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Research Abstracts
2006 Missouri Physical Therapy
Association Abstracts
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A Comparison of the Effects of Aerobic
and Resistance Training on predicted Vo2 Max
and 6 Minute Walking Distance in Healthy Weight,
Overweight, and Obese Individuals; a Pilot Study. Backs,
D.M., Filla, M.J., Poremba, A.V., Schenk, S.A.
Program in Physical Therapy, Maryville University,
St. Louis, MO.
Aerobic exercise is the gold standard for VO2
max (maximum oxygen uptake) training; however individuals
who are overweight or obese may be unable to participate
in a high intensity aerobic training program.
Purpose:
The purpose of this pilot study was to compare
the effect of a short term aerobic training program
versus a resistance training program on VO2 max
and 6 minute walking distance in individuals with
healthy weight, overweight, and obesity. The
clinical significance of the study was to determine
if resistance training would be an effective alternative
to aerobic exercise for patients of all body types
to improve aerobic capacity and general fitness.
Subjects:
The study consisted of a convenience sample of
12 untrained, healthy, female subjects ranging
in age from 19 to 29. The subjects were randomly
assigned according to BMI as follows: aerobic normal
weight BMI=18.5-24.9 (n=2), resistance normal weight
(n=5), aerobic overweight BMI>25 (n=2), and
resistance overweight (n=1). Two subjects
(both from the aerobic normal weight group) failed
to complete the training program due to an unrelated
injury and scheduling conflicts.
Methods
and Materials: The study contained a pre-test
session, a 6 week supervised exercise program (either
resistance or aerobic), and a post-test session. The
pre- and post-test measures included the Chester
Step Test for VO2 max and the 6 Minute Walk Test. A
univariate ANOVA was used for data analysis and
the significance level was set at p<0.05.
Results:
Tests showed no significant difference from pre-
to post-test or between exercise groups for VO2
max and 6 minute walking distance. The variable
of weight regardless of exercise type approached
statistical significance (p=0.078) for VO2 max. The
Pearson correlation showed no relationship between
VO2 max and 6 Minute Walk Test with a 6 week exercise
program (r=0.218).
Conclusions:
Despite the lack of statistical significance, the
results of VO2 max and walking distance were similar
following a training program of resistance or aerobic
training. Resistance training and aerobic
training did not demonstrate benefits on cardiopulmonary
endurance for this cohort of subjects.
Funding
Source: There was no funding source for
this study.
Contact: Matt Filla (314)808-5366. mfilla@maryville.edu
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Effect
of the SaeboFlex Orthosis on upper extremity
recovery in patients with chronic spastic hemiplegia: a
pilot study. Baker
D, Beck K, Fogarty J, Saabye S, Barry J.
Program in Physical Therapy, Maryville University
of St. Louis, MO. dlehnen@maryville.edu
The SaeboFlex orthosis is a new device designed
to aid wrist and hand release function in individuals
with limited upper extremity function and spastic
hemiplegia. We are not aware of any published
research on this device.
Purpose: The
purpose of this pilot study was to examine the
effects of a home exercise program utilizing the
SaeboFlex orthosis on the affected upper extremity
of individuals with chronic spastic hemiplegia. We
hypothesized that individuals would have improved
function, strength, and range of motion (ROM) following
an exercise program with the SaeboFlex orthosis.
Subjects: Subjects
consisted of four men and one woman with a mean
age of 58.2 years who had experienced spastic hemiplegia
secondary to cerebrovascular accidents (CVA) at
least six months prior to this pilot study (mean
chronicity 5.98 years). All participants
were right-hand dominant prior to CVA, three exhibited
hemiparesis on the right side and two on the left.
Methods
and Materials: This pilot study
was conducted as a single-group pretest-posttest
design. Each subject was issued and custom-fitted
with a SaeboFlex orthosis and instructed on the
performance of a specific exercise program focusing
on grasp and release tasks. They were instructed
to exercise 45 minutes twice daily, performing
at least 120 repetitions of grasp and release each
session. The subjects were pre and posttested
for outcome measures including: 1) wrist
extension PROM and index PIP flexion AROM by means
of goniometry 2) gross MCP extensor and wrist extensor
strength by means of MMT 3) grip strength by means
of hand-held dynamometry, and 4) upper extremity
function as measured by the Action Research Arm
Test (ARAT). One subject withdrew from the
study prior to completion. The other four
subjects performed the program independently for
six weeks with weekly follow-ups by the investigators.
Analyses: Parametric
data including wrist extension PROM, index PIP
flexion AROM, and grip strength were analyzed using
paired t tests. The remaining
nonparametric data including ARAT, gross MCP extension
MMT, and wrist extension MMT was analyzed using
Wilcoxen Signed Rank Tests. For this pilot
study, P values were used to look for
statistically significant changes and general trends
that support a larger study in the future.
Results: Among
the results of the four subjects who completed
the study, increased grip strength (P =
.05) was statistically significant. The P values
of the remaining outcome measures were: index PIP
flexion AROM (P = .12), wrist extension
PROM (P = .06), ARAT (P = .14),
and wrist extension strength (P = .14),
and MCP extension strength (P = .18).
Discussion/Conclusions: Despite
the limited size and resources and lack of supervised
exercise, the subjects did show a significant improvement
for grip strength in this pilot study. The
trends seen support the need for further research
to determine the efficacy of the SaeboFlex orthosis. Clinically,
the use of the SaeboFlex orthosis to help patients
with chronic spastic hemiplegia may help reverse
the tendency of learned nonuse and restore some
function of the affected upper extremity. The
investigators recommend that future studies involve
a larger and more diverse sample with a control
group and blinded testers. Skilled therapy
intervention in combination with a more intense
home exercise program should also be investigated.
Funding
Source: Saebo, Inc. loaned the braces
for the six-week study.
Contact: Deanna Baker (636) 352-9778. dlehnen@maryville.edu
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Concentric and Eccentric Strength Differences
of the Shoulder Rotators of
College-Aged Baseball Players with Elbow
Pain: A Pilot Study
Basden CM, SPT, Bolander MN, SPT, Heuschober
GR, SPT, Ross SA, PT, DPT, PCS
Purpose. It is critical
for physical therapists to identify muscular imbalances
that could relate to pain or pathology in distal
joints and subsequent limitations or cessation
of functional activities and athletic performance. The
purpose of our investigation was to determine if
there is a relationship between muscular imbalances,
both concentric and eccentric strength of the shoulder
rotators, and elbow pain in college-aged athletes. . We
hypothesized that in a group of symptomatic college-aged
baseball players, the dynamic strength ratios of
the throwing shoulder would be less than that of
asymptomatic college-aged peers. Additionally,
the relationship of internal and external rotational
shoulder strength would be inversely related to
the presence of elbow pain.
Subjects. Twenty-two
subjects between the ages of 18 and 23; eight baseball
players with elbow pain, six baseball players without
elbow pain, and eight control subjects. Exclusion
criteria included subjects with diagnosed shoulder
or elbow injuries or surgeries.
Procedures. Assessment
of demographic and subjective pain rating using
the Visual Analog Scale. Measurement of active
elbow extension. Concentric and eccentric
strength testing of shoulder rotators at speeds
of 180°.s-1 and 250°.s-1 using an isokinetic dynamometer.
Analyses. Univariate
analyses of variance between subject group and
test type for peak torque strength ratios and active
elbow extension. Linear regression tests
for elbow pain rating and both range of motion
and peak torque ratios.
Results. No
significant differences were found between groups
or between test speeds for either strength ratio
compared. No significant correlation was
found between either strength ratios and pain or
elbow extension range of motion and pain. Active
elbow extension range of motion was significant
for the group of baseball players with elbow pain
only.
Conclusion. Although
there were no significant differences between our
sample groups, it was consistent throughout all
subjects that eccentric external rotational strength
was approximately 50% that of concentric internal
rotational strength, significantly less than the
normal range of 65% to 70%. With our knowledge
of the demands on the shoulder during the deceleration/follow-through
phase of throwing, it is imperative that muscle
balance is achieved across both the anterior and
posterior aspect of the glenohumeral joint. Further
research is recommended to correlate distal joint
pathologies to proximal muscular imbalances.
Contact: Micah Bolander 314-440-6381 mbolander@maryville.edu
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Establishing normative strength values
for hyperpronators using the standing heel rise
test: a pilot study. Michael Coalson,
Matthew Damrell, David Johnson, Kyle Stein, Jack
BennettSPT. Program in Physical Therapy, Maryville
University, St. Louis, MO.
This study intended to
establish normative strength values of the plantar
flexors, primarily the gastrocnemius muscle, in
individuals with hyperpronation using the standing
heel rise test. The specific aim of this
study was to establish a value which can be considered
a normal muscle grade of the gastrocnemius for
hyperpronators when using the standing heel rise
test.
Following
the principles of the length tension relationship, individuals with hyperpronation
should have less torque producing capability of the gastrocnemius, as compared
to individuals with ideal foot posture. The decreased torque production
in individuals with hyperpronation will influence several activities of daily
living that require gastrocnemius strength including standing and walking. The
standing heel rise test is a clinically applicable measure for clinicians to
determine gastrocnemius strength.
In a recent
study by Snook, subjects with excessive pronation demonstrated decreased plantar
flexion strength compared to individuals with ideal foot posture when tested
with an isokinetic machine. However, there is currently no research available
on normative strength values for hyperpronators using the standing heel rise
test.
The hypothesis
of this study was that individuals with hyperpronation would perform fewer
heel rises than individuals with normal foot posture using the standing heel
rise test. This study used a convenience sample of 23 subjects form Maryville
University including students, faculty, and staff. The ages of subjects
ranged from 18-35 with an average age of 22.78. Navicular drop was used
to measure the amount of foot pronation and was taken using a modified version
of Brody’s method of navicular drop measurement. After measuring navicular
drop, the strength of the gastrocnemius muscle was measured by using the standing
heel rise test. Prior to data collection, reliability testing was conducted
for navicular drop and standing heel rise tests. The navicular drop test
showed acceptable inter-rater reliability (.70-.76), while the standing heel
rise test showed acceptable inter-rater reliability (.57-.74) and very good
intra-rater reliability (.90), using Cronbach’s Alpha score.
The results
of the study showed that hyperpronation with 10+ mm of navicular drop demonstrated
decreased gastrocnemius strength when measured by the standing heel rise test. This
study showed that the group comprised of individuals with normal amounts of
navicular drop showed an average of 16.47 heel rises completed, while the hyperpronator
group showed an average of 9.75 heel rises completed. The results of
the Pearson product moment correlation showed adequate significance for an
inverse relationship between navicular drop and the number of heel rises completed
with
r= -.421.
Based on the results of our study, we concluded
that a normal muscle grade for individuals with
10 mm or greater of navicular drop should be less
than the current standard of 20 heel rises as suggested
by Hislop. However, further research with
larger subject samples is needed to determine exact
number which can be considered a normal muscle
grade for the gastrocnemius muscle in individuals
with hyperpronation using the standing heel rise
test.
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THE EFFECTIVENESS OF THERATOGS
ON GAIT IN A 5 YEAR-OLD CHILD WITH SPASTIC HEMIPLEGIA. Engelmeyer,K.,
Meyer, A., Quinlisk, A., Wassell, M., Ross,
S., Program in Physical Therapy, Maryville University,
St. Louis, MO.
Gait abnormalities often
exist in children with spastic hemiplegia. TheraTogs™
are a new intervention that consists of an orthopedic
undergarment and strapping system and has been
recommended to improve gait patterns; however
no research has been conducted on the effect
of the device.
Purpose: The
purpose of our study was to determine the effect
of TheraTogs™ on the gait pattern of a 5-year-old
child with spastic hemiplegia.
Subject: A
5 year-old child diagnosed with spastic hemiplegia
who walked with a walker.
Methods: The
study was a single-subject prospective experimental
analysis of differences that investigated the effectiveness
of TheraTogs™ using a single strapping application
to see how they affected gait dynamics measured
using a GAITRite® system. The data collection included
5 test sessions; each session consisted of three
trials of ambulating on the GAITRite®. An
initial baseline was established on the first session,
after which the TheraTogs™ were introduced. The
subject wore them for 4 weeks; sessions were performed
after initial application and both 2 and 4 weeks
post application. The TheraTogs™ were then
removed for 2 weeks and a final session was performed. The
data collected included velocity, stride length,
cadence, step time, heel to midline base of support,
and toe in/out.
Data Analysis: The
data in this study was analyzed using a two-standard-deviation
band analysis for each gait parameter. The results
were considered significant if they were two standard
deviations above or below the baseline mean.
Results: Significant
improvements were found in heel to midline base
of support, velocity, and cadence when comparing
the baseline measure to measures post intervention. No
significant difference was found for step time,
stride length, or right toe in/out. A significant
decline was found for left toe in/out. A
positive carryover effect was significant for velocity,
cadence, and heel to midline base of support.
Conclusion: The
results of the study were mixed, showing gains
in some gait variables, no change in others, and
a decline in one variable. This is a single
subject case design and generalizability of the
results should be considered with caution.
Contact: Kelly Engelmeyer 636-357-1593. kengelmeyer@maryville.edu
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The Effect of High Frequency Transcutaneous
Electrical Nerve Stimulation on Heart Rate in
Healthy 18-30 Year Old Subjects: a Pilot Study. Dias,
K., Gillardi, A., Kuck, A., Meyer, D., Robertson,
A. Program in Physical Therapy, Maryville
University, St. Louis, MO.
Background and Purpose. Heart
rate (HR) increases as a result of stimulation
of the sympathetic nervous system (SNS). Interventions
to regulate sympathetic activity, such as TENS,
have demonstrated promise in their ability to improve
outcomes in patients with chronic diseases such
as chronic heart failure and coronary artery disease.
Transcutaneous electrical nerve stimulation (TENS)
decreases SNS activity by blocking afferent nerve
signals. Preliminary trials using TENS have
demonstrated an ability to alter autonomic activity
measured by blood pressure and peripheral blood
flow. However, there has been little research
on the effects of TENS on HR. The purpose
of this pilot study was to determine the effects
of TENS on HR in healthy eighteen to thirty year
old individuals. The primary goal of this
study was to determine the effects of TENS on reducing
sympathetic measured responses to a handgrip strength
test, valsalva maneuver, and treadmill walking.
The secondary goal of this study was to determine
if TENS will reduce measures of SNS dominance at
rest. We hypothesized that TENS would decrease
HR during SNS stimulating activities and during
rest.
Subjects. Eight healthy
eighteen to thirty year old college students, four
males and four females with a mean age of 20.88,
participated in the study.
Methods. Participants
performed three SNS stimulating activities including
a valsalva maneuver, handgrip strength test, and
treadmill walking while his/her HR was recorded. Participants
completed these activities on three consecutive
days, the first two of which no TENS was utilized. The
third day TENS was applied over the sympathetic
ganglion of the lower cervical and the upper thoracic
areas. Data was analyzed using paired t-tests
in SPSS. Day one and day two data were compared
to determine if baseline measurements remained
stable. Day one and day three data were compared
to determine if TENS had an effect on HR.
Results. When
comparing day one and day two data, no significant
differences was found. The results showed
a significant decline in HR with TENS stimulation
during the rest period prior to treadmill walking
(p=.043) and during treadmill walking at the five
minute mark (p=.011). No significant differences
were found for all other variables.
Discussion
and Conclusion. No significant changes
were observed in HR immediately after the application
of TENS, evidenced by no changes in HR for grip
strength or valsalva maneuver. A significant
decline in HR was observed with longer periods
of TENS stimulation, as seen during the rest period
prior to treadmill walking and during treadmill
walking at the five minute mark. Therefore,
it may be beneficial to apply TENS for an initial
period of greater than fifteen minutes prior to
testing to obtain the true effects of TENS on the
SNS. Further research is needed involving
larger populations of healthy participants and
finally in persons with cardiac pathologies.
Contact: Angela Gillardi 314-808-7491. agillardi@maryville.edu
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A Comparison of Student and Faculty Perspectives
on Learning Activities that Promote Reflection. Kliebert,
K. & Tomlinson, E., Decker, A. Department
of Physical Therapy Education, Rockhurst University. deckera@rockhurst.edu
The complexity of today’s physical therapy client
makes reflection a necessary skill for the physical
therapist of the 21st century. Educating
students on how to be reflective practitioners
has become an important component of physical therapy
education programs.
Purpose: The
purpose of this study was to examine the use of
reflective activities by faculty and to compare
student and faculty perceptions regarding the effectiveness
of these activities.
Subjects: One
hundred sixty-three full-time students enrolled
in an entry-level physical therapy program and
forty faculty members completed a survey on the
topic of learning activities that promote reflection.
Methods
and Materials: An electronic message including
a link to an online survey hosted by Zoomerang
software was developed by the researchers to question
both students and faculty from Midwest physical
therapy programs regarding the use and importance
of reflective techniques in the physical therapy
curriculum. Subjects were surveyed on five
different activities found to promote reflective
practice ranging from attending a lecture on the
topic of reflection to reflective discussion between
students and instructors via web board. Internal
University Review Board approved this research
project prior to launch of the survey.
Analyses: Analytical
data was completed using SPSS v. 13. Descriptive
statistics gathered showed 96% of students participated
in and 100% of faculty engaged students in group
discussion to promote reflective practice. Students
working towards a Master’s degree report lectures
on reflection of less benefit than peers enrolled
in DPT programs.
Results: Results
demonstrate students participate in reflective
activities and faculty often engage students in
reflective activities. Both students and
faculty report group discussion as most beneficial
and efficient means for reflection.
Conclusions: Various
activities that promote reflection are being incorporated
in physical therapy programs throughout the Midwest
to assist developing student physical therapists
into reflective practitioners.
Funding
Source: The authors of this study
have received no monetary support for this study,
nor is any financial gain expected from the results
of this study.
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Patient Perceptions about Physical Therapist
Appearance and Behaviors
Authors: Boulton, JL, Hargis,
DM, Hunt, MJB, Winder, MA, Dronberger, JA. Physical
Therapy Education Program, Rockhurst University,
Kansas City, MO.
Purpose: To investigate
patient perceptions about the appearance and behaviors
of physical therapists in the outpatient setting.
Subjects: 177 self-administered
questionnaires were provided to patients, yielding
a 95% return rate. Respondents ranged in age from
18 to 88 years. Inclusion criteria required
that the respondents attend at least three outpatient
physical therapy sessions and be >=18 years of age. Eight
clinics were included in this study.
Methods & Materials: Questionnaires
were given to the patients by the researchers of
this study and by the staff of included clinics. Each
respondent was asked to complete a survey following
the third or fourth visit to the clinic: confidentiality
was maintained during its completion. The survey
was either returned to the person who provided
it or placed in a designated, secure drop-off box.
Analyses: SPSS 13 was used
to calculate Pearson Correlation, Spearman Correlation,
and Cross Tabs across all comparisons.
Results: Survey results
revealed the following correlations (1) older respondents
had more pronounced preferences about the appearance
of male therapists (notably in regard to facial
hair and hair length) than did younger respondents.
Respondents were less influenced by the dress/appearance
of female therapists (2) respondents who reported
that they are negatively influenced by a therapist’s
excess weight were also those who preferred to
have their diagnoses explained in greater detail,
and (3) the location where patients were treated
(e.g. in an open area) influenced their level of
concentration during treatment.
Conclusions: Results suggest
that patients do have strong opinions in regard
to male physical therapist appearance, excess weight
of therapists of either gender, the degree to which
their diagnoses are explained, and the level of
privacy within the treatment area. Therapists
may wish to be aware of these concerns when providing
care to their patients.
Funding Source: None.
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THE EFFECT OF THE MENSTRUAL CYCLE ON ACL
TEARS IN HIGH SCHOOL AGED FEMALES. Dean,
S.K., Faris, R.C., Foley, A., Sparks, J.L. Program
in Physical Therapy, Rockhurst University, Kansas
City, MO. Amy.Foley@rockhurst.edu
Background & Purpose: Anterior
Cruciate Ligament (ACL) tears have become more
prevalent in females, with females suffering
four to eight times the number of ACL injuries
compared to men. Research has shown multiple
mechanisms of injury, however, the main purpose
of this study is to find out if there is a relationship
between ACL tears and the phases of the menstrual
cycle.
Subjects: Twelve
female subjects were recruited from the greater
Kansas City area to participate in a self-reported
written survey pertaining to their past ACL injury.
Subjects average age was 16.75 ± 1.65 years with
no reported previous pregnancies.
Methods: A
survey previously used by Wojtys, et al. was
used to collect data on this study. The reliability
and validity of this survey has been previously
established. The surveys were distributed to
participating physician and physical therapy
clinics. The mechanism of injury, details
about the menstrual cycle, oral contraceptives,
minutes played until injured, and ankle protection
were all recorded in the survey. The data were
coded and compiled for statistical analysis.
Analysis: Comparisons
were made between phases in the menstrual cycle
in relation to injury using Friedman Analysis
of Variance for Correlated Samples. Alpha level
was set at 0.05.
Results: Friedman
test showed no significant difference between
the phase of menstrual cycle and ACL injury (p>.17).
This indicates that the phase of the cycle has
no effect on the ACL injury.
Conclusion: Although
6 women reported injuries in the luteal period
as compared to 5 in the follicular and 1 in the
ovulatory this difference did not reach the level
of significance. Clinically, regardless of what
menstrual phase women are in ACL injuries still
occur. This study should be expanded to include
a larger number of participants to enhance the
strength of the investigation.
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NEUROMUSCULAR
STIMULATION IMPROVES GRASPING FUNCTION IN INDIVIDUALS
WITH CHRONIC STROKE. B. Quaney,
LH. Zahner, MJ. Santos, Z. Kadivar, C. Cao, S.
Frank, S. Hurt, B. McKiernan, Landon Center on
Aging, University of Kansas, Kansas City, KS, Physical
Therapy and Rehabilitation Sciences, Kansas University
Medical Center, Kansas City, KS, Physical Therapy
Education, Rockhurst University, Kansas City, MO. brian.mckiernan@rockhurst.edu
Purpose/Hypothesis: Despite rehabilitation
efforts, 60% of individuals continue to have significant
upper extremity (UE) disability one year poststroke.
It is unclear if manual dexterity can be further
improved after this time. The purpose of this pilot
study was: 1) To determine if neuromuscular stimulation
(NMES) improves grasping function in individuals
with chronic stroke, and 2) To determine if grasping
function is enhanced when NMES is used during functional
task training. Subjects: Six subjects
(58 ± 2.9 y/o) with chronic ischemic stroke (3
- 10 yrs. post-stroke) and severe hand dysfunction
participated in this study. Materials/Methods: Each
subject received two applications of NMES (passive
vs. functional) in a counterbalanced order (30
min x 5x/wk x 2 wks). Passive NMES was performed
by placing the impaired forearm in a mid-position
and stimulating the wrist flexors and extensors
to produce two contractions/minute (30 contractions).
Functional NMES was performed using single channels
from two separate stimulators to assist grasping
and releasing a tennis ball (30 repetitions). UE
motor performance speed, function and strength
was measured at baseline, following treatment and
two weeks after treatment using conventional clinical
tests: a) UE Fugl-Meyer (FM); b) Box and Block
(BB); c) Jebsens Dexterity Test (JDT); d) Grip
Strength (GS) and e) Pinch Strength (PS). Results: While
subjects generally improved motor performance speed,
function and strength with both applications of
NMES, significant gains in fine motor skills were
specific to the functional NMES. Compared to baseline,
functional NMES increased movement speeds in the
JDT by 17% (p< 0.02) and increased FM scores
by 19% (p< 0.05). In contrast, passive NMES
only demonstrated significant gains in FM (18%;
p< 0.04). JDT improvements using functional
NMES continued to be significant two weeks after
treatment. Conclusions: NMES appears
to be a viable method for facilitating motor performance
gains in chronic stroke, especially when paired
with functional task training. The increased grasping
function observed with this brief therapeutic intervention
is most likely due to mechanisms other than muscle
hypertrophy. Clinical Relevance: The
increased movement speeds (JDT) suggest that fine
motor control can be improved by applying NMES
during a grasping task.
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A COMPARISON OF HAND STRENGTH AND BALANCE
IN ROCK CLIMBERS AND NON-CLIMBERS Kreher,
JL, Muehl, AM, Swanson, MB, Wilson, BT, and Hiebert,
JM. Physical Therapy Education, Rockhurst University,
Kansas City, MO. jean.hiebert@rockhurst.edu
Purpose: The mechanics
involved in rock climbing suggest that climbers
would demonstrate increased hand strength and balance
when compared to individuals that do not participate
in this sport. Therefore, the purpose of
this study was to compare these variables in two
groups of individuals: one group that regularly
exercises by rock climbing and a second group that
regularly exercises using some other type of aerobic
activity (running, bicycling, etc.).
Subjects: Two groups of
12 males and 4 females volunteered for this study. One
group consisted of intermediate to advance-skilled
rock climbers (age = 27.00 ±4.6 years; weight
= 155 ±27.5 lbs) who climb at least 8-12 times
a month. The other group consisted of non-climbers
(age = 24.25 ±3.0 years; weight = 177±27.4 lbs)
that participate in 20-30 minutes of aerobic
exercise at least 8-12 times per month. All
subjects reported exercising at a rating of perceived
exertion of 7/10 or greater and reported being
right hand and leg dominant.
Methods and Materials: Three
jaw pinch, key pinch, tip to tip pinch, and handgrip
strength (five positions) for the right and left
hands were assessed using the Greenleaf Eval
System (Palo Alto, California). The Balance Master
6.0 (Clackamus, Oregon) assessed unilateral stance
with eyes open and closed, bilateral stance standing
on firm and foam surfaces with eyes open and
closed, limits of stability, and rhythmic weight
shift.
Analysis and Results: Independent
t-tests were performed using SPSS 13.0. Results
indicated that climbers exhibited greater handgrip
strength relative to body weight in all positions
bilaterally except grip position 5 on the left
(p<=.05). Climbers also had fewer touch downs
with their left foot during unilateral stance
on the right with their eyes closed; decreased
sway during bilateral stance when standing on
a firm surface with eyes closed; and increased
displacement of center of gravity when moving
forward and obliquely forward to the left (p<=.05).
Conclusions: These findings
suggest rock climbing may provide additional
benefits than those obtained by aerobic conditioning
alone. It may serve as an alternative to
traditional rehabilitation exercise for individuals
in need of developing hand strength and balance
capabilities.
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THE DEVELOPMENT OF LEADERSHIP IN PHYSICAL
THERAPY Martin, JL, Russell,
SA, Sonderegger, SA, Spake, EF. Department
of Physical Therapy Education, Rockhurst University,
Kansas City, MO ellen.spake@rockhust.edu .
Purpose: The development
of leadership has been studied in many fields,
but has not been well documented in physical therapy. Active
responsibility for the growth of the profession
has been identified as an integral aspect of professionalism,
as reflected in one of the six pillars of Vision
2020. The purpose of this qualitative study
was to describe and explain influences in the development
of leadership in the physical therapy profession.
Subjects: Fourteen current
members of the APTA Board of Directors as well
as one past president of the Association comprised
a sample of convenience for this study. All
subjects had held multiple leadership positions
within the Association.
Methods and Materials: All
current members of the APTA Board of Directors
and one past president were invited to participate
in a telephone interview about their development
as a leader in the profession. Fourteen
of the fifteen board members and one identified
past president agreed to participate. A
semi-structured interview format consisting of
five to eight open ended questions based on individual
response was utilized. Published materials
and transcripts of taped interviews were qualitatively
analyzed to describe and explain pathways to
leadership.
Analyses: Content analysis
was conducted by four examiners. Each researcher
independently developed a qualitative coding
procedure to evaluate the written artifacts and
transcribed interviews. Recurring regularities
in data reproduced patterns that were sorted
into categories and emergent themes were compared
across examiners. Reliability was ensured
through the use of multiple, independent examiners
and low inference descriptors. Validity
was ensured through the use of systematic coding,
analytical triangulation, and a search for negative
evidence.
Results: Six themes were
derived utilizing content analysis from written
materials and transcripted interviews: Participation
in community activities prior to PT school, influence
of PT faculty as role models, student involvement
in professional activities, importance of mentors,
opportunity, and strategic planning toward leadership.
Conclusions: Understanding
the influences that have impacted the development
of current leaders in the profession can sensitize
and empower others to recognize both the potential
for growth as well as provide a model for systematic
planning towards leadership.
Funding: None
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AN EXAMINATION OF THE EFFECT OF ANTERIOR
AND POSTERIOR HEEL FLARE ON KINEMATIC CHARACTERISTICS
OF HUMAN GAIT. Rose, G., Hunt
G., Knutson, L., Department of Physical Therapy,
Missouri State University, Springfield, MO. Rose032@missouristate.edu
Purpose: The intent of this study
was to determine effects of anterior and posterior
heel flare on kinematic variables at the hip, knee,
and forward tibial advancement from heel contact
through loading response during a walking gait
cycle.
Background: The literature reports
that lateral heel flare may be associated with
various foot and leg injuries. Studies on the
effects of anterior and posterior heel flare
have not gained the same attention. However,
one recent running study evaluated the kinetic
effects of posterior heel flare and its possible
relation to chronic exertional compartment syndrome
in the anterior leg. Since walking as a mode
of exercise to improve fitness has been encouraged
for deconditioned individuals, it seems appropriate
that similar heel design studies with walking
are needed.
Subjects/Methods: Digital video
recordings were taken of four female subjects
walking at self selected speeds for five trials
of each heel condition (anterior and posterior).
Angular velocities of lower extremity joints
and segments were analyzed using Pro Sport 5.1
software. Single-subject data were examined for
serial dependency and evaluated through visual
appraisal, slope analysis, and effect size.
Results: No serial dependency
was found. Hip and knee angular velocities
revealed marked variability patterns across subjects.
The largest angular displacement occurred with
forward tibial advancement for all subjects. Angular
tibial velocity through the ankle joint increased
with the posterior flare in 3 of 4 subjects.
Effect size of angular tibial velocity, as determined
by paired t-tests and omega2, for the same three
subjects ranged from 0.73 to 0.90.
Conclusion: Initial results
suggest that posterior heel flare may lead to
increased eccentric loading of anterior compartment
muscles with an elevated risk of overuse syndromes. Clinicians
should consider the influence of heel design
on anterior leg muscle activity when educating
clients on footwear selection. Based on these
results, further evaluation of posterior heel
flare during walking is warranted.
Contact: Gabrielle Rose (417) 425-6463 Rose032@missouristate.edu
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ARCH TAPING AS A SYMPTOMATIC
TREATMENT IN PATIENTS WITH SEVER’S DISEASE: A
MULTIPLE CASE SERIES. Hunt G.C., Stowell
T., Alnwick G., Evans S, Missouri State
University, Springfield, MO, Franklin Pierce
College, Concord , NH, Cox Health Care Systems,
Springfield, MO garyhunt@missouristate.edu
Purpose: To describe the clinical
outcomes of arch taping in controlling heel pain
during ambulation in subjects with Sever’s disease
and to discuss possible biomechanical explanations. Background: Sever’s
disease, is a musculoskeletal condition occurring
in adolescence that symptomatically manifests as
posterior heel pain during ambulation. Often participation
in physical activity is severely limited resulting
in frustration for children and parents alike. Conservative
treatment options have included rest, abstinence
from athletic activity, heel lifts, foot orthotic
devices, ice, and calf-stretching exercise. The
authors are proposing arch taping as a viable treatment
option for controlling heel pain during athletic
and other weight-bearing activities in patients
with Sever’s disease.
Methods and Measures: Eleven subjects
diagnosed with Sever’s disease with a history
of posterior heel pain were included in this
study. The subjects were evaluated and
treated by three different therapists in three
different regions in the USA. The main
treatment consisted of arch taping. Two of the
eleven subjects of this multiple case series
were studied using single subject design analysis
comparing time to onset of pain during treadmill
ambulation with and without arch taping. The
treatment response to arch taping was described
in the remaining nine cases of this series. Results: Each
subject reported an immediate reduction in heel
pain during ambulation and functional activities
with arch taping, and those who participated
in organized youth sports were able to return
to competition earlier than reported in the literature.
Visual and statistical analysis using the Two
Standard Deviation Band method for two subjects
showed improvement at the P<0.05 significance
level for ambulation time with arch taping. Conclusions: The
arch taping technique applied in these cases
was effective in the immediate control of pain
during ambulation and sports activities. This
technique could be considered a viable treatment
option for other individuals with similar clinical
presentations. Possible biomechanical explanations
may relate to a windlass effect provided by the
taping technique.
Contact: Gary Hunt 417 598-0764 garyhunt@missouristate.edu
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CONSERVATIVE MANAGEMENT OF OSTEOCHONDRAL
DEFECT IN THE TALOCRUAL JOINT: A CASE REPORT. Lerche,
F., Hunt G.C., Cox Health Care Systems and
Physical Therapy Program, Missouri State University,
Springfield, Missouri. Lerche2@sbcglobal.net
Purpose: Foot pain secondary
to osteochondral defect in the talocrual joint
can severely affect an individual’s gait and functional
abilities. The purpose of presenting this
case is to outline a conservative approach that
was utilized to manage this problem that included
orthotic and exercise intervention. Subject: The
subject was a middle-aged female with an 18 month
history of chronic right ankle pain following a
motor vehicle accident. Conservative treatment
provided marginal relief after which time the patient
decided to seek further orthopaedic consultation. MRI
revealed an anterior tibial osteophyte with possible
osteochondral defect in the medial ankle which
was later confirmed during arthroscopic surgery. Postoperative
physical therapy was uncomplicated but she was
still having residual activity pain rated 7-8/10
and antalgic gait abnormalities. Weight-bearing
radiographic examination documented a talar tilt
of 9o. Physical therapy reassessment revealed weakness
of the peroneus longus (4/5) associated with difficulty
in single leg balance testing. Methods: Treatment
included: 1) custom hindfoot orthosis for the right
ankle fabricated with low temperature plastic,
2) motor control exercise to improve peroneus longus
function, and 3) single leg balancing activities.
Pain and functional levels were assessed through
perceived rating scales to document treatment response. Analyses: Perceived
pain and functional activity levels and trends
were graphed with excel spreadsheet for visual
and comparative analysis. Results: The
subject reported marked reduction in pain and increased
functional activity while using the hindfoot orthosis. Steady
pain reduction and increased functional activity
improved over the course of treatment. Follow-up
weight-bearing radiographs while wearing the hindfoot
orthosis revealed a talar tilt angle reduction
of 3.2o. Peroneus longus force production improved
to 5/5 and single leg balance time increased from
3 seconds to 20 seconds with follow-up assessment. Conclusions: The
positive results in this case are encouraging and
suggest that orthotic hindfoot control combined
with exercise and balance training maybe a viable
intervention option for osteochondral defect of
the ankle. Documentation
of other similar cases with this intervention approach
would be helpful to determine its effectiveness
in managing this condition.
Contact: Fred Lerche (417) 269-5500, Lerche2@sbcglobal.net
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The use of the BrainPort™ balance device
to Facilitate Balance and Gait in an Individual
with Bilateral Prosthetic Legs and Bilateral
Vestibular Dysfunction (BVD) due to Gentamicin
Ototoxicity.
Stephen E. Price, Barbara S. Robinson,
Jeanne L. Cook, Cynthia McCormick Richburg. Missouri
State University, Springfield, MO, Cox
Health Care Systems, Springfield, MO Stephen923@missouristate.edu
Study Design: Case Study Purpose: To
determine the efficacy of the BrainPortTM, an electrotactile
vestibular sensory substitution device, on static
and dynamic standing balance and gait of a subject
with bilateral vestibular dysfunction (BVD) and
bilateral transtibial amputation (TTA). Subject: The
subject was a 69-year-old male with BVD due to
gentamicin ototoxicity. The subject had bilateral
prosthetic legs after TTA due to lower extremity
infection; significant co-morbidities were present. Methods
and Materials: Physical therapy intervention
focused on training with the BrainPortTM balance
device over 12-weeks, and was
organized in three phases: orientation, clinical
training, and in-home training. The subject
was assessed with objective balance (SOT) and gait
tests (DGI, 6-minute walk test), as well as functional
outcome measures (ABC, DHI) at the end of weeks
1, 2, 4, 8, and 12. Descriptive statistics
were employed for analysis. Results: Intervention
with the BrainPortTM balance device was
effective in improving the subject’s gait and balance;
decreased functional limitations were noted. The
subject reported improvements in gaze stability;
however, symptoms of oscillopsia did not diminish. Conclusion: Improvement
was demonstrated in all outcome measures used. Marked
changes were observed in the subject’s balance
and gait. Residual effects occurred that
might be attributed to active stimulation of brainstem
nuclei. The use of the BrainPortTM balance
device warrants further research.
Acknowledgements: Wicab, Inc.
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Comparison of Infraspinatus
Strength in the Dominant (Pitching) Arm Vs the
Non-Dominant Arm in Minor League Baseball Pitchers. Barton,
H., Wallentine S. Department of Physical
Therapy, Missouri State University, Springfield,
MO. swallentine@missouristate.edu
Purpose: The purpose of this
study was to compare infraspinatus muscle strength
in dominant Vs non-dominant arms of minor league
baseball pitchers. Subjects:
Eight pitchers from the Springfield Cardinals (AA
affiliate of the St. Louis Cardinals) baseball
team participated in the study. Methods:
A hand held dynamometer was used to assess infraspinatus
muscle strength. Subjects sat with the arm
at their side in a position of 90? of elbow flexion
and 45? of shoulder internal rotation while the
examiner applied resistance at the wrist. A
standard goniometer was used to ensure that the
testing position was consistent for each subject.
Three trials were performed for each arm. Results: Seven
of the 8 pitchers demonstrated dominant infraspinatus
muscle weakness when compared to the non-dominant
muscle. The mean difference in strength was
4.87 lbs of force. A paired T-test was used
to assess the difference between the means of dominant
Vs non-dominant infraspinatus strength. Conclusion: Upon
comparison, there was a statistically significant
difference (at the .05 level) which showed that
the infraspinatus muscle of the non-dominant arm
was stronger than the infraspinatus muscle of the
dominant arm. This may be evidence to support the
hypothesis that pitchers develop infraspinatus
weakness early in their careers due to repetitive
traction of the suprascapular nerve at the spinoglenoid
notch.
Contact: Scott Wallentine (417) 836-4514. swallentine@missouristate.edu
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WOUND CARE AFTER CANCER TREATMENT AND
NECROTIZING FASCIITIS; A RETROSPECTIVE CHART
REVIEW. Matheny, C., Caudill, S. Program
in Physical Therapy, Southwest Baptist University,
Bolivar MO. cmatheny@sbuniv.edu.
PURPOSE: The purpose of this
study was to describe the interventions used to
heal the wound of a diabetic female with necrotic
fasciitis status post chemotherapy, radiation therapy
and colonic resection. SUBJECT: The
single subject for this study was a 64-year-old
female status post chemotherapy, radiation therapy
and colonic resection following a diagnosis of
cancer. After surgery the subject developed
necrotic fasciitis in her lower abdomen, left hip
and posterior left thigh, which destroyed a large
amount of subcutaneous tissue, muscle tissue, neuronal
tissue and fascia. INTERVENTIONS: The
wound on the posterior thigh and buttock were surgically
debrided until viable tissue was found. A
wound vac with automatic saline flush was placed
and the wound was packed with dakin’s-soaked kerlix
and covered. The wound vac remained in place
and dressing changes continued packing the wound
with dakin’s-soaked kerlix as needed. METHOD: The
size of the open wound and the type of tissue present
was used to determine the progression of healing. Initially,
the wound on the posterior thigh measured 9.0 cm
wide, 30 cm long and 7 cm deep. The wound
was 95% red granulation tissue and 5% yellow slough. At
the time of discharge, the wound measured 3.0 cm
wide, 30 cm long, and 0.6 cm deep and was completely
covered with healthy granulation tissue. Approximately
three weeks later a skin graft was performed to
cover the wound. Data was collected using
a retrospective chart review. RESULTS: The
wound was completely healed in approximately 8
weeks following surgical debridement; wound care
that included a wound vac and packing with dakin’s-soaked
kerlix and a skin graft. CONCLUSION: Results
of this case study support use of a wound care
protocol that included dakin’s-soaked kerlix, a
wound vac and skin grafting as effective forms
of intervention for a diabetic patient with necrotizing
fasciitis, status post chemotherapy, radiation
therapy and colonic resection.
Contact: Connie Matheny 417-328-1910. cmatheny@sbuniv.edu
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CRITICAL THINKING: DOES EDUCATIONAL LEVEL
MAKE A DIFFERENCE IN THE CRITICAL THINKING SKILLS
OF PHYSICAL THERAPIST STUDENTS? Matheny,
C. Program in Physical Therapy, Southwest
Baptist University, Bolivar, MO. cmatheny@sbuniv.edu,
Zabel, R. University of Central Arkansas.
PURPOSE: The purpose of this
study was to examine and compare the critical thinking
skills of physical therapist students educated
at the master’s level and the doctoral level. SUBJECTS: The
subjects of this study were students enrolled in
either a master’s level or doctoral level physical
therapist education program. Inclusion criteria
for participation in this study were the completion
of both the didactic and clinical components of
a physical therapist educational program. METHODS: Physical
therapist students from master’s level and doctoral
level programs were recruited to participate in
this study. Students were given the California
Critical Thinking Skills Test (CCTST) to determine
their level of critical thinking skills. The
test was a 34-question, non-discipline-specific,
multiple-choice test. ANALYSIS: The
data were analyzed using the unpaired independent
t-test, means, standard deviations, range, and
norm percentiles. Comparison of
means and standard deviations of test scores at
each educational level were conducted to determine
if a significant difference was present between
the two groups of students. RESULTS: For
the sample tested in this study, scores ranged
from a low of 11 to a high of 30 out of 34. The
mean score for the master’s level students was
(n=64) 19.47 (SD = 4.06). For students at
the doctoral level the mean score (n = 43) was
20.79 (SD = 4.63). The results of the t-test
indicated no significant difference between total
CCTST scores of master’s level students and doctoral
level students. (p = .14, t = (-)1.5, df = 105). CONCLUSION:
Based on the use of
a commercially available instrument in critical
thinking, critical thinking skills
of master’s level physical therapist students are
not significantly different from physical therapist
students at the doctoral level. Development
of a discipline-specific tool to measure critical
thinking in physical therapists students may be
needed to detect differences between those educated
at the master’s level verses those educated at
the doctoral level.
Contact: Connie Matheny 417-328-1910. cmatheny@sbuniv.edu
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CHANGES IN GROSS MOTOR
FUNCTION MEASURE (GMFM) 8 MONTHS POST SELECTIVE
DORSAL RHIZOTOMY (SDR) AND REHABILITATION ACCOUNTING
FOR GROWTH AND MATURATION Puglisi JA, Ross
SA, Collins DR, Park TS, Engsberg JR, Therapy
Services Department, St. Louis Children’s Hospital,
Department of Pediatric Neurosurgery, Human Performance
Laboratory, Washington University School of Medicine.
OBJECTIVE: The purpose of this
investigation was to determine the changes in
GMFM 8 months post SDR and rehabilitation accounting
for growth and maturation.
DESIGN: Retrospective nonrandomized
study using before-after trial.
SETTING: Teaching Institution,
Children’s Hospital.
SUBJECTS: One hundred eighteen
subjects (age 5.9 years, range 2-36) with spastic
CP, (69 male, 49 female) underwent SDR. Forty
four were independent ambulators, 60 used an
assistive device, and 14 were non ambulators
(GMFCS levels I=12, II=45, III=32, IV=26 and
V=3). The subjects included all patients
undergoing SDR in years 1999 and 2000 at St.
Louis Children’s Hospital. Subjects were
diagnosed with spastic diplegia (n=98), spastic
triplegia (n=4) and spastic quadriplegia (n=16).
METHODS: SDR is a surgical procedure used to reduce
spasticity and improve function in individuals with cerebral palsy (CP). The
Gross Motor Function Classification System (GMFCS) is a five-level system intended
to classify the severity of motor involvement in children with cerebral palsy. The
GMFM is a standard criterion-referenced test designed to assess change in function
in children with CP. Subjects were tested on the day before SDR and 8
months later using the GMFM. They were assigned a pre-operative GMFCS
level.
INTERVENTION: Subjects underwent SDR and 8 months postoperative
rehabilitation consisting of intensive PT 4 times/per week.
MEASUREMENTS AND MAIN RESULTS: A formula was used for predicting
changes in GMFM scores based on pre-operative GMFCS levels with consideration
of expected maturation in this group. The predicted developmental change
score was subtracted from the 8 month post-operative score. A paired
t-test was used to determine if a significant difference (p<0.05) existed
between pre-operative and 8 month post-operative GMFM scores with the predicted
improvements that would be associated with normal growth and maturation removed. There
was a highly significant difference (p<.001) between the pre-operative and
the actual 8 month post-operative GMFM scores.
CONCLUSION: Following SDR and rehabilitation, improvements
in GMFM at 8 months post-operative was significantly greater than what was
developmentally predicted based on age and GMFCS for this group of patients. Long-term
studies using the GMFM should consider adjusting for growth and maturation
to determine the true effect of a treatment.
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Effectiveness of Intensive Sports Programs
for Children with Cerebral Palsy (CP)
Miros, J.E., Koyn, D., Olson, N.M., Brunstrom,
J.E. St. Louis Children’s Hospital
One Children’s Place, St. Louis, MO. jem0061@bjc.org
Purpose:Determine efficacy of
an intensive sports program for children with CP.
Subjects: Sixteen participants
(six females, ten males) between the ages of
six and fourteen years old (mean= 10.4) were
divided in the following Gross Motor Functional
Classification System (GMFCS), I=6, II=3, III=
7. Sports program participants in the GMFCS
IV and V were excluded from this study due to
their inability to complete the motor assessments.
Methods:All participants completed
motor assessments before and after the sports
program consisting of 1) Timed Up and Go (TUG),
2) balance walking on a line, and 3) balance
tests. Parents and participants completed
a) Pediatric Outcomes Data Collection Instrument
(PODCI), b) Impact of Childhood Neurologic Disability
Scale (ICNDS), and c) Children’s Assessment of
Participation and Enjoyment (CAPE). A 2-Tailed
Paired t Test was used to test significance
of the motor assessments.
Intervention:Participants were
at the sports program five days per week for
up to six weeks for six hours each day. They
learned sports skills from physical therapists
and trained volunteers. They participated
in baseball, basketball, dance, adaptive cycling,
martial arts, ice-skating, hockey, swimming,
soccer, tennis, and volleyball. The program
adapted sports for varying levels of abilities
and made modifications when necessary.
Results:Significant changes
(p=0.043) from pre-assessment to post-assessment
occurred in the TUG. There were no other
significant changes in the other functional tests
administered. Self-esteem measures will
continue to be studied over the next six months.
Conclusion:The data supported
motor function improvement in the TUG after the
sports program intervention. Future considerations
include refining outcomes tool and expanding
the sports program to other pediatric populations. Also,
sports programs for children with CP should be
incorporated into a community setting by a local
recreation center with the assistance of a physical
therapist.
Acknowledgements:The Carol and Paul Hatfield Cerebral
Palsy Sports and Rehabilitation Center at St. Louis
Children’s Hospital supported this project.
Contact: Jennifer Miros 314.454.2604
jem0061@bjc.org
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Title: ASSESSING AND TARGETING
HEALTH RISKS AMONG HEALTHCARE EMPLOYEES: A MODEL
PROGRAM
SUSAN B RACETTE, PhD1, SUSAN S DEUSINGER, PT PhD1
and KATHLEEN A KILLION, PT2. 1St. Louis, MO, United
States and 2St. Louis, MO, United States.
Background: BJC HealthCareSM, one of the largest nonprofit
health care systems in the US, launched a health literacy program to promote
health awareness and understanding, and adoption of healthier lifestyle behaviors
and personal health responsibility among its 25,574 employees. The a
