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Research Abstracts
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Maryville University Abstracts
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University Abstracts
Reliability in Measuring Scapular Position Using
the Scapulometer; a Pilot Study.
Authors: Julie M. Johnson, SPT, Angela M. Leonard,
SPT, Sara E. Mann, SPT, Brandi N. Vitale, SPT.
Maryville University St. Louis, Physical Therapy
Program.
Purpose: Physical therapists determine scapular
position by subjectively observing the scapula.
This pilot study established reliability of a tool
(Scapulometer), designed to objectively measure
scapular positions in normal standing posture.
Ideally, the Scapulometer will become a reliable
tool, to measure scapular positions on patients
with pathologies.
Subjects: A sample of eight, healthy, female subjects
between the ages of 22 and 25, without a history
of chronic back pain, scoliosis, back, shoulder
or rib pathology, or currently pregnant participated.
Four subjects participated in part one and four
in part two.
Methods and Materials: The study was conducted
in a two-part investigation. Part one established
inter- and intra-rater reliability of four researchers
amongst each other. Researchers were blinded during
data collection of part one. During part two, the
researchers were not blinded, while taking measurements
on four subjects. Part two compared inter-rater
reliability established in part one to the inter-rater
reliability results of part two. Materials used
throughout the study included room dividers, patient
gowns, body pencils, alcohol swabs and two Scapulometers,
designed by Sandy Ross at the Human Performance
Laboratory at Washington University in St. Louis.
Measurements took place at Maryville University's
Physical Therapy student laboratory.
Analyses: We hypothesized the Scapulometer would
be a reliable tool. Cronbach's Alpha (CA) values
= 0.80 was considered acceptable.
Results: Part one CA values ranged from 0.75-0.99
and from 0.23-0.96 for part two.
Conclusions: The Scapulometer is a reliable tool
in measuring inter-rater reliability of right and
left tipping, left rotation, and right and left
abduction. Due to the limited number of subjects,
further research is strongly suggested.
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Assessing Interrater Reliability of Wound Measurement
by Health Care Professionals: A Pilot Study.
Authors: Christina Cogorno, SPT; Heidi Hill, SPT;
Alisha Rees, SPT; Kathryn Summers, SPT; Charles
Gulas, PT, MAEd, GCS.
Purpose: The purpose of this study was to assess
the interrater reliability of wound measurement
among health care professionals treating pressure
ulcers.
Methods: Given the extensive number of techniques
used to measure wounds, this study utilized a transparent
ruler and subjects from a long-term care facility.
Two pressure ulcers on a buttock pressure ulcer
model were measured using the greatest length times
greatest width method.
Analysis: Cronbach's alpha was used to determine
interrater reliability between the subjects' measurements.
ANOVA was used to determine if a significant difference
existed between the baseline measurements and the
subjects' measurements. Pearson product moment
correlation was used to measure the correlation
between the amount of subject measurement error
with the subjects' actual years of experience in
their respective health care field and their personal
rating of their experience with wounds.
Results: Cronbach's alpha for wound 1 had good
reliability. Cronbach's alpha for wound 2 had poor
reliability except for the width which had good
reliability. The only measurement not significant
(p = 0.05) for ANOVA was the length of wound 2.
No variables were found to be clinically significant
(p = 0.05) for the Pearson product moment correlation.
Conclusions: Based on this pilot study, using
a transparent ruler and the greatest length times
greatest width method would be recommended, for
it is practical and reliable. With improved measuring
techniques, better wound analysis and outcomes
would lead to enhanced quality of care with a better
functional return for the patient.
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A Research Proposal: The effects of early aquatic
therapy interventions versus a land-based exercise
program in functional outcomes of microdiscectomy
patients.
Authors: Becker E, Buswell J, Henderson N, Wood
L. Maryville University of St. Louis.
Purpose: The purpose of this study was to determine
whether aquatic therapy for patients who underwent
microdiscectomy surgery improved functional outcomes
more expeditiously than a land-based exercise program
alone.
Study Design: The study involved a randomized
pilot study with a pretest/post-test design. Dependent
variables included the Oswestry Low Back Pain Disability
Questionnaire, straight leg raise test, and trunk
range of motion.
Methods: The participants, between the ages of
25 and 55, had undergone microdiscectomy surgery
within three weeks prior to the start of the study.
The patients have had no surgical interventions
within the last five years. Consents from the referring
physician and the patient were obtained prior to
the selection of the participants. Participants
will be given an exercise program based on the
group he/she is placed in, as well as a home program
to be completed on the days in between therapy
sessions.
Analyses: We will be using a 2x3 factorial ANOVA
to analyze the data collected, with a standard
power of .80 and an alpha level of .05.
Results: It was expected that aquatic rehabilitation
would improve functional outcomes more quickly
and more efficiently than land-based rehabilitation
due to the effects that the physical properties
of water have on an immersed body.
Discussion and Conclusion: The hypothesis was
that the patient receiving aquatic therapy would
have improved functional outcomes more quickly
than the patients who received land-based therapy
alone. We hope to educate other health care professions
of the advantages of utilizing aquatic therapy
for rehabilitation purposes.
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The Effect of Excessive Hamstring Length on Hamstring
Strength in Gymnasts
Authors: Melissa Johnson, SPT; Shelley Johnston,
SPT; Jessica Meyer, SPT; Megan Thompson, SPT. Maryville
University School of Health Professions; St. Louis,
MO.
Purpose: The purpose of the study was to determine
how excessive hamstring length of gymnasts effects
force production of the hamstring muscles when
compared to age matched non-gymnasts with normal
hamstring length. The goal was to determine whether
there was a significant difference in the amount
of work produced between gymnasts and non-gymnasts,
and to determine whether the differences in hamstring
length correlates with these values.
Subjects: A total of 20 female subjects, 14 gymnasts
and 6 non-gymnasts, ranging from 6-14 years of
age participated in this study. All subjects were
selected based on specific inclusion and exclusion
criteria.
Methods and Materials: Age, height, and body weight
were recorded in both gymnasts and non-gymnasts
through a questionnaire. All subjects were given
a warm-up session. Following the warm-up session,
hamstring length was measured using a goniometer.
Peak torque to body weight using a KinCom isokinetic
dynamometer was then assessed.
Analyses: Means and standard deviations were calculated
for each category of the results that were collected.
A statistical analysis was performed on all of
the data using t-tests.
Results: When comparing the gymnasts to the non-gymnasts,
t-test scores showed that gymnasts have significantly
higher peak torque values, as well as longer hamstring
lengths.
Conclusions: It would have been ideal for us to
gather the research in the overlay mode on the
Kin-Com isokinetic dynamometer to determine specific
values at 60 degrees of knee flexion. More research
may also need to be done to discover if hamstring
weakness in the shortened range is a cause for
injury in gymnasts.
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Characteristics of Gait in Individuals who are
Overweight and Obese Compared to Individuals of
Normal Weight Using the GAITRiteŽ System.
Authors: Bridget Davis, SPT; Amy Posadas, SPT;
Michelle Skala, SPT; Amie Wells, SPT; Sandy Ross,
PT, MHS, DPT, PCS
Context: Obesity is reaching epidemic levels in
America and gait deviations characteristic to this
population need to be established.
Objective: Determine if differences exist between
gait parameters in three different BMI populations.
Methods: A convenience sample of 4 males and 25
females between 18 and 31years (mean=23.5). All
individuals gave informed consent. BMI and body
fat percentage (using skin fold calipers) was calculated.
Participants were categorized into three groups:
normal weight, overweight and obese class I, and
obese classes II and III. Participants then walked
across the GAITRiteŽ system. Gait parameters measured:
cadence, stride length, heel-to-heel base of support,
toe angle, and percentage of gait cycle spent in
double limb support.
Outcome Measures: Unpaired t-tests and ANOVAs
were performed.
Results: An unpaired t-test demonstrated significant
differences for longer stride length (p=0.040),
larger heel-to-heel base of support (p=0.041),
and greater percentage of gait cycle spent in double
limb support (p=0.048) for the combined groups
of all individuals who were overweight and obese.
An ANOVA demonstrated significant differences for
a larger heel-to-heel base of support (p=0.019)
and greater percentage of gait cycle spent in double
limb support (p=0.050) when comparing the three
subject groups. No significant differences were
observed for cadence and toe angle.
Discussion: The individuals who are overweight
and obese presented with a larger base of support
and longer double limb support time. The findings
are thought to be result of increased tissue on
the inside of the individuals' thighs and/or using
a balance strategy due to a displaced center of
gravity. The longer stride length may be the result
of an unequal distribution among heights between
groups.
Conclusion: More research is necessary with larger
sample sizes, higher BMIs and BF% including an
even distribution of heights. Future research should
consider a measure for balance and thigh circumference.
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Evidence in Practice: Efficacy of Electrical Stimulation
for Patients with chronic facial muscle paresis.
Authors: Barry JG. Maryville University of St.
Louis, St. Louis, MO.
Purpose: This systematic review explored the use
of electrical stimulation (ES) in patients who
have facial nerve damage with paresis without spontaneous
recovery in the first few months.
Methods: An electronic search of three databases
(MEDLINE, CINAHL & EBSCO) from 1966 - present
was performed. The terms searched included electrical
stimulation/therapy, facial nerve/muscle injuries
limited to English. Over 500 references matched
these terms. Studies using ES for diagnostic/prognostic
purposes or to treat acute injuries were excluded.
Four studies met inclusion criteria.
Results: No studies of direct current ES were
located, although its use was mentioned in the
literature. Three pre-post human studies used Faradic
ES from 1-7 hours/day for up to 6 months. They
found significant improvements in nerve conduction
and/or facial musculature. One pre-post study on
normal facial nerves in rats looked into effects
of ES used 20 minutes/day for 6 months found abnormal
EMG activity which disappeared in 4 weeks after
stopping ES.
Conclusions:
No randomized controlled trials were found on patients
with chronic facial paresis.
The pre-/ post studies done lacked blinding and
controls.
Research of a strong design is needed to determine
the efficacy of ES for this patient population.
The trend not to publish research without a positive
finding may have limited available evidence.
Disscussion and Evidence-Based Recommendations:
Currently there is no research supporting concerns
that detrimental effects of ES are long lasting.
There is not enough evidence to support the efficacy
of ES for chronic facial paresis. If a therapist
chose to utilize ES, the patient must be motivated
to comply with treatment for several hours/day.
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Pacemaker Settings and Exercise Tolerance in Heart
Failure: A Case Presentation.
Authors: Dias KJ; Maryville University of St.
Louis, St. Louis, MO.
Background: Rate responsive pacemaker settings
are critical to a patient's exercise tolerance.
In this case, the care of a patient is discussed
spanning two hospital courses whereby physical
therapy played a role in the discovery and evaluation
of exercise intolerance associated with suboptimal
pacemaker settings.
Case Description: A 50 year old male was admitted
following an orthotopic heart transplant for left
ventricular dysfunction (EF 36%) due to humeral
rejection and DDDR pacer set at 110 bpm. The initial
PT examination revealed an asymptomatic decrease
in blood pressure from 150/80 to 120/70 as the
patient ambulated for 25 minutes. Further exercise
sessions revealed worsening cardiovascular responses
including the presence of a Wenckebach rhythm at
the maximum heart rate limit set on the pacemaker.
Physical therapy evaluation determined that the
patient had impaired activity tolerance due to
ventricular dysfunction, exacerbated by suboptimal
pacer settings. Consultation with the electrophysiology
service resulted in an increase in the maximum
heart rate to 120 bpm to help augment cardiac output.
A year later, the patient presented with worsening
LV function, EF 18%. Physical therapy noted a reoccurrence
of the Wenckebach rhythm at 120 bpm with concomitant
signs of exercise intolerance. Electrophysiology
was reconsulted and pacer settings were changed
to allow for a maximum heart rate of 140 bpm enabling
the patient to exercise at a greater intensity.
Discussion: This case highlights the role of the
therapist in helping to establish optimal pacer
settings. Optimal pacer settings appear to improve
cardiovascular responses and exercise capacity.
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