Physical Therapy Faculty Publications

Sleep disturbance has been found to trigger a stress response with a subsequent activation of the psychoneuroimmunological (PNI) pathway associated with adverse health outcomes. This study aimed to assess the association among selected PNI biomarkers, sleep disturbances, and adverse health outcomes (depressive symptoms, physical symptoms). A stratified, quota sample (14 poor sleepers and 15 good sleepers) was drawn from a pool of healthy college women from a larger scale of study. The participants reported their sleep, stress, depressive, and physical symptoms. Wrist actigraphy was used to collect objective sleep data, and the Enzyme-Linked ImmunoSorbent Assay was used to assess PNI biomarkers. Poor sleep quality, higher stress perception, elevated serum serotonin, and lower serum interleukin-10 explained 75.3% of the variances for the depressive symptoms. Poor sleep quality along with delayed peak activity rhythms accounted 31.4% of the physical symptoms. High serotonin and tumor necrosis factor-α were the significant predictors for poor sleep efficiency, and serotonin was the single significant predictor for poor daytime functioning. Stress and sleep disturbances negatively impact the health of college women and should be as part of regular check-ups on campus. PNI effects on health outcomes should be further explored. Educational materials in the areas of sleep hygiene, health impacts from sleep disturbances, and strategies to maintain synchronized circadian rhythms should be mandatorily included in the college curriculum.

Objective. The purpose of this pilot study was to determine whether Super Pop VR, a low-cost virtual reality (VR) system, was a feasible system for documenting improvement in children with cerebral palsy (CP) and whether a home-based VR intervention was effective. Methods. Three children with CP participated in this study and received an 8-week VR intervention (30 minutes × 5 sessions/week) using the commercial EyeToy Play VR system. Reaching kinematics measured by Super Pop VR and two fine motor tools (Bruininks-Oseretsky Test of Motor Proficiency second edition, BOT-2, and Pediatric Motor Activity Log, PMAL) were tested before, mid, and after intervention. Results. All children successfully completed the evaluations using the Super Pop VR system at home where 85% of the reaches collected were used to compute reaching kinematics, which is compatible with literature using expensive motion analysis systems. Only the child with hemiplegic CP and more impaired arm function improved the reaching kinematics and functional use of the affected hand after intervention. Conclusion. Super Pop VR proved to be a feasible evaluation tool in children with CP.

Objective. To describe and analyze the potential use of games in the commercially available EyeToy Play and EyeToy Play 2 on required/targeted training skills and feedback provided for clinical application. Methods. A summary table including all games was created. Two movement experts naïve to the software validated required/targeted training skills and feedback for 10 randomly selected games. Ten healthy school-aged children played to further validate the required/targeted training skills. Results. All but two (muscular and cardiovascular endurance) had excellent agreement in required/targeted training skills, and there was 100% agreement on feedback. Children’s performance in required/targeted training skills (number of unilateral reaches and bilateral reaches, speed, muscular endurance, and cardiovascular endurance) significantly differed between games . Conclusion. EyeToy Play games could be used to train children’s arm function. However, a careful evaluation of the games is needed since performance might not be consistent between players and therapists’ interpretation.

The objective of the study was to determine if low intensity, high frequency vibration training impacted the musculoskeletal system in a mouse model of Duchenne muscular dystrophy, relative to healthy mice. Three-week old wildtype (n = 26) and mdx mice (n = 22) were randomized to non-vibrated or vibrated (45 Hz and 0.6 g, 15 min/d, 5 d/wk) groups. In vivo and ex vivo contractile function of the anterior crural and extensor digitorum longus muscles, respectively, were assessed following 8 wks of vibration. Mdx mice were injected 5 and 1 days prior to sacrifice with Calcein and Xylenol, respectively. Muscles were prepared for histological and triglyceride analyses and subcutaneous and visceral fat pads were excised and weighed. Tibial bones were dissected and analyzed by micro-computed tomography for trabecular morphometry at the metaphysis, and cortical geometry and density at the mid-diaphysis. Three-point bending tests were used to assess cortical bone mechanical properties and a subset of tibiae was processed for dynamic histomorphometry. Vibration training for 8 wks did not alter trabecular morphometry, dynamic histomorphometry, cortical geometry, or mechanical properties (P≥0.34). Vibration did not alter any measure of muscle contractile function (P≥0.12); however the preservation of muscle function and morphology in mdx mice indicates vibration is not deleterious to muscle lacking dystrophin. Vibrated mice had smaller subcutaneous fat pads (P = 0.03) and higher intramuscular triglyceride concentrations (P = 0.03). These data suggest that vibration training at 45 Hz and 0.6 g did not significantly impact the tibial bone and the surrounding musculature, but may influence fat distribution in mice.

An estimated 70% of people will experience low back pain at some point in their lives, and recurrence rates can be as high as 85%. Recent studies suggest that yoga – a widely practiced physical/mental discipline – may relieve back pain and reduce functional disability. The objective of this study was to conduct a systematic review and meta-analysis of the existing research on the effects of yoga on chronic low back pain and function. Our literature search began April 2011 and continued through October 2011. Cochrane, PubMed, CINAHL, Embase, ProQuest Dissertations and Theses, Google Scholar, and Clinicaltrials.gov databases were searched electronically. The search terms used were: yoga AND back pain. A total of 58 relevant studies were originally identified through the database searches. Of those, 45 were excluded on the basis of the title and/or review of the abstract. The 13 remaining studies were fully evaluated via a careful review of the full text. On the basis of the inclusion and exclusion criteria, 6 studies were excluded, leaving a total of 7 studies to be included in the meta-analyses of the impact of yoga on low back pain and function. Effect sizes were calculated as the standardized mean difference and meta-analyses were completed using a random-effects model. Overall, yoga was found to result in a medium, beneficial effect on chronic low back pain [overall effect size (ES) = 0.58, p<0.001], indicating that subjects practicing yoga reported significantly less pain than control subjects. Yoga subjects also reported significantly less functional disability after the intervention (overall ES = 0.53, p<0.001). Moreover, the improvements in pain and function for yoga subjects remained statistically significant 12-24 weeks after the end of the intervention (overall ES = 0.44-0.54, p≤0.002). In conclusion, yoga practice can significantly reduce pain and increase functional ability in chronic low back pain patients.

Skeletal muscle, after spinal cord injury (SCI), becomes highly susceptible to fatigue. Variable-frequency trains (VFTs) enhance force in fatigued human skeletal muscle of able-bodied (AB) individuals. VFTs do this by taking advantage of the "catch-like" property of skeletal muscle. However, mechanisms responsible for fatigue in AB and SCI subjects may not be the same, and the efficacy of VFT stimulation after SCI is unknown. Accordingly, we tested the hypothesis that VFT stimulation would augment torque-time integral in SCI subjects. The quadriceps femoris muscle was stimulated with constant frequency trains (CFTs) (six 200 s square wave pulses separated by 70 ms) or VFTs (a train identical to the CFT, except that the first two pulses were separated by 5 ms) in SCI and AB subjects. After 180 contractions (50% duty cycle), isometric peak torque decreased 44, 56, and 67 percent, in the AB (n = 10), acute SCI (n = 10), and chronic SCI (n = 12) groups, respectively. In fatigued muscle, VFTs enhanced the torque-time integral by 18 percent in AB subjects and 6 percent in chronic SCI patients, and had no effect in acute SCI patients when compared to the corresponding CFT. The much faster rise times in SCI subjects (~80 ms vs. 120 ms in AB subjects) probably contributed to the inability of VFTs to enhance torque-time integrals in SCI patients. The results suggest that the use of VFT stimulation in patients with SCI may not be as efficacious as it is in AB persons.

Recent studies have shown that during unimanual motor tasks, aging adults show bilateral recruitment of primary motor cortex (M1), while younger adults show a suppression of the ipsilateral motor cortex. Additional work has indicated that increased bilateral M1 recruitment in older adults may be deleterious when performing some motor tasks. However, higher levels of physical fitness are associated with improved dexterity and fitness may mitigate the loss of both inhibitory and excitatory communication in aging adults. The goal of this study was to assess dexterity and interhemispheric motor communication in physically fit and sedentary middle-age (40–60 years) right handed participants using tests of hand deftness and transcranial magnetic stimulation (TMS). To behaviorally assess the influence of interhemispheric communication on motor performance, participants also perform the coin rotation deftness task while maintaining pinch force with the opposite hand (bimanual condition). We correlated these behavioral measures with the ipsilateral silent period using TMS to assess interhemispheric inhibition. Our results show that the middle-aged adults who were physically fit had better dexterity of their right hand (finger tapping and peg-board). When performing the coin rotation task the fit group had no between hand differences, but the sedentary group’s left hand performance was inferior to the their right hand. We found that better dexterity correlated with ipsilateral silent period duration (greater inhibition) thereby supporting the postulate that fitness improves interhemispheric motor communication.

AIM: To determine if the addition of hip-strengthening exercises decreases pain and improves function in patients with patellofemoral pain syndrome.

METHODS: The authors completed a systematic review searching eight databases (i.e. , PubMed, Cochrane, CINHAL, MEDLINE, SportsDiscus, EMBASE, APTA Hooked on Evidence, and PEDro). Two independent reviewers screened and excluded studies if they did not meet the following inclusion criteria: subjects had a primary diagnosis of patellofemoral pain syndrome (PFPS), intervention group included hip-strengthening exercises, control group included a traditional physical therapy intervention, study included outcome measures of pain and/or function, study used a randomized controlled trial design, PEDro score was ≥ 7, and study was published in a peer-reviewed journal. Primary outcome measures were subjective scales of pain and function. These measures were converted to standardized mean difference [effect size (ES)], and a random-effects model was used to calculate the overall ES.

RESULTS: Two hundred eighty-three studies were screened for inclusion in our meta-analysis. Nine studies were deemed suitable for data extraction and analysis. A total of 426 subjects were used in the nine studies. Overall, there was a significant positive effect of hip-strengthening exercises on measures of pain and function in subjects with PFPS (ES = 0.94, P = 0.00004). None of the individual studies had a negative ES, with study ES ranging from 0.35 to 2.59. Because of the high degree of between-study variance (I 2 = 76%; Q = 34.0, P < 0.001), subgroup meta-analyses and meta-regressions were performed. None of the potential moderator variables that were investigated (e.g. , outcome type, hip region targeted, duration of treatment) could explain a significant amount of the between-study variance in ES (P ≥ 0.23).

CONCLUSION: Overall, the addition of hip-strengthening exercises to traditional physical therapy produced greater improvements in measures of pain and function.

Stroke is a leading cause of death and disability in the USA. Up to 60% of patients do not fully recover despite intensive physical therapy treatment. N-Methyl-D-aspartate receptors (NMDA-R) have been shown to play a role in synaptic plasticity when activated. D-Cycloserine promotes NMDA receptor function by binding to receptors with unoccupied glycine sites. These receptors are involved in learning and memory. We hypothesized that D-cycloserine, when combined with robotic-assisted physiotherapy (RAP), would result in greater gains compared with placebo + RAP in stroke survivors. Participants (n=14) were randomized to D-cycloserine plus RAP or placebo plus RAP. Functional, cognitive, and quality-of-life measures were used to assess recovery. There was significant improvement in grip strength of the affected hand within both groups from baseline to 3 weeks (95% confidence interval for mean change, 3.95 ± 2.96 to 4.90 ± 3.56 N for D-cycloserine and 5.72 ± 3.98 to 8.44 ± 4.90 N for control). SIS mood domain showed improvement for both groups (95% confidence interval for mean change, 72.6 ± 16.3 to 82.9 ± 10.9 for D-cycloserine and 82.9 ± 13.5 to 90.3 ± 9.9 for control). This preliminary study does not provide evidence that D-cycloserine can provide greater gains in learning compared with placebo for stroke survivors.

Stroke is a leading cause of death and disability in the USA. Up to 60% of patients do not fully recover despite intensive physical therapy treatment.N-Methyl-D-aspartate receptors(NMDA-R) have been shown to play a role in synaptic plasticitywhen activated. D-Cycloserine promotes NMDA receptor function by binding to receptors with unoccupied glycine sites. These receptors are involved in learning and memory.We hypothesized thatD-cycloserine,when combined with robotic-assisted physiotherapy (RAP), would result in greater gains compared with placebo + RAP in stroke survivors. Participants (𝑛 = 14) were randomized to Dcycloserine plus RAP or placebo plus RAP. Functional, cognitive, and quality-of-life measures were used to assess recovery. There was significant improvement in grip strength of the affected hand within both groups from baseline to 3 weeks (95% confidence interval for mean change, 3.95 ± 2.96 to 4.90 ± 3.56N for D-cycloserine and 5.72 ± 3.98 to 8.44 ± 4.90N for control). SIS mood domain showed improvement for both groups (95% confidence interval for mean change, 72.6 ± 16.3 to 82.9 ± 10.9 forD-cycloserine and 82.9 ± 13.5 to 90.3 ± 9.9 for control).This preliminary study does not provide evidence that D-cycloserine can provide greater gains in learning compared with placebo for stroke survivors.

Background and Purposes: The purposes of this meta-analysis were (1) to investigate the relation between prematurity and the parameters of infant kicking, and (2) to examine to what degree the effect size varies as a function of age, study type, publication type, and country of origin. Methods: Six studies met all the inclusion criteria and were used for this meta-analysis. A r-indicator was used to represent the effect size indicating the difference between low-risk preterm and full term infants and the difference in kinematic variables between high-risk preterm and full term infants. A fixed-effect model was assumed in this study. To determine whether the r-indicators were derived from a common population, a heterogeneity analysis (Q) was computed for each kinematic variable. Potential moderators (study type, publication type, country of origin, and age) were analyzed for each variable. Results: Overall, there was a consistent moderate to large effect size for intralimb coordination variables between high-risk preterm and full term infants. For other kicking parameters, there was a small effect size between preterm infants (both low-risk and high­ risk groups) and full term infants. From the moderator analyses, studies testing high-risk infants younger than 4 months had a small positive effect for the measures of intralimb coordination, the hip-knee and hip-ankle joint correlations; whereas studies testing infants older than 4 months had a large positive effect on these hip-knee and hip-ankle pairs. On the contrary, studies testing low-risk infants younger than 4 months had a medium positive effect; whereas studies testing low-risk infants older than 4 months showed no effect. Conclusion: The results suggest that intralimb coordination parameters after 4 months of age may be early indicators of atypical coordination since low-risk infants resolved their differences after 4 months of age but high-risk infants sustained the atypical intralimb coordination.

Virtual reality (VR) is a computer technology that artificially generates sensory information in a form that people perceive as real-world objects and events. It has been proposed that VR can improve upper-extremity function in children with cerebral palsy (CP) by decreasing physical disabilities, precisely adjusting the difficulty of task and feedback, enhancing motivation and manipulating perceptual information. The purpose of this study was to investigate the training effects of VR on reaching behavior in a child with CP. This case was a 6-year-old boy with spastic quadriplegic CP who had good cooperation and normal cognition. A single-subject A-B-A design was used. The case received 3 baseline, 4 intervention, and 2 follow-up measures. He received a 4-week (3 times a week) individualized VR training using VR-hand function training system and Eyetoy-play system with therapist's manual guidance. The outcome measures included (1) four reaching kinematic parameters (movement time (MT), path, peak velocity (PV), and number of movement units (MU)) in 2 activities (pegboard and mail-delivery) at 3 directions (abduction, adduction, and forward); (2) touching a swing ball; and (3) the fine motor domain of Peabody Development Motor Scale-2nd edition (PDMS2). Visual inspection and 2-standard deviation band method were used to compare the outcome measures between the two adjacent phases. Improvements were found in the kinematic parameters in all directions from baseline to intervention, and the effects were maintained in some directions from intervention to follow-up. Improvement was also shown in the ability to touch a swing ball, but the effect was not maintained from intervention to follow-up. Furthermore, there was an increase (11 points) in the PDMS2 scores from baseline to intervention and an increase (1 point) from intervention to follow-up. This case study demonstrated the potential effect of VR training program to improve the upper-extremity function in children with CP. The training effects might retain for 1 month post intervention.

Background and purpose: Studies of adults and typically developing (TD) children find the number of hands and fingers used to grasp an object is influenced by the relationship between object size and hand size. Children with Down syndrome (DS) between 3 and 11 years have shown no differences in number of hands (1 or 2 hands) used to grasp different sized objects compared to TD children when the object size was body-scaled. The purpose of this study was to examine whether body-scaled information affected the number of hands and fingers used to grasp different sized objects in toddlers with and without DS. Method: Ten toddlers were included, 5 DS ( = 16 mo) and 5 age-matched TD ( = 16.3 mo). Subjects were videotaped grasping 14 boxes, 1.4 cm to 13.5 cm. in size. Number of hands and fingers used for grasping were recorded. Descriptive statistics, t-tests and Spearman correlation coefficient were used to compare the differences between toddlers with DS and TD. Results: Toddlers with DS had significantly smaller hand length than toddlers without DS (p=.004 right hand, p=.007 left hand). As box size increased, both groups switched from one-hand to two-hand grasping. There was a significant difference between groups where this transition occurred (p=.02). However, when the body-scaled ratio between object size and hand size was considered, the differences between groups disappeared (t(8)=1.479; p=.18). Moreover, the number of fingers used to grasp boxes also increased with increasing box size across both groups (ρ=0.94). Conclusion: Toddlers with DS show similar body-scaled grasping pattern as their age-matched peers with TD indicating that the differences in grasping patterns between toddlers with and without DS may be attributed to differences in body size, besides the motor abilities.

Background and purposes: The purposes of this study were 1) to describe the general productivity and productivities in 4 special fields (neurological, orthopedic, pediatric, and cardiopulmonary) of physical therapists (PT) and physical therapist assistants (PTA) in Taiwan, and 2) to explore the association between characteristics of PT/PTA and productivity.

Method: Questionnaire was mailed to the members of all PT and PTA associations in Taiwan. The total mailing number of questionnaire for PT and PTA were 2466 and 1117, respectively. The content of this questionnaire included basic demographic data and information in clinical work. Survey period was between September, 2002 and December, 2002.

Results: Total returned questionnaires were 764 from PT and 269 from PTA. General productivity for aPT was 21.39 patients per day, assuming working 8 hours per day. For each specialization field, the productivity of neurological, orthopedic, pediatric, cardiop­ ulmonary patients of each PT per day was 19.72 (sd=9.50), 24.98 (sd=11.07), 15.55 (sd=8.75), and 21.42 (sd=10.63), respectively. For the association between PT characteristics and productivity, working place and PT' s gender were significantly associated with general productivity. PT's age, educational level, and working place were significantly associated with neurological and pediatric productivities. Working experience was also significantly associated with neurological productivity. PT' s characteristics were not significantly associated with orthopedic and cardiopulmonary productivity. General productivity for a PTA was 29.75 patients per day. The productivity of neurological, orthopedic, pediatric, cardiopulmonary patients of each PTA per day was 22.29 (sd=9.50), 35.07 (sd=11.07), 19.48 (sd=8.75), and 19.55 (sd=10.63), respectively. Only PTA's education level was signifi­cantly associated with orthopedic productivity. There were no other significant associations between any of the PTA's characteristics and productivity.

Conclusion: This study repported the current status of clincial practice in PT and PTA. There will be a series of articles investigating the projection of supply and demand of physical therapy manpower for the next twenty years.

Background: Estrogens are associated with the loss of skeletal muscle strength in women with age. Ovarian hormone removal by ovariectomy in mice leads to a loss of muscle strength, which is reversed with 17β-estradiol replacement. Aging is also associated with an increase in antioxidant stress, and estrogens can improve antioxidant status via their interaction with estrogen receptors (ER) to regulate antioxidant gene expression. The purpose of this study was to determine if ER and antioxidant gene expression in skeletal muscle are responsive to changes in circulating estradiol, and if ERs regulate antioxidant gene expression in this tissue.

Methodology/Principal Findings: Adult C57BL/6 mice underwent ovariectomies or sham surgeries to remove circulating estrogens. These mice were implanted with placebo or 17β-estradiol pellets acutely or chronically. A separate experiment examined mice that received weekly injections of Faslodex to chronically block ERs. Skeletal muscles were analyzed for expression of ER genes and proteins and antioxidant genes. ERα was the most abundant, followed by Gper and ERβ in both soleus and EDL muscles. The loss of estrogens through ovariectomy induced ERα gene and protein expression in the soleus, EDL, and TA muscles at both the acute and chronic time points. Gpx3 mRNA was also induced both acutely and chronically in all 3 muscles in mice receiving 17β-estradiol. When ERs were blocked using Faslodex, Gpx3 mRNA was downregulated in the soleus muscle, but not the EDL and TA muscles.

Conclusions/Significance: These data suggest that Gpx3 and ERα gene expression are sensitive to circulating estrogens in skeletal muscle. ERs may regulate Gpx3 gene expression in the soleus muscle, but skeletal muscle regulation of Gpx3 via ERs is dependent upon muscle type. Further work is needed to determine the indirect effects of estrogen and ERα on Gpx3 expression in skeletal muscle, and their importance in the aging process.