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Introduction
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Publications
Publications (98)
Introduction
Advances in artificial intelligence (AI) offer physical therapy educators opportunities to improve student learning. We applied AI to identify themes and determine the extent to which physical therapy professional values were reflected upon by students during a high-impact international service learning (ISL) course in México.
Review...
Background
Clinical Guidelines for Exercise and Physiotherapy in Huntington’s Disease (HD) were published in 2020. Physiotherapists working in HD Specialist clinics are key stakeholders in the implementation of these guidelines. Resources that facilitate implementation of these guidelines in clinical practice are urgently needed.
Aim
To generate c...
Background
Balance is affected early in the Huntington’s disease (HD) course and progressively worsens over time, impacting the ability to move safely and contributing to increased falls risk. No valid and reliable outcome measure specific to balance impairments in HD currently exists. A better understanding of tasks that decline across stages of H...
Background
Single Leg Stance Time (SLST) is a quick and straightforward method of examining balance. It has been used to assess balance in older adults and can be followed over time.
Methods
This retrospective study assessed how SLST correlates with other measures of balance and function in Huntington’s disease (HD). We reviewed charts of 77 indiv...
Background
Clinical guidelines for physiotherapy for people with Huntington’s disease (HD) were published in 2020 (Quinn et al. 2020). The EHDN Physiotherapy Working Group (PWG) developed resources to ensure communication and collaboration with the HD community so that education and advice regarding the guidelines is freely available to all.
Metho...
Background and Purpose
Stair negotiation is crucial for functional independence and is a leading cause of fall-related injuries in older adults. The Step Test Evaluation of Performance on Stairs (STEPS) is a quick and easily administered outcome measure for assessing stair negotiation. This study investigated the reliability and concurrent content...
Background/Purpose
Gait impairments in Parkinson disease (PD) contribute to decreased quality of life. This randomized controlled trial examined immediate- and longer-term effects of a single joint robotic exoskeleton device (EXOD), the Honda Walking Assist device, on gait.
Methods
Participants (n = 45) with PD (Hoehn and Yahr stages 1-3) were ran...
Background
Millions of older US adults fall annually, leading to catastrophic injuries, over 32,000 deaths and healthcare costs of over $55 billion. This study evaluated perceived benefits and limitations of using community paramedicine for fall prevention strategies from the lens of older adults, caregivers, and healthcare providers.
Methods
Semi...
Background:
In 2020, our group published physical therapy clinical practice guidelines (CPG) for people with Huntington's disease (HD). The guideline recommendations were categorized according to six primary movement impairment classifications.
Objective:
To facilitate implementation of this CPG, we have developed guideline-based algorithms for...
Background
The EHDN Physiotherapy Working Group (EHDN PWG) aims to share resources to support physiotherapy practice guidelines across clinical settings. A subgroup of the EHDN PWG, the HD specialist clinic work stream, focuses on supporting people particularly in pre-manifest and early stages of HD.Following publication of Physiotherapy Guidelines...
Interdisciplinary care teams for people with Huntington’s disease (HD) consist of neurologists, neuropsychologists, psychiatrists, geneticists and/or genetic counselors, physical, occupational, and speech therapists, dieticians, social workers, and nurses who provide patient-centered, comprehensive evaluations and make recommendations for pharmacol...
In 2020, our group published physiotherapy clinical practice guidelines (CPG) for people with Huntington’s disease (HD). The guideline recommendations were categorized according to six primary movement impairment classifications. To facilitate implementation of this CPG and knowledge translation, we have developed decision algorithms for physiother...
This paper presents a framework for physical therapy through the course of Huntington’s disease (HD) which includes coordinated care plans with neurologists. HD is an inherited neurodegenerative disorder that leads to impaired strength and coordination and ultimately progressive loss of function. Interdisciplinary HD care teams provide patient-cent...
Background:
The recently published clinical practice guideline for physiotherapy practice for Huntington's disease (HD) should be integrated into practice to develop interventions that enable people with HD to achieve personalised goals. The European Huntington's Disease Network Physiotherapy Working Group aims to support and enable the use of bes...
Research Objectives
To determine the feasibility of Action Observation (AO) + Repetitive Task Practice (RTP) compared to placebo + RTP interventions through detecting changes in Upper Limb (UL) impairment, function, and spasticity outcomes in the chronic stroke survivor.
Design
Randomized controlled single-blinded, parallel-group pilot study.
Set...
Background
Clinical practice guidelines are often not optimally translated to clinical care. Following the publication of the Huntington’s disease (HD) physiotherapy clinical practice guidelines in 2020, the European Huntington’s Disease Network Physiotherapy Working Group (EHDN PWG) identified a need to explore perceived facilitators and barriers...
Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Both action observation and repetitive-task practice are efficacious interventions for poststroke upper limb hemiplegia individually, yet these interventions have not been combined before. A feasibility study was completed to determine prelimin...
Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Both action observation and repetitive-task practice are efficacious interventions for poststroke upper limb hemiplegia individually, yet these interventions have not been combined before. A feasibility study was completed to determine prelimin...
Background
Treadmill training may improve gait disorders associated with neurodegenerative diseases. In Parkinson’s disease (PD), treadmill training alters gait patterns after one session, and long-term training improves gait parameters, fall risk, and quality of life.
Research question
What is the feasibility and safety of using this intervention...
Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in single- and dual-task conditions in persons with MS to age- and sex-matched healthy controls. We a...
Purpose
Falls are the leading cause of injury-related emergency department (ED) visits in older adults, but we lack a sensitive screening tool for fall risk. We evaluated the sensitivity and specificity of the 4-Stage Balance Test (4SBT) to identify older adults at risk of falling in an ED setting and whether accelerometry-based trunk sway measures...
Objective:
In the past decade, an increasing number of studies have examined the efficacy of physical therapy interventions in people with Huntington disease (HD).
Methods:
We performed a mixed-methods systematic review using Joanna Briggs Institute (JBI) methodology and included experimental and observational study designs. The search resulted...
Background
Individuals with neurological disorders often have difficulty negotiating stairs that can lead to injurious falls. Clinicians lack a clinical tool to identify impairments in stair negotiation and to assist their decision making regarding treatment plans to improve stair performance and safety. We developed a new tool called the Step Test...
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STEPS: Step Test Evaluation of Performance on Stairs.
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Background:
Despite the prevalence of dual-task (e.g., walking while talking) deficits in people with multiple sclerosis (MS), no neuroimaging studies to date have examined neuronal networks used for dual-task processing or specific brain areas related to dual-task performance in this population. A better understanding of the relationship among un...
International service learning (ISL) courses within physical therapy (PT) education programs are designed, in part, to promote the development of professional values. Assessment of students' professional values, however, is a challenge for educators.
Methods:
This study focused on the reflective learning component of an elective 10-day ISL course...
Individuals with HD have progressive motor, cognitive and behavioral impairments that contribute to difficulty with stair negotiation leading to falls on stairs. To assess stair safety, we developed a tool called the Step Test Evaluation of Performance on Stairs (STEPS) that allows systematic observation of movement and analysis of stair performanc...
Case description:
A 44-year-old man with traumatic spinal cord and brain injuries from a motor vehicle accident was admitted to an inpatient rehabilitation hospital. His spinal cord injury was classified as T4 American Spinal Injury Association Impairment Scale (AIS) A, and his cognitive status was level IV on the Ranchos Los Amigos Scale. Initial...
Background:
Huntington's disease (HD) is a progressive neurodegenerative disorder that results in a gradual decline in mobility and balance. Increasing evidence has documented an important role of executive function in the safe ambulation of the elderly and people with a variety of neurological disorders. Little is known about the contribution of...
Background
A number of studies evaluating physical therapy and exercise interventions in Huntington’s disease have been conducted over the past 15 years. However, an assessment of the quality and strength of the evidence in support of these interventions is lacking.
Objective
The purpose of this systematic review was to investigate the effectivene...
Review question/objective::
The review seeks to evaluate the effectiveness of physical therapy and exercise interventions in Huntington's disease (HD). The review question is: What is the effectiveness of physiotherapy and therapeutic exercise interventions in people with HD, and what are patients', families' and caregivers' perceptions of these i...
Due to the fast pace and high complexity of managing patients in intensive and acute care units (ICUs), healthcare students often feel challenged and unprepared to practice in this environment. Simulations and standardised patients provide "hands-on" learning experiences that are realistic and help students to gain competence and confidence. This s...
Postural instability is common in individuals with Huntington's disease (HD), yet little is known about control of the trunk during static and dynamic activities. We compared the trunk motion of 41 individuals with HD and 36 controls at thoracic and pelvic levels during sitting, standing, and walking using wearable iPod sensors. We also examined th...
Objectives:
The American College of Emergency Physicians Geriatric Emergency Department (ED) Guidelines and the Center for Disease Control recommend that older adults be assessed for risk of falls. The standard ED assessment is a verbal query of fall risk factors, which may be inadequate. We hypothesized that the addition of a functional balance t...
Background
Individuals with HD develop postural instability and gait deviations with concurrent loss of function. While trunk sway is a prominent symptom of HD, little is known about its impact on functional task performance.
Aims
We explored the relationship among trunk sway during static and dynamic tasks and measures of gait, mobility, and fall...
Limited data compares clinical profiles of Lewy Body Dementia (LBD) with Alzheimer’s disease (AD) and Parkinson’s disease (PD). Twenty-one mildly demented ambulatory LBD subjects were individually matched by MMSE score with 21 AD subjects and by UPDRS motor score with 21 PD subjects. Matched by age, gender, education, and race, pairs were compared...
Introduction:
Differential diagnosis of dementia with Lewy bodies (DLB), Parkinson's disease with dementia (PDD), Parkinson's disease (PD) and Alzheimer's disease (AD) is challenging. Comparative motor profiles of these neurodegenerative disorders may aid in earlier diagnosis but have not been extensively studied.
Methods:
Groups were rigorously...
Clinicians are in need of valid and objective measures of postural sway. Accelerometers have been shown to be suitable alternatives to expensive and stationary force plates. We evaluated the test-retest reliability and balance task discrimination capability of a new wireless tri-axial accelerometer (YEI 3-Space Sensor™). Four testing conditions (ey...
Chorea may contribute to balance problems and walking difficulties that lead to higher fall rates in individuals with Huntington’s disease (HD). Few studies have examined the effects of tetrabenazine (TBZ), an anti-choreic drug, on function and mobility in HD. The purpose of this study was to compare: 1) gait measures in forward walking, 2) balance...
Background and Purpose
Individuals with Huntington's disease (HD) experience balance and gait problems that lead to falls. Clinicians currently have very little information about the reliability and validity of outcome measures to determine the efficacy of interventions that aim to reduce balance and gait impairments in HD. This study examined the...
Background Individuals with Huntington’s disease (HD) experience balance and walking problems. Treadmill training (TT) improves walking function (e.g., gait speed, stride length) in Parkinson’s disease suggesting that TT may also be beneficial in HD.
Aims We investigated the safety, feasibility, and possible effects on gait of a single session of T...
Assessment of individuals with stroke using reliable and valid outcome measures is a key component of the treatment planning process. Health care professionals may have difficulty selecting balance and mobility measures given the large number of measures to choose from. This article utilizes a case-based approach to describe the benefits of using a...
Objective
To investigate the feasibility, acceptability, and safety of a supervised video game exercise program administered via Dance Dance Revolution in individuals with Huntington’s disease.
Design
A cross-over, controlled, single-blinded, six-week trial.
Setting
Home-based.
Participants
Eighteen ambulatory individuals with Huntington’s disea...
Joint infection is a rare but serious complication after knee injury that should be part of a physical therapist's differential diagnosis. This case report presents the care of a 17 year-old female athlete with septic arthritis from a Fusobacterium infection after sustaining a right lateral meniscus tear. Joint pathology combined with the aggressiv...
Background:
Clinical intervention trials in people with Huntington disease (HD) have been limited by a lack of reliable and appropriate outcome measures.
Objective:
The purpose of this study was to determine the reliability and minimal detectable change (MDC) of various outcome measures that are potentially suitable for evaluating physical funct...
Gait abnormalities are a hallmark of Parkinson's disease (PD) and contribute to fall risk. Therapy and exercise are often encouraged to increase mobility and decrease falls. As disease symptoms progress, assistive devices are often prescribed. There are no guidelines for choosing appropriate ambulatory devices. This unique study systematically exam...
Many falls occur from backward perturbations or during transitional movements that require a person to turn and step backwards, suggesting that deficits in backward stepping may negatively impact mobility. Previous studies found significant declines in backward walking (BW) spatiotemporal measures in healthy elderly compared to young adults. No stu...
Background Chorea may contribute to balance problems and walking difficulties that lead to higher fall rates in individuals with Huntington's disease (HD). Few studies have examined the effects of anti-choreic drugs on functional abilities. We noted that patients report decreased falls on stable dose of tetrabenazine, and we observed declines in ga...
Gait and balance impairments lead to frequent falls and injuries in individuals with Huntington's disease (HD). Assistive devices (ADs) such as canes and walkers are often prescribed to prevent falls, but their efficacy is unknown. We systematically examined the effects of different types of ADs on quantitative gait measures during walking in a str...
The Tinetti Mobility Test (TMT) is a clinical balance and gait test that predicts fall risk in the elderly. This study examined the concurrent validity, usefulness of the TMT as a fall risk screening tool, and the potential ability of the TMT to predict falls in individuals with Huntington's disease (HD). Data from a retrospective review of 94 pati...
Spinal cord injury (SCI) impairs sensory systems causing allodynia. Measuring the development of allodynia in rodent models of SCI is challenging due to spinal shock and marked motor impairments. Assessment of SCI-induced allodynia is not standardized across labs, making interpretation of results difficult. Therefore, we validated sensory threshold...
Background Huntington's disease (HD) produces balance and gait impairments that increase fall risk and decrease quality of life for affected individuals.
Aims This study examined the efficacy of an exercise program using the video game Dance Dance Revolution (DDR) to improve dynamic balance and mobility in individuals with HD. Methods. Participants...
Introduction
Falls are frequent in individuals with Huntington's disease (HD), due to gait and balance impairments. Falls often occur when turning, or when maneuvering in tight spaces and around obstacles when walking.
Methods
This study examined the effect of 8 different ambulatory assistive devices (ADs, e.g., canes, walkers) on spatiotemporal g...
The purpose of this article is to describe the development of a unique interdisciplinary service-learning course and to evaluate the impact of this experience on allied health students' professional development. One hundred and twenty-seven students from occupational and physical therapy programs served medically uninsured individuals (n = 170) at...
Functional recovery following central nervous system (CNS) injury in adult animals may depend on the reestablishment of the precise pattern of connections made during development. When the nervous system is injured during embryonic development, functional recovery may involve the formation of atypical connections. Can such atypical synapses regener...
This study examined the interrater and intrarater reliability, concurrent validity, and criterion validity of the Tinetti Mobility Test (TMT) as a fall risk screening tool in individuals with Parkinson disease (PD).
Thirty individuals with PD voluntarily participated in the study, and data from a retrospective review of 126 patient records were inc...
To determine the effects of resistance exercise on function, fatigue, and quality of life in individuals with ALS.
Subjects with a diagnosis of clinically definite, probable, or laboratory-supported ALS, forced vital capacity (FVC) of 90% predicted or greater, and an ALS Functional Rating Scale (ALSFRS) score of 30 or greater were randomly assigned...
Spinal cord injury (SCI) causes motor and sensory deficits that impair functional performance. While more functional recovery occurs with greater white matter sparing (WMS), it is unclear which locomotor features are more vulnerable to SCI than others, if recovery of certain features depends on specific amounts of WMS, and whether motor recovery pa...
Background and Purpose: Individuals with amyotrophic lateral sclerosis (ALS) develop balance problems. This study was conducted to determine the reliability of the Tinetti Balance Test for individuals with ALS.
Subjects and Methods: Subjects in Stages I - III volunteered for Parts 1 (n=21) and 2 (n=11). One physical therapist and 2 physical therapy...
The current status of evaluation and management provided by individual healthcare professionals (HCP) at amyotrophic lateral sclerosis (ALS) centers and clinics needs to be analyzed. This paper describes one ALS center's experiences with the development, analysis, refinement, and utility of an interdisciplinary, HCP-driven ALS database. The purpose...
Background and purpose:
This case report describes the use of Sinaki and Mulder's approach to staging amyotrophic lateral sclerosis (ALS) and functional outcome measures in designing a treatment program for a 59-year-old woman with ALS.
Case description and outcomes:
As the patient progressed from stage I through stage VI, over 12 months, the ph...
Adaptation to the thermal environment depends upon heritable, intraspecific variability in the thermal dependence of organismal function. We tested for variability in the thermal dependence of crawling speed, population growth rate, and mating compatibility among four strains of the ciliate Euplotes vannus (LL1, Elba, Por7, and Sard6). In addition,...
Thesis (M.S. in Bio.)--Cleveland State University, 1987.
