Physical Therapy
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Item Rehabilitation of a Female Dancer with Patellofemoral Pain Syndrome: Applying the Concepts of Regional Interdependence in Practice(2010) Podschun, LauraDue to complex movements and high physical demands, dance is often associated with a multitude of impairments including pain of the low back, pelvis, leg, knee, and foot. This case report provides an exercise progression, emphasizing enhancement of strength and neuromuscular performance using the concept of regional interdependence in a 17 year old female dancer with patellofemoral pain syndrome.Item Neuropeptides and Other Chemical Mediators, and the Role of Anti-inflammatory Drugs in Primary Headaches(2010) Samsam, MohtashemPrimary headaches including the migraine, cluster, and tension headaches are common neurological disorders which cause pain and disability to the patients. The pathomechanism of migraine is not very well understood however, current clinical findings indicate a possible primary brain disorder due to activation of the brain and brainstem as triggers for migraine. The headache phase of migraine may be due to activation of the peripheral nerves including the trigeminal nerve and others innervating the cranial blood vessels and release of vasoactive substances including the calcitonin generelated peptides (CGRP), possibly leading to vasodilation and brainstem activation. Several of our studies in an experimental model of pain using electrical stimulation of the trigeminal ganglion in rats focused on various neuropeptides release from the peripheral and central trigeminal nerve terminals, however, clinically only the CGRP in migraine and CGRP and vasoactive intestinal peptide (VIP) in cluster headache were found in patient's blood. Although several drugs are used in the treatment of migraine, the non-steroid anti-inflammatory drugs (NSAIDs) and the triptan family of drugs are the first choice drugs recommended for the treatment of acute migraine headache. Although clinically very few studies detected other vasoactive/inflammatory molecules in the blood of migraine patients, sensitization of peripheral axons can involve many inflammatory mediators affecting the peripheral tissue substrates of pain. Moreover, central sensitization in the trigeminal nucleus can also contribute to additional pain responses. This article reviews neuropeptides and other molecules involved in primary headaches and major drugs proposed for their treatment in recent years.Item Functionally Oriented Regional Anatomy(Hayden-McNeil Publishing, 2011) Samsam, MohtashemItem Central Nervous System Acting Drugs in Treatment of Migraine Headache(2012) Samsam, MohtashemMigraine is a primary headache disorder with an unknown pathophysiology. The growing evidence in recent years indicates migraine being a brain disorder, a sensory dysmodulation, and a system failure of normal sensory processing of the brainstem that involves the vascular tone and pain. At the moment, triptan family and NSAIDs are the first choice drugs for the treatment of acute migraine. There are several prophylactic drugs including the antiepileptic drugs (AEDs), betablockers, and Ca2+ channel blockers that are used for the treatment of migraine. Although many drugs including the triptans, NSAIDs, and others target the peripheral sites of activation, several novel drugs are being developed to target neural sites of action in the central nervous system (CNS). The first trigeminal synapses in the brain stem as well as the ascending and descending pathways and higher brain centers are involved in the transmission of pain and therefore be the main targets of several drugs some of which are in clinical trials. Central sensitization may also aggravate the headache and some drugs tend to alleviate pain by targeting neurotransmitters, receptors, or signalling molecules involved in this phenomenon. This article discusses the CNS acting novel drugs and those that are currently in use for the treatment of migraine.Item Differential Diagnosis of Deep Gluteal Pain in a Female Runner with Pelvic Involvement: A Case Report(2013) Podschun, LauraBackground: Gluteal injuries, proximal hamstring injuries, and pelvic floor disorders have been reported in the literature among runners. Some suggest that hip, pelvis, and/or groin injuries occur in 3.3% to 11.5% of long distance runners. The purpose of this case report is to describe the differential diagnosis and treatment approach for a patient presenting with combined hip and pelvic pain. Case description: A 45-year-old female distance runner was referred to physical therapy for proximal hamstring pain that had been present for several months. This pain limited her ability to tolerate sitting and caused her to cease running. Examination of the patient’s lumbar spine, pelvis, and lower extremity led to the initial differential diagnosis of hamstring syndrome and ischiogluteal bursitis. The patient’s primary symptoms improved during the initial four visits, which focused on education, pain management, trunk stabilization and gluteus maximus strengthening, however pelvic pain persisted. Further examination led to a secondary diagnosis of pelvic floor hypertonic disorder. Interventions to address the pelvic floor led to resolution of symptoms and return to running. Outcomes: Pain level on the Visual Analog Scale decreased from 7/10 to 1/10 over the course of treatment. The patient was able to return to full sport activity and improved sitting tolerance to greater then two hours without significant discomfort. Discussion: This case suggests the interdependence of lumbopelvic and lower extremity kinematics in complaints of hamstring, posterior thigh and pelvic floor disorders. This case highlights the importance of a thorough examination as well as the need to consider a regional interdependence of the pelvic floor and lower quarter when treating individuals with proximal hamstring pain.Item Functionally Oriented Regional Anatomy(Hayden-McNeil Publishing, 2013) Samsam, MohtashemItem Pathophysiology of Autism Spectrum Disorders: Revisiting Gastrointestinal Involvement and Immune Imbalance(2014) Samsam, MohtashemAutism spectrum disorders (ASD) comprise a group of neurodevelopmental abnormalities that begin in early childhood and are characterized by impairment of social communication and behavioral problems including restricted interests and repetitive behaviors. Several genes have been implicated in the pathogenesis of ASD, most of them are involved in neuronal synaptogenesis. A number of environmental factors and associated conditions such as gastrointestinal (GI) abnormalities and immune imbalance have been linked to the pathophysiology of ASD. According to the March 2012 report released by United States Centers for Disease Control and Prevention, the prevalence of ASD has sharply increased during the recent years and one out of 88 children suffers now from ASD symptoms. Although there is a strong genetic base for the disease, several associated factors could have a direct link to the pathogenesis of ASD or act as modifiers of the genes thus aggravating the initial problem. Many children suffering from ASD have GI problems such as abdominal pain, chronic diarrhea, constipation, vomiting, gastroesophageal reflux, and intestinal infections. A number of studies focusing on the intestinal mucosa, its permeability, abnormal gut development, leaky gut, and other GI problem raised many questions but studies were somehow inconclusive and an expert panel of American Academy of Pediatrics has strongly recommended further investigation in these areas. GI tract has a direct connection with the immune system and an imbalanced immune response is usually seen in ASD children. Maternal infection or autoimmune diseases have been suspected. Activation of the immune system during early development may have deleterious effect on various organs including the nervous system. In this review we revisited briefly the GI and immune system abnormalities and neuropeptide imbalance and their role in the pathophysiology of ASD and discussed some future research directions.Item The IBB Forelimb Scale as a Tool to Assess Functional Recovery after Peripheral Nerve Injury in Mice(2014) Swarowsky, AlessandraBackground This study was conducted to test whether the IBB Forelimb Scale (Irvine et al., 2010) which was originally developed for rats with spinal cord injury, is also capable of measuring the functional performance of Swiss mice with lesions of the median and ulnar nerves inflicted via crushing with standardized strength. New method This test was performed at days 1, 3, 7, 10, 14 and 21 after surgery and each animal gives a score of 9, where 0 represented the worst functionality and 9 represented the habitual behavior. Results The control animals usually exhibited movements in the task that were scored as 9 during the experimental period. The lesion group began with a score of 2 on the 1st and 3rd post-operative days. On the 7th and 10th postoperative days, respectively, they scored 7, and on the 14th post-operative day, they achieved a score of 8. Only on the 21st post-operative day, did they exhibit habitual skillful behaviors. Comparison with existing method(s) IBB Forelimb Scale is effective for determining how the animals perform the movements in detail, which is not readily revealed by other methods. Furthermore, this test show similar recovery periods with grasping test, staircase test and seems to be more sensitive than paw print analysis for this type of lesion. Conclusions Our data demonstrate that IBB scale was capable of measuring gradual improvements in motor forelimb functions in this model and may be a new and effective assessment tool for peripheral nerve injury.Item Is Body Weight-Support Treadmill Training Effective in Increasing Muscle Trophism After Traumatic Spinal Cord Injury?(2015) Swarowsky, AlessandraObjective: To determine the effectiveness of body weight-support treadmill training (BWSTT) for muscle atrophy management in people with spinal cord injury (SCI). Setting: Studies from multiple countries were included. Methods: The following databases were consulted from January to October 2013: PubMed, Institute for Scientific Information (ISI), Science Direct and Lilacs. The methodological quality of the articles included was classified according to Jovell and Navarro-Rubio. Results: A total of five studies were included. These studies reported a significant association between BWSTT and increased trophism of the lower limb muscles of humans with SCI, which was observed as an increase in the cross-sectional area. Moreover, improvements in the ability to generate peak torque, contract the knee extensors and ankle plantarflexors with reduction of body weight support were observed after BWSTT. Conclusion: The results were considered inconclusive because of the low methodological quality of the articles, which was because of the absence of sample homogeneity, thereby providing a low level of evidence for clinical practice.Item The Use of Sensory Reweighting for a Woman with Persistent Mal de Debarquement: A Case Report(2015) Liphart, JodiBackground and Purpose: Persistent mal de debarquement is an uncommon disorder occurring after a sea voyage, or a plane or train trip. Symptoms include unsteadiness, rocking sensation, visual motion intolerance, cognitive slowing, and excessive fatigue. It is thought to be a result of faulty multisensory adaptation. The purpose of this case report was to describe the use of sensory reweighting, a therapeutic approach aimed at reweighting the balance between the 3 sensory systems, to decrease symptoms and increase functional abilities of a woman with persistent mal de debarquement. Case Description: A 69-year-old woman with a 4-year history of persistent mal de debarquement after a plane trip reported a constant feeling of rocking, unsteadiness, and a loss of balance in low lighting or visually rich environments. She experienced a previous fall and had limited her social activities because of her symptoms. Interventions: Sensory reweighting therapy was administered twice a week for 10 weeks. Activities included balance training using vestibular, somatosensory, and visual challenges to vary the sensory input available. Outcomes: A 5-point increase was observed on the Berg Balance Scale, she doubled her balance time in tandem stance position, and improved from moderate to low impairment on the Dizziness Handicap Inventory. She had a significant change on the Global Rating of Change Scale. Subjectively, she felt she had improved 50% and was less disabled. Discussion: A rehabilitation approach aimed at sensory reweighting improved this patient's function and community reintegration. Her symptoms were reduced and stability and balance improved.Item Parkinson Activity Scale: Cross-cultural Adaptation and Reliability of the Brazilian Version(2015) Swarowsky, AlessandraAim Following the substantial growth of the elderly population in Brazil, there has been an increase in cases of Parkinson's disease (PD), which raises the need for reliable and culturally adapted scales specific to the disease. The Parkinson Activity Scale (PAS) was developed in order to assess the activity level of people with PD through tasks related to mobility. The aims of the present study were to translate the cross-cultural adaptation of the PAS into Brazillian Portuguese and analyze its reliability during the “on” phase of PD. Methods A total of 25 patients with PD participated in the study. The intrarater reliability was evaluated using a test–retest design with a 1-week interval. Results The interrater reliability was tested twice on the same day by two different raters. The intraclass correlation coefficient (ICC), and the Bland and Altman plots were calculated to examine the test–retest and interrater reliabilities for total score of the PAS, whereas the weighted Kappa (Wk) was used to assess interrater agreement. The interrater ICC was 0.89 and Wk was 0.65 for the total score. For intrarater reliability, the total score ICC was 0.88. Conclusions The present study suggests that the Brazilian version of the PAS is a reliable instrument for the assessment of mobility in elderly patients with PD. Geriatr Gerontol Int 2015; 15: 89–95.Item Locomotor Treadmill Training-induced Soleus Muscle Trophism by mtor/p70s6k in Paraplegic Rats(2015) Swarowsky, AlessandraItem Functionally Oriented Regional Anatomy(Hayden-McNeil Publishing, 2015) Samsam, MohtashemItem Body Surface Posture Evaluation: Construction, Validation and Protocol of the SPGAP System (Posture Evaluation Rotating Platform System)(2016) Swarowsky, AlessandraBackground Several posture evaluation devices have been used to detect deviations of the vertebral column. However it has been observed that the instruments present measurement errors related to the equipment, environment or measurement protocol. This study aimed to build, validate, analyze the reliability and describe a measurement protocol for the use of the Posture Evaluation Rotating Platform System (SPGAP, Brazilian abbreviation). Methods The posture evaluation system comprises a Posture Evaluation Rotating Platform, video camera, calibration support and measurement software. Two pilot studies were carried out with 102 elderly individuals (average age 69 years old, SD = ±7.3) to establish a protocol for SPGAP, controlling the measurement errors related to the environment, equipment and the person under evaluation. Content validation was completed with input from judges with expertise in posture measurement. The variation coefficient method was used to validate the measurement by the instrument of an object with known dimensions. Finally, reliability was established using repeated measurements of the known object. Results Expert content judges gave the system excellent ratings for content validity (mean 9.4 out of 10; SD 1.13). The measurement of an object with known dimensions indicated excellent validity (all measurement errors <1 %) and test-retest reliability. A total of 26 images were needed to stabilize the system. Participants in the pilot studies indicated that they felt comfortable throughout the assessment. The use of only one image can offer measurements that underestimate or overestimate the reality. To verify the images of objects with known dimensions the values for the width and height were, respectively, CV 0.88 (width) and 2.33 (height), SD 0.22 (width) and 0.35 (height), minimum and maximum values 24.83–25.2 (width) and 14.56 – 15.75 (height). In the analysis of different images (similar) of an individual, greater discrepancies were observed in the values found. The cervical index, for example, presented minimum and maximum values of 15.38 and 37.5, a coefficient of variation of 0.29 and a standard deviation of 6.78. Conclusions The SPGAP was shown to be a valid and reliable instrument for the quantitative analysis of body posture with applicability and clinical use, since it managed to reduce several measurement errors, amongst which parallax distortion.Item Examining Leadership Knowledge and Skills Development Opportunities for Physical Therapy Students: A Multiple Case Study Design(2016) Clark, ElizabethThis study examined leadership knowledge and skills development in accredited physical therapist programs. Data were triangulated across program director and faculty member interviews, course descriptions and student learning outcomes. The use of the FINHOP framework by Schafer et al. (2007) facilitated an analysis of the data and a delineation of knowledge development versus skills acquisition. Additionally, programs with and without pro bono clinics were compared. This multiple case study examined four purposively recruited physical therapy programs. Four themes and related subthemes were identified through data analysis and included: (a) inconsistent definition of leadership; (b) leading leaders with subthemes professional socialization, networking, and pedagogy of integrated leadership; (c) business savvy with one subtheme of resource management; and (d) never enough time. Programs demonstrated consistency in evaluation of graduates’ acquisition of leadership knowledge, but lacked measurement of graduates’ application of leadership skills. The comparison between programs with and without pro bono clinics identified a weak link between pro bono clinical experiences and graduates’ leadership knowledge and skills development. The voluntary status of student and faculty participation within the pro bono clinics in combination with a lack of measurable student learning outcomes limited linking leadership knowledge and skills development to pro bono clinic participation. Recommendations for future research included: programs’ use of a consistent definition of leadership threaded across the curriculum, graduates self-assessment of leadership knowledge and skills development, and programs’ use of student learning outcomes to link pro bono clinic participation to leadership knowledge and skills development.