Rehabilitative Sciences

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    Retraining Sensory Weighting Using Virtual Environment and Vibrotactile Biofeedback
    (2018-03-14) Schwarz, Brandy; Kowalewski, Victoria; Patterson, Rita; Bugnariu, Nicoleta; Hebron, Alejandra
    Purpose: The aim of this study was to evaluate the effectiveness of a balance rehabilitation protocol to retrain the sensory weighting mechanism by utilizing vibrotactile feedback and training in virtual environment (VE). Materials/Methods: 20 participants, 10 non-diabetic young adults (NDYA) and 10 diabetic older adults with peripheral neuropathy (DAPN). We experimentally induced somatosensory loss in NDYA with inflated pressure cuffs on the ankles for 35 min and then placed a vibrotactile system with low and high frequency stimulation. Data was collected at baseline and during the last 15 minutes of the ischemic protocol under three conditions: no vibration, low frequency and high frequency vibrations. Outcome measures included center of pressure (COP) variability, plantar surface pressure sensation and vibratory threshold. The DAPN participated in 6 (1-hour) training sessions with visually engaging VE which progressively challenged walking and balance tasks. Vibratory devices were placed around ankles, above the level of sensory loss, delivering constant sub-threshold white noise stimulation. In visits 1 and 8 pre- and post-training functional assessments of balance and gait function were conducted. Results:In NDYA, ischemia increased COP variability and plantar surface pressure sensation threshold (p=.01 and p= 0.3 respectively) and decreased the vibratory extension threshold measured at the hallux IP joint (p during CTSIB for eyes closed conditions both on stable and foam surface (p Conclusions: The vibratory biofeedback was able to partially compensate for the experimental induced sensory loss and improve balance function in healthy young adults. Results of the training protocol suggest support for the stochastic resonance theory and show that sensory retraining in VE and vibratory device is feasible in diabetic subjects holding promise for improvement of function due to an increased ability to integrate all sensory inputs available and a decreased reliance on visual inputs.
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    Does Cognitive Restructuring Improve Postural Control in Older Adults?
    (2018-03-14) Papa, Evan; Bugnariu, Nicoleta; Watson, Taylin
    Purpose: Falls are a major source of disability in the aging population. The cause of falls is multifactorial, but components such as fear of falling are often overlooked.1 Older adults that have a fear of falling also have an increased risk for future falls.2-3 Physical therapists use cognitive-behavioral therapy techniques such as cognitive restructuring, to enhance treatment and reverse the fear of falling.4-5 However, there is a paucity of evidence regarding the effects of cognitive restructuring on postural control. The purpose of this investigation was to determine if an 8-week cognitive restructuring program, designed to reduce the fear of falling, can improve postural control in older adults. Methods: 4 healthy older adults (avg age 73.3 + 8.5 yrs) who passed a screening test underwent postural control testing before (T0) and after (T1) an 8-week cognitive restructuring program. Clinical balance testing included the Activities-Specific Balance Confidence (ABC) Scale, Timed-Up and Go (TUG), and Four Square Step (FSST) tests. The experimental balance testing included static and dynamic balance using a 12-camera Motion Analysis system that tracked markers on the body for calculation of temporal and spatial kinematic movements. A V-GAIT CAREN system with dual-belt treadmill motion platform was used to create perturbations to balance. Paired samples t tests were used to compare before and after variables of each of the clinical and experimental tests. Significance was set at p Results: Clinical balance testing of the ABC (p=.672), TUG (p=.179), and FSST (p=.748), found no statistically significant differences. Statistical significance was found for experimental testing of dynamic backward-directed balance perturbations in two phases. The center of pressure-center of mass difference (COP-COM) was significantly increased at 1/3rd (p=.003) and 2/3rd (p=.009) of the recovery step from before (T0) to after (T1). The mean difference in scores was -.014mm for 1/3rd, -.027mm for 2/3rd, and -.065mm for 3/3rd of the recovery step. Conclusions: Experimental testing showed significant increases in COP-COM in two of three phases of stepping and approached significance for the complete task. Large differences in COP-COM are indicative of robust postural control.6 Our results demonstrate that a cognitive restructuring program can improve stability and control over falls in older adults.
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    Impact of High Intensity Aerobic Exercise on Aging-Related Motor Function Changes
    (2018-03-14) Wilson, Mary-Catherine
    Purpose: Impairments in motor function are predictive of adverse health outcomes including increased mortality and disability. This study investigated the longitudinal impact of high intensity aerobic exercise on motor function impairment associated with aging. Effects on baseline heart function were also evaluated. Methods: Subjects completed motor function testing including a grip strength test using the Hydraulic Hand Dynamometer, the 6-minute walk test (6MWT), responses to unexpected balance perturbations delivered by surface translation in anterior posterior direction, and self-selected gait speed. These motor function tests were administered at baseline, 1-2 months post-baseline, and 3-4 months post-baseline at the end of exercise training. Subjects were randomly assigned to an exercise or non-exercise group. The exercise group completed 36, 1-hour exercise sessions, 3 times a week over 3-4 months. Exercise was standardized for each subject and consisted of a 10-minute warm-up (range of motion exercise, walking, stretching), followed by a fast pace walk/jog on a treadmill for 40 minutes, and concluded with a 10-minute cooldown. A high intensity exercise at 80% max heart rate was aimed for as long as possible in each session. Exercise intensity was progressively increased over the weeks of training. Heart rate, blood pressure and oxygen levels were monitored throughout the exercise sessions. Data was analyzed and compared between the groups of subjects with repeated measures ANOVA Results: Preliminary results from the exercise subject, show improvement in motor function, increased self-selected gait speed and endurance (6MWT) at the mid-point and at the end of exercise regime. There were no effects on grip strength or balance control measures. Compared to baseline values, after exercise training, average resting heart rate and blood pressure measurement decreased significantly from 88 bpm, 138/89 to 75 bpm, 124/80 respectively. Conclusion: A program of sustained, high intensity aerobic exercise, at the upper limits of currently prescribed maximum heart rate is feasible in middle age and older individuals without adverse effects. Improvements in gait speed, endurance and heart function are promising.
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    A Systematic Review of Physical Therapy Interventions for Parkinson’s Disease
    (2018-03-14) Garcia, Stephanie; Kelley, Caitlin; Howe, Liu; Rose, Kendall
    Abstract Purpose: The purpose of this systematic review is to identify effective interventions applied by physical therapists to address common impairments in patients with Parkinson’s Disease(PD). Methods: A search of Pubmed, Medline, Scopus, Wiley Online Library, EbscoHost, CINHAHL were used to identify studies published from 2007 to 2017 written in English with the key words: Parkinson’s Disease, posture, balance, gait, rigidity. Results: 25 studies published between 2007 to 2017 that met the inclusion criteria were used. Based on the quality level of evidence, 13 of the studies were qualified as IB, two as IIB, and 10 as III. To address posture, using a hyperextension brace while performing strengthening exercises for 30 minutes a day for four months, strengthening while wearing a weighted backpack twice a day for five weeks, or a multiple intervention approach that incorporates functional strengthening for five days a week in a four week period can be beneficial. Usage of an UpRight device for 21 consecutive days or kinesio tape with postural rehabilitation in 12 visits over four weeks can be incorporated. Use of aquatic rehabilitation can be used to treat abnormal flexion when completing five sessions per week for a total of eight weeks. To address rigidity, Yoga can be beneficial when performed two times a week for 12 weeks. Interval training three times a week for eight weeks can decrease rigidity. Treatments for gait include LVST BIG four times per week for four weeks. A curved walking program for 12 sessions over four to six weeks can increase gait speed. Auditory cueing during the first month of gait training and progressive resistance training can be incorporated two times a week for 10 weeks. Such improvements include decreasing freezing of gait, increased stride length, and speed of movement. To address balance impairments, Tai Chi can be done for two to three times a week for 60 minutes, dance therapy for 75 minutes, Adaptive Tango twice a week, or Argentine Tango can be performed five times a week. Repetitive step training three times a week or HiBalance training three times a week can improve balance. Conclusion: This review indicates that multiple approaches can be used to treat common impairments such as posture abnormalities, rigidity, balance and gait deficits seen in patients with PD. Keywords: Posture, Balance, Parkinson’s Disease, Gait, Rigidity
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    Temperature Regulated Cooling Wheelchair Design and Testing for Pressure Ulcer Prevention
    (2018-03-14) Nguyen, Ryan; Yavuz, Metin; Ersen, Ali
    TEMPERATURE REGULATED COOLING WHEELCHAIR DESIGN AND TESTING FOR PRESSURE ULCER PREVENTION Ali Ersen, Ryan Nguyen, Metin Yavuz Background: Long-term wheelchair users are prone to developing pressure ulcers due complications including reduced mobility, impaired sensations from neurological insults, vascular problems, decreased cognition, and morbid obesity. Pressure ulcers are wounds that results from breakdown of tissue over bony prominences due to localized ischemia caused by constant pressure. The compromised blood circulation along with reduced airflow results in an accumulation of heat in the tissue over the bony prominence that accelerates tissue breakdown. Current ulcer preventing wheelchairs employ thick, foam cushions, which distribute and reduce pressure, but also lead to poor heat distribution contributing to the risk of developing pressure ulcers. Purpose: In this study, we designed a custom-built cushion that circulates chilled water. We measured buttocks surface temperatures and peak pressures around the pelvic bones, with a targeted maximum temperature and pressure of 28°C and 60mmHg, respectively. Method: In this ongoing study, we recruited three subjects who were asked to sit and operate a motorized wheelchair with the aforementioned cushion for 30 minutes. Thermal images of participants buttocks were taken before and after wheelchair use by an Infrared (IR) thermal camera (Flir, T650sc). Temperatures of buttocks (coccyx, right and left thighs proximal to ischial tuberosities), circulating water and ambient were acquired about every second while seated, using digital thermometers (DS18S20) via a microcontroller unit (Arduino Uno). Pressure distribution was captured at the end of the wheelchair use using a pressure mat (Tekscan ConforMat), which was placed on top of the cooling cushion. All study procedures were approved by the institutional review board (IRB) prior to recruitment and testing, and informed consent was obtained from subjects prior to testing. Results: The results indicated that the cooling cushion was capable of cooling tissue from 27.9 to 24.9°C in 30 minutes. The circulating water temperature was 21.8(0.3)°C while ambient temperature was 22.3(0.5)°C. Peak pressure occurred at the right ischial tuberosity in all subjects and was quantified as 92(5)mmHg while average pressure was around 60mmHg. Conclusion: The custom-built cooling cushion maintained temperatures of the buttocks below 28°C, but failed to lower the peak pressure to below 60mmHg. Further modifications such as an additional comfort layer and a longer duration testing of the design are warranted to achieve our goals.