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The Effect of Repeated Measurements using an Upper Extremity Robot on Healthy Adults The use of the MIT MANUS robotics is being expanded to persons with impairments due exclusively to orthopedic disorders. Purposes of this study were to assess the learning effect of repeated exposure to robotic evaluations and to demonstrate the ability to detect a change in protocol in outcome measurements. Ten healthy, unimpaired participants performed six repeated evaluations on the MIT-MANUS. Reaching outcomes were aiming error, mean and peak speed, movement smoothness and duration. Outcomes for circle drawing were axis ratio metric and shoulder-elbow joint angles correlation metric. Reliability of measures was determined. All variables were reliable, without learning across testing sessions. Intraclass correlation values were good to high (reaching, R³0.80, circle drawing R³0.90). Outcome measures of the MIT-MANUS proved to be reliable, yet sensitive to change, in healthy adults without motor learning over the course of repeated measurements.

Finley, MA, Dipietro, L, Ohlhoff, J, Whitall, J, Krebs, HI, Bever, CT. Journal of Applied Biomechanics, 2008.

When the University of Indianapolis Krannert School of Physical Therapy redesigned the curriculum for the transition to the DPT degree, a decision was made to more explicitly reflect the UIndy motto of "Education for Service" through implementation of a service learning requirement. This paper outlines the design and implementation of this course. Course outcomes from the first year of the course demonstrated that students achieved the course learning objectives and developed a broader understanding of health and illness, demonstrated a sense of professional and social responsibility, and adapted communication skills for diverse others. In addition, students also developed a stronger sense of personal strengths and areas for development, recognized and challenged biases and stereotypes about the community and were able to link the course to their future as a physical therapist.

Kelly SP, Miller EW. Education for Service: Development of a Service Learning Course. J Phys Ther Educ. Vol 22, No. 1, Spring 2008, p. 33-41.

Physical Therapy Management of Hyperhidrosis Using Commercial Iontophoresis Device. A case report on the use of an iontophoresis device in the management of hyperhidrosis.
Electromyographic Analysis of the Peroneus Longus During Conventional and Novel Rehabilitation Exercises. An electromyographic analysis of novel exercises for the peroneus longus that more accurately reflect the muscle's biomechanical function.
Interferential Current: A Reintroduction and Look at Best Evidence.
A critical look at the biophysical characteristics of interferential current and analysis of literature examining evidence for use of interferential current.

Bellew, JW.
Feb. 2008. Nashville, TN, Combined Sections Meeting, APTA.

Autonomous Physical Therapist Practice: It May Be Where You Might Not Expect. Among the characteristics of autonomous physical therapist practice are independent, self determined professional judgment, ability to refer to and collaborate with health care providers and responsibility and acceptance of risk for all aspects of physical therapist patient/client management. Highly regulated and often bureaucratic acute care hospitals are not often considered to be settings that foster and promote those characteristics. Also, being located in a state that has yet to achieve any form of direct access to physical therapists and does not have an independent physical therapy state board to regulate physical therapy practice are factors which add to a generally unfavorable practice environment. As physical therapist practitioners in a large multi-hospital health care system, we have learned the importance of independent, self determined professional judgment. Despite obstacles, we are thriving in an interdependent and collaborative environment, which is considered key to autonomous practice.

Downs, A. M., Flesch, P., Brickens, M., Lucich, S., Haan, J. Feb. 2008. Nashville, TN, Combined Sections Meeting, APTA.

Three-Dimensional Shoulder Kinematics to Complete ADLS in an Older Population. The purpose of this study was to examine the movement of all shoulder components in an older population while performing (ADLs) using 3-D analysis. Similar results as Doorenbosch et al, Magermans et al, and Pearl for combing hair, feeding, and reaching up back. Less ROM for reaching overhead. Rationale for differences: Flock-of-Birds eliminates thoracic substitution; mean elevation found for reaching an overhead shelf may be less in the current study due to standardized height. In the older population, glenohumeral and scapulothoracic ROM significantly contribute to accomplishing humerothoracic ROM necessary to perform upper extremity ADL's.

Rundquist, P. J., Fasano, E., Mattioda, M. Feb. 2008. Nashville, TN, Combined Sections Meeting, APTA.

This investigated the impact of a manual 2-gear drive wheelchair wheel (MWGW) on shoulder pain and function in wheelchair users (MWCU). Outcomes included Wheelchair Users Shoulder Pain Index (WUSPI), Wheelchair Users Functional Assessment (WUFA © ), and timed hill climb test with relative perceived exertion (RPE) were compared before, during and following a five month trial using the geared wheel Significant reduction in shoulder pain with the intervention was found at week 2 (p= 0.004) through week 16 (p=0.015). Hill climb time was longer using the 2-gear wheel (p=0.01), but no difference in the RPE (p=0.13) resulted. There not a significant percentage increase as compared from the final week using the MWGW (p<0.05). Conclusions : Pain reductions were found 2 weeks after using the (MWGW) indicating a rapid response to the intervention. These findings indicate the potential for shoulder pain reduction with the use of (MWGW) during daily mobility, even in highly functional MWCU.

Finley, MA , Rodgers, MM. Effect of two-speed manual wheelchair wheel on shoulder pain and function in manual wheelchair users. Arch Physl Med Rehabil, 2007; 18(12).

As physical therapy grows in recognition as a profession of knowledgeable health care experts, we are being asked to present information on a variety of topics. Microsoft's PowerPoint is a powerful tool that can be used to enhance presentations. The purpose of the article is not to provide a tutorial on PowerPoint, but to describe some of the considerations, strengths, and weaknesses for the innovative use of PowerPoint in professional presentations.

Staples, W H. Putting Power in Your Point. GeriNotes, 2007; 14 (6): 10-12.

This session provided clinicians with simple strategies to quickly access electronic databases readily available in the clinic, critically assess the evidence, integrate the evidence into clinical decision making, and immediately apply the evidence. PTs were encouraged to take action in their practice settings by conducting searches as well as encouraging and assisting colleagues to perform evidence-based electronic searches on clinical questions to enhance clinical decision making.

Gahimer, J, Schlessman, A. "Six Easy Steps for Accessing and Applying the Evidence to Clinical Decisions in Neurological Rehabilitation," June 2007, Denver, CO, APTA Annual Conference.

A Preliminary Exploration of Physical Therapy Practice in the Emergency Department: A Descriptive and Experimental Study. The purposes of this study were to: (1) describe physical therapy practice in the emergency setting based on direct observation; (2) summarize findings from an ED staff survey regarding their experiences with a physical therapist in this setting; and (3) examine the influence of early physical therapy examination and intervention on pain, anxiety, and return to function for patients presenting to the ED with a whiplash injury following a motor vehicle crash (MVC) . The ED is a very fast-paced environment. The physical therapist was observed examining non-critical patients with musculoskeletal, neuromuscular, integumentary, and cardiopulmonary conditions. Types of interventions were varied, including direct care, prevention, and patient education. Survey results indicated that opinions regarding physical therapy practice in the ED were very favorable and suggestions were made that physical therapy services be expanded to cover all hours of ED operation. Results from the experimental study suggested that physical therapy management of patients with whiplash may allow for prevention of the onset of head pain, reduced functional impairment levels, and a faster time to full recovery.

Fruth, S. Poster Presentation, June 2007. Vancouver, Canada, World Confederation for Physical Therapy and Denver, CO, APTA annual conference.

Clinical instructors play an important role in the professional education of physical therapy students. Although characteristics of effective clinical instructors have been described in the literature, some evidence exists that these approaches are not consistently implemented by clinical instructors. Describing in depth the nature of the clinical instructor experience from the viewpoint of an exemplary clinical teacher can provide valuable insight into the clinical teaching process. Therefore, the purpose of this qualitative case study is to describe instructional reasoning and teaching strategies used by one exemplary clinical instructor.

Kelly SP. The exemplary clinical instructor: a qualitative case study. Journal of Physical Therapy Education. 2007; 21(1): 63-69.

Purpose: A previous study on hypotonia surveyed pediatric physical and occupational therapists to determine the characteristics commonly observed in children with hypotonia. The current study attempted to confirm the previous study’s findings by increasing the sample size of participating clinicians and seeking further clarification of those results. Results: Characteristics from the previous study most agreed upon and cited as most frequently observed by the current respondents included decreased strength, hypermobile joints, and increased flexibility. The characteristics of poor attention/motivation and decreased activity tolerance were the least agreed upon and cited as least frequently occurring by this study’s respondents. Conclusions: Despite the level of agreement among clinicians regarding the characteristics and potential for improvement, clear clinical guidelines for the diagnosis and quantification of hypotonia have yet to be determined. Clinical Relevance: Hypotonia is a term frequently used by many disciplines as a component of many pediatric diagnoses or even as a diagnosis itself. An operational definition would allow clinicians to develop valid testing measures, employ correct terminology, and assess effectiveness of intervention.

Martin K, Kaltenmark T, Lewallen A, Smith C, Yoshida A. Clinical characteristics of hypotonia: a survey of pediatric physical and occupational therapists. Pediatric Physical Therapy 2007;19:217-226.

Numerous factors affect the dietary intake and nutritional status of older adults. Many are psychosocial in origin, some are related to biological aging effects on organs and digestive function, and a few are related to physical activity levels and dietary habits. Physical therapy goals often focus on the facilitation of healing within integumentary and neuromusculoskeletal systems, and on client rehabilitation toward optimal function. Integration of nutrition screening, education and/or dietary referral within traditional therapy could improve the rate and extent of healing and recovery that can occur. Investigations have shown that nutritional health strongly impacts individual response to exercise in older adults. Physical therapists can assume several roles regarding the nutritional health of older clients.

McCloy, C. Nutrition and healthy promotion in the older adult. GeriNotes, 2007; 14 (4): 18-29.

The purpose of this single-subject report was to determine the effect of a targeted training regimen aimed at improving motor and functional outcomes for a patient with chronic deficits after stroke. A 51-year-old woman with hemiparesis, 6 months post-stroke, participated in this prospective study. During the baseline, intervention and immediate retention phases, performance was established using repeated measures of four dependent variables: Fugl-Meyer assessment, Berg Balance Scale, 10-meter walk, and 6-minute walk. Two standard deviation band analyses were conducted on the four dependent variables with repeated measures. The Frenchay Activities Index and step length/single-limb support time measured at baseline and immediate retention were compared. During intervention, the participant was involved in a combined treatment protocol including body weight supported (BWS) treadmill training and strengthening exercises. Results indicated significant improvements in motor activity, balance, gait speed and endurance. Progression was found in self-perceived participation. Although an improvement in step length symmetry occurred following training, a decrease in single- limb support time symmetry was found. BWS treadmill training combined with strength training significantly improved motor and functional performance in this participant with chronic deficits after stroke.

Combs, S., Miller, E.W., & Forsyth, E. (2007). Motor and Functional Outcomes of a Patient Post-Stroke Following Combined Task and Impairment Level Training. Physiotherapy Theory & Practice, 23, 219-229.

Subjects with idiopathic loss of shoulder range of motion have difficulty performing activities of daily living. An analysis of variance compared the impaired subjects noninvolved to the nonimpaired subjects' scapulae at 4 scapular plane elevation positions. A repeated-measures analysis of variance compared the impaired subjects' involved and noninvolved scapulae at 3 scapular plane elevation positions, and matched-pairs t test compared peak elevation values. The between-group ANOVAs demonstrated no difference in anterior tipping, internal rotation, or upward rotation. The repeated-measures ANOVAs demonstrated no difference in anterior tipping or internal rotation and a position-by-side interaction in upward rotation. The involved-side scapulae were more upwardly rotated (7.7°) at peak humerus-to-trunk scapular plane elevation. The impaired subjects' noninvolved scapular kinematics were not significantly different than the nonimpaired subjects, but were significantly different than their involved scapulae. The upward rotation differences may be a substitution pattern used to accomplish functional elevation.

Rundquist, R: Alterations in scapular kinematics in subjects with idiopathic loss of shoulder range of motion. Journal of Orthopaedic & Sports Physical Therapy, 2007; 37 (1): 19-25.

Investigated the effects of using flexible supramalleolar orthoses (SMO) as an intervention at an early age to increase the postural stability in children with Down syndrome (DS) as they are beginning to stand and walk. During an 8-10 week study period, the participants were fitted with SureStep SMOs and evaluated during 3 separate sessions using the sitting, crawling/kneeling, standing, and walking/running/jumping dimensions of the Gross Motor Function Measure (GMFM) and the stationary, locomotion, and object manipulation subtests of the Peabody Developmental Motor Scales 2nd ed (PDMS-2). The 8 children wore the SMOs for an average of 6.78 hours per day for a mean of 44.33 days. Improvements were seen from visit 2 without SMOs to visit 3 with SMOs for the PDMS-2 locomotion subtest and the GMFM standing and walking/running/ jumping dimensions. Postural stability did improve throughout the course of this study both in shoes only and in shoes with SMOs. Although not statistically significant, improvement was greater with the SMOs than without them. There were also trends for improvement in the rate of gross motor skill acquisition with the SMOs within the relatively short 6-week intervention period.

Martin, K, Carey, K, Dexter, K, Shinabery, C, Willhelm, G: "The Effects of Supramalleolar Orthoses on Postural Stability of Young Children with Down Syndrome," June 2006, Orlando, FL, APTA Annual Conference.

Synthesized current thought on parental perceived stress, parental reactions and solutions to stress, and role of health care professionals (HCPs) in assisting parents to manage their stress and maximize their child's potential. Supplied HCPs with recommendations for more effective interactions with parents of children with disabilities to improve professional health services for and relationships with this patient population. Published studies have established that parents of a child with disabilities are under increased stress when compared to parents of a typically developing child; however, the study of coping in families of a child with disabilities has been inconclusive. HCPs play an active role in the lives of parents of a child with disabilities. HCPs must be informed of available sources of support and information for parents. HCPs must also be educated on various cultural and religious traditions that may effect how parents interact with their child with disabilities and with the HCPs. Most importantly, HCPs need to realize that each child is a member of a unique family unit and that one solution to decrease stress will not work with all families.

Martin, K: Poster Presentation, February 2006 San Diego, CA, Combined Sections Meeting.

We developed a Webquest with the purpose of having students analyze complex issues related to the physical therapy profession. Topics included ethics, fraud and abuse, direct access, PT/PTA role delineation, and importance of continuing education. Students developed a consensus paper and oral presentation. Presentations included role playing, case scenarios, mock game shows, or videos. Student responses were extremely favorable.

Gahimer, J, Staples, W: "Webquests: Description, utilization and outcomes of an
innovative teaching strategy involving technology, self
directed learning and group dynamics in physical therapy
education" February 2006 San Diego CA, Combined Sections Meeting

The purpose of this report was to investigate the feasibility of training a 38-year-old man, 2.5 years post-stroke to run using body-weight support treadmill training. A prospective case report design was selected in which baseline was established and followed by an 8-week treatment phase. Results indicated significant improvements in running quality and speed. Our data supported current literature that suggests that patients with chronic deficits due to stroke can make functional gains with continued rehabilitation and also that body-weight support treadmill training is a useful and effective tool in the clinical setting.

Miller, E, Combs, S, Fish, C, Lakin Bense, B, Schlotterbeck Owens, A, Sieber, A:
"Effects of Body Weight Support Treadmill Training on
Running in a Patient Post-Stroke: A Prospective Case Report"
February 3, 2006 San Diego CA, Combined Sections Meeting

Discussed health promotion, wellness and disease prevention and the role of the physical therapist in promoting health and reducing health disparities in selected populations.  In addition, screening and intervention at the primary, secondary and tertiary prevention/care levels and evidence to support these interventions were explored.  Concepts, health behavior theories, and models that serve as foundations to plan, implement and evaluation programs for well and special populations were discussed.

McCloy C, Stikeleather J, Gahimer J. Health Promotion for the Physical Therapist: Concepts, Theory, Evidence, and Application. Jun. 9, 2005, Boston, MA.

The term hypotonia is often used to describe children with reduced muscle tone, yet it remains abstract and undefined.  The purpose of this study was to characterize hypotonia in children to begin the process of developing an operational definition of hypotonia.  Three hundred physical and occupational therapists were asked to respond to an open-ended survey.  The consensus was that children with hypotonia have the following characteristics:  decreased activity tolerance, decreased strength, rounded shoulder posture, hypermobile joints, increased flexibility, poor attention and motivation, and gait deviations.  Hypotonia is often associated with childhood disorders, but an objective tool for defining and quantifying it does not exist.  A preliminary characterization of hypotonia was established, but further research is needed to achieve objectivity and clarity.

Martin K, Inman, J, Kirschner, A, Deming K, Sorg R, Voelker, L. Characteristics of Hypotonia in Children: A Consensus Opinion of Pediatric Occupational and Physical Therapists. Pediatric Physical Therapy, 2005;17:275-282.

The purpose of this report is to describe the level of participation with clinical activities performed by students during integrated clinical experiences using a mix of traditional and community-based clinical sites. The results showed that community-based clinics provide an appropriate environment for students to gain experience with patient management skills within a first-year integrated clinical education experience, allowing ample opportunities for hands-on exposure to examination and intervention skills.

Kelly SP. Use of community-based settings within an integrated model of clinical education. National Clinical Education Conference, 2004, St. Louis, MO.

Investigation of a consistent pattern of motion restriction in patients with adhesive capsulitis. Adhesive capsulitis is a common clinical problem experienced by individuals from 40-60 years old. This problem often occurs insidiously, resulting in an extended period of pain and disability. Many competing theories exist as to the etiology and treatment of this disease. Faculty members Sam Kegerreis and Jill Stikeleather working with Professional students Jeff Mitsch, Jennifer Casey, and Rachel McKinnis in conjunction with physicians Gary Misamore MD, Peter Sallay MD, and physical therapists Scott Hamersly and Genevieve DeCelles of the Methodist Sports Medicine Center examined the nature of ROM restriction in patients with adhesive capsulitis in an effort to better understand the nature of this complex disease. Their work was presented at the annual mid-winter meeting of the American Physical Therapy Association in Nashville, Tennessee in February 2004 and published in the Journal of Manual and Manipulative Therapy.

Mitsch J, Casey J, McKinnis R, Kegerreis S, Stikeleather J. Investigation of a consistent pattern of motion restriction in patients with adhesive capsulitis. Journal of Manual and Manipulative Therapy 2004; 12: 153-159.

Effects of supramalleolar orthoses on the postural stability of children with Down syndrome.  This study was able to show an improvement in the balance and postural stability of children with Down syndrome (ages 4 to 8 years) with daily wear of flexible supramalleolar orthoses over a 6 week time frame.  This was significant in the fact that all of the children in the study were already functionally independent in their gross motor skills but were still able to show improvement with the use of an orthosis.

Martin K.  Effects of supramalleolar orthoses on the postural stability of children with Down syndrome.  Developmental Medicine and Child Neurology.  2004;46:406-411.

Idiopathic loss of shoulder range of motion is a debilitating shoulder condition that affects nearly 3 percent of the population.  The condition is characterized by global loss of shoulder motion affecting the ability to perform activities of daily living including dressing and performing overhead tasks.  The evaluation and treatment literature is largely inconclusive.  Dr. Peter Rundquist (Assistant Professor) is investigating the way these shoulders move in an attempt to assist in more accurate diagnosis and eventual treatment.  The overall goal is to develop an intervention that lessens the amount of recovery time patients must endure.  The recovery time lasts up to 7 years.  Dr. Rundquist is currently leading a third year research group investigating the scapulohumeral rhythm between impaired subjects’ involved and non-involved shoulders and the shoulders of non-impaired peers.

Rundquist PJ, Ludewig PM Patterns of motion loss in subjects with idiopathic loss of shoulder range of motion.Clin Biomech. 2004;19:810-818.

Subacute care involves restoration of function and mobility following a debilitating health event. The purpose is to examine the subacute care delivery paradigm in relation to components of Guide to Physical Therapist Practice (APTA, 2001); and to explore the proposition that there are major barriers to preparing PT students to enter this practice area. If Subacute Care is the fastest growing area of practice, are PT clinicians and future PT’s supported sufficiently through professional education to keep pace with the changing rehabilitative health care delivery environment?

Gahimer JE, co-presenter. Subacute Care and the Changing Practice of Physical Therapy. Feb. 7, 2004, Nashville, TN