2012 Graduate Physical Therapy and Prosthetics and Orthotics Presentations
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2012 Graduate Physical Therapy and Prosthetics and Orthotics Presentations

Title: Mobility Index: Clinical Evaluation of Mobility
Faculty Advisors: Catherine Certo, Kevin Ball, Walter Gorack

Mobility IndexThe primary purpose of this study was to create a clinical Mobility Score (M-Score) to assess dynamic balance abilities. The sample population for this initial study were elderly adults undergoing gait rehabilitation. Numerous studies report good correlations between fall risk and static balance, but the precise relationship between static balance ability and the maintenance of dynamic balance is not well known. Static and dynamic balance are both integral parts of activities of daily living, and this relationship should be further examined to enhance the comprehension of different factors that affect fall risk.  Previous studies have demonstrated that multidirectional movements correlate with increased falls in elderly adults. Thus, the M-Score was devised to incorporate a subset of clinically reliable standardized tests: 5-times sit-to-stand; 360 degree turn;  four-square step test; that in addition to timed-gait, were chosen specifically for their transitional or multidirectional challenges. The secondary purpose of this study was to evaluate the reliability and validity of the M-Score in comparison to the Berg Balance Score (BBS) considered the gold standard in clinical practice, and the laboratory-based force platform system that is used for static balance assessment. The findings of the study show strong support for the M-Score as a time-efficient and effective means of scoring dynamic balance performance.

Title: Clinical Efficacy of KISS Dynamic Wheelchair Seating System.
Faculty Advisor: Barbara Crane

FESDynamic wheelchair seating is known to improve comfort of people who use wheelchairs for mobility, however its effect on function and pressure relief are not well understood.  In this project, DPT students investigated the effects of a new dynamic wheelchair seating system (the Kinetic Innovative Seating System, or KISS) on wheelchair propulsion, body movement, and seat interface pressure during mobility. These are all important wheelchair user characteristics that are affected by wheelchair seating. This helped us to gain a better understanding of some of the potential “side effects” of this new technology and how it might impact the lives and function of wheelchair users.  This laboratory-based study is being followed up with a longer-term study of the potential comfort advantages of the KiSS system, during which wheelchair users will try out this system in their home environments over an extended length of time (several weeks).

Title:  A Comparative Study of AF Dynamics during Simulated Gait
Faculty Advisor: David A. Knapp

Comparative StudyThis is a new line of research to investigate the effect of ankle foot orthoses (AFOs) on human gait.  Students will design and build a testing device that simulates human gait and use the device to measure the resulting kinematics and kinetics under the influence of 18 different AFOs.  This research is key to developing clinical guidelines for prescribing orthoses for a wide variety of patients with lower limb dysfunction.

Title:  Adding a 10 Minute Dynamic Balance Training Program to Current Strength and Conditioning Practice Will Improve Stability and Agility as it Relates to Athletic Performance
Faculty Advisor:  Paul Higgins

Dynamic Balance TrainingBalance training is a key component in the rehabilitation of an injury and an integral part of determining function for returning to sport.  If balance training is important for rehabilitation, should it be a part of strength training to enhance performance?  This project will add a 10 minute dynamic balance training program into current strength and conditioning programs, test stability and agility and correlate the data collected to changes in sports performance.

Title:  Foot Type Effects on Navicular, Rearfoot and Tibial Rotation
Faculty Advisors: John Leard, Kevin Ball

Foot TypeLower kinetic chain theory suggests that as the foot hits the ground, a predictable “chain reaction” of forces causes specific movements of the lower extremity to occur. Over decades, belief in this theory has led clinical scholars to propose, develop, and conduct certain measurements to quantify characteristics of the foot, ankle, and the rest of the chain. While various clinical tests and measures have been tested individually for reliability (and less frequently for validity), few studies have attempted to test the overall concept of the “chain reaction”. This study investigated the clinically relevant topic of the effects of foot types on clinical measures taken in various static postures. Only one posture, supination, showed significant results between foot types.  The correlation of  rearfoot angle and navicular rise measurements were significantly different between low and high arched feet. The correlation of tibial rotation and navicular rise were also significantly different between low and high arched feet. Measuring the movement of the midfoot may provide clinicians with better information to predict “chain reaction”  movement patterns between foot types.

Title:  FES Rehabilitation of a Person with an Incomplete Spinal Cord Injury
Faculty Advisors: Noelle Kisela, Catherine Certo, Kevin Ball

Rehabilitation-Spinal CordThe loss of motor function associated with Spinal cord Injury (SCI) often produces severe limitations on mobility and self care. Chronic incomplete SCI (iSCI) is defined as incomplete lesions to the spinal cord having occurred at least 12 months prior. Over the past decade, body weight support treadmill training (BWSTT) has emerged as a promising method for improving functional ambulation after SCI, however where therapist provided manual advancement of the extremities can provide sensory cues, it does not always facilitate muscle contraction.  Electrical stimulation such as Functional Electrical Stimulation (FES) is a modality that can create an isolated muscle contraction. FES has been used to generate purposeful contractions of paralyzed muscles, thereby enabling functional activities such as standing and stepping. It is suggested that FES offers therapeutic benefits such as decreasing muscle spasm, retaining neurological functions and returning reflexes closer to the normal physiological state. With respect to gait, the use of FES for assistance with limb advancement may offer advantages over BWSTT alone. This study evaluates the response of a single case subject to BWSTT with FES. With respect to the specific muscles that receive FES during training it is hypothesized that the patient will demonstrate functional gait and balance improvements, technology unassisted.

Title:  How are Static and Dynamic Balance Influenced by an Instant Total Contact Cast?
Faculty Advisors: Adam Goodworth, Michelle Kunsman

Static and Dynamic BalanceDespite the importance of offloading devices on healing of diabetic foot ulcers, their influence on balance has received little attention. We tested the hypotheses that an instant Total Contact Cast (iTCC) negatively impacts balance.  Balance was assessed in quiet stance, in functional reach, and on a treadmill (in unperturbed and perturbed conditions).  Results consistently indicated that an iTCC negatively affects measures of balance in 12 healthy subjects.  We also found that adding a heel lift to the opposite shoe improved measures of balance in quiet stance tests by correcting the leg length discrepancy.

Title: Sensory Feedback in Diabetic Neuropathy Patients
Faculty Advisor: Michael Wininger

Sensory Feedback

Title: Prosthetic Training Across Borders
Faculty Advisor: Diana Veneri

Neuropathic patients suffer from a loss of sensory acuity in their distal limbs; this sensory loss contributes to abnormal gait pattern, postural instability, and increased risk for falls. In this project, we seek to integrate a vibrotactile feedback device, comprising a pressure sensor coupled to a vibrating tactor, into the ankle-foot orthoses of neuropathic patients with moderate walking skill in order to assess the efficacy of a feedback in reducing fall risk. In Phase I of this project we have designed the device and the study design; in Phase II we will begin prototyping and pilot testing of the device.

Title: Prosthetic Training Across Borders
Faculty Advisor: Diana Veneri

Prosthetic Training Across BordersLIMBS International is a non-profit organization which designs, creates and tests new prosthetic devices in clinics throughout the developing world. The Physical Therapy Department at the University of Hartford joined with the educational efforts in 2011. The project is two-fold: The first phase is to develop education materials for both clinicians and patients. The clinician manual is comprised of text and photographs of a live model, the clinic posters have pictures with minimal words, and the patient pamphlets have only pictures. The second phase of the project is to evaluate the effectiveness of the education materials.