The Spring 2020 Campus Research Day was to be held on April 22, 2020 on the San Marcos, CA, campus of the University of St. Augustine for Health Sciences. Unfortunately, due to the COVID-19 restrictions, we were unable to hold the in-person symposium. However, the library has gatherd many of those research posters to be shared online through SOAR@USA.
Note, the OTD capstones for this term were presented in an online symposium and are gathered in the Spring 2020 Virtual OTD Capstone Symposium collection of SOAR@USA.
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The Health Benefits of Visual Art Activities in the Geriatric Population
Melody Au-Yeung, Abraham Avila, Jason Bandong, Hy Ia, Naureen Imam, and Kayla Wilcox
Purpose: The purpose of this poster presentation is to assess the efficacy of visual art therapy on the physical and mental health of the geriatric population.
Description: The potential impact of art therapy on cognition and dementia is a growing field of research in the rehabilitative world. Some researchers have found support for certain mediums, such as ceramic painting, while others have explored multimodal treatment programs that integrate art into physical activities. Combining physical activity with an arts and crafts program could posit a significant impact on ADL function and quality of life in older adults. As a growing list of ailments accompany aging, it would be of interest to explore the effects of visual art therapy on life satisfaction, cognitive status, ADLs, and levels of depression in older adults.
Methods: A literature review was conducted on visual art activities and health in the geriatric population using the following search terms: art therapy, visual art, mental health, health, cognition, geriatric, and older adults. Five peer-reviewed studies that were published between 2016 and 2019 were selected for review.
Conclusion: The current literature supports the inclusion of visual art therapy as treatment for older adults. Research shows that art therapy can decrease grief, mourning, negative emotions, and depression while promoting positive memories, socializing, language function and quality of life in older adults. Art therapy has also been correlated with positive effects on emotional status and cognitive status in patients with dementia.
Summary of Use: This poster presentation reviews the benefits of implementing visual art therapy in geriatric rehabilitation in terms of both physical and mental health.
Clinical Relevance: Visual art activities are low-intensity interventions that work to improve both gross motor and fine motor skills in the geriatric population. Art activities can specifically help address deficits of upper body strength, stability, proprioception, and tactile skills. In addition to physical improvements, participant engagement, mood, quality of life, and well-being are positively affected as well. Given the potential benefits, further research is needed to bolster support for the integration of visual art activities with traditional exercise.
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The Effectiveness of LSVT-BIG and PWR! Programs on a Patient with Parkinson’s Disease: A Case Report
Naureen Imam and Jennifer Dannenbring
Background: The prevalence of Parkinson’s Disease (PD) drives the search for effective interventions. While LSVT-BIG and high-intensity training improve gait speed and balance deficits, only limited research exists on the impact of the Parkinson's Wellness Recovery (PWR!) program on PD symptoms. Thus, LSVT-BIG and PWR! should be explored in tandem as standardized treatment for patients with PD.
Purpose: The primary purpose of this case report is to determine the effects of LSVT-BIG and PWR! programs on gait impairments, balance deficits, and participation restrictions in a patient with PD.
Case Description: A 74-year old male with PD attended PT with a referral for LSVT-BIG, given PD progression. The patient fell twice recently and reported no changes in function with medication. PT treatment began on October 7, 2019 with 16 sessions of LSVT-BIG by certified SPT and OT. Initial evaluation revealed the following outcomes: Mini-BEST of 13/28, Five Times Sit to Stand (5xSTS) of 12.9 s, Timed Up and Go (TUG) of 13.21 s, TUG-Cognitive of 24.11 s, and TUG Manual of 14.7 s. Following completion of LSVT and reevaluation, the patient was approved for 12 sessions of PWR! program.
Methods: The patient completed the 4-weeks LSVT-BIG training protocol for four 1-hour PT and OT sessions weekly. Sessions included 7 maximal daily exercises with large-amplitude movements in multidirectional planes. Other components included sit-to-stands, hierarchy tasks of car transfers, and gait. At the conclusion of LSVT-BIG, the patient began PWR! training in various positions, such as prone and quadruped, to assist with fall recovery and bed mobility. Patient was provided with HEP of both maximal daily exercises and PWR! moves.
Results: After 16 total sessions of LSVT-BIG, the pt. improved on his TUG Cognitive to 15 s, but his 5xSTS was 12 s. Following 8 sessions of PWR!, the patient attained the following: Mini-BEST of 25/28, 5xSTS of 9 s, TUG of 11 s, TUG Cognitive of 11 s, and TUG Manual of 10 s.
Discussion: The temporal outcome measures showed improvement above the MDC values. The TUG manual task improved 4.7 sec and 13.11s in TUG cognitive task (TUG MDC 3.5 s), The patient’s 5xSTS score decreased by 3.9 s (MDC 3.6 s) and his Mini-BEST score improved by 12 points (MDC 5.9 points). Thus, both programs allowed the patient to work towards functional goals and should be considered jointly as avenues to slow down the progression of Parkinson’s disease.
Conclusion: After 24 sessions of LSVT-BIG and PWR!, the patient demonstrated improvements in gait, balance, posture, and functional mobility. He was able to walk safely and negotiate car transfers with ease. Specifically, he demonstrated dramatic changes in the Mini-BEST of 12 points, 5xSTS of 3.9 s, TUG Cognitive of 13.11 s, and TUG Manual of 4.7 s. Given these findings, the patient benefited from the combinatory LSVT-BIG and PWR! approach. Future research into the specific benefits of each program may be beneficial.
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Case Report: Effects of Therapeutic Exercise on a Patient with Metastatic Osteosarcoma and Pathological Fracture
Jessica Phung and Sarah Mathew
Purpose: The purpose of this case report is to demonstrate how conditioning exercise for patients with active metastatic neoplasms can improve quality of life (QoL) after a pathological fracture of lumbar vertebrae. Spinal metastasis, in this case from breast cancer, is primarily asymptomatic, and therefore, difficult to detect during early stages. Detection and diagnosis usually occur after initial manifestation of a pathological fracture leading to debilitating effects. Complications with metastatic bone cancer and surgical contraindications may bring patients into outpatient physical therapy to address the pathological fractures and QoL for patients.
Case Description & Methods: The patient is a 44-year old female, diagnosed with breast cancer in Sept 2019. Following a pathological fracture in the L1 vertebrae, she was diagnosed with thoracic and lumbar spine bone cancer in Nov 2019. On evaluation, she had completed a round of radiation therapy, home health physical therapy, and was currently taking Zometa to improve bone health. The patient was unable to receive surgical tumor removal intervention due to location and metastasis. She had an active lifestyle before her diagnosis, but an excessive increase in heart rate was now contraindicated for the patient, contributing to psychosocial factors. She was fearful of sit-to-stand (STS) motion due to her mechanism of injury. Interventions included gentle manual therapy and exercises avoiding end-range motion and a home exercise program consisting of lumbopelvic stability and stretches. Education provided on energy conservation. No mobilizations were performed.
Results: After 6 sessions in 3 weeks of physical therapy consisting of therapeutic exercise, neuromuscular reeducation, and therapeutic activity, the patient showed improvements in strength, decreased neurovascular symptoms into the lower extremity, and increased endurance. The patient was wearing a thoracolumbosacral orthosis (TLSO) less frequently. The patient’s Modified Oswestry Disability Index (ODI) score change from 46% (severe disability) to 38% (moderate disability) is reflective of improved functional capacity. At re-assessment, she was able to perform single-limb balance testing with fair control and 5xSTS in 20.2 seconds. Strength increased half grades in L LE. Flexibility testing revealed 90/90 hamstring length increase from 15° to 0°. The patient had (-) slump test and hyposensitivity to L LE to L1-L2 dermatome compared to the initial evaluation of hyposensitivity in all L LE dermatomes and bilateral (+) slump test; she reported ability to sit without increasing neurovascular symptoms.
Discussion: The current literature has good evidence for low-level functioning patients. This is because more debilitated patients have more to gain compared to their higher functioning counterparts with similar or less severe diagnoses. Psychosocial factors including previous activity level could be appropriate qualitative studies of improved quality of life in patients with cancer. The patient was seen in outpatient, giving her control over her HEP. Her internal motivation and willingness to perform ADLs and walk regardless of physical therapy intervention may have been threats to internal validity and resulted in gains with or without therapeutic interventions or education. Further controlled studies could assist in more quantitative measures and improved validity.
Conclusion: Breast cancer is one the most common cancer in females which can lead to metastasis into other body regions including bone. While therapists are frequently trained to screen out non-musculoskeletal pain, including cancer, it is less common for therapists in the outpatient orthopedic setting to see patients rehabilitating low back pain dues to active cancer. With contraindications to tumor removal, these patients can improve quality of life through medical interventions and physical therapy as indicated. It is important to know the effectiveness of such interventions while following all contraindications and precautions for this population, especially with an unpredictable course of the disease.
