Shana Harrington

Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants

IntroductionDeficits after breast cancer treatment have been examined by comparing the surgically affected upper extremity to the unaffected extremity. It is not possible to know precisely if anti-cancer treatment such as radiation and chemotherapy had any effect on the unaffected arm. The purpose of this study was to compare ROM, strength, and shoulder function between breast cancer survivors and healthy, matched controls.MethodsShoulder pain and function was assessed using the Disabilities of the Arm Shoulder Hand (DASH) and the Pennsylvania Shoulder Score (PSS). Active and passive range of motion (ROM) for shoulder flexion, extension, external rotation (ER) at 0° and 90° of abduction, internal rotation (IR) at 90° of abduction were measured on the affected side using a digital inclinometer. Strength was measured using a hand held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, internal rotation, ER, scaption, and horizontal adduction.ResultsSignificant differences were found between the two groups for the DASH (p < 0.001) and PSS (p < 0.001), active flexion (p < 0.001), 90° ER (p = 0.020), extension (p = 0.004) and passive flexion (p < 0.001) and 90° ER (p = 0.012). All 7 of the shoulder girdle strength measures were significantly different between groups for abduction and upward rotation (p = 0.006), depression and adduction (p = 0.001), flexion (p < 0.001), ER (p = 0.004), IR (p = 0.001), scaption (p < 0.001), and adduction (p < 0.001).Discussion/ConclusionsThese results provide preliminary evidence to suggest clinicians focus on these particular ROM, strength, and shoulder function measures when treating a breast cancer survivors.Implications for Cancer SurvivorsShoulder ROM, strength, and function are important to assess in BCS.

A Cross-Sectional Study Examining Shoulder Pain and Disability in Division I Female Swimmers

CONTEXT The prevalence of shoulder pain in the competitive swimming population has been reported to be as high as 91%. Female collegiate swimmers have a reported shoulder-injury rate 3 times greater than their male counterparts. There has been little information on how to best prevent shoulder pain in this population. The purpose of this study was to examine if differences exist in shoulder range of motion, upper-extremity strength, core endurance, and pectoralis minor length in NCAA Division I female swimmers with and without shoulder pain and disability. METHODS NCAA Division I females (N = 37) currently swimming completed a brief survey that included the pain subscale of the Penn Shoulder Score (PSS) and the sports/performing arts module of the Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure. Passive range of motion for shoulder internal rotation (IR) and external rotation (ER) at 90° abduction was measured using a digital inclinometer. Strength was measured using a handheld dynamometer for scapular depression and adduction, scapular adduction, IR, and ER. Core endurance was assessed using the side-bridge and prone-bridge tests. Pectoralis minor muscle length was assessed in both a resting and a stretched position using the PALM palpation meter. All measures were taken on the dominant and nondominant arms. RESULTS Participants were classified as positive for pain and disability if the following 2 criteria were met: The DASH sports module score was >6/20 points and the PSS strenuous pain score was ≥4/10. If these criteria were not met, participants were classified as negative for pain and disability. Significant differences were found between the 2 groups on the dominant side for pectoralis muscle length at rest (P = .003) and stretch (P = .029). CONCLUSIONS The results provide preliminary evidence regarding an association between a decrease in pectoralis minor length and shoulder pain and disability in Division I female swimmers.

Upper extremity strength and range of motion and their relationship to function in breast cancer survivors

The impact upper extremity impairments (UE) have on UE function in breast cancer survivors (BCS) is unclear. The purpose of this study was to evaluate the associations between upper extremity active range of motion (AROM), passive range of motion (PROM), and strength with self-reported function in BCS. BCS (n  =  24) completed the Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PSS). AROM and PROM of shoulder flexion, extension, external rotation (ER) at 0° and 90° of abduction, and internal rotation (IR) at 90° of abduction were measured using a digital inclinometer. Strength was measured using a hand-held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, IR, ER, scaption, and horizontal adduction. All constructs of AROM, PROM, and strength were correlated with the DASH and PSS. DASH was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 6 of 7 shoulder strength measures. PSS was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 4 of 7 shoulder strength measures. Regression analysis showed that AROM explained 40% of the DASH scores and strength explained 20% of scores on the PSS. This study characterizes the impact that shoulder motion, flexibility, and strength losses have on shoulder function in BCS. Deficits in AROM and shoulder strength explained the greatest proportion of shoulder disability. Future clinical trials should consider incorporating AROM and strengthening techniques to improve shoulder use after breast cancer treatments.

Scapular Bracing and Alteration of Posture and Muscle Activity in Overhead Athletes With Poor Posture

CONTEXT Overhead athletes commonly have poor posture. Commercial braces are used to improve posture and function, but few researchers have examined the effects of shoulder or scapular bracing on posture and scapular muscle activity. OBJECTIVE To examine whether a scapular stabilization brace acutely alters posture and scapular muscle activity in healthy overhead athletes with forward-head, rounded-shoulder posture (FHRSP). DESIGN Randomized controlled clinical trial. SETTING Applied biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-eight healthy overhead athletes with FHRSP. INTERVENTION(S) Participants were assigned randomly to 2 groups: compression shirt with no strap tension (S) and compression shirt with the straps fully tensioned (S + T). Posture was measured using lateral-view photography with retroreflective markers. Electromyography (EMG) of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) in the dominant upper extremity was measured during 4 exercises (scapular punches, Ws, Ys, Ts) and 2 glenohumeral motions (forward flexion, shoulder extension). Posture and exercise EMG measurements were taken with and without the brace applied. MAIN OUTCOME MEASURE(S) Head and shoulder angles were measured from lateral-view digital photographs. Normalized surface EMG was used to assess mean muscle activation of the UT, MT, LT, and SA. RESULTS Application of the brace decreased forward shoulder angle in the S + T condition. Brace application also caused a small increase in LT EMG during forward flexion and Ys and a small decrease in UT and MT EMG during shoulder extension. Brace application in the S + T group decreased UT EMG during Ws, whereas UT EMG increased during Ws in the S group. CONCLUSIONS Application of the scapular brace improved shoulder posture and scapular muscle activity, but EMG changes were highly variable. Use of a scapular brace might improve shoulder posture and muscle activity in overhead athletes with poor posture.

Physical therapy students’ perceptions of team-based learning in gross anatomy using the Team-Based Learning Student Assessment Instrument

Purpose: The objective of this study was to assess physical therapy student perceptions of team-based learning (TBL) in a graduate level gross anatomy course using the TBL Student Assessment Instrument (TBL-SAI). Methods: The TBL-SAI was administered to 85 doctor of physical therapy (DPT) students, comprising three cohorts (classes of 2013, 2014, and 2015), who successfully completed a gross anatomy course where TBL was implemented. The TBL-SAI surveys 33 items, each rated from one (strongly disagree) to five (strongly agree) and measures three subscales: students’ perceptions of accountability, preference for lecture or TBL, and student satisfaction. Results: The means for each subscale and the total TBL-SAI score for each cohort fell above the neutral score. The 2015 group (mean, 37.97; 95% confidence interval [CI], 35.67 to 40.26) reported significantly higher satisfaction than that of the 2013 group (mean, 32.71; 95% CI, 30.31 to 35.05) and the 2014 group (mean, 33.11; 95% CI, 30.69 to 35.53). The 2015 group (mean, 125.3; 95% CI, 120.6 to 130.3) also had a significantly higher total score than that of the 2013 group (mean, 115.6; 95% CI, 110.5 to 120.5). Conclusion: The physical therapy students reported an overall positive experience in using TBL to learn gross anatomy in terms of accountability, preference for learning mode, and satisfaction. This positive experience with TBL was accompanied by their successful academic performance. Given the traits and learning preferences in this generation of graduate students, TBL could be a teaching method that is received positively elsewhere and results in successful academic performance and learning.

Precision and Validity of a Clinical Method for Pectoral Minor Length Assessment in Overhead-Throwing Athletes

Methods of assessing pectoral minor length are needed to determine the criterion validity, reliability, and precision of a clinical method for pectoralis minor length assessment. Twentynine overhead-throwing athletes volunteered for this study. All measures were taken with an electromagnetic motion analysis system and Palpation Meter. Pearson correlation coeffi cients were calculated for the average pectoralis minor length values from the electromagnetic motion analysis system and Palpation Meter (0.05) to determine the validity of pectoralis minor length. Intraclass correlation coeffi cients (ICC 2,k) and standard error measures were calculated to determine the intrarater reliability and precision of pectoralis minor length measures. Signifi cant correlations were found between pectoralis minor length measures from the electromagnetic motion analysis system and Palpation Meter for the dominant and nondominant arms. The Palpation Meter was also found to be reliable and precise when measuring pectoralis minor length for the dominant and nondominant arms.

Oncology Section Task Force on Breast Cancer Outcomes: Clinical Measures of Upper Extremity Function

Background: Women treated for breast cancer experience significant deficits in shoulder function that directly impact quality of life. It is critical to assess shoulder function as part of a standard physical therapy evaluation for persons with breast cancer and survivors. The Oncology Section Task Force on Breast Cancer Outcomes was created to uncover the evidence behind clinical outcome measures of shoulder function in persons with breast cancer and survivors. Methods: The authors systematically reviewed the literature for outcome measures that directly measure shoulder function to assess clinical utility and whether psychometric properties are reported and to determine whether the measure was used in the breast cancer population. Results: The DASH, SPADI, SRQ, and PSS were highly recommended by the task force. The QuickDASH was also recommended. The Task Force was unable to recommend 16 measures for use in the breast cancer population at this time. Conclusions: Several outcome measures are used to measure shoulder function in people with breast cancer. Further research is needed to determine reliability and validity of these tools specific to the breast cancer population.

Breast cancer EDGE task force outcomes: Clinical measures of health related quality of life

Background: Health related quality of life (HRQOL) is a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life and has been extensively studied in the breast cancer population. The purpose of this review was to identify evidence‐based HRQOL assessment tools found in breast cancer research using the methodology of the Oncology Section Cancer EDGE Task Force. Methods: The authors systematically reviewed the literature for outcome measures used to assess HRQOL in published research involving women diagnosed with breast cancer. The goal was to examine the psychometric properties of commonly used HRQOL measures in order to determine their clinical utility. Results: European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) ‐ Breast 23, BREAST‐Q, Functional Assessment of Cancer Therapy (FACT) ‐ Breast, FACT‐B+4, EORTC QLQ ‐ Cancer 30, FACT‐General, Functional Living Index‐Cancer, Ferrans and Powers Quality of Life Index‐Cancer Version, Psychological Adjustment to Illness Scale, World Health Organization Quality of Life, and SF‐Health Surveys, were highly recommended by the Task Force. Conclusions: A variety of outcome measures have been reported in the literature to assess HRQOL in women diagnosed with breast cancer. Eleven measures were found to have satisfactory psychometric properties and are recommended for clinical use by the researchers on this Task Force.

Breast Cancer Rehabilitation: Clinical Examination and Outcomes Assessment

Breast cancer is the most commonly diagnosed cancer in women in the United States. The treatment for breast cancer occurs along a protracted time period and includes many different disease treatment modalities. These treatments carry with them a large number of side effects that negatively impact function in both the short-term and long-term. It is necessary for rehabilitation providers to interface with patients being treated for breast cancer throughout the continuum of care so that interval assessments can be conducted to identify emerging impairments and alleviate disability. In order to achieve this, the rehabilitation provider must have an understanding of the clinical measurement tools best suited for examination and assessment of breast cancer-related impairments and disability. This article aims to provide a comprehensive overview of the evidence supporting the use of various clinical measurement tools for the breast cancer population and highlights the implementation of rehabilitation examination and assessment along the continuum of disease treatment.