Doctor of Philosophy, Case Western Reserve University, 0, Nursing

One in six children in the United States have developmental disabilities, and infants and toddlers may exhibit telling symptoms of delay in their earliest days with a failure to master milestone benchmarks. Despite modest gains in developmental screening rates, less than one in five children with a known delay will receive developmental enrichment services via the federal Early Intervention service line or special education preschool programs, and those remaining are left to struggle with their undiagnosed and untreated delays until they are identified upon entering kindergarten. This research aimed to uncover quantitative data patterns in the diagnosis and treatment of young children with developmental delays. Using predictive modeling techniques, the findings add to related research evidence for future interventions to increase timely conversions of delay diagnosis to treatment utilization. This work is underpinned by a developmental adaptation of Ryan and Sawin's Individual and Family Self-Management Theory (2014), exploring contextual and family management processes leading to service utilization outcomes. Sourcing data from the National Survey of Children's Health (NSCH 2018-2021), three research questions aided in identifying the demographic and social factor clusters of children with undiagnosed and/or untreated delays within the developmental screening, diagnosis of delay, and developmental service utilization trajectory. Indicators of medical care access, including sick care sources and recent preventive visits, and children's special health care needs, including the impact of conditions on the child's daily life, were key indicators in resulting models. However, all created classification and regression tree (CART) and random forest models had varying levels of predictive ability from low-moderate (developmental screening) to high (developmentally related diagnosis and service utilization) predictive ability, with areas under the curve ranging between 0.56 (open full item for complete abstract)

Doctor of Philosophy in Health Sciences, Youngstown State University, 2024, Department of Graduate Studies in Health and Rehabilitation Sciences

This dissertation investigates the efficacy and real-world implementation of high-intensity locomotor training (HIT) for stroke patients during inpatient rehabilitation. The project was guided by three specific aims: (1) to evaluate the strength of the evidence supporting HIT for improving ambulation outcomes, (2) to determine whether clinicians can replicate these results in a real-world setting, and (3) to identify the barriers and facilitators to implementing HIT in inpatient rehabilitation facilities (IRFs) across the United States. The first study, a systematic review, confirmed that HIT is more effective than usual care in improving gait speed and endurance at discharge for patients with stroke, with moderate effect sizes on meta-analysis. The second study, a retrospective analysis of a clinician-initiated HIT project, revealed challenges in replicating these outcomes in a real world setting, possibly due to low implementation fidelity suggesting that a minimum threshold of fidelity may be necessary to see unit-wide improvements. The third study used a Delphi survey approach to explore the experiences of clinicians implementing HIT in IRFs. While several facilitators to HIT adoption were identified, a notable barrier was insufficient time, consistent with barriers to evidence-based practice reported in other rehabilitation disciplines. Despite favorable conditions, less than half of surveyed clinicians reported using HIT daily, indicating ongoing challenges. HIT is an effective intervention for improving walking ability in patients post-stroke during inpatient rehabilitation. Future research should focus on addressing key barriers, exploring optimal dosing strategies and fidelity targets, and developing interdisciplinary approaches to increase the widespread adoption of HIT across the continuum of care in stroke rehabilitation.

Master of Science, The Ohio State University, 2024, Health and Rehabilitation Sciences

Background: Individuals with Huntington's disease (HD) with balance and gait impairments experience falls, which often leads to injuries and reduced quality of life. Therefore, clinicians need to identify individuals who are at risk of falling to prescribe appropriate fall prevention strategies. Objectives: This study investigated the ability of a variety of clinical balance and gait assessments to differentiate between fallers and non-fallers and the accuracy of each assessment to determine fall risk. Methods: Thirty-three individuals with diagnosed HD were recruited for the study (18 retrospectively identified fallers and 15 non-fallers). Each participant was evaluated with three categories of scales: HD-specific scales (Unified Huntington Disease Rating Scale total motor score [UHDRS-TMS] and UHDRS-TMS balance and gait subitems (i.e., gait, tandem walk, and retropulsion pull test), balance specific scales (Mini Balance Evaluation System Test [Mini-BESTest] and the Activities-Specific Balance Confidence Scale [ABC Scale]), and functional gait scales (Community Balance and Mobility Scale [CBM] and Functional Gait Assessment [FGA]). Results: The discriminant function analysis determined that the best discriminators of faller or non-faller group memberships were the Mini-BESTest, CBM and the UHDRS-TMS balance and gait subitems. Receiver operating characteristic (ROC) curve was used to determine the best fall risk cutoff score. The highest three clinical tests had an area under the curve and a corresponding cut off score as follows: Mini-BESTest (0.774, ≤19/28), CBM (0.761, ≤37/96), and the UHDRS-TMS balance and gait subitems (0.728, ≥4/12). The odds ratio for the Mini-BESTest, CBM, and UHDRS-TMS balance and gait subitems were 7, 10.21, and 11.2, respectively. Using a pretest probability of 54%, and a positive likelihood ratio, the posttest probability changes were Mini-BESTest (73.2%), CBM (84.3%), and the UHDRS-TMS balance and gait subitems (88.6%). Con (open full item for complete abstract)

Master of Science (M.S.), University of Dayton, 2024, Mechanical Engineering

Injuries to the spinal cord can be debilitating to the function of the upper extremity. Many people with spinal cord injuries (SCIs) undergo rigorous therapies to help preserve range of motion and strength. Task specific training has been shown to offer benefits in upper extremity rehabilitation. In recent years, virtual reality has gained popularity for its ability to offer task specific training in an engaging and immersive environment. This study explores therapeutic virtual reality gaming for people with spinal cord injuries. The first aim of the study is to compare the kinematic performance of individuals with spinal cord injuries to healthy controls. This study's second aim is to characterize the qualities of the movement task, such as movement direction and block position, that generate maximum kinematic responses in the SCI group. Finally, the third study aim is to compare the effects of different movement types on overall kinematic performance. Individuals with spinal cord injuries (n=7) and healthy, age-matched, sex-matched controls (n=7) were asked to play Beat Saber in an immersive virtual reality environment. Participants were equipped with upper extremity motion capture markers, virtual reality trackers, and the virtual reality headset/controllers. Custom levels were created in Beat Saber that had different movement directions (UP, DOWN, IN, OUT) and different block positions (HIGH, LOW, MED, LAT). Trials were composed of either movements with one hand (UNI), movements mirrored about the midline (MIR), or movements in opposing directions about the midline (OPP). Participants completed six randomized trials, repeating each of these movement types twice. Results showed that the joint profiles of the participants with SCIs used less overall shoulder and elbow joint motion to accomplish the tasks, compared to the healthy controls. At the wrist, SCI participants were able to use comparable or greater wrist radial/ulnar deviation than the controls. SCI parti (open full item for complete abstract)

Master of Science (M.S.), University of Dayton, 2024, Mechanical Engineering

Posturography provides insight into balance and postural stability but has little evidence of its effectiveness in its ability to predict falls, an event that happens to over 25% of senior adults each year. Analysis of transient responses within force plate center of pressure (COP) data and inertial measurement unit (IMU) acceleration data could increase the effectiveness of posturography in predicting senior fallers. Fifty adults aged 60 or older volunteered to participate in a balance assessment wherein three perturbations (cognitive, visual, and weight shift) were tested, and the response collected. Typical balance COP metrics such as sway range in addition to the transient metrics of ellipse area, mean velocity, and root mean squared (RMS) were calculated. While there were no significant differences observed between fallers and non-fallers, the data showed a promising effect of the transient analysis in that fallers generally exhibited higher values in the calculated metrics, as expected. Additionally, strong correlations were observed between the IMU and force plate. A larger sample size may provide a more comprehensive investigation of the effect of transient balance in identifying and predicting fallers in senior adults.

Doctor of Education (Ed.D.), University of Findlay, 2024, Education

Background and Purpose: Physical therapy (PT) student academic and clinical success is dependent on their ability to develop clinical reasoning in the first year, especially prior to the first clinical education experience. However, literature has revealed a very low ability of learners to spontaneously transfer basic science knowledge into clinical reasoning. The purpose of this study was to examine entry-level PT student critical thinking ability and understanding of clinical reasoning concepts, study methods, and testing strategies to improve student clinical reasoning. Participants: Study participants included 19 incoming PT students, mean age of 21.3 years, 57.9% female and 100% Caucasian. A focus group determined 11 of the 19 participants were able to provide acceptable definitions of clinical reasoning and thus appropriate for participation in the phenomenological interview regarding clinical reasoning perceptions. Methods: This mixed-methods study utilized the California Critical Thinking Skills Test (CCTST) to quantify student critical thinking ability. The number of correct responses formed a composite overall score for the entire test and in each of the areas of critical thinking. The composite score was also accompanied by a qualitative rating: Superior (86-100), Strong (79-85), Moderate (70-78), Weak (63-69), or Not Manifested (50-62). Student perceptions of clinical reasoning were gathered via focus group and interviews. Interviews were conducted with 11 eligible students and response saturation was achieved. Interviews were transcribed and codes developed using the MAXQDA data analysis software. Interpretation of the codes developed themes used to answer the research questions. Results: Entry-level incoming PT students displayed overall moderate critical thinking abilities. Additionally, students were able to provide acceptable definitions of clinical reasoning but were largely unaware of Bloom's taxonomy, students understand clinical reasoni (open full item for complete abstract)

MS, Kent State University, 2024, College of Arts and Sciences / Department of Computer Science

The purpose of this thesis is to develop a series of a game interfaces to help in upper limb rehabilitation for individuals suffering with Parkinson's Disease. Parkinson's Disease affects more than 10 million people worldwide. The games incorporate haptic feedback as a more engaging way of encouraging individuals to perform motor tasks. A haptic stylus pen will be used as the main method of interacting with the game interface and the main means of providing resisting force during the tasks, and the use of a virtual reality headset as a means of making the game experience more engaging and immersive. Validating the usability and efficacy of the game system towards upper limb rehabilitation by using data collected from participants of the prototype using three designed games: fishing, archery, and mining. For data collected with the prototype system, both healthy and Parkinson's Disease participants were asked to complete predefined task sessions and provide the usability ratings using a NASA Task Load Index after the sessions. Participants' skills and efficacy were assessed using task specific data (task completion time, hand motion tracking, task score within time limit, etc.) and were automatically recorded in the system for each session. The collected data will be used to improve or refine the game rehabilitation system and analysis the systems efficacy, usability, and potential for a comparable alternative to traditional Parkinson's rehabilitation. Both healthy and Parkinson's participants data have been analyzed and compared with one another and each other to find meaning full discussions and results to better improve the system and rehabilitation process, such as how haptic feedback has affected user performance for both healthy and Parkinson's Disease participants when it comes to completion times, scores, and movement trajectory. This data will be used as the basis of developing a more refined gaming rehabilitation syst (open full item for complete abstract)

Doctor of Philosophy, The Ohio State University, 2024, Health and Rehabilitation Sciences

Frequently referred to as “immobility harm,” reduced mobilization among hospitalized adults is associated with worse patient outcomes, longer length of stay, and additional costs. Significant systemic barriers contribute to low mobility among hospitalized adults and include lack of staff availability, unclear expectations for both patients and clinical staff, and lack of routine physical function assessment. Consequences of immobility harms are myriad and include mobility-related complications such as falls, hospital-acquired pressure injuries (HAPI), and hospital-associated functional decline (HAFD). Despite being considered mostly preventable, these complications are unfortunately common. The purpose of this dissertation is to address the complexities of mobility-related complications within hospital settings using a multifaceted approach that scrutinizes existing practices, examines physical therapy (PT) intervention strategies, and explores innovative solutions. Using a qualitative approach with a thematic analysis technique, chapter 3 identified several themes regarding the perspectives of acute care physical therapists on fall prevention practice in hospitals. Therapists highlighted that although their practice positively supports multidisciplinary mobility promotion and fall prevention efforts, the practice of PT is not central to fall prevention. Critically, participants described that contextual factors often limit fall prevention-focused PT interventions altogether. Instead, practice choices are influenced by the hospital context as therapists strive to maximize their impact despite identified barriers. Chapter 4 involved a quantitative analysis of 7693 hospital episodes in which patients received at least two PT visits. We developed multivariable logistic regression models to examine the relationship between minutes of PT provided and patient functional improvement and discharge disposition. Increasing PT was positively associated with odds of funct (open full item for complete abstract)

Bachelor of Science (BS), Ohio University, 2024, Translational Health

Ankle sprains are one of the most common musculoskeletal injuries in active populations, which can develop into chronic ankle instability (CAI), a condition with uncertain etiology and symptoms that include poor dynamic balance performance. There are biomechanical and psychophysiological components of CAI, indicating that both the body and mind may impact the development and persistence of CAI. Hence, integrative therapies like hypnosis could help with the restoration of functional performance. Purpose: To investigate the relationship between interoceptive awareness and (1a) self-reported ankle instability and (1b) single-limb dynamic balance performance, (2a) kinesiophobia and emotional distress-anxiety with heart rate variability (HRV), and (2b) kinesiophobia and pain self-efficacy with single-limb dynamic balance. In addition, we assessed (3) the impact of a brief hypnosis practice on single-limb dynamic balance. Methods: Twenty-four participants from Ohio University and local community were recruited to participate in this basic experimental study with a randomized crossover design. Participants received an educational video discussing ankle disability and rehabilitation strategies (Ankle Ed) and an audio guided hypnosis (Hypnos) with a 3-day washout period between interventions. Participants were screened for CAI using 2 self-report ankle physical function outcomes - the Identification of Functional Ankle Instability (IdFAI) and Functional Ankle Ability Measure (FAAM). Eligible participants completed 5 additional self-report outcomes for interoceptive awareness (2 self-reports), self-efficacy, emotional distress-anxiety, and kinesiophobia. Baseline resting heart rate variability (HRV) was recorded for each of the 2 lab sessions. Single-limb dynamic balance was assessed with the stability indices derived from the Biodex Stability System (BSS) and Y-Balance Test (YBT) pre- and post-Ankle Ed and Hypnos interventions. Results: No significant relationship exi (open full item for complete abstract)

Doctor of Philosophy, The Ohio State University, 2024, Health and Rehabilitation Sciences

Musculoskeletal disorders represent a significant global health burden, affecting individuals of all ages and leading to substantial disability. However, beyond physical symptoms, musculoskeletal disorders can also have profound psychological implications, both contributing to or resulting from psychological trauma. Despite the interconnectedness of physical and psychological well-being, there remains a gap in the training and practices of physical therapists (PTs) regarding their responsibility and practice involving their patients' psychological trauma. This dissertation addressed this gap through a multi-project approach aimed at understanding and improving the integration of trauma-informed care (TIC) into musculoskeletal physical therapy practice. The first project focused on developing an evidence-based TIC Toolkit tailored for rehabilitation clinicians, including PTs, providing practical guidance for implementing TIC techniques. The toolkit aimed to enhance clinician confidence and competence in responding to the mental health needs of patients (Chapter 3). The second project investigated the attitudes and practices of PTs concerning TIC. By identifying barriers and facilitators to TIC implementation, these findings laid the groundwork for targeted strategies to overcome obstacles and promote effective integration of TIC into clinical practice (Chapter 4). Building on the insights from the survey, the third project employed in-depth interviews with musculoskeletal PTs. These interviews aimed to provide a deeper understanding of the specific challenges and opportunities in implementing TIC, offering rich contextual insights into current practices and barriers faced by PTs (Chapter 5). This work is the first to our knowledge to specifically address the current practices and opportunities for MSK PTs to integrate TIC into their practice. Collectively, these projects contribute to advancing the field of musculoskeletal physical therapy by addressing the critica (open full item for complete abstract)

Specialist in Education (Ed.S.), University of Dayton, 2023, School Psychology

Traumatic Brain Injuries (TBI) can have a devastating impact on victims and their families. Families living in rural communities experience unique barriers to receiving care for complex medical needs. While little research exists surrounding TBI specifically, medical staff, school staff, and caregivers for children with complex medical conditions report a range of barriers and facilitators to coordinating care for their child. The current study explored the experiences of rural caregivers for children with TBI, gaining the insights of caregivers, school staff, and medical professionals who cared for a child with a TBI who transitioned to public school after the injury. Themes included the need to navigate complex situations, support from small communities, isolation and loneliness, differences in experience based on severity of injury, and feelings of hope. Barriers to quality care coordination included navigating complex situations, access to transportation, and lack of communication or education from agencies. Facilitators included support from small communities and interagency communication. Based on information from the interviews, more comprehensive coordination between agencies is recommended, including care coordination that was not limited to that covered by insurance. Implications for practitioners include being cognizant of the difficulties caregivers face, providing flexibility due to transportation barriers, creating more comprehensive care for students with mild TBI, and providing more education.

Doctor of Philosophy, The Ohio State University, 2023, Health and Rehabilitation Sciences

Anterior Cruciate Ligament (ACL) injury is a frequently occurring sports-related knee injury which is surgically remedied with an ACL reconstruction (ACLR). ACL injury and ACLR create a cascade of events which negatively impact an individual's musculoskeletal function, neuromuscular control, and central nervous system (CNS). Individuals undergoing ACLR have immediate deficits in knee related biomechanics which remain unresolved for years. Deficits are noted early during gait and as individual's regain more function are also noted in higher level activities such as jumping, running, cutting, and pivoting. These biomechanics deficits coincide with, but are not always explained by strength deficits, patient reported function, and range of motion limitations. These deficits also have long term consequences with the prevalence of cartilage degeneration and knee osteoarthritis being higher in individuals post-ACLR compared to age and activity matched individuals. The broad array of musculoskeletal deficits noted following ACLR have remained, even with updated clinical practice guidelines leading to investigation of neuromuscular and CNS function. This dissertation strives to illuminate how brain activity is altered after ACLR by investigating connections between the brain and musculoskeletal system. This will be done by systematically reviewing prior literature on ACLR populations who have had their blood oxygen level dependent (BOLD) response evaluated using functional magnetic resonance imaging (fMRI). All peak voxel coordinates from articles included in this review will be entered in activation estimation likelihood (ALE) meta-analysis to determine if any regions are identified as systematically active across all studies (Chapter 3). We will then investigate how BOLD signal is associated with biomechanics during a run to pivot task to determine the neural correlates of knee loading in individuals who were cleared for full activity following ACLR (Chapter 4). Finall (open full item for complete abstract)

Doctor of Philosophy (PhD), Ohio University, 2023, Translational Biomedical Sciences

Anterior cruciate ligament (ACL) rupture is a common and debilitating knee injury occurring in young active populations and can lead to rapid development of osteoarthritis. Most individuals undergo reconstructive surgery to restore the mechanical stability of the joint in an attempt to preserve knee joint health and physical function. Unfortunately, despite reconstructive surgery, individuals demonstrate protracted recovery of postural stability, muscle strength, and other neuromuscular impairments. Rupture of the ACL may be considered a partial deafferentation injury, where the sensory afferents from the joint and ligament are disrupted from the central nervous system. Deafferentation is confounded with pain and joint inflammation, making it difficult to understand what the isolated contribution of joint deafferentation to neuromuscular deficits are. Cross-sectional neuroimaging data suggests that widespread whole brain plasticity occurs after ACL reconstruction (ACL-R). However, the isolated effect of deafferentation to whole brain plasticity or physical performance is unknown. Integrating a novel model for knee joint deafferentation in healthy individuals, our findings suggest that joint afferents may contribute to the resting-state functional connectivity of multisensory integration regions with the whole brain. Additionally, physical function on postural stability in the presence of joint deafferentation may be preserved secondary to differences in resting state functional connectivity. We demonstrate a similar phenomenon in those with ACL-R, where individuals appear to be able to preserve physical function on proprioception and dynamic stability tasks through visual-cognitive 4 function and associated neural activity. Collectively, this work expands the current literature by exploring multisensory integration neuroplasticity after knee joint deafferentation, and associated visual-cognitive compensation strategies. Future work should aim (open full item for complete abstract)

Doctor of Philosophy in Health Sciences, Youngstown State University, 2023, Department of Graduate Studies in Health and Rehabilitation Sciences

Individual values are an integral component of personal identity, guiding attitudes, behaviors, and dispositions and are the foundation for professional values formation in physical therapy. Professional identity formation occurs throughout a physical therapist's academic preparation and career. During this process, introduction to professional values as defined by the Core Values for the Physical Therapist and Physical Therapist Assistant occurs within an educational context. The integration of professional and programmatic values within the framework of individual values yields a complex multidimensional understanding of values and values formation. A scoping review was conducted to understand the existing understanding of values within physical therapy. A survey of physical therapists explored basic human values of physical therapists across the United States. Thematic coding and analysis of Doctorate of Physical Therapy program mission and vision statements was completed to determine the values of academic programs. Findings from the studies within this manuscript suggest that a diverse and changing understanding of values exists within physical therapy with the need for a contemporary perspective on values. Physical therapists embrace values that are others-centric though differences in values exist, and programmatic values center on societal benefit, competence, scholarship, recognition, and excellence. The findings suggest that physical therapists hold values associated with the betterment of others and society while physical therapy programs value their societal impact and the societal influence of their graduates. However, further studies are needed to understand the process of values formation and to create an updated values framework for physical therapy.

Master of Science (M.S.), University of Dayton, 2023, Interdisciplinary Studies

The SARS-CoV2 virus was responsible for the COVID-19 Pandemic, one of the most fatal international public health emergencies experienced in the past century. SARS-CoV2 induces symptoms like increased inflammatory response, severe acute respiratory syndrome (SARS), cognitive dysfunction like brain fog, and cardiovascular defects. Prolonged or long-term infection led to the emergence of Post-COVID-19 Syndrome, or PCS. PCS is characterized by chronic cardiovascular, autoimmune, and neurological manifestations and remains understudied. Individuals with pre-existing neurological insult like those with neuroinflammatory or neurodegenerative diseases are likely more vulnerable to such PCS effects. Furthermore, individuals with pre-existing neurological conditions often have comorbidities like obesity, hypertension, hyperlipidemia, and low activity levels. However, little is understood about the molecular effects of SARS-CoV2 on neuron in both healthy and neuro-compromised individuals. Currently, many individuals experiencing PCS-related neurological symptoms require management of their symptoms even though our knowledge in this area is still limited. Therefore, this study utilized an interdisciplinary approach to better understand how SARS-CoV2 impacts both neurons at a cellular level and clinically in neurologically compromised populations such as Multiple Sclerosis (MS). This interdisciplinary approach sheds light on how translational work is being done where basic science efforts complement efforts made clinically to make connections and identify relationships between observed effects and known science. To do so, SARS-CoV2 proteins were misexpressed in the Drosophila eye and through a forward genetic screen evaluated for changes to cellular structure or function. To corroborate these findings, SARS-CoV2 proteins were also transfected into Neuro-2a cells to assess how these proteins affected cellular functioning. Furthermore, SARS-CoV2 protein structure-function analys (open full item for complete abstract)

Doctor of Philosophy in Health Sciences, Youngstown State University, 2023, Department of Health Professions

Manual Therapy (MT) is a heterogenous, non-pharmacological analgesic treatment approach utilized by healthcare practitioners to manage pain. The utility of MT has been well established; however, developments within the field of MT question how patients should be selected, and by what mechanism(s) MT is providing analgesia. Patient-centered care models emphasize the need to use tailored treatment directed at patients who are most likely to respond. Historically, MT models have utilized clinical exam findings and biomechanics to guide treatment in a ‘patient centered' way, recent literature has suggested biomechanical and technique factors to be less important than previously understood. This prompts a shift towards patient-level factors dictating treatment. Pain phenotyping may use patient characteristics to subgroup individuals in an attempt to identify those who are likely to respond to an intervention. The purpose of this dissertation was to establish the concept of pain phenotyping as a step towards patient centered care within Orthopedic Manual Therapy. The concept of pain phenotyping was introduced across several platforms (digital and print). A scoping review was completed to investigate how patient specific phenotypic variables interact with MT treatment effect. An international Delphi study was completed investigating necessary changes within MT training paradigms based on this progressive knowledge. The results of the studies produced within this dissertation support manual therapies transition from a biomedical model to a patient centered biopsychosocial model for application. Pain phenotyping in orthopaedic manual therapy has enormous potential to improve patient -centered care models. This dissertation framed the concept of pain phenotyping across three different subgrouping methods in several ways and took several steps towards a better understanding of how this concept should influence orthopedic manual therapy clinical practice and research.

Doctor of Philosophy in Health Sciences, Youngstown State University, 2023, Department of Graduate Studies in Health and Rehabilitation Sciences

The guiding question of this dissertation was “What knowledge, skills, and attitudes regarding financial management do physical therapists (PTs) need for entry-level practice and how do they obtain them?” Financial management aspects of clinical practice required for entry-level PTs are not well defined. Additionally, despite a transition from the Master of Physical Therapy degree to the Doctor of Physical Therapy degree in the mid 2000s as a requirement for program accreditation and the constant evolution of healthcare reimbursement, research is sparse about strategies for teaching financial management concepts to ensure students are prepared to effectively navigate this area of practice upon graduation and licensure. This hybrid, three-manuscript dissertation project includes a systematic review of instructional platforms and teaching methods used by professional physical therapist education programs (PTEPs), a retrospective analysis of student performance on Criteria #17 of the American Physical Therapy Association's Physical Therapist Clinical Performance Instrument (PT CPI) for the final terminal clinical education experience, and a survey soliciting the perspectives of PTs on the financial management aspects that are essential for entry-level PTs. The purpose of this multi-study dissertation is to explore educational platforms and strategies used to deliver financial resources management content to students during academic and clinical preparation and to gather data to offer more clarity about the financial management knowledge, skills, and attitudes (KSAs) necessary for entry-level PT practice. Five themes were generated for instructional platforms or teaching strategies addressing financial management KSAs in PTEPs in the systematic review. These themes were: program curriculum/processes (n=2), didactic coursework (n=2), clinical education (n=4), pro- bono clinics (n=7), and service-learning (n=3). Qualitative retrospective analysis of PT CPI #17 identified (open full item for complete abstract)

Doctor of Philosophy in Health Sciences, Youngstown State University, 2022, Department of Graduate Studies in Health and Rehabilitation Sciences

Background: Physical Therapists in the United States can perform Dry Needling (DN) in most states with the legal requirement for the therapist to obtain written and/or verbal informed consent (IC). When consenting patients to DN treatment, it is necessary to inform patients of potential risks of harms.In cases where risks are disclosed as part of IC, patients have potentially shown poor recall which calls into question how best this type of information should be presented. Purpose: To develop a risk of harm statement that can be used on an IC form for DN in both the clinic and research settings to improve patient autonomy and decision making. Research Design and Methods: The Delphi study involved three rounds of questionnaires to gain expert consensus for inclusion of AEs for IC. Inclusion criteria for DN experts included: (1) >= 5 years practice performing DN and one of the following secondary criteria: (a) Certification in DN, (b) Completion of a manual therapy fellowship that included DN training, or (c) >= 1 publication involving the use of DN. Participants rated their level of agreement using a 4-point Likert scale. Consensus was defined as >= 80% agreement or >=70% and < 80% agreement with Median >= 3, Interquartile Range <= 1, and Standard Deviation <= 1. A Nominal Group Technique (NGT) methodology was used to achieve consensus among participants to identify what needs to be included in a risk of harm statement to allow patients understand the true risks. Participants included: policy experts, legal experts, DN experts, and patients who received DN. The NGT session consisted of 5 rounds of idea generation and final consensus voting which lasted for 2 hours. Consensus for inclusion of ideas was defined as >= 80% agreement following 2 rounds of voting. Analysis: In both studies, median, Interquartile range (IQR), standard deviation, and (open full item for complete abstract)

Doctor of Philosophy in Health Sciences, Youngstown State University, 2022, Department of Graduate Studies in Health and Rehabilitation Sciences

Purpose/Significance: Dynamic postural stability is needed for quick change of direction and jumping during sport. Reduced postural stability in athletes is associated with injury. Studies of collegiate athletes show the ability to maintain postural stability is compromised when fatigued. Less is known about fatigue effects in high school athletes. The purpose of this research was to investigate high school athletes to determine if fatigued postural stability declines. Methods: 260 high school (injury free) athletes participating in basketball, baseball/softball, lacrosse, soccer or track were recruited. Postural stability testing occurred using the Lower Quarter Y Balance Test (YBT-LQ) prior to, and after fatigue induced by sport specific training, designed by the team coach during a typical practice session. The YBT-LQ measured reach distances of the moving leg in 3 directions during single leg stance of the non-moving leg using standardized procedures with athletes wearing their sport shoes. Fatigue was defined as a level 14 on the Borg Rating of Perceived Exertion. Findings: Hypothesis testing did not find a reduction in fatigued postural stability except for clinically unimportant change in the anterior direction. Male and female adolescent athletes performed similarly indicating no sex difference in fatigued postural stability. Only lacrosse athletes showed reduced reach distance when fatigued indicating partial support of hypothesis 3. Another outcome of the study is the creation of normative fatigue data for adolescent athletes participating in 6 sports at 7 schools in Ohio. Implication: This study begins to answer the call for population specific normative data sets of postural stability. It also adds to the body of knowledge about fatigue induced postural stability that is age, sex and sport specific. A limitation of this study's findings is the possibility that coach led practice sessions did not induce enough fatigue to effect postural stabil (open full item for complete abstract)

Doctor of Philosophy, The Ohio State University, 2022, Biomedical Engineering

A total knee arthroplasty (TKA) or knee replacement is considered successful to the extent that it relieves the pain caused by knee osteoarthritis (OA). While the aim is to restore function limited by the pain of OA, functional deficits may still persist post-surgery. Anterior Cruciate Ligament (ACL) injuries are a common cause of functional deficit in athletes, and anterior cruciate ligament reconstruction (ACLR) surgery is the surgical intervention to restore function and allow for participation in sport (Warren R Dunn et al. 2013). In the case of both TKA and ACLR, patients' recovery is aimed at restoring function following the surgery. Unfortunately, several complications unique to each patient population beleaguer patients' recovery, even when the normal course of therapy is followed and despite achieving metrics and milestones set forth by physical therapists and guidelines. In the case of TKA, persistent disability, especially performing tasks of daily living like stair-climbing, dissatisfaction, instability, and failure requiring revision are among the outcomes. For patients following ACL reconstruction, complications can include a failure to return to preinjury levels of sport participation, increased risk of a subsequent ACL injury in the ipsilateral or contralateral limb. These complications and issues often manifest clinically within two years of surgery. These problems raise the questions of how current guidelines for rehabilitation, whether it is the length of time spent, the goals and metrics against which we measure patients or even perhaps the way we group and categorize patients, can be reexamined, and updated to improve outcomes and reduce the incidence of these complications. A way to begin to do that is a biomechanical analysis of patients who undergo these surgeries at two years post-surgery to examine what measures of function, namely limb strength, and biomechanics can tell us about the surgery itself or prognosis of outcomes. The works (open full item for complete abstract)