The demyelinating and degenerating disease, multiple sclerosis, is the highlight of this evidence-based research project. A set of questions were created specifically to the patients and physicians. I conducted interviews with patients and physician to gather relevant data. The results were qualitatively analyzed and reported in the project.
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Low back pain (LBP) is the most common symptom leading to hospitalization and medical assistance. In the US, LBP is the fifth most prevalent case for visiting hospitals. Approximately 2.06 million LBP incidents were reported during the timeline between 2004…
Low back pain (LBP) is the most common symptom leading to hospitalization and medical assistance. In the US, LBP is the fifth most prevalent case for visiting hospitals. Approximately 2.06 million LBP incidents were reported during the timeline between 2004 and 2008. Globally, LBP occurrence increased by almost 200 million from 1990 to 2017. This problem is further implicated by physical and financial constraints that impact the individual’s quality of life. The medical cost exceeded $87.6 billion, and the lifetime prevalence was 84%. This indicates that the majority of people in the US will experience this symptom. Also, LBP limits Activities of Daily Living (ADL) and possibly affects the gait and postural stability. Prior studies indicated that LBP patients have slower gait speed and postural instability. To alleviate this symptom, the epidural injection is prescribed to treat pain and improve mobility function. To evaluate the effectiveness of LBP epidural injection intervention, gait and posture stability was investigated before and after the injection. While these factors are the fundamental indicator of LBP improvement, ADL is an element that needs to be significantly considered. The physical activity level depicts a person’s dynamic movement during the day, it is essential to gather activity level that supports monitoring chronic conditions, such as LBP, osteoporosis, and falls. The objective of this study was to assess the effects of Epidural Steroid Injection (ESI) on LBP and related gait and postural stability in the pre and post-intervention status. As such, the second objective was to assess the influence of ESI on LBP, and how it influences the participant’s ADL physical activity level. The results indicated that post-ESI intervention has significantly improved LBP patient’s gait and posture stability, however, there was insufficient evidence to determine the significant disparity in the physical activity levels. In conclusion, ESI depicts significant positive effects on LBP patients’ gait and postural parameters, however, more verification is required to indicate a significant effect on ADL physical activity levels.
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Chronic ankle instability (CAI) is caused by the failure to seek treatment and rehabilitation after an acute ankle sprain. Typically, clinical assessment of ankle sprains is done under unloaded conditions, despite the fact that ankle sprains occur during weight loading.…
Chronic ankle instability (CAI) is caused by the failure to seek treatment and rehabilitation after an acute ankle sprain. Typically, clinical assessment of ankle sprains is done under unloaded conditions, despite the fact that ankle sprains occur during weight loading. Characterization of ankle stiffness, a representation of ankle stability during weight loading, is crucial to quantify ankle stability. Patients with CAI suffer from gait asymmetry, and the descriptions of the asymmetry ratio vary widely throughout the research community. Bilateral ankle stiffness could be a systematic metric to describe the gait asymmetry of CAI patients. Additionally, women generally have higher ankle joint and ligamentous laxity than men, and lower ankle stiffness, which has been thoroughly investigated in previous literature. However, differences in bilateral ankle stiffness between sexes still need to be investigated. Using twin dual-axis robotic platforms, this study investigated the weight loading effect on ankle stiffness in the frontal plane during standing, the bilateral difference in stiffness between the dominant and non-dominant ankle, and the sex difference in bilateral ankle stiffness during standing for varying weight distribution. The group average results of 20 healthy subjects showed that ankle stiffness increased with increasing weight loading on the ankle, which is speculated to be caused by active muscle contraction and changes in passive structure due to weight loading. For the bilateral difference of the group, the statistical analysis showed that there was no significant difference between dominant and non-dominant ankle stiffness for all the weight distributions considered. Although the group average result of the difference in bilateral ankle stiffness was statistically insignificant, individual analysis confirmed the importance of subject-specific investigation of bilateral ankle stiffness, as there were more cases of dominant ankle stiffness being larger than non-dominant ankle stiffness, and the bilateral difference was subject-specific. Investigations into sex differences in bilateral ankle stiffness showed that ankle stiffness in males is significantly greater than in females, even after normalizing the stiffness by weight, which is speculated to be caused by higher joint and ligamentous laxity in females regardless of laterality.
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While REM Sleep Behavior disorder (RBD) has been linked with synucleinopathies, difficulties persist in clinically convenient diagnostic tools which can differentiate between underlying diseases. Identifying markers in the gait of RBD patients may ease the diagnostic process and indicate potential…
While REM Sleep Behavior disorder (RBD) has been linked with synucleinopathies, difficulties persist in clinically convenient diagnostic tools which can differentiate between underlying diseases. Identifying markers in the gait of RBD patients may ease the diagnostic process and indicate potential or status for developing more severe disorders. Individuals were referred to Movement Disorders Center of Arizona (MDCA) by a sleep specialist with a confirmed diagnosis of RBD, or those who were clinically indicated after questioning. All participants underwent a skin-biopsy test for α-synuclein, I-ioflupane dopamine transporter(DAT) scan, and had their gait velocity, cadence and stride dynamics assessed by an automated gait analysis system.
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Introduction: Lateral reactive stepping is correlated with impairment in people with Parkinson’s Disease (PwPD). Despite this, there is little known of lateral stepping strategies and performance of these strategies in reactive stepping. Objective: To characterize step strategy in people with…
Introduction: Lateral reactive stepping is correlated with impairment in people with Parkinson’s Disease (PwPD). Despite this, there is little known of lateral stepping strategies and performance of these strategies in reactive stepping. Objective: To characterize step strategy in people with PD, characterize changes in these stepping strategies through training, and identify performance improvements in the lateral step strategies. Methods: A total of 31 PwPd who are currently at risk for falls took part in an 18-week various background reactive stepping intervention. The stepping strategies were assessed on two baseline assessments (B1 and B2) immediately followed by a 6- session step training intervention occurring over two weeks. Step strategies were again assessed immediately after training (P1) and two months later (P2). Initial outcomes were characterized step strategies, changes in step strategies, and improvement in performance of step strategies. Results: Three step strategies were established and split into two groups (no cross and cross). Changes in step strategies did not occur significantly both before and after training. Improvement in performance of the step strategies occurred at a significant amount (p=0.05) via a decrease in use of support after training occurred for any step strategies utilized. Conclusion: Step strategies were characterized, and performance of strategies was improved upon following the 2-week training. Lateral step strategies are defined and repeated throughout reactive step training with potential for improvement.
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Parkinson’s Disease (PD) is characterized by involuntary tremors, muscle rigidity, slowed movement, and cognitive impairments. Some people with PD experience “Freezing of Gait” (FOG), which is an acute inability to release effective stepping. The severity of Freezing of Gait can…
Parkinson’s Disease (PD) is characterized by involuntary tremors, muscle rigidity, slowed movement, and cognitive impairments. Some people with PD experience “Freezing of Gait” (FOG), which is an acute inability to release effective stepping. The severity of Freezing of Gait can be influenced by disease duration, disease severity, and medication. Freezing of Gait can lead to an increased risk of falls, mood disorders, reduced quality of life, poorer cognition, and executive function impairments (Morris et. al.). It is important to understand how Freezing of Gait can affect cognition, as this can alter the plan of cognitive rehabilitation that the patient receives in order to improve their cognition. Within each of these domains, are a variety of tests that all claim to measure the same cognition the same way and achieve similar results. A recent meta analysis assessed this hypothesized effect. However, to best understand this relationship, it is important to assess whether the effects of FOG status on cognition are similar across cognitive tests of the same domain. This research was performed by using a previously completed meta analysis on PD tests and the domains that tests fall into. Each of the domains were analyzed individually, and the most common tests used within each domain were compared to determine their effect sizes. The effect sizes were then compared to determine which tests have a greater influence on cognition, and if the effect sizes of each test within the same domain are similar, showing that FOG affects cognition to a similar degree.
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Fine control of standing postural balance is essential for completing various tasks in daily activities, which might be compromised when interacting with dynamically challenging environments (e.g., moving ground). Among various biofeedback to improve postural balance control, vibrotactile feedback has an…
Fine control of standing postural balance is essential for completing various tasks in daily activities, which might be compromised when interacting with dynamically challenging environments (e.g., moving ground). Among various biofeedback to improve postural balance control, vibrotactile feedback has an advantage of providing supplementary information about balance control without disturbing other core functions (e.g., seeing and hearing). This paper investigated the effectiveness of a waist vibrotactile feedback device to improve postural control during standing balance on a dynamically moving ground simulated by a robotic balance platform. Four vibration motors of the waist device applied vibration feedback in the anterior-posterior and medio-lateral direction based on the 2-dimensional sway angle, measured by an inertia measurement unit. Experimental results with 15 healthy participants demonstrated that the waist vibrotactile feedback is effective in improving postural control, evidenced by improvements in center-of-mass and center-of-pressure stability measures. In addition, this study confirmed the effectiveness of the waist vibrotactile feedback in improving standing balance control even under muscle fatigue induced by lower body exercise. The study further confirmed that the waist feedback is more effective in people with lower baseline balance performance in both normal and fatigue conditions.
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The present study aimed to compare brain activity changes related to proactive and reactive control strategies in patients with Parkinson’s disease during “On” levodopa and “Off” levodopa conditions. The study consisted of two participants who had received a prior diagnosis…
The present study aimed to compare brain activity changes related to proactive and reactive control strategies in patients with Parkinson’s disease during “On” levodopa and “Off” levodopa conditions. The study consisted of two participants who had received a prior diagnosis of Parkinson’s Disease. The participants completed AX-CPT task as a measure of attention control in two sessions: a) “On Levodopa” and b) “Off Levodopa” while they were in the fMRI scanner. Prior to the analysis, the T1- weighted anatomical scan images and the BOLD multiband functional images of both the participants were BIDS (Brain Imaging Data Structure) validated and preprocessed using the standard FMRIPrep pipeline. The imaging data was then analyzed using SPM12 (Statistical parametric mapping) software. Individual-level analysis of the imaging data was conducted by creating General Linear models for both the participants on “ON” and “OFF” levodopa conditions. The BOLD responses were compared using AY>BY and BX > BY contrasts. Where BX >, BY contrast, measured BOLD activity related to reactive control strategy and AY> BY contrast measured BOLD activity related to the proactive control strategy. It was observed that participants tended towards reactive control strategy in both “On” and “Off” levodopa conditions.
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One of the long-standing issues that has arisen in the sports medicine field is identifying the ideal methodology to optimize recovery following anterior cruciate ligament reconstruction (ACLR). The perioperative period for ACLR is notoriously heterogeneous in nature as it consists…
One of the long-standing issues that has arisen in the sports medicine field is identifying the ideal methodology to optimize recovery following anterior cruciate ligament reconstruction (ACLR). The perioperative period for ACLR is notoriously heterogeneous in nature as it consists of many variables that can impact surgical outcomes. While there has been extensive literature published regarding the efficacy of various recovery and rehabilitation topics, it has been widely acknowledged that certain modalities within the field of ACLR rehabilitation need further high-quality evidence to support their use in clinical practice, such as blood flow restriction (BFR) training. BFR training involves the application of a tourniquet-like cuff to the proximal aspect of a limb prior to exercise; the cuff is inflated so that it occludes venous flow but allows arterial inflow. BFR is usually combined with low-intensity (LI) resistance training, with resistance as low as 20% of one-repetition maximum (1RM). LI-BFR has been used as an emerging clinical modality to combat postoperative atrophy of the quadriceps muscles for those who have undergone ACLR, as these individuals cannot safely tolerate high muscular tension exercise after surgery. Impairments of the quadriceps are the major cause of poor functional status of patients following an otherwise successful ACLR procedure; however, these impairments can be mitigated with preoperative rehabilitation done before surgery. It was hypothesized that the use of a preoperative LI-BFR training protocol could help improve postoperative outcomes following ACLR; primarily, strength and hypertrophy of the quadriceps. When compared with a SHAM control group, subjects who were randomized to a BFR intervention group made greater preoperative strength gains in the quadriceps and recovered quadriceps mass at an earlier timepoint than that of the SHAM group aftersurgery; however, the gains made in strength were not able to be maintained in the 8-week postoperative period. While these results do not support the use of LI-BFR from the short-term perspective after ACLR, follow-up data will be used to investigate trends in re-injury and return to sport rates to evaluate the efficacy of the use of LI-BFR from a long-term perspective.
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Shoulder injuries are common in major league baseball (MLB) players due to the explosive and unnatural throwing motion. The goal of the thesis was to provide quantitative information about factors that influence pitching outcomes, to better understand risk management of…
Shoulder injuries are common in major league baseball (MLB) players due to the explosive and unnatural throwing motion. The goal of the thesis was to provide quantitative information about factors that influence pitching outcomes, to better understand risk management of rotator cuff tears/injuries. Typically, shoulder injuries are due to the stress placed on the glenohumeral joint. While the kinetic chain and joint muscular forces produce the explosive overhead throw. There’s a vast range when it comes to shoulder injuries for pitchers. Rotator cuff injuries are common, and multiple factors contribute to either impingement/strains, tendinitis, or tears. The purpose of this study was to assess shoulder injuries sustained by MLB pitchers between 2015-2021, to identify changes between performance metrics, collected from a publicly available database for differences between pre and post injury. Selected factors of interest are: playing years in the league, injury history, average pitch types thrown for both preinjury and postinjury, release speed, release position in the x, y, and z directions, horizontal and vertical movement, horizontal and vertical positions of the ball when it crosses home plate (plate_x and plate_z), resultant velocities and accelerations, release spin rate, release extension, spin axis and return-to-sport determined by length of time spent on the injured list (IL) for more than 100 days or less than 100 days. Resultant velocities and accelerations were calculated using the provided metrics for velocity and acceleration in the x, y, z global dimensions. Resultant velocities were significant only for off-speed pitches (P= 0.053). Multiple linear regression analysis was preformed to relate ball flight kinematics (displacement, ball velocity, and acceleration), angular kinematics (spin rate and spin axis) per each pitch bin (e.g., fastballs, breaking balls, and off-speed pitches) to relate performance metrics found prior to injury and those after the sustained injury. Ball speed in miles per hour presented significance in the off-speed pitches, though spin rate was only significant for breaking ball pitches. Two distinct spin axis orientations were significant: breaking balls and off-speed pitches. The horizontal release position was significant for both fastballs and breaking balls than in the vertical release position which was significant for all pitch bins. From the analysis of variance, inferences were made to additional factors of interest that are out of the scope such as, kinematic sequence velocities and ground reaction forces.
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