Kimberly A. Szucs

Three-dimensional scapula kinematics and shoulder function examined before and after surgical treatment for breast cancer

Shoulder motion loss following surgical treatment of breast cancer is common and may be associated with surgery-related soft tissue changes and altered shoulder kinematics. Knowledge of short term biomechanical changes at the shoulder will inform treatment decisions and may help prevent the development of shoulder pathology. Shoulder motion loss following surgery also impacts quality of life and shoulder function, and measuring function with a shoulder-specific tool may direct rehabilitation. This study examined the short term effects of surgery on scapula kinematics and function in breast cancer survivors. Bilateral three-dimensional scapular kinematics were quantified before and after surgery for unilateral breast cancer and analyzed with repeated measures ANOVA. Shoulder function was assessed with the Shoulder Rating Questionnaire (SRQ) and analyzed with ANOVA. Subjects (n = 11) demonstrated statistically significant increases in scapula internal rotation on their involved side following surgery. An intention to treat analysis on all enrolled subjects supported this finding. The findings suggest that soft tissues restrictions impact short-term scapula motion following surgery for breast cancer. Significantly poorer shoulder function was reported for pain, recreation/athletic activities and total SRQ score after surgery. The SRQ appears sensitive enough to identify areas of life affected by changes in shoulder function following surgical intervention for breast cancer.

Gender differences between muscle activation and onset timing of the four subdivisions of trapezius during humerothoracic elevation

The aim of this study was to provide a description of gender differences of the normal muscle activation patterns of the four subdivisions of the trapezius (clavicular, descending, transverse, ascending) during arm elevation. Surface EMG was collected from these four subdivisions from twenty-two healthy subjects (12 females, 10 males) during arm elevation in the scapular plane. Percent activation (RMS) of each subdivision was compared between genders across arm angles and elevation phase and onset time of each subdivision was compared between genders. Females demonstrated significantly higher % activation levels for each subdivision (p<.05), except transverse trapezius (p=.36). A statistically significant difference for onset time was observed between gender for the descending trapezius, with a slower onset time for females (p<.05). Findings from this study support the theory that subdivisions within descending trapezius are preferentially activated and demonstrate that gender differences are present within the fourth subdivision of trapezius. As subjects were without shoulder pathology, the observed gender differences may be explained by normal motor control variations. However, as coordinated activation of trapezius is required for normal shoulder motion, it is recommended to include all four subdivisions of trapezius and address gender differences in future studies.

An Experiential Learning Lab Embedded in a Didactic Course: Outcomes from a Pediatric Intervention Course

ABSTRACT This paper examines the outcomes of an experiential learning lab embedded in a didactic course. Program evaluation results were derived from student surveys and reflective journaling. The outcomes indicate that students valued the opportunity for experiential learning citing the primary benefits as the opportunity to, apply and manipulate knowledge, build clinical reasoning skills, and develop the professional skills to engage in and effectively manage an intervention session.

Teachers' Perceptions of the Role of Occupational Therapist in Schools.

ABSTRACT This article explores how teachers in the school system perceive the role of the occupational therapist. Participants of this study were 47 teachers in the school systems that currently work with an occupational therapist in a public or private school. Data were collected via an anonymous online survey and analyzed using descriptive statistics and qualitative coding. The majority of the participants view occupational therapists as valuable team members. They report limitations to the system that challenge collaborative teaming. The participant’s desire increased communication and collaboration with the occupational therapist. Occupational therapy is perceived as a valuable contribution to the educational team that is underutilized. An increase in collaboration and communication is indicated to support the educational process but will require system change.

Differences in the activation and co-activation ratios of the four subdivisions of trapezius between genders following a computer typing task

The aim of this study was to provide a description of gender differences of the activation patterns of the four subdivisions of the trapezius (clavicular, upper, middle, lower) following a 60min computer work task. Surface EMG was collected from these subdivisions from 21 healthy subjects during bilateral arm elevation pre-/post- task. Subjects completed a standardized 60min computer work task at a standard, ergonomic workstation. Normalized activation and activation ratios of each trapezius subdivision were compared between genders and condition with repeated measures ANOVAs. The interaction effect of Gender×Condition for upper trapezius% activation approached significance at p=0.051with males demonstrating greater activation post-task. The main effect of Condition was statistically significant for% activation of middle and lower trapezius (p<0.05), with both muscles demonstrating increase activation post-task. There was a statistically significant interaction effect of Gender×Condition for the Middle Trapezius/Upper Trapezius ratio and main effect of Condition for the Clavicular Trapezius/Upper Trapezius ratio, with a decreased ratio post-typing. Gender differences exist following 60min of a low force computer typing task. Imbalances in muscle activation and activation ratios following computer work may affect total shoulder kinematics and should be further explored.

Use of a journal club for professional development: Outcomes in a school-based occupational therapy practice

ABSTRACT This article investigates the outcomes of a journal club on the evidence-based practice (EBP) skills of school-based practitioners. Participants’ knowledge, attitudes, and perceptions of EBP were collected using pre- and postsurveys following 6 monthly journal club sessions. Participants identified time, availability of articles, and decreased understanding of results as barriers. On the postsurvey, participants reported improvements in comfort with evidence-based skills, including leading an EBP discussion, using evidence in documentation, and referring colleagues to appropriate evidence-based resources. Journal club sessions improved practitioners’ comfort with the ability to discuss and utilize evidence-based resources.

A comparison of upper body and limb postures across technology and handheld device use in college students

[Purpose] People using technology and handheld devices adopt postures of the upper limb and neck that could result in musculoskeletal pathology. Previous research has explored the postures assumed during isolated use of technology devices, such as a smartphone, however a comparison of posture assumed between multiple devices has not been completed. The purpose of this study was to compare the posture of the upper body and limb between handheld devices and technology. [Participants and Methods] Twenty one healthy college students completed this study. Pictures of participants were taken in a neutral posture and as they performed standard tasks with 3 devices (mobile phone, tablet, laptop). A mobile application calculated sagittal and coronal plane posture variables, which were compared between device conditions with an ANOVA and post-hoc tests. [Results] Head translation and angulation and shoulder angulation varied significantly between conditions in both planes. Shoulder translation varied significantly between conditions in the sagittal plane. Rib translation varied significantly between conditions in the coronal plane. Tablet use produced postures that were statistically different than the other devices. [Conclusion] Use of each device altered posture however, frequent, regular use of a tablet may produce greater deleterious effects than regular use of other handheld devices/technology.

Rater reliability and construct validity of a mobile application for posture analysis

[Purpose] Measurement of posture is important for those with a clinical diagnosis as well as researchers aiming to understand the impact of faulty postures on the development of musculoskeletal disorders. A reliable, cost-effective and low tech posture measure may be beneficial for research and clinical applications. The purpose of this study was to determine rater reliability and construct validity of a posture screening mobile application in healthy young adults. [Subjects and Methods] Pictures of subjects were taken in three standing positions. Two raters independently digitized the static standing posture image twice. The app calculated posture variables, including sagittal and coronal plane translations and angulations. Intra- and inter-rater reliability were calculated using the appropriate ICC models for complete agreement. Construct validity was determined through comparison of known groups using repeated measures ANOVA. [Results] Intra-rater reliability ranged from 0.71 to 0.99. Inter-rater reliability was good to excellent for all translations. ICCs were stronger for translations versus angulations. The construct validity analysis found that the app was able to detect the change in the four variables selected. [Conclusion] The posture mobile application has demonstrated strong rater reliability and preliminary evidence of construct validity. This application may have utility in clinical and research settings.

Student Response Systems and Learning: Perceptions of the Student

ABSTRACT To assess student perception of learning and use of a student response system (SRS) as a teaching/learning strategy. Survey methods were used to explore student perceptions of learning and use of student response systems as a pedagogical strategy. Fifty-nine graduate students participated in the survey post completion of two graduate intervention courses. Overall, there was a positive response to the use of SRSs in the classroom. All of the students (100%) recommended the continued use of the clickers for various reasons. The primary benefit reported by students related to providing immediate feedback, the opportunity to manipulate and revisit the content, and the ability to check for understanding within a class session. Students recommended the continued use of the SRS in classes to support acquisition of content and exam preparation. The student reported technology difficulties as the only the negative to SRS use in the classroom. Instructor perception was that the addition of the SRS devices added a new way to interact with the students. Suggestions for incorporating the use of a SRS devices into classroom instruction are offered.

A Protocol of Manual Tests to Measure Sensation and Pain in Humans

Numerous qualitative and quantitative techniques can be used to test sensory nerves and pain in both research and clinical settings. The current study demonstrates a quantitative sensory testing protocol using techniques to measure tactile sensation and pain threshold for pressure and heat using portable and easily accessed equipment. These techniques and equipment are ideal for new laboratories and clinics where cost is a concern or a limiting factor. We demonstrate measurement techniques for the following: cutaneous mechanical sensitivity on the arms and legs (von-Frey filaments), radiant and contact heat sensitivity (with both threshold and qualitative assessments using the Visual Analog Scale (VAS)), and mechanical pressure sensitivity (algometer, with both threshold and the VAS). The techniques and equipment described and demonstrated here can be easily purchased, stored, and transported by most clinics and research laboratories around the world. A limitation of this approach is a lack of automation or computer control. Thus, these processes can be more labor intensive in terms of personnel training and data recording than the more sophisticated equipment. We provide a set of reliability data for the demonstrated techniques. From our description, a new laboratory should be able to set up and run these tests and to develop their own internal reliability data.