Physical Medicine / OMM
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30823
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Browsing Physical Medicine / OMM by Author "Kennedy, Shawn"
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Item Altered Balance in those with Back Pain(2022) Doederlein, Alexander R.; Kennedy, Shawn; Patterson, RitaPurpose: Numerous studies have attempted to find an association between back pain (BP) and altered standing balance. These quiet standing (QS) studies measure a subject's center of pressure (COP) via a force plate system. From the COP data, variables such as COP area and COP velocity are calculated to measure the amount of sway a subject had while attempting to stand still during the QS trial. In reviewing previous research, most studies had relatively small sample sizes, and while some were able to achieve statistically significant differences in sway variables between subjects with BP and healthy controls, most were too underpowered to achieve clinical statistical significance. Also, what is concerning is that some studies with shared variables had inconsistent results of whether BP or healthy control participants had greater values. Our study sought to test potential associations with a much larger sample size (greater than 10-fold larger than many other studies) to find clinically meaningful relationships. Methods: This research is built from the results of previous QS studies and an ongoing QS project at UNTHSC. A Bertec force plate (Bertec, Columbus, Ohio) was used to collect data from participants standing quietly on it for a period of 30 seconds with their eyes open (EO), and then 30 seconds with their eyes closed (EC). Each 30 second period was collected as three 10 second trials for each condition. This study's data was collected from people suffering from BP and healthy controls. Results: COP area was statistically significantly greater for BP subjects, however, only during EC trials. In contrast, during EO trials, the COP area was not statistically different between the two groups. Furthermore, in distinction from previous studies, velocity was statistically significantly greater for healthy controls regardless of the trial's eye condition. Conclusions: These results led us to hypothesize that during the EC trials, BP subjects cover a greater COP area than the controls due to decreased proprioception, in which they sway further from their balance point before being able to detect they are moving. However, in EO trials, this area is not statistically different, likely because BP subjects have learned to compensate for their decreased proprioception by relying more on their vision for positional sense. Furthermore, since the healthy controls exhibited a greater velocity than the BP subjects, this could mean that the BP subjects are taking longer to regain their balance due to decreased reflexes. In conclusion, we suggest that future QS studies screen subjects for delays in reflexes, a lesser sense of proprioception, and whether lighting conditions create altered sway outcomes. This study contributes precautionary information to help prevent falls in those with BP.Item Designing a Sustainable in-Clinic Protocol to Expand Postural Stability Data Collection(2022) Dinh, Mai; Kennedy, Shawn; Gupta, Sanya; Nayak, Rajesh; Mason, David; Lee, Yein; Patterson, RitaPurpose: Assessing postural stability may help to predict fall risk and aid in understanding underlying mechanisms of injuries due to falls. Several studies have compared postural stability in different populations of patients; however, the age, gender, race, health conditions, and the number of participants were limited. To answer clinical questions on the relationship between postural stability and fall risk, it is necessary to expand the dataset by including minority and vulnerable populations. The objective of this study is to design a sustainable clinic research data collection protocol to better understand fall risk in the diverse minority populations surrounding the HSC community and provide clinicians with sway information on their patients. Methods: Sustainable data collection protocol: Third-year medical students rotating in OMM clinic collected sway data for one half day during their month-long rotation. Data collectors were presented a video demo of the protocol and a didactic video on balance and falls before collecting data. Medical assistants in the clinic brought patients to students before the appointment time or when the patient's physician was seeing another patient, to avoid delays in clinic schedule. The total time for data collection is approximately two minutes. Postural sway data: Postural sway was evaluated in patients seen in the Osteopathic Manipulated Medicine (OMM) clinic at the University of North Texas Health Science Center between 6/7/2021 and 12/21/2021. Patients who were cane or wheelchair-dependent and children less than 65 lbs. were excluded. Patients took off their shoes and put on shoe covers. Patients then stood on footprints attached to the Bertec Force Plate (Bertec Columbus, Ohio). Patients were asked to stand straight, hands by their sides, body facing toward and looking at a target in front of them for 10 seconds with their eyes open. The same procedure was repeated with their eyes closed. Three trials of each condition were performed. A rest period of three seconds took place between each trial. Measurements of Mean Center of Gravity Sway Velocity were collected. Postural sway data was retrospectively analyzed from the clinic data collection (UNTHSC IRB# 2013-102). Results: 701 postural sway measurements were collected on a total of 511 patients between 06/07/2021 and 12/21/2021. Conclusion: As a result of creating a sustainable data collecting model by incorporating third-year medical students in their rotations as data collectors, 701 postural sway measurements were obtained in approximately seven months. This achievement was possible due to the continuous improvement of the protocol with the collaboration of clinic staff and physicians to ensure data collection incorporates smoothly into the natural flow of the clinic. Future steps: One next step is to allow treatment providers secure access to their patient's data so they can discuss changes in sway during clinic visits. Another is to partner with artificial intelligence experts to form algorithms to analyze the data on diverse patient populations to assist clinicians in clinical assessments/treatments and possibly provide fall prediction alerts.