Physical therapy patients still receive their plan of care onto a piece of paper when there are hundreds of engaging physical therapy exercise videos on the internet. These exercise videos are way more appealing to watch and physical therapists should consider delivering Home Exercise Programs (HEP) digitally. There are apps and online services such as Physioadvisor, Physprac app, Anterior Cruciate Ligament repair app, and work-out apps for people to create their own plan of care and are easily accessible with any electronic device. Most people are receiving information and learning through a lit screen anyways so it may only be a matter of time before people start using these resources instead of a physical therapist. Physical Therapists need to provide better resources for their patients and an app may be all they need. Figures of the results of the Qualtrics survey both Physical Therapists and Patient responses and were provided. A data analysis of each question and responses were interpreted to determine whether patients and physical therapists would like to use a physical therapy app as part of their rehab program. A Physiotherapy research journal with Switzerland researchers conducted a case study in a hospital and determined whether a HEP app testing was effective for patients to utilize.

Reactive step and treadmill perturbation training have been shown to improve first step measurements and reduce falls. However, the effect of variable training on the efficacy of generalization is poorly understood. The objective of this study was to measure whether the addition of variability in the perturbation training protocol can increase the amount of generalization seen in forward perturbations. The study included 28 young, healthy adults between the age of 20-35 years old with no known significant medical history. Fifteen participants underwent constant training in one direction with the same belt acceleration (4 m/s2) and thirteen participants underwent variable training where their foot positioned and belt acceleration (3 m/s2, 4 m/s2, 5 m/s2) were randomized throughout the collections All slips were done in the forward direction requiring a forward reactive step. To assess the effects of variable training an independent sample t-test of the differences in generalization between each group was calculated. Primary outcome variables in both studies were margin of stability (MOS), step length, and step latency. Results from the study indicated that variable training made no significant improvement (p<0.05) in generalization across the variables. The P-values for the difference in generalization of MOS, step length, and step latency were 0.635, 0.225, 0.148 respectively. Despite the lack of significant evidence to support improvement in generalization with variable training, further investigations are warranted to develop training methods capable of reducing falls in at risk populations.

Individuals fluent in sign language who have at least one deaf parent are considered native signers while those with non-signing, hearing parents are non-native signers. Musculoskeletal pain from repetitive motion is more common from non-natives than natives. The goal of this study was twofold: 1) to examine differences in upper extremity (UE) biomechanical measures between natives and non-natives and 2) upon creating a composite measure of injury-risk unique to signers, to compare differences in scores between natives and non-natives. Non-natives were hypothesized to have less favorable biomechanical measures and composite injury-risk scores compared to natives. Dynamometry was used for measurement of strength, electromyography for ‘micro’ rest breaks and muscle tension, optical motion capture for ballistic signing, non-neutral joint angle and work envelope, a numeric pain rating scale for pain, and the modified Strain Index (SI) as a composite measure of injury-risk. There were no differences in UE strength (all p≥0.22). Natives had more rest (natives 76.38%; non-natives 26.86%; p=0.002) and less muscle tension (natives 11.53%; non-natives 48.60%; p=0.008) for non-dominant upper trapezius across the first minute of the trial. For ballistic signing, no differences were found in resultant linear segment acceleration when producing the sign for ‘again’ (natives 27.59m/s2; non-natives 21.91m/s2; p=0.20). For non-neutral joint angle, natives had more wrist flexion-extension motion when producing the sign for ‘principal’ (natives 54.93°; non-natives 46.23°; p=0.04). Work envelope demonstrated the greatest significance when determining injury-risk. Natives had a marginally greater work envelope along the z-axis (inferior-superior) across the first minute of the trial (natives 35.80cm; non-natives 30.84cm; p=0.051). Natives (30%) presented with a lower pain prevalence than non-natives (40%); however, there was no significant difference in the modified SI scores (natives 4.70 points; non-natives 3.06 points; p=0.144) and no association between presence of pain with the modified SI score (r=0.087; p=0.680). This work offers a comprehensive analysis of all the previously identified UE biomechanics unique to signers and helped to inform a composite measure of injury-risk. Use of the modified SI demonstrates promise, although its lack of association with pain does confirm that injury-risk encompasses other variables in addition to a signer’s biomechanics.

According to the Center for Disease Control, 1 in every 3 individuals will fall in their lifetime. Treadmill perturbation training has been a beneficial tool to increase reactive postural control and decrease the amount of falls. This study looked at the extent of the training effects on 29 healthy young adults to evaluate if stepping improvements in one direction could generalize to improvements in the quality of stepping in other directions. Outcome variables of Margin of Stability (MOS), step length, and step latency were evaluated for all 15 participants trained with forward perturbations and 14 participants trained with backward perturbations. From the paired t-tests, there were limited significant improvements in stepping with regards to motor learning and generalization. The only significant outcome was an increase in step length for the participants who trained in the backward direction (p=0.014; p<0.05). However, this significant increase in step length for this backward group did not generalize when the participants stepped in the forward direction post training. From the correlation tests, there was a significant, moderate correlation between motor learning and generalization (rho =0.527, p= 0.043; p<0.05), thus suggesting there may be a relationship between the amount of learning and the amount of generalization observed. Further evaluation of the second step and the foot motion during stepping may reveal more information and explain the changes in stepping to describe how healthy young adults were able to regain balance with each perturbation given.

Muscular weakness is a common manifestation for Stroke survivors and for patients with Anterior Cruciate Ligament reconstruction leading to reduced functional independence, especially mobility. Several rigid orthotic devices are being designed to assist mobility. However, limitations in majority of these devices are: 1) that they are constrained only to level walking applications, 2) are mostly bulky and rigid lacking user comfort. For these reasons, rehabilitation using soft-robotics can serve as a powerful modality in gait assistance and potentially accelerate functional recovery. The characteristics of soft robotic exosuit is that it’s more flexible, delivers high power to weight ratio, and conforms with the user’s body structure making it a suitable choice. This work explores the implementation of an existing soft robotic exosuit in assisting knee joint mechanism during stair ascent for patients with muscular weakness. The exosuit assists by compensating the lack of joint moment and minimizing the load on the affected limb. It consists of two I-cross-section soft pneumatic actuators encased within a sleeve along with insole sensor shoes and control electronics. The exosuit actuators were mechanically characterized at different angles, in accordance to knee flexion in stair gait, to enable the generation of the desired joint moments. A linear relation between the actuator stiffness and internal pressure as a function of the knee angle was obtained. Results from this characterization along with the insole sensor outputs were used to provide assistance to the knee joint. Analysis of stair gait with and without the exosuit ‘active’ was performed, using surface electromyography (sEMG) sensors, for two healthy participants at a slow walking speed. Preliminary user testing with the exosuit presented a promising 16% reduction in average muscular activity of Vastus Lateralis muscle and a 3.6% reduction on Gluteus Maximus muscle during the stance phase and unrestrained motion during the swing phase of ascent thereby demonstrating the applicability of the soft-inflatable exosuit in rehabilitation.

Background: Falls are a leading cause of injury in older adults with roughly 1 in 4 American's over the age of 65 experiencing a fall. Research that looks at reactive stepping, or the steps a person takes when they encounter a loss of balance, is sparse. Whether a specific aspect of reactive stepping can be linked to falls has yet to be determined. Purpose: The purpose of this study was to determine which reactive stepping characteristics may be correlated with falls in from community dwelling older adults. Methods: 54 older adults (11 fallers & 43 non-fallers) underwent 3 "postural perturbations", in which they leaned back into the testers hands and were released, resulting in one or more reactive steps. Inertial sensors (APDM, inc.) were used to measure participant movement and Quantify reactive steps. Step length and step latency, which is the time it takes for an individual to perform a step, were the primary outcomes measured, along with time to stabilization, number of steps taken, and time until first foot strike. Results: Neither step length or step latency were significantly different in fallers compared to non-fallers (p=0.537 and p=0.431, respectively). However, four square step test was significantly different between the populations (p= 0.045). Conclusions: These results showed that four square step test may be more closely related to falls than step length or latency. When performing fall prevention training, or working with an individual at risk for falling, it may be more beneficial to focus on four square step test and the changes in direction associated with it, as opposed to other stepping characteristics in order to improve their fall risk.

In motor training, transfer is defined as the gain/loss of performance in one task as a result of training on another. In our laboratory, we have observed that training on a multi-joint coordination task (which simulates arm and wrist movement when feeding) transfers to a dexterity task (which simulates finger and hand movement when dressing), such that there are improvements in the dexterity task that emerge without having trained on that specific task. More recently, we have shown that the dexterity task transfers to the multi-joint coordination task. These collective findings suggest that there are shared movement patterns between these two functional motor tasks that may yield this bi-directional transfer effect. Therefore, the objective of this thesis project was to collect kinematic data of the hand to use in future principal component analyses to better understand the underlying mechanism of transfer between these two functional motor tasks. The joint angles of the hand were recorded during twenty second trials of the multi-joint coordination task and the dexterity task. The ranges of motion for the joints in the hand during naïve performance of both motor tasks were analyzed. From a linear regression analysis, we observe that the hand’s ranges of motion were strongly correlated between the two tasks, which suggests that these two functionally different tasks may share movement patterns in terms of joint angles. This similarity of joint angles of the hand may play a role in why we observe this bi-directional transfer between the dexterity and multi-joint coordination tasks. Following neurological injury, patients participate in physical therapy in order to retrain their nervous system to restore lost motor function(s). If patients can only practice a limited number of activities in therapy, our data suggest that other activities may also improve through transfer of training. Kinematic data collection may inform how much a patient improves with motor training and why there may be an improvement in untrained motor tasks.