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169 JNPT is Officially Indexed in MEDLINE!!. Judith E. Deutsch, PT, PhD

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170 Center of Pressure Measures during Standing Tasks in Minimally Impaired Persons with Multiple Sclerosis. Gregory M. Karst, PT, PhD; Dawn M. Venema, PT, MPT; Tammy G. Roehrs, PT, MA, NCS; Amy E. Tyler, PhD

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181 Age- and Gender-related Test Performance in Community-dwelling Adults. T M Steffen, PT, PhD; L A Mollinger, PT, MSs

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CSM ABSTRACTS Platforms, Thematic Posters, & Posters for CSM 2006: PLATFORMS: Biomechanics and Motor Control Saturday 8: 00-11: 00 am

189 HETERONYMOUS REFLEXES IN THE PRIMARY AGONIST ARE ENHANCED WHEN SUPPORTING AN INERTIAL LOAD.. K. S. Maluf; Z. A. Riley; M. K. Anderson; B. K. Barry; S. S. Aidoor; R. M. Enoka


189 VIBRATION OF THE BICEPS BRACHII TENDON REDUCES TIME TO FAILURE WHEN MAINTAINING LIMB POSITION DURING A FATIGUING CONTRACTION.. C Mottram; K S Maluf; M K Anderson; J L Stephenson; R M Enoka


189 CUTANEOUS CUING DECREASES REACTION TIMES FOR STEP INITIATION.. C G Kukulka; E Olson; A Peters; K Podratz; C Quade


190 INFLUENCE OF AGE ON NEUROMUSCULAR CONTROL OF THE KNEE.. S Madhavan; S Burkart; G Carpenter; K Read; T Teckenburg; M Zwanziger; R Shields


190 DE-COUPLING GAIT PARAMETERS TO INVESTIGATE THE CONTRIBUTION OF STEP LENGTH TO FALL RISK.. D Espy; Y Pai; F Yang; J Sun


190 INFLUENCE OF HAMSTRING LOW FREQUENCY FATIGUE ON NEU-ROMUSCULAR CONTROL OF THE KNEE DURING WEIGHT BEARING EXERCISE.. M. Iguchi; A. Ganju; B. Ballantyne; R. Shields


190 CHANGES IN SELF-PERCEPTION OF TURNING FOLLOWING ROTATING TREADMILL STIMULATION.. G Earhart; S Wang; M Hong; E Stevens


191 RELATIONSHIP BETWEEN CHANGES IN MUSCLE SIZE FOLLOWING 12 WEEKS OF NMES INDUCED RESISTANCE TRAINING USING MRI and FIBER SPECIFIC ANALYSES IN PERSONS WITH COMPLETE SPINAL CORD INJURY.. A. Jayaraman; K. Vandenborne; E. M. Mahoney; G. A. Dudley; C. M. Gregory; S. C. Bickel


191 PERIPHERAL QUANTITATIVE COMPUTERIZED TOMOGRAPHY (PQCT): MEASUREMENT SENSITIVITY IN INDIVIDUALS WITH and WITHOUT SPINAL CORD INJURY.. S. Dudley-Javoroski; T. Corey; D. Fog; K. Hanish; J. Ruen; R. Shields


191 CHANGES IN SOLEUS MUSCLE FORCE and FATIGUE AFTER SPINAL CORD INJURY WITH TREADMILL LOCOMOTOR TRAINING IN RATS.. J E Stevens; W A O'Steen; D K Ander son; M Liu; K Vandenbor ne; P Bose; F J Thompson


192 EXAMINATION OF SPASTICITY OF THE KNEE FLEXORS and KNEE EXTENSORS USING ISOKINETIC DYNAMOMETRY and CLINICAL SCALES IN CHILDREN WITH SPINAL CORD INJURY.. S. Pierce; T. E. Johnston; R. T. Lauer


CSM ABSTRACTS Platforms, Thematic Posters, & Posters for CSM 2006: PLATFORMS: Parkinson Disease Saturday 1: 30-3: 30

192 TREADMILL EXERCISE TRAINING INDUCES ANGIOGENESIS and IMPROVES ENDURANCE and NEURONAL INDICATORS IN CHRONIC MOUSE MODEL OF

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Page 1 of 4Journal of Neurologic Physical Therapy - December 2005, Volume 29, Issue 4

4/1/2009http://www.jnpt.org/pt/re/jnpt/toc.01253086-200512000-00000.htm;jsessionid=JT5N2Cvn3...

PARKINSON'S DISEASE.. M. D. Al-Jarrah; L. Novikova; L. Stehno-Bittel; Y. Lau

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192 ADAPTATION OF VOLUNTARY STEP INITIATION IN PERSONS WITH PARKINSON'S DISEASE.. J. Spears; K. Ryczek; S. Schumacher; A. Orzel; J. Zhang; K. Martinez; M. E. Johnson; M. Mille; M. W. Rogers; T. Simuni


193 EVIDENCE FOR ACTIVITY-DEPENDENT NEUROPLASTICITY IN AN INDIVIDUAL WITH PARKINSON'S DISEASE: A TRANSCRANIAL MAGNETIC STIMULATION STUDY.. M. S. Fong; T. L. Brown; K. R. Wolcott; J. Lin; B. E. Fisher; A. Wu


193 FUNCTIONAL REACH: IS THIS A VALID MEASURE OF RECURRENT FALLS IN INDIVIDUALS WITH PARKINSON'S DISEASE?. J. Robichaud; Pfann D.M. Corcos; C. Cindy


193 RELIABILITY and VALIDITY OF THE TINETTI MOBILITY TEST FOR INDIVIDUALS WITH PARKINSON DISEASE.. D. Kegelmeyer; A. D. Kloos; S. K. Kostyk; K. M. Thomas


CSM ABSTRACTS Platforms, Thematic Posters, & Posters for CSM 2006: THEMATIC POSTERS: Imagery and Imaging Friday 4: 30-6: 00

194 REPRESENTATION OF IMAGINED and EXECUTED SEQUENTIAL FINGER MOVEMENTS OF ADULTS POST STROKE and HEALTHY CONTROLS.. J. E. Deutsch; S. Fischer; W. Liu; A. Kalnin; K. Mosier


194 RECOVERY FROM STROKE: WHAT IS THE ROLE OF THE UNDAMAGED, CONTRALESIONAL CORTEX?. L. Boyd; E. D. Vidoni


195 BRAIN ACTIVATION DURING KINESTHETIC and VISUAL IMAGERY OF WALKING.. C A Chatto; J E Deutsch; J. Pillai; T. Lavin; J. Allison


195 EFFECT OF WALKING VS SHAM TREATMENT ON FINGER MOVEMENT CONTROL and BRAIN REORGANIZATION IN WELL ELDERLY.. S. Anderson; H. Aldrich; S. Knight; C. Battles; J. R. Carey


195 INFLUENCE OF MOTOR-IMAGERY ABILITY ON SMA and PSMA CORTICAL ACTIVATION.. T. J. Kimberley; G. S. Khandekar


196 MOVEMENT CONTROL and CORTICAL ACTIVATION IN FUNCTIONAL ANKLE INSTABILITY.. K. Anderson; J. R. Carey


CSM ABSTRACTS Platforms, Thematic Posters, & Posters for CSM 2006: THEMATIC POSTER SESSION: Post-Stroke Hemiplegia Saturday 8: 00-11:

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196 SPLIT-BELT TREADMILL ADAPTATION and GAIT SYMMETRY POST-STROKE.. D S Reisman; A J Bastian


196 PARETIC LOWER EXTREMITY LOADING and WEIGHT TRANSFER FOLLOWING STROKE.. V. S. Mercer; S. Chang; J. L. Purser; J. K. Freburger


197 SINGLE LIMB BODY WEIGHT SUPPORTED TREADMILL TRAINING.. J. H. Kahn; T. Hornby


197 THE EFFECTS OF SPEED and LEVEL OF VOLUNTARY MUSCLE ACTIVATION ON REFLEX RESPONSES IN CHRONIC STROKE PATIENTS.. D. Nichols; M. Pelliccio; I. Black; J. Hidler


197 DYNAMIC WALKING STABILITY IN HEMIPARETIC CHRONIC STROKE SUBJECTS.. K. P. Brady; J. M. Hidler; M. C. Sinopoli


198 LOWER LIMB STRENGTH and COORDINATION PATTERNS OF CHRONIC STROKE SUBJECTS IN A FUNCTIONAL POSTURE.. M M Pelliccio; N Neckel; D Nichols; J Hidler


198 GAIT PARAMETERS ASSOCIATED WITH RESPONSIVENESS TO A TASK-SPECIFIC AND/OR STRENGTH TRAINING PROGRAM POST-STROKE.. T. Klassen; S. J. Mulroy; K. J. Sullivan


198 HIP JOINT POSITION AFFECTS VOLITIONAL KNEE EXTENSOR ACTIVITY POST-STROKE.. M. Lewek; T. Hornby; Y. Dhaher; B. Schmit


199 DEVELOPMENT and VALIDATION OF CIRCUMDUCTION ASSESSMENT SCALE FOR INDIVIDUALS WITH HEMIPLEGIA.. J L Moore; H R Roth; M. Lewek; Y Y. Dhaher; T G. Hornby




199 SENSORIMOTOR IMPAIRMENTS and REACHING PERFORMANCE IN PERSONS WITH HEMIPARESIS: RELATIONSHIPS DURING THE ACUTE and SUBACUTE PHASE AFTER STROKE.. J M. Wagner; C E. Lang; S A. Sahrmann; D. F. Edwards; A W. Dromerick


199 NEUROMUSCULAR STIMULATION IMPROVES GRASPING FUNCTION IN INDIVIDUALS WITH CHRONIC STROKE.. B. Quaney; L H. Zahner; M J. Santos; Z. Kadivar; B. McKiernan


200 BILATERAL MOTOR OUTPUTS FROM THE RETICULOSPINAL SYSTEM TO THE UPPER LIMBS DURING REACHING IN THE MONKEY.. J A. Buford; A G. Davidson


CSM ABSTRACTS Platforms, Thematic Posters, & Posters for CSM 2006: THEMATIC POSTER SESSION: Motor Learning Saturday 1: 30-3: 30

200 TELEREHABILITATION FOR MOTOR RETRAINING IN PATIENTS WITH STROKE.. M K. Holden; T. Dyar; E. Bizzi; L. Schwamm; L. Dayan-Cimadoro


200 EFFECTS OF RANDOM and BLOCKED ORDER PRACTICE ON MOTOR LEARNING IN INDIVIDUALS WITH PARKINSON DISEASE.. C. Lin; C J Winstein; K J Sullivan; A D Wu


201 LEARNING EFFECT ASSESSMENT ON SUBSEQUENT SUBJECT PERFORMANCE ON THE EQUITEST. BALANCE SYSTEM.. B. Gilliam; D. Charles; S. Kathmann; J. Smith; N. S. Darr; D. Greathouse


201 UPPER LIMB FUNCTIONAL RESPONSE TO MOTOR LEARNING ALONE and MOTOR LEARNING WITH FUNCTIONAL NEUROMUS-CULAR STIMULATION FOR STROKE SURVIVORS.. J J Daly; J. Rogers; I. Brenner; E. Perepezko; M. Dohring; E. Fredrickson; J. Gansen


202 PROCEDURAL LEARNING OF FUNCTIONAL MOBILITY TASKS IN THE PRESENCE OF SEVERE MEMORY DEFICITS FROM INTRAVEN-TRICULAR HEMORRHAGE.. K. A. Volk; R. O. Myers; E. Fitzpatrick-DeSalme


CSM ABSTRACTS Platforms, Thematic Posters, & Posters for CSM 2006: POSTERS

202 VASOMOTOR INNERVATION PATTERNS OF PERIPHERAL NERVES SUPPLYING THE DISTAL LOWER EXTREMITY.. R J Allen; E M Jefferson; V K Bhangu


202 LASER MICRODISSECTION OF BRAIN STEM NEURONS TO EXAMINE CHANGES IN GENE EXPRESSION AFTER SPINAL CORD INJURY.. S R Allen; J D Houle


202 MOVEMENT CONTROL and CORTICAL ACTIVATION IN FUNCTIONAL ANKLE INSTABILITY.. K. Anderson; J. R. Carey


203 EFFECT OF WALKING VS SHAM TREATMENT ON FINGER MOVEMENT CONTROL and BRAIN REORGANIZATION IN WELL ELDERLY.. S. Anderson; H. Aldrich; S. Knight; C. Battles


203 ASSESSING FACTORS IMPACTING COMMUNITY MOBILITY AFTER STROKE: A PILOT STUDY.. J. Beaverson; L. Beaudreau; J. Filkowski; C. A. Robinson; P. Noritake Matsuda; A. Shumway-Cook


203 DIAZEPAM TOLERANCE EFFECTS ON VESTIBULAR FUNCTION TESTS FOLLOWING REPEATED ORAL DOSES.. P A Blau; N. Schwade; P. Roland


203 THE EFFECTS OF BODY WEIGHT SUPPORTED GAIT TRAINING and FUNCTIONAL ELECTRICAL STIMULATION ON GAIT SPEED and CONTROL IN AN INDIVIDUAL WITH A TRAUMATIC BRAIN INJURY.. J. Bogle; D. Dennison; K. Gorgos; V. Stivala; M. Pascal


204 RECOVERY FROM STROKE: WHAT IS THE ROLE OF THE UNDAMAGED, CONTRALESIONAL CORTEX?. L. Boyd; E. D. Vidoni


204 DYNAMIC WALKING STABILITY IN HEMIPARETIC CHRONIC STROKE SUBJECTS.. K. P. Brady; J. M. Hidler; M. C. Sinopoli


204 RISK and PROTECTIVE FACTORS FOR FALLS AMONG INDIVIDUALS WITH INCOMPLETE SPINAL CORD INJURY.. S S Brotherton; J. S. Krause; P. J. Nietert


204 BILATERAL MOTOR OUTPUTS FROM THE RETICULOSPINAL SYSTEM TO THE UPPER LIMBS DURING REACHING IN THE MONKEY..




J. A. Buford; A. G. Davidson

204 EFFECT OF TYPE 2 DIABETES MELLITUS ON DECISION-MAKING and SELECTIVE ATTENTION.. S. D. Burns

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204 BRAIN ACTIVATION DURING KINESTHETIC and VISUAL IMAGERY OF WALKING. C. A. Chatto; J. E. Deutsch; J. Pillai; T. Lavin; J. Allison


204 THE PATIENT-REPORTED IMPACT OF SPASTICITY MEASURE (PRISM): A NEW MEASURE ASSESSING THE IMPACT OF SPACTICITY ON PERSONS WITH SPINAL CORD INJURY.. K. Cook; A. Williams; C. Teal; S. Robinson-Wheelen; J. Mahoney; J. C. Engebretson; K. Hart; A. M. Sherwood


205 UPPER LIMB FUNCTIONAL RESPONSE TO MOTOR LEARNING ALONE and MOTOR LEARNING WITH FUNCTIONAL NEUROMUS-CULAR STIMULATION FOR STROKE SURVIVORS.. J. J. Daly; J. Rogers; I. Brenner; E. Perepezko; M. Dohring; E. Fredrickson; J. Gansen


205 CONSTRAINT INDUCED MOVEMENT THERAPY FOR AN INDIVIDUAL EXHIBITING HEMIAKINESIA POST STROKE.. S. B. Davis; L. G. Richards; A. L. Behrman


205 REPRESENTATION OF IMAGINED and EXECUTED SEQUENTIAL FINGER MOVEMENTS OF ADULTS POST STROKE and HEALTHY CONTROLS.. J E Deutsch; S. Fischer; W. Liu; A. Kalnin; K. Mosier


205 VELOCITY OF VERTICAL and HORIZONTAL EYE MOVEMENTS IN PROGRESSIVE SUPRANUCLEAR PALSY.. K. E. Donley; M. J. Johnson; C. Zampieri; R. P. Di Fabio


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Journal ofNeurologicPhysicalTherapy EDITORJudith E. Deutsch, PT, PhDUMDNJ/SHRPPT ProgramBergen Bldg, Rm 110P.O. Box 1709Newark, NJ 07101-1709(W) 973/972-2373(Fax) 973/[email protected]

EDITORIAL BOARD

ABSTRACTS & REVIEWS

EDITORKathleen Gill-Body, DPT, MS, NCSBoston, [email protected]

Edelle Field-Fote, PT, PhDMiami, FL

James Gordon, PT, EdDLos Angeles, CA

Susan Herdman, PT, PhD, FAPTAAtlanta, GA

Patricia S. Pohl, PT, PhDKansas City, KS

Mark Rogers, PT, PhDChicago, IL

Margaret Schenkman, PT, PhDDenver, CO

CONSULTING EDITORSRebecca Craik, PT, PhD, FAPTAGlenside, PA

Carol Richards, PT, PhDQuebec, Canada

PUBLISHERSharon KlinskiOrthopaedic Section,APTA2920 E Ave S, Suite 200LaCrosse,WI 54601-7202(W) 608/788-3982, ext 202(Fax) 608/[email protected]

WEB MASTERCaduceusWebs Co.P.O. Box 2272Tallahassee, FL 32316800/[email protected]

Executive CommitteePRESIDENTKatherine Sullivan, PT, PhDDept. of Biokinesiology & PTUniversity of Southern California1540 E Alcazar St, Chp-155Los Angeles, CA 90089-0103(W) 323/442-2651(FAX) 323/[email protected]

VICE PRESIDENTMike Studer, PT, MHS, NCSNorthwestern RehabilitationAssociates1380 Liberty St SESalem, OR 97302(W) 503/371-0779(Fax) 503/[email protected]

SECRETARY Karen Mccullough, PT, PhD, NCSUniv. of NC Chapel HillDivisionof PT, CB 7135Chapel Hill, NC 27599-0001(W) 919/843-8783(Fax) 919/[email protected]

TREASUREREdelle Carmen Field-Fote, PT, PhDUniversity of Miami - PT5915 Ponce De Leon Blvd, 5th FloorCoral Gables, FL 33146-2435(W) 305/243-7119(Fax) 305/[email protected]

PROGRAM CHAIR Dorian Rose, PT, PhDN Florida/S Georgia Veterans-Health System1601 SW Archer Rd (151 B)Gainesville, FL 32608-1197(W) 352/376-1611, ext 4955(Fax) 352/[email protected]

EDITORJudith E. Deutsch, PT, PhD

EXECUTIVE OFFICERJanice M. FordNeurology Section1111 N Fairfax StreetAlexandria,VA 22313(W) 1-800/999-2782, ext 3237(FAX) 703/[email protected]

It is official, JNPT is indexed in MEDLINE. The national library of med-icine has confirmed that we meet all of the electronic formattingrequirements for inclusion in the index.We were also notified that index-ing will begin with the March 2005 issue.Only journals that are less than3 years old are backward indexed.

When I accepted the position of Neurology Report Editor, I wasasked how long I would do it. I really had no idea but ventured to guessthat it would be a 5-year commitment. My long-term goal was to preparethe journal for indexing in MEDLINE.Five years seemed like a reasonabletime frame. I thought that in fact I had estimated quite well and with thepublication of this issue I would complete 5 years of service,only to findout that this was the sixth year! Now I am asked how much longer willI stay on as Editor of JNPT? I still really do not know.We have a lot morework to do with the journal. It relates to streamlining our operation andtransferring some of the responsibilities that have been shouldered byvolunteers to paid staff as well as continuing to raise the level of the pub-lication and increase access and communication related to the journalby improving our electronic venue.

For now though, we can take a moment to reflect on achieving ourgoal of MEDLINE inclusion.This goal could only be achieved by workingwith committed members of the Section.The Editorial Board and peerreviewers and electronic media liaison (aka Jim Cavanaugh) formed thecore of that group. Of course the authors who have worked patientlywith us and represent both the new and more seasoned contributors toour field deserve credit as well. I think however, in the end, the reasonfor being considered in MEDLINE has to do with the evolution of ourspecialty, neurologic physical therapy. The journal is just the reflectionof the Section and its members who are clinicians, educators, and re-searchers that can converge and benefit from our singular publication.

169 Journal of Neurological Physical Therapy Vol. 29 • No. 4 • 2005

Editor’s Note: JNPT is OfficiallyIndexed in MEDLINE!

Judith E. Deutsch, PT, PhD, Editor JNPT

Vol. 29 • No. 4 • 2005 Journal of Neurological Physical Therapy 170

ABSTRACTBackground and Purpose: Balance impairments are

common in persons with multiple sclerosis (MS), but clini-cal balance tests may not detect subtle deficits in adultswith MS who are not yet experiencing functional limita-tions or disability. The purpose of this study was to deter-mine if center of pressure (COP) displacement duringstanding tasks could be a useful performance-based evalua-tive measure for adults with MS who have minimal or nobalance deficits on clinical examination using the BergBalance Scale (BBS). Subjects and Methods: Twenty-oneadults with MS were compared with 21 age- and gender-matched healthy adults. Subjects with MS were tested withthe BBS, Mini-mental State Exam, Expanded Disability StatusScale (EDSS), and Multiple Sclerosis Functional Composite(MSFC). They also performed voluntary leaning and reach-ing movements while kinematic and kinetic data were col-lected. Control subjects performed the same tasks with theexception of the EDSS and MSFC. Results: COP displace-ment during reaching and leaning was less in adults withMS when compared to control subjects. There were no dif-ferences in anthropometric, kinematic,or foot position vari-ables that could account for this difference. Furthermore,there was no difference between groups when COP dis-placement during reaching was expressed as a percentageof the maximum COP displacement during leaning.Discussion and Conclusion: COP measures show cleardifferences when comparing healthy adults with minimallyimpaired adults with MS. The lack of between-group differ-ences when COP displacement during reaching wasexpressed as a percentage of the maximum COP displace-ment during leaning suggests that the subjects with MSadopt a reaching strategy that allows them to stay withintheir reduced limits of stability. COP measures duringstanding tasks appear well-suited to quantifying changes inpostural control over time or in response to intervention forminimally impaired persons with MS.

Key Words: balance, reaching, postural control

INTRODUCTIONMultiple sclerosis (MS) is a chronic neurological disease

characterized by demyelination and inflammation of the cen-tral nervous system (CNS).1-4 The often progressive natureand variable sites of CNS involvement lead to varied presen-

tations of neurological dysfunction.1-3 People with MS oftenexperience difficulty with mobility, extremity function,somatosensation, vestibular function, vision, cognition, andbowel and bladder control.1-3 Balance is the result of complexinteractions between musculoskeletal and neuromuscularsystems, including sensory, motor, and integrative compo-nents.5,6 Because these components are frequently affectedby MS, many persons with MS have balance deficits.2,3,7-11

One objective of rehabilitative interventions for personswith MS is to address balance impairment.12-14 Clinicallybased tests such as the Berg Balance Scale (BBS), TinettiPerformance Oriented Mobility Assessment, and FunctionalReach test, among others, have been used to test balanceimpairment and functional mobility in persons withMS.9,11,12,15,16 These measures indicate whether or not an indi-vidual can perform a given task and can identify individualsat risk for falls. However, they may not be sensitive to min-imal impairments of balance in those persons not yet expe-riencing functional limitations or disability. An assessmentof balance that could identify subtle impairments beforethey lead to functional decline could promote earlier inter-vention and possibly prevent or delay functional limitationand disability.

Laboratory measures offer the potential to identify sub-tle deficits in postural control that may not be otherwiseapparent based on clinical tests.17 Force platforms are onelaboratory assessment tool that have been used to assesspostural control in individuals with MS during quiet stanceconditions7-10,18 or in dynamic conditions, namely inresponse to external perturbations such as support surfacemovements.8,10,19 In individuals with MS who demonstrateminimal or no balance impairment on clinical exam, somestudies have shown force plate measures in static anddynamic conditions to be sensitive to subtle balance impair-ments.8,10,18,19 However, some studies have shown staticstance to be less discriminating than dynamic testing.Nelson et al identified abnormal scores with sensory orga-nization testing in only 30% of subjects with MS in a ‘highfunction’group (defined as those who scored at least 24 outof 26 points on the Tinetti Performance Oriented MobilityAssessment).9 Similarly, Daley and Swank found only 6% ofsubjects with MS who were free from functional limitationshad abnormal sway in quiet stance with eyes open, and thispercentage increased to only 15% when the same subjectsstood with eyes closed.7 These results suggest that force

Center of Pressure Measures during Standing Tasks in MinimallyImpaired 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

1Associate Professor and Associate Director, Division of Physical Therapy Education, University of Nebraska Medical Center,Omaha, NE ([email protected])

2Graduate Teaching Assistant, Division of Physical Therapy Education, University of Nebraska Medical Center3Assistant Professor, Division of Physical Therapy Education, University of Nebraska Medical Center4was an Assistant Professor, Division of Physical Therapy Education, University of Nebraska Medical Center


plate measures under static conditions may not be a verysensitive measure in minimally impaired persons with MS,7-

9 but that dynamic testing shows promise.8,10,19

In contrast to testing postural control in response toexternal perturbations of the support surface, no studies todate have used a force platform to assess postural control inpersons with MS during voluntary movements such as thoseused during performance of daily activities. Voluntary upperextremity movements cause internally-generated perturba-tions to balance due to inertial effects and changes in theposition of the center of mass. It has been well documentedthat there is an anticipatory phase of postural activity in thetrunk and lower extremities prior to the initiation of armmovements in standing.20-27 These anticipatory posturaladjustments (APAs) include EMG activity in the trunk andlegs20-25,27 and changes in kinetic variables measured by a forceplatform.20-22,24,26 Researchers have hypothesized that the CNSemploys APAs to provide postural control in anticipation ofthe potentially destabilizing effects of the arm movement.20-23

One laboratory measure that can reflect an attempt bythe CNS to maintain an upright posture is the center ofpressure (COP).22,24-27 Center of pressure is the point ofapplication of the vertical ground reaction force.28 The COPdisplacement can be determined while subjects stand qui-etly on the force platform, or as they respond to perturba-tions, either internal or external, imposed on their bodies.Assessing COP displacement during a task such as standingand reaching provides a means for assessing postural con-trol in response to internally-generated perturbations in thecontext of a common functional activity.

The purpose of this study was to determine if the labora-tory measure of COP displacement during standing reachescould identify subtle changes in postural control in a groupof individuals with MS who showed minimal or no balancedeficits on clinical examination using the BBS. The task weanalyzed consisted of standing and reaching to various dis-tances, both within and beyond arms’ length. We also exam-ined limits of stability as reflected by the maximum COPexcursion in the sagittal plane while the subjects voluntarilyleaned as far anterior and posterior as possible without lossof balance. We hypothesized that the COP displacement vari-ables during rapid, bilateral reaching movements and leaningmovements would be different in minimally impaired sub-jects with MS when compared to a control group consistingof age- and gender-matched adults with no known orthope-dic or neurological impairments. A preliminary report ofthese results has been published in abstract form.29

METHODSSubjects

Subjects with MS were recruited through the Universityof Nebraska Medical Center (UNMC) MS clinic. Potentialsubjects were required to have a definite diagnosis of MS,30

be able to stand unassisted for 5 minutes, and be able toreach forward with both arms in standing without assis-tance. (Although there are newer criteria for the diagnosis

of MS,31 our subjects were recruited before these criteriawere published.) We operationally defined ‘minimal or nobalance impairment’ as a score of 48 or greater on the BBSbased on our desire to have some heterogeneity in our sam-ple of subjects with MS while avoiding subjects likely torequire an assistive device.15 As such, exclusion criteriaincluded a score on the BBS less than 48 out of 56, a scoreon the Mini-mental State Exam (MMSE) less than 20 out of30, the presence of coexisting neurological or orthopedicconditions that limited the subjects’ ability to perform thetesting protocol, or the use of an assistive device whilestanding or walking. Twenty-one subjects with MS, 15women (44.1 ± 8.38 years) and 6 men (50.2 ± 8.61 years)met the criteria for the study and were tested.

Control subjects were recruited through advertisementson the UNMC campus and website, and the local newspa-per. Recruitment of control subjects followed the recruit-ment and testing of subjects with MS, so that control sub-jects could be age- (± 2 years) and gender-matched. Controlsubjects were eligible to participate if they met the sameinclusion criteria as the subjects with MS, with the excep-tion of having a diagnosis of MS. The same exclusion crite-ria also applied to the control group. Twenty-one controlsubjects, 15 women (45.3 ± 8.56 years) and 6 men (49.7 ±8.41 years) met the criteria for the study and were tested.

The study protocol was approved by the UNMCInstitutional Review Board. All subjects provided writteninformed consent prior to participating in testing proce-dures, and all subjects participated in 2 testing sessions.

Clinical MeasuresBerg Balance Scale

The performance-based BBS consists of 14 tasks, withperformance rated on each task from 0 (cannot perform) to4 (normal performance) for a total of 56 possible points.32

The BBS has been shown to be a reliable32 and valid33 pre-dictor of fall status in older adults and patients with acutestroke. When combined with fall history, it has been shownto be a powerful predictor of fall risk in community-dwelling older adults.34 Reliability and validity of the BBShave not been established in persons with MS. However,the BBS has been found to change in response to rehabili-tation in adults with clinically stable MS.12 Also, a prelimi-nary study found a modest correlation (r = -0.498) betweenthe BBS score and self-reported falls in this population, aswell as a difference in mean BBS score between adults withMS who used an assistive device (mean = 42.1) and thosewho did not (mean = 49.3).15

Mini-mental State ExamThe MMSE is a 7-item test of general cognitive ability.35

Possible scores range from 0 to 30, with higher scores indi-cating better cognition.

Expanded Disability Status ScaleThe Expanded Disability Status Scale (EDSS) is an 11-

point scale (0 = normal neurological examination; 10 =


death due to MS) of general impairment and disability spe-cific to persons with MS.36 The EDSS has been widely usedfor many years to classify disease severity,37 but it has beencriticized because it is an ordinal scale based on subjectiveevaluation,38 it has poor inter-rater reliability,39,40 and itmixes components of impairment and disability.39,40

Additionally, the EDSS appears to be less sensitive tochanges in function than other scales.41-43 We included theEDSS, despite its limitations, to allow for comparison withprior studies that have characterized persons with MS interms of EDSS scores.

Multiple Sclerosis Functional CompositeDue to the limitations of the EDSS, the Multiple Sclerosis

Functional Composite (MSFC) was devised as a multidi-mensional tool to reflect the varied clinical presentations ofMS.37 It consists of 3 performance tests that measure 3 clin-ical dimensions of function: a Timed 25-Foot Walk (leg func-tion), the 9-Hole Peg Test (arm and hand function), and thePaced Auditory Serial Addition Test (cognitive function).The scores from these 3 dimensions are combined to forma composite Z-score that can be used to detect change overtime relative to the general population of persons with MS.

Laboratory MeasuresAccelerometry

The TSD 109C tri-axial piezoelectric accelerometer (out-put ± 5g, 400 mV/g; BIOPAC Systems, Inc., Santa Barbara,Calif) was calibrated prior to data collection according to itsmanufacturer. The accelerometer was attached to the radialside of each subject’s left wrist, with one of its axes ori-ented in the sagittal plane and perpendicular to the longaxis of the forearm. Onset of arm movement was deter-mined from the signal from this axis.

TargetThe target consisted of two 7.6 cm by 15.2 cm carbon

rubber electrodes mounted individually to a flexible foambar attached to a free-standing, lightweight metal frame.The frame could be adjusted so that the target was at shoul-der height and at appropriate distances for each subject.Two targets were used to promote symmetrical reachingwith both hands,however contact data were collected fromonly the left target. Subjects wore a metal thimble on theirleft index finger. Touching the thimble to the target closeda low-voltage circuit to indicate target acquisition.

Force platformDuring the leaning and reaching movements, subjects

stood on a strain gauge force platform (Advanced MechanicalTechnology, Inc.,Watertown, Mass) with their feet in a com-fortable stance and arms resting at their sides with theirpalms facing medially. Subjects were barefoot to minimizevariability in performance that may occur due to differencesin footwear. The position of each subject’s feet on the forceplatform was marked to maintain consistent foot position

during testing and so that individual characteristics such asfoot length and position could be determined. A researchassistant stood by the subject during testing to ensure main-tenance of foot position as well as to assist the subject in theevent of a loss of balance. Signals were collected for the ver-tical ground reaction force (Fz) and the moment of forceabout the mediolateral axis (Mx). Center of pressure move-ment in the sagittal plane (COPy) was calculated using thefollowing equation: COPy = Mx/Fz.

Kinematic dataIn order to assess movement velocity, 3-dimensional

kinematics of the hand were recorded using the WATS-MART 2-camera infrared motion analysis system (NorthernDigital, Waterloo, ON, Canada) with an infrared emittingdiode (IRED) placed on the left index fingertip. The 2 cam-eras were placed approximately 3 m away from the subjectsand oriented at approximately 60º apart. The cameras werecalibrated prior to data collection according to the manu-facturer’s specifications using a cubic calibration frame, andcalibration parameters were deemed acceptable if the over-all root-mean-square error for marker positions was lessthan 5 mm.

Data captureMP100 Workstation hardware and Acknowledge® soft-

ware (BIOPAC Systems, Inc., Santa Barbara, Calif) were usedwith one computer system to collect and store signals fromthe accelerometer, target circuit, and force platform ampli-fier. These signals were all sampled at a rate of 1000 Hzusing a 16-bit analog-to-digital converter. Electromyograph-ic data were collected simultaneously, but will be reportedin a separate communication. A second computer systemwas used to collect and store kinematic data from theinfrared motion analysis system using WATSMART hardwareand software. These signals were sampled at 250 Hz. Datacollection was synchronized between the two systemsusing a 5-volt electronic trigger signal.

Testing ProcedureTest sessions for subjects with multiple sclerosis

During the first test session,each subject with MS under-went a neurological examination consisting of the adminis-tration of the EDSS and the MMSE by a board-certified neu-rologist. The neurologist determined subjects’ ability toperform the standing and reaching task, and interviewedthem about current medications, age of onset, recent(within 6 months) fall history, and relevant orthopedic con-ditions. Additional clinical tests during the first test sessionincluded the BBS and MSFC, both conducted by a licensedphysical therapist.

Within 7 days of the clinical test session, subjects withMS returned for a second testing session to collect labora-tory data. Three items from the BBS were repeated to deter-mine the stability of the subject’s balance performanceacross test sessions. These items were: Item 1, sitting to


standing; Item 8, reaching forward with outstretched arm;and Item 14, standing on one foot. Arm’s length (AL) wasmeasured from the acromion to the tip of the index finger,and height measurements were taken.

The first laboratory task consisted of anterior and poste-rior leans. The subjects stood on the force platform andwere instructed to lean as far forward and backward as pos-sible without falling and to hold this position for 5 seconds.Subjects were asked to keep their feet flat on the floor andaligned with respect to the frontal plane, but stance widthand toe-out were not dictated to the subjects. Center ofpressure movement in the sagittal plane measurementswere recorded for a total of 4 leaning trials, 2 backward and2 forward.

The second laboratory task consisted of a series ofreaching movements performed from the same stance posi-tion as the leaning trials with the eyes open. Following theindication that the subject was ready, data collection wasinitiated after a random interval of 1 to 3 seconds. Five hun-dred milliseconds (ms) after the initiation of data collection,an audible tone was generated as the signal for the subjectto perform the movement. The subject was instructed toreach forward with both arms to touch a target placed atshoulder height. The subject was told to move as fast aspossible to minimize variation in the reaching activity,44 butthat reaction time in response to the tone was not impor-tant. The final reach position was held until the 3 seconddata 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 toplace the target at AL and control for differences in theamount of scapular protraction the subjects may have usedto reach the target, a rigid yardstick was used to measurefrom the anterior aspect of each subject’s acromion to thetarget as the subject stood on the force platform with theirarms held at their side. Distances of the target beyond andwithin AL were then determined from the AL position usinga tape measure placed on the floor under the frame onwhich the target was mounted. Target distance varied by 5cm increments from AL minus 10 cm to AL plus 20 cm (AL-10, AL-5, AL, AL+5, AL+10, AL+15, AL+20). A Latin Squaredesign45 was used to vary the order of target distance acrosssubjects. One subject with MS (subject M13) was unable tosafely reach the furthest target distance, and therefore per-formed only 30 reaches to 6 target distances. Subjects wereallowed up to 5 practice reaches to the AL+10 distanceprior to data collection. If visible movement of the subject’sarms or trunk occurred prior to the auditory ‘go’ signal, ifthe movement appeared markedly slower than other trialsat the same distance, or if the target was missed, the trialwas repeated.

Test sessions for control subjectsControl subjects also participated in 2 testing sessions.

During the first session, the control subjects’ orthopedic

and neurologic health was confirmed by the same board-certified neurologist that examined the subjects with MS.The second testing session occurred within 60 days of thefirst test session. At the second test session, a licensed phys-ical therapist administered the BBS and the MMSE. Testingof leaning and reaching movements for control subjectsinvolved the same instrumentation and protocol as thatdescribed for subjects with MS.

Data ReductionFoot position data

Figure 1 provides operational definitions for foot posi-tion characteristics from one representative control sub-ject. The following variables were determined from the foottracings for all subjects: foot length (the distance from thegreat toe to the mid-point of the calcaneus), toe distance(the distance between the great toes),heel distance (the dis-tance between the mid-points of the calcanei), and anterior-posterior base of support (AP BOS; the sagittal plane dis-tance between the most anterior and most posterior pointof contact on the force plate). Foot position was defined asthe ratio of in- or out-toeing determined by dividing the toedistance by the heel distance, with ratios greater than oneindicating a toe-out position.

Kinematic dataThree-dimensional position data from the IRED placed at

the tip of the index finger were low pass filtered (12 Hz)and differentiated to determine peak tangential velocity ofthe fingertip and time to peak tangential velocity relative tomovement onset for each trial. Averages of peak tangentialvelocity and time to peak tangential velocity for each reachdistance for each subject were calculated. The two groupswere compared across distances.

Arm movement onsets were identified for each trial foreach subject from the accelerometer signal using a com-

Toe Distance

Foot Length

Heel Distance

AP BOS

Figure 1. Foot tracing for a representative control subject withoperational definitions for foot placement characteristics. Footlength is defined as the distance from the great toe to the mid-pointof the calcaneus. Heel distance is defined as the distance betweenthe mid-point of the calcanei. Toe distance is defined as the dis-tance between the great toes. Anterior-posterior base of support(AP BOS) is defined as the sagittal plane distance between the mostanterior and most posterior point of contact on the force plate.


puter algorithm. The algorithm identified peak wrist accel-eration, and then searched backwards in time to when theacceleration trace first exceeded the baseline. Baseline ofthe acceleration trace was defined as the mean value of thesignal over the first 250 ms of the sampling period (the sam-pling period having started 500 ms prior to the tone). Theonsets identified by the computer were visually confirmedby one of the investigators. If the onset was uncertainbecause of artifacts that may have been due to backwardmovement of the hand or slow hand movement prior toonset of the reach, the trial was rejected. Out of a total of1465 trials, 27 (2%) were rejected because of difficulties inidentifying the onset of arm movement.

Kinetic dataCenter 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. Figure2A shows the change in COPy position over time (0 cm =initial starting position of the subject) during reaching todistance AL+20 for one representative healthy subject. Thistrace represents the average of 5 reaches, aligned to theonset of arm movement (time = 0 ms), and illustrates howCOPy displacements were calculated. Negative values(COPy-) represent movement of COPy in the posteriordirection,and positive values (COPy+) represent movementof 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 displacementwas defined as the difference between the COPy position inthe subject’s initial resting posture and the COPy positionin the final reach posture. Initial COPy position was calcu-lated as the mean value over 250 ms prior to the ‘go’ signaland final COPy position was based on the mean value over250 ms after the subject had attained the final reach pos-ture. When comparing groups, the peak-to-peak and netCOPy displacements were adjusted for each subject toaccount for differences in foot length and placement bydividing these values by the subject’s AP BOS.

Figure 2B shows COPy position data from one represen-tative subject with MS during 2 leaning trials (1 backwardand 1 forward). Zero on the x-axis represents the initialstarting position of the subject. Changes in COPy positionin the positive direction on the y-axis represent anteriorleans, while posterior leans result in negative values ofCOPy position. The limit of stability in the anterior-poste-rior direction (LOSAP) was defined as the differencebetween a subject’s most anterior and most posterior posi-tion of the COPy during the leaning trials. The percentageof the LOSAP used during the reaching task was also calcu-lated as: (peak-to-peak COPy/LOSAP) x 100.

Statistical AnalysisPaired two-tailed t-tests were used to compare the 2

groups of subjects on the following variables that may have

had an influence on the task: height, arm length, footlength, foot position, and AP BOS. Paired two-tailed t-testswere also used to compare groups on LOSAP during the lean-ing trials. Two-way ANOVAs (group x target distance) with

Figure 2. A. Change in center of pressure in the sagittal plane(COPy) position over time during reaching to a distance of arm’slength plus 20 cm (AL+20). Data are from a representative controlsubject. The trace represents the average of five trials to this dis-tance. The x-axis depicts time in ms, with the five trials aligned sothat zero ms is the point in time that arm movement began. They-axis shows COPy position in cm relative to the initial startingposition (0 cm) of the subject. Negative values (COPy-) indicatemovement of the subject’s COPy in the posterior direction, whilepositive values (COPy+) indicate movement in the anterior direc-tion. The dotted lines indicate the initial and final COPy positions.The initial COPy position was calculated as the mean value over250 ms prior to the “go” signal. The final COPy position was deter-mined from the mean value over 250 ms after the subject hadattained the final reach posture. COPy net is the differencebetween the initial and final positions of COPy. Dashed lines indi-cate the maximum COPy- and COPy+ positions. COPy peak-to-peak is the difference between the maximal COPy- and COPy+positions. COPy+ and COPy- are calculated relative to the initialCOPy position. B. Changes in COPy position for a representativesubject with MS during leaning trials. Data are shown for 2 leans,one anterior and one posterior. Data were collected for a total of5 seconds (x-axis). The y-axis depicts COPy position relative to theinitial starting position (0 cm) of the subject. The limit of stabilityin the anterior-posterior direction (LOSAP) is defined as the differ-ence between the most anterior and most posterior position of theCOPy during the leaning trials.


one repeated measure (target distance) were used to evalu-ate group differences and the effects of target distance onCOPy net, COPy+, COPy- and COPy peak-to-peak displace-ment, percentage of LOSAP used during the reaching task,peak tangential velocity of the fingertip, and time to peaktangential velocity of the fingertip. Tukey’s test was used forpost-hoc multiple comparisons for the variable of reach dis-tance. The alpha level was set at P ≤ 0.05. Microsoft® Excel2002 (Microsoft Corporation, Redmond,WA) and SigmaStatfor Windows Version 2.03 (SPSS, Inc.,Chicago,Ill) were usedfor data analysis.

RESULTS Subject Characteristics

Descriptive characteristics (mean ± SD) for all subjectsare listed in Table 1. Subjects were matched for age (± 2years) and gender. Paired two-tailed t-tests revealed thatsubjects with MS did not differ from control subjects on anyof the other variables listed in Table 1.

Table 2 provides clinical characteristics for all subjectswith MS. These subjects scored well on the various clinicaltests. Ten out of the 21 subjects scored the maximum num-ber of points (56) on the BBS, with a median score of 55

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

Control Subjects Subjects withMultiple Sclerosis

Gender 6M/15F 6M/15F

Age (years)(mean ± SD) 46.6 ± 8.8 46.0 ± 8.7(range) 28 – 65 28 - 65

Height (cm)(mean ± SD) 169.3 ± 8.4 169.3 ± 8.7(range) 153.7 – 185.4 156.2 – 185.4

Arm Length (cm)(mean ± SD) 73.4 ± 3.7 73.5 ± 4.7(range) 67.3 – 81.3 66.0 – 83.8

Foot Length (cm)(mean ± SD) 25.4 ± 1.6 26.0 ± 1.4(range) 22.9 – 28.5 23.9 – 28.8

Foot Position (toe distance/heel distance)

(mean ± SD) 1.41 ± 0.31 1.24 ± 0.36(range) 0.98 – 2.33 0.81 – 2.35

AP BOS* (cm)(mean ± SD) 25.9 ± 1.8 26.7 ± 1.5(range) 23.4 – 29.4 24.1 – 29.4

*AP BOS = anterior-posterior base of support (the sagittal plane distance between the most anterior and most posterior point of contact on the force plate)

Table 1. General Characteristics of Subjects. Subjects were matched forage (± 2 years) and gender. Groups did not differ on other variables listed.


(one control subject scored 55, all other control subjectsscored 56 on the BBS). The median score on the EDSS was2.0 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 thanthe 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 secondtest session, only 4 subjects differed on the 3 items thatwere repeated, and only by one point each.

Kinematic variablesThere were significant main effects of reach distance on

peak tangential velocity of the fingertip and time-to-peaktangential velocity (P < 0.001 for each variable). There wasno between-group difference in peak tangential velocity ortime-to-peak tangential velocity, and no group x distanceinteraction.

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 overa 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 takeninto account and the LOSAP was expressed as a percentageof the base of support.

Center of Pressure Movement in the Sagittal Plane:Reach Trials

Figure 3A depicts mean (± SD) net and Figure 3B showsmean (± SD) peak-to-peak COPy displacements for bothgroups of subjects across reach distances after AP BOS wastaken into account. For both groups, COPy net displace-ment increased as target distance increased (P < 0.001), butthere was no difference between groups and no group xdistance interaction. Figure 3B illustrates that there was adifference in peak-to-peak COPy displacement betweengroups (P < 0.001), with control subjects showing greaterpeak-to-peak COPy displacement. The greater peak-to-peakCOPy displacement in the control group was primarily dueto a significant difference in COPy+, while COPy- did notdiffer significantly between groups. Peak-to-peak COPy dis-placement increased as target distance increased (P <0.001), but there was no group x distance interaction.

Group LOSAP* (cm) LOSAP/ AP BOS† (%)(mean±SD) (mean±SD)

Subjects with MultipleSclerosis (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

Table 3. Group Differences During Lean Trials. Control subjectsdemonstrated 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 =0.002).

Figure 3. A. Mean net COPy displacement for both groups duringreaches to each distance. Reach distance in cm relative to arm’slength is depicted along the x-axis. Reach distances varied by 5 cmincrements and ranged from 10 cm short of arm’s length to 20 cmbeyond arm’s length. (AL-10, AL-5, AL, AL+5, AL+10, AL+15, AL+20).COPy displacement is expressed as a percentage of each subject’sAP BOS and is represented along the y-axis as means (±SD) of eachgroup. The black bars represent subjects with MS and the whitebars represent control subjects. B. Mean peak-to-peak COPy dis-placement for both groups during reaches to each distance. Axesare the same as in Fig 3A. The black bars represent subjects withMS, while the white bars represent control subjects. C. Mean per-centage of LOSAP used during reaching for both groups to all targetdistances. The x-axis is as in Figure 3A. The percentage of LOSAP

used during reaching was calculated by dividing the COPy peak-to-peak displacement during reaching by the LOSAP determined fromthe leaning trials for each subject. These values are expressed asmeans (±SD) for each group along the y-axis. The black bars rep-resent subjects with MS, while the white bars represent controlsubjects.


The percentage of the LOSAP used during the reachingtask was evaluated for each group. Figure 3C illustrates themean (± SD) percentage of the LOSAP used for peak-to-peakCOPy displacement during the reaching task to each dis-tance. Percentage of LOSAP used increased as target distanceincreased, with means approaching 100% for both groupsfor the longest distance. For the longest reaches, some indi-vidual subjects in each group demonstrated peak-to-peakCOPy displacement greater than the LOSAP they demon-strated during the leaning task. There was an effect for distance on the percentage of LOSAP used during reaching(p < 0.001), but there was no difference between groupsand no group x distance interaction.

Secondary Analysis of Center of Pressure Movementin the Sagittal Plane During Reaching

A secondary analysis was performed in order to deter-mine if significant differences in COPy measures could stillbe seen when comparing healthy subjects to those subjectswith MS who had the least balance impairments based onBBS scores. To do this, we divided the subjects into 3groups: Healthy subjects with a BBS score of 55 or 56 (n =21; 1 with a BBS score of 55), subjects with MS and a BBSscore of 55 or 56 (n = 12;2 with a BBS score of 55),and sub-jects with MS and a BBS score < 55 (n = 9; mean ± SD BBSscore of 52 ± 2). Both groups with MS still differed signifi-cantly (P ≤ .02) from the Healthy group on COPy peak-to-peak and COPy+ measures. The mean values for 2 groupswith MS did not differ significantly, but the test was under-powered after dividing the subjects with MS into 2 groups.

DISCUSSIONWe found differences in COPy measurements between a

group of minimally impaired adults with MS and age- andgender-matched control subjects, during rapid reaches tovarious target distances and during leaning movements.These differences persisted even when the control subjectswere compared only to the 12 subjects with MS whoscored the highest (55 or 56) on the BBS. Specific variablesthat these groups differed on included their LOSAP duringmaximum leans and their peak-to-peak COPy and anterior(COPy+) displacement during the reaching tasks. These dif-ferences cannot be explained by differences in anthropo-metric variables, differences in foot position, or differencesin movement kinematics as assessed by peak tangentialvelocity of the fingertip and time to peak tangential veloc-ity.

Variations in foot position in quiet standing have beenfound to affect postural sway and mean position of COP.46

Kaminski and Simpkins26 found increases in COPy displace-ments in healthy subjects using a step stance (right footahead of the left at a distance equal to 40% of leg length),when compared to subjects in parallel stance during stand-ing reaches to distances greater than AL. They suggested theincrease in COPy displacement occurred to assist wholebody motion to the target. We examined AP BOS in our

study and did not find a difference between groups. We fur-ther controlled for this variable by dividing each subject’sLOSAP and COPy displacements by their AP BOS before com-paring groups. Additionally, there was no differencebetween groups in foot position variables (heel distance,toe distance, or ratio of toe distance to heel distance).Therefore, differences in stance configuration cannotaccount for differences in LOSAP or peak-to-peak COPybetween the two groups.

Greater arm velocity during reaching movements is asso-ciated with earlier activation of postural muscles andgreater response magnitude.44 However, in our study, kine-matic variables of peak tangential velocity of the fingertipand time to reach peak tangential velocity did not differbetween groups. Consequently, the greater COPy excur-sions observed in healthy individuals do not appear to bedue to differences in movement speed.

The Functional Reach (FR) was developed as a test ofbalance in response to the voluntary movement of reach-ing, and was found to correlate with COP excursion (r =0.71).47 Frzovic et al found that the FR was a useful test todifferentiate between adults with MS and control subjects.11

In contrast to the relatively slow, unilateral reaches per-formed in the FR test, the reaching task used in this studywas intended to produce greater postural control demandsduring a task of reaching while standing. Horak et al foundthat postural muscle activity was more variable, was some-times absent, and did not always precede arm movementwhen subjects were asked to raise their arms slowly com-pared to quick arm movements.44 They speculated that lessstabilization force is necessary during low velocity move-ments. While the FR is destabilizing in that subjects mustdisplace their center of mass to perform reaches to theirmaximal distance, the rapid arm movements used in thisstudy would generate larger inertial forces in addition to dis-placing the body center of mass. Furthermore, consistentwith previous findings,20-22,24,26 changes in COPy occurredprior to the internal perturbation of rapid arm movement,indicating anticipatory behavior. Thus, we would suggestthat the rapid, goal-directed reaching paradigm used in thisstudy provides additional information not gained with theFR alone.

Subjects with MS demonstrated smaller LOSAP than ourcontrol group. The smaller LOSAP demonstrated by subjectswith MS in our study suggests that our subjects were lesswilling and/or able to deviate from their initial COP posi-tion in the sagittal plane when compared to individualswith no neurological impairment, indicating a voluntary orinvoluntary self-limiting strategy. Interestingly, there wereno differences between groups in the percent of LOSAP usedfor peak-to-peak COPy displacement during the reachingtasks. For both groups, percent of LOSAP used during reach-ing increased as target distance increased, nearing 100% forthe longest distances. The fact that there was no differencebetween groups on this variable suggests that the subjectswith MS were instinctively aware of their limitations, and


were able to find a strategy to achieve the same task as thecontrols, despite their decreased LOSAP.

Reach distance had a main effect for many of the vari-ables in our study, including net COPy displacement, peak-to-peak COPy displacement, COPy+ and COPy- displace-ment, percentage of LOSAP used during reaching, peaktangential velocity of the fingertip, and time to peak tan-gential velocity of the fingertip. Systematic differences inCOPy displacement with reach distance have been previ-ously found in healthy young adults25-27 as well as healthyelderly.25 In these studies, COPy trajectories were qualita-tively similar across reach distances, with COPy initiallymoving posteriorly, then anteriorly, then to a relativelysteady final position. In addition, these authors found thatas target distance increased, net and peak-to-peak COPy dis-placement increased. Our findings are consistent withthese qualitative patterns of COPy during reaching as wellas the main effect of reach distance on net and peak-to-peakCOPy displacement. In addition, we found the qualitativepattern of the COPy displacement during reach to be iden-tical in all subjects tested, regardless of whether or not theyhad a diagnosis of MS.

In the interest of simplicity, we chose not to report eachpair-wise difference found with post-hoc testing. In gen-eral, differences were found between most pairs of reachdistances for all of the COPy variables, with the exceptionof the two shortest distances (AL-10 and AL-5). This findingis in agreement with previous studies of healthy sub-jects.25,27 We suggest that in future studies, the task could bestreamlined to include only one short and one long distancewithout losing the salient features of the data. Furthermore,because of the complex and multidimensional nature of bal-ance, there is no single test that adequately assesses bal-ance.5 Streamlining this reaching task would allow moretime to assess patients or subjects with other types of bal-ance tests such as sensory manipulation, external perturba-tions, or functional scales.

Our study found that healthy subjects demonstrated sig-nificantly more peak-to-peak COPy displacement than sub-jects with MS during reaching movements. However,no dif-ferences were found between groups in net COPydisplacement (the difference between the initial and finalCOPy positions). The fact that there was no difference innet COPy between groups indicates that both groups wereable to successfully reach the target and maintain contactwith it. Since the peak-to-peak COPy gives insight into thepattern of COPy movement prior to reaching the target, thesignificant difference in peak-to-peak COPy displacementsuggests that subjects with MS used different movementstrategies to achieve target acquisition.

The adults with MS in this study appeared minimallyaffected when assessed with standard clinical tests (seeTable 2). For instance, a clinician scoring most of these sub-jects on the BBS would not document a substantial balanceimpairment based on their scores. However, the subjectswith MS demonstrated differences from healthy control

subjects on COPy variables, implying that the BBS had a ceil-ing effect and failed to detect subtle balance deficits in thispopulation. Other studies have suggested a ceiling effect inthe BBS with elderly persons.48,49 Furthermore, the BBS maylack sensitivity to change for subjects such as those in ourstudy, with little room left for improvement in response tointervention.

The instrumented measures used here may be more sen-sitive than common clinical tests for objectively document-ing both deficits and improvements in balance. With forceplate technology becoming more common in physical ther-apy clinics, these variables would be easy to capture as partof a physical therapy examination. Because MS is a pro-gressive disease, tools to measure balance impairments dur-ing early stages of the disease may lead to identification ofpersons at risk for future decline and lead to earlier inter-vention.

CONCLUSIONOur data demonstrate that peak-to-peak COPy and

COPy+ displacement during reaching, as well LOSAP duringleaning, are less in minimally impaired adults with MS thanin age- and gender-matched control subjects. However,there was no difference between these groups when theCOPy displacement during reaching was expressed as a per-centage of the LOSAP during leaning. This suggests that per-sons with minimal impairments due to MS were instinctivelyaware of their limitations, and were able to find a strategy toachieve the same task as the controls, while staying withintheir decreased LOSAP. These center of pressure measuresshow clear differences in persons with MS who show littleor no deficit on clinical measures such as the BBS whencompared to a healthy control group.The usefulness of COP-related variables to measure change, either over time or inresponse to intervention, is worth further exploration.

ACKNOWLEDGEMENTSThis work was supported in part by a Pilot Research

Award from the National Multiple Sclerosis Society. TheNebraska Bankers Association provided funding for theforce platform. We would also like to thank Eliad Culcea,MD; Grace Johnson, PT, OCS; Janis McCullough, PT, DPT;Wade Lucas, PT, DPT; and Thomas Spray, PT, DPT for assis-tance with data collection and analysis.

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15 Dieruf KA,Foley A,Ford CC.Correlation of the Berg bal-ance test with falling and assistive device use in peoplewith MS. Neurol Report. 1999;23:193.

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Mechanisms.Vol 2. Portland, Ore: University of OregonBooks; 1992:118-121.

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ABSTRACTObjective: Interpretation of patient scores on func-

tional tests is enhanced by an understanding of test perfor-mance in reference groups.The purpose of this study wasto expand performance values, by age and gender, on bal-ance tests [the Multi-Directional Reach (MDRT); BergBalance (BBS); Sharpened Romberg, eyes open (SREO), eyesclosed (SREC); Activities-Specific Balance Confidence(ABC)], and a general mobility test [Physical PerformanceTest, (PPT-7, PPT-9)].The study also examined relationshipsbetween test performance and subject characteristics.Design and Subjects: Eighty-three community-dwellingadults over 50 participated in the study and completed the5 functional tests during one test session. Means, standarddeviations, and confidence intervals were calculated foreach of the tests. Multiple linear regression analysis wasused to examine relationships between test scores and age,gender, height, and weight. Results: Test performance isreported by gender, within 10-year age cohorts. Regressionanalysis showed that age contributed significantly to pre-diction of performance on all of the tests and gender con-tributed significantly to prediction of scores on the Berg,SREO, and SREC. Conclusions:Test performance values, ina sample of community-dwelling adults, is provided by ageand gender cohorts to provide additional reference datathat can be used by clinicians for comparison with clientdata. The small sample size for subjects over 80 years limitsthe reference value of data for this age group. In regressionanalyses, age and gender help predict outcomes on thedependent variables used in the study.

Key Words: Multi-directional Reach Test, Berg Balance Scale,Sharpened Romberg,Activities-specific Balance ConfidenceScale, Physical Performance Test

INTRODUCTIONIn the patient examination, physical therapists include

tests at the disablement levels of impairment and functionallimitation in order to determine a physical therapy diagno-sis, prognosis, and plan of care.1 These tests can be used todocument progress during therapy and to compare thepatient’s performance with that of a target reference group.As tests of functional limitations develop, there is a need forparallel development of performance data in referencegroups.

Several functional-level tests that are practical for clinicaluse and of interest to the authors are the subscales of the

Multi-directional Reach Test (MDRT), the Berg Balance Scale(BBS), the Sharpened Romberg test with eyes open (SREO)or with eyes closed (SREC), the Activities-Specific BalanceConfidence Scale (ABC), and 2 versions of the PhysicalPerformance Test (PPT-7 and PPT-9).The MDRT, BBS, SREO,SREC, and ABC were all designed to capture aspects of bal-ance performance or perceived balance confidence. ThePPT was designed to measure aspects of general physicalmobility. The literature provides varying levels of studyregarding the reliability and validity of these tests and somemean group data.A brief review of this literature follows asbackground for the main purpose of this study which wasto provide additional reference data for clinicians usingthese tests with patient groups.

Multi-directional Reach TestThis clinical test of the limits of postural stability in 4

directions during standing2 has been shown to have goodintra-rater reliability in community-dwelling older adults.3

For the lateral reaches, inter-rater reliability4 and test-retestreliability5 were also high. The forward reach has shownhigh intra- and inter-rater reliability6-14 and high test-retestreliability.15 Construct validity was supported with signifi-cant correlations between laboratory measures of excur-sion of the center of pressure with lateral reach5 and for-ward reach.9 Concurrent validity of the MDRT wassupported with correlations with other functional tests.3

Brauer et al5 found an inverse correlation between theMDRT results and age. Newton3 has reported mean data forthe MDRT (n = 254) in an ethnically-mixed sample of com-munity-dwelling older adults, although these data are notcategorized by age or gender.Other reference data are avail-able for older females for lateral reach.4,5

Berg Balance ScaleThis performance-oriented measure of balance during

standing activities16 has been shown to have high intra- andinter-rater reliability17-21 and good internal consistency16,22 inpopulations of healthy or disabled older adults living in thecommunity or in residential care facilities. Concurrentvalidity has been supported by moderate to high correla-tions between the BBS and other functional measuresamong older adults at different functional levels (ie, institu-tionalized, hospitalized, community-dwelling, post-stroke,fallers, or with a range of balance abilities).11,18-21,23,24

Increasing age was shown to relate to decreasing BBS

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

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

1Program Director in Physical Therapy, Concordia University Wisconsin, 12800 N Lake Shore Dr., Mequon, WI([email protected])2Assistant Professor in Physical Therapy, Concordia University Wisconsin, 12800 N Lake Shore Dr., Mequon,WI


scores in a study of community-dwelling elderly.25 An aver-age summary test score for older adults living in the com-munity has been reported by Newton3 and Hatch et al.26

Reference data by gender and 10-year age cohorts for com-munity-dwelling seniors has been reported once for theBBS.25

Sharpened RombergThis measure of ability to maintain balance during tan-

dem standing, with eyes open and eyes closed,27 has beenshown to have good intra- and inter-rater reliability inhealthy older women7 and good test-retest reliability inhealthy young adults.28 Significant correlations of the SREOand SREC with other balance tests support concurrentvalidity of the Romberg tests.7 Age and SREC were inverselyrelated in community-dwelling male subjects.29 Mean datahave been reported for community-dwelling males,29

females,30,31 and active or inactive former athletes.32

Activities-specific Balance Confidence ScaleThis self-report measure of an individual’s confidence in

performing common mobility tasks33 has been shown tohave good test-retest reliability and internal consistency incommunity seniors.33 Correlations between the ABC andthe Dizziness Handicap Inventory support concurrent valid-ity.34 Myers et al35 found no significant difference betweenmales and females on ABC scores. In subjects from inde-pendent senior facilities (n = 287), Kressig et al36 found nocorrelation between age and ABC scores. Hatch et al26

reported a mean score for 50 community dwelling olderadults.

Physical Performance TestThe PPT is available in a 9- (PPT-9) or 7-item (PPT-7)

form. Both versions share the same first 7 items. This per-formance measure of multiple aspects of upper and lowerextremity function37 has been shown to have good inter-rater reliability and internal consistency in community-dwelling older adults for the PPT-7 and PPT-937,38 and goodtest- retest reliability for the PPT-7 in persons withParkinson disease.39 Validity of the PPT-7 has also beenshown through correlations with functional tests.38,40 ThePPT-7 was shown to be negatively correlated with age inolder adults.37 A mean score for the PPT-9 has been reportedfor community-dwelling older men.41 Mean values for thePPT-7 have been reported for community-dwelling seniors42-

44 and for various groups of frail elderly persons.38,39,45-48

Reference data in community-dwelling women by agecohort on the PPT-7 have been reported.49

Although the literature currently provides some refer-ence data for these tests of function, it is seldom reportedby age and gender cohorts. Based on literature suggestingrelationships between test scores and age,5,25,29,37 it seemsvaluable to provide clinicians with reference data catego-rized by age. It is also reasonable to expect gender differ-ences in functional performance,as reported for some func-

tional tests not included in this study.50-53 Of the functionaltests examined in this study, the MDRT is the most recentlyintroduced and has the least amount of literature support-ing its interpretation.

The purposes of this study were to: (1) provide addi-tional reference values for clinical tests of balance andmobility using a sample of independently functioning com-munity-dwelling adults over age 50; (2) present test perfor-mance values in age and gender categories; (3) identifywhether age, gender, height, or weight contribute to pre-diction of test scores.

METHODSThis study was approved by the University Institutional

Review Board. Community-dwelling adults were recruitedvia notices in churches, University bulletins, flyers aroundthe local area,and contacts with local senior centers.Eighty-three community-dwelling adults between the ages of 50and 90, volunteered for the study. All volunteers werescreened by telephone for inclusion in the study. Inclusioncriteria included: ability to stand for one minute indepen-dently, ability to walk 50 feet without sitting to rest, no useof an assistive device, no heart condition that would limitactivity, and no fainting spells or extended dizziness. Thesecriteria assured that all subjects would be able to completethe tests. No volunteer was excluded based on the screen-ing.All subjects provided informed consent.

Data collection was completed within a 50-minute ses-sion for each subject. Descriptive data were collected,including age, height, weight, medical diagnoses, number ofmedications used, and number of falls in the past 6 months.All subjects completed the functional tests in the followingorder: ABC Scale, BBS, SREO, SREC, MDRT (forward, right,left, backwards), and the PPT-9. All subjects were offeredrests and water during the session and completed the 50minute testing protocol without complaint of fatigue or dis-comfort. Throughout the data collection period, each testwas administered by the same testers. These testers werephysical therapy students who were experienced in the testprotocols and had completed a pilot study of the tests on 15subjects prior to initiation of data collection for this study.

MDRT. This test requires the subject to lean maximallyforward, backwards, to the right, and to the left.2 Distanceof the lean was measured as the excursion of the thirdmetacarpal head from the start to end positions, with thearm extended forward (or to the side), during the leaningtrials. The subject stood with the heels 10 cm apart andeach foot angled at 15° of out-toeing. For each direction ofthe MDRT,1 practice and 3 recorded trials were performed.Subjects were instructed to keep feet flat on the floor, raisethe dominant arm to match the height of a yardstickclamped onto a camera tripod set at acromion height, andmake a fist with the extended hand (Figure 1). Subjectswere instructed to “lean as far forward (…or backwards,right, left) as possible without lifting your heels or losingyour balance.” The change in the position of the third


metacarpal head along the yardstick was indicated by awooden marker that the researcher slid along a level trackas the subject performed each leaning trial. The differencebetween the initial and final positions for each attempt wasrecorded. Reproducibility of 3 same day trials of the MDRTwas high: ICC (3,1) for forward = 0.94,backwards = 0.96, right= 0.95, left = 0.90. An average of the 3 recorded trials wasused in data analysis similar to previous research.9

Berg Balance Scale. The BBS includes 14 tasks challeng-ing body stability.16 The test was administered according tostandard protocol,except for item #8 (forward reach) whichwas 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-imum score of 56 points indicating the best performance.

Sharpened Romberg. This test required that a subjectperform a tandem stand with arms free and the nondomi-nant foot ahead of the dominant foot for up to 60 sec-onds.30,31 Up to 3 trials were attempted with eyes open,then with eyes closed. The test ended when a subjectachieved the 60 second maximum time, opened the eyesduring an eyes closed trial, moved the feet, or needed assis-tance to prevent a fall. The test was scored as the maximumseconds achieved during the best trial.

ABC Scale. This 16-item questionnaire asks a subject toestimate how confident he/she would be in performing 16common mobility tasks without losing balance.33 Each itemis scored from 0% to 100%, indicating increasing levels ofconfidence about each task. A tester read each questionaloud and asked the subject to respond using only incre-ments of 10% (ie, 0%, 10%, 20%, …100%).

Physical Performance Test.The PPT-9 has 9 items, mea-suring upper extremity fine motor coordination, balance,mobility, and endurance.37 Total scores can range from 0 to

36. Another version of the test, PPT-7, includes only the first 7 items ofthe PPT –9, with a total possiblescore of 28. For each item a 5-pointordinal scale (0–4) is used to recordperformance, with 0 indicating“unable to do”and 4 indicating high-est functioning. Seven of the 9 itemsare timed and the time to completethe task corresponds with an ordinalscoring category. Scores for bothversions of the PPT were used indata analysis.

Data AnalysisThe data were analyzed using

SPSS for Windows (Version 11.5;SPSS, Ind., Chicago, Ill). Descriptivestatistics were performed to calcu-late means, standard deviations, and95% confidence intervals for each ofthe tests by age decades and gender

cohorts. One-way ANOVA and Tukey’s HSD post hoc testwere used to examine differences between the age and gen-der cohorts on demographic variables. Multiple linearregression analysis (Enter method) was used to determinewhether the demographic variables (age, gender, height,weight) were significant predictors of test outcomes. Anindependent t-test was used to compare right and left reachscores in the MDRT. An alpha level of 0.05 was used todetermine significance in all statistical tests. To further char-acterize the properties of the tests with multiple items onordinal scales (BBS,ABC, PPT), Cronbach alphas were calcu-lated as a measure of internal consistency.

RESULTSFor the total sample, the average age of the subjects was

69 (SD = 11; range = 50-90) years. The average height formales was 177 cm (SD = 8) and for females was 161 cm (SD= 6). Subjects reported use of an average of 2 medicationsper day (range 0-12) and had a variety of diagnoses includ-ing: 45% with hypertension; 46% arthritis; 18% heart dis-ease;17% history of cancer; and 16% thyroid disorders. Onesubject reported falling twice and 12 subjects (15%)reported falling once in the 6 months prior to the study.Three participants identified themselves as smokers and 13of the 83 reported a “bone or joint problem that could beaggravated by walking.”Table 1 shows mean demographiccharacteristics for each age cohort in the sample. One-wayANOVA between age cohorts showed significant maineffects for height (F = 3.2, p = 0.028), number of diagnoses(F = 5.2; p = 0.002) and number of daily medications (F =3.2, p = 0.026).Tukey’s post hoc testing showed that heightwas significantly greater for the youngest compared to theoldest group (p = 0.047), number of diagnoses was signifi-cantly greater for the oldest compared to the youngestgroup (p = 0.001), and showed that number of medications

Figure 1. Multidirectional reach.


was significantly greater for the 60-69 year olds than the 50-59 year olds (p = 0.024). There was no significant differ-ence between age cohorts on weight or number ofreported falls in the previous 6 months.

MDRT. The mean test scores, standard deviations, and95% confidence intervals by age and gender cohorts foreach direction of the MDRT are shown in Table 2. Therewas no significant difference between the mean right andleft reach scores (t = 0.15; p = 0.88).Age was a significantvariable in regression models predicting MDRT scores ineach direction, with increasing age associated with adecrease in reach scores (Table 3). Height was significantin the model for predicting backward reach only, withincreasing height associated with increased backwardreach scores.

Berg Balance Scale. Table 4 reports the means, standarddeviations, and 95% confidence intervals for the BBS resultsby age and gender cohorts. Internal consistency for the 14-item BBS, indicated by Cronbach’s alpha,was 0.81. Age,gen-der, and height were all significant predictor variables forBBS scores (Table 3). Thirty six percent (30 persons) of the

subjects achieved a maximum score of 56, with only 5 ofthese in the oldest two age groups. Only 3 subjects, all over80 years, scored below the commonly used cutoff of 45 forpredicting fall risk.54

Sharpened Romberg Tests. Means, standard deviations,and 95% confidence intervals for the SREO and SREC testsare reported in Table 4. The confidence intervals for bothtests showed a wide range of variability. Age, gender, andheight were significant predictors for SREO scores,whereasonly age and gender were significant predictor variables inthe regression model for SREC (Table 3). A maximum scoreof 60 seconds was achieved by 77% of the subjects for theSREO and by 31% for the SREC. Most subjects achieving theceiling score were in the two younger age groups.

ABC Scale. Results from the ABC Scale are summarizedin Table 4 by age and gender cohorts. The internal consis-tency of the 16-item ABC Scale, based on Cronbach’s alpha,was high (α = 0.93). Age and weight were significant pre-dictors of ABC scores (Table 3). The mean ABC score for thetotal sample was 91% out of a maximum 100% confidencein performing the mobility tasks. The mean ABC score for

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), andPhysical Performance Tests (PPT-7 & 9).

MDRTForward Backward Right Left BBS SREO SREC ABC PPT-7 PPT-9

R2 .31 .52 .35 .31 .38 .35 .26 .22 .38 .40Age -.39a -.31a -.36a -.32b -.64a -.58a -.54a -.35b -.58a -.61a

Gender .00 .11 -.14 -.18 -.42b -.51a -.33c -.23 .04 .01Height .27 .70a .28 .18 -.33c -.35c -.28 -.10 .07 .07Weight .04 -.18 .01 .07 .02 -.01 -.02 -.24c .05 .01

ap<.001bp<.01cp<.05

Table 2. Means (X), Standard Deviations (SD), and 95% Confidence Intervals (CI) of the Multi-directional Reach Test by Age and GenderCohorts (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 19-26Female 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 17-21Female 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 15-21Female 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 6-28Female 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 1. Demographic Characteristics of the Study Sample by Age Cohort

Age Cohort Gender (% female) Height* (cm) Weight* (kg) Number of Falls in Number ofDiagnoses* 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)


males was 94% and for females was 89%.Ten percent of thesubjects reached the ceiling of 100% on this test, with allage groups similarly represented in this distribution.

Physical Performance Tests. Results of both the PPT-7and PPT-9 are reported by age and gender cohorts in Table4. Internal consistency, as measured by Cronbach’s alpha,was 0.70 for the PPT-7 and 0.75 for the PPT-9. Age was theonly significant variable in the regression models predictingPPT-7 or PPT-9 scores (Table 3). No subject achieved theceiling score for either version of this test. Only one sub-ject scored at the cut off of 15 used for identifying fallers.55

DISCUSSIONFor all of the functional tests in this study, age was a sig-

nificant predictor variable for test outcome scores. This find-ing is supportive of the practice of providing reference datain age cohorts so that individual patient results can be com-pared to age-appropriate group data. Gender, height, andweight were not consistently significant predictors of testscores. Because the men in our sample were, on average,taller than the women, one might expect that gender andheight would have similar predictive influence on testscores. In most, but not all, cases, these 2 variables were thesame in their predictive significance or lack of significance.Gender and height were both significant predictors for BBSand SREO scores. Conversely, neither gender nor height wasa significant predictor for scores on the MDRT (forward,right, left), the ABC, or the PPT. Hypothesizing that heightand position of the center of mass are the salient features dif-ferentiating males and females, it may be that these featuresprovided additional challenges to taller persons (males) dur-ing the varied static balance tasks of the BBS and SREO. It isnot clear, however, why such a hypothesis about height/gen-der doesn’t hold for the static balance tasks of the MDRT.Further studies and larger sample sizes are needed to con-firm or refute these findings on gender and height.

MDRT. Of the tests studied here, the MDRT was mostrecently introduced into the literature, with Newton2,3 pro-viding the first data. The test is a logical expansion of theForward Functional Reach test developed by Duncan et al9

and was designed to provide a clinical measure of a per-son’s margins of stability. We found that repeated measures

of the components of the MDRT within the same day werehighly reproducible, as has been reported for the ForwardFunctional Reach test.9 Compared to Duncan’s forwardreach data in men, our male subjects had slightly lowerscores. In her subjects under 70 years, this may beexplained by her inclusion of subjects, age 41-50 years. Theslight differences may also be due to test positions. Duncanhad subjects stand comfortably while we used a predeter-mined foot position. In Newton’s original study2 the sub-jects’mean age was 74 (SD = 8) while in this study mean agewas slightly younger (69 years,SD = 11).The age differencesin the 2 studies may explain why the mean forward andbackwards reaches are higher in our study (29 ± 7 cm and19 ± 8 cm, respectively) than in Newton’s sample (23 ± 8cm [8.9 ± 3.3 inches] and 12 ± 8 cm [4.6 ± 3.0 inches],respectively). There also could be the factor that our sub-jects were taller on average. However, regression analysisshowed height as a significant variable only for predictingbackward reach, not forward. Any biomechanical hypothe-sis related to size of base of support or position of the cen-ter of mass in tall versus short persons should seem to applyto both forward and backward reaches similarly. Both talland short persons have a longer lever arm for forward reachthan for backward reach. However, perhaps there is aninteraction between lever length and base of support thatinfluences backward, but not forward, reach.The mean val-ues of the lateral reaches between the two studies arewithin 0.4 cm. Our study, as in previous studies, demon-strated no significant differences between the right and leftreaches,3-5 suggesting that asymmetries in the lateral reachesfor a given client are an abnormal finding.

Berg Balance Scale. Our current study confirmed pre-vious findings of Steffen et al25 on the BBS for each of 3 agecohorts (60-69, 70-79, and 80+ years). In contrast, Newton3

and Hatch et al26 found slightly lower average BBS scores inslightly older samples of community-dwelling adults. Wefound it interesting that only 36% of our essentially nondis-abled or high functioning sample achieved a maximumscore on the BBS. Clinicians performing fall risk screeningsin community populations of older adults need to be cau-tious in making assumptions that a perfect score is to beexpected in these age groups.

Table 4. Means (X), Standard Deviations (SD), and 95% Confidence Intervals (CI) of test results for the Berg Balance Scale (BBS), SharpenedRomberg-Eyes Open (SREO), Sharpened Romberg-Eyes Closed (SREC), Activities Specific Balance Confidence Scale (ABC), and PhysicalPerformance Tests (PPT-7 & 9) by Age and Gender Cohorts

Total BBS Total SREO (sec) Total SREC (sec) Total ABC (%) Total PPT-7 Total PPT-9Age Gender N X SD CI X SD CI X SD CI X SD CI X SD CI X SD CI

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 30-33Female 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 29-33Female 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 27-31Female 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 25-30Female 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


Sharpened Romberg. Briggs et al31 reported SREO andSREC scores in 5 year age cohorts for community-dwellingfemales (mean age = 72). Although their total mean scoreswere the same as ours, their average scores for subjects inthe 80-85 year cohort were substantially higher (SREO = 45seconds, SD = 21; SREC = 23 seconds, SD = 21) than ours.Perhaps this difference was due to the strict exclusion intheir study of participants with neurologic disorders andsome musculoskeletal disorders.Our mixed-gender SREO of49 seconds falls between that of Heitmann et al30 whoreported a mean score of 37 seconds (SD = 27) for females(mean age = 74) and Iverson et al29 who reported a meanscore of 55 seconds (SD = 15) for males (mean age = 71).For SREO, some subjects in all age cohorts achieved a max-imum score of 60 seconds. No subjects in the oldest agegroup achieved a maximum score on the SREC. Scoresshowed much more variability for the SREC, across all agegroups, than for the SREO. Also, the ceiling effect for theSREC occurred much less frequently than for the SREO orthe Berg. Thus the SREC may detect minimal impairmentsin balance better than these other two tests.

ABC. Of those reporting reference data for the ABC, ourstudy had subjects with the lowest mean age and the high-est average score. In a similar but older community-dwelling sample (average age = 82), Hatch et al26 reported alower mean score (79%, SD = 19). Kressig et al36 found alower average score of 52% (SD = 20) in their sample ofseniors in independent living facilities (mean age = 81).Comparisons of these studies appear to reinforce the find-ing of a relationship between age and ABC test score. It isof interest that even subjects in our youngest age cohort didnot all report 100% confidence in balance.

PPT. The values on the PPT-7 are similar to thosereported by Puggaard49 in 3 age groups of community-dwelling older adults. Other reports of average PPT-7 scoresin community-dwelling seniors are also similar to ours,42,43

although samples in these other studies were slightly olderthan ours on average. Our average data on the PPT-9 arealso similar to the only other reported values in a study ofmen (mean age = 76 years).41 Interestingly, none of our sub-jects reached the ceiling on these tests, although Brach etal43 found that 7% of their subjects did so on the PPT-7.

Although our data are intended to expand available ref-erence data, this use of the data is limited by the relativelysmall number of subjects in each age and gender category,especially for subjects over 80. In particular, cautious inter-pretation is required when the sample size is small and con-fidence intervals are large, as is the case for males over 80on all tests. More studies with diversity in subject ethnicityand with larger sample sizes, especially for the oldest agegroups, are needed. Although none of the participantsreported fatigue during the study, future studies should ran-domize the order of the tests.

In summary, this study provides age- and gender-relatedvalues for the performance of older adults on tests of func-tional balance and mobility. These data can be used by clin-

icians in interpreting test results of clients. A relationshipbetween increased age and decline in test performance hasbeen demonstrated. Additional research would be benefi-cial to determine if using all 4 directions of the MDRT pro-vides more valuable information about balance ability andfall risk than just the Forward Functional Reach alone.Further research is also needed to establish larger databasesof reference values on all functional tests and to establishthe validity of the MDRT for predicting likely direction ofpotential falls, so that treatment can focus on each client’sdirection-specific deficits of stability.

ACKNOWLEDGEMENTSA special thank you to Jill Kison, Sarah Lindau,Al Meives,

and Zachary Sommermeyer who assisted with data collec-tion while they were physical therapy students atConcordia University Wisconsin and Lina La Licata for cler-ical support.

Dr Steffen provided concept/research design, projectmanagement, fund procurement, subject recruitment, facili-ties/equipment,data analysis, and writing.Ms Mollinger pro-vided consultation and writing.

This study was approved by the Institutional ReviewBoard of Concordia University Wisconsin and was sup-ported by the Program in Physical Therapy, ConcordiaUniversity Wisconsin.

The main findings were presented as a poster presenta-tion at the Wisconsin Physical Therapy AssociationConference 2002 and the 14th International WCPTCongress, Barcelona, Spain 2003.

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PLATFORMS: Biomechanics and Motor ControlSaturday 8:00-11:00 am

HETERONYMOUS REFLEXES IN THE PRIMARY AGONIST AREENHANCED WHEN SUPPORTING AN INERTIAL LOAD. K.S. Maluf1,Z.A. Riley2, M.K.Anderson2, B.K. Barry2, S.S.Aidoor2, R.M. Enoka2, 1GraduateProgram in Physical Therapy and Rehabilitation Science, University ofIowa, Iowa City, IA, 2Department of Integrative Physiology, University ofColorado, Boulder, CO.

Purpose/Hypothesis: Previous studies indicate that stretch reflexes inthe human upper limb are influenced by the stability of the load sup-ported during an isometric contraction. Our purpose was to assesswhether changes in the sensitivity of spinal motor neurons to afferentfeedback from accessory muscles contribute to reflex modulation whensupporting an inertial load compared with exerting an equivalent forcewith the limb restrained.Number of Subjects: 13 healthy adults (aged 18-47 years, 9 men) participated in the study. Materials/Methods:Heteronymous reflexes were evoked in the first dorsal interosseus (ago-nist) and second palmar interosseus (antagonist) muscles by stimulatingthe 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 taskrequired subjects to exert a constant isometric force by pushing up againsta rigid restraint, whereas the other task required subjects to maintain aconstant angle at the metacarpophalangeal joint while supporting an iner-tial load suspended from the finger. Net torque (20% of maximum), theposition of the index finger (0 degrees abduction), and the intensity ofperipheral nerve stimulation were the same for both tasks. Twenty-fourreflex responses were recorded in each muscle using surface or intramus-cular electrodes, and the averaged EMG records were compared using a 2-factor ANOVA for repeated measures. Results: Heteronymous reflexresponses were observed in 10/13 subjects (77%) for the first dorsalinterosseus,but only 2/11 subjects (18%) in the second palmar interosseus.Despite similar tonic EMG of the agonist and antagonist muscles acrosstasks (P = 0.27), peak amplitudes of the short-latency (SL 28.6 ± 5.6 ms)and long-latency (LL 52.2 ± 3.5 ms) reflexes in the first dorsal interosseuswere greater when subjects supported the inertial load (SL = 0.45 ± 0.19vs. 0.57 ± 0.28 mV; LL = 0.32 ± 0.11 vs. 0.41 ± 0.19 mV; main effect of taskP = 0.02). Conclusions: Agonist motor neurons exhibit heightened sen-sitivity to afferent feedback from median-innervated accessory muscleswhen controlling the position of an inertial load. Clinical Relevance:Findings indicate that the type of load used in strength and endurancetraining programs can influence the response of the primary agonist toconcurrent activity of accessory musculature.

VIBRATION OF THE BICEPS BRACHII TENDON REDUCES TIME TOFAILURE WHEN MAINTAINING LIMB POSITION DURING A FATIGU-ING CONTRACTION. C Mottram,KS Maluf,MK Anderson, JL Stephenson,RM Enoka, Integrative Physiology, University of Colorado, Boulder , CO.

Purpose/Hypothesis: Vibration reduces the tendon jerk, and theHoffmann and stretch reflexes in the muscle exposed to the vibration(Bove et al,2003;Cresswell and Ludieroscher et al,2000;Lance et al,1966),but does not alter the time to task failure when exerting a submaximalforce against a rigid restraint (Cresswell and Ludieroscher 2000). Becausethe amplitude of the stretch reflex can be enhanced when the limb actsagainst a compliant load compared with a rigid restraint (Akazawa et al.1983; De Serres et al. 2002), the purpose was to determine the influenceof tendon vibration on the time to task failure when light loads were sup-ported while maintaining limb position (position task) with the elbowflexor muscles. Number of Subjects:Twenty-five healthy adult men (22± 4 yr; range, 18 - 39 yr) performed the position task at 20% MVC force bymaintaining a 90º elbow position until task failure. Materials/Methods:Subjects visited the laboratory for three sessions to perform the positiontask with two different levels of vibration (100 Hz, 2.5 N force, sub-thresh-old and supra-threshold for the tonic vibration reflex), and without vibra-tion of the biceps brachii tendon. Results: MVC force prior to task perfor-

mance was similar across the three sessions (313 ± 54 N, P = 0.83), indi-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 bicepsbrachii, brachioradialis, and brachialis was similar across conditions (P >0.05). Despite the similar criteria for task failure and a similar decline inMVC force (18.0 ± 8.0 %,P > 0.05), the time to task failure differed for eachcondition: supra-threshold vibration = 3.7 ± 1.4 min, sub-threshold vibra-tion = 4.3 ± 2.1 min, and no-vibration conditions = 5.0 ±2.2 min (P < 0.001).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(0.28 ± 0.15 m/s2) for the supra-threshold condition compared with theno-vibration (0.13 ± 0.06 and 0.16 ± 0.09 m/s2;P = 0.03) condition,but wassimilar at task termination (0.83 ± 0.50 m/s2) for the three conditions.Conclusions: These findings indicate that both low and high levels ofvibration applied to the biceps brachii tendon reduced the time to failurewhen maintaining limb position, which has implications for work-placeactivities. Clinical Relevance: Documenting evidence for early fatigueduring tasks performed with prolonged vibration confirms the importanceof afferent input during sustained tasks, and has implications for work andergonomic environments.

CUTANEOUS CUING DECREASES REACTION TIMES FOR STEP INITI-ATION. CG Kukulka, E Olson,A Peters, K Podratz, C Quade, Phys Med &Rehab, University of Minnesota, Minneapolis, MN.

Purpose/Hypothesis:The purpose of this study was to assess the effect ofvisual and sural nerve stimulation cuing on reaction times to step initiation(SI) in young, healthy subjects. We hypothesized that these times woulddecrease with a cutaneous go cue as compared to a visual cue. Number ofSubjects:Thirteen subjects,9 women and 4 men between the ages of 23 and30 years (mean = 23 yrs), participated in the study. Materials/Methods:EMG was recorded from tibialis anterior (TA) of the right stepping leg.Thesural nerve was stimulated with a train of 300/s,1 ms pulses delivered for 20ms at an intensity of 1.5 radiating threshold. Subjects stood with their rightleg on a force platform with weight equally distributed and were instructedto take three steps as fast as possible.A warning visual cue was first deliv-ered followed at random intervals (1-3 s) by either a visual go cue or thesural stimulation cue. Twenty repetitions for SI were randomized by cue.After a 5 min rest, 20 additional steps were obtained. SI is characterized byan abrupt loading of the stepping limb and this loading was used to deter-mine 3 response times relative to the go signal (load onset, peak load, andload offset). The onset time of TA onset relative to the go signal was alsodetermined.Two way ANOVAs (p<.05) were used to evaluate the interactioneffect of trial versus cue and the main effects of trial and cue. Results: Nostatistically significant interactions were found for any of the loading timesand the main effect of trail was also not statistically significant. Significantdifferences were found between visual and cutaneous cue for all loadingtimes. Time to load onset decreased on average from 254.2 ms with thevisual cue to 186.5 ms with the sural cue.Time to peak loading decreasedon average from 482.7 to 391.7 ms and time to unloading decreased from688.1 to 610.9 ms.TA onset was found to decrease from 194.6 ms (visualcue) to 131.5 ms (cutaneous cue). Conclusions:The results of these exper-iments indicate that reaction times to a cutaneous cue are significantlyshortened for SI in healthy subjects.These findings raise two important neu-rophysiological questions. Could a cutaneous cue be priming the motor cor-tex via a cortical pathway (Christensen et al, Prog Neurobiol 62:251, 2000)to heighten cortical excitability thereby resulting in a faster reaction.Alternatively, could the cutaneous cue be acting as a startle (Valla-Sole, et al,J Physiol 516:931, 1999) to release the stepping response via subcorticalstructures. The latter possibility is currently being investigated in our labo-ratory. Clinical Relevance:Previous experiments have shown that reactiontime is a strong predictor of falls in the elderly and that a sural go cue canincrease center of pressure changes during SI in both young and elderly sub-jects.The current results therefore raise the possibility that a cutaneous cuemight be used to decrease reaction times and positively alter ground reac-tion forces in elderly subjects who fall. It will be necessary to first replicatethe current findings in the elderly.

Platforms, Thematic Posters, & Posters for CSM 2006


INFLUENCE OF AGE ON NEUROMUSCULAR CONTROL OF THEKNEE. S Madhavan, S Burkart, G Carpenter, K Read, T Teckenburg, MZwanziger, R Shields, Graduate Program in Physical Therapy andRehabilitation Science, University of Iowa, Iowa City, IA.

Purpose/Hypothesis:An increased incidence of injury has made neuro-muscular control of the knee joint a focus of attention in motor controlresearch. The central nervous system (CNS) controls the knee againstunpredictable perturbations that occur during movement.Age associatedchanges in the musculoskeletal, neuromuscular and sensory systems com-promise the ability of the elderly to respond effectively to a perturbation,thereby placing the older population at a higher risk of injury.Weight bear-ing exercises have been primarily used to re-educate neuromuscular con-trol of the knee following pathology. Limited information is available onthe strategies used by the elderly to control the knee during dynamic activ-ities.This study examined the effect of age on the neuromuscular controlof the knee by examining accuracy of performance, muscle synergies andlong latency reflexes (LLR) during a functional weight bearing exercise.Wehypothesized that the elderly would show greater impairment in neuro-muscular control than the young.Number of Subjects:Ten young and tenelderly subjects performed a single leg squat exercise (SLS) while trackinga sinusoidal target with knee motion at different levels of resistances (4%,8% and 12% body weight). Materials/Methods: Subjects first performed aset of learning trials to gain proficiency with the task.Later, they performedthe SLSs with random perturbations (drop in resistance level to 0% BW)during the knee flexion phase.A split plot repeated measures ANOVA wasused to assess between and within group differences in movement accu-racy, synergistic activation patterns (EMG), and long latency reflexes.Results:The elderly group 1) had a 50% greater absolute error in trackingthe target angle when compared to the younger group (p<0.05); 2)showed a 60% greater activation of the quadriceps and hamstrings at alllevels of resistances as compared to the younger group (p<0.05); andshowed 15% greater LLR for the quadriceps and biceps femoris when com-pared to the younger group (p <0.05).Conclusions:These results indicatethat the elderly recruit higher percentages of MVC and have greater errorwhen performing the SLS weight bearing exercise. Clinical Relevance:Age associated changes of the sensorimotor system necessitates greatermuscle activity to help stabilize the knee in the elderly.These findings pro-vide important clinical implications when developing rehabilitation pro-grams for the young and elderly.

DE-COUPLING GAIT PARAMETERS TO INVESTIGATE THE CONTRI-BUTION OF STEP LENGTH TO FALL RISK. D Espy,Y Pai, F Yang, J Sun,Physical Therapy (M/C 898), University of Illinois at Chicago, Chicago, IL.

Purpose/Hypothesis: Background and Purpose. It is generally acceptedthat, as people age, their gait becomes slower and of shorter step-lengthand that both improve stability against balance threats.Recent studies havesuggested that a faster gait velocity may provide more stability against aslip induced backward loss of balance than the benefit gained by shorterstep-lengths. Since they are tightly coupled, the individual contributions ofstep-length and gait velocity to stability are unknown.The purpose of thisstudy was to pioneer a gait training approach that enables us to de-couplethis relationship. Number of Subjects:Thirty-five. Materials/Methods:Subjects and Methods.Thirty-five healthy, young adults participated in thisrandomized, experimental comparison study. Subjects were slipped unex-pectedly while walking on a walkway at one target gait velocity and eithera short or a long target step-length.Motion and force data were used to cat-egorize each first slip as a fall or non-fall. Results: Four of the 19 subjectsin the long step-length group, but none of the 16 in the short step-lengthgroup, fell upon the first unexpected slip (chi2 3.803; p = .05).Conclusions: Discussion and Conclusion. De-coupling of the gait parame-ters was successful; at gaits of similar velocity, the subjects taking shorterstep-lengths were less likely to fall upon initial slip than those with longerstep lengths. Clinical Relevance: Understanding the individual contribu-tions to stability of both gait speed and step length will allow PhysicalTherapists to refine gait training recommendations to enhance stability.

INFLUENCE OF HAMSTRING LOW FREQUENCY FATIGUE ON NEU-ROMUSCULAR CONTROL OF THE KNEE DURING WEIGHT BEARING

EXERCISE. M. Iguchi,A. Ganju, B. Ballantyne, R. Shields, Graduate Programin Physical Therapy and Rehabilitation Science, University of Iowa, IowaCity, IA.

Purpose/Hypothesis: Muscle fatigue may be a predisposing factor toinjury during athletic competition. Low frequency fatigue (LFF), which isdue to long duration exercise, is most characteristic of the type of fatigueinduced during sports activities.Altered neuromuscular control as a resultof LFF may increase the risk of injury to the knee.The purposes of this studywere to examine the extent to which LFF could be induced in the ham-string muscles and test whether LFF altered the neuromuscular control ofthe knee during a single limb weight bearing exercise. We hypothesizedthat LFF of the hamstrings alters the neuromuscular control of the kneeduring weight bearing exercise.Number of Subjects: 10 healthy male sub-jects performed a fatigue protocol consisting of repetitive eccentric con-tractions of the left hamstring muscles using an isokinetic dynamometer.Materials/Methods: The work/rest velocity of 13º/sec-1 / 7º/sec-1 respec-tively, over an arc of movement from 30º -70º flexion (0º = full extension)was administered until the subject was fatigued.The fatigue protocol wasterminated when the peak torque decreased 25% from the largest value ofthe three pre-fatigue eccentric MVCs. Hamstring peak twitch torques wereobtained by double pulse stimulation at 40 Hz followed by a train of fourpulse stimulation at 166 Hz.The twitch torques were calculated pre-fatigue,immediately post fatigue and then at 5, 10, 15 and 20 minutes into recov-ery.The ratio of the twitch torque at 166 Hz to 40 Hz was calculated andaveraged. Before and after the fatigue protocol, a subgroup of subjects per-formed a lateral step down weight bearing exercise to a predetermined tar-get on a custom built device designed to assess neuromuscular control ofthe knee. Absolute error to knee movement (accuracy), EMG synergisticactivation patterns (quad/hamstring ratio), and triggered long latencyreflexes were assessed.A Split Plot Repeated Measures Analysis of Variancewas used to compare within and between groups. Results: The averagenumber of eccentric contractions performed before the torque decreasedto 75% of the pre-fatigue value was 35 ±9.3. Immediately after the fatiguetask, the ratio increased, on average, by 15.6% ±7.3 of its pre-fatigue value(p < 0.05), and stayed elevated at 20 min post fatigue (12.4% ± 4.9).Theeccentric contraction torque immediately after fatigue was 69.9% ± 6.0 andremained depressed at 20 min post fatigue (80.1% ± 9.0). Absolute errorduring the weight bearing exercise was increased 50%; the quadriceps tohamstring ratio was unchanged; and the biceps femoris and vastus medialislong latency response was increased 20% after fatigue. Conclusions: Weconclude that LFF can be induced in the hamstring muscles using repetitiveeccentric contractions and that this fatigue alters the neuromuscular con-trol of the knee during weight bearing exercise.Clinical Relevance:Thesefindings have important clinical implications for the prevention and reha-bilitation of injuries in individuals involved in athletic competition.

Funding: NIH R01HD39445.

CHANGES IN SELF-PERCEPTION OF TURNING FOLLOWING ROTAT-ING TREADMILL STIMULATION. G Earhart1, S Wang1, M Hong1, EStevens2, 1Program in Physical Therapy, Washington University School ofMedicine, St. Louis, MO, 2Biology Department,Washington University in St.Louis, St. Louis, MO.

Purpose/Hypothesis: The purpose of this work was to determinewhether rotating treadmill stimulation, which has been shown to causeunintentional turning during attempts to step in place, would also causechanges in behavior when subjects knowingly turn in place.We hypothe-sized that, following stepping on a rotating treadmill, 1) subjects asked toactively turn in place would overshoot their targets when turning in thedirection opposite treadmill rotation and undershoot their targets whenturning in the other direction and 2) there would be no change in per-ception of passive whole body turning.Number of Subjects:We tested 10healthy control subjects. Materials/Methods: Subjects wore a blindfoldand earplugs and completed trials of active and passive turning in place.For active conditions, subjects were told the direction and amplitude ofthe desired turn and then attempted to turn in place the specified amount(e.g. ‘turn 90 degrees to your left’). For passive conditions, subjects weretold that the disc they stood on would turn and they were to press a but-ton when they perceived that they had traveled the specified amplitude


(e.g.‘the disc will turn to your left, press the button when you think youhave gone 90 degrees’). Subjects completed active and passive trials to theleft and right with amplitudes of 90, 180, 270, and 360 degrees for a totalof 16 trials. Subjects then stepped in place for 15 min on a disc rotatingclockwise at 90º /s. Subjects then repeated the 16 trials of active and pas-sive turning.All trials were presented in random order and the order wasdifferent for each subject. We recorded the total excursion that subjectswent through during active trials and the excursion from start position tothe time of button press in passive trials.These excursions were comparedwithin each condition (e.g.90 degrees left active) for pre- vs.post-treadmillstimulation using paired t-tests (p<.05). Results: Subjects asked to turn inthe direction opposite disc rotation (i.e., to the left) consistently and sig-nificantly overshot their targets in the active trials.There were no changesin the accuracy of active turning to the right or passive turning in eitherdirection. Conclusions: Adaptation to the rotating disc is expressed evenwhen subjects have a conscious intent to turn.The positive after-effects ofthe rotating disc appear to add to the intended active turning in the direc-tion of the after-effect, increasing the amplitude of the turn. There is nonegative interaction of after-effects with intended turning in the oppositedirection. Clinical Relevance:This demonstration that rotating disc after-effects are still expressed even when there is conscious intent to turn sug-gests that rotating disc stimulation may be useful in the treatment of turn-ing difficulties experienced by individuals with Parkinson disease. Subjectswho have difficulty turning in one direction more than the other may ben-efit from this intervention, which could enhance turning in one directionwhile not reducing turning in the other direction.

RELATIONSHIP BETWEEN CHANGES IN MUSCLE SIZE FOLLOWING12 WEEKS OF NMES INDUCED RESISTANCE TRAINING USING MRIAND FIBER SPECIFIC ANALYSES IN PERSONS WITH COMPLETESPINAL CORD INJURY. A. Jayaraman1, K. Vandenborne1, E.M. Mahoney2,G.A. Dudley2, C.M. Gregory3, S.C. Bickel4, 1Physical Therapy, University ofFlorida, Gainesville, FL, 2Kinesiology, University of Georgia,Athens, GA, 3VARR&D Brain Rehabilitation Research Center, 3Malcom Randall VA MedicalCenter, Gainesville, FL, 4Physical Therapy, Louisiana State University, NewOrleans, LA.

Purpose/Hypothesis: Chronic spinal cord injury (SCI) results in extremeatrophy of skeletal muscle below the level of lesion. We previouslyreported substantial muscle hypertrophy measured via magnetic reso-nance imaging (MRI) resulting from a neuromuscular electrical stimulation(NMES) induced resistance training program (RT).The purpose of this fol-low-up study was to determine the relationship between changes in mus-cle cross-sectional area (CSA) via magnetic resonance imaging (MRI) andfiber CSA measured using in-vitro histochemical techniques after 12 weeksof NMES-induced RT in subjects with chronic complete SCI. Number ofSubjects: Three men (35.6 ± 4.9 yrs, 76.6 ± 21.5kg) with chronic(13.±6.5yrs post-injury) complete SCI (ASIA A, C5-T10) participated in thisstudy. Materials/Methods: Subjects performed four sets of ten NMES-induced knee extensions, two days per week for 12 weeks with resistanceprogressively increased over the training period. Percutaneous skeletalmuscle biopsies from the m. vastus lateralis and MR images of the thighwere obtained from each subject both pre- and post- resistance training.Histological staining of individual fibers in muscle cross-sections was per-formed and fiber specific CSA was determined using computerizedplanimetry (NIH Scion Image Program (Version 4.0.2). Transaxial MRImages of the thighs were collected with a 1.5-T magnet (TR=500ms;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 bodycoil. Linear regression analysis was used to determine the relationshipbetween changes in whole muscle CSA and changes in individual fiberCSA. Dependent samples t-tests were used to assess for differences in fiberarea pre- and post-NMES training. Significance was set at p ≤ 0.05. Results:Changes in muscle CSA explained 99.5% of the variance in fiber hypertro-phy following NMES induced RT (y = 2.215x - 0.0128;R2 = 0.9956). In addi-tion, following RT, average muscle fiber CSA increased from (2807 ±327cm2) at baseline to (4581 ± 510cm2) after training (p ≤ 0.05).Conclusions:The main finding of this study was that 12 weeks of NMES-induced RT elicited substantial hypertrophy in individual muscle fibers insubjects with complete SCI. In addition, the relationship between these

changes and improvements in whole muscle CSA via MRI were extremelystrong. Clinical Relevance: These data provide further evidence of theresponsiveness of skeletal muscle to RT in the SCI population as well assupport the use of NMES as a training modality capable of eliciting sub-stantial hypertrophy in human skeletal muscle.

PERIPHERAL QUANTITATIVE COMPUTERIZED TOMOGRAPHY(PQCT): MEASUREMENT SENSITIVITY IN INDIVIDUALS WITH ANDWITHOUT SPINAL CORD INJURY. S. Dudley-Javoroski,T. Corey, D. Fog,K. Hanish, J. Ruen, R. Shields, Graduate Program in Physical Therapy andRehabilitation Science, University of Iowa, Iowa City, IA.

Purpose/Hypothesis: Individuals with spinal cord injury (SCI) experi-ence rapid trabecular bone loss within the first year after their injury.Thedistal tibia is a common fracture site after SCI;however,at this site the stan-dard bone density measurement method, Dual Energy X-rayAbsorptiometry (DEXA), has significant limitations. Peripheral quantitativecomputerized tomography (pQCT) holds much promise, but the sensitiv-ity associated with repeated scans has not been established for the distaltibia. The purposes of this study were to: 1) establish the between andwithin tester error in measuring tibia length as needed during pQCT analy-sis;2) determine the error in distal tibia trabecular bone density when mea-suring three different scan sites in individuals with and without SCI; and 3)determine the magnitude of distal tibia bone loss as a result of SCI.Number of Subjects: Repeated tibia length measurements were takenfrom 8 able-bodied subjects using a newly developed operationally definedprotocol. Bone analysis (pQCT) was performed on 7 male subjects withSCI and 7 age-matched male able-bodied subjects. Materials/Methods:Aninvestigator marked the distal tip of the medial malleolus and the proximalmargin of the tibial plateau in order to obtain tibia length. Subjects in thetwo scan groups underwent pQCT analysis at 3 sites along the distal tibia(4% of total length, ±3mm). Three subjects in the SCI group were con-currently enrolled in electrical stimulation training of the soleus. Results:Results revealed no significant difference between average repeated tibialength measurements (p=0.94). Absolute inter-rater error for tibia lengthwas 0.61 cm with an r2 = 0.94.An ICC (1, k) showed that there was strongintra-tester agreement (0.94).Average change in bone density across 3 mmfor individuals with SCI was 3.77%. Individuals with SCI had 50.6% less tra-becular bone density than the able-bodied group (p<0.0001). Interestingly,there was a 26.7% increase in bone density in the subset of SCI subjectswho trained their extremities (p<0.05).Conclusions:We conclude:1) thatthe error in measuring limb length is a minor contributor to repeatedpQCT measurement analysis; 2) the effect of SCI on bone loss at the distaltibia can be readily measured using pQCT,and;3) pQCT may detect effectsof early electrical stimulation training in individuals with SCI. ClinicalRelevance:A sensitive method to measure bone properties is important asphysical therapists strive to develop new technologies to prevent the dele-terious effects of bone loss after SCI.

Funding: NIH R01HD39445, the Christopher Reeve Paralysis Foundation,and the Foundation for Physical Therapy.

CHANGES IN SOLEUS MUSCLE FORCE AND FATIGUE AFTER SPINALCORD INJURY WITH TREADMILL LOCOMOTOR TRAINING IN RATS.JE Stevens1,WA O’Steen1, DK Anderson1, M Liu2, K Vandenborne2, P Bose3, FJThompson3, 1Malcom Randall VA Medical Center, Gainesville, FL,2Department of Physical Therapy, University of Florida, Gainesville, FL,3Department of Neuroscience, University of Florida, Gainesville, FL.

Purpose/Hypothesis: Currently, a major therapeutic problem centersaround several issues related to profound atrophy of the primary locomo-tor skeletal muscles following spinal cord injury (SCI).The purpose of thisstudy was to further study the influence of SCI on skeletal muscle atrophyand to evaluate therapeutic influence of early treadmill locomotor trainingon soleus muscle force and fatigability following spinal cord injury in rats.Our hypothesis was that locomotor training would attenuate some of thefunctional changes in muscle seen early after injury by improving muscleforce and decreasing muscle fatigue. Number of Subjects: Twenty fouradult Sprague Dawley rats (female, 16-20 weeks, weighing 220-260g) wereused. Eight rats served as controls and sixteen received a moderate T8spinal cord contusion injury using a standard NYU impactor. Eight injured


rats received treadmill locomotor training starting 1 week after SCI for 5consecutive days, 20 minutes/trial, 2 trials/day.The additional eight injuredrats received no exercise intervention. Materials/Methods: In situ soleusforce measurements were performed 2 weeks after SCI (following 1 weekof training). Maximum tetanic force was electrically elicited in the soleusmuscle using a single train,1500ms in duration at 100 Hz with a 5 min inter-val between trails.The maximum tetanic force of 3 attempts was recorded.Similarly, the fatigue test was electrically elicited and consisted of a modi-fied Burke fatigue test with 300ms trains delivered every second for 2 min-utes. Fatigue was calculated as (initial-final force)/initial force. A one-wayANOVA with post hoc testing was used for statistical analysis of data and ap value of less than 0.05 was considered significant. Results: One week oftraining after SCI significantly increased soleus muscle force (178+19mN)compared to SCI rats without training (117+29mN) (p<0.05), an improve-ment of 52.1%.The force of trained animals was not different from that ofuninjured animals (201+14mN) (p<0.05). Injured rats that received train-ing also demonstrated comparable fatigue to control animals (27+0.04%and 26+0.09% respectively) compared to rats without training (36+0.1%)(p<0.05). Conclusions: One week of therapeutic locomotor treadmilltraining initiated at 1 week following SCI produced soleus muscle forcesthat were 52.1% stronger than recorded in injured/untrained control ani-mals. In addition, compared with normal controls, the injured/trained ani-mals retained 100% of their fatigue resistance measures; whereas a 27.2%decrease was recorded in the injured/untrained control animals. ClinicalRelevance: One week of therapeutic locomotor treadmill training initiatedat 1 week following SCI produced soleus muscle forces that were 52.1%stronger than recorded in injured/untrained control animals. In addition,compared with normal controls, the injured/trained animals retained 100%of their fatigue resistance measures; whereas a 27.2% decrease wasrecorded in the injured/untrained control animals.

EXAMINATION OF SPASTICITY OF THE KNEE FLEXORS AND KNEEEXTENSORS USING ISOKINETIC DYNAMOMETRY AND CLINICALSCALES IN CHILDREN WITH SPINAL CORD INJURY. S. Pierce, T.E.Johnston, R.T. Lauer, Research, Shriners Hospital for Children, Philadelphia,PA.

Purpose/Hypothesis:The management of spasticity is a common goal forchildren with spinal cord injury (SCI).A better understanding of spasticityis important for clinicians working with this population.The purpose ofthis study is to examine the electromyography (EMG) responses of theknee flexors and knee extensors during the examination of spasticityusing an isokinetic dynamometer and to correlate peak passive resistancetorque with clinical scales of spasticity in children with SCI. Number ofSubjects: A convenience sample of 14 children with chronic SCI (meanage = 9.1 years; 13 ASIA A, 1 ASIA B) was recruited. Materials/Methods:One set of ten passive movements from 90 degrees of knee flexion to 25degrees of knee flexion and from 25 degrees of knee flexion to 90 degreesof knee flexion was completed using an isokinetic dynamometer at 15, 90,and 180º/s with a return speed of 5 degrees per second to assess kneeflexor and knee extensor spasticity respectively. Surface EMG was col-lected from the vastus lateralis (VL) and medial hamstrings (MH) concur-rent with the dynamometry data.Gravity corrected peak passive torque foreach repetition was calculated. EMG onset was defined as three standarddeviations above baseline level. Spasticity was clinically assessed using theAshworth Scale (AS) and Spasm Frequency Scale (SFS). Descriptive analy-sis of the EMG responses was completed. Non-parametric correlationalanalyses between peak passive resistive torque and the clinical measuresof spasticity were calculated. Results: During passive knee extension,reflexive muscle activity in the MH occurred in less than 4% of trials whilereflexive muscle activity in the VL occurred in less than 6% of trials withmovements at each velocity. During passive knee flexion, reflexive muscleactivity in the VL occurred in less than 5% of trials while reflexive muscleactivity in the VL occurred in less than 8% of trials with movements at eachvelocity.The median AS for the knee flexors and knee extensors was 0.5and 0 respectively while the median SFS was 2.There were no significantcorrelations (p<0.05) between peak passive torque of the knee flexors andknee extensors at each velocity,AS, and SFS with the exception of a signif-icant negative correlation (p=0.034) between SFS and peak passive torqueof the knee flexors with movements at 15º/sec. Conclusions : Reflexive

muscle activity of the MH and VL appears to have a minor role during themeasurement of spasticity of the knee flexors and knee extensors usingdynamometry in children with SCI, which suggests that passive musclestiffness may be more important than increased reflexes. Quantitative andclinical examination tools for spasticity appear to be measuring differentaspects of spasticity.Clinical Relevance: Examination of spasticity shouldincorporate both quantitative and clinical tools in order to have a morecomplete understanding of spasticity. Interventions for spasticity in chil-dren with SCI may benefit from addressing non-reflexive muscle stiffness.

PLATFORMS: Parkinson DiseaseSaturday 1:30-3:30

TREADMILL EXERCISE TRAINING INDUCES ANGIOGENESIS ANDIMPROVES ENDURANCE AND NEURONAL INDICATORS IN CHRONICMOUSE MODEL OF PARKINSON’S DISEASE.M.D.Al-Jarrah1,L.Novikova1,L. Stehno-Bittel1,Y. Lau2, 1Physical Therapy and Rehabilitation Sciences,TheUniversity of Kansas Medical Center, Kansas City, KS, 2Department ofPharmacology,The University of Missouri, Kansas City , Kansas City, MO.

Purpose/Hypothesis:The goal of this study was to determine whether a4-week treadmill running protocol could induce angiogenesis and improveendurance and neuronal indicators in a chronic MPTP/probenecid mousemodel of Parkinson’s disease. Number of Subjects:Twenty-three C57BL/6mice were randomly assigned in 4 groups: sedentary control, exercise-trained control, sedentary PD, and exercise-trained PD. Materials/Methods: The PD was induced by 10 chronic injections of 25 mg/kgMPTP and 250 mg/kg probenecid, which exhibited many symptoms ofhuman PD. Exercised groups of mice were trained to run 40 min, 5days/week for 4 weeks at an average speed of 18 m/min on a treadmill.Citrate synthase activity, cardiovascular parameters, dopamine level in sub-stantia nigra, tyrosine hydroxylase contents and blood vessels density inthe striatum were analyzed and compared between the animal groups.Results: Compared to the respective sedentary groups, the soleus musclecitrate synthase activity increased by 21% in the exercise-trained PD groupand 18% in the exercise-trained control group (p<0.05). Citrate synthaseactivity in the gastrocnemius produced similar results. Resting heart ratesdeclined significantly in both exercise-trained groups. PD showed adecrease in the resting heart rate by about 10%. Substantia nigra tyrosinehydroxylase content and striatal dopamine levels were increased nearly30% in the exercise-trained PD over the sedentary PD mice, whereas theselevels were indifferent between sedentary and exercise-trained controls.Exercise also resulted in a significant increase in blood vessel density in thestriatum of trained PD animals compared to the sedentary group (P<0.003). Conclusions: In summary, our study demonstrated that improve-ment in endurance and neuronal parameters as well as angiogenesis couldbe achieved in PD mice with a 4-week exercise training protocol. ClinicalRelevance:According to our results, aerobic exercise could be beneficialfor limited functional recovery in subjects with debilitating neurodegener-ative disorders, including Parkinson’s disease

ADAPTATION OF VOLUNTARY STEP INITIATION IN PERSONS WITHPARKINSON’S DISEASE. J. Spears1, K. Ryczek1, S. Schumacher1,A. Orzel1,J. Zhang1, K. Martinez1, M.E. Johnson1, M. Mille1, M.W. Rogers1, T. Simuni2,1Physical Therapy & Human Movement Sciences, Northwestern University,Chicago, IL, 2Neurology, Northwestern University, Chicago, IL.

Purpose/Hypothesis: Difficulties with gait initiation and other locomo-tion activities are characteristic and often debilitating problems for peoplewith Parkinson’s disease (PD).Anticipatory postural adjustments (APAs) forlateral weight shift and stability normally precede and accompany step ini-tiation. Patients with PD demonstrate prolonged and reduced APAs anddelayed step initiation.A lateral postural assist at the pelvis has been shownto acutely decrease APA duration and step onset time in PD.The aim of thisstudy was to determine if patients with PD would adapt to lateral assisttraining by demonstrating decreases in APA duration and step onset timefollowing removal of lateral assist. Number of Subjects: 6 patients withearly-stage PD (Hoehn and Yahr stage 1 & 2) and 6 age-matched controls.Materials/Methods:Ground reaction forces were recorded with two forceplatforms to determine APA characteristics based on the net medio-lateral


center of pressure displacement.Whole body kinematic data were recordedusing a 6-camera infrared motion analysis system to determine step charac-teristics.The lateral assist training session consisted of 3 blocks of trials dur-ing rapid forward stepping:10 baseline trials,50 trials with lateral assist, and10 post-assist trials without assist.Ten retention trials without assist werecollected one week after the initial session.The lateral assist was providedby a motor driven robotic system with a cable attachment hooked onto abelt around the subject’s pelvis. The assist was applied when 55% of thesubject’s weight was on the swing limb to aid with weight transfer duringthe APA phase of step initiation. Data was analyzed using ANOVA (p <0.05).Results: There were no significant group effects between PD andcontrol subjects.However,PD subjects tended to show longer APA durationand slower step onset times compared to controls. Significant conditioneffects between baseline and lateral assist trials, indicated a decrease in totalAPA duration (p < 0.01), thrust phase (APA onset to peak amplitude (p <0.02), unloading phase (peak APA amplitude to end of APA, (p < 0.02), andstep onset time (p < 0.01).There was a significant decrease in thrust dura-tion between baseline and retention (p = 0.01).A decrease in APA durationbetween baseline and retention was marginally significant (p = 0.06) and ashorter step onset time approached significance (p = 0.11).Conclusions :This study supports previous research that a lateral assist can acutelyimproves step initiation characteristics, in patients with PD.A trend for sub-jects to retain shorter APA duration and step onset with practice suggesteda potential for adaptation. Greater significance may have been achievedwith larger sample size. Clinical Relevance: The approach illustratesapplication of current theories of neural plasticity pertaining to adaptivemechanisms of posture and locomotion interactions and their managementin people with PD. To attain greater training effects patients may benefitfrom increased practice time and additional rest breaks to optimize neuraladaptation and minimize fatigue.

EVIDENCE FOR ACTIVITY-DEPENDENT NEUROPLASTICITY IN ANINDIVIDUAL WITH PARKINSON’S DISEASE: A TRANSCRANIAL MAG-NETIC STIMULATION STUDY. M.S. Fong1, T.L. Brown1, K.R. Wolcott1, J.Lin1, B.E. Fisher1,A.Wu2, 1Biokinesiology and Physical Therapy, University ofSouthern California, Los Angeles, CA, 2Neurology Department of the KeckSchool of Medicine, University of Southern California, Los Angeles, CA.

Background & Purpose: Few studies have investigated the effect of high-intensity exercise such as Body-weight-supported treadmill training(BWSTT) on functional improvement in Parkinson’s disease (PD). Further,the role of neuroplasticity as the underlying mechanism of functionalimprovement has not been examined.An important recent advance is thedemonstration of activity-dependent neuroplasticity in animal models ofPD. Currently we are determining the application of these findings to thehuman condition. Single-pulsed Transcranial Magnetic Stimulation (TMS)has been used to evaluate corticomotor excitability in PD compared withhealthy individuals. In PD, the amplitude of the motor-evoked potential(MEP) is higher at low stimulation intensities with a blunted response toincreasing stimulation compared to healthy individuals.The purpose of thispreliminary study was to determine the effect of high intensity exercise onneuroplasticity and functional recovery in an individual with PD.This caseis part of a larger study designed to investigate the underlying neuralprocesses by which BWSTT promotes functional changes in PD. To ourknowledge this is the first report that has used TMS to identify centralchanges post physical therapy intervention. If exercise induces neuroplas-ticity we might expect to see ‘normalization’ of TMS measures. CaseDescription:The subject was a 74 year old functionally independent malewho had been diagnosed with PD within the last 3 years. He participatedin 24 sessions of BWSTT (3 x/week for 8 weeks). PD symptoms primarilyaffected the left (L) extremities.Over training,weight support was graduallyreduced (30% to 5%); treadmill speed and incline were increased (2.0 to 7.0meters/second, 0 to 3% grade).The following measures were taken pre andpost exercise: 1) gait parameters using a motion analysis system and 2) cor-ticomotor excitability (CE) over L and right (R) primary motor cortex withTMS. CE was characterized by slope of the input-output recruitment regres-sion line (RL Slope) for MEP amplitude during active contraction of the firstdorsal interosseous muscle. Outcomes: A 14% and 16% increase in speedand single limb support time respectively were accompanied by an 84%change in RL Slope for MEP amp of the R (more affected) hemisphere. Pre

exercise RL Slope was 17 with a minimal increase in MEP amplitude withincreasing stimulation. Post exercise MEP amplitude increased with stimu-lation intensity in a near linear fashion (RL Slope = 107) approximatingwhat is seen in healthy individuals. Discussion:To our knowledge, this isthe first demonstration of exercise-induced changes in recorded TMS valuesin conjunction with functional improvement. Our data suggests that thereis an effect of high-intensity exercise on measures of both brain and behav-ior in PD.By understanding the effects of exercise on neuroplasticity,novel,non-pharmacological therapeutic modalities may be designed to delay orreverse disease progression in Idiopathic Parkinson’s disease.

FUNCTIONAL REACH: IS THIS A VALID MEASURE OF RECURRENTFALLS IN INDIVIDUALS WITH PARKINSON’S DISEASE? J. Robichaud1,Pfann, D.M. Corcos2, C. Cindy3, 1Physical Therapy, Indiana University,Indianapolis, IN;K.D, 2Movement Sciences,University of Illinois at Chicago,Chicago, IL, 3Department of Neurological Sciences, Rush University,Chicago, IL.

Purpose/Hypothesis: Functional reach (FR) of less than 25.4cm has pre-dictive validity in identifying elderly frail subjects at risk for recurrent falls(when adjusted for age, Folstein mental score and depression). In contrast,this measure has not been shown to be a sensitive measure for identifyingmedicated individuals with Parkinson’s disease (PD) who were at risk forrecurrent falls. However, movement disorders associated with PD that pre-disposes these individuals to slips, trips, and falls,become exacerbated dur-ing the ‘off’ or coming ‘off’ medication conditions. The purpose of thisstudy was to determine the effect medication has on the predictive valid-ity of FR in determining the risk of recurrent falls in individuals with PD.Number of Subjects: Forty subjects with PD were tested both off med-ication (12-hour overnight withdrawal of anti-parkinsonian medications) and then after the subject’s regular medication was resumed. Materials/Methods: Subjects underwent a clinical evaluation,which consisted of themotor (part III) subclass of the Unified Parkinson’s Disease Rating Scale(UPDRS) and the FR test. Individuals were also asked if they had experi-enced 1 or more falls in the past year.A fall was defined as an incident thatresulted in the person unexpectedly coming to the ground.The FR test wasadministered according to the procedure established by Duncan and col-leagues. Each subject performed 1 practice trail and 3 test trials.The meandifference between the initial position and the end position for the threetrials was calculated as the FR.Data was analyzed using analysis of varianceand regression analysis.The independent variables were medication status(off, on), the motor subsection of the UPDRS and history of falls.Dependent variable was FR. All levels of significance were designated atp < 0.05.Results: Individuals with PD exhibited greater FR and higherUPDRS scores in the ‘off’ as compared to ‘on’ medication condition. FR, asa measure of the risk for recurrent falls in the ‘off’ medication conditionrevealed a test sensitivity of 100% and test specificity of 74%.Further, therewas a significant correlation (R = .79) between ‘off’ medication UPDRSscore and FR. In contrast, in the ‘on’ medication condition test validity forthe FR test (measure of the risk of recurrent falls) revealed a test sensitiv-ity of 30% and test specificity of 100%.Further,no correlation (R = .30) wasrevealed between the ‘on’ medication UPDRS score and FR. Conclusions:FR measured in the off medication condition, can identify individuals withPD who are at risk for recurrent falls.This study also illustrates the differ-ing conclusions that can be reached when these individuals are tested inthe ‘off’ as compared to the ‘on’ medication condition. ClinicalRelevance: FR in the ‘off’ medication condition is a simple test that clini-cians may use to identify individuals with PD who are at risk for recurrentfalls. Due to the progressive nature of PD, individuals who are identified atrisk should be enrolled in a fall risk intervention program.

RELIABILITY AND VALIDITY OF THE TINETTI MOBILITY TEST FORINDIVIDUALS WITH PARKINSON DISEASE. D. Kegelmeyer1, A.D.Kloos1, S.K. Kostyk2, K.M. Thomas2, 1Physical Therapy, The Ohio StateUniversity, Columbus, OH, 2Movement Disorders Division,The Ohio StateUniversity, Columbus, OH.

Purpose/Hypothesis: Individuals with Parkinson disease (PD) developprogressive gait and balance problems that often result in falls. The TinettiMobility Test (TMT) is a clinical balance and gait test that predicts fall risk


in elderly individuals.The aims of this study were to determine the inter-rater (Part 1) and intrarater (Part 2) reliability of TMT scores of individualswith PD, the construct validity of the TMT as a measure of balance and gaitimpairment severity (Part 3), and the predictive validity of the TinettiMobility Test as a screening tool to identify individuals with PD at risk forfalls (Part 4). Number of Subjects:Thirty individuals with a diagnosis ofPD (mean age=65.47 ±11.17;male/female ratio=23/7;mean Hahn and Yahrscore =2.41 ± .39) who attended the Madden/NPF Center of Excellence(Columbus, Ohio) were recruited to voluntarily participate in all portionsof this study. Inclusion criteria were Hoehn and Yahr stages I-III or earlystage IV, and ability to independently ambulate with or without the use ofan assistive device. Subjects who had any other neurological diagnosis orparalysis from another condition were excluded. Materials/Methods:Two physical therapists and 3 physical therapy students rated subjects liveperformances of the TMT (Part 1). During the gait portion of the test, timefor each subject to ambulate 25 feet was recorded.Two physical therapistsand 4 physical therapy students rated subjects videotaped performances ofthe TMT on two separate days one week apart (Part 2). One of two physi-cians administered the Unified Parkinson Disease Rating Scale Motor Exam(Section III) and scores obtained were correlated with the TMT scores(Part 3).A falls history was obtained for each subject and the discrimina-tive power of the TMT to predict fallers was assessed using statistical tests(Part 4). Data were analyzed using intraclass correlation coefficients (Parts1&2), Spearman correlation coefficients (Part 3), and statistical tests of sen-sitivity, specificity,positive and negative predictive values (Part 4).Results:Interrater reliability of total TMT scores was good to excellent between allraters (ICC=.87), physical therapist raters (ICC=.84), student raters(ICC=.88), and between physical therapist and student raters (ICCrange=.82-.94). Preliminary results showed moderate to excellentintrarater reliability of total scores for two raters (ICCs=.99 and .67). Meantotal TMT scores were moderately correlated with UPDRS motor examscores (Spearman correlation=-.45) and comfortable gait speed (Spearmancorrelation =.53), but did not predict falls (sensitivity=13% and speci-ficity=86% at cutoff score of 19).Conclusions: Our findings suggest thatthe TMT is a reliable and valid measure of balance performance duringfunctional activities in individuals with PD.Analysis is in progress to deter-mine if individual test items are predictive of falls. Clinical Relevance:Toidentify individuals with PD at risk of falling, physical therapists need validand reliable examination tools that objectively measure functional mobil-ity and balance in PD.

THEMATIC POSTERS: Imagery and ImagingFriday 4:30-6:00

REPRESENTATION OF IMAGINED AND EXECUTED SEQUENTIALFINGER MOVEMENTS OF ADULTS POST STROKE AND HEALTHYCONTROLS. J.E.Deutsch1,S.Fischer1,W.Liu2,A.Kalnin3,K.Mosier3, 1PhysicalTherapy, UMDNJ-SHRP, Newark, NJ, 2Radiology, UMDNJ, Newark, NJ,3Radiology, Indiana University, IN.

Purpose/Hypothesis: The purpose of this study was to describe theeffects of brain injury on imagery ability and representation by examiningexecuted and imagined complex finger movement sequences with eachhand. We hypothesized that individuals post-stroke would exhibit similarpatterns of brain activation for executed and imagined movements tohealthy controls (HC) when using their ipsilesional hand but not their con-tra-lesional hand.Number of Subjects: Five individuals post stroke (at leastone year post-stroke, right CVA with preserved motor function in the con-tralesional hand) and five age matched HC. Materials/Methods: Subjectswere tested in two sessions with one week interval. In the first sessionimagery ability was examined using the Motor Imagery Questionnaire(MIQ) and chronometric break tests. Subjects practiced executed and imag-ined paced sequential finger movement sequences with each hand.Audiotaped instructions were provided for practice of the tasks at home. Duringthe second session prior to brain scanning accuracy of finger movementswas confirmed.Data were acquired with a 3T Allegra MR scanner (Siemens)using an echo-planar imaging (EPI) gradient system. Functional studies(fMRI) were acquired using a 32 slice gradient echo EPI (TR=4000,TE=30,64x64 matrix, FOV=22 cm); and a blocked paradigm, each consisting of 4epochs of task performance alternating with visual attention.The four trials

of hand movements were:executed ipsi-lesional, imagined ipsi-lesional, exe-cuted contra-lesional, imagined contra-lesional. MRI data were analyzedusing SPM 99, with a corrected height (p=.05) threshold. Group analyseswere performed to determine the volume of activation in pre-determinedregions of interest. Results: MIQ scores did not differ significantly betweengroups. HC’s pattern of activation during executed tasks by either handincluded the contralateral primary sensory (1, 2, 3) motor (4) parietal (5, 7)and premotor (PMC) and supplementary motor areas (SMA) (6). Individualspost stroke pattern of brain activation when using their ipsilesional handwas similar to that of HC.For the stroke affected hand executed movementswere bilaterally represented while imagined movements were lateralized tothe brains’ primary lesioned side. For all tasks performed by the individualspost-stroke there was greater activation (50-500%) of area six on the con-tralesional side of the brain. Conclusions: The pattern of activationobserved for tasks by the stroke affected hand suggest that it was easier forindividuals post-stroke to imagine rather than execute the movements.Theincreased activity of the pre-motor and supplementary motor areas of thecontra-lesional side during all tasks for the stroke affected subjects suggeststhat there may be a compensatory shift in the tasks of planning andsequencing both imagined and executed sequential finger movements.Clinical Relevance: Mental imagery by individuals post-stroke may serveas a stimulus for plasticity of stroke affected side of the brain and possiblybe a good tool for rehabilitation of motor function.

RECOVERY FROM STROKE: WHAT IS THE ROLE OF THE UNDAM-AGED, CONTRALESIONAL CORTEX? L. Boyd, E.D. Vidoni, PhysicalTherapy & Rehabilitation Science, University of Kansas Medical Center,Kansas City, KS.

Purpose/Hypothesis:The main goal of this study is to map the relation-ships between the phenomenon of contralesional cortical activation afterstroke and motor learning.One explanation for contralesional cortical activ-ity posits that it is a compensatory strategy, employed in response to taskdifficulty. We hypothesize that contralesional cortical activity will bereduced by motor skill learning indexed by a laterality index (LI) derivedfrom fMRI data (H1). Because skill learning is critical for neuroplasticchange, we also hypothesize that increased but non-specific use of thehemiparetic upper extremity (UE) will not alter contralesional cortical acti-vation (H2). Number of Subjects: For this report we mapped individualchanges in neural activation patterns across motor skill practice and atretention in 6 people with chronic subcortical stroke.Materials/Methods: The effect of 2 interventions on activation in theundamaged cortex was assessed using fMRI.All participants used the hemi-paretic UE to either to learn a joystick based targeting task (LEARN group;n=4; mean motor UE Fugl-Meyer 37.0) or to completed a program ofincreased but non-specific use of the hemiparetic UE (USE group;n=2;Fugl-Meyer 40.5).Over 5 days all completed an initial fMRI testing session,3 daysof practice or treatment and a day 5 fMRI retention test. The number ofmovements and UE excursion was standardized across groups. Brain activ-ity was quantified on an individual basis by calculating the LI using theproduct of intensity and area of activation data for the primary motor cor-tex (M1). Results: Demonstrating behavioral learning of the task,response time (RT) decreased significantly (p<.05) for the LEARN group (-278ms) while the percentage of correct target hits increased (+8%). Thiswas not true for USE group (RT slowed +62ms; % target hits reduced -5%).Importantly,normalization of the pattern of brain activation was evident forthe LEARN group; LI improved significantly for M1 by retention (day 1 M1LI -.125; retention M1 LI .735; 1=normal M1 activation). Again, the USEgroup did not change (M1 LI day 1 -.16; retention -.09). Conclusions:Despite the abnormal patterns of neural activation that occurred after braindamage,clearly chronic stroke does not abolish motor learning ability. Ourdata demonstrate that the functional organization of the motor system canbe modified by use even after stroke. Specifically, the magnitude of activa-tion in undamaged, contralesional M1 was altered by task specific motorlearning but not by increasing non-specific hemiparetic UE use. ClinicalRelevance: These data support our hypothesis that post-stroke contrale-sional M1 activation is in some part related to task difficulty and representsa compensatory strategy (H1). It also appears that task specific practice andlearning are required to alter patterns of brain activation after stroke (H2).Our findings have great clinical relevance for rehabilitation; it appears likely


that task specific learning is required to restore more normal patterns ofbrain activity and improve functional outcomes after stroke.

BRAIN ACTIVATION DURING KINESTHETIC AND VISUAL IMAGERYOF WALKING. CA Chatto1, JE Deutsch1, J. Pillai2, T. Lavin2, J. Allison2,1Program in Physical Therapy, UMDNJ, Newark, NJ, 2Department ofRadiology, Medical College of Georgia,Agusta, GA.

Purpose/Hypothesis: The purpose of this study was to contrast howkinesthetic and visual imagery strategies, when used to mentally imaginewalking, would affect brain activation patterns. We hypothesized thatimagery strategy would modify cortical representation. Number ofSubjects: Six healthy, right handed adults (39-64 years old).Materials/Methods: Subjects were tested in two sessions one week apart.In the first session imagery ability was measured with the Vividness ofMovement Imagery Question-naire (VMIQ). Subjects practiced imagingwalking using visual and kinesthetic strategies, using a visual context (hall-way) in which to practice imagined walking.A week after practicing sub-jects returned for brain imaging.Actual and imagined walking speeds wereassessed to determine chronometric consistency. Functional MagneticResonance Images were acquired on a 1.5T scanner (GE LX HorizonEchospeed) using echo-planar technique. Images were acquired using ablocked paradigm with 8 epochs of task performance alternating withdirected attention. Subjects viewed a video of hallway and then performedthe following tasks: 1) imagined walking down hallway using visualimagery 2) imagined walking down hallway using kinesthetic imagery 3)bilateral foot movements 4) imagined foot movements using visualimagery and 5) imagined foot movement with kinesthetic imagery.Subjects’ imagery vividness was recorded after each scan with the VMIQ.Brain imaging data were analyzed using SPM99. For each subject, SPMmaps were computed by subtracting rest from task conditions to identifyvoxels having increased intensity during tasks.A simple t-test was used todetermine significant activation in the following regions of interest (ROIs):sensorimotor cortex (SMC), supplemental motor area (SMA), parietal cor-tex (PC), dorsolateral prefrontal cortex (DLPFC). Data were analyzed at p= .0001 with 20 voxel clustering and p = .05 corrected. Results:All ROIswere activated bilaterally during both visual and kinesthetic imagery ofwalking. The visual imagery task produced a right lateralized pattern forSMC,DLPFC,and PC;while the kinesthetic imagery task produced a left lat-eralized pattern for SMC, DLPFC, SMA and PC. Differences between rightand left sided activation within tasks were not significant due to subjectvariability. The SMC exhibited 29% greater extent of activation for thekinesthetic task than the visual task. Conclusions:These descriptive pre-liminary findings suggest that similar brain regions are recruited withvisual and kinesthetic imagery of walking. The lateralization of the brainactivation and the different weighting of SMC may be related to the typeof imagery. Clinical Relevance: These findings provide a foundation forfurther research with the use of mental practice of walking as an adjunctto the rehabilitation. Selection of imagery strategy may be especially rele-vant for persons following stroke.

EFFECT OF WALKING VS SHAM TREATMENT ON FINGER MOVE-MENT CONTROL AND BRAIN REORGANIZATION IN WELL ELDERLY.S. Anderson, H. Aldrich, S. Knight, C. Battles, J.R. Carey, University ofMinnesota, Minneapolis, MN.

Purpose/Hypothesis: Previous studies have shown that aerobic training,including walking,can have beneficial cognitive effects.The possibility thatsuch cognitive effects might improve motor control is real.The purpose ofthis study was to investigate whether a walking training program couldinduce improvement in finger tracking performance accompanied bychanges in cortical activation within primary motor area (M1),as measuredby fMRI, in well elderly subjects.We hypothesized that subjects in the walk-ing group would show greater improvement in finger tracking and signifi-cant changes in brain reorganization compared to a sham group. Numberof Subjects: Fourteen well elderly subjects were assigned to either a walk-ing group (N = 6, mean age = 81.7, SD = 1.9 years) or a sham group (N=8,mean age 79.8, SD = 2.3 years). Materials/Methods: All subjects wore apedometer for one week prior to group assignment to record baselinelevel of walking distance. Subjects assigned to walking group were

instructed to double their weekly walking distance within six weeks andthen maintain or further increase that distance for an additional six weeks.Subjects assigned to the sham group received one 30-minute treatment perweek for 12 weeks of sham electrical stimulation to the finger and wristextensor muscles of their dominant hand. During this time, they wereinstructed to maintain their regular walking distance. Before and aftertraining, subjects performed a six-minute finger movement tracking testwith functional magnetic resonance imaging of the brain inside a three-Tesla magnet to measure finger movement control and the associated cor-tical activation. Analysis of data was done with paired tests comparingpretest to posttest change for both groups. Results: Results showed thatthe walking group significantly increased their walking distance (p =0.003), whereas the sham group showed no change. The finger trackingaccuracy increased significantly for the walking group (p = 0.01), whereasfor the sham group no change occurred. Despite the significant improve-ment in tracking performance in the walking group, there were no signifi-cant changes in measurements of brain reorganization (active voxel countand signal intensity) in M1 of either group. Conclusions:We concludedthat walking training improved finger movement tracking control in wellelderly subjects but did not show a change in brain reorganization. Theabsence of significant change in brain reorganization accompanying thebehavioral improvement may be due to the area (M1) studied or the timeat which the cortical activity was measured at posttest. ClinicalRelevance:These results suggest that an active walking training programhas beneficial effects on fine motor control of movements unrelated to thewalking exercise. The possibility exists that aerobic/walking training,through molecular mechanisms not yet identified, may have similar bene-ficial effects on motor control in patients with neurological problems.

INFLUENCE OF MOTOR-IMAGERY ABILITY ON SMA AND PSMACORTICAL ACTIVATION. T.J. Kimberley, G.S. Khandekar, PhysicalMedicine and Rehabilitation, University of Minnesota, Minneapolis, MN.

Purpose/Hypothesis:The supplementary motor area (SMA) and pre-sup-plementary motor area (PSMA) are considered to be vital in the planning,initiation, and execution of motor tasks. Several studies have investigatedthe role of SMA in mental imagery, but little is known about how the abil-ity to imagine influences brain activation.The purpose of this study was toinvestigate the role of SMA and PSMA during mental imagery in bothhealthy subjects and subjects with stroke and how the ability to imagineinfluences brain activation. Number of Subjects: Six subjects with severehemiparesis (Fugl Meyer UE score: 9-14, range: 8-113 months post stroke,mean: 64.3 months) and six age and gender matched healthy subjects.Materials/Methods:Whole-brain 3-Tesla fMRI was performed in subjectswith stroke during alternating phases of active wrist-tracking with the lessaffected hand and imagined wrist-tracking with the hemiparetic side andresting. Control subjects were assigned a side to imagine and a side totrack.At the end of the session, subjects were asked to rate the ability toimagine the movements,on a scale of 0-5 with zero being inability to imag-ine and five being perfect imagining of the task. Cortical activation inten-sity within each region was determined and the percent change in signalintensity from baseline was calculated. Subjects with stroke and healthysubjects were divided into two groups: high imagery ability (self-rating: 3-5) and low imagery ability (self-rating: 0-2). Statistical analysis of fMRI datawas done with two-tailed T-tests using percent signal intensity change.Results:During the motor imagery task, subjects with stroke displayed sig-nificantly greater percent increase in activation in contralateral SMA ascompared to healthy subjects [SMA: healthy: 0.88 ± 0.14, stroke: 1.39 ±0.52, P = 0.03]. Pre SMA also showed a greater percent increase in thestroke group, but this was not significant [PSMA: healthy: 0.48 ± 0.71,stroke: 1.10 ± 1.24]. For the imagined wrist-tracking task, there was no sig-nificant difference in the percent signal-intensity change between the highand low imagining ability groups.This finding of no difference is supportedby adequate power [effect size: 1.1, N=12, power .80]. Conclusions:Thisstudy provides evidence that mental imagery of a motor task in patientswith stroke promotes cortical activity, which is consistent with previousresearch. Additionally, self-reported ability to imagine does not influencethe signal intensity of SMA and PSMA activation. Clinical Relevance:Studies have shown that mental imagery may have beneficial effects whencombined with rehabilitation. Our findings show that motor imagery facil-


itates cortical activity that is functionally relevant. The data also supportthat the strength of motor imagery ability does not influence the amountof cortical activation.Thus, it is plausible that even patients that have diffi-culty performing motor imagery will exhibit increases in cortical activa-tion which may be an important adjunct to rehabilitation.

MOVEMENT CONTROL AND CORTICAL ACTIVATION IN FUNC-TIONAL ANKLE INSTABILITY. K. Anderson, J.R. Carey, Program inPhysical Therapy, University of Minnesota, Minneapolis, MN.

Purpose/Hypothesis: One-third or greater of first time ankle sprain suf-ferers report continuing instances of ankle instability, regardless of inter-vention or severity of injury.This high prevalence of prolonged instabilityrequires exploration into contributing factors. Previous research has impli-cated impaired sensorimotor control of the ankle. The purpose of thisstudy was to explore for differences in cortical activation, measured withfunctional magnetic resonance imaging (fMRI),between people with a his-tory of recurrent ankle sprains and those without such a history during anankle movement control task. Number of Subjects:Ten subjects (meanage 29.9 ± 8.4 years) with complaint of unilateral (8 right,2 left) functionalankle instability (FI) and ten control subjects (age 26.9 ± 9.0) wererecruited from a sample of convenience.All subjects were right ankle dom-inant. Materials/Methods: Functional MRI images using a 3 Tesla magnetwere obtained while the subjects performed an ankle tracking task witheach ankle separately (order randomized) using ankle inversion and ever-sion to follow a 0.4 Hz sine wave. Movement control was calculated foreach ankle with an accuracy index. Using blood oxygenation level depen-dent (BOLD) contrast method, cortical activation was assessed.We calcu-lated the percent increase in signal intensity from baseline (% intensity)during the task over all voxels in the anatomically defined regions of pri-mary motor (M1), primary somatosensory (S1), and supplementary motor(SMA) cortices using non-parametric tests. Results: Ankle pairwise %intensity differences were found in FI subjects in S1 and M1. In M1, whiletracking with the sprained ankle, the FI subjects showed greater intensityin the contralateral than ipsilateral hemisphere (p=0.005) while the con-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-strated greater intensity in the contralateral than ipsilateral regions(p=0.021 sprained ankle, 0.047 unsprained ankle). Control subjectsdemonstrated no difference between hemispheres for either ankle(p=0.953 right, 0.374 left). Differences found in SMA were not significant.No differences were observed between FI subjects and controls for eitherankle tracked in any of the three regions.Accuracy indices demonstratedno between group or within subject differences. Conclusions: We con-cluded that differences in patterns of cortical activation during a move-ment accuracy task exist between those with recurring functional anklecomplaints and those without such complaints.Clinical Relevance:Theseresults invite further work into discovering a neurological mechanism forfunctional ankle instability, which may lead to new interventions.

THEMATIC POSTER SESSION: Post-Stroke HemiplegiaSaturday 8:00-11:00

SPLIT-BELT TREADMILL ADAPTATION AND GAIT SYMMETRY POST-STROKE. DS Reisman1, AJ Bastian2, 1Department of Physical Therapy,University of Delaware, Newark, DE, 2Kennedy Krieger Institute, Baltimore,MD.

Purpose/Hypothesis: The purpose of this study is to understand thecapacity of persons with post-stroke hemiparesis to adapt locomotor inter-limb coordination and the influence of this on gait symmetry. Number ofSubjects: 8 subjects with chronic post-stroke hemiparesis and age-matchedcontrols have been tested to date. Materials/Methods:Subjects walked ona custom split-belt treadmill (Woodway) where the speed of each belt (leg)could be controlled independently. Subjects walked in baseline conditions(belts tied, slow=0.5 m/s and fast=1.0 m/s), split-belt conditions (impairedleg moving fast (1.0 m/s) in one session, slow (0.5 m/s) in another) andpost-adaptation conditions (belts tied, slow=0.5 m/s). OPTOTRAK(Northern Digital,Waterloo ON) sensors were used to record 3-dimensionalposition data from both sides of the body. Infrared emitting diodes (IREDs)

were placed bilaterally on the 5th metatarsal head, lateral malleolus, lateralknee joint space, greater trochanter, iliac crest and acromion process. Footcontacts were determined using foot switches. Intra-limb (i.e. those mea-sured from a single leg: stride length, stance/swing time) and inter-limb (i.e.those where the measurement depended on both legs: time in double sup-port, step length, limb orientation at weight transfer, limb phasing) kine-matic variables were calculated. Results: Both controls and people withchronic stroke could adapt inter-limb coordination and showed after-effects following split-belt practice. Subjects with hemiparesis changedlimb phasing and step length from the baseline period to the early adapta-tion period (p<0.05, p=0.10, respectively) and stored an after-effect (com-paring baseline and early post-adaptation periods, p=0.09, p<0.05, respec-tively). Similar results were found for double support and limb orientationat weight transfer, though individual stroke subjects varied in their adaptiveabilities. Intra-limb parameters changed rapidly for controls and peoplewith hemiparesis, with no difference between the groups. For the 6 out of8 subjects with hemiparesis that demonstrated a gait asymmetry, walkingon the split-belt treadmill temporarily reduced or eliminated the asymme-try either during split-belt adaptation or due to after-effects in the post-adaptation period. Conclusions: Since all subjects showed some adaptiveability, we suggest that this form of locomotor adaptation may be lessdependent on cerebral structures. We speculate that the adaptation andexpression of the after-effect may be influenced by several factors includ-ing: the degree of locomotor impairment, lesion location, and/or which legis driven faster during the adaptation. Clinical Relevance: The results ofthis study preliminarily suggest that persons with post-stroke hemiparesisretain the capability to adapt inter-limb coordination to produce a moresymmetric locomotor pattern. Split-belt treadmill training may therefore beuseful to improve gait symmetry of people with certain types of stroke.

PARETIC LOWER EXTREMITY LOADING AND WEIGHT TRANSFERFOLLOWING STROKE. V.S. Mercer1, S. Chang1, J.L. Purser2, J.K. Freburger3,1Allied Health Sciences, UNC-CH, Chapel Hill, NC, 2Medicine, DukeUniversity Medical Center, Durham, NC, 3Cecil G. Sheps Center for Health,University of North Carolina at Chapel Hill, Chapel Hill, NC.

Purpose/Hypothesis: Improved ability to bear weight on or load theparetic lower extremity (LE) and to transfer weight from one LE to theother is one of the main goals of stroke rehabilitation.Although this goalappears theoretically sound, the functional significance of these abilitieshas not been addressed empirically. The purpose of this project was todetermine how impairment-level measures of paretic LE loading andweight transfer relate to clinical and/or self-report measures of physicalfunction and disability during early recovery from mild to moderate stroke.Number of Subjects:Twenty-five subjects (12 men, 13 women; mean age= 60.5 ± 17.2 years) with a diagnosis of a single, unilateral stroke partici-pated in the study. Materials/Methods: Subjects were tested at 1, 2, and 3months post stroke.The Step Test (ST) and the Repetitive Reach (RR) testwere used as measures of LE loading and weight transfer, respectively. Athird impairment-level measure, paretic hip abductor muscle torque, wasexamined because of the important role of the hip abductors in both load-ing and weight transfer. Self-selected gait speed (GS) and the MOS ShortForm-36 Physical Functioning Index (PFI) were used to assess physicalfunction.Three domains (mobility,ADL/IADL, participation) of the StrokeImpact Scale (SIS) were used to assess self-reported disability. Regressionanalyses were conducted to examine the bivariate associations betweeneach impairment and physical function measure and between each impair-ment and disability measure for each time point (1, 2, 3 months). Results:All of the impairment measures were positively associated with all of thephysical function measures.These associations generally got stronger overtime (i.e., from 1 to 3 months). The associations were stronger for self-selected gait speeds (R2 values 0.30 - 0.79) than for the PFI scores (R2 val-ues 0.15- 0.63). Both ST and RR scores were strongly associated with gaitspeed at all 3 time points.At 3 months, each additional step on the ST cor-responded to a 0.08 m/sec increase in gait speed (95% CI=0.06-0.10,p<0.001), and each additional reach during RR was associated with a 0.03m/sec gait speed increment (95% CI=0.02-0.04, p=<0.001). The impair-ment-disability associations were weaker than the impairment-physicalfunction associations, with only some reaching statistical significance. STscores and RR scores were positively associated with SIS mobility (R2 val-


ues .32-.46) and SIS ADL/IADL (R2 values .16-.37), with RR scores havingthe strongest associations. Hip abductor torque was positively associatedwith SIS mobility (R2=.19).The impairment-disability associations also gotstronger over time. Conclusions: Impairment in paretic lower extremityloading and weight transfer abilities relates to physical function and dis-ability during the first 3 months following stroke. Clinical Relevance: Byuse of interventions that promote symmetrical weight bearing andsmooth, rapid weight transfer between the lower extremities, physicaltherapists may be able to help stroke survivors improve function and min-imize disability.

SINGLE LIMB BODY WEIGHT SUPPORTED TREADMILL TRAINING.J.H. Kahn1,T. Hornby2, 1Sensory Motor Performance Program, RehabilitationInstitute of Chicago, Chicago, IL, 2Physical Therapy, University of Illinois atChicago, Chicago, IL.

Purpose/Hypothesis: Gait asymmetries, characterized by differences instep length as well as timing, are common deviations seen in people whohave had a stroke. Body weight supported treadmill training (BWSTT) hasbeen shown to improve functional walking ability, including gait asymme-try, in individuals post stroke.Despite these improvements, the labor inten-sive demands of the task limit its use in the clinic. Multiple therapists areoften required and controlling gait kinematics is difficult with one thera-pist. Previous evidence has shown that unilateral walking training mayhave an effect on bilateral locomotor activity; specifically, altering condi-tions on one leg may have an effect on bilateral activity. Unilateral trainingmay have the potential to affect gait symmetry following stroke, althoughapplication of this training has not been reported. This study investigatedthe effects of single limb BWSTT in people with chronic stroke whostepped with their unimpaired limb. Stepping with the unimpaired limbmay encourage weight-bearing on the impaired extremity and promotesymmetrical walking. Hypothesis: Single limb BWSTT will improve steplength symmetry in individuals with chronic stroke.Number of Subjects:Six subjects with chronic stroke who demonstrated a 20% step lengthasymmetry completed the protocol. Materials/Methods: Subjects com-pleted a 20 minute session of unilateral stepping with their unimpairedlimb on the treadmill, and the impaired limb held in a stationary position.Subjects walked on the treadmill for 5 minutes at their normal,overgroundgait velocity and speed was increased by 25% every 5 minutes. Bodyweight support was determined by the least amount of support toleratedwithout buckling. Subjects were evaluated using the Berg Balance Scaleand Gait Mat II Regis. Gait speed and symmetry during normal and fastwalking speeds were obtained at 1 week pre- and post-training.Additionally, spatial-temporal data was collected immediately pre- and 10,20, and 30 minutes post-training and 24 hours later. Step length asymmetrywas calculated as the ratio of impaired to unimpaired limb step length.Results: Increased step length symmetry was observed at 10 minutes post-single limb walking, with increases in gait speed observed up to 30 min-utes. Symmetry changes returned to baseline by the following day whileimprovements in speed lasted until 1 week post training. Changes in fastwalking speed were statistically significant (p<.05), and improvements insymmetry were observed (p = 0.11) but not statistically significant.Conclusions: Single limb BWSTT may improve step length symmetry inthe chronic stroke population,although more experimentation is required.Clinical Relevance: The initial findings indicate that unilateral trainingmay improve bilateral walking performance in chronic stroke. Single limbBWSTT may have the potential to be used in the clinic to assist in improv-ing gait speed and symmetry. Such therapy may improve the feasibility ofperforming BWSTT in the clinic while specifically targeting those whodemonstrate gait asymmetry.

THE EFFECTS OF SPEED AND LEVEL OF VOLUNTARY MUSCLE ACTI-VATION ON REFLEX RESPONSES IN CHRONIC STROKE PATIENTS.D. Nichols1, M. Pelliccio1, I. Black2, J. Hidler2, 1Inpatient PT, NationalRehabilitation Hospital,Washington, DC, 2Center for Applied Biomechanicsand Rehabilitation Research, National Rehabilitation Hospital,Washington,DC.Purpose/Hypothesis: PURPOSE: To determine if reflex responses areexaggerated in chronic stroke subjects following multi-joint leg extensionmovements, and the extent to which movement speed and muscle pre-acti-

vation modulates these reflex responses.BACKGROUND:Many factors con-tribute to abnormal movement patterns in patients following unilateralstroke including weakness, poor motor control and spasticity. Reflexresponses have been shown to be exaggerated following stroke which pre-sents challenges while weight-bearing or stepping with the paretic leg.While studies have quantified reflex behavior at a single joint (Knutsson,1980) little has been done to look at reflexes during controlled multi-jointmovements. HYPOTHESIS:We hypothesize that stroke subjects will demon-strate greater reflex activity following multi-joint leg movements and thatthis activity becomes pronounced at higher movement velocities or whenmuscles are voluntarily activated compared to controls. Number ofSubjects: 14 unilateral chronic (> 1 year) stroke survivors and 10 healthyage-matched controls participated in this study. Materials/Methods: Eachsubject was instrumented with surface electrodes over the gastrocnemius(gastroc), hamstring (HS), rectus femoris (RF), vastus medialis (VM) and lat-eralis (VL), adductor longus (AL), and gluteus medius (Gmed) and maximus(Gmax). Subjects were seated in a BIODEX with their foot rigidly attachedto a 6 DOF load cell and footplate that could slide on a horizontal track toproduce passive leg extension. Using a visual feedback, subjects wereinstructed to target match hip and knee torques at 10, 20 and 30% of theirmaximum after which the leg was extended at one of three speeds (30, 60,and 120º/s). EMGs were normalized by their maximum value, after whichthe reflex response was identified as the integrated muscle activity for thefirst 200 ms following the onset of movement.A single-factor ANOVA wasused to compare reflex response between groups (alpha = 0.05) acrossspeeds and pre-activation levels. Results: 1) The mean reflex activity in thegastroc, HS and AL are larger in stroke survivors compared to controls (p <0.05), while reflex responses in the rectus femoris were smaller in thestroke subjects (p < 0.05). 2) Changes in speed affected stroke survivorsmore than controls in the gastroc, HS and AL (p < 0.05). 3) Changes in mus-cle pre-activation correlated with reductions in reflex activity, particularlyat slow speeds, however the correlation coefficient was not significant.Conclusions: Stroke survivors have exaggerated reflex activity that is exac-erbated with increases in movement speed, particularly in the biarticularmuscles. Clinical Relevance: Exaggerated reflex responses with increas-ing speed may influence a stroke patient’s ability to perform tasks requir-ing rapid leg extension movements such as sit-to-stand and postural adjust-ments for balance. Stroke patients may self select slower movementspeeds to diminish the effect of speed on these muscles and enable patientsto maintain control of their movements.

DYNAMIC WALKING STABILITY IN HEMIPARETIC CHRONICSTROKE SUBJECTS. K.P. Brady1, J.M. Hidler1, M.C. Sinopoli2, 1Center forApplied Biomechanics and Rehabilitation Research, NationalRehabilitation Hospital, Washington, DC, 2Department of BiomedicalEngineering, Catholic University,Washington, DC.

Purpose/Hypothesis: The goal of this study was to identify key charac-teristics of ground reaction forces exhibited during gait that could be usedto quantitatively evaluate stability during ambulation. The most commonway to measure stability during ambulation in stroke patients is throughforce platform data analysis (Karlsson and Frykberg,2000) and clinical testsperformed by health professionals such as the Berg Balance Test (Berg et al.,1995).These tests give a numerical score based on an individual’s ability tocomplete a set of tasks yet focus on static posture and limited dynamic sta-bility that are limited by their subjectiveness. Number of Subjects: Eightindividuals with hemiparesis resulting from a CVA no less than one yearprior to the onset of the study and eight healthy age-matched control sub-jects participated in the study.Materials/Methods:Each subject walked ona split belt instrumented treadmill (ADAL3D-F/COP/Mz,TECMACHINE) out-fitted with force sensors under each belt (Kistler,Winterthur, Switzerland),which allows for the calculation of ground reaction forces and center ofpressure (COP) under each foot. Each subject walked on the treadmill atfive different speeds: their normal over-ground self-selected walking speed(SS), ± 10% SS and ± 25% SS. Data was collected at each of the five speedsfor two periods of 30-seconds.The Fugl-Myer (Fugl-Meyer et al.,1975) lowerextremity scale was used to assess each stroke subject’s motor functionwhile the Berg Balance test was completed to give a known clinical mea-sure of stability. Repeated measures ANOVA calculations were used to com-pare ground reaction forces in each direction and variability in COP data


while Pearson correlation coefficients were used to determine whetherthere are relationships between the gait metrics measured in this study andBerg Balance and Fugl-Meyer clinical scales. Results: Both propulsion andbraking forces were significantly smaller in the stroke subjects than in thecontrol subjects in both the affected and unaffected legs (p < 0.05).Interestingly, in the medial-lateral plane, there were no differences betweencontrols and the affected lower limb of stroke subjects yet there were sig-nificant differences between controls and the unaffected leg at all speeds(p < 0.05). A similar trend emerged for variability measures of COP wherethere were no differences between control subjects and the affected strokelower limb yet there were significant differences for the unaffected leg,par-ticularly at heel strike and mid-stance. There were no correlations withthese measure and commonly used clinical scales of postural stability (BergBalance) and motor function (Fugl-Meyer). Conclusions: Results from thisstudy indicate that stroke subjects exhibit a wider variety of spatial patternsin both their ground reaction force and COP trajectories than do healthyindividuals. Clinical Relevance:These results suggest that kinetic analysisof hemiparetic gait may be useful to incorporate into future assessments ofdynamic stability.

LOWER LIMB STRENGTH AND COORDINATION PATTERNS OFCHRONIC STROKE SUBJECTS IN A FUNCTIONAL POSTURE. MMPelliccio, N Neckel, D Nichols, J Hidler, National Rehabilitation Hospital,Washington, DC.

Purpose/Hypothesis:The goal of this study was to quantify the strengthand coordination patterns of the paretic leg in individuals with chronicstroke while in a functional position. Following cerebrovascular accident(CVA) patients often lose independent control over synergistic musclegroups, resulting in joint movements that are often inappropriate for thedesired task (Twitchell, 1951; Brunnstrom, 1970). In the upper limb, theseinappropriate movements have been attributed to abnormal torque gener-ation about joints secondary to the intended, or primary, joint axis(DeWald et al, 2001). No such abnormal secondary joint torque patternswere found in the lower limb of acute (<6 months post injury) CVApatients (Hidler et al, 2005).We hypothesize that compensatory strategiesadopted by acute stroke subjects necessary to overcome excessive lowerlimb weakness (Hidler et al, 2005) may lead to abnormal secondary jointpatterns in the chronic (>1 year post injury) stages of their injury.Number of Subjects: Fourteen chronic CVA survivors with unilaterallesions and ten age-matched, non-neurologically involved control subjectsparticipated in the study. Materials/Methods:With their trunks stabilizedwith large foam bumpers, stroke subjects stood on their affected lowerextremity while their affected foot was attached to a 6-degree of freedomload cell (JR3,Woodland CA) which recorded forces and torques. Subjectswere asked to generate a maximum torque along eight different directions(hip abduction/ adduction, hip and knee flexion/extension, and ankle dor-siflexion/ plantarflexion) during which a visual display provided bio-feed-back of the torque they generated about that primary joint axis.Simultaneous secondary torques generated about the other joints, as wellas EMG data from eight leg muscle groups, were recorded during eachmaximum exertion. Results: Across all conditions tested, stroke groupgenerated significantly less primary torque in their affected leg than thecontrol group (p<0.05). Furthermore, with maximum exertions, they pro-duced significantly different secondary joint torque patterns during ankleplantarflexion,knee extension, and hip abduction (p<0.05),demonstratingchanges in coordination. Analysis of muscle activity revealed significantdifferences in muscle activation patterns which were consistent with theobserved abnormal secondary torques. Conclusions : Our findingsdemonstrate that chronic stroke subjects experience changes in coordina-tion that were not found in acute stroke subjects, suggesting that com-pensatory strategies utilized early after CVA may develop into chronicmotor impairments. Clinical Relevance:At the onset of stroke, throughyears after, rehabilitation techniques should continue to be adapted toaccount for the detrimental contributions of abnormal muscle synergies.Not only should therapists and their patients re-educate the muscles abouta particular joint, but they should be mindful of coordination of othermusculature to prevent development of abnormal secondary joint patternslimiting inefficiency with functional tasks.

GAIT PARAMETERS ASSOCIATED WITH RESPONSIVENESS TO ATASK-SPECIFIC AND/OR STRENGTH TRAINING PROGRAM POST-STROKE. T. Klassen1, S.J. Mulroy2, K.J. Sullivan3, 1Vancouver Coastal Health,Vancouver, British Columbia, CANADA, 2Pathokinesiology Laboratory,Rancho Los Amigos National Rehabilitation Center, Downey, CA,3Biokinesiology and Physical Therapy,University of Southern California,LosAngeles, CA.

Purpose/Hypothesis: After stroke, patients exhibit weakness that con-tributes to decreased walking velocity and increased disability.While evi-dence exists that patient’s post-stroke respond to task-specific andstrength training programs, it is not clear which biomechanical parametersof gait are most influential in improved walking outcome.The purpose ofthis study was to identify the gait parameters associated with responsive-ness to a task-specific and/or strength training program designed toimprove locomotor recovery. Number of Subjects: 20 subjects, rangingfrom 4 to 60 months post-stroke. Materials/Methods: Subjects com-pleted one of four training regimens consisting of a combination of two ofthe following: body weight supported treadmill training; lower extremity(LE) resisted cycling, progressive resistive LE strengthening, or a sham con-dition (arm ergometry). Each subject received 24 treatment sessions (1hour/day; 4x/week; 6 weeks), and the exercises were alternated each day.Subjects ambulated at a self-selected velocity across a 10-meter walkwayusing customary assistive devices,but no lower extremity orthoses,both atbaseline and post intervention. Kinematics and kinetics of the hemipareticLE were recorded with a VICON motion system and a Kistler force plate.Electromyographic activity was recording using indwelling, fine wire elec-trodes in soleus, anterior tibialis, vastus intermedius, rectus femoris, semi-membranosus, adductor longus, gluteus maximus and gluteus medius.Changes in LE kinematics,kinetics,and muscle activation intensities for the10 subjects with the greatest increase in velocity (HI group) were com-pared with those of subjects with less improvement (LO group) using anindependent T-test with a p value of < .05. Results:Velocity increased afterintervention by 0.144 m/sec with the HI group vs. 0.016 m/sec with theLO group.Subjects in the HI group displayed greater increases of preswingankle plantarflexion angle [+3.8 deg vs -0.2 deg], ankle plantarflexionpower [+0.248 W/kgm vs +0.031 W/kgm], terminal stance hip extensionangle [+5.8 deg vs -0.7deg], hip flexor moment [+0.154 Nm/kgm vs -.031Nm/kgm], and hip flexor power [+0.188 W/kgm vs 0.006 W/kgm].Furthermore, intensity of soleus activation was also significantly greater inthe HI group subjects after the intervention [15%max vs 0.3%max].Conclusions: Increased activation of soleus, promoting an improvementof the trailing limb posture, combined with changes in hip and ankle bio-mechanics during terminal stance and pre-swing, were associated with thegreatest increase in gait velocity in individuals post-stroke that completeda task-specific and/or strength training program designed to improve loco-motor recovery. Clinical Relevance: Biomechanical analyses can be aneffective tool for understanding the mechanisms that underlie responsive-ness to physical therapy interventions, therefore allowing a more targetedapproach to ameliorating impairments to function.

Supported by The Foundation for Physical Therapy as part ofPTClinResNet.

HIP JOINT POSITION AFFECTS VOLITIONAL KNEE EXTENSORACTIVITY POST-STROKE. M. Lewek1,T. Hornby1,Y. Dhaher1, B. Schmit2,1Sensory Motor Performance Program, Rehabilitation Institute of Chicago,Chicago, IL, 2Marquette University, Milwaukee,WI.

Purpose/Hypothesis: Individuals post-stroke often exhibit significantfunctional limitations due to either inadequate or inappropriate volitionalmuscle activation. In the lower extremity this is particularly apparent dur-ing ‘spastic paretic stiff-legged gait’,which has been attributed to excessivequadriceps activity during the stance to swing transition.The mechanismunderlying the altered volitional activation of the knee extensors has yet tobe elucidated; however, evidence from animal and human models hasdemonstrated the importance of hip angle sensors in modulating lowerextremity muscle activity.Although the hip’s position has become a focusfor retraining ‘normal’ walking patterns following stroke, there are as ofyet, no quantitative studies which examined the influence of hip angleafferent information during isolated volitional muscle activation after


stroke.The purpose of this study was therefore to quantify the role of hipjoint positioning on the volitional activation of the uniarticular knee exten-sor muscles after stroke. It was hypothesized that greater hip flexionwould yield greater quadriceps activity. Number of Subjects: Fourteensubjects with chronic (> 1 yr) stroke were recruited for testing.Materials/ Methods: Subjects were positioned on a Biodex dynamometerto record the electromyographic (EMG) activity from the uniarticular kneeextensor muscles [vastus lateralis (VL) and vastus medialis (VM)] duringmaximum voluntary isometric knee extension contractions.The knee wasfixed at 60º, while hip position was fixed by altering the subject’s posturein random order to include: sitting upright (90º), semi-reclined (45º), andsupine (0º). EMG data was full wave rectified and low pass filtered to pro-duce a linear envelope.The outcome variable of interest was the integratedEMG activity around peak torque production.A two-way (muscle and hipposition) repeated-measures ANOVA (repeated for hip position) was usedto determine the effect of varying hip posture on knee extensor activity.Results: Hip position had a substantial effect on the amount of volitionalVL and VM muscle activity produced (p=0.07).With the hip positioned infull extension, both muscles were volitionally activated significantly lessthan when the hip was positioned in flexion (p=0.03). Conclusions:Theangle of the hip joint appears to play a significant role in the volitional acti-vation of the uniarticular knee extensors, although more data is required.Patients with stroke tend to walk with the hips in greater flexion, whichmay facilitate activation of the knee extensors contributing to ‘stiff kneegait’ pattern. Clinical Relevance: Hip joint angle contributes to the mod-ulation of volitional quadriceps activation and likely influences reflex-ive/spastic activation contributing to inappropriate muscle activity duringfunctional activities.A strong emphasis should therefore be placed on hipjoint posturing during gait retraining to assist with appropriate muscleactivation patterns.

DEVELOPMENT AND VALIDATION OF CIRCUMDUCTION ASSESS-MENT SCALE FOR INDIVIDUALS WITH HEMIPLEGIA. JL Moore1, HRRoth1, M. Lewek1,YY. Dhaher1,TG. Hornby2, 1Sensory Motor Performance ,Rehabilitation Institute of Chicago, Chicago, IL, 2Department of PhysicalTherapy, University of Illinois of Chicago, Chicago, IL.

Purpose/Hypothesis: Circumduction is a compensatory technique com-monly observed in individuals with hemiparesis following unilateralstroke.This maladaptive strategy is a combination of hip abduction and hiphiking to produce a hemi-circular movement of the leg during the swingphase of gait.Such movements increase energy expenditure and may resultin unstable walking patterns. Despite subjective clinical evidence suggest-ing that circumduction movements are common in individuals followingstroke there is no standardized definition or clinical rating tool to quantifycircumduction.Our purpose is therefore to develop a reliable and valid rat-ing scale to quantify circumduction based on observational gait analysis.Number of Subjects:Ten subjects were recruited for this study. All sub-jects had chronic (>1 year) stroke with resulting hemiplegia and presentedwith hip circumduction during ambulation. Materials/Methods: TheCircumduction Assessment Scale (CAS) is an 11 point rating scale of cir-cumduction, which we define as a lower extremity movement performedduring the swing phase of gait in which the heel of the hemiparetic limbmoves lateral to the foot’s position during stance. Subjects underwentvideotaped optoelectronic gait analysis for the purposes of collecting 3Dtrajectories of limb segments. Physical therapists scored circumduction onthe CAS while viewing the videotaped sessions. Spearman rank correlationcoefficients were used to assess the validity of the CAS by comparing theobjective gait measures during the computerized gait analysis to the ther-apist’s ratings on the CAS.The precision of the rating scale was investigatedby calculating the standard error of estimating the peak circumductionlength during swing. The inter- and intra-rater reliability of the CAS wasassessed by ICCs. Results:We developed the CAS to serve as an objectivemeasure of circumduction in patients with hemiplegia. The results todate indicate that physical therapists can reliably measure circumductionusing clinical gait analysis using the CAS, with an ICC of 0.896.Conclusions:The CAS was designed to be a reliable and valid measure oflimb circumduction in individuals with hemiplegia using only clinical gaitassessment. The CAS has the potential to be a reliable measure of limb cir-cumduction during gait in the chronic stroke population. Clinical

Relevance:The CAS may be used to assess the effect of a specific treat-ment intervention, or changes in an individuals gait over time. Objectivedocumentation of gait impairments has the potential to improve insurancecoverage and demonstrate the need for further therapy.This scale can be integrated into therapists’ and researchers’ evaluations, treatment plans/protocols, goal setting, and may aid in development of improved rehabili-tation techniques for gait recovery in patients with stroke.

SENSORIMOTOR IMPAIRMENTS AND REACHING PERFORMANCE INPERSONS WITH HEMIPARESIS: RELATIONSHIPS DURING THEACUTE AND SUBACUTE PHASE AFTER STROKE. JM. Wagner1, CE.Lang1, SA. Sahrmann1, D.F. Edwards2, AW. Dromerick3, 1Program in PhysicalTherapy,Washington University School of Medicine,St.Louis,MO, 2Programin Occupational Therapy, Washington University School of Medicine, St.Louis, MO, 3Department of Neurology, Washington University School ofMedicine, St. Louis, MO.

Purpose/Hypothesis: The purpose of this study was evaluate the rela-tionships between measures of upper extremity (UE) sensorimotor impair-ment and reaching performance in patients with hemiparesis during earlyrecovery after stroke, and to evaluate how measures collected shortly afterstroke are related to future performance. Number of Subjects: 33 patients(age = 64.1) with mild-moderate hemiparesis resulting from a stroke weretested twice: acutely (average = 9.8 days) and subacutely (average = 108.6days). Materials/Methods: UE isometric strength of the shoulder, elbow,and wrist flexors/extensors was assessed using a hand held dynamometer.Shoulder pain, tactile sensation, joint position sense, and spasticity wereassessed using standard clinical tests. UE active range of motion (AROM),isolated joint movement, and reaching performance were assessed using a3-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 strengthscore was calculated by taking the mean of the ratio values.A composite UEtactile sensation score was calculated by averaging the monofilamentscores.The ability to perform isolated movement at each joint was quanti-fied by calculating an individuation index (II) for the shoulder, elbow, andwrist joints. AROM was calculated during the isolated movement task.Reaching performance was assessed during the initial phase of reaching.Reaching performance variables were movement speed (peak wrist veloc-ity), accuracy (endpoint error) and efficiency (reach path ratio). Pearsonproduct moment correlations were used to describe the relationshipsbetween impairment and reaching performance. Results: Acutely, AROMand strength were moderately correlated with all reach variables. Theserelationships were maintained in the subacute phase. Isolated movementcontrol was moderately correlated with all reach variables during the acutephase but was poorly correlated to reaching during the subacute phase.Somatosensory impairments were poorly correlated to reaching perfor-mance during both phases. AROM was the only impairment measured inthe acute phase that was moderately correlated with subacute reachingperformance.All other acute impairment measures were poorly correlatedwith subacute reaching performance. Conclusions: UE AROM had thestrongest and most consistent relationship with reaching performance dur-ing the acute and subacute phases after stroke. Clinical Relevance:Theultimate goal of UE rehabilitation is to promote use of the UE.These dataillustrate the importance of objectively quantifying UE AROM during theacute phase after stroke since it was the only clinical impairment measurethat demonstrated a moderate relationship with future performance.

NEUROMUSCULAR STIMULATION IMPROVES GRASPING FUNCTIONIN INDIVIDUALS WITH CHRONIC STROKE. B. Quaney1, LH. Zahner1,MJ. Santos2, Z. Kadivar2, B. McKiernan3, 1Landon Center on Aging, Universityof Kansas, Kansas City, KS, 2Physical Therapy and Rehabilitation Sciences,Kansas University Medical Center, Kansas City, KS, 3Physical TherapyEducation, Rockhurst University, Kansas City, MO.

Purpose/Hypothesis: Despite rehabilitation efforts, 60% of individualscontinue to have significant upper extremity (UE) disability one year post-stroke. It is unclear if manual dexterity can be further improved after thistime.The purpose of this pilot study was twofold: 1) To determine if neu-romuscular stimulation (NMES) improves grasping function in individualswith chronic stroke, and 2) To determine if grasping function is enhanced


when NMES is used during functional task training. Number of Subjects:Six subjects (4 FE, 2 M, 58 ± 2.9 y/o) with chronic ischemic stroke (3 - 10yrs. post-stroke) and severe hand dysfunction participated in this study.Inclusion criteria: a) 10 deg. passive wrist extension, c) 90% passive exten-sion of the fingers and thumb with the wrist in a neutral position, and d)no evidence of other neurological disorders.Subjects did not participate inother UE exercise programs during the study. Materials/Methods: Eachsubject received two applications of NMES (passive or functional) in acounterbalanced order (30 min x 5x/wk x 2 wks). Passive NMES was per-formed by placing the impaired forearm in a mid-position and stimulatingthe wrist flexors and extensors to produce two contractions/minute (30contractions: 300usec pulse width @ 40 Hz; 2s ramp up/down with a 6shold). Functional NMES when grasping and releasing a tennis ball was per-formed using single channels from two separate stimulators with manualswitches (30 grasp-releases: 300usec pulse width @ 40 Hz; 0.1 on/offramp). UE motor performance speed, function and strength was measuredat baseline, following treatment and 2 weeks after treatment using con-ventional clinical tests: a) UE Fugl-Meyer (FM) (66 total points possible), b)Box to Block (BB), i.e., the number of 1-inch blocks transported perminute, c) Jebsens Dexterity Test (JDT) (7 tasks), d) Grip Strength (GS) ande) Pinch Strength (PS). Results: While subjects generally improved theirmotor performance speed, function and strength with both applications ofNMES, significant gains in fine motor skills were specific to the functionalNMES. Compared to baseline, functional NMES increased movementspeeds in the JDT by 17% (p< 0.02) and increased FM scores by 19% (p<0.05). In contrast, passive NMES only demonstrated significant gains in FM(18%; p< 0.04). JDT improvements using functional NMES continued to besignificant two weeks after treatment.Conclusions:These results are con-trary to the prevailing clinical view that UE motor recovery is limited to 1year post-stroke.NMES appears to be a viable method in which to facilitatemotor performance gains in chronic stroke.The increased grasping func-tion observed with this brief therapeutic intervention is most likely due tomechanisms other than muscle hypertrophy. Clinical Relevance: Theincreased movement speeds (JDT) suggest that fine motor control can beimproved by applying NMES during a grasping task. Further study is war-ranted to determine if specific types of NMES applications are appropriateacross UE disability levels.

BILATERAL MOTOR OUTPUTS FROM THE RETICULOSPINAL SYS-TEM TO THE UPPER LIMBS DURING REACHING IN THE MONKEY.JA. Buford1, AG. Davidson2, 1Physical Therapy, The Ohio State University,Columbus, OH, 2Neurobiology and Anatomy, University of RochesterMedical Center, Rochester, NY.

Purpose/Hypothesis:This study describes the motor outputs and neuralactivity of the reticulospinal system in the monkey during reaching. Thehypotheses are 1) that single sites in the reticular formation will producebilateral motor outputs to the upper limbs and 2) that neural activity in thereticulospinal system will code for the preparation as well as the executionof upper limb movement during voluntary reaching. Number of Subjects:2 young adult male <Macaca fascicularis> monkeys were the subjects.Materials/Methods: Subjects were trained to reach with the R or L arm toa target on the R or L side, depending on instructions given during a wait-ing period before each trial.An electrode positioning system was then sur-gically implanted, allowing daily access to the brainstem with tungstenmicroelectrodes in the awake, behaving animal. Single-pulse microstimula-tion at 10 Hz was applied to areas throughout the reticulospinal system inthe brainstem as EMG was recorded throughout the shoulder girdle andupper limbs (24 muscles). Extracellular action potentials were alsorecorded from cells in this region. Neural activity patterns in relation topreparatory and movement-related periods of the task were analyzed aswere averaged muscle responses to microstimulation. Results:Microstimulation of the reticulospinal system tended to inhibit extensorsand facilitate flexors ipsilateral to the stimulus and produce the oppositeeffects contralaterally.Effects were strongest and most frequently elicited inthe extensors and in the proximal muscles, especially the upper trapezius.Bilateral effects were the norm, though some sites did produce strictly ipsior contralateral effects in the muscles studied.About 25% of the 196 neu-rons analyzed had activity related to preparation,25% had activity related topreparation and to movement, and 50% had only movement-related activity.

About 30% of the neurons had activity that was related to the arm used forreaching, and 30% (non-exclusive) had activity related to the target con-tacted. Only about 10% had activity that was unique to a certain hand-tar-get combination. Conclusions: Reticulospinal neurons have motor outputeffects and neural activity patterns during movement that demonstrate arole in the control of voluntary reaching. Effects were observed in theshoulder girdle, shoulder, elbow, and even at the wrist. Characterization ofthe reticulospinal system as strictly for postural control or for control oflocomotion may be oversimplified.This major descending system also con-tributes to the execution of discrete, skilled reaching movements. ClinicalRelevance:The motor patterns emanating from the reticulospinal systemare reminiscent of the limb movements associated with the ATNR and withsynergies associated with recovery from stroke. The present findings lendstrength to the long-held concept that the reticulospinal system may be analternative pathway for voluntary motor control after stroke.

THEMATIC POSTER SESSION: Motor LearningSaturday 1:30-3:30

TELEREHABILITATION FOR MOTOR RETRAINING IN PATIENTSWITH STROKE. MK. Holden, T.. Dyar1, E. Bizzi1, L. Schwamm2, L. Dayan-Cimadoro3, 1Dept. of Brain & Cognitive Sciences and Mc Govern Institutefor Brain Research, Massachusetts Institute of Technology, Cambridge, MA,2Clinical Research Center, Massachusetts Institute of Technology,Cambridge, MA, 3Dept. of Physical Therapy, Spaulding RehabilitationHospital, Boston, MA.

Purpose/Hypothesis:To assess the clinical feasibility and effectiveness ofproviding home-based virtual environment (VE) training using a remotelycontrolled telerehabilitation system. Number of Subjects: 12 patientswith chronic stroke were admitted; 1 patient dropped out prior to start oftraining.Mean age for subjects who completed training was 56.7 ± 15.6yr.;duration post-injury was 5.8 ± 4.4yr.; gender, 6 male, 5 female; involvedside, 5 Right, 6 Left. Mean upper extremity (UE) Fugl-Meyer (FM) motorscore (max=66) at entry was 38.3 ±13.8. Materials/Methods:Treatmentintervention consisted of 30 one-hr sessions of real-time interactive VEmotor training for the involved UE, delivered remotely by a therapist viathe internet, 5x/wk for 6 wk. During training, patients practiced move-ments within virtual ‘scenes’ designed to elicit goal oriented movements.Outcome measures FM,Wolf Motor test (WMT) and Strength (grip, shoul-der flexion) were given Pre-training, Post 15 and 30 sessions, and at 4 mo.follow-up. Stability of motor recovery prior to training was assessed withFM (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 significantdifference (-0.3 +/- 1.6, p=0.56), indicating stable motor recovery prior toVE training via telerehabilitation. Following training, mean FM-UE Motorscores improved significantly after 15rx (+2.5, p=0.003), after 30rx (+6.7,p=<0.0001), and at 4 mo. follow-up (+7.6, p=0.001). Mean WMT scoresimproved significantly after 15rx (-6 sec, p=0.0235), after 30rx (-15.5sec.,p=0.0097),and at 4 mo. follow-up (-18.4 sec.,p=0.0032).Shoulder Strengthimproved after 15rx (40%, p=0.0027), 30rx (69%, p=0.0010) and at follow-up (66%, p=<0.0001). Grip Strength improved significantly after 30rx(44%, p=0.0253) but was only partially maintained at followup (26%,p=0.0897).Conclusions: Subjects’ improvements indicate that VE trainingconducted remotely over the internet is feasible and may be a viable newmethod for neurorehabilitation. Subjects gains on all 3 clinical measures(FM,WMT,Strength) show that they were able to generalize motor trainingreceived in VE to real world performance, even to tasks not specificallytrained in VE, and to retain gains for 4 mos. Our results concur with thoseof others, that subjects with chronic stroke are capable of significantmotor improvements even many years s/p stroke.Clinical Relevance:Thenovel home-based treatment method used in this study may provide advan-tages and a viable treatment alternative for patients with stroke. For exam-ple, the difficulty of obtaining transportation to/from therapy clinic isavoided; no commute also allows patients to have more energy to devoteto motor practice during sessions, and facilitates more intense frequencyof treatment. VE motor retraining via telerehabilitation appears effectivein improving UE motor control and functional performance in subjectswith chronic stroke; in addition it provides a fun and motivating treatmentalternative to standard therapy exercises.


Supported by NIH Grants No. HD40959, HD40959-02S1 and 3MO1RR01066-25S.

EFFECTS OF RANDOM AND BLOCKED ORDER PRACTICE ONMOTOR LEARNING IN INDIVIDUALS WITH PARKINSON DISEASE. C.Lin1, CJ Winstein1, KJ Sullivan1, AD Wu2, 1Biokinesiology and PhysicalTherapy, University of Southern California, Los Angeles, CA, 2Neorology,University of Southern California, Los Angeles, CA.

Purpose/Hypothesis: In general, random order practice has been shownto be superior for motor learning in young adults compared to blockedorder task practice. Random practice is thought to be beneficial to learn-ing since the learner’s task-switching capability is strengthened. Since indi-viduals with Parkinson disease (PD) have a task-switching deficit, the pur-pose of this study is to investigate the effects of practice order on learninggoal-directed arm movements in individuals with PD compared to age-matched controls (CN). We hypothesize that blocked order practice issuperior for motor learning for those with mild PD. Number of Subjects:Ten adults with mild PD (mean age= 68.7 yrs; Hoehn & Yahr I or II; ran-domly assigned to either blocked practice, PDB, n=5, or random practice,PDR, n=5) and 8 age-matched controls (mean age= 57.1, assigned toblocked practice, CNB, n=4, or random practice, CNR, n=4) participated.Materials/Methods:All participants practiced 3 lever arm movement pat-terns, each with specific spatial and temporal requirements. Performanceaccuracy was quantified across acquisition and delayed (day 2) retentiontest using root mean square error (RMSE) and timing error (TF). Results:Both groups (PD and CN) decreased error (RMSE) across practice (p<.01).At the end of acquisition, the control groups showed more accurateperformance than the PD groups. In delayed retention, the control subjectswho practiced in the random condition had lower RMSE than those thatpracticed in the block condition (effect size,ES=0.7). Interestingly, this wasnot the case for the PD groups.Consistent with our hypothesis, the PD sub-jects who practiced with a blocked schedule were more accurate indelayed retention than the PD subjects who practiced in the random con-dition (ES= 0.8 for group RMSE difference). In addition, the temporal accu-racy was better for the PD group that practiced in the block condition (ES=0.8 for group TE difference). Conclusions: Consistent with our hypothe-sis, adults with PD learned motor skills better in blocked order practicethan in random order practice. Clinical Relevance:This pilot data sug-gests that conditions of practice that may be beneficial for motor learningin healthy adults may not be as effective for individuals with PD in whichtask-switching deficits are commonly present.

LEARNING EFFECT ASSESSMENT ON SUBSEQUENT SUBJECT PER-FORMANCE ON THE EQUITEST. BALANCE SYSTEM. B. Gilliam, D.Charles, S. Kathmann, J. Smith, N.S. Darr, D. Greathouse, Belmont University,Nashville,TN.

Purpose/Hypothesis: The sensory organization test (SOT) assesses theability to maintain equilibrium as somatosensory, vestibular, and visualinput is altered in a systematic manner. Previous studies have suggestedthe possibility of a learning effect with repeated SOTs.The purpose of ourstudy was to determine if a learning effect occurred with repeated admin-istration of the SOT over two test days performed one week apart.Number of Subjects: Thirty-five healthy subjects (20 female, 15 male)between 22 and 57 years old participated in this study.Materials/Methods: Subjects signed an informed consent approved byBelmont University Institutional Review Board and underwent a shortphysical examination to determine eligibility. Exclusion criteria includedprevious experience with the EquiTest |*regis*| System or other sensoryorganization testing equipment,vision outside the range of 20/20 to 20/60,positive Rhomberg test, lower extremity strength or ROM deficits,or lowerextremity injury within last 6 months. Data were collected using theNeuroCom EquiTest Regis System. Testing occurred during two separatesessions seven days apart. During the first testing session subjects com-pleted a baseline SOT, performing three trials of each of the six conditionsfor a total of 18 trials. Two additional SOTs (post test 1 and post test 2)were performed on the first day of testing. One week later subjectsreturned and completed three additional SOTs (post tests 3,4, and 5) usingthe identical protocol to the first day of testing. Mean equilibrium scores

were calculated from subject performance during the 6 conditions.Composite equilibrium scores were calculated using the weighted averageof the 6 equilibrium scores Composite equilibrium scores and mean equi-librium scores for each SOT were analyzed using one-way repeated mea-sures ANOVA. Significant differences from baseline scores (p≤0.05) wereexamined further using paired t-test comparisons with a Bonferroni cor-rection. Results:There was a significant increase in mean equilibrium SOTscores from baseline across post-tests 3 and 4, and there was a significantincrease in composite equilibrium SOT scores from baseline across post-test 3.When each testing condition was analyzed separately,only condition3 showed statistically significant improvements from baseline across all sixSOTs;however, the SOT score patterns across the six testing conditions areconsistent with those found in previous research throughout all six SOTs.Conclusions:The increase in performance during post-test 3 and post-test4, which were performed one week after baseline testing, is indicative of alearning effect which is most likely due to the subject learning how toanticipate and cope with impaired visual feedback or altered propriocep-tive input. Clinical Relevance: Clinicians and researchers should beaware that mean equilibrium scores and composite equilibrium scoresmay increase with practice even when subjects are tested a week later.

UPPER LIMB FUNCTIONAL RESPONSE TO MOTOR LEARNINGALONE AND MOTOR LEARNING WITH FUNCTIONAL NEUROMUS-CULAR STIMULATION FOR STROKE SURVIVORS. JJ Daly1, J. Rogers2, I.Brenner2, E. Perepezko2, M. Dohring2, E. Fredrickson2, J. Gansen2, 1Neurology,Case Western Reserve University School of Medicine, Cleveland, OH,2Research Service, LS Cleveland VA Medical Center, Cleveland, OH.

Purpose/Hypothesis:The purpose of the study was to test two interven-tions in chronic stroke survivors (>12 months) with moderate to severeupper limb functional deficits.The two interventions were: 1) motor learn-ing (ML-alone); and 2) functional neuromuscular stimulation along withmotor learning (FNSML). Number of Subjects: Eighteen. Materials/Methods: Eighteen subjects were stratified according to the Fugl-MeyerUpper Limb Coordination Scale and randomized to: FNSML or ML-alone.Subjects had a Trace wrist extensor grade. Many had 0 grade finger flex-ors/extensors. Treatment was: 5 times/wk for 12 weeks. The therapistpatient ratio was 1:3. Subjects practiced task components and full task per-formance (60-tasks array). For 1.5 hrs of each daily session, FNS was pro-vided for the subjects in the FNSML group.A two-channel, surface stimula-tor, the EMS+2 (Staodyne, Inc., Longmont, Colorado) was used forfinger/wrist flexors/extensors and lower/middle trapezius. The waveformwas biphasic, symmetric, and rectangular. Stimulus parameters were:300microsecs phase duration; 30Hz; amplitude, 1mA to the highest com-fortable stimulus; and 10secs on/10secs off duty cycle (1sec ramp up,10secs on, 1 sec ramp down, 10secs off). Subjects practiced single and mul-tiple joint movements using FNS, including the following movements: alter-nating wrist flexion/extension;and simultaneous wrist extension and fingerflexion.FNS was used in conjunction with task component movements likepreparation before grasping an object. Outcome measures were: 1) the ArmMotor Ability Test (AMAT); 2) the AMAT wrist/hand components(AMATW/H); and 3) the Functional Independence Measure. The AMAT iscomprised of 13 functional tasks (using knife/fork; grasping mug handleand drinking from cup). Pre-treatment baseline comparisons between thetwo groups were made using t-test.Within-group, pre-/post-treatment com-parisons were made using t-test. Group comparisons in response to treat-ment were made using an ordinal regression model (PLUM Ordinal Model,SPSS) for the FIM. Post-treatment FIM score was the dependent variable,pre-treatment was a co-variate, and group assignment was the independentvariable. Results:At baseline, there was no significant difference betweenthe two groups for the outcome measures (p>.05). In response to treat-ment, there were significantly greater gains for FNSML group versus ML-alone, according to the FIM (p=.003). In response to treatment, FNSML hadsignificant improvement in the AMAT, AMATW/H, and FIM (p= .042, .036,and .007, respectively); whereas the ML-alone group did not (p=.167; .242;.068, respectively). Conclusions: Results suggested that FNSML could befunctionally beneficial for moderately to severely involved stroke survivorswith chronic deficits. Clinical Relevance:The treatment was successfullyoffered with a therapist:patient ratio of 1:3.Moderately to severely involvedstroke survivors with chronic deficits can benefit from intervention.


PROCEDURAL LEARNING OF FUNCTIONAL MOBILITY TASKS INTHE PRESENCE OF SEVERE MEMORY DEFICITS FROM INTRAVEN-TRICULAR HEMORRHAGE. K.A.Volk, R.O. Myers, E. Fitzpatrick-DeSalme,MossRehab, Philadelphia, PA.

Background & Purpose: Memory deficits frequently occur in patientswith both acquired and traumatic brain injuries. Declarative memory, orlearning of facts and events, is often impaired in these patients. However,procedural memory, or learning of motor skills, is often preserved. Thiscase report describes how a severely amnestic patient was able to learnfunctional mobility tasks in physical therapy through the use of procedurallearning techniques. Case Description:A 52-year old woman suffered anintraventricular hemorrhage in all 4 ventricles. She was oriented to persononly, and presented with significant anterograde and retrograde amnesia.She demonstrated severe declarative memory deficits with no awarenessof the tasks that she was practicing in therapy. Her working memory wasalso devastated. Within minutes she would be unable to recall what shewas doing while she was performing a specific skill. Upon admission shewas dependent in all areas of functional mobility. Physical therapy inter-vention consisted of repetitive procedural learning techniques. Functionalmobility training included regimented routines with consistent, brief cuesprovided on a minute-to-minute basis to re-orient the patient to the currenttask. Novel tasks consisted of wheelchair propulsion and ambulation witha rolling walker.Outcomes:The patient remained disoriented to place, rea-son for hospitalization, date, and time. She remained unable to activelyrecall or describe the functional tasks that she performed in therapy on adaily basis. Despite the severity of her deficits, she progressed from adependent to a minimal assist level of overall function with the provisionof frequent and discrete verbal cues. Discussion:The literature supportsthe use of procedural learning for those lacking declarative and workingmemories. However, the majority of this research utilized small samplesthat significantly limit the ability to generalize their findings to this partic-ular population as a whole.The literature also does not involve the use ofreal-world tasks or functional mobility skills. Physical therapists often con-front the challenge of treating patients who suffer severe memory impair-ments resulting from neurologic insult or disease processes. Despite thedifficulties that these patients present, therapists can successfully use tech-niques involving procedural learning when training functional mobilitytasks in order to facilitate the acquisition of such skills and to increasefunctional outcomes overall.

POSTERS

VASOMOTOR INNERVATION PATTERNS OF PERIPHERAL NERVESSUPPLYING THE DISTAL LOWER EXTREMITY. RJ Allen1, EM Jefferson2,VK Bhangu3, 1Physical Therapy, University of Puget Sound, Tacoma, WA,2UCI, Irvine, CA, 3Royal Medical Institute, New Delhi, INDIA.

Purpose/Hypothesis: Investigate innervation patterns to the arterial sys-tem of the leg and foot from eight major peripheral nerves and comparethese vasomotor innervation patterns with somatosensory distributionfields. Number of Subjects: Seven adult volunteers (5 females,2 males),ageranging from 31 to 64 yrs (x = 39), reporting no history of vascular pathol-ogy or insufficiency, peripheral neuropathy, chronic lower limb pain, hyper-tension, or hypersensitive responses to amine-type anesthetics.Materials/Methods: Peripheral nerves studied included superficial anddeep fibular, sural, saphenous, and tibial nerves, along with the tibial nervesmedial and lateral plantar and medial calcaneal branches.On eight days,withat least 24 hour separation, each subject received a neural blockade to onenerve following thermal stabilization in a 16o C climate controlled chamber.Neural blockade temporarily interrupted local sympathetic innervation toarteries supplied by the nerve resulting in vasodilation and superficialhyperemia.Fields of hyperemia represented the vascular innervation field ofthe nerve and was imaged using digital thermography.The anesthetic agentwas 1.8 ml of 3% Carbocaine hydrochloride solution injected at each nervesmost proximal selective location using tissue infiltration. Success and selec-tivity of each block was established via somatosensory testing using SemmesWeinstein monofilaments. Results: All subjects showed consistency inhyperemia fields for each of the nerves blocked. In most cases, vasomotorinnervation fields corresponded with expected sensory patterns. Notably

different from sensory distributions were the vasomotor fields for superfi-cial and deep fibular nerves. Deep fibular nerve blockade produced hyper-emia of the entire lateral leg and proximal aspect of the foots dorsum, theninto the webspace between digits 1 and 2. Blocking the superficial fibularnerve produced vascular change only in the middle aspect foots dorsumextending through digits 2 through 5. Hyperemia was not observed duringsingle distal branch blockades for the plantar surface between digits 3 and4, suggesting dual innervation. Conclusions:Vasomotor innervation fieldsof the leg and foot from peripheral nerves show patterns similar to sensoryinnervation,with the exception of vascular fields supplied by superficial anddeep fibular nerves.These patterns are consistent with the hypothesis thatperipheral nerves innervate principle adjacent blood vessels, thus produc-ing potential neurovascular symptoms that may deviate from expected sen-sory patterns. Clinical Relevance: Prior studies established that upperlimb vasomotor innervation varies from well known sensory patterns.Upper extremity vasomotor innervation charts are proving useful in estab-lishing neurovascular etiologies for atypical symptom patterns due toperipheral neuropathies. The present study represents the initial phase ofinvestigating vasomotor innervation to the lower extremity in an effort toarrive at a complete mapping of arterial innervation of the limbs.

LASER MICRODISSECTION OF BRAIN STEM NEURONS TO EXAMINECHANGES IN GENE EXPRESSION AFTER SPINAL CORD INJURY. SRAllen1, JD Houle2, 1University of Central Arkansas, Conway,AR, 2Departmentof Neurobiological and Developmental Sciences, University of Arkansas forMedical Sciences, Little Rock,AR.

Purpose/Hypothesis: Previous studies have used in situ hybridizationindicating changes in regeneration-associated genes (RAGs) expression tomeasure the effects of neurotrophic factors administered to damaged neu-rons after spinal cord injury (SCI). In-situ hybridization is a lengthy processfor recording gene expression.The goal of this preliminary study was to usea more time efficient method of laser microdissection and quantitative poly-merase chain reaction (Q-PCR) to determine the effects of glial cell-linederived neurotrophic factor (GDNF) on the expression levels of (RAGs) inred nucleus neurons affected by a cervical level SCI. Number of Subjects:Six female Sprague-Dawley rats. GDNF treated rats, experimental group(N=3) Saline treated rats, control group (N=3). Materials/Methods: Sixadult female Sprague-Dawley rats underwent surgery for the completeremoval 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 ofthe hemi-section for one hour.The second group of rats was administeredsaline to serve as a control. Two days after the surgery, animals in bothgroups were sacrificed and red nucleus neurons in the midbrain were iso-lated via laser micro dissection techniques. Neuronal mRNA was preparedfor Q-PCR.The RAGs measured were BII-tubulin and growth associated pro-tein-43 (GAP-43).Actin was used as the housekeeping gene for controlledgene expression. Results:The results of the Q-PCR showed no significantdifference in the RAGs expression levels between injured and uninjuredneurons of the red nucleus two days after SCI. However, there was a trendfor increased expression of BII-tubulin mRNA in the injured red nucleusneurons during this time frame. For spinal cord injuries treated with GDNFat their lesion site, no significant increases were found in the expression ofthe RAGs. However, a trend towards the increase of a growth-associatedprotein (GAP-43) mRNA for the GDNF treated group was indicated duringthis time frame. Conclusions:These results demonstrate the ability to mea-sure changes in gene expression in specific neurons after a traumatic injury.It is possible that significant effects of acute treatment with GDNF may bedetected after longer periods post injury and treatment. Follow-up studiesare planned for using larger sample groups and looking at the effects ofGDNF on RAGs gene expression at various time periods after injury andtreatment. Clinical Relevance: By observing the effects of neurotrophicfactors on changing the gene expression of RAGs and genes important tothe survival of damaged neurons after SCI, it may be beneficial to treatpatients with neurotrophic factors following SCI.

MOVEMENT CONTROL AND CORTICAL ACTIVATION IN FUNC-TIONAL ANKLE INSTABILITY. K. Anderson, J.R. Carey, Program inPhysical Therapy, University of Minnesota, Minneapolis, MN. (See Imageryand Imaging Thematic poster session for abstract)


EFFECT OF WALKING VS SHAM TREATMENT ON FINGER MOVE-MENT CONTROL AND BRAIN REORGANIZATION IN WELL ELDERLY.S. Anderson, H. Aldrich, S. Knight, C. Battles, J.R. Carey, University ofMinnesota, Minneapolis, MN. (See Imagery and Imaging Thematic postersession for Abstract)

ASSESSING FACTORS IMPACTING COMMUNITY MOBILITY AFTERSTROKE: A PILOT STUDY. J. Beaverson, L. Beaudreau, J. Filkowski, C.A.Robinson, P. Noritake Matsuda, A. Shumway-Cook, Dept of Rehabilitation,University of Washington, Seattle,WA.

Purpose/Hypothesis: Limited community mobility is a common occur-rence following stroke and is associated with disability in both basic andinstrumental activities of daily living.The skills and factors affecting com-munity mobility following stroke are largely unknown.This pilot study mea-sured participation in community mobility among survivors of stroke andexamined the relationship between clinical measures of sensation,strength,balance, and gait and participation in community mobility in order to iden-tify factors constraining community mobility following stroke. Number ofSubjects: Thirteen adults diagnosed with stroke (mean age 64 ± 7; meantime since stroke 66 mos, independent ambulators) and 19 older adults(mean age 78 ± 6) without stroke participated. Materials/Methods:Measures included self-reported trips/activities into community, perfor-mance on Berg Balance Test (BBT), 10m-gait velocity, Rivermead MobilityIndex (RMI) and Dynamic Mobility Evaluation (DYME). Impairment testingincluded dynamometer measures of lower extremity (LE) strength, gonio-metric measures of LE range of motion (ROM), ankle spasticity, and LE sen-sation. Results: Participation in community mobility following stroke wascharacterized by equivalent number of trips into the community, but fewerwalking related activities per trip, as compared to adults without stroke.Gait velocity and BBT were significantly (p<.001) worse in the subjectswith 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 variabilityamong subjects with stroke. Some tasks (stairs and obstacles) consistentlyaffected gait velocity in all subjects with stroke,while others (load and talk)did not. Impairments in plantarflexion and hip abduction strength in theparetic limb correlated with community mobility (activities per trip), andwith other clinical measures of balance and gait. Conclusions:This pilotstudy suggests the impact of stroke on community mobility is variable.Clinical measures of balance, strength (plantarflexor and hip abduction)and gait velocity are related to level of participation in community mobil-ity, specifically the number of walking activities performed per trip.Performance of complex walking tasks was globally impacted by stroke,butthe degree of impact varied by individual and task. Further studies areneeded to confirm results and explore the relationship between locomotoradaptation and participation in community mobility following stroke.Clinical Relevance: Community mobility is a highly valued outcome topatients following stroke and is complex and difficult to measure, withmany factors influencing outcome. Specifically, strength, balance, velocityand ability to adapt gait appear to be important to ambulation outcomes,while ROM, sensation, and spasticity may be less important.

DIAZEPAM TOLERANCE EFFECTS ON VESTIBULAR FUNCTIONTESTS FOLLOWING REPEATED ORAL DOSES. PA Blau1, N. Schwade2, P.Roland2, 1Physical Therapy, UT Southwestern Medical School, Dallas, TX,2Otorhinolaryngology, University of Texas Southwestern Medical Center,Dallas,TX.

Purpose/Hypothesis: Benzodiazepines are used in clinical practice tosuppress acute vestibular symptoms.There have been limited studies look-ing at the effects of tolerance on parameters designed to measure theintegrity of the vestibular system and its interaction with the oculomotorand balance systems.The goals of this study were two-fold:1) to determineif clinical doses of diazepam (10 mg/day) administered for 14 days impairperformance measures that assess the integrity of the vestibular ocularreflex and the ocular motor system and 2) to examine if tolerance devel-ops over time. Number of Subjects: Thirty normal male subjects whoranged in age from 20-36 years were randomly assigned to placebo ordiazepam group. Materials/Methods:The effects of divided doses of 10

mg diazepam given daily over a 2-week period were recorded using ran-dom saccadic eye movements (SEM), sinusoidal harmonic accelerationstimulus for the vestibular ocular reflex (VOR), and subjective ratings ofsedation. Measures were collected at baseline, 90 min after each dose ondays 3, 7, 10, and 14, and 48 hours after drug cessation on day 16. Urinesamples were collected one time per week. Both subjects and investigatorwere blinded to treatment condition. Results:The present study indicatesthat vestibular function tests are sensitive indicators for drug effectsrelated to low doses of diazepam between treatment groups.There weresignificant effects for the parameters of saccadic latency, self-ratings forperceived sedation,VOR gain and phase at 0.01,0.02,0.04,and 0.08 Hz,butno effect on saccadic peak velocity or accuracy measures and gain andphase frequency at 0.16 Hz., indicating selective effects on different CNSmechanisms. No significant effects for time were seen in any of the vari-ables measured, but trends were observed, indicating greater impairmenton day 3 of drug administration followed by gradual return toward base-line by day 16. Conclusions:The results of this investigation demonstratethat low divided doses of diazepam selectively impair behavioral tests mea-suring the integrity of the VOR and SEM.These findings confirm previousliterature in man showing an effect for diazepam on both phase and gainparameters during rotational tests. Studies using vestibular function teststo evaluate the development of tolerance over time will need to minimizeerror variance within and between the treatment groups. ClinicalRelevance: It is still not known if clinical patients need to be drug-free for48 hours prior to undergoing vestibular function testing. It does appearthat low divided doses of diazepam do not affect the overall interpretationof VOR results as subjects still remained in the normal ranges. Saccadiclatency and sedation measures appear to be more sensitive to changes overtime and less affected by subject variability than VOR parameters.

THE EFFECTS OF BODY WEIGHT SUPPORTED GAIT TRAINING ANDFUNCTIONAL ELECTRICAL STIMULATION ON GAIT SPEED ANDCONTROL IN AN INDIVIDUAL WITH A TRAUMATIC BRAIN INJURY.J. Bogle, D. Dennison, K. Gorgos, V. Stivala, M. Pascal, Physical Therapy,College Misericordia, Dallas, PA.

Purpose/Hypothesis:The purpose of this study was to determine if bodyweight supported treadmill training (BWS-TT) and functional electricalstimulation (FES) would improve gait speed and endurance in an individ-ual with a traumatic brain injury. Number of Subjects: One. Materials/Methods:This study had an ABA design. In condition A, the subject partic-ipated in BWS-TT for 10 sessions. In condition B, he participated in BWS-TT with the addition of FES for 8 sessions. FES was controlled by a switchplaced in the subject’s left shoe. Unweighting his leg in pre-swing trig-gered electrical stimulation to the left peroneal nerve to help increase leftswing. In the last phase of the study, the subject again participated inBWS-TT without FES for 5 sessions. During each session, the subject had30 percent of his weight supported by the BWS system.Treadmill speed,distance, and time walked were recorded for each trial of walking.The sub-ject performed 3 to 4 trials per session. Data Analysis: Distance walkedand walking speed per trial were graphed and visually analyzed using cel-eration lines drawn using the split-middle technique. Results:The subjectdemonstrated improvements in both distance and speed throughout thecourse of the study. Examination of the celeration lines revealed he wasable to sustain a higher level of consistent improvement while using FES.His walking speed on the treadmill improved from 1.1 mph at the start ofthe study to 1.7 mph at the end of the first set of BWS-TT sessions. Speedincreased to 2.2 mph at the end of sessions with BWS-TT and FES. Whenhe resumed BWS-TT only, speed decreased to 2.0 mph; it increased to 2.2mph at the end of the study. Distance walked per trial improved from 195feet in the beginning of the study to 369 feet at the end. Conclusions:Theuse of BWS-TT can be a useful intervention to increase gait speed andwalking distance in an individual with a traumatic brain injury.Adding FESduring this intervention increased the improvement in this subject.Clinical Relevance: Decreased independence in gait is a frequent func-tional limitation in individuals with TBI. Using BWS-TT and FES togetheras interventions may help improve gait speed and endurance. The FESused in this study was relatively inexpensive and easy to apply, making itfeasible for clinical use.


RECOVERY FROM STROKE: WHAT IS THE ROLE OF THE UNDAM-AGED, CONTRALESIONAL CORTEX? L. Boyd, E.D. Vidoni, PhysicalTherapy & Rehabilitation Science, University of Kansas Medical Center,Kansas City, KS. (See: Imagery and Imaging Thematic Poster Session forAbstract)

DYNAMIC WALKING STABILITY IN HEMIPARETIC CHRONICSTROKE SUBJECTS. K.P. Brady1, J.M. Hidler1, M.C. Sinopoli2, 1Center forApplied Biomechanics and Rehabilitation Research, NationalRehabilitation Hospital, Washington, DC, 2Department of BiomedicalEngineering, Catholic University, Washington, DC. (See: Post-StrokeHemiplegia Thematic Poster Session for Abstract)

RISK AND PROTECTIVE FACTORS FOR FALLS AMONG INDIVIDUALSWITH INCOMPLETE SPINAL CORD INJURY. SS Brotherton1, J.S.Krause1, P.J. Nietert2, 1Rehabilitation Sciences, Medical University of SouthCarolina, Charleston, SC, 2Biostatistics, Bioinformation, and Epidemiology,Medical University of South Carolina, Charleston, SC.

Purpose/Hypothesis: The purpose of this study was to determine therisk and protective factors for falls among ambulatory individuals withincomplete spinal cord injury (SCI). Number of Subjects: Participantswere recruited from a group of individuals with incomplete SCI who tookpart in a previous study on subsequent injuries following SCI. One hun-dred and twenty individuals from a potential subject pool of 221 personsconsented to participate. Materials/Methods: A survey instrument wasdesigned to collect data on the incidence of falls, demographic and SCIcharacteristics, health, and physical activity and was completed by studyparticipants.These data were compared among fallers and non-fallers usingt tests and chi square statistics. Unadjusted bivariate analyses were thenused to determine factors that were moderately associated with having afall.These variables were entered into a forward stepwise regression modelto identify which ones were associated with increased risk for falling. Alogistic regression that included only participant characteristics that couldhave been present before the fall was also used to identify subject factorsassociated with increased risk for having a fall. Results: Seventy-five per-cent of respondents sustained a fall over the previous year.Stepwise regres-sion revealed that the odds of having a fall were significantly lower for indi-viduals who exercised more frequently (OR=0.65, p=0.013) and for thosewho used a walker (OR=0.18, p=0.009).The odds of having a fall were sig-nificantly higher for individuals who restricted community activities dueto fear of falling (OR=1.56, p=0.034), had a higher level of education (OR=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 thatcould have been present before the fall, stepwise analysis revealed that theodds of having a fall were higher for individuals who reported dizziness(OR=7.72, p=0.013) and had a higher level of education (OR=2.26,p=0.002). Conclusions: Increased exercise frequency and walker usewere associated with decreased risk of falls (protective factors), whereasmore days of poor physical health, limited participation in communityactivities due to fear of falling, and a higher level of education were asso-ciated with increased risk of falls.When only subject characteristics wereconsidered, dizziness and higher levels of education were independentpredictors of experiencing a fall in the SCI population. ClinicalRelevance: The findings provide a better understanding of the risk andprotective factors for falls and may assist rehabilitation professionals indeveloping strategies for health promotion and injury prevention forambulatory individuals with incomplete SCI.

BILATERAL MOTOR OUTPUTS FROM THE RETICULOSPINAL SYS-TEM TO THE UPPER LIMBS DURING REACHING IN THE MONKEY.J.A. Buford1, A.G. Davidson2, 1Physical Therapy, The Ohio State University,Columbus, OH, 2Neurobiology and Anatomy, University of RochesterMedical Center, Rochester, NY. (See: Post- Stroke Hemiplegia ThematicPoster Session for Abstract)

EFFECT OF TYPE 2 DIABETES MELLITUS ON DECISION-MAKINGAND SELECTIVE ATTENTION. S.D. Burns, Dept. of RehabilitationScience, University of Oklahoma Health Sciences Center, Oklahoma City,OK, L. Riolo, Dept. of Physical Therapy, Indiana University, Indianapolis, IN.

Purpose/Hypothesis:The purpose of this study was to examine the inter-action between type 2 diabetes, depression, and cognitive function.Number of Subjects: 65 male veterans, 33 having DM, were recruitedfrom the Veterans Administration Medical Center in Oklahoma City.Veterans included in the study were aged 50 to 69 years old and had nocurrent or past (within 20 years) history of drug or alcohol abuse, demen-tia, psychiatric disorder, stroke or head trauma with loss of consciousness> 10 minutes, or any sensory or motor disorder that would preclude neu-ropsychological testing.Veterans with type 1 diabetes were also excluded.Materials/Methods: The presence of depression was assessed with theBeck Depression Inventory (BDI).The Stroop Color Word Test (SCWT) wasused to measure selective attention and the Iowa Gambling Test (IGT) toevaluate decision-making. Most recent glycosylated hemoglobin (HbA1c)values were obtained through chart review and used as indicators of meta-bolic control. Results: After removing one outlier, group differences inmean values of BDI scores, SCWT interference scores, and ratio of badcards to good cards chosen in the IGT were compared with independentt-tests. Pearson or Spearman correlation coefficients were determined forall variables. Partial correlation coefficients and r2 values were computed.There were significant group differences in BDI scores (t (62) = 2.58,p=.01) and SCWT interference scores (t (62) = .03, p=.04) but not IGTratios.BDI scores were significantly correlated with diabetic status (r =.35,p=.004) and IGT ratios (r = .39, p=.001) and inversely correlated withinterference scores (r = -.25, p=.04). HbA1c values were strongly inverselycorrelated to interference scores (r=-.60, p=.0003). Diabetic statusaccounted for 12% of variation in BDI scores, 5% of variance in interfer-ence scores, and 3% of variance in IGT ratios. Variation in BDI scoresaccounted for 15.7% of the variation in IGT ratios and 6% of the variationin interference scores. Variance in HbA1c values explained 37% of thevariation in interference scores. The partial correlation between BDI andIGT ratio scores was r =.51 (p=.004) and r =-.62 (p=.0003) for HbA1c andinterference scores. Conclusions: Male veterans with type 2 DM demon-strated more depression and poorer selective attention compared to vet-erans without DM. The correlations point to a relationship between DMand depression and support the generally accepted premise that depres-sion affects cognitive performance.Depression explained more of the vari-ation in cognitive test scores than did diabetic status particularly for theIGT.The strong relationship between metabolic control of DM and a mea-sure of selective attention suggests directions for research into causality.Clinical Relevance:Adequate cognitive functioning is necessary for self-care, a key component in management of DM. Factors affecting cognitionin this population have not yet been fully delineated.

BRAIN ACTIVATION DURING KINESTHETIC AND VISUAL IMAGERYOF WALKING. C.A. Chatto1, J.E. Deutsch1, J. Pillai2, T. Lavin2, J. Allison2,1Program in Physical Therapy, UMDNJ, Newark, NJ, 2Department ofRadiology, Medical College of Georgia, Agusta, GA. (See Imagery andImaging Thematic Poster session for Abstract)

THE PATIENT-REPORTED IMPACT OF SPASTICITY MEASURE(PRISM): A NEW MEASURE ASSESSING THE IMPACT OF SPACTICITYON PERSONS WITH SPINAL CORD INJURY. K. Cook1, A. Williams2, C.Teal2, S. Robinson-Wheelen2, J. Mahoney3, J.C. Engebretson3, K. Hart4, A.M.Sherwood5, 1METRIC, Veterans Affairs, Houston, TX, 2Veterans Affairs,Research, Houston, TX, 3Nursing, University of Texas Health ScienceCenter, Houston, TX, 4The Institute for Rehabilitation Research, Houston,TX, 5National Institute on Disability and Rehabilitation Research (NIDRR),Washington, DC.

Purpose/Hypothesis: Clinicians have long known that spasticity has asubstantial impact on the quality of life of persons who have spinal cordinjury (SCI).To date, however, there has been no self-report instrument toassess the range of its impact.The study purpose was to understand theexperiences of spasticity in the everyday lives of persons with SCI anddevelop a measure to standardize evaluation of these experiences.Number of Subjects: Open-ended semi-structured interviews lastingapproximately 45 to 90 minutes were conducted with 24 persons with SCIand spasticity. Patients reported a wide range of ways in which their spas-ticity impacted their lives; including some positive ones (help with trans-fers). We developed pilot items based on patients’ natural language state-


ments and administered these to 181 participants. Materials/Methods:Data were factor analyzed and items were clustered into 7 subscales assess-ing: (1) impact on ADLs, (2) social avoidance, (3) psychological impact, (4)impact on health service utilization, (5) impact on independence, (6)embarrassment, and (7) positive impact of spasticity. Results:The 7 PRISMsubscales exhibited excellent internal consistency and test/retest reliabili-ties. Conclusions: Content validity was supported in the factor analyticresults; discriminant validity was supported by the only moderate correla-tions among subscales; and construct validity was supported by the psy-chometric design (items developed based on participant interviews).Clinical Relevance:To date, there have not been effective tools for evalu-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 whatpersons with SCI view as positive aspects of spasticity.

UPPER LIMB FUNCTIONAL RESPONSE TO MOTOR LEARNINGALONE AND MOTOR LEARNING WITH FUNCTIONAL NEUROMUS-CULAR STIMULATION FOR STROKE SURVIVORS. J.J. Daly1, J. Rogers2, I.Brenner2, E. Perepezko2, M. Dohring2, E. Fredrickson2, J. Gansen2, 1Neurology,Case Western Reserve University School of Medicine, Cleveland, OH,2Research Service, LS Cleveland VA Medical Center, Cleveland, OH. (SeeMotor Learning Thematic poster session for Abstract)

CONSTRAINT INDUCED MOVEMENT THERAPY FOR AN INDIVID-UAL EXHIBITING HEMIAKINESIA POST STROKE. S.B. Davis1, L.G.Richards1,A.L.Behrman2, 1Brain Rehab Research Ctr,Malcom Randall VAMC,Gainesville, FL, 2Physical Therapy, University of Florida, Gainesville, FL.

Background & Purpose: Patients with hemiakinesia exhibit the inabilityto carryout purposeful movements in the absence of paresis.They may notspontaneously use their upper extremity contralateral to the lesion.Whenasked to move they may have the ability to coordinate movements. Duringmanual muscle testing they demonstrate good to normal strength.This hasbeen a clinically challenging scenario and few interventions have beenadvocated to remediate hemiakinesia.The purpose of this case study wasto examine the effect of Constraint Induced Movement Therapy (CIMT) onupper extremity (UE) performance. Case Description:The individual wasa 39 year old right handed white female seen 11 months after a major leftputamenal hemorrhage during her fifth month of pregnancy.She exhibitedaphasia, anomia, pronounced hemiakinesia with right UE strength 4+ to 5,mild right shoulder subluxation, mild increased tone, normal propriocep-tion, stereognosis, impaired 2-point discrimination and minimal sponta-neous use of her right UE. She initially scored 1.00 on the Amount of Useof the Motor Activity Log (MAL) indicating very rare use.The initial ActualAmount of Use Test (AAUT) was 0.53 in Amount and 1.12 in Quality. Shewas an independent ambulator at 1.16 meters per second (mps) self-selected speed and 1.69 mps fast walking. She did not exhibit any rightarm swing. Prior to the stroke she was a dental hygienist, homemaker andactive in her community.She lived at home with her husband, two childrenrequiring help from caregivers. Her goals were to become more indepen-dent in cooking, child care and driving. She participated in CIMT for 6hours/day for 10 days and was mitt compliant at least 90% of wakinghours. Outcomes: Outcome measures were collected pre, post, 6 and 12months.At post-test,amount and quality of arm use (MAL) increased almostto the pre-stroke levels (4.8 and 4.6, respectively).This was maintained at3.98 and 4.05 at 12 months.The AAUT continued improving at 6 months,in both maximum amount 1.71 and maximum quality 3.19.Times on theWolf Motor Function Test improved from 2.69 seconds to 1.7 post CIMT,approaching the less involved side (1.35), however, increased to 2.21 at 6months and 5.63 at 12 months. Fugl Meyer improved across all testingfrom baseline 56 to 61 at 12 months.Box and Blocks Test initially increasedfrom 31 to 37 post CIMT and maintained an average of 56% of the left UEextremity at 12 months. MOS-36 increased from 22 to 28 post and 29 at12 months. Geriatric Depression Scale decreased from 7 to 4 after CIMT.The personal goals for childcare and resuming driving were attained.Discussion: Outcomes demonstrated the potential value and efficacy ofCIMT as an intervention for the challenging problem of hemiakinesia.Measures of function and quality of life substantiate the participant’s per-ception of improvement and gains.This case study illustrates a potentialapplication of CIMT for hemiakinesia post-stroke.

REPRESENTATION OF IMAGINED AND EXECUTED SEQUENTIALFINGER MOVEMENTS OF ADULTS POST STROKE AND HEALTHYCONTROLS. JE Deutsch1, S. Fischer1,W. Liu2,A. Kalnin3, K. Mosier3, 1PhysicalTherapy, UMDNJ, Newark, NJ, 2Radiology, UMDNJ, Newark, NJ, 3Radiology,Indiana University, Newark, IN. (See Imagery and Imaging Thematic PosterSession for Abstract)

VELOCITY OF VERTICAL AND HORIZONTAL EYE MOVEMENTS INPROGRESSIVE SUPRANUCLEAR PALSY. K.E. Donley, M.J. Johnson, C.Zampieri, R.P. Di Fabio, Physical Therapy, University of Minnesota,Minneapolis, MN.

Purpose/Hypothesis: Purpose.The objectives of this study were to inves-tigate the velocity of vertical and horizontal saccades in people with PSPin the early stages of their disease and to compare the velocity of voluntaryvertical eye movements with concurrent unintended horizontal eye move-ments associated with vergence. Number of Subjects: Subjects. Nine sub-jects (70.3 /- 5.36 years, 4 women and 5 men) participated in a withingroup cross-sectional study. Six subjects were diagnosed with probablePSP and 3 with possible PSP. Materials/Methods: Methods. Vertical andhorizontal saccades were practiced prior to data collection. Infrared ocu-lography was used to measure the eye velocities in raw voltage per secondduring the saccade attempts. Orthogonal eye velocities were comparedusing one-way ANOVA and paired t-tests. Results: Results. Left horizontaleye velocity due to vergence was significantly faster than intended down-ward saccade velocity during a vertical saccade attempt (z-value = 3.6827,p =0.000). Similarly, right horizontal velocity due to vergence was fastercompared to intended upward vertical saccade velocity (z = 2.118,p=0.034).When comparing eye movement in a pure plane without regardto vergence, voluntary horizontal right saccades were significantly fasterthan vertical up saccades (z =6.38, p=0.000) and voluntary left horizontalsaccades were significantly faster than vertical downward saccades (z =6.98, p= 0.000). Conclusions: Discussion and Conclusion.The results ofthis preliminary work suggest that early in the course of PSP, the verticalburst neurons in the rostral interstitial nucleus of the medial longitudinalfasciculus are selectively degenerated.The velocities recorded also implythat the horizontal burst neurons in the paramedian pontine reticular for-mation are not markedly affected. During a volitional vertical saccade, theaccompanying horizontal eye movements due to vergence are compara-tively faster.This illustrates that although the vertical saccade is slowed, theomnipause neurons are not limiting the speed of horizontal vergence eyemovements Clinical Relevance: Background. Progressive SupranuclearPalsy (PSP) is a Parkinsonian syndrome characterized by oculomotordeficits (slow and limited voluntary eye movement) and recurrent falls.The mechanism responsible for the loss of rapid eye movements or sac-cades in PSP is not clear.

Funded by grant #H133G 030159 to Dr. Di Fabio from the NationalInstitute on Disability & Rehabilitation Research.

ORTHOPEDIC CONSIDERATIONS IN THE MANAGEMENT OF APATIENT WITH NEUROLOGICALLY INDUCED IMPAIRMENTS OFTHE FOOT AND ANKLE: A CASE REPORT. A. Driscoll1, R. Joshi2, M.Johnson3, 1Mercy Rehab Associates, Darby, PA, 2Mercy Rehab Associates,Darby, PA, 3Mercy Rehab Associates, Darby, PA.

Background & Purpose: Joint range of motion (ROM) limitations are asignificant issue in patients with neurological disabilities, particularlywhen considering lower extremity orthotic management, transfers andambulation. Joint mobilization techniques have been successful in increas-ing joint ROM of the foot and ankle in the orthopedic population thoughlittle literature exists supporting the use of manual therapy in restoringROM deficits in patients with neurological impairments.This case reportdescribes the use of joint mobilization techniques in a patient with multi-ple sclerosis (MS). Case Description:A 24 year old female with a historyof chronic progressive MS was referred for outpatient physical therapy(PT) with increased difficulty with transfers and ambulation and patientreport of her feet turning inside her present MAFOs. During ambulationwith PLS MAFOs supination was noted during mid stance with plantarflexion out of the orthoses bilaterally in terminal stance. Patient goalsinclude return to previous independent (I) transfers and ambulation with


a rolling walker and wear of MAFOs with increased comfort. PT interven-tions initially included manual stretching to the gastroc/soleus musclesthough no significant improvement was noted in 7 sessions. Upon furtherexamination by a neurologic clinical specialist, similar ROM limitationswere noted in ankle dorsiflexion in both knee flexion and extension. Inaddition, decreased articular motions were noted at the talus and the midfoot, indicating restrictions in joint mobility at the talocrural joint. Jointmobilization techniques to the foot and ankle were then incorporated intothe treatment program. Outcomes: The patient responded well to jointmobilization gaining 15/22 degrees of ankle dorsiflexion at the right andleft respectively following 4 sessions of PT.The increase in ROM allowedfor casting for articulating MAFOs with the foot aligned in sub-talar neutraland ankle dorsiflexion at 0.Ambulation was improved and the patient wasable to resume (I) transfers and household ambulation using new orthoseswith a full foot plate, ankle strap and a rolling walker. Discussion:Thiscase demonstrates the significant role of PT in the restoration of joint ROMand correction of underlying biomechanical dysfunctions in a patient withprimary neurological dysfunction.Thorough examination of the foot andankle allowed for appropriate treatment strategies to correct underlyingjoint mechanics. Through the combination of stretching and joint mobi-lization, ROM was restored within a minimal number of sessions allowingprogression to alternate orthoses and functional mobility training. Of sig-nificance is the need to incorporate principles of manual therapy, specifi-cally joint mobilization techniques, into the care of clients with neurologi-cal disabilities to achieve optimal functional mobility.

PREDICTING OUTCOME OF A PHYSICAL THERAPY PROGRAM INPATIENTS WITH PARKINSON’S DISEASE. T. Ellis1, R.Wagenaar1, C.J. deGoede2, G. Kwakkel2, W.C. Eric2, 1Physical Therapy & Athletic Training,Boston University, Boston, MA, 2Boston University, Boston, MA.

Purpose/Hypothesis: The ability to identify those patients withParkinson’s Disease (PD) who are most likely to benefit from rehabilitationwould help physical therapists target patients more appropriately. Thepurpose of this study was to determine the value of patient characteristicsin predicting rehabilitation outcome. Number of Subjects:This study waspart of a randomized controlled trial in which the efficacy of a physicaltherapy (PT) program was investigated.Sixty-eight subjects with PD withinHoehn and Yahr stage II or III participated in group treatment conductedtwice per week for 1.5 hours in duration over a six-week period.Materials/ Methods:Outcome measures consisted of the Sickness ImpactProfile (SIP-68), mobility portion of the SIP-68 (SIPM), the UnifiedParkinson’s Disease Rating Scale (UPDRS) and comfortable walking speed(CWS). Regression analyses were conducted to identify which determi-nants predicted rehabilitation outcome. Results: Baseline CWS, SIPM,UPDRS II and UPDRS total scores best predicted outcomes in CWS, SIPM,UPDRS II and UPDRS total scores, respectively. Age, gender and diseaseseverity were not predictive of outcome. Slow pretreatment CWS, higherscores (greater disability) on the SIPM, UPDRS II and total UPDRS wererelated to greater improvements after intervention. Conclusions:Thoseindividuals with the greatest level of disability and functional limitations inthis sample were more likely to improve after participating in a groupphysical therapy program. Clinical Relevance: This data highlights thepotential usefulness of classifying individuals with PD according to theirbaseline functional status to determine rehabilitation outcome.

AEROBIC CONDITIONING OF OLDER ADULTS USING AN INDEPEN-DENT HOME EXERCISE PROGRAM IN THE CHRONIC PHASE OFRECOVERY FROM STROKE. ML English,A. Ruble,T.Thompson, PhysicalTherapy, University of Kentucky, Lexington, KY.

Purpose/Hypothesis:To determine if an intervention program consistingof independent, self-monitored aerobic exercise designed specifically forthe individual older adult recovering from stroke will result in improvedaerobic exercise tolerance, endurance and improved functional mobility.Number of Subjects:Three,using a Single Subject Design,multiple probesacross subjects. Materials/Methods: A sample of convenience of threeolder adults who were recovering from stroke > one year prior to initia-tion of the study served as subjects. Subjects were tested in a staggeredfashion, with Subject A beginning first, Subject B beginning after Subject A

began to improve in performance, and Subject C beginning as Subject Bdemonstrated improvement. Subjects initially completed the Folstein MiniMental Status Examination (MMSE) and the SF-36 Item Health Survey.Functional tests/measures included in baseline testing were the Timed Upand Go Test (TUG),Three-Minute Walk Test, and the Physical Performanceand Mobility Exam (PPME). Each subject was instructed in an individuallyprescribed aerobic exercise program and instructed to exercise 3 timesper week for 12 weeks, using exercise equipment of his/her choice, eval-uated and approved by the investigators. Researchers provided a heartmonitor and blood pressure cuff to each subject for self-monitoring, andsubjects recorded results from each exercise session.The functional testslisted above were reassessed weekly throughout the exercise program andthree months following completion of the program. Subjects alsorepeated the SF 36-Item Health Survey at the end of the twelve weeks ofexercise. Results:All three subjects successfully completed 12 weeks ofindependent, self-monitored exercise, though one was unable to return forthree month follow-up tests due to medical complications.Over the twelveweek period, all three subjects improved in time of performance of theTUG.Two subjects demonstrated increased distance covered in the Three-Minute Walk Test. Two subjects showed improvement in the PhysicalPerformance and Mobility Exam. Two subjects demonstrated increasedendurance in exercise sessions by gradually increasing duration from 15minutes to 45 and 20 minutes to 45, respectively. No significant changeswere noted in the Quality of Life Health Survey. Results at the three monthfollow-up: two subjects were approaching baseline levels in all tests.Conclusions: Older adults recovering from stroke who perform an inde-pendent aerobic exercise program using a location and equipment of theirchoice demonstrate the ability to self-monitor and improve exercise toler-ance and endurance. Further study is required to determine if improvedexercise tolerance contributes to improved functional mobility and qualityof life. Clinical Relevance: Diminished exercise tolerance and enduranceare closely associated with stroke.Older adults recovering from stroke maybenefit from a specifically prescribed and designed, self-monitored exer-cise program as part of a total rehabilitation program.

KINEMATICS OF REACH-TO-GRASP MOVEMENTS IN SUBJECTSWITH CEREBELLAR DEFICITS. K.M. Erickson, P.L. van Kan, Kinesiology,University of Wisconsin-Madison, Madison,WI.

Purpose/Hypothesis:We examined the kinematics of reaching to graspin humans to determine the role of the cerebellum in the timing of fingeropening with proximal joint movement.The cerebellum is important forthe control of multijoint, coordinated movements, such as reaching tograsp.An unresolved question is whether the cerebellum specifically con-trols temporal relations between reach, hand preshaping, and grasp com-ponents or whether the cerebellum integrates reach,hand preshaping, andgrasp components into a single central program. Number of Subjects: 5subjects with cerebellar damage and 6 healthy, age-matched controls werestudied. Materials/Methods:We measured kinematics of reach, hand pre-shaping, and grasp while subjects with cerebellar damage (n=5) andmatched controls (n=6) performed reaches with a precision grip thatrequired opposition of the index finger and thumb. The task was per-formed under two conditions: as fast and accurately as possible, and slowlyand accurately.Transport of the hand was characterized by angular veloc-ity of elbow and shoulder joints,wrist trajectory, and amplitude and timingof tangential wrist velocity. Hand preshaping was characterized by ampli-tude and variability of peak grip aperture and its timing relative to thereach. Grasp was characterized by relative timing of contact of the indexfinger and thumb with the target. Results: Results showed that PGA istightly coupled to both peak shoulder velocity (PSV) and peak elbowvelocity (PEV) in healthy controls. Cerebellar subjects showed disruptionsin timing of PGA with PSV and PEV, with both joints contributing to anoverall disruption in timing of PGA with peak wrist deceleration (PWD).These disruptions were more profound in the fast and accurate condition.In addition, cerebellar subjects were much more variable in the timing ofmultiple aspects of reaching to grasp including time of PGA relative tototal movement time, timing of peak wrist velocity (PWV), time of PSV,time of PEV, as well as relative timing of PGA with PWD, PSV, and PEV.Conclusions: Kinematics of reaching to grasp in subjects with cerebellardamage are characterized by increased variability. The increased variabil-


ity uncouples reach, hand preshaping, and grasp components in both spa-tial and temporal domains.Clinical Relevance:Current recommendationsto patients with cerebellar lesions include learning to slow their move-ment down and to decompose movement into a series of single jointmovements (Bastian 1997).This study supports the usefulness of slowingmovements, as timing of proximal joints with finger opening is less dis-rupted in slower movements. If patients can be trained to move moreslowly, disruptions to the proximal joint coordination are minimized andthe overall movement of reaching to grasp is more normalized. However,at slower speeds, increased variability in magnitude and timing of PGAshould still be expected based on the current results.

UPPER EXTREMITY PHASE MANIPULATION AND WALKING IN PER-SONS WITH A CVA. M.P. Ford1, R.C. Wagenaar2, K.M. Newell3, 1PhysicalTherapy, The University of Alabama at Birmingham, Birmingham, AL,2Physical Therapy, Boston University, Boston, MA, 3Kinesiology, ThePennsylvania State University, University Park, PA.

Purpose/Hypothesis: To investigate the effects of walking velocity andupper extremity phase manipulation on inter-segmental coordination dur-ing treadmill walking in persons with a CVA. Number of Subjects: 8 indi-viduals (12 - 72 yrs; mean 49; standard deviation: 17.4) who have suffereda CVA participated. Materials/Methods: There were 3 separate condi-tions while walking at 0.22, 0.40, 0.63, 0.85, 1.10, 1.30, and 1.52 m/s: 1) noupper extremity phase manipulation; 2) instructions to move the arms inphase at each velocity level; 3) instructions to move the arms out of phaseat each velocity level. 3D kinematic data were collected using a SkillTechnologies 6D Research System. The total range of movement ampli-tudes for arms (τA) and legs (τL), and transverse rotation of thorax (τT),pelvis (τP) was calculated. The amplitude of transverse trunk rotation(τPT) was calculated by determining the maximum differences between(τT) and (τP). The shoulder and hip angle time-series data were used tocompute the point estimates of relative phase between the arms.We deter-mined if the power (power spectrum) in arm movement frequency washigher at stride or step frequency during walking. For statistical analysis awithin-group analysis of variance with repeated measures, including twowithin-factors, 1) velocity manipulation and 2) instruction was used with a.05 significance level. Results: Across all walking velocities the armsmoved more out of phase during no upper extremity phase manipulationand instruction to move the arms out of phase, as compared to instructionto move the arms in phase. Instructions to move both in or out of phase,led to larger involved arm movement amplitude (τAi) and non-involvedarm movement amplitude (τAni) as compared to the condition with noupper extremity phase manipulation. When participants were instructedto move the arms in phase the τAi was larger at both 0.43 and 0.66 m/s, ascompared to instructions to move out of phase.The larger τAni coincidedwith the power in the non-involved arm movement frequency beinghigher at stride frequency when participants were instructed to movetheir arms in phase as compared to out of phase. Finally, τT, τP, and τPTwere greater when participants were instructed to move their arms out ofphase,as compared to in phase.Conclusions:The results from the presentstudy demonstrate flexibility of the coordination patterns of walking tomeet constraints imposed on the movements of body segments.Additionally, these results suggest that the ability to modify arm movementamplitude, along with frequency, is necessary for synchronization with thestride frequency. Clinical Relevance: Slower walking velocity in patientswith severe upper extremity dysfunction (e.g., CVA) may be due to inabil-ity to alter coordination patterns. Future studies should investigate theunderlying dynamics of arm dysfunction and adaptations during treadmilland over-ground walking.This will provide a foundation for interventionswhich address motor impairments of the upper and lower extremityrelated to walking in persons with a CVA.

PROTECTIVE STEP TRAINING IN PEOPLE WITH PROGRESSIVESUPRANUCLEAR PALSY. C.E. Franzen, S.L. Gubka, L. Hamilton, C.Zampieri, R.P. Di Fabio, Physical Medicine & Rehabilitation, University ofMinnesota, Minneapolis, MN.

Purpose/Hypothesis: Progressive Supranuclear Palsy (PSP) is an atypicalparkinsonian disorder affecting the basal ganglia and the brainstem.

Clinical features include oculomotor deficits, dysphagia, and postural insta-bility.The fall rate for people with PSP is reported to be 100% in the firstyear of diagnosis.The purpose of this pilot study was to compare the effectof traditional balance training to a program augmented by saccade exer-cises and a cognitive challenge during gait on protective step reaction time(RT) in people with PSP. Number of Subjects: 187 perturbations inducedprotective step trials were collected from four subjects with PSP.Materials/Methods: Each subject participated in two phases of the study.During the control phase, subjects underwent four weeks of perturbationand balance training followed by an eight-week rest phase. Subsequently,subjects were entered into the experimental phase, consisting of fourweeks of perturbation and balance training along with saccade exercisesand a cognitive challenge during gait. Following each session of training,electromagnetic sensors placed on the trunk and feet were utilized to mea-sure body segment position during perturbation trials. Data were collec-tively analyzed for expected and unexpected backward perturbationsadministered at the hips or shoulders.The dependent variables were leadand lag foot step RT. Results:A within group control vs. treatment analy-sis of lead foot step RT showed a significant decrease in median step RTfrom 0.50 seconds in the control phase to 0.31 following the experimen-tal phase (H = 9.40, df = 2, p = 0.0022). Similar results were found for thelag foot.Conclusions:Four weeks of perturbation training combined withsaccade exercises and a cognitive challenge during gait resulted in signifi-cantly faster step RT in people with PSP when compared to step RT fol-lowing perturbation training alone. Clinical Relevance: Protective step-ping for people with PSP can be improved with rehabilitation training.However, our study did not address the relationship between step RT andthe incidence of falls.At this time, it is not known if a faster protective stepreaction time results in decreased falls risk.

FUNCTIONAL PREDICTORS OF OUTCOMES FOLLOWING CON-STRAINT-INDUCED MOVEMENT THERAPY FOR INDIVIDUALS WITHPOST-STROKE HEMIPARESIS. S.L. Fritz, Exercise Science/ PhysicalTherapy, University of South Carolina, Columbia, SC.

Purpose/Hypothesis:Constraint Induced Movement Therapy (CIMT) is arehabilitative strategy used primarily with the post-stroke population toincrease the functional use of the neurologically-weaker upper-extremitythrough massed practice while restraining the lesser-involved upper-extremity.While solid research evidence supports CIMT, limited evidenceexists regarding the specific characteristics of individuals who benefitmost from this intervention.The goal of this study was to determine thedescriptive predictors for CIMT outcomes. Number of Subjects:A conve-nience sample of 55 individuals post-stroke was recruited that met specificinclusion and exclusion criteria. Materials/Methods: These individualsparticipated in CIMT 6-hours per day, for two-weeks with restraint of theirless-affected upper extremity. Pre-test, post-test and follow-up assessmentswere performed to assess the outcomes for the Wolf Motor Function Test(WMFT) and the amount section of the Motor Activity Log (MALa). Thepotential functional predictors were: minimal motor criteria, finger exten-sion, grip strength, Fugl-Meyer upper-extremity motor score, and theFrenchay score. A step-wise regression analysis was used in which thegroup of potential predictors was entered in a linear regression modelwith simultaneous entry of the dependent variables’ pre-test score as thecovariate. Two regressions models were determined for each dependentvariable per experiment, one for the post-test, and one for the follow-uptest. Results: Finger extension was the only significant predictor of WMFToutcomes. Minimal motor criteria and upper-extremity Fugl-Meyer motorscore were predictive of the MALa immediately following therapy,but onlythe Fugl-Meyer score was predictive of outcomes at the follow-up.Conclusions:This experiment provides the most comprehensive investi-gation of predictors of CIMT outcomes to date. Further substantiation ofthese findings in more diverse samples is warranted in order to meet theurgent need of determining the appropriate candidates for CIMT. ClinicalRelevance:The identification of clinical predictors for outcomes of CIMTis of value to both research and clinical settings.Who benefits most fromCIMT needs to be understood, in order to target the correct population.

LEARNING EFFECT ASSESSMENT ON SUBSEQUENT SUBJECT PER-FORMANCE ON THE EQUITEST. BALANCE SYSTEM. B. Gilliam, D.


Charles, S. Kathmann, J. Smith, N.S. Darr, D. Greathouse, Belmont University,Nashville,TN. (See Motor Learning Thematic Poster Session for abstract)

SELF-REPORTED EARLIEST SYMPTOMS OF PARKINSON DISEASE. D.Glendinning, V. Patel, D. Maldonado, G. Siozon, P.Trivedi, Physical Therapyand Sport Sciences, Seton Hall University, South Orange, NJ.

Purpose/Hypothesis: Parkinson disease (PD) is caused by cell death inthe substantia nigra pars compacta of the midbrain. Although the classicdiagnostic signs of PD are muscle rigidity, tremor, and bradykinesia, thesesigns only appear after approximately 90% of the neurons within the parscompacta have degenerated. Currently, research is focused on developingneuroprotective treatments to halt the progression of cell death in PD.Neuroprotective treatments will only be effective if the cell death can berecognized by signs that precede the cardinal signs of PD. Physical thera-pists, trained to observe movement, are well-suited to develop early detec-tion tests for PD. The purpose of this study was to ask persons with PDdirectly about their earliest symptoms, to obtain clues for early detection.To date, no one has methodically queried persons with the disease aboutpre-diagnostic symptoms. Number of Subjects: 45. Materials/Methods:Surveys were distributed at support groups, physician offices, and on aninternet website, and were completed anonymously by persons with idio-pathic PD. The survey included basic demographic data, multiple-choicequestions, and open-ended questions related to pre-diagnostic physical andemotional symptoms. Subjects were required to order the onset of symp-toms in each section. Results: Forty-five people (16 females, 29 males, aged73.2 ± 8.9) responded to the survey.The average number of years with PDwas 8 ± 6.53.Thirty-five percent of respondents reported tremor as the firstsign of PD.The remaining subjects reported diminished olfaction, depres-sion, voice changes, and bradykinesia.An analysis of all early signs revealedthat 1) as a cluster of early symptoms, sleep disorders, fatigue, depressionand tiredness occurred in 50% of subjects, and 2) males and females had dif-ferent early signs: males more often reported classic signs of the disease,and females more often reported fatigue, tiredness, depression and voice-weakening. Ten-percent of all subjects also reported that symptoms firstappeared after major medical events, such as surgery or trauma.Conclusions:This study had 2 major findings. First, most people with PDreported a classic symptom as the first symptom of PD,suggesting that theywere unable to detect any subtle earlier symptoms of impending PD.Second, females especially, reported fatigue, depression, tiredness and sleepdisturbances as early signs of PD.This cluster of symptoms should be addedto previously reported micrographia and diminished olfaction, as early indi-cators of PD. Clinical Relevance: Because individuals may not be able todetect the early symptoms of PD, physical therapists should be aware thatpre-diagnostic signs of PD may include fatigue, depression, tiredness, andsleep disturbances, in addition to the previously reported micrographia anddiminished olfaction. In addition, physical therapists need to conduct moreresearch to develop clinical test batteries for early detection.The ultimategoal would be to halt disease progression with new neuroprotective treat-ments, such as drug, gene, or physical therapy.

CASE REPORT: A MODIFIED CONSTRAINT INDUCED MOVEMENTTHERAPY (MCIMT) PROGRAM FOR THE UPPER EXTREMITY OF ACOMMUNITY-DWELLING MALE WITH SEVERE CHRONIC HEMIPLE-GIA. R.M.Hakim,E.Driscoll, J.Ricci,T. Szasz,Physical Therapy,University ofScranton, Scranton, PA.

Background & Purpose: Traditional Constraint-Induced MovementTherapy (CIMT) protocol may be difficult to implement because of thetime commitment and use of a restrictive device (Page et al., 2002).Recentstudies of modified Constraint-Induced Movement Therapy (mCIMT) pro-tocol using a combination of outpatient therapy and unsupervised practicewere effective in improving function of the more affected upper extrem-ity (UE) for patients with mild hemiparesis and learned nonuse (Page et al.,2001; Page, Sisto & Levine, 2002).The purpose of this case report was todetermine if a modified, reduced intensity version of the traditional CIMTprotocol would elicit functional improvements in the UE of a community-dwelling individual with severe, chronic hemiplegia. Case Description:The case was a 68 year old male, eight years after a right stroke, who dis-played severe UE hemiplegia that did not meet the traditional minimum

motor criteria for CIMT (i.e., active wrist extension of at least 20 degreesand finger extension of at least 10 degrees), but had the ability to grasp awashcloth on a table top, lift it, and release it (Taub & Morris, 2001;Bonifer& Anderson, 2003). He participated in a two-hour mCIMT program for tenweekdays over a two week period using a mitt and/or verbal cueing as theconstraint. During the program, the patient agreed to engage his moreaffected UE in activities for 90% of waking hours.Testing was conductedbefore and after intervention, and again at a one-month follow up visit.Theoutcome measures used were: the Wolf Motor Function Test (WMFT),Action Research Arm Test (ARAT), and Motor Activity Log (MAL).Outcomes: The WMFT scores displayed improvements in performancetime (PT) for 13 of 15 timed items and 16 of 17 functional ability (FA)/qual-ity of movement items at post testing. At follow up, all items of WMFTeither remained the same or improved in FA (except item 17) and 10 of 15items further improved for PT. Grip strength doubled from pretest toposttest. However, only 27% of grip strength gain was maintained at one-month follow up. For the ARAT, the subject demonstrated improvementwith an average increase of 2.3, 1.7, and 0.3 on grasp, grip and pinch sub-tests respectively, and had an increase of 3.3 on his overall score.At follow-up testing, he demonstrated further improvements on grasp and overallscore showing gains of 2.7 and 0.7 respectively, and the time it took tocomplete tasks in both grasp and grip decreased/improved from pretestand posttest to follow-up. For the MAL, the patient showed minimalimprovement in affected arm usage for the tasks specified, despite subjec-tive reports that he was using his affected arm more often and with lesseffort during activities of daily living. Discussion: This program showspromise as an effective and practical application of mCIMT for personswith severe, chronic hemiplegia. Further research is warranted on a largergroup of individuals following stroke who demonstrate learned nonuse.

RELIABILITY OF CLINICAL MEASURES TO ASSESS PATIENTS WITHVESTIBULAR HYPOFUNCTION. C.D. Hall1, S.J. Herdman2, 1Rehab R&DCenter, Atlanta VAMC, Decatur, GA, 2Rehabilitation Medicine, EmoryUniversity,Atlanta, GA.

Purpose/Hypothesis: Evaluation of patients with vestibular hypofunc-tion includes measures of subjective complaints, balance, gait and qualityof life.A variety of tools can be used to identify patient problems and assesschange with intervention or time. It is important that a measure be reliablein order to be assured that any changes in score over time are due to realchanges in the individual’s performance rather than to errors in scoring.Many of the measures and tools have established interrater reliability, yettest-retest reliability has not been determined, has been determined with avery small sample size or has not been determined in individuals withvestibular hypofunction. The purposes of this research were to 1) deter-mine test-retest reliability of clinical measures of subjective complaints,balance, gait and quality of life in patients with vestibular hypofunctionand 2) establish criteria for significant change in each of these measures.Number of Subjects: Sixteen volunteers were recruited from patientsreferred to the Emory University Dizziness & Balance Center with a diag-nosis of either unilateral or bilateral vestibular hypofunction. Diagnosiswas confirmed with a positive head thrust test and rotary chair or calorictesting. Materials/Methods: Participants performed two trials of each ofthe measures within the initial physical therapy session. The measuresincluded rating of disability, percent of day affected by dizziness, headmovement induced dizziness, SF-36, preferred gait speed, gait deviationsand dynamic gait index. In order to assess test-retest reliability of the mea-sures Pearson product moment correlations (r) were calculated using SPSS11.0. Correlation values greater than .75 are generally considered to indi-cate good reliability. Significant change in each measure was based on themean change in score plus 2 SD of the test-retest variability. Results:Theaverage age of the group was 51.8 years (range: 29-78 years) with 18.8% ofthe patients at least 65 years old and 38% male.Three of the subjects hadbilateral vestibular loss.The average time from onset of symptoms was 12.8months (range = .75 - 43 months). All measurement tools demonstratedexcellent reliability (r = .82 - 1.00) except for head movement induceddizziness (r = .59).For each measure we report what constitutes significantchange. For example based on our definition, a change of 3 points or morein the total dynamic gait index score constitutes significant change.Conclusions:A variety of tools are available for the assessment of patients


with vestibular hypofunction.We found that all of the scales examined inthis study, with the exception of head movement induced dizziness,demonstrate excellent test-retest reliability in the vestibular patient popu-lation.Clinical Relevance: Incorporation of valid and reliable assessmentsin clinical practice is critical in order to demonstrate the effectiveness oftherapeutic intervention.The variability in test-retest reliability can be usedas criterion for significant change but criteria based on functional signifi-cance need to be developed.

VESTIBULAR EVALUATION IN INDIVIDUALS WITH MILD BRAININJURY. S.L.Hammond1,C.Harro2, 1Mary Free Bed Rehabilitation Hospital,Grand Rapids, MI, 2Grand Valley State University, Grand Rapids, MI.

Purpose/Hypothesis: Clients with mild brain injuries (MBI) are suscepti-ble to vestibular dysfunction. The Dizziness Handicap Inventory (DHI),Sensory Organization Testing (SOT), Dynamic Gait Index (DGI), Dix-Hallpike Maneuver (DHM), and Head-Impulse Test (HIT) are objectivevestibular examination measures that have been validated in subjects withvestibular pathologies. Research utilizing these tests to examine the preva-lence of vestibular dysfunction post-MBI and assessing the validity of thesemeasures in clients with MBI is lacking. The primary purpose of thisdescriptive study was to investigate the application of objective measuresto examine the incidence of vestibular dysfunction in clients with MBI andsecondly, to examine the concurrent validity of the DGI with SOT and DHIscores in clients with MBI. Number of Subjects: Fifteen subjects withdiagnosis of MBI with onset < 6 months were recruited from MBI outpa-tient clinic.Mean age was 40 years (range 19-78) and mean time post-injurywas 69 days (range 12-167). Subjects were excluded if they had spinal orextremity injuries that contraindicated test administration or previous neu-rologic diagnoses. Materials/Methods:The DHI, SOT, DGI, DHM, and HITwere administered in controlled order to subjects over two sessions.TheDHI was used to quantify subjects’ self report of dizziness. SOT was usedto assess the use of sensory inputs for balance,specifically vestibular input.The DGI was used to evaluate subjects’ functional balance during gaittasks.The DHM and HIT were administered to detect BPPV and vestibulo-ocular function, respectively. Descriptive statistics were used to examinethe sample’s score distribution for each test and Pearson correlation wasused to examine the relationship between tests. Results:The mean scoreon the DHI was 50 (IQR 35-72), with 60% of scores being 50 or higher.Themean SOT composite balance score was 61.1 (IQR 54.5-71.0), with 73.3%of subjects falling below their normative age group scores. Forty-six per-cent of subjects were determined to have difficulty using vestibular inputto 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 positiveDHM results and 3 subjects had positive HIT results.A significant good cor-relation (r = -0.795) was found between DHI and DGI scores, indicatingthat subjective vestibular symptoms were related to subjects’ functionalbalance deficits. Conclusions:These findings demonstrate that vestibulardysfunction is prevalent in clients with MBI.The DHI, DGI, and SOT find-ings detected a large percentage of subjects with vestibular impairment,demonstrating the validity of vestibular testing in MBI. ClinicalRelevance: Individuals who experience MBI should be screened forvestibular dysfunction. In this study the DHI demonstrated sensitivity inmeasuring self-reported vestibular symptoms, which correlated with sub-jects’ functional balance scores.The DGI and SOT were valid measures fordetecting balance dysfunction in MBI.

BOTULINUM TOXIN A AND SERIAL CASTING AS ADJUNCT TREAT-MENTS FOR REHABILITATING UPPER EXTREMITY SPASTICITY FOL-LOWING BRAIN INJURY IN A PEDIATRIC PATIENT. N.J. Hellyer, S.L.Eischen, Program in Physical Therapy, Mayo Clinic College of Medicine,Rochester, MN.

Background & Purpose: Disabling subdural hemorrhage can occur inchildren secondary to arteriovenous malformations (AVM).AVMs occur ata frequency of one in every 100,000 children and can cause movementdysfunction following hemorrhagic brain injury. Like other types of uppermotor neuron injury, the recovery of functional movement followinginjury is often impeded by the development of spasticity. Therefore, themanagement of spasticity is a critical concern for the patient and health

care providers. Casting, soft tissue mobilization, motor re-education,surgery, and anti-spasticity medications are traditionally used to managespasticity, increase ROM, and improve functional mobility. Botulinum toxintype A (BTA) is one anti-spasticity medicine that is used as an adjunct agentto facilitate traditional physical therapy interventions. However, there isvery little evidence that documents the effectiveness of BTA and/or serialcasting for improving functional movement, especially in the upperextremities of pediatric patients. Case Description: The patient was anine year old male referred for rehabilitation three months post hydro-cephalus secondary to sudden hemorrhage of a previously asymptomaticAVM. Initially the patient demonstrated a marked reduction in upperextremity PROM of all joints. Notably for this case, left elbow extensionwas restricted to 90º- 60º PROM.Gross voluntary muscle activity within theavailable ROM was absent to poor. Upper extremity spasticity was rated 3(modified Ashworth) bilaterally at the shoulder, elbow, and wrist. FIMscores were 0 for transfers, self-care, and mobility. Upper extremity inter-ventions included a single BTA injection and ROM, neuromuscular re-edu-cation, casting (left elbow only), and functional training over a 4 weekperiod. Outcomes:At discharge the patient demonstrated improved ROM(left elbow extension 115º - 60º PROM), decreased spasticity (+2 wrist, +1elbow, -1 shoulder), left extremity anti-gravity control through availableROM, and improved FIM scores (3 for bed mobility, 1 for gait, and 4 forwheel chair mobility). At one year follow-up, FIM scores were furtherimproved with no additional serial casting or BTA administration.Discussion: Despite the limited clinical evidence, it is reasonable to pre-dict that an agent, such as BTA, is capable of creating a therapeutic windowduring which time spasticity is attenuated and ROM can be improved. Inthis particular case, we observed a persistent functional change in theupper extremity of a pediatric patient treated with traditional physicaltherapy, casting and BTA injection. This outcome suggests that BTX andcasting are appropriate adjunct treatments for upper extremity spasticity.However, systematic studies are needed to more clearly demonstrate theeffectiveness of BTA and casting interventions on improving upperextremity function in pediatric patients with brain injury.

TELEREHABILITATION FOR MOTOR RETRAINING IN PATIENTS WITHSTROKE. M.K.Holden,T.A.Dyar1,E.Bizzi1,L.Schwamm2,L.Dayan-Cimadoro3,1Dept. of Brain & Cognitive Sciences and Mc Govern Institute for BrainResearch, Massachusetts Institute of Technology, Cambridge, MA, 2ClinicalResearch Center, Massachusetts Institute of Technology, Cambridge, MA,3Dept. of Physical Therapy, Spaulding Rehabilitation Hospital, Boston, MA.(See Motor Learning Thematic poster session for abstract)

DECREASED ARM SWING AT FAST WALKING SPEED IN MILDPARKINSON DISEASE (PD). M. Hong1, G. Earhart1, D. Damiano2, J.Perlmutter2, 1Physical Therapy,Washington University in St. Louis, St. Louis,MO, 2Neurology,Washington University in St. Louis, St. Louis, MO.

Purpose/Hypothesis: Clinicians commonly note that people with mildPD have reduced arm swing but the relationship to walking speed remainsunknown.The purpose of this study was to determine whether arm swingwas reduced at various walking speeds compared to controls.We hypoth-esized that PD subjects would 1) have a narrower range of gait speedscompared to controls and 2) demonstrate less arm swing than controls.Number of Subjects:We tested 10 subjects with mild PD (stages 1-3) and10 healthy age and gender matched control subjects.Materials/Methods:Subjects walked across a 10 m room at three different speeds:slow,natural,and fast. For the slow and fast conditions, the subjects were instructed towalk as slow or as fast as they could.For the natural walking condition, thesubjects were told to walk at their normal and comfortable walking speed.Three trials in each condition were recorded using a Vicon system. Theorder of the conditions was randomized for each subject. Gait speeds andshoulder angles in the sagittal plane, as a measure of arm swing, were cal-culated for two strides per trial. For the PD group, we looked at the moreimpaired arm and for the control group, we analyzed their dominant side.At matched speeds, Mann-Whitney Rank Sum Tests were used to comparepeak-to-peak shoulder angles per stride between the two groups.A PearsonProduct Moment r was calculated between gait speeds and peak-to-peakshoulder angles for both groups. Results:There was no difference in themean speeds for the three different conditions between the two groups.


Both groups increased arm swing with an increase in gait velocity (r =.71for PD group, r =.79 for control group).The PD group demonstrated sig-nificantly smaller amplitudes of arm swing in the fast walking condition(p=.045) compared to the control group.There were no differences in armswing between the two groups in the slow or the natural walking condi-tions (p=.212, p=.089). Conclusions:The PD group was able to regulategait speed across the same range as the control group. However, decreasedarm swing was noted in patients with mild PD only in the fast condition,when they were walking at a faster than normal speed. ClinicalRelevance: Clinicians should be cautious to take gait speed into accountwhen assessing arm swing. Previous work has shown that with verbalinstructions to increase arm swing, patients with PD not only increasedarm swing but also walked faster than natural walking speed. Instructingmore advanced PD patients,whose fast walking speeds are below the levelof functional ambulation, to increase arm swing while walking fast mayincrease walking speed and improve function, but this remains to beproven.

SINGLE LIMB BODY WEIGHT SUPPORTED TREADMILL TRAINING.J.H. Kahn1,T. Hornby2, 1Sensory Motor Performance Program, RehabilitationInstitute of Chicago, Chicago, IL, 2Physical Therapy, University of Illinois atChicago, Chicago, IL. (See Post-Stroke Hemiplegia Thematic poster sessionfor abstract)

PHYSIOLOGICAL RESPONSES OF INDIVIDUALS WITH SPINAL CORDINJURY DURING ROBOTIC-ASSISTED TREADMILL WALKING. J.F.Israel,T.Hornby,Physical Therapy,University of Illinois at Chicago,Chicago,IL.

Purpose/Hypothesis: Body weight supported treadmill training (BWSTT)has been shown to be effective in retraining walking following incompletespinal cord injury (SCI), although its performance in the clinic is limited.Development of robotic devices which provide passive guidance duringwalking may increase performance of BWSTT, but may minimize voluntaryeffort by the subject.The purpose of this study was to investigate whetherrobotic-assisted treadmill walking provides a sufficient stimulus to generateappropriate muscle activity and metabolic responses compared to thera-pist-assisted walking. We hypothesized that therapist-assisted treadmillwalking would generate increased Vo2 responses and more appropriatelower extremity muscle activity vs., robotic-assisted treadmill walking.Number of Subjects:Twelve individuals with motor incomplete SCI par-ticipated in the study. Materials/Methods: Cardiopulmonary, metabolic,and electromyographic (EMG) responses during therapist-assisted treadmillwalking were compared to robotic-assisted ambulation with and withoutvisual biofeedback. Robotic training was provided by the Lokomat andvisual feedback of bilateral hip and knee torques during swing and stancephases were displayed on a computer screen. Subjects were asked to walkon the treadmill with <40% BWS for 10 minutes with either robotic- or ther-apist-assistance followed by 10 minutes of the other testing method.Standardized metabolic testing equipment was used to obtain cardiopul-monary measurements for 5 minutes in sitting and 2 minutes in standingprior to treadmill walking and throughout the testing period including 10minutes of recovery. Electromyographic (EMG) activity was collected fromkey lower extremity muscles during each minute of treadmill walking.Results: Therapist-assisted treadmill walking demonstrated significantlyhigher (p<0.01) Vo2, heart rate (HR), and minute ventilation (VE) during all10 minutes compared with robotic-assisted walking without biofeedback.Providing visual biofeedback during the walking tasks minimized the dif-ferences between conditions, although Vo2 responses during therapist-assisted walking were greater (p<0.05) during the last 3 minutes of walk-ing. EMG activity was significantly higher only for the rectus femoris inpre-swing during therapist- vs. robotic-assisted walking without feedback.This difference was minimized with feedback. Conclusions: Therapist-assisted treadmill walking elicits increased aerobic responses and moreappropriate muscle activity compared to robotic-assisted treadmill walking,although provision of biofeedback of joint torques may increase patienteffort. Clinical Relevance: Understanding the physiological responses torobotic- or therapist-assisted BWSTT is important the relative contributionof passive guidance during walking tasks.

SINGLE LIMB BODY WEIGHT SUPPORTED TREADMILL TRAINING.J.H. Kahn1,T. Hornby2, 1Sensory Motor Performance Program, RehabilitationInstitute of Chicago, Chicago, IL, 2Physical Therapy, University of Illinois atChicago, Chicago, IL. (See Post-Stroke Hemiplegia Thematic Poster Sessionfor Abstract).

INFLUENCE OF MOTOR-IMAGERY ABILITY ON SMA AND PSMACORTICAL ACTIVATION. T.J. Kimberley, G.S. Khandekar, PhysicalMedicine and Rehabilitation, University of Minnesota, Minneapolis, MN.(See Imagery and Imaging Thematic poster session for abstract)

NEUROMOTOR CONTROL IN FOCAL HAND DYSTONIA. T.J.Kimberley1, K.J. Simura2, M. Flanders2, 1Physical Medicine andRehabilitation, University of Minnesota, Minneapolis, MN, 2Neuroscience,University of Minnesota, Minneapolis, MN.

Purpose/Hypothesis: Focal hand dystonia is an under-diagnosed disorderassociated with repetitive hand movements that require fine motor controland sensory-motor integration, such as typing or playing a musical instru-ment.The disorder involves excessive co-contraction of muscles and abnor-mal postures that prevent normal motor function when performing the spe-cific hand movements.The cause of the disorder is widely debated, and noobjective diagnostic criteria or fully successful treatment exists. Current lit-erature focuses on spinal cord reflexes and a cortical change associated withfocal hand dystonia, and does not include a comprehensive analysis of mus-cle activation.Thus, the purpose of this study is to analyze neuromotor con-trol in focal hand dystonia compared to healthy motor control in the sametask.We hypothesize that patient’s abnormal muscle synergies can be iden-tified and characterized by the time course of muscular activation.This maycontribute towards the development of specific diagnostic categories andsuggest successful treatment options. Number of Subjects:Three subjectswith focal hand dystonia and three healthy subjects. Materials/Methods:Surface electrodes were used to record electromyographic (EMG) activity ofproximal and distal muscles of each hand and arm (abductor pollicis brevis,first dorsal interosseus, flexor digitorum superficialis in two positions: cen-tral portion, and ulnar portion, abductor digiti minimi, extensor digitorum,and the deltoid) while an instrumented glove and 3D motion monitoringwas used to record kinematic activity of fingers, arms, and trunk.All subjectsperformed a task involving repetitive typing of a sequence of letters on aninstrumented keyboard, at increasing speeds. Principal components analysiswas used to quantitatively describe the main EMG bursting patterns and thepatterns of co-variation across synergistic and antagonistic hand muscles dis-tinguishing the fundamental difference between groups. Results:Preliminary results show that the onset of dystonic symptoms is gradual, andinvolves a steady decrease in activation of the muscle controlling the dys-tonic digit and progressive compensatory increase in synergistic muscleactivity as well as proximal arm muscles and trunk compensations normallynot involved in the movement.Subjects with dystonia avoided making force-ful contraction of the dystonic finger muscles by substituting early activityin a muscle synergistic to the affected finger. Conclusions: Identifying thissynergistic activity and the method of co-activation in a subject may suggestdiagnostic criteria for dystonia types and lead to identifying possible treat-ment interventions. Clinical Relevance:The results of this study will serveas the basis for subsequent studies aiming to develop (1) categorizations ofdystonia types, (2) effective diagnostic tools and (3) treatment options spe-cific to each individual’s disorder.

GAIT PARAMETERS ASSOCIATED WITH RESPONSIVENESS TO ATASK-SPECIFIC AND/OR STRENGTH TRAINING PROGRAM POST-STROKE. T. Klassen1, S.J. Mulroy2, K.J. Sullivan3, 1Vancouver Coastal Health,Vancouver, British Columbia, CANADA, 2Pathokinesiology Laboratory,Rancho Los Amigos National Rehabilitation Center, Downey, CA,3Biokinesiology and Physical Therapy,University of Southern California,LosAngeles, CA. (See Post-Stroke Hemiplegia Thematic poster session forabstract)

CHANGES IN SIT-TO-STAND FOLLOWING ANKLE JOINT MOBILIZA-TIONS IN SUBJECTS WITH HEMIPLEGIA. P. Kluding, M. Santos, PhysicalTherapy and Rehabilitation Sciences, University of Kansas Medical Center,Kansas City, KS.


Purpose/Hypothesis:The purpose of this research project was to deter-mine if manual mobilization of the ankle joint can increase ankle range ofmotion (ROM) and improve sit-to-stand (STS) function for patients withhemiplegia following stroke. Stroke is one of the leading causes of adultdisability and often results in hemiparesis, or weakness on one side of thebody.This weakness together with spasticity, muscle and joint stiffness canmake it very difficult for patients to move their limbs and perform basicfunctional tasks.The research hypotheses were that joint mobilizations willbe effective in increasing ankle ROM, and that increased ankle ROM withstructured practice of functional skills will result in greater improvementon functional performance than practice alone. Number of Subjects:Sixteen subjects with hemiplegia following stroke were randomly assignedto either an experimental group (mean age 55.5 ± 10.7 years, 18.3 ± 11.8months post-CVA) or a control group (age 56.1 ± 13.7 years, 24.6 ± 15.7months post-CVA). Materials/Methods: All subjects participated in 30minutes of functional task practice, twice each week for 4 weeks. Theexperimental subjects also received joint mobilizations to the proximaland distal tibia-fibula, and talocrural articulations of the hemiplegic lowerleg during each treatment session. Dependent variables, including ankleROM and biomechanical analysis during STS, were measured at baselineand following the intervention with a motion analysis system and force-plate. Changes in these variables were compared between the 2 groupsusing an independent t-test (0.05 level of significance). Results: Theexperimental 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 thecontrol), and total active ROM (10.8º ± 7.5 compared to 2.3º ± 7.5 in thecontrol).The experimental group also performed the STS task significantlyfaster (-0.82 seconds ± 0.91 compared to -0.016 seconds ± 0.45 for thecontrol), and there was a significant correlation (r =-0.79) between gain inROM and time from start of STS to peak dorsiflexion. However, the controlgroup significantly decreased the difference in average vertical forcebetween the two lower extremities during STS (-9.56% body weight) com-pared to the experimental group (1.86% body weight). Conclusions:Thispreliminary work demonstrates that joint mobilizations may be effective atincreasing ankle ROM and improving time for STS when combined withfunctional task practice in subjects with hemiplegia after stroke. However,the control group appeared to receive greater benefit from the functionaltask practice in achieving more equal weight bearing between the lowerextremities. Clinical Relevance: This study raises questions about therelationship between ankle mobility and weight bearing during STS.Thesubjects who received the ankle stretching intervention may not have hadenough practice opportunity with their newly available motion to fullyimprove on the task. Further investigation may be indicated.

RELATIONSHIPS BETWEEN MOVEMENT CONTROL AT 9 UPPEREXTREMITY SEGMENTS AND LOSS OF HAND FUNCTION IN PEOPLEWITH CHRONIC HEMIPARESIS. C.E. Lang, Physical Therapy,WashingtonUniversity, St. Louis, MO.

Purpose/Hypothesis:The hand is a tool that people use to interact withtheir environment, and consequently, loss of hand function in people withhemiparesis is a major contributor to disability post stroke.To use the handfor functional activities, a person may need adequate control of the moreproximal upper extremity segments, to appropriately position and orientthe hand with respect to the environment, and may need adequate controlof the fingers, to manipulate objects within the environment.The purposeof this study was to investigate how movement control at 9 segments of theupper extremity (shoulder,elbow, forearm,wrist, and 5 fingers) contributedto loss of hand function in people with chronic hemiparesis. Number ofSubjects: 20 subjects with chronic hemiparesis, age range 43-85.Materials/Methods:To measure movement control at the 9 segments, sub-jects were studied making isolated movements at the shoulder, elbow, fore-arm, wrist, and five fingers using 3-D kinematic techniques. Extracted vari-ables for each segment included the: active range of motion (AROM),individuation index, and stationarity index.To measure hand function, sub-jects performed a battery of standardized clinical tests. Principal compo-nent analysis was used to create a single hand function score for each sub-ject from the clinical test battery. Correlation analyses were used toexamine relationships between movement control at the 9 segments andhand function. Multiple regression was used to determine how proximal,

middle, and distal segments contributed to the variance in hand function.Results: The ability to move each segment against gravity (AROM) wasstrongly correlated with hand function, such that the greater the AROM, thegreater the hand function. The ability to move segments in isolation (indi-viduation index), and the ability to hold segments still (stationarity index)were also correlated to hand function, with more proximal segments hav-ing similar correlation coefficients to the more distal segments. Proximal,middle,and distal AROM values accounted for > 80% of the variance in handfunction, with the largest contribution coming from the distal segments. Inseparate analyses,proximal,middle, and distal individuation and stationarityindices accounted for > 65% of the variance in hand function, with thelargest contribution coming from the proximal segments. Conclusions:Movement control at proximal, middle, and distal upper extremity seg-ments was important for functional use of the hand in people with chronichemiparesis. Clinical Relevance: An understanding of how movementcontrol at each upper extremity segment contributes to hand function inpeople with hemiparesis will provide insight into how future therapeuticinterventions may be better structured to optimize recovery of function.

GAIT INITIATION IN HEALTHY YOUNG AND HEALTHY OLDERADULTS AND IN ADULTS WITH PARKINSON’S DISEASE. C.A. Larson,B. Amman, V. Lopez, M. Syjud, J. Wolf, N. Yip, School of HealthSciences/Program in Physical Therapy, Oakland University, Rochester, MI.

Purpose/Hypothesis:Gait initiation refers to the transition from standingmotionless to taking a step forward and reaching a constant walkingspeed. Gait initiation is often problematic in persons with Parkinson’s dis-ease due to akinesia and bradykinesia.The purposes of this study were todescribe gait initiation kinetics, specifically center of pressure (COP)excursion patterns, and to determine if COP varies when gait is initiatedwith the right or left foot, slow or fast speeds and between healthy young(HY) and healthy older (HO) adults and adults with Parkinson’s Disease(PD). Number of Subjects: Fourteen subjects, five HY (ages 21-27), fiveHO (ages 50-60) and four persons with PD (ages 75-85 with Hoehn andYahr scores of I-III) initiated gait upon seeing a light-emitting diode signaland walked forward approximately four meters. Materials/Methods: Sixtrials were performed for each condition (step with right or left foot first,self-determined slow or fast speed) for a total of 24 trials. COP wasobtained using a Kistler force plate and spatial and temporal parameterswere determined by a Labview data analysis program designed by the firstauthor. Initially, a 3 (HY, HO, PD) x 2 (right or left step foot) x 2 (slow orfast speed) ANOVA with repeated measures was used to analyze individualtrial data. No differences (p=0.08-0.97) were found when comparing theright and left step foot trials, therefore, right and left trials were pooled foranalysis.Then slow and fast speed data were analyzed separately using aone-way ANOVA and Bonferroni post hoc tests using mean data. Results:Subjects with PD tended to be slower than the HY and HO adults as mea-sured by the following temporal variables: reaction time, onset to farthestswing time, farthest swing to forward progression time, and forward pro-gression to end time and were significantly slower for total movement timeat slow speeds (p=0.01) and fast speeds (p=0.04). Subjects with PD alsohad smaller COP excursions than HY and HO adults with respect to thefarthest lateral and posterior distance toward the swing limb from the ini-tial COP position and the farthest swing to forward progression distance.There were no differences between the groups in the COP angles for slow(p=0.24) and fast (p=0.16) speeds. Conclusions: Individuals withParkinson’s disease tend to or significantly move slower and have reducedCOP spatial excursion patterns as compared to HY and HO adults whichmay indicate a safety strategy or an unwillingness to produce forces whichwould move them toward the edges of their base of support and challengebalance during gait initiation. Clinical Relevance:A better understandingof the kinetics during gait initiation in persons with PD will eventually leadto development of more appropriate intervention strategies and hopefullyreduce risk of fall.

HIP JOINT POSITION AFFECTS VOLITIONAL KNEE EXTENSORACTIVITY POST-STROKE. M. Lewek1,T. Hornby1,Y. Dhaher1, B. Schmit2,1Sensory Motor Performance Program, Rehabilitation Institute of Chicago,Chicago, IL, 2Marquette University, Milwaukee, WI. (See Post-StrokeHemiplegia Thematic poster session for abstract)


INVESTIGATION OF LATERAL FORCES WHILE PERFORMINGVOLUN-TARY FORWARD STEPPING WITH AND WITHOUT USING ACANE IN HEALTHY ADULTS AND HEMIPLEGIC PATIENTS WITHSTROKE. Y. Lin1, P.Tang1,W. Chang1, L. Lu2, 1School and Graduate Instituteof Physical Therapy, National Taiwan University, Taipei, TAIWAN, 2PhysicalTherapy, Chung Shan Medical University Rehabilitation Hospital,Taichung,TAIWAN.

Hypothesis:This study investigated differences in the lateral forces whileperforming voluntary forward stepping with and without a cane in healthyadults and hemiplegic patients with stroke. Number of Subjects: Fivehemiplegic patients with stroke (mean age=55.9 ± 11.5yrs) and five age-matched healthy adults (mean age=56.0 ± 7.0yrs) participated in thisstudy. Materials/Methods: Four conditions, stepping forward with theleft and right leg, and with and without using a cane, were tested. Groundreaction forces underneath the lower extremities and the cane were col-lected by two force plates and an instrumented cane, respectively. Theloading duration (from onset of the increase in lateral force toward thestepping leg to the first zero crossing of the lateral force), unloading dura-tion (onset of the increase in lateral force toward the stance leg to the sec-ond zero crossing of the lateral force), force impulses during the loadingand unloading durations, and the rate of lateral force transfer prior to footliftoff were analyzed. Results: Compared with healthy adults, patientswith stroke showed longer loading duration (P = 0.003), smaller forceimpulse in the loading phase (P = 0.024), and slower rate of lateral forcetransfer (P = 0.001) when stepping with the unaffected leg without a cane;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-ping with the affected leg without a cane.Without using a cane, patientswith stroke also showed longer unloading duration (P = 0.017), faster rateof lateral force transfer (P = 0.009), greater force impulse in the loadingphase (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-fected leg. While using a cane to perform the stepping, most of thesepatients decreased the generation of force impulses in the loading andunloading phase although the amount of the decreases did not reach a sig-nificant level (loading phase P = 0.059; unloading phase P = 0.071). No sig-nificant change was observed for the rate of lateral force transfer betweenthe no cane and cane use conditions for the patient group either.Conclusions :To achieve a safe lateral weight transfer required prior toand during a forward stepping movement, patients with stroke appearedto lengthen the loading and unloading durations in order to compensatefor their decreased ability to generate lateral impulses in the loading andunloading phases, respectively. Using a cane might partially contribute tothe lateral impulse generation required for performing the stepping move-ment such that the impulses generated by the lower extremities decreasedslightly. Clinical Relevance : For patients with stroke to step forward, theuse of a cane might potentially decrease the difficulty of the lower extrem-ities to perform the lateral weight shifting required prior to and during thismovement.

EFFECTS OF RANDOM AND BLOCKED ORDER PRACTICE ONMOTOR LEARNING IN INDIVIDUALS WITH PARKINSON DISEASE.C. Lin1, C.J. Winstein1, K.J. Sullivan1, A.D. Wu2, 1Biokinesiology and PhysicalTherapy, University of Southern California, Los Angeles, CA, 2Neorology,University of Southern California, Los Angeles, CA. (See Motor LearningThematic poster session for abstract)

USE OF ‘TIME SPENT IN BALANCE CORRECTION’ AS A MEASURE OFBALANCE. P.V. Loubert1, L. Swan2, H. Otani3, 1Physical Therapy, CentralMichigan University, Mt. Pleasant, MI, 2Physical Therapy, University of thePacific,Stockton,CA, 3Psychology,Central Michigan University,Mt.Pleasant,MI.

Purpose/Hypothesis: Conventional measurement of postural sway fromforce plate technology has been derived from the standard deviation of theindividual center of pressure locations relative to the average center ofpressure location.When measuring static balance activities such as tandemstance, some data was occasionally lost if subjects took a step (i.e. used astep strategy) or otherwise changed body position during testing.The pur-

poses of this study were to: 1) develop a measure of postural sway thatincorporated these normal balance strategies and 2) examine the relation-ship of this new measure with conventional measurement. Number ofSubjects: Fourteen women with a mean age of 26 years. Materials/Methods: The subjects completed two trials each of two different staticstanding balance tasks while standing on a force plate with their eyesclosed: 1) standing with feet together and 2) standing with feet togetherwith a vibratory stimulus applied to the bilateral gastrocnemius muscles.Asliding,10 ms time window was used to examine each 60 second trial. If thesubject had more than a pre-specified change in any of the three dimen-sions of movement, “corrective activity”was recorded. The final measurewas the percentage of time spent in balance correction (TSBC). Results:ANOVAs demonstrated that the new measure,TSBC, and conventional mea-surement both showed a significant difference between the vibration con-dition and the normal condition (p<0.05).When the effect size of the bal-ance tasks on each measure were examined, the strength of associationbetween the balance tasks and the measure was greater for the TSBC mea-sure (R2 =0.79) than for the conventional measure (R2 = 0.68).Conclusions:The TSBC measure demonstrated more sensitivity than con-ventional measurements in detecting the balance difference between twostatic standing balance tasks. Clinical Relevance:Therapists working clin-ically view balance strategies, such as stepping, as appropriate responses ina given environmental context. Researchers have seldom incorporated theappropriate use of balance strategies into their measurement of posturalsway.The TSBC measure offers the advantage of incorporating a clinical per-spective to bridge the gap between research and clinical views of balance.

THE FIVE-ITEM DYNAMIC GAIT INDEX: DEVELOPMENT ANDTESTING. G.F. Marchetti1, S.L. Whitney2, 1Physical Therapy, DuquesneUniversity, Pittsburgh , PA, 2Physical Therapy, University of Pittsburgh,Pittsburgh, PA.

Purpose/Hypothesis: The Dynamic Gait Index (DGI) was developed toexamine patient ability to modify gait responses during 8 walking tasks.The DGI has been reported to help clinicians identify patients at increaserisk of falls.The purpose of this study was to examine the scaling and rat-ings of the DGI and to evaluate the properties of a 5-item version in patientswith balance and vestibular dysfunction. Number of Subjects: Ninetythree patients (mean age 61 years, SD 16, range 14 -90) with balance andvestibular disorders seen in a tertiary-care clinic for balance disorders wereincluded. Materials/Methods:All subjects were examined while perform-ing 8 items of the DGI by a licensed physical therapist. Scaling of the ordi-nal DGI measure was examined using Rasch analysis modeling to determinethe range of item difficulty and subject ability. Items showing similar prop-erties were considered for elimination. Coefficient Alpha was used to deter-mine the internal consistency of the reduced item DGI. Factor analysis wasused to determine the construct structure of the new 5-item DGI.The abil-ity of the 5-item DGI to identify subjects with a self-reported history of fallswas determined using analysis of discriminative function and a receiveroperating characteristic (ROC) curve. Results: The 8-item DGI demon-strated excellent inter-item reliability (0.96).Rasch model scaling and fit sta-tistics identified three items for elimination: walking-horizontal head turns,gait with pivot turn, and stair climbing.The 5-item test (level gait, changegait speed, walking-vertical head turns, step over obstacle, step aroundobstacle) showed good internal consistency (Crohnbachs alpha=0.89).Factor analysis demonstrated a single construct explained 71% of test vari-ance with a minimum item loading of 0.76.The 5-item DGI demonstratedgood ability to discriminate fallers (p < 0.01, 61% correctly identified). ROCcurve analysis showed optimal screening for fallers at a score of 12/15 (sen-sitivity 70%, specificity 53%) and was superior to the full 8 item test.Conclusions:The 5-item DGI appears sufficient to identify gait responsesto changing task demands in patients with balance and vestibular disorders.Clinical Relevance:The 5-item DGI can reduce examination time withoutcompromising information gained about dynamic gait.

EFFICACY OF SPLIT ANTERIOR TENDON TRANSFER SURGERY ANDBODY WEIGHT SUPPORTED TREADMILL TRAINING POST-STROKE:A CASE STUDY. N.D. Matthews1, K.J. Sullivan1, V. Eberly2, S. Mulroy2,1Biokinesiology & Physical Therapy, USC, Los Angeles, CA, 2Pathokinesiol-ogy Laboratory, Rancho Los Amigos Medical Center, Downey, CA.


Background & Purpose:To investigate the efficacy of body weight sup-ported treadmill training (BWSTT) following split anterior tendon transfer(SPLATT) surgery to improve walking ability in an individual post-stroke.Case Description:The patient is a 53 year old male, 5 years post left inter-nal capsule hemorrhage resulting in right hemiplegia who had severe walk-ing disability due to inadequate right hip and knee flexion during swingand excessive inversion/plantarflexion throughout the gait cycle. Thepatient’s functional walking ability improved with outpatient therapy;how-ever,his gait continued to be severely limited by the equinovarus deformity.A SPLATT procedure was recommended. Surgery was performed four yearspost-stroke and included the SPLATT, toe flexor release, tendo-Achilleslengthening, and rectus femoris release. Two months after surgery thepatient returned to physical therapy for treatment. Intervention: Physicaltherapy intervention consisted of BWSTT 1-3x/week x 25 weeks (52 ses-sions) for a total of 20 minutes of treadmill walking each session.Treadmillspeed varied between 1.7 and 2.2 mph, with the body weight supportdecreased across training from 40% to 10%. Concurrently, the patient per-formed a home exercise program on non-treatment days which focused onlower extremity stretching and strengthening. Outcomes: LE Fugl-MeyerMotor Score (LEFM), gait velocity, six minute walk and other musculoskele-tal measures were taken pre-treatment, every 4-5 weeks across sessions, atcompletion of therapy, and at 1- and 3-month follow-up. Instrumented gaitand motion analysis with fine-wire EMG recording of LE muscle activity wasperformed before surgery and 1-wk post treatment. Across post-surgicaltreatment, there was minimal change in the LEFM (pre 26/34, post 27/34);however, self-selected gait velocity with AFO and cane increased 62% (pre0.59, post 0.95m/s) and 6-minute walk increased 75% (pre 169.2, post296m). Gait and motion analysis revealed a decrease in ankle inversion dur-ing stance from 30 degrees to 10 degrees. Pre-operatively, tibialis anteriorfired continuously throughout the gait cycle, post-treatment EMG revealednormal onset and cessation of tibialis anterior at 53.3% and 14.0% of thegait cycle, respectively.The patient reported increased confidence in walk-ing with and without his brace and increased daily community walking. Healso resumed an active role in his community. Discussion: This casedemonstrates the beneficial use of SPLATT surgery combined with BWSTTto improve walking ability in an individual with chronic stroke. Theimproved structural alignment gained from surgery combined with task-specific training resulted in significant changes in muscle phasing andvelocity during gait and improved functional ambulation in our patient.

CLINICAL TESTS OF WALKING DUAL-TASK PERFORMANCE AFTERACQUIRED BRAIN INJURY (ABI): FEASIBILITY AND DUAL-TASKCOST COMPARISONS TO A YOUNG ADULT GROUP. K. McCulloch, K.Blakley, L. Freeman, Division of PT,Allied Health Sciences, UNC-Chapel Hill,Chapel Hill, NC.

Purpose/Hypothesis: 1) To describe feasibility of three tests of dual-taskperformance during walking for individuals with ABI. 2) To compare dual-task performance on the most feasible measure between subjects with ABIand a group of young adults. umber of Subjects: 18 ambulatory adults(5 women) with ABI (age range 24-58); independently ambulatory for a dis-tance of at least 40 feet (3 subjects used a cane or walker).Two subjectsundergoing day treatment with recent onset were limited householdambulators. 16 subjects with chronic cognitive impairments required sup-port for independent living; 14 were community ambulators. Comparisongroup subjects were 25 young adults (7 male) without brain injury (agerange 22-35). Materials/Methods:ABI subjects performed 1- ‘Stops walk-ing while talking test’(SWWT); 2- Walking While Talking Test (WWTT) thatrequires walking while repeating the alphabet and alternate letters of thealphabet; and 3- Walking and Remembering Test (WART)that tests speededwalking on a 12 inch narrow path while performing a working memorytask. Dual-task costs on the WART were compared for the ABI and youngadult sample. Results:Task feasibility and difficulty for ABI subjects:TheSWWT test was negative for all subjects.The alphabet WWTT task was easyfor 89%, but the alternate alphabet task was too difficult for the majority(66%).The WART cognitive task was completed by all subjects, even thosewith severe declarative memory deficits.The WART walking task was notfeasible for one subject who was legallyABI and young adult dual-task costcomparisons:WART median relative dual-task costs for walking speed weregreater for ABI subjects [.18, 95% C.I. (.01, .24)] than young adults [.002,

95% C.I. -.02, .05)]. Mean reductions in digit span accuracy were similar[ABI subjects .87, 95% C.I. (.79, 95); young adults .92, 95% C.I.88, .95)].Subjects with ABI had more difficulty with step accuracy on average, butthe median dual-task steps off the path was zero for both groups.Conclusions:Task difficulty is important when assessing dual-task perfor-mance.The SWWT and WWTT have limitations for ambulatory individualswith ABI, as the cognitive tasks are either too simple (SWWT) or too diffi-cult (WWTT alternate alphabet cognitive task). Measures that allow foradjustment of task difficulty (WART) are feasible for individuals with cog-nitive impairment.The use of a working memory task revealed similar dual-task costs for cognitive task performance between the ABI and young.Clinical Relevance:The diverse nature of deficits following ABI necessi-tates flexibility in outcome measures. Dual-task measures that record per-formance of both tasks and allow some adjustment of task difficulty mayprovide better insight into the effects of dual-task conditions and informplans for intervention.

PARETIC LOWER EXTREMITY LOADING AND WEIGHT TRANSFERFOLLOWING STROKE. V.S. Mercer1, S. Chang1, J.L. Purser2, J.K. Freburger3,1Allied Health Sciences, UNC-CH, Chapel Hill, NC, 2Medicine, DukeUniversity Medical Center, Durham, NC, 3Cecil G. Sheps Center for Health,University of North Carolina at Chapel Hill, Chapel Hill, NC. (See Post-Stroke Hemiplegia Thematic poster session for abstract)

EFFECTS OF BODY WEIGHT SUPPORTED TREADMILL TRAINING ONRUNNING IN A PATIENT POST-STROKE: A PROSPECTIVE CASEREPORT. E.W. Miller, S. Combs, C. Fish, B. Lakin,A. Schlotterbeck,A. Sieber,Krannert School of Physical Therapy, University of Indianapolis,Indianapolis, IN.

Purpose/Hypothesis: Many benefits of body weight supported treadmilltraining (BWSTT) have been documented, including increased cadence,symmetry, gait velocity and confidence of ambulation. However, there areno studies that have focused on BWSTT and running. Further, there is lim-ited literature regarding rehabilitation of running in individuals who haveneurological conditions such as stroke. The purpose of this report was toinvestigate the feasibility and effectiveness of using BWSTT to improve therunning ability of a patient post stroke. We hypothesized that the inter-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:Aprospective case report design was selected in which baseline was estab-lished and followed by an 8-week treatment phase. Immediate and delayedpost testing was performed. Dependent variables used for single systemanalysis included: single leg balance, running step length, step length ratio,step width, and 25-meter sprint speed. Pre/post dependent variablesincluded: lower extremity strength, 6-minute walk, and the Stroke ImpactScale.The 2 standard deviation band method was used to analyze the datawith alpha set a 0.05. The variables measured during pre-and post-testphases were subjectively analyzed based on a 10% difference defined as afunctional change in ability.Results: Left single leg balance, right step, stepwidth, and sprint speed changed significantly from baseline to delayedpost-test. All pre-post measures showed greater than 10% improvement.Conclusions: Our data supported current literature that suggests thatpatients with chronic deficits due to stroke can make functional gains withcontinued rehabilitation and also that BWSTT is a useful and effective toolin the clinical setting. Our data also added to current literature by demon-strating the feasibility and effectiveness of using BWSTT to improve run-ning ability. Clinical Relevance: BWSTT was a feasible and effective inter-vention for improving running ability in this high functioning patientpost-stroke. It may be an option for other patients with neurological con-ditions with a goal of regaining running ability.

DEVELOPMENT AND VALIDATION OF CIRCUMDUCTION ASSESSMENTSCALE FOR INDIVIDUALS WITH HEMIPLEGIA. J.L. Moore1, H.R. Roth1, M.Lewek1, Y.Y. Dhaher1, T.G. Hornby2, 1Sensory Motor Performance ,Rehabilitation Institute of Chicago, Chicago, IL, 2Department of PhysicalTherapy, University of Illinois of Chicago, Chicago, IL. (See Post-StrokeHemiplegia Thematic poster session for abstract)

THE EFFECTS OF SPEED AND LEVEL OF VOLUNTARY MUSCLEACTIVATION ON REFLEX RESPONSES IN CHRONIC STROKE


PATIENTS. D. Nichols1, M. Pelliccio1, I. Black2, J. Hidler2, 1Inpatient PT,National Rehabilitation Hospital, Washington, DC, 2Center for AppliedBiomechanics and Rehabilitation Research, National RehabilitationHospital,Washington,DC. (See Post-Stroke Hemiplegia Thematic poster ses-sion for abstract)

TETRAPLEGIA DUE TO CRITICAL ILLNESS POLYNEUROPATHY FOL-LOWING SEVERE TBI, ACCOMPANIED BY MULTIPLE COMPLICA-TIONS. A CASE REPORT OF PROLONGED INPATIENT ACUTE REHA-BILITATION COURSE AND FUNCTIONAL OUTCOMES. A. Packel,Physical Therapy, MossRehab Hospital, Cheltenham, PA.

Purpose/Hypothesis: Descriptions of severe critical illness polyneuropa-thy (CIP) and functional recovery are sparse in the literature.This case illus-trates the potential for recovery from concomitant TBI and CIP, and rein-forces the need for intensive, comprehensive services. Number ofSubjects: Case report of a 54-year-old man who sustained a severe TBI dueto a mechanical explosion in close proximity to his face. Patient was admit-ted to rehab 8 weeks after injury, with no active movement or muscle con-tractions in his trunk, neck, and three extremities. He was able to open andclose his right hand spontaneously. He was unable to communicate, andinconsistently able to perform actions with his right hand upon command.Initial FIM scores were all either 1 or 0 and initial Disability Rating Score(DRS) = 21T, indicating extremely severe disability. Materials/Methods:Patient’s acute inpatient rehabilitation course lasted 37 weeks. On thetenth day of his rehab stay, Pt. had EMG/NCV tests with finding of severeperipheral polyneuropathy affecting lower extremities more than upperextremities, diagnosed as critical illness polyneuropathy.This provided anexplanation for his minimal movement throughout and also led to the beliefthat considerable motor recovery might occur,but might require months toyears.A strong social situation allowed planning for discharge to his home,despite the expectation of prolonged severe deficits in movement through-out. Heavy focus was placed on family training for all aspects of care, andoptimizing return of strength as the polyneuropathy resolved. Results:Attime of discharge, the patient was able to communicate basic needs mostlyconsistently, drive a power wheelchair indoors with frequent verbal cuesand minimal assistance, and feed himself with minimal assistance. Strengthremained 1/5 to 2/5 throughout except his right upper extremity, whichachieved up to 4/5 strength. FIM scores ranged from 1 to 4, and DRS scoreat discharge = 13, indicating severe disability. His wife and hired caregiverwere able to assist him with all care, including prescribed exercises, posi-tioning, and standing program. Continued recovery of motor function andstrength were anticipated, over a prolonged period. Further results will bepresented at 3 month and 6-month follow-up after discharge.Conclusions:Early detection of critical illness polyneuropathy in this patient helped toguide his course of treatment.An extended inpatient rehabilitation coursewas required due to his severe TBI, severe CIP, and multiple medical com-plications.This allowed him to be successfully discharged to home and becared for by his family, while his polyneuropathy continued to resolve.Clinical Relevance: Limited information is available in the literatureregarding recovery from severe critical illness polyneuropathy. More infor-mation is needed in order to aid in prognosis and help to guide treatmentin patients with severe critical illness polyneuropathy.

LOWER LIMB STRENGTH AND COORDINATION PATTERNS OFCHRONIC STROKE SUBJECTS IN A FUNCTIONAL POSTURE. M.M.Pelliccio, N. Neckel, D. Nichols, J. Hidler, National Rehabilitation Hospital,Washington, DC. (See Post-Stroke Hemiplegia Thematic poster session forabstract)

NEUROMUSCULAR STIMULATION IMPROVES GRASPING FUNCTIONIN INDIVIDUALS WITH CHRONIC STROKE. B. Quaney1, L.H. Zahner1,M.J. Santos2, Z. Kadivar2, B. McKiernan3, 1Landon Center on Aging, Universityof Kansas, Kansas City, KS, 2Physical Therapy and Rehabilitation Sciences,Kansas University Medical Center, Kansas City, KS, 3Physical TherapyEducation, Rockhurst University, Kansas City, MO. (See Post-StrokeHemiplegia Thematic poster session for abstract)

EFFECT OF PLANTAR SOMATOSENSORY INPUT ON VERTIGO:COMPARISON BETWEEN DIRECT PRESSURE AND TRANSCUTAN-EOUS ELECTRICAL NERVE STIMULATION. N.L. Nicolai, L.N. Cartwright,

S.T. Quenga, L.P. Frasier, R.J. Allen, Physical Therapy, University of PugetSound,Tacoma,WA.

Purpose/Hypothesis:To compare the effects on vertigo of two methods ofsomatosensory input to the plantar surfaces of the feet; direct plantar sur-face pressure versus TENS. Number of Subjects:Twenty-one normal vol-unteers (5 male, 16 female; age range 22-44 yrs) screened for history ofvestibular or oculomotor pathology,episodic dizziness, lower extremity painor somatosensory loss, and use of oculomotor altering or ototoxic sub-stances. Materials/Methods: Subjects were assessed for intact plantar sen-sation via 4.56 (metatarsal heads) and 5.07 (calcaneus) Semmes Weinsteinmonofilaments. Subjects reclined 60o from vertical were exposed to vertigoinduction via 90 sec irrigation of the right external auditory meatus with 90ml of 5o C water.Using a within-subjects design,vertigo was induced in eachsubject three times; each induction was followed by one of three treatmentconditions. Condition A was no-treatment control. Condition B involvedbilateral plantar stimulation via sensory level TENS applied to the calcanealregion and second metatarsal heads, using random intensity and rate modu-lation with subjects self-selecting the amplitude limit prior to vertigo induc-tion. In condition C the plantar aspects of both feet pressed against a solidsurface with peak pressures ranging from 12 to 53 kg.To eliminate order-effects or habituation bias the order of treatment conditions was variedaccording to a preset schedule. Efficacy of each treatment condition wasassessed via subjective reports of vertigo intensity (visual analog scale) andtimed vertigo duration. Differences between responses for each conditionon each dependent variable were assessed using one-way ANOVAs forrepeated measures with multiple contrast analyses. Results: While not sig-nificantly different from each other, the two plantar stimulation conditionsyielded significant reductions in vertigo intensity compared to control (p =0.019). Analysis of duration of vertigo revealed no significant differencesbetween the three groups (p = 0.424). Conclusions:These findings sup-port the hypothesis that plantar pressure may reduce the intensity of calor-ically induced vertigo, whether that stimulation is from direct plantar pres-sure or TENS. Both methods of providing plantar pressure appear similarlyefficacious.These findings do not support the hypothesis that plantar pres-sure reduces the duration of a vertigo episode. Clinical Relevance: Priorstudies have established that plantar stimulation via direct pressure reducessome aspects of vertigo. The current study assessed whether a passiveapproach to delivering plantar stimulation using TENS might also be effec-tive.While supporting the notion that plantar stimulation may attenuate ver-tigo, the current findings indicate that plantar TENS produces similar results.Given further investigation with a clinical sample, results from this studycould directly translate into an easily implemented clinical intervention forbed-ridden patients suffering from unrelenting vertigo.

SPLIT-BELT TREADMILL ADAPTATION AND GAIT SYMMETRY POST-STROKE. D.S. Reisman1, A.J. Bastian2, 1Department of Physical Therapy,University of Delaware, Newark, DE, 2Kennedy Krieger Institute, Baltimore,MD. (See Post-Stroke Hemiplegia Thematic poster session for abstract)

A MOTOR LEARNING PHYSICAL THERAPY INTERVENTIONAPPROACH AND BOTULINUM TOXIN TYPE A INJECTIONS IN THETREATMENT OF SPASTICITY AND REHABILITATION OF UPPEREXTREMITY FUNCTION FOLLOWING STROKE: A CLINICAL CASEREPORT. W.J. Sanchez, A.D. Kloos, Physical Therapy, The Ohio StateUniversity, Columbus, OH. (See Motor Learning Thematic Poster Sessionfor Abstract)

SPINAL CORD INJURY PATIENT EDUCATION: HOW TO MAKE ITWORK IN A RURAL REHAB SETTING. K.M. Stoneman, S.D. Standard,Inpatient Rehabilitation, Fletcher Allen Health Care, Colchester,VT.

Purpose:The purpose of this presentation is to describe the process used todevelop a consistent and comprehensive interdisciplinary approach topatient/caregiver education for individuals with an acquired spinal cordinjury (SCI). Another objective is to relate the creation of a clinician-baseddocumentation system which serves to improve coordination of individualeducational plans and topics.Description:As part of a review of the SCI pro-gram at our thirty-five bed inpatient rehabilitation hospital, patient/caregivereducation was examined by an interdisciplinary committee. Chart audits


revealed inconsistencies in the type, depth and breadth of topics coveredamong and between disciplines.A phone survey of former patients reflectedthis as well.Through discussions with clinicians, it also became apparent thatpaternalistic assumptions existed regarding the amount of information thatan individual with a new diagnosis of SCI could emotionally handle and inter-nalize.After these limitations of the system were ascertained, a new processwas incrementally developed. |*bund*|Yes|*eund*| |*bund*|You|*eund*||*bund*|Can|* eund*|, a book distributed by the Paralyzed Veterans ofAmerica, was identified as the primary resource for education. Based on thisbook, knowledge and performance objectives for pertinent topics were cre-ated. Next, a patient education binder, including these objectives as well asadditional resources, was compiled.This binder follows the patient as s/hemoves through the continuum of care.To supplement these steps, additionalmulti-media, patient-focused educational resources were purchased. Allresources were catalogued so that patients could easily access informationon topics of interest. Summary of Use:The new patient/caregiver educa-tion system was introduced to each rehabilitation discipline. Although ini-tially enthusiastic about the concept, some members of the treatment teamwere slow to adopt the new system.Therefore, a series of six in-service train-ing sessions was presented regarding key educational points, best practice,learning styles and pedagogical methods. For each topic, a concise referencesheet of information was developed for staff.A team leader/point person wasidentified to ensure discussion of patient education at Discharge PlanningRounds. Importance to Members: A consistent, comprehensive approachto patient/caregiver education is imperative to the health maintenance ofindividuals with an acquired spinal cord injury.An interdisciplinary team iscrucial to the success of such a process. Furthermore, clinicians should betrained to assess learning styles and adjust teaching strategies accordingly inorder to better support the needs of individuals with a spinal cord injury andtheir caregivers.

PSYCHOMETRIC PROPERTIES OF THE NATIONAL INSTITUTES OFHEALTH STROKE SCALE IN SUBJECTS WITH ACUTE LEFT ANDRIGHT CEREBRAL ISCHEMIC STROKE. D. Straube1, S.R. Millis2, C.Iramaneerat3, E. Smith3, 1Physical Therapy, Univ. of Illinois - Chicago,Chicago, IL, 2School of Medicine, Physical Medicine and Rehabilitation,Wayne State University, Detroit, MI, 3College of Education, University ofIllinois - Chicago, Chicago, IL.

Purpose/Hypothesis: The National Institutes of Health Stroke Scale(NIHSS) is a widely used instrument for the assessment and monitoring ofprogress for individuals with stroke. Published factor analyses of theNIHSS revealed at least two underlying factors, representing left and righthemispheres.The purpose of this study was to assess the contributions ofthe items of the NIHSS in individuals with either left or right hemispherestroke in order to improve the validity of the scale to document neurologicimpairment in these two groups. Number of Subjects:NIHSS scores from387 individuals with acute left hemisphere stroke and 347 individuals withacute right hemisphere stroke were analyzed. Individuals with bilateralcerebral stroke or cerebellar stroke were not included. Materials/Methods:The Rasch partial credit model was used to analyze the NIHSSraw scores. Data was assessed using principal component analysis of theperson and item residuals and item fit statistics. Based on the results of thefirst analysis, two subsequent analyses were performed with NIHSS scoresfrom the sample of individuals with left hemispheric stroke and righthemispheric stroke. Results: The findings support previous findings oftwo distinct populations with stroke, subjects with left hemisphere andright hemisphere stroke.Additional analyses performed generated a linearscale for each subject population consisting of a subset of items of theNIHSS. Conclusions:The findings provide a more valid and efficient scalefor the assessment of impairment following stroke consistent with hemi-spheric lateralization of function in either the left or right hemisphere.Clinical Relevance:The findings support the need for unique scales forthe assessment of impairment following stroke related to the unique rolesof the left and right cerebral hemispheres. The scales presented for eachgroup contain fewer items, and are thus more efficiently targeted.

STEPPING OUT: IMPROVING COMMUNITY AMBULATION ANDFUNCTION AFTER STROKE. J.Teepen1, K. Baltzer1, K. Dunning1, P. Levine2,S. Page2, 1Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH,

2Department of Physical Medicine and Rehabilitation, University ofCincinnati, Cincinnati, OH.

Background & Purpose: Due to affected leg disability and nonuse, com-munity-dwelling stroke patients frequently exhibit impaired leg function,reduced functional aerobic capacity, activity intolerance, low bone densityand increased risk of falls and hip fracture. Research suggests repeated,bilateral practice incorporating the more affected limb can restore func-tion.The NuStep machine provides repetitive, bilateral practice to both theupper and lower extremities. It is commonly available in therapy settingsand is commercially available.We hypothesized that intensive training withthe NuStep could be a safe and effective form of bilateral practice to reduceaffected limb impairment and improve conditioning for stroke patients.Thepurpose of this case study was to determine cardiovascular and functionalchanges in a stroke patient using NuStep for 10 weeks. Case Description:This subject is a 60 year-old African American male 4.5 years post strokewith right hemiplegia. Outcomes: This case is one subject in a largercrossover study involving 10 weeks of NuStep intervention followed by 10weeks of home exercise. NuStep sessions emphasize cardiovascular train-ing and strength building, decreasing or increasing resistance, respectively.From November 2004 through May 2005, the following assessments wereconducted prior to intervention (pre), after 10 weeks of intervention (post-intervention) and after 10 weeks of HEP (post-HEP): heart rate and bloodpressure, LE Fugl-Meyer, Berg Balance, and Short Physical PerformanceBattery. Resting blood pressure decreased: systolic from 132 to 120 mmHgand diastolic from 78 to 71 mmHg. Resting heart rate decreased from 70 to66 bpm. Berg Balance scores improved from 32 (pre) to 33 (post-interven-tion, post-HEP). Walking speed increased from 44.5 sec (pre) to 31.9 sec(post-intervention) to 22.0 sec (post-HEP). Fugl-Meyer did not change.Ability to semi-tandem stand improved from 0 (pre-test) to 1 (post-inter-vention, post-HEP). Patient reported increased confidence and endurancewith community ambulation. He also reported no longer needing a scooterfor grocery shopping. Discussion: Ten weeks of NuStep resulted inimproved cardiovascular measures and function.Walking speed continuedto improve up to ten weeks after intervention was finished. NuStep offerspromise to improve cardiovascular fitness and function for patients withchronic stroke. It may be an effective adjunct to PT requiring minimumsupervision with lasting effects after discharge. It also offers promise topatients discharged from therapy. The combination of cardiovascular andstrength training and reciprocal movements requiring minimum supervi-sion may make this an ideal exercise for chronic stroke patients.

PROCEDURAL LEARNING OF FUNCTIONAL MOBILITY TASKS IN THEPRESENCE OF SEVERE MEMORY DEFICITS FROM INTRAVEN-TRICU-LAR HEMORRHAGE. K.A. Volk, R.O. Myers, E. Fitzpatrick-DeSalme,MossRehab, Philadelphia, PA. (See Motor Learning Thematic poster sessionfor abstract)

SENSORIMOTOR IMPAIRMENTS AND REACHING PERFORMANCE INPERSONS WITH HEMIPARESIS: RELATIONSHIPS DURING THEACUTE AND SUBACUTE PHASE AFTER STROKE. J.M. Wagner1, C.E.Lang1, S.A. Sahrmann1, D.F. Edwards2,A.W. Dromerick3, 1Program in PhysicalTherapy,Washington University School of Medicine, St. Louis, MO, 2Programin Occupational Therapy, Washington University School of Medicine, St.Louis, MO, 3Department of Neurology, Washington University School ofMedicine, St. Louis, MO. (See Post-Stroke Hemiplegia Thematic poster ses-sion for abstract)

THE WOLF MOTOR FUNCTION TEST: NORMATIVE DATA FOR ABLEBODIED INDIVIDUALS. S. Wolf, J. McJunkin, M. DeGreef, Program inPhysical Therapy, Department of Rehabilitation Medicine, EmoryUniversity School of Medicine,Atlanta, GA.

Purpose/Hypothesis:The purpose of this study was to establish a nor-mative database for the Wolf Motor Function Test (WMFT) and to deter-mine trends between and within specific age groups, gender, sequence oftesting, and specific WMFT tasks. We hypothesized that movement timeswould increase and strength would decrease among older participants.Wefurther hypothesized that women would not be as strong as men for thetwo strength tasks. Number of Subjects: A convenience sample of 52


healthy able-bodied adult individuals, both male and female, between theages of 40 and 80 participated.The sample was then grouped by decades.All participants met pre-established inclusion/exclusion criteria includingno past medical history of stroke or other brain injury and no previousupper extremity (UE) impairments or limitations.All but one person wereright handed by statement of hand preference for writing. Prior to testing,all participants read and signed an informed consent and a HIPAA form.Materials/Methods: Administration of the WMFT required standardizedpositions for table and seat height, the correct position of a standardizedtemplate, standard items for testing,and specific verbal instructions.WMFTtasks remained constant throughout (tasks 1-17, sequentially) and pro-gressed from proximal single joint movements to more complex multi-seg-mental UE motions. Both UE for each participant were tested. Limbsequencing was determined randomly by a coin flip.Two co-investigatorswere responsible for administering the WMFT throughout the study. Eachco-investigator established intra-rater reliability prior to administration ofthe WMFT (ICC3, 1 = 0.99). Inter-rater reliability was established prior toand throughout testing (ICC2, 1 = 0.91 - 1.00). Results:An age effect fortimed tasks was observed between the forty - sixty, forty - seventy, and fifty- seventy year age groups for the right hand and between the forty - sixtyand forty - seventy year age groups for the left hand (p = 0.0027). An inter-action was also seen within hand by sequencing in timed tasks (p <0.0001). No gender differences existed for the timed tasks; however, dif-ferences between genders were found for both strength tasks (p <0.0001).Conclusions:This study presents a normative database of healthyable-bodied adult individuals for the WMFT. On timed tasks, older adultswere slower than younger adults and the first hand tested was slower.Menwere consistently stronger than women on strength tasks. ClinicalRelevance: Currently the WMFT is administered to the less affected UEfirst; therefore the more impaired UE may yield better scores because of asequence effect. Consequently, randomizing the limb sequence for testingmay combat a potential testing effect. Having this normative data set willhelp clinicians and third party payers to understand relative improvementin patients with mild to moderate stroke following interventions. Periodicassessment of change scores among individual tasks will also assist clini-cians in modifying treatment programs to target those joint movementsrequiring additional attention.

OPTOKINETIC STIMULATION AS A TREATMENT FOR IMBALANCEWITH VESTIBULAR IMPAIRMENT: 3 CASE REPORTS. N.M.Wubenhorst, Balance and Vestibular Center, San Joaquin ValleyRehabilitation Hospital, Fresno, CA.

Purpose: Treating vestibular dysfunction with optokinetic stimulation(OKS) has been suggested as both efficient and effective. It is based onthe theory that a sensory conflict situation can force central compensationof a diseased vestibular system to yield successful balance. Studies haveshown that body sway is minimized and optokinetic nystagmus is normal-ized after 6 to 8 sessions.These case reports are presented with the pur-pose of demonstrating an effective, easily applied clinical treatment forvestibular impairment. Description: Three subjects were selected withdiagnoses or clinical evidence of vestibular dysfunction with imbalance.Physical therapy evaluation included subjective balance and dizzinessquestionnaires, vestibulo-ocular testing, computerized balance testing, andfunctional measures including Berg Balance Scale and Dynamic Gait Index.Treatment was provided by an optokinetic device that provided visualstimuli that could be applied both horizontally and vertically depending onimpairments determined in evaluation. Patient positioning was individual-ized to maximally challenge balance while still being sustainable by thepatient. Duration was to tolerance with 10 minutes being a goal. Retestresults were compared to established norms for each test.Case One under-went 9 treatments of traditional vestibular and balance retraining withmodest response. She continued treatment for another 4 visits with OKS.Re-evaluation showed dizziness resolved and unsteadiness significantlyreduced. Case Two received 5 treatments of OKS in conjunction with tra-ditional vestibular and balance exercises. Re-evaluation showed her dizzi-ness resolved and balance confidence improved. Case Three participatedin 6 treatments of OKS in conjunction with traditional vestibular and bal-ance exercises. Re-evaluation revealed decreased vertigo in addition toimproved functional mobility and stability. Summary of Use: All three

cases responded well to this treatment. In the first case, it proved to bemore effective than the traditional approach. Equipment was inexpensiveand readily available.Treatment was easily tolerated by the patients sincechallenge levels were tailored to each case. Further studies are needed tocompare these results to a similar amount of time spent with vision elimi-nated while standing in a challenging balance situation, or with comput-erized sensory organization training. Long term carryover should be inves-tigated as well. Importance to Members: Imbalance is a common andsignificant impairment that can lead to injury and disability.When vestibu-lar system pathology is an underlying component, optokinetic stimulationcan be an effective, readily available, and cost efficient method of treat-ment.

THE EFFECTIVENESS OF THERAPEUTIC YOGA ON COMMUNITYDWELLING OLDER ADULTS WITH AND WITHOUT BALANCEDEFICITS. K.K. Zettergren, E. Moriarty, A. Zabel, Physical Therapy,Quinnipiac University, Hamden, CT.

Purpose/Hypothesis:The purpose of this study was to assess the bene-fits of a therapeutic yoga program on one group of community dwellingelderly individuals. A second purpose of the study was to determine theeffects of yoga on the confidence levels of participants while performingspecific activities of daily living. Number of Subjects: Nine communitydwelling elderly adults (aged 62-83) participated in the program. All sub-jects were female. Four community dwelling elderly adults (aged 63-84)served as control subjects. Control subjects were evenly divided, two maleand two female. Materials/Methods:All subjects signed an informed con-sent prior to participating in the study. Subjects were then evaluated usingthe Tinetti Balance Scale and the Falls Efficacy Scale. Subjects participatingin the therapeutic yoga received one-hour of yoga for four consecutiveweeks. The yoga program consisted of: Pranayama (concentrated breath-ing), warm-ups, asana (physical poses, with props and modifications asneeded), and meditation. In addition,participants received a detailed hometherapy program that included several of the postures performed duringthe therapeutic yoga session. Control subjects received no intervention.After four weeks, all subjects were re-tested on both measures. A singletester performed all evaluations and was blinded to subjects’ group assign-ment. Results: Paired t-tests were used to assess change scores on theTinetti Balance Scale. The Mann Whitney U Analysis was used to assesschange scores on the Falls Efficacy Scale. The intervention group showeda statistically significant increase on the Tinetti Balance Scale (p = .001).The control group showed no significant change.There was no statisticallysignificant change on the Falls Efficacy Scale for either group.Conclusions: The effects of therapeutic yoga on balance, strength andflexibility have not been thoroughly studied.This study showed a statisti-cally significant change with a relatively short intervention program.Thisstudy supports the use of therapeutic yoga for improving functional bal-ance in community dwelling older adults. Clinical Relevance: Recentstudies reveal that more than half of community-dwelling elderly individu-als over the age of 62 report a fear of falling. Other studies indicate thathigher levels of physical activity, including strength, flexibility and balancetraining, may improve mobility and balance and subsequently reduce falls.Some researchers propose that community-based exercise programs mayreduce the likelihood of falls. In addition, by the year 1990, Americansspent approximately 13.7 billion dollars on complementary and alterativehealth care.To that end, exercise programs that are community based andinclude balance, strength and flexibility training but also consider thebody/mind connection could prove effective in reducing falls and improv-ing function. Physical therapists are ideal individuals to administer com-munity based, alternative therapy programs and monitor participantsimprovements and changes as they relate to function and quality of life.

NEUROPATHIC PAIN AFTER SPINAL CORD INJURY AND ITSRELATIONSHIP TO MICROGLIA AND ATP RECEPTORUPREGULATION. L.C. Fisher, Z.A. Kloos, A.D. Kloos, D. Basso, PhysicalTherapy, The Ohio State University, Columbus, OH; M.R. Detloff,Neuroscience Graduate Studies Program, The Ohio State University,Columbus, OH; E.E. McDaniel,V. McGaughy, P.G. Popovich, Department ofMolecular Virology, Immunology & Medical Genetics, The Ohio StateUniversity, Columbus, OH.


Purpose/Hypothesis: Spinal cord injury (SCI) often causes neuropathicpain (chronic allodynia and hyperalgesia) but the underlying neu-roanatomical mechanisms are unknown. In peripheral nerve injury modelsof pain, allodynia developed after upregulation of ATP receptors, specifi-cally P2X4, on dorsal horn microglia. Since astrocyte networks communi-cate through ATP receptors, altered microglial and astrocytic responsesmay underlie neuropathic pain after SCI.Therefore, we investigated if allo-dynia and hyperalgesia after SCI is associated with greater microglial andastrocytic response and the upregulation of P2X4 receptors in the dorsalhorn. Number of Subjects: Thirty-seven adult, female, Sprague-Dawleyrats were used. Materials/Methods: Rats were randomly assigned to:naive, spinal nerve ligation (SNL), laminectomy, mild (0.5 mm displace-ment) or moderate (1.1 mm displacement) SCI groups.To rule out cellularresponses due to surgery, we included laminectomy and mild SCI groupsbecause they do not historically develop pain.We assessed allodynia andhyperalgesia with von Frey hair and plantar heat tests for 5 weeks aftersurgery. SCI severity was classified by the amount of white matter sparedat the lesion epicenter (WMS) and was analyzed via myelin staining. L5cross-sections were stained for microglia (OX42), astrocytes (GFAP) andP2X4 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, mRNAwas quantified in a subset of L5 spinal cords (n=2) from naive, SNL, andmoderate SCI groups. Results: Lesion severity was within expected limitswith 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 moreactivated microglia (p<.01) but not astrocytes (p>.01) in the L5 dorsalhorn. Allodynia was positively correlated with microglial activation(p<.05). Interestingly, there was no significant upregulation of P2X4 ATPreceptors in the dorsal horn of rats exhibiting neuropathic pain.Conclusions: Robust microglial activation occurs only in rats whichdevelop neuropathic pain, indicating that microglia but not astrocytes orP2X4 ATP receptors are key mediators in the development and mainte-nance of neuropathic pain. Clinical Relevance: Modulating themicroglial response after SCI may prove to be effective at limiting or pre-venting neuropathic pain after SCI in humans.

EXERCISE-INDUCED RECOVERY OF DYNAMIC VISUAL ACUITY INPATIENTS WITH BILATERAL VESTIBULAR HYPOFUNCTION. S.J.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 headmovement-induced visual blurring (oscillopsia). Little is known about exer-cise-induced recovery in patients with BVH.A randomized,controlled studyfound that performance of customized vestibular and balance exercisesresulted in better stability during stair climbing and faster gait speed thandid performance of placebo exercises (Krebs et al 1993; Oto Head NeckSurg).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 orDVA) in patients with BVH. We hypothesized that 1) patients performingvestibular exercises would have improved DVA compared to patients per-forming placebo exercises and 2) improvement in DVA would be reflectedby changes in vestibulo-ocular reflex (VOR) gain. Number of Subjects:Thirteen volunteers were recruited from patients referred to the Universityof Miami and Emory University Dizziness and Balance Center with a diag-nosis of bilateral vestibular hypofunction. Materials/Methods: Patientswere randomly assigned to the vestibular (n=8) or the placebo exercisegroup (n=5). DVA was measured using a computerized system. Vestibularfunction was measured using rotary chair step tests at 60 and 240 d/s.Baseline differences between groups for age, DVA, complaints of oscillopsiaand disequilibrium were examined using ANOVA.To determine if vestibularrehabilitation improved DVA, we performed repeated measures univariateanalysis of variance (RM ANOVA) with time (pre and post treatment) as the

repeated factor and DVA as the variable of interest. Appropriate post-hocstatistics were performed if a significant main effect or interaction wasfound (p < 0.05). Factors contributing to change in DVA were examinedusing a forward stepwise linear regression. Results: There were no differ-ences in group characteristics at baseline (p > 0.05). RM ANOVA showedthat patients who performed vestibular exercises showed a significantimprovement in DVA (p = 0.001), while those performing placebo exer-cises did not (p = 0.125). Based on stepwise regression analysis, the leadingfactor contributing to improvement in DVA was vestibular exercise, whichcontributed 41% of the variability pre to post treatment.Vestibular functiondid not change with intervention. Conclusions: The use of vestibularexercises is the main factor involved in the recovery of DVA in patients withBVH. Our study suggests that recovery of DVA may be due to mechanismsother than improvement in residual vestibular function. ClinicalRelevance: Improvement in visual acuity during head movement inpatients with BVH may contribute to improved quality of life by enablingpatients to see more clearly while walking or driving. Further studies areneeded to examine the functional implications of improved DVA.


Amador M, Guest JD. An Appraisal of Ongoing Experimental Procedures inHuman Spinal Cord Injury. 2005;29(2):70-86.

Asano M. See Noreau L.

Beekhuizen KS. New Perspectives on Improving Upper ExtremityFunction after Spinal Cord Injury. 2005;29(3):157-162.

Bolton M. See Mount J.

Bouyer LJ. Animal Models for Studying Potential Training Strategies inPersons with Spinal Cord Injury. 2005;29(3):117-125.

Bunge MB. See Moon L.

Cesari M. See Mount J.

Deutsch JE. (Editorial) Enabling Our Patients. 2005;29(1):1.

Deutsch JE. (Editorial) JNPT Special Topic Issues—Transitional Researchand Educational Resources. 2005;29(2):53.

Deutsch JE. (Editorial) JNPT is Indexed in MEDLINE. 2005;29(3):113.

Deutsch JE. (Editorial) JNPT is Officially Indexed in MEDLINE. 2005;29(4):169.

Dibble L. See Lien J.

Field-Fote E, Lindley SD, Sherman AL. Locomotor Training Approaches forIndividuals with Spinal Cord Injury: A Preliminary Report of Walking-related Outcomes. 2005;29(3):127-137.

Field-Fote E. (Editorial) Guest Editorial: Promoting Functional Recoveryafter Spinal Cord Injury. 2005;29(2):54.

Field-Fote E. (Editorial) Guest Editorial: Standardization of OutcomeMeasure: The First Step Toward a Classification Approach to Treatment.2005;29(3):114-115.

Fougeyrollas P. See Noreau L.

Fulk GD. Locomotor Training and Virtual Reality-based Balance Training forIndividuals with Multiple Sclerosis:A Case Report. 2005;29(1):34-42.

Guest JD. See Amador M.

Guzzardo K. See Mount J.

Henderson CE. Application of Ventilatory Strategies to Enhance FunctionalActivities for an Individual with Spinal Cord Injury. 2005;29(2):107-111.

Hinman MR. See Newstead AH.

Hirsch MA. See Lehman DA.

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

Kim CM, Kothari DH, Lum PS, Patten C. Reliability of Dynamic MusclePerformance 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 InstructionalCues Results in Near-term Improvement of Gait in People with ParkinsonDisease. 2005;29(1):2-8.

Lien J, Dibble L. Systems Model Guided Balance Rehabilitation in anIndividual with Declarative Memory Deficits and a Total Knee Arthroplasty:A Case Report. 2005;29(1):43-49.

Lindley SD. See Field-Fote E.

Lofald D. See Lehman DA.

Lum PS. See Kim CM.

Mollinger LA. See Steffen TM.

Moon L, Bunge MB. From Animal Models to Humans: Strategies forPromoting CNS Axon Regeneration and Recovery of Limb Function afterSpinal Cord Injury. 2005;29(2):55-69.

Mount J,Bolton M,Cesari M,Guzzardo K,Tarsi J. Group Balance Skills ClassStroke:A Case Series. 2005;29(1):24-33.

Myslinski MJ. Evidence-based Exercise Prescription for Individuals withSpinal Cord Injury. 2005;29(2):104-106.

Nash MS. Exercise as a Health-Promoting Activity Following Spinal CordInjury. 2005;29(2):87-103.

Newstead AH, Hinman MR,Tomberlin JA. Reliability of the Berg BalanceScale and Balance Master Limits of Stability Tests for Individuals with BrainInjury. 2005;29(1):18-23.

Noreau L, Fougeyrollas P, Post M,Asano M. Participation after Spinal CordInjury:The Evolution of Conceptualization and Measurement. 2005;29(3):147-156.

Noreau L. See Post M.

Patten C. See Kim CM.

Post M, Noreau L. Quality of Life after Spinal Cord Injury. 2005;29(3):139-146.

Post M. See Noreau L.

Roehrs TG. See Karst GM.

Sherman AL. See Field-Fote E.

Steffen TM, Mollinger LA. Age and Gender-Related Test Performance inCommunity-Dwelling Adults. 2005;29(4):181-188.

Tarsi J. See Mount J.

Tomberlin JA. See Newstead AH.

Toole T. See Lehman DA.

Tyler E. See Karst GM.

Venema DM. See Karst GM.

2005 Author Index


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

Lien J, Dibble L. Systems Model Guided Balance Rehabilitation in anIndividual with Declarative Memory Deficits and a Total Knee Arthroplasty:A Case Report.2005;29(1):43-49.

Mount J, Bolton M, Cesari M, Guzzardo K,Tarsi J. Group Balance Skills ClassStroke:A Case Series.2005;29(1):24-33.

Newstead AH, Hinman MR, Tomberlin JA. Reliability of the Berg BalanceScale and Balance Master Limits of Stability Tests for Individuals with BrainInjury. 2005;29(1):18-23.

Steffen TM, Mollinger LA. Age And Gender-Related Test Performance InCommunity-Dwelling Adults: Multi-directional Reach Test, Berg BalanceScale, Sharpened Romberg Tests, Activities-Specific Balance ConfidenceScale, and Physical Performance Test. 2005;29(4):181-188.

Brain InjuryNewstead AH, Hinman MR, Tomberlin JA. Reliability of the Berg BalanceScale and Balance Master Limits of Stability Tests for Individuals with BrainInjury.2005;29(1):18-23.

EditorialsDeutsch JE. (Editorial) Enabling Our Patients.2005;29(1):1.

Deutsch JE. (Editorial) JNPT Special Topic Issues - Transitional Research andEducational Resources.2005;29(2):53.

Deutsch JE. (Editorial) JNPT is Indexed in MEDLINE.2005;29(3):113.

Deutsch JE. (Editorial) JNPT is Officially Indexed in MEDLINE. 2005;29(4):169.

ExerciseMyslinski MJ. Evidence-based Exercise Prescription for Individuals withSpinal Cord Injury.2005;29(2):104-106.

Nash MS.Exercise As A Health-Promoting Activity Following Spinal CordInjury.2005;29(2):87-103.

LocomotionField-Fote E, Lindley SD, Sherman AL. Locomotor Training Approaches forIndividuals with Spinal Cord Injury: A Preliminary Report of Walking-related Outcomes.2005;29(3):127-137.

Fulk GD. Locomotor Training and Virtual Reality-based Balance Training forIndividuals with Multiple Sclerosis:A Case Report.2005;29(1):34-42.

Lehman DA,Toole T, Lofald D, Hirsch MA.Training with Verbal InstructionalCues Results in Near-term Improvement of Gait in People with ParkinsonDisease.2005;29(1):2-8.

Mutiple SclerosisFulk GD. Locomotor Training and Virtual Reality-based Balance Training forIndividuals with Multiple Sclerosis:A Case Report. 2005;29(1):34-42.

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

Parkinson DiseaseLehman DA,Toole T, Lofald D, Hirsch MA.Training with Verbal InstructionalCues Results in Near-term Improvement of Gait in People with ParkinsonDisease. 2005;29(1):2-8.

Participation and Quality of LifePost M, Noreau L. Quality of Life after Spinal Cord Injury. 2005;29(3):139-146.


SCIAmador M, Guest JD.An Appraisal of Ongoing Experimental Procedures inHuman Spinal Cord Injury. 2005;29(2):70-86.

Beekhuizen KS. New Perspectives on Improving Upper ExtremityFunction after Spinal Cord Injury. 2005;29(3):157-162.

Bouyer LJ. Animal Models for Studying Potential Training Strategies inPersons with Spinal Cord Injury. 2005;29(3):117-125.

Field-Fote E, Lindley SD, Sherman AL. Locomotor Training Approaches forIndividuals with Spinal Cord Injury: A Preliminary Report of Walking-related Outcomes. 2005;29(3):127-137.

Field-Fote E. (Editorial) Guest Editorial: Promoting Functional Recoveryafter Spinal Cord Injury.2005;29(2):54.

Henderson CE.Application of Ventilatory Strategies to Enhance FunctionalActivities for an Individual with Spinal Cord Injury. 2005;29(2):107-111.

Moon L, Bunge MB. From Animal Models to Humans: Strategies forPromoting CNS Axon Regeneration and Recovery of Limb Function afterSpinal Cord Injury. 2005;29(2):55-69.

Myslinski MJ. Evidence-based Exercise Prescription for Individuals withSpinal Cord Injury. 2005;29(2):104-106.

Nash MS. Exercise as a Health-Promoting Activity Following Spinal CordInjury. 2005;29(2):87-103.


Post M, Noreau L.Quality of Life after Spinal Cord Injury. 2005;29(3):139-146.

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

Mount J, Bolton M, Cesari M, Guzzardo K,Tarsi J. Group Balance Skills ClassStroke:A Case Series. 2005;29(1):24-33.

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

Lehman DA,Toole T,Lofald D, Hirsch MA.Training with Verbal InstructionalCues Results in Near-term Improvement of Gait in People with ParkinsonDisease.2005;29(1):2-8.

Lien J, Dibble L. Systems Model Guided Balance Rehabilitation in anIndividual with Declarative Memory Deficits and a Total Knee Arthroplasty:A Case Report.2005;29(1):43-49.

Upper ExtremityBeekhuizen KS. New Perspectives on Improving Upper ExtremityFunction after Spinal Cord Injury.2005;29(3):157-162.

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

2005 Subject Index


Literature Reviewed

AbstractsFullerton HD, Borckardt JJ,Alfano AP. Shoulder Pain: AComparison of Wheelchair Athletes and NonathleticWheelchair Users. Medicine and Science in Sports andExercise. 2003:1958-1961. Reviewed by Elrod M.

Ferris DP, Gordon KE, Beres-Jones JA, Harkema SJ. MuscleActivation During Unilateral Stepping Occurs in theNonstepping Limb of Humans with Clinically CompleteSpinal Cord Injury. Spinal Cord. 2004;42:14-23. Reviewedby Winchester P.

BooksCanadian Spinal Research Organization/American SpinalResearch Organization. The After and Beyond Spinal CordInjury Resource Manual. 2004. Reviewed by Snowdon LC.

VideosNeumann D, Lanouett M. Clinical Kinesiology Applied toPersons with Quadriplegia. Part I: Maximizing MovementPotential, Part II: Enhancing Function. 2002. Reviewed byBehrman AL.

THE NEUROLOGY SECTION of the AMERICAN PHYSICAL THERAPY ASSOCIATION

WILLINGNESS TO SERVE CALL FOR NOMINATIONSThe 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 [email protected] or contact your SIG nominating chair:

Vestibular/Balance & Falls SIG Nominating Chairs: Spinal Cord Injury SIG Nominating Chair:Lisa Selby-Silverstein Robin F. Moss610/558-5645 • [email protected] 540/932-4018 • [email protected] Morris412/647-8091 • [email protected] Stroke SIG Nominating Chair:

Kristin ParlmanBrain Injury SIG Nominating Chair: 617/724-7489 • [email protected] McCarthy Jacobson617/724-6363 • [email protected] Section Nominating Chair:

Marcia Hall ThompsonDegenerative Diseases SIG Nominating Chair: 503/653-2144 x 3345 • [email protected] Fry-Welch810/762-3373 • [email protected]

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Fax: 703/706-8575 • [email protected]


Volunteer associations such as the Neurology Section facemany challenges. Members entrust elected officers to direct theSection’s business and financial affairs. Section officers ensurethat the Section is financially solvent, efficiently managed, meet-ing the needs of its members, promoting and advancing the pro-fession, and advocating for the beneficiaries of our services.1 Butmore importantly, the elected or appointed leaders are entrustedby the members to be stewards; individuals who are “morallyresponsible for the careful use of money, time, talents, or otherresources, especially in respect to the principles or needs of acommunity or group (Webster’s New World Dictionary 1988, p1315).”

Strategic stewardship reflects the self-reflective, thoughtful,and visionary process that the Section’s leadership team hasembarked upon in order to develop a strategic plan that willguide our efforts in the next 5 years.The last weekend in Octoberthe Neurology Section invited Section leaders to an initial strate-gic planning meeting at the American Physical TherapyAssociation (APTA) headquarters in Alexandria,VA. Section lead-ers included the elected and appointed officers of the ExecutiveCommittee and the Chairs/representative of the Special InterestGroups and Committees.We were skillfully led through the initialstep of the strategic planning process by Dr Jody Gandy, Directorof Physical Therapy Education,APTA. Dr Gandy challenged us toleverage the Neurology Section’s strengths and acknowledge ourweaknesses in order to craft a new vision for the Section.

It is evident that the Neurology Section has several strengthsthat are recognized in the national arena and the APTA at large.We are a highly motivated group with accomplishments inadvancing the science and practice of neurologic physical ther-apy.We were the first section to fund doctoral student scholar-ships. We have consistently offered programming that reflectsthe “cutting edge” of the science and practice of neurologicphysical therapy.We have effective dissemination vehicles suchas the recently MEDLINE indexed Journal of NeurologicPhysical Therapy (JNPT) and our Neurology Section and JNPTwebsites. In addition, because of careful management, theSection is financially strong.

Members value the Section for the caliber of its educationalprogramming and publications; however, we acknowledged thatwe may not be as well-recognized in other communities oramongst grassroots physical therapists that may benefit from thestrengths of our Section. This is highlighted by a recent trip Imade to present on neurologic physical therapy for individualswith stroke at the Ohio Physical Therapy Association Meeting.Ofthe 40 participants who attended, 2 had been to IIISTEP, 5 hadheard of IIISTEP, and 35 had never heard of IIISTEP.The physi-cal therapists and physical therapist assistants who attended thisconference are a cross-section of the grassroots practitionerswho care for individuals with neurologic disease or injury. Itappears they are missing our message.

Looking beyond our current membership opens the doors towonderful opportunities for Section growth and collaboration.Currently, the Neurology Section is the 6th largest of 18 APTAsections. Sections larger than us include (in rank order):Orthopaedics, Sports, Pediatrics, Geriatrics, and Private Practice.There is a perception among non-Neurology Section membersthat we are not accessible either in reaching out to therapistswho cannot get to the Combined Sections Meeting or in provid-ing a balance of programming and educational materials thatdeal with real-life issues related to neurologic physical therapypractice. Increasing access to basic and essential information onneurologic physical therapy will undoubtedly increase ourgrowth, but more importantly, by increasing membership, wehave the potential to increase the quality of care for individualswith neurologic disease or injury.

Many opportunities exist for the Section in the next 5 yearsand beyond. Examples include the opportunity to collaboratewith the international physical therapy community and otherorganizations such as the American Stroke Association,AmericanCongress of Physical Medicine & Rehabilitation, and theAmerican Spinal Cord Injury Association, to name but a few. Likeus, these physical therapists and organizations share similarvisions—to improve care, advocate, and change health care pol-icy for individuals who receive our services.

Now is the time for us to act. Real threats do exist that affectaccess to neurologic physical therapy services and reimburse-ment for the services we do provide. In many health care arenas,there is limited recognition of the scope and expertise of physi-cal therapists who specialize in neurology.There is great dispar-ity not only in the health care delivery system but amongst phys-ical therapists who deliver physical therapy services; the Sectioncan provide leadership in these areas.

We want a shared vision for our Section that includes thevoice of our members.We need your insights, perspectives, andvolunteerism to make this Section move beyond our currentcapabilities. In January, all Section members will receive an emailblast with a document link. The document will include therevised vision and mission statements and goals and objectivesthat will guide the Section’s leadership in the next 5 years.TheMyelin Melter and Section Business Meeting is scheduled forFriday, February 3 from 6:30 – 8:00 PM.The major focus of themeeting is to share the strategic plan with the membership, seekyour feedback in making the changes that will lead to final adop-tion, and provide opportunities for you to participate.

The Section leadership looks forward to your participation.Come, be heard, and shape the future of the Neurology Section.

REFERENCE1 Dimitru D. Strategic servitude: what has the Academy done

for me lately? Arch Phys Med Rehabil. 2004; 85:1393-1394.

SECTION BUSINESSPresident’s AddressShared Vision: The Foundation of Strategic Stewardship

Katherine J. Sullivan, PT, PhDPresident, Neurology Section


Promotion of Fitness and Prevention ofSecondary Complications

in People with Neurologic Disorders

Clinical Scientists: Richard F Macko, MD & JamesRimmer, PhD

Clinicians: Leizl M Adolphi, PT, ART, Bill BodryMaria A Fragala-Pinkham, PT, Heather A Hayes, PT, DPT

Cynthia Miles, PT, MEd, PCSJanuary 31 and February 1, 2006CSM 2006 Pre-Conference Course

San Diego, CaliforniaCan a fitness program help children with CP and adults withstroke in a functional and meaningful way?How can the evidence on fitness programs for individualswith neurologic disorders be put into clinical practice?This 2-day intensive course will focus on the evidence ofthe effects of regular intensive training on recovery fromimpairments, improvement of function, participation andquality of life in persons with neurologic disease and willoffer practical recommendations for translating scientificevidence into both clinical and community fitness environ-ments.• Complete brochure and registration materials for this APTA

Neurology Section, Section on Pediatrics , and Section onGeriatrics co-sponsored course are available atwww.neuropt.org or www.apta.org.

• Tel: 800-999-2782, ext. 3395; or Fax: 703-706-3396.

Neurocurriculum Across the Lifespan:Educating the Next Generation

January 31-February 1, 2006 • San Diego, CA

Judith Deutsch, PT, PhD; Sally Westcott, PT,PhD

Ann VanSant, PT, PhD

All clinicians and educators are encouraged to attendthis dynamic workshop that will synthesize and applyrelevant conceptual frameworks and specific contentgleaned from the IIIStep conference held this pastsummer. The focus will be on developing strategiesfor updating curricula and relevant clinical education.Topics covered will include: models for clinical deci-sion making, task analysis for movement examination,levels and analysis of measurements, and applicationof research on neural plasticity and motor develop-ment. Incorporation of technologies and complemen-tary therapies into physical therapy education will alsobe discussed. There will be active learning sessionsthroughout allowing time for discussion and theexchange of ideas. • Complete brochure and registration materials for

this APTA Neurology Section, Section on Pediatrics,and Section on Geriatrics co-sponsored course areavailable at www.neuropt.org or www.apta.org/

•Tel: 800-999-2782, ext. 3395 or Fax: 703-706-3396.

2006 PODS Announcement

For 2006, two Foundation for Physical Therapy’s Promotion of Doctoral Studies Scholarships (PODS I & II) will be fundedby 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 2esteemed 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 definedby 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 theapplicant’s institution).

The PODS I & II applications are now available on-line at www.apta.org/foundation.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.


Tuesday, January 31, 200612:30pm – 6:30pm Preconference Course A:

Neurocurriculum Across the LifeSpan: Educating the Next Generation.Speakers: Judy Deutsch, PhD, PTSally Westcott, PhD, PT Ann VanSant, PhD, PT

7:30pm – 5:00pm Preconference Course B: Promotionof Fitness and Prevention ofSecondary Complications inIndividuals with NeurologicDisordersSpeakers: Jim Rimmer, PhD, RichardMacko, MD, Heather Hayes, PT, DPT,Bill Brody, Leizel Adolphi, PT, ART,Maria A Fragala-Pinkham, PT, MS,Cindy Miles, PT, MEd, PCS

Wednesday, February 01, 20068:30am – 6:30pm Preconference Course A:

Neurocurriculum Across the LifeSpan: Educating the Next Generation.Speakers: Judy Deutsch, PhD, PTSally Westcott, PhD, PT Ann VanSant PhD, PT

7:30am – 5:00pm Pre-Conference Course B:Promotion of Fitness and Preventionof Secondary Complications inIndividuals with NeurologicDisordersSpeakers: Jim Rimmer, PhD, RichardMacko, MD, Heather Hayes, PT, DPT,Bill Brody, Leizel Adolphi, PT, ART,Maria A Fragala-Pinkham, PT, MS,Cindy Miles, PT, MEd, PCS

Thursday, February 02, 20066:30 – 7:45am First Time at CSM? Welcome to the

First Timers’ Breakfast

8:00am – 3:00pm Planning for the Future:The Neurology Section at Work -Executive Committee Meeting

11:30am – 3:30pm Understanding Adaptation:Why ShouldClinicians Care? Speakers:Anne Shumway–Cook,PhD, PT;Amy Bastian, PhD, PT;JoAnn Kluzik, PhD, PT, PCS

1:00pm – 3:00pm Patient Perspectives and Quality ofLife: Early PTClinResNet OutcomesSpeakers: James Gordon, EdD, PT,FAPTA; Bryan Kemp, PhD; SaraMulroy, PhD, PT; Sharon DeMuth,DPT; Loretta Knuttson, PhD, PT, NCS;Kornelia Kulig, PhD, PT;TaraKlassen, MS, PT, NCS

3:00 -4:30pm Degenerative Diseases SpecialInterest Group: Intervention Issuesin Degenerative Disease- A CaseBased ApproachSpeakers: Herb Karpatkin, PT, MS,NCS; Willia Werner EdD, PT; PeggyIngels PT, Sue Imbriglio PT

3:00 -4:30pm Spinal Cord Injury Special InterestGroup: Current Trends in SCIResearch - An Update of What’sHappeningSpeaker: Deborah Backus, PhD, PT

3:45 –4:30pm Become a Contributor to the Journalof Neurologic Physical therapy: Meetthe Editor and Editorial Board Speaker: Judy Deutsch, PhD, PT

6:30 – 8:30pm Journal of Neurologic PhysicalTherapy Editorial Board Meeting

Friday, February 03, 20066:30 – 8:30am Neurologic Clinical Specialists’

Breakfast: Exercising LeadershipSpeaker: Janice Benzer, PhD, PT

8:00 – 11:00am The Best of III Step: Implications forNeurologic PracticeSpeakers: Darcy Umphred PhD, PT,FAPTA; Kathy Gill-Body DPT, MS,NCS; Andrea Behrman PhD, PT

9:00 – 11:00am To Brace or Not to Brace: MakingEvidence-based Decisions for ourClients with NeurologicialImpairments.Speakers:Valerie Eberly PT, NCSKelley Kubota PT, MS, NCSWalter Weiss PT, MPT, NCS

11:00am – 1:00pm Neurology Section SIG OfficersMeeting

Neurology Section Programming at CSM 2006January 31-February 04, 2006 San Diego, California

1:00 – 4:00pm The EXCITE Trial: Formulation,Implementation, and ResultsSpeakers: Steve Wolf, PhD, PT,FAPTA; Patricia C. Clark, PhD, RN; J.Philip Miller, PhD; Carolee J.Winstein,PhD, PT, FAPTA

1:00 – 5:00pm Understanding Sensory Dysfunction:Evidence-based Evaluation, Retraining,and Mechanisms of RecoverySpeakers: Deborah Nichols-Larsen,PhD, PT; D. Michele Basso EdD, PT,Nancy Byl PhD, PT, FAPTA

4:30–6:00pm Vestibular, Balance and Falls SpecialInterest Group: Management of theDizzy Patient – Team ApproachSpeakers: Michael Hoffer, MD; KimGottshall Col, USAR, PT, PhD, ATC

4:30 – 6:00pm Brain Injury Special Interest Group:Evaluation and Management of theDizzy Patient- A Team ApproachSpeakers: Michael Hoffer, MD; KimGottshall Col, USAR, PT, PhD, ATC

4:30 – 6:00pm Stroke Special Interest Group:One Hand or Two? DesigningInterventions for successfulOutcomes Post-StrokeSpeaker: Dorian Rose, PhD, PT

4:30 – 6:00pm Thematic Poster Session I: Imageryand Imaging Moderator: Carolynn Patten, PhD, PT

6:00 – 8:30pm Myelin Melter: Neurology SectionBusiness Meeting and Reception

Saturday, February 04, 20068:00 – 11:00am Thematic Poster Session II:

Post-Stroke HemiplegiaModerator: Carolynn Patten, PhD, PT

8:00 – 11:00am Research Platform Session I:Biomechanics and Motor ControlModerator: Martin Bilodeau, Ph.D.,PT

9:00- 11:00am Spinal Cord Injury: MaximizingSensory and Motor Recovery byTargeting Cellular ResponsesSpeaker: D. Michele Basso, EdD, PT

1:00 – 3:00pm Mild Brain Injury and Dizziness Speaker: Laura Morris, PT, NCS

1:30- 3:00pm Thematic Poster Session III: MotorLearning Moderator: John Buford, PhD, PT

1:30- 3:00pm Research Platform Session II:Parkinson DiseaseModerator: Gammon Earhart, PhD, PT

3:00- 5:00pm Practice Issues Forum: Developmentof an Evaluation Database to GuideClinical EffectivenessFacilitator: Edee Field-Fote, PhD, PT

3:00 – 5:00 pm Neurology Section Roundtables

Brain Injury SIG Multisensory Impairments in Relationto Postural Control in the BIPopulationFacilitator: Michelle Peterson, PT, NCS

Degenerative Diseases SIGCognitive Issues in DegenerativeDiseasesFacilitator: Vanina Dal Bello-Haas,PhD, PT

Spinal Cord Injury SIGOutcome Measures – How Do WeUse Them in Spinal Cord Injury Care?Facilitators: Leslie Van Hiel, PT;Mary Schmidt-Reed, MS, PT

Stroke SIGUsing “Hooked on Evidence” withinStroke RehabilitationFacilitator: David Scalzitti, PT, MS, OCS

Vestibular SIGThe Do’s and Don’ts of MigrainousVertigoFacilitator: Colin Grove, MS, PT

Balance and Falls: Bubbles, Balloons,and PVCFacilitator: Cecelia Griffith, PT, DPT

Coding, Reimbursement, and PaymentPolicy Challenges in Vestibular RehabFacilitator: Helene Fearon, PT

Body-Weight Support Systems:Practical Considerations in PT IFacilitators:Tara Klassen, MS, PT,NCS; Jim Cavannaugh, PhD, PT,NCS; Paul Hansen, PhD, PT

Body-Weight Support Systems:Practical Considerations in PT IIFacilitators: Mark Bowden, MS, PT;George Fulk, MS, PT


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