Standard Deviation Band Research Articles

Influence of specific muscle training on pain, activity limitation and kinesiophobia in women with back pain post‐partum — A ‘Single‐subject research design’

Many women suffer from back pain and experience activity limitation post-partum. To our knowledge the physiological factors and physiotherapy related to back pain post-partum have received limited evaluation and the effectiveness of specific physiotherapeutic approaches to exercise should be tested. In addition, there has been limited research on kinesiophobia in women with back pain post-partum. The purpose of the current study was to test the influence of specific trunk muscle training on pain, activity limitation and kinesiophobia in 10 subjects with back pain post-partum. The treatment consisted of specific deep muscle training of the transversus abdominus and multifidus muscles. Pain was rated based on the visual analogue scale (VAS) and pain drawings. Activity limitation was recorded using the Disability Rating Index. Kinesiophobia was evaluated using the Swedish version of the Tampa Scale for Kinesiophobia. An A-B-A single-subject research design was used and a number of measurements were obtained during each phase. The analysis consisted of a visual inspection and a two standard deviation band test (2-SD). The visual analysis showed a trend towards reduced pain and activity limitation for all 10 subjects. The 2-SD test showed mixed results among all subjects. In addition, all subjects reported kinesiophobia before and after treatment. Individual specific deep muscle training of the transversus abdominus and multifidus muscles reduced pain and activity limitation in women with back pain post-partum. Further research is needed to determine more precisely how kinesiophobia affects women with back pain post-partum.

Lightweight and Ultralight Wheelchairs: Propulsion and Preferences of Two Young Children with Spina Bifida

This study compared the influence of two wheelchair styles, an ultralight rigid frame and a lightweight folding frame, on preference and propulsion in young children with spina bifida. Speed, distance, energy expenditure, and perceived exertion of two girls were studied in an A-B-A single subject design. Questionnaires were used after the three phases to obtain parent and child preference. Visual inspection of the data favored the ultralight wheelchair for all variables, except the first child's speed with classmates and perceived exertion. Parents and children indicated preference for the ultralight wheelchair on all questions but one by Child 1. Using two standard deviation band width (2SDBW) analyses, 12 of 16 comparisons between the phases differed significantly. 2SDBW comparison was not used in the other four phase comparisons because of autocorrelations. This study presents initial evidence supporting the use of ultralight rigid-framed wheelchairs by young children.

Motor and functional outcomes of a patient post-stroke following combined activity and impairment level training

The purpose of this single-subject report was to determine the effect of a targeted training regimen aimed at improving motor and functional outcomes for a patient with chronic deficits after stroke. A 51-year-old woman with hemiparesis, 6 months post-stroke, participated in this prospective study. During the baseline, intervention, and immediate retention phases, performance was established by using repeated measures of four dependent variables: Fugl-Meyer assessment, Berg Balance Scale, 10-meter walk, and 6-minute walk. Two standard deviation band analyses were conducted on the four dependent variables with repeated measures. The Frenchay Activities Index and step length/single-limb support time measured at baseline and immediate retention were compared. During intervention, the participant was involved in a combined treatment protocol including body weight supported (BWS) treadmill training and strengthening exercises. Results indicated significant improvements in motor activity, balance, gait speed, and endurance. Progression was found in self-perceived participation. Although an improvement in step length symmetry occurred following training, a decrease in single-limb support time symmetry was found. BWS treadmill training, combined with strength training, significantly improved motor and functional performance in this participant with chronic deficits after stroke.

PARTIAL BODY WEIGHT SUPPORT TREADMILL TRAINING IMPROVES BALANCE AND GAIT IN A FRAIL OLDER ADULT.

Purpose/Hypothesis: Partial body weight support treadmill training (PBWSTT) has been documented to improve balance, walking ability, gait speed, and gait symmetry in people who have experienced a stroke, spinal cord injury, or traumatic brain injury. Given these improvements and the task specific nature of PBWSTT, one question is whether this intervention could have a similar effect in frail older adults at a high risk for falls. By supporting part of the person's body weight, the postural demands of walking are decreased, improving the ability to walk with a normal gait pattern at a desired faster speed. Also, by supporting some of the body weight, the energy demands are decreased, allowing the person to walk for longer distances. This intervention may allow for improvements in gait speed and balance in frail older adults and therefore increase their mobility and decrease their risk for falls. The purpose of this study was to determine the effects of PBWSTT on the balance and gait characteristics of an older adult with a history of falls. Number of Subjects: One. Materials/Methods: A single subject ABAA design with multiple measurements was used. The subject was a 97 year-old female with a history of balance problems and falls. The Berg Balance Scale (BBS), Modified Falls Efficacy Scale (MFES), and the GAITRite computerized gait analysis system were utilized in data collection. The A1 phase consisted of outcome measures gathered four times per week for two weeks to establish a baseline. The B phase, the intervention phase, consisted of PBWSTT three times per week for four weeks with outcome measurements recorded two of three sessions each week. The A2 phase immediately followed the B phase and mirrored the A1 phase. The A3 phase was scheduled to be performed five months after the B phase and mirror the A1 phase. Data was analyzed using the two standard deviation band method, with two consecutive data points outside the band considered a significant change Results: Compared to the A1 phase, the subject demonstrated significant increases in BBS score, velocity, cadence, and stride length, and a significant decrease in base of support in the B and A2 phases. As a result of a change in our subject's medical status during the time between the A2 and A3 phases, data was not collected for the A3 phase. Average BBS scores for the A1, B, and A2 phases were 33.25, 40.5, and 44.8 respectively. Gait speed averaged .61 m/s in the A1 phase, .85 m/s in the B phase, and .84 m/s in the A2 phase. Conclusions: A 97-year-old female with a history of balance deficits and falls was found to tolerate and benefit from a four-week training program of partial body weight support treadmill training as demonstrated by improvements in balance and gait characteristics. These improvements were maintained throughout the two-week follow up. Clinical Relevance: Decreased balance and slower gait speed are associated with falls in older adults. PBWSTT may be an effective intervention to improve balance and gait and decrease the risk for falls.

Effectiveness of Manual Physical Therapy, Therapeutic Exercise, and Patient Education on Bilateral Disc Displacement Without Reduction of the Temporomandibular Joint: A Single-Case Design

Single-case A1-B-A2 design. To determine if manual physical therapy, therapeutic exercise, and patient education would be an effective management strategy for a patient with a disc displacement without reduction of both temporomandibular joints. A number of conservative management strategies have been proposed for the treatment of temporomandibular disorders. However, little evidence exists to indicate the effectiveness of physical therapy interventions in patients with bilateral disc displacement without reduction. Phase A1 of the study consisted of a baseline condition in which no intervention was initiated. Phase B included manual physical therapy, therapeutic exercise, and patient education focusing on the temporomandibular joint and cervical spine. Phase A2 consisted of withdrawal of the intervention. The Steigerwald/Maher disability questionnaire was used to collect data relative to function. A visual analog scale was used to collect pain data and maximal mouth opening measurements were obtained as an indicator of range of motion. Visual analysis and the 2 standard deviation band method of statistical analysis were used to compare data. Following the implementation of the intervention phase, the patient demonstrated significant reductions in pain and improvements in maximal mouth opening and function as measured by the Steigerwald/Maher disability questionnaire. These observed improvements were maintained at the time of a 3-month follow-up. The results of our study suggest that manual physical therapy, therapeutic exercise, and patient education may have been an effective management strategy for a patient with bilateral disc displacement without reduction of the temporomandibular joints. Further outcome studies in the form of randomized controlled trials are needed to determine the clinical utility of this treatment approach in a larger population.

Biomechanical and histiological considerations for development of plantar fasciitis and evaluation of arch taping as a treatment option to control associated plantar heel pain: a single-subject design

Study design: Alternating single-subject A-B and A-B-A designs. Objective: To discuss biomechanical and histiological issues related to the development of plantar fasciitis and to evaluate the effectiveness of arch taping in controlling heel pain during ambulation. Background: Plantar heel pain as a consequence of plantar fascial strain, a condition frequently diagnosed as plantar fasciitis, can significantly interfere with functional ambulation. Biomechanical causes of plantar fasciitis have been related to microfailure of plantar fascial tissue followed by incomplete repair resulting from abnormal histiological responses. Arch taping has been suggested as a viable treatment option for patients with this diagnosis but few studies have documented its clinical effectiveness in reducing pain. Methods and measures: Two female subjects diagnosed with plantar fasciitis with a history of chronic heel pain participated in the clinical evaluation. Time to onset of pain was recorded during ambulation with and without arch taping on several days. Results: Visual and statistical analysis using the Two Standard Deviation Band method showed improvement at the P<0.05 significance level in walking time for both subjects with arch taping. Conclusions: Biomechanical and histiological factors need to be considered for successful management of plantar fasciitis. The arch taping technique applied in these two cases was effective in controlling pain during ambulation and could be considered as a viable treatment option for other individuals with similar clinical presentations. Slower healing time of dense connective tissue such as plantar fascia needs to be protected for longer periods of time to ensure resolution of plantar fasciitis.

Imaging of the Near-Surface Shear-Wave Velocity Structure of the Granada Basin (Southern Spain)

The seismic velocity structure of the Granada Basin (southern Spain) at depths of 1-4 km is investigated by dispersion analysis of 0.5- to 5.9-sec Rayleigh waves. We have used records from 12 quarry blasts detonated between 1990 and 2000 and 16 local earthquakes with magnitudes between 2.6 and 3.8 that occurred between 1990 and 1997. All events were recorded on the Regional Seismic Network of Andalucia, Spain, and on the National Seismic Network. P -, S - and Rg -phases were recorded at 13 stations at distances between 10 and 72 km from the source. The analysis and inversion of Rg waveforms is performed using multiple filtering techniques and a generalized inversion approach. We measured ray-path group velocities from 0.83 to 2.15 km/sec in the 0.6- to 5.8-sec period interval, and obtained shear-wave velocity profiles for 29 source-station paths. The shear velocities lie between 0.8 and 3.34 km/sec within a standard deviation band of 0.05-0.14 km/sec. From these models, it is possible to infer the most conspicuous features in the upper 4 km of the region and the existence of some degree of lateral variation in velocity. After applying an imaging method aimed at volumetric modeling and data visualization, we present the first velocity images obtained for the Granada Basin. Our results characterize the basin and are correlated with the surface geology. Manuscript received 7 September 2001.

Effects of Axial Weight Loading on Gait for Subjects with Cerebellar Ataxia

Background and Purpose: Weighting the axial skeleton has been recommended to improve gait for patients with ataxia. In this study the effect of axial loading on gait of individuals with cerebellar ataxia was examined. Subjects and Methods: Five subjects with ataxic gait ambulated 9.76 meters for 5 trials in each of 4 conditions: an initial unweighted phase, with weight at the shoulders, with weight at the waist, and a final unweighted phase in a repeated ABCA single-subject design. Footfall characteristics were recorded for 3.66 meters of each trial using a GAITRite® mat. The two standard deviation band method was used to analyze 6 gait parameters: velocity, cadence, standard deviation of step time, standard deviation of step length, width of the base of support, and double stance time. Results: Gait characteristics changed unpredictably in the 4 conditions, worsening more often than improving. Discussion: Effects of axial loading on gait were inconsistent. Conclusion: Using axial weights to improve gait for patients with ataxia was not supported.

A survey of the shallow structure beneath the Alboran Sea using Rg-waves and 3D imaging

A dispersion analysis of Rg waves generated by local earthquakes surrounding the Alboran Sea (Western Mediterranean) has been undertaken to obtain its shear-wave velocity structure at shallow depths. We have used single-component short-period stations belonging to the Regional Seismic Network of Andalucia and the Spanish National Seismic Network. Our database includes seismograms generated by 18 earthquakes that occurred in the area during the period of 1992–95. The seismic events, with magnitudes between 2.9 and 4.9 and focal depths ranging from 2.7 to 12 km, were recorded at 13 stations at distances between 91 and 245 km from the source. We have analysed a total of 20 source-station Rg-wave paths. These seismic trajectories across the Alboran Sea provide irregular path coverage due to their geographical location. Despite sparse sampling the data collected have been processed with the help of digital filtering and group velocity dispersion curves have been obtained. The path group velocities vary from 1.21 to 1.91 km s −1 within the 1.7–5.8 s period interval. Then using a generalised inversion approach we have obtained 1D shear-wave velocity models for all source-station paths. Inversion for shear velocity structure gives velocity profiles down to a depth of 5 km. The shear-wave velocities range between 0.7 and 3.2 km s −1 within the standard deviation band of 0.05–0.17 km s −1, and show significant variations from each other in the region of the Alboran Basin. We have applied an imaging technique aimed at volumetric modelling and data visualisation and we hereby present the tomographic results based on ray-path seismic velocities that were obtained for the basin. We have got an overall view of the sedimentary cover of the area regarding its geometry and S-wave velocity structure at very shallow depths (0–5 km). Although the relationship between lateral change in Rg dispersion and geologic structure may not be straightforward, we have observed a good correlation between those changes and surface geology.

Structured habituation training for movement provoked vertigo after severe traumatic brain injury: a single case experiment

The purpose of this study was to evaluate the effect of structured habituation training HT for movement provoked vertigo PV secondary to unilateral peripheral hypofunction in a 16 year old patient who had sustained a severe TBI. Treatment of PV with severe TBI patients can be quite different from other patients with vestibular deficits because of the physiological, behavioural and cognitive sequelae of brain trauma. A single subject experimental paradigm using an ABA protocol was used to assess efficacy of HT. The data were submitted to C statistic analysis. The transformed data were submitted to combined visual and statistical analysis by the celeration line with a directional one tailed test and the two standard deviation band method. Significant change in duration from sitting to supine without triggering vertigo was found between baseline phase A and structured HT phase B and was maintained for 1 month after the end of treatment. This single case experiment demonstrates successful structured HT for PV for a 16 year old severe TBI patient. Important clinical decisions time of introduction of treatment, type of activity, pacing, frequency, intensity, repetition, support and education necessary to achieve optimal resolution of PV with HT in severe TBI patients are discussed.

An Evaluation of the Soft Splint in the Acute Management of Elbow Hypertonicity

This paper presents an evaluation of the Soft Splint used in the management of hypertonicity at the elbow. An “A1,B1,A2,B2” single system design was used with elbow range of motion, measured with a standard goniometer, as the dependent variable. Visual analysis of the data and the two standard deviation band method of data analysis indicated that the Soft Splint is highly effective in the management of hypertonicity. Elbow range of motion improved significantly during the intervention phases. During the A2 (non-intervention) phase the measurements returned to the baseline level. The findings support the continuing use of the Soft Splint in reducing hypertonicity at the elbow. Replication of this design is required to generalize the results of this study.

The use of computers in occupational therapy for visual-scanning training.

This study examined the effect of computer-assisted remediation, with the use of specific visual-scanning software, in the retraining of a functional scanning deficit. Three subjects who displayed significant deficits in visual scanning were selected. A single-subject study was conducted, involving an ABA multiple baseline across-subjects design. Introduction of computer-based intervention with visual-scanning software occurred after 2 to 3 weeks of the gathering of baseline data. Removal of this intervention followed six to nine sessions of 15 to 30 min each over 3 weeks, and data were collected over a 2-week return-to-baseline phase. The dependent variables--speed, accuracy, and the number of re-referencing glances--were measured on functional performance of a grocery-shelf scanning task. Analysis with the two standard deviation band method did not reveal a significant change in performance on the functional task between the three phases. Visual and graphic analyses confirmed that computer intervention did not significantly affect performance on the functional task. The clinical significance of the results suggest that software-assisted remediation may not be an appropriate modality for achievement of a functional occupational therapy outcome.

The Effectiveness of Neurodevelopmental Treatment in Adults with Neurological Conditions: A Single-Subject Study

A single-subject random treatment design was used to investigate the effectiveness of neurodevelopmental treatment (NDT) vsconventional physiotherapy treatment in attaining short-term goals in adults with neuromuscular dysfunction. Ten treatments (five NDTs and five conventional treatments) were randomly ordered and administered to three patients. A fourth patient was given five conventional physiotherapy treatments followed by five NDTs. The target goals were operationalised for all of the subjects prior to the first treatment. Qualitative outcomes were measured using pre- and post-test videotapes, graded by independent assessors. The two standard deviation (2 SD) band method of analysis, appropriate for single-subject studies, was used. The results favoured conventional therapy over NDT, although all patients attained their goals regardless of treatment type. This study provides a method for evaluating the short-term effects of NDT using a single-subject design.

Effects of Lateralized Tasks on Unilateral Neglect after Right Cerebral Vascular Accident

This study examined whether activities designed to stimulate the right hemisphere of the brain resulted in decreased neglect in patients with right cerebral vascular accident (CVA) and unilateral neglect (UN) and, conversely, whether activities designed to stimulate the left hemisphere resulted in increased left neglect. An alternating treatment, single subject design was used with five subjects, ages 57 to 74, who demonstrated neglect on both the Schenkenberg Line Bisection Test and the behavioral subtest of the Behavioral Inattention Test. Each subject received 8 days of baseline measures (Schenkenberg Line Bisection Test) and 10 days of treatment, during which the subjects were alternately engaged in the groups of tasks intended to arouse a particular hemisphere, followed by six to eight baseline measures. Line bisection scores were taken after each treatment. The significance of change in UN after either group of activities was determined by visual inspection and semi-statistical analysis using the two standard deviation band method. The findings did not support the hypotheses. Two subjects demonstrated no significant change after either treatment phase; one subject showed a significant decrease in neglect after both phases of treatment; one subject showed a significant decrease in neglect after activities designed to stimulate the right hemisphere but no change after activities to facilitate the left hemisphere; and one subject showed a significant increase in neglect after both types of treatment. Results are discussed in terms of severity of impairment, fatigue effect, spontaneous recovery, and the adequacy of the tasks to differentially activate a single hemisphere.

The Supraspinal Anxiolytic Effect of Baclofen for Spasticity Reduction

Recent studies in the psychiatric literature indicate that baclofen has an anxiolytic action in certain psychopathologic conditions. Clinical observation has shown that manifestations of spasticity are increased in anxious individuals, implicating a supraspinal site of mediation for these responses. The purposes of this study were to determine if baclofen reduced anxiety in individuals with traumatic spinal cord lesions and whether that reduction was correlated with decreased spasticity from the baclofen. Five adult males with traumatic spinal cord injury were randomly assigned to the study protocol. A double-blind, repeated measures, multiple base-line, single-case research design was employed. The independent variable was dose of medication with the three levels being placebo, 40 mg/day of baclofen and 80 mg/day of baclofen, in four evenly divided doses. The dependent variable was the score obtained on the Beck Inventory-A anxiety scale (BIA). The subjects were administered the BIA twice per week for a nine-week period of time, during which they received the doses of medication as described. Quantitative measurements of spasticity were also taken at each session. Visual inspection analysis of the data showed that two subjects had no measurable anxiety of the BIA throughout the study. Three subjects had measurable anxiety on the BIA during the base-line/placebo phase. They showed a decreased level of their BIA scores with 40 mg/day of baclofen, and a further level reduction with 80 mg/day of baclofen. The reduction in BIA scores was statistically significant using the standard deviation band test in one of these subjects. These data indicate that BIA probably has an anxiolytic effect for individuals status post-traumatic spinal cord injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Flashing Inception in Flowing Liquids

The inception of net vaporization in flashing flows is examined. It is suggested that the flashing inception can be expressed as two additive effects. One is due to the static decompression which is a function of the initial temperature and also of the expansion rate. The other effect which is a function of Reynolds number and flashing index, is due to the turbulent fluctuations of the flowing liquid. It is shown that by taking a three standard deviation band on the turbulent velocity fluctuations, an adequate representation of the inverse mass flux effect on flashing inception for existing data is obtained. The turbulence effects are combined with the correlation of Alamgir and Lienhard to provide predictive methods recommended for the case where both static and convective decompression effects exist.