Alison McKenzie

Chapman University · Department of Physical Therapy

Background In the United States, there are over seven million stroke survivors, with many facing gait impairments due to foot drop. This restricts their community ambulation and hinders functional independence, leading to several long-term health complications. Despite the best available physical therapy, gait function is incompletely recovered, an...

This viewpoint proposes eight anatomy threshold concepts related to physical therapist education, considering both movement system theory and anatomical competence. Movement system theory provides classifications and terminology that succinctly identifies and describes physical therapy practice from a theoretical and philosophical framework. The ca...

Stroke survivors are at high risk of falling during turning. The kinematics of performing a 360° turn have not been fully analyzed among individuals after stroke. Quantitative differences in the parameters of turning between healthy older adults and those after stroke could provide detailed information on turning ability among these groups. The pur...

A need currently exists for the establishment of anatomy learning objectives for physical therapist education programs. Developing recommended anatomy objectives to serve as a curricular guide may foster more consistent student outcomes while preserving instructional autonomy. These objectives could serve as a vital resource when making decisions d...

Objective: To evaluate the effect of intensive rehabilitation on the modified Rankin Scale (mRS), a measure of activities limitation commonly used in acute stroke studies, and to define the specific changes in body structure/function (motor impairment) most related to mRS gains. Methods: Patients were enrolled >90 days post-stroke. Each was eval...

Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR pr...

Objective: Telerehabilitation (TR) is now, in the context of COVID-19, more clinically relevant than ever as a major source of outpatient care. The social network of a patient is a critical yet understudied factor in the success of TR that may influence both engagement in therapy programs and post-stroke outcomes. We designed a 12-week home-based T...

Background Studies examining the effects of therapeutic interventions after stroke often focus on changes in loss of body function/structure (impairment). However, improvements in activities limitations and participation restriction are often higher patient priorities, and the relationship that these measures have with loss of body function/structu...

Background and Objectives Gross anatomy guidelines and recommendations are available for pre‐clinical medical faculty, however there is no consensus regarding anatomy student learning objectives for physical therapist education (PTE) programs. The Commission on Accreditation in Physical Therapy Education (CAPTE) requirements for gross anatomic cont...

Introduction: High doses of activity-based rehabilitation therapy help but many patients do not receive this, e.g., due to access, cost, and low compliance. Home-based telerehabilitation (TR) can address these issues. A prior study found 6 weeks of TR targeting arm motor deficits after stroke comparably efficacious vs. therapy delivered in-clinic....

Objective: This paper reports a qualitative study of a home-based stroke telerehabilitation system. The telerehabilitation system delivers treatment sessions in the form of daily guided rehabilitation games, exercises, and stroke education in the patient’s home. The aims of the current report are to investigate patient perceived benefits of and bar...

Importance: Many patients receive suboptimal rehabilitation therapy doses after stroke owing to limited access to therapists and difficulty with transportation, and their knowledge about stroke is often limited. Telehealth can potentially address these issues. Objectives: To determine whether treatment targeting arm movement delivered via a home...

The heterogeneity of stroke prompts the need for predictors of individual treatment response to rehabilitation therapies. We previously studied healthy subjects with EEG and identified a frontoparietal circuit in which activity predicted training-related gains in visuomotor tracking. Here we asked whether activity in this same frontoparietal circui...

Biomarkers that capture treatment effects could improve the precision of clinical decision making for restorative therapies. We examined the performance of candidate structural, functional, and angiogenesis-related MRI biomarkers before and after a 3-week course of standardized robotic therapy in 18 patients with chronic stroke and hypothesized tha...

Purpose: This abstract reports a qualitative study on a home-based stroke telerehabilitation system. The telerehabilitation system delivers treatment sessions in the form of daily guided rehabilitation games, exercises, and stroke education at the patient’s home. Therapists examine patients then establish regular videoconferences with them via the...

Introduction: Standardized measurement of clinical outcomes across sites and over time is critical to clinical trials. Barriers to outcome measure training include availability of standardized materials and time to train, plus wide geographic distribution of trial personnel. To address these, an online training and certification program based on NI...

Background: Although rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit because of access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed, then evaluated a home-based telerehabilitation system in patients with chronic hemiparetic stroke. Methods:...

Objective: To examine the validity of 5 robot-based assessments of arm motor function post-stroke. Design: Cross sectional. Setting: Outpatient clinical research center. Participants: Volunteer sample of 40 participants, age >18 years, 3-6 months post-stroke, with arm motor deficits that had plateaued. Intervention: None. Main outcome mea...

Supplementary material.

While the corpus callosum (CC) is important to normal sensorimotor function, its role in motor function after stroke is less well understood. This study examined the relationship between structural integrity of the motor and sensory sections of the CC, as reflected by fractional anisotropy (FA), and motor function in individuals with a range of mot...

Introduction: Emerging brain mapping methods measure function of individual brain circuits and have the potential to predict a patient’s gains and needs in the context of stroke rehabilitation. We recently described a motor-parietal circuit underlying visuomotor tracking and defined an EEG coherence measure (reflecting connectivity) that predicts v...

Advances in technology are providing new forms of human-computer interaction. The current study examined one form of human-computer interaction, augmented reality (AR), whereby subjects train in the real-world workspace with virtual objects projected by the computer. Motor performances were compared with those obtained while subjects used a traditi...

Valid biomarkers of motor system function after stroke could improve clinical decision-making. Electroencephalography-based measures are safe, inexpensive, and accessible in complex medical settings and so are attractive candidates. This study examined specific electroencephalography cortical connectivity measures as biomarkers by assessing their r...

Introduction: Paretic hand movements after stroke often correspond to activation in both the ipsilesional and contralesional hemispheres. Changes in intra- and interhemispheric connectivity have been reported but most studies have focused on individuals with limited motor impairment. The purpose of this pilot study was to examine connectivity betwe...

Introduction: Responsiveness to motor rehabilitation varies greatly after stroke. Improved knowledge of the brain correlates of motor function are needed to assist in the development of more effective and personalized rehabilitation protocols. Changes in the integrity of the ipsilesional corticospinal tract after stroke have been well documented, b...

Objective: This study was undertaken to better understand the high variability in response seen when treating human subjects with restorative therapies poststroke. Preclinical studies suggest that neural function, neural injury, and clinical status each influence treatment gains; therefore, the current study hypothesized that a multivariate approa...

In recent years, the field of Human-Computer Interaction (HCI) has been advanced with many technologies, however, most are limited to healthy users. In this paper, we leveraged the technology of free-hand interaction to rehabilitate patients with stroke. We modified the game of Fruit Ninja to use Leap Motion controller's hand tracking data for stro...

We explore the differences of direct (DI) vs. indirect (IDI) interaction in stroke rehabilitation. Direct interaction is when the patients move their arms in reaction to changes in the augmented physical environment; indirect interaction is when the patients move their arms in reaction to changes on a computer screen. We developed a rehabilitation...

Many different measures have been found to be related to behavioral outcome after stroke. Preclinical studies emphasize the importance of brain injury and neural function. However, the measures most important to human outcomes remain uncertain, in part because studies often examine one measure at a time or enroll only mildly impaired patients. The...

Introduction: Virtual Reality (VR) has been found useful for numerous rehabilitation applications, but has some intrinsic constraints such as the need for a visuospatial transformation when guiding movements. Augmented Reality (AR) is a new approach to human-computer interaction that enables patients to interact directly with virtual objects. The c...

Background and Purpose: We used voxel-based lesion symptom mapping (VLSM) to determine the relationship between lesion location and performance on upper extremity behavioral outcome measures post-stroke. We hypothesized that a lesion within the upper extremity region of the primary motor cortex would correlate with poorer hand motor outcome measure...

Introduction: Numerous predictors of treatment-induced behavioral gains after stroke have been identified. However, only a few types of predictors have generally been examined at a time. The current study examined multiple categories of established predictors in parallel among patients enrolled in a motor therapy study, hypothesizing that brain inj...

Evidence suggests that greater duration and intensity of rehabilitation therapy improves outcomes for patients with stroke. Delivery of care is often limited, however, e.g., due to systems of care delivery, cost, rural location, or difficulty travelling. The current study addressed this unmet need by examining the feasibility of a home-based telere...

Introduction: Refinement of biomarkers and predictors of treatment response could greatly benefit restorative stroke therapeutics. The current study examined the performance of established biomarker/predictor measures in patients undergoing 4 weeks of therapy, and also examined performance of dense array EEG (d-EEG) measures of cortical connectivit...

Background: Standardizing scoring reduces variability and increases accuracy. A detailed scoring and training method for the Fugl-Meyer motor assessment (FMA) is described and assessed, and implications for clinical trials considered. Methods: A standardized FMA scoring approach and training materials were assembled, including a manual, scoring...

INTRODUCTION: The increasing number of restorative stroke trials has generated increased discussion about optimal endpoints to detect changes in behavior over time. Robotic devices are under study as a therapeutic intervention, and in some cases the design of these devices might also make them useful for assessing behavioral status. If true, simila...

INTRODUCTION: A key challenge in the treatment of patients with chronic stroke is identifying which patients are most likely to benefit from therapy. An assessment of stroke-related injury can help, but it remains unclear which are the most useful measures. This issue was examined in the current study bearing in mind that restorative therapeutics i...

This was a pre post test design. Retraining the brain is one approach to remediate movement dysfunction resulting from task specific focal hand dystonia (FHD(TSP)). Document change in task specific performance (TSP) for patients with FHD(TSP) after 8 weeks of comprehensive home training (fitness activities, task practice, learning based memory and...

Focal hand dystonia (FHd) is a recalcitrant, disabling movement disorder, characterized by involuntary co-contractions of agonists and antagonists, that can develop in patients who overuse or misuse their hands. The aim of this study was to document clinical neuromusculoskeletal performance and somatosensory responses (magnetoencephalography) in he...

Recent studies show that rapid, nearly simultaneous, stereotypical repetitive fine motor movements can degrade the sensory representation of the hand and lead to a loss of normal motor control with a target task, referred to as occupational hand cramps or focal hand dystonia. The purpose of this prospective follow-up study was to determine whether...

Focal hand dystonia is a disabling, involuntary disorder of movement that can disrupt a successful musician's career. This problem is difficult to treat, to some extent because we do not fully understand its origin. Somatosensory degradation has been proposed as one etiology. The purpose of this case study was to compare the differences in the soma...

Some individuals with repetitive strain injury (RSI) develop focal dystonia of the hand (FDh), a disorder of motor control manifested in a specific context during skilled, hand movements. This descriptive study was designed to determine if musicians with FDh had reduced tactile discrimination. Ten healthy adults and ten patients with FDh participat...

Repetitive strain injuries are reaching epidemic levels among workers who perform heavy schedules of rapid alternating movements (eg., computer programmers, data entry workers) or repetitive, sustained, coordinated movements (eg., editors, writers, salespeople). The purpose of this study was to determine if patients with repetitive strain injury de...

Although physical therapists and physicians often treat patients with local musculoskeletal inflammation using topically applied steroids enhanced with ultrasound, there is a paucity of research confirming that phonophoresis significantly enhances drug diffusion. The purpose of this study was to determine if ultrasound enhances the diffusion of tra...

Ultrasound is commonly used by physical therapists, but there is no consensus regarding the most effective therapeutic dose for accelerating healing of open or closed wounds. A controlled, single-blind, posttest experimental study was carried out to compare differences in wound breaking strength and collagen deposition [hydroxyproline (HoPro)]. For...

In marked contrast to adult wound healing, healing in the fetus occurs without fibrosis or scar formation. In an attempt to simulate the fetal environment, amniotic fluid was applied to experimental wounds in an animal model. Quality of healing, breaking strength, collagen deposition and DNA were measured in wound in 5 mini Yucatan pigs following a...