational and correlational screening study was held in Houston County, Minnesota over a one year time period. Parents of eligible infants were invited to attend one of five clinics. Of the 213 eligible families invited to attend screening clinics, 55 infants were screened. Forty three were evaluated by the principal investigator, who was blind to all screening information. Parent concerns were measured in step one, by their choice to attend screening clinics and also their scores on the Parent Concerns Survey, a questionnaire including selected Parent Evaluation Development (PEDS) questions and two additional questions eliciting parent estimation of their child’s development and feeding concerns. Parents who chose to attend the screening clinics were later compared to a random group of parents who chose not to participate, to ensure that the two groups were comparable. Infants identified by parent concerns were tested with an observational screening test, the Meade Movement Checklist (MMCL) in step two. Parents attending the clinics had significantly more concerns on the modified PEDS than parents who did not attend. Sixty one percent of parents expressed concerns about feeding issues. Significant correlation was found between the MMCL and Movement Assessment of Infants and Bayley Scales of Infant Development II. No correlation occurred with scores between 4 and 6 months of age and the pass/fail on the Ages and Stages Questionnaire between 8 to 9 months of age. The specificity of the modified PEDS was 48% and sensitivity was 80%. The following psychometric qualities were found for the MMCL: specificity 88.2; sensitivity 77.8; positive predictive value (PPV) 63.6%; and negative predictive value (NPV) 93.8%. When Bayley Scale scores and medical diagnosis categories were combined to determine referrals, 15 infants were referred for further evaluation (27.7%). Referrals represented 7.04% of the 213 families’ invited and 34.8% of the independent evaluations completed. Screening 25% of a birth cohort identified by parent concerns, resulted in high specificity (88.2%) and high sensitivity (77.8%) in identifying infants at 4 to 6 months of age. Increasing specificity and combining two tests effectively increased PPV to 63.6% and NPV to 93.8% in this community. The model decreased professional time to successfully address current barriers to infant screening recommendations. Priorities for future research include further investigation of methods to estimate the number of clinic attendees, maintain screener reliability over time, create flexible testing times, and evaluate dollar costs of clinic and follow up personnel.

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    Potential Risk Factors Related to Diagnosis of Torticollis

    Published Year: 2013
    Specialization: Pediatrics

    Miles, Cindy

    Purpose: To investigate potential risk factors associated with torticollis in infants diagnosed less than 24 months of age. The potential risk factors included: 1) infant positional preferences, 2) sleep position factors, 3) infant factors, 4) obstetrical and birt factors, 5) family factors, and 6) torticollis diagnostic factors. Methods: Case control design with a convenience sample of 100 children diagnosed with torticollis and 200 controls without a diagnosis of torticollis. Data collected included chart review of case subects and caregiver interview of both case and control groups. Results: Infants with torticollis were significantly more likely to have a diagnosis of reflux, delayed development, and/or a congenital anomaly than infants in the non-torticollis control group. Infants with torticollis demonstrated positiional perference during the first few months, aversion to prone, and a preference for feeding to one side. Eighty seven percent of both infants with torticollis and non-torticollis slept in supine. Infants with torticollis were significantly more likely to have spent greater than 30 minutes per day in supine and sitting devices and have spent less than 15 min per day in prone than infants without torticollis. Parents of infants with torticollis were significantly more likely than parents of infants without torticollis to have reported they did not receive instructions from their physicians to place their infant in prone during non-sleep time. Cranial and fascial asymmetries were significantly higher among infants with torticollis compared to infants without torticollis. Conclusions: This study revealed a combination of obstetric and infant positioning factors that were significantly associated with the diagnosis of torticollis. When considering a 24-hour period, infants with torticollis were significantly were more likely than mothers of infants without torticollis to have reported pain during the last few week of their pregnancy. The findings of this study warrant that more research is needed to discern the amount of time infants spend in non-prone positions and risk of torticollis.

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    Congenital Muscular Torticollis: Severity Classification System Psychometrics and Parent Experiences with Diagnosis and Intervention

    Published Year: 2019
    Specialization: Pediatrics

    Oldezka, Magdalena Maria

    Congenital muscular torticollis (CMT) is a common musculoskeletal deformity observed at birth or in infancy. The purposes of this study were to: 1. establish inter- and intrarater reliability for determining severity grades of the Congenital Muscular Torticollis Severity Classification System, 2. examine the relationship between congenital muscular torticollis severity clasification grades and the length of treatment, 3. investigate, and analyze and describe the experiences of parents and infants diagnosed with CMT, and 4. compare the experiences of parents of infants with mild grade versus severe grades of involvement based on the CMT-SCS.

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    Learning Needs During a Group Parent-Training with Parents of Children with Sensory Over-Responsivity: A Mixed Methods Study

    Published Year: 2020
    Specialization: Pediatrics

    Porter, Lisa M.

    Parent training is an essential and well-documented component of pediatric occupational therapy. For parents of children with Sensory Over-responsitivity (SOR), which is linked to high levels of parental anxiety and decreased parenting self-efficacy, training opportunities are particularly important. This study used a mixed-methods design to explore the lived experiences of parents of children with SOR and the possible relationships between parenting self-efficacy (PSE) and program satisfaction. The 3-part group parent-training intervention was designed for parents of children with SOR, with an emphasis on problem-solving and active learning. The purpose was to improve understanding of parents’ learning needs and expectations of a group training. Data from participants’ responses to surveys and semi-structured interview questions were mixed and analyzed to provide a deeper understanding of parents’ varied learning needs during the group training. Key findings indicate that while PSE may play an essential role in training, participants’ self-perceptions of efficacy very greatly and is therefore not a valid measure of parents’ satisfaction or learning needs. Qualitative findings illuminate parents’ learning experiences during the group training, and the mixing of data further corroborate the fluctuation in PSE. Therapists should consider parents’ varied learning needs, and assess children through a family system lens, allowing for variability in the sense of competence and further support parents of children with SOR and other sensory-based challenges.

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    Effect of the Built Environment on the Playground Participation of Ambulatory Children with Cerebral Palsy

    Published Year: 2012
    Specialization: Pediatrics

    Pratt, Brenda

    Purpose: To compare the effect of two different built playground environments on the physical activity levels and support needs of ambulatory children with cerebral palsy during playground play. Methods: Five seven- to eight-year-old children with ambulatory cerebral palsy participated in an alternating treatment, single-subject design. Step activity pattern and support need measurements were obtained on an American with Disabilities Act Accessibility Guidelines (ADAAG)-compliant and non-compliant built playground. Results: Level of support for the hypotheses varied on the basis of the outcome measurement and participant. Four of the five participants showed an increase in the number of steps taken on an ADAAG-compliant playground. All participants exhibited increased medium and/or high activity levels during play on an ADAAG-compliant playground. Three of the five participants demonstrated greater independent play on an ADAAG-compliant playground. Conclusions: Children with ambulatory cerebral palsy (GMFCS II) may benefit from an ADAAG-compliant playground to increase their physical activity and its intensity. Less clear is the affect of an ADAAG-compliant playground on the degree of independent play. Further research is needed to determine the most important variables that positively influence community-based physical activity for children with ambulatory cerebral palsy.

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    Effects of Positioning On Respiratory Measurements In Individuals With Cerebral Palsy And Severe Scoliosis

    Published Year: 2008
    Specialization: Pediatrics

    Robertson, Sheila Y.

    Purpose: This study was designed to examine the effects of positioning on respiratory measurements in individuals with cerebral palsy and severe scoliosis. Methods: Five individuals (17-37 years of age) participated in an alternating treatment single subject research design. Oxygen saturation, respiratory rate, pulse rate, and chest wall excursion measurements were obtained during supine, sitting, and sidelying positions. Results: Positioning in sitting and sidelying was associated with increased oxygen saturation and decreased respiratory rate. Pulse rate did not change as expected with the positions due to large variances within and between subjects. Chest wall excursion values were limited in all positions due to structural restrictions. Clinical observations such as increased communicative interactions, decreased effort in breathing and in frequency of suctioning were found in sitting and sidelying in certain subjects. Conclusions: Therapeutic positioning in sitting and sidelying may be preferred over supine, and associated with improved oxygen saturation and respiratory rates for adolescents and adults with cerebral palsy and scoliosis. Further research is needed with a larger population to empirically link specific positions with improved respiratory efficiency across various parameters.

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    The Effects of Aerobic Exercise on Endurance, Strength, Function and Self-Perception in Adolescents with Spastic Cerebral Palsy

    Published Year: 2002
    Specialization: Pediatrics

    Schlough, Kathleen

    Purpose: The purpose of this study was to investigate the effects of aerobic exercise on endurance, strength, function, and self-perception in ambulatorry adolescents with spastic cerebral palsy. The intent was to utilize fitness equipment readily available in schools, colleges, and community fitness centeres and testing procedures, which can be easily adapted to clinical settings. Methods: Three participants with varying classifications of spastic cerebral palsy were involved in the single systems A1B1A2B2 design to study changes before, during and after two different regimens of aerobic exercise. Data collection during the different phases included the energy expenditure index (EEI), measurement of lower extremity muscle strength using a handheld dynamometer, the Gross Motor Function Measure (GMFM) and the Self-Perception Profile for College Students (SPPCS) Results: One participant showed a significant improvement in the EEI, one had no change in EEI and another participant showed a significant deterioration in EEI, however all participants had a significant improvement in at least one of the components of the EEI. Combined mean strength of bilateral quadriceps, hamstrings, plantarflexor and dorsiflexor muscles increased for all participants. Gross motor function improved for all participants in at least one phase of the study. There was an improvement in the self-perception of appearance for all participants. Two participants improved the symmetry of muscle strength in the lower extremities. The initial exercise intervention phase showed some evidence of overtraining effects. Conclusions: The use of aerobic exercise, while maintaining the HR at appropriate levels, may aid in increasing the strength of the lower extremity muscles, decrease the amount of energy required to ambulate, improve gross motor function and improve self-perception for some adolescents with spastic cerebral palsy.

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    Consistency of Identification by School Personnel of Children with Developmental Coordination Disorder in the Public School Setting

    Published Year: 2009
    Specialization: Pediatrics

    Stemm, Katherine A.

    This study was designed to investigate the reliability and validity of the newly revised second edition of the Movement Assessment Battery for Children Checklist and Test to determine its usefulness in the public school setting to identify children with motor coordination difficulties.

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    Reliability And Validity of the Heel-Rise Test for Children

    Published Year: 2002
    Specialization: Pediatrics

    Yocum, Allison A.

    Purpose: The purpose of this study was to establish a standardized protocol for the heel-rise test for children, document reliability and validity of this protocol, and establish beginning normative heel-rise values for typically developing children between the ages of 5 and 12 years. Subjects: The sample consisted of 57 typically developing children and 34 children with plantarflexion weakness. Each subject group was divided into four age groups: 5 to 6, 7 to 8, 9 to 10, and 11 to 12 years. Methods: All 91 children participated in three tests of lower extremity strength: the heel-rise test, the vertical jump test, and a force test measured with a hand-held dynamometer. The heel-rise test involved a laser pointer, mounted on a tripod base, projecting a 2 foot horizontal line on a wall and marking 50% of each subject’s maximum vertical plantarflexion excursion. Children faced the wall used fingertip support for balance, and performed heel-rises to exhaustion, breaking the laser beam with each repetition. Vertical jmp height was measured and recorded along with the force values obtained with a hand-held dynamometer from three isometric plantarflexion contractions. The reliability assessment included examination of intrarater, interrater, and test-retest reliability. Both construct and concurrent validity were examined and reported. Finally, beginning normative values along with analyses of the relationships between the number of heel-rise repetitions and gender, age, height, weight, and activity level of the subjects were examined. Results: The Intraclass correlation coefficient was 0.997 for intrarater reliability and the ICC measured 0.99 for interrater reliability and 0.911 for test-retest reliability. Pearson product moment correlation coefficients were 0.693 and 0.454 when heel-rise scores were compared to the vertical jump and handheld dynamometer values respectively. Children with weakness performed significantly fewer heel-rises than typically developing children. In the typically developing group, the mean number of heel-rises increased linearly with age: 12.7, 18.6, 22.1, 31.6 repetitions for the 5-6, 7-8, 9-10, and 11-12 year old children respectively. Scores from the two youngest age groups differed significantly from the scores achieved by children in the oldest age group. Children age 5 to 8 years performed a mean of 15.1 (plus or minus) 5.4 repetitions and children age 9 to 12 years performed a mean of 27.7 (plus or minus) 11.7 repetitions. Males performed a greater number of repetitions than females. Age, height, and weight were all significantly and moderately correlated with the number of heel-rises. No significant correlation was found between heel-rise repetitions and activity level of the subjects. Conclusions: A standardized protocol for the heel-rise test in children is documented. This protocol is both reliable and valid for use in 5 to 12 year old children with and without plantarflexion weakness. The mean results may serve as guidelines for assessing performance until normative values are established with a larger number of children. The influence of age, gender, height, weight, and activity level should also be further explored with a larger sample.

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Sports

    Strength and Conditioning Coaches’ Emotions, Emotional Labor, and Reflective Practice During Interpersonal Problems with Their Athletes in the Weight Room

    Published Year: 2023
    Specialization: Sports

    Abitz, Crystal Lee

    This autoethnographic account illuminates the integration of emotions, emotional labor, and reflective practice of a young, female strength and conditioning coach as she worked to reslove an interpersonal problem with a male athlete during the American football season. The lead author referred to her reflective journal from this season and engaged in retrospective reflection-in-action by writing analytical memos. She collaborated with the co-authors to develop an analytic and evocative account of her strength and conditioning coaching stories integrated with theoretical concepts. We drew upon the works of Goffman and Hochschild to depict the emotions and EL of the lead author during her front stage and backstage coaching performances. Furthermore, we can see the integration of emotions and EL throughout Schon’s reflective practice cycle. With this new knowledge, coaches and coach developers may mitigate the negative effects from EL associated with experiencing and resolving interpersonal coaching problems.

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    The Effectiveness of a Prevent injury, Enhance Performance (PEP) Program on Improving the Neuromuscular Performance of 14 to 18 Year Old High School Female Basketball Players Friend

    Published Year: 2003
    Specialization: Sports

    Amundson, Friend Mark

    Study Design: Randomized controlled trial of a convenience sampling. Objective: To determine the effectiveness of a Prevent injury, Enhance Performance (PEP) program in improving the neuromuscular performance of 14-to-18 year old female high school basketball players. Background: Studies have identified female basketball players to be at high risk of anterior cruciate ligament (ACL) injuries and have also shown that interventions that improve neuromuscular performance can decrease the incidence of ACL injuries. Therefore, the effectiveness of a basketball modified PEP program in improving the neuromuscular performance of 14-to-18 year old female basketball players was investigated. Method and Measures: A convenience sample of 40 14-to-18 year old high school female basketball players was randomly assigned to one of two groups, an experimental group of 20 that participated in the PEP program prior to basketball practice and a control group of 20 that participated in a traditional warm-up prior to basketball practice. Pre and posttesting of neuromuscular performance consisted of three timed hop-tests: the 6-meter hop, crossover hop, and agility hop tests. A 2x3s analysis of variance (ANOVA) for analysis of the time to complete the hop tests and one-tailed paired t-tests for completion rate of the crossover hop test were used. Results: Those participating in the PEP program demonstrated significant improvement in their performance of one of the hop tests, the crossover hop test. These results provide evidence that when using the crossover hop as the outcome measure, the PEPE program did improve the neuromuscular performance of the 14-to-18 year old female basketball players within this study. Conclusion: This study demonstrated that the modified for basketball PEP program was effective in improving the subjects’ ability to perform a specific neuromuscular performance task, the crossover hop test. Future research is needed to determine the efficacy of the PEP program in decreasing the rate of ACL injuries among female adolescent basketball players.

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    Nutrition Knowledge Modification Following A Brief Education Intervention In Middle And Junior High School Students

    Published Year: 2007
    Specialization: Sports

    Black, Stephen A.

    The obesity epidemic, the increasing occurrence of adult diseases in childhood, and the growing awareness of a connection between adult diseases and the diet of children and adolescents has led to increased interest in adolescents’ diet. However, there are many challenges in evaluating and addressing adolescents’ eating habits. The purposes of this study were: 1) to determine whether a school-based nutrition education intervention can improve food choice knowledge and eating patterns in middle and junion high school students, and 2) to determine if there is a significant difference between lecture, video, and lecture/video delivery methods in terms of behavior change of middle and junior high school students.

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    The Effects of a Novel Ground-Based Movement Training Program on Functional Movement, Range of Motion, Muscular Strength and Endurance

    Published Year: 2019
    Specialization: Sports

    Buxton, Jeffrey

    Ground-based movement training (GBMT) is a form of bodyweight training that incorporates various animal poses, transitions, and crawling patterns to reportedly improve fitness and performance. Unfortunately, little evidence exists to validate such claims and to guide practitioners in the best use of GBMT. Therefore, the purpose of this study was to assess the impact of 8 weeks of a commercially available GBMT program, using the Animal Flow system, on functional movement, dynamic balance, active joint range of motion, and upper body muscular strength and endurance. Forty-two physically active college-age subjects were randomly assigned to a GBMT or control group. The GBMT group performed 60-minutes of GBMT twice a week for 8 weeks in addition to their normal physical activity, while the CON group maintained their normal physical activity throughout the intervention period. The GBMT group showed significantly greater improvements than the CON group in overall functional movement screen composite score, functional movement and fundamental stability scores, hip flexion, hip medial rotation and shoulder extension. Our results indicate that GBMT can improve functional movement patterns and various active joint ranges of motion.

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    The Effects of Closed Kinetic Chain Versus Open Kinetic Chain Upper Body Resistance Training on Serve Velocity in Junior Tennis Players

    Published Year: 2019
    Specialization: Sports

    Chandler, Walter B.

    Several exercise training methodologies have been studied for their effects on performance in overhead sports such as baseball and tenis. Multiple studies have demonstrated that lower body closed kinetic chain (CKC) exercises produce greater improvements in performance compared to open kinetic chain (OKC) training. However, evidence comparing the effects of upper body OKC and CKC training on performance is limited. The purpose of this study was to compare the effects of an upper body CKC resistance training program to an OKC resistance training program on maximal serve velocity (MSV), average serve velocity (ASV), seated 1-arm medicine all shot put distance (MBT), 3 repetition maximum (RM) bench press strength (BP), push-up repetitions (PU), and modified pull-up repetitions (MPU) in competitive junior tennis players. Sixteen subjects performed a total body resistance training program 3 times per week for 8 weeks. The results of this study showed that both OKC and CKC training produced improvements in both ASV and MSV but there was no significant difference between groups for either ASV or MSV. However, there was a difference between groups in both dominant and non-dominant MBT with the CKC training group producing significantly greater improvements. Both groups showed improvements in BP, PU and MPU with no significant differences between training groups. These results suggest that both OKC and CKC upper body training can be used to improve upper body strength ad serve velocity in competitive junior tennis players.

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    Integrated Versus Pilates Based Core Training in Collegiate Dancers

    Published Year: 2020
    Specialization: Sports

    Elmore, Grayson

    Purpose: Collegiate dancers (CDs) require prominent levels of muscular strength, endurance, power, and balance to achieve optimal performance. Core training (CT) purportedly improves CDs’ explosive power and dynamic balance. However, much of the available CT evidence for CDs are quasi-experimental designs that lack a control group and are specific to the Pilates CT methodology. Therefore, the present study aimed to determine the effects of distinct CT programs on CDs jumping and dynamic balance changes using a more rigorous study design. Methods: Thirteen non-resistance trained male and female CDs were randomly assigned into and eight-week mat-based Pilates, eight-week strength endurance CT program, or a non-CT control group. The participants had no prior experience with the exercise interventions. They completed a single-leg horizontal hop, Y-Balance Test Lower Quarter (YBT-LQ), and Y-Balance Test Upper Quarter (YBT-UQ) assessment before and after their eight-week intervention to determine changes in explosive power and dynamic balance. Results: A factorial repeated measures ANOVA was used to compare group and time for the SLH, YBT-LQ, and YBT-UQ assessments. The Pilates group had greater SLH changes over time as compared to the control and integrated groups. YBT-LQ composite score (right lower extremity) increased for both the integrated and Pilates group over time but remained similar for the control group. YBT-LQ composite score (left lower extremity) increased for both the integrated and Pilates group over time but remained similar for the control group. YBT-UQ composite score (left upper extremity) increased over time for the Pilates group but remained similar for the control and integrated groups. Conclusions: Pilates and strength endurance CT programs lead to positive changes in non-resistance trained CDs explosive power and dynamic balance over an eight-week duration. While the results do not show a difference between CT groups, they show improvement across the outcome variables for the participants who completed a CT program. Practitioners and dance instructors can use the present study programs to implement affordable, efficient, and flexible exercise programs into their existing dance curriculums.

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    A Comparison of Temperature Increase in Human Muscle During 3 MHz Continuous and 3 MHz Pulsed Ultrasound With Equivalent Temporal Average Intensities

    Published Year: 2004
    Specialization: Sports

    Gallo, Joseph A.

    Study Design: A repeated measure cross-over design was used. The indepentent variable was the type of ultrasound (pulsed or continuous) and the dependent variable was intramuscular temperature. Objective: To compare changes in intramuscular temperature of pulsed ultrasound against continuous ultrasound with an equivalent spatial average temporal average (SATA) intensity. Background: There is a lack of research on the heat generating capabilities of pulsed ultrasound within human muscle. Methods and Measures: Subjects were 16 volunteers free of left lower extremity injury. Each subject was treated with pulsed ultrasound and continuous ultrasound during a single testing session. Tissue temperature returned to baseline and stabilized between treatments and treatment order was randomized. Tissue temperature was measured every 30 seconds using a 26-gauge needle microprobe inserted at a depth of 2 cm in the left medial gastrocnemius muscle. Data were analyzed using a linear mixed model. Results: Treatment with continuous ultrasound produced a mean temperature increase of 2.8, 0.8C above baseline. Treatment with pulsed ultrasound produced a mean temperature increase of 2.8, 0.7C above baseline. Statistical analysis revealed no significant differences in either the extent or rate of temperature increases between the two modes of ultrasound application. Conclusion: Pulsed ultrasound produces similar intramuscular temperature increases as continuous ultrasound at a 2 cm depth in the human gastrocnemius. Spatial average temporal average intensity is an important consideration when selecting pulsed ultrasound parameters intended to deliver “non-thermal” effects.

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    The Effects of Pelvic Tilt Training on Anterior Pelvic Tilt, Vertical Jump Kinetics, and Jump Height

    Published Year: 2021
    Specialization: Sports

    Gatzke, Bryan

    Jumping ability is a defining characteristic of an athlete’s performance during volleyball, with greater ability providing a competitive advantage. Current research focuses on combining plyometric, resistance, and power exercises to increase jumping performance. However, additional characteristics have yet to be evaluated fully, including skeletal alignment and the role of alignment in the kinetic change. The purpose of this study was to examine the effects of an eight-week group training intervention program on improving anterior pelvic tilt and its effect on vertical jump kinetics and countermovement jump height in women volleyball players compared to a control group with a volume-matched program. The study was a pre-test post-test prospective randomized control design. Thirteen women volleyball athletes were recruited for thie pre-test post-test prospective randomized control study. Participants were randomly assigned to a pelvic tilt training group or control group. Participants completed 15 training sessions over five weeks and data were collected for (1) pelvic tilt, (2) peak ground reaction force during takeoff, (3) time-to-takeoff, (4) flight time, (5) jump height, (6) peak power, (7) propulsive impulse, (8) eccentric impulse, (9) time-to-stabilization, and landing (10) peak ground reaction force during. A MANOVA was used to assess pre- and post-test differences in treatment effect for peak power, peak ground reaction force on landing, and time to stabilization. Additionally, a paired T-test was used to assess changes in pelvic tilt, peak ground reaction force on takeoff, time to takeoff, flight time, jump height, propulsive impulse, and eccentric impluse. There was no significant difference in any of the varilables assessed. The use of core-specific exercises for decreasing pelvic tilt and improving kinetic measzures during a countermovement jump demonstrated non-significant improvements in anterior pelvic tilt and vertical jump kinetics. Using a pelvic tilt training program altered anterior pelvic tilt and kinetic variables of the countermovement jump, albeit not significantly, while a volume match core program produced similar improvement in anterior pelvic tilt and kinetic variables in the control group.

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    The Effect of Load on the Functional Movement Screen In-Line Lunge and its Scoring Criteria

    Published Year: 2021
    Specialization: Sports

    Leshinske, Brad

    Background: The Functional Movement System (FMS) is a pre-participation evaluation tool used among physical therapists, strength coaches, personal trainers, and athletic trainers to identify movement deficiencies. The FMS displays intra-rater and interrater reliability but has been challenged regarding the validity of the composite score and its use to predict injuries. Also, several studies have examined the impact of a weight vest on the FMS screen in firefighters. The purpose of this study is to investiigate how load may impact the FMS scoring system, specifically the Inline Lunge (ILL) and overall movement using a weight vest based on percent bodyweight (BW) in collage age athletes 18-24 years old. The primary investigator hypothesizes that load will impact the ILL with 10% or 20% BW load. Study Design: A quasi-experimental design was used to properly assess the impact of load on the scoring criteria of the FMS’s ILL> A p-value of <.05 was set to determine statistical significance. A Wilcoxon Signed Ranked test was used to determine significance between BW, 10% and 20% additional load. A Spearman Rho test was used to determine the magnitude of the relationship. Furthermore, a ROC curve was used to show how sensititve the ILL was to load. A 2×2 table was used to establish significance and effect size. Purpose: This study aimed to establish the sensitivity of the FMS ILL to load and look at the differences between the right and lef sides when a load is applied. Methods: A convenience sample of 23 student-athletes from Saint Xavier University performed the Inline Lunge as instructed from the Functional Movement System (FMS). The participants performed the FMS ILL without load, and if a score of 2 or 3 were attained on each leg, participants would retest wearing a weighted vest to include 10% of their bodyweight (BW). If a score of 2 or 3 were achieved on each leg, an additional load would be added to the weight vest equaling 20% of their bodyweight to produce a final FMS score for each leg. Results: The ROC analysis showed that the left side under 20% load was sensitive and proved to be an accurate test. In the comparison between right and left sides, a Wilcoxon Signed Rank Test showed that a load of 10% BW did not elicit a significant difference compared to the bodyweight inline lunge on the right side. However, a difference was shown on the left. A load of 20% resulted in a significant difference on both right and left sides compared to a bodyweight lunge. When comparing right and left sides to loads of 10% and 20%, significance was reached on the left side only. Large effect sizes were seen with 10 and 20% loads on the left side. Loads of 10 and 20% on the right side showed a moderate effect size but lacked significance. When comparing limbs, the 10% load was moderate but lacked signficance, where the load of 20% was large and significant. Conclusions: The results of this study indicated that the addition of load does play a role in the scoring of the FMS inline lunge on both the left side and right side with 20%, a load of 10% on the left side, and a change of load on the left side from 10-20%. Sensitivity was seen only on the left side with a 20% load. Limb differences were explicitly seen with loads of 20% and a change of load from 10-20% on the left side. The results of this study will help practitioners understand how to load their clients more effectively in knee dominant movements, understand the FMS screen more indepth, utilize applying load based on bodyweight to establish proper resistance to the knee dominant movement, and understand limb asymmetries better.

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    The Effects of a Land-Based Home Exercise Program on Surfing Performance in Recreational Surfers

    Published Year: 2022
    Specialization: Sports

    Monaco, Jerry-Thomas

    In the past 20 years, surfing has become a popular, non-age dependent sport that can be performed at most ocean beaches. As it gains exposure, surfers have recognized the importance of physical preparation to enhance their performance and reduce injury risk. This realization has led to an increase in the study and practice of biomechanical and environmental analysis as well as training methodologies for the competitive surfer. As a result, coaches and athletes are including land-based training protocols to maximize the competitive surfer’s performance and are designing them based upon their surfing schedules. Not only is this training important for competitive surfers, but also for surfers who engage in this sport recreationally. Therefore, the aim was to provide a needs analysis of surfing components such as environmental factors, biomechanical and physiological demands, and current training methods for performance enhancement.

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    Effectiveness of Shoulder Positioning in Isokenetic Strength and Throwing Velocity in High School Basketball Pitchers

    Published Year: 2003
    Specialization: Sports

    Mulligan, Ivan J.

    Baseball is enjoyed by millions in the United States every year. One of the more prevalent positions in baseball for injury is the pitcher. Baseball pitchers place the throwing shoulder under tremendous stress. For this reason, the shoulder in the throwing athlete has been the subject of extensive research. The purpose of this study was four-fold: 1) to determine the isokinetic profile of shoulder internal and external rotators of concentric and eccentric contractions of the nondominant and dominant shoulder in high school aged baseball pitchers; 2) to determine if a clinical examination could be used to determine scapular weakness which then could be used in a preseason screening to possibly prevent injuries; 3) to determine if a pitcher who demonstrated scapular weakness would exhibit more pain and limitations when examining the postseason questionnaire; and 4) to determine if placing the shoulder in a posterior position enhances isokinetic strength and velocity.

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    Preceding Workload Patterns Influence Performance in NCAA Division I in Ice Hockey

    Published Year: 2020
    Specialization: Sports

    Neeld, Kevin L.

    Maximizing performance requires a strategic approach to providing both sufficient stimuli for physiological adaptation, as well as appropriate time for recovery. To optimize preparatory training for a give sport, it is important to identify both the demands of competition and how the workload characteristics of practice relate to in-game demands. External load monitoring using Catapult S5 units offers one valid method of quatifying the kinematic characteristics of sport participation. Previous research has identified that specific workload patterns are associated with injury risk. The mechanisms proposed to explain this relationship should also impact performance. The purposes of this study are to 1) determine differences in workload characteristics between practices and games; 2) assess differences between forwards and defensemen; 3) determine the impact of preceding workloads on game workload; and 4) identify if preceding workloads influence game performance.

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    Hip Weakness and Overuse Syndromes in Recreational Runners

    Published Year: 2003
    Specialization: Sports

    Niemuth, Paul E.

    The purpose of the study is to test for differences in strength of six muscle groups of the hip on both the involved and uninvolved legs in recreational runners experiencing overuse injuries.

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    Prevalence, Risk Factors, and Quality of Life Concerning Stress Urinary Incontinence in Female Athletes Participating in Strength Sports

    Published Year: 2020
    Specialization: Sports

    Rohde, Meghan

    Stress urinary incontinence (SUI) is a complaint of involuntary loss of urine during effort or physical exertion, or during sneezing or coughing. Stress urinary incontinence is frequently a symptom during pregnancy and in the postpartum periods. However, it also affects women in sport. There is a paucity of literature in the strength and conditioning and personal training communities related to urinary incontinence in female athletes. Many women will avoid reporting symptoms to physicians, coaches, personal trainers, and athletic trainers, and believe SUI to be a normal part of the athletic and aging process. The purpose of this study was to identify the scope of the problem of SUI in women participating in strength sports, movement patterns that elecit SUI, and the impact on the quality of life in female athletes with SUI. Female athletes, age 18-65 who participate in strength sports of Olympic weightlifting, powerlifting, and CrossFit were included in the study.

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    Upper Body Power As Measured By Medicine Ball Throw Distance, And Its Relationship To Class Level Among Ten And Eleven Year Old Female Participants In Club Gymnastics

    Published Year: 2002
    Specialization: Sports

    Salonia, Maria

    The purpose of this study was to determine whether or not there was a relationship between upper body power and class level among female club gymnasts. Sixty female gymnasts between the ages of ten and eleven and between class levels five and eight participated in the study. The distance of a medicine ball throw was used to measure upper body power. Three types of throws, the overhead forward, overhead backward, and chest pass, were performed using a six-pound rubber medicine ball. The mean distances of two trails were calculated and categorized into age group and class level. An ANOVA design was used to determine the relatiionship between mean throw distance and throw type, age, and class level. No significant differences were found between mean throw distance and throw type, age, or class level. The results of this study show no relationship between upper body power of female gymnasts and throw type, age, and class level.

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    An Investigation into a Soccer-Specific Exercise Designed to Improve Acceleration and Maximum Sprinting Speed in Female Soccer Players

    Published Year: 2020
    Specialization: Sports

    Shrum, Brian

    Objective: This study aimed to determine if sprinting speed can be trained within a soccer-specific situation, how the contextual elements of the game impact the demand of the exercise, along with the emotional responses on a player’s milieu. Method: This study used a quasi-experimental sequential explanatory mixed-method design. Phase I was a pre-test/post-test, six-week intervention. A total of 39 participants were included in the final analysis. Phase II used a telephone interview of thirteen participants selected based on aspects of compliance and completion of the intervention. A grounded theory approach was used to analyze the collected data. Results: Partipants improved in sprinting speed regardless of the format of the exercise. However, higher ratings for motivation and enjoyment were found in the SSE group compared to the ILS group. Coaches identified applicability via traditional methods, exercise format, importance to performance, and coaching information. Participants associated internal motivation via training intensity and perceptions of training, and finally, perceptions of their attitude via attitude, competitiveness, enjoyment, and motivation. Conclusion: Speed development in soccer can be trained with contextual elements specific to a frequent situation. Training intensity may be higher. However, a player’s enjoyment and motivation are higher when elements of the game are used within the training exercise.

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    Diagnostic Values of Two Labral Tests in Patients with Shoulder Pain

    Published Year: 2003
    Specialization: Sports

    Steinley, Maurie S.

    Principle Investigator: Maurie Steinley, PT, MS Study Design: Quasi-experimental. Objectives: 1) To determine if the high diagnostic values found in original research for the Active Compression Test and the Pain Provocative Test are reproduced, 2) Examine the two labral tests, which show good promise of being accurate clinical examination procedures, in a comparison to identify subtle quantifiable differences in the tests, and 3) Examine the Pain Provocative Test in a broader patient population and determine if it maintains high diagnostic values for labral tears. Background: In original research, the Active Compression Test and Pain Provocative Test demonstrated high levels of sensitivity, specificity, positive predictive values and negative predictive values for diagnosing SLAP lesions in the shoulder. Methods and Measures: The two tests were performed on 53 patients (two bilateral for a total of 55 shoulders) who subsequently underwent a shoulder surgical procedure and/or a magnetic resonance arthrogram (MRA). The results of the physical examination were compared with the surgical and/or MRA findings and analyzed for sensitivity, specificity, positive predictive value, and negative predictive value. Results: A total of 50 shoulders were analyzed with five subjects excluded from data analysis. The Active Compression Test demonstrated a sensitivity of 55%, specificity of 77%, positive predictive value of 40%, and a negative predictive value of 86%. The Pain Provocative Test demonstrated a sensitivity of 33%, specificity of 74%, positive predictive value of 23%, and negative predictive value of 83%. Conclusions: This study did not reproduce the high levels of diagnostic values found in the original research of the Active Compression Test and the Pain Provocative Test.

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    The Effect of Voice Inflection Combined with an External Focus of Attention on Standing Long Jump Performance and Kinematics in 9-year-old to 11-year-old Novice Physical Education Students

    Published Year: 2021
    Specialization: Sports

    Verdin, Peter A.

    The purpose of the current study was to examine how voice inflection, a paraverbal communication element, combined with an external focus of attention (EFA) or interntal focus of attention (IFA) impacts jumping performance and kinematics. Participants included 21 male and female fourth and fifth-grade physical education students from Future Public School in Garden City, Idaho. The inclusion criterion was being in the fourth or fifth grade. Exclusion criteria were any injury, illness, or other circumstance that would have prevented the child from participating to the best of their ability. The injury was defined as any physical ailment that would negatively affect jump performance. Participants performed a standing long jump pretest under neutral conditions. Seven days later, participants were randomly assigned to four groups using the pretest data, stratified into quartiles, as the blocking variable. These groups were: one that received an IFA without voice inflection (IN), an IFA with voice inflection (INI), an EFA without voice inflection (EX), and an EFA with voice inflection (EXI) on the standing long jump task. The two internal focus groups’ instruction was to jump toward a cone set at the distance of each subject’s pretest jump distance. There was a significant change pretest to posttest distance between groups. The IN and INI groups did not differ significantly prestest to posttest, nor did the EX and EXI groups. The EX and EXI groups both outperformed the INI group. There was a strong correlation between jump distances and body angles at takeoff. There was no significant effect on alpha between groups. Using a voice inflection on the adverb of the task instruction did not enhance jump distance or kinematics. On average, an external focus of attention improved jump distance, while an internal focus of attention resulted in participants performing worse. These results confirm the benefits of using an external focus of attention with children and novice skill participants.

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    Manual Therapy, Exercise, and Traction For Patients With Cervical Radiculopathy: A Randomized Clinical Trial

    Published Year: 2008
    Specialization: Sports

    Young, Ian A.

    Objectives: To compare the effects of manual therapy, exercise, and cervical traction to manual therapy, exercise, and sham traction on pain, function and disability in patients with cervical radiculopathy (CR). Summary of Background Data: To date, optimal strategies for the management of patients with CR remain elusive. Preliminary evidence suggests that a multi-modal program consisting of manual therapy, exercise and cervical traction, may result in positive outcomes for patients with CR. However, there exists limited evidence to support the use of mechanical cervical traction in patients with CR. Methods: Patients with CR were randomized into one of two groups: Group MTEXTraction (manual therapy, exercise and intermittent cervical traction) and Group MTEX (manual therapy, exercise and sham intermittent cervical traction). Patients were treaated on average 2 times per week for an average of 4.2 weeks. Outcomes measures collected at baseline, 2 weeks, and 4 weeks included the numeric pain rating scale (NPRS), patient specific functional scale (PSFS), and neck disability index (NDI). Results: Subjects in both groups experienced significant improvements in pain, function disbility at the 2 and 4 week follow-up. There were no significant differences between the groups for any outcome measure at 2 weeks or 4 weeks. Conclusions: The addition of intermittent cervical traction to manual therapy and exercise did not provide additional improvements in pain, function, and disability. Patients receiving either management strategy demonstrated improvements in pain, function and disability over the course of a 4 week treatment program.

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