Raymond McKenna

The Effect of Thoracic Spine Mobilization On Lower Trapezius Strength Testing

Abstract Evidence has shown that muscle strength and function become altered due to motion restrictions. Strengthening muscles with traditional therapeutic exercise will not be completely successful unless inhibition is removed by restoring normal joint mechanics. This study investigated the effect of Grade-IV thoracic spine mobilizations on lower trapezius strength testing in normal subjects. The mobilization for the treatment group (n=20) consisted of posterior-anterior (P-A) oscillations performed from T6-T12 at each segments end range (Grade-IV). This technique is aimed at restoring normal joint play. The control group (n=20) received a Grade-I mobilization consisting of P-A oscillations performed at the beginning of the joints range, which is not expected to have articular reflexogenic effects. Before and after the mobilizations, isometric muscle strength of the lower trapezius was measured using a Nicholas Manual Muscle Tester. An independent group t-test comparing the groups demonstrated a statistically significant effect of thoracic spine mobilization on lower trapezius strength testing (P<.05).

Delphi Study to Determine Rehabilitation Research Priorities for Older Adults With Cancer

OBJECTIVE To solicit expert opinions and develop consensus around the research that is needed to improve cancer rehabilitation for older adults. DESIGN Delphi methods provided a structured process to elicit and prioritize research questions from national experts. SETTING National, Web-based survey. PARTICIPANTS Members (N=32) of the American Congress of Rehabilitation Medicine completed at least 1 of 3 investigator-developed surveys. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES In the first survey, participants identified up to 5 research questions that needed to be answered to improve cancer rehabilitation for older adults. In 2 subsequent surveys, participants viewed the compilation of questions, rated the importance of each question, and identified the 5 most important questions. This generated priority scores for each question. Consensus scores were created to describe the degree of agreement around the priority of each question. RESULTS Highest priority research concerns the epidemiology and measurement of function and disability in older adult cancer survivors; the effects of cancer rehabilitation interventions on falls, disability, participation, survival, costs, quality of care, and health care utilization; and testing models of care that facilitate referrals from oncology to rehabilitation providers as part of coordinated, multicomponent care. CONCLUSIONS A multipronged approach is needed to fill these gaps, including targeted funding opportunities developed with an advisory panel of cancer rehabilitation experts, development of a research network to facilitate novel collaborations and grant proposals, and coordinated efforts of clinical groups to advocate for funding, practice change, and policy change.

Balance in children with acute lymphoblastic leukemia

Treatment for acute lymphoblastic leukemia (ALL) can affect balance via different mechanisms, including sensory and motor peripheral neuropathy, cognitive impairment, and reduced muscle strength and flexibility. To provide an overview of what is currently known about the effects of cancer treatment on balance in pediatric ALL patients and survivors, and of the predictors of poor balance, a review of the literature was conducted.

Trends in availability and usage of biophysical agents among physical therapists in the United States

Background Biophysical agents (BPA) are adjuncts to care plans prescribed by physical therapists to patients in clinic. Recent statements by the American Physical Therapy Association caution usage of certain BPAs. Currently, information is lacking as to which BPAs are available and utilized in physical therapy settings in the United States, rationale for inclusion of BPAs in patient care plans and perceptions of importance of inclusion in a DPT curriculum. Objectives A survey was sent out to 520 physical therapists in the United States (response rate 25%) Major Findings Over 80% of respondents reported access to BPAs and of those, 92% used BPAs with patients. The most commonly used BPAs were cold packs, hot packs, and varied applications of electrical stimulation, while mechanical compression and diathermy were least frequently used. The most common rationale for BPA use was prior positive experience. Respondents’ perceptions of importance of inclusion of specific BPAs in a DPT curriculum mirrored some of the clinical usage patterns found in this study. Conclusions BPAs are widely available and utilized in physical therapy practice in the United States. Rationale for clinician use of BPAs includes both prior positive experience- and evidence-based practice. Results from this study suggest the importance of BPAs in DPT curriculum to ensure safe and appropriate use.

Balance deficits in long-term pediatric ALL survivors

A person’s ability to maintain balance emerges from a complex interaction among sensory systems that makes that person aware of his/her location in regards to the environment, higher-level central nervous system processes that analyze and interpret sensory information and plan movement strategies, and the motor system that executes these strategies [1]. The treatment for acute lymphoblastic leukemia (ALL) can impair all of these body systems resulting in difficulties with movement and balance [2]. As adequate balance is a prerequisite for stabilizing the body in upright positions during voluntary movements, deficits in balance may help explain why childhood ALL survivors have lower physical activity levels and lower participation rates in sports [3, 4]. In a recent study of long-term childhood ALL survivors [5], we examined the potential effect of peripheral neuropathy on static and dynamic measures of balance. As hypothesized, the level of peripheral neuropathy was associated with poorer performance on dynamic measures of mobility (i.e., Timed Up and Go test) and endurance (i.e., 6-Minute Walk test); however the level of peripheral neuropathy was not associated with sway values for maintaining an upright posture on a dynamic posturography device. Another examined factor, visual-motor processing speed, which was obtained from the Digit-Symbol Coding test from the Wechsler Adult Intelligence Scale–Fourth Edition, was associated with balance performance on all investigated measures. Survivors with slower visual-motor processing speed had more sway on the computerized posturography device, took longer to finish the Timed Up and Go test, and achieved a shorter distance in the 6-Minute Walk test. The associations between visual-motor processing speed and static and dynamic measures of balance suggest that cognitive deficits may be a key factor in the observed balance deficits among ALL survivors. Based on these findings, we suggest the integration of cognitive activities when assessing balance in ALL survivors. Outside of the clinic, balance tasks are rarely performed in isolation. Often, maintaining balance is combined with simultaneously performing a cognitive activity, such as walking and attending to a conversation. The performance of two tasks is unaffected if the person has enough attentional resources (i.e., the informationprocessing resources that are required to complete a task [1]); otherwise, performance on the cognitive task, balance task, or both can be impaired. Many long-term ALL survivors experience deficits in muscle strength and flexibility [6]. To compensate for this physical disadvantage, they may devote more attentional resources to perform a dynamic task, such as walking on a busy street. However, survivors may also have limited attentional resources, compared to their healthy peers. The negative effects of anticancer treatment on cognitive function in ALL survivors have been well documented; these deficits include structural alterations in the brain, decreased processing speed, and attention deficits [7, 8]. Given these limitations in physical and cognitive performance, long-term ALL survivors may be more challenged to maintain their upright posture during movement and particularly in situations that involve additional attentional demands, such as walking on a busy street and attending to a conversation. Therefore, evaluating balance while a survivor performs a cognitive task (i.e., a cognitive-motor paradigm) is an appropriate strategy to examine his/her ability to maintain an upright posture as this setting more closely resembles the functional requirements of everyday life. These findings emphasize the application of cognitive–motor task training to address balance deficits and gait limitations among long-term childhood ALL survivors. By utilizing rehabilitation approaches that concurrently challenge survivors’ physical and cognitive functions, rather than those that individually target balance and gait, survivors may be able to better transfer their improvements to real-life situations.

Peripheral Neuropathy, Sensory Processing, and Balance in Survivors of Acute Lymphoblastic Leukemia

Purpose To compare peripheral nervous system function and balance between adult survivors of childhood acute lymphoblastic leukemia (ALL) and matched controls and to determine associations between peripheral neuropathy (PN) and limitations in static balance, mobility, walking endurance, and quality of life (QoL) among survivors. Patients and Methods Three hundred sixty-five adult survivors of childhood ALL and 365 controls with no cancer history completed assessments of PN (modified Total Neuropathy Score [mTNS]), static balance (Sensory Organization Test [SOT]), mobility (Timed Up and Go), walking endurance (6-minute walk test), QoL (Medical Outcomes Study 36-Item Short Form Survey), and visual-motor processing speed (Wechsler Adult Intelligence Scale). Results PN, but not impairments, in performance on SOT was more common in survivors than controls (41.4% v 9.5%, respectively; P < .001). In multivariable models, higher mTNS scores were associated with longer time to complete the Timed Up and Go (β = 0.15; 95% CI, 0.06 to 0.23; P < .001), shorter distance walked in 6 minutes (β = -4.39; 95% CI, -8.63 to -0.14; P = .04), and reduced QoL (β = -1.33; 95% CI, -1.79 to -0.87; P < .001 for physical functioning; β = -1.16; 95% CI, -1.64 to -0.67; P < .001 for role physical; and β = -0.88; 95% CI, -1.34 to -0.42; P < .001 for general health). Processing speed (β = 1.69; 95% CI, 0.98 to 2.40; P < .001), but not mTNS score, was associated with anterior-posterior sway on the SOT. Conclusion PN in long-term ALL survivors is associated with movement, including mobility and walking endurance, but not with static standing balance. The association between processing speed and sway suggests that static balance impairment in ALL survivors may be influenced by problems with CNS function, including the processing of sensory information.