San Marcos, Summer 2020

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  Occupational Therapy’s Role in Addressing Sensory Deficits in Children with Behavioral Health Challenges Through Teacher Training

  Devon A. Ayres, Becki Cohill, Susan MacDermott, and Mark Wilson

  Sensory processing difficulties have been well-documented in children who have behavioral health challenges. Addressing a child’s sensory processing needs may decrease behaviors that disrupt occupational participation and thus leading to improved learning and better information retention. A review of current literature revealed that teachers who work with children with behavioral health challenges are not required to receive education in addressing sensory deficits in the classroom.

  This study performed a needs assessment, exploring current teacher understanding of sensory processing and what role occupational therapy could play in providing training for teachers. The project also generated pertinent online teacher training modules so that teachers may be supported despite the current Covid-19 pandemic in the United States.

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  Understanding the Impact of Social Distancing on Older Adults and Senior Organizations to Better Adapt Towards a New Normal

  Salina Jivan

  COVID-19 brought about social distancing mandates that posed as a new barrier to meaningful social participation in the community. The purpose of this project was to understand the impact of social distancing on older adults and senior organizations to better inform the role of OT in helping seniors adapt towards a new normal within the community. A qualitative study and needs assessment were performed through phone interviews with seniors and organizations that support them from around the United States. Themes highlighted seniors desire for social contact and cautious return to the community once mandates are lifted. Both seniors and organizations were accepting towards a new normal.

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  The Effectiveness of Home Health Physical Therapy Following Diagnosis of Acute Respiratory Failure Secondary to Covid-19: A Case Report

  Desiree Lyall and Maura Owens

  The purpose of this case study is to describe the effects of home health physical therapy involving gait training, respiratory exercises, disease process education and rehabilitation exercises for strength, endurance and balance in the treatment of a 73 year-old, male patient with a diagnosis of acute respirtory failure secondary to Covid-19.

  For a patient with a diagnosis of acute respiratory failure secondary to Covid-19 diagnosis home health physical therapy was an effective treatment option to facilitate return to prior level of function. This case study supports previous research and recommended treatment guidelines for the effectiveness of gait training, respiratory exercises, disease process education and rehabilitation exercises for strength, endurance and balance.^1,4,5

  This patient was able to make functional improvements from home health physical therapy in a 6-week time frame. Limitations of this study is patient received multi-disciplinary approach with the addition of occupational therapy and skilled nursing. Further research is needed for effectiveness of physical therapy after Covid-19 positive test based on comorbidities, treatment received during hospital stay, complications during hospital stay, and with or without intubation.

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  Dressing Skills for Children with Cerebral Palsy [Research plan]

  Diane Mellin, Jenna Oberg, Amber Torgerson, and Charlene Yuson

  Cerebral palsy (CP) is the most common physical dysfunction in children. Because there is damage to their cortex and corticospinal tracts, children who have cerebral palsy have difficulty in precise grasping and fine motor control, affecting their activities of daily living and quality of life (Ouyang et al., 2020).

  The purpose of this study will be to develop an OT intervention using threading techniques that will help children with cerebral palsy dress independently without using adaptive clothing. This study will utilize a quasi-experimental design with the subjects as their own control. Pre- and post-tests will be administered for each child assessing their dressing skills:

  • to assess what adaptive clothing the child is using, which skills each child possesses, and which skills need to be worked on.
  • to determine if there is any progression related to independence and dressing.

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  Analysis of Physical Therapy Interventions vs. Kinesio Taping for Relieving Low Back Pain

  Amanda Orr

  Introduction/Background: This topic focuses on the utilization of kinesio taping (KT) to assist with decreasing pain in the low back. According to Shipton, low back pain has gone up by more than 50% since 1990. These factors are attributed to smoking, obesity, sedentary occupations, and to low socioeconomic status.Globally, in 2016, it is said that low back pain contributed 57.6 years to disability and the prevalence peaks around the ages of 35-55 years according to the World Health Organization.

  Purpose: The purpose of this literature review is to compare research articles between KT with physical therapy interventions as compared to sole physical therapy interventions for alleviating LBP.

  Methods: The three search engines used for this literature review were Google Scholar, PubMed, and the University of St. Augustine Library database. The inclusion criteria for this study were participants >18 years old, no allergies to KT, and have LBP. The exclusion criteria were participants younger than 18, allergies to KT, patients that do not have LBP. There are eighteen articles that were analyzed in this literature review.

  Results: In the overall analysis of this literature review, 12 out of the 18 articles were in favor of KT taping to provide relief as a secondary intervention for alleviating low back pain.

  Discussion: This literature review provides interpretation that KT as a secondary intervention provides further support than relying on sole physical therapy interventions to improve functional mobility and pain for patients with chronic non-specific LBP. As a result of this review, most of the research was in favor of KT as a secondary intervention to relieve symptoms of low back pain. Even though the results of this literature review reveal that KT assists as a secondary intervention to relieve low back pain, the overall research is low quality since there are many studies to confirm that there is no significant difference between utilizing KT versus other interventions to alleviate low back pain. The limitations with this study are that there are only 12 articles to support in favor of KT to assist with relieving back pain and that the results are low quality for many of the studies analyzed in this literature review due to the smaller sample sizes. This literature review can contribute to the utilization of KT in physical therapy practice to determine if it assists in alleviating back pain for those who present with symptoms of low back pain.

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  The Occupation of Training Service Dogs: A Therapeutic Intervention for Combat Veterans with PTSD

  Denae A. Padilla and Jessica De Brun

  There are few interventions that present opportunities to engage in meaningful occupation (Kashiwa et al., 2017) to help Veterans reintegrate into the civilian lifestyle that create a desire to participate and attend therapy (Goetteret al., 2015).

  The purpose of this study is to explore the effectiveness of training service dogs as an occupation and means of social support for combat Veterans living with PTSD with the following objectives:

  • explore an occupation basedintervention that addresses low retention rates in occupational therapy.
  • teach coping mechanisms and provide social support as a by-product to training service dogs in order to assist in reintegration into the civilian lifestyle.
  • decrease symptoms of PTSD experienced in everyday life through increased purpose and quality of life.

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  Remedying Healthcare Disparities Affecting the Black Community

  Savonna Reed

  The purpose of this literature review is to determine how black communities are being impacted by racial/social determinants of cardiovascular health, and to investigate potential healthcare solutions to eliminate these disparities.

  As physical therapists, we commonly treat patients following lumbar spinal fusion surgery. Post-op outcomes have been found to be impacted by racial disparities in decision making in whether care providers offer surgical care, differences in access to care due to socioeconomic barriers, and differences in attitudes towards surgical care among ethnic groups.

  Review of current literature has revealed that more research should be done to establish ways of remedying the systemic and environmental issues influencing healthcare disparities. Methods that have been proposed to mediate disparities impacting the well-being of minorities populations innclude:

  • Community-based programs to establish trust with the medical profession within the black community
  • Improve access to adequate affordable healthcare, nutritious foods, and other health resources
  • Increase recruitment of minorities into healthcare professions

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  The Effectiveness of Heart Rate Variability Biofeedback in Conjunction with Traditional Treatment for Thoracic Outlet Syndrome in a 25-year-old female: A Case Report

  Sepehr Rezaei

  Introduction: Thoracic outlet syndrome (TOS) is a complex condition that causes pain, tingling sensation, hypesthesia, muscle atrophy, weakness, and edematous changes in the upper quadrant (UQ) and down upper extremity (UE). ^3,7,8,16,17 TOS is due to compression of neurovascular bundles in the interscalene triangle, costoclavicular space, and under pectoralis minor and caused by trauma, congenital malformations such as a cervical rib, and abnormal/poor postures from muscle imbalances.^3,7,8,16,17 Interventions for TOS can consist of correcting posture by addressing muscle imbalance, decreasing tone and muscle tightness and rib mobilization, and in rare cases, rib resection. ^{3,7,8,13,16,17} However, there is limited research on the effectiveness of heart rate variability biofeedback (HRVBF) for the treatment of TOS.

  Purpose: The purpose of this case report is to find the effectiveness of HRVBF in conjunction with traditional treatment for a 25-year-old female with TOS who was referred for Physical Therapy (PT) services prior to rib resection.

  Case Description: An ectomorphic right (R)-handed female patient (pt) with complaints of constant numbness, pain, pins and needles sensations from R UQ from scapula/trapezius and R upper chest into R UE for the past year after a traumatic chiropractic treatment. Initial Electromyography found radial neuritis in R UE. Magnetic resonance imaging found a small SLAP tear of R superior labrum adjacent to bicep anchor. Pt comorbidities include asthma and a history of chronic depression/anxiety disorder and panic attacks.

  Interventions: The treatment included ten sessions over seven weeks by a student PT under the supervision of a certified PT. A plan of care (POC) was implemented which included HRVB, myofascial release, trigger point release, 1^st rib and thoracic spine mobilization, corrective stretching, nerve glides, neuromuscular education, strength/motor control training, positive reinforcement to movement, and pt education to include a home exercise program (HEP).^8,16,17

  Outcomes: The pt made progress completing most of her goals in decreasing her pain from 8/10 at worst and 4/10 at best throughout the day to 0/10 based on a numerical pain scale. The pt increased range of motion (ROM) in cervical spine and in R shoulder, increased strength, and normalized sensation in R UQ. Upper Extremity Functional Index initially scored 47/80 and after 71/80 scores, showing an increase in physical function with activities of daily living and life participation. The pt was able to improve her quality of life (QoL) based on the SF-12 QoL¹³, which initially scored at 31.03 physical score (PCS) and 40.86 mental score (MCS) that improved to PCS 40.43 and MCS 52.73. Pt also has less fear and avoidance of movement based on her Fear-Avoidance Beliefs Questionnaire (FABQ)¹⁰ score, which initially scored at 28 for physical activity FABQ (PA) and 37 for work FABQ (W) improved to FABQ(PA) 12 and FABQ (W) 7.

  Discussion: Depression, anxiety, and asthma have impacted this pt’s posture and muscle tone, and the assault from the traumatic experience manifested TOS, which has impaired her ROM, sensory system, strength/motor control, and increased fear and avoidance of movement. Implementation of HRVBF in relaxing the pt through her day and not utilizing accessory muscles to breathe was found to be beneficial in diminishing pt symptoms.^1,2,5,6,9 Pt was set for a 1^st rib resection and was thought to have possible nerve damage but was able to recover with conservative treatment in conjunction with HRVBF. More studies need to be conducted to see if there is a relationship with asthma and depression/anxiety disorders with TOS and the impact of HRVBF in a POC for TOS.

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  Occupational Therapy’s Role in Addressing Sex and Intimacy for Individuals with Progressive Neuromuscular Disorders

  Lindsay N. Richards, Becki Cohill, Katrhyn Ellis, and Susan MacDermott

  Individuals with progressive neuromuscular disorders (PND); specifically, Parkinson’s disease (PD), Multiple Sclerosis (MS), Huntington’s Disease (HD), and Amyotrophic Lateral Sclerosis (ALS) often face physical, psychological, and social challenges related to sex and intimacy. Occupational therapy (OT) practitioners are experts in activity analysis and are equipped with unique knowledge of performance skills and client factors to address deficits in occupational performance.

  Though there is literature presenting the effects of PND on sexual occupations, a gap exists as it relates to qualitative data from the perspective of the individual and their partners. A mixed-methods survey was conducted examining the lived experience of adults with progressive neuromuscular disorders to inform programming addressing intimate and sexual needs.

  Themes were identified from study results in order to inform an evidence-based program addressing sexual and intimate participation and enhance relationships. This research reaffirmed that sexual occupations should not go unaddressed as these can be beneficial not only to the individual patient's well-being, but their partnership and social domains as well. Occupational therapists can facilitate meaningful participation in sexual occupations for these individuals by addressing: their unique physical barriers through positioning and adaptations, providing stress management strategies for both internal and external stressors, and facilitating positive communication between individuals with PND and their partners. The findings from this study support an increased role for OT practitioners in the domain of sexuality.

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  Optimal Interventions to Address Drop Foot and Increase Gait Speed in Stroke Populations

  Christopher Tran, Tommy Ngo, Dana Hazlett, Ethan Jung, and Faris Alshammari

  Background: The mechanism of stroke or cerebral vascular accident (CVA) is an interruption of blood flow to the brain, which can result in many different neuromuscular impairments including drop foot. There is limited research focusing on comparative interventions for gait improvement in early stroke.

  Purpose: The purpose of this study was to review the various physical thereapy interventions to benefit patients with drop foot following a single stroke.

  Methods: A comprehensive systematic search was conducted within the PubMed and ProQuest databases. This study examined papers assessing conventional physical therapy for stroke patients with drop foot who had their 1st stroke and treatment within the 1st year.

  Results: The study identified five interventions including, kinesiotaping, ankle-foot orthosis with drop foot stimulator, treadmill training with Thera Band, functional electrical stimulationn, and neuromuscular electrical stimulation. Outcome measures (OMs) related to gait speed were assessed to determine effectiveness of treatment.

  Conclusions: All five interventions were found to be effective in improving gait speed and OMs, such as Berg Balance Scale (BBS), Meter Walk Test(10MWT), Timed Up and Go (TUG), and Fugl-Meyer Assessment Lower Extremity (FMA-LE). These OMs can be correlated towards fall risk. Results are also dependent on compliance and patient preference, not just clinical results.