Human and Movement Science

Permanent URI for this collectionhttps://hdl.handle.net/10323/11891

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Physical Therapy Considerations in the Management of Individuals with Non-Arthritic Sources of Hip and Shoulder Symptoms: Examination Sequence, Treatment, and Potential Barriers to the Restoration of Function
(2025-01-01) Venglar, Brian Michael; Kondratek, Melodie; Brandt, Lindsay; Beam, Maria
Musculoskeletal conditions are a common reason that patients seek a referral to physical therapy. The hip and shoulder have anatomical similarities and are prone to comparable pathologies. The increased mobility of the hip in the presence of hip dysplasia, increases the anatomical similarities between these 2 joints, and enhances the comparisons that can be made. The examination sequence in individuals with musculoskeletal pain is multifaceted with information obtained through a physical examination and/or the utilization of standardized outcome measures. When performing the physical exam, it can be difficult to differentiate between the potential sources of symptoms when the joints are anatomically adjacent to the spine. Symptom localization (SL) can be used to help determine the region, spinal segment, and/or structure(s) responsible for the source of symptoms. Regional testing is used to rule out the influence one joint has on the other when two adjacent joints could be responsible for causing symptoms. The proximity of the hip and the shoulder to the spine make this line of testing important to rule out the possibility of referred pain and/or neurogenic diagnosis. Once the region has been determined, structural localization can be used to identify the structure(s) contributing to symptoms. Another component of the physical therapy examination includes the use of outcome measures. For the purpose of this dissertation, I am dividing these outcome measures into two categories, functional and psychosocial. The functional questionnaires are used to help identify symptom characteristics, functional tasks, and activities that can be addressed during a course of therapy. Many of the common functional outcome measures used for the assessment of pathologies related to the upper and lower extremities, focus primarily on the ability to perform a task but give little to no consideration of the other factors that may be influencing performance such as psychosocial factors of depression, anxiety, stress, and/or fear-avoidance behaviors. The subsequent chapters of this dissertation will focus on two components of the examination process. First, symptom localization, the examination strategy utilized to differentiate between adjacent body regions to determine the source of symptoms and the sequencing of treatment in a patient with anterior shoulder pain. The second strategy is the use of outcome measures, these are used to investigate psychosocial impairments, using the Fear Avoidance Belief Questionnaire (FABQ), and the Depression Anxiety and Stress Scale (DASS-21) on an individual’s function as measured through the International Hip Outcome Tool (iHOT) in individuals with hip dysplasia.
Juvenile Idiopathic Arthritis: Exploring Patient, Parent, and Physical Therapist Perspectives on Physical Activity, Kinesiophobia and Physical Therapy Intervention
(2025-01-01) Nautiyal, Meghna; Kondratek, Melodie; Brandt, Lindsay; Qu, Xianggui
Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic condition with an unknown etiology affecting children and adolescents under the age of 16. It can lead to short-term and long-term disabilities. Despite having a low disease activity score, children with JIA often exhibit low levels of physical activity, and pain. This is a significant concern for these children. While physical therapy is well-documented to improve physical activity and function in adults with arthritis, there is insufficient evidence to support its benefits specifically for JIA. To explore physical activity, kinesiophobia and physical therapy intervention two survey-based studies were conducted: one focusing on the perspectives of parents and children, and the other on the perspectives of physical therapists. In the first study, parents reported that their children had reduced levels of physical activity, and only a few children received physical therapy. These findings confirm previous research reporting reduced physical activity in children with JIA. The parents expressed varying degrees of willingness—neutral, likely, or very likely—to consider physical therapy as a treatment option for their child. Additionally, this study is one of the few that explored kinesiophobia in these children; however, the results were inconclusive. The positive response from parents regarding the potential of physical therapy highlights their openness to non-pharmacological management and their recognition of the potential value of physical therapy in improving their childs physical activity levels. When parents are actively involved and supportive of physical therapy, children are more likely to adhere to treatment plans and engage consistently in physical activity leading to better outcomes and long-term benefits. In the second study, physical therapists noted that their knowledge of pediatric rheumatology is limited, which affects their ability to effectively treat the patients. To address pain-related questions, therapists utilized a combination approach, considering input from both the parents/guardians and the child. Parents/guardians will be referred to as “parents” from this point forward. The PTs and PTAs used various treatment strategies to improve physical function and quality of life, including manual therapy. Early referral to physical therapy may enhance physical activity, manage pain, and improve the overall quality of life for children with JIA.
The therapeutic effects of a high velocity resistance training intervention for chemotherapy induced polyneuropathy
(2024-01-01) Gleeson, Mariah Elizabeth; Boright, Lori; Doherty, Deborah; Brown, Elise
Chemotherapy induced polyneuropathy, also referred to as chemotherapy induced peripheral neuropathy (CIPN) is a dose dependent, neurotoxicity from known neuropathic agents, such as taxanes, platinums, and vinca alkaloids, causing damage to the peripheral nervous system which sends signals between the central nervous system and the body. CIPN can present as sensory, motor, or autonomic symptoms, such as paresthesia, hyperpathia, hypoesthesia, muscle weakness, balance impairments, orthostatic hypotension, or altered sexual function. Currently, there are no standard treatment or standard prevention methods for CIPN. The purpose of this case series was to assess the therapeutic effects of a high velocity resistance training (HVRT), or power training, in women diagnosed and treated for cancer, who presented with CIPN by measuring balance, functional performance, neuropathy, quality of life (QoL), and an inflammatory biomarker (c-reactive protein [CRP]). The HVRT consisted of 24 exercise sessions over 12 weeks including upper and lower extremity movements. The intensity prescribed was 30-60% one repetition maximum for upper extremity, and 0-60% one repetition maximum for lower extremity exercises. Findings demonstrate the feasibility of designing and implementing a HVRT intervention to potentially attenuate CIPN symptoms. Moreover, HVRT may improve in balance, functional performance, and QoL outcomes. Although the CRP results increased, the values remained within normal limits (Quest Diagnostics, n.d.), thus lifestyle modifications are needed. This study provides encouraging evidence for a future HVRT intervention pilot study modulating CIPN symptoms. Assessments such as balance, functional performance, and inflammatory markers should be measured prior and throughout treatment in persons receiving known neuropathic agents to better establish baseline values. Further research is needed to enable clinicians to provide comprehensive and effective treatment plans for persons with neuropathy, subsequently improving QoL
Applying machine learning to track and analyze human movement
(2024-01-01) Higgins, Seth; Goble, Daniel J; Kakar, Rumit S; Haworth, Joshua L
Traditional statistical methods comparing movement kinematics in biomechanics involvecalculating discrete variables and comparing between pre-defined groups based on age, sex, pathology, or condition. However, this method generalizes that the movement patterns of individuals within a group are similar and inherently different from those of the group being compared to, which might not be the case. Clustering analysis, which takes an unlabeled set of data and organizes them into homogenous groups, may provide a unique way to distinguish movement patterns within a group of individuals. However, there are many things to consider when clustering any dataset including each clustering algorithm and evaluation measure taking different approaches, leading to different clustering results. This dissertation proposed a method of determining the most appropriate clustering model by comparing k-means and hierarchical clustering (HCA) on different types of biomechanics time-series data using several evaluation measures. Using a majority ranking method, we were able to generate movement profiles of lumbar and pelvis angles during a trunk flexion/extension, head and trunk anterior-posterior (AP) acceleration during steady-state gait, and pelvis AP linear acceleration and vertical (V) angular velocity during a timed up and go (TUG) test. Overall, it was found that most clusters generated on each dataset did not contain a single age or sex demographic. The differences observed between movement profiles were the magnitude and timing of the clustered variable. Clustering analysis was able to separate participants that may have compromised ability to control the head during steady state walking and were slower at turning during the turn-around subphase of the TUG test. Overall, our findings underscore the utility of clustering analysis in elucidating subtle variations in movement behavior in a wide range of different movement evaluations, thereby enhancing our understanding of functional mobility and falls risk assessment in diverse populations.
Cardiac rehabilitation in children with congenital heart disease: exploring dance as an exercise modality and barriers to exercise for this population
(2024-01-01) Umbras, Miranda Mae Pelkey; Kondratek, Melodie D; Choi, Myung; Brown, Elise
Heart disease is widespread and complex. Acquired heart disease is the number one killer of Americans and congenital heart disease (CHD) is the most common birth defect. An important aspect of living with heart disease is participating in regular exercise, at least 150 minutes per week for adults and around 60 minutes per day for children. Most Americans do not come close to meeting these guidelines. One way individuals with heart disease can achieve their exercise is through a cardiac rehabilitation program. A hurdle to overcome with cardiac rehabilitation is the high dropout rate due to a variety of factors, including lack of variety in programing. The first project below explores utilizing aerobic dance as a modality of exercise during cardiac rehabilitation with children. A 30-minute dance class was completed with children without heart disease to establish a control and for safety considerations. Utilizing guidelines from the American College of Sports Medicine (ACSM) for moderate intensity, the 45 participants, aged six through 10 years old, all fell within the guidelines for both heart rate reserve and percent of age predicted maximum heart rate. These results demonstrate that this aerobic dance protocol is moderate intensity and is a potential mode of exercise for use within cardiac rehabilitation. The other project aims were to determine why children with CHD are not meeting the established exercise guidelines. Participants completed an 18-item survey to report their barriers to exercise. The most common barriers came from external factors, with the highest reported being “the weather is too bad”. Another highly reported barrier was “I don’t have enough energy”. Low energy level has been historically noted in persons with CHD. The tool used was reliable within the sample population, but the validity is lacking, and further validation in children with CHD is a prospect for future research. The results of this study may aid in determining how to create exercise interventions for this population. Overall, these two studies fill gaps in the literature of exercise in children, CHD, and pediatric cardiac rehabilitation. They also provide a foundation for many future studies.
Healthcare Utilization for Balance Problems In Community-Dwelling Adults In the United States of America
(2025-01-01) Kapur, Shweta; Goble, Daniel J.; Haworth, Joshua
This dissertation addresses healthcare utilization for balance problems in community-dwelling adults in the United States of America. Balance problems are one of the major risk factors for falls. Falls are the leading cause of mortality and chronic disability in elderly adults. The first project (review article) presented in this dissertation explored factors associated with healthcare utilization for balance problems as guided by the Andersen Healthcare Utilization Model. This model is frequently used to examine the factors leading to the use of health services. Age, sex, race/ethnicity, BMI, and comorbidities were identified as some of the factors that pre-disposed the underutilization of healthcare services for balance problems. Socioeconomic status, health insurance, and access to primary care could enable or disable healthcare utilization. The severity of balance problems, perceived illness, and its impact on daily activities were the factors that could affect the need for care. The second study used real-world nationally representative data from the National Health and Nutrition Examination Survey (NHANES) to investigate the associations suggested by the literature review. A total of 1834 adults who self-reported having balance problems in the past 12 months were included in this study. Outcome measure was whether the individual ever saw a health professional for balance problems. Only 32.13 of the individuals who reported having balance problems sought healthcare services for balance problems. Older age, lack of health insurance, not seeing a healthcare provider in the past year, and not experiencing any fall(s) in the past year had a significant association with reduced healthcare utilization for balance problems. These findings can help identify populations at increased risk of underutilization. The third study investigated the congruency between self-reported balance information and performance-based balance measures (Romberg Test of Standing Balance on Firm and Compliant Support Surfaces, RTSBFCSS), along with exploring the predictors of congruency between these balance measures. A nationally representative sample of 4939 community-dwelling adults (≥40 years) for whom self-reported balance status responses and performance-based balance examination results were available was used for this study. Of the 4939 study participants, 36.9 had evidence of balance problems on RTSBFCSS. About 7 in 10 adults with performance-based balance deficits reported no balance problems on the self-reported question. Sole reliance on self-reported information for balance screening may be inadequate. Results can help identify populations more likely to have discrepancies between balance measures.

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