Volume 6:3
Classification-Based Treatment of Cervical Disorders: Analysis of Student Physical Therapist Clinical Internship Experience
Douglas Kelley, SPT; Brenda Boucher, PT, PhD
Texas State University – San Marcos, TX
Abstract
Objectives: 1) To determine if selected student physical therapists (SPTs) treating cervical disorders practice in a manner consistent with the current practice guidelines concerning treatment-based classification. 2) To determine if selected SPTs treating cervical disorders achieve similar results compared to that reported in the literature.
Background: Cervical disorders are a common complaint and contributor to pain and disability. To improve physical therapy intervention, a treatment-based classification for neck pain has been proposed to achieve significant improvement in pain and disability.
Methods: Four SPTs collected twenty-one data sets for patients with primary complaint of neck pain over a nine month period of student clinical internships. Two health-related quality of life measures, Neck Disability Index (NDI) and Numeric Pain Rating Scale (NPRS), were used to assess patient outcomes. Patients were categorized and treated using proposed interventions for treatment-based classification.
Results: Clinically significant outcomes were found in both areas of patient-reported pain and disability as measured by the NPRS and the NDI. Patients reported clinically significant reductions in NPRS scores across all five categories. Patients in the Pain Control and Mobility categories reported clinically significant changes in NDI scores.
Conclusion: Patients treated with matched interventions demonstrated clinically significant improvement in self-reported pain and disability. Treatment interventions were consistent with current practice guidelines to achieve patient reported success and yielded outcomes that matched or exceeded those reported in the literature.
Rehabilita-fun: A Comparison of Active Gaming and Traditional Conditioning Exercises
Jillian Donohue, SPT; Lisa Witherspoon, Ph.D.
University of South Florida – Tampa, FL
Abstract
Objectives: This study examined childrens’ preference for either active games or standard exercises used for rehabilitation. An additional purpose was to determine the effect of each activity on participants’ heart rates in order to ascertain validity of active games as an aerobically stimulating component of rehabilitation.
Background: Active games, which include the Wii, Microsoft Kinect, and the Cateye Gamebike are a modern approach to the incorporation of video games into a less sedentary lifestyle. These technology-driven activities require participants to move their bodies in order to play. Although research is limited, recent studies performed on active gaming in physical therapy settings have aimed to employ the positively reinforcing aspects of video games to motivate users while also promoting exercise.
Methods and Measures: Five children, not in rehabilitation, aged eight to ten years, participated in a mixed methods pilot study involving three active games and three traditional exercises over three 90- to 120-minute sessions. Data from social validity surveys, an Organizing Medical Networked Information (OMNI) scale of perceived exertion adapted for children, interview questions, and heart rate monitors were collected.
Results: Data shows that subjects did not have a preference between active games and traditional conditioning exercises. The heart rate data demonstrated increases over resting heart rates at 55.45% for active games and 45.72% for traditional exercises.
Conclusions: The results suggest that children prefer a variety of activities to repeating one activity. The heart rate data suggests participation in active games is a comparable means of physical rehabilitation.
Rehabilitation Management of Dizziness after Cerebellar CVA: A Case Report
Bryan Ghiossi, DPT, CSCS; Sharon Gorman, PT, DPTSc, GCS; Patrick Aguiar, PT, DPT, CSCS
Samuel Merritt University – Oakland, CA
Abstract
Background: Dizziness is a common symptom in patients status post cerebellar CVA, but it is rarely addressed as the primary limiting symptom. Vestibular Rehabilitation Therapy (VRT) is often used to manage dizziness as part of comprehensive rehabilitation programs, but its efficacy in this population is poorly understood. This case report describes the physical therapy management, including VRT techniques, of a patient after cerebellar CVA with primary symptoms of dizziness.
Case Description: A previously independent seventy-seven-year old woman presented to a skilled nursing facility four days status post cerebellar CVA. She presented with significant balance deficits (five-second Romberg) and required assistance for five feet of gait due to severe motion-provoked dizziness. The patient participated in daily physical therapy sessions consisting of functional mobility, balance, and gait interventions. VRT techniques involving visual smooth pursuit, vestibulo-occular reflex, and habituation exercises were integrated into treatment to decrease motion-provoked dizziness.
Outcomes: At discharge the patient improved her Romberg score to thirty-three seconds and gait distance to eighty feet. She completed all functional mobility at a supervised assist level or less. No measurable changes in motion-provoked dizziness were observed.
Conclusions:Physical therapy incorporating VRT techniques may be useful in improving balance and gait in patients status post cerebellar CVA but additional research is necessary to determine its effectiveness in reducing motion-provoked dizziness. The use of self-report measures such as the Dizziness Handicap Inventory and Activities-specific Balance Confidence Scale may more effectively detect meaningful functional improvements in this population when dizziness symptoms are severe.
Correlation of Cystic Fibrosis Related Diabetes with Sensation, Gait Characteristics, and Balance
Jessica Crook, DPT; Melissa Evans, DPT; Heidi Floyd, DPT; Renee Saffell, DPT; Megan Vincent, DPT; Corrie Mancinelli, PT, PhD, GCS; Maple Landvoight, MD; Kathryn Moffett, MD; Anne K. Swisher, PT, PhD, CCS
Division of Physical Therapy, West Virginia University – Morgantown, WV
Department of Pediatrics, West Virginia University – Morgantown, WV
Abstract
Objective: To assess if people with cystic fibrosis related diabetes (CFRD) exhibit characteristics of peripheral neuropathy as compared to those with cystic fibrosis alone.
Background: Diabetic peripheral neuropathy can cause impaired sensation, gait and balance. It is unknown if CFRD manifests in similar ways. We assessed peripheral nerve function in adults with CFRD (6 M, 1 F, mean age 28 yrs) and adults with CF only (2 M,1 F, mean age 28yrs).
Methods and Measures: Light touch, vibration, pinprick, and temperature sensation were tested on both feet, as well as ankle reflex testing as per the Neuropathy Disability Score test. Self-selected gait characteristics (velocity and step length) were assessed via GAITRite computerized walkway. Balance was assessed using the Sensory Organization Test performed on a computerized posturography device.
Results: Sensation was normal in both groups. The CFRD group walked significantly slower (1.18 vs. 1.43 m/sec) and took shorter steps (64 vs. 76 cm) than the CF only group. Both groups scored below population norms on vestibular balance conditions.
Conclusion: CFRD-related peripheral neuropathy, which was undetectable by sensory tests, is related to altered gait and could predispose to falling. CF, or its treatments, may impair balance via vestibular system damage. CFRD adults should be evaluated for peripheral neuropathy and its effects.
