Physical Therapy

Deckard, Gloria, J;Present, Ron, M

doi: 10.1093/ptj/69.9.713pmid: 2772034

This study examined the relationship between role stress and the physical and emotional well-being of 187 physical therapists practicing in the state of Missouri. Data collected via survey research established a significant relationship between role conflict (conflict between organizational demands and personal and professional values) and emotional exhaustion (r = .50) and between role conflict and somatic and job-induced tension (r = .43 and r = .44, respectively). Role ambiguity created by an uncertain organizational climate was related significantly to emotional exhaustion (r = .26) and to somatic and job-induced tension (r = .21 and r = .29, respectively). Perceived improper allocation of time, inadequate staff or resources, and receipt of incompatible demands were identified as significant role stressors and predictors of diminished emotional and physical well-being. Physical therapy directors and individual therapists should work within their organizations to reduce role stress and its detrimental effects, to align professional and organizational values, and to maintain personal and professional standards. Burnout, professional, Physical therapy profession, professional issues, Role, Stress This content is only available as a PDF. © 1989 by the American Physical Therapy Association Inc.

Wolf, Steven, L;LeCraw, Debbie, E;Barton, Lisa, A

doi: 10.1093/ptj/69.9.719pmid: 2772035

A total of 30 targeted training electromyographic biofeedback treatments were administered to the hemiplegic upper extremities of 12 chronic stroke and head-injured patients (TT Group). The 30 treatments were divided into three series of 10 treatments each directed to the shoulders; the elbow; and the wrist, fingers, and thumb, respectively. Evaluations for function, active range of motion, and integrated EMG activity were undertaken five times before treatment (baseline measurements), after each series of 10 treatments, and at follow-up intervals for one year. Data from these evaluations were compared with those obtained over an identical time course from 14 chronic stroke and head-injured patients undergoing a motor copy procedure (MC Group) in which the patients matched EMG output viewed on a screen from homologous upper extremity muscles. Both groups showed appropriate significant changes among many independent variables. Changes within the TT Group, however, appeared more treatment-related, whereas changes among the MC Group were latent, occurring more frequently at follow-up evaluations. There were no substantial correlations between EMG activity, active ROM, or function, thus highlighting the continuing difficulty of identifying a causative relationship between physiologic change and enhanced motor capabilities among patients with neurologic disorders. Nonetheless, the results do suggest that both techniques are of clinical benefit, with the motor copy technique offering potential cost-effectiveness because patients can self-train. Biofeedback, Cerebrovascular disorders, Head injury, Hemiplegia, evaluation, Movement This content is only available as a PDF. Author notes This study was supported in part by Grant No. G008300041 from the National Institute on Disability and Rehabilitation Research, US Department of Education, Washington, DC. © 1989 by the American Physical Therapy Association Inc.

York,, Jennifer

doi: 10.1093/ptj/69.9.736pmid: 2772036

Efficient mobility methods are a necessity for maximum participation in home and community environments. Individuals who require the use of assistive devices for mobility are at risk for limited environmental access. Few investigations have compared the effectiveness of various mobility methods as a function of the environments in which mobility is required. Sixty-eight adults with physical disabilities who used assistive devices for independent mobility were surveyed to determine mobility methods selected for use in specific home and community environments and to determine how far they would travel outdoors before resorting to use of a motor vehicle. Results indicated that frequently individuals used more than one mobility method at home but only one method in outdoor and community environments. Individuals who used wheeled mobility methods traveled greater distances outdoors than those who walked. Implications for practice and research are discussed. Ambulation aids, general, Community health, Delivery of health care, Equipment, home care, Rehabilitation This content is only available as a PDF. Author notes The development of this study was supported in part by Grant #G008730009 from the Office of Special Education and Rehabilitative Services, US Department of Education, to the Department of Communication Disorders, University of Minnesota. Points of view or opinions stated in this article do not necessarily represent the official position of the US Department of Education. No official endorsement should be inferred. © 1989 by the American Physical Therapy Association Inc.

Briggs, Randall, C;Gossman, Marilyn, R;Birch,, Robert;Drews, Judith, E;Shaddeau, Shirley, A

doi: 10.1093/ptj/69.9.748pmid: 2772037

Descriptive data were collected regarding static standing balance of 71 noninstitutionalized elderly women as they performed two timed balance tests. All subjects performed the sharpened Romberg test and the one-legged stance test on each foot in four test conditions: 1) eyes open, 2) eyes closed, 3) shoes on, and 4) shoes off. Subjects were grouped and analyzed according to the following age ranges: 1) 60 to 64 years, 2) 65 to 69 years, 3) 70 to 74 years, 4) 75 to 79 years, and 5) 80 to 86 years. The best time of three trials was used for data analysis. The maximum balance time for the sharpened Romberg test was 60 seconds. For the one-legged stance test, a maximum balance time was 30 seconds. No significant difference was found between right and left or dominant and nondominant limbs while performing the one-legged stance test. No significant difference was found in mean balance time between subjects who had fallen versus those who had not fallen, nor between shoes-on and shoes-off test performance. Subjects' performance on the eyes-open test was consistently superior to their eyes-closed test performance (p < .0001). The one-legged stance test mean balance time decreased significantly as age increased. More subjects reached the maximum balance time on the sharpened Romberg test than on the one-legged stance test. The results of this study indicate that additional research is needed in the area of balance maintenance among the elderly population. Aging, Equilibrium, Geriatrics, Tests and measurements, functional This content is only available as a PDF. Author notes Address correspondence to Mr Briggs at 2136 N 4th St, Harrisburg, PA 17110 (USA). This study was completed in partial fulfillment of the requirements for Mr Briggs's Master's degree, The University of Alabama at Birmingham. © 1989 by the American Physical Therapy Association Inc.

O&apos;Connor,, Patrick;Sforzo, Gary, A;Frye,, Patricia

doi: 10.1093/ptj/69.9.757pmid: 2772038

Twenty-seven normotensive, college-aged, female subjects were studied to assess the effects of training in breathing techniques on blood pressure during isometric contractions. Subjects were randomly and equally assigned to one of three training groups: 1) a group that was taught to perform a Valsalva maneuver during isometric efforts (VAL Group), 2) a group that was instructed to avoid performing the Valsalva maneuver (NO-VAL Group), and 3) a control group that was given no instructions (CONT Group). Prior to and following three breathing technique training sessions, two blood pressure measurements were made by amplified auscultation during 10 isometric contractions of the quadriceps femoris muscle with the leg positioned at 65 degrees of knee flexion. Breathing patterns were recorded on an impedance pneumograph. Data were submitted to a 2 × 2 × 3 (time × trial × group) multivariate analysis of covariance using resting systolic and diastolic blood pressures as covariates. A significant (p < .05) time-×-group interaction revealed posttraining blood pressure response to isometric exercise had significantly increased in the VAL Group (162/124 vs 179/136 mm Hg), had significantly decreased in the NO-VAL Group (163/120 vs 148/112 mm Hg), and had not significantly changed in the CONT Group (157/117 vs 153/117 mm Hg). These data illustrate that training to avoid the Valsalva maneuver may help attenuate the pressor response observed during isometric contractions and provide a means for safer patient exercise. Cardiac, tests and measurements, Cardiovascular system, Exercise, general, Tests and measurements, functional This content is only available as a PDF. Author notes This article is adapted from a presentation at the Thirty-Fourth Annual Meeting of the American College of Sports Medicine, Las Vegas, NV, May 28, 1987. © 1989 by the American Physical Therapy Association Inc.

Hayes, Karen, W;Sullivan, Jane, E

doi: 10.1093/ptj/69.9.762pmid: 2772039

The purposes of the study were to determine the reliability of a new device used to quantify shoulder subluxation and to estimate its standard error of measurement. The device is an L-shaped thermoplastic jig with a metric tape measure embedded in it. A sliding beak-like marker, which can be anchored with a thumbscrew, is used to identify landmarks and to measure the amount of subluxation. Eight male and two female hemiplegic subjects, 40 to 80 years old, consented to be measured for subluxation. Three standardized subluxation measurements were taken by one investigator to determine the reliability with a single rater. One measurement was taken by a second investigator and compared with the first measurement obtained by the first investigator to determine the reliability using more than one rater. Both investigators were experienced physical therapists. Each measurement was read by the other investigator, who disassembled the jig and cleaned the marks from the patient between measurements. For both analyses, an analysis of variance for repeated measures reflected no differences between measurements attributable to raters. The unbiased intraclass correlation coefficent for a single measurement by a single rater was .89 (p < 01) and for more than one rater was .74 (p < .01). The standard error of measurement was ± 0.77 mm for a single rater and ± 1.20 mm for more than one rater. We recommend the jig as a tool to measure shoulder subluxation in patients. Hemiplegia, evaluation, Tests and measurements, general, Upper extremity, shoulder This content is only available as a PDF. Author notes The results of this study were presented in poster format at the Joint Congress of the American Physical Therapy Association-Canadian Physiotherapy Association, Las Vegas, NV, June 12-16, 1988. © 1989 by the American Physical Therapy Association Inc.

Andrews, A, Williams;Bohannon, Richard, W

doi: 10.1093/ptj/69.9.768pmid: 2772040

The purposes of this investigation of patients with stroke were to 1) determine and compare shoulder lateral rotation range of motion (SLRROM) measured at the threshold of pain on the paretic and nonparetic sides; 2) establish the intrarater and interrater reliability of the measurements; and 3) determine the relationship between SLRROM measurements and the independent variables of age, sex, and time since onset of stroke. Subjects were 25 rehabilitation inpatients. The two investigators each measured the patients' SLRROM twice on both the paretic and nonparetic sides using a gravity goniometer. An analysis of variance (ANOVA) demonstrated that SLRROM was significantly less on the paretic side than on the nonparetic side (F = 28.98, p < .001). The ANOVA demonstrated no difference in the two raters' measurements of SLRROM. The intraclass correlation coefficients (ICC[3,1]) and interrater reliability coefficients were all good to high (.874–.989). The SLRROM on the paretic side correlated significantly with time since onset of stroke (r = −.538, p < .01) As a consequence of this study, we concluded that 1)patients with stroke tend to lose SLRROM on the paretic side, 2) SLRROM tends to decrease with time, and 3) measurements of SLRROM obtained with a gravity goniometer are reliable and sensitive. Cerebrovascular disorders, Pain, Paresis, Upper extremity, shoulder This content is only available as a PDF. © 1989 by the American Physical Therapy Association Inc.

Duncan, Christopher, E

doi: 10.1093/ptj/69.9.773pmid: 2672057

Burns on the posterior lower extremity from the popliteal space to Achilles tendon areas often result in an atypical standing posture and gait pattern. During the acute care hospital stay, the patient frequently assumes a stance position of excessive knee flexion and ankle plantar flexion because of pain splinting or soft tissue shortening, or both (Fig. 1). This burn distribution frequently results in a temporary shortening of the gastrocnemius-soleus muscles. The abnormal stance translates into a familiar gait pattern of absent heel-strike in addition to decreased stride length, weight bearing,1 and duration of stance phase on the involved lower extremity. Furthermore, the pattern may be observed before and after skin grafting is performed. Early intervention is important because a patient is more likely to have optimal results after skin grafting if full active range of motion was attained during the pregrafting phase of burn rehabilitation.1… Burns, Gait training, Orthopedics, Posture, general This content is only available as a PDF. © 1989 by the American Physical Therapy Association Inc.

Greathouse, David, G;Underwood, Frank, B;Tuttle,, Paul

doi: 10.1093/ptj/69.9.777pmid: 2772041

This article describes a technique to determine orthodromic sensory neural conduction of the median and ulnar nerves. The Roth technique is an accurate, yet time-conserving, method to orthodromically measure median and ulnar nerve latency and amplitude. This technique can be an alternative method to the orthodromic ring electrode stimulation technique. Neural conduction studies (NCSs) are used to aid in the diagnosis of several neuromuscular disorders such as entrapment neuropathies, diffuse polyneuropathies, and other diseases of the peripheral nerves.1–3 Two methods used for the determination of sensory neural action potential (SNAP) amplitude and latency are the orthodromic (OD) and antidromic (AD) techniques.1–3 Median and ulnar sensory neural conduction of the upper extremity may be determined by stimulating the appropriate digital nerves and recording the SNAP from a more proximal site on the nerve (OD) or alternatively by stimulating the nerve proximally and recording the SNAP distally (AD).3 Electrotherapy, electrical stimulation, Nerve conduction studies, Neural conduction This content is only available as a PDF. Author notes The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Department of the Army or the US Department of Defense. © 1989 by the American Physical Therapy Association Inc.

Carr,, Janet;Shepherd,, Roberta

doi: 10.1093/ptj/69.9.780pmid: 2772042

To the Editor: We wish to draw your attention to a recent article by Loewen and Anderson, “Reliability of the Modified Motor Assessment Scale and the Barthel Index” (Physical Therapy, July 1988, pages 1077–1081). In this article, the authors state that the Modified Motor Assessment Scale (MMAS) is a modification of the Motor Assessment Scale (MAS) described by Carr et al. It should be made clear, however, that not only did we describe the scale, but we also in fact designed it and tested it for reliability, publishing both the scale and our findings in your journal.1 Loewen and Anderson state that their modifications increase the assessment's sensitivity to changes in patient status. This of course is an empirical question.… Author Response: Sandy C Loewen, BMR(PT), Senior Physiotherapist, Physiotherapy Dept, St Boniface General Hospital, 409 Taché Ave, Winnipeg, Manitoba, Canada R2H 2A6. Brian A Anderson, MD, FRCP(C), Section Head, Section of Neurology, Dept of Medicine, St Boniface General Hospital. This content is only available as a PDF. © 1989 by the American Physical Therapy Association Inc.