Volume 3:1
Examining Dance Therapy as an Adjunct Therapy for Selected Measures of Postural Stability, Gait, and Sensory Processing for Children with Mild to Moderate Cerebral Palsy
Dana B McCarty, PT, DPT; Bruce McClenaghan, PED, PT; Erika Blanck DPT, ATC; Stacy Fritz, PhD, PT
University of South Carolina, Columbia, SC
Journal of Student Physical Therapy Research. 2010:3(1)1-13.
Study Design: This case report examined benefits of dance therapy to improve static and dynamic balance, gait, and sensory processing in children with cerebral palsy. Subjects were two 4 year-olds with Level I cerebral palsy based on the Gross Motor Function Classification Scale. Background: Cerebral palsy (CP) is one of the most common pediatric neurological disorders and has been of interest in research for many years. Physical therapists help children improve dynamic and static stability to normalize gait and reactive balance. Children with CP may also process sensory information with difficulty. Case Description: The intervention consisted of three 45-minute dance lessons weekly over five weeks (15 sessions). Sessions included stepping, jumping, skipping, and swaying to promote core stability while engaging the limbs. Proper mechanics were reinforced through verbal and tactile cues and demonstration. Baseline, pre-test, and post-test measures were taken. Static balance was measured using an AMTI force platform. Dynamic balance and gait components were assessed using the GAITRite mat. Peabody Developmental Motor Scales – 2nd Edition (PDMS-2) and Sensory Profile were administered to quantify gross motor skills and sensory processing changes, respectively. Outcomes: PDMS-2 and the Sensory Profile noted small improvements. GAITRite and force platform data exhibited high variability among and within testing sessions making drawing definitive conclusions difficult. Conclusion: Dance therapy is an alternative treatment for children with CP that may provide multi-sensory stimulation as indicated by the Sensory Profile improvements. Results from the PDMS-2 suggest increased exposure to dance therapy provides opportunities to practice gross motor skills. GAITRite and force platform results are somewhat inconclusive and may not be appropriate or reliable testing instruments for this population.
Outcomes Following Treadmill Training with Partial Body Weight Support of an Individual with a Traumatic Brain Injury and Multiple CVAs
Shannon Gray SPT; Danielle Poli SPT; Sara Schwartz SPT; Jessica Sommer SPT; Gabriele Moriello PT, PhD, MS, GCS
The Sage Colleges, Troy, NY
Journal of Student Physical Therapy Research. 2010:3(1)14-30.
Purpose: The purpose of this case report was to document outcomes of 16 weeks of body weight supported treadmill training (BWSTT) on range of motion, muscle strength, cardiovascular parameters, trunk control, quality of movement, functional mobility, and weight loss in a single participant. Methods: The participant was a 38 year old, Caucasian female with a chronic traumatic brain injury and multiple cerebral vascular accidents. The participant received BWSTT two times per week for a total of 16 weeks. Outcome measures included passive range of motion, manual muscle testing, heart rate, the Trunk Impairment Scale, video analysis of transfers, functional assessments, Motor FIM, and body weight. Outcomes: The participant showed some improvements on all outcomes measures, most noticeably in her lower extremity extensor strength, and trunk control. The participant lost on average 1.5 pounds per month more during the intervention than she did prior to the intervention. Anecdotal improvements were made in the participant’s quality of life. Discussion: The participant’s improvements suggest that BWSTT may be beneficial in improving overall functional abilities even when recovery of walking ability is not achieved. Improvements in balance and upper extremity function, along with reduced effort required to complete transfers, suggests that the intervention may have had a positive effect on her trunk control. The participant was able to respond to the cardiovascular demands of BWSTT which increased her energy expenditure enough to stimulate greater weight loss. Further research is needed to determine whether the use of BWSTT can improve other parameters besides gait.
Conservative Physical Therapy Management of an Adult with Cerebral Palsy and Severe Upper and Lower Extremity Contractures: A Case Report
Amanda Cope Hooper, SPT
Elon University – Elon, NC
Journal of Student Physical Therapy Research. 2010:3(1)31-39.
Background and Purpose: Physical therapists often treat patients with joint contractures that are a result of chronic immobility. There is no consensus on the most effective treatment strategy for managing an immobile patient with multiple joint contractures. The purpose of this case report is to describe the intervention strategies used with an adult patient with cerebral palsy, profound developmental disabilities and both upper and lower extremity contractures affecting the patient’s daily function. Case Description: A 62-year-old female with profound developmental and intellectual disabilities who presented with severe contractures of the left hip, knee, and upper extremity was referred to physical therapy. During initial evaluation, significantly decreased upper and lower extremity range of motion and strength, and no visible signs of pain were observed. The patient was treated for 21 visits over a seven-week period with an individualized program including manual therapy, therapeutic exercise, wheelchair modifications, and relaxation techniques. Outcomes: Moderate improvements, based on visual observation and goniometric measurements, in lower and upper extremity range of motion and in function were noted. Direct care staff reported greater ease with activities of daily living such as dressing and feeding. Discussion: Currently, there is very little research focusing on older individuals with cerebral palsy and the impairments these individuals present with. Minimal research is available on the most appropriate management of an adult with cerebral palsy having joint contractures. The intervention strategies used with this patient aimed to address these impairments. This patient demonstrated functional improvements; however, a direct cause-effect relationship cannot be concluded from a single subject case report. Further research is warranted to determine the effectiveness of using this approach to treat individuals with decreased range of motion and strength secondary to joint contractures obtained from long-term wheelchair use. Conclusion: This patient demonstrated actual improvements in joint range of motion based on goniometric measurements, as well as apparent improvements in her sitting posture in her wheelchair following a program of aggressive joint mobilizations and stretching. Further research is necessary to investigate the evolution of abilities and limitations in individuals with cerebral palsy across the lifespan, as well as the most appropriate management of impairments associated with those limitations.
Using Tai Chi to Improve Balance and Mobility among Community-Dwelling Elders
Richard J Call, SPT; Frank Lai, SPT; Carol A. Maritz, PT, EdD, GCS
University of Sciences in Philadelphia–Philadelphia, PA
Journal of Student Physical Therapy Research. 2010:3(1)40-46.
Objectives: The purpose of this study was to examine the effectiveness of a 10-week long Tai Chi exercise program in decreasing the risk of fear and falling in the community-dwelling elderly population. Background: A prevalent concern for the elderly population is the risk of falling. With falls accounting for a majority of medical complications affecting this population, exercise programs have been developed to decrease the risk of falling. Tai Chi focuses on balance, coordination, and endurance, providing increases in overall health and wellness, and a possible decrease in the risk of falling. Methods and Measures: This one-group pretest-posttest design involved a sample of 9 community-dwelling elderly female subjects that voluntarily participated in a Tai Chi program for 45 minutes, twice a week (one live session and one using a DVD per week) for 10 weeks. The primary outcome tools, Timed Up and Go (TUG) and Tinetti were administered before the start of the program and at the conclusion of the program. Results: Statistical analysis using a dependent t-test revealed that the elderly subjects significantly achieved better scores on both the TUG (p = 0.01) and Tinetti test (p = 0.001) after 10 weeks of the program. Conclusions: The above findings suggest that a 10-week long Tai Chi exercise program may improve functional balance and overall quality of life in the community-dwelling elderly population.
A Case Study Examining The Recovery of Gait Using Treadmill Training Followed by Overground Ambulation in a Patient with a Middle Cerebral Artery Stroke
Michelle Gorman DPT and Dr. A. Williams Andrews, PT, MS, EdD, NCS.
Mission Hospital – Asheville, NC and Elon University – Elon, NC
Journal of Student Physical Therapy Research. 2010:3(1)47-56.
Study Design: Body weight support treadmill training (BWSTT) has been shown to increase gait speed and improve balance in patients suffering from a stroke. The purpose of this case study is to describe a specific treadmill training exercise program in conjunction with an overground walking program to demonstrate improvements in function and quality of life in a middle-aged patient having had a stroke. The patient in this case study received 12 sessions of treadmill intervention followed by overground ambulation with a focus on improving gait speed. Each “session” consists of ambulating on a treadmill for three to four bouts at increasing speeds, duration, and decreasing amount of need for manual assist followed by overground walking up to patient tolerance. Background: The patient is a 54 year old male having suffered a stroke five months ago. The patient’s heart rate (HR), blood pressure (BP), and rate of perceived exertion (RPE) are assessed. Case Description: The patient is given verbal, visual (mirror) and tactile cues during treadmill training to facilitate a normal, reciprocal gait pattern followed by overground walking. Outcomes: Following 12 sessions of intervention and a home exercise program of daily walking, the patient statistically improved in gait speed (Ten Meter Walk), distance walked (Six Meter Walk), and balance abilities (Berg Balance Scale). Conclusion: The use of a standard treadmill followed by overground ambulation in an outpatient facility may be effective intervention for patients with gait deficits following a stroke or other neurological infarct.
