School of Physical Therapy

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Eccentric/concentric torque deficits in the quadriceps muscle
(The Journal of Orthopaedic & Sports Physical Therapy®, Inc. (JOSPT®), 1989-10-01) Trudelle-Jackson, Elaine; Meske, Neil; Highgenboten, Carl; Jackson, Allen
The purpose of the present investigation was to estimate the percentage of asymptomatic subjects who demonstrate an eccentric/concentric torque deficit in leg extension. One hundred and five subjects with a mean age of 23.51 were tested on the KIN-COM® dynamometer for maximum eccentric and concentric torque during leg extension using an 80° range of motion at 50°/sec velocity. The subjects were categorized as demonstrating a deficit if at any point in the range of motion the eccentric torque was 85% or less of the corresponding concentric torque. The results revealed that 35–54% of the subjects, depending upon sex or leg tested, demonstrated a deficit. These results suggest that many asymptomatic individuals possess an eccentric/concentric torque deficit. These findings question the validity of previous clinical research indicating that patients with anterior knee pain tend to possess an eccentric/concentric torque deficit and that correction of the deficit alleviates the pain.
Lower extremity muscular flexibility in long distance runners
(The Journal of Orthopaedic & Sports Physical Therapy®, Inc. (JOSPT®), 1993-02-01) Wang, Sharon; Whitney, Susan; Burdett, Ray; Janosky, Janine
Muscle tightness is often considered to be a predisposing factor in muscle injuries. The purpose of this study was to assess the muscle flexibility of the hamstrings, rectus femoris, iliopsoas, gastrocnemius, and soleus muscles in long distance runners. Range of motion measurements of five movements, including hip flexion with knee extended, hip extension with knee flexed, hip extension with knee extended, ankle dorsiflexion with knee extended, and ankle dorsiflexion with knee flexed, were evaluated to determine muscle tightness. Twenty runners and 20 nonrunners volunteered for the study. Each group consisted of 10 males and 10 females. The observed means were compared between runners and nonrunners, males and females, plus the dominant and nondominant leg using a three-way analysis of variance. The runners were found to have tighter hamstrings (p < .05), and soleus (p < .05) muscles than nonrunners. There was no significant difference in rectus femoris and iliopsoas muscle tightness in runners compared with nonrunners. In addition, the males had tighter hamstring muscles than the females in both runners and nonrunners (p < .05). The hamstring muscles of the dominant leg were tighter than the hamstrings of the nondominant leg in all subjects (p < .05). In conclusion, long distance runners appear to have posterior muscle tightnesc in the lower extremity.
Interdevice reliability and validity assessment of the Nicholas Hand-Held Dynamometer
(The Journal of Orthopaedic & Sports Physical Therapy®, Inc. (JOSPT®), 1994-12-01) Trudelle-Jackson, Elaine; Jackson, Allen; Frankowski, Carolyn; Long, Kara; Meske, Neil
The Nicholas Hand-Held Dynamometer (HHD) has been shown to have excellent interday and intraday reliability when using the same HHD. Since clinics may haw more than one HHD with which to evaluate patients, it would be of value to know if two identical HHDs measure the same variable consistently. The purpose of this investigation was to assess interdevice reliability of the Nicholas HHD as well as to determine its validity. Thirty healthy female subjects between the ages of 20 and 56 years () were tested for hamstring strength. Three measurements of maximum hamstring contractions were obtained using the first HHD (Device A). The average of these three measurements was compared with the average of three measurements obtained after a brief rest using a second HHD (Device B). Measurements from the two HHDs were also compared with measurements obtained from a Kin-Com isokinetic dynamometer. The Kin-Com measurements were used as criteria to determine validity of the HHD. An intraclass correlation coefficient (ICC) calculated to determine reliability between the two HHDs was low (ICC = .58). Pearson product-moment correlation coefficients were calculated between the Kin-Com and each of the two HHDs. These values were .85 and .83 for Device A and B, respectively. Analysis of variance showed no significant difference between the Kin-Com and Device A but a significant difference between the Kin-Com and Device B(p < .001). Measurements obtained from two identical HHDs may be significantly different and should not be compared.
The effect of the McConnell shoulder taping technique on people with anterior shoulder pain
(1999-12) Wang-Price, Sharon; Olson, Sharon; Hanten, William; Etnyre, Bruce
This study was to investigate the effect of the McConnell shoulder taping in people with anterior shoulder pain. There were two phases in this study. In phase one, the purposes were to determine the immediate effect of the taping on (1) activity of the upper and lower trapezius and the infraspinatus muscles during shoulder scaption; (2) pain level during shoulder scaption and (3) range of shoulder scaption. (ROM). In phase two, the purposes were to determine the effect of a six-week course of the taping combined with an exercise program as compared to the effect of an exercise program only on (1) ROM and (2) pain level and functional status. In phase one, twenty-three subjects and twenty-four shoulders were accepted for the study. Surface electromyography (EMG) was used to detect muscle activity. A standard goniometer was used to determine ROM and a visual analogue scale (VAS) was used to measure pain level. The EMG data, ROM measurements and VAS pain scores were collected from each subject under the taping and no taping conditions on the same day. Results revealed no difference in EMG data between the two conditions. Results showed improved VAS pain scores and ROM with the taping condition. In phase two, twenty-three subjects and twenty-four shoulders were accepted for the study. The Shoulder Pain And Disability Index (SPADI) was used to determine subjects' pain level and functional status. Twelve subjects in the exercise only group performed a specific exercise program for six weeks. Twelve subjects in the exercise with taping group were taped daily for the first two weeks and performed the same exercise program for six weeks. SPADI scores and ROM measurements were collected on four different days. Results revealed no difference in SPADI scores or ROM between the two groups. Results indicated the McConnell shoulder taping technique may be beneficial for temporary pain relief and an increase in ROM when treating people with anterior shoulder pain. However, the taping technique may not add any effect to the exercise program. Therefore, it may not be cost-effective to introduce the taping technique for people with anterior shoulder pain.
Evaluation of ergonomic dental stools through clinical simulation
(Academy of General Dentistry, 2000) Parsell, Douglas E.; Weber, Mark D.; Anderson, B. Craig; Cobb Jr., George W.
Work-related musculoskeletal pain occurs commonly within the dental community. Three stool designs were utilized in this study: a standard dental stool, a stool with dual arm supports, and a stool with dual arm supports and chest support. Electromyographic data from four muscle groups were collected on 13 clinicians during a simulated crown preparation procedure. Clinical simulation suggests that a potential musculoskeletal benefit to the clinician exists through utilization of dental stool designs which incorporate static arm supports.
Outcomes of total hip arthroplasty: A study of patients one year postsurgery
(The Journal of Orthopaedic & Sports Physical Therapy®, Inc. (JOSPT®), 2002-06-01) Trudelle-Jackson, Elaine; Emerson, Roger; Smith, Sue
STUDY DESIGN: Ex post facto research using prospective analysis of differences between the involved hip and uninvolved hip.
Factors influencing applicant selection of entry-level physical therapist education programs in the United States
(Association of Schools of Allied Health Professions, 2005) Wilcox, Kim Curbow; Weber, Mark
Physical therapist education programs must compete for qualified applicants due to a nationwide reduction in the applicant pool. To develop successful recruitment strategies, faculty members need information on factors influencing applicant selection of a program. The purpose of this study was to analyze factors influencing selection of an entry-level physical therapist education program. Survey subjects were students enrolled in the first professional year of an accredited entry-level physical therapist education program. A survey instrument was developed based on the literature and interviews with physical therapist students and faculty members. Results of pilot studies to determine face and content validity were acceptable. Stratified random cluster sampling was applied to select 66 entry-level physical therapy programs from an available population of 150 of the 199 accredited programs. Forty-nine programs were not included in the population for various reasons. Using a five-point Likert scale, subjects rated the influence of 51 items on their selection of a specific physical therapist education program. The overall return rate was 70.4% (1,250 surveys returned). Data were analyzed by response frequency. Four factors were selected as "very influential" by 50% or more of the subjects: degree offered, accreditation status, perception of educational quality, and program atmosphere. Additional factors selected by 45% or more of respondents as "very influential" were pass rate on licensing examination, marketability of degree, student/faculty ratio, and small class size. Factors rated "not influential" by 50% or more of subjects included ethnic, cultural, and gender issues. Since 1998, the physical therapy profession has experienced changes in entry-level degree requirements, practice requirements, and employment opportunities, resulting in increased competition for qualified applicants to education programs. The information gained in this study may assist faculty in the development of recruitment strategies.
Kinematic and kinetic reliability of two jumping and landing physical performance tasks in young adult women
(North American Sports Medicine Institute, 2007-05) Ortiz, Alexis; Olson, Sharon; Libby, Charles; Kwon, Young-Hoo; Trudelle-Jackson, Elaine
BACKGROUND: Jumping and landing tasks are commonly used functional measurement tools to assess lower extremity performance in female athletes. However, few studies have established the number of trials needed to achieve reliability of measurement for evaluating landing mechanics
Interrater reliability of a movement impairment-based classification system for lumbar spine syndromes in patients with chronic low back pain
(The Journal of Orthopaedic & Sports Physical Therapy®, Inc. (JOSPT®), 2008-06-01) Trudelle-Jackson, Elaine; Sarvaiya-Shah, Shweta; Wang, Sharon
STUDY DESIGN: A prospective methodological study of interrater reliability.
Effectiveness of surface electromyographic biofeedback-triggered neuromuscular electrical stimulation on knee rehabilitation
(North American Sports Medicine Institute, 2009-08) Boucher, Tony; Wang, Sharon; Trudelle-Jackson, Elaine; Olson, Sharon
BACKGROUND: Neuromuscular electrical stimulation initiated by a surface electromyographic biofeedback threshold (sEMG-triggered NMES) has been studied in populations of patients with neurological problems, but has not been applied to orthopedic populations.
Effectiveness of a 6-week injury prevention program on kinematics and kinetic variables in adolescent female soccer players: A pilot study
(University of Puerto Rico Medical Sciences Campus, 2010-03) Ortiz, Alexis; Trudelle-Jackson, Elaine; McConnell, Keegan; Wylie, Stephanie
BACKGROUND: Incidence of knee injuries in female soccer players is 2-6 times that of male counterparts. The objective was to determine whether an injury prevention program incorporated into the athlete’s regular soccer practice is effective for improving landing mechanics.
Reduction of diffusion barriers in isolated rat islets improves survival, but not insulin secretion or transplantation outcome
(2010-04-01) Williams, S. Janette; Huang, Han-Hung; Kover, Karen; Moore, Wayne V; Berkland, Cory; Singh, Milind; Smirnova, Irina S.; MacGregor, Ronal; Stehno-Bittel, Lisa
For people with type 1 diabetes and severe hypoglycemic unawareness, islet transplants offer hope for improving the quality of life. However, islet cell death occurs quickly during or after transplantation, requiring large quantities of islets per transplant. The purpose of this study was to determine whether poor function demonstrated in large islets was a result of diffusion barriers and if removing those barriers could improve function and transplantation outcomes. Islets were isolated from male DA rats and measured for cell viability, islet survival, glucose diffusion and insulin secretion. Modeling of diffusion barriers was completed using dynamic partial differential equations for a sphere. Core cell death occurred in 100% of the large islets (diameter > 150 μm), resulting in poor survival within 7 days after isolation. In contrast, small islets (diameter < 100 μm) exhibited good survival rates in culture (91%). Glucose diffusion into islets was tracked with 2-NBDG; 4.2 μm/min in small islets and 2.8 μm/min in large islets. 2-NBDG never permeated to the core cells of islets larger than 150μm diameter. Reducing the diffusion barrier in large islets improved their immediate and long-term viability in culture. However, reduction of the diffusion barrier in large islets failed to improve their inferior in vitro insulin secretion compared to small islets, and did not return glucose control to diabetic animals following transplantation. Thus, diffusion barriers lead to low viability and poor survival for large islets, but are not solely responsible for the inferior insulin secretion or poor transplantation outcomes of large versus small islets.
Relations of meeting national public health recommendations for muscular strengthening activities with strength, body composition, and obesity: The Women's Injury Study
(American Public Health Association, 2011) Trudelle-Jackson, Elaine; Jackson, Allen W.; Morrow, James R. Jr.
Objectives. We examined the relations of meeting or not meeting the 2008 Physical Activity Guidelines for Americans recommendations for muscular strengthening activities with percentage of body fat, body mass index (BMI; defined as weight in kilograms divided by height in meters, squared), muscular strength, and obesity classification in women.
Low insulin content of large islet population is present in situ and in isolated islets
(2011-01-01) Huang, Han-Hung; Novikova, Lesya; Williams, S. Janette; Smirnova, Irina V.; Stehno-Bittel, Lisa
The existence of morphologically distinct populations of islets in the pancreas was described over 60 years ago. Unfortunately, little attention has been paid to possible functional differences between islet subpopulations until recently. We demonstrated that one population, the small islets, were superior to large islets in a number of functional aspects. However, that work did not determine whether these differences were inherent, or whether they arose because of the challenge of isolation procedures. Nor, were there data to explain the differences in insulin secretion. We utilized immunohistochemistry, immunofluorescence, ELISA, and transmission electron microscopy to compare the unique characteristics found in isolated rat islet populations in situ and after isolation. Insulin secretion of small isolated islets was significantly higher compared to large islets, which correlated with higher insulin content/area in small islets (in situ), a higher density of insulin secretory granules, and greater insulin content/volume in isolated islets. Specifically, the core b-cells of the large islets contained less insulin/cell with a lower insulin granule density than peripheral b-cells. When insulin secretion was normalized for total insulin content, large and small islets released the same percentage of total insulin. Small islets had a higher density of cells/area than large islets in vitro and in situ. The data provide a possible explanation for the inferior insulin secretion from large islets, as they have a lower total cell density and the b-cells of the core contain less insulin/cell.
Thoracic Syrinx in a patient with balance difficulties
(The Journal of Orthopaedic & Sports Physical Therapy®, Inc. (JOSPT®), 2011-04-01) Richard, Shanan; Wang, Sharon; Georgelas, Timothy
The patient was a 42-year-old woman who was referred to a physical therapist with diagnoses of lumbar degenerative joint disease and a left ankle fracture. The patient reported an insidious onset of low back and left lower extremity pain, which began approximately 2 years prior to referral. She reported having difficulties with balance, which ultimately led to a fall 1 year after her low back and left lower extremity pain began. Her fall resulted in a left ankle fracture that required open reduction and internal fixation. Magnetic resonance imaging of her brain and spine revealed a diffuse, abnormally increased cord signal. The patient was diagnosed with a thoracic syrinx, which is a longitudinal fluid-filled cavity along the spinal cord. The patient underwent a T5-T6 hemilaminectomy, with placement of a syringopleural shunt between T4 and T6. Following surgery, the patient's neurologic status stabilized and did not deteriorate any further.
Exercise Increases Insulin Content and Basal Secretion in Pancreatic Islets in Type 1 Diabetic Mice
(2011-09-11) Huang, Han-Hung; Farmer, Kevin; Windscheffel, Jill; Yost, Katie; Power, Mary; Wright, Douglas E.; Stehno-Bittel, Lisa
Exercise appears to improve glycemic control for people with type 1 diabetes (T1D). However, the mechanism responsible for this improvement is unknown. We hypothesized that exercise has a direct effect on the insulin-producing islets. Eight-week-old mice were divided into four groups: sedentary diabetic, exercised diabetic, sedentary control, and exercised control. The exercised groups participated in voluntary wheel running for 6 weeks. When compared to the control groups, the islet density, islet diameter, and β-cell proportion per islet were significantly lower in both sedentary and exercised diabetic groups and these alterations were not improved with exercise. The total insulin content and insulin secretion were significantly lower in sedentary diabetics compared to controls. Exercise significantly improved insulin content and insulin secretion in islets in basal conditions. Thus, some improvements in exercise-induced glycemic control in T1D mice may be due to enhancement of insulin content and secretion in islets.
Effect of aerobic exercise on cognition and sendentary behavior in persons with Parkinson disease
(2011-12-30) Swank, Chad
Parkinson disease (PD) progressively impairs individuals of physical function and cognitive capacity promoting sedentary behavior. Participation in regular exercise improves executive function in elderly persons. However, no studies have observed the impact of exercise on cognitive function or sedentary behavior in people with PD. The purposes of this study were to examine the effect of aerobic exercise on cognitive function and sedentary behavior in persons with PD. Both mode (self paced versus forced) and intensity (≤60 rpm versus >60 rpm) of exercise were investigated. We recruited 20 participants for our 12-week aerobic exercise intervention with 1-month follow-up. Executive function was measured by the Repeatable Battery for the Assessment of Neuropsychological Status(TM) (RBANS(TM)) and dual tasks (TUG manual and TUG cognitive ). Sedentary behavior was determined by physical activity level (volume and intensity) as gathered by the StepWatch(TM) Activity Monitor (SAM). Mann Whitney U tests were selected to analyze the difference between groups--both mode of exercise and intensity. Friedman's Analysis of Variance (ANOVA) test was used to analyze groups across time to determine the impact of our intervention. Wilcoxon Signed Ranks test was used post-hoc. There were no differences between exercise modes for cognitive function or physical activity. Differences with TUG manual were observed across time (X2 =9.69, p =0.01) for all participants. Specifically, TUGmanual scores were different between posttest and 1-month follow-up (z=-2.38, p =0.017) and between baseline and 1-month follow-up (z=-2.83, p =0.005). RBANS(TM) had differences between post-test and 1-month follow-up (z=-2.876, p =0.004) with post-hoc analysis. No differences were observed for the low pedal rate group on cognition over time. For the high pedal rate group, TUGcognitive scores were significantly different over time (X 2 =7.14, p =0.03) but not after post-hoc analysis. Our aerobic exercise intervention failed to minimize sedentary behavior. However, improvements were observed across time for all participants with executive function, specifically dual tasking during gait. While individuals with a high pedal rate may have benefitted from the intervention, the low pedal rate participants achieved clinically relevant improvement and reduced their fall risk. The exercise intervention may be a valuable adjunct for a multidimensional approach to maximize function in persons with PD.
Aerobic exercise in people with multiple sclerosis
(Consortium of Multiple Sclerosis Centers, 2013) Swank, Chad; Thompson, Mary; Medley, Ann
The aims of this study were to explore the feasibility of structured aerobic exercise followed by a period of unstructured physical activity and determine the impact of such exercise on cognition, mood, and quality of life in people with multiple sclerosis (MS). A convenience sample of 9 individuals with relapsing-remitting MS performed 30 minutes of aerobic exercise (upper- and lower-extremity ergometry and treadmill ambulation) twice weekly for 8 weeks, followed by 3 months of unstructured physical activity. Eight participants completed the intervention and posttest; 6 returned for the 3-month follow-up. Cardiovascular fitness, cognition, mood (measured with the Beck Depression Inventory–II; BDI-II), and quality of life (measured with the Multiple Sclerosis Quality of Life–54; MSQOL-54) were assessed. Participants completed 27.9 minutes of exercise per session, with an 85.1% attendance rate. Evaluation using the Wilcoxon signed rank test revealed no deleterious effects and improved results on the BDI-II and MSQOL-54 mental subscale. Analysis of change scores using the one-sample t test revealed that the BDI-II and MSQOL-54 were changed from zero after structured exercise, but only the BDI-II maintained improvement after unstructured physical activity. Further analysis of BDI-II subscales revealed that improvement occurred only in the Somato-Affective subscale. In this study, program feasibility was demonstrated in several ways. There were no declines in cognitive function over the 5-month period. Despite unchanged cognitive function, participants may value the improved mood enough to continue both the structured and unstructured physical activity. The role of unstructured physical activity in concert with periodic structured exercise programs merits further investigation.
Relationship between plantar flexor weakness and low back region pain in people with postpolio syndrome: A case control study
(Orthopaedic Section, APTA, 2013) Kelley (Da Silva), Carolyn
Study Design: Case control study.
Health informatics as a bridge to the underserved - Primary care strategy
(2013-10-03) Hersh, B.; Mancuso, Peggy; Roux, Gayle M.; Tietze, Mari; Thompson, Mary E.; Pawloski, B.; Restrepo, Elizabeth; Hersch, Gayle Ilene; Pancheri, Karen
Addressing our patients with a team approach at any level in the medical community is vital to their wellbeing and continued care. Every profession approaches the health [care] model from a different angle and being aware of the differences in knowledge and how to communicate leads to better health care delivery.

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