Research

This was preliminary research to determine the amount of scapula (shoulder blade) and humerus (upper arm) motion necessary to complete activities of daily living.  Activities included hair combing, feeding, washing the opposite arm pit, reaching up the back, and putting an item on an overhead shelf.  Data was collected across 3-dimensions simultaneously using the MotionMonitor in the movement science lab.  The research was conducted by KSPT DPT students on their peers. 

Rundquist, PJ, Obrecht, C, Woodruff, L. Three-Dimensional Shoulder Kinematics to Complete Activities of Daily Living, American Journal of Physical Medicine & Rehabilitation. 88(8):623-629, 2009.

Posters and Presentations:
Bellew, JW, Staples, WH. Acute Fatigue of the Hip Abductors Does Not Impair Control of Balance in Older Females.
Diehl, MD. The Role of Head-in-Space Stability on Stepping Reactions in Young and Elderly Adults.
Downs, AM. Autonomous Practice in Acute Care Rehabilitation.

June 2009, Baltimore, MD, APTA Annual Conference.

Clinical research on pulmonary fibrosis is ongoing and may have additional benefits for other fibroproliferative diseases such as  therosclerosis, cirrhosis, and connective tissue diseases. Similarities between atherosclerosis and pulmonary fibrosis were discussed.

Staples, WH. Pulmonary Fibrosis:  A Case Report. Gerinotes, 2009, 16 (3): 17-23.

This study examined the role of visual fixation and gaze stabilization on reaction time and stepping responses following a destabilizing perturbation. Comparisons were made between young and older participants and it was found that young participants were better able to visually fixate a target and to maintain fixation while attempting to recover balance. Also, young participants were able to utilize improved visual information to take a more rapid step when compared with healthy older adults.

Diehl, MD. The Influence of Gaze Stabilization and Fixation on Stepping Reactions in Younger and Older Adults. Journal of Geriatric Physical Therapy, 2009.

CSM Posters and Presentations:
Bellew, JW. Microcurrent: what is it, what does it do, and what is the evidence?;  The effect of acute fatigue of the hip abductors on control of balance in healthy young women.
Downs, AM, Fruth, S, Clifford, A, Freed, S, Huckstep, J, Merkel, H, Wilkinson, H, & Yoder, J.  The effects of a 6-week interactive video dance exercise program in an adult population.
Finley, MA, Rundquist, PJ, & Combs, S. Relationship between lower extremity motor impairment and spatiotemporal gait variables in persons with chronic stroke: A pilot study; Relationship between upper extremity impairment and 3-dimensional scapulohumeral kinematics in persons with chronic stroke: A pilot study.
Kegerreis, S. The creation of a compendium to facilitate the development of manual therapy skills.
Kelly, S. Clinical instruction in physical therapy:  Novice and expert approaches to instructional reasoning.
Martin, K. Development and reliability of an observational gait analysis tool for children with Down syndrome.
Rundquist, P, Bratton, J, Grant, A. A comparison of 3-D shoulder kinematics to perform ADLs between older and younger adults.
Staples, WH. Physical therapists' attitudes and interventions when working with patients diagnosed with Alzheimer's disease or dementia living in skilled nursing homes; Long term outcomes in a patient with Guillain-Barre syndrome: A case report; Update on Normal Pressure Hydrocephalus: Medical and therapeutic interventions; Student forum: Working with geriatric patients in various settings.

Feb. 2009, Las Vegas, NV, Combined Sections Meeting, APTA.

Many studies propose educational programming or social support for family caregivers as a way to decrease stress and burden. Social support can come from many different areas and has been shown to moderate functional declines in depressed older adults. Three types of social support are support groups, professional staff, and informal social support.

Staples, WH. How Stress Affects Caregivers of People with Chronic Illness and Dementia. Gerinotes, 2009, 16 (1): 9-12.

The use of direct current stimulation via tap water, a process termed tap water galvanism, has been reported as an effective treatment for hyperhidrosis for decades and is well within the scope of physical therapy practice. That the vast majority of evidence supporting tap water galvanism for hyperhidrosis use devices that are obsolete or custom designed limits the widespread use of this technique by therapists. However, most all clinical iontophoresis units on the market today generate direct current and thus, may theoretically be used to deliver tap water galvanism. This study sought to investigate the efficacy of using a commercially available clinical iontophoresis device for the management of palmar hyperhidrosis. A protocol was designed and implemented on subjects with primary palmar hyperhidrosis. A significant reduction in the amount and area of sweat production was observed.

Bellew, JW, Baker, R, & Williams, J. Tap water galvanism in the management of palmar hyperhidrosis: A case report. British Journal of Hand Therapy, 2008, 13 (2): 40-44.

Rehabilitation of the peroneus longus (PL) often includes activities that are non-weightbearing and uni-planar. However, past evidence from biomechanical studies suggests that peak activity of the PL occurs while weight-bearing and is multi-planar. Inconsistency between evidence and clinical training may result in less than efficacious outcomes when training the PL. This study examined the electromyographic activity of the PL during conventional and novel exercises for training the PL. One of the exercises created by Dr. Bellew received the 2003 Most Creative Use of Theraband Award and has been described in The Journal of Strength and Conditioning Research 2002: 24:61-63. Results demonstrated greater activity in the novel exercises that more appropriately reflect the biomechanical function of the PL.

Bellew, JW, Frilot, C, Busch, S, Lamothe, T, & Ozane, C. Electromyographic analysis of the peroneus longus during conventional and novel rehabilitation exercises. Journal of Orthopedic and Sports Physical Therapy, 2008, 38 (1): A36.

Bellew, J, Williams, J, & Baker, R. Physical therapy management of hyperhidrosis using a commercial iontophoresis device. Journal of the Clinical Electrophysiology and Wound Management Section of the American Physical Therapy Association, 2008; 22 (1): 11.

The purpose was to describe the presence of physical symptoms in college-age musicians and the impact of these symptoms on music-playing and other daily occupations. Data collection was completed on college instrumental music majors using two survey questionnaires, which documented the presence of physical symptoms in the upper limb and the impact of these symptoms on function. Results indicate that a significant number of students reported pain or discomfort that occurred during music-playing, at rest, and during other daily occupations. As self-reported pain increased, a greater level of dysfunction in occupational performance was found. Results also indicated that when participants were already implementing intervention strategies, this was perhaps a predictor of the presence of pain and dysfunction.

Barton, R, Killian, C, Bushee, M, Callen, J, Cupp, T, Ochs, B, Sharp, M, Tetrault, K. Occupational performance issues and predictors of dysfunction in college instrumentalists. Medical Problems of Performing Artists,  2008; 23: 72-77.

The use of the MIT MANUS robotics is being expanded to persons with impairments due exclusively to orthopedic disorders. Purposes 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, R 0.80, circle drawing R 0.90). 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, M, Dipietro, L, Ohlhoff, J, Whitall, J, Krebs, H, Bever, C. The effect of repeated measurements using an upper extremity robot on healthy adults. Journal of Applied Biomechanics, 2008; 24 (4).

This article discuses the issue of obtaining informed consent for physical therapy intervention from people who are cognitively impaired. Consent for medical treatment is rooted in case law. Every physical therapist has the legal and ethical obligation to obtain informed consent from the patient or their surrogate decision maker. The United States is a highly litigious society, and the risk for healthcare malpractice is present with any patient encounter. Failure to obtain informed consent may constitute professional negligence. As physical therapists move toward autonomous practice with direct access, the need to follow risk management policy grows. Informed consent should be part of every therapist's risk management policy, no matter what the practice setting.

Staples WH.  Cognition and consent to treat. Gerinotes, 2008; 15 (3): 5-8.

This study was carried out to investigate the feasibility and effectiveness of the use of intensive task-oriented training in the body-weight support/ treadmill environment to improve running for a subject after stroke. A single-subject design with baseline, intervention, immediate postintervention, and 6-month postintervention phases was conducted. Dependent variables included 25-m sprint time, single-leg balance, running step width, running step length ratio, Stroke Impact Scale, 6-minute walk test, and lower-extremity strength (force-generating capacity). At the 6-month postintervention phase, sprint speed, left single-leg balance, and step width changed significantly from the baseline phase. Step length ratio trended toward less symmetry but more consistency, and muscle strength improved more than 20% in 6 of 8 muscle groups in the involved lower extremity and 4 of 8 muscle groups in the uninvolved lower extremity. Intensive task-specific training was feasible and effective for retraining running ability in the study subject. He returned to recreational running, which provided him with a greatly improved outlook and a better quality of life.

Miller, E, Combs, S, Fish, C, Lakin, B, Schlotterbeck, A, Seiber, A. Training running after stroke: A single-subject report. Phys Ther, 2008; 88: 511-522.

When the Krannert School of Physical Therapy redesigned the curriculum for 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. 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, S, Miller, E. Education for service: Development of a service learning course. J Phys Ther Educ, 2008; 22 (1): 33-41.

CSM Posters and Presentations:
Bellew, J. Physical therapy management of hyperhidrosis using commercial iontophoresis device; Electromyographic analysis of the peroneus longus during conventional and novel rehabilitation exercises; Interferential current: A reintroduction and look at best evidence.
Downs, A, Flesch, P, Brickens, M, Lucich, S, Haan, J. Autonomous physical therapist practice: It may be where you might not expect.
Rundquist, P, Fasano, E, Mattioda, M.  Three-dimensional shoulder kinematics to complete ADLS in an older population.

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, M , Rodgers, M. Effect of two-speed manual wheelchair wheel on shoulder pain and function in manual wheelchair users. Arch Physl Med Rehabil, 2007; 18 (12): 1622-1627.

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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. Putting power in your point. GeriNotes, 2007; 14 (6): 10-12.

Conference Presentations:
Fruth, S. A preliminary exploration of physical therapy practice in the emergency department: A descriptive and experimental study.
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.

Conference Presentation:
Fruth, S. A preliminary exploration of physical therapy practice in the emergency department: A descriptive and experimental study.

June 2007, Vancouver, Canada, World Confederation for Physical Therapy.

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. The purpose of this qualitative case study is to describe instructional reasoning and teaching strategies used by one exemplary clinical instructor.

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

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. 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. 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.

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.

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. 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, Forsyth, E. Motor and functional outcomes of a patient post-stroke following combined task and impairment level training. Physiotherapy Theory & Practice, 2007; 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, PJ. 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.

Conference Presentation:
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.

CSM Posters and Presentations:
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.
Martin, K. 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.
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.
Shurig, M. A. Physical therapists' perceptions of the use of complementary therapy as a component of physical therapy practice.
Staples, W. H. Student forum: Working with the older adult can be fun: A look at various areas of practice.

Feb. 2006, San Diego, CA, Combined Sections Meeting, APTA.

Determining the source of a patient's pain in the upper thoracic region can be difficult. Costovertebral (CV) and costotransverse (CT) joint hypomobility and active trigger points (TrPs) are possible sources of upper thoracic pain. This case report describes the clinical decision-making process for a patient with posterior upper thoracic pain. The patient had a 4-month history of pain; limited cervical, trunk, and shoulder active range of motion; limited and painful mobility of the right CV/CT joints of ribs 3 through 6; and periscapular TrPs. Interventions included CV/CT joint mobilizations, TrP release, and flexibility and postural exercises. The patient reported intermittent mild discomfort after 7 physical therapy sessions. Examination findings were normal, and he was able to resume all preinjury activities. This case suggests that CV/CT mobilizations and active TrP release may have been beneficial in reducing pain and restoring function in this patient.

Fruth, S. Differential diagnosis and treatment in a patient with posterior upper thoracic pain. Phys Ther, 2006; 86: 254-68.