Drayer Physical Therapy Institute

Lexington, KY, United States

Drayer Physical Therapy Institute

Lexington, KY, United States
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Crowell H.P.,U.S. Army | Davis I.S.,University of Delaware | Davis I.S.,Drayer Physical Therapy Institute
Clinical Biomechanics | Year: 2011

Background: Tibial stress fractures, which are among the most common running related injuries, have been associated with increased lower extremity loading (i.e., peak positive acceleration of the tibia, vertical force impact peak, and average and instantaneous vertical force loading rates) during initial contact. This study was conducted to evaluate the efficacy of a gait retraining program designed to reduce this loading during running and to assess the short-term persistence of these reductions. Methods: Ten runners (six females and four males) with peak positive tibial acceleration greater than 8 g, measured in an initial screening, participated in the retraining program. During the retraining sessions, subjects ran on a treadmill and received real-time visual feedback from an accelerometer attached to their distal tibias. Tibial acceleration and vertical ground reaction force data were collected from subjects during overground data collection sessions held pre-training, post-training, and at a 1-month follow-up. Findings: Peak positive acceleration of the tibia, vertical force impact peak, and average and instantaneous vertical force loading rates were all reduced immediately following the gait retraining. The decrease in tibial acceleration was nearly 50%. The reductions in vertical force loading rates and vertical force impact peak were approximately 30% and 20%, respectively. These reductions were maintained at the 1-month follow-up. Interpretation: Subjects were able to run with reduced tibial acceleration and vertical force loading immediately following completion of the gait retraining program and at the 1-month follow-up evaluation. This may reduce their risk of stress fractures. © 2010 Elsevier Ltd.


PubMed | U.S. Army, Eastern Kentucky University, University of Kentucky and Drayer Physical Therapy Institute
Type: Journal Article | Journal: Archives of physical medicine and rehabilitation | Year: 2016

To describe the rehabilitation experiences, expectations, and treatment adherence of patients receiving upper extremity (UE) rehabilitation who demonstrated discrepancy between functional gains and overall improvement.Qualitative (phenomenologic) interviews and analysis.Outpatient UE rehabilitation.Patients with acute UE injuries (N=10).Not applicable.Concerns related to UE rehabilitation patients demonstrating discrepancy between outcome measures.Five key themes emerged from the interviews of patients demonstrating discrepancy in their self-reported patient outcomes: (1) desire to return to normal, (2) initial anticipation of brief recovery, (3) trust of therapist, (4) cannot stop living, and (5) feelings of ambivalence. Challenges included living with the desire to move back into life. Multiple factors affected patient adherence: cost of treatment, patient-provider relation (difference between therapist and patient understanding on what is important for treatment), and patients expecting the treating therapists to be an expert and fix their problem.Patient adherence to UE rehabilitation presents many challenges. Patients view themselves as laypersons and seek the knowledge of a dedicated therapist who they trust to spend time with them to understand what they value as important and clarify their injury, collaboratively make goals, and explain the intervention to get them in essence, back into life, in the minimal required time. When categorized according to the World Health Organizations multidimensional adherence model, domains identified in this model include social and economic, health care team and system, condition-related, therapy-related, and patient-related dimensions. Assessing factors identified to improve efficiency and effectiveness of clinical management can enhance patient adherence.


Dierks T.A.,Indiana University | Davis I.S.,University of Delaware | Davis I.S.,Drayer Physical Therapy Institute | Hamill J.,University of Massachusetts Amherst
Journal of Biomechanics | Year: 2010

Runners rarely run to the point of maximum fatigue or exhaustion. However, no studies have investigated how the level of exertion associated with a typical running session influences running mechanics. The purpose of this study was to investigate the effects that running in an exerted state had on the kinematics and joint timing within the lower extremity of uninjured, recreational runners. Twenty runners performed a prolonged treadmill run at a self-selected pace that best represented each runner's typical training run. The run ended based on heart rate or perceived exertion levels that represented a typical training run. Kinematics and joint timing between the foot, knee, and hip were analyzed at the beginning and end of the run. Increases were primarily observed at the end of the run for the peak angles, excursions, and peak velocities of eversion, tibial internal rotation, and knee internal rotation. No differences were observed for knee flexion, hip internal rotation, or any joint timing relationship. Based on these results, runners demonstrated subtle changes in kinematics in the exerted state, most notably for eversion. However, runners were able to maintain joint timing throughout the leg, which may have been a function of the knee. Thus, uninjured runners normally experience small alterations in kinematics when running with typical levels of exertion. It remains unknown how higher levels of exertion influence kinematics with joint timing and the association with running injuries, or how populations with running injuries respond to typical levels of exertion. © 2010 Elsevier Ltd.


Dierks T.A.,Indiana University | Manal K.T.,University of Delaware | Hamill J.,University of Massachusetts Amherst | Davis I.,University of Delaware | Davis I.,Drayer Physical Therapy Institute
Medicine and Science in Sports and Exercise | Year: 2011

PURPOSE: Investigate lower extremity kinematics in runners with patellofemoral pain (PFP) syndrome during a prolonged run. METHODS: For this study, 20 runners with PFP and 20 uninjured controls performed a prolonged run on a treadmill at a self-selected pace. The run ended based on HR, perceived exertion, or level of knee pain. Kinematic data were analyzed at the beginning and at the end of the run. RESULTS: The PFP group demonstrated less peak knee flexion, peak hip adduction, eversion excursion, peak knee flexion velocity, peak hip adduction velocity, and peak hip internal rotation velocity compared with controls. A significant main effect for time indicated that increases in most kinematic variables occurred at the end of the run. Interestingly, five runners with PFP displayed atypical motions of knee valgus and eight displayed hip abduction during the first half of stance. CONCLUSIONS: The PFP group as a whole displayed less overall motion compared with controls. This may be indicative of a strategy aimed at limiting lower extremity movement to reduce pain. However, increases in joint motion occurred at the end of the run where pain levels were greatest. Three distinct PFP subgroups were noted, and each demonstrated unique kinematic mechanisms that may be associated with PFP. In the knee valgus subgroup, increased knee valgus and decreased peak motions were noted in other joints. In the hip abduction subgroup, less knee flexion and motion overall was noted. In the subgroup that displayed typical first half patterns (knee and hip adduction), increased hip internal rotation and decreased knee internal rotation were observed. These results suggest that several different kinematic mechanisms related to PFP may exist. © 2011 The American College of Sports Medicine.


Fellin R.E.,University of Delaware | Manal K.,University of Delaware | Davis I.S.,University of Delaware | Davis I.S.,Drayer Physical Therapy Institute
Journal of Applied Biomechanics | Year: 2010

Researchers conduct gait analyses utilizing both overground and treadmill modes of running. Previous studies comparing these modes analyzed discrete variables. Recently, techniques involving quantitative pattern analysis have assessed kinematic curve similarity in gait. Therefore, the purpose of this study was to compare hip, knee and rearfoot 3-D kinematics between overground and treadmill running using quantitative kinematic curve analysis. Twenty runners ran at 3.35 m/s ± 5% during treadmill and overground conditions while right lower extremity kinematics were recorded. Kinematics of the hip, knee and rearfoot at footstrike and peak were compared using intraclass correlation coefficients. Kinematic curves during stance phase were compared using the trend symmetry method within each subject. The overall average trend symmetry was high, 0.94 (1.0 is perfect symmetry) between running modes. The transverse plane and knee frontal plane exhibited lower similarity (0.86-0.90). Other than a 4.5 degree reduction in rearfoot dorsiflexion at footstrike during treadmill running, all differences were ≤1.5 degrees. 17/18 discrete variables exhibited modest correlations (>0.6) and 8/18 exhibited strong correlations (>0.8). In conclusion, overground and treadmill running kinematic curves were generally similar when averaged across subjects. Although some subjects exhibited differences in transverse plane curves, overall, treadmill running was representative of overground running for most subjects. © 2010 Human Kinetics, Inc.


Lloyd C.H.,University of Calgary | Stanhope S.J.,University of Delaware | Davis I.S.,University of Delaware | Davis I.S.,Drayer Physical Therapy Institute | Royer T.D.,University of Delaware
Gait and Posture | Year: 2010

Persons with a unilateral, trans-tibial amputation have an increased risk of developing osteoarthritis (OA) in the knee of their intact limb. Between-side strength discrepancies observed in individuals with an amputation may indicate overuse of the intact limb and increased osteoarthritis risk; however, the relationship between lower extremity strength and gait mechanics has not been addressed in previous literature. It was hypothesized that amputee subjects' strength and gait would be more asymmetrical than controls, and that strength asymmetry would positively correlate with gait variable asymmetry and intact side gait variables associated with osteoarthritis risk. Eight persons with unilateral, trans-tibial amputation and eight able-bodied control subjects participated. Three gait variables related to osteoarthritis risk (knee external adduction moment, knee adduction moment load rate, and vertical ground reaction force load rate) were measured bilaterally, along with three strength measures (hip abductors, knee extensors, and knee flexors). Four of the six variables were more asymmetrical in the amputee group than the control group (p< 0.05 and/or effect size greater than 0.70). Knee extension strength asymmetry was significantly related to knee adduction moment load rate asymmetry (rho = 0.714), and knee flexion strength asymmetry was moderately related to the vertical ground reaction force on the intact limb (rho = 0.643). Results suggest that strength asymmetry in unilateral trans-tibial amputees has a moderate relationship with osteoarthritis risk, and may be a useful way to assess gait ability and the need for rehabilitation in this population. © 2010.


Altman A.R.,University of Delaware | Reisman D.S.,University of Delaware | Higginson J.S.,University of Delaware | Davis I.S.,University of Delaware | Davis I.S.,Drayer Physical Therapy Institute
Gait and Posture | Year: 2012

Introduction: Instrumented treadmills are becoming increasingly more common in gait laboratories. Instrumented side-split treadmills allow the collection of forces under each foot during walking. However, there may be a tendency to increase the base of support when walking on these treadmills, influencing other frontal plane mechanics as well. Therefore, the purpose of this study was to examine the effect of walking on a side-split instrumented treadmill on base of gait and frontal plane kinematics of the lower extremity. Methods: Twenty subjects walked on both a split and a single-belt treadmill. Base of gait and frontal plane kinematic angles and variability data were recorded. A one-way ANOVA was used to determine differences between the single and split-belt conditions at baseline and following a 10. min accommodation on the split-belt. The relationships between the change in base of gait and change in each kinematic variable were also determined. Results: On average, the base of gait was 3.7 cm wider on the split-belt treadmill with a 4 mm gap between belts. No significant differences were observed in the mean values of lower extremity kinematics or kinematic variability at baseline or following the 10. min accommodation. However, the increase in base of gait was significantly related to a decrease in peak knee and hip adduction angles. Conclusion: The 4 mm gap between the treadmill belts significantly increased the mean base of gait in all subjects. This did not alter mean frontal plane kinematics. However, as base of gait increased, the tendency towards hip and knee abduction also increased. © 2011 Elsevier B.V.


Altman A.R.,University of Delaware | Davis I.S.,University of Delaware | Davis I.S.,Drayer Physical Therapy Institute
Gait and Posture | Year: 2012

Footstrike patterns during running can be classified discretely into a rearfoot strike, midfoot strike and forefoot strike by visual observation. However, the footstrike pattern can also be classified on a continuum, ranging from 0% to 100% (extreme rearfoot to extreme forefoot) using the strike index, a measure requiring force plate data. When force data are not available, an alternative method to quantify the strike pattern must be used. The purpose of this paper was to quantify the continuum of foot strike patterns using an easily attainable kinematic measure, and compare it to the strike index measure. Force and kinematic data from twenty subjects were collected as they ran across an embedded force plate. Strike index and the footstrike angle were identified for the four running conditions of rearfoot strike, midfoot strike and forefoot strike, as well as barefoot. The footstrike angle was calculated as the angle of the foot with respect to the ground in the sagittal plane. Results indicated that the footstrike angle was significantly correlated with strike index. The linear regression model suggested that strike index can be accurately estimated, in both barefoot and shod conditions, in the absence of force data. © 2011 Elsevier B.V.


Fellin R.E.,University of Delaware | Rose W.C.,University of Delaware | Royer T.D.,University of Delaware | Davis I.S.,University of Delaware | Davis I.S.,Drayer Physical Therapy Institute
Journal of Science and Medicine in Sport | Year: 2010

When analysing gait, the identification of the period of stance is often needed. Forceplates are typically used, but in their absence kinematic data can be employed. Five kinematic methods have been previously described in the literature. However, these methods have not been compared to each other for overground or treadmill running. Therefore, the purpose of this study was to compare these five kinematic methods of identifying the stance phase with vertical ground reaction force data both during overground and treadmill running. We recruited forty recreational runners (20 males) for this study. Twenty runners underwent an instrumented gait analysis during overground running, and twenty were tested during instrumented treadmill running. All runners ran at 3.35. m/s. Each kinematic method was compared with stance identified from the vertical ground reaction force (gold standard) for overground running. This method was then repeated for treadmill running. Two methods were found to be valid and reliable for determining footstrike. These were the time when the distal heel marker reached a minimum vertical position, and when the vertical velocity of this same marker changed from negative to positive. These methods had absolute errors that ranged from 22.4. ms to 24.6. ms for both modes of running. Toe-off was best identified using peak knee extension, with absolute errors of 4.9. ms for overground running and 5.2. ms for treadmill running. Utilising automated kinematic methods of determining stance will aid researchers studying running when forceplates are unavailable. © 2010 Sports Medicine Australia.


PubMed | University of Kentucky, Eastern Kentucky University, Graduate Medical Education and Drayer Physical Therapy Institute
Type: Journal Article | Journal: Journal of hand therapy : official journal of the American Society of Hand Therapists | Year: 2016

Retrospective cohort design. The minimal clinically important difference (MCID) for the quick Disabilities of the Arm, Shoulder and Hand (QDASH) has been established using a pool of multiple conditions, and only exclusively for the shoulder. Understanding diagnoses-specific threshold change values can enhance the clinical decision-making process. Before and after QDASH scores for 406 participants with conditions of surgical distal radius fracture, non-surgical lateral epicondylitis, and surgical carpal tunnel release were obtained. The external anchor administered at each fourth visit was a 15-point global rating of change scale. The test-retest reliability of the QDASH was moderate for all diagnoses: intraclass correlation coefficient model 2, 1, for surgical distal radius=0.71; non-surgical lateral epicondylitis=0.69; and surgical carpal tunnel=0.69. The minimum detectable change at the 90% confidence level was 25.28; 22.49; and 27.63 points respectively; and the MCID values were 25.8; 15.8 and 18.7, respectively. For these three distal upper extremity conditions, a QDASH MCID of 16-26 points could represent the estimate of change in score that is important to the patient and guide clinicians through the decision-making process.

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