Examining the effects of amplitude-based training as a component of the plan of care in an individual with olivopontocerebellar atrophy.

BACKGROUND: Amplitude-based exercise training has been shown to be effective in the motor performance of individuals with idiopathic Parkinson's disease, with limited research investigating its effects on Parkinson plus syndromes such as olivopontocerebellar atrophy (OPCA). The purpose of this clinical case report is to examine the effects of amplitude-based training exercises on an individual with OPCA. CASE DESCRIPTION: A 68-year-old man with a 14-month history of OPCA presented to physical therapy with bradykinesia, rigidity, and postural instability. The individual participated in 34 intervention sessions. Pre- and post-test measurements were collected for the following outcome measures: Five Times Sit to Stand (FTSTS); Functional Gait Assessment (FGA); Activities-Specific Balance Confidence Scale (ABC-6); 9 Hole Peg Test (9HPT); preferred and maximal gait speed. OUTCOMES: Improvements reaching Minimum Detectable Change (MDC) or Minimal Clinically Important Difference (MCID) were recorded with a pre (Week 1) and post (Week 20) intervention: FGA score (4-point improvement (MDC95 = 4 points), preferred gait speed (0.09 meters/second improvement (MCID = 0.05 meters/second)), FTSTS (6-second improvement (MDC95 = 2.3 seconds)), and 9HPT on the dominant hand (3-second improvement (MDC95 = 2.6 seconds)). Fluctuations during the plan of care were observed for these measures, and additional outcomes did not demonstrate a worsening of function. CONCLUSION: In an individual with OPCA, amplitude-based exercise training as a component of the plan of care increased dynamic balance in walking, gait speed, and hand dexterity. However, these results need to be validated on a larger sample of individuals with OPCA through randomized controlled trials.

Patterns of balance loss with systematic perturbations in Parkinson's disease and multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) and Parkinson's disease (PD) may affect balance differently. However, no studies have compared loss of balance (LOB) patterns following multi-directional perturbations. OBJECTIVE: 1) determine reliability of LOB ratings following standardized manual perturbations; 2) compare LOB ratings in MS, PD, and healthy control (HC) groups following perturbations at upper/lower torso, in anterior/posterior, right/left, and rotational directions. METHODS: 1) reviewers rated videotaped LOB following perturbations applied by 4 clinicians in 6-10 HCs. 2) three groups (64 MS, 42 PD and 32 HC) received perturbations. LOB ratings following perturbations were analyzed using two-factor mixed ANOVAs for magnitude and prevalence. RESULTS: 1) LOB ratings showed moderate to good ICC and good to excellent agreement. 2) MS group showed greater magnitude and prevalence of LOB than PD or HC groups (p < .001). All groups showed greater LOB from right/left versus anterior/posterior perturbations (p < .01). PD showed greater LOB from perturbations at upper versus lower torso; MS and HC showed greater LOB from posterior versus anterior perturbations. CONCLUSIONS: Our reliable rating scale showed differences in patterns of LOB following manual perturbations in MS, PD, and HC. Clinically accessible and reliable assessment of LOB could facilitate targeted perturbation-based interventions and reduce falls in vulnerable populations.

The Immediate Effect of Trunk Weighting on Balance and Functional Measures of People with Parkinson's Disease: A Feasibility Study.

BACKGROUND: Declines in postural control, mobility, and gait are related to negative health outcomes in Parkinson's disease (PD). The addition of small weights to the trunk has been used to increase postural stability and functional performance in persons with neurological dysfunctions but not in persons with PD. The purpose of the study was to determine if small weights applied on the torso have immediate effects on balance and mobility in people with PD. DESIGN: Randomized controlled clinical trial. METHODS: Forty-two subjects with PD were randomly assigned to a no weight (NW), fixed weight (FW), and variable weight (VW) placement group. Outcome measures included the instrumented modified clinical test of sensory interaction in balance (mCTSIB), Tinetti Performance Oriented Mobility Assessment (POMA), timed up and go (TUG), modified timed up and go (mTUG), functional reach test (FRT), 360° turns, 10-meter walk test (10MWT), and lower extremity strength. These measures were performed at baseline and after group assignment. Weights approximately 1-1.5% of the participant's body weight were attached to the trunk using a vest garment according to group assignment. Post-testing was performed immediately after application of weights, using the same outcome measures as the pre-test. Analysis of covariance (ANCOVA) and post hoc tests were used to determine the group with the most statistically significant improvement. RESULTS: The VW group showed significant improvement in the 10-meter walk compared with the NW group (p=0.039) and the FW group (p=0.008). All other outcome measures did not reach significant differences between all groups. CONCLUSIONS: Strategic trunk weighting has the potential to improve mobility and balance in a sample of individuals with PD. The findings support existing literature on the positive effects of torso weighting. A treatment that includes the addition of small weights on the torso is a promising intervention that may improve balance and mobility.

Preparation, roles, and responsibilities of Filipino occupational therapists in disaster preparedness, response, and recovery.

PURPOSE: Despite the increasing number of literature that identifies the roles of various rehabilitation professionals in disaster-related work, there is still limited evidence that examines how these professionals prepare for and function in the various phases of disasters. This study describes the roles and responsibilities practiced by Filipino occupational therapists in disaster preparedness, response, and recovery. The study also describes the preparations undertaken for the therapists to assume these roles. MATERIALS AND METHODS: A survey was conducted among licensed occupational therapists with prior experiences in disaster response. The survey consisted of 23 items - seven were related to preparedness, ten to disaster response, and six to the recovery phase. The participants were asked to indicate their degree of involvement in specific roles and responsibilities using a 5-point Likert scale. The questionnaire also explored their personal preparation for disaster-related work. RESULTS: The participants were mostly engaged in roles related to the recovery phase, followed by the response phase, and were least engaged in the preparedness phase. The roles most frequently performed include: encourage connectedness and social interactions among survivors (recovery); provide supportive mental health services to survivors and their families (response); and attend trainings in disaster response to be part of a response team (preparedness). The majority of the participants received training in mental health responses and orientation prior to deployment. They identified the need to gain additional knowledge on emergency response and the effects of human displacement in disaster situations. CONCLUSIONS: Given additional training and orientation, occupational therapists are able to perform various roles and responsibilities in the different phases of disasters. They can serve as additional resources for government and non-government organizations to address the needs of vulnerable populations in disasters. The study results could inform professional organizations on how rehabilitation professionals could be further trained to address disaster-related concerns.IMPLICATIONS FOR REHABILITATIONWith additional orientation and training, occupational therapists could serve as an important health human resource especially in providing mental health services to people with special needs in disasters.There is a need to intentionally integrate disaster preparedness in the scope of practice of rehabilitation professionals to prepare people with special needs for disasters.Additional knowledge and skills in humanitarian action need to be integrated with clinical expertise to benefit government and non-government disaster management activities.

Effects of Lower Body Positive Pressure Treadmill Training on Balance, Mobility and Lower Extremity Strength of Community-Dwelling Older Adults: A Pilot Study.

AIM: There is growing evidence that confirms the benefits of partially supporting a person's body weight during exercise. Lower body positive pressure (LBPP) unweighting is a new method of providing partial body weight support. This pilot study aims to investigate the effect of LBPP treadmill training on balance, mobility and lower extremity strength in community-dwelling older adults. SUBJECTS: Five community-dwelling females aged 60-85 years with no neurological conditions or musculoskeletal injuries within the past year. METHODS: The subjects participated in twice-weekly treadmill training sessions using LBPP at 80% of body weight. They exercised using their self-selected speed and incline for 20 min each session for 8 wks. Pre- and post-test measures included measures of balance, mobility and lower extremity strength. RESULTS: Average self-selected speed more than doubled from initial to final training session. All subjects exercised within their safe limits, with no unsafe increases in blood pressure or heart rate, and no complaints of extremity pain or muscle soreness throughout the entire training period. Wilcoxon signed ranks test results showed statistically significant improvement in lower extremity strength. CONCLUSIONS: In a sample of community-dwelling older adult females, an 8-wk regimen of treadmill exercise with LBPP unweighing resulted in improvements in lower extremity strength. The study provides preliminary support for the safe and effective use of LBPP treadmill training in community-dwelling older adults. Improvement in lower extremity strength may have significant implications in maintaining balance and mobility and decreasing fall risk in this population.

Proprioceptive neuromuscular facilitation to improve motor outcomes in older adults with chronic stroke.

This case series described changes in motor outcomes across 4 cases of older adults (mean age - 64.75) with chronic stroke (more than 6 months) after implementation of a 6-week proprioceptive neuromuscular facilitation-based program. Findings of this study were compared with a previously reported case. At baseline, all cases presented with motor impairments that increased their fall risk such as impaired balance, lower extremity strength, and mobility. Outcomes were measured using the Mini-BESTest, posturography, 5 times sit-to-stand test, upright motor control test, and 10-meter walk test. All cases completed 1 hour of therapy 3 times a week for 6 consecutive weeks at a university-based outpatient rehabilitation clinic. Positive outcomes in balance, strength, and mobility were seen in all cases. Proprioceptive neuromuscular facilitation can modify motor outcomes to decrease fall risk in older people with chronic stroke. Chronicity of stroke, age, and co-morbidities may influence the degree of improvements expected in these motor outcomes.

Clinimetrics of the Upright Motor Control Test in chronic stroke.

INTRODUCTION: Insufficient literature exists regarding the clinimetric properties of the Upright Motor Control Test Knee Extension and Flexion subtests (UMCT-KE and UMCT-KF, respectively). This study examined the interrater and test-retest reliability of these subtests, and determined the relationship between the UMCT-KE and a clinical measure of muscle function in a sample of adults with chronic stroke. METHODS: Three raters independently administered the UMCT-KE and UMCT-KF on adults with chronic stroke with spasticity/abnormal movement patterns. Testing of each participant occurred on two occasions (T1 and T2) separated by a two-week interval. A fourth rater independently administered the Five Times Sit to Stand Test (FTSST), a measure of lower extremity muscle function (power), on T2. RESULTS: Twenty-nine adults aged 55 ± 8 years, comprising 21 men (72%), and who were 9 ± 5 years poststroke, completed the study. Most of the participants (66%, 19/29) did not require an assistive device during walking. The UMCT-KE and UMCT-KF demonstrated substantial interrater reliability (W = 0.63-0.67 and 0.72-0.75, respectively) and substantial to almost perfect test-retest reliability across the raters (W = 0.75-0.82 and 0.85-0.87, respectively). The UMCT-KE showed positive inverse correlation with the FTSST (ρ = -0.52, p = .003). CONCLUSIONS: Scores on both subtests are reproducible within raters and across different raters. The relationship of UMCT-KE scores with FTSST scores implies that the UMCT-KE can provide information that relates with the construct of muscle function in a weight-bearing position.

Effects of proprioceptive neuromuscular facilitation on balance, strength, and mobility of an older adult with chronic stroke: A case report.

This study described the effects of a proprioceptive neuromuscular facilitation (PNF) program on balance, strength, and mobility in an older adult with chronic stroke. The patient was male, aged 69 years, with right hemiplegia for 17 years, and had diminished balance, balance confidence, lower extremity (LE) strength, and gait velocity. He received 1 h of PNF-based therapy thrice a week for six weeks. Outcome measures were: Mini-BESTest, limits of stability (LOS), Activities-Specific Balance Confidence Scale (ABC), Five Time Sit-to-Stand Test (FTSST), Upright Motor Control Test (UMCT), and 10 Meter Walk Test (10 MWT). The patient improved on the Mini-BESTest (25/28, from 21/28), FTSST (27.47 s, from 30.27 s), UMCT knee extension (moderate, from weak), and 10 MWT (0.82 m/s, from 0.67 m/s); and positive changes in LOS dimensions. PNF was effective in enhancing balance, strength, and mobility in an older adult with chronic stroke and may mitigate falls risk in this population. More research is needed to determine its impact in a larger sample of older people with chronic stroke.

Measurement properties of the upright motor control test for adults with stroke: a systematic review.

BACKGROUND: The Upright Motor Control Test (UMCT) has been used in clinical practice and research to assess functional strength of the hemiparetic lower limb in adults with stroke. It is unclear if evidence is sufficient to warrant its use. The purpose of this systematic review was to synthesize available evidence on the measurement properties of the UMCT for stroke rehabilitation. METHODS: Electronic databases that indexed biomedical literature were systematically searched from inception until October 2015 (week 4): Embase, PubMed, Web of Science, CINAHL, PEDro, Cochrane Library, Scopus, ScienceDirect, SPORTDiscus, LILACS, DOAJ, and Google Scholar. All studies that had used the UMCT in the time period covered underwent hand searching for any additional study. Observational studies involving adults with stroke that explored any measurement property of the UMCT were included. The COnsensus-based Standards for the selection of health Measurement INstruments was used to assess the methodological quality of included studies. The CanChild Outcome Measures Rating Form was used for extracting data on measurement properties and clinical utility. RESULTS: The search yielded three methodologic studies that addressed criterion-related validity and contruct validity. Two studies of fair methodological quality demonstrated moderate-level evidence that Knee Extension and Knee Flexion subtest scores were predictive of community-level and household-level ambulation. One study of fair methodological quality provided limited-level evidence for the correlation of Knee Extension subtest scores with a laboratory measure of ground reaction forces. No published studies formally assessed reliability, responsiveness, or clinical utility. Limited information on responsiveness and clinical utility dimensions could be inferred from the included studies. CONCLUSIONS: The UMCT is a practical assessment tool for voluntary control or functional strength of the hemiparetic lower limb in standing in adults with stroke. Although different levels of evidence suggest that the Knee Extension and Knee Flexion subtests may possess criterion and construct validity, the lack of published literature examining content validity, reliability, and responsiveness raises questions regarding the use of the UMCT in routine clinical practice. These key findings highlight the need to further investigate the UMCT's measurement properties toward enhancing its standardization.

A systematic review of the effectiveness of contrast baths.

STUDY DESIGN: Systematic review. INTRODUCTION: Contrast baths are used as an intervention in hand therapy, yet it is unclear which patients, if any, benefit from this intervention. PURPOSE OF THE STUDY: To examine the nature and quality of the evidence regarding the use of contrast baths using a systematic review process. METHODS: Of a total of 28 clinical research articles on contrast baths, from 1938 forward, ten met the inclusion criteria set by the authors. RESULTS: These studies addressed the physiological changes of hot and cold on blood flow, intramuscular temperature, subcutaneous temperature, and the influence of room temperature and age. The subjects included normal/healthy volunteers and patients with a diagnosis of rheumatoid arthritis, diabetes, or foot/ankle injuries. The diversity of conditions, protocols, and outcomes limited the ability to make definitive conclusions on efficacy. CONCLUSIONS: The contrast bath procedure may increase superficial blood flow and skin temperature, though the evidence on the impact on edema is conflicting. No relationship between physiologic effects and functional outcomes has been established. LEVEL OF EVIDENCE: 2A.

Physical therapy intervention for an adolescent with a knee flexion contracture and diagnosis of multiple pterygium syndrome.

PURPOSE: The purpose of this case report is to describe a course of physical therapy for a client with a rare genetic condition, multiple pterygium syndrome (MPS). SUMMARY OF KEY POINTS: MPS is a rare genetic disorder characterized by connective tissue webbing across multiple joints, dysmorphic facies, and various visceral and skeletal deformities. Before the patient commenced physical therapy, surgical amputation was recommended for the client's knee flexion contracture. The client's treatment plan included stretching, manual therapy, and resisted exercise. Long-term outcomes were decreased back and knee pain and improved range of motion, strength, and ambulation. CLINICAL RECOMMENDATIONS: Therapists using techniques to improve joint range of motion in clients with MPS should be aware that pterygia may include contractile tissue, nerves, and blood vessels and there may be underlying skeletal deformity or weakness in these areas. Children with MPS are at high risk of developing scoliosis and should be appropriately assessed in early childhood.

Improving cultural diversity awareness of physical therapy educators.

In a climate of increasing diversity in the population of patients requiring physical therapy (PT) services, PT educators must prepare students and future clinicians to work competently in culturally diverse environments. To be able to achieve this goal, PT educators must be culturally competent as well. The purposes of the study were to develop a valid and reliable instrument to assess cultural diversity awareness and to develop an educational workshop to improve cultural diversity awareness of PT academic and clinical educators. Phase 1 of the study involved the development of an instrument to assess cultural diversity awareness. The Cultural Diversity Awareness Questionnaire (CDAQ) was developed, validated for content, analyzed for reliability, and field and pilot tested. Results indicated that the CDAQ has favorable psychometric properties. Phase 2 of the study involved the development and implementation of the Cultural Diversity Workshop (CDW). The seminar contents and class materials were developed, validated, and implemented as a one-day cultural diversity awareness seminar. A one-group, pretest-posttest experimental design was used, with participants who completed the CDAQ before and after the workshop. Results indicated that the workshop was effective in improving cultural diversity awareness of the participants. Results of the workshop evaluation affirmed the achievement of objectives and effectiveness of the facilitator. This study provided a solid initial foundation upon which a comprehensive cultural competence program can be developed.

Physiotherapists' perceptions and use of medical imaging information in practice.

BACKGROUND AND PURPOSE: Physiotherapists must take responsibility for all aspects of patient care. Information from medical imaging studies can influence clinical decisions. The purpose of the present study was to gather information about physiotherapists' perceptions and use of medical imaging information in clinical practice. METHOD: A survey questionnaire was developed, validated and pilot tested. Subjects were randomly selected from a pool of licensed physiotherapists practising in four California Physical Therapy Association Districts. The survey was sent to 500 physiotherapists. Data gathered from the survey were transcribed to spreadsheets for analysis. RESULTS: One hundred and twenty participants completed and returned the survey. Information from radiographs was most frequently available, followed by MRI and CT scan information, respectively. Respondents reported more use of information from reports than from images. Respondents also indicated that it was important to be able to review medical imaging information (70%), that they use medical imaging information in their practice when it is available (83.4%), that physiotherapists have the necessary knowledge and skills to use this type of information (77.3%), and that medical imaging should be covered in entry-level educational programmes (84.2%). Respondents additionally indicated that medical imaging information could be used to understand a patient's disease process (85%), improve communication about patient care (90%), improve diagnosis, prognosis and interventions for patients (81.6%), and identify contraindications to examination and interventions (87.5%). CONCLUSIONS: Physiotherapists have access to some medical imaging information and perceive that this information could be valuable in patient care; however, not all therapists are confident in their ability to interpret this information. Curricula in entry-level physiotherapist educational programmes should include information about medical imaging.

Shoulder impingement syndromes: implications on physical therapy examination and intervention.

A painful shoulder presents challenges in examination, diagnosis and intervention for the physical therapist because of the complexity of the structures involved. A common cause of shoulder pain is shoulder impingement syndrome. This was first described as a condition in which the soft tissues of the subacromial space were chronically entrapped and compressed between the humeral head and the subacromial arch. This definition does not account for the myriad potential causes of shoulder impingement conditions, as forms of impingement other than subacromial soft tissue compression may explain different symptomatic shoulder injuries. This paper describes shoulder impingement syndromes that have been hypothesized, identified and analyzed in the literature. Physical Therapy examination and intervention for these syndromes are also discussed.