Low back pain is a common but severe health problem. Chronic low back pain accounts for the bulk of the burden of low back pain. Exercise interventions are effective in the management of chronic low back pain. Current clinical thinking in physical therapy treats low back pain as a heterogeneous entity seeking to match specific interventions to subpopulations. None of these subgroups assess the role of gluteus medius dysfunction in chronic low back pain. These projects seek to describe the prevalence of gluteus medius weakness in people with chronic low back pain and test the effectiveness of a gluteus medius strengthening exercise intervention in people with chronic low back pain. Gluteus medius strength was assessed in 150 people seeking care for chronic low back pain and 75 healthy people without low back pain. Gluteus medius was found to be weaker on affected sides compared to unaffected sides within people with chronic low back pain and weaker than people without low back pain. Gluteus medius weakness was a strong predictor of the presence of low back pain. A gluteus medius strengthening program was compared with lumbar stabilization exercises in 56 people with chronic low back pain. Although there was a clinically significant improvement in pain in people who performed the gluteus medius strengthening exercise program, this was not significantly different from the stabilization exercise intervention. Adherence to exercise was significantly correlated with reduction in pain and perceived improvement of low back pain. Although gluteus medius weakness is common in people with low back pain and treating this weakness with a targeted exercise intervention is effective, it is not better than a standard stabilization exercise intervention. Doing exercise is likely more important than what exercise is done.

Injury occurs when people are exposed to an unexpected event. There is a knowledge gap regarding whether people can learn to respond to unexpected events and whether this learning is moderated by age, physical activity level, cognitive function, and motor cortical excitability. The purpose of this research was to examine the influence of: 1) age, 2) physical activity, 3) cognitive function, and 4) motor cortical excitability on motor performance and learning during a novel visual motor task of the wrist. The major outcomes of this research revealed that the ability to respond to unexpected events is reduced with age; however, with practice, older people retain the capacity to learn to respond to unexpected events. This work also demonstrates that elderly people use both feed-forward and feedback strategies to improve their response to unexpected events. Conversely, young people predominantly use a feed-forward strategy to improve their ability to respond to an unexpected event. Importantly, active older people show greater capacity to respond to unexpected events and to learn to improve responses than less active older people. Older people with higher cognitive function demonstrate a greater capacity to respond to unexpected events than those with lower cognitive function. Furthermore, merely increasing motor cortex excitability does not translate into improved performance after young people have learned a motor task. Taken together, age, physical activity, and cognitive function impact human performance and the capacity to learn to respond to unexpected events. These findings have important implications as to how to rehabilitate and/or prevent injury to unexpected events in older people.

Approximately 20% of the general population is affected by a vestibular disorder. Vestibular dysfunction is recognized as an important intrinsic factor leading to falls. Despite research on balance strategies with platform perturbations, limited information exists on neuromuscular performance of the knee with perturbations during functional tasks. Improved understanding of the effects of BVL on neuromuscular control of the knee will aid researchers and clinicians in developing rehabilitation programs that address the adaptations and balance deficits that occur with vestibular loss. Hence, the main purpose was to examine accuracy of performance, knee muscle activation patterns and long latency responses in response to unexpected perturbations during a controlled single leg squat in healthy individuals and those with bilateral vestibular loss (BVL). The first study provided information about the ability to improve performance accuracy with perturbations based on the feedback available. It also showed concomitant changes in the LLR of quadriceps muscles with learning. In the second study, it was found that competent subjects with BVL show similar performance accuracy as healthy individuals during the SLS, with the exception of endpoint error. Muscle strategies are slightly different and vary on firm and foam surfaces. A significant finding was that the LLR is reduced in this group in response to unexpected perturbations, especially when visual feedback is absent. Rehabilitation and/or time living with bilateral vestibular deficiency can lead to a reorganization of the central nervous system, which may partly explain the alterations in neuromuscular control. More research is needed to determine the relationship between the long latency response and fall risk and if different training dosages with perturbations affect these in both healthy and vestibular-deficient populations.

A paucity of research exists in the strength training and aging literature. Hettinger (1958) reported that strength declined with age and that older persons gained less with strength training than younger persons. This study altered Hettinger's design by using a different muscle and a different strengthening routine. The purpose of this study was to compare the effects of isometric strength training of the non-dominant left abductor digiti minimi muscles of young subjects and old subjects. The ten young female subjects, mean age 22.6 years, were all nursing students. The ten older female subjects, mean age 69.2 years, did not constitute a similar homogeneous group; although they all lived in the metropolitan area of Richmond, Virginia. All subjects were volunteers. Training consisted of each subject performing twenty maximal isometric contractions of the left abductor digiti minimi three times weekly for six weeks. A pretest and six weekly measurements of strength were made on a strain gauge. The results of this study are not in agreement with Hettinger's findings. Significant strength increases were found for the pretest-post-test measurements within each group at the same P < .0001 level. However, when the young and older groups were compared on the initial strength measurements, no statistically significant differences were found. Therefore the null hypotheses were accepted.

Currently there is no model of the development of reading skills currently exists for children with hearing impairments. Using the framework of a commonly excepted model of reading for children with typical hearing researchers have sought to determine how children with hearing impairments develop reading skills. The purpose of this is study was to examine a possible link between two components of reading development, speech reading and language. Participants consisted of 5 school aged children with severe to profound hearing loss with cochlear implants or hearing aids. These children were administered the CELF-4 and a department created speech reading test. Results indicated that children with poor language scores had the best speech reading scores while the child with good language scores had poor speech reading score. Performance on tasks examining syntax proved to be crucial to performance on speech reading tasks.

The purpose of this study was twofold: 1) To determine what type of early intervention for stuttering is being offered in the public schools and compare those interventions to the Lidcombe Program for early stuttering. 2) To find out if the Lidcombe Program can be effectively implemented in the public schools. A small focus group of speech language pathologists was conducted and a questionnaire was completed by 47 school speech language pathologists in Knoxville, TN. The questionnaire revealed that school clinicians have very little familiarity with the Lidcombe Program, most do not use any particular evidenced-based programs for fluency intervention, parents have very limited roles in the treatment of preschool students who stutter, and most children are not being identified for services until approximately third grade. In order to determine if the Lidcombe program could be implemented effectively in the schools, one treatment subject, female, 4;5, received Lidcombe treatment for 10 weeks at her school while a control subject, male, 5;3, received traditional therapy from his school SLP. The treatment subject decreased in severity from moderate to mild and her percent stuttered syllables (PSS) was reduced by 76% (from 25% to 6%). The control subject increased in severity from moderate-severe to severe and his PSS rose from 12% to 16%. As a result, it appears that the Lidcombe Program can be effectively implemented in the public schools and it would be extremely cost-effective for schools to use the program. Community education and SLP training, however, are essential to increase early identification and intervention of children who stutter.

The purposes of this study were to investigate the kinematics of two ankle brace testing protocols. They were drop landing on a slanted surface and the inversion drop test. Difference in kinematics and ground reaction forces of drop landing wearing an ankle brace on flat and lateral slant surfaces were also investigated. Eleven healthy subjects performed five trials in each of six dynamic movement conditions. They were an ankle inversion drop test on the inversion platform, drop landing from 0.45 m onto slant surface, and drop landing from 0.45 m onto flat surface with and without an ankle brace. A 7-camera motion analysis system was used to obtain the threedimensional kinematics. In addition, a force platform was used to measure the ground reaction forces (GRF) during drop landing. A 2 × 2 (brace × movement) repeated measures ANOVA was used to evaluate selected variables for inversion drop test and landing on slant surface (p < 0.05). In addition, the differences between landing on the flat and slant surfaces were examined using a 2 × 2 (brace × surface) repeated measures ANOVA. The results showed that the slant surface landing resulted in significantly earlier maximum inversion angle occurrence. Significantly higher maximum eversion and inversion velocities were also found in the slant surface landing compared to the inversion drop. In the comparison of landing on the slant surface and flat surfaces, the results showed that slant surface landing led to smaller 1stand 2ndpeak vertical and horizontal GRFs, greater maximum inversion and its range of motion (ROM), and smaller dorsiflexion ROM. The results suggest that the slant surface landing simulate ankle sprain mechanism better than the inversion drop test. Subjects adopted a softer landing strategy when landing onto the flat surface and a stiffer strategy when landing onto the slanted surface.

Currently there is no model of the development of reading skills currently exists for children with hearing impairments. Using the framework of a commonly excepted model of reading for children with typical hearing researchers have sought to determine how children with hearing impairments develop reading skills. The purpose of this is study was to examine a possible link between two components of reading development, speech reading and language. Participants consisted of 5 school aged children with severe to profound hearing loss with cochlear implants or hearing aids. These children were administered the CELF-4 and a department created speech reading test. Results indicated that children with poor language scores had the best speech reading scores while the child with good language scores had poor speech reading score. Performance on tasks examining syntax proved to be crucial to performance on speech reading tasks.

Patient compliance is a fundamental component of rehabilitation therapy of which the ultimate goal is improved recovery outcome. Without compliance to the treatment regimen, the expected outcomes cannot be achieved. Many factors can influence a patient's level of compliance, such as demographics, psychology, environment, attitude, and patient-provider relationships. Identifiable barriers to compliance need to be assessed prior to the onset of a therapeutic program to optimize compliance and achieve positive recovery outcomes. A reduction in these barriers along with an increase in motivation results in positive compliance and recovery outcomes. A variety of rehabilitation modalities reveal that compliance spans all areas of therapy and should not be limited to one specific regimen. The evidence provided in this study would be useful for rehabilitation therapists in determining the appropriate therapy regimen to prescribe in order to help their patients improve their compliance rates and achieve optimal recovery outcomes.

The purpose of this study was to discover attitudes and knowledge of four healthcare student groups toward occupational therapy in Iceland. A fact-sheet identifying philosophy, theoretical background, skills roles and occupational therapy working areas was developed. Pre-test and post-test questionnaires were used to measure any attitude and knowledge changes which might have occurred after reading the fact-sheet. The results demonstrated that the four student groups had obtained knowledge about occupational therapy during their university experiences; either from in class information or from field trips to occupational therapy departments. The questionnaire results indicated that students' attitudes toward cooperation with occupational therapists was positive. The overall outcome indicated that as a result of information gained from the fact-sheet, significant attitude and knowledge changes were demonstrated among the four student groups about occupational therapy in Iceland.