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169 JNPT is Officially Indexed in MEDLINE!!. PDF (70 K)
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170 Center of Pressure Measures during Standing Tasks in Minimally Impaired Abstract
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181 Age- and Gender-related Test Performance in Community-dwelling Adults. HTML
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169 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

Journal of Editor’s Note: JNPT is Officially

Neurologic Indexed in MEDLINE!
Physical Judith E. Deutsch, PT, PhD, Editor JNPT
It is official, JNPT is indexed in MEDLINE. The national library of med-
Judith E. Deutsch, PT, PhD icine has confirmed that we meet all of the electronic formatting
PT Program
requirements for inclusion in the index.We were also notified that index-
Bergen Bldg, Rm 110
Executive ing will begin with the March 2005 issue. Only journals that are less than
P.O. Box 1709
3 years old are backward indexed.
Newark, NJ 07101-1709
(W) 973/972-2373
Committee When I accepted the position of Neurology Report Editor, I was
(Fax) 973/972-3717
PRESIDENT asked how long I would do it. I really had no idea but ventured to guess
Katherine Sullivan, PT, PhD
Dept. of Biokinesiology & PT that it would be a 5-year commitment. My long-term goal was to prepare
EDITORIAL BOARD University of Southern California the journal for indexing in MEDLINE. Five years seemed like a reasonable
1540 E Alcazar St, Chp-155
ABSTRACTS & REVIEWS Los Angeles, CA 90089-0103 time frame. I thought that in fact I had estimated quite well and with the
EDITOR (W) 323/442-2651
Kathleen Gill-Body, DPT, MS, NCS (FAX) 323/442-1515
publication of this issue I would complete 5 years of service, only to find
Boston, MA out that this was the sixth year! Now I am asked how much longer will
I stay on as Editor of JNPT? I still really do not know.We have a lot more
Edelle Field-Fote, PT, PhD Mike Studer, PT, MHS, NCS work to do with the journal. It relates to streamlining our operation and
Miami, FL Northwestern Rehabilitation
Associates transferring some of the responsibilities that have been shouldered by
James Gordon, PT, EdD 1380 Liberty St SE volunteers to paid staff as well as continuing to raise the level of the pub-
Los Angeles, CA Salem, OR 97302
(W) 503/371-0779 lication and increase access and communication related to the journal
Susan Herdman, PT, PhD, FAPTA (Fax) 503/371-0886 by improving our electronic venue.
Atlanta, GA
For now though, we can take a moment to reflect on achieving our
Patricia S. Pohl, PT, PhD SECRETARY goal of MEDLINE inclusion.This goal could only be achieved by working
Kansas City, KS Karen Mccullough, PT, PhD, NCS
Univ. of NC Chapel Hill with committed members of the Section. The Editorial Board and peer
Mark Rogers, PT, PhD Divisionof PT, CB 7135
Chicago, IL Chapel Hill, NC 27599-0001
reviewers and electronic media liaison (aka Jim Cavanaugh) formed the
(W) 919/843-8783 core of that group. Of course the authors who have worked patiently
Margaret Schenkman, PT, PhD (Fax) 919/966-3678
Denver, CO
with us and represent both the new and more seasoned contributors to
our field deserve credit as well. I think however, in the end, the reason
Rebecca Craik, PT, PhD, FAPTA Edelle Carmen Field-Fote, PT, PhD for being considered in MEDLINE has to do with the evolution of our
Glenside, PA University of Miami - PT specialty, neurologic physical therapy. The journal is just the reflection
5915 Ponce De Leon Blvd, 5th Floor
Carol Richards, PT, PhD Coral Gables, FL 33146-2435 of the Section and its members who are clinicians, educators, and re-
Quebec, Canada (W) 305/243-7119 searchers that can converge and benefit from our singular publication.
(Fax) 305/284-6128
Sharon Klinski
Orthopaedic Section,APTA PROGRAM CHAIR
2920 E Ave S, Suite 200 Dorian Rose, PT, PhD
LaCrosse,WI 54601-7202 N Florida/S Georgia Veterans-
(W) 608/788-3982, ext 202 Health System
(Fax) 608/788-3965 1601 SW Archer Rd (151 B) Gainesville, FL 32608-1197
(W) 352/376-1611, ext 4955
WEB MASTER (Fax) 352/271-4540
CaduceusWebs Co.
P.O. Box 2272
Tallahassee, FL 32316 EDITOR
800/951-9327 Judith E. Deutsch, PT, PhD
Janice M. Ford
Neurology Section
1111 N Fairfax Street
Alexandria,VA 22313
(W) 1-800/999-2782, ext 3237
(FAX) 703/706-8575
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 170

Center of Pressure Measures during Standing Tasks in Minimally

Impaired Persons with Multiple Sclerosis
Gregory M. Karst, PT, PhD;1 Dawn M.Venema, PT, MPT;2 Tammy G. Roehrs, PT, MA, NCS;3 Amy E. Tyler, PhD4

ABSTRACT tations of neurological dysfunction.1-3 People with MS often

Background and Purpose: Balance impairments are experience difficulty with mobility, extremity function,
common in persons with multiple sclerosis (MS), but clini- somatosensation, vestibular function, vision, cognition, and
cal balance tests may not detect subtle deficits in adults bowel and bladder control.1-3 Balance is the result of complex
with MS who are not yet experiencing functional limita- interactions between musculoskeletal and neuromuscular
tions or disability. The purpose of this study was to deter- systems, including sensory, motor, and integrative compo-
mine if center of pressure (COP) displacement during nents.5,6 Because these components are frequently affected
standing tasks could be a useful performance-based evalua- by MS, many persons with MS have balance deficits.2,3,7-11
tive measure for adults with MS who have minimal or no One objective of rehabilitative interventions for persons
balance deficits on clinical examination using the Berg with MS is to address balance impairment.12-14 Clinically
Balance Scale (BBS). Subjects and Methods: Twenty-one based tests such as the Berg Balance Scale (BBS), Tinetti
adults with MS were compared with 21 age- and gender- Performance Oriented Mobility Assessment, and Functional
matched healthy adults. Subjects with MS were tested with Reach test, among others, have been used to test balance
the BBS, Mini-mental State Exam, Expanded Disability Status impairment and functional mobility in persons with
Scale (EDSS), and Multiple Sclerosis Functional Composite MS.9,11,12,15,16 These measures indicate whether or not an indi-
(MSFC). They also performed voluntary leaning and reach- vidual can perform a given task and can identify individuals
ing movements while kinematic and kinetic data were col- at risk for falls. However, they may not be sensitive to min-
lected. Control subjects performed the same tasks with the imal impairments of balance in those persons not yet expe-
exception of the EDSS and MSFC. Results: COP displace- riencing functional limitations or disability. An assessment
ment during reaching and leaning was less in adults with of balance that could identify subtle impairments before
MS when compared to control subjects. There were no dif- they lead to functional decline could promote earlier inter-
ferences in anthropometric, kinematic, or foot position vari- vention and possibly prevent or delay functional limitation
ables that could account for this difference. Furthermore, and disability.
there was no difference between groups when COP dis- Laboratory measures offer the potential to identify sub-
placement during reaching was expressed as a percentage tle deficits in postural control that may not be otherwise
of the maximum COP displacement during leaning. apparent based on clinical tests.17 Force platforms are one
laboratory assessment tool that have been used to assess
Discussion and Conclusion: COP measures show clear
differences when comparing healthy adults with minimally postural control in individuals with MS during quiet stance
conditions7-10,18 or in dynamic conditions, namely in
impaired adults with MS. The lack of between-group differ-
response to external perturbations such as support surface
ences when COP displacement during reaching was
movements.8,10,19 In individuals with MS who demonstrate
expressed as a percentage of the maximum COP displace-
minimal or no balance impairment on clinical exam, some
ment during leaning suggests that the subjects with MS
studies have shown force plate measures in static and
adopt a reaching strategy that allows them to stay within
dynamic conditions to be sensitive to subtle balance impair-
their reduced limits of stability. COP measures during
ments.8,10,18,19 However, some studies have shown static
standing tasks appear well-suited to quantifying changes in
stance to be less discriminating than dynamic testing.
postural control over time or in response to intervention for
Nelson et al identified abnormal scores with sensory orga-
minimally impaired persons with MS.
nization testing in only 30% of subjects with MS in a ‘high
Key Words: balance, reaching, postural control function’ group (defined as those who scored at least 24 out
of 26 points on the Tinetti Performance Oriented Mobility
INTRODUCTION Assessment).9 Similarly, Daley and Swank found only 6% of
Multiple sclerosis (MS) is a chronic neurological disease subjects with MS who were free from functional limitations
characterized by demyelination and inflammation of the cen- had abnormal sway in quiet stance with eyes open, and this
tral nervous system (CNS).1-4 The often progressive nature percentage increased to only 15% when the same subjects
and variable sites of CNS involvement lead to varied presen- stood with eyes closed.7 These results suggest that force
Associate Professor and Associate Director, Division of Physical Therapy Education, University of Nebraska Medical Center,
Omaha, NE (
Graduate Teaching Assistant, Division of Physical Therapy Education, University of Nebraska Medical Center
Assistant Professor, Division of Physical Therapy Education, University of Nebraska Medical Center
was an Assistant Professor, Division of Physical Therapy Education, University of Nebraska Medical Center
171 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

plate measures under static conditions may not be a very of MS,31 our subjects were recruited before these criteria
sensitive measure in minimally impaired persons with MS,7- were published.) We operationally defined ‘minimal or no
but that dynamic testing shows promise.8,10,19 balance impairment’ as a score of 48 or greater on the BBS
In contrast to testing postural control in response to based on our desire to have some heterogeneity in our sam-
external perturbations of the support surface, no studies to ple of subjects with MS while avoiding subjects likely to
date have used a force platform to assess postural control in require an assistive device.15 As such, exclusion criteria
persons with MS during voluntary movements such as those included a score on the BBS less than 48 out of 56, a score
used during performance of daily activities. Voluntary upper on the Mini-mental State Exam (MMSE) less than 20 out of
extremity movements cause internally-generated perturba- 30, the presence of coexisting neurological or orthopedic
tions to balance due to inertial effects and changes in the conditions that limited the subjects’ ability to perform the
position of the center of mass. It has been well documented testing protocol, or the use of an assistive device while
that there is an anticipatory phase of postural activity in the standing or walking. Twenty-one subjects with MS, 15
trunk and lower extremities prior to the initiation of arm women (44.1 ± 8.38 years) and 6 men (50.2 ± 8.61 years)
movements in standing.20-27 These anticipatory postural met the criteria for the study and were tested.
adjustments (APAs) include EMG activity in the trunk and Control subjects were recruited through advertisements
legs20-25,27 and changes in kinetic variables measured by a force on the UNMC campus and website, and the local newspa-
platform.20-22,24,26 Researchers have hypothesized that the CNS per. Recruitment of control subjects followed the recruit-
employs APAs to provide postural control in anticipation of ment and testing of subjects with MS, so that control sub-
the potentially destabilizing effects of the arm movement.20-23 jects could be age- (± 2 years) and gender-matched. Control
One laboratory measure that can reflect an attempt by subjects were eligible to participate if they met the same
the CNS to maintain an upright posture is the center of inclusion criteria as the subjects with MS, with the excep-
pressure (COP).22,24-27 Center of pressure is the point of tion of having a diagnosis of MS. The same exclusion crite-
application of the vertical ground reaction force.28 The COP ria also applied to the control group. Twenty-one control
displacement can be determined while subjects stand qui- subjects, 15 women (45.3 ± 8.56 years) and 6 men (49.7 ±
etly on the force platform, or as they respond to perturba- 8.41 years) met the criteria for the study and were tested.
tions, either internal or external, imposed on their bodies. The study protocol was approved by the UNMC
Assessing COP displacement during a task such as standing Institutional Review Board. All subjects provided written
and reaching provides a means for assessing postural con- informed consent prior to participating in testing proce-
trol in response to internally-generated perturbations in the dures, and all subjects participated in 2 testing sessions.
context of a common functional activity.
The purpose of this study was to determine if the labora- Clinical Measures
tory measure of COP displacement during standing reaches Berg Balance Scale
could identify subtle changes in postural control in a group The performance-based BBS consists of 14 tasks, with
of individuals with MS who showed minimal or no balance performance rated on each task from 0 (cannot perform) to
deficits on clinical examination using the BBS. The task we 4 (normal performance) for a total of 56 possible points.32
analyzed consisted of standing and reaching to various dis- The BBS has been shown to be a reliable32 and valid33 pre-
tances, both within and beyond arms’ length. We also exam- dictor of fall status in older adults and patients with acute
ined limits of stability as reflected by the maximum COP stroke. When combined with fall history, it has been shown
excursion in the sagittal plane while the subjects voluntarily to be a powerful predictor of fall risk in community-
leaned as far anterior and posterior as possible without loss dwelling older adults.34 Reliability and validity of the BBS
of balance. We hypothesized that the COP displacement vari- have not been established in persons with MS. However,
ables during rapid, bilateral reaching movements and leaning the BBS has been found to change in response to rehabili-
movements would be different in minimally impaired sub- tation in adults with clinically stable MS.12 Also, a prelimi-
jects with MS when compared to a control group consisting nary study found a modest correlation (r = -0.498) between
of age- and gender-matched adults with no known orthope- the BBS score and self-reported falls in this population, as
dic or neurological impairments. A preliminary report of well as a difference in mean BBS score between adults with
these results has been published in abstract form.29 MS who used an assistive device (mean = 42.1) and those
who did not (mean = 49.3).15
METHODS Mini-mental State Exam
Subjects The MMSE is a 7-item test of general cognitive ability.35
Subjects with MS were recruited through the University Possible scores range from 0 to 30, with higher scores indi-
of Nebraska Medical Center (UNMC) MS clinic. Potential cating better cognition.
subjects were required to have a definite diagnosis of MS,30
be able to stand unassisted for 5 minutes, and be able to Expanded Disability Status Scale
reach forward with both arms in standing without assis- The Expanded Disability Status Scale (EDSS) is an 11-
tance. (Although there are newer criteria for the diagnosis point scale (0 = normal neurological examination; 10 =
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 172

death due to MS) of general impairment and disability spe- during testing and so that individual characteristics such as
cific to persons with MS.36 The EDSS has been widely used foot length and position could be determined. A research
for many years to classify disease severity,37 but it has been assistant stood by the subject during testing to ensure main-
criticized because it is an ordinal scale based on subjective tenance of foot position as well as to assist the subject in the
evaluation,38 it has poor inter-rater reliability,39,40 and it event of a loss of balance. Signals were collected for the ver-
mixes components of impairment and disability.39,40 tical ground reaction force (Fz) and the moment of force
Additionally, the EDSS appears to be less sensitive to about the mediolateral axis (Mx). Center of pressure move-
changes in function than other scales.41-43 We included the ment in the sagittal plane (COPy) was calculated using the
EDSS, despite its limitations, to allow for comparison with following equation: COPy = Mx/Fz.
prior studies that have characterized persons with MS in
terms of EDSS scores. Kinematic data
In order to assess movement velocity, 3-dimensional
Multiple Sclerosis Functional Composite kinematics of the hand were recorded using the WATS-
Due to the limitations of the EDSS, the Multiple Sclerosis MART 2-camera infrared motion analysis system (Northern
Functional Composite (MSFC) was devised as a multidi- Digital, Waterloo, ON, Canada) with an infrared emitting
mensional tool to reflect the varied clinical presentations of diode (IRED) placed on the left index fingertip. The 2 cam-
MS.37 It consists of 3 performance tests that measure 3 clin- eras were placed approximately 3 m away from the subjects
ical dimensions of function: a Timed 25-Foot Walk (leg func- and oriented at approximately 60º apart. The cameras were
tion), the 9-Hole Peg Test (arm and hand function), and the calibrated prior to data collection according to the manu-
Paced Auditory Serial Addition Test (cognitive function). facturer’s specifications using a cubic calibration frame, and
The scores from these 3 dimensions are combined to form calibration parameters were deemed acceptable if the over-
a composite Z-score that can be used to detect change over all root-mean-square error for marker positions was less
time relative to the general population of persons with MS. than 5 mm.

Laboratory Measures Data capture

Accelerometry MP100 Workstation hardware and Acknowledge® soft-
The TSD 109C tri-axial piezoelectric accelerometer (out- ware (BIOPAC Systems, Inc., Santa Barbara, Calif) were used
put ± 5g, 400 mV/g; BIOPAC Systems, Inc., Santa Barbara, with one computer system to collect and store signals from
Calif) was calibrated prior to data collection according to its the accelerometer, target circuit, and force platform ampli-
manufacturer. The accelerometer was attached to the radial fier. These signals were all sampled at a rate of 1000 Hz
side of each subject’s left wrist, with one of its axes ori- using a 16-bit analog-to-digital converter. Electromyograph-
ented in the sagittal plane and perpendicular to the long ic data were collected simultaneously, but will be reported
axis of the forearm. Onset of arm movement was deter- in a separate communication. A second computer system
mined from the signal from this axis. was used to collect and store kinematic data from the
infrared motion analysis system using WATSMART hardware
Target and software. These signals were sampled at 250 Hz. Data
The target consisted of two 7.6 cm by 15.2 cm carbon collection was synchronized between the two systems
rubber electrodes mounted individually to a flexible foam using a 5-volt electronic trigger signal.
bar attached to a free-standing, lightweight metal frame.
The frame could be adjusted so that the target was at shoul- Testing Procedure
der height and at appropriate distances for each subject. Test sessions for subjects with multiple sclerosis
Two targets were used to promote symmetrical reaching During the first test session, each subject with MS under-
with both hands, however contact data were collected from went a neurological examination consisting of the adminis-
only the left target. Subjects wore a metal thimble on their tration of the EDSS and the MMSE by a board-certified neu-
left index finger. Touching the thimble to the target closed rologist. The neurologist determined subjects’ ability to
a low-voltage circuit to indicate target acquisition. perform the standing and reaching task, and interviewed
them about current medications, age of onset, recent
Force platform (within 6 months) fall history, and relevant orthopedic con-
During the leaning and reaching movements, subjects ditions. Additional clinical tests during the first test session
stood on a strain gauge force platform (Advanced Mechanical included the BBS and MSFC, both conducted by a licensed
Technology, Inc.,Watertown, Mass) with their feet in a com- physical therapist.
fortable stance and arms resting at their sides with their Within 7 days of the clinical test session, subjects with
palms facing medially. Subjects were barefoot to minimize MS returned for a second testing session to collect labora-
variability in performance that may occur due to differences tory data. Three items from the BBS were repeated to deter-
in footwear. The position of each subject’s feet on the force mine the stability of the subject’s balance performance
platform was marked to maintain consistent foot position across test sessions. These items were: Item 1, sitting to
173 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

standing; Item 8, reaching forward with outstretched arm; and neurologic health was confirmed by the same board-
and Item 14, standing on one foot. Arm’s length (AL) was certified neurologist that examined the subjects with MS.
measured from the acromion to the tip of the index finger, The second testing session occurred within 60 days of the
and height measurements were taken. first test session. At the second test session, a licensed phys-
The first laboratory task consisted of anterior and poste- ical therapist administered the BBS and the MMSE. Testing
rior leans. The subjects stood on the force platform and of leaning and reaching movements for control subjects
were instructed to lean as far forward and backward as pos- involved the same instrumentation and protocol as that
sible without falling and to hold this position for 5 seconds. described for subjects with MS.
Subjects were asked to keep their feet flat on the floor and
Data Reduction
aligned with respect to the frontal plane, but stance width
Foot position data
and toe-out were not dictated to the subjects. Center of
Figure 1 provides operational definitions for foot posi-
pressure movement in the sagittal plane measurements
tion characteristics from one representative control sub-
were recorded for a total of 4 leaning trials, 2 backward and
ject. The following variables were determined from the foot
2 forward.
tracings for all subjects: foot length (the distance from the
The second laboratory task consisted of a series of
great toe to the mid-point of the calcaneus), toe distance
reaching movements performed from the same stance posi- (the distance between the great toes), heel distance (the dis-
tion as the leaning trials with the eyes open. Following the tance between the mid-points of the calcanei), and anterior-
indication that the subject was ready, data collection was posterior base of support (AP BOS; the sagittal plane dis-
initiated after a random interval of 1 to 3 seconds. Five hun- tance between the most anterior and most posterior point
dred milliseconds (ms) after the initiation of data collection, of contact on the force plate). Foot position was defined as
an audible tone was generated as the signal for the subject the ratio of in- or out-toeing determined by dividing the toe
to perform the movement. The subject was instructed to distance by the heel distance, with ratios greater than one
reach forward with both arms to touch a target placed at indicating a toe-out position.
shoulder height. The subject was told to move as fast as
possible to minimize variation in the reaching activity,44 but
Toe Distance
that reaction time in response to the tone was not impor-
tant. The final reach position was held until the 3 second
data collection period was complete. Subjects were pro-
vided opportunities to rest at any point during testing.
Five reaches were performed to each of 7 different tar-
get distances, some within and some beyond AL. In order to
place the target at AL and control for differences in the
amount of scapular protraction the subjects may have used Foot Length
to reach the target, a rigid yardstick was used to measure
from the anterior aspect of each subject’s acromion to the
target as the subject stood on the force platform with their
arms held at their side. Distances of the target beyond and
Heel Distance
within AL were then determined from the AL position using
a tape measure placed on the floor under the frame on Figure 1. Foot tracing for a representative control subject with
operational definitions for foot placement characteristics. Foot
which the target was mounted. Target distance varied by 5 length is defined as the distance from the great toe to the mid-point
cm increments from AL minus 10 cm to AL plus 20 cm (AL- of the calcaneus. Heel distance is defined as the distance between
10, AL-5, AL, AL+5, AL+10, AL+15, AL+20). A Latin Square the mid-point of the calcanei. Toe distance is defined as the dis-
tance between the great toes. Anterior-posterior base of support
design45 was used to vary the order of target distance across
(AP BOS) is defined as the sagittal plane distance between the most
subjects. One subject with MS (subject M13) was unable to anterior and most posterior point of contact on the force plate.
safely reach the furthest target distance, and therefore per-
formed only 30 reaches to 6 target distances. Subjects were Kinematic data
allowed up to 5 practice reaches to the AL+10 distance Three-dimensional position data from the IRED placed at
prior to data collection. If visible movement of the subject’s the tip of the index finger were low pass filtered (12 Hz)
arms or trunk occurred prior to the auditory ‘go’ signal, if and differentiated to determine peak tangential velocity of
the movement appeared markedly slower than other trials the fingertip and time to peak tangential velocity relative to
at the same distance, or if the target was missed, the trial movement onset for each trial. Averages of peak tangential
was repeated. velocity and time to peak tangential velocity for each reach
distance for each subject were calculated. The two groups
Test sessions for control subjects were compared across distances.
Control subjects also participated in 2 testing sessions. Arm movement onsets were identified for each trial for
During the first session, the control subjects’ orthopedic each subject from the accelerometer signal using a com-
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 174

puter algorithm. The algorithm identified peak wrist accel-

eration, and then searched backwards in time to when the
acceleration trace first exceeded the baseline. Baseline of
the acceleration trace was defined as the mean value of the
signal over the first 250 ms of the sampling period (the sam-
pling period having started 500 ms prior to the tone). The
onsets identified by the computer were visually confirmed
by one of the investigators. If the onset was uncertain
because of artifacts that may have been due to backward
movement of the hand or slow hand movement prior to
onset of the reach, the trial was rejected. Out of a total of
1465 trials, 27 (2%) were rejected because of difficulties in
identifying the onset of arm movement.
Kinetic data
Center of pressure movement in the sagittal plane data
were averaged for the reaching trials to each distance (max-
imum of 5 trials, minimum of 3 trials to each distance) rela-
tive to the onset of arm movement and examined for peak-
to-peak and net displacement in the sagittal plane. Figure
2A shows the change in COPy position over time (0 cm =
initial starting position of the subject) during reaching to
distance AL+20 for one representative healthy subject. This
trace represents the average of 5 reaches, aligned to the
onset of arm movement (time = 0 ms), and illustrates how
COPy displacements were calculated. Negative values
(COPy-) represent movement of COPy in the posterior
direction, and positive values (COPy+) represent movement
of COPy in the anterior direction. Peak-to-peak COPy dis-
placement was defined as the difference between the max-
imum COPy- and COPy+ positions. Net COPy displacement Figure 2. A. Change in center of pressure in the sagittal plane
was defined as the difference between the COPy position in (COPy) position over time during reaching to a distance of arm’s
the subject’s initial resting posture and the COPy position length plus 20 cm (AL+20). Data are from a representative control
subject. The trace represents the average of five trials to this dis-
in the final reach posture. Initial COPy position was calcu- tance. The x-axis depicts time in ms, with the five trials aligned so
lated as the mean value over 250 ms prior to the ‘go’ signal that zero ms is the point in time that arm movement began. The
and final COPy position was based on the mean value over y-axis shows COPy position in cm relative to the initial starting
250 ms after the subject had attained the final reach pos- position (0 cm) of the subject. Negative values (COPy-) indicate
movement of the subject’s COPy in the posterior direction, while
ture. When comparing groups, the peak-to-peak and net positive values (COPy+) indicate movement in the anterior direc-
COPy displacements were adjusted for each subject to tion. The dotted lines indicate the initial and final COPy positions.
account for differences in foot length and placement by The initial COPy position was calculated as the mean value over
dividing these values by the subject’s AP BOS. 250 ms prior to the “go” signal. The final COPy position was deter-
mined from the mean value over 250 ms after the subject had
Figure 2B shows COPy position data from one represen- attained the final reach posture. COPy net is the difference
tative subject with MS during 2 leaning trials (1 backward between the initial and final positions of COPy. Dashed lines indi-
and 1 forward). Zero on the x-axis represents the initial cate the maximum COPy- and COPy+ positions. COPy peak-to-
starting position of the subject. Changes in COPy position peak is the difference between the maximal COPy- and COPy+
positions. COPy+ and COPy- are calculated relative to the initial
in the positive direction on the y-axis represent anterior COPy position. B. Changes in COPy position for a representative
leans, while posterior leans result in negative values of subject with MS during leaning trials. Data are shown for 2 leans,
COPy position. The limit of stability in the anterior-poste- one anterior and one posterior. Data were collected for a total of
rior direction (LOSAP) was defined as the difference 5 seconds (x-axis). The y-axis depicts COPy position relative to the
initial starting position (0 cm) of the subject. The limit of stability
between a subject’s most anterior and most posterior posi- in the anterior-posterior direction (LOSAP) is defined as the differ-
tion of the COPy during the leaning trials. The percentage ence between the most anterior and most posterior position of the
of the LOSAP used during the reaching task was also calcu- COPy during the leaning trials.
lated as: (peak-to-peak COPy/LOSAP) x 100.
had an influence on the task: height, arm length, foot
Statistical Analysis length, foot position, and AP BOS. Paired two-tailed t-tests
Paired two-tailed t-tests were used to compare the 2 were also used to compare groups on LOSAP during the lean-
groups of subjects on the following variables that may have ing trials. Two-way ANOVAs (group x target distance) with
175 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

one repeated measure (target distance) were used to evalu- Table 1. General Characteristics of Subjects. Subjects were matched for
age (± 2 years) and gender. Groups did not differ on other variables listed.
ate group differences and the effects of target distance on
COPy net, COPy+, COPy- and COPy peak-to-peak displace- Control Subjects Subjects with
Multiple Sclerosis
ment, percentage of LOSAP used during the reaching task,
Gender 6M/15F 6M/15F
peak tangential velocity of the fingertip, and time to peak
Age (years)
tangential velocity of the fingertip. Tukey’s test was used for (mean ± SD) 46.6 ± 8.8 46.0 ± 8.7
post-hoc multiple comparisons for the variable of reach dis- (range) 28 – 65 28 - 65
tance. The alpha level was set at P ≤ 0.05. Microsoft® Excel Height (cm)
2002 (Microsoft Corporation, Redmond,WA) and SigmaStat (mean ± SD) 169.3 ± 8.4 169.3 ± 8.7
(range) 153.7 – 185.4 156.2 – 185.4
for Windows Version 2.03 (SPSS, Inc., Chicago, Ill) were used
for data analysis. Arm Length (cm)
(mean ± SD) 73.4 ± 3.7 73.5 ± 4.7
(range) 67.3 – 81.3 66.0 – 83.8
RESULTS Foot Length (cm)
Subject Characteristics (mean ± SD) 25.4 ± 1.6 26.0 ± 1.4
Descriptive characteristics (mean ± SD) for all subjects (range) 22.9 – 28.5 23.9 – 28.8
are listed in Table 1. Subjects were matched for age (± 2 Foot Position (toe
distance/heel distance)
years) and gender. Paired two-tailed t-tests revealed that (mean ± SD) 1.41 ± 0.31 1.24 ± 0.36
subjects with MS did not differ from control subjects on any (range) 0.98 – 2.33 0.81 – 2.35
of the other variables listed in Table 1. AP BOS* (cm)
Table 2 provides clinical characteristics for all subjects (mean ± SD) 25.9 ± 1.8 26.7 ± 1.5
(range) 23.4 – 29.4 24.1 – 29.4
with MS. These subjects scored well on the various clinical
*AP BOS = anterior-posterior base of support (the sagittal plane
tests. Ten out of the 21 subjects scored the maximum num- distance between the most anterior and most posterior point of
ber of points (56) on the BBS, with a median score of 55 contact on the force plate)

Table 2. Clinical Characteristics of Subjects with Multiple Sclerosis

Subject Gender Age Fall History* EDSS† BBS‡ MMSE§ MSFC||
M1 M 43 0 2.0 56 24 -0.25
M2 F 53 0 0.0 54 28 -0.06
M3 F 48 0 0.0 56 30 0.41
M4 F 48 0 6.0 48 30 -1.37
M5 M 45 0 1.5 56 30 0.19
M6 F 29 0 0.0 56 30 0.62
M7 M 45 2 0.0 56 30 0.77
M8 M 51 0 3.5 53 30 -0.27
M9 F 44 0 2.5 55 30 -0.06
M10 F 43 0 3.0 53 30 -0.85
M11 M 55 0 4.0 56 30 0.37
M12 F 44 0 2.0 56 29 0.24
M13 M 66 0 1.5 53 30 0.23
M14 F 34 0 2.0 56 30 0.76
M15 F 45 0 1.5 56 30 0.72
M16 F 57 0 4.0 52 30 0.42
M17 F 46 2 2.5 56 27 0.16
M18 F 39 0 0.0 54 30 0.17
M19 F 30 5 3.0 51 30 0.34
M20 F 53 0 3.0 50 30 0.04
M21 F 52 0 2.5 55 30 0.84
Mean 2.1 54.2 29.4 -0.16
SD 1.6 2.3 1.5 0.54
Median 2.0 55 30 0.23
Range 0.0 – 6.0 48 - 56 24 - 30 -1.37 – 0.84
* Number of falls within the previous 6 months as reported by the subject
† Expanded Disability Status Scale; range of 0 – 10; a higher score indicates greater impairment and disability
‡ Berg Balance Scale; range of 0 – 56; a higher score indicates better balance performance
§ Mini Mental State Examination; range of 0 – 30; a higher score indicates better cognitive performance
|| Multiple Sclerosis Functional Composite overall z-score; a positive score indicates function better than the average for persons with multiple sclerosis
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 176

(one control subject scored 55, all other control subjects

scored 56 on the BBS). The median score on the EDSS was
2.0 on a scale of 0 to 10, with lower scores indicating bet-
ter function. Fifteen of the 21 subjects with MS had a posi-
tive MSFC overall z-score, indicating function better than
the average of the general population of persons with MS.
The subjects with MS also appeared stable in their per-
formance between sessions on the BBS. During the second
test session, only 4 subjects differed on the 3 items that
were repeated, and only by one point each.
Kinematic variables
There were significant main effects of reach distance on
peak tangential velocity of the fingertip and time-to-peak
tangential velocity (P < 0.001 for each variable). There was
no between-group difference in peak tangential velocity or
time-to-peak tangential velocity, and no group x distance
Center of Pressure Movement in the Sagittal Plane:
Lean Trials
Table 3 shows the mean (± SD) of LOSAP during the max-
imum anterior and posterior lean trials for both groups.
When leaning, the control subjects moved their COPy over
a greater (P = 0.008) distance (14.2 ± 2.6 cm) than the sub-
jects with MS (11.9 ± 2.9 cm). There was also a difference
(P = 0.002) between groups when the AP BOS was taken
into account and the LOSAP was expressed as a percentage
of the base of support.

Table 3. Group Differences During Lean Trials. Control subjects

demonstrated a larger LOSAP (p = 0.008) than subjects with MS. This dif-
ference was also apparent when the AP BOS was taken into account (p =
Group LOSAP* (cm) LOSAP/ AP BOS† (%)
(mean±SD) (mean±SD)
Subjects with Multiple
Sclerosis (n =21) 11.9 ± 2.9 44.8 ± 10.9
Control Subjects (n = 21) 14.2 ± 2.6 54.6 ± 9.3
* LOSAP = Limit of Stability in the Anterior-posterior Direction
† AP BOS = Anterior-posterior Base of Support

Center of Pressure Movement in the Sagittal Plane:

Reach Trials Figure 3. A. Mean net COPy displacement for both groups during
reaches to each distance. Reach distance in cm relative to arm’s
Figure 3A depicts mean (± SD) net and Figure 3B shows length is depicted along the x-axis. Reach distances varied by 5 cm
mean (± SD) peak-to-peak COPy displacements for both increments and ranged from 10 cm short of arm’s length to 20 cm
groups of subjects across reach distances after AP BOS was beyond arm’s length. (AL-10, AL-5, AL, AL+5, AL+10, AL+15, AL+20).
taken into account. For both groups, COPy net displace- COPy displacement is expressed as a percentage of each subject’s
AP BOS and is represented along the y-axis as means (±SD) of each
ment increased as target distance increased (P < 0.001), but group. The black bars represent subjects with MS and the white
there was no difference between groups and no group x bars represent control subjects. B. Mean peak-to-peak COPy dis-
distance interaction. Figure 3B illustrates that there was a placement for both groups during reaches to each distance. Axes
difference in peak-to-peak COPy displacement between are the same as in Fig 3A. The black bars represent subjects with
MS, while the white bars represent control subjects. C. Mean per-
groups (P < 0.001), with control subjects showing greater centage of LOSAP used during reaching for both groups to all target
peak-to-peak COPy displacement. The greater peak-to-peak distances. The x-axis is as in Figure 3A. The percentage of LOSAP
COPy displacement in the control group was primarily due used during reaching was calculated by dividing the COPy peak-to-
to a significant difference in COPy+, while COPy- did not peak displacement during reaching by the LOSAP determined from
the leaning trials for each subject. These values are expressed as
differ significantly between groups. Peak-to-peak COPy dis- means (±SD) for each group along the y-axis. The black bars rep-
placement increased as target distance increased (P < resent subjects with MS, while the white bars represent control
0.001), but there was no group x distance interaction. subjects.
177 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

The percentage of the LOSAP used during the reaching study and did not find a difference between groups. We fur-
task was evaluated for each group. Figure 3C illustrates the ther controlled for this variable by dividing each subject’s
mean (± SD) percentage of the LOSAP used for peak-to-peak LOSAP and COPy displacements by their AP BOS before com-
COPy displacement during the reaching task to each dis- paring groups. Additionally, there was no difference
tance. Percentage of LOSAP used increased as target distance between groups in foot position variables (heel distance,
increased, with means approaching 100% for both groups toe distance, or ratio of toe distance to heel distance).
for the longest distance. For the longest reaches, some indi- Therefore, differences in stance configuration cannot
vidual subjects in each group demonstrated peak-to-peak account for differences in LOSAP or peak-to-peak COPy
COPy displacement greater than the LOSAP they demon- between the two groups.
strated during the leaning task. There was an effect for Greater arm velocity during reaching movements is asso-
distance on the percentage of LOSAP used during reaching ciated with earlier activation of postural muscles and
(p < 0.001), but there was no difference between groups greater response magnitude.44 However, in our study, kine-
and no group x distance interaction. matic variables of peak tangential velocity of the fingertip
and time to reach peak tangential velocity did not differ
Secondary Analysis of Center of Pressure Movement between groups. Consequently, the greater COPy excur-
in the Sagittal Plane During Reaching sions observed in healthy individuals do not appear to be
A secondary analysis was performed in order to deter- due to differences in movement speed.
mine if significant differences in COPy measures could still The Functional Reach (FR) was developed as a test of
be seen when comparing healthy subjects to those subjects balance in response to the voluntary movement of reach-
with MS who had the least balance impairments based on ing, and was found to correlate with COP excursion (r =
BBS scores. To do this, we divided the subjects into 3 0.71).47 Frzovic et al found that the FR was a useful test to
groups: Healthy subjects with a BBS score of 55 or 56 (n = differentiate between adults with MS and control subjects.11
21; 1 with a BBS score of 55), subjects with MS and a BBS In contrast to the relatively slow, unilateral reaches per-
score of 55 or 56 (n = 12; 2 with a BBS score of 55), and sub- formed in the FR test, the reaching task used in this study
jects with MS and a BBS score < 55 (n = 9; mean ± SD BBS was intended to produce greater postural control demands
score of 52 ± 2). Both groups with MS still differed signifi- during a task of reaching while standing. Horak et al found
cantly (P ≤ .02) from the Healthy group on COPy peak-to- that postural muscle activity was more variable, was some-
peak and COPy+ measures. The mean values for 2 groups times absent, and did not always precede arm movement
with MS did not differ significantly, but the test was under- when subjects were asked to raise their arms slowly com-
powered after dividing the subjects with MS into 2 groups. pared to quick arm movements.44 They speculated that less
stabilization force is necessary during low velocity move-
DISCUSSION ments. While the FR is destabilizing in that subjects must
We found differences in COPy measurements between a displace their center of mass to perform reaches to their
group of minimally impaired adults with MS and age- and maximal distance, the rapid arm movements used in this
gender-matched control subjects, during rapid reaches to study would generate larger inertial forces in addition to dis-
various target distances and during leaning movements. placing the body center of mass. Furthermore, consistent
These differences persisted even when the control subjects with previous findings,20-22,24,26 changes in COPy occurred
were compared only to the 12 subjects with MS who prior to the internal perturbation of rapid arm movement,
scored the highest (55 or 56) on the BBS. Specific variables indicating anticipatory behavior. Thus, we would suggest
that these groups differed on included their LOSAP during that the rapid, goal-directed reaching paradigm used in this
maximum leans and their peak-to-peak COPy and anterior study provides additional information not gained with the
(COPy+) displacement during the reaching tasks. These dif- FR alone.
ferences cannot be explained by differences in anthropo- Subjects with MS demonstrated smaller LOSAP than our
metric variables, differences in foot position, or differences control group. The smaller LOSAP demonstrated by subjects
in movement kinematics as assessed by peak tangential with MS in our study suggests that our subjects were less
velocity of the fingertip and time to peak tangential veloc- willing and/or able to deviate from their initial COP posi-
ity. tion in the sagittal plane when compared to individuals
Variations in foot position in quiet standing have been with no neurological impairment, indicating a voluntary or
found to affect postural sway and mean position of COP.46 involuntary self-limiting strategy. Interestingly, there were
Kaminski and Simpkins26 found increases in COPy displace- no differences between groups in the percent of LOSAP used
ments in healthy subjects using a step stance (right foot for peak-to-peak COPy displacement during the reaching
ahead of the left at a distance equal to 40% of leg length), tasks. For both groups, percent of LOSAP used during reach-
when compared to subjects in parallel stance during stand- ing increased as target distance increased, nearing 100% for
ing reaches to distances greater than AL. They suggested the the longest distances. The fact that there was no difference
increase in COPy displacement occurred to assist whole between groups on this variable suggests that the subjects
body motion to the target. We examined AP BOS in our with MS were instinctively aware of their limitations, and
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 178

were able to find a strategy to achieve the same task as the subjects on COPy variables, implying that the BBS had a ceil-
controls, despite their decreased LOSAP. ing effect and failed to detect subtle balance deficits in this
Reach distance had a main effect for many of the vari- population. Other studies have suggested a ceiling effect in
ables in our study, including net COPy displacement, peak- the BBS with elderly persons.48,49 Furthermore, the BBS may
to-peak COPy displacement, COPy+ and COPy- displace- lack sensitivity to change for subjects such as those in our
ment, percentage of LOSAP used during reaching, peak study, with little room left for improvement in response to
tangential velocity of the fingertip, and time to peak tan- intervention.
gential velocity of the fingertip. Systematic differences in The instrumented measures used here may be more sen-
COPy displacement with reach distance have been previ- sitive than common clinical tests for objectively document-
ously found in healthy young adults25-27 as well as healthy ing both deficits and improvements in balance. With force
elderly.25 In these studies, COPy trajectories were qualita- plate technology becoming more common in physical ther-
tively similar across reach distances, with COPy initially apy clinics, these variables would be easy to capture as part
moving posteriorly, then anteriorly, then to a relatively of a physical therapy examination. Because MS is a pro-
steady final position. In addition, these authors found that gressive disease, tools to measure balance impairments dur-
as target distance increased, net and peak-to-peak COPy dis- ing early stages of the disease may lead to identification of
placement increased. Our findings are consistent with persons at risk for future decline and lead to earlier inter-
these qualitative patterns of COPy during reaching as well vention.
as the main effect of reach distance on net and peak-to-peak
COPy displacement. In addition, we found the qualitative CONCLUSION
pattern of the COPy displacement during reach to be iden- Our data demonstrate that peak-to-peak COPy and
tical in all subjects tested, regardless of whether or not they COPy+ displacement during reaching, as well LOSAP during
had a diagnosis of MS. leaning, are less in minimally impaired adults with MS than
In the interest of simplicity, we chose not to report each in age- and gender-matched control subjects. However,
pair-wise difference found with post-hoc testing. In gen- there was no difference between these groups when the
eral, differences were found between most pairs of reach COPy displacement during reaching was expressed as a per-
distances for all of the COPy variables, with the exception centage of the LOSAP during leaning. This suggests that per-
of the two shortest distances (AL-10 and AL-5). This finding sons with minimal impairments due to MS were instinctively
is in agreement with previous studies of healthy sub- aware of their limitations, and were able to find a strategy to
jects.25,27 We suggest that in future studies, the task could be achieve the same task as the controls, while staying within
streamlined to include only one short and one long distance their decreased LOSAP. These center of pressure measures
without losing the salient features of the data. Furthermore, show clear differences in persons with MS who show little
because of the complex and multidimensional nature of bal- or no deficit on clinical measures such as the BBS when
ance, there is no single test that adequately assesses bal- compared to a healthy control group.The usefulness of COP-
ance.5 Streamlining this reaching task would allow more related variables to measure change, either over time or in
time to assess patients or subjects with other types of bal- response to intervention, is worth further exploration.
ance tests such as sensory manipulation, external perturba-
tions, or functional scales. ACKNOWLEDGEMENTS
Our study found that healthy subjects demonstrated sig- This work was supported in part by a Pilot Research
nificantly more peak-to-peak COPy displacement than sub- Award from the National Multiple Sclerosis Society. The
jects with MS during reaching movements. However, no dif- Nebraska Bankers Association provided funding for the
ferences were found between groups in net COPy force platform. We would also like to thank Eliad Culcea,
displacement (the difference between the initial and final MD; Grace Johnson, PT, OCS; Janis McCullough, PT, DPT;
COPy positions). The fact that there was no difference in Wade Lucas, PT, DPT; and Thomas Spray, PT, DPT for assis-
net COPy between groups indicates that both groups were tance with data collection and analysis.
able to successfully reach the target and maintain contact
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181 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

Age- and Gender-related Test Performance in Community-dwelling

TM Steffen, PT, PhD;1 LA Mollinger, PT, MS2

ABSTRACT Multi-directional Reach Test (MDRT), the Berg Balance Scale

Objective: Interpretation of patient scores on func- (BBS), the Sharpened Romberg test with eyes open (SREO)
tional tests is enhanced by an understanding of test perfor- or with eyes closed (SREC), the Activities-Specific Balance
mance in reference groups. The purpose of this study was Confidence Scale (ABC), and 2 versions of the Physical
to expand performance values, by age and gender, on bal- Performance Test (PPT-7 and PPT-9).The MDRT, BBS, SREO,
ance tests [the Multi-Directional Reach (MDRT); Berg SREC, and ABC were all designed to capture aspects of bal-
Balance (BBS); Sharpened Romberg, eyes open (SREO), eyes ance performance or perceived balance confidence. The
closed (SREC); Activities-Specific Balance Confidence PPT was designed to measure aspects of general physical
(ABC)], and a general mobility test [Physical Performance mobility. The literature provides varying levels of study
Test, (PPT-7, PPT-9)].The study also examined relationships regarding the reliability and validity of these tests and some
between test performance and subject characteristics. mean group data.A brief review of this literature follows as
Design and Subjects: Eighty-three community-dwelling background for the main purpose of this study which was
adults over 50 participated in the study and completed the to provide additional reference data for clinicians using
5 functional tests during one test session. Means, standard these tests with patient groups.
deviations, and confidence intervals were calculated for
each of the tests. Multiple linear regression analysis was Multi-directional Reach Test
used to examine relationships between test scores and age, This clinical test of the limits of postural stability in 4
gender, height, and weight. Results: Test performance is directions during standing2 has been shown to have good
reported by gender, within 10-year age cohorts. Regression intra-rater reliability in community-dwelling older adults.3
analysis showed that age contributed significantly to pre- For the lateral reaches, inter-rater reliability4 and test-retest
diction of performance on all of the tests and gender con- reliability5 were also high. The forward reach has shown
tributed significantly to prediction of scores on the Berg, high intra- and inter-rater reliability6-14 and high test-retest
SREO, and SREC. Conclusions:Test performance values, in reliability.15 Construct validity was supported with signifi-
a sample of community-dwelling adults, is provided by age cant correlations between laboratory measures of excur-
and gender cohorts to provide additional reference data sion of the center of pressure with lateral reach5 and for-
that can be used by clinicians for comparison with client ward reach.9 Concurrent validity of the MDRT was
data. The small sample size for subjects over 80 years limits supported with correlations with other functional tests.3
the reference value of data for this age group. In regression
Brauer et al5 found an inverse correlation between the
analyses, age and gender help predict outcomes on the
MDRT results and age. Newton3 has reported mean data for
dependent variables used in the study.
the MDRT (n = 254) in an ethnically-mixed sample of com-
Key Words: Multi-directional Reach Test, Berg Balance Scale, munity-dwelling older adults, although these data are not
Sharpened Romberg,Activities-specific Balance Confidence categorized by age or gender. Other reference data are avail-
Scale, Physical Performance Test able for older females for lateral reach.4,5

INTRODUCTION Berg Balance Scale

In the patient examination, physical therapists include This performance-oriented measure of balance during
tests at the disablement levels of impairment and functional standing activities16 has been shown to have high intra- and
limitation in order to determine a physical therapy diagno- inter-rater reliability17-21 and good internal consistency16,22 in
sis, prognosis, and plan of care.1 These tests can be used to populations of healthy or disabled older adults living in the
document progress during therapy and to compare the community or in residential care facilities. Concurrent
patient’s performance with that of a target reference group. validity has been supported by moderate to high correla-
As tests of functional limitations develop, there is a need for tions between the BBS and other functional measures
parallel development of performance data in reference among older adults at different functional levels (ie, institu-
groups. tionalized, hospitalized, community-dwelling, post-stroke,
Several functional-level tests that are practical for clinical fallers, or with a range of balance abilities).11,18-21,23,24
use and of interest to the authors are the subscales of the Increasing age was shown to relate to decreasing BBS
Program Director in Physical Therapy, Concordia University Wisconsin, 12800 N Lake Shore Dr., Mequon, WI
Assistant Professor in Physical Therapy, Concordia University Wisconsin, 12800 N Lake Shore Dr., Mequon,WI
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 182

scores in a study of community-dwelling elderly.25 An aver- tional tests not included in this study.50-53 Of the functional
age summary test score for older adults living in the com- tests examined in this study, the MDRT is the most recently
munity has been reported by Newton3 and Hatch et al.26 introduced and has the least amount of literature support-
Reference data by gender and 10-year age cohorts for com- ing its interpretation.
munity-dwelling seniors has been reported once for the The purposes of this study were to: (1) provide addi-
BBS.25 tional reference values for clinical tests of balance and
mobility using a sample of independently functioning com-
Sharpened Romberg munity-dwelling adults over age 50; (2) present test perfor-
This measure of ability to maintain balance during tan- mance values in age and gender categories; (3) identify
dem standing, with eyes open and eyes closed,27 has been whether age, gender, height, or weight contribute to pre-
shown to have good intra- and inter-rater reliability in diction of test scores.
healthy older women7 and good test-retest reliability in
healthy young adults.28 Significant correlations of the SREO METHODS
and SREC with other balance tests support concurrent This study was approved by the University Institutional
validity of the Romberg tests.7 Age and SREC were inversely Review Board. Community-dwelling adults were recruited
related in community-dwelling male subjects.29 Mean data via notices in churches, University bulletins, flyers around
have been reported for community-dwelling males,29 the local area, and contacts with local senior centers. Eighty-
females,30,31 and active or inactive former athletes.32 three community-dwelling adults between the ages of 50
and 90, volunteered for the study. All volunteers were
Activities-specific Balance Confidence Scale screened by telephone for inclusion in the study. Inclusion
This self-report measure of an individual’s confidence in criteria included: ability to stand for one minute indepen-
performing common mobility tasks33 has been shown to dently, ability to walk 50 feet without sitting to rest, no use
have good test-retest reliability and internal consistency in of an assistive device, no heart condition that would limit
community seniors.33 Correlations between the ABC and activity, and no fainting spells or extended dizziness. These
the Dizziness Handicap Inventory support concurrent valid- criteria assured that all subjects would be able to complete
ity.34 Myers et al35 found no significant difference between the tests. No volunteer was excluded based on the screen-
males and females on ABC scores. In subjects from inde- ing.All subjects provided informed consent.
pendent senior facilities (n = 287), Kressig et al36 found no Data collection was completed within a 50-minute ses-
correlation between age and ABC scores. Hatch et al26 sion for each subject. Descriptive data were collected,
reported a mean score for 50 community dwelling older including age, height, weight, medical diagnoses, number of
adults. medications used, and number of falls in the past 6 months.
All subjects completed the functional tests in the following
Physical Performance Test order: ABC Scale, BBS, SREO, SREC, MDRT (forward, right,
The PPT is available in a 9- (PPT-9) or 7-item (PPT-7) left, backwards), and the PPT-9. All subjects were offered
form. Both versions share the same first 7 items. This per- rests and water during the session and completed the 50
formance measure of multiple aspects of upper and lower minute testing protocol without complaint of fatigue or dis-
extremity function37 has been shown to have good inter- comfort. Throughout the data collection period, each test
rater reliability and internal consistency in community- was administered by the same testers. These testers were
dwelling older adults for the PPT-7 and PPT-937,38 and good physical therapy students who were experienced in the test
test- retest reliability for the PPT-7 in persons with protocols and had completed a pilot study of the tests on 15
Parkinson disease.39 Validity of the PPT-7 has also been subjects prior to initiation of data collection for this study.
shown through correlations with functional tests.38,40 The MDRT. This test requires the subject to lean maximally
PPT-7 was shown to be negatively correlated with age in forward, backwards, to the right, and to the left.2 Distance
older adults.37 A mean score for the PPT-9 has been reported of the lean was measured as the excursion of the third
for community-dwelling older men.41 Mean values for the metacarpal head from the start to end positions, with the
PPT-7 have been reported for community-dwelling seniors42- arm extended forward (or to the side), during the leaning
and for various groups of frail elderly persons.38,39,45-48 trials. The subject stood with the heels 10 cm apart and
Reference data in community-dwelling women by age each foot angled at 15° of out-toeing. For each direction of
cohort on the PPT-7 have been reported.49 the MDRT, 1 practice and 3 recorded trials were performed.
Although the literature currently provides some refer- Subjects were instructed to keep feet flat on the floor, raise
ence data for these tests of function, it is seldom reported the dominant arm to match the height of a yardstick
by age and gender cohorts. Based on literature suggesting clamped onto a camera tripod set at acromion height, and
relationships between test scores and age,5,25,29,37 it seems make a fist with the extended hand (Figure 1). Subjects
valuable to provide clinicians with reference data catego- were instructed to “lean as far forward (…or backwards,
rized by age. It is also reasonable to expect gender differ- right, left) as possible without lifting your heels or losing
ences in functional performance, as reported for some func- your balance.” The change in the position of the third
183 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

36. Another version of the test, PPT-

7, includes only the first 7 items of
the PPT –9, with a total possible
score of 28. For each item a 5-point
ordinal scale (0–4) is used to record
performance, with 0 indicating
“unable to do” and 4 indicating high-
est functioning. Seven of the 9 items
are timed and the time to complete
the task corresponds with an ordinal
scoring category. Scores for both
versions of the PPT were used in
data analysis.
Data Analysis
The data were analyzed using
SPSS for Windows (Version 11.5;
SPSS, Ind., Chicago, Ill). Descriptive
statistics were performed to calcu-
late means, standard deviations, and
95% confidence intervals for each of
Figure 1. Multidirectional reach. the tests by age decades and gender
cohorts. One-way ANOVA and Tukey’s HSD post hoc test
metacarpal head along the yardstick was indicated by a were used to examine differences between the age and gen-
wooden marker that the researcher slid along a level track der cohorts on demographic variables. Multiple linear
as the subject performed each leaning trial. The difference regression analysis (Enter method) was used to determine
between the initial and final positions for each attempt was whether the demographic variables (age, gender, height,
recorded. Reproducibility of 3 same day trials of the MDRT weight) were significant predictors of test outcomes. An
was high: ICC (3,1) for forward = 0.94, backwards = 0.96, right independent t-test was used to compare right and left reach
= 0.95, left = 0.90. An average of the 3 recorded trials was scores in the MDRT. An alpha level of 0.05 was used to
used in data analysis similar to previous research.9 determine significance in all statistical tests. To further char-
Berg Balance Scale. The BBS includes 14 tasks challeng- acterize the properties of the tests with multiple items on
ing body stability.16 The test was administered according to ordinal scales (BBS,ABC, PPT), Cronbach alphas were calcu-
standard protocol, except for item #8 (forward reach) which lated as a measure of internal consistency.
was scored with the first forward reach trial from the MDRT.
Each task is scored on an ordinal scale of 0 to 4, with a max- For the total sample, the average age of the subjects was
imum score of 56 points indicating the best performance. 69 (SD = 11; range = 50-90) years. The average height for
Sharpened Romberg. This test required that a subject males was 177 cm (SD = 8) and for females was 161 cm (SD
perform a tandem stand with arms free and the nondomi- = 6). Subjects reported use of an average of 2 medications
nant foot ahead of the dominant foot for up to 60 sec- per day (range 0-12) and had a variety of diagnoses includ-
onds.30,31 Up to 3 trials were attempted with eyes open, ing: 45% with hypertension; 46% arthritis; 18% heart dis-
then with eyes closed. The test ended when a subject ease; 17% history of cancer; and 16% thyroid disorders. One
achieved the 60 second maximum time, opened the eyes subject reported falling twice and 12 subjects (15%)
during an eyes closed trial, moved the feet, or needed assis- reported falling once in the 6 months prior to the study.
tance to prevent a fall. The test was scored as the maximum Three participants identified themselves as smokers and 13
seconds achieved during the best trial. of the 83 reported a “bone or joint problem that could be
ABC Scale. This 16-item questionnaire asks a subject to aggravated by walking.” Table 1 shows mean demographic
estimate how confident he/she would be in performing 16 characteristics for each age cohort in the sample. One-way
common mobility tasks without losing balance.33 Each item ANOVA between age cohorts showed significant main
is scored from 0% to 100%, indicating increasing levels of effects for height (F = 3.2, p = 0.028), number of diagnoses
confidence about each task. A tester read each question (F = 5.2; p = 0.002) and number of daily medications (F =
aloud and asked the subject to respond using only incre- 3.2, p = 0.026).Tukey’s post hoc testing showed that height
ments of 10% (ie, 0%, 10%, 20%, …100%). was significantly greater for the youngest compared to the
Physical Performance Test.The PPT-9 has 9 items, mea- oldest group (p = 0.047), number of diagnoses was signifi-
suring upper extremity fine motor coordination, balance, cantly greater for the oldest compared to the youngest
mobility, and endurance.37 Total scores can range from 0 to group (p = 0.001), and showed that number of medications
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 184

was significantly greater for the 60-69 year olds than the 50- subjects achieved a maximum score of 56, with only 5 of
59 year olds (p = 0.024). There was no significant differ- these in the oldest two age groups. Only 3 subjects, all over
ence between age cohorts on weight or number of 80 years, scored below the commonly used cutoff of 45 for
reported falls in the previous 6 months. predicting fall risk.54
MDRT. The mean test scores, standard deviations, and Sharpened Romberg Tests. Means, standard deviations,
95% confidence intervals by age and gender cohorts for and 95% confidence intervals for the SREO and SREC tests
each direction of the MDRT are shown in Table 2. There are reported in Table 4. The confidence intervals for both
was no significant difference between the mean right and tests showed a wide range of variability. Age, gender, and
left reach scores (t = 0.15; p = 0.88). Age was a significant height were significant predictors for SREO scores, whereas
variable in regression models predicting MDRT scores in only age and gender were significant predictor variables in
each direction, with increasing age associated with a the regression model for SREC (Table 3). A maximum score
decrease in reach scores (Table 3). Height was significant of 60 seconds was achieved by 77% of the subjects for the
in the model for predicting backward reach only, with SREO and by 31% for the SREC. Most subjects achieving the
increasing height associated with increased backward ceiling score were in the two younger age groups.
reach scores. ABC Scale. Results from the ABC Scale are summarized
Berg Balance Scale. Table 4 reports the means, standard in Table 4 by age and gender cohorts. The internal consis-
deviations, and 95% confidence intervals for the BBS results tency of the 16-item ABC Scale, based on Cronbach’s alpha,
by age and gender cohorts. Internal consistency for the 14- was high (α = 0.93). Age and weight were significant pre-
item BBS, indicated by Cronbach’s alpha, was 0.81. Age, gen- dictors of ABC scores (Table 3). The mean ABC score for the
der, and height were all significant predictor variables for total sample was 91% out of a maximum 100% confidence
BBS scores (Table 3). Thirty six percent (30 persons) of the in performing the mobility tasks. The mean ABC score for

Table 1. Demographic Characteristics of the Study Sample by Age Cohort

Age Cohort Gender (% female) Height* (cm) Weight* (kg) Number of Falls in Number of
Diagnoses* Prior 6 Months* Medications*
50-59 N = 24 63 171 (11) 82 (17) 1.5 (1.4) .04 (.20) 1.3 (1.2)
60-69 N = 19 53 170 (12) 81 (22) 2.3 (1.8) .11 (.32) 3.0 (2.8)
70-79 N = 24 58 165 (10) 79 (12) 2.5 (1.4) .25 (.44) 2.2 (1.4)
80-89 N = 16 75 162 (10) 73 (22) 3.4 (1.4) .31 (.60) 2.6 (2.1)
*Values presented are means and (standard deviations)

Table 2. Means (X), Standard Deviations (SD), and 95% Confidence Intervals (CI) of the Multi-directional Reach Test by Age and Gender
Cohorts (in centimeters)
Forward (cm) Backward (cm) Right (cm) Left (cm)
Age (yrs) Gender N X SD CI X SD CI X SD CI X SD CI
50-59 Male 9 37 6 32-41 28 6 24-32 22 4 19-25 22 4 19-26
Female 15 32 6 28-35 20 6 16-23 18 4 16-20 18 4 16-20
60-69 Male 9 30 5 27-34 25 9 17-32 20 3 19-23 19 3 17-21
Female 10 30 5 24-30 20 8 14-25 15 5 13-18 17 5 13-20
70-79 Male 10 29 5 26-32 19 7 14-24 17 4 15-19 18 4 15-21
Female 14 29 7 25-33 15 7 11-19 16 7 12-19 15 7 11-19
80+ Male 4 27 9 13-40 16 4 9-23 16 7 8-23 17 7 6-28
Female 12 22 6 18-26 11 4 8-13 13 3 11-15 12 3 10-14
Total Sample 83 29 7 28-29 19 8 17-20 17 5 16-18 17 5 16-18

Table 3. Multiple linear regression results (standardized coefficients & significance) for the Multidirection Reach (MDRT), Berg Balance Scale
(BBS), Sharpened Romberg-Eyes Open (SREO), Sharpened Romberg-Eyes Closed (SREC), Activities Specific Balance Confidence Scale (ABC), and
Physical Performance Tests (PPT-7 & 9).
Forward Backward Right Left BBS SREO SREC ABC PPT-7 PPT-9
R2 .31 .52 .35 .31 .38 .35 .26 .22 .38 .40
Age -.39a -.31a -.36a -.32b -.64a -.58a -.54a -.35b -.58a -.61a
Gender .00 .11 -.14 -.18 -.42b -.51a -.33c -.23 .04 .01
Height .27 .70a .28 .18 -.33c -.35c -.28 -.10 .07 .07
Weight .04 -.18 .01 .07 .02 -.01 -.02 -.24c .05 .01
185 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

Table 4. Means (X), Standard Deviations (SD), and 95% Confidence Intervals (CI) of test results for the Berg Balance Scale (BBS), Sharpened
Romberg-Eyes Open (SREO), Sharpened Romberg-Eyes Closed (SREC), Activities Specific Balance Confidence Scale (ABC), and Physical
Performance Tests (PPT-7 & 9) by Age and Gender Cohorts
Total BBS Total SREO (sec) Total SREC (sec) Total ABC (%) Total PPT-7 Total PPT-9
50-59 Male 9 56 0 56-56 60 0 60-60 51 18 37-60 93 7 88-98 24 2 23-25 31 2 30-33
Female 15 55 1 55-56 56 15 48-64 37 22 24-49 95 5 92-98 24 1 24-25 32 1 31-33
60-69 Male 9 55 1 54-56 60 0 60-60 32 26 12-52 96 6 92-100 24 2 22-25 31 2 29-33
Female 10 55 2 54-56 60 0 60-60 42 23 26-59 93 5 89-96 23 1 22-23 31 1 30-31
70-79 Male 10 53 2 52-55 54 17 42-60 26 20 12-40 96 4 93-98 22 2 20-24 29 2 27-31
Female 14 52 4 50-54 44 24 30-58 23 21 11-35 86 15 77-95 22 2 20-23 29 2 27-30
80+ Male 4 52 5 45-59 48 24 9-60 20 25 0-60 91 13 71-100 20 1 18-22 27 2 25-30
Female 12 48 7 44-53 19 20 7-32 5 6 1-9 82 16 72-92 20 3 19-23 27 3 25-30
Total Sample 83 53 4 52-54 49 21 45-54 29 24 24-35 91 11 89-93 22 2 22-23 30 3 29-30

males was 94% and for females was 89%.Ten percent of the of the components of the MDRT within the same day were
subjects reached the ceiling of 100% on this test, with all highly reproducible, as has been reported for the Forward
age groups similarly represented in this distribution. Functional Reach test.9 Compared to Duncan’s forward
Physical Performance Tests. Results of both the PPT-7 reach data in men, our male subjects had slightly lower
and PPT-9 are reported by age and gender cohorts in Table scores. In her subjects under 70 years, this may be
4. Internal consistency, as measured by Cronbach’s alpha, explained by her inclusion of subjects, age 41-50 years. The
was 0.70 for the PPT-7 and 0.75 for the PPT-9. Age was the slight differences may also be due to test positions. Duncan
only significant variable in the regression models predicting had subjects stand comfortably while we used a predeter-
PPT-7 or PPT-9 scores (Table 3). No subject achieved the mined foot position. In Newton’s original study2 the sub-
ceiling score for either version of this test. Only one sub- jects’mean age was 74 (SD = 8) while in this study mean age
ject scored at the cut off of 15 used for identifying fallers.55 was slightly younger (69 years, SD = 11).The age differences
in the 2 studies may explain why the mean forward and
DISCUSSION backwards reaches are higher in our study (29 ± 7 cm and
For all of the functional tests in this study, age was a sig- 19 ± 8 cm, respectively) than in Newton’s sample (23 ± 8
nificant predictor variable for test outcome scores. This find- cm [8.9 ± 3.3 inches] and 12 ± 8 cm [4.6 ± 3.0 inches],
ing is supportive of the practice of providing reference data respectively). There also could be the factor that our sub-
in age cohorts so that individual patient results can be com- jects were taller on average. However, regression analysis
pared to age-appropriate group data. Gender, height, and showed height as a significant variable only for predicting
weight were not consistently significant predictors of test backward reach, not forward. Any biomechanical hypothe-
scores. Because the men in our sample were, on average, sis related to size of base of support or position of the cen-
taller than the women, one might expect that gender and ter of mass in tall versus short persons should seem to apply
height would have similar predictive influence on test to both forward and backward reaches similarly. Both tall
scores. In most, but not all, cases, these 2 variables were the and short persons have a longer lever arm for forward reach
same in their predictive significance or lack of significance. than for backward reach. However, perhaps there is an
Gender and height were both significant predictors for BBS interaction between lever length and base of support that
and SREO scores. Conversely, neither gender nor height was influences backward, but not forward, reach.The mean val-
a significant predictor for scores on the MDRT (forward, ues of the lateral reaches between the two studies are
right, left), the ABC, or the PPT. Hypothesizing that height within 0.4 cm. Our study, as in previous studies, demon-
and position of the center of mass are the salient features dif- strated no significant differences between the right and left
ferentiating males and females, it may be that these features reaches,3-5 suggesting that asymmetries in the lateral reaches
provided additional challenges to taller persons (males) dur- for a given client are an abnormal finding.
ing the varied static balance tasks of the BBS and SREO. It is Berg Balance Scale. Our current study confirmed pre-
not clear, however, why such a hypothesis about height/gen- vious findings of Steffen et al25 on the BBS for each of 3 age
der doesn’t hold for the static balance tasks of the MDRT. cohorts (60-69, 70-79, and 80+ years). In contrast, Newton3
Further studies and larger sample sizes are needed to con- and Hatch et al26 found slightly lower average BBS scores in
firm or refute these findings on gender and height. slightly older samples of community-dwelling adults. We
MDRT. Of the tests studied here, the MDRT was most found it interesting that only 36% of our essentially nondis-
recently introduced into the literature, with Newton2,3 pro- abled or high functioning sample achieved a maximum
viding the first data. The test is a logical expansion of the score on the BBS. Clinicians performing fall risk screenings
Forward Functional Reach test developed by Duncan et al9 in community populations of older adults need to be cau-
and was designed to provide a clinical measure of a per- tious in making assumptions that a perfect score is to be
son’s margins of stability. We found that repeated measures expected in these age groups.
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 186

Sharpened Romberg. Briggs et al31 reported SREO and icians in interpreting test results of clients. A relationship
SREC scores in 5 year age cohorts for community-dwelling between increased age and decline in test performance has
females (mean age = 72). Although their total mean scores been demonstrated. Additional research would be benefi-
were the same as ours, their average scores for subjects in cial to determine if using all 4 directions of the MDRT pro-
the 80-85 year cohort were substantially higher (SREO = 45 vides more valuable information about balance ability and
seconds, SD = 21; SREC = 23 seconds, SD = 21) than ours. fall risk than just the Forward Functional Reach alone.
Perhaps this difference was due to the strict exclusion in Further research is also needed to establish larger databases
their study of participants with neurologic disorders and of reference values on all functional tests and to establish
some musculoskeletal disorders. Our mixed-gender SREO of the validity of the MDRT for predicting likely direction of
49 seconds falls between that of Heitmann et al30 who potential falls, so that treatment can focus on each client’s
reported a mean score of 37 seconds (SD = 27) for females direction-specific deficits of stability.
(mean age = 74) and Iverson et al29 who reported a mean
score of 55 seconds (SD = 15) for males (mean age = 71). ACKNOWLEDGEMENTS
For SREO, some subjects in all age cohorts achieved a max- A special thank you to Jill Kison, Sarah Lindau,Al Meives,
imum score of 60 seconds. No subjects in the oldest age and Zachary Sommermeyer who assisted with data collec-
group achieved a maximum score on the SREC. Scores tion while they were physical therapy students at
showed much more variability for the SREC, across all age Concordia University Wisconsin and Lina La Licata for cler-
groups, than for the SREO. Also, the ceiling effect for the ical support.
SREC occurred much less frequently than for the SREO or Dr Steffen provided concept/research design, project
the Berg. Thus the SREC may detect minimal impairments management, fund procurement, subject recruitment, facili-
in balance better than these other two tests. ties/equipment, data analysis, and writing. Ms Mollinger pro-
ABC. Of those reporting reference data for the ABC, our vided consultation and writing.
study had subjects with the lowest mean age and the high- This study was approved by the Institutional Review
est average score. In a similar but older community- Board of Concordia University Wisconsin and was sup-
dwelling sample (average age = 82), Hatch et al26 reported a ported by the Program in Physical Therapy, Concordia
lower mean score (79%, SD = 19). Kressig et al36 found a University Wisconsin.
lower average score of 52% (SD = 20) in their sample of The main findings were presented as a poster presenta-
seniors in independent living facilities (mean age = 81). tion at the Wisconsin Physical Therapy Association
Comparisons of these studies appear to reinforce the find- Conference 2002 and the 14th International WCPT
ing of a relationship between age and ABC test score. It is Congress, Barcelona, Spain 2003.
of interest that even subjects in our youngest age cohort did
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189 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

Platforms, Thematic Posters, & Posters for CSM 2006

PLATFORMS: Biomechanics and Motor Control mance was similar across the three sessions (313 ± 54 N, P = 0.83), indi-
Saturday 8:00-11:00 am cating that the net torque exerted by the limb during the fatiguing con-
tractions was similar.The EMG for the short and long heads of the biceps
HETERONYMOUS REFLEXES IN THE PRIMARY AGONIST ARE brachii, brachioradialis, and brachialis was similar across conditions (P >
ENHANCED WHEN SUPPORTING AN INERTIAL LOAD. K.S. Maluf1, 0.05). Despite the similar criteria for task failure and a similar decline in
Z.A. Riley2, M.K.Anderson2, B.K. Barry2, S.S.Aidoor2, R.M. Enoka2, 1Graduate MVC force (18.0 ± 8.0 %, P > 0.05), the time to task failure differed for each
Program in Physical Therapy and Rehabilitation Science, University of condition: supra-threshold vibration = 3.7 ± 1.4 min, sub-threshold vibra-
Iowa, Iowa City, IA, 2Department of Integrative Physiology, University of tion = 4.3 ± 2.1 min, and no-vibration conditions = 5.0 ±2.2 min (P < 0
Colorado, Boulder, CO. .001).The standard deviation (SD) for the vertical fluctuations in accelera-
tion was greater at the start (0.27 ± 0.13 m/s2) and at 25% of task duration
Purpose/Hypothesis: Previous studies indicate that stretch reflexes in (0.28 ± 0.15 m/s2) for the supra-threshold condition compared with the
the human upper limb are influenced by the stability of the load sup- no-vibration (0.13 ± 0.06 and 0.16 ± 0.09 m/s2; P = 0.03) condition, but was
ported during an isometric contraction. Our purpose was to assess similar at task termination (0.83 ± 0.50 m/s2) for the three conditions.
whether changes in the sensitivity of spinal motor neurons to afferent Conclusions: These findings indicate that both low and high levels of
feedback from accessory muscles contribute to reflex modulation when vibration applied to the biceps brachii tendon reduced the time to failure
supporting an inertial load compared with exerting an equivalent force when maintaining limb position, which has implications for work-place
with the limb restrained. Number of Subjects: 13 healthy adults (aged 18- activities. Clinical Relevance: Documenting evidence for early fatigue
47 years, 9 men) participated in the study. Materials/Methods: during tasks performed with prolonged vibration confirms the importance
Heteronymous reflexes were evoked in the first dorsal interosseus (ago- of afferent input during sustained tasks, and has implications for work and
nist) and second palmar interosseus (antagonist) muscles by stimulating ergonomic environments.
the median nerve at the wrist (1 ms pulse width; 3-5 s inter-stimulus inter-
val) as subjects performed two motor tasks with the index finger. One task CUTANEOUS CUING DECREASES REACTION TIMES FOR STEP INITI-
required subjects to exert a constant isometric force by pushing up against ATION. CG Kukulka, E Olson, A Peters, K Podratz, C Quade, Phys Med &
a rigid restraint, whereas the other task required subjects to maintain a Rehab, University of Minnesota, Minneapolis, MN.
constant angle at the metacarpophalangeal joint while supporting an iner-
tial load suspended from the finger. Net torque (20% of maximum), the Purpose/Hypothesis:The purpose of this study was to assess the effect of
position of the index finger (0 degrees abduction), and the intensity of visual and sural nerve stimulation cuing on reaction times to step initiation
peripheral nerve stimulation were the same for both tasks. Twenty-four (SI) in young, healthy subjects. We hypothesized that these times would
reflex responses were recorded in each muscle using surface or intramus- decrease with a cutaneous go cue as compared to a visual cue. Number of
cular electrodes, and the averaged EMG records were compared using a 2- Subjects:Thirteen subjects, 9 women and 4 men between the ages of 23 and
factor ANOVA for repeated measures. Results: Heteronymous reflex 30 years (mean = 23 yrs), participated in the study. Materials/Methods:
responses were observed in 10/13 subjects (77%) for the first dorsal EMG was recorded from tibialis anterior (TA) of the right stepping leg.The
interosseus, but only 2/11 subjects (18%) in the second palmar interosseus. sural nerve was stimulated with a train of 300/s, 1 ms pulses delivered for 20
Despite similar tonic EMG of the agonist and antagonist muscles across ms at an intensity of 1.5 radiating threshold. Subjects stood with their right
tasks (P = 0.27), peak amplitudes of the short-latency (SL 28.6 ± 5.6 ms) leg on a force platform with weight equally distributed and were instructed
and long-latency (LL 52.2 ± 3.5 ms) reflexes in the first dorsal interosseus to take three steps as fast as possible. A warning visual cue was first deliv-
were greater when subjects supported the inertial load (SL = 0.45 ± 0.19 ered followed at random intervals (1-3 s) by either a visual go cue or the
vs. 0.57 ± 0.28 mV; LL = 0.32 ± 0.11 vs. 0.41 ± 0.19 mV; main effect of task sural stimulation cue. Twenty repetitions for SI were randomized by cue.
P = 0.02). Conclusions: Agonist motor neurons exhibit heightened sen- After a 5 min rest, 20 additional steps were obtained. SI is characterized by
sitivity to afferent feedback from median-innervated accessory muscles an abrupt loading of the stepping limb and this loading was used to deter-
when controlling the position of an inertial load. Clinical Relevance: mine 3 response times relative to the go signal (load onset, peak load, and
Findings indicate that the type of load used in strength and endurance load offset). The onset time of TA onset relative to the go signal was also
training programs can influence the response of the primary agonist to determined.Two way ANOVAs (p<.05) were used to evaluate the interaction
concurrent activity of accessory musculature. effect of trial versus cue and the main effects of trial and cue. Results: No
statistically significant interactions were found for any of the loading times
VIBRATION OF THE BICEPS BRACHII TENDON REDUCES TIME TO and the main effect of trail was also not statistically significant. Significant
FAILURE WHEN MAINTAINING LIMB POSITION DURING A FATIGU- differences were found between visual and cutaneous cue for all loading
ING CONTRACTION. C Mottram, KS Maluf, MK Anderson, JL Stephenson, times. Time to load onset decreased on average from 254.2 ms with the
RM Enoka, Integrative Physiology, University of Colorado, Boulder , CO. visual cue to 186.5 ms with the sural cue.Time to peak loading decreased
on average from 482.7 to 391.7 ms and time to unloading decreased from
Purpose/Hypothesis: Vibration reduces the tendon jerk, and the 688.1 to 610.9 ms. TA onset was found to decrease from 194.6 ms (visual
Hoffmann and stretch reflexes in the muscle exposed to the vibration cue) to 131.5 ms (cutaneous cue). Conclusions:The results of these exper-
(Bove et al, 2003; Cresswell and Ludieroscher et al, 2000; Lance et al, 1966), iments indicate that reaction times to a cutaneous cue are significantly
but does not alter the time to task failure when exerting a submaximal shortened for SI in healthy subjects.These findings raise two important neu-
force against a rigid restraint (Cresswell and Ludieroscher 2000). Because rophysiological questions. Could a cutaneous cue be priming the motor cor-
the amplitude of the stretch reflex can be enhanced when the limb acts tex via a cortical pathway (Christensen et al, Prog Neurobiol 62:251, 2000)
against a compliant load compared with a rigid restraint (Akazawa et al. to heighten cortical excitability thereby resulting in a faster reaction.
1983; De Serres et al. 2002), the purpose was to determine the influence Alternatively, could the cutaneous cue be acting as a startle (Valla-Sole, et al,
of tendon vibration on the time to task failure when light loads were sup- J Physiol 516:931, 1999) to release the stepping response via subcortical
ported while maintaining limb position (position task) with the elbow structures. The latter possibility is currently being investigated in our labo-
flexor muscles. Number of Subjects:Twenty-five healthy adult men (22 ratory. Clinical Relevance: Previous experiments have shown that reaction
± 4 yr; range, 18 - 39 yr) performed the position task at 20% MVC force by time is a strong predictor of falls in the elderly and that a sural go cue can
maintaining a 90º elbow position until task failure. Materials/Methods: increase center of pressure changes during SI in both young and elderly sub-
Subjects visited the laboratory for three sessions to perform the position jects.The current results therefore raise the possibility that a cutaneous cue
task with two different levels of vibration (100 Hz, 2.5 N force, sub-thresh- might be used to decrease reaction times and positively alter ground reac-
old and supra-threshold for the tonic vibration reflex), and without vibra- tion forces in elderly subjects who fall. It will be necessary to first replicate
tion of the biceps brachii tendon. Results: MVC force prior to task perfor- the current findings in the elderly.
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 190

INFLUENCE OF AGE ON NEUROMUSCULAR CONTROL OF THE EXERCISE. M. Iguchi,A. Ganju, B. Ballantyne, R. Shields, Graduate Program
KNEE. S Madhavan, S Burkart, G Carpenter, K Read, T Teckenburg, M in Physical Therapy and Rehabilitation Science, University of Iowa, Iowa
Zwanziger, R Shields, Graduate Program in Physical Therapy and City, IA.
Rehabilitation Science, University of Iowa, Iowa City, IA.
Purpose/Hypothesis: Muscle fatigue may be a predisposing factor to
Purpose/Hypothesis: An increased incidence of injury has made neuro- injury during athletic competition. Low frequency fatigue (LFF), which is
muscular control of the knee joint a focus of attention in motor control due to long duration exercise, is most characteristic of the type of fatigue
research. The central nervous system (CNS) controls the knee against induced during sports activities. Altered neuromuscular control as a result
unpredictable perturbations that occur during movement. Age associated of LFF may increase the risk of injury to the knee.The purposes of this study
changes in the musculoskeletal, neuromuscular and sensory systems com- were to examine the extent to which LFF could be induced in the ham-
promise the ability of the elderly to respond effectively to a perturbation, string muscles and test whether LFF altered the neuromuscular control of
thereby placing the older population at a higher risk of injury.Weight bear- the knee during a single limb weight bearing exercise. We hypothesized
ing exercises have been primarily used to re-educate neuromuscular con- that LFF of the hamstrings alters the neuromuscular control of the knee
trol of the knee following pathology. Limited information is available on during weight bearing exercise. Number of Subjects: 10 healthy male sub-
the strategies used by the elderly to control the knee during dynamic activ- jects performed a fatigue protocol consisting of repetitive eccentric con-
ities.This study examined the effect of age on the neuromuscular control tractions of the left hamstring muscles using an isokinetic dynamometer.
of the knee by examining accuracy of performance, muscle synergies and Materials/Methods: The work/rest velocity of 13º/sec-1 / 7º/sec-1 respec-
long latency reflexes (LLR) during a functional weight bearing exercise.We tively, over an arc of movement from 30º -70º flexion (0º = full extension)
hypothesized that the elderly would show greater impairment in neuro- was administered until the subject was fatigued. The fatigue protocol was
muscular control than the young. Number of Subjects:Ten young and ten terminated when the peak torque decreased 25% from the largest value of
elderly subjects performed a single leg squat exercise (SLS) while tracking the three pre-fatigue eccentric MVCs. Hamstring peak twitch torques were
a sinusoidal target with knee motion at different levels of resistances (4%, obtained by double pulse stimulation at 40 Hz followed by a train of four
8% and 12% body weight). Materials/Methods: Subjects first performed a pulse stimulation at 166 Hz.The twitch torques were calculated pre-fatigue,
set of learning trials to gain proficiency with the task. Later, they performed immediately post fatigue and then at 5, 10, 15 and 20 minutes into recov-
the SLSs with random perturbations (drop in resistance level to 0% BW) ery.The ratio of the twitch torque at 166 Hz to 40 Hz was calculated and
during the knee flexion phase.A split plot repeated measures ANOVA was averaged. Before and after the fatigue protocol, a subgroup of subjects per-
used to assess between and within group differences in movement accu- formed a lateral step down weight bearing exercise to a predetermined tar-
racy, synergistic activation patterns (EMG), and long latency reflexes. get on a custom built device designed to assess neuromuscular control of
Results:The elderly group 1) had a 50% greater absolute error in tracking the knee. Absolute error to knee movement (accuracy), EMG synergistic
the target angle when compared to the younger group (p<0.05); 2) activation patterns (quad/hamstring ratio), and triggered long latency
showed a 60% greater activation of the quadriceps and hamstrings at all reflexes were assessed.A Split Plot Repeated Measures Analysis of Variance
levels of resistances as compared to the younger group (p<0.05); and was used to compare within and between groups. Results: The average
showed 15% greater LLR for the quadriceps and biceps femoris when com- number of eccentric contractions performed before the torque decreased
pared to the younger group (p <0.05). Conclusions:These results indicate to 75% of the pre-fatigue value was 35 ±9.3. Immediately after the fatigue
that the elderly recruit higher percentages of MVC and have greater error task, the ratio increased, on average, by 15.6% ±7.3 of its pre-fatigue value
when performing the SLS weight bearing exercise. Clinical Relevance: (p < 0.05), and stayed elevated at 20 min post fatigue (12.4% ± 4.9). The
Age associated changes of the sensorimotor system necessitates greater eccentric contraction torque immediately after fatigue was 69.9% ± 6.0 and
muscle activity to help stabilize the knee in the elderly.These findings pro- remained depressed at 20 min post fatigue (80.1% ± 9.0). Absolute error
vide important clinical implications when developing rehabilitation pro- during the weight bearing exercise was increased 50%; the quadriceps to
grams for the young and elderly. hamstring ratio was unchanged; and the biceps femoris and vastus medialis
long latency response was increased 20% after fatigue. Conclusions: We
DE-COUPLING GAIT PARAMETERS TO INVESTIGATE THE CONTRI- conclude that LFF can be induced in the hamstring muscles using repetitive
BUTION OF STEP LENGTH TO FALL RISK. D Espy,Y Pai, F Yang, J Sun, eccentric contractions and that this fatigue alters the neuromuscular con-
Physical Therapy (M/C 898), University of Illinois at Chicago, Chicago, IL. trol of the knee during weight bearing exercise. Clinical Relevance:These
findings have important clinical implications for the prevention and reha-
Purpose/Hypothesis: Background and Purpose. It is generally accepted bilitation of injuries in individuals involved in athletic competition.
that, as people age, their gait becomes slower and of shorter step-length Funding: NIH R01HD39445.
and that both improve stability against balance threats. Recent studies have
suggested that a faster gait velocity may provide more stability against a CHANGES IN SELF-PERCEPTION OF TURNING FOLLOWING ROTAT-
slip induced backward loss of balance than the benefit gained by shorter ING TREADMILL STIMULATION. G Earhart1, S Wang1, M Hong1, E
step-lengths. Since they are tightly coupled, the individual contributions of Stevens2, 1Program in Physical Therapy, Washington University School of
step-length and gait velocity to stability are unknown.The purpose of this Medicine, St. Louis, MO, 2Biology Department,Washington University in St.
study was to pioneer a gait training approach that enables us to de-couple Louis, St. Louis, MO.
this relationship. Number of Subjects: Thirty-five. Materials/Methods:
Subjects and Methods.Thirty-five healthy, young adults participated in this Purpose/Hypothesis: The purpose of this work was to determine
randomized, experimental comparison study. Subjects were slipped unex- whether rotating treadmill stimulation, which has been shown to cause
pectedly while walking on a walkway at one target gait velocity and either unintentional turning during attempts to step in place, would also cause
a short or a long target step-length. Motion and force data were used to cat- changes in behavior when subjects knowingly turn in place.We hypothe-
egorize each first slip as a fall or non-fall. Results: Four of the 19 subjects sized that, following stepping on a rotating treadmill, 1) subjects asked to
in the long step-length group, but none of the 16 in the short step-length actively turn in place would overshoot their targets when turning in the
group, fell upon the first unexpected slip (chi2 3.803; p = .05). direction opposite treadmill rotation and undershoot their targets when
Conclusions: Discussion and Conclusion. De-coupling of the gait parame- turning in the other direction and 2) there would be no change in per-
ters was successful; at gaits of similar velocity, the subjects taking shorter ception of passive whole body turning. Number of Subjects:We tested 10
step-lengths were less likely to fall upon initial slip than those with longer healthy control subjects. Materials/Methods: Subjects wore a blindfold
step lengths. Clinical Relevance: Understanding the individual contribu- and earplugs and completed trials of active and passive turning in place.
tions to stability of both gait speed and step length will allow Physical For active conditions, subjects were told the direction and amplitude of
Therapists to refine gait training recommendations to enhance stability. the desired turn and then attempted to turn in place the specified amount
(e.g. ‘turn 90 degrees to your left’). For passive conditions, subjects were
INFLUENCE OF HAMSTRING LOW FREQUENCY FATIGUE ON NEU- told that the disc they stood on would turn and they were to press a but-
ROMUSCULAR CONTROL OF THE KNEE DURING WEIGHT BEARING ton when they perceived that they had traveled the specified amplitude
191 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

(e.g.‘the disc will turn to your left, press the button when you think you changes and improvements in whole muscle CSA via MRI were extremely
have gone 90 degrees’). Subjects completed active and passive trials to the strong. Clinical Relevance: These data provide further evidence of the
left and right with amplitudes of 90, 180, 270, and 360 degrees for a total responsiveness of skeletal muscle to RT in the SCI population as well as
of 16 trials. Subjects then stepped in place for 15 min on a disc rotating support the use of NMES as a training modality capable of eliciting sub-
clockwise at 90º /s. Subjects then repeated the 16 trials of active and pas- stantial hypertrophy in human skeletal muscle.
sive turning. All trials were presented in random order and the order was
different for each subject. We recorded the total excursion that subjects PERIPHERAL QUANTITATIVE COMPUTERIZED TOMOGRAPHY
went through during active trials and the excursion from start position to (PQCT): MEASUREMENT SENSITIVITY IN INDIVIDUALS WITH AND
the time of button press in passive trials.These excursions were compared WITHOUT SPINAL CORD INJURY. S. Dudley-Javoroski,T. Corey, D. Fog,
within each condition (e.g. 90 degrees left active) for pre- vs. post-treadmill K. Hanish, J. Ruen, R. Shields, Graduate Program in Physical Therapy and
stimulation using paired t-tests (p<.05). Results: Subjects asked to turn in Rehabilitation Science, University of Iowa, Iowa City, IA.
the direction opposite disc rotation (i.e., to the left) consistently and sig-
nificantly overshot their targets in the active trials.There were no changes Purpose/Hypothesis: Individuals with spinal cord injury (SCI) experi-
in the accuracy of active turning to the right or passive turning in either ence rapid trabecular bone loss within the first year after their injury.The
direction. Conclusions: Adaptation to the rotating disc is expressed even distal tibia is a common fracture site after SCI; however, at this site the stan-
when subjects have a conscious intent to turn.The positive after-effects of dard bone density measurement method, Dual Energy X-ray
the rotating disc appear to add to the intended active turning in the direc- Absorptiometry (DEXA), has significant limitations. Peripheral quantitative
tion of the after-effect, increasing the amplitude of the turn. There is no computerized tomography (pQCT) holds much promise, but the sensitiv-
negative interaction of after-effects with intended turning in the opposite ity associated with repeated scans has not been established for the distal
direction. Clinical Relevance:This demonstration that rotating disc after- tibia. The purposes of this study were to: 1) establish the between and
effects are still expressed even when there is conscious intent to turn sug- within tester error in measuring tibia length as needed during pQCT analy-
gests that rotating disc stimulation may be useful in the treatment of turn- sis; 2) determine the error in distal tibia trabecular bone density when mea-
ing difficulties experienced by individuals with Parkinson disease. Subjects suring three different scan sites in individuals with and without SCI; and 3)
who have difficulty turning in one direction more than the other may ben- determine the magnitude of distal tibia bone loss as a result of SCI.
efit from this intervention, which could enhance turning in one direction Number of Subjects: Repeated tibia length measurements were taken
while not reducing turning in the other direction. from 8 able-bodied subjects using a newly developed operationally defined
protocol. Bone analysis (pQCT) was performed on 7 male subjects with
RELATIONSHIP BETWEEN CHANGES IN MUSCLE SIZE FOLLOWING SCI and 7 age-matched male able-bodied subjects. Materials/Methods:An
12 WEEKS OF NMES INDUCED RESISTANCE TRAINING USING MRI investigator marked the distal tip of the medial malleolus and the proximal
AND FIBER SPECIFIC ANALYSES IN PERSONS WITH COMPLETE margin of the tibial plateau in order to obtain tibia length. Subjects in the
SPINAL CORD INJURY. A. Jayaraman1, K. Vandenborne1, E.M. Mahoney2, two scan groups underwent pQCT analysis at 3 sites along the distal tibia
G.A. Dudley2, C.M. Gregory3, S.C. Bickel4, 1Physical Therapy, University of (4% of total length, ±3mm). Three subjects in the SCI group were con-
Florida, Gainesville, FL, 2Kinesiology, University of Georgia,Athens, GA, 3VA currently enrolled in electrical stimulation training of the soleus. Results:
RR&D Brain Rehabilitation Research Center, 3Malcom Randall VA Medical Results revealed no significant difference between average repeated tibia
Center, Gainesville, FL, 4Physical Therapy, Louisiana State University, New length measurements (p=0.94). Absolute inter-rater error for tibia length
Orleans, LA. was 0.61 cm with an r2 = 0.94.An ICC (1, k) showed that there was strong
intra-tester agreement (0.94).Average change in bone density across 3 mm
Purpose/Hypothesis: Chronic spinal cord injury (SCI) results in extreme for individuals with SCI was 3.77%. Individuals with SCI had 50.6% less tra-
atrophy of skeletal muscle below the level of lesion. We previously becular bone density than the able-bodied group (p<0.0001). Interestingly,
reported substantial muscle hypertrophy measured via magnetic reso- there was a 26.7% increase in bone density in the subset of SCI subjects
nance imaging (MRI) resulting from a neuromuscular electrical stimulation who trained their extremities (p<0.05). Conclusions:We conclude: 1) that
(NMES) induced resistance training program (RT).The purpose of this fol- the error in measuring limb length is a minor contributor to repeated
low-up study was to determine the relationship between changes in mus- pQCT measurement analysis; 2) the effect of SCI on bone loss at the distal
cle cross-sectional area (CSA) via magnetic resonance imaging (MRI) and tibia can be readily measured using pQCT, and; 3) pQCT may detect effects
fiber CSA measured using in-vitro histochemical techniques after 12 weeks of early electrical stimulation training in individuals with SCI. Clinical
of NMES-induced RT in subjects with chronic complete SCI. Number of Relevance:A sensitive method to measure bone properties is important as
Subjects: Three men (35.6 ± 4.9 yrs, 76.6 ± 21.5kg) with chronic physical therapists strive to develop new technologies to prevent the dele-
(13.±6.5yrs post-injury) complete SCI (ASIA A, C5-T10) participated in this terious effects of bone loss after SCI.
study. Materials/Methods: Subjects performed four sets of ten NMES- Funding: NIH R01HD39445, the Christopher Reeve Paralysis Foundation,
induced knee extensions, two days per week for 12 weeks with resistance and the Foundation for Physical Therapy.
progressively increased over the training period. Percutaneous skeletal
muscle biopsies from the m. vastus lateralis and MR images of the thigh CHANGES IN SOLEUS MUSCLE FORCE AND FATIGUE AFTER SPINAL
were obtained from each subject both pre- and post- resistance training. CORD INJURY WITH TREADMILL LOCOMOTOR TRAINING IN RATS.
Histological staining of individual fibers in muscle cross-sections was per- JE Stevens1,WA O’Steen1, DK Anderson1, M Liu2, K Vandenborne2, P Bose3, FJ
formed and fiber specific CSA was determined using computerized Thompson3, 1Malcom Randall VA Medical Center, Gainesville, FL,
planimetry (NIH Scion Image Program (Version 4.0.2). Transaxial MR 2
Department of Physical Therapy, University of Florida, Gainesville, FL,
Images of the thighs were collected with a 1.5-T magnet (TR=500ms; 3
Department of Neuroscience, University of Florida, Gainesville, FL.
TE=14ms; FOV=20cm; encoding matrix=256x256; 1cm slice thickness sep-
arated by 0.5cm) from the hip joint to the knee joint using the whole body Purpose/Hypothesis: Currently, a major therapeutic problem centers
coil. Linear regression analysis was used to determine the relationship around several issues related to profound atrophy of the primary locomo-
between changes in whole muscle CSA and changes in individual fiber tor skeletal muscles following spinal cord injury (SCI).The purpose of this
CSA. Dependent samples t-tests were used to assess for differences in fiber study was to further study the influence of SCI on skeletal muscle atrophy
area pre- and post-NMES training. Significance was set at p ≤ 0.05. Results: and to evaluate therapeutic influence of early treadmill locomotor training
Changes in muscle CSA explained 99.5% of the variance in fiber hypertro- on soleus muscle force and fatigability following spinal cord injury in rats.
phy following NMES induced RT (y = 2.215x - 0.0128; R2 = 0.9956). In addi- Our hypothesis was that locomotor training would attenuate some of the
tion, following RT, average muscle fiber CSA increased from (2807 ± functional changes in muscle seen early after injury by improving muscle
327cm2) at baseline to (4581 ± 510cm2) after training (p ≤ 0.05). force and decreasing muscle fatigue. Number of Subjects: Twenty four
Conclusions:The main finding of this study was that 12 weeks of NMES- adult Sprague Dawley rats (female, 16-20 weeks, weighing 220-260g) were
induced RT elicited substantial hypertrophy in individual muscle fibers in used. Eight rats served as controls and sixteen received a moderate T8
subjects with complete SCI. In addition, the relationship between these spinal cord contusion injury using a standard NYU impactor. Eight injured
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 192

rats received treadmill locomotor training starting 1 week after SCI for 5 muscle activity of the MH and VL appears to have a minor role during the
consecutive days, 20 minutes/trial, 2 trials/day.The additional eight injured measurement of spasticity of the knee flexors and knee extensors using
rats received no exercise intervention. Materials/Methods: In situ soleus dynamometry in children with SCI, which suggests that passive muscle
force measurements were performed 2 weeks after SCI (following 1 week stiffness may be more important than increased reflexes. Quantitative and
of training). Maximum tetanic force was electrically elicited in the soleus clinical examination tools for spasticity appear to be measuring different
muscle using a single train, 1500ms in duration at 100 Hz with a 5 min inter- aspects of spasticity. Clinical Relevance: Examination of spasticity should
val between trails.The maximum tetanic force of 3 attempts was recorded. incorporate both quantitative and clinical tools in order to have a more
Similarly, the fatigue test was electrically elicited and consisted of a modi- complete understanding of spasticity. Interventions for spasticity in chil-
fied Burke fatigue test with 300ms trains delivered every second for 2 min- dren with SCI may benefit from addressing non-reflexive muscle stiffness.
utes. Fatigue was calculated as (initial-final force)/initial force. A one-way
ANOVA with post hoc testing was used for statistical analysis of data and a PLATFORMS: Parkinson Disease
p value of less than 0.05 was considered significant. Results: One week of Saturday 1:30-3:30
training after SCI significantly increased soleus muscle force (178+19mN)
compared to SCI rats without training (117+29mN) (p<0.05), an improve- TREADMILL EXERCISE TRAINING INDUCES ANGIOGENESIS AND
ment of 52.1%.The force of trained animals was not different from that of IMPROVES ENDURANCE AND NEURONAL INDICATORS IN CHRONIC
uninjured animals (201+14mN) (p<0.05). Injured rats that received train- MOUSE MODEL OF PARKINSON’S DISEASE. M.D.Al-Jarrah1, L. Novikova1,
ing also demonstrated comparable fatigue to control animals (27+0.04% L. Stehno-Bittel1,Y. Lau2, 1Physical Therapy and Rehabilitation Sciences,The
and 26+0.09% respectively) compared to rats without training (36+0.1%) University of Kansas Medical Center, Kansas City, KS, 2Department of
(p<0.05). Conclusions: One week of therapeutic locomotor treadmill Pharmacology,The University of Missouri, Kansas City , Kansas City, MO.
training initiated at 1 week following SCI produced soleus muscle forces
that were 52.1% stronger than recorded in injured/untrained control ani- Purpose/Hypothesis:The goal of this study was to determine whether a
mals. In addition, compared with normal controls, the injured/trained ani- 4-week treadmill running protocol could induce angiogenesis and improve
mals retained 100% of their fatigue resistance measures; whereas a 27.2% endurance and neuronal indicators in a chronic MPTP/probenecid mouse
decrease was recorded in the injured/untrained control animals. Clinical model of Parkinson’s disease. Number of Subjects:Twenty-three C57BL/6
Relevance: One week of therapeutic locomotor treadmill training initiated mice were randomly assigned in 4 groups: sedentary control, exercise-
at 1 week following SCI produced soleus muscle forces that were 52.1% trained control, sedentary PD, and exercise-trained PD. Materials/
stronger than recorded in injured/untrained control animals. In addition, Methods: The PD was induced by 10 chronic injections of 25 mg/kg
compared with normal controls, the injured/trained animals retained 100% MPTP and 250 mg/kg probenecid, which exhibited many symptoms of
of their fatigue resistance measures; whereas a 27.2% decrease was human PD. Exercised groups of mice were trained to run 40 min, 5
recorded in the injured/untrained control animals. days/week for 4 weeks at an average speed of 18 m/min on a treadmill.
Citrate synthase activity, cardiovascular parameters, dopamine level in sub-
EXAMINATION OF SPASTICITY OF THE KNEE FLEXORS AND KNEE stantia nigra, tyrosine hydroxylase contents and blood vessels density in
EXTENSORS USING ISOKINETIC DYNAMOMETRY AND CLINICAL the striatum were analyzed and compared between the animal groups.
SCALES IN CHILDREN WITH SPINAL CORD INJURY. S. Pierce, T.E. Results: Compared to the respective sedentary groups, the soleus muscle
Johnston, R.T. Lauer, Research, Shriners Hospital for Children, Philadelphia, citrate synthase activity increased by 21% in the exercise-trained PD group
PA. and 18% in the exercise-trained control group (p<0.05). Citrate synthase
activity in the gastrocnemius produced similar results. Resting heart rates
Purpose/Hypothesis:The management of spasticity is a common goal for declined significantly in both exercise-trained groups. PD showed a
children with spinal cord injury (SCI).A better understanding of spasticity decrease in the resting heart rate by about 10%. Substantia nigra tyrosine
is important for clinicians working with this population. The purpose of hydroxylase content and striatal dopamine levels were increased nearly
this study is to examine the electromyography (EMG) responses of the 30% in the exercise-trained PD over the sedentary PD mice, whereas these
knee flexors and knee extensors during the examination of spasticity levels were indifferent between sedentary and exercise-trained controls.
using an isokinetic dynamometer and to correlate peak passive resistance Exercise also resulted in a significant increase in blood vessel density in the
torque with clinical scales of spasticity in children with SCI. Number of striatum of trained PD animals compared to the sedentary group (P<
Subjects: A convenience sample of 14 children with chronic SCI (mean 0.003). Conclusions: In summary, our study demonstrated that improve-
age = 9.1 years; 13 ASIA A, 1 ASIA B) was recruited. Materials/Methods: ment in endurance and neuronal parameters as well as angiogenesis could
One set of ten passive movements from 90 degrees of knee flexion to 25 be achieved in PD mice with a 4-week exercise training protocol. Clinical
degrees of knee flexion and from 25 degrees of knee flexion to 90 degrees Relevance:According to our results, aerobic exercise could be beneficial
of knee flexion was completed using an isokinetic dynamometer at 15, 90, for limited functional recovery in subjects with debilitating neurodegener-
and 180º/s with a return speed of 5 degrees per second to assess knee ative disorders, including Parkinson’s disease
flexor and knee extensor spasticity respectively. Surface EMG was col-
lected from the vastus lateralis (VL) and medial hamstrings (MH) concur- ADAPTATION OF VOLUNTARY STEP INITIATION IN PERSONS WITH
rent with the dynamometry data. Gravity corrected peak passive torque for PARKINSON’S DISEASE. J. Spears1, K. Ryczek1, S. Schumacher1,A. Orzel1,
each repetition was calculated. EMG onset was defined as three standard J. Zhang1, K. Martinez1, M.E. Johnson1, M. Mille1, M.W. Rogers1, T. Simuni2,
deviations above baseline level. Spasticity was clinically assessed using the 1
Physical Therapy & Human Movement Sciences, Northwestern University,
Ashworth Scale (AS) and Spasm Frequency Scale (SFS). Descriptive analy- Chicago, IL, 2Neurology, Northwestern University, Chicago, IL.
sis of the EMG responses was completed. Non-parametric correlational
analyses between peak passive resistive torque and the clinical measures Purpose/Hypothesis: Difficulties with gait initiation and other locomo-
of spasticity were calculated. Results: During passive knee extension, tion activities are characteristic and often debilitating problems for people
reflexive muscle activity in the MH occurred in less than 4% of trials while with Parkinson’s disease (PD).Anticipatory postural adjustments (APAs) for
reflexive muscle activity in the VL occurred in less than 6% of trials with lateral weight shift and stability normally precede and accompany step ini-
movements at each velocity. During passive knee flexion, reflexive muscle tiation. Patients with PD demonstrate prolonged and reduced APAs and
activity in the VL occurred in less than 5% of trials while reflexive muscle delayed step initiation.A lateral postural assist at the pelvis has been shown
activity in the VL occurred in less than 8% of trials with movements at each to acutely decrease APA duration and step onset time in PD.The aim of this
velocity. The median AS for the knee flexors and knee extensors was 0.5 study was to determine if patients with PD would adapt to lateral assist
and 0 respectively while the median SFS was 2.There were no significant training by demonstrating decreases in APA duration and step onset time
correlations (p<0.05) between peak passive torque of the knee flexors and following removal of lateral assist. Number of Subjects: 6 patients with
knee extensors at each velocity,AS, and SFS with the exception of a signif- early-stage PD (Hoehn and Yahr stage 1 & 2) and 6 age-matched controls.
icant negative correlation (p=0.034) between SFS and peak passive torque Materials/Methods: Ground reaction forces were recorded with two force
of the knee flexors with movements at 15º/sec. Conclusions : Reflexive platforms to determine APA characteristics based on the net medio-lateral
193 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

center of pressure displacement.Whole body kinematic data were recorded exercise RL Slope was 17 with a minimal increase in MEP amplitude with
using a 6-camera infrared motion analysis system to determine step charac- increasing stimulation. Post exercise MEP amplitude increased with stimu-
teristics.The lateral assist training session consisted of 3 blocks of trials dur- lation intensity in a near linear fashion (RL Slope = 107) approximating
ing rapid forward stepping: 10 baseline trials, 50 trials with lateral assist, and what is seen in healthy individuals. Discussion:To our knowledge, this is
10 post-assist trials without assist. Ten retention trials without assist were the first demonstration of exercise-induced changes in recorded TMS values
collected one week after the initial session.The lateral assist was provided in conjunction with functional improvement. Our data suggests that there
by a motor driven robotic system with a cable attachment hooked onto a is an effect of high-intensity exercise on measures of both brain and behav-
belt around the subject’s pelvis. The assist was applied when 55% of the ior in PD. By understanding the effects of exercise on neuroplasticity, novel,
subject’s weight was on the swing limb to aid with weight transfer during non-pharmacological therapeutic modalities may be designed to delay or
the APA phase of step initiation. Data was analyzed using ANOVA (p < reverse disease progression in Idiopathic Parkinson’s disease.
0.05).Results: There were no significant group effects between PD and
control subjects. However, PD subjects tended to show longer APA duration FUNCTIONAL REACH: IS THIS A VALID MEASURE OF RECURRENT
and slower step onset times compared to controls. Significant condition FALLS IN INDIVIDUALS WITH PARKINSON’S DISEASE? J. Robichaud1,
effects between baseline and lateral assist trials, indicated a decrease in total Pfann, D.M. Corcos2, C. Cindy3, 1Physical Therapy, Indiana University,
APA duration (p < 0.01), thrust phase (APA onset to peak amplitude (p < Indianapolis, IN; K.D, 2Movement Sciences, University of Illinois at Chicago,
0.02), unloading phase (peak APA amplitude to end of APA, (p < 0.02), and Chicago, IL, 3Department of Neurological Sciences, Rush University,
step onset time (p < 0.01).There was a significant decrease in thrust dura- Chicago, IL.
tion between baseline and retention (p = 0.01).A decrease in APA duration
between baseline and retention was marginally significant (p = 0.06) and a Purpose/Hypothesis: Functional reach (FR) of less than 25.4cm has pre-
shorter step onset time approached significance (p = 0.11).Conclusions : dictive validity in identifying elderly frail subjects at risk for recurrent falls
This study supports previous research that a lateral assist can acutely (when adjusted for age, Folstein mental score and depression). In contrast,
improves step initiation characteristics, in patients with PD.A trend for sub- this measure has not been shown to be a sensitive measure for identifying
jects to retain shorter APA duration and step onset with practice suggested medicated individuals with Parkinson’s disease (PD) who were at risk for
a potential for adaptation. Greater significance may have been achieved recurrent falls. However, movement disorders associated with PD that pre-
with larger sample size. Clinical Relevance: The approach illustrates disposes these individuals to slips, trips, and falls, become exacerbated dur-
application of current theories of neural plasticity pertaining to adaptive ing the ‘off’ or coming ‘off’ medication conditions. The purpose of this
mechanisms of posture and locomotion interactions and their management study was to determine the effect medication has on the predictive valid-
in people with PD. To attain greater training effects patients may benefit ity of FR in determining the risk of recurrent falls in individuals with PD.
from increased practice time and additional rest breaks to optimize neural Number of Subjects: Forty subjects with PD were tested both off med-
adaptation and minimize fatigue. ication (12-hour overnight withdrawal of anti-parkinsonian medications)
and then after the subject’s regular medication was resumed. Materials/
EVIDENCE FOR ACTIVITY-DEPENDENT NEUROPLASTICITY IN AN Methods: Subjects underwent a clinical evaluation, which consisted of the
INDIVIDUAL WITH PARKINSON’S DISEASE: A TRANSCRANIAL MAG- motor (part III) subclass of the Unified Parkinson’s Disease Rating Scale
NETIC STIMULATION STUDY. M.S. Fong1, T.L. Brown1, K.R. Wolcott1, J. (UPDRS) and the FR test. Individuals were also asked if they had experi-
Lin1, B.E. Fisher1,A.Wu2, 1Biokinesiology and Physical Therapy, University of enced 1 or more falls in the past year.A fall was defined as an incident that
Southern California, Los Angeles, CA, 2Neurology Department of the Keck resulted in the person unexpectedly coming to the ground.The FR test was
School of Medicine, University of Southern California, Los Angeles, CA. administered according to the procedure established by Duncan and col-
leagues. Each subject performed 1 practice trail and 3 test trials.The mean
Background & Purpose: Few studies have investigated the effect of high- difference between the initial position and the end position for the three
intensity exercise such as Body-weight-supported treadmill training trials was calculated as the FR. Data was analyzed using analysis of variance
(BWSTT) on functional improvement in Parkinson’s disease (PD). Further, and regression analysis.The independent variables were medication status
the role of neuroplasticity as the underlying mechanism of functional (off, on), the motor subsection of the UPDRS and history of falls.
improvement has not been examined. An important recent advance is the Dependent variable was FR. All levels of significance were designated at
demonstration of activity-dependent neuroplasticity in animal models of p < 0.05.Results: Individuals with PD exhibited greater FR and higher
PD. Currently we are determining the application of these findings to the UPDRS scores in the ‘off’ as compared to ‘on’ medication condition. FR, as
human condition. Single-pulsed Transcranial Magnetic Stimulation (TMS) a measure of the risk for recurrent falls in the ‘off’ medication condition
has been used to evaluate corticomotor excitability in PD compared with revealed a test sensitivity of 100% and test specificity of 74%. Further, there
healthy individuals. In PD, the amplitude of the motor-evoked potential was a significant correlation (R = .79) between ‘off’ medication UPDRS
(MEP) is higher at low stimulation intensities with a blunted response to score and FR. In contrast, in the ‘on’ medication condition test validity for
increasing stimulation compared to healthy individuals.The purpose of this the FR test (measure of the risk of recurrent falls) revealed a test sensitiv-
preliminary study was to determine the effect of high intensity exercise on ity of 30% and test specificity of 100%. Further, no correlation (R = .30) was
neuroplasticity and functional recovery in an individual with PD.This case revealed between the ‘on’ medication UPDRS score and FR. Conclusions:
is part of a larger study designed to investigate the underlying neural FR measured in the off medication condition, can identify individuals with
processes by which BWSTT promotes functional changes in PD. To our PD who are at risk for recurrent falls.This study also illustrates the differ-
knowledge this is the first report that has used TMS to identify central ing conclusions that can be reached when these individuals are tested in
changes post physical therapy intervention. If exercise induces neuroplas- the ‘off’ as compared to the ‘on’ medication condition. Clinical
ticity we might expect to see ‘normalization’ of TMS measures. Case Relevance: FR in the ‘off’ medication condition is a simple test that clini-
Description:The subject was a 74 year old functionally independent male cians may use to identify individuals with PD who are at risk for recurrent
who had been diagnosed with PD within the last 3 years. He participated falls. Due to the progressive nature of PD, individuals who are identified at
in 24 sessions of BWSTT (3 x/week for 8 weeks). PD symptoms primarily risk should be enrolled in a fall risk intervention program.
affected the left (L) extremities. Over training, weight support was gradually
reduced (30% to 5%); treadmill speed and incline were increased (2.0 to 7.0 RELIABILITY AND VALIDITY OF THE TINETTI MOBILITY TEST FOR
meters/second, 0 to 3% grade).The following measures were taken pre and INDIVIDUALS WITH PARKINSON DISEASE. D. Kegelmeyer1, A.D.
post exercise: 1) gait parameters using a motion analysis system and 2) cor- Kloos1, S.K. Kostyk2, K.M. Thomas2, 1Physical Therapy, The Ohio State
ticomotor excitability (CE) over L and right (R) primary motor cortex with University, Columbus, OH, 2Movement Disorders Division, The Ohio State
TMS. CE was characterized by slope of the input-output recruitment regres- University, Columbus, OH.
sion line (RL Slope) for MEP amplitude during active contraction of the first
dorsal interosseous muscle. Outcomes: A 14% and 16% increase in speed Purpose/Hypothesis: Individuals with Parkinson disease (PD) develop
and single limb support time respectively were accompanied by an 84% progressive gait and balance problems that often result in falls. The Tinetti
change in RL Slope for MEP amp of the R (more affected) hemisphere. Pre Mobility Test (TMT) is a clinical balance and gait test that predicts fall risk
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 194

in elderly individuals.The aims of this study were to determine the inter- of hand movements were: executed ipsi-lesional, imagined ipsi-lesional, exe-
rater (Part 1) and intrarater (Part 2) reliability of TMT scores of individuals cuted contra-lesional, imagined contra-lesional. MRI data were analyzed
with PD, the construct validity of the TMT as a measure of balance and gait using SPM 99, with a corrected height (p=.05) threshold. Group analyses
impairment severity (Part 3), and the predictive validity of the Tinetti were performed to determine the volume of activation in pre-determined
Mobility Test as a screening tool to identify individuals with PD at risk for regions of interest. Results: MIQ scores did not differ significantly between
falls (Part 4). Number of Subjects:Thirty individuals with a diagnosis of groups. HC’s pattern of activation during executed tasks by either hand
PD (mean age=65.47 ±11.17; male/female ratio=23/7; mean Hahn and Yahr included the contralateral primary sensory (1, 2, 3) motor (4) parietal (5, 7)
score =2.41 ± .39) who attended the Madden/NPF Center of Excellence and premotor (PMC) and supplementary motor areas (SMA) (6). Individuals
(Columbus, Ohio) were recruited to voluntarily participate in all portions post stroke pattern of brain activation when using their ipsilesional hand
of this study. Inclusion criteria were Hoehn and Yahr stages I-III or early was similar to that of HC. For the stroke affected hand executed movements
stage IV, and ability to independently ambulate with or without the use of were bilaterally represented while imagined movements were lateralized to
an assistive device. Subjects who had any other neurological diagnosis or the brains’ primary lesioned side. For all tasks performed by the individuals
paralysis from another condition were excluded. Materials/Methods: post-stroke there was greater activation (50-500%) of area six on the con-
Two physical therapists and 3 physical therapy students rated subjects live tralesional side of the brain. Conclusions: The pattern of activation
performances of the TMT (Part 1). During the gait portion of the test, time observed for tasks by the stroke affected hand suggest that it was easier for
for each subject to ambulate 25 feet was recorded.Two physical therapists individuals post-stroke to imagine rather than execute the movements.The
and 4 physical therapy students rated subjects videotaped performances of increased activity of the pre-motor and supplementary motor areas of the
the TMT on two separate days one week apart (Part 2). One of two physi- contra-lesional side during all tasks for the stroke affected subjects suggests
cians administered the Unified Parkinson Disease Rating Scale Motor Exam that there may be a compensatory shift in the tasks of planning and
(Section III) and scores obtained were correlated with the TMT scores sequencing both imagined and executed sequential finger movements.
(Part 3). A falls history was obtained for each subject and the discrimina- Clinical Relevance: Mental imagery by individuals post-stroke may serve
tive power of the TMT to predict fallers was assessed using statistical tests as a stimulus for plasticity of stroke affected side of the brain and possibly
(Part 4). Data were analyzed using intraclass correlation coefficients (Parts be a good tool for rehabilitation of motor function.
1&2), Spearman correlation coefficients (Part 3), and statistical tests of sen-
sitivity, specificity, positive and negative predictive values (Part 4). Results: RECOVERY FROM STROKE: WHAT IS THE ROLE OF THE UNDAM-
Interrater reliability of total TMT scores was good to excellent between all AGED, CONTRALESIONAL CORTEX? L. Boyd, E.D. Vidoni, Physical
raters (ICC=.87), physical therapist raters (ICC=.84), student raters Therapy & Rehabilitation Science, University of Kansas Medical Center,
(ICC=.88), and between physical therapist and student raters (ICC Kansas City, KS.
range=.82-.94). Preliminary results showed moderate to excellent
intrarater reliability of total scores for two raters (ICCs=.99 and .67). Mean Purpose/Hypothesis: The main goal of this study is to map the relation-
total TMT scores were moderately correlated with UPDRS motor exam ships between the phenomenon of contralesional cortical activation after
scores (Spearman correlation=-.45) and comfortable gait speed (Spearman stroke and motor learning. One explanation for contralesional cortical activ-
correlation =.53), but did not predict falls (sensitivity=13% and speci- ity posits that it is a compensatory strategy, employed in response to task
ficity=86% at cutoff score of 19).Conclusions: Our findings suggest that difficulty. We hypothesize that contralesional cortical activity will be
the TMT is a reliable and valid measure of balance performance during reduced by motor skill learning indexed by a laterality index (LI) derived
functional activities in individuals with PD.Analysis is in progress to deter- from fMRI data (H1). Because skill learning is critical for neuroplastic
mine if individual test items are predictive of falls. Clinical Relevance: To change, we also hypothesize that increased but non-specific use of the
identify individuals with PD at risk of falling, physical therapists need valid hemiparetic upper extremity (UE) will not alter contralesional cortical acti-
and reliable examination tools that objectively measure functional mobil- vation (H2). Number of Subjects: For this report we mapped individual
ity and balance in PD. changes in neural activation patterns across motor skill practice and at
retention in 6 people with chronic subcortical stroke.
THEMATIC POSTERS: Imagery and Imaging Materials/Methods: The effect of 2 interventions on activation in the
Friday 4:30-6:00 undamaged cortex was assessed using fMRI.All participants used the hemi-
paretic UE to either to learn a joystick based targeting task (LEARN group;
REPRESENTATION OF IMAGINED AND EXECUTED SEQUENTIAL n=4; mean motor UE Fugl-Meyer 37.0) or to completed a program of
FINGER MOVEMENTS OF ADULTS POST STROKE AND HEALTHY increased but non-specific use of the hemiparetic UE (USE group; n=2; Fugl-
CONTROLS. J.E. Deutsch1, S. Fischer1,W. Liu2,A. Kalnin3, K. Mosier3, 1Physical Meyer 40.5). Over 5 days all completed an initial fMRI testing session, 3 days
Therapy, UMDNJ-SHRP, Newark, NJ, 2Radiology, UMDNJ, Newark, NJ, of practice or treatment and a day 5 fMRI retention test. The number of
Radiology, Indiana University, IN. movements and UE excursion was standardized across groups. Brain activ-
ity was quantified on an individual basis by calculating the LI using the
Purpose/Hypothesis: The purpose of this study was to describe the product of intensity and area of activation data for the primary motor cor-
effects of brain injury on imagery ability and representation by examining tex (M1). Results: Demonstrating behavioral learning of the task,
executed and imagined complex finger movement sequences with each response time (RT) decreased significantly (p<.05) for the LEARN group (-
hand. We hypothesized that individuals post-stroke would exhibit similar 278ms) while the percentage of correct target hits increased (+8%). This
patterns of brain activation for executed and imagined movements to was not true for USE group (RT slowed +62ms; % target hits reduced -5%).
healthy controls (HC) when using their ipsilesional hand but not their con- Importantly, normalization of the pattern of brain activation was evident for
tra-lesional hand. Number of Subjects: Five individuals post stroke (at least the LEARN group; LI improved significantly for M1 by retention (day 1 M1
one year post-stroke, right CVA with preserved motor function in the con- LI -.125; retention M1 LI .735; 1=normal M1 activation). Again, the USE
tralesional hand) and five age matched HC. Materials/Methods: Subjects group did not change (M1 LI day 1 -.16; retention -.09). Conclusions:
were tested in two sessions with one week interval. In the first session Despite the abnormal patterns of neural activation that occurred after brain
imagery ability was examined using the Motor Imagery Questionnaire damage, clearly chronic stroke does not abolish motor learning ability. Our
(MIQ) and chronometric break tests. Subjects practiced executed and imag- data demonstrate that the functional organization of the motor system can
ined paced sequential finger movement sequences with each hand. Audio be modified by use even after stroke. Specifically, the magnitude of activa-
taped instructions were provided for practice of the tasks at home. During tion in undamaged, contralesional M1 was altered by task specific motor
the second session prior to brain scanning accuracy of finger movements learning but not by increasing non-specific hemiparetic UE use. Clinical
was confirmed. Data were acquired with a 3T Allegra MR scanner (Siemens) Relevance: These data support our hypothesis that post-stroke contrale-
using an echo-planar imaging (EPI) gradient system. Functional studies sional M1 activation is in some part related to task difficulty and represents
(fMRI) were acquired using a 32 slice gradient echo EPI (TR=4000,TE=30, a compensatory strategy (H1). It also appears that task specific practice and
64x64 matrix, FOV=22 cm); and a blocked paradigm, each consisting of 4 learning are required to alter patterns of brain activation after stroke (H2).
epochs of task performance alternating with visual attention.The four trials Our findings have great clinical relevance for rehabilitation; it appears likely
195 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

that task specific learning is required to restore more normal patterns of instructed to double their weekly walking distance within six weeks and
brain activity and improve functional outcomes after stroke. then maintain or further increase that distance for an additional six weeks.
Subjects assigned to the sham group received one 30-minute treatment per
BRAIN ACTIVATION DURING KINESTHETIC AND VISUAL IMAGERY week for 12 weeks of sham electrical stimulation to the finger and wrist
OF WALKING. CA Chatto1, JE Deutsch1, J. Pillai2, T. Lavin2, J. Allison2, extensor muscles of their dominant hand. During this time, they were
Program in Physical Therapy, UMDNJ, Newark, NJ, 2Department of instructed to maintain their regular walking distance. Before and after
Radiology, Medical College of Georgia,Agusta, GA. training, subjects performed a six-minute finger movement tracking test
with functional magnetic resonance imaging of the brain inside a three-
Purpose/Hypothesis: The purpose of this study was to contrast how Tesla magnet to measure finger movement control and the associated cor-
kinesthetic and visual imagery strategies, when used to mentally imagine tical activation. Analysis of data was done with paired tests comparing
walking, would affect brain activation patterns. We hypothesized that pretest to posttest change for both groups. Results: Results showed that
imagery strategy would modify cortical representation. Number of the walking group significantly increased their walking distance (p =
Subjects: Six healthy, right handed adults (39-64 years old). 0.003), whereas the sham group showed no change. The finger tracking
Materials/Methods: Subjects were tested in two sessions one week apart. accuracy increased significantly for the walking group (p = 0.01), whereas
In the first session imagery ability was measured with the Vividness of for the sham group no change occurred. Despite the significant improve-
Movement Imagery Question-naire (VMIQ). Subjects practiced imaging ment in tracking performance in the walking group, there were no signifi-
walking using visual and kinesthetic strategies, using a visual context (hall- cant changes in measurements of brain reorganization (active voxel count
way) in which to practice imagined walking.A week after practicing sub- and signal intensity) in M1 of either group. Conclusions: We concluded
jects returned for brain imaging.Actual and imagined walking speeds were that walking training improved finger movement tracking control in well
assessed to determine chronometric consistency. Functional Magnetic elderly subjects but did not show a change in brain reorganization. The
Resonance Images were acquired on a 1.5T scanner (GE LX Horizon absence of significant change in brain reorganization accompanying the
Echospeed) using echo-planar technique. Images were acquired using a behavioral improvement may be due to the area (M1) studied or the time
blocked paradigm with 8 epochs of task performance alternating with at which the cortical activity was measured at posttest. Clinical
directed attention. Subjects viewed a video of hallway and then performed Relevance:These results suggest that an active walking training program
the following tasks: 1) imagined walking down hallway using visual has beneficial effects on fine motor control of movements unrelated to the
imagery 2) imagined walking down hallway using kinesthetic imagery 3) walking exercise. The possibility exists that aerobic/walking training,
bilateral foot movements 4) imagined foot movements using visual through molecular mechanisms not yet identified, may have similar bene-
imagery and 5) imagined foot movement with kinesthetic imagery. ficial effects on motor control in patients with neurological problems.
Subjects’ imagery vividness was recorded after each scan with the VMIQ.
Brain imaging data were analyzed using SPM99. For each subject, SPM INFLUENCE OF MOTOR-IMAGERY ABILITY ON SMA AND PSMA
maps were computed by subtracting rest from task conditions to identify CORTICAL ACTIVATION. T.J. Kimberley, G.S. Khandekar, Physical
voxels having increased intensity during tasks.A simple t-test was used to Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN.
determine significant activation in the following regions of interest (ROIs):
sensorimotor cortex (SMC), supplemental motor area (SMA), parietal cor- Purpose/Hypothesis:The supplementary motor area (SMA) and pre-sup-
tex (PC), dorsolateral prefrontal cortex (DLPFC). Data were analyzed at p plementary motor area (PSMA) are considered to be vital in the planning,
= .0001 with 20 voxel clustering and p = .05 corrected. Results:All ROIs initiation, and execution of motor tasks. Several studies have investigated
were activated bilaterally during both visual and kinesthetic imagery of the role of SMA in mental imagery, but little is known about how the abil-
walking. The visual imagery task produced a right lateralized pattern for ity to imagine influences brain activation.The purpose of this study was to
SMC, DLPFC, and PC; while the kinesthetic imagery task produced a left lat- investigate the role of SMA and PSMA during mental imagery in both
eralized pattern for SMC, DLPFC, SMA and PC. Differences between right healthy subjects and subjects with stroke and how the ability to imagine
and left sided activation within tasks were not significant due to subject influences brain activation. Number of Subjects: Six subjects with severe
variability. The SMC exhibited 29% greater extent of activation for the hemiparesis (Fugl Meyer UE score: 9-14, range: 8-113 months post stroke,
kinesthetic task than the visual task. Conclusions:These descriptive pre- mean: 64.3 months) and six age and gender matched healthy subjects.
liminary findings suggest that similar brain regions are recruited with Materials/Methods:Whole-brain 3-Tesla fMRI was performed in subjects
visual and kinesthetic imagery of walking. The lateralization of the brain with stroke during alternating phases of active wrist-tracking with the less
activation and the different weighting of SMC may be related to the type affected hand and imagined wrist-tracking with the hemiparetic side and
of imagery. Clinical Relevance: These findings provide a foundation for resting. Control subjects were assigned a side to imagine and a side to
further research with the use of mental practice of walking as an adjunct track. At the end of the session, subjects were asked to rate the ability to
to the rehabilitation. Selection of imagery strategy may be especially rele- imagine the movements, on a scale of 0-5 with zero being inability to imag-
vant for persons following stroke. ine and five being perfect imagining of the task. Cortical activation inten-
sity within each region was determined and the percent change in signal
EFFECT OF WALKING VS SHAM TREATMENT ON FINGER MOVE- intensity from baseline was calculated. Subjects with stroke and healthy
MENT CONTROL AND BRAIN REORGANIZATION IN WELL ELDERLY. subjects were divided into two groups: high imagery ability (self-rating: 3-
S. Anderson, H. Aldrich, S. Knight, C. Battles, J.R. Carey, University of 5) and low imagery ability (self-rating: 0-2). Statistical analysis of fMRI data
Minnesota, Minneapolis, MN. was done with two-tailed T-tests using percent signal intensity change.
Results: During the motor imagery task, subjects with stroke displayed sig-
Purpose/Hypothesis: Previous studies have shown that aerobic training, nificantly greater percent increase in activation in contralateral SMA as
including walking, can have beneficial cognitive effects.The possibility that compared to healthy subjects [SMA: healthy: 0.88 ± 0.14, stroke: 1.39 ±
such cognitive effects might improve motor control is real.The purpose of 0.52, P = 0.03]. Pre SMA also showed a greater percent increase in the
this study was to investigate whether a walking training program could stroke group, but this was not significant [PSMA: healthy: 0.48 ± 0.71,
induce improvement in finger tracking performance accompanied by stroke: 1.10 ± 1.24]. For the imagined wrist-tracking task, there was no sig-
changes in cortical activation within primary motor area (M1), as measured nificant difference in the percent signal-intensity change between the high
by fMRI, in well elderly subjects.We hypothesized that subjects in the walk- and low imagining ability groups.This finding of no difference is supported
ing group would show greater improvement in finger tracking and signifi- by adequate power [effect size: 1.1, N=12, power .80]. Conclusions:This
cant changes in brain reorganization compared to a sham group. Number study provides evidence that mental imagery of a motor task in patients
of Subjects: Fourteen well elderly subjects were assigned to either a walk- with stroke promotes cortical activity, which is consistent with previous
ing group (N = 6, mean age = 81.7, SD = 1.9 years) or a sham group (N=8, research. Additionally, self-reported ability to imagine does not influence
mean age 79.8, SD = 2.3 years). Materials/Methods: All subjects wore a the signal intensity of SMA and PSMA activation. Clinical Relevance:
pedometer for one week prior to group assignment to record baseline Studies have shown that mental imagery may have beneficial effects when
level of walking distance. Subjects assigned to walking group were combined with rehabilitation. Our findings show that motor imagery facil-
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 196

itates cortical activity that is functionally relevant. The data also support were placed bilaterally on the 5th metatarsal head, lateral malleolus, lateral
that the strength of motor imagery ability does not influence the amount knee joint space, greater trochanter, iliac crest and acromion process. Foot
of cortical activation.Thus, it is plausible that even patients that have diffi- contacts were determined using foot switches. Intra-limb (i.e. those mea-
culty performing motor imagery will exhibit increases in cortical activa- sured from a single leg: stride length, stance/swing time) and inter-limb (i.e.
tion which may be an important adjunct to rehabilitation. those where the measurement depended on both legs: time in double sup-
port, step length, limb orientation at weight transfer, limb phasing) kine-
MOVEMENT CONTROL AND CORTICAL ACTIVATION IN FUNC- matic variables were calculated. Results: Both controls and people with
TIONAL ANKLE INSTABILITY. K. Anderson, J.R. Carey, Program in chronic stroke could adapt inter-limb coordination and showed after-
Physical Therapy, University of Minnesota, Minneapolis, MN. effects following split-belt practice. Subjects with hemiparesis changed
limb phasing and step length from the baseline period to the early adapta-
Purpose/Hypothesis: One-third or greater of first time ankle sprain suf- tion period (p<0.05, p=0.10, respectively) and stored an after-effect (com-
ferers report continuing instances of ankle instability, regardless of inter- paring baseline and early post-adaptation periods, p=0.09, p<0.05, respec-
vention or severity of injury.This high prevalence of prolonged instability tively). Similar results were found for double support and limb orientation
requires exploration into contributing factors. Previous research has impli- at weight transfer, though individual stroke subjects varied in their adaptive
cated impaired sensorimotor control of the ankle. The purpose of this abilities. Intra-limb parameters changed rapidly for controls and people
study was to explore for differences in cortical activation, measured with with hemiparesis, with no difference between the groups. For the 6 out of
functional magnetic resonance imaging (fMRI), between people with a his- 8 subjects with hemiparesis that demonstrated a gait asymmetry, walking
tory of recurrent ankle sprains and those without such a history during an on the split-belt treadmill temporarily reduced or eliminated the asymme-
ankle movement control task. Number of Subjects:Ten subjects (mean try either during split-belt adaptation or due to after-effects in the post-
age 29.9 ± 8.4 years) with complaint of unilateral (8 right, 2 left) functional adaptation period. Conclusions: Since all subjects showed some adaptive
ankle instability (FI) and ten control subjects (age 26.9 ± 9.0) were ability, we suggest that this form of locomotor adaptation may be less
recruited from a sample of convenience.All subjects were right ankle dom- dependent on cerebral structures. We speculate that the adaptation and
inant. Materials/Methods: Functional MRI images using a 3 Tesla magnet expression of the after-effect may be influenced by several factors includ-
were obtained while the subjects performed an ankle tracking task with ing: the degree of locomotor impairment, lesion location, and/or which leg
each ankle separately (order randomized) using ankle inversion and ever- is driven faster during the adaptation. Clinical Relevance: The results of
sion to follow a 0.4 Hz sine wave. Movement control was calculated for this study preliminarily suggest that persons with post-stroke hemiparesis
each ankle with an accuracy index. Using blood oxygenation level depen- retain the capability to adapt inter-limb coordination to produce a more
dent (BOLD) contrast method, cortical activation was assessed. We calcu- symmetric locomotor pattern. Split-belt treadmill training may therefore be
lated the percent increase in signal intensity from baseline (% intensity) useful to improve gait symmetry of people with certain types of stroke.
during the task over all voxels in the anatomically defined regions of pri-
mary motor (M1), primary somatosensory (S1), and supplementary motor PARETIC LOWER EXTREMITY LOADING AND WEIGHT TRANSFER
(SMA) cortices using non-parametric tests. Results: Ankle pairwise % FOLLOWING STROKE. V.S. Mercer1, S. Chang1, J.L. Purser2, J.K. Freburger3,
intensity differences were found in FI subjects in S1 and M1. In M1, while 1
Allied Health Sciences, UNC-CH, Chapel Hill, NC, 2Medicine, Duke
tracking with the sprained ankle, the FI subjects showed greater intensity University Medical Center, Durham, NC, 3Cecil G. Sheps Center for Health,
in the contralateral than ipsilateral hemisphere (p=0.005) while the con- University of North Carolina at Chapel Hill, Chapel Hill, NC.
trols did not show a difference with either limb (p=0.333 right ankle,
0.208 left). In S1, while tracking with either ankle, the FI subjects demon- Purpose/Hypothesis: Improved ability to bear weight on or load the
strated greater intensity in the contralateral than ipsilateral regions paretic lower extremity (LE) and to transfer weight from one LE to the
(p=0.021 sprained ankle, 0.047 unsprained ankle). Control subjects other is one of the main goals of stroke rehabilitation. Although this goal
demonstrated no difference between hemispheres for either ankle appears theoretically sound, the functional significance of these abilities
(p=0.953 right, 0.374 left). Differences found in SMA were not significant. has not been addressed empirically. The purpose of this project was to
No differences were observed between FI subjects and controls for either determine how impairment-level measures of paretic LE loading and
ankle tracked in any of the three regions. Accuracy indices demonstrated weight transfer relate to clinical and/or self-report measures of physical
no between group or within subject differences. Conclusions: We con- function and disability during early recovery from mild to moderate stroke.
cluded that differences in patterns of cortical activation during a move- Number of Subjects:Twenty-five subjects (12 men, 13 women; mean age
ment accuracy task exist between those with recurring functional ankle = 60.5 ± 17.2 years) with a diagnosis of a single, unilateral stroke partici-
complaints and those without such complaints. Clinical Relevance:These pated in the study. Materials/Methods: Subjects were tested at 1, 2, and 3
results invite further work into discovering a neurological mechanism for months post stroke.The Step Test (ST) and the Repetitive Reach (RR) test
functional ankle instability, which may lead to new interventions. were used as measures of LE loading and weight transfer, respectively. A
third impairment-level measure, paretic hip abductor muscle torque, was
THEMATIC POSTER SESSION: Post-Stroke Hemiplegia examined because of the important role of the hip abductors in both load-
Saturday 8:00-11:00 ing and weight transfer. Self-selected gait speed (GS) and the MOS Short
Form-36 Physical Functioning Index (PFI) were used to assess physical
SPLIT-BELT TREADMILL ADAPTATION AND GAIT SYMMETRY POST- function. Three domains (mobility, ADL/IADL, participation) of the Stroke
STROKE. DS Reisman1, AJ Bastian2, 1Department of Physical Therapy, Impact Scale (SIS) were used to assess self-reported disability. Regression
University of Delaware, Newark, DE, 2Kennedy Krieger Institute, Baltimore, analyses were conducted to examine the bivariate associations between
MD. each impairment and physical function measure and between each impair-
ment and disability measure for each time point (1, 2, 3 months). Results:
Purpose/Hypothesis: The purpose of this study is to understand the All of the impairment measures were positively associated with all of the
capacity of persons with post-stroke hemiparesis to adapt locomotor inter- physical function measures.These associations generally got stronger over
limb coordination and the influence of this on gait symmetry. Number of time (i.e., from 1 to 3 months). The associations were stronger for self-
Subjects: 8 subjects with chronic post-stroke hemiparesis and age-matched selected gait speeds (R2 values 0.30 - 0.79) than for the PFI scores (R2 val-
controls have been tested to date. Materials/Methods: Subjects walked on ues 0.15- 0.63). Both ST and RR scores were strongly associated with gait
a custom split-belt treadmill (Woodway) where the speed of each belt (leg) speed at all 3 time points.At 3 months, each additional step on the ST cor-
could be controlled independently. Subjects walked in baseline conditions responded to a 0.08 m/sec increase in gait speed (95% CI=0.06-0.10,
(belts tied, slow=0.5 m/s and fast=1.0 m/s), split-belt conditions (impaired p<0.001), and each additional reach during RR was associated with a 0.03
leg moving fast (1.0 m/s) in one session, slow (0.5 m/s) in another) and m/sec gait speed increment (95% CI=0.02-0.04, p=<0.001). The impair-
post-adaptation conditions (belts tied, slow=0.5 m/s). OPTOTRAK ment-disability associations were weaker than the impairment-physical
(Northern Digital,Waterloo ON) sensors were used to record 3-dimensional function associations, with only some reaching statistical significance. ST
position data from both sides of the body. Infrared emitting diodes (IREDs) scores and RR scores were positively associated with SIS mobility (R2 val-
197 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

ues .32-.46) and SIS ADL/IADL (R2 values .16-.37), with RR scores having vation modulates these reflex responses. BACKGROUND: Many factors con-
the strongest associations. Hip abductor torque was positively associated tribute to abnormal movement patterns in patients following unilateral
with SIS mobility (R2=.19).The impairment-disability associations also got stroke including weakness, poor motor control and spasticity. Reflex
stronger over time. Conclusions: Impairment in paretic lower extremity responses have been shown to be exaggerated following stroke which pre-
loading and weight transfer abilities relates to physical function and dis- sents challenges while weight-bearing or stepping with the paretic leg.
ability during the first 3 months following stroke. Clinical Relevance: By While studies have quantified reflex behavior at a single joint (Knutsson,
use of interventions that promote symmetrical weight bearing and 1980) little has been done to look at reflexes during controlled multi-joint
smooth, rapid weight transfer between the lower extremities, physical movements. HYPOTHESIS:We hypothesize that stroke subjects will demon-
therapists may be able to help stroke survivors improve function and min- strate greater reflex activity following multi-joint leg movements and that
imize disability. this activity becomes pronounced at higher movement velocities or when
muscles are voluntarily activated compared to controls. Number of
SINGLE LIMB BODY WEIGHT SUPPORTED TREADMILL TRAINING. Subjects: 14 unilateral chronic (> 1 year) stroke survivors and 10 healthy
J.H. Kahn1,T. Hornby2, 1Sensory Motor Performance Program, Rehabilitation age-matched controls participated in this study. Materials/Methods: Each
Institute of Chicago, Chicago, IL, 2Physical Therapy, University of Illinois at subject was instrumented with surface electrodes over the gastrocnemius
Chicago, Chicago, IL. (gastroc), hamstring (HS), rectus femoris (RF), vastus medialis (VM) and lat-
eralis (VL), adductor longus (AL), and gluteus medius (Gmed) and maximus
Purpose/Hypothesis: Gait asymmetries, characterized by differences in (Gmax). Subjects were seated in a BIODEX with their foot rigidly attached
step length as well as timing, are common deviations seen in people who to a 6 DOF load cell and footplate that could slide on a horizontal track to
have had a stroke. Body weight supported treadmill training (BWSTT) has produce passive leg extension. Using a visual feedback, subjects were
been shown to improve functional walking ability, including gait asymme- instructed to target match hip and knee torques at 10, 20 and 30% of their
try, in individuals post stroke. Despite these improvements, the labor inten- maximum after which the leg was extended at one of three speeds (30, 60,
sive demands of the task limit its use in the clinic. Multiple therapists are and 120º/s). EMGs were normalized by their maximum value, after which
often required and controlling gait kinematics is difficult with one thera- the reflex response was identified as the integrated muscle activity for the
pist. Previous evidence has shown that unilateral walking training may first 200 ms following the onset of movement. A single-factor ANOVA was
have an effect on bilateral locomotor activity; specifically, altering condi- used to compare reflex response between groups (alpha = 0.05) across
tions on one leg may have an effect on bilateral activity. Unilateral training speeds and pre-activation levels. Results: 1) The mean reflex activity in the
may have the potential to affect gait symmetry following stroke, although gastroc, HS and AL are larger in stroke survivors compared to controls (p <
application of this training has not been reported. This study investigated 0.05), while reflex responses in the rectus femoris were smaller in the
the effects of single limb BWSTT in people with chronic stroke who stroke subjects (p < 0.05). 2) Changes in speed affected stroke survivors
stepped with their unimpaired limb. Stepping with the unimpaired limb more than controls in the gastroc, HS and AL (p < 0.05). 3) Changes in mus-
may encourage weight-bearing on the impaired extremity and promote cle pre-activation correlated with reductions in reflex activity, particularly
symmetrical walking. Hypothesis: Single limb BWSTT will improve step at slow speeds, however the correlation coefficient was not significant.
length symmetry in individuals with chronic stroke. Number of Subjects: Conclusions: Stroke survivors have exaggerated reflex activity that is exac-
Six subjects with chronic stroke who demonstrated a 20% step length erbated with increases in movement speed, particularly in the biarticular
asymmetry completed the protocol. Materials/Methods: Subjects com- muscles. Clinical Relevance: Exaggerated reflex responses with increas-
pleted a 20 minute session of unilateral stepping with their unimpaired ing speed may influence a stroke patient’s ability to perform tasks requir-
limb on the treadmill, and the impaired limb held in a stationary position. ing rapid leg extension movements such as sit-to-stand and postural adjust-
Subjects walked on the treadmill for 5 minutes at their normal, overground ments for balance. Stroke patients may self select slower movement
gait velocity and speed was increased by 25% every 5 minutes. Body speeds to diminish the effect of speed on these muscles and enable patients
weight support was determined by the least amount of support tolerated to maintain control of their movements.
without buckling. Subjects were evaluated using the Berg Balance Scale
and Gait Mat II Regis. Gait speed and symmetry during normal and fast DYNAMIC WALKING STABILITY IN HEMIPARETIC CHRONIC
walking speeds were obtained at 1 week pre- and post-training. STROKE SUBJECTS. K.P. Brady1, J.M. Hidler1, M.C. Sinopoli2, 1Center for
Additionally, spatial-temporal data was collected immediately pre- and 10, Applied Biomechanics and Rehabilitation Research, National
20, and 30 minutes post-training and 24 hours later. Step length asymmetry Rehabilitation Hospital, Washington, DC, 2Department of Biomedical
was calculated as the ratio of impaired to unimpaired limb step length. Engineering, Catholic University,Washington, DC.
Results: Increased step length symmetry was observed at 10 minutes post-
single limb walking, with increases in gait speed observed up to 30 min- Purpose/Hypothesis: The goal of this study was to identify key charac-
utes. Symmetry changes returned to baseline by the following day while teristics of ground reaction forces exhibited during gait that could be used
improvements in speed lasted until 1 week post training. Changes in fast to quantitatively evaluate stability during ambulation. The most common
walking speed were statistically significant (p<.05), and improvements in way to measure stability during ambulation in stroke patients is through
symmetry were observed (p = 0.11) but not statistically significant. force platform data analysis (Karlsson and Frykberg, 2000) and clinical tests
Conclusions: Single limb BWSTT may improve step length symmetry in performed by health professionals such as the Berg Balance Test (Berg et al.,
the chronic stroke population, although more experimentation is required. 1995).These tests give a numerical score based on an individual’s ability to
Clinical Relevance: The initial findings indicate that unilateral training complete a set of tasks yet focus on static posture and limited dynamic sta-
may improve bilateral walking performance in chronic stroke. Single limb bility that are limited by their subjectiveness. Number of Subjects: Eight
BWSTT may have the potential to be used in the clinic to assist in improv- individuals with hemiparesis resulting from a CVA no less than one year
ing gait speed and symmetry. Such therapy may improve the feasibility of prior to the onset of the study and eight healthy age-matched control sub-
performing BWSTT in the clinic while specifically targeting those who jects participated in the study. Materials/Methods: Each subject walked on
demonstrate gait asymmetry. a split belt instrumented treadmill (ADAL3D-F/COP/Mz,TECMACHINE) out-
fitted with force sensors under each belt (Kistler,Winterthur, Switzerland),
THE EFFECTS OF SPEED AND LEVEL OF VOLUNTARY MUSCLE ACTI- which allows for the calculation of ground reaction forces and center of
VATION ON REFLEX RESPONSES IN CHRONIC STROKE PATIENTS. pressure (COP) under each foot. Each subject walked on the treadmill at
D. Nichols1, M. Pelliccio1, I. Black2, J. Hidler2, 1Inpatient PT, National five different speeds: their normal over-ground self-selected walking speed
Rehabilitation Hospital,Washington, DC, 2Center for Applied Biomechanics (SS), ± 10% SS and ± 25% SS. Data was collected at each of the five speeds
and Rehabilitation Research, National Rehabilitation Hospital,Washington, for two periods of 30-seconds.The Fugl-Myer (Fugl-Meyer et al., 1975) lower
DC. extremity scale was used to assess each stroke subject’s motor function
Purpose/Hypothesis: PURPOSE: To determine if reflex responses are while the Berg Balance test was completed to give a known clinical mea-
exaggerated in chronic stroke subjects following multi-joint leg extension sure of stability. Repeated measures ANOVA calculations were used to com-
movements, and the extent to which movement speed and muscle pre-acti- pare ground reaction forces in each direction and variability in COP data
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 198

while Pearson correlation coefficients were used to determine whether GAIT PARAMETERS ASSOCIATED WITH RESPONSIVENESS TO A
there are relationships between the gait metrics measured in this study and TASK-SPECIFIC AND/OR STRENGTH TRAINING PROGRAM POST-
Berg Balance and Fugl-Meyer clinical scales. Results: Both propulsion and STROKE. T. Klassen1, S.J. Mulroy2, K.J. Sullivan3, 1Vancouver Coastal Health,
braking forces were significantly smaller in the stroke subjects than in the Vancouver, British Columbia, CANADA, 2Pathokinesiology Laboratory,
control subjects in both the affected and unaffected legs (p < 0.05). Rancho Los Amigos National Rehabilitation Center, Downey, CA,
Interestingly, in the medial-lateral plane, there were no differences between Biokinesiology and Physical Therapy, University of Southern California, Los
controls and the affected lower limb of stroke subjects yet there were sig- Angeles, CA.
nificant differences between controls and the unaffected leg at all speeds
(p < 0.05). A similar trend emerged for variability measures of COP where Purpose/Hypothesis: After stroke, patients exhibit weakness that con-
there were no differences between control subjects and the affected stroke tributes to decreased walking velocity and increased disability. While evi-
lower limb yet there were significant differences for the unaffected leg, par- dence exists that patient’s post-stroke respond to task-specific and
ticularly at heel strike and mid-stance. There were no correlations with strength training programs, it is not clear which biomechanical parameters
these measure and commonly used clinical scales of postural stability (Berg of gait are most influential in improved walking outcome.The purpose of
Balance) and motor function (Fugl-Meyer). Conclusions: Results from this this study was to identify the gait parameters associated with responsive-
study indicate that stroke subjects exhibit a wider variety of spatial patterns ness to a task-specific and/or strength training program designed to
in both their ground reaction force and COP trajectories than do healthy improve locomotor recovery. Number of Subjects: 20 subjects, ranging
individuals. Clinical Relevance:These results suggest that kinetic analysis from 4 to 60 months post-stroke. Materials/Methods: Subjects com-
of hemiparetic gait may be useful to incorporate into future assessments of pleted one of four training regimens consisting of a combination of two of
dynamic stability. the following: body weight supported treadmill training; lower extremity
(LE) resisted cycling, progressive resistive LE strengthening, or a sham con-
LOWER LIMB STRENGTH AND COORDINATION PATTERNS OF dition (arm ergometry). Each subject received 24 treatment sessions (1
CHRONIC STROKE SUBJECTS IN A FUNCTIONAL POSTURE. MM hour/day; 4x/week; 6 weeks), and the exercises were alternated each day.
Pelliccio, N Neckel, D Nichols, J Hidler, National Rehabilitation Hospital, Subjects ambulated at a self-selected velocity across a 10-meter walkway
Washington, DC. using customary assistive devices, but no lower extremity orthoses, both at
baseline and post intervention. Kinematics and kinetics of the hemiparetic
LE were recorded with a VICON motion system and a Kistler force plate.
Purpose/Hypothesis:The goal of this study was to quantify the strength
Electromyographic activity was recording using indwelling, fine wire elec-
and coordination patterns of the paretic leg in individuals with chronic
trodes in soleus, anterior tibialis, vastus intermedius, rectus femoris, semi-
stroke while in a functional position. Following cerebrovascular accident
membranosus, adductor longus, gluteus maximus and gluteus medius.
(CVA) patients often lose independent control over synergistic muscle
Changes in LE kinematics, kinetics, and muscle activation intensities for the
groups, resulting in joint movements that are often inappropriate for the
10 subjects with the greatest increase in velocity (HI group) were com-
desired task (Twitchell, 1951; Brunnstrom, 1970). In the upper limb, these
pared with those of subjects with less improvement (LO group) using an
inappropriate movements have been attributed to abnormal torque gener-
independent T-test with a p value of < .05. Results:Velocity increased after
ation about joints secondary to the intended, or primary, joint axis
intervention by 0.144 m/sec with the HI group vs. 0.016 m/sec with the
(DeWald et al, 2001). No such abnormal secondary joint torque patterns LO group. Subjects in the HI group displayed greater increases of preswing
were found in the lower limb of acute (<6 months post injury) CVA ankle plantarflexion angle [+3.8 deg vs -0.2 deg], ankle plantarflexion
patients (Hidler et al, 2005).We hypothesize that compensatory strategies power [+0.248 W/kgm vs +0.031 W/kgm], terminal stance hip extension
adopted by acute stroke subjects necessary to overcome excessive lower angle [+5.8 deg vs -0.7deg], hip flexor moment [+0.154 Nm/kgm vs -.031
limb weakness (Hidler et al, 2005) may lead to abnormal secondary joint Nm/kgm], and hip flexor power [+0.188 W/kgm vs 0.006 W/kgm].
patterns in the chronic (>1 year post injury) stages of their injury. Furthermore, intensity of soleus activation was also significantly greater in
Number of Subjects: Fourteen chronic CVA survivors with unilateral the HI group subjects after the intervention [15%max vs 0.3%max].
lesions and ten age-matched, non-neurologically involved control subjects Conclusions: Increased activation of soleus, promoting an improvement
participated in the study. Materials/Methods:With their trunks stabilized of the trailing limb posture, combined with changes in hip and ankle bio-
with large foam bumpers, stroke subjects stood on their affected lower mechanics during terminal stance and pre-swing, were associated with the
extremity while their affected foot was attached to a 6-degree of freedom greatest increase in gait velocity in individuals post-stroke that completed
load cell (JR3,Woodland CA) which recorded forces and torques. Subjects a task-specific and/or strength training program designed to improve loco-
were asked to generate a maximum torque along eight different directions motor recovery. Clinical Relevance: Biomechanical analyses can be an
(hip abduction/ adduction, hip and knee flexion/extension, and ankle dor- effective tool for understanding the mechanisms that underlie responsive-
siflexion/ plantarflexion) during which a visual display provided bio-feed- ness to physical therapy interventions, therefore allowing a more targeted
back of the torque they generated about that primary joint axis. approach to ameliorating impairments to function.
Simultaneous secondary torques generated about the other joints, as well Supported by The Foundation for Physical Therapy as part of
as EMG data from eight leg muscle groups, were recorded during each PTClinResNet.
maximum exertion. Results: Across all conditions tested, stroke group
generated significantly less primary torque in their affected leg than the HIP JOINT POSITION AFFECTS VOLITIONAL KNEE EXTENSOR
control group (p<0.05). Furthermore, with maximum exertions, they pro- ACTIVITY POST-STROKE. M. Lewek1, T. Hornby1, Y. Dhaher1, B. Schmit2,
duced significantly different secondary joint torque patterns during ankle 1
Sensory Motor Performance Program, Rehabilitation Institute of Chicago,
plantarflexion, knee extension, and hip abduction (p<0.05), demonstrating Chicago, IL, 2Marquette University, Milwaukee,WI.
changes in coordination. Analysis of muscle activity revealed significant
differences in muscle activation patterns which were consistent with the Purpose/Hypothesis: Individuals post-stroke often exhibit significant
observed abnormal secondary torques. Conclusions : Our findings functional limitations due to either inadequate or inappropriate volitional
demonstrate that chronic stroke subjects experience changes in coordina- muscle activation. In the lower extremity this is particularly apparent dur-
tion that were not found in acute stroke subjects, suggesting that com- ing ‘spastic paretic stiff-legged gait’, which has been attributed to excessive
pensatory strategies utilized early after CVA may develop into chronic quadriceps activity during the stance to swing transition.The mechanism
motor impairments. Clinical Relevance: At the onset of stroke, through underlying the altered volitional activation of the knee extensors has yet to
years after, rehabilitation techniques should continue to be adapted to be elucidated; however, evidence from animal and human models has
account for the detrimental contributions of abnormal muscle synergies. demonstrated the importance of hip angle sensors in modulating lower
Not only should therapists and their patients re-educate the muscles about extremity muscle activity.Although the hip’s position has become a focus
a particular joint, but they should be mindful of coordination of other for retraining ‘normal’ walking patterns following stroke, there are as of
musculature to prevent development of abnormal secondary joint patterns yet, no quantitative studies which examined the influence of hip angle
limiting inefficiency with functional tasks. afferent information during isolated volitional muscle activation after
199 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

stroke.The purpose of this study was therefore to quantify the role of hip Relevance: The CAS may be used to assess the effect of a specific treat-
joint positioning on the volitional activation of the uniarticular knee exten- ment intervention, or changes in an individuals gait over time. Objective
sor muscles after stroke. It was hypothesized that greater hip flexion documentation of gait impairments has the potential to improve insurance
would yield greater quadriceps activity. Number of Subjects: Fourteen coverage and demonstrate the need for further therapy.This scale can be
subjects with chronic (> 1 yr) stroke were recruited for testing. integrated into therapists’ and researchers’ evaluations, treatment plans/
Materials/ Methods: Subjects were positioned on a Biodex dynamometer protocols, goal setting, and may aid in development of improved rehabili-
to record the electromyographic (EMG) activity from the uniarticular knee tation techniques for gait recovery in patients with stroke.
extensor muscles [vastus lateralis (VL) and vastus medialis (VM)] during
maximum voluntary isometric knee extension contractions.The knee was SENSORIMOTOR IMPAIRMENTS AND REACHING PERFORMANCE IN
fixed at 60º, while hip position was fixed by altering the subject’s posture PERSONS WITH HEMIPARESIS: RELATIONSHIPS DURING THE
in random order to include: sitting upright (90º), semi-reclined (45º), and ACUTE AND SUBACUTE PHASE AFTER STROKE. JM. Wagner1, CE.
supine (0º). EMG data was full wave rectified and low pass filtered to pro- Lang1, SA. Sahrmann1, D.F. Edwards2, AW. Dromerick3, 1Program in Physical
duce a linear envelope.The outcome variable of interest was the integrated Therapy,Washington University School of Medicine, St. Louis, MO, 2Program
EMG activity around peak torque production. A two-way (muscle and hip in Occupational Therapy, Washington University School of Medicine, St.
position) repeated-measures ANOVA (repeated for hip position) was used Louis, MO, 3Department of Neurology, Washington University School of
to determine the effect of varying hip posture on knee extensor activity. Medicine, St. Louis, MO.
Results: Hip position had a substantial effect on the amount of volitional
VL and VM muscle activity produced (p=0.07).With the hip positioned in Purpose/Hypothesis: The purpose of this study was evaluate the rela-
full extension, both muscles were volitionally activated significantly less tionships between measures of upper extremity (UE) sensorimotor impair-
than when the hip was positioned in flexion (p=0.03). Conclusions:The ment and reaching performance in patients with hemiparesis during early
angle of the hip joint appears to play a significant role in the volitional acti- recovery after stroke, and to evaluate how measures collected shortly after
vation of the uniarticular knee extensors, although more data is required. stroke are related to future performance. Number of Subjects: 33 patients
Patients with stroke tend to walk with the hips in greater flexion, which (age = 64.1) with mild-moderate hemiparesis resulting from a stroke were
may facilitate activation of the knee extensors contributing to ‘stiff knee tested twice: acutely (average = 9.8 days) and subacutely (average = 108.6
gait’ pattern. Clinical Relevance: Hip joint angle contributes to the mod- days). Materials/Methods: UE isometric strength of the shoulder, elbow,
ulation of volitional quadriceps activation and likely influences reflex- and wrist flexors/extensors was assessed using a hand held dynamometer.
ive/spastic activation contributing to inappropriate muscle activity during Shoulder pain, tactile sensation, joint position sense, and spasticity were
functional activities.A strong emphasis should therefore be placed on hip assessed using standard clinical tests. UE active range of motion (AROM),
joint posturing during gait retraining to assist with appropriate muscle isolated joint movement, and reaching performance were assessed using a
activation patterns. 3-D motion capture system.The strength of each muscle group was repre-
sented as a ratio of involved to non-involved force.A composite UE strength
DEVELOPMENT AND VALIDATION OF CIRCUMDUCTION ASSESS- score was calculated by taking the mean of the ratio values.A composite UE
MENT SCALE FOR INDIVIDUALS WITH HEMIPLEGIA. JL Moore1, HR tactile sensation score was calculated by averaging the monofilament
Roth1, M. Lewek1,YY. Dhaher1,TG. Hornby2, 1Sensory Motor Performance , scores.The ability to perform isolated movement at each joint was quanti-
Rehabilitation Institute of Chicago, Chicago, IL, 2Department of Physical fied by calculating an individuation index (II) for the shoulder, elbow, and
Therapy, University of Illinois of Chicago, Chicago, IL. wrist joints. AROM was calculated during the isolated movement task.
Reaching performance was assessed during the initial phase of reaching.
Purpose/Hypothesis: Circumduction is a compensatory technique com- Reaching performance variables were movement speed (peak wrist veloc-
monly observed in individuals with hemiparesis following unilateral ity), accuracy (endpoint error) and efficiency (reach path ratio). Pearson
stroke.This maladaptive strategy is a combination of hip abduction and hip product moment correlations were used to describe the relationships
hiking to produce a hemi-circular movement of the leg during the swing between impairment and reaching performance. Results: Acutely, AROM
phase of gait. Such movements increase energy expenditure and may result and strength were moderately correlated with all reach variables. These
in unstable walking patterns. Despite subjective clinical evidence suggest- relationships were maintained in the subacute phase. Isolated movement
ing that circumduction movements are common in individuals following control was moderately correlated with all reach variables during the acute
stroke there is no standardized definition or clinical rating tool to quantify phase but was poorly correlated to reaching during the subacute phase.
circumduction. Our purpose is therefore to develop a reliable and valid rat- Somatosensory impairments were poorly correlated to reaching perfor-
ing scale to quantify circumduction based on observational gait analysis. mance during both phases. AROM was the only impairment measured in
Number of Subjects:Ten subjects were recruited for this study. All sub- the acute phase that was moderately correlated with subacute reaching
jects had chronic (>1 year) stroke with resulting hemiplegia and presented performance.All other acute impairment measures were poorly correlated
with hip circumduction during ambulation. Materials/Methods: The with subacute reaching performance. Conclusions: UE AROM had the
Circumduction Assessment Scale (CAS) is an 11 point rating scale of cir- strongest and most consistent relationship with reaching performance dur-
cumduction, which we define as a lower extremity movement performed ing the acute and subacute phases after stroke. Clinical Relevance: The
during the swing phase of gait in which the heel of the hemiparetic limb ultimate goal of UE rehabilitation is to promote use of the UE. These data
moves lateral to the foot’s position during stance. Subjects underwent illustrate the importance of objectively quantifying UE AROM during the
videotaped optoelectronic gait analysis for the purposes of collecting 3D acute phase after stroke since it was the only clinical impairment measure
trajectories of limb segments. Physical therapists scored circumduction on that demonstrated a moderate relationship with future performance.
the CAS while viewing the videotaped sessions. Spearman rank correlation
coefficients were used to assess the validity of the CAS by comparing the NEUROMUSCULAR STIMULATION IMPROVES GRASPING FUNCTION
objective gait measures during the computerized gait analysis to the ther- IN INDIVIDUALS WITH CHRONIC STROKE. B. Quaney1, LH. Zahner1,
apist’s ratings on the CAS.The precision of the rating scale was investigated MJ. Santos2, Z. Kadivar2, B. McKiernan3, 1Landon Center on Aging, University
by calculating the standard error of estimating the peak circumduction of Kansas, Kansas City, KS, 2Physical Therapy and Rehabilitation Sciences,
length during swing. The inter- and intra-rater reliability of the CAS was Kansas University Medical Center, Kansas City, KS, 3Physical Therapy
assessed by ICCs. Results:We developed the CAS to serve as an objective Education, Rockhurst University, Kansas City, MO.
measure of circumduction in patients with hemiplegia. The results to
date indicate that physical therapists can reliably measure circumduction Purpose/Hypothesis: Despite rehabilitation efforts, 60% of individuals
using clinical gait analysis using the CAS, with an ICC of 0.896. continue to have significant upper extremity (UE) disability one year post-
Conclusions:The CAS was designed to be a reliable and valid measure of stroke. It is unclear if manual dexterity can be further improved after this
limb circumduction in individuals with hemiplegia using only clinical gait time.The purpose of this pilot study was twofold: 1) To determine if neu-
assessment. The CAS has the potential to be a reliable measure of limb cir- romuscular stimulation (NMES) improves grasping function in individuals
cumduction during gait in the chronic stroke population. Clinical with chronic stroke, and 2) To determine if grasping function is enhanced
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 200

when NMES is used during functional task training. Number of Subjects: About 30% of the neurons had activity that was related to the arm used for
Six subjects (4 FE, 2 M, 58 ± 2.9 y/o) with chronic ischemic stroke (3 - 10 reaching, and 30% (non-exclusive) had activity related to the target con-
yrs. post-stroke) and severe hand dysfunction participated in this study. tacted. Only about 10% had activity that was unique to a certain hand-tar-
Inclusion criteria: a) 10 deg. passive wrist extension, c) 90% passive exten- get combination. Conclusions: Reticulospinal neurons have motor output
sion of the fingers and thumb with the wrist in a neutral position, and d) effects and neural activity patterns during movement that demonstrate a
no evidence of other neurological disorders. Subjects did not participate in role in the control of voluntary reaching. Effects were observed in the
other UE exercise programs during the study. Materials/Methods: Each shoulder girdle, shoulder, elbow, and even at the wrist. Characterization of
subject received two applications of NMES (passive or functional) in a the reticulospinal system as strictly for postural control or for control of
counterbalanced order (30 min x 5x/wk x 2 wks). Passive NMES was per- locomotion may be oversimplified.This major descending system also con-
formed by placing the impaired forearm in a mid-position and stimulating tributes to the execution of discrete, skilled reaching movements. Clinical
the wrist flexors and extensors to produce two contractions/minute (30 Relevance: The motor patterns emanating from the reticulospinal system
contractions: 300usec pulse width @ 40 Hz; 2s ramp up/down with a 6s are reminiscent of the limb movements associated with the ATNR and with
hold). Functional NMES when grasping and releasing a tennis ball was per- synergies associated with recovery from stroke. The present findings lend
formed using single channels from two separate stimulators with manual strength to the long-held concept that the reticulospinal system may be an
switches (30 grasp-releases: 300usec pulse width @ 40 Hz; 0.1 on/off alternative pathway for voluntary motor control after stroke.
ramp). UE motor performance speed, function and strength was measured
at baseline, following treatment and 2 weeks after treatment using con- THEMATIC POSTER SESSION: Motor Learning
ventional clinical tests: a) UE Fugl-Meyer (FM) (66 total points possible), b) Saturday 1:30-3:30
Box to Block (BB), i.e., the number of 1-inch blocks transported per
minute, c) Jebsens Dexterity Test (JDT) (7 tasks), d) Grip Strength (GS) and TELEREHABILITATION FOR MOTOR RETRAINING IN PATIENTS
e) Pinch Strength (PS). Results: While subjects generally improved their WITH STROKE. MK. Holden, T.. Dyar1, E. Bizzi1, L. Schwamm2, L. Dayan-
motor performance speed, function and strength with both applications of Cimadoro3, 1Dept. of Brain & Cognitive Sciences and Mc Govern Institute
NMES, significant gains in fine motor skills were specific to the functional for Brain Research, Massachusetts Institute of Technology, Cambridge, MA,
NMES. Compared to baseline, functional NMES increased movement 2
Clinical Research Center, Massachusetts Institute of Technology,
speeds in the JDT by 17% (p< 0.02) and increased FM scores by 19% (p< Cambridge, MA, 3Dept. of Physical Therapy, Spaulding Rehabilitation
0.05). In contrast, passive NMES only demonstrated significant gains in FM Hospital, Boston, MA.
(18%; p< 0.04). JDT improvements using functional NMES continued to be
significant two weeks after treatment. Conclusions:These results are con- Purpose/Hypothesis:To assess the clinical feasibility and effectiveness of
trary to the prevailing clinical view that UE motor recovery is limited to 1 providing home-based virtual environment (VE) training using a remotely
year post-stroke. NMES appears to be a viable method in which to facilitate controlled telerehabilitation system. Number of Subjects: 12 patients
motor performance gains in chronic stroke. The increased grasping func- with chronic stroke were admitted; 1 patient dropped out prior to start of
tion observed with this brief therapeutic intervention is most likely due to training. Mean age for subjects who completed training was 56.7 ± 15.6yr.;
mechanisms other than muscle hypertrophy. Clinical Relevance: The duration post-injury was 5.8 ± 4.4yr.; gender, 6 male, 5 female; involved
increased movement speeds (JDT) suggest that fine motor control can be side, 5 Right, 6 Left. Mean upper extremity (UE) Fugl-Meyer (FM) motor
improved by applying NMES during a grasping task. Further study is war- score (max=66) at entry was 38.3 ±13.8. Materials/Methods:Treatment
ranted to determine if specific types of NMES applications are appropriate intervention consisted of 30 one-hr sessions of real-time interactive VE
across UE disability levels. motor training for the involved UE, delivered remotely by a therapist via
the internet, 5x/wk for 6 wk. During training, patients practiced move-
BILATERAL MOTOR OUTPUTS FROM THE RETICULOSPINAL SYS- ments within virtual ‘scenes’ designed to elicit goal oriented movements.
TEM TO THE UPPER LIMBS DURING REACHING IN THE MONKEY. Outcome measures FM, Wolf Motor test (WMT) and Strength (grip, shoul-
JA. Buford1, AG. Davidson2, 1Physical Therapy, The Ohio State University, der flexion) were given Pre-training, Post 15 and 30 sessions, and at 4 mo.
Columbus, OH, 2Neurobiology and Anatomy, University of Rochester follow-up. Stability of motor recovery prior to training was assessed with
Medical Center, Rochester, NY. FM (2 tests, 1-12wk apart). Paired t-tests were used to assess significance.
Results: Mean values for the 2 baseline FM-UE tests showed no significant
Purpose/Hypothesis:This study describes the motor outputs and neural difference (-0.3 +/- 1.6, p=0.56), indicating stable motor recovery prior to
activity of the reticulospinal system in the monkey during reaching. The VE training via telerehabilitation. Following training, mean FM-UE Motor
hypotheses are 1) that single sites in the reticular formation will produce scores improved significantly after 15rx (+2.5, p=0.003), after 30rx (+6.7,
bilateral motor outputs to the upper limbs and 2) that neural activity in the p=<0.0001), and at 4 mo. follow-up (+7.6, p=0.001). Mean WMT scores
reticulospinal system will code for the preparation as well as the execution improved significantly after 15rx (-6 sec, p=0.0235), after 30rx (-15.5sec.,
of upper limb movement during voluntary reaching. Number of Subjects: p=0.0097), and at 4 mo. follow-up (-18.4 sec., p=0.0032). Shoulder Strength
2 young adult male <Macaca fascicularis> monkeys were the subjects. improved after 15rx (40%, p=0.0027), 30rx (69%, p=0.0010) and at follow-
Materials/Methods: Subjects were trained to reach with the R or L arm to up (66%, p=<0.0001). Grip Strength improved significantly after 30rx
a target on the R or L side, depending on instructions given during a wait- (44%, p=0.0253) but was only partially maintained at followup (26%,
ing period before each trial.An electrode positioning system was then sur- p=0.0897). Conclusions: Subjects’ improvements indicate that VE training
gically implanted, allowing daily access to the brainstem with tungsten conducted remotely over the internet is feasible and may be a viable new
microelectrodes in the awake, behaving animal. Single-pulse microstimula- method for neurorehabilitation. Subjects gains on all 3 clinical measures
tion at 10 Hz was applied to areas throughout the reticulospinal system in (FM,WMT, Strength) show that they were able to generalize motor training
the brainstem as EMG was recorded throughout the shoulder girdle and received in VE to real world performance, even to tasks not specifically
upper limbs (24 muscles). Extracellular action potentials were also trained in VE, and to retain gains for 4 mos. Our results concur with those
recorded from cells in this region. Neural activity patterns in relation to of others, that subjects with chronic stroke are capable of significant
preparatory and movement-related periods of the task were analyzed as motor improvements even many years s/p stroke. Clinical Relevance:The
were averaged muscle responses to microstimulation. Results: novel home-based treatment method used in this study may provide advan-
Microstimulation of the reticulospinal system tended to inhibit extensors tages and a viable treatment alternative for patients with stroke. For exam-
and facilitate flexors ipsilateral to the stimulus and produce the opposite ple, the difficulty of obtaining transportation to/from therapy clinic is
effects contralaterally. Effects were strongest and most frequently elicited in avoided; no commute also allows patients to have more energy to devote
the extensors and in the proximal muscles, especially the upper trapezius. to motor practice during sessions, and facilitates more intense frequency
Bilateral effects were the norm, though some sites did produce strictly ipsi of treatment. VE motor retraining via telerehabilitation appears effective
or contralateral effects in the muscles studied. About 25% of the 196 neu- in improving UE motor control and functional performance in subjects
rons analyzed had activity related to preparation, 25% had activity related to with chronic stroke; in addition it provides a fun and motivating treatment
preparation and to movement, and 50% had only movement-related activity. alternative to standard therapy exercises.
201 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

Supported by NIH Grants No. HD40959, HD40959-02S1 and 3MO1RR were calculated from subject performance during the 6 conditions.
01066-25S. Composite equilibrium scores were calculated using the weighted average
of the 6 equilibrium scores Composite equilibrium scores and mean equi-
EFFECTS OF RANDOM AND BLOCKED ORDER PRACTICE ON librium scores for each SOT were analyzed using one-way repeated mea-
MOTOR LEARNING IN INDIVIDUALS WITH PARKINSON DISEASE. C. sures ANOVA. Significant differences from baseline scores (p≤0.05) were
Lin1, CJ Winstein1, KJ Sullivan1, AD Wu2, 1Biokinesiology and Physical examined further using paired t-test comparisons with a Bonferroni cor-
Therapy, University of Southern California, Los Angeles, CA, 2Neorology, rection. Results:There was a significant increase in mean equilibrium SOT
University of Southern California, Los Angeles, CA. scores from baseline across post-tests 3 and 4, and there was a significant
increase in composite equilibrium SOT scores from baseline across post-
Purpose/Hypothesis: In general, random order practice has been shown test 3.When each testing condition was analyzed separately, only condition
to be superior for motor learning in young adults compared to blocked 3 showed statistically significant improvements from baseline across all six
order task practice. Random practice is thought to be beneficial to learn- SOTs; however, the SOT score patterns across the six testing conditions are
ing since the learner’s task-switching capability is strengthened. Since indi- consistent with those found in previous research throughout all six SOTs.
viduals with Parkinson disease (PD) have a task-switching deficit, the pur- Conclusions:The increase in performance during post-test 3 and post-test
pose of this study is to investigate the effects of practice order on learning 4, which were performed one week after baseline testing, is indicative of a
goal-directed arm movements in individuals with PD compared to age- learning effect which is most likely due to the subject learning how to
matched controls (CN). We hypothesize that blocked order practice is anticipate and cope with impaired visual feedback or altered propriocep-
superior for motor learning for those with mild PD. Number of Subjects: tive input. Clinical Relevance: Clinicians and researchers should be
Ten adults with mild PD (mean age= 68.7 yrs; Hoehn & Yahr I or II; ran- aware that mean equilibrium scores and composite equilibrium scores
domly assigned to either blocked practice, PDB, n=5, or random practice, may increase with practice even when subjects are tested a week later.
PDR, n=5) and 8 age-matched controls (mean age= 57.1, assigned to
blocked practice, CNB, n=4, or random practice, CNR, n=4) participated. UPPER LIMB FUNCTIONAL RESPONSE TO MOTOR LEARNING
Materials/Methods:All participants practiced 3 lever arm movement pat- ALONE AND MOTOR LEARNING WITH FUNCTIONAL NEUROMUS-
terns, each with specific spatial and temporal requirements. Performance CULAR STIMULATION FOR STROKE SURVIVORS. JJ Daly1, J. Rogers2, I.
accuracy was quantified across acquisition and delayed (day 2) retention Brenner2, E. Perepezko2, M. Dohring2, E. Fredrickson2, J. Gansen2, 1Neurology,
test using root mean square error (RMSE) and timing error (TF). Results: Case Western Reserve University School of Medicine, Cleveland, OH,
Both groups (PD and CN) decreased error (RMSE) across practice (p< 2
Research Service, LS Cleveland VA Medical Center, Cleveland, OH.
.01).At the end of acquisition, the control groups showed more accurate
performance than the PD groups. In delayed retention, the control subjects Purpose/Hypothesis:The purpose of the study was to test two interven-
who practiced in the random condition had lower RMSE than those that tions in chronic stroke survivors (>12 months) with moderate to severe
practiced in the block condition (effect size, ES=0.7). Interestingly, this was upper limb functional deficits.The two interventions were: 1) motor learn-
not the case for the PD groups. Consistent with our hypothesis, the PD sub- ing (ML-alone); and 2) functional neuromuscular stimulation along with
jects who practiced with a blocked schedule were more accurate in motor learning (FNSML). Number of Subjects: Eighteen. Materials/
delayed retention than the PD subjects who practiced in the random con- Methods: Eighteen subjects were stratified according to the Fugl-Meyer
dition (ES= 0.8 for group RMSE difference). In addition, the temporal accu- Upper Limb Coordination Scale and randomized to: FNSML or ML-alone.
racy was better for the PD group that practiced in the block condition (ES= Subjects had a Trace wrist extensor grade. Many had 0 grade finger flex-
0.8 for group TE difference). Conclusions: Consistent with our hypothe- ors/extensors. Treatment was: 5 times/wk for 12 weeks. The therapist
sis, adults with PD learned motor skills better in blocked order practice patient ratio was 1:3. Subjects practiced task components and full task per-
than in random order practice. Clinical Relevance: This pilot data sug- formance (60-tasks array). For 1.5 hrs of each daily session, FNS was pro-
gests that conditions of practice that may be beneficial for motor learning vided for the subjects in the FNSML group.A two-channel, surface stimula-
in healthy adults may not be as effective for individuals with PD in which tor, the EMS+2 (Staodyne, Inc., Longmont, Colorado) was used for
task-switching deficits are commonly present. finger/wrist flexors/extensors and lower/middle trapezius. The waveform
was biphasic, symmetric, and rectangular. Stimulus parameters were:
LEARNING EFFECT ASSESSMENT ON SUBSEQUENT SUBJECT PER- 300microsecs phase duration; 30Hz; amplitude, 1mA to the highest com-
FORMANCE ON THE EQUITEST. BALANCE SYSTEM. B. Gilliam, D. fortable stimulus; and 10secs on/10secs off duty cycle (1sec ramp up,
Charles, S. Kathmann, J. Smith, N.S. Darr, D. Greathouse, Belmont University, 10secs on, 1 sec ramp down, 10secs off). Subjects practiced single and mul-
Nashville,TN. tiple joint movements using FNS, including the following movements: alter-
nating wrist flexion/extension; and simultaneous wrist extension and finger
Purpose/Hypothesis: The sensory organization test (SOT) assesses the flexion. FNS was used in conjunction with task component movements like
ability to maintain equilibrium as somatosensory, vestibular, and visual preparation before grasping an object. Outcome measures were: 1) the Arm
input is altered in a systematic manner. Previous studies have suggested Motor Ability Test (AMAT); 2) the AMAT wrist/hand components
the possibility of a learning effect with repeated SOTs.The purpose of our (AMATW/H); and 3) the Functional Independence Measure. The AMAT is
study was to determine if a learning effect occurred with repeated admin- comprised of 13 functional tasks (using knife/fork; grasping mug handle
istration of the SOT over two test days performed one week apart. and drinking from cup). Pre-treatment baseline comparisons between the
Number of Subjects: Thirty-five healthy subjects (20 female, 15 male) two groups were made using t-test.Within-group, pre-/post-treatment com-
between 22 and 57 years old participated in this study. parisons were made using t-test. Group comparisons in response to treat-
Materials/Methods: Subjects signed an informed consent approved by ment were made using an ordinal regression model (PLUM Ordinal Model,
Belmont University Institutional Review Board and underwent a short SPSS) for the FIM. Post-treatment FIM score was the dependent variable,
physical examination to determine eligibility. Exclusion criteria included pre-treatment was a co-variate, and group assignment was the independent
previous experience with the EquiTest |*regis*| System or other sensory variable. Results: At baseline, there was no significant difference between
organization testing equipment, vision outside the range of 20/20 to 20/60, the two groups for the outcome measures (p>.05). In response to treat-
positive Rhomberg test, lower extremity strength or ROM deficits, or lower ment, there were significantly greater gains for FNSML group versus ML-
extremity injury within last 6 months. Data were collected using the alone, according to the FIM (p=.003). In response to treatment, FNSML had
NeuroCom EquiTest Regis System. Testing occurred during two separate significant improvement in the AMAT, AMATW/H, and FIM (p= .042, .036,
sessions seven days apart. During the first testing session subjects com- and .007, respectively); whereas the ML-alone group did not (p=.167; .242;
pleted a baseline SOT, performing three trials of each of the six conditions .068, respectively). Conclusions: Results suggested that FNSML could be
for a total of 18 trials. Two additional SOTs (post test 1 and post test 2) functionally beneficial for moderately to severely involved stroke survivors
were performed on the first day of testing. One week later subjects with chronic deficits. Clinical Relevance:The treatment was successfully
returned and completed three additional SOTs (post tests 3, 4, and 5) using offered with a therapist: patient ratio of 1:3. Moderately to severely involved
the identical protocol to the first day of testing. Mean equilibrium scores stroke survivors with chronic deficits can benefit from intervention.
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 202

PROCEDURAL LEARNING OF FUNCTIONAL MOBILITY TASKS IN different from sensory distributions were the vasomotor fields for superfi-
THE PRESENCE OF SEVERE MEMORY DEFICITS FROM INTRAVEN- cial and deep fibular nerves. Deep fibular nerve blockade produced hyper-
TRICULAR HEMORRHAGE. K.A.Volk, R.O. Myers, E. Fitzpatrick-DeSalme, emia of the entire lateral leg and proximal aspect of the foots dorsum, then
MossRehab, Philadelphia, PA. into the webspace between digits 1 and 2. Blocking the superficial fibular
nerve produced vascular change only in the middle aspect foots dorsum
Background & Purpose: Memory deficits frequently occur in patients extending through digits 2 through 5. Hyperemia was not observed during
with both acquired and traumatic brain injuries. Declarative memory, or single distal branch blockades for the plantar surface between digits 3 and
learning of facts and events, is often impaired in these patients. However, 4, suggesting dual innervation. Conclusions: Vasomotor innervation fields
procedural memory, or learning of motor skills, is often preserved. This of the leg and foot from peripheral nerves show patterns similar to sensory
case report describes how a severely amnestic patient was able to learn innervation, with the exception of vascular fields supplied by superficial and
functional mobility tasks in physical therapy through the use of procedural deep fibular nerves.These patterns are consistent with the hypothesis that
learning techniques. Case Description:A 52-year old woman suffered an peripheral nerves innervate principle adjacent blood vessels, thus produc-
intraventricular hemorrhage in all 4 ventricles. She was oriented to person ing potential neurovascular symptoms that may deviate from expected sen-
only, and presented with significant anterograde and retrograde amnesia. sory patterns. Clinical Relevance: Prior studies established that upper
She demonstrated severe declarative memory deficits with no awareness limb vasomotor innervation varies from well known sensory patterns.
of the tasks that she was practicing in therapy. Her working memory was Upper extremity vasomotor innervation charts are proving useful in estab-
also devastated. Within minutes she would be unable to recall what she lishing neurovascular etiologies for atypical symptom patterns due to
was doing while she was performing a specific skill. Upon admission she peripheral neuropathies. The present study represents the initial phase of
was dependent in all areas of functional mobility. Physical therapy inter- investigating vasomotor innervation to the lower extremity in an effort to
vention consisted of repetitive procedural learning techniques. Functional arrive at a complete mapping of arterial innervation of the limbs.
mobility training included regimented routines with consistent, brief cues
provided on a minute-to-minute basis to re-orient the patient to the current LASER MICRODISSECTION OF BRAIN STEM NEURONS TO EXAMINE
task. Novel tasks consisted of wheelchair propulsion and ambulation with CHANGES IN GENE EXPRESSION AFTER SPINAL CORD INJURY. SR
a rolling walker. Outcomes:The patient remained disoriented to place, rea- Allen1, JD Houle2, 1University of Central Arkansas, Conway,AR, 2Department
son for hospitalization, date, and time. She remained unable to actively of Neurobiological and Developmental Sciences, University of Arkansas for
recall or describe the functional tasks that she performed in therapy on a Medical Sciences, Little Rock,AR.
daily basis. Despite the severity of her deficits, she progressed from a
dependent to a minimal assist level of overall function with the provision Purpose/Hypothesis: Previous studies have used in situ hybridization
of frequent and discrete verbal cues. Discussion:The literature supports indicating changes in regeneration-associated genes (RAGs) expression to
the use of procedural learning for those lacking declarative and working measure the effects of neurotrophic factors administered to damaged neu-
memories. However, the majority of this research utilized small samples rons after spinal cord injury (SCI). In-situ hybridization is a lengthy process
that significantly limit the ability to generalize their findings to this partic- for recording gene expression.The goal of this preliminary study was to use
ular population as a whole.The literature also does not involve the use of a more time efficient method of laser microdissection and quantitative poly-
real-world tasks or functional mobility skills. Physical therapists often con- merase chain reaction (Q-PCR) to determine the effects of glial cell-line
front the challenge of treating patients who suffer severe memory impair- derived neurotrophic factor (GDNF) on the expression levels of (RAGs) in
ments resulting from neurologic insult or disease processes. Despite the red nucleus neurons affected by a cervical level SCI. Number of Subjects:
difficulties that these patients present, therapists can successfully use tech- Six female Sprague-Dawley rats. GDNF treated rats, experimental group
niques involving procedural learning when training functional mobility (N=3) Saline treated rats, control group (N=3). Materials/Methods: Six
tasks in order to facilitate the acquisition of such skills and to increase adult female Sprague-Dawley rats underwent surgery for the complete
functional outcomes overall. removal of a 2mm hemi-section on the right side of their spinal cord.
During the surgery, one group of rats was treated with GDNF at the site of
POSTERS the hemi-section for one hour.The second group of rats was administered
saline to serve as a control. Two days after the surgery, animals in both
VASOMOTOR INNERVATION PATTERNS OF PERIPHERAL NERVES groups were sacrificed and red nucleus neurons in the midbrain were iso-
SUPPLYING THE DISTAL LOWER EXTREMITY. RJ Allen1, EM Jefferson2, lated via laser micro dissection techniques. Neuronal mRNA was prepared
VK Bhangu3, 1Physical Therapy, University of Puget Sound, Tacoma, WA, for Q-PCR.The RAGs measured were BII-tubulin and growth associated pro-
UCI, Irvine, CA, 3Royal Medical Institute, New Delhi, INDIA. tein-43 (GAP-43). Actin was used as the housekeeping gene for controlled
gene expression. Results:The results of the Q-PCR showed no significant
Purpose/Hypothesis: Investigate innervation patterns to the arterial sys- difference in the RAGs expression levels between injured and uninjured
tem of the leg and foot from eight major peripheral nerves and compare neurons of the red nucleus two days after SCI. However, there was a trend
these vasomotor innervation patterns with somatosensory distribution for increased expression of BII-tubulin mRNA in the injured red nucleus
fields. Number of Subjects: Seven adult volunteers (5 females, 2 males), age neurons during this time frame. For spinal cord injuries treated with GDNF
ranging from 31 to 64 yrs (x = 39), reporting no history of vascular pathol- at their lesion site, no significant increases were found in the expression of
ogy or insufficiency, peripheral neuropathy, chronic lower limb pain, hyper- the RAGs. However, a trend towards the increase of a growth-associated
tension, or hypersensitive responses to amine-type anesthetics. protein (GAP-43) mRNA for the GDNF treated group was indicated during
Materials/Methods: Peripheral nerves studied included superficial and this time frame. Conclusions:These results demonstrate the ability to mea-
deep fibular, sural, saphenous, and tibial nerves, along with the tibial nerves sure changes in gene expression in specific neurons after a traumatic injury.
medial and lateral plantar and medial calcaneal branches. On eight days, with It is possible that significant effects of acute treatment with GDNF may be
at least 24 hour separation, each subject received a neural blockade to one detected after longer periods post injury and treatment. Follow-up studies
nerve following thermal stabilization in a 16o C climate controlled chamber. are planned for using larger sample groups and looking at the effects of
Neural blockade temporarily interrupted local sympathetic innervation to GDNF on RAGs gene expression at various time periods after injury and
arteries supplied by the nerve resulting in vasodilation and superficial treatment. Clinical Relevance: By observing the effects of neurotrophic
hyperemia. Fields of hyperemia represented the vascular innervation field of factors on changing the gene expression of RAGs and genes important to
the nerve and was imaged using digital thermography.The anesthetic agent the survival of damaged neurons after SCI, it may be beneficial to treat
was 1.8 ml of 3% Carbocaine hydrochloride solution injected at each nerves patients with neurotrophic factors following SCI.
most proximal selective location using tissue infiltration. Success and selec-
tivity of each block was established via somatosensory testing using Semmes MOVEMENT CONTROL AND CORTICAL ACTIVATION IN FUNC-
Weinstein monofilaments. Results: All subjects showed consistency in TIONAL ANKLE INSTABILITY. K. Anderson, J.R. Carey, Program in
hyperemia fields for each of the nerves blocked. In most cases, vasomotor Physical Therapy, University of Minnesota, Minneapolis, MN. (See Imagery
innervation fields corresponded with expected sensory patterns. Notably and Imaging Thematic poster session for abstract)
203 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

EFFECT OF WALKING VS SHAM TREATMENT ON FINGER MOVE- mg diazepam given daily over a 2-week period were recorded using ran-
MENT CONTROL AND BRAIN REORGANIZATION IN WELL ELDERLY. dom saccadic eye movements (SEM), sinusoidal harmonic acceleration
S. Anderson, H. Aldrich, S. Knight, C. Battles, J.R. Carey, University of stimulus for the vestibular ocular reflex (VOR), and subjective ratings of
Minnesota, Minneapolis, MN. (See Imagery and Imaging Thematic poster sedation. Measures were collected at baseline, 90 min after each dose on
session for Abstract) days 3, 7, 10, and 14, and 48 hours after drug cessation on day 16. Urine
samples were collected one time per week. Both subjects and investigator
ASSESSING FACTORS IMPACTING COMMUNITY MOBILITY AFTER were blinded to treatment condition. Results:The present study indicates
STROKE: A PILOT STUDY. J. Beaverson, L. Beaudreau, J. Filkowski, C.A. that vestibular function tests are sensitive indicators for drug effects
Robinson, P. Noritake Matsuda, A. Shumway-Cook, Dept of Rehabilitation, related to low doses of diazepam between treatment groups. There were
University of Washington, Seattle,WA. significant effects for the parameters of saccadic latency, self-ratings for
perceived sedation,VOR gain and phase at 0.01, 0.02, 0.04, and 0.08 Hz, but
Purpose/Hypothesis: Limited community mobility is a common occur- no effect on saccadic peak velocity or accuracy measures and gain and
rence following stroke and is associated with disability in both basic and phase frequency at 0.16 Hz., indicating selective effects on different CNS
instrumental activities of daily living. The skills and factors affecting com- mechanisms. No significant effects for time were seen in any of the vari-
munity mobility following stroke are largely unknown.This pilot study mea- ables measured, but trends were observed, indicating greater impairment
sured participation in community mobility among survivors of stroke and on day 3 of drug administration followed by gradual return toward base-
examined the relationship between clinical measures of sensation, strength, line by day 16. Conclusions:The results of this investigation demonstrate
balance, and gait and participation in community mobility in order to iden- that low divided doses of diazepam selectively impair behavioral tests mea-
tify factors constraining community mobility following stroke. Number of suring the integrity of the VOR and SEM.These findings confirm previous
Subjects: Thirteen adults diagnosed with stroke (mean age 64 ± 7; mean literature in man showing an effect for diazepam on both phase and gain
time since stroke 66 mos, independent ambulators) and 19 older adults parameters during rotational tests. Studies using vestibular function tests
(mean age 78 ± 6) without stroke participated. Materials/Methods: to evaluate the development of tolerance over time will need to minimize
Measures included self-reported trips/activities into community, perfor- error variance within and between the treatment groups. Clinical
mance on Berg Balance Test (BBT), 10m-gait velocity, Rivermead Mobility Relevance: It is still not known if clinical patients need to be drug-free for
Index (RMI) and Dynamic Mobility Evaluation (DYME). Impairment testing 48 hours prior to undergoing vestibular function testing. It does appear
included dynamometer measures of lower extremity (LE) strength, gonio- that low divided doses of diazepam do not affect the overall interpretation
metric measures of LE range of motion (ROM), ankle spasticity, and LE sen- of VOR results as subjects still remained in the normal ranges. Saccadic
sation. Results: Participation in community mobility following stroke was latency and sedation measures appear to be more sensitive to changes over
characterized by equivalent number of trips into the community, but fewer
time and less affected by subject variability than VOR parameters.
walking related activities per trip, as compared to adults without stroke.
Gait velocity and BBT were significantly (p<.001) worse in the subjects
with stroke, and correlated with walking related activities (r =.508, p<.01)
but not trips into the community. Gait velocity was slower on all complex-
walking tasks in the DYME; however there was considerable variability
J. Bogle, D. Dennison, K. Gorgos, V. Stivala, M. Pascal, Physical Therapy,
among subjects with stroke. Some tasks (stairs and obstacles) consistently
College Misericordia, Dallas, PA.
affected gait velocity in all subjects with stroke, while others (load and talk)
did not. Impairments in plantar- flexion and hip abduction strength in the
Purpose/Hypothesis:The purpose of this study was to determine if body
paretic limb correlated with community mobility (activities per trip), and
weight supported treadmill training (BWS-TT) and functional electrical
with other clinical measures of balance and gait. Conclusions: This pilot
stimulation (FES) would improve gait speed and endurance in an individ-
study suggests the impact of stroke on community mobility is variable.
Clinical measures of balance, strength (plantarflexor and hip abduction) ual with a traumatic brain injury. Number of Subjects: One. Materials/
and gait velocity are related to level of participation in community mobil- Methods:This study had an ABA design. In condition A, the subject partic-
ity, specifically the number of walking activities performed per trip. ipated in BWS-TT for 10 sessions. In condition B, he participated in BWS-
Performance of complex walking tasks was globally impacted by stroke, but TT with the addition of FES for 8 sessions. FES was controlled by a switch
the degree of impact varied by individual and task. Further studies are placed in the subject’s left shoe. Unweighting his leg in pre-swing trig-
needed to confirm results and explore the relationship between locomotor gered electrical stimulation to the left peroneal nerve to help increase left
adaptation and participation in community mobility following stroke. swing. In the last phase of the study, the subject again participated in
Clinical Relevance: Community mobility is a highly valued outcome to BWS-TT without FES for 5 sessions. During each session, the subject had
patients following stroke and is complex and difficult to measure, with 30 percent of his weight supported by the BWS system.Treadmill speed,
many factors influencing outcome. Specifically, strength, balance, velocity distance, and time walked were recorded for each trial of walking.The sub-
and ability to adapt gait appear to be important to ambulation outcomes, ject performed 3 to 4 trials per session. Data Analysis: Distance walked
while ROM, sensation, and spasticity may be less important. and walking speed per trial were graphed and visually analyzed using cel-
eration lines drawn using the split-middle technique. Results:The subject
DIAZEPAM TOLERANCE EFFECTS ON VESTIBULAR FUNCTION demonstrated improvements in both distance and speed throughout the
TESTS FOLLOWING REPEATED ORAL DOSES. PA Blau1, N. Schwade2, P. course of the study. Examination of the celeration lines revealed he was
Roland2, 1Physical Therapy, UT Southwestern Medical School, Dallas, TX, able to sustain a higher level of consistent improvement while using FES.
Otorhinolaryngology, University of Texas Southwestern Medical Center, His walking speed on the treadmill improved from 1.1 mph at the start of
Dallas,TX. the study to 1.7 mph at the end of the first set of BWS-TT sessions. Speed
increased to 2.2 mph at the end of sessions with BWS-TT and FES. When
Purpose/Hypothesis: Benzodiazepines are used in clinical practice to he resumed BWS-TT only, speed decreased to 2.0 mph; it increased to 2.2
suppress acute vestibular symptoms.There have been limited studies look- mph at the end of the study. Distance walked per trial improved from 195
ing at the effects of tolerance on parameters designed to measure the feet in the beginning of the study to 369 feet at the end. Conclusions:The
integrity of the vestibular system and its interaction with the oculomotor use of BWS-TT can be a useful intervention to increase gait speed and
and balance systems.The goals of this study were two-fold: 1) to determine walking distance in an individual with a traumatic brain injury.Adding FES
if clinical doses of diazepam (10 mg/day) administered for 14 days impair during this intervention increased the improvement in this subject.
performance measures that assess the integrity of the vestibular ocular Clinical Relevance: Decreased independence in gait is a frequent func-
reflex and the ocular motor system and 2) to examine if tolerance devel- tional limitation in individuals with TBI. Using BWS-TT and FES together
ops over time. Number of Subjects: Thirty normal male subjects who as interventions may help improve gait speed and endurance. The FES
ranged in age from 20-36 years were randomly assigned to placebo or used in this study was relatively inexpensive and easy to apply, making it
diazepam group. Materials/Methods:The effects of divided doses of 10 feasible for clinical use.
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 204

RECOVERY FROM STROKE: WHAT IS THE ROLE OF THE UNDAM- Purpose/Hypothesis:The purpose of this study was to examine the inter-
AGED, CONTRALESIONAL CORTEX? L. Boyd, E.D. Vidoni, Physical action between type 2 diabetes, depression, and cognitive function.
Therapy & Rehabilitation Science, University of Kansas Medical Center, Number of Subjects: 65 male veterans, 33 having DM, were recruited
Kansas City, KS. (See: Imagery and Imaging Thematic Poster Session for from the Veterans Administration Medical Center in Oklahoma City.
Abstract) Veterans included in the study were aged 50 to 69 years old and had no
current or past (within 20 years) history of drug or alcohol abuse, demen-
DYNAMIC WALKING STABILITY IN HEMIPARETIC CHRONIC tia, psychiatric disorder, stroke or head trauma with loss of consciousness
STROKE SUBJECTS. K.P. Brady1, J.M. Hidler1, M.C. Sinopoli2, 1Center for > 10 minutes, or any sensory or motor disorder that would preclude neu-
Applied Biomechanics and Rehabilitation Research, National ropsychological testing.Veterans with type 1 diabetes were also excluded.
Rehabilitation Hospital, Washington, DC, 2Department of Biomedical Materials/Methods: The presence of depression was assessed with the
Engineering, Catholic University, Washington, DC. (See: Post-Stroke Beck Depression Inventory (BDI).The Stroop Color Word Test (SCWT) was
Hemiplegia Thematic Poster Session for Abstract) used to measure selective attention and the Iowa Gambling Test (IGT) to
evaluate decision-making. Most recent glycosylated hemoglobin (HbA1c)
RISK AND PROTECTIVE FACTORS FOR FALLS AMONG INDIVIDUALS values were obtained through chart review and used as indicators of meta-
WITH INCOMPLETE SPINAL CORD INJURY. SS Brotherton1, J.S. bolic control. Results: After removing one outlier, group differences in
Krause1, P.J. Nietert2, 1Rehabilitation Sciences, Medical University of South mean values of BDI scores, SCWT interference scores, and ratio of bad
Carolina, Charleston, SC, 2Biostatistics, Bioinformation, and Epidemiology, cards to good cards chosen in the IGT were compared with independent
Medical University of South Carolina, Charleston, SC. t-tests. Pearson or Spearman correlation coefficients were determined for
all variables. Partial correlation coefficients and r2 values were computed.
Purpose/Hypothesis: The purpose of this study was to determine the There were significant group differences in BDI scores (t (62) = 2.58,
risk and protective factors for falls among ambulatory individuals with p=.01) and SCWT interference scores (t (62) = .03, p=.04) but not IGT
incomplete spinal cord injury (SCI). Number of Subjects: Participants ratios. BDI scores were significantly correlated with diabetic status (r =.35,
were recruited from a group of individuals with incomplete SCI who took p=.004) and IGT ratios (r = .39, p=.001) and inversely correlated with
part in a previous study on subsequent injuries following SCI. One hun- interference scores (r = -.25, p=.04). HbA1c values were strongly inversely
dred and twenty individuals from a potential subject pool of 221 persons correlated to interference scores (r=-.60, p=.0003). Diabetic status
consented to participate. Materials/Methods: A survey instrument was accounted for 12% of variation in BDI scores, 5% of variance in interfer-
designed to collect data on the incidence of falls, demographic and SCI ence scores, and 3% of variance in IGT ratios. Variation in BDI scores
characteristics, health, and physical activity and was completed by study accounted for 15.7% of the variation in IGT ratios and 6% of the variation
participants.These data were compared among fallers and non-fallers using in interference scores. Variance in HbA1c values explained 37% of the
t tests and chi square statistics. Unadjusted bivariate analyses were then variation in interference scores. The partial correlation between BDI and
used to determine factors that were moderately associated with having a IGT ratio scores was r =.51 (p=.004) and r =-.62 (p=.0003) for HbA1c and
fall.These variables were entered into a forward stepwise regression model interference scores. Conclusions: Male veterans with type 2 DM demon-
to identify which ones were associated with increased risk for falling. A strated more depression and poorer selective attention compared to vet-
logistic regression that included only participant characteristics that could erans without DM. The correlations point to a relationship between DM
have been present before the fall was also used to identify subject factors and depression and support the generally accepted premise that depres-
associated with increased risk for having a fall. Results: Seventy-five per- sion affects cognitive performance. Depression explained more of the vari-
cent of respondents sustained a fall over the previous year. Stepwise regres- ation in cognitive test scores than did diabetic status particularly for the
sion revealed that the odds of having a fall were significantly lower for indi- IGT.The strong relationship between metabolic control of DM and a mea-
viduals who exercised more frequently (OR=0.65, p=0.013) and for those sure of selective attention suggests directions for research into causality.
who used a walker (OR=0.18, p=0.009).The odds of having a fall were sig- Clinical Relevance:Adequate cognitive functioning is necessary for self-
nificantly higher for individuals who restricted community activities due care, a key component in management of DM. Factors affecting cognition
to fear of falling (OR=1.56, p=0.034), had a higher level of education (OR= in this population have not yet been fully delineated.
4.17, p=0.001), and reported more days of poor physical health (OR=1.12,
p=0.015). When the analysis was limited to subject characteristics that BRAIN ACTIVATION DURING KINESTHETIC AND VISUAL IMAGERY
could have been present before the fall, stepwise analysis revealed that the OF WALKING. C.A. Chatto1, J.E. Deutsch1, J. Pillai2, T. Lavin2, J. Allison2,
odds of having a fall were higher for individuals who reported dizziness 1
Program in Physical Therapy, UMDNJ, Newark, NJ, 2Department of
(OR=7.72, p=0.013) and had a higher level of education (OR=2.26, Radiology, Medical College of Georgia, Agusta, GA. (See Imagery and
p=0.002). Conclusions: Increased exercise frequency and walker use Imaging Thematic Poster session for Abstract)
were associated with decreased risk of falls (protective factors), whereas
more days of poor physical health, limited participation in community THE PATIENT-REPORTED IMPACT OF SPASTICITY MEASURE
activities due to fear of falling, and a higher level of education were asso- (PRISM): A NEW MEASURE ASSESSING THE IMPACT OF SPACTICITY
ciated with increased risk of falls.When only subject characteristics were ON PERSONS WITH SPINAL CORD INJURY. K. Cook1, A. Williams2, C.
considered, dizziness and higher levels of education were independent Teal2, S. Robinson-Wheelen2, J. Mahoney3, J.C. Engebretson3, K. Hart4, A.M.
predictors of experiencing a fall in the SCI population. Clinical Sherwood5, 1METRIC, Veterans Affairs, Houston, TX, 2Veterans Affairs,
Relevance: The findings provide a better understanding of the risk and Research, Houston, TX, 3Nursing, University of Texas Health Science
protective factors for falls and may assist rehabilitation professionals in Center, Houston, TX, 4The Institute for Rehabilitation Research, Houston,
developing strategies for health promotion and injury prevention for TX, 5National Institute on Disability and Rehabilitation Research (NIDRR),
ambulatory individuals with incomplete SCI. Washington, DC.

BILATERAL MOTOR OUTPUTS FROM THE RETICULOSPINAL SYS- Purpose/Hypothesis: Clinicians have long known that spasticity has a
TEM TO THE UPPER LIMBS DURING REACHING IN THE MONKEY. substantial impact on the quality of life of persons who have spinal cord
J.A. Buford1, A.G. Davidson2, 1Physical Therapy, The Ohio State University, injury (SCI).To date, however, there has been no self-report instrument to
Columbus, OH, 2Neurobiology and Anatomy, University of Rochester assess the range of its impact. The study purpose was to understand the
Medical Center, Rochester, NY. (See: Post- Stroke Hemiplegia Thematic experiences of spasticity in the everyday lives of persons with SCI and
Poster Session for Abstract) develop a measure to standardize evaluation of these experiences.
Number of Subjects: Open-ended semi-structured interviews lasting
EFFECT OF TYPE 2 DIABETES MELLITUS ON DECISION-MAKING approximately 45 to 90 minutes were conducted with 24 persons with SCI
AND SELECTIVE ATTENTION. S.D. Burns, Dept. of Rehabilitation and spasticity. Patients reported a wide range of ways in which their spas-
Science, University of Oklahoma Health Sciences Center, Oklahoma City, ticity impacted their lives; including some positive ones (help with trans-
OK, L. Riolo, Dept. of Physical Therapy, Indiana University, Indianapolis, IN. fers). We developed pilot items based on patients’ natural language state-
205 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

ments and administered these to 181 participants. Materials/Methods: REPRESENTATION OF IMAGINED AND EXECUTED SEQUENTIAL
Data were factor analyzed and items were clustered into 7 subscales assess- FINGER MOVEMENTS OF ADULTS POST STROKE AND HEALTHY
ing: (1) impact on ADLs, (2) social avoidance, (3) psychological impact, (4) CONTROLS. JE Deutsch1, S. Fischer1,W. Liu2,A. Kalnin3, K. Mosier3, 1Physical
impact on health service utilization, (5) impact on independence, (6) Therapy, UMDNJ, Newark, NJ, 2Radiology, UMDNJ, Newark, NJ, 3Radiology,
embarrassment, and (7) positive impact of spasticity. Results:The 7 PRISM Indiana University, Newark, IN. (See Imagery and Imaging Thematic Poster
subscales exhibited excellent internal consistency and test/retest reliabili- Session for Abstract)
ties. Conclusions: Content validity was supported in the factor analytic
results; discriminant validity was supported by the only moderate correla- VELOCITY OF VERTICAL AND HORIZONTAL EYE MOVEMENTS IN
tions among subscales; and construct validity was supported by the psy- PROGRESSIVE SUPRANUCLEAR PALSY. K.E. Donley, M.J. Johnson, C.
chometric design (items developed based on participant interviews). Zampieri, R.P. Di Fabio, Physical Therapy, University of Minnesota,
Clinical Relevance:To date, there have not been effective tools for evalu- Minneapolis, MN.
ating the impact of spasticity on persons with SCI.The PRISM fills this gap.
Of particular importance is the inclusion of a subscale to measure what Purpose/Hypothesis: Purpose.The objectives of this study were to inves-
persons with SCI view as positive aspects of spasticity. tigate the velocity of vertical and horizontal saccades in people with PSP
in the early stages of their disease and to compare the velocity of voluntary
UPPER LIMB FUNCTIONAL RESPONSE TO MOTOR LEARNING vertical eye movements with concurrent unintended horizontal eye move-
ALONE AND MOTOR LEARNING WITH FUNCTIONAL NEUROMUS- ments associated with vergence. Number of Subjects: Subjects. Nine sub-
CULAR STIMULATION FOR STROKE SURVIVORS. J.J. Daly1, J. Rogers2, I. jects (70.3 /- 5.36 years, 4 women and 5 men) participated in a within
Brenner2, E. Perepezko2, M. Dohring2, E. Fredrickson2, J. Gansen2, 1Neurology, group cross-sectional study. Six subjects were diagnosed with probable
Case Western Reserve University School of Medicine, Cleveland, OH, PSP and 3 with possible PSP. Materials/Methods: Methods. Vertical and
Research Service, LS Cleveland VA Medical Center, Cleveland, OH. (See horizontal saccades were practiced prior to data collection. Infrared ocu-
Motor Learning Thematic poster session for Abstract) lography was used to measure the eye velocities in raw voltage per second
during the saccade attempts. Orthogonal eye velocities were compared
CONSTRAINT INDUCED MOVEMENT THERAPY FOR AN INDIVID- using one-way ANOVA and paired t-tests. Results: Results. Left horizontal
UAL EXHIBITING HEMIAKINESIA POST STROKE. S.B. Davis1, L.G. eye velocity due to vergence was significantly faster than intended down-
Richards1,A.L. Behrman2, 1Brain Rehab Research Ctr, Malcom Randall VAMC, ward saccade velocity during a vertical saccade attempt (z-value = 3.6827,
Gainesville, FL, 2Physical Therapy, University of Florida, Gainesville, FL. p =0.000). Similarly, right horizontal velocity due to vergence was faster
compared to intended upward vertical saccade velocity (z = 2.118,
Background & Purpose: Patients with hemiakinesia exhibit the inability p=0.034).When comparing eye movement in a pure plane without regard
to carryout purposeful movements in the absence of paresis.They may not to vergence, voluntary horizontal right saccades were significantly faster
spontaneously use their upper extremity contralateral to the lesion.When than vertical up saccades (z =6.38, p=0.000) and voluntary left horizontal
asked to move they may have the ability to coordinate movements. During saccades were significantly faster than vertical downward saccades (z =
manual muscle testing they demonstrate good to normal strength.This has 6.98, p= 0.000). Conclusions: Discussion and Conclusion. The results of
been a clinically challenging scenario and few interventions have been this preliminary work suggest that early in the course of PSP, the vertical
advocated to remediate hemiakinesia.The purpose of this case study was burst neurons in the rostral interstitial nucleus of the medial longitudinal
to examine the effect of Constraint Induced Movement Therapy (CIMT) on fasciculus are selectively degenerated. The velocities recorded also imply
upper extremity (UE) performance. Case Description:The individual was that the horizontal burst neurons in the paramedian pontine reticular for-
a 39 year old right handed white female seen 11 months after a major left mation are not markedly affected. During a volitional vertical saccade, the
putamenal hemorrhage during her fifth month of pregnancy. She exhibited accompanying horizontal eye movements due to vergence are compara-
aphasia, anomia, pronounced hemiakinesia with right UE strength 4+ to 5, tively faster.This illustrates that although the vertical saccade is slowed, the
mild right shoulder subluxation, mild increased tone, normal propriocep- omnipause neurons are not limiting the speed of horizontal vergence eye
tion, stereognosis, impaired 2-point discrimination and minimal sponta- movements Clinical Relevance: Background. Progressive Supranuclear
neous use of her right UE. She initially scored 1.00 on the Amount of Use Palsy (PSP) is a Parkinsonian syndrome characterized by oculomotor
of the Motor Activity Log (MAL) indicating very rare use.The initial Actual deficits (slow and limited voluntary eye movement) and recurrent falls.
Amount of Use Test (AAUT) was 0.53 in Amount and 1.12 in Quality. She The mechanism responsible for the loss of rapid eye movements or sac-
was an independent ambulator at 1.16 meters per second (mps) self- cades in PSP is not clear.
selected speed and 1.69 mps fast walking. She did not exhibit any right Funded by grant #H133G 030159 to Dr. Di Fabio from the National
arm swing. Prior to the stroke she was a dental hygienist, homemaker and Institute on Disability & Rehabilitation Research.
active in her community. She lived at home with her husband, two children
requiring help from caregivers. Her goals were to become more indepen- ORTHOPEDIC CONSIDERATIONS IN THE MANAGEMENT OF A
dent in cooking, child care and driving. She participated in CIMT for 6 PATIENT WITH NEUROLOGICALLY INDUCED IMPAIRMENTS OF
hours/day for 10 days and was mitt compliant at least 90% of waking THE FOOT AND ANKLE: A CASE REPORT. A. Driscoll1, R. Joshi2, M.
hours. Outcomes: Outcome measures were collected pre, post, 6 and 12 Johnson3, 1Mercy Rehab Associates, Darby, PA, 2Mercy Rehab Associates,
months.At post-test, amount and quality of arm use (MAL) increased almost Darby, PA, 3Mercy Rehab Associates, Darby, PA.
to the pre-stroke levels (4.8 and 4.6, respectively).This was maintained at
3.98 and 4.05 at 12 months.The AAUT continued improving at 6 months, Background & Purpose: Joint range of motion (ROM) limitations are a
in both maximum amount 1.71 and maximum quality 3.19.Times on the significant issue in patients with neurological disabilities, particularly
Wolf Motor Function Test improved from 2.69 seconds to 1.7 post CIMT, when considering lower extremity orthotic management, transfers and
approaching the less involved side (1.35), however, increased to 2.21 at 6 ambulation. Joint mobilization techniques have been successful in increas-
months and 5.63 at 12 months. Fugl Meyer improved across all testing ing joint ROM of the foot and ankle in the orthopedic population though
from baseline 56 to 61 at 12 months. Box and Blocks Test initially increased little literature exists supporting the use of manual therapy in restoring
from 31 to 37 post CIMT and maintained an average of 56% of the left UE ROM deficits in patients with neurological impairments. This case report
extremity at 12 months. MOS-36 increased from 22 to 28 post and 29 at describes the use of joint mobilization techniques in a patient with multi-
12 months. Geriatric Depression Scale decreased from 7 to 4 after CIMT. ple sclerosis (MS). Case Description:A 24 year old female with a history
The personal goals for childcare and resuming driving were attained. of chronic progressive MS was referred for outpatient physical therapy
Discussion: Outcomes demonstrated the potential value and efficacy of (PT) with increased difficulty with transfers and ambulation and patient
CIMT as an intervention for the challenging problem of hemiakinesia. report of her feet turning inside her present MAFOs. During ambulation
Measures of function and quality of life substantiate the participant’s per- with PLS MAFOs supination was noted during mid stance with plantar
ception of improvement and gains. This case study illustrates a potential flexion out of the orthoses bilaterally in terminal stance. Patient goals
application of CIMT for hemiakinesia post-stroke. include return to previous independent (I) transfers and ambulation with
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 206

a rolling walker and wear of MAFOs with increased comfort. PT interven- began to improve in performance, and Subject C beginning as Subject B
tions initially included manual stretching to the gastroc/soleus muscles demonstrated improvement. Subjects initially completed the Folstein Mini
though no significant improvement was noted in 7 sessions. Upon further Mental Status Examination (MMSE) and the SF-36 Item Health Survey.
examination by a neurologic clinical specialist, similar ROM limitations Functional tests/measures included in baseline testing were the Timed Up
were noted in ankle dorsiflexion in both knee flexion and extension. In and Go Test (TUG),Three-Minute Walk Test, and the Physical Performance
addition, decreased articular motions were noted at the talus and the mid and Mobility Exam (PPME). Each subject was instructed in an individually
foot, indicating restrictions in joint mobility at the talocrural joint. Joint prescribed aerobic exercise program and instructed to exercise 3 times
mobilization techniques to the foot and ankle were then incorporated into per week for 12 weeks, using exercise equipment of his/her choice, eval-
the treatment program. Outcomes: The patient responded well to joint uated and approved by the investigators. Researchers provided a heart
mobilization gaining 15/22 degrees of ankle dorsiflexion at the right and monitor and blood pressure cuff to each subject for self-monitoring, and
left respectively following 4 sessions of PT.The increase in ROM allowed subjects recorded results from each exercise session.The functional tests
for casting for articulating MAFOs with the foot aligned in sub-talar neutral listed above were reassessed weekly throughout the exercise program and
and ankle dorsiflexion at 0.Ambulation was improved and the patient was three months following completion of the program. Subjects also
able to resume (I) transfers and household ambulation using new orthoses repeated the SF 36-Item Health Survey at the end of the twelve weeks of
with a full foot plate, ankle strap and a rolling walker. Discussion: This exercise. Results: All three subjects successfully completed 12 weeks of
case demonstrates the significant role of PT in the restoration of joint ROM independent, self-monitored exercise, though one was unable to return for
and correction of underlying biomechanical dysfunctions in a patient with three month follow-up tests due to medical complications. Over the twelve
primary neurological dysfunction. Thorough examination of the foot and week period, all three subjects improved in time of performance of the
ankle allowed for appropriate treatment strategies to correct underlying TUG.Two subjects demonstrated increased distance covered in the Three-
joint mechanics. Through the combination of stretching and joint mobi- Minute Walk Test. Two subjects showed improvement in the Physical
lization, ROM was restored within a minimal number of sessions allowing Performance and Mobility Exam. Two subjects demonstrated increased
progression to alternate orthoses and functional mobility training. Of sig- endurance in exercise sessions by gradually increasing duration from 15
nificance is the need to incorporate principles of manual therapy, specifi- minutes to 45 and 20 minutes to 45, respectively. No significant changes
cally joint mobilization techniques, into the care of clients with neurologi- were noted in the Quality of Life Health Survey. Results at the three month
cal disabilities to achieve optimal functional mobility. follow-up: two subjects were approaching baseline levels in all tests.
Conclusions: Older adults recovering from stroke who perform an inde-
PREDICTING OUTCOME OF A PHYSICAL THERAPY PROGRAM IN pendent aerobic exercise program using a location and equipment of their
PATIENTS WITH PARKINSON’S DISEASE. T. Ellis1, R. Wagenaar1, C.J. de choice demonstrate the ability to self-monitor and improve exercise toler-
Goede2, G. Kwakkel2, W.C. Eric2, 1Physical Therapy & Athletic Training, ance and endurance. Further study is required to determine if improved
Boston University, Boston, MA, 2Boston University, Boston, MA. exercise tolerance contributes to improved functional mobility and quality
of life. Clinical Relevance: Diminished exercise tolerance and endurance
Purpose/Hypothesis: The ability to identify those patients with are closely associated with stroke. Older adults recovering from stroke may
Parkinson’s Disease (PD) who are most likely to benefit from rehabilitation benefit from a specifically prescribed and designed, self-monitored exer-
would help physical therapists target patients more appropriately. The cise program as part of a total rehabilitation program.
purpose of this study was to determine the value of patient characteristics
in predicting rehabilitation outcome. Number of Subjects:This study was KINEMATICS OF REACH-TO-GRASP MOVEMENTS IN SUBJECTS
part of a randomized controlled trial in which the efficacy of a physical WITH CEREBELLAR DEFICITS. K.M. Erickson, P.L. van Kan, Kinesiology,
therapy (PT) program was investigated. Sixty-eight subjects with PD within University of Wisconsin-Madison, Madison,WI.
Hoehn and Yahr stage II or III participated in group treatment conducted
twice per week for 1.5 hours in duration over a six-week period. Purpose/Hypothesis: We examined the kinematics of reaching to grasp
Materials/ Methods: Outcome measures consisted of the Sickness Impact in humans to determine the role of the cerebellum in the timing of finger
Profile (SIP-68), mobility portion of the SIP-68 (SIPM), the Unified opening with proximal joint movement. The cerebellum is important for
Parkinson’s Disease Rating Scale (UPDRS) and comfortable walking speed the control of multijoint, coordinated movements, such as reaching to
(CWS). Regression analyses were conducted to identify which determi- grasp.An unresolved question is whether the cerebellum specifically con-
nants predicted rehabilitation outcome. Results: Baseline CWS, SIPM, trols temporal relations between reach, hand preshaping, and grasp com-
UPDRS II and UPDRS total scores best predicted outcomes in CWS, SIPM, ponents or whether the cerebellum integrates reach, hand preshaping, and
UPDRS II and UPDRS total scores, respectively. Age, gender and disease grasp components into a single central program. Number of Subjects: 5
severity were not predictive of outcome. Slow pretreatment CWS, higher subjects with cerebellar damage and 6 healthy, age-matched controls were
scores (greater disability) on the SIPM, UPDRS II and total UPDRS were studied. Materials/Methods:We measured kinematics of reach, hand pre-
related to greater improvements after intervention. Conclusions: Those shaping, and grasp while subjects with cerebellar damage (n=5) and
individuals with the greatest level of disability and functional limitations in matched controls (n=6) performed reaches with a precision grip that
this sample were more likely to improve after participating in a group required opposition of the index finger and thumb. The task was per-
physical therapy program. Clinical Relevance: This data highlights the formed under two conditions: as fast and accurately as possible, and slowly
potential usefulness of classifying individuals with PD according to their and accurately.Transport of the hand was characterized by angular veloc-
baseline functional status to determine rehabilitation outcome. ity of elbow and shoulder joints, wrist trajectory, and amplitude and timing
of tangential wrist velocity. Hand preshaping was characterized by ampli-
AEROBIC CONDITIONING OF OLDER ADULTS USING AN INDEPEN- tude and variability of peak grip aperture and its timing relative to the
DENT HOME EXERCISE PROGRAM IN THE CHRONIC PHASE OF reach. Grasp was characterized by relative timing of contact of the index
RECOVERY FROM STROKE. ML English,A. Ruble,T.Thompson, Physical finger and thumb with the target. Results: Results showed that PGA is
Therapy, University of Kentucky, Lexington, KY. tightly coupled to both peak shoulder velocity (PSV) and peak elbow
velocity (PEV) in healthy controls. Cerebellar subjects showed disruptions
Purpose/Hypothesis:To determine if an intervention program consisting in timing of PGA with PSV and PEV, with both joints contributing to an
of independent, self-monitored aerobic exercise designed specifically for overall disruption in timing of PGA with peak wrist deceleration (PWD).
the individual older adult recovering from stroke will result in improved These disruptions were more profound in the fast and accurate condition.
aerobic exercise tolerance, endurance and improved functional mobility. In addition, cerebellar subjects were much more variable in the timing of
Number of Subjects:Three, using a Single Subject Design, multiple probes multiple aspects of reaching to grasp including time of PGA relative to
across subjects. Materials/Methods: A sample of convenience of three total movement time, timing of peak wrist velocity (PWV), time of PSV,
older adults who were recovering from stroke > one year prior to initia- time of PEV, as well as relative timing of PGA with PWD, PSV, and PEV.
tion of the study served as subjects. Subjects were tested in a staggered Conclusions: Kinematics of reaching to grasp in subjects with cerebellar
fashion, with Subject A beginning first, Subject B beginning after Subject A damage are characterized by increased variability. The increased variabil-
207 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

ity uncouples reach, hand preshaping, and grasp components in both spa- Clinical features include oculomotor deficits, dysphagia, and postural insta-
tial and temporal domains. Clinical Relevance: Current recommendations bility.The fall rate for people with PSP is reported to be 100% in the first
to patients with cerebellar lesions include learning to slow their move- year of diagnosis.The purpose of this pilot study was to compare the effect
ment down and to decompose movement into a series of single joint of traditional balance training to a program augmented by saccade exer-
movements (Bastian 1997).This study supports the usefulness of slowing cises and a cognitive challenge during gait on protective step reaction time
movements, as timing of proximal joints with finger opening is less dis- (RT) in people with PSP. Number of Subjects: 187 perturbations induced
rupted in slower movements. If patients can be trained to move more protective step trials were collected from four subjects with PSP.
slowly, disruptions to the proximal joint coordination are minimized and Materials/Methods: Each subject participated in two phases of the study.
the overall movement of reaching to grasp is more normalized. However, During the control phase, subjects underwent four weeks of perturbation
at slower speeds, increased variability in magnitude and timing of PGA and balance training followed by an eight-week rest phase. Subsequently,
should still be expected based on the current results. subjects were entered into the experimental phase, consisting of four
weeks of perturbation and balance training along with saccade exercises
UPPER EXTREMITY PHASE MANIPULATION AND WALKING IN PER- and a cognitive challenge during gait. Following each session of training,
SONS WITH A CVA. M.P. Ford1, R.C. Wagenaar2, K.M. Newell3, 1Physical electromagnetic sensors placed on the trunk and feet were utilized to mea-
Therapy, The University of Alabama at Birmingham, Birmingham, AL, sure body segment position during perturbation trials. Data were collec-
Physical Therapy, Boston University, Boston, MA, 3Kinesiology, The tively analyzed for expected and unexpected backward perturbations
Pennsylvania State University, University Park, PA. administered at the hips or shoulders.The dependent variables were lead
and lag foot step RT. Results:A within group control vs. treatment analy-
Purpose/Hypothesis: To investigate the effects of walking velocity and sis of lead foot step RT showed a significant decrease in median step RT
upper extremity phase manipulation on inter-segmental coordination dur- from 0.50 seconds in the control phase to 0.31 following the experimen-
ing treadmill walking in persons with a CVA. Number of Subjects: 8 indi- tal phase (H = 9.40, df = 2, p = 0.0022). Similar results were found for the
viduals (12 - 72 yrs; mean 49; standard deviation: 17.4) who have suffered lag foot. Conclusions: Four weeks of perturbation training combined with
a CVA participated. Materials/Methods: There were 3 separate condi- saccade exercises and a cognitive challenge during gait resulted in signifi-
tions while walking at 0.22, 0.40, 0.63, 0.85, 1.10, 1.30, and 1.52 m/s: 1) no cantly faster step RT in people with PSP when compared to step RT fol-
upper extremity phase manipulation; 2) instructions to move the arms in lowing perturbation training alone. Clinical Relevance: Protective step-
phase at each velocity level; 3) instructions to move the arms out of phase ping for people with PSP can be improved with rehabilitation training.
at each velocity level. 3D kinematic data were collected using a Skill However, our study did not address the relationship between step RT and
Technologies 6D Research System. The total range of movement ampli- the incidence of falls.At this time, it is not known if a faster protective step
tudes for arms (τA) and legs (τL), and transverse rotation of thorax (τT), reaction time results in decreased falls risk.
pelvis (τP) was calculated. The amplitude of transverse trunk rotation
(τPT) was calculated by determining the maximum differences between FUNCTIONAL PREDICTORS OF OUTCOMES FOLLOWING CON-
(τT) and (τP). The shoulder and hip angle time-series data were used to STRAINT-INDUCED MOVEMENT THERAPY FOR INDIVIDUALS WITH
compute the point estimates of relative phase between the arms.We deter- POST-STROKE HEMIPARESIS. S.L. Fritz, Exercise Science/ Physical
mined if the power (power spectrum) in arm movement frequency was Therapy, University of South Carolina, Columbia, SC.
higher at stride or step frequency during walking. For statistical analysis a
within-group analysis of variance with repeated measures, including two Purpose/Hypothesis: Constraint Induced Movement Therapy (CIMT) is a
within-factors, 1) velocity manipulation and 2) instruction was used with a rehabilitative strategy used primarily with the post-stroke population to
.05 significance level. Results: Across all walking velocities the arms increase the functional use of the neurologically-weaker upper-extremity
moved more out of phase during no upper extremity phase manipulation through massed practice while restraining the lesser-involved upper-
and instruction to move the arms out of phase, as compared to instruction extremity. While solid research evidence supports CIMT, limited evidence
to move the arms in phase. Instructions to move both in or out of phase, exists regarding the specific characteristics of individuals who benefit
led to larger involved arm movement amplitude (τAi) and non-involved most from this intervention. The goal of this study was to determine the
arm movement amplitude (τAni) as compared to the condition with no descriptive predictors for CIMT outcomes. Number of Subjects:A conve-
upper extremity phase manipulation. When participants were instructed nience sample of 55 individuals post-stroke was recruited that met specific
to move the arms in phase the τAi was larger at both 0.43 and 0.66 m/s, as inclusion and exclusion criteria. Materials/Methods: These individuals
compared to instructions to move out of phase.The larger τAni coincided participated in CIMT 6-hours per day, for two-weeks with restraint of their
with the power in the non-involved arm movement frequency being less-affected upper extremity. Pre-test, post-test and follow-up assessments
higher at stride frequency when participants were instructed to move were performed to assess the outcomes for the Wolf Motor Function Test
their arms in phase as compared to out of phase. Finally, τT, τP, and τPT (WMFT) and the amount section of the Motor Activity Log (MALa). The
were greater when participants were instructed to move their arms out of potential functional predictors were: minimal motor criteria, finger exten-
phase, as compared to in phase. Conclusions:The results from the present sion, grip strength, Fugl-Meyer upper-extremity motor score, and the
study demonstrate flexibility of the coordination patterns of walking to Frenchay score. A step-wise regression analysis was used in which the
meet constraints imposed on the movements of body segments. group of potential predictors was entered in a linear regression model
Additionally, these results suggest that the ability to modify arm movement with simultaneous entry of the dependent variables’ pre-test score as the
amplitude, along with frequency, is necessary for synchronization with the covariate. Two regressions models were determined for each dependent
stride frequency. Clinical Relevance: Slower walking velocity in patients variable per experiment, one for the post-test, and one for the follow-up
with severe upper extremity dysfunction (e.g., CVA) may be due to inabil- test. Results: Finger extension was the only significant predictor of WMFT
ity to alter coordination patterns. Future studies should investigate the outcomes. Minimal motor criteria and upper-extremity Fugl-Meyer motor
underlying dynamics of arm dysfunction and adaptations during treadmill score were predictive of the MALa immediately following therapy, but only
and over-ground walking.This will provide a foundation for interventions the Fugl-Meyer score was predictive of outcomes at the follow-up.
which address motor impairments of the upper and lower extremity Conclusions:This experiment provides the most comprehensive investi-
related to walking in persons with a CVA. gation of predictors of CIMT outcomes to date. Further substantiation of
these findings in more diverse samples is warranted in order to meet the
PROTECTIVE STEP TRAINING IN PEOPLE WITH PROGRESSIVE urgent need of determining the appropriate candidates for CIMT. Clinical
SUPRANUCLEAR PALSY. C.E. Franzen, S.L. Gubka, L. Hamilton, C. Relevance:The identification of clinical predictors for outcomes of CIMT
Zampieri, R.P. Di Fabio, Physical Medicine & Rehabilitation, University of is of value to both research and clinical settings. Who benefits most from
Minnesota, Minneapolis, MN. CIMT needs to be understood, in order to target the correct population.

Purpose/Hypothesis: Progressive Supranuclear Palsy (PSP) is an atypical LEARNING EFFECT ASSESSMENT ON SUBSEQUENT SUBJECT PER-
parkinsonian disorder affecting the basal ganglia and the brainstem. FORMANCE ON THE EQUITEST. BALANCE SYSTEM. B. Gilliam, D.
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 208

Charles, S. Kathmann, J. Smith, N.S. Darr, D. Greathouse, Belmont University, motor criteria for CIMT (i.e., active wrist extension of at least 20 degrees
Nashville,TN. (See Motor Learning Thematic Poster Session for abstract) and finger extension of at least 10 degrees), but had the ability to grasp a
washcloth on a table top, lift it, and release it (Taub & Morris, 2001; Bonifer
SELF-REPORTED EARLIEST SYMPTOMS OF PARKINSON DISEASE. D. & Anderson, 2003). He participated in a two-hour mCIMT program for ten
Glendinning, V. Patel, D. Maldonado, G. Siozon, P. Trivedi, Physical Therapy weekdays over a two week period using a mitt and/or verbal cueing as the
and Sport Sciences, Seton Hall University, South Orange, NJ. constraint. During the program, the patient agreed to engage his more
affected UE in activities for 90% of waking hours. Testing was conducted
Purpose/Hypothesis: Parkinson disease (PD) is caused by cell death in before and after intervention, and again at a one-month follow up visit.The
the substantia nigra pars compacta of the midbrain. Although the classic outcome measures used were: the Wolf Motor Function Test (WMFT),
diagnostic signs of PD are muscle rigidity, tremor, and bradykinesia, these Action Research Arm Test (ARAT), and Motor Activity Log (MAL).
signs only appear after approximately 90% of the neurons within the pars Outcomes: The WMFT scores displayed improvements in performance
compacta have degenerated. Currently, research is focused on developing time (PT) for 13 of 15 timed items and 16 of 17 functional ability (FA)/qual-
neuroprotective treatments to halt the progression of cell death in PD. ity of movement items at post testing. At follow up, all items of WMFT
Neuroprotective treatments will only be effective if the cell death can be either remained the same or improved in FA (except item 17) and 10 of 15
recognized by signs that precede the cardinal signs of PD. Physical thera- items further improved for PT. Grip strength doubled from pretest to
pists, trained to observe movement, are well-suited to develop early detec- posttest. However, only 27% of grip strength gain was maintained at one-
tion tests for PD. The purpose of this study was to ask persons with PD month follow up. For the ARAT, the subject demonstrated improvement
directly about their earliest symptoms, to obtain clues for early detection. with an average increase of 2.3, 1.7, and 0.3 on grasp, grip and pinch sub-
To date, no one has methodically queried persons with the disease about tests respectively, and had an increase of 3.3 on his overall score.At follow-
pre-diagnostic symptoms. Number of Subjects: 45. Materials/Methods: up testing, he demonstrated further improvements on grasp and overall
Surveys were distributed at support groups, physician offices, and on an score showing gains of 2.7 and 0.7 respectively, and the time it took to
internet website, and were completed anonymously by persons with idio- complete tasks in both grasp and grip decreased/improved from pretest
pathic PD. The survey included basic demographic data, multiple-choice and posttest to follow-up. For the MAL, the patient showed minimal
questions, and open-ended questions related to pre-diagnostic physical and improvement in affected arm usage for the tasks specified, despite subjec-
emotional symptoms. Subjects were required to order the onset of symp- tive reports that he was using his affected arm more often and with less
toms in each section. Results: Forty-five people (16 females, 29 males, aged effort during activities of daily living. Discussion: This program shows
73.2 ± 8.9) responded to the survey.The average number of years with PD promise as an effective and practical application of mCIMT for persons
was 8 ± 6.53.Thirty-five percent of respondents reported tremor as the first with severe, chronic hemiplegia. Further research is warranted on a larger
sign of PD. The remaining subjects reported diminished olfaction, depres- group of individuals following stroke who demonstrate learned nonuse.
sion, voice changes, and bradykinesia.An analysis of all early signs revealed
that 1) as a cluster of early symptoms, sleep disorders, fatigue, depression RELIABILITY OF CLINICAL MEASURES TO ASSESS PATIENTS WITH
and tiredness occurred in 50% of subjects, and 2) males and females had dif- VESTIBULAR HYPOFUNCTION. C.D. Hall1, S.J. Herdman2, 1Rehab R&D
ferent early signs: males more often reported classic signs of the disease, Center, Atlanta VAMC, Decatur, GA, 2Rehabilitation Medicine, Emory
and females more often reported fatigue, tiredness, depression and voice- University,Atlanta, GA.
weakening. Ten-percent of all subjects also reported that symptoms first
appeared after major medical events, such as surgery or trauma. Purpose/Hypothesis: Evaluation of patients with vestibular hypofunc-
Conclusions:This study had 2 major findings. First, most people with PD tion includes measures of subjective complaints, balance, gait and quality
reported a classic symptom as the first symptom of PD, suggesting that they of life.A variety of tools can be used to identify patient problems and assess
were unable to detect any subtle earlier symptoms of impending PD. change with intervention or time. It is important that a measure be reliable
Second, females especially, reported fatigue, depression, tiredness and sleep in order to be assured that any changes in score over time are due to real
disturbances as early signs of PD.This cluster of symptoms should be added changes in the individual’s performance rather than to errors in scoring.
to previously reported micrographia and diminished olfaction, as early indi- Many of the measures and tools have established interrater reliability, yet
cators of PD. Clinical Relevance: Because individuals may not be able to test-retest reliability has not been determined, has been determined with a
detect the early symptoms of PD, physical therapists should be aware that very small sample size or has not been determined in individuals with
pre-diagnostic signs of PD may include fatigue, depression, tiredness, and vestibular hypofunction. The purposes of this research were to 1) deter-
sleep disturbances, in addition to the previously reported micrographia and mine test-retest reliability of clinical measures of subjective complaints,
diminished olfaction. In addition, physical therapists need to conduct more balance, gait and quality of life in patients with vestibular hypofunction
research to develop clinical test batteries for early detection.The ultimate and 2) establish criteria for significant change in each of these measures.
goal would be to halt disease progression with new neuroprotective treat- Number of Subjects: Sixteen volunteers were recruited from patients
ments, such as drug, gene, or physical therapy. referred to the Emory University Dizziness & Balance Center with a diag-
nosis of either unilateral or bilateral vestibular hypofunction. Diagnosis
CASE REPORT: A MODIFIED CONSTRAINT INDUCED MOVEMENT was confirmed with a positive head thrust test and rotary chair or caloric
THERAPY (MCIMT) PROGRAM FOR THE UPPER EXTREMITY OF A testing. Materials/Methods: Participants performed two trials of each of
COMMUNITY-DWELLING MALE WITH SEVERE CHRONIC HEMIPLE- the measures within the initial physical therapy session. The measures
GIA. R.M. Hakim, E. Driscoll, J. Ricci,T. Szasz, Physical Therapy, University of included rating of disability, percent of day affected by dizziness, head
Scranton, Scranton, PA. movement induced dizziness, SF-36, preferred gait speed, gait deviations
and dynamic gait index. In order to assess test-retest reliability of the mea-
Background & Purpose: Traditional Constraint-Induced Movement sures Pearson product moment correlations (r) were calculated using SPSS
Therapy (CIMT) protocol may be difficult to implement because of the 11.0. Correlation values greater than .75 are generally considered to indi-
time commitment and use of a restrictive device (Page et al., 2002). Recent cate good reliability. Significant change in each measure was based on the
studies of modified Constraint-Induced Movement Therapy (mCIMT) pro- mean change in score plus 2 SD of the test-retest variability. Results:The
tocol using a combination of outpatient therapy and unsupervised practice average age of the group was 51.8 years (range: 29-78 years) with 18.8% of
were effective in improving function of the more affected upper extrem- the patients at least 65 years old and 38% male.Three of the subjects had
ity (UE) for patients with mild hemiparesis and learned nonuse (Page et al., bilateral vestibular loss.The average time from onset of symptoms was 12.8
2001; Page, Sisto & Levine, 2002). The purpose of this case report was to months (range = .75 - 43 months). All measurement tools demonstrated
determine if a modified, reduced intensity version of the traditional CIMT excellent reliability (r = .82 - 1.00) except for head movement induced
protocol would elicit functional improvements in the UE of a community- dizziness (r = .59). For each measure we report what constitutes significant
dwelling individual with severe, chronic hemiplegia. Case Description: change. For example based on our definition, a change of 3 points or more
The case was a 68 year old male, eight years after a right stroke, who dis- in the total dynamic gait index score constitutes significant change.
played severe UE hemiplegia that did not meet the traditional minimum Conclusions:A variety of tools are available for the assessment of patients
209 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

with vestibular hypofunction.We found that all of the scales examined in care providers. Casting, soft tissue mobilization, motor re-education,
this study, with the exception of head movement induced dizziness, surgery, and anti-spasticity medications are traditionally used to manage
demonstrate excellent test-retest reliability in the vestibular patient popu- spasticity, increase ROM, and improve functional mobility. Botulinum toxin
lation. Clinical Relevance: Incorporation of valid and reliable assessments type A (BTA) is one anti-spasticity medicine that is used as an adjunct agent
in clinical practice is critical in order to demonstrate the effectiveness of to facilitate traditional physical therapy interventions. However, there is
therapeutic intervention.The variability in test-retest reliability can be used very little evidence that documents the effectiveness of BTA and/or serial
as criterion for significant change but criteria based on functional signifi- casting for improving functional movement, especially in the upper
cance need to be developed. extremities of pediatric patients. Case Description: The patient was a
nine year old male referred for rehabilitation three months post hydro-
VESTIBULAR EVALUATION IN INDIVIDUALS WITH MILD BRAIN cephalus secondary to sudden hemorrhage of a previously asymptomatic
INJURY. S.L. Hammond1, C. Harro2, 1Mary Free Bed Rehabilitation Hospital, AVM. Initially the patient demonstrated a marked reduction in upper
Grand Rapids, MI, 2Grand Valley State University, Grand Rapids, MI. extremity PROM of all joints. Notably for this case, left elbow extension
was restricted to 90º- 60º PROM. Gross voluntary muscle activity within the
Purpose/Hypothesis: Clients with mild brain injuries (MBI) are suscepti- available ROM was absent to poor. Upper extremity spasticity was rated 3
ble to vestibular dysfunction. The Dizziness Handicap Inventory (DHI), (modified Ashworth) bilaterally at the shoulder, elbow, and wrist. FIM
Sensory Organization Testing (SOT), Dynamic Gait Index (DGI), Dix- scores were 0 for transfers, self-care, and mobility. Upper extremity inter-
Hallpike Maneuver (DHM), and Head-Impulse Test (HIT) are objective ventions included a single BTA injection and ROM, neuromuscular re-edu-
vestibular examination measures that have been validated in subjects with cation, casting (left elbow only), and functional training over a 4 week
vestibular pathologies. Research utilizing these tests to examine the preva- period. Outcomes:At discharge the patient demonstrated improved ROM
lence of vestibular dysfunction post-MBI and assessing the validity of these (left elbow extension 115º - 60º PROM), decreased spasticity (+2 wrist, +1
measures in clients with MBI is lacking. The primary purpose of this elbow, -1 shoulder), left extremity anti-gravity control through available
descriptive study was to investigate the application of objective measures ROM, and improved FIM scores (3 for bed mobility, 1 for gait, and 4 for
to examine the incidence of vestibular dysfunction in clients with MBI and wheel chair mobility). At one year follow-up, FIM scores were further
secondly, to examine the concurrent validity of the DGI with SOT and DHI improved with no additional serial casting or BTA administration.
scores in clients with MBI. Number of Subjects: Fifteen subjects with Discussion: Despite the limited clinical evidence, it is reasonable to pre-
diagnosis of MBI with onset < 6 months were recruited from MBI outpa- dict that an agent, such as BTA, is capable of creating a therapeutic window
tient clinic. Mean age was 40 years (range 19-78) and mean time post-injury during which time spasticity is attenuated and ROM can be improved. In
was 69 days (range 12-167). Subjects were excluded if they had spinal or this particular case, we observed a persistent functional change in the
extremity injuries that contraindicated test administration or previous neu- upper extremity of a pediatric patient treated with traditional physical
rologic diagnoses. Materials/Methods:The DHI, SOT, DGI, DHM, and HIT therapy, casting and BTA injection. This outcome suggests that BTX and
were administered in controlled order to subjects over two sessions. The casting are appropriate adjunct treatments for upper extremity spasticity.
DHI was used to quantify subjects’ self report of dizziness. SOT was used However, systematic studies are needed to more clearly demonstrate the
to assess the use of sensory inputs for balance, specifically vestibular input. effectiveness of BTA and casting interventions on improving upper
The DGI was used to evaluate subjects’ functional balance during gait extremity function in pediatric patients with brain injury.
tasks.The DHM and HIT were administered to detect BPPV and vestibulo-
ocular function, respectively. Descriptive statistics were used to examine TELEREHABILITATION FOR MOTOR RETRAINING IN PATIENTS WITH
the sample’s score distribution for each test and Pearson correlation was STROKE. M.K. Holden,T.A. Dyar1, E. Bizzi1, L. Schwamm2, L. Dayan-Cimadoro3,
used to examine the relationship between tests. Results:The mean score 1
Dept. of Brain & Cognitive Sciences and Mc Govern Institute for Brain
on the DHI was 50 (IQR 35-72), with 60% of scores being 50 or higher.The Research, Massachusetts Institute of Technology, Cambridge, MA, 2Clinical
mean SOT composite balance score was 61.1 (IQR 54.5-71.0), with 73.3% Research Center, Massachusetts Institute of Technology, Cambridge, MA,
of subjects falling below their normative age group scores. Forty-six per- 3
Dept. of Physical Therapy, Spaulding Rehabilitation Hospital, Boston, MA.
cent of subjects were determined to have difficulty using vestibular input (See Motor Learning Thematic poster session for abstract)
to maintain balance.The mean score on the DGI was 19 (IQR 16.5-22.0),
with 53.3% of subjects in a fall risk category. Two subjects had positive DECREASED ARM SWING AT FAST WALKING SPEED IN MILD
DHM results and 3 subjects had positive HIT results.A significant good cor- PARKINSON DISEASE (PD). M. Hong1, G. Earhart1, D. Damiano2, J.
relation (r = -0.795) was found between DHI and DGI scores, indicating Perlmutter2, 1Physical Therapy,Washington University in St. Louis, St. Louis,
that subjective vestibular symptoms were related to subjects’ functional MO, 2Neurology,Washington University in St. Louis, St. Louis, MO.
balance deficits. Conclusions:These findings demonstrate that vestibular
dysfunction is prevalent in clients with MBI.The DHI, DGI, and SOT find- Purpose/Hypothesis: Clinicians commonly note that people with mild
ings detected a large percentage of subjects with vestibular impairment, PD have reduced arm swing but the relationship to walking speed remains
demonstrating the validity of vestibular testing in MBI. Clinical unknown.The purpose of this study was to determine whether arm swing
Relevance: Individuals who experience MBI should be screened for was reduced at various walking speeds compared to controls.We hypoth-
vestibular dysfunction. In this study the DHI demonstrated sensitivity in esized that PD subjects would 1) have a narrower range of gait speeds
measuring self-reported vestibular symptoms, which correlated with sub- compared to controls and 2) demonstrate less arm swing than controls.
jects’ functional balance scores.The DGI and SOT were valid measures for Number of Subjects:We tested 10 subjects with mild PD (stages 1-3) and
detecting balance dysfunction in MBI. 10 healthy age and gender matched control subjects. Materials/Methods:
Subjects walked across a 10 m room at three different speeds: slow, natural,
BOTULINUM TOXIN A AND SERIAL CASTING AS ADJUNCT TREAT- and fast. For the slow and fast conditions, the subjects were instructed to
MENTS FOR REHABILITATING UPPER EXTREMITY SPASTICITY FOL- walk as slow or as fast as they could. For the natural walking condition, the
LOWING BRAIN INJURY IN A PEDIATRIC PATIENT. N.J. Hellyer, S.L. subjects were told to walk at their normal and comfortable walking speed.
Eischen, Program in Physical Therapy, Mayo Clinic College of Medicine, Three trials in each condition were recorded using a Vicon system. The
Rochester, MN. order of the conditions was randomized for each subject. Gait speeds and
shoulder angles in the sagittal plane, as a measure of arm swing, were cal-
Background & Purpose: Disabling subdural hemorrhage can occur in culated for two strides per trial. For the PD group, we looked at the more
children secondary to arteriovenous malformations (AVM).AVMs occur at impaired arm and for the control group, we analyzed their dominant side.
a frequency of one in every 100,000 children and can cause movement At matched speeds, Mann-Whitney Rank Sum Tests were used to compare
dysfunction following hemorrhagic brain injury. Like other types of upper peak-to-peak shoulder angles per stride between the two groups.A Pearson
motor neuron injury, the recovery of functional movement following Product Moment r was calculated between gait speeds and peak-to-peak
injury is often impeded by the development of spasticity. Therefore, the shoulder angles for both groups. Results:There was no difference in the
management of spasticity is a critical concern for the patient and health mean speeds for the three different conditions between the two groups.
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 210

Both groups increased arm swing with an increase in gait velocity (r =.71 SINGLE LIMB BODY WEIGHT SUPPORTED TREADMILL TRAINING.
for PD group, r =.79 for control group). The PD group demonstrated sig- J.H. Kahn1,T. Hornby2, 1Sensory Motor Performance Program, Rehabilitation
nificantly smaller amplitudes of arm swing in the fast walking condition Institute of Chicago, Chicago, IL, 2Physical Therapy, University of Illinois at
(p=.045) compared to the control group.There were no differences in arm Chicago, Chicago, IL. (See Post-Stroke Hemiplegia Thematic Poster Session
swing between the two groups in the slow or the natural walking condi- for Abstract).
tions (p=.212, p=.089). Conclusions:The PD group was able to regulate
gait speed across the same range as the control group. However, decreased INFLUENCE OF MOTOR-IMAGERY ABILITY ON SMA AND PSMA
arm swing was noted in patients with mild PD only in the fast condition, CORTICAL ACTIVATION. T.J. Kimberley, G.S. Khandekar, Physical
when they were walking at a faster than normal speed. Clinical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN.
Relevance: Clinicians should be cautious to take gait speed into account (See Imagery and Imaging Thematic poster session for abstract)
when assessing arm swing. Previous work has shown that with verbal
instructions to increase arm swing, patients with PD not only increased NEUROMOTOR CONTROL IN FOCAL HAND DYSTONIA. T.J.
arm swing but also walked faster than natural walking speed. Instructing Kimberley1, K.J. Simura2, M. Flanders2, 1Physical Medicine and
more advanced PD patients, whose fast walking speeds are below the level Rehabilitation, University of Minnesota, Minneapolis, MN, 2Neuroscience,
of functional ambulation, to increase arm swing while walking fast may University of Minnesota, Minneapolis, MN.
increase walking speed and improve function, but this remains to be
proven. Purpose/Hypothesis: Focal hand dystonia is an under-diagnosed disorder
associated with repetitive hand movements that require fine motor control
SINGLE LIMB BODY WEIGHT SUPPORTED TREADMILL TRAINING. and sensory-motor integration, such as typing or playing a musical instru-
J.H. Kahn1,T. Hornby2, 1Sensory Motor Performance Program, Rehabilitation ment.The disorder involves excessive co-contraction of muscles and abnor-
Institute of Chicago, Chicago, IL, 2Physical Therapy, University of Illinois at mal postures that prevent normal motor function when performing the spe-
Chicago, Chicago, IL. (See Post-Stroke Hemiplegia Thematic poster session cific hand movements.The cause of the disorder is widely debated, and no
for abstract) objective diagnostic criteria or fully successful treatment exists. Current lit-
erature focuses on spinal cord reflexes and a cortical change associated with
PHYSIOLOGICAL RESPONSES OF INDIVIDUALS WITH SPINAL CORD focal hand dystonia, and does not include a comprehensive analysis of mus-
INJURY DURING ROBOTIC-ASSISTED TREADMILL WALKING. J.F. cle activation.Thus, the purpose of this study is to analyze neuromotor con-
Israel,T. Hornby, Physical Therapy, University of Illinois at Chicago, Chicago, trol in focal hand dystonia compared to healthy motor control in the same
IL. task.We hypothesize that patient’s abnormal muscle synergies can be iden-
tified and characterized by the time course of muscular activation.This may
contribute towards the development of specific diagnostic categories and
Purpose/Hypothesis: Body weight supported treadmill training (BWSTT)
has been shown to be effective in retraining walking following incomplete suggest successful treatment options. Number of Subjects:Three subjects
with focal hand dystonia and three healthy subjects. Materials/Methods:
spinal cord injury (SCI), although its performance in the clinic is limited.
Surface electrodes were used to record electromyographic (EMG) activity of
Development of robotic devices which provide passive guidance during
proximal and distal muscles of each hand and arm (abductor pollicis brevis,
walking may increase performance of BWSTT, but may minimize voluntary
first dorsal interosseus, flexor digitorum superficialis in two positions: cen-
effort by the subject.The purpose of this study was to investigate whether
tral portion, and ulnar portion, abductor digiti minimi, extensor digitorum,
robotic-assisted treadmill walking provides a sufficient stimulus to generate
and the deltoid) while an instrumented glove and 3D motion monitoring
appropriate muscle activity and metabolic responses compared to thera-
was used to record kinematic activity of fingers, arms, and trunk.All subjects
pist-assisted walking. We hypothesized that therapist-assisted treadmill
performed a task involving repetitive typing of a sequence of letters on an
walking would generate increased Vo2 responses and more appropriate
instrumented keyboard, at increasing speeds. Principal components analysis
lower extremity muscle activity vs., robotic-assisted treadmill walking.
was used to quantitatively describe the main EMG bursting patterns and the
Number of Subjects: Twelve individuals with motor incomplete SCI par- patterns of co-variation across synergistic and antagonistic hand muscles dis-
ticipated in the study. Materials/Methods: Cardiopulmonary, metabolic, tinguishing the fundamental difference between groups. Results:
and electromyographic (EMG) responses during therapist-assisted treadmill Preliminary results show that the onset of dystonic symptoms is gradual, and
walking were compared to robotic-assisted ambulation with and without involves a steady decrease in activation of the muscle controlling the dys-
visual biofeedback. Robotic training was provided by the Lokomat and tonic digit and progressive compensatory increase in synergistic muscle
visual feedback of bilateral hip and knee torques during swing and stance activity as well as proximal arm muscles and trunk compensations normally
phases were displayed on a computer screen. Subjects were asked to walk not involved in the movement. Subjects with dystonia avoided making force-
on the treadmill with <40% BWS for 10 minutes with either robotic- or ther- ful contraction of the dystonic finger muscles by substituting early activity
apist-assistance followed by 10 minutes of the other testing method. in a muscle synergistic to the affected finger. Conclusions: Identifying this
Standardized metabolic testing equipment was used to obtain cardiopul- synergistic activity and the method of co-activation in a subject may suggest
monary measurements for 5 minutes in sitting and 2 minutes in standing diagnostic criteria for dystonia types and lead to identifying possible treat-
prior to treadmill walking and throughout the testing period including 10 ment interventions. Clinical Relevance: The results of this study will serve
minutes of recovery. Electromyographic (EMG) activity was collected from as the basis for subsequent studies aiming to develop (1) categorizations of
key lower extremity muscles during each minute of treadmill walking. dystonia types, (2) effective diagnostic tools and (3) treatment options spe-
Results: Therapist-assisted treadmill walking demonstrated significantly cific to each individual’s disorder.
higher (p<0.01) Vo2, heart rate (HR), and minute ventilation (VE) during all
10 minutes compared with robotic-assisted walking without biofeedback. GAIT PARAMETERS ASSOCIATED WITH RESPONSIVENESS TO A
Providing visual biofeedback during the walking tasks minimized the dif- TASK-SPECIFIC AND/OR STRENGTH TRAINING PROGRAM POST-
ferences between conditions, although Vo2 responses during therapist- STROKE. T. Klassen1, S.J. Mulroy2, K.J. Sullivan3, 1Vancouver Coastal Health,
assisted walking were greater (p<0.05) during the last 3 minutes of walk- Vancouver, British Columbia, CANADA, 2Pathokinesiology Laboratory,
ing. EMG activity was significantly higher only for the rectus femoris in Rancho Los Amigos National Rehabilitation Center, Downey, CA,
pre-swing during therapist- vs. robotic-assisted walking without feedback. 3
Biokinesiology and Physical Therapy, University of Southern California, Los
This difference was minimized with feedback. Conclusions: Therapist- Angeles, CA. (See Post-Stroke Hemiplegia Thematic poster session for
assisted treadmill walking elicits increased aerobic responses and more abstract)
appropriate muscle activity compared to robotic-assisted treadmill walking,
although provision of biofeedback of joint torques may increase patient CHANGES IN SIT-TO-STAND FOLLOWING ANKLE JOINT MOBILIZA-
effort. Clinical Relevance: Understanding the physiological responses to TIONS IN SUBJECTS WITH HEMIPLEGIA. P. Kluding, M. Santos, Physical
robotic- or therapist-assisted BWSTT is important the relative contribution Therapy and Rehabilitation Sciences, University of Kansas Medical Center,
of passive guidance during walking tasks. Kansas City, KS.
211 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

Purpose/Hypothesis:The purpose of this research project was to deter- middle, and distal segments contributed to the variance in hand function.
mine if manual mobilization of the ankle joint can increase ankle range of Results: The ability to move each segment against gravity (AROM) was
motion (ROM) and improve sit-to-stand (STS) function for patients with strongly correlated with hand function, such that the greater the AROM, the
hemiplegia following stroke. Stroke is one of the leading causes of adult greater the hand function. The ability to move segments in isolation (indi-
disability and often results in hemiparesis, or weakness on one side of the viduation index), and the ability to hold segments still (stationarity index)
body.This weakness together with spasticity, muscle and joint stiffness can were also correlated to hand function, with more proximal segments hav-
make it very difficult for patients to move their limbs and perform basic ing similar correlation coefficients to the more distal segments. Proximal,
functional tasks.The research hypotheses were that joint mobilizations will middle, and distal AROM values accounted for > 80% of the variance in hand
be effective in increasing ankle ROM, and that increased ankle ROM with function, with the largest contribution coming from the distal segments. In
structured practice of functional skills will result in greater improvement separate analyses, proximal, middle, and distal individuation and stationarity
on functional performance than practice alone. Number of Subjects: indices accounted for > 65% of the variance in hand function, with the
Sixteen subjects with hemiplegia following stroke were randomly assigned largest contribution coming from the proximal segments. Conclusions:
to either an experimental group (mean age 55.5 ± 10.7 years, 18.3 ± 11.8 Movement control at proximal, middle, and distal upper extremity seg-
months post-CVA) or a control group (age 56.1 ± 13.7 years, 24.6 ± 15.7 ments was important for functional use of the hand in people with chronic
months post-CVA). Materials/Methods: All subjects participated in 30 hemiparesis. Clinical Relevance: An understanding of how movement
minutes of functional task practice, twice each week for 4 weeks. The control at each upper extremity segment contributes to hand function in
experimental subjects also received joint mobilizations to the proximal people with hemiparesis will provide insight into how future therapeutic
and distal tibia-fibula, and talocrural articulations of the hemiplegic lower interventions may be better structured to optimize recovery of function.
leg during each treatment session. Dependent variables, including ankle
ROM and biomechanical analysis during STS, were measured at baseline GAIT INITIATION IN HEALTHY YOUNG AND HEALTHY OLDER
and following the intervention with a motion analysis system and force- ADULTS AND IN ADULTS WITH PARKINSON’S DISEASE. C.A. Larson,
plate. Changes in these variables were compared between the 2 groups B. Amman, V. Lopez, M. Syjud, J. Wolf, N. Yip, School of Health
using an independent t-test (0.05 level of significance). Results: The Sciences/Program in Physical Therapy, Oakland University, Rochester, MI.
experimental subjects had a significantly greater increase in passive dorsi-
flexion (5.7º ±3.1 compared to an increase of 0.19|*omicron*| ± 2.6 in the Purpose/Hypothesis: Gait initiation refers to the transition from standing
control), and total active ROM (10.8º ± 7.5 compared to 2.3º ± 7.5 in the motionless to taking a step forward and reaching a constant walking
control).The experimental group also performed the STS task significantly speed. Gait initiation is often problematic in persons with Parkinson’s dis-
faster (-0.82 seconds ± 0.91 compared to -0.016 seconds ± 0.45 for the ease due to akinesia and bradykinesia.The purposes of this study were to
control), and there was a significant correlation (r =-0.79) between gain in describe gait initiation kinetics, specifically center of pressure (COP)
ROM and time from start of STS to peak dorsiflexion. However, the control excursion patterns, and to determine if COP varies when gait is initiated
group significantly decreased the difference in average vertical force with the right or left foot, slow or fast speeds and between healthy young
between the two lower extremities during STS (-9.56% body weight) com- (HY) and healthy older (HO) adults and adults with Parkinson’s Disease
pared to the experimental group (1.86% body weight). Conclusions:This (PD). Number of Subjects: Fourteen subjects, five HY (ages 21-27), five
preliminary work demonstrates that joint mobilizations may be effective at HO (ages 50-60) and four persons with PD (ages 75-85 with Hoehn and
increasing ankle ROM and improving time for STS when combined with Yahr scores of I-III) initiated gait upon seeing a light-emitting diode signal
functional task practice in subjects with hemiplegia after stroke. However, and walked forward approximately four meters. Materials/Methods: Six
the control group appeared to receive greater benefit from the functional trials were performed for each condition (step with right or left foot first,
task practice in achieving more equal weight bearing between the lower self-determined slow or fast speed) for a total of 24 trials. COP was
extremities. Clinical Relevance: This study raises questions about the obtained using a Kistler force plate and spatial and temporal parameters
relationship between ankle mobility and weight bearing during STS. The were determined by a Labview data analysis program designed by the first
subjects who received the ankle stretching intervention may not have had author. Initially, a 3 (HY, HO, PD) x 2 (right or left step foot) x 2 (slow or
enough practice opportunity with their newly available motion to fully fast speed) ANOVA with repeated measures was used to analyze individual
improve on the task. Further investigation may be indicated. trial data. No differences (p=0.08-0.97) were found when comparing the
right and left step foot trials, therefore, right and left trials were pooled for
RELATIONSHIPS BETWEEN MOVEMENT CONTROL AT 9 UPPER analysis. Then slow and fast speed data were analyzed separately using a
EXTREMITY SEGMENTS AND LOSS OF HAND FUNCTION IN PEOPLE one-way ANOVA and Bonferroni post hoc tests using mean data. Results:
WITH CHRONIC HEMIPARESIS. C.E. Lang, Physical Therapy,Washington Subjects with PD tended to be slower than the HY and HO adults as mea-
University, St. Louis, MO. sured by the following temporal variables: reaction time, onset to farthest
swing time, farthest swing to forward progression time, and forward pro-
Purpose/Hypothesis:The hand is a tool that people use to interact with gression to end time and were significantly slower for total movement time
their environment, and consequently, loss of hand function in people with at slow speeds (p=0.01) and fast speeds (p=0.04). Subjects with PD also
hemiparesis is a major contributor to disability post stroke.To use the hand had smaller COP excursions than HY and HO adults with respect to the
for functional activities, a person may need adequate control of the more farthest lateral and posterior distance toward the swing limb from the ini-
proximal upper extremity segments, to appropriately position and orient tial COP position and the farthest swing to forward progression distance.
the hand with respect to the environment, and may need adequate control There were no differences between the groups in the COP angles for slow
of the fingers, to manipulate objects within the environment.The purpose (p=0.24) and fast (p=0.16) speeds. Conclusions: Individuals with
of this study was to investigate how movement control at 9 segments of the Parkinson’s disease tend to or significantly move slower and have reduced
upper extremity (shoulder, elbow, forearm, wrist, and 5 fingers) contributed COP spatial excursion patterns as compared to HY and HO adults which
to loss of hand function in people with chronic hemiparesis. Number of may indicate a safety strategy or an unwillingness to produce forces which
Subjects: 20 subjects with chronic hemiparesis, age range 43-85. would move them toward the edges of their base of support and challenge
Materials/Methods:To measure movement control at the 9 segments, sub- balance during gait initiation. Clinical Relevance:A better understanding
jects were studied making isolated movements at the shoulder, elbow, fore- of the kinetics during gait initiation in persons with PD will eventually lead
arm, wrist, and five fingers using 3-D kinematic techniques. Extracted vari- to development of more appropriate intervention strategies and hopefully
ables for each segment included the: active range of motion (AROM), reduce risk of fall.
individuation index, and stationarity index.To measure hand function, sub-
jects performed a battery of standardized clinical tests. Principal compo- HIP JOINT POSITION AFFECTS VOLITIONAL KNEE EXTENSOR
nent analysis was used to create a single hand function score for each sub- ACTIVITY POST-STROKE. M. Lewek1, T. Hornby1, Y. Dhaher1, B. Schmit2,
ject from the clinical test battery. Correlation analyses were used to 1
Sensory Motor Performance Program, Rehabilitation Institute of Chicago,
examine relationships between movement control at the 9 segments and Chicago, IL, 2Marquette University, Milwaukee, WI. (See Post-Stroke
hand function. Multiple regression was used to determine how proximal, Hemiplegia Thematic poster session for abstract)
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 212

INVESTIGATION OF LATERAL FORCES WHILE PERFORMING poses of this study were to: 1) develop a measure of postural sway that
VOLUN-TARY FORWARD STEPPING WITH AND WITHOUT USING A incorporated these normal balance strategies and 2) examine the relation-
CANE IN HEALTHY ADULTS AND HEMIPLEGIC PATIENTS WITH ship of this new measure with conventional measurement. Number of
STROKE. Y. Lin1, P.Tang1, W. Chang1, L. Lu2, 1School and Graduate Institute Subjects: Fourteen women with a mean age of 26 years. Materials/
of Physical Therapy, National Taiwan University, Taipei, TAIWAN, 2Physical Methods: The subjects completed two trials each of two different static
Therapy, Chung Shan Medical University Rehabilitation Hospital,Taichung, standing balance tasks while standing on a force plate with their eyes
TAIWAN. closed: 1) standing with feet together and 2) standing with feet together
with a vibratory stimulus applied to the bilateral gastrocnemius muscles.A
Hypothesis:This study investigated differences in the lateral forces while sliding, 10 ms time window was used to examine each 60 second trial. If the
performing voluntary forward stepping with and without a cane in healthy subject had more than a pre-specified change in any of the three dimen-
adults and hemiplegic patients with stroke. Number of Subjects: Five sions of movement, “corrective activity”was recorded. The final measure
hemiplegic patients with stroke (mean age=55.9 ± 11.5yrs) and five age- was the percentage of time spent in balance correction (TSBC). Results:
matched healthy adults (mean age=56.0 ± 7.0yrs) participated in this ANOVAs demonstrated that the new measure,TSBC, and conventional mea-
study. Materials/Methods: Four conditions, stepping forward with the surement both showed a significant difference between the vibration con-
left and right leg, and with and without using a cane, were tested. Ground dition and the normal condition (p<0.05).When the effect size of the bal-
reaction forces underneath the lower extremities and the cane were col- ance tasks on each measure were examined, the strength of association
lected by two force plates and an instrumented cane, respectively. The between the balance tasks and the measure was greater for the TSBC mea-
loading duration (from onset of the increase in lateral force toward the sure (R2 =0.79) than for the conventional measure (R2 = 0.68).
stepping leg to the first zero crossing of the lateral force), unloading dura- Conclusions:The TSBC measure demonstrated more sensitivity than con-
tion (onset of the increase in lateral force toward the stance leg to the sec- ventional measurements in detecting the balance difference between two
ond zero crossing of the lateral force), force impulses during the loading static standing balance tasks. Clinical Relevance:Therapists working clin-
and unloading durations, and the rate of lateral force transfer prior to foot ically view balance strategies, such as stepping, as appropriate responses in
liftoff were analyzed. Results: Compared with healthy adults, patients a given environmental context. Researchers have seldom incorporated the
with stroke showed longer loading duration (P = 0.003), smaller force appropriate use of balance strategies into their measurement of postural
impulse in the loading phase (P = 0.024), and slower rate of lateral force sway.The TSBC measure offers the advantage of incorporating a clinical per-
transfer (P = 0.001) when stepping with the unaffected leg without a cane; spective to bridge the gap between research and clinical views of balance.
and showed longer loading (P = 0.003) and unloading durations (P = 0.01),
and smaller force impulses in the unloading phase (P = 0.001) while step- THE FIVE-ITEM DYNAMIC GAIT INDEX: DEVELOPMENT AND
ping with the affected leg without a cane. Without using a cane, patients TESTING. G.F. Marchetti1, S.L. Whitney2, 1Physical Therapy, Duquesne
with stroke also showed longer unloading duration (P = 0.017), faster rate University, Pittsburgh , PA, 2Physical Therapy, University of Pittsburgh,
of lateral force transfer (P = 0.009), greater force impulse in the loading Pittsburgh, PA.
phase (P = 0.021), and smaller force impulse in the unloading phase (P =
0.017) while stepping forward with the affected leg than with the unaf- Purpose/Hypothesis: The Dynamic Gait Index (DGI) was developed to
fected leg. While using a cane to perform the stepping, most of these examine patient ability to modify gait responses during 8 walking tasks.
patients decreased the generation of force impulses in the loading and The DGI has been reported to help clinicians identify patients at increase
unloading phase although the amount of the decreases did not reach a sig- risk of falls.The purpose of this study was to examine the scaling and rat-
nificant level (loading phase P = 0.059; unloading phase P = 0.071). No sig- ings of the DGI and to evaluate the properties of a 5-item version in patients
nificant change was observed for the rate of lateral force transfer between with balance and vestibular dysfunction. Number of Subjects: Ninety
the no cane and cane use conditions for the patient group either. three patients (mean age 61 years, SD 16, range 14 -90) with balance and
Conclusions : To achieve a safe lateral weight transfer required prior to vestibular disorders seen in a tertiary-care clinic for balance disorders were
and during a forward stepping movement, patients with stroke appeared included. Materials/Methods:All subjects were examined while perform-
to lengthen the loading and unloading durations in order to compensate ing 8 items of the DGI by a licensed physical therapist. Scaling of the ordi-
for their decreased ability to generate lateral impulses in the loading and nal DGI measure was examined using Rasch analysis modeling to determine
unloading phases, respectively. Using a cane might partially contribute to the range of item difficulty and subject ability. Items showing similar prop-
the lateral impulse generation required for performing the stepping move- erties were considered for elimination. Coefficient Alpha was used to deter-
ment such that the impulses generated by the lower extremities decreased mine the internal consistency of the reduced item DGI. Factor analysis was
slightly. Clinical Relevance : For patients with stroke to step forward, the used to determine the construct structure of the new 5-item DGI.The abil-
use of a cane might potentially decrease the difficulty of the lower extrem- ity of the 5-item DGI to identify subjects with a self-reported history of falls
ities to perform the lateral weight shifting required prior to and during this was determined using analysis of discriminative function and a receiver
movement. operating characteristic (ROC) curve. Results: The 8-item DGI demon-
strated excellent inter-item reliability (0.96). Rasch model scaling and fit sta-
EFFECTS OF RANDOM AND BLOCKED ORDER PRACTICE ON tistics identified three items for elimination: walking-horizontal head turns,
MOTOR LEARNING IN INDIVIDUALS WITH PARKINSON DISEASE. gait with pivot turn, and stair climbing. The 5-item test (level gait, change
C. Lin1, C.J. Winstein1, K.J. Sullivan1, A.D. Wu2, 1Biokinesiology and Physical gait speed, walking-vertical head turns, step over obstacle, step around
Therapy, University of Southern California, Los Angeles, CA, 2Neorology, obstacle) showed good internal consistency (Crohnbachs alpha=0.89).
University of Southern California, Los Angeles, CA. (See Motor Learning Factor analysis demonstrated a single construct explained 71% of test vari-
Thematic poster session for abstract) ance with a minimum item loading of 0.76.The 5-item DGI demonstrated
good ability to discriminate fallers (p < 0.01, 61% correctly identified). ROC
USE OF ‘TIME SPENT IN BALANCE CORRECTION’ AS A MEASURE OF curve analysis showed optimal screening for fallers at a score of 12/15 (sen-
BALANCE. P.V. Loubert1, L. Swan2, H. Otani3, 1Physical Therapy, Central sitivity 70%, specificity 53%) and was superior to the full 8 item test.
Michigan University, Mt. Pleasant, MI, 2Physical Therapy, University of the Conclusions:The 5-item DGI appears sufficient to identify gait responses
Pacific, Stockton, CA, 3Psychology, Central Michigan University, Mt. Pleasant, to changing task demands in patients with balance and vestibular disorders.
MI. Clinical Relevance:The 5-item DGI can reduce examination time without
compromising information gained about dynamic gait.
Purpose/Hypothesis: Conventional measurement of postural sway from
force plate technology has been derived from the standard deviation of the EFFICACY OF SPLIT ANTERIOR TENDON TRANSFER SURGERY AND
individual center of pressure locations relative to the average center of BODY WEIGHT SUPPORTED TREADMILL TRAINING POST-STROKE:
pressure location.When measuring static balance activities such as tandem A CASE STUDY. N.D. Matthews1, K.J. Sullivan1, V. Eberly2, S. Mulroy2,
stance, some data was occasionally lost if subjects took a step (i.e. used a 1
Biokinesiology & Physical Therapy, USC, Los Angeles, CA, 2Pathokinesiol-
step strategy) or otherwise changed body position during testing.The pur- ogy Laboratory, Rancho Los Amigos Medical Center, Downey, CA.
213 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

Background & Purpose: To investigate the efficacy of body weight sup- 95% C.I. -.02, .05)]. Mean reductions in digit span accuracy were similar
ported treadmill training (BWSTT) following split anterior tendon transfer [ABI subjects .87, 95% C.I. (.79, 95); young adults .92, 95% C.I.88, .95)].
(SPLATT) surgery to improve walking ability in an individual post-stroke. Subjects with ABI had more difficulty with step accuracy on average, but
Case Description:The patient is a 53 year old male, 5 years post left inter- the median dual-task steps off the path was zero for both groups.
nal capsule hemorrhage resulting in right hemiplegia who had severe walk- Conclusions:Task difficulty is important when assessing dual-task perfor-
ing disability due to inadequate right hip and knee flexion during swing mance.The SWWT and WWTT have limitations for ambulatory individuals
and excessive inversion/plantarflexion throughout the gait cycle. The with ABI, as the cognitive tasks are either too simple (SWWT) or too diffi-
patient’s functional walking ability improved with outpatient therapy; how- cult (WWTT alternate alphabet cognitive task). Measures that allow for
ever, his gait continued to be severely limited by the equinovarus deformity. adjustment of task difficulty (WART) are feasible for individuals with cog-
A SPLATT procedure was recommended. Surgery was performed four years nitive impairment.The use of a working memory task revealed similar dual-
post-stroke and included the SPLATT, toe flexor release, tendo-Achilles task costs for cognitive task performance between the ABI and young.
lengthening, and rectus femoris release. Two months after surgery the Clinical Relevance:The diverse nature of deficits following ABI necessi-
patient returned to physical therapy for treatment. Intervention: Physical tates flexibility in outcome measures. Dual-task measures that record per-
therapy intervention consisted of BWSTT 1-3x/week x 25 weeks (52 ses- formance of both tasks and allow some adjustment of task difficulty may
sions) for a total of 20 minutes of treadmill walking each session.Treadmill provide better insight into the effects of dual-task conditions and inform
speed varied between 1.7 and 2.2 mph, with the body weight support plans for intervention.
decreased across training from 40% to 10%. Concurrently, the patient per-
formed a home exercise program on non-treatment days which focused on PARETIC LOWER EXTREMITY LOADING AND WEIGHT TRANSFER
lower extremity stretching and strengthening. Outcomes: LE Fugl-Meyer FOLLOWING STROKE. V.S. Mercer1, S. Chang1, J.L. Purser2, J.K. Freburger3,
Motor Score (LEFM), gait velocity, six minute walk and other musculoskele- Allied Health Sciences, UNC-CH, Chapel Hill, NC, 2Medicine, Duke
tal measures were taken pre-treatment, every 4-5 weeks across sessions, at University Medical Center, Durham, NC, 3Cecil G. Sheps Center for Health,
completion of therapy, and at 1- and 3-month follow-up. Instrumented gait University of North Carolina at Chapel Hill, Chapel Hill, NC. (See Post-
and motion analysis with fine-wire EMG recording of LE muscle activity was Stroke Hemiplegia Thematic poster session for abstract)
performed before surgery and 1-wk post treatment. Across post-surgical
treatment, there was minimal change in the LEFM (pre 26/34, post 27/34); EFFECTS OF BODY WEIGHT SUPPORTED TREADMILL TRAINING ON
however, self-selected gait velocity with AFO and cane increased 62% (pre RUNNING IN A PATIENT POST-STROKE: A PROSPECTIVE CASE
0.59, post 0.95m/s) and 6-minute walk increased 75% (pre 169.2, post REPORT. E.W. Miller, S. Combs, C. Fish, B. Lakin,A. Schlotterbeck,A. Sieber,
296m). Gait and motion analysis revealed a decrease in ankle inversion dur- Krannert School of Physical Therapy, University of Indianapolis,
ing stance from 30 degrees to 10 degrees. Pre-operatively, tibialis anterior Indianapolis, IN.
fired continuously throughout the gait cycle, post-treatment EMG revealed
normal onset and cessation of tibialis anterior at 53.3% and 14.0% of the Purpose/Hypothesis: Many benefits of body weight supported treadmill
gait cycle, respectively.The patient reported increased confidence in walk- training (BWSTT) have been documented, including increased cadence,
ing with and without his brace and increased daily community walking. He symmetry, gait velocity and confidence of ambulation. However, there are
also resumed an active role in his community. Discussion: This case no studies that have focused on BWSTT and running. Further, there is lim-
demonstrates the beneficial use of SPLATT surgery combined with BWSTT ited literature regarding rehabilitation of running in individuals who have
to improve walking ability in an individual with chronic stroke. The neurological conditions such as stroke. The purpose of this report was to
improved structural alignment gained from surgery combined with task- investigate the feasibility and effectiveness of using BWSTT to improve the
specific training resulted in significant changes in muscle phasing and running ability of a patient post stroke. We hypothesized that the inter-
velocity during gait and improved functional ambulation in our patient. vention would be feasible and effective. Number of Subjects:The partic-
ipant was a 38-year-old man, 2.5 years post-stroke. Materials/Methods:A
CLINICAL TESTS OF WALKING DUAL-TASK PERFORMANCE AFTER prospective case report design was selected in which baseline was estab-
ACQUIRED BRAIN INJURY (ABI): FEASIBILITY AND DUAL-TASK lished and followed by an 8-week treatment phase. Immediate and delayed
COST COMPARISONS TO A YOUNG ADULT GROUP. K. McCulloch, K. post testing was performed. Dependent variables used for single system
Blakley, L. Freeman, Division of PT,Allied Health Sciences, UNC-Chapel Hill, analysis included: single leg balance, running step length, step length ratio,
Chapel Hill, NC. step width, and 25-meter sprint speed. Pre/post dependent variables
included: lower extremity strength, 6-minute walk, and the Stroke Impact
Purpose/Hypothesis: 1) To describe feasibility of three tests of dual-task Scale.The 2 standard deviation band method was used to analyze the data
performance during walking for individuals with ABI. 2) To compare dual- with alpha set a 0.05. The variables measured during pre-and post-test
task performance on the most feasible measure between subjects with ABI phases were subjectively analyzed based on a 10% difference defined as a
and a group of young adults. umber of Subjects: 18 ambulatory adults functional change in ability. Results: Left single leg balance, right step, step
(5 women) with ABI (age range 24-58); independently ambulatory for a dis- width, and sprint speed changed significantly from baseline to delayed
tance of at least 40 feet (3 subjects used a cane or walker). Two subjects post-test. All pre-post measures showed greater than 10% improvement.
undergoing day treatment with recent onset were limited household Conclusions: Our data supported current literature that suggests that
ambulators. 16 subjects with chronic cognitive impairments required sup- patients with chronic deficits due to stroke can make functional gains with
port for independent living; 14 were community ambulators. Comparison continued rehabilitation and also that BWSTT is a useful and effective tool
group subjects were 25 young adults (7 male) without brain injury (age in the clinical setting. Our data also added to current literature by demon-
range 22-35). Materials/Methods:ABI subjects performed 1- ‘Stops walk- strating the feasibility and effectiveness of using BWSTT to improve run-
ing while talking test’(SWWT); 2- Walking While Talking Test (WWTT) that ning ability. Clinical Relevance: BWSTT was a feasible and effective inter-
requires walking while repeating the alphabet and alternate letters of the vention for improving running ability in this high functioning patient
alphabet; and 3- Walking and Remembering Test (WART)that tests speeded post-stroke. It may be an option for other patients with neurological con-
walking on a 12 inch narrow path while performing a working memory ditions with a goal of regaining running ability.
task. Dual-task costs on the WART were compared for the ABI and young DEVELOPMENT AND VALIDATION OF CIRCUMDUCTION ASSESSMENT
adult sample. Results: Task feasibility and difficulty for ABI subjects: The SCALE FOR INDIVIDUALS WITH HEMIPLEGIA. J.L. Moore1, H.R. Roth1, M.
SWWT test was negative for all subjects.The alphabet WWTT task was easy Lewek1, Y.Y. Dhaher1, T.G. Hornby2, 1Sensory Motor Performance ,
for 89%, but the alternate alphabet task was too difficult for the majority Rehabilitation Institute of Chicago, Chicago, IL, 2Department of Physical
(66%).The WART cognitive task was completed by all subjects, even those Therapy, University of Illinois of Chicago, Chicago, IL. (See Post-Stroke
with severe declarative memory deficits.The WART walking task was not Hemiplegia Thematic poster session for abstract)
feasible for one subject who was legallyABI and young adult dual-task cost
comparisons:WART median relative dual-task costs for walking speed were THE EFFECTS OF SPEED AND LEVEL OF VOLUNTARY MUSCLE
greater for ABI subjects [.18, 95% C.I. (.01, .24)] than young adults [.002, ACTIVATION ON REFLEX RESPONSES IN CHRONIC STROKE
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 214

PATIENTS. D. Nichols1, M. Pelliccio1, I. Black2, J. Hidler2, 1Inpatient PT, S.T. Quenga, L.P. Frasier, R.J. Allen, Physical Therapy, University of Puget
National Rehabilitation Hospital, Washington, DC, 2Center for Applied Sound,Tacoma,WA.
Biomechanics and Rehabilitation Research, National Rehabilitation
Hospital,Washington, DC. (See Post-Stroke Hemiplegia Thematic poster ses- Purpose/Hypothesis:To compare the effects on vertigo of two methods of
sion for abstract) somatosensory input to the plantar surfaces of the feet; direct plantar sur-
face pressure versus TENS. Number of Subjects: Twenty-one normal vol-
TETRAPLEGIA DUE TO CRITICAL ILLNESS POLYNEUROPATHY FOL- unteers (5 male, 16 female; age range 22-44 yrs) screened for history of
LOWING SEVERE TBI, ACCOMPANIED BY MULTIPLE COMPLICA- vestibular or oculomotor pathology, episodic dizziness, lower extremity pain
TIONS. A CASE REPORT OF PROLONGED INPATIENT ACUTE REHA- or somatosensory loss, and use of oculomotor altering or ototoxic sub-
BILITATION COURSE AND FUNCTIONAL OUTCOMES. A. Packel, stances. Materials/Methods: Subjects were assessed for intact plantar sen-
Physical Therapy, MossRehab Hospital, Cheltenham, PA. sation via 4.56 (metatarsal heads) and 5.07 (calcaneus) Semmes Weinstein
Purpose/Hypothesis: Descriptions of severe critical illness polyneuropa- monofilaments. Subjects reclined 60o from vertical were exposed to vertigo
thy (CIP) and functional recovery are sparse in the literature.This case illus- induction via 90 sec irrigation of the right external auditory meatus with 90
trates the potential for recovery from concomitant TBI and CIP, and rein- ml of 5o C water. Using a within-subjects design, vertigo was induced in each
forces the need for intensive, comprehensive services. Number of subject three times; each induction was followed by one of three treatment
Subjects: Case report of a 54-year-old man who sustained a severe TBI due conditions. Condition A was no-treatment control. Condition B involved
to a mechanical explosion in close proximity to his face. Patient was admit- bilateral plantar stimulation via sensory level TENS applied to the calcaneal
ted to rehab 8 weeks after injury, with no active movement or muscle con- region and second metatarsal heads, using random intensity and rate modu-
tractions in his trunk, neck, and three extremities. He was able to open and lation with subjects self-selecting the amplitude limit prior to vertigo induc-
close his right hand spontaneously. He was unable to communicate, and tion. In condition C the plantar aspects of both feet pressed against a solid
inconsistently able to perform actions with his right hand upon command. surface with peak pressures ranging from 12 to 53 kg. To eliminate order-
Initial FIM scores were all either 1 or 0 and initial Disability Rating Score effects or habituation bias the order of treatment conditions was varied
(DRS) = 21T, indicating extremely severe disability. Materials/Methods: according to a preset schedule. Efficacy of each treatment condition was
Patient’s acute inpatient rehabilitation course lasted 37 weeks. On the assessed via subjective reports of vertigo intensity (visual analog scale) and
tenth day of his rehab stay, Pt. had EMG/NCV tests with finding of severe timed vertigo duration. Differences between responses for each condition
peripheral polyneuropathy affecting lower extremities more than upper on each dependent variable were assessed using one-way ANOVAs for
extremities, diagnosed as critical illness polyneuropathy. This provided an repeated measures with multiple contrast analyses. Results: While not sig-
explanation for his minimal movement throughout and also led to the belief nificantly different from each other, the two plantar stimulation conditions
that considerable motor recovery might occur, but might require months to yielded significant reductions in vertigo intensity compared to control (p =
years.A strong social situation allowed planning for discharge to his home, 0.019). Analysis of duration of vertigo revealed no significant differences
despite the expectation of prolonged severe deficits in movement through- between the three groups (p = 0.424). Conclusions: These findings sup-
out. Heavy focus was placed on family training for all aspects of care, and port the hypothesis that plantar pressure may reduce the intensity of calor-
optimizing return of strength as the polyneuropathy resolved. Results: At ically induced vertigo, whether that stimulation is from direct plantar pres-
time of discharge, the patient was able to communicate basic needs mostly sure or TENS. Both methods of providing plantar pressure appear similarly
consistently, drive a power wheelchair indoors with frequent verbal cues efficacious.These findings do not support the hypothesis that plantar pres-
and minimal assistance, and feed himself with minimal assistance. Strength sure reduces the duration of a vertigo episode. Clinical Relevance: Prior
remained 1/5 to 2/5 throughout except his right upper extremity, which studies have established that plantar stimulation via direct pressure reduces
achieved up to 4/5 strength. FIM scores ranged from 1 to 4, and DRS score some aspects of vertigo. The current study assessed whether a passive
at discharge = 13, indicating severe disability. His wife and hired caregiver approach to delivering plantar stimulation using TENS might also be effec-
were able to assist him with all care, including prescribed exercises, posi- tive.While supporting the notion that plantar stimulation may attenuate ver-
tioning, and standing program. Continued recovery of motor function and tigo, the current findings indicate that plantar TENS produces similar results.
strength were anticipated, over a prolonged period. Further results will be Given further investigation with a clinical sample, results from this study
presented at 3 month and 6-month follow-up after discharge. Conclusions: could directly translate into an easily implemented clinical intervention for
Early detection of critical illness polyneuropathy in this patient helped to bed-ridden patients suffering from unrelenting vertigo.
guide his course of treatment.An extended inpatient rehabilitation course
was required due to his severe TBI, severe CIP, and multiple medical com- SPLIT-BELT TREADMILL ADAPTATION AND GAIT SYMMETRY POST-
plications.This allowed him to be successfully discharged to home and be STROKE. D.S. Reisman1, A.J. Bastian2, 1Department of Physical Therapy,
cared for by his family, while his polyneuropathy continued to resolve. University of Delaware, Newark, DE, 2Kennedy Krieger Institute, Baltimore,
Clinical Relevance: Limited information is available in the literature MD. (See Post-Stroke Hemiplegia Thematic poster session for abstract)
regarding recovery from severe critical illness polyneuropathy. More infor-
mation is needed in order to aid in prognosis and help to guide treatment A MOTOR LEARNING PHYSICAL THERAPY INTERVENTION
in patients with severe critical illness polyneuropathy. APPROACH AND BOTULINUM TOXIN TYPE A INJECTIONS IN THE
CHRONIC STROKE SUBJECTS IN A FUNCTIONAL POSTURE. M.M. REPORT. W.J. Sanchez, A.D. Kloos, Physical Therapy, The Ohio State
Pelliccio, N. Neckel, D. Nichols, J. Hidler, National Rehabilitation Hospital, University, Columbus, OH. (See Motor Learning Thematic Poster Session
Washington, DC. (See Post-Stroke Hemiplegia Thematic poster session for for Abstract)
IN INDIVIDUALS WITH CHRONIC STROKE. B. Quaney1, L.H. Zahner1, Inpatient Rehabilitation, Fletcher Allen Health Care, Colchester,VT.
M.J. Santos2, Z. Kadivar2, B. McKiernan3, 1Landon Center on Aging, University
of Kansas, Kansas City, KS, 2Physical Therapy and Rehabilitation Sciences, Purpose:The purpose of this presentation is to describe the process used to
Kansas University Medical Center, Kansas City, KS, 3Physical Therapy develop a consistent and comprehensive interdisciplinary approach to
Education, Rockhurst University, Kansas City, MO. (See Post-Stroke patient/caregiver education for individuals with an acquired spinal cord
Hemiplegia Thematic poster session for abstract) injury (SCI). Another objective is to relate the creation of a clinician-based
documentation system which serves to improve coordination of individual
EFFECT OF PLANTAR SOMATOSENSORY INPUT ON VERTIGO: educational plans and topics. Description:As part of a review of the SCI pro-
COMPARISON BETWEEN DIRECT PRESSURE AND TRANSCUTAN- gram at our thirty-five bed inpatient rehabilitation hospital, patient/caregiver
EOUS ELECTRICAL NERVE STIMULATION. N.L. Nicolai, L.N. Cartwright, education was examined by an interdisciplinary committee. Chart audits
215 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

revealed inconsistencies in the type, depth and breadth of topics covered Department of Physical Medicine and Rehabilitation, University of

among and between disciplines.A phone survey of former patients reflected Cincinnati, Cincinnati, OH.
this as well.Through discussions with clinicians, it also became apparent that
paternalistic assumptions existed regarding the amount of information that Background & Purpose: Due to affected leg disability and nonuse, com-
an individual with a new diagnosis of SCI could emotionally handle and inter- munity-dwelling stroke patients frequently exhibit impaired leg function,
nalize.After these limitations of the system were ascertained, a new process reduced functional aerobic capacity, activity intolerance, low bone density
was incrementally developed. |*bund*|Yes|*eund*| |*bund*|You|*eund*| and increased risk of falls and hip fracture. Research suggests repeated,
|*bund*|Can|* eund*|, a book distributed by the Paralyzed Veterans of bilateral practice incorporating the more affected limb can restore func-
America, was identified as the primary resource for education. Based on this tion.The NuStep machine provides repetitive, bilateral practice to both the
book, knowledge and performance objectives for pertinent topics were cre- upper and lower extremities. It is commonly available in therapy settings
ated. Next, a patient education binder, including these objectives as well as and is commercially available.We hypothesized that intensive training with
additional resources, was compiled. This binder follows the patient as s/he the NuStep could be a safe and effective form of bilateral practice to reduce
moves through the continuum of care.To supplement these steps, additional affected limb impairment and improve conditioning for stroke patients.The
multi-media, patient-focused educational resources were purchased. All purpose of this case study was to determine cardiovascular and functional
resources were catalogued so that patients could easily access information changes in a stroke patient using NuStep for 10 weeks. Case Description:
on topics of interest. Summary of Use: The new patient/caregiver educa- This subject is a 60 year-old African American male 4.5 years post stroke
tion system was introduced to each rehabilitation discipline. Although ini- with right hemiplegia. Outcomes: This case is one subject in a larger
tially enthusiastic about the concept, some members of the treatment team crossover study involving 10 weeks of NuStep intervention followed by 10
were slow to adopt the new system.Therefore, a series of six in-service train- weeks of home exercise. NuStep sessions emphasize cardiovascular train-
ing sessions was presented regarding key educational points, best practice, ing and strength building, decreasing or increasing resistance, respectively.
learning styles and pedagogical methods. For each topic, a concise reference From November 2004 through May 2005, the following assessments were
sheet of information was developed for staff.A team leader/point person was conducted prior to intervention (pre), after 10 weeks of intervention (post-
identified to ensure discussion of patient education at Discharge Planning intervention) and after 10 weeks of HEP (post-HEP): heart rate and blood
Rounds. Importance to Members: A consistent, comprehensive approach pressure, LE Fugl-Meyer, Berg Balance, and Short Physical Performance
to patient/caregiver education is imperative to the health maintenance of Battery. Resting blood pressure decreased: systolic from 132 to 120 mmHg
individuals with an acquired spinal cord injury. An interdisciplinary team is and diastolic from 78 to 71 mmHg. Resting heart rate decreased from 70 to
crucial to the success of such a process. Furthermore, clinicians should be 66 bpm. Berg Balance scores improved from 32 (pre) to 33 (post-interven-
trained to assess learning styles and adjust teaching strategies accordingly in tion, post-HEP). Walking speed increased from 44.5 sec (pre) to 31.9 sec
order to better support the needs of individuals with a spinal cord injury and (post-intervention) to 22.0 sec (post-HEP). Fugl-Meyer did not change.
their caregivers. Ability to semi-tandem stand improved from 0 (pre-test) to 1 (post-inter-
vention, post-HEP). Patient reported increased confidence and endurance
PSYCHOMETRIC PROPERTIES OF THE NATIONAL INSTITUTES OF with community ambulation. He also reported no longer needing a scooter
HEALTH STROKE SCALE IN SUBJECTS WITH ACUTE LEFT AND for grocery shopping. Discussion: Ten weeks of NuStep resulted in
RIGHT CEREBRAL ISCHEMIC STROKE. D. Straube1, S.R. Millis2, C. improved cardiovascular measures and function. Walking speed continued
Iramaneerat3, E. Smith3, 1Physical Therapy, Univ. of Illinois - Chicago, to improve up to ten weeks after intervention was finished. NuStep offers
Chicago, IL, 2School of Medicine, Physical Medicine and Rehabilitation, promise to improve cardiovascular fitness and function for patients with
Wayne State University, Detroit, MI, 3College of Education, University of chronic stroke. It may be an effective adjunct to PT requiring minimum
Illinois - Chicago, Chicago, IL. supervision with lasting effects after discharge. It also offers promise to
patients discharged from therapy. The combination of cardiovascular and
Purpose/Hypothesis: The National Institutes of Health Stroke Scale strength training and reciprocal movements requiring minimum supervi-
(NIHSS) is a widely used instrument for the assessment and monitoring of sion may make this an ideal exercise for chronic stroke patients.
progress for individuals with stroke. Published factor analyses of the
NIHSS revealed at least two underlying factors, representing left and right PROCEDURAL LEARNING OF FUNCTIONAL MOBILITY TASKS IN THE
hemispheres.The purpose of this study was to assess the contributions of PRESENCE OF SEVERE MEMORY DEFICITS FROM INTRAVEN-TRICU-
the items of the NIHSS in individuals with either left or right hemisphere LAR HEMORRHAGE. K.A. Volk, R.O. Myers, E. Fitzpatrick-DeSalme,
stroke in order to improve the validity of the scale to document neurologic MossRehab, Philadelphia, PA. (See Motor Learning Thematic poster session
impairment in these two groups. Number of Subjects: NIHSS scores from for abstract)
387 individuals with acute left hemisphere stroke and 347 individuals with
acute right hemisphere stroke were analyzed. Individuals with bilateral SENSORIMOTOR IMPAIRMENTS AND REACHING PERFORMANCE IN
cerebral stroke or cerebellar stroke were not included. Materials/ PERSONS WITH HEMIPARESIS: RELATIONSHIPS DURING THE
Methods: The Rasch partial credit model was used to analyze the NIHSS ACUTE AND SUBACUTE PHASE AFTER STROKE. J.M. Wagner1, C.E.
raw scores. Data was assessed using principal component analysis of the Lang1, S.A. Sahrmann1, D.F. Edwards2, A.W. Dromerick3, 1Program in Physical
person and item residuals and item fit statistics. Based on the results of the Therapy,Washington University School of Medicine, St. Louis, MO, 2Program
first analysis, two subsequent analyses were performed with NIHSS scores in Occupational Therapy, Washington University School of Medicine, St.
from the sample of individuals with left hemispheric stroke and right Louis, MO, 3Department of Neurology, Washington University School of
hemispheric stroke. Results: The findings support previous findings of Medicine, St. Louis, MO. (See Post-Stroke Hemiplegia Thematic poster ses-
two distinct populations with stroke, subjects with left hemisphere and sion for abstract)
right hemisphere stroke.Additional analyses performed generated a linear
scale for each subject population consisting of a subset of items of the THE WOLF MOTOR FUNCTION TEST: NORMATIVE DATA FOR ABLE
NIHSS. Conclusions:The findings provide a more valid and efficient scale BODIED INDIVIDUALS. S. Wolf, J. McJunkin, M. DeGreef, Program in
for the assessment of impairment following stroke consistent with hemi- Physical Therapy, Department of Rehabilitation Medicine, Emory
spheric lateralization of function in either the left or right hemisphere. University School of Medicine,Atlanta, GA.
Clinical Relevance:The findings support the need for unique scales for
the assessment of impairment following stroke related to the unique roles Purpose/Hypothesis: The purpose of this study was to establish a nor-
of the left and right cerebral hemispheres. The scales presented for each mative database for the Wolf Motor Function Test (WMFT) and to deter-
group contain fewer items, and are thus more efficiently targeted. mine trends between and within specific age groups, gender, sequence of
testing, and specific WMFT tasks. We hypothesized that movement times
STEPPING OUT: IMPROVING COMMUNITY AMBULATION AND would increase and strength would decrease among older participants.We
FUNCTION AFTER STROKE. J.Teepen1, K. Baltzer1, K. Dunning1, P. Levine2, further hypothesized that women would not be as strong as men for the
S. Page2, 1Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH, two strength tasks. Number of Subjects: A convenience sample of 52
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 216

healthy able-bodied adult individuals, both male and female, between the cases responded well to this treatment. In the first case, it proved to be
ages of 40 and 80 participated.The sample was then grouped by decades. more effective than the traditional approach. Equipment was inexpensive
All participants met pre-established inclusion/exclusion criteria including and readily available.Treatment was easily tolerated by the patients since
no past medical history of stroke or other brain injury and no previous challenge levels were tailored to each case. Further studies are needed to
upper extremity (UE) impairments or limitations.All but one person were compare these results to a similar amount of time spent with vision elimi-
right handed by statement of hand preference for writing. Prior to testing, nated while standing in a challenging balance situation, or with comput-
all participants read and signed an informed consent and a HIPAA form. erized sensory organization training. Long term carryover should be inves-
Materials/Methods: Administration of the WMFT required standardized tigated as well. Importance to Members: Imbalance is a common and
positions for table and seat height, the correct position of a standardized significant impairment that can lead to injury and disability.When vestibu-
template, standard items for testing, and specific verbal instructions.WMFT lar system pathology is an underlying component, optokinetic stimulation
tasks remained constant throughout (tasks 1-17, sequentially) and pro- can be an effective, readily available, and cost efficient method of treat-
gressed from proximal single joint movements to more complex multi-seg- ment.
mental UE motions. Both UE for each participant were tested. Limb
sequencing was determined randomly by a coin flip.Two co-investigators THE EFFECTIVENESS OF THERAPEUTIC YOGA ON COMMUNITY
were responsible for administering the WMFT throughout the study. Each DWELLING OLDER ADULTS WITH AND WITHOUT BALANCE
co-investigator established intra-rater reliability prior to administration of DEFICITS. K.K. Zettergren, E. Moriarty, A. Zabel, Physical Therapy,
the WMFT (ICC3, 1 = 0.99). Inter-rater reliability was established prior to Quinnipiac University, Hamden, CT.
and throughout testing (ICC2, 1 = 0.91 - 1.00). Results:An age effect for
timed tasks was observed between the forty - sixty, forty - seventy, and fifty Purpose/Hypothesis:The purpose of this study was to assess the bene-
- seventy year age groups for the right hand and between the forty - sixty fits of a therapeutic yoga program on one group of community dwelling
and forty - seventy year age groups for the left hand (p = 0.0027). An inter- elderly individuals. A second purpose of the study was to determine the
action was also seen within hand by sequencing in timed tasks (p < effects of yoga on the confidence levels of participants while performing
0.0001). No gender differences existed for the timed tasks; however, dif- specific activities of daily living. Number of Subjects: Nine community
ferences between genders were found for both strength tasks (p < dwelling elderly adults (aged 62-83) participated in the program. All sub-
0.0001). Conclusions:This study presents a normative database of healthy jects were female. Four community dwelling elderly adults (aged 63-84)
able-bodied adult individuals for the WMFT. On timed tasks, older adults served as control subjects. Control subjects were evenly divided, two male
were slower than younger adults and the first hand tested was slower. Men and two female. Materials/Methods:All subjects signed an informed con-
were consistently stronger than women on strength tasks. Clinical sent prior to participating in the study. Subjects were then evaluated using
Relevance: Currently the WMFT is administered to the less affected UE the Tinetti Balance Scale and the Falls Efficacy Scale. Subjects participating
first; therefore the more impaired UE may yield better scores because of a in the therapeutic yoga received one-hour of yoga for four consecutive
sequence effect. Consequently, randomizing the limb sequence for testing weeks. The yoga program consisted of: Pranayama (concentrated breath-
may combat a potential testing effect. Having this normative data set will ing), warm-ups, asana (physical poses, with props and modifications as
help clinicians and third party payers to understand relative improvement needed), and meditation. In addition, participants received a detailed home
in patients with mild to moderate stroke following interventions. Periodic therapy program that included several of the postures performed during
assessment of change scores among individual tasks will also assist clini- the therapeutic yoga session. Control subjects received no intervention.
cians in modifying treatment programs to target those joint movements After four weeks, all subjects were re-tested on both measures. A single
requiring additional attention. tester performed all evaluations and was blinded to subjects’ group assign-
ment. Results: Paired t-tests were used to assess change scores on the
OPTOKINETIC STIMULATION AS A TREATMENT FOR IMBALANCE Tinetti Balance Scale. The Mann Whitney U Analysis was used to assess
WITH VESTIBULAR IMPAIRMENT: 3 CASE REPORTS. N.M. change scores on the Falls Efficacy Scale. The intervention group showed
Wubenhorst, Balance and Vestibular Center, San Joaquin Valley a statistically significant increase on the Tinetti Balance Scale (p = .001).
Rehabilitation Hospital, Fresno, CA. The control group showed no significant change.There was no statistically
significant change on the Falls Efficacy Scale for either group.
Purpose: Treating vestibular dysfunction with optokinetic stimulation Conclusions: The effects of therapeutic yoga on balance, strength and
(OKS) has been suggested as both efficient and effective. It is based on flexibility have not been thoroughly studied.This study showed a statisti-
the theory that a sensory conflict situation can force central compensation cally significant change with a relatively short intervention program.This
of a diseased vestibular system to yield successful balance. Studies have study supports the use of therapeutic yoga for improving functional bal-
shown that body sway is minimized and optokinetic nystagmus is normal- ance in community dwelling older adults. Clinical Relevance: Recent
ized after 6 to 8 sessions. These case reports are presented with the pur- studies reveal that more than half of community-dwelling elderly individu-
pose of demonstrating an effective, easily applied clinical treatment for als over the age of 62 report a fear of falling. Other studies indicate that
vestibular impairment. Description: Three subjects were selected with higher levels of physical activity, including strength, flexibility and balance
diagnoses or clinical evidence of vestibular dysfunction with imbalance. training, may improve mobility and balance and subsequently reduce falls.
Physical therapy evaluation included subjective balance and dizziness Some researchers propose that community-based exercise programs may
questionnaires, vestibulo-ocular testing, computerized balance testing, and reduce the likelihood of falls. In addition, by the year 1990, Americans
functional measures including Berg Balance Scale and Dynamic Gait Index. spent approximately 13.7 billion dollars on complementary and alterative
Treatment was provided by an optokinetic device that provided visual health care.To that end, exercise programs that are community based and
stimuli that could be applied both horizontally and vertically depending on include balance, strength and flexibility training but also consider the
impairments determined in evaluation. Patient positioning was individual- body/mind connection could prove effective in reducing falls and improv-
ized to maximally challenge balance while still being sustainable by the ing function. Physical therapists are ideal individuals to administer com-
patient. Duration was to tolerance with 10 minutes being a goal. Retest munity based, alternative therapy programs and monitor participants
results were compared to established norms for each test. Case One under- improvements and changes as they relate to function and quality of life.
went 9 treatments of traditional vestibular and balance retraining with
modest response. She continued treatment for another 4 visits with OKS. NEUROPATHIC PAIN AFTER SPINAL CORD INJURY AND ITS
Re-evaluation showed dizziness resolved and unsteadiness significantly RELATIONSHIP TO MICROGLIA AND ATP RECEPTOR
reduced. Case Two received 5 treatments of OKS in conjunction with tra- UPREGULATION. L.C. Fisher, Z.A. Kloos, A.D. Kloos, D. Basso, Physical
ditional vestibular and balance exercises. Re-evaluation showed her dizzi- Therapy, The Ohio State University, Columbus, OH; M.R. Detloff,
ness resolved and balance confidence improved. Case Three participated Neuroscience Graduate Studies Program, The Ohio State University,
in 6 treatments of OKS in conjunction with traditional vestibular and bal- Columbus, OH; E.E. McDaniel, V. McGaughy, P.G. Popovich, Department of
ance exercises. Re-evaluation revealed decreased vertigo in addition to Molecular Virology, Immunology & Medical Genetics, The Ohio State
improved functional mobility and stability. Summary of Use: All three University, Columbus, OH.
217 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

Purpose/Hypothesis: Spinal cord injury (SCI) often causes neuropathic repeated factor and DVA as the variable of interest. Appropriate post-hoc
pain (chronic allodynia and hyperalgesia) but the underlying neu- statistics were performed if a significant main effect or interaction was
roanatomical mechanisms are unknown. In peripheral nerve injury models found (p < 0.05). Factors contributing to change in DVA were examined
of pain, allodynia developed after upregulation of ATP receptors, specifi- using a forward stepwise linear regression. Results: There were no differ-
cally P2X4, on dorsal horn microglia. Since astrocyte networks communi- ences in group characteristics at baseline (p > 0.05). RM ANOVA showed
cate through ATP receptors, altered microglial and astrocytic responses that patients who performed vestibular exercises showed a significant
may underlie neuropathic pain after SCI.Therefore, we investigated if allo- improvement in DVA (p = 0.001), while those performing placebo exer-
dynia and hyperalgesia after SCI is associated with greater microglial and cises did not (p = 0.125). Based on stepwise regression analysis, the leading
astrocytic response and the upregulation of P2X4 receptors in the dorsal factor contributing to improvement in DVA was vestibular exercise, which
horn. Number of Subjects: Thirty-seven adult, female, Sprague-Dawley contributed 41% of the variability pre to post treatment.Vestibular function
rats were used. Materials/Methods: Rats were randomly assigned to: did not change with intervention. Conclusions: The use of vestibular
naive, spinal nerve ligation (SNL), laminectomy, mild (0.5 mm displace- exercises is the main factor involved in the recovery of DVA in patients with
ment) or moderate (1.1 mm displacement) SCI groups.To rule out cellular BVH. Our study suggests that recovery of DVA may be due to mechanisms
responses due to surgery, we included laminectomy and mild SCI groups other than improvement in residual vestibular function. Clinical
because they do not historically develop pain. We assessed allodynia and Relevance: Improvement in visual acuity during head movement in
hyperalgesia with von Frey hair and plantar heat tests for 5 weeks after patients with BVH may contribute to improved quality of life by enabling
surgery. SCI severity was classified by the amount of white matter spared patients to see more clearly while walking or driving. Further studies are
at the lesion epicenter (WMS) and was analyzed via myelin staining. L5 needed to examine the functional implications of improved DVA.
cross-sections were stained for microglia (OX42), astrocytes (GFAP) and
P2X4 ATP receptors, and positively labeled tissue was quantified.To deter-
mine whether intracellular signals which cause more activated microglia,
astrocytes or ATP receptors occurred in rats with neuropathic pain, mRNA
was quantified in a subset of L5 spinal cords (n=2) from naive, SNL, and
moderate SCI groups. Results: Lesion severity was within expected limits
with greater WMS in the mild (26.995.43%) vs. moderate SCI (2.840.475%)
(p<.01). Significant allodynia and hyperalgesia developed in the L5 der-
matome for moderate SCI and SNL groups (p<.01).These groups had more
activated microglia (p<.01) but not astrocytes (p>.01) in the L5 dorsal
horn. Allodynia was positively correlated with microglial activation
(p<.05). Interestingly, there was no significant upregulation of P2X4 ATP
receptors in the dorsal horn of rats exhibiting neuropathic pain.
Conclusions: Robust microglial activation occurs only in rats which
develop neuropathic pain, indicating that microglia but not astrocytes or
P2X4 ATP receptors are key mediators in the development and mainte-
nance of neuropathic pain. Clinical Relevance: Modulating the
microglial response after SCI may prove to be effective at limiting or pre-
venting neuropathic pain after SCI in humans.


Herdman, Rehabilitation Medicine, Emory University,Atlanta, GA; C.D. Hall,
Rehabilitation Research and Development,Atlanta VAMC,Atlanta, GA; M.C.
Schubert, Otolaryngology, Johns Hopkins University, Baltimore, MD; V.E.
Das, R.J.Tusa, Neurology, Emory University,Atlanta, GA.

Purpose/Hypothesis: Patients with bilateral vestibular hypofunction

(BVH) complain of imbalance, head movement-induced dizziness and head
movement-induced visual blurring (oscillopsia). Little is known about exer-
cise-induced recovery in patients with BVH.A randomized, controlled study
found that performance of customized vestibular and balance exercises
resulted in better stability during stair climbing and faster gait speed than
did performance of placebo exercises (Krebs et al 1993; Oto Head Neck
Surg).There have been no studies that have examined the effect of vestibu-
lar exercises on visual acuity during head movement in patients with BVH.
The purpose of this study was to examine the effect of an exercise inter-
vention on visual acuity during head movement (Dynamic Visual Acuity or
DVA) in patients with BVH. We hypothesized that 1) patients performing
vestibular exercises would have improved DVA compared to patients per-
forming placebo exercises and 2) improvement in DVA would be reflected
by changes in vestibulo-ocular reflex (VOR) gain. Number of Subjects:
Thirteen volunteers were recruited from patients referred to the University
of Miami and Emory University Dizziness and Balance Center with a diag-
nosis of bilateral vestibular hypofunction. Materials/Methods: Patients
were randomly assigned to the vestibular (n=8) or the placebo exercise
group (n=5). DVA was measured using a computerized system. Vestibular
function was measured using rotary chair step tests at 60 and 240 d/s.
Baseline differences between groups for age, DVA, complaints of oscillopsia
and disequilibrium were examined using ANOVA.To determine if vestibular
rehabilitation improved DVA, we performed repeated measures univariate
analysis of variance (RM ANOVA) with time (pre and post treatment) as the
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 218

2005 Author Index

Amador M, Guest JD. An Appraisal of Ongoing Experimental Procedures in Lien J, Dibble L. Systems Model Guided Balance Rehabilitation in an
Human Spinal Cord Injury. 2005;29(2):70-86. Individual with Declarative Memory Deficits and a Total Knee Arthroplasty:
A Case Report. 2005;29(1):43-49.
Asano M. See Noreau L.

Beekhuizen KS. New Perspectives on Improving Upper Extremity Lindley SD. See Field-Fote E.
Function after Spinal Cord Injury. 2005;29(3):157-162.
Lofald D. See Lehman DA.
Bolton M. See Mount J.
Lum PS. See Kim CM.
Bouyer LJ. Animal Models for Studying Potential Training Strategies in
Persons with Spinal Cord Injury. 2005;29(3):117-125. Mollinger LA. See Steffen TM.

Bunge MB. See Moon L. Moon L, Bunge MB. From Animal Models to Humans: Strategies for
Promoting CNS Axon Regeneration and Recovery of Limb Function after
Cesari M. See Mount J. Spinal Cord Injury. 2005;29(2):55-69.

Deutsch JE. (Editorial) Enabling Our Patients. 2005;29(1):1. Mount J, Bolton M, Cesari M, Guzzardo K,Tarsi J. Group Balance Skills Class
Stroke:A Case Series. 2005;29(1):24-33.
Deutsch JE. (Editorial) JNPT Special Topic Issues—Transitional Research
and Educational Resources. 2005;29(2):53. Myslinski MJ. Evidence-based Exercise Prescription for Individuals with
Spinal Cord Injury. 2005;29(2):104-106.
Deutsch JE. (Editorial) JNPT is Indexed in MEDLINE. 2005;29(3):113.
Nash MS. Exercise as a Health-Promoting Activity Following Spinal Cord
Deutsch JE. (Editorial) JNPT is Officially Indexed in MEDLINE. 2005; Injury. 2005;29(2):87-103.
Newstead AH, Hinman MR, Tomberlin JA. Reliability of the Berg Balance
Dibble L. See Lien J. Scale and Balance Master Limits of Stability Tests for Individuals with Brain
Injury. 2005;29(1):18-23.
Field-Fote E, Lindley SD, Sherman AL. Locomotor Training Approaches for
Individuals with Spinal Cord Injury: A Preliminary Report of Walking- Noreau L, Fougeyrollas P, Post M, Asano M. Participation after Spinal Cord
related Outcomes. 2005;29(3):127-137. Injury:The Evolution of Conceptualization and Measurement. 2005;29(3):
Field-Fote E. (Editorial) Guest Editorial: Promoting Functional Recovery
after Spinal Cord Injury. 2005;29(2):54. Noreau L. See Post M.

Field-Fote E. (Editorial) Guest Editorial: Standardization of Outcome Patten C. See Kim CM.
Measure: The First Step Toward a Classification Approach to Treatment.
2005;29(3):114-115. Post M, Noreau L. Quality of Life after Spinal Cord Injury. 2005;29(3):139-
Fougeyrollas P. See Noreau L.
Post M. See Noreau L.
Fulk GD. Locomotor Training and Virtual Reality-based Balance Training for
Individuals with Multiple Sclerosis:A Case Report. 2005;29(1):34-42. Roehrs TG. See Karst GM.

Guest JD. See Amador M. Sherman AL. See Field-Fote E.

Guzzardo K. See Mount J. Steffen TM, Mollinger LA. Age and Gender-Related Test Performance in
Community-Dwelling Adults. 2005;29(4):181-188.
Henderson CE. Application of Ventilatory Strategies to Enhance Functional
Activities for an Individual with Spinal Cord Injury. 2005;29(2):107-111. Tarsi J. See Mount J.

Hinman MR. See Newstead AH. Tomberlin JA. See Newstead AH.

Hirsch MA. See Lehman DA. Toole T. See Lehman DA.

Karst GM, Venema DM, Roehrs TG, Tyler E. Center of Pressure Measures Tyler E. See Karst GM.
During Standing Tasks in Minimally Impaired Persons with Multiple
Sclerosis. 2005;29(4):170-180. Venema DM. See Karst GM.

Kim CM, Kothari DH, Lum PS, Patten C. Reliability of Dynamic Muscle
Performance in the Hemiparetic Upper Limb. 2005;29(1):9-17.

Kothari DH. See Kim CM.

Lehman DA,Toole T, Lofald D, Hirsch MA. Training with Verbal Instructional

Cues Results in Near-term Improvement of Gait in People with Parkinson
Disease. 2005;29(1):2-8.
219 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

2005 Subject Index

Balance Noreau L, Fougeyrollas P, Post M, Asano M. Participation after Spinal Cord
Karst GM,Venema DM, Roehrs TG,Tyler E. Center of Pressure Measures dur- Injury:The Evolution of Conceptualization and Measurement. 2005;29(3):
ing Standing Tasks in Minimally Impaired Persons with Multiple Sclerosis. 147-156.
Lien J, Dibble L. Systems Model Guided Balance Rehabilitation in an Amador M, Guest JD.An Appraisal of Ongoing Experimental Procedures in
Individual with Declarative Memory Deficits and a Total Knee Arthroplasty: Human Spinal Cord Injury. 2005;29(2):70-86.
A Case Report.2005;29(1):43-49.
Beekhuizen KS. New Perspectives on Improving Upper Extremity
Mount J, Bolton M, Cesari M, Guzzardo K,Tarsi J. Group Balance Skills Class
Stroke:A Case Series.2005;29(1):24-33. Function after Spinal Cord Injury. 2005;29(3):157-162.

Newstead AH, Hinman MR, Tomberlin JA. Reliability of the Berg Balance Bouyer LJ. Animal Models for Studying Potential Training Strategies in
Scale and Balance Master Limits of Stability Tests for Individuals with Brain Persons with Spinal Cord Injury. 2005;29(3):117-125.
Injury. 2005;29(1):18-23.
Field-Fote E, Lindley SD, Sherman AL. Locomotor Training Approaches for
Steffen TM, Mollinger LA. Age And Gender-Related Test Performance In Individuals with Spinal Cord Injury: A Preliminary Report of Walking-
Community-Dwelling Adults: Multi-directional Reach Test, Berg Balance related Outcomes. 2005;29(3):127-137.
Scale, Sharpened Romberg Tests, Activities-Specific Balance Confidence
Scale, and Physical Performance Test. 2005;29(4):181-188. Field-Fote E. (Editorial) Guest Editorial: Promoting Functional Recovery
after Spinal Cord Injury.2005;29(2):54.
Brain Injury
Newstead AH, Hinman MR, Tomberlin JA. Reliability of the Berg Balance
Henderson CE.Application of Ventilatory Strategies to Enhance Functional
Scale and Balance Master Limits of Stability Tests for Individuals with Brain
Injury.2005;29(1):18-23. Activities for an Individual with Spinal Cord Injury. 2005;29(2):107-111.

Editorials Moon L, Bunge MB. From Animal Models to Humans: Strategies for
Deutsch JE. (Editorial) Enabling Our Patients.2005;29(1):1. Promoting CNS Axon Regeneration and Recovery of Limb Function after
Spinal Cord Injury. 2005;29(2):55-69.
Deutsch JE. (Editorial) JNPT Special Topic Issues - Transitional Research and
Educational Resources.2005;29(2):53. Myslinski MJ. Evidence-based Exercise Prescription for Individuals with
Spinal Cord Injury. 2005;29(2):104-106.
Deutsch JE. (Editorial) JNPT is Indexed in MEDLINE.2005;29(3):113.
Nash MS. Exercise as a Health-Promoting Activity Following Spinal Cord
Deutsch JE. (Editorial) JNPT is Officially Indexed in MEDLINE. 2005; Injury. 2005;29(2):87-103.
Noreau L, Fougeyrollas P, Post M, Asano M. Participation after Spinal Cord
Injury:The Evolution of Conceptualization and Measurement. 2005;29(3):
Myslinski MJ. Evidence-based Exercise Prescription for Individuals with
Spinal Cord Injury.2005;29(2):104-106. 147-156.

Nash MS.Exercise As A Health-Promoting Activity Following Spinal Cord Post M, Noreau L.Quality of Life after Spinal Cord Injury. 2005;29(3):139-
Injury.2005;29(2):87-103. 146.

Locomotion Stroke
Field-Fote E, Lindley SD, Sherman AL. Locomotor Training Approaches for Kim CM, Kothari DH, Lum PS, Patten C. Reliability of Dynamic Muscle
Individuals with Spinal Cord Injury: A Preliminary Report of Walking- Performance in the Hemiparetic Upper Limb. 2005;29(1):9-17.
related Outcomes.2005;29(3):127-137.
Mount J, Bolton M, Cesari M, Guzzardo K,Tarsi J. Group Balance Skills Class
Fulk GD. Locomotor Training and Virtual Reality-based Balance Training for Stroke:A Case Series. 2005;29(1):24-33.
Individuals with Multiple Sclerosis:A Case Report.2005;29(1):34-42.
Lehman DA,Toole T, Lofald D, Hirsch MA.Training with Verbal Instructional
Karst GM,Venema DM, Roehrs TG,Tyler E. Center of Pressure Measures dur-
Cues Results in Near-term Improvement of Gait in People with Parkinson
Disease.2005;29(1):2-8. ing Standing Tasks in Minimally Impaired Persons with Multiple Sclerosis.
Mutiple Sclerosis
Fulk GD. Locomotor Training and Virtual Reality-based Balance Training for Lehman DA,Toole T, Lofald D, Hirsch MA.Training with Verbal Instructional
Individuals with Multiple Sclerosis:A Case Report. 2005;29(1):34-42. Cues Results in Near-term Improvement of Gait in People with Parkinson
Karst GM,Venema DM, Roehrs TG,Tyler E. Center of Pressure Measures dur-
ing Standing Tasks in Minimally Impaired Persons with Multiple Sclerosis. Lien J, Dibble L. Systems Model Guided Balance Rehabilitation in an
2005;29(4):170-180. Individual with Declarative Memory Deficits and a Total Knee Arthroplasty:
A Case Report.2005;29(1):43-49.
Parkinson Disease
Lehman DA,Toole T, Lofald D, Hirsch MA.Training with Verbal Instructional
Upper Extremity
Cues Results in Near-term Improvement of Gait in People with Parkinson
Disease. 2005;29(1):2-8. Beekhuizen KS. New Perspectives on Improving Upper Extremity
Function after Spinal Cord Injury.2005;29(3):157-162.
Participation and Quality of Life
Post M, Noreau L. Quality of Life after Spinal Cord Injury. 2005;29(3):139- Kim CM, Kothari DH, Lum PS, Patten C. Reliability of Dynamic Muscle
146. Performance in the Hemiparetic Upper Limb.2005;29(1):9-17.
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 220

Literature Reviewed
Not to worry, we can get you back in sequence…
Fullerton HD, Borckardt JJ,Alfano AP. Shoulder Pain: A
We are pleased to announce that the
Comparison of Wheelchair Athletes and Nonathletic
plenary sessions at III STEP (nearly 30
Wheelchair Users. Medicine and Science in Sports and
Exercise. 2003:1958-1961. Reviewed by Elrod M. hours of presentations) were profes-
sionally videotaped and recorded, for
Ferris DP, Gordon KE, Beres-Jones JA, Harkema SJ. Muscle you to re-live, review or share. These
Activation During Unilateral Stepping Occurs in the high-quality recordings have a split-
Nonstepping Limb of Humans with Clinically Complete screen view of the speaker and their
Spinal Cord Injury. Spinal Cord. 2004;42:14-23. Reviewed power point presentation simultane-
by Winchester P. ously. Read, listen and watch as you follow along the
footsteps toward the future of rehabilitation.
Important Note: Conference recordings will be avail-
Books able in for Windows-based (PC) operating systems ONLY.
Canadian Spinal Research Organization/American Spinal Order your copy of this limited edition product today,
Research Organization. The After and Beyond Spinal Cord in DVD or CD for $99.95 By going on line
Injury Resource Manual. 2004. Reviewed by Snowdon LC. or contacting our section office:
Neurology Section Executive Office
III Step Order Fulfillment
Videos c/o American Physical Therapy Association
Neumann D, Lanouett M. Clinical Kinesiology Applied to 1111 N. Fairfax Street
Persons with Quadriplegia. Part I: Maximizing Movement Alexandria, VA 22314
Potential, Part II: Enhancing Function. 2002. Reviewed by
Fax: 703/706-8575 •
Behrman AL.


The Neurology Section welcomes its’ members with a willingness to serve at the level of Section,
SIG/Special Interest Group, Committee or Advisory.

The following positions are open in the 2006 election:

Section: SIGs:
Vice President (3 year term) Nominating Committee (3 year term)
Nominating Committee (3 year term)
If you are interested in getting involved and serving your section now or in the future, contact our Nominating Committee Chairperson,
Marcia Hall Thompson at or contact your SIG nominating chair:

Vestibular/Balance & Falls SIG Nominating Chairs: Spinal Cord Injury SIG Nominating Chair:
Lisa Selby-Silverstein Robin F. Moss
610/558-5645 • 540/932-4018 •
Laura Morris
412/647-8091 • Stroke SIG Nominating Chair:
Kristin Parlman
Brain Injury SIG Nominating Chair: 617/724-7489 •
Anne McCarthy Jacobson
617/724-6363 • Section Nominating Chair:
Marcia Hall Thompson
Degenerative Diseases SIG Nominating Chair: 503/653-2144 x 3345 •
Donna Fry-Welch
810/762-3373 •
221 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

President’s Address
Shared Vision: The Foundation of Strategic Stewardship
Katherine J. Sullivan, PT, PhD
President, Neurology Section

Volunteer associations such as the Neurology Section face Looking beyond our current membership opens the doors to
many challenges. Members entrust elected officers to direct the wonderful opportunities for Section growth and collaboration.
Section’s business and financial affairs. Section officers ensure Currently, the Neurology Section is the 6th largest of 18 APTA
that the Section is financially solvent, efficiently managed, meet- sections. Sections larger than us include (in rank order):
ing the needs of its members, promoting and advancing the pro- Orthopaedics, Sports, Pediatrics, Geriatrics, and Private Practice.
fession, and advocating for the beneficiaries of our services.1 But There is a perception among non-Neurology Section members
more importantly, the elected or appointed leaders are entrusted that we are not accessible either in reaching out to therapists
by the members to be stewards; individuals who are “morally who cannot get to the Combined Sections Meeting or in provid-
responsible for the careful use of money, time, talents, or other ing a balance of programming and educational materials that
resources, especially in respect to the principles or needs of a deal with real-life issues related to neurologic physical therapy
community or group (Webster’s New World Dictionary 1988, p practice. Increasing access to basic and essential information on
1315).” neurologic physical therapy will undoubtedly increase our
Strategic stewardship reflects the self-reflective, thoughtful, growth, but more importantly, by increasing membership, we
and visionary process that the Section’s leadership team has have the potential to increase the quality of care for individuals
embarked upon in order to develop a strategic plan that will with neurologic disease or injury.
guide our efforts in the next 5 years.The last weekend in October Many opportunities exist for the Section in the next 5 years
the Neurology Section invited Section leaders to an initial strate- and beyond. Examples include the opportunity to collaborate
gic planning meeting at the American Physical Therapy with the international physical therapy community and other
Association (APTA) headquarters in Alexandria, VA. Section lead- organizations such as the American Stroke Association,American
ers included the elected and appointed officers of the Executive Congress of Physical Medicine & Rehabilitation, and the
Committee and the Chairs/representative of the Special Interest American Spinal Cord Injury Association, to name but a few. Like
Groups and Committees.We were skillfully led through the initial
us, these physical therapists and organizations share similar
step of the strategic planning process by Dr Jody Gandy, Director
visions—to improve care, advocate, and change health care pol-
of Physical Therapy Education, APTA. Dr Gandy challenged us to
icy for individuals who receive our services.
leverage the Neurology Section’s strengths and acknowledge our
Now is the time for us to act. Real threats do exist that affect
weaknesses in order to craft a new vision for the Section.
access to neurologic physical therapy services and reimburse-
It is evident that the Neurology Section has several strengths
ment for the services we do provide. In many health care arenas,
that are recognized in the national arena and the APTA at large.
there is limited recognition of the scope and expertise of physi-
We are a highly motivated group with accomplishments in
cal therapists who specialize in neurology.There is great dispar-
advancing the science and practice of neurologic physical ther-
apy. We were the first section to fund doctoral student scholar- ity not only in the health care delivery system but amongst phys-
ships. We have consistently offered programming that reflects ical therapists who deliver physical therapy services; the Section
the “cutting edge” of the science and practice of neurologic can provide leadership in these areas.
physical therapy. We have effective dissemination vehicles such We want a shared vision for our Section that includes the
as the recently MEDLINE indexed Journal of Neurologic voice of our members.We need your insights, perspectives, and
Physical Therapy (JNPT) and our Neurology Section and JNPT volunteerism to make this Section move beyond our current
websites. In addition, because of careful management, the capabilities. In January, all Section members will receive an email
Section is financially strong. blast with a document link. The document will include the
Members value the Section for the caliber of its educational revised vision and mission statements and goals and objectives
programming and publications; however, we acknowledged that that will guide the Section’s leadership in the next 5 years.The
we may not be as well-recognized in other communities or Myelin Melter and Section Business Meeting is scheduled for
amongst grassroots physical therapists that may benefit from the Friday, February 3 from 6:30 – 8:00 PM. The major focus of the
strengths of our Section. This is highlighted by a recent trip I meeting is to share the strategic plan with the membership, seek
made to present on neurologic physical therapy for individuals your feedback in making the changes that will lead to final adop-
with stroke at the Ohio Physical Therapy Association Meeting. Of tion, and provide opportunities for you to participate.
the 40 participants who attended, 2 had been to IIISTEP, 5 had The Section leadership looks forward to your participation.
heard of IIISTEP, and 35 had never heard of IIISTEP.The physi- Come, be heard, and shape the future of the Neurology Section.
cal therapists and physical therapist assistants who attended this
conference are a cross-section of the grassroots practitioners REFERENCE
who care for individuals with neurologic disease or injury. It 1
Dimitru D. Strategic servitude: what has the Academy done
appears they are missing our message. for me lately? Arch Phys Med Rehabil. 2004; 85:1393-1394.
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 222

2006 PODS Announcement

For 2006, two Foundation for Physical Therapy’s Promotion of Doctoral Studies Scholarships (PODS I & II) will be funded
by the Neurology Section of the American Physical Therapy Association and the Foundation’s Neurology Endowment Fund.
Both scholarships will be given to applicants whose doctoral studies are in neurology.These scholarships honor 2
esteemed Neurology Section members.

The Patricia Leahy, PT, Doctoral Scholarship:

PODS I – $7,500 in support of the coursework phase of post-professional doctoral studies prior to candidacy (as defined
by the applicant’s institution).

The Marylou Barnes, PT, FAPTA, Doctoral Scholarship:

PODS II – Up to $15,000 in support of the post-candidacy phase of post-professional doctoral studies (as defined by the
applicant’s institution).

The PODS I & II applications are now available on-line at

Should a hardcopy of the PODS guidelines and application be preferred, please contact the Foundation at 800/999-2782,
ext. 8438.The deadline for returning the completed application is January 17, 2006.

Promotion of Fitness and Prevention of Neurocurriculum Across the Lifespan:

Secondary Complications Educating the Next Generation
in People with Neurologic Disorders January 31-February 1, 2006 • San Diego, CA

Clinical Scientists: Richard F Macko, MD & James

Judith Deutsch, PT, PhD; Sally Westcott, PT,
Rimmer, PhD
Clinicians: Leizl M Adolphi, PT, ART, Bill Bodry
Maria A Fragala-Pinkham, PT, Heather A Hayes, PT, DPT Ann VanSant, PT, PhD
Cynthia Miles, PT, MEd, PCS All clinicians and educators are encouraged to attend
January 31 and February 1, 2006 this dynamic workshop that will synthesize and apply
CSM 2006 Pre-Conference Course relevant conceptual frameworks and specific content
San Diego, California gleaned from the IIIStep conference held this past
Can a fitness program help children with CP and adults with summer. The focus will be on developing strategies
stroke in a functional and meaningful way? for updating curricula and relevant clinical education.
How can the evidence on fitness programs for individuals Topics covered will include: models for clinical deci-
with neurologic disorders be put into clinical practice? sion making, task analysis for movement examination,
This 2-day intensive course will focus on the evidence of levels and analysis of measurements, and application
the effects of regular intensive training on recovery from of research on neural plasticity and motor develop-
impairments, improvement of function, participation and ment. Incorporation of technologies and complemen-
quality of life in persons with neurologic disease and will tary therapies into physical therapy education will also
offer practical recommendations for translating scientific be discussed. There will be active learning sessions
evidence into both clinical and community fitness environ- throughout allowing time for discussion and the
ments. exchange of ideas.
• Complete brochure and registration materials for this APTA • Complete brochure and registration materials for
Neurology Section, Section on Pediatrics , and Section on this APTA Neurology Section, Section on Pediatrics,
Geriatrics co-sponsored course are available at and Section on Geriatrics co-sponsored course are or available at or
• Tel: 800-999-2782, ext. 3395; or Fax: 703-706-3396. •Tel: 800-999-2782, ext. 3395 or Fax: 703-706-3396.
223 J ournal of N eurological P hysical T herapy Vol. 29 • No. 4 • 2005

Neurology Section Programming at CSM 2006

January 31-February 04, 2006 San Diego, California
Tuesday, January 31, 2006 1:00pm – 3:00pm Patient Perspectives and Quality of
12:30pm – 6:30pm Preconference Course A: Life: Early PTClinResNet Outcomes
Neurocurriculum Across the Life Speakers: James Gordon, EdD, PT,
Span: Educating the Next Generation. FAPTA; Bryan Kemp, PhD; Sara
Speakers: Judy Deutsch, PhD, PT Mulroy, PhD, PT; Sharon DeMuth,
Sally Westcott, PhD, PT DPT; Loretta Knuttson, PhD, PT, NCS;
Ann VanSant, PhD, PT Kornelia Kulig, PhD, PT; Tara
Klassen, MS, PT, NCS
7:30pm – 5:00pm Preconference Course B: Promotion
3:00 -4:30pm Degenerative Diseases Special
of Fitness and Prevention of
Interest Group: Intervention Issues
Secondary Complications in
in Degenerative Disease- A Case
Individuals with Neurologic
Based Approach
Speakers: Herb Karpatkin, PT, MS,
Speakers: Jim Rimmer, PhD, Richard
NCS; Willia Werner EdD, PT; Peggy
Macko, MD, Heather Hayes, PT, DPT,
Ingels PT, Sue Imbriglio PT
Bill Brody, Leizel Adolphi, PT, ART,
Maria A Fragala-Pinkham, PT, MS,
3:00 -4:30pm Spinal Cord Injury Special Interest
Cindy Miles, PT, MEd, PCS
Group: Current Trends in SCI
Research - An Update of What’s
Wednesday, February 01, 2006 Happening
8:30am – 6:30pm Preconference Course A: Speaker: Deborah Backus, PhD, PT
Neurocurriculum Across the Life
Span: Educating the Next Generation. 3:45 –4:30pm Become a Contributor to the Journal
Speakers: Judy Deutsch, PhD, PT of Neurologic Physical therapy: Meet
Sally Westcott, PhD, PT the Editor and Editorial Board
Ann VanSant PhD, PT Speaker: Judy Deutsch, PhD, PT

7:30am – 5:00pm Pre-Conference Course B: 6:30 – 8:30pm Journal of Neurologic Physical

Promotion of Fitness and Prevention Therapy Editorial Board Meeting
of Secondary Complications in
Individuals with Neurologic Friday, February 03, 2006
Disorders 6:30 – 8:30am Neurologic Clinical Specialists’
Speakers: Jim Rimmer, PhD, Richard Breakfast: Exercising Leadership
Macko, MD, Heather Hayes, PT, DPT, Speaker: Janice Benzer, PhD, PT
Bill Brody, Leizel Adolphi, PT, ART,
Maria A Fragala-Pinkham, PT, MS, 8:00 – 11:00am The Best of III Step: Implications for
Cindy Miles, PT, MEd, PCS Neurologic Practice
Speakers: Darcy Umphred PhD, PT,
Thursday, February 02, 2006 FAPTA; Kathy Gill-Body DPT, MS,
6:30 – 7:45am First Time at CSM? Welcome to the NCS; Andrea Behrman PhD, PT
First Timers’ Breakfast
9:00 – 11:00am To Brace or Not to Brace: Making
8:00am – 3:00pm Planning for the Future: Evidence-based Decisions for our
The Neurology Section at Work - Clients with Neurologicial
Executive Committee Meeting Impairments.
Speakers:Valerie Eberly PT, NCS
11:30am – 3:30pm Understanding Adaptation:Why Should Kelley Kubota PT, MS, NCS
Clinicians Care? Walter Weiss PT, MPT, NCS
Speakers: Anne Shumway–Cook,
PhD, PT; Amy Bastian, PhD, PT; 11:00am – 1:00pm Neurology Section SIG Officers
JoAnn Kluzik, PhD, PT, PCS Meeting
Vol. 29 • No. 4 • 2005 J ournal of N eurological P hysical T herapy 224

1:00 – 4:00pm The EXCITE Trial: Formulation, 1:30- 3:00pm Thematic Poster Session III: Motor
Implementation, and Results Learning
Speakers: Steve Wolf, PhD, PT, Moderator: John Buford, PhD, PT
FAPTA; Patricia C. Clark, PhD, RN; J.
Philip Miller, PhD; Carolee J.Winstein, 1:30- 3:00pm Research Platform Session II:
PhD, PT, FAPTA Parkinson Disease
Moderator: Gammon Earhart, PhD, PT
1:00 – 5:00pm Understanding Sensory Dysfunction:
Evidence-based Evaluation, Retraining, 3:00- 5:00pm Practice Issues Forum: Development
and Mechanisms of Recovery of an Evaluation Database to Guide
Speakers: Deborah Nichols-Larsen, Clinical Effectiveness
PhD, PT; D. Michele Basso EdD, PT, Facilitator: Edee Field-Fote, PhD, PT
Nancy Byl PhD, PT, FAPTA
3:00 – 5:00 pm Neurology Section Roundtables
4:30–6:00pm Vestibular, Balance and Falls Special Brain Injury SIG
Interest Group: Management of the Multisensory Impairments in Relation
Dizzy Patient – Team Approach to Postural Control in the BI
Speakers: Michael Hoffer, MD; Kim Population
Gottshall Col, USAR, PT, PhD, ATC Facilitator: Michelle Peterson, PT, NCS
Degenerative Diseases SIG
4:30 – 6:00pm Brain Injury Special Interest Group:
Cognitive Issues in Degenerative
Evaluation and Management of the
Dizzy Patient- A Team Approach
Facilitator: Vanina Dal Bello-Haas,
Speakers: Michael Hoffer, MD; Kim
Gottshall Col, USAR, PT, PhD, ATC
Spinal Cord Injury SIG
4:30 – 6:00pm Stroke Special Interest Group: Outcome Measures – How Do We
One Hand or Two? Designing Use Them in Spinal Cord Injury Care?
Interventions for successful Facilitators: Leslie Van Hiel, PT;
Outcomes Post-Stroke Mary Schmidt-Reed, MS, PT
Speaker: Dorian Rose, PhD, PT
Stroke SIG
Using “Hooked on Evidence” within
4:30 – 6:00pm Thematic Poster Session I: Imagery
Stroke Rehabilitation
and Imaging
Facilitator: David Scalzitti, PT, MS, OCS
Moderator: Carolynn Patten, PhD, PT
Vestibular SIG
6:00 – 8:30pm Myelin Melter: Neurology Section The Do’s and Don’ts of Migrainous
Business Meeting and Reception Vertigo
Facilitator: Colin Grove, MS, PT
Saturday, February 04, 2006
Balance and Falls: Bubbles, Balloons,
8:00 – 11:00am Thematic Poster Session II:
and PVC
Post-Stroke Hemiplegia
Facilitator: Cecelia Griffith, PT, DPT
Moderator: Carolynn Patten, PhD, PT
Coding, Reimbursement, and Payment
8:00 – 11:00am Research Platform Session I: Policy Challenges in Vestibular Rehab
Biomechanics and Motor Control Facilitator: Helene Fearon, PT
Moderator: Martin Bilodeau, Ph.D.,
Body-Weight Support Systems:
Practical Considerations in PT I
Facilitators: Tara Klassen, MS, PT,
9:00- 11:00am Spinal Cord Injury: Maximizing
NCS; Jim Cavannaugh, PhD, PT,
Sensory and Motor Recovery by
NCS; Paul Hansen, PhD, PT
Targeting Cellular Responses
Speaker: D. Michele Basso, EdD, PT Body-Weight Support Systems:
Practical Considerations in PT II
1:00 – 3:00pm Mild Brain Injury and Dizziness Facilitators: Mark Bowden, MS, PT;
Speaker: Laura Morris, PT, NCS George Fulk, MS, PT