Clyde B. Killian

Locomotor Training Improves Daily Stepping Activity and Gait Efficiency in Individuals Poststroke Who Have Reached a “Plateau” in Recovery

Background and Purpose— Individuals with chronic stroke often demonstrate a “plateau,” or deceleration of motor recovery, which may lead to discharge from physical therapy (PT). However, numerous studies report improvements in motor function when individuals are provided intensive practice of motor tasks. We suggest that reduced task-specific walking practice during clinical PT contributes to limited gains in ambulatory function in those with a perceived plateau poststroke, and suggest that further gains can be realized if intensive stepping, or locomotor training (LT) is provided after discharge. Methods— Twenty subjects with chronic stroke completed a repeated baseline measures, randomized crossover trial in which walking performance was assessed during the last 4 weeks of clinical PT before discharge secondary to reaching a plateau, followed by 4 weeks of intensive LT and 4 weeks of no intervention. Outcome measures included clinical and physiological (metabolic) measures of walking overground and on a treadmill, and measures of daily stepping activity in the home and community, including during clinical PT and subsequent LT sessions. Results— Stepping practice was more than 4-fold higher during LT versus clinical PT sessions, with significant improvements in daily stepping and gait efficiency only after LT. Changes in daily stepping after clinical PT and intensive LT were correlated (P<0.001) with the amount of stepping practice received during these interventions. Conclusions— Intensive LT results in improved daily stepping in individuals poststroke who have been discharged from PT because of a perceived plateau in motor function. These improvements may be related to the amount and intensity of stepping practice.

Hippotherapy—An Intervention to Habilitate Balance Deficits in Children With Movement Disorders: A Clinical Trial

Background Clinical observations have suggested that hippotherapy may be an effective strategy for habilitating balance deficits in children with movement disorders. However, there is limited research to support this notion. Objective The purposes of this study were to assess the effectiveness of hippotherapy for the management of postural instability in children with mild to moderate balance problems and to determine whether there is a correlation between balance and function. Design A repeated-measures design for a cohort of children with documented balance deficits was used. Methods Sixteen children (9 boys and 7 girls) who were 5 to 16 years of age and had documented balance problems participated in this study. Intervention consisted of 45-minute hippotherapy sessions twice per week for 6 weeks. Two baseline assessments and 1 postintervention assessment of balance, as measured with the Pediatric Balance Scale (PBS), and of function, as measured with the Activities Scale for Kids—Performance (ASKp), were performed. Results With the Friedman analysis of variance, the PBS and the ASKp were found to be statistically significant across all measurements (P<.0001 for both measures). Post hoc analysis revealed a statistical difference between baseline and postintervention measures (P≤.017). This degree of difference resulted in large effect sizes for PBS (d=1.59) and ASKp (d=1.51) scores after hippotherapy. A Spearman rho correlation of .700 indicated a statistical association between PBS and ASKp postintervention scores (P=.003). There was no correlation between the change in PBS scores and the change in ASKp scores (rs=.13, P>.05). Limitations Lack of a control group and the short duration between baseline assessments are study limitations. Conclusions The findings suggest that hippotherapy may be a viable strategy for reducing balance deficits and improving the performance of daily life skills in children with mild to moderate balance problems.

Anterior cruciate ligament injury in female and male athletes: the relationship between foot structure and injury.

BACKGROUND It has been shown that anterior cruciate ligament (ACL) injuries are more prevalent in female athletes than in male athletes. Soccer and basketball are considered high-risk sports for ACL injury in female athletes. Several studies have reported a relationship between ACL injury and measures of foot structure. This study was conducted to investigate the relationship between foot structure and ACL injury rates in female and male soccer and basketball players. METHODS One hundred five soccer and basketball players (53 women and 52 men) were recruited and divided into an ACL-normal group (n=89) and an ACL-injured group (n=16). Two measures of foot structure (subtalar joint neutral position and navicular drop test values) were recorded for each subject. An independent t test and a paired t test were used to analyze differences in ACL status, foot structure, and sex. A chi2 analysis determined whether the prevalence of ACL injury was independent of sport. RESULTS No statistically significant differences were found in the foot structure measures between women and men. Female soccer and basketball players had an ACL injury rate seven times that of male players. CONCLUSIONS Values derived from subtalar joint neutral position measurement and the navicular drop test were not associated with ACL injury in collegiate female and male soccer and basketball players.

Education Affects Attitudes of Physical Therapy Providers toward People with Dementia.

A survey was sent to every skilled nursing home (N = 495) in Indiana regarding the demographics, education, and whether the severity of dementia impacts the attitudes of people in physical therapy practice. Physical therapists (PTs) and physical therapist assistants (PTAs) practicing in nursing homes spend considerable time (44.0%) working with patients who have a diagnosis of dementia. As patients with dementia disorders declined cognitively, attitudes of PTs/PTAs become increasingly negative, and respondents feel that education, training, and resources are insufficient to maximize outcomes in the later stages of the disease.

Development of an Instrument to Measure Attitudes of Physical Therapy Providers Working With People With Dementia

Background and Purpose: This study investigated the factor structure of an instrument to measure attitudes and beliefs of how physical therapist (PT) practitioners perceive working with people with a dementia disorder. Methods: A survey was mailed to every skilled nursing facility in Indiana (n = 495) for completion by a PT or physical therapist assistant. The survey was developed and included whether the severity of Alzheimer’s disease (AD) impacts the attitudes of physical therapy practitioners. Results: Of the 12 attitudinal questions, 11 were significant (P < .001) concerning how the severity of a diagnosis of AD (early, middle, and late) impacts attitudes of people in physical therapy practice. Principal component analysis identified 3 factors with Eigen values of 3.3 or higher accounting for 43% of the cumulative variance. These factors include professional competence, resources, and conscientiousness. Conclusion: This brief instrument could serve as an assessment tool to determine whether PT practitioners exhibit therapeutic nihilism when working with people with a dementia disorder.

MEASURES OF LIMB SYMMETRY USED FOR INJURY RISK IDENTIFICATION: WHAT IS NORMAL?

Background Limb asymmetries have been identified as a significant predictor of injury risk. However, the natural boundaries of variation in a non-injured population using clinically relevant and reliable measures has not been determined. Objective To assess clinical measures of limb symmetry and determine the natural boundaries of symmetry present in a non-injured population. Design Prospective cohort study. Setting Controlled laboratory research. Participants 39 non-injured participants, 12 male, 27 female (23.2±2.9 years, 170.2±9.1 cm, 68.4±15.6 kg). Assessment of Risk Factors Knee PROM, effusion, endfeel, knee extension, flexion, and hip abduction strength, dynamic balance, single leg hop, and IKDC Subjective rating were measured. Main Outcome Measurements In measures demonstrating excellent reliability (ICC≥0.75, Kappa≥0.81), limb symmetry index (LSI) and variability scores were calculated. Results All clinical measures, except hip abduction strength, demonstrated excellent reliability. Knee extension PROM was 6.0±5.0°, flexion PROM was 154.0±5.0°. 100% of participants had normal knee extension endfeel, and no knee effusion. 95% had normal flexion endfeel. LSI scores for each measure ranged between 96.6–100.0%. Using minimal detectable change (MDC) scores for each measure, boundaries of limb symmetry were calculated for knee extension PROM (100±1.0°), knee flexion PROM (100±4°), knee extension strength (100±21.0%), knee flexion strength (100±24.0%), dynamic balance (100±6.0%), single leg hop (100±9.1%), and IKDC Subjective rating (100±3.3%). Conclusions Most measures of limb symmetry used in the study demonstrated appropriate reliability for clinical use. Although strength measures had high degrees of limb symmetry, there was significant variability present in non-injured participants. Conversely, high levels of limb symmetry with very little variation were observed in knee PROM, dynamic balance, single leg hop, and IKDC Subjective measures. Strength may not be the best measure of limb symmetry while PROM, dynamic balance, single leg hop, and the IKDC Subjective form appear to have more utility to identify limb asymmetries.