School of Physical Therapy
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Item Measurement and training of dual-task of gait in persons with multiple sclerosis(10/27/2020) Brusola, Gregory A.; Mitchell, Katy, Ph. D.; Mitchell, Katy, Ph. D.Individuals with multiple sclerosis (MS) present with a wide variability of motor, sensory, and cognitive symptoms that affect their ability to engage in and perform their daily activities. Walking is a motor task that is known to be widely affected by the symptoms of MS and individuals with MS demonstrate difficulties with their ability to ambulate even early on in their disease process. Although it is broadly accepted that walking is heavily influenced by motor and sensory symptoms, recent studies in the area of cognitive-motor interference have identified a relationship between cognitive functioning and motor performance in individuals with MS. The concurrent performance of a motor and cognitive task (dual-task) has been found to adversely affect the gait mechanics of individuals with MS, effectually increasing their risk for falling. Physical therapists often rely on outcome measures to help quantify an individual’s physical performance; however, there is a lack of a standardized dual-task outcome measure that not only measures overall dual-task performance but also measures the single-task performance of the motor and cognitive task. The modified Walking and Remembering Test (mWART) is one such dual-task outcome measure that quantifies dual-task performance relative to the single-task performance of the motor and the cognitive task. Additionally, the mWART adjusts the difficulty of the dual-task cognitive task relative to the individual’s single-task cognitive performance. As we continue to improve our understanding of the underlying mechanisms of cognitive-motor interference and the anatomical correlates of dual-task performance, studies have emerged to study methods by which we can improve dual-task ability. Although there has been a substantial growth of research in individuals with Parkinson disease, stroke, or dementia, more studies are needed, especially in individuals with MS. Three studies comprise this dissertation. The first study determined the test-retest reliability and discriminant validity of the mWART. The second study assessed the feasibility and effects of a six-week gait-specific dual-task training intervention on gait velocity, cadence, and step length. Finally, the third study evaluated the effects of the training intervention on walking capacity, self-perceived walking ability, and subjective fatigue. The participants were tested on two separate days to collect the average baseline data for studies one and two. Participants were randomly allocated to a six-week dual-task training group or a six-week single-task training group for studies two and three. Study one results revealed good to excellent test-retest reliability of the mWART for single-task gait velocity (ICC2,k = .961, p<.001), dual-task gait velocity (ICC2,k = .968, p<.001), and single-task digit span recall (ICC2,k = .829, p=.004) for individuals with MS. The mWART was also able to discriminate based on single-task gait velocity (p=.001) and dual-task gait velocity (p=.002) between individuals with MS and without MS. To assess spatiotemporal gait parameters, the Protokinetics ZenoWalkway was used to quantify gait velocity, cadence, and step length in response to the gait-specific dual-task training intervention. Results from the second study revealed that the dual-task training intervention elicited clinically significant improvements in single-task (18.6% improvement) and dual-task gait velocity (13.0% improvement) at post intervention. The dual-task group was the only group able to demonstrate significantly different changes in single-task gait velocity at both post-intervention (p=.018) and follow-up (p=.042). Observationally, the results also suggest that dual-task training supports more robust changes in dual-task performance (3.5% or less change at follow-up compared to post-intervention). The results from the final study revealed clinically meaningful improvements in walking capacity (p=.007, partial η2=.505) and self-perceived walking ability (p=.009, partial η2=.345) following the dual-task training intervention despite there being no significant changes in subjective fatigue. The overall results indicate the mWART is a valid and reliable clinical measure of dual-task performance in individuals with MS. Additionally, the gait-specific dual-task training intervention detailed within is effective in improve single-task and dual-task performance in individuals with MS and can serve as a framework from which clinicians may initiate dual-task training for their patients with MS.Item A mixed method analysis of the role of balance outcome measures in therapist decision-making and patient outcomes(10/30/2020) Lyon, Marissa F; GLEESON, PEGGY BThe purpose of these three studies was to assess the impact of using outcome measures on physical therapists' decision-making and patient functional outcomes. Three hundred thirty-seven physical therapists completed an online survey focused on their use of outcome measures and their relationship with decision-making for patients with acquired brain injury. Physical therapists reported that the use of outcome measures frequently impacted decision-making in estimating prognosis, identifying a patient's risk for adverse events, setting goals, communicating, educating, making discharge decisions, and selecting treatment interventions. Twenty-three physical therapists participated in semi-structured interviews focused on outcome measures' impact on decision-making and patient outcomes. Therapists indicated that outcome measures played a large role in clinical decisions, and a majority reported they believed there was a relationship between outcome measures and patient outcomes. Finally, eight physical therapists (PTs) and physical therapist assistants (PTAs) participated in a knowledge translation intervention focused on outcome measures. Patients treated by these therapists demonstrated significantly better ambulation ability and participated in significantly fewer minutes of physical therapy compared to patients treated by six PTs and PTAs who did not participate in an educational intervention.Item Usability and effectiveness of a self-care mobile health app in individuals with heart failure(11/15/2021) Ababneh, Anas; Jackson, ElaineRe-hospitalization is one of the challenges that the medical community encounters when treating individuals with heart failure (HF). The hospitalization is an independent risk factor of mortality in this population. Patients often describe the HF symptoms as minor deviations in their health, neglect them, and delay in seeking early medical care. Therefore, establishing a novel self-care strategy to monitor symptoms is important, which may subsequently reduce hospital readmission and minimize negative consequences of hospitalization. Mobile health (mHealth) apps have features to actively engage individuals, such as real-time adjustments, graphic feedback, and social interaction functionalities, which may make the apps a convenient tool for promoting self-care management and improving health outcomes. The Heart Failure Health Storylines (HFHS), a mHealth app, is created specifically for people with HF for self-care management. However, its clinical effectiveness on people with HF has not been reported yet. Purposes. This study will assess the usability and the effectiveness of HFHS app on self-care management and physical activity promotion in people with HF. Participants. A total of 60 ambulatory participants with stable HF will be enrolled. Methods. In terms of studying the usability of the HFHS app, the study will provide a description of the frequency of tracking health habits by participants and their responses toward alert messages sent. The other part of this study will be a randomized controlled trial in which participants will be randomized into a self-care intervention group (App group) and control group (No App group). All participants will complete the SF-36 Quality of Life survey and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) before and after 4 weeks of intervention. All participants will learn how to monitor their daily physical activity with a pedometer and receive weekly follow up phone calls from the research team. The App group will also be trained to use the HFHS app to track their resting heart rate and resting blood pressure in the morning, medication schedule, body weight, and physical activity over 4 weeks, and to complete the Quality of Experience (QoE) survey about the app after 4 weeks. The research team will monitor participants’ data entry on the HFHS app over 4 weeks. Clinical Relevance. The experience of this study may provide us a better understanding on the usability and the effectiveness of the HFHS app on self-care management and physical activity promotion in people with HF at a community setting. Results of this study can provide preliminary data for future larger interventional studies with a longer duration on the effects of self-care management apps in decreasing hospitalization rate among people with HF.Item An integrated model of functional status and socioeconomic factors affecting hospital length of stay and 30-day readmission risk in individuals with heart failure(11/22/2021) Tran, Vinh Q; Lin, Suh-JenBackground: Acute management of heart failure (HF) is a high-cost enterprise. Cost-effective management of acute HF hinges upon hospital outcomes such as length of stay (LOS) and 30-day readmission (30dRA) rate. Literature has produced regression models that predict these hospital outcomes; however, existing models use a limited scope of traditional medical predictors resulting in weak predictive ability. Functional status (FS) and socioeconomic factors (SEFs) have been found to predict various hospital outcomes in patients with HF; however, existing model performance is limited in its scope. Therefore, a modernized, holistic approach through the integration of FS and SEFs into existing medical predictor based regression models may better predict LOS and 30dRA rate in HF. Purpose: To determine the predictive utility of a model utilizing FS, SEFs, and traditional medical variables on hospital LOS and 30-day re-admission rate (30dRA) in individuals with HF. Methods: Secondary data for 2016 to 2020 calendar years was gathered from a Trauma Level I, safety-net hospital. Hospital admissions with a primary diagnosis of HF were included. Subjects under 18 years old at admission and death during hospitalization were excluded. A total of 2204 medical records were analyzed using hierarchical linear regression on log-transformed LOS data and 1953 records were analyzed using logistic regression on 30dRA data. Results: A LOS model utilizing FS, SEFs, and traditional medical factors was found to be significant (r2 = .207, adjusted r2 = .204, F(8, 2195) = 71.579, p < .001). A 30dRA model utilizing SEFs and traditional medical factors was found to be significant (χ2(10) = 43.185, df = 10, p < .001). Within the 30dRA model, FS was found to be not statistically significant (OR: .996, 95% CI [.985 to 1.007], p = .449). Conclusion: A model utilizing FS, SEFs, and traditional medical factors can predict hospital LOS. FS appears to be less contributory to a 30dRA model compared to SEFs and traditional medical factors.Item The impact of spinal stabilization exercises on pain, disability, and physical functional after lumbar spinal fusion(11/8/2019) Sawyer, Kathryn; Roddey, Toni S.Lumbar spinal fusion (LSF) surgery is one of the most commonly performed procedures for degeneration of the lumbar spine. Though minimally invasive surgical techniques have been developed in an attempt to reduce muscle injury, some damage is unavoidable. Research on postoperative rehabilitation has not kept pace with the increased utilization of LSF in the United States over the past three decades, and there is a lack of high-quality evidence to answer questions regarding the optimal timing, duration, and type of rehabilitation to implement following surgery. Spinal stabilization exercises target the muscles that corset the lumbar spine to improve functional control of the trunk. Initiation of a spinal stabilization program early after LSF may reduce loss of muscle function, potentially improving clinical outcomes following surgery. The purpose of the three studies was to explore spinal surgeons’ perceptions of rehabilitation after LSF, investigate deep abdominal muscle performance during spinal stabilization exercises, and compare the effectiveness of early initiation of a spinal stabilization program to the current standard of care on outcomes after surgery. Spinal surgeons participated in one-on-one interviews to discuss their opinions on postoperative recovery. Data was assessed with content analysis, coding and triangulation. Findings indicated that surgeons prefer a rehabilitative program that includes cardiovascular activity, trunk stabilization exercises performed with the lumbar spine in a neutral position, and reinforcement of body mechanics. Next, five low-load, neutral spine stabilization exercises were tested with ultrasound imaging. Two one-way repeated measures ANOVAs were calculated to compare resting and contracted measurements of the transversus abdominis and internal oblique muscles. Results of this study were incorporated into a randomized, prospective clinical trial comparing the effects of early initiation of a spinal stabilization exercise program to standard of care after LSF. Participants randomized to the control group followed standardized guidelines for cardiovascular activity. Participants randomized to the intervention group received instruction in performance of a daily spinal stabilization exercise program. Four separate 2x3 mixed ANOVAs were used in data analysis. Results indicated that the program did not have either a positive or negative impact on pain, disability, or physical function up to six months postoperatively.Item The influence of positioning and torticollis on the development and treatment of abnormal infant head shapes(12/13/2019) Shill, Julie; Trudelle-Jackson, ElaineThe purpose of this project was to investigate how positioning and torticollis influence the development and treatment of abnormal head shapes. Study one is a regression analysis to determine if time in inclined positioning equipment, birth (singleton or multiple), and sex are predictors of brachycephaly and/or severe plagiocephaly. Charts of 4-month-old infants were reviewed. Two binomial logistic regression analyses were done. The two dependent variables were presence of brachycephaly (cephalic index ≥ 92) or not, and presence of severe plagiocephaly (cranial vault asymmetry ≥ 12 mm) or not. The model for presence or absence of cephalic index ≥ 92 was significant. Only hours spent in incline was significant. The model for presence or absence of cranial vault asymmetry (CVA) was not significant. Study two determined reliability and validity of using Image J software to measure torticollis from digital images. Using Image J software, two physical therapy students measured the head tilt of 24 infants from digital images of the infants. The images were printed and manually measured by the principal investigator. All measurers were blinded to the measurements of each other and to previous measurements from an earlier session. ICC analyses were done to determine inter and intra rater reliability of the Image J software measurement method. A paired samples t-test was done comparing Image J measurements to the manual measurements to determine concurrent validity. All ICCs were above .75. Inter and intra-rater reliability was established. There was no significant difference comparing Image J measurements and manual measurements. Concurrent validity was established. Study three is a retrospective comparative analysis of the effect of age and head tilt on the amount of change in CVA in infants with plagiocephaly who receive dynamic orthotic cranioplasty (DOC) band treatment. Charts of infants with CVA ≥ 12mm who received DOC band treatment were reviewed. A two-way ANOVA was performed comparing age (< 5 months, ≥ 5 months) and head tilt (< 5 degrees ≥ 5 degrees) at the beginning of treatment. The dependent variable was change in CVA. The interaction effect between age and head tilt was not significant. Analysis of the main effect of age showed that infants < 5 months of age demonstrated significantly greater change in CVA than older infants. There was no significant difference in change in CVA measurements for infants with < 5 degrees of head tilt compared to ≥ 5 degrees. This project provides new information on how inclined equipment contributes to the development of brachycephaly. It introduces a new software method for measuring torticollis. It informs that infants with torticollis achieve similar change in CVA from DOC band treatment as infants without torticollis, while emphasizing the need for physical therapy during DOC band treatment.Item Factors that influence sports-related concussion measures in contact, non-contact sports and non-athletes.(12/15/2020) Cookinham, Brittani H.; Weber, Mark D.The purpose of this two-study dissertation was to determine how concussion history, career status, cumulative years of football exposure (study one), and activity status (study two) affect performance on sports-related concussion measures in healthy, elite athletes and non-athletes. Elite, American football players (study one), and elite athletes from all sports and non-athletes (study two), between the ages of 18-45 were invited to voluntarily participate. Individuals were excluded if they had a diagnosed concussion within the past 30 days, if they were currently experiencing symptoms preventing return to play/sport or if they were pregnant. Both studies followed a cross-sectional design. Each participant underwent a single session where demographic data, as well as data from a symptom evaluation, neurocognitive testing, and balance testing (study 1) and additional data from the Vestibular/Ocular-Motor Screening tool (VOMS) and dual-task tandem gait (DT TG) testing (study two), were collected. Data was analyzed utilizing regression modeling, alpha was set to .05, a priori. Results revealed symptom reports from the symptom evaluation and the VOMS were affected by concussion history, activity status, age, and career status. Balance was affected by both concussion history and age. Neurocognitive performance and DT TG were measures not significantly impacted by the outlined factors: concussion history, career status, cumulative years of football exposure, and activity status. Additionally, cumulative years of football exposure was not a significant factor. Therefore, clinicians should take concussion history, career status, and activity status into consideration when analyzing symptom reports and balance scores, for all patient examinations regardless of their referral diagnosis, secondary to the long-term implications of these factors. Although our studies did not reach the point of significance with contact sports influencing neurocognitive performance and DT performance, we believe further research is needed to explore these relationships to better understand long-term implications associated with concussive and sub-concussive exposure. Thus, a longitudinal study is recommended to explore the long-term effects of contact sports and their effect on neurocognition, balance, and DT TG. Our studies provide foundations for future studies by identifying factors that influence common sports-related concussion measures.Item The role of extrapelvic musculoskeletal impairments in women with chronic pelvic pain: Quantification to intervention(12/8/2021) Proulx, Laurel E; Brizzolara, KelliThe purpose of this 3-study dissertation was to examine the role of extrapelvic musculoskeletal impairments in women with CPP. For study one and two, asymptomatic and women with CPP were recruited. Health history, psychosocial status, pain, and pelvic floor function were collected to define the population and explore relationships with muscular impairments. Muscle stiffness and pain-pressure threshold (PPT) were measured in 11 extrapelvic muscles shown as having a relationship with CPP in previous research. Stiffness of the rectus femoris, adductor longus, lumbar paraspinals and piriformis were all significantly stiffer in women with CPP as compared to the asymptomatic cohort. Additionally, there was a significant difference in PPT between groups in the majority of the muscles measured. For the CPP group, there were no significant correlations between muscle stiffness and PPT. Therefore, some extrapelvic muscles may have increased stiffness in women with CPP; however, muscle stiffness is not associated with PPT. For study 2, correlation results revealed significant, but weak and likely unimportant relationships between extrapelvic muscle stiffness and urogynecologic health history. Using an exploratory factor analysis, three clusters of impairments emerged: 1) greater pelvic floor dysfunction and psychosocial involvement, 2) increased muscle stiffness of the hips and thighs, and 3) increased muscle stiffness of the low back and abdomen. The third study examined the effect of an individualized orthopedic-based physical therapy intervention on pain intensity, extrapelvic muscle stiffness, and PPT in two women with CPP. Pelvic floor muscle function and psychosical status were also assessed before and after intervention. After intervention, the participants demonstrated significant improvements in pain and PPT for some of the extrapelvic muscles measured. Muscle stiffness measurements were significantly decreased in each participant’s primary area of pain or dysfunction. Both participants demonstrated improvement in pelvic floor function and one demonstrated improvements in central sensitization and depression symptoms. This study highlights alternate assessment and treatment of CPP beyond the pelvic floor. Clinically, extrapelvic muscle stiffness and decreased PPT are common in women with CPP, however; they do not seem to be correlated. This should be considered when clinicians prioritize interventions as extrapelvic muscle stiffness may not be a pain generating impairment. Additionally, intervening upon extrapelvic impairments may be beneficial in women with CPP. Preliminary symptom categorization suggests that women with CPP who present with greater pelvic floor dysfunction and psychosocial involvement may be more appropriately streamlined to see a pelvic health physical therapist versus those who present with stiffness of the hips and thighs or low back and abdomen. If clinicians can identify which women with CPP necessitate specialized pelvic health physical therapy, this might improve access to care for those who do not need intrapelvic intervention. Additionally, the utilization of an extrapelvic intervention on CPP resulted in positive outcomes in pelvic floor pain and function for those with CPP; this challenges the current paradigm necessitating intravaginal physical therapy for all women with CPP. Physical therapists have the appropriate set of skills necessary to treat extrapelvic musculoskeletal impairments of CPP. However, future research is needed to better understand the role specific musculoskeletal impairments have on pain and function, beyond extrapelvic muscle stiffness. This information would help guide the variables of interest for future intervention trials. By identifying other common musculoskeletal impairments in this population, the impairment categories of CPP could become more robust and help guide treatment of the impairment sequelae. Subsequent research examining the effects of singular extrapelvic intervention strategies, such as the ones used in the third study, are necessary to understand their effects not only on the musculoskeletal impairment but also on pain and pelvic floor function.Item A computer programmed physical therapy student clinical evaluation form(1980-12-31) Youens, Edith K.; Cramer, Barbara; Rozier, Carolyn; Pittman, MildredItem Knowledge and perceptions of entry level physical therapy clinical skills by Texas orthopedic interns, residents, and faculty(1982-05) Kristoferson, Sandra Nelson; Cramer, Barbara Dr.Item Profile of Texas Physical Therapists employed in educational environments(1984-05-30) Fincher, V. Kathleen; Cramer, Barbara; Morrison, Eileen; Friberg, RobertItem Relationship between lumbar range of motion and patients' disability status(1994-12) Plasencia, Osvaldo; Olson, SharonThe purpose of this study was to determine any association between lumbar range of motion (ROM) and a disability questionnaire in patients with low back pain. The data were obtained from twenty charts of 12 male and 8 female adults, ages 20 to 50 years old, who had physical therapy treatment due to low back pain. The patients completed a Roland Scale questionnaire and the BROM instrument was used to measure frontal and sagittal plane ROM of the lumbar spine. The Pearson Correlation Coefficient between flexion and the Roland Scale was $-$0.19; extension and the Roland Scale, r = $-$0.22; and lateral flexion and the Roland Scale, r = $-$0.31. The data analysis using the standard multiple regression showed that R$\sp2$ =.018 and an adjusted R$\sp2$ =.023, with no significance at the.05 level (p =.36). The results of this study showed no significant correlations between lumbar ROM and the Roland Scale.Item Factor analysis of children's attitude inventory toward physical education(1995-05) Atkins, SusanItem Muscle activity in tight hip and loose hip subjects during two different hip extension tasks(1996-12-31) Wise, David Dale; Hasson, Scott; Etnyre, Bruce; Nicodemus, Nic; Watson, MaryPurpose. The purpose of the study was to investigate: 1) whether motor programming as a role in perpetuating muscle imbalance and 2) if subjects with tight hip f lexors demonstrate hyperactivity of the erector spinae musculature. Subjects. From 254 potential subjects, 16 subjects who met the criteria for "loose hip" and 16 for "tight hip" flexors were selected. Subjects were selected who varied 1.5 sd from the mean on measures standardized for this study using an inclinometer. Methods. Subjects performed two movements: 1) voluntary lift; and 2) isometric hold, while in a hip extended or hip flexed prone position. Surface EMG was taken at the right and left erector spinae, right gluteus maximus and right hamstring. Dependent variables taken from the EMG were: 1) duration of muscle onset sequence (DMOS) - the time between the onsets of the first and fourth muscles; 2) latency of the erector spinae muscles (LES latency and RES latency) -the time between muscle onset and movement onset, and 3) early amplitude of the erector spinae (EAC) - average percent MVC during 0.4 sec after muscle onset minus average percent MVC during 0.1 sec prior to muscle onset. Data Analysis. The research design was a 2X2X2 repeated measures. Therefore, a three-way multi-variate analysis (MANOVA) was used . Results. A three-way interaction was found for DMOS. The difference was between the loose and tight hip subjects for the lifting movement in the flexed hip position (p < 0.0004). This suggests that the muscle activation of the back and hip extensors is different in these two populations when hip tension is altered, but only for the lift movement. A main effect of movement (p < 0.01) was found for LES latency. There was no main effect for hip type. For EAC there was a significant movement by position 2-way interaction (p < 0.016), and no main effect for hip type. Conclusion. It does not appear that motor programming has a role in perpetuating this particular muscle imbalance and that subjects with tight hip flexors do not demonstrate hyperactivity of the erector spinae musculature. Clinical Relevance. This research seems to support Kendall's suggestion that muscle behaviors respond more to immediate external mechanical changes rather than constant internal mechanical differences.Item H-reflex changes with loading and unloading(1997-12) Ali, Ashraf A.; Sabbahi, Mohamed A.; Olson, Sharon; Simmonds, MaureenSoleus H-reflex has been tested clinically in lying position. Stresses on the spine vary during lying, standing, weight lifting and unloading. This may influence the H-reflex. The purpose of this study was to measure the changes that might occur in the soleus H-reflex during such loading and unloading conditions. Twenty healthy volunteers (20-50y) with no history of significant low back pain or radiculopathy participated in the study. Cadwell Excel EMG unit was used to elicit and record the soleus H-reflex. The tibial nerve was stimulated at the popliteal fossa using 1 ms pulses and 0.2pps of H-max. Each subject was tested under four different conditions; prone, free standing, standing while lifting 20% of the body weight and standing unloaded by 25% of the body weight using the ZUNI II. H-reflex maximum peak-to-peak amplitudes and onset latencies from eight trials were averaged for each lower extremity. Two factor ANOVAs with repeated measures over each factor were used to test the effect of the position and the side on the H-reflex amplitude and latency with alpha = 0.025. Results showed no significant effect of the side on the H-reflex amplitude and latency. Compared to prone lying, there was a significant reflex inhibition during free standing, loading and unloading conditions. No significant difference was recorded in the reflex latency among different conditions. These results imply a significant interplay between peripheral and central mechanisms on the spinal motoneurons. It suggests testing of the H-reflex amplitude and latency in functional postures to detect subtle changes in root impingement.Item Relationship of exercise tolerance, exercise intensity, and physical performance in frail elderly individuals residing in a long-term care facility(Texas Woman's University, 1997-12-30) Zabel, Reta J.; Walker, Ann; Hasson, Scott; Olson, Sharon; Ishee, JimmyLiterature regarding the relationship between physiologic capacity and physical performance is limited and non-conclusive among the frail elderly. The purposes of this study were to examine the relationship of physiologic response to activity and physical performance using lower extremity activities, to describe performance capabilities, and to propose thresholds of performance in a sample of 78 frail older adults residing in long-term care facilities. Physiologic performance was evaluated using measures of heart rate during five minutes of walking and during a low level seated exercise test. Ratings of perceived exertion were determined following the exercise test. Physical performance was determined by timed chair rise and sit, challenged standing, 8-foot walk speed, and 5- minute walk distance. The subjects were tested in one session at the residential facility. All tests followed the same sequence with scheduled rest periods: challenged stands, walking speed test, five repetitions of chair rise and sit, rest break, 5-minute walk test, rest break, and seated step test. The subject's heart rate was monitored throughout and recorded during the last three minutes of the 5-minute walk and during the seated step test. The subject's heart rate was allowed to return to the resting rate between the test as indicated. Pearson product-moment correlation coefficients for heart rate measures and physical performance measures of walking speed demonstrated no relationship in the frail sample. Likewise, Spearman rank-order correlation analyses found no relationship between the ability to rise from a chair repeatedly and heart rate measures. Challenged stands also did not demonstrate a relationship to the recorded heart rate values in the frail sample. However, the 5-minute walk distance was found to have a fair relationship to walking speed (r = .35) for the frail sample. The 5-minute walk test and the physical performance measures exhibited fair to good relationships to each other and were safe, acceptable, and discriminative measures. The physical performance measures were objective, sensitive to different levels of physical capacity, and easily administered in spite of the frail status of the subjects. When combined, the walk speed, challenged stands, chair rise and sit, and the 5-minute walk distance were useful in describing the elderly in the sample. The heart rate data was easily obtained from the subjects, but was not as useful in determination of physical performance capabilities. Based on the data from the study, performance thresholds for the 5-minute walk was less than/equal to 380 feet, walking speed was less than/equal to .75 feet/second, challenged stands was inability to stand in tandem, and chair rise and sit was greater than/equal to 27.69 seconds to perform five repetitions.Item Effectiveness of individualized physical therapy in treating subjects with neck pain(1999-05) Wang, Wendy Tzyy-Jiuan; Olson, Sharon L.; Hanten, William P.; Gleeson, Peggy B.There is sparse scientific evidence in support of physical therapy for patients with neck dysfunction. Clinical studies investigating treatment effectiveness of neck pain have come under criticism for their unclear or nonstandardized treatment protocols, insensitive outcome measures, and inappropriate statistical procedures. The purpose of this study was to determine the effectiveness of an individualized physical therapy intervention in treating mechanical neck pain based on a clinical reasoning algorithm. Treatment effectiveness was examined by assessing changes in impairment, physical performance, and disability in response to intervention. A quasi-experimental, nonequivalent, pretest-post-test control group design was used in this study. One treatment group of patients with neck pain who received physical therapy treatment and one control group of subjects with neck pain who did not receive treatment were included. Thirty patients (15 males and 15 females, mean age: 50.8 years) with neck pain were enrolled in the treatment group and completed the physical therapy intervention. Twenty-seven subjects (7 males and 20 females, mean age: 49.1 years) with neck pain were included in the control group. Both groups completed the initial and follow-up tests with a duration of 4 weeks in between. There were no significant differences between groups in physical characteristics as well as the baseline test scores of the six outcome measures. Intervention for patients in the treatment group was an eclectic approach rendered by an experienced manual physical therapist. A description of the intervention strategy was delineated with an algorithm which convey the information about a clinical decision-making process for treating neck pain. Six dependent variables including cervical range of motion, numeric pain rating, timed weighted overhead endurance, the supine capital flexion test, the Patient-Specific Functional Scale, and the Neck Disability Assessment Scale were used to measure the treatment outcome. Results of six mixed ANOVAs with follow-up tests showed a significant improvement of all outcome measures in the treatment group (p < 0.01). After an average 4-week physical therapy intervention, patients demonstrated statistically significant increases of cervical range of motion, decreases of pain, increases of physical performance measures, and decreases in the level of disability as compared to the control group who showed no differences in all six outcome variables between the initial and follow-up test scores. Therefore, an organized and systematic physical therapy intervention was effective in improving the status of patients with neck pain.Item Early detection of cervical spine disorder in industrial and job related injuries(1999-08) Balbaa, Alaa-Eldin A.; Sabbahi, Mohamed; Olson, Sharon; Khalifa, AhmedBackground. There has been growing awareness among occupational health professionals worldwide over the past several years of the large number of musculoskeletal disorders (MSDs), in particular, neck and upper limb pain. Purposes. The first aim of this study was to develop a set of criteria (cervical spine tests) for subjects at high risk for cervical spine disorders. The criteria included electromyography (EMG), clinical and biomechanical assessment tools. The second aim was to develop normal values using the criteria. The third aim was to objectively evaluate the use of the criteria measures in subjects employed in ergonomic workplace environments. Methods. A total of 45 subjects participated in the study, 15 normal subjects (male and female), ages 30–50 years. Fifteen subjects with neck pain and another 15 without neck pain (male and female) who were consistent computer workers for three years were tested using the criteria. Neck ROMs were tested using the cervical range of motion (CROM) device. Muscle strength of the neck extensors and the upper trapezius muscles were tested using load cells transducer. Multi-channel surface EMG (Noraxon) was used to test the EMG parameters including the initial median frequency, median frequency slope values of the neck, at 80% and 50% of maximum voluntary isometric strength. Three repetition of each test were carried out. Data Analysis. Three one-way MANOVA were used with a post hoc analysis. This was followed by a discriminant function analysis to determine the most sensitive criteria measures that predict possible future neck disorders and could discriminate among the groups. Results. Computer workers with neck pain developed limited neck ROM in side-bend and retraction, reduced neck extensors and upper trapezius muscle strength, and increased fatigability of the neck extensors and upper trapezius muscles. Computer workers without neck pain, results showed limited ROM of neck side-bend, reduced neck extensors muscle strength, and increased fatigability of the upper trapezius muscle. The criterion discriminates successfully among the groups. EMG test of muscle fatigability of upper trapezius muscle was the most sensitive discriminate measure for detecting future neck disorders.