MS, University of Cincinnati, 2013, Education, Criminal Justice, and Human Services: Health Education

This study examined collegiate student-athletes' knowledge of injury, injury prevention, and barriers to seeking out an athletic trainer based upon basic demographic information (sex, sport, ever injured, ever visited an athletic trainer). A total of 100 collegiate student-athletes completed a valid and reliable survey. Results indicated the knowledge of injury prevention based on ever visited an athletic trainer to be statistically significant. Top barriers to seeking out an athletic trainer included the ability to self- treat, injury not serious enough to seek out athletic trainer, and not wanting coach to know injured. Information from this study may assist athletic trainers and other professionals working with collegiate student-athletes.

Committee: Rebecca Vidourek Ph.D. (Committee Chair); Keith King Ph.D. (Committee Member) Subjects: Accounting

Master of Science (MS), Ohio University, 2017, Athletic Training (Health Sciences and Professions)

Background: The traditional preparticipation examination (PPE), which is required for high school athletes, has been implemented for decades to assist the safe participation of athletes in sport. The PPE is a multifaceted screen that includes a previous medical history review and a general health examination. The general health examination includes cardiovascular, neurologic and musculoskeletal assessments. The musculoskeletal assessment aims to detect predisposing factors of injury; however, it has been shown to only have 51% sensitivity. To help predict injury risk factors more accurately a functional preparticipation examination (F-PPE) was proposed. Purpose: The purpose of this study was to determine if there is a change in the F-PPE measures over the course of a season (pre-, mid-, and postseason). Methods: The F-PPE includes the impression Landing Error Scoring System (iLESS), Single-Leg Anterior Reach (SLAR), Single-Leg Hop (SLHOP) and ankle dorsiflexion range of motion (ROM) tests. This investigation used these 4 tests, and implemented them 3 separate times during an athletic season (pre, mid, post) to determine if they are sensitive to change over time. Results: The F-PPE was able to identify increases in dynamic postural stability, unilateral balance, trunk stabilization and flexibility in the SLAR and SLHOP tests. ROM did not change significantly and iLESS scores showed consistency throughout the athletic season. Conclusion: The F-PPE should be added to preparticipation physicals and athletic programs to assist coaches and athletes in measuring performance during an athletic season.

Committee: Janet Simon PhD (Advisor); Dustin Grooms PhD (Committee Member); Jae Yom PhD (Committee Member); James Onate PhD (Committee Member) Subjects: Health Care; Sports Medicine

Doctor of Philosophy, The Ohio State University, 2014, Biomedical Engineering

Second anterior cruciate ligament (ACL) injury after ACL reconstruction occurs at reported rates ranging from 5 to 20 times greater than for primary injury, and results in significantly poorer patient outcomes. In athletes, the majority of second ACL injuries occur within the first two years of return to sport. Significant functional impairments and deficits in neuromuscular control are frequently reported up to two years post-reconstruction. Targeted neuromuscular training (NMT) alters high-risk biomechanics and reduces rates of primary ACL injury, but its efficacy in ACL-injured subjects is currently unknown. External loads during dynamic motion, specifically knee abduction moment (KAM), internal tibial rotation moment (ITR), and proximal anterior tibial shear force (ATS) increase ACL strain. These factors are reportedly influenced by modifiable and non-modifiable factors. Thorough determination of post-operative biomechanical impairments, modifiable and non-modifiable risk factors, and the effects of NMT on these factors will likely aid in eventual reduction of second ACL injury rates. The goals of this dissertation were: 1) Define the relationships between select modifiable and non-modifiable risk factors for second ACL injury, and high-risk biomechanics after ACL reconstruction. 2) Determine the clinical and biomechanical efficacy of NMT in ACL-reconstructed subjects, and 3) Model effects of NMT at the tissue-level using finite element (FE) modeling. We hypothesized that modifiable risk factors would be most strongly associated with KAM, a known predictor of primary injury. We also hypothesized that that NMT would significantly improve biomechanics and patient outcomes, and result in reduced finite element (FE) model-predicted ACL strain during landing. Thirteen ACL-reconstructed subjects (7 males, 6 females, 20.15±7.97 years) were enrolled in the NMT group and evaluated at 36.0±18.3 weeks post-operative, and were re-tested after participation in a 12 ses (open full item for complete abstract)

Committee: Timothy Hewett PhD (Advisor); Alan Litsky MD, ScD (Committee Member); Michael Knopp MD, PhD (Committee Member) Subjects: Biomechanics; Biomedical Engineering; Engineering; Health Sciences; Mechanics; Physical Education

Doctor of Philosophy, University of Toledo, 2013, Exercise Science

Introduction: The purpose of this study was to design and evaluate the validity and effectiveness of a prototype real-time Kinect-based biofeedback and screening system (KBBFSS) during drop vertical jump (DVJ) ACL injury prevention training in young female athletes. We hypothesized that KBBFSS would be both valid and reliable as compared with traditional MOCAP, and that a four-week intervention using KBBFSS would be effective at improving landing kinematics. Methodology: 24 female gymnasts were randomized into control (CTRL) or Kinect-based biofeedback (KBF) groups. Eight of the subjects were additionally randomized into a validation subset. Subjects were grouped as high risk or normal risk using a novel risk stratification algorithm. Custom KBBFSS software afforded on-screen representation of limb and joint segments responding intuitively and immediately to subject movement. Subjects performed twenty 30cm drop landings three days per week for four weeks, wherein KBF subjects used the KBBFSS to augment landing mechanics, while CTRL subjects did so without KBBFSS. Alpha-level was set a priori at p≤0.05. Results: KBBFSS results were valid for pre (r=0.963) and post (r=0.897) knee flexion, and pre (r=0.815) and post (r=0.916) knee separation distance as compared with MOCAP. Knee flexion change score was statistically different between groups (p=0.001) and effect size was large (d= 1.618), power of 0.93. Knee separation distance change score was statistically different (p=0.024) between groups, with moderate effect size (d=0.99) and power of 0.73. KBF group reduced peak vGRF more than controls, with large effect size (d=1.84). KBF decreased peak bilateral frontal plane valgus knee moment more than controls, with moderate effect size (d=0.44). Correlations between pre-training RQS and changes in knee flexion and separation distance for high risk subjects were moderate. Conclusion: KBBFSS kinematic values are valid and KBF intervention significantly improved non-contact A (open full item for complete abstract)

Committee: Barry Scheuermann PhD (Committee Chair); Charles Armstrong PhD (Committee Member); Martin Rice PhD (Committee Member); Vijay Goel PhD (Committee Member) Subjects: Biomechanics; Computer Science; Health Sciences; Kinesiology; Rehabilitation; Sports Medicine

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2024, Nursing

Burn injuries are considered a global cause of morbidity and mortality (Fuzaylov et al., 2021). Increased incidences of burn-related injury have been found to coincide with the lack of community burn prevention programs (Fuzaylov et al., 2021). In this DNP scholarly project, findings are presented specific to the implementation of a pop-up community burn prevention event in the city of Norwood, Ohio. The following PICO(T) question was asked, are community members in Norwood, Ohio more likely to improve and implement individual fire safety and burn prevention interventions after participation in a community burn prevention program? The scholarly project assessed validity, reliability, and self-efficacy specific to the introduction of fire safety and burn prevention education via teach back and a self-assessment survey following the implementation of burn prevention education specific to fire extinguisher use, smoke detector operation, and mapping out a home fire escape plan. A total of 43 individuals participated in the burn prevention pop-up event. Of the 43 community members, 37 individuals completed and returned the questionnaire. Six community members opted not to participate in the post education assessment. Of the study participants measured, 38 individuals were able to correctly perform the PASS method of fire extinguisher operation, 41 individuals were able to demonstrate competence of smoke detector operation, and 35 individuals were able to correctly map out the correct exit sequence on a home escape map. Of the study participants measured, 31 individuals correctly identified that smoke detectors should be tested once monthly, 30 study participants were able to correctly identify the Pull, Aim, Squeeze, and Sweep process of fire extinguisher operation, and 30 study participants noted improved self-efficacy of fire safety/burn prevention knowledge. Study findings noted improvement in individual implementation specific to fire safety/burn prevention i (open full item for complete abstract)

Committee: Miranda Knapp PhD, DNP, APRN, AGNS-BC, CNE, EBP-C (Committee Chair); Angela Liggett DHA, MSN, RN, APFN (Advisor) Subjects: Health Care; Nursing

Doctor of Philosophy, University of Toledo, 2023, Exercise Science

Athletic populations commonly suffer from various injuries to the back, hip, and knee. Common risk factors, often in the form of movement patterns or strength deficits, have been identified for injuries that negatively impact sport performance or the ability to participate in sport. These common risk factors may be suggestive of a proximal cause-the lumbopelvic-hip complex (LPHC). The LPHC is the center of the kinetic chain and is important for optimal force generation and distribution to the lower extremity during athletic movements. LPHC stability can be defined as the ability of the trunk to maintain optimal positioning over the pelvis and lower extremity in the presence of perturbations. Additionally, LPHC stability can be considered the combined muscular strength, endurance, and sensorimotor control of the muscles and fascia within the complex. Deficits in LPHC stability have been related to movement patterns that are related to increased injury risk and incidence of injury. The proposed connections between LPHC stability and injury risk prompt recommendations for inclusion of LPHC stability training in injury prevention efforts. To better understand the emphasis that should be placed on LPHC stability training for the purpose of injury prevention or rehabilitation, it is important to further investigate the mechanisms by which LPHC stability relates to injury risk factors, and whether improving LPHC stability results in relevant functional changes. Our population of interest included university club sport athletes who are regularly at risk for injury due to their participation in sport, but represents a more recreational population that commonly do not have access to outside training regimens or clinical interventions. In manuscript 1, we explored the relationships between clinical measures of LPHC stability, trunk kinematics, and the margin of stability during landing tasks. Because the head, arms, and trunks make up 70% of the body's mass, control of trunk m (open full item for complete abstract)

Committee: Amanda Murray (Committee Chair); Grant Norte (Committee Member); Lauren Mangum (Committee Member); Neal Glaviano (Committee Member); David Bazett-Jones (Committee Member) Subjects: Biomechanics; Health Sciences; Kinesiology; Rehabilitation; Sports Medicine

PhD, University of Cincinnati, 2022, Pharmacy: Pharmaceutical Sciences

Traumatic brain injury (TBI) is a significant cause of death and disability with an estimated 176 TBI-related deaths occurring each day within the United States alone. While everyone is exposed to factors that could lead to a TBI, certain groups of individuals are at a higher risk for sustaining neurotrauma than others. The technological evolution of modern warfare has led to the increased use of explosive devices. Consequently, military personnel are experiencing more TBI related injuries with an estimated 20% of all military personnel suffering at least one TBI during their deployment. TBI leads to long term complications including depression, deficits in memory and learning, and increased risk for suicide and suicidal ideation. The lack of effective preventative measures to prevent TBI significantly contributes to the high rates of injury. While the causes of TBI are situational, the majority of TBIs result from the body experiencing deleterious acceleration/deceleration forces. These forces result in a dissipative transfer of energy between the brain and the skull resulting in significant strain and shear stress on the brain tissue. Despite the common misconception that helmets can protect against TBI, they are unable to effectively mitigate energy transmission and leave wearers susceptible to head injury. A small quantifiable volume dubbed the compensatory reserve volume (CRV) permits energy transmission to brain tissue during acceleration/deceleration events. Recent work has found that increases in cerebral blood flow (CBF) are able to exhaust the CRV and reduce the absorption of energy and damage to the brain resulting from acceleration/deceleration forces. The most powerful biologic determinant of CBF and therefore the CRV is the concentration of inspired Carbon Dioxide (CO2). We therefore hypothesized that experimental hypercapnia (i.e. increased inspired concentration of CO2) may prevent and mitigate the actions of acceleration/deceleration-induce (open full item for complete abstract)

Committee: Matthew Robson Ph.D. (Committee Member); Gary Gudelsky Ph.D. (Committee Member); Eric Wohleb (Committee Member); Timothy Phoenix Ph.D. (Committee Member); Jennifer McGuire Ph.D. (Committee Member) Subjects: Pharmaceuticals

Bachelor of Science (BS), Ohio University, 2022, Translational Health

Background: The unique demands of different sports may contribute to the prevalence of biomechanical injury risk factors for female, adolescent athletes. However, there has been insufficient investigation on the effect of different sports on landing biomechanics. Hypothesis/Purpose: We hypothesize that there will be knee biomechanical differences during a forward drop jump landing task dependent on sport participation, in adolescent female athletes due to different movements involved in basketball, soccer, and volleyball. Study Design: Cohort study Methods: 116 participants were recruited from middle and high school basketball, soccer, or volleyball teams in four local school districts. Participants completed a forward drop jump landing task with 3D motion capture instrumentation to capture peak knee flexion angle and peak knee abduction angle for each participant. Two one-way ANOVAs compared knee flexion and abduction angle between basketball, soccer, and volleyball athletes. Results: There was a statistically significant main effect of sport participation for peak knee flexion angle, F(2,111) = 3.655, p < 0.029, ω2 = 0.062. However, post-hoc testing revealed no significant differences between groups. There was a medium effect size (d=0.46) for knee flexion angle between basketball and volleyball athletes. For peak knee abduction angle, there was no statistically significant main effect (F(2,111) = 1.185, p < 0.310, ω2 = 0.021). Conclusion: Although there no statistically significant differences in the variables of interest between sports, there was a trend towards significance for peak knee flexion in basketball and volleyball players with a medium effect size. The forward drop jump test may not be an adequate test to find differences in biomechanics between sports. Differences in biomechanics between sports may suggest a need for sport-specific neuromuscular training injury prevention programs to better reduce ACL injuries in athletes. Level of Evidenc (open full item for complete abstract)

Committee: Dustin R. Grooms (Advisor); Meredith Chaput (Other); Janet E. Simon (Advisor) Subjects: Biomechanics; Health Sciences

Bachelor of Science (BS), Ohio University, 2019, Translational Health

Foot injuries frequently occur in dancers, and researchers have investigated different protective measures that prevent injuries for this population. Research has primarily focused on ballet dancers, but foot injuries also are common in modern and contemporary dance where footwear is not worn. The purpose of this study is to explore whether the padded dance-support socks can serve as a protective measure for modern dancers by attenuating force on their feet during a dance sequence and when landing from a saute jump. In this randomized, cross-over designed study, seventeen injury-free dancers (2 M, 15 F; age=21.7±7.3 yrs; height=165.4±6.2 cm, mass=69.5±15.5 kg) volunteered to perform a 40-second modern dance sequence and a saute jump landing under two conditions: while wearing DS and BF. A 0.5 cm2 Flexiforce A201 445N sensor (Tekscan, Boston, MA) was affixed under the first metatarsophalangeal joint (great toe); a second was affixed under the heel. The sensors wirelessly recorded foot forces during dancing. A Bertec 600x1200mm force plate (Bertec Inc., Columbus, OH) measured vertical ground reaction force (VGRF) and time to peak VGRF of the jump landings. A Noraxon MR3.12 biomechanics system (Noraxon, Inc., Scottsdale, AZ) synchronized and recorded the data. Peak toe force, peak heel force, mean toe force, and mean heel force were measured during the dance sequence, while VGRF, time to peak VGRF, peak toe force, and peak heel force were measured during the jump onto the force plate. A dependent samples t-test was used to assess pairwise differences in these measures between the DS and BF conditions. Statistical significance was set to p < 0.05. The peak forces on the heel when dancing and landing from the saute jump with DS were significantly lower compared with the BF condition (Dance Sequence: p=0.005; Saute Jump: p=0.042). All other variables were not significant between conditions. When considering the high demands of a dance training, results of this study showi (open full item for complete abstract)

Committee: Jeff Russell (Advisor) Subjects: Biomechanics; Dance

PHD, Kent State University, 2018, College of Arts and Sciences / Department of Geography

Research focusing on neighborhood effects on health often fails to connect aspects of the neighborhoods which contribute to disparities, and the mechanisms in which social processes and the built environment affects the lives of individuals. The purpose of this dissertation is to explore the neighborhood risks affecting health and well-being for the pediatric population in Akron, Ohio, through novel methods in geospatial technologies. Within the context of injury prevention and childhood lead exposure, I explore factors which impact children living in Akron through the collection, mapping and analysis of data at a granular spatial scale. The first of the three studies is focused on the use of spatial video in assessment of child behaviors and injury surveillance for active school transport immediately before, during and after an intervention (at three time periods) as part of International Walk to School Day at one Community Learning Center (CLC) in Akron, Ohio. This paper analyzes data generated from coding spatial video in a GIS for variables related to child characteristics, activity, location, and the surrounding environment to identify behaviors and aspects of the built environment which may contribute to unintentional injuries during active school transport. The focus of the second study is to investigate aspects of properties that may contribute to lead exposure through the development of an Environmental Lead Index (ELI). Spatial video was coded for the presence of eight variables and summarized to create a number value. Blood lead levels, extracted from the EMR as lead test results, were used to assess the validity of the ELI. Additional insights into the challenges affecting this diverse pediatric population, such as a residential mobility rate over 70 percent, are provided through a descriptive analysis of the study population, which includes a growing immigrant population. The last paper concentrates on the challenges associated with residential m (open full item for complete abstract)

Committee: Andrew Curtis (Committee Chair); Jacqueline Curtis (Committee Member); Eric Jefferis (Committee Member); Eric Shook (Committee Member) Subjects: Environmental Health; Epidemiology; Geographic Information Science; Geography

Doctor of Philosophy, The Ohio State University, 2017, Biomedical Engineering

The anterior cruciate ligament (ACL) is one of four major ligaments that passively stabilize the knee joint. One of the primary functions of the ACL is to prevent excess anterior tibial translation relative to the femur, but the ACL also includes a sensorimotor reflex between the ligament and the muscles surrounding the knee. Early studies have noted that once the ACL is stimulated it elicits a motor response from the quadriceps and hamstring muscles. Injuries to the ACL occur nearly at a rate of 150,000 annually in the United States, with a disproportionately greater incidence in young, active athletes. The clinical standard of care for athletes who desire to return to pre-injury level of activity is restoring passive stability through ACL reconstruction (ACLR), but some resort to alternative, non-operative treatments and modify their activity level. The evidence in the literature indicates that following ACL injury, regardless of electing operative or non-operative treatment, athletes are less likely to resume pre-injury level of activity, are at a significantly greater risk of further knee injury than their uninjured counterpart, and rapidly progress to radiographic, knee osteoarthritis as early as 10-20 years after injury. These poor outcomes are associated with abnormal knee joint function that persists following ACL injury. The loss of ACL-sensorimotor function is implicated in knee dysfunction following ACL injury, and this prevailing deficit is not addressed by the current treatment options. In addition, the impact of losing ACL sensorimotor function is confounded with structural loss of the ligament. This prevents the full characterization of knee dysfunction following ACL injuries and may lead to clinical treatments which have limited efficacy. Therefore, the aims of this dissertation are to: 1) Determine the impact of ACL sensory loss on knee joint function and health in pre-clinical animal model, 2) Determine the effects of temporary altering neuro-sens (open full item for complete abstract)

Committee: Timothy Hewett PhD (Advisor); Litsky Alan MD, ScD (Committee Member); Di Stasi Stephanie PT, PhD (Committee Member) Subjects: Biomechanics; Biomedical Engineering; Biomedical Research; Sports Medicine

PhD, University of Cincinnati, 2017, Arts and Sciences: Psychology

Anterior cruciate ligament (ACL) injuries are a growing public health problem in the United States, with associated healthcare costs exceeding $2 billion annually (Kim, Bosque, Meehan, Jamali, & Marder, 2011). Females are more likely to incur an ACL injury, and in recent years adolescent females (i.e., 14-17 year olds) have experienced the largest increase in ACL injury rate (Csintalan, Inacio, & Funahashi, 2008). A large amount of research has investigated and identified several potential risk factors for ACL injuries in females. Prevention of ACL injuries has emerged as a priority, but current injury prevention programs suffer from several problems, such as noncompliance (Sugimoto, Myer, Bush et al., 2012) and limited reductions in injury risk (Sugimoto, Myer, McKeon, & Hewett, 2012), and thus fail to address the rising rates of ACL injuries. The objective of this dissertation was to determine the efficacy of a real-time, visual-feedback display for ACL injury risk reduction in adolescent females. This was accomplished in two-stages. First, a pilot study tested the feedback protocol on a small group of participants to ensure the newly developed technical aspects of the feedback program and display operated successfully. The results of the pilot study were used to adjust the feedback protocol before the second stage of the project, which used the modified feedback protocol to investigate the ability of the feedback display to reduce biomechanical risk factors associated with ACL injuries. This was achieved by comparing the effects of the real feedback stimulus to those of a control stimulus—a sham display that was phenomenologically similar but did not provide informative feedback—on movement biomechanics during a body-weight squat exercise. It was hypothesized that participants would improve movement biomechanics more when they received the real feedback than when they received the sham feedback and that these enhanced, lower-risk movement biomechanics for the rea (open full item for complete abstract)

Committee: Michael Riley Ph.D. (Committee Chair); Adam Kiefer (Committee Member); Michael Richardson Ph.D. (Committee Member); Kevin Shockley Ph.D. (Committee Member) Subjects: Psychology

MS, University of Cincinnati, 2014, Education, Criminal Justice, and Human Services: Health Education

Context: Knee valgus or medial knee displacement during sports with bounding, landing and cutting has been reported as a common risk factor resulting in injury for teenage and adolescent athletic participants. Squatting maneuvers and landing mechanics have been used to evaluate the occurrence of knee valgus displacement. Commonly squat mechanics are used during rapid change in directions and landing from a jump; however, the occurrence of knee valgus in pre-pubertal adolescents has not been evaluated. Objective: To investigate the difference in observed knee valgus displacement during an overhead squat and the box drop landing maneuver in pre-pubertal adolescent males and females. Design: Prospective cohort study. Setting: Laboratory. Patients or Other Participants: Sixty-two elementary school students, with a mean age= 9.32, height= 54.38cm, and weight= 79.04lbs for males and a mean age= 9.37, height= 53.80cm, and weight= 74.81lbs for females. Intervention(s): Overhead squat and box drop landing maneuver. Main Outcome Measure(s): Visual observation of a frontal plane knee valgus displacement of approximately 10 degrees. Results: A two-tailed independent Student's t-test indicated females have significantly greater occurrence of observed knee valgus defects when compared to males during the squat (P= .008). Overall, females had more than two-times the observed knee valgus defects when compared to males (females= 21, males= 10) and more observed left, right, and bilateral defects; however, a two-tailed independent Student's t-test indicated no significant difference between sexes during the box drop landing maneuver (P= .33). Conclusions: Observed valgus knee displacement was observed in both male and female pre-adolescents. The greater occurrence of knee valgus displacement in females is unexplained. Further research is needed to explore the differences between sexes and the implementation of early interventions targeting knee valgus disp (open full item for complete abstract)

Committee: Bradley Wilson Ph.D. (Committee Chair); Thomas Palmer Ph.D. (Committee Member) Subjects: Biomechanics

Master of Science in Exercise and Health Studies, Miami University, 2012, Exercise and Health Studies

The purpose of this study was to implement a 6-week prophylactic neuromuscular training program prior to the athletes' upcoming competitive season and to experimentally analyze the neuromuscular adaptations elicited by this training during a standardized sidecutting maneuver. Sixteen competitive female athletes aged 15 ¿¿¿¿ 1 year participated in the study. A pre- and post-test was performed within 1-week of the start and end of the intervention, respectively. Neuromuscular activity at the knee joint and initial ground contact time (IC) were recorded using surface electromyography (EMG) and footswitches, respectively. Neuromuscular activity was obtained at 10- and 50-ms time-intervals both before and after IC. Results revealed a significant increase in the neuromuscular activity of the biceps femoris muscle (P < 0.01) 10-ms after IC, while quadriceps activity remained unchanged. In conclusion, the selective increase in the lateral hamstring muscles may reduce the risk of anterior tibial shear force and internal tibial rotation, potentially decreasing non-contact ACL injury risk among female athletes.

Committee: Mark Walsh PhD (Advisor); Rose Marie Ward PhD (Committee Member); William Berg PhD (Committee Member) Subjects: Kinesiology

Master of Arts in Education, Defiance College, 2008, Education

Eight NCAA Division III female collegiate athletes participated in a study pertaining to Anterior Cruciate Ligament (ACL) injury prevention education and student athletes. The purpose of this study was to determine if the implementation of an Anterior Cruciate Ligament (ACL) injury prevention education program pertaining to ACL injuries and injury prevention for female athletes at a NCAA Division III college would increase their knowledge of ACL injuries and prevention. The data confirmed that there was an increase in ACL knowledge among the female athletes (participants) following the ACL injury prevention education program.

Committee: Jo Ann Burkhardt (Advisor) Subjects: Sports Medicine