Physical Therapy - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

PHYSICAL THERAPY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Physical Therapy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84166-7 1. Physical Therapy-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on physical therapy. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON PHYSICAL THERAPY.................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Physical Therapy........................................................................... 4 E-Journals: PubMed Central ....................................................................................................... 54 The National Library of Medicine: PubMed ................................................................................ 54 CHAPTER 2. ALTERNATIVE MEDICINE AND PHYSICAL THERAPY ................................................. 97 Overview...................................................................................................................................... 97 The Combined Health Information Database............................................................................... 97 National Center for Complementary and Alternative Medicine.................................................. 98 Additional Web Resources ........................................................................................................... 98 General References ..................................................................................................................... 102 CHAPTER 3. DISSERTATIONS ON PHYSICAL THERAPY ................................................................. 103 Overview.................................................................................................................................... 103 Dissertations on Physical Therapy ............................................................................................ 103 Keeping Current ........................................................................................................................ 115 CHAPTER 4. CLINICAL TRIALS AND PHYSICAL THERAPY ............................................................ 117 Overview.................................................................................................................................... 117 Recent Trials on Physical Therapy ............................................................................................ 117 Keeping Current on Clinical Trials ........................................................................................... 118 CHAPTER 5. PATENTS ON PHYSICAL THERAPY ............................................................................ 121 Overview.................................................................................................................................... 121 Patents on Physical Therapy...................................................................................................... 121 Patent Applications on Physical Therapy.................................................................................. 148 Keeping Current ........................................................................................................................ 162 CHAPTER 6. BOOKS ON PHYSICAL THERAPY ................................................................................ 163 Overview.................................................................................................................................... 163 Book Summaries: Federal Agencies............................................................................................ 163 Book Summaries: Online Booksellers......................................................................................... 164 The National Library of Medicine Book Index ........................................................................... 166 Chapters on Physical Therapy ................................................................................................... 166 CHAPTER 7. MULTIMEDIA ON PHYSICAL THERAPY ..................................................................... 169 Overview.................................................................................................................................... 169 Video Recordings ....................................................................................................................... 169 Bibliography: Multimedia on Physical Therapy ........................................................................ 171 CHAPTER 8. PERIODICALS AND NEWS ON PHYSICAL THERAPY .................................................. 173 Overview.................................................................................................................................... 173 News Services and Press Releases.............................................................................................. 173 Newsletters on Physical Therapy............................................................................................... 175 Newsletter Articles .................................................................................................................... 176 Academic Periodicals covering Physical Therapy ...................................................................... 177 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 179 Overview.................................................................................................................................... 179 U.S. Pharmacopeia..................................................................................................................... 179 Commercial Databases ............................................................................................................... 180 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 185 Overview.................................................................................................................................... 185 NIH Guidelines.......................................................................................................................... 185 NIH Databases........................................................................................................................... 187 Other Commercial Databases..................................................................................................... 191

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APPENDIX B. PATIENT RESOURCES ............................................................................................... 193 Overview.................................................................................................................................... 193 Patient Guideline Sources.......................................................................................................... 193 Finding Associations.................................................................................................................. 200 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 203 Overview.................................................................................................................................... 203 Preparation................................................................................................................................. 203 Finding a Local Medical Library................................................................................................ 203 Medical Libraries in the U.S. and Canada ................................................................................. 203 ONLINE GLOSSARIES................................................................................................................ 209 Online Dictionary Directories ................................................................................................... 209 PHYSICAL THERAPY DICTIONARY ...................................................................................... 211 INDEX .............................................................................................................................................. 265

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with physical therapy is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about physical therapy, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to physical therapy, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on physical therapy. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to physical therapy, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on physical therapy. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON PHYSICAL THERAPY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on physical therapy.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and physical therapy, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “physical therapy” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

The Effects of an AIDS Education Program on the Knowledge and Attitudes of a Physical Therapy Class Source: Physical Therapy; Vol. 73, No. 3. Contact: Daemen College, Department of Physical Therapy, PO Box 789, Amherst, NY, 14226. Summary: This article reports on an investigation to determine the effect of an education unit on entry-level undergraduate physical therapy students knowledge about AIDS, their attitudes towards patients with AIDS, and their willingness to treat patients who have AIDS. The data is analyzed and presented in tables. The results support observations that physical therapy students are not well prepared to treat AIDS patients and they are in need of appropriate discipline-specific AIDS education. The author

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concludes follow-up research, as well as further study of other levels of physical therapy students, measurement of actual practice behaviors, and comparison of different educational interventions is needed. •

Physical Therapy for Management of RA Source: Journal of Musculoskeletal Medicine. 19(9): 352-364. September 2002. Summary: This journal article examines the role of physical therapy and exercise in managing the symptoms of rheumatoid arthritis (RA) and maximizing joint range of motion, endurance, and flexibility. Interventions should be initiated early in the disease course, before structural changes in the joints occur. Patient education helps patients perform exercises independently and adapt to fluctuations in disease activity. The physical therapy examination consists of taking the patient's history, performing a musculoskeletal exam, and assessing range of motion and muscular force. This examination helps determine appropriate interventions based on factors that include the extent and stage of joint impairments and general body conditioning. Goals of therapy during the active phase include reducing pain and maximizing joint range of motion; isometric and gentle range of motion exercises may be used. In the subacute disease stage, range of motion exercises can be increased and combined with flexibility and dynamic exercises such as swimming and aerobics. During inactive disease, patients may add higher-intensity strength and endurance training. 3 figures, 1 table, and 20 references. (AAM).

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How To Manage Low Back Pain: Physical Therapy or Physical Training? Source: Journal of Musculoskeletal Medicine. 18(4): 182-184,187-189. April 2001. Summary: This journal article, the fourth in a special series on evaluation and management of back pain, provides health professionals with an overview of low back pain (LBP) and examines the debate over the effectiveness of physical therapy and physical training in managing it. The causes of LBP often cannot be specifically determined, so current treatment guidelines recommend taking minimal action. In many cases, clinicians suggest simple measures that patients can implement on their own. Which therapeutic approach to take is the subject of debate. One method, physical therapy, includes passive measures and active exercises for controlling pain. Physical training incorporates more specific, self-directed exercises geared to restoring fitness and preventing future symptoms. The lack of a clear distinction between approaches and the lack of well defined goals may lead to ill advised hybrid treatment. Proponents of both treatment methods should recognize the importance of patient response. People who suffer from back pain may benefit from a combination of passive and active modes of treatment. 1 table and 18 references. (AA-M).

Federally Funded Research on Physical Therapy The U.S. Government supports a variety of research studies relating to physical therapy. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable 2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to physical therapy. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore physical therapy. The following is typical of the type of information found when searching the CRISP database for physical therapy: •

Project Title: A BRIDGE BETWEEN THE ACADEMIC AND CLINICAL SETTING: EVI* Principal Investigator & Institution: Craik, Rebecca L.; Associate Professor; Physical Therapy; Arcadia University 450 S Easton Rd Glenside, Pa 19038 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-MAY-2004 Summary: (provided by applicant): A Bridge between the Academic and Clinical Setting: Evidence-based Heatthcare Practice in the Clinic. Healthcare providers routinely make decisions affecting patients in daily care. Traditionally, such decisions have been based on such factors as experiences, intuition, lectures from teachers or colleagues, and findings from the research literature. Evidence-based medicine (EBM), on the other hand, is the integration of best research evidence with clinical expertise and patient values. Information technology makes access to scientific literature more available than ever before, but access to on-line services is still subject to the "digital divide." Obstacles preventing health care providers from using databases such as PubMed or Medline to answer clinical questions include: lack of access to Internet, lack of skills to search databases effectively, and lack of confidence in evaluating research reports, among others. Arcadia University requests a grant that will better prepare undergraduate and graduate students in biology, psychology, and health sciences and also assist fifteen clinical sites to move towards the use of evidence-based medicine in their clinical practices. The program described here will merge the capabilities of the NLM Medline database with subscriptions to peer-reviewed journals so that Arcadia faculty and students and the professional staff at small health care facilities (where our students complete internships or clinical education rounds) may access full-text articles on-line. If funded, the grant will provide substantially improved medical research capabilities for students and faculty in the following graduate programs at Arcadia University: doctorate of physical therapy, master of science in physician assistant studies, master of science in genetic counseling, the master of science in public health, master of science in health education, and master of arts in counseling psychology programs. Undergraduate students and faculty in the psychology and biology departments will also make us of the medical library services. The grant will provide library access and services for clinical staff and students at fifteen smaller hospitals and healthcare institutions in rural and underserved urban locations. The institutions selected provide clinical education opportunities for our physical therapy, physicianassistant studies, and counseling psychology students. Grant-funded activities will include: two years subscription fees for approximately 55 peer-reviewed journals in the Allied Health field to be accessed by clinic sites and Arcadia students, a two-day training session on evidence-based practice, information literacy, and use of Medline database for clinicians from participating sites; a new Dell desktop computer for each participating clinic site dedicated to research, two years of cable Internet service for

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participating sites that don't already have lnternet access, website for cohort of clinic sites and student interns; and a symposium on evidence-based medicine for cohorts from clinic sites. The principal investigator is Rebecca Craik, professor and chair of the Department of Physical Therapy at Arcadia University. The planning team for this grant includes Param Bedi, head of information technology and Ann Ranieri, head of library technical services at Arcadia University. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: A TREATMENT FOR EXCESS MOTOR DISABILITY IN THE AGED Principal Investigator & Institution: Taub, Edward; Professor; Psychology; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 09-DEC-1996; Project End 30-NOV-2003 Summary: Stroke afflicts over 700,000 persons in America every year. There is thus an urgent need to translate unique behavioral techniques shown to have an impact on plasticity of the nervous system into practical evidence-based therapeutic interventions, especially at a time when the duration of treatments has shortened. In this laboratory we have developed on such set of techniques derived from basic research with an8mal and human subjects. Randomized, controlled studies indicate that it can substantially reduce the motor deficit of patients with mild to moderate chronic strokes from the upper two quartiles of motor functioning and can increase their independence over a period of years. The techniques, termed Constrain- Induced (CI) Movement Therapy, involve motor restriction of the less affected upper extremity for a period of two or three weeks while at the same time training the more affected upper limb. This gives rise to massed or repetitive use of the more affected extremity and to a large increase in use-dependent cortical reorganization involving the recruitment of substantial new regions of the brain in the innervation of more-affected extremity movement. One of the main aims of the proposed research is to determine if Cl Therapy can be used with therapeutic success for increasing the amount of real work extremity use in patients with chronic stroke who have a greater level of motor impairment than those previously worked with in this laboratory (i.e., patients who are approximately in the next to lowest quartile of motor functioning). Another aim is to ascertain whether the locus of the lesion and its size as determined by MRI, are factors influencing the extent to which motor function can be recovered through the use of CI Therapy. This prospective, 4-year randomized trial, including 18-month follow-up will use a crossover design. Eight patients with chronic stroke from the next to lowest quartile of motor functioning will be randomly assigned to receive either Cl therapy (40 subjects) or a General Fitness placebo control intervention (40 subjects). Two years after intake the control patients will be crossed over to receive Cl Therapy. Primary outcome measures will be a laboratory motor function test and amount of extremity use in the real world setting. Changes in psychosocial functioning will also be measured. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ADULT ATTACHMENT AND INTERVENTION EFFICACY WITH PRETERMS Principal Investigator & Institution: Teti, Douglas M.; Professor; Psychology; University of Maryland Balt Co Campus Baltimore, Md 21250 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 31-MAY-2003 Summary: (provided by applicant): Premature birth is a major cause of developmental delay, and the need remains for cost effective, replicable methods to promote

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development in preterm children. Despite the success of first generation interventions, little is understood about why early intervention does not affect all parents and preterms to the same degree. This randomized clinical trial aims to 1) evaluate the efficacy of an integrated, replicable intervention designed to facilitate parent-infant interaction, infant physical development, mental and motor development, and socioemotional development in a group of infants at medical and environmental risk for developmental delay; and 2) explore the role of mothers' and fathers' states of mind with regard to attachment and parents' commitment to the intervention, as moderators of intervention efficacy. The study will recruit 240 urban, single, African-American mothers and fathers of preterm (<37 weeks gestational age), low birthweight (< 2,500 grams at birth) infants admitted to the neonatal intensive care unit. Half of the families will be randomly assigned to an intervention group, and half to a control group. Both groups will be comparable with respect to race, maternal parity, education, income, presence/absence of partner, infant gestational age, infant small-for-date status, and infant gender. The intervention integrates a videotape about preterm infant competencies, serial administrations of the Brazelton Neonatal Behavioral Assessment Scale with increasing parental involvement, and parent-administered infant massage, beginning when infants are 32-to-36 weeks post-conceptual age (PCA) and terminating at 52-to-56 weeks PCA. Intervention efficacy, and the moderating roles of adult attachment and parental commitment to intervention, will be evaluated along dimensions of infant physical, mental, motor, and social development, and parental adjustment and sensitivity to the infant during the first two years. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMELIORATING DISABILITY THROUGH POWER TRAINING Principal Investigator & Institution: Bean, Jonathan; Spaulding Rehabilitation Hospital 125 Nashua St Boston, Ma 02114 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): Limitations in mobility affect almost one in 4 individuals over 65 and have been demonstrated to be predictive of disability and institutionalization. In those most limited, muscular power, the ability to perform muscular work per unit time, is closely associated with the functional tasks that predict disability. Muscular power is a separate attribute from strength declining more precipitously in late life. The preservation of muscular power in late life has been recently identified as high priority for gerontological research. The candidate in this application is a physiatrist, a clinician researcher with a Masters in Exercise Physiology, who specializes in geriatric rehabilitation. It is the applicant's goal to evaluate the influence of eight Vest Exercise a form of muscle power training (MPT) on functional loss in mobility limited elders. Through pilot studies in elders with mobility limitations, the applicant and his collaborators have demonstrated the close relationship between lower extremity muscular power and important tasks of functional performance. Additionally, pilot studies have shown that MPT is not only safe, but also more potent than strength training at correcting lower extremity motor impairments. Lastly, the applicant is investigating the potential of Weighted Vest Exercise, having preliminary results demonstrating its effectiveness. This award is framed around the following activities: 1) conducting a pilot intervention trial utilizing weighted vest exercise, a potential home-based type of MPT in elders with significant mobility limitations; 2) enhance my career development plan through continued involvement as co-investigator in an RO1 studying closely related issues; 3) completing studies in clinical trial methodology and utilizing these previous experiences as the basis for a randomized

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controlled trial, that is appropriately powered to evaluate the influence of non-machine based MPT on all disablement outcomes, including disability; and 4) develop the skills, expertise and experience to become a successful independent clinician scientist within the field of geriatric rehabilitation. This proposal contains a strong environment and mentorship plan containing leading institutions and individuals from the fields of Aging and Rehabilitation. It will provide important insights into exercise's role in preserving late life functioning. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMPHETAMINE ENHANCED STROKE RECOVERY--BURKE SRCI GROUP Principal Investigator & Institution: Goldstein, Larry B.; Professor Medicine; Medicine; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 30-JUN-2003 Summary: This is a "Pilot Grant" which proposes to collect preliminary data in order to help in the design of a full scale clinical trail testing the efficacy of amphetamine in conjunction with physical therapy to facilitate motor recovery after stroke. This clinical study will incorporate five sites including, Duke University, Burke Rehabilitation Hospital, Helen Hayes Hospital, Wake Forest University and Washington University. Under the direction of Dr. Goldstein, this pilot proposal is designed to refine the amphetamine-physical therapy as well as the targeted patient population. In addition, the proposed work will help in the estimation for appropriate sample size, refine outcome measures, monitoring techniques, patient protocols and data management procedures. Finally, the completion of this pilot study would result in data addressing the efficacy of this treatment strategy. Patients will be randomized for either amphetamine or placebo during 10-30 days after stroke. The initial design will incorporate a treatment of 10-mg d-amphetamine or placebo combined with a one-hour physical therapy session beginning one hour after drug/placebo administration every 4 days for a total of 6 sessions. Analyzing the first 65 patients, a second cohort of patients will then be entered into a different regimen depending on whether the first regimen suggests a benefit of this combined therapy. If the data are supported, the second regiment will consist of 10 mg of d-amphetamine or placebo combined with a one-hour physical therapy session as in the first regimen, but the interval between treatments will be decreased to very 2 days. If the initial data is not supportive, the second regimen will consist of treatments with 10 mg of d-amphetamine or placebo combined with a onehour physical therapy session beginning one hour after drug/placebo administration every 4 days. However the treatment duration will be increased to a total of 10 sessions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BODY WEIGHT SUPPORTED AMBULATION TRAINING AFTER SCI Principal Investigator & Institution: Calancie, Blair M.; Professor; Neurosurgery; Upstate Medical University Research Administration Syracuse, Ny 13210 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 30-NOV-2004 Summary: Fundamental strategies first adopted in major centers 20 years ago for the physical rehabilitation of persons with sub-acute or chronic spinal cord injury (SCI) have changed little since that time. One novel method of gait rehabilitation involves the use of an overhead support point and a harness. This body weight support' (BWS) strategy has been combined with treadmill-based gait training in several centers throughout the world, with what are claimed to be dramatic results; we also have seen

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marked improvement in function in our subjects trained in this manner from preliminary studies. It is speculated that this form of training may enhance output of a 'central pattern generator' of stepping movement from circuitry intrinsic to the subject's spinal cord. However, published studies of this type have been limited in their ability to form strong conclusions due to small sample size, inadequate control interventions, and/or limited outcome measures. In particular, only limited attention has been paid to the role that training-induced physical conditioning might play in mediating the functional improvements reported. This study will address these weaknesses to determine whether BWS-gait training is more effective than conventional rehabilitation therapy in improving functional gait in person's with neurologically-incomplete spinal cord injury. Two populations will be studied: persons with chronic SCI (greater than 1 year post-injury), and persons with sub-acute SCI (2 - 8 months post-injury). For the chronic SCI study, subjects will be randomly assigned to one of 3 groups: body weight support and treadmill-based training, body weight support and overground training, and conventional rehabilitation therapy. This design allows us to directly compare whether treadmill-based training, and its inherent advantage of providing highlyrhythmic input to the subject's legs, is superior to overground-based training, and its inherent advantage of allowing use of assistive devices, thereby replicating a more 'natural' training condition. Training sessions will typically last up to 1 hour/session, at a frequency of 3 sessions per week for a 13 week period. Persons with sub-acute injury will be randomized to receive either BWS-treadmill training, or conventional rehabilitation. All subjects will be evaluated with a battery of functional, metabolic and neurophysiologic measures prior to the onset of training, and during the week after training has been completed. The primary outcome measure will be average maximum overground walking velocity without body weight support but with the use of passive assistive devices. Secondary measures will concentrate on function (balance, mobility), fitness (work capacity, strength, gait efficiency), and spinal cord neurophysiology (motor conduction, reflex excitability). These studies will allow us to determine whether the functional improvements associated with BWS-based training are due to neurologic adaptation within the spinal cord, or reflect an increased work capacity secondary to fitness training; both possibilities have important implications with respect to optimizing therapy for persons with spinal cord injury. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BRAIN AND BEHAVIOR CORRELATES OF ARM REHABILITATION Principal Investigator & Institution: Winstein, Carolee J.; Associate Professor; Biokinesiology & Phys Therapy; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, Ca 90033 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 30-JUN-2005 Summary: (provided by applicant): Of all impairments that result from brain stroke, perhaps the most serious and most needing of rehabilitation effectiveness studies is hemiparesis of the upper extremity. Overall, this proposal will use 3-D behavioral kinematics and MRI neuroimaging techniques to examine the motor control and cerebral activity changes associated with constraint-induced (CI) movement therapy for patients with sub-acute stroke who are between 3 and 6 months post stroke. This is a companion study to the previously funded multi-center randomized clinical trial (H D37606-01), Extremity Constraint-Induced Therapy Evaluation (EXCITE). This project complements EXCITE by probing the neurobiological and behavioral mechanisms underlying this clinical intervention in stroke rehabilitation. The specific aims are to: 1) determine the relationship between lesion size and location, residual hand capability,

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and responsiveness to CI therapy; 2) determine the effects of CI therapy on the motor control of reaching and grasping actions; 3) determine the effects of Cl therapy on the cortical sensorimotor neural network associated with the planning and execution of goal-directed wrist and grasping actions; and 4) determine the persistence and or stability of these changes in motor control, brain activity, and functional outcomes one year later as a consequence of Cl therapy. Expected changes in sensorimotor area activation (learning-dependent neural plasticity) and motor behavior associated with two weeks of intensive practice of the impaired upper extremity in combination with restraint of the less affected upper extremity in stroke patients (n = 14) who meet the EXCITE inclusion criteria will be determined by comparison with that of a delayedintervention stroke group (n = 14) who will receive "usual and customary" care. This comparison will allow the direct effects of "forced use" to be exposed at both the neurobiological (brain activity) and behavioral (motor performance and function) levels while controlling for spontaneous recovery processes and those achieved through standard post-stroke physical rehabilitation methods. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BUILDING LIFE SKILLS IN CHILDREN WITH CYSTIC FIBROSIS Principal Investigator & Institution: Christian, Becky J.; None; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 01-MAR-1998; Project End 30-NOV-2002 Summary: (Adapted from the Investigator's Abstract): This project will test the effectiveness of an intervention to improve psychosocial adjustment and functional and physiologic health in children (8 to 12 years) with cystic fibrosis (CF) by teaching them life skills to manage their chronic illness in their everyday lives. The goal is to help children develop strategies for managing their health status and life experience to maximize their development progress and quality of life. It is hypothesized that at the end of treatment, children who receive the KIDS with CF -- Building Life Skills protocol will show significantly greater improvement in psychosocial adjustment (self-esteem and self-competence, loneliness, impact of illness), functional health (functional disability, treatment adherence), and physiologic health status (pulmonary function and physical growth) over time than those receiving usual CF care. A two-group experimental, repeated measures design will compare children who receive the intervention with those who receive usual care; 116 children will be randomly assigned to the experimental or control groups. Treatment will include social problem-solving training and social skills training delivered in individual and small group sessions over a 5-week time span with 1-week intervals between sessions. At each group session, FEV1, height, and weight will be measured and children will have a brief interview on medication use, performance of chest physical therapy, and physical activity. At baseline assessment, immediately after, and at 3-, 6-, and 9-months after the intervention, children will complete the Self-Perception Profile for Children, Loneliness in Children Scale, Perceived Illness Experience Scale, and Functional Disability Inventory; pulmonary function FEV1, height, and weight will be measured; and a brief interview focusing on medication use, performance of chest physical therapy, and level of physical activity will be conducted. Multivariate ANOVA will be used to compare the pre-intervention equivalence of the study groups. Repeated measures MANOVA will compare each psychosocial, functional, and physiologic health outcome variable for the intervention and control groups. Interview data will be analyzed using content analysis. This life skills intervention should also have applicability for children with other chronic illnesses.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CAN EXERCISE TRAINING REVERSE PHYSICAL FRAILTY? Principal Investigator & Institution: Holloszy, John O.; Professor; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001 Summary: (Adapted from applicant's abstract). The major research focus of this OAIC is on the reduction of physical frailty resulting in a decrease in the risk of loss of independence and nursing home admission. The goals of this intervention study, IS-1, are: a) to determine the extent to which frail women and men over the age of 78 years can respond to exercise training with the cardiovascular, skeletal muscle, and central nervous system adaptations that have been shown to occur in younger individuals; and b) if significant adaptations do occur, to assess whether or not the magnitudes of these adaptations are sufficiently large and functionally important to result in improvements in performance of activities of daily living (ADL), instrumental ADL (IADL), advanced ADL (AADL) and in objective physical performance tests that correlate with the ability to perform IADL and AADL and are predictors of loss of independence, nursing home admission, and short- term mortality. The long-term goal is to obtain information that can be used to design practical, individualized programs of exercise that can be utilized in community settings to prevent or reverse physical frailty and maintain functional independence. The exercise training will have three phases consisting of 3 months of physical therapy exercises, 3 months of weight lifting superimposed on physical therapy exercises, and 3 months of aerobic exercise superimposed on physical therapy and weight lifting exercise. The aims of this research are to determine: a) the effectiveness of physical therapy exercises in improving flexibility, gait, balance, coordination, and strength and in reversing frailty; b) whether frail old people can adapt to weight lifting with significant increases in strength of all major muscle groups, whole body and skeletal muscle protein anabolism, and muscle mass, and a further reduction in frailty; c) whether frail old people can adapt to aerobic exercise training with increases in oxygen uptake capacity with a further decrease in frailty, and to evaluate the mechanisms involved in any increase in oxygen uptake capacity by determining maximal cardiac output, left ventricular stroke volume, and peripheral oxygen extraction; d) whether the exercise training decreases arterial stiffness; e) whether exercise training lowers blood pressure in subjects with mild hypertension; f) whether the exercise increases bone mineral density in the proximal femur, spine, and other regions of the skeleton; g) whether the exercise improves cognitive function and central processing speed; and h) whether the exercise improves quality of life. An important component of this research is to determine the extent to which the graduates from the program maintain improvements in functional capacity. Before discharge from the study, participants will be given individualized exercise prescriptions to follow at home and will be helped to put together home gyms or referred to a convenient exercise facility. Contact with the graduates will maintained by means of monthly phone calls and they will be brought back to the exercise facility once per month for a training session and periodic evaluations of functional capacity, using simple measures such as the standardized Physical Performance Test. Cost-effectiveness and cost-utility analysis will be used to evaluate the relative costs and benefits of the exercise. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CAN HRT AMELIORATE PHYSICAL FRAILTY IN OLD WOMEN? Principal Investigator & Institution: Kohrt, Wendy M.; Professor; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001 Summary: (Adapted from applicant's abstract). The major research focus of the OAIC is on the reduction of physical frailty resulting in a decrease in the risk of loss of independence and nursing home admission. The overall goals of this intervention study, IS-2, are to determine: whether 9 months of hormone replacement therapy (HRT) can bring about a reduction in frailty in physically frail women over 78 years of age; and whether exercise training results in greater improvements in functional capacity as reflected in strength, flexibility, balance, coordination, reaction time, aerobic power, and instrumental activities of daily living (IADL) and advanced ADL (AADL), as well as in muscle mass, cardiovascular function, and bone quantity and quality, in women who have been on HRT than in sex hormone-deficient women. Exercise training will begin after the women have been on HRT for 9 months, and will have three phases, consisting of 3 months of physical therapy exercises, 3 months of weight lifting superimposed on physical therapy exercises, and 3 months of aerobic exercise superimposed on physical therapy and weight lifting exercises. The first goal of IS-2 is to determine whether HRT can reduce frailty. The aims relative to this goal are to determine whether HRT can: a) increase skeletal muscle strength; b) increase capacity for aerobic exercise and improve cardiovascular function; c) increase bone quantity and quality; d) improve cognitive function and central processing speed; e) improve reaction time, balance, coordination, flexibility, and ability to perform IADL and AADL; f) decrease insulin resistance and improve glucose tolerance and plasma lipid and lipoprotein levels; and g) improve quality of life. Relative to the second goal, which is to determine if women who have adapted to 9 months of HRT have an enhanced adaptive response to the exercise program, the investigators will compare the magnitude of the adaptations to exercise plus HRT with the effect of HRT alone and with the effect of exercise alone in the women in IS-1. The specific aims relative to this goal are to determine whether HRT plus exercise is more effective than the exercise program alone or HRT alone in improving: a) flexibility, gait, balance, and coordination; b) strength of all major muscle groups, whole body and skeletal muscle protein anabolism, and muscle mass; c) oxygen uptake capacity; d) arterial elasticity; e) blood pressure in those with mild hypertension; f) bone mineral density in the proximal femur, spine, and other regions of the skeleton; g) cognitive function and central processing speed; and h) candidate of life. The plan is also to investigate mechanisms underlying any improvements in oxygen uptake capacity, muscle strength, blood pressure, and bone mass. Before discharge from the study, participants will be encouraged to continue HRT if there are no contraindications, and will be given individualized exercise prescriptions to follow at home. They will be helped to put together home gyms or referred to a convenient exercise facility. The investigative group will stay in contact with the graduates by means of monthly phone calls, and will bring them back to our exercise facility once per month for a training session and periodic evaluations of functional capacity using simple measures such as the standardized Physical Performance Test. Cost effectiveness and cost-utility analysis will be used to evaluate the relative costs and benefits of HRT and exercise. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CLINICAL MEASURES TO LOWER GENITAL TRACT TRAUMA AT BIRTH Principal Investigator & Institution: Albers, Leah L.; None; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 30-APR-2005 Summary: (provided by applicant): Over 3 million women deliver vaginally each year in the United States, and most experience trauma to the genital tract with birth. This trauma can cause short and long term problems for new mothers, including pain and other functional impairments. Although lowering the rate of childbirth trauma would benefit many women, preventive measures have not been fully explicated. One factor, which may influence rates of childbirth trauma, is the hand maneuvers used by the birth attendant for perineal management late in the second stage of labor (the pushing or expulsive phase). Beyond limiting the routine use of episiotomies, no evidence supports any specific recommendations or perineal management immediately prior to vaginal birth. This study will assess the effects of techniques used by nurse-midwives on rates of spontaneous lacerations to the birth canal. A randomized trial of 1200 low-risk women will compare three strategies on the likelihood of an intact perineum after birth, with control for confounding variables (maternal age and parity, birth position, style of pushing, size and position of baby at birth, length of second stage, and epidural analgesia). The perineal care measures are 1) warm compresses to the perineum, 2) perineal massage with lubricants, and 3) no touching, that is hands off the perineum until crowning and expulsion of the baby. Patients will be recruited in six ambulatory clinics staffed by certified nurse midwives in Albuquerque, NM. Healthy gravidas at term will be randomized in labor. In second stage labor a staff midwife will perform one of the three-perineal management techniques (list above) prior to vaginal birth. After birth all perineal trauma will be documented by physical exam, and other clinical data recorded. Medical records will also be reviewed at hospital discharge and at the 4-6 weeks office visit to identify any complications/ adverse experiences. This study will identify whether any technique is superior for trauma reduction, and will generate evidence to inform the practice of all clinicians who work with childbearing women: nurses, nurse-midwives, family physicians, and obstetricians. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COMBINATION THERAPY FOLLOWING SPINAL CORD INJURY Principal Investigator & Institution: Leasure, J L.; Salk Institute for Biological Studies 10010 N Torrey Pines Rd San Diego, Ca 92037 Timing: Fiscal Year 2001; Project Start 27-SEP-2001 Summary: Much recent research suggests that administration of neurotrophins to injured spinal neurons has beneficial effects on neuronal survival, and can even improve recovery of motor function. In addition, there is a wealth of past research indicating that physical therapy can improve motor function following central nervous system damage, even if such treatment is begun years after the initial injury. Indeed, rehabilitative interventions that target an impaired extremity have been shown to be highly effective in improving the range of ability of that affected limb. It is rare, however, that pharmacological treatment is combined with physical therapy measures, and the combination of neurotrophin administration and targeted physical rehabilitation has not been attempted. It is the goal of this proposal to combine these two strategies that have repeatedly been shown to improve neuroanatomical and behavioral recovery of function. Thus, administration of neurotrophins to the injured

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Physical Therapy

spinal cord will be combined simultaneously with physical rehabilitative measures both immediately after spinal cord injury, as well as during the chronic phase. The results may have clinical relevance, should either the acute or delayed combined approach prove efficacious in improving neuroanatomical outcome and restitution of motor function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONSTRAINT THERAPY FOR HEMIPLEGIA AFTER PEDIATRIC TBI Principal Investigator & Institution: Michaud, Linda J.; Associate Professor; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 45229 Timing: Fiscal Year 2001; Project Start 24-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant): Traumatic brain injury (TBI) is the most common cause of acquired disability in childhood. Children with impairment following moderate to severe injury subsequently show negligible rates of change in motor function after one year. Adults with chronic stroke have demonstrated improvement in motor function years following insult with constraint-induced movement therapy (CI therapy). Neuroimaging correlates of recovered function in adult hemiplegic extremities reveal differences in cortical activation patterns in comparison with normal patterns The objective of this proposal is to organize a research team that will develop a clinical trial of CI therapy in children with hemiplegia persisting more than one year following TBI. The study proposed for development would be prospective, randomized, crossover, and single-blinded, to test the major hypotheses: 1) that changes in motor function in hemiplegic extremities occur at a higher rate, to a greater extent, and with more qualitative improvement following CI therapy, in comparison to traditional physical and occupational therapy and 2) that improvement following CI therapy is accompanied by discernable differences in patterns of cortical activation on functional magnetic resonance imaging. While the emphasis is intended to be focused on forced use of the upper extremity in developing the study, consideration will also be given to developing a component of forced weight shift for the lower extremity. The planning process would include development of the protocols, selection of outcome measures, and methods of statistical analyses. Individual rate-of-change modeling will explored for inclusion in the statistical methods. Additional brain mapping correlates of changes in functional motor activity will be considered for inclusion in the clinical trial, including transcranial magnetic stimulation paradigms. Lessons learned from designing an innovative study to evaluate the effectiveness of rehabilitative intervention in improving motor function after pediatric TBI and the accompanying changes in cortical reorganization may be generalizable to studies of interventions directed toward other domains of dysfunction and in other study populations. Functional MRI offers clear potential to increase our understanding between rehabilitation efforts, functional recovery, and neurological reorganization in ways that could direct the design of future interventions in pediatric rehabilitation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORE--FUNCTIONAL ASSESSMENT Principal Investigator & Institution: Brown, Marybeth; Associate Professor; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001 Summary: (Adapted from applicant's abstract). The major function of this Core (RRC-B) is to support the research of the two intervention studies in this OAIC, as well as that of

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pilot studies supported by the OAIC. A second important function of RRC-B is to train young investigators in geriatrics and gerontology who are interested in research relevant to maintenance of functional independence of the elderly, in the performance of the procedures available within the RRC- B. To the extent that the investigators' time and the resources of the RRC-B permit, the RRC-B will also support other pilot and preliminary studies as well as funded studies in geriatrics and gerontology. Use of the Core will be prioritized on the basis of the relevance of the research to the goal of this OAIC, which is to find effective means of preventing and reversing physical frailty and maintaining functional independence of the elderly. A specific function of RRC-B is to quantitatively assess physical performance capabilities and degree of physical frailty. This will include a physical performance test that correlates with degree of physical frailty and predict loss of independence and nursing home admission, as well as evaluation of range- of-motion, balance, gait, coordination, speed-of-movement, and strength. Another function of RRC-B is to apply physical therapy expertise to the initial evaluation of the volunteers to assist in identifying the functional impairments (e.g., muscle weakness, limited range-of-motion, poor balance, etc.) responsible for the frailty, and any pathological processes (e.g., arthritis, other orthopedic problems, decreased proprioception, etc.) underlying the functional impairments. A third function is to train young investigators in geriatrics and gerontology who are interested in research relevant to maintenance of functional independence of the elderly, in the performance of the functional assessments in RRC-B. This will provide an opportunity for junior faculty, research associates, and master and doctoral students in physical therapy, occupational therapy, exercise science, and other disciplines to gain expertise in the functional assessments of frail elderly that are applicable to their own research in areas relating to maintenance of independence of older people. Performing the functional assessments in RRC-B instead of in each of the intervention studies is intended to increase efficiency by eliminating the need to have personnel trained in the performance of the procedures in each of the studies and by eliminating the need to duplicate equipment. Furthermore, having all the assessments performed by the same physical therapist will enhance data quality by decreasing data variability. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CUSTOMIZED REHABILITATION

ELECTRICAL

STIMULATION

FOR

SCI

Principal Investigator & Institution: Hartman, Eric C.; President; Customkynetics, Inc. Versailles, Ky 40383 Timing: Fiscal Year 2002; Project Start 13-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Exercise for people with SCI can enhance physical fitness and slow secondary complications of SCI. Unfortunately, available exercise equipment is expensive and provides marginal benefits. In this Phase II project, we will continue to develop and evaluate an exercise system for individuals with SCI seeking to improve their physical fitness and/or enable use of a functional electrical stimulation system for standing. The device uses electrical stimulation of lower-extremity musculature to generate a coupled hip/knee bending motion that moves the upper body against gravity. It provides the ability to perform strength and endurance training exercises in a manner that provides graded loading of the lower extremities. It consists of mechanical frame and a multi-channel stimulator with an adaptive controller to generate the desired movement and GRF profiles. The Phase I project demonstrated feasibility by developing a prototype, evaluating it in experiments on human subjects with SCl, and identifying its limitations.The Phase II goals are to move towards Phase Ill

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Physical Therapy

commercialization by:1. Designing and developing an improved device; 2. Evaluating the ability to provide substantial exercise benefits in a clinical setting; 3. Characterizing the biomechanics of the exercise; and 4. Interfacing the device with an implanted electrical stimulation system. 3. characterizing the biomechanics of the exercise; and 4. interfacing the device with an implanted electrical stimulation system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DETERMINANTS (BONE/MUSCLE)

OF

RECOVERY

FROM

HIP

FRACTURE

Principal Investigator & Institution: Magaziner, Jay S.; Professor; Epidemiology and Prev Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001; Project Start 01-JUL-1992; Project End 30-JUN-2002 Summary: Hip fracture represents a major health problem facing the aged; 18-27% die in the year after fracture, and as many as 40% do not return to pre- fracture levels in functional domains involving lower extremities. Changes in bone mineral density (BMD) and muscle mass and strength which are expected to follow the immobility of hip fracture are thought to be key factors in subsequent falls, fractures and disability. The primary aim of the proposed study is to describe the changes in BMD during the year following hip fracture, and to identify potentially modifiable determinants of this change. The potentially modifiable factors of major interest include: time of weight bearing relative to the fracture, timing and intensity and post-fracture and the association between functional recovery in lower extremities and post-fracture changes in BMD and muscle mass and strength. These issues will be addressed through a prospective study of community- dwelling white women, aged 65 and older, entering Union Memorial Hospital with a fresh hip fracture (N-250). BMD and muscle mass and strength will be measured at 3, 10, 60, 180 and 360 days post-fracture. Information on pre-fracture health, functional status and activity level will be obtained. Ambulatory status, physical therapy, functioning/ activity level, medical events, and falls will be monitored for one year. Data will be analyzed using multivariate techniques designed to assess the impact of prefracture functioning/activity level, time to weight bearing, and commencement, duration and frequency of physical therapy on short-and long-term changes in BMD and muscle mass and strength post-fracture. In addition, the effect of changes in BMD and muscle mass and strength on the risk of falling post-fracture will be examined. Analyses will also evaluate the relationship between post-fracture changes in bone and muscle and lower extremity functioning during the post-fracture year. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT OF A MASSED PRACTICE STROKE THERAPY DEVICE Principal Investigator & Institution: Koeneman, James B.; Kinetic Muscles, Inc. 1949 E Broadway Rd Tempe, Az 85282 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2004 Summary: (provided by applicant): Stroke (CVA) is the leading cause of disability in the United States and it is estimated that its prevalence will more than double over the next 50 years. Current stroke therapy is labor-intensive and costly. The United States spends $17 billion taking care of stroke survivors. Recently, concentrated, massed practice therapies have been developed that improve function in CVA patients by reversing the effects of "learned nonuse." The objective of this project is to investigate the feasibility of a device that facilitates the administration of massed practice stroke therapy. The long-

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term objective is to provide a lightweight device for home use that provides motion and biofeedback of desired and undesirable muscle activity. Software controls the function of the device and monitors patient progress and compliance. A pneumatic artificial muscle will be used to provide physical motion. This artificial muscle has many of the properties of human muscle. It is lightweight, flexible and has spring like properties. This project will focuses on treating wrist and finger extensor weakness, however, the concept applies to all areas affected by motor impairment. This Phase I study includes detailed design verification measurements on the device and measures the responses of able bodied test subjects to the treatment protocol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT OF THE GAMECYCLE EXERCISE SYSTEM Principal Investigator & Institution: Boninger, Ronald M.; Three Rivers Holdings, Llc 1826 W Broadway Rd, Ste 43 Mesa, Az 85202 Timing: Fiscal Year 2003; Project Start 15-MAY-2001; Project End 31-AUG-2005 Summary: (provided by applicant): Wheelchair users benefit from exercise through reduced risk of cardiovascular disease, better functioning in the activities of daily living, increased self-esteem, and improved rehabilitation outcomes. Unfortunately, wheelchair users report that the exercise options they have provide little motivation to exercise. There is a need to create environments in which people in wheelchairs are able and motivated to exercise. The GAMECycle addresses this need by merging exercise with videogame playing. In Phase I, lab testing demonstrated that the GAMECycle allows users to maintain target aerobic training levels, and was perceived by users as fun and as likely to enhance their motivation to exercise more frequently. In Phase II, we will further refine the design of the GAMECycle by 1) improving the stability of the system to minimize vibrations even when exercising vigorously, 2) maximizing the user's capabilities within the videogame context and expanding the variety of videogames with which the system is compatible, 3) enhancing the extent to which the system can be modified to meet the needs of the user, and 4) readying the system for commercial production. We will also place the refined prototype in rehab facilities and in the homes of end-users for a four-month trial for more extensive testing and evaluation of the GAMECycle, as compared with a standard arm-ergometer. The design improvements coupled with extensive off-site testing will insure the commercial viability of the GAMECycle, both as a product for individual in-home use, and as a product for institutions interested in better meeting the needs of their clients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DRUG-ENHANCED REHABILITATION IN RECOVERY FROM STROKE Principal Investigator & Institution: Wolf, William A.; Chicago Assn for Research & Educ in Sci Education in Science Hines, Il 60141 Timing: Fiscal Year 2003; Project Start 25-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Stroke occurs in 600,000 U.S. citizens every year and is the leading cause of neurologic disability worldwide. Most stroke victims are left with permanent sensorimotor deficits as the result of ischemia-induced brain damage. Physical therapy (PT) remains the primary strategy to improve recovery, but there is a clear need to improve rehabilitation strategies. Promising investigational studies indicate that the stimulant drug amphetamine (AMPH) can enhance the rate and extent of sensorimotor recovery when paired with PT (AMPH/PT). However, AMPH adjunct

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therapy remains investigational due to concerns over its side effect profile and addiction potential. Alternatives are not available because there is little understanding of the mechanism underlying the clinical benefits of AMPH. The objective of this application is to understand the pharmacology and neurobiological mechanisms underlying AMPH enhancement of PT-aided sensorirnotor recovery following stroke. Our preliminary data indicate that AMPH/PT following brain damage leads to improved motor recovery that is associated with enhanced neurite outgrowth from corticomotor cells. We also demonstrate that AMPH activates cAMP response element binding protein (CREB), a transcription factor involved in neural plasticity and neurite outgrowth via growth factor activation. We will test the hypothesis that AMPH enhances sensorimotor recovery through specific receptor activation that leads to neurite outgrowth and formation of new motor pathways. Aims I and I! will focus on the pharmacology of AMPH. In Aim I we will establish the role of noradrenergic alphal and dopaminergic D1 and D2 receptors in mediating AMPH-enhanced sensorimotor recovery in rats that have received permanent middle cerebral artery occlusion. Motor recovery will be assessed using a battery of sensorimotor tasks. In Aim II we will ascertain whether selective stimulation of alphal, D1 or D2 receptors can emulate AMPH enhancement of sensorimotor recovery. Aim III will establish that recovery of function is associated with neurite outgrowth and determine the origin of this new growth. Aim IV will focus on key signaling molecules modulated by AMPH and which are critical mediators of neuronal plasticity. First, we will determine that drug-enhanced motor recovery is associated with activation of CREB in corticomotor cells. Next we will establish a role for basic fibroblast growth factor in mediating AMPH enhanced recovery of function as well as neurite outgrowth. From Aims I and II we will identify potential drug candidates that can rapidly translate into clinical use. From Aims III and IV we will identify potential targets for future therapy. Together our findings will lead to optimization of pharmacological approaches to enhance functional recovery after stroke. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRAINING

DURATION

AND

TIMING

OF

SUPPORTED

TREADMILL

Principal Investigator & Institution: Duncan, Pamela W.; Professor; Health Services Administration; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Body-weight supported treadmill training (BWSTT) is one therapeutic modality for locomotor training that is rapidly being adopted into physical rehabilitation to improve walking after stroke. While there is preliminary support for the efficacy of this therapeutic modality, the optimal intensity, frequency, and duration for this intervention is not known. There is lack of evidence concerning when delivery of this intervention is most effective post-stroke (e.g. sub-acute: 6 months post-stroke). The primary aim of this clinical trial planning grant is to organize an effective research team and develop the elements essential for conducting a successful randomized clinical trial (RCT) of BWSTT in individuals post-stroke. The proposed clinical trial of BWSTT will be designed to assess: (1) the optimal treatment duration (12 vs. 24 training sessions), (2) the timing of treatment delivery (1 - 3 months post-stroke vs. > 6 months post-stroke), and (3) the effects of severity of locomotor impairments. There are many essential components for the successful implementation of this RCT. Specifically, this planning grant will (1) identify additional collaborators, (2) develop (a) the experimental design and (b) the intervention protocols, (3) select and establish protocols for assessing the primary and secondary outcome measures, (4a) determine

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the effect size and power needed for clinically meaningful results and (4b) establish an analysis plan, (5) develop a data coordination/management team, (6) assess the feasibility of subject recruitment strategies, (7) select exclusion and inclusion criteria, (8) develop methods to characterize competing interventions, (9) develop a training program to assure that the intervention is replicable across sites, (10) select sites for the RCT and attain Institutional Review Board approval, and (11) develop administrative operations to manage the RCT. The clinical trial planning grant will result in an organized and well-prepared research team ready to conduct an effective RCT of duration and timing of BWSTT and the effect of severity of locomotor impairment on outcomes. The long-term objective is to improve the ability to walk in individuals following stroke by providing clinical practice guidelines, based on scientific evidence, for the optimal use of BWSTT in rehabilitation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFICACY OF ACUPUNCTURE WITH PT FOR KNEE OSTEOARTHRITIS Principal Investigator & Institution: Farrar, John T.; Senior Scholar; Biostatistics and Epidemiology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 15-JUL-2001; Project End 31-MAR-2006 Summary: Acupuncture is an ancient Chinese technique of using a fine needle to stimulate points along theoretical meridians of energy to correct imbalances thought to be responsible for specific disease states. In the United States, acupuncture is often used for the treatment of painful conditions. The 1997 NIH Consensus Conference concluded that there was adequate evidence of efficacy in an acute dental pain model and in nausea. In chronic pain, most studies were too small, poorly designed, poorly executed, or improperly controlled to adequately demonstrate that needle acupuncture worked better than sham acupuncture, placebo, standard medical therapy, or even no treatment. Osteoarthritis (OA) of the knee has been proposed as a good model to test the efficacy of acupuncture in a chronic pain condition because it is an extremely common, well defined, and disabling condition with well established outcome measures for symptoms and functional status. There is clinical trial evidence of efficacy for the standard treatments of acetaminophen and NSAIDs, and exercise physical therapy (EPT), which is usually added when the patient develops functional limitations. One high quality study of acupuncture for knee OA, demonstrated moderate benefit in an unblinded comparison to a usual care control group. As such, a major question remains about whether acupuncture, used in addition to exercise therapy, will provide a clinically meaningful improvement in pain and function. Since pain can be the primary limiting factor in improved exercise capacity, if acupuncture has any efficacy in reducing the pain of knee OA, then the combination with an EPT program should be substantially more effective than EPT alone. Another major concern is that the effect of the acupuncture may be predominantly mediated by non- specific placebo effects rather than the specific effects of the placement of a needle. Another important component of this proposal is our use of a validated blinded placebo needle instead of sham acupuncture points. Therefore, the primary goal of this proposal is to use a properly designed randomized blinded clinical trial, using American College of Rheumatology (ACR) criteria and Food and Drug Administration (FDA) recommended outcome measures, to determine whether the addition of acupuncture to standard EPT provides an overall clinically important benefit to patients with symptomatic knee OA compared to placebo acupuncture. As a secondary goal, we will use the clinical trial data to develop prognostic and etiologic models for the patients that are most likely to respond

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to acupuncture. If a clinically important benefit for acupuncture is found, a broader application of this technique would be justified. However, if the results are negative, then the addition of acupuncture to EPT should be generally curtailed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ELECTROSTIMULATION FOR HEMIPLEGIA Principal Investigator & Institution: Chae, John; Associate Professor and Director of Rese; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001; Project Start 04-MAY-2001; Project End 30-APR-2005 Summary: (Verbatim from the application) Stroke is the most common serious neurological disorder in the United States and its incidence doubles with each decade after the age of 55. Hemiplegia is a striking manifestation of stroke and contributes significantly to the physical disability and impaired quality of life of stroke survivors. The evolving scientific data suggest that active repetitive movement of the hemiparetic limb is effective in facilitating the motor recovery of stroke survivors. However, present rehabilitation strategies emphasize compensatory training of the unimpaired extremity to maximize function, and prevention of complications of immobility. The broad goal or this project is to develop strategies to facilitate the motor recovery of stroke survivors, and thereby maximize. their function and quality of life. Previous studies have suggested that repetitive exercises facilitated by electromyogram (EMG) controlled neuromuscular electrical stimulation (NMES) enhance the upper extremity motor recovery of stroke survivors. However, these early studies were poorly controlled, sample sizes were small, long-term follow up were absent and outcomes were limited to motor impairments only. The aim of this project is to assess the tong-term effect of EMG-controlled NMES on the motor impairment and physical disability of chronic stroke survivors. This study complements an approved project that investigates the short-term effect of EMG-controlled NMES on neurophysiologic measures of central motor function. A stratified randomized clinical trial design will be utilized. This study will demonstrate that EMG-controlled neuromuscular stimulation enhances the upper extremity motor and functional recovery of chronic stroke survivors. The proposed intervention may be effective for acute stroke survivors and for persons with other forms of central nervous system motor dysfunction such as traumatic brain injury, cerebral palsy, multiple sclerosis and incomplete spinal cord injury. EMG-controlled NIMES may also be effective for lower extremity motor and functional recovery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ENHANCING RECOVERY OF SENSATION AFTER CEREBRAL ISCHEMIA Principal Investigator & Institution: Hoffman, John R.; Biology; Arcadia University 450 S Easton Rd Glenside, Pa 19038 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 30-JUN-2006 Summary: There is sufficient evidence to demonstrate the capacity for reorganization of the mature mammalian cerebral cortex as a function of experience following brain injury. The use of physical and pharmacological interventions has been used to alter the post-infarct behavioral experience of animals following cortical lesions, and anatomical and functional recovery has been analyzed primarily within motor systems. The mystacial vibrissae of the rat, with their corresponding representation in the somatosensory cortex, provides an ideal vehicle for studies dealing with damage and subsequent recovery in the central nervous system. We have developed a surgical model

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that results in ischemic damage confined to the posteriomedial barrel subfield (PBMSF) of the first somatosensory cortex of the rat. Damage to the PBMSF results in a loss of tactile discrimination using the mystacial vibrissae. The recovery of sensory function can be examined using a gap crossing test in which animals discriminate between two textures. Preliminary data obtained using this model indicates that early physical intervention in the form of short bouts of whisker stimulation results in a dramatic acceleration in the rate of functional recovery in this sensory system. This project is designed to determine an optimal rehabilitation paradigm for the recovery of sensory function following ischemic injury to the cerebral cortex of the rat. The focus of this research will be to examine factors that optimize functional recovery and maximize the anatomical and physiological reorganization of the central nervous system (CNS) following central lesions. By examining the effect of types, duration and intensity of intervention on the behavioral and anatomical data from the same animal, we will provide important information regarding 1) an optimal mode of intervention; 2) how different modes of training maximize or limit CNS plasticity; and 3) the global functional activity pattern throughout the central neuraxis and the "path" of effective connectivity along that neuraxis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EVIDENCE-BASED GERIATRIC PT CONFERENCE Principal Investigator & Institution: Wong, Rita A.; Physical Therapy; Marymount College of Virginia 2807 N Glebe Rd Arlington, Va 22207 Timing: Fiscal Year 2001; Project Start 01-FEB-2001; Project End 31-MAR-2002 Summary: Physical therapists provide primary, secondary, and tertiary health care and wellness services to individuals with impairments, functional limitations, and disabilities related to movement dysfunction. The purpose of this conference is to formulate an action plan to develop, assess, disseminate, and foster the appropriate utilization of scientific evidence to enhance patient care and improve the physical therapy outcomes of older patients. Existing models for clinical scholarship will be critiqued, a vision and plan for the future developed, and an assessment and dissemination plan implemented. Specific conference goals are to 1) guide the development of more efficient and effective ways to access and incorporate new evidence into geriatric rehabilitation and wellness practice, 2) enhance the commitment to, and perceived value of, evidence-based decision-making in physical therapy clinical settings, and 3) provide a model for formulating a best-practice plan-of-action that can be used across practice settings. The two-day conference will include formal present6ations panel discussions, and small workgroup activities. Speakers will include leaders in evidence-based clinical decision making, educational methodology, geriatric physical therapy, information technology, and health care delivery systems. Conference participants include geriatrically-focused physical therapy educators, clinical service delivery managers, clinical outcomes researchers, and physical therapy clinicians. Conference products will be widely disseminated. Expected products include 1) formal conference proceedings with a specified action plan, 2) examples of model programs for evidence-based clinical-decision making, 3) a list of key focus areas for the development of evidence-based literature in geriatric physical therapy, and 4) recommendations for user-friendly and effective websites for geriatric rehabilitation and wellness evidence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EXERCISE/TRAINING IN CHILDREN WITH HEART DISEASE Principal Investigator & Institution: Chang, Ruey-Kang R.; Medical Doctor; Harbor-Ucla Research & Educ Inst 1124 W Carson St Torrance, Ca 90502 Timing: Fiscal Year 2002; Project Start 15-MAY-2002; Project End 31-DEC-2002 Summary: (provided by applicant): The principal investigator will develop expertise in exercise testing and training of children and obtain the experience and skill necessary to initiate independent research projects during the award period. The principal investigator's long-term career goal as an academic pediatric cardiologist is to become a clinical investigator with a research focus in exercise physiology and cardiac rehabilitation. Exercise intolerance is an under-recognized chronic morbidity in children with heart disease. Poor exercise capacity leads to low self-esteem and poor quality of life. Children with single ventricle after the Fontan operation and children after orthotopic heart transplantation (OHT) are among children with the lowest exercise capacity. Whether exercise intolerance in these children is due to cardiopulmonary dysfunction or deconditioning from decreased physical activity remains unclear. The role of skeletal muscle and humoral responses in determining exercise capacity and the effect of exercise training in children with heart disease are unknown. They propose a prospective, randomized and controlled study to compare physical activity level of healthy children and children with Fontan or OHT, to evaluate the skeletal muscle, catecholamine and cytokines in relation to exercise capacity, and to determine the effect of exercise training on cardiopulmonary function, skeletal muscle and quality of life. In order to conduct this study, prepubertal children six to 13 years of age, including 40 children after Fontan, 40 children after OHT, and 40 healthy children will be recruited. Subjects will be randomized to a six-week endurance training program or computer workshops (no training). The project will be conducted over five years and training sessions will be held in the summer. The following tests will be performed before and immediately after exercise training is completed: lean body mass by dual energy X-ray absorptiometry (DEXA) scan, thigh muscle volume by magnetic resonance imaging (MRI), echocardiogram, pulmonary function test, cardiopulmonary exercise test, catecholamine and cytokine tumor necrosis factor (TNF)-alpha, IL-1beta, and IL-6 levels at rest and during exercise, physical activity level by activity monitor and quality of life measures by a questionnaire. They will compare these measurements between children with training and children without training and compare the effect of exercise training on children with Fontan, OHT and healthy children. The study is designed to define important mechanisms of exercise intolerance among children with severe forms of heart disease. The results of exercise training will provide evidence related to the physiologic and psychosocial benefits of increased physical activity and form the basis for future research on cardiopulmonary rehabilitation for children with heart disease. The principal investigator will take advanced courses to enhance knowledge and skills needed for patient-oriented research and work with the mentors to conduct the proposed project during the award period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FES AND BIOMECHANICS: TREATING MOVEMENT DISORDERS Principal Investigator & Institution: Buchanan, Thomas S.; Professor and Director; None; University of Delaware Newark, De 19716 Timing: Fiscal Year 2002; Project Start 07-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): This Biomedical Research Partnership project proposes to combine resources from professors of Mechanical Engineering and Physical

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Therapy through our newly organized Center for Biomedical Engineering Research at the University of Delaware. The five-year goal of this project is to assist patients with CNS dysfunction to produce improved walking patterns through a combination of functional electrical stimulation (FES), robotic-assistive training and biomechanical modeling. In the first phase of this project, which is described in this proposal, the focus will be on individuals with stroke exhibiting hemiparetic leg impairment. The technique should be generalizable to a variety of neurological impairments. The movements for these individuals will be improved or "optimized" in four ways: Nonrisk Maximize postural stability, Injury Minimize musculoskeletal injury (e.g., arthritis) during movement, Cosmesis Develop a more natural looking gait, and Energy Minimize metabolic energy consumption during movement. The "NICE" optimization protocol will be realized through musculoskeletal modeling, robotic assistance, functional electrical stimulation, and neuromuscular training. The specific task we will study will be partial body weight suspension gait on a treadmill. The organization of this project has been divided into 3 distinct aims, which may be summarized as follows. Aim 1: Identify impairments in the locomotor patterns of the lower extremity in patients with hemiparetic stroke and create a paradigm to optimize the movement patterns ("NICE" optimization). This will be accomplished through biomechanical modeling using gait analysis and electromyographic data. Aim 2: Develop the methods and equipment ("NICE" rehabilitation system) necessary to implements the "NICE" optimization of locomotion in patients with stroke. We will achieve this through the use of a robotic device and an electrical stimulation system. Aim 3: Test the feasibility of the use of the "NICE" rehabilitation system in patients with hemiparetic stroke and make adjustments to the system based on the patient trials. Our ten-year goal is to produce a portable (wearable) FES system to assist patients with CNS dysfunction in the production of coordinated movements. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTIONALLY BASED TREATMENT OF STRESS INCONTINENCE Principal Investigator & Institution: Borello-France, Diane F.; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001 Summary: The long-term efficacy of pelvic floor exercise (PFE) as a treatment for urinary incontinence is threatened by patient compliance. To enhance compliance, PFE needs to be effective, while reducing the time burden placed on the patient. Our longterm objectives are to 1) validate a physiologically based, task-specific approach to PFE and 2) determine the exercise frequency needed to preserve muscle strength. Our specific aims are to determine: 1) the effectiveness of an individualized, physiologically based PFE regimen, 2) if a treatment progression to include exercise in upright postures is more effective than one performed in a lying position, and 3) if a low frequency exercise program is sufficient to preserve therapeutic gains over a six-month period. We will study 50 women, ages 40-70, with genuine stress incontinence. Based on symptom severity, we will randomly assign subjects to perform exercise either in upright postures or in a lying position. Subjects will attend 12 weekly physical therapy (PT) visits and perform a home exercise program (HEP) consisting of muscle strength, power, and endurance exercise. Using electromyography (an electrical recording of muscle activity), we will determine exercise progression using a protocol that individualizes exercise prescription based on muscle fatigue. At each weekly assessment, we will adjust the subject's HEP accordingly. Subjects assigned to the upright training group will perform one third of their exercises in the supine, sitting and standing positions. The other group

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will perform all exercises while in a lying position. At week 12, we will randomly assign subjects in each treatment group to either a low-(exercise once a week) or high-(exercises every other day) maintenance group. To determine treatment outcomes, we will compare group differences in the number of incontinent episodes, amount of urine lost during a psd test, a measure of urethral resistance (Valsalva leak point pressure), and scores on a quality of life measure. To determine the overall effectiveness of the treatment protocol, we will compare pre-to post-treatment changes in incontinent episodes to similar data reported in the literature. We will also examine the relationships between menopausal status, incontinence severity, and treatment outcomes. The results of this study may lead to a more effective exercise approach. Thus, future clients may benefit from fewer PT visits, greater pelvic muscle functions, and avoidance of surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HOW ACCESS AFFECTS OUTCOMES OF REHABILITATION SERVICES Principal Investigator & Institution: Iezzoni, Lisa L.; Associate Professor; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 31-DEC-2005 Summary: (provided by applicant): With the aging population, the number of Americans with functional limitations will rise by over 300% by 2049 if the age-specific prevalence of major chronic conditions remains unchanged. While medical interventions can sometimes dramatically improve physical functioning, restoring functional abilities is unrealistic for many people. The focus shifts to preserving function, slowing its decline; and preventing secondary complications. Rehabilitation services, including physical therapy (PT) and occupational therapy (OT), are central to these efforts. Few studies have examined the outcomes of PT and OT as they are routinely practiced throughout communities in the United States. This project will use a longitudinal, nationwide survey of Medicare beneficiaries over and under age 65 (the 1 994-2001 Medicare Current Beneficiary Surveys), linked with respondents' Medicare claims, to examine outcomes of PT and OT. A major change in Medicare payment policy -- the 1997 Balanced Budget Act, which tightened payments for rehabilitation services -- will serve as a "natural experiment" of conditions under which access to routine rehabilitation care is constrained. The proposed study aims to examine the association between the intensity of PT and OT services and likelihood of good outcomes, including lower rates of: self-reported functional decline; worsening overall health; activities of daily living (ADL) and instrumental ADL dependence; institutionalization; acute care hospitalization; injury prompting medical attention; decubitus ulcer development; purchase of assistive technology; social isolation; and death. The study will examine persons within five conditions: arthritis; stroke; acute myocardial infarction; chronic obstructive pulmonary disease; and lower extremity mobility problems, regardless of cause. Two inter-related hypotheses will guide this work: (1) increased intensity of PT and OT is associated with better outcomes; and (2) decreased access to PT and OT is associated with worse outcomes. These hypotheses will be tested using cross-sectional and longitudinal analyses; analytic techniques will include time series, propensity score, instrumental variable, and proportional hazards regression modeling. The primary outcome of the proposed study will be an assessment of the association of PT and OT, as routinely practiced nationwide and important outcomes of care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HUMAN GENOME EDUCATION MODEL (HUGEM) PROJECT II Principal Investigator & Institution: Lapham, E V.; Pediatrics; Georgetown University Washington, Dc 20057 Timing: Fiscal Year 2001; Project Start 28-SEP-1993; Project End 31-OCT-2001 Summary: (Applicant's abstract) The field of medical genetics continues to witness dramatic advances (largely resulting from the Human Genome Project) which have led to an increased demand for genetic services and brought genetics issues to the forefront of health care. While physicians and nurses provide primary medical care for persons with genetic conditions, the allied health professionals (such as nutritionists, occupational therapists, physical therapists, psychologists, social workers, and speechlanguage pathologists) are often the first to: 1) suspect that their clients have a genetic disorder; 2) give a label to the developmental or behavioral symptoms; 3) recommend further evaluations including genetic testing 4) interpret and discuss results of testing and sometimes give diagnoses; 5) influence attitudes and decisions of their clients about participating in genetic testing or research; 6) provide referrals to other resources such as genetic counseling and genetic support groups; 7) provide counseling related to coping with and adjusting to a genetic condition; and, 9) educate the public about genetic conditions and ELSI issues. Allied health professionals, in general, remain inadequately informed in the area of human genetics and issues related to genetic knowledge, genetic testing, and genetic research. Building on the experiences and products of the Human Genome Education Model Project (1993-1997), Georgetown University Child Development Center-University Affiliated Program (UAP) (Dept. of Pediatrics) and the Alliance of Genetic Support Groups plan to use the collaborative (consumer and health professional) education model to educate allied health professionals through their respective national organizations (American Dietetic Association, American Occupational Therapy Association, American Physical Therapy Association, American Speech-Language-Hearing Association, American Psychological Association, Council on Social Work Education, and National Association of Social Workers). The overall goal is to derive optimal benefit from development of the Human Genome Project for allied health professionals and the consumers they serve. The specific aims are: 1. to conduct surveys to assess needs, determine education priorities, and identify resources of the respective organizations; 2. to use information from the surveys to adapt the collaborative education model to educate and sensitize health professionals about genetics, the HGP and its ELSI issues and to implement education for national staff, practitioners, and educators; and 3) to evaluate each level of education and disseminate information about the project. HuGEM II is designed to be carried out over a three-year period. An advisory committee will provide expertise in medical genetics, ethics, law, consumer issues, social policy, and health education. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MASSAGE LYMPHEDEMA

THERAPY

FOR

BREAST

CANCER-RELATED

Principal Investigator & Institution: Bernas, Michael J.; Surgery; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAY-2004 Summary: (provided by applicant): Massage therapy [in the form of Manual Lymph Drainage (MLD)] is an integral component, with compression bandaging (CB), of Combined Physical Therapy (CPT), the international consensus-recommended optimal treatment for peripheral lymphedema (LE). According to the World Health

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Organization, LE afflicts hundreds of millions worldwide (most from parasitic filarial infestation) and probably millions in the United States (most from operative and irradiation treatment of cancer). For more than a century, close links between various forms of massage and salutary effects on lymph circulation have been postulated but the efficacy of MLD alone without CB remains to be convincingly demonstrated. New experimental data derived from our NCCAMR21 funded investigation of a rat subacute LE model mimicking cancer-treatment related unilateral LE (radical groin lymphectomy/lymphadenectomy + irradiation) suggests that MLD alone reduces established LE volume as effectively as CB and CPT while minimizing LE development. As an initial translation of these experimental findings to patients and based on our retrospective clinical observations, we propose to examine prospectively the short-term and long-term efficacy of MLD alone compared to MLD + CB as part of CPT in a randomized trial in patients with mild (5-20% increase in arm volume) breast cancer treatment-related LE using and further developing both objective (serial arm LE volume reduction and lymphatic tracer transport enhancement using minimally invasive lymphangioscintigraphy) and standardized subjective/qualitative outcome measures (improved quality of life/compliance/cost-benefit scores). This initial study should lay the groundwork and evidence-based rationale for the design and implementation of expanded prospective randomized clinical trials of MLD alone in various types and stages of upper and lower extremity LE in children and adults. This combined experimental and clinical translational approach should thereby shed light not only on the physiologic mechanisms underlying massage therapy but also have potentially substantial impact on simpler cost-effective LE treatment alternatives worldwide. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MASSAGE THERAPY FOR CANCER-RELATED FATIGUE Principal Investigator & Institution: Avins, Andrew L.; Assistant Clinical Professor; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-MAR-2001; Project End 31-DEC-2002 Summary: (APPLICANT'S ABSTRACT): The proposed project is a randomized pilot trial of a Swedish-style massage therapy intervention for the treatment of fatigue in patients who are undergoing cancer chemotherapy. Fatigue is the most common complaint of patients receiving treatment for cancer, but is often difficult to treat and causes a substantial decrement in patients' quality of life. Massage therapy is a noninvasive intervention used in many patients with cancer for symptom control. Prior small studies have suggested some efficacy of bodywork therapies in conditions characterized by fatigue, such as fibromyalgia and chronic fatigue syndrome. Based on these results, massage therapy may provide an important adjunct in ameliorating fatigue and enhancing cancer patients' well being. The proposed study is a 12-week, randomized, three-arm, parallel-comparison clinical trial comparing the effects of a Swedish-style massage regimen to a sham bodywork control and a usual-care group for fatigue reduction in cancer patents undergoing chemotherapy. Sixty patients with breast, ovarian, prostate, or colo-rectal cancer will be enrolled; the primary outcome measure is a quantitative assessment of fatigue symptoms. In addition to obtaining estimates of efficacy, this Exploratory/Developmental Research Grant (R21) application also proposes several research design innovations to address critical methodological issues that have plagued prior studies of complementary and alternative medicine (CAM) interventions in general, and bodywork therapies, in particular. 1) Current quantitative assessment tools often fail to fully capture the nature and degree of change

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in highly subjective conditions and their impact on an individual's functioning and quality of life. We propose to add a novel qualitative research component to study changes in participants' perceptions of fatigue severity and its impact on their lives. 2) Most prior studies in bodywork interventions have failed to adequately control for the non-specific effects of the time spent with a practitioner and physical contact between the provider and participant. We propose to test a unique control condition (in addition to a usual-care control arm) to account for these effects. 3) Prior studies of bodywork therapies have neglected important psychological and sociocultural factors associated with subjects' participation and outcomes. We will examine these issues within the qualitative research component. 4) Because bodywork involves close personal physical contact, gender issues may complicate the provision and success of massage therapy. We will study these effects using qualitative methods, as well as a stratified randomization of gender-concordant and gender-discordant pairs to examine outcomes. This study should provide not only important data on the potential efficacy of massage therapy for the treatment of fatigue, but also advance the methodology for studying CAM interventions for difficult-to-treat symptomatic conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MIEL: MEDITATION AND MASSAGE IN END OF LIFE Principal Investigator & Institution: Katz, David L.; Director of Medical Studies; Griffin Hospital 130 Division St Derby, Ct 06418 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant): Despite considerable advances over recent years in palliative care, end of life care, and the assessment of quality of life (QoL), little work has specifically addressed means of improving overall quality at end of life. Attention to the spiritual aspect of QoL, notwithstanding increasingly widespread acknowledgement of its importance, has been especially limited. Interventions to improve quality at end of life are needed with particular urgency to address the needs of the large and growing population of patients with AIDS in the US, a group subject to bereavement at end of life often compounded by isolation and alienation. On the basis of prior literature, meditation, and specifically Metta meditation, is promising as an intervention uniquely suited to meet spiritual needs at end of life. Of note, while meditation has the potential to address spiritual needs, it does not necessarily compensate for the benefits of physical contact. Among patients with AIDS subject to a sense of physical isolation, the benefits of meditation could be blunted unless the need for physical contact is also addressed. Whether the benefits of meditation and physical contact such as massage are interchangeable, independent, additive, or even synergistic is as yet unknown. We therefore proposed a randomized, controlled, single-blind 2X2 factorial pilot study of Metta meditation, with and without massage, to determine the effects on QoL among late-stage patients with AIDS at an AIDS-dedicated skilled nursing facility in Connecticut. The Missoula-Vitas QoL survey, a validated instrument for end-of-life, will be used to measure the independent and interdependent effects of meditation and massage on QoL during, immediately post, and late post-intervention in subjects randomly assigned to each of 4 treatment conditions. The meditation intervention will consist of initial instruction by an expert in the technique, followed by selfadministration with audiocassettes. A certified massage therapist will provide the massage intervention. The methods to be tested in the proposed study are inexpensive, and do not require specialized facilities, and thus offer the promise of widespread application if proved effective. By addressing high priority aspects of end of life care for patients with AIDS in a methodologically rigorous manner, the proposed pilot study has

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considerable potential to advance the standards of care for this large, growing, and particularly needful population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR MECHANISMS IN GLYCOGEN STORAGE DISEASE TYPE III Principal Investigator & Institution: Kishnani, Priya S.; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001 Summary: Purpose: The long term objectives of the proposed research is to obtain a more complete understanding of the phenotype of different forms of glycogen storage disease type III (GSD-III), to identify mutations responsible for the disease, to help predict the clinical outcome and develop a new treatment strategy for the disease. In type III glycogen storage disease there are patients with deficient debranching enzyme activity in both liver and muscle (IIIa) and patients with deficiency in the liver but not the muscle (IIIb) yet the enzyme is a monomeric protein and appears to be identical in all tissues. The disease is characterized by hepatomegaly and/or progressive myopathy for which there is currently no effective treatment. Patients with this disease vary remarkably, both clinically and enzymatically. Although liver symptoms improve with age, muscle symptoms, which are minimal in childhood, increase in the third or fourth decade of life. There is a remarkable clinical variability even within the subgroup of patients who develop myopathy/cardiomyopathy, with no way to accurately predict the progression of the disease at the present time. We have identified exon 3 mutations in GSDIIIb patients. We hypothesize that mutations in GSD IIIb patients will shed light in the tissue specific expression of the debrancher gene. The second aim is to delineate the phenotype and clinical course within subtypes of GSD III through liver, muscle and cardiac studies. We hypothesize that patients with GSD IIIb will not develop muscle disease. The third aim is to study the relationship between location and type pf mutations in GSD III patients to the subtype and clinical severity of the disease. We hypothesize that the clinical outcome can be predicted in part based on the molecular definition. The fourth aim is to test the feasibility of enzyme replacement therapy for the disease by treating type III GSD patient cells in vitro with acid alpha-glucosidase (GAA). Methods Identification and characterization of mutations in different forms of GSD III will be done by SSCP followed by DNA sequencing. To better delineate phenotype and clinical course of the disease within subtypes of GSD III, detailed studies are performed on liver ( liver function tests, abdominal CT). Muscle studies to assess muscle strength and detailed cardiac studies (Holter and Echo) are being performed on all subjects. We are exploring the relationship between location and type of mutations in GSD III to subtype the clinical severity of the disease. Results (12/97 TO 12/98) 7 patients, 5M:2F ( 3 1/2 years -64 years), have been evaluated on this protocol. Of these patients, 6 are Caucasian, and one is African-American. 6 patients have GSD IIIa and one GSDIIIb. No adverse or unusual reactions were noted. After detailed muscle testing by the physical therapist involved in the project, it was found that all 6 subjects with GSDIIIa had myopathy. Subtle changes which may not have been identified by routine muscle testing were identified in 2/6 patients by the method (muscle dynamometry) used by us. Physical therapy has been initiated. 3/6 patients were also found to be deficient in carnitine, (documented for first time in this disease) and have since been started on carnitine. No changes on 24-hour holter monitor were found in the 6 patients. Significance and Future Plans Information gained by analysis of the debrancher gene and clinical and molecular dissection of different subtypes of GSD III will provide

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insight into patient phenotype, the molecular basis of the disease, functional domains for the multifunctional enzyme, and general mechanisms controlling tissue-specific gene expression. Experiments with enzyme replacement therapy in vitro represents the first step in an overall program to develop an effective treatment for type III. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOTOR CONTROL DEFICIT IN LOW BACK PAIN: CAUSE OR EFFECT? Principal Investigator & Institution: Cholewicki, Jacek; Associate Professor; Orthopedics and Rehabilitation; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001; Project Start 01-MAY-2001; Project End 30-APR-2004 Summary: (Verbatim from application) Revised Application: Because the specific causes underlying low back pain LBP have not yet been identified, it continues to be a significant public health problem. Many of the factors associated with low-back pain are mechanical in nature. Epidemiological and biomechanical studies have suggested that there is a link between sudden and unexpected loading, such as slips and falls, and lowback injuries. Under these circumstances, motor control of the mechanical stability of the lumbar spine is crucial in determining trunk kinematic response to sudden loading and the subsequent likelihood of injury. Compared to healthy controls, however, LBP patients exhibit deficits in motor control such as delayed trunk muscle reflex response, poor trunk positioning sense, and impaired postural control. These deficits may constitute predisposing risk factors for sustaining an injury, a compensation/pain avoidance mechanism, or they may be the consequence of damage sustained by the lumbar spine tissues. The objective of the proposed research is to improve our understanding of the relationship between the measured motor control deficit and LBP. Two experimental studies and a post-hoc analysis of the entire data set form the 3 specific aims. The first prospective design study will consist of the initial testing and a 2year follow-up of varsity athletes. The goal is to determine whether poor motor control of the lumbar spine increases the risk for sustaining a low-back injury. The second randomized prospective study will be conducted to document the changes in motor control of the lumbar spine in LBP patients before and after standard and modified rehabilitation programs that emphasize motor control training. Several tests, developed in preliminary studies, will quantify the deficit in the motor control in LBP individuals: response of trunk muscles to a sudden, multi-directional load release and the stability of the lumbar spine, and postural control of the trunk in unstable sitting. Correlations between the above measures of motor control and other variables in the LBP population will be determined in the third specific aim. These additional variables will include: trunk position and motion proprioception, objective and subjective measures of physical function, diagnosis and duration of symptoms, and personal characteristics such as age and gender. The results of the proposed research will have a significant clinical relevance for designing more effective prevention, diagnosis, and rehabilitation strategies for LBP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MOTOR MAP PLASTICITY IN CONSTRAINT THERAPY FOR STROKE Principal Investigator & Institution: Good, David C.; Professor; Neurology; Wake Forest University Health Sciences Winston-Salem, Nc 27157

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Timing: Fiscal Year 2002; Project Start 02-MAY-2002; Project End 31-MAR-2006 Summary: This study will evaluate the effect of a well-defined physical intervention (constraint-induced movement therapy (CIMT)) on cortical motor reorganization following stroke using transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI). The primary objectives are 1) to determine whether TMS motor maps or fMRI activation predictably change following CIMT, 2) to assess whether this change correlates with motor recovery, and 3) to identify possible mechanisms underlying that change. Eighty patients participating in a randomized multicenter trial (EXCITE) of CIMT administered either immediately or one year later will be studied. Clinical assessment, TMS and fMRI will be obtained prior to randomization into the treatment arms, and repeated within three days of completing CIMT (or at the equivalent time for patients randomized to delayed treatment), and one year later. The primary focus of the study will be changes in the primary motor cortices (FMC's) of each hemisphere in response to CIMT, but we will also qualitatively evaluate activation changes in other motor regions. Outcome measures for TMS will include indices of cortical map area and center of gravity to evaluate changes in size and directional shift of motor maps over time. Functional MRI outcome measures will be generated from a volume of interest (VOI) analysis of activation in the PMC during a motor task, and will parallel TMS measures. In addition, a "laterality index" will measure the relative activation in the PMC's contralateral and ipsilateral to hand movement. Clinical outcome measures will be obtained as part of the EXCITE trial, and will include the laboratory-based Wolf Motor Function Test and a measure of real life use of the strokeaffected arm: the Motor Activity Log. Nonparametric statistical analyses will be used to examine the relationship between changes in TMS maps, fMRI activation and clinical outcome for each group of patients. The study is a unique opportunity to use noninvasive methods to study cortical plasticity in subjects receiving a specific therapy intervention, compared to a control group. We expect to identify specific patterns of change in TMS motor maps and fMRI activation patterns in response to the CIMT intervention. The project will validate the concept that physiological cortical motor changes after stroke are closely correlated with motor improvement and are influenced by a physical intervention. This could lead to the development of new rehabilitative strategies based on the interaction between therapeutic interventions and the physiology and anatomy of recovery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROBIOLOGY OF MUSCULOSKELETAL PAIN Principal Investigator & Institution: Sluka, Kathleen A.; Physical Therapy and Rehabilitation Science; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2006 Summary: (Taken from the applicant's abstract): The long-term goals are to gain a better understanding of pain associated with the musculoskeletal system and the analgesia produced by physical therapy treatments. The award will allow more research-related time to expand current and develop new collaborative efforts. These collaborative efforts will be aimed at developing new techniques (isolated primary afferent recording and push-pull perfusion), new ideas (mechanisms of analgesia produced by joint mobilization) and expanding current ideas (TENS, microdialysis, muscle hyperalgesia). Interactions with scientists from multiple basic science (Anatomy, Neurosciences, Pharmacology, Chemistry, Molecular Biology) and clinical disciplines (Physical Therapy, Internal Medicine, Anesthesia, Pathology, Chiropractic) provide an interdisciplinary perspective to the examination of musculoskeletal pain and physical

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therapy pain treatments. Group journal clubs and laboratory meetings are held weekly with several laboratories (Gebhart, Brennan, Hammond, Proudfit, Sluka) investigating pain. The research proposal in this application is designed to characterize a newly developed animal model of chronic pain induced by two unilateral injections of low pH saline into the gastrocnemius muscle. In the work proposed they hypothesize that the development of the long lasting bilateral hyperalgesia is dependent initially on activation of acid sensing ion channels (ASIC) from the site of injection. Activation of acid sensing ion channels results in long lasting, widespread hyperalgesia that is sustained by activation of central mechanisms in the spinal cord. These proposed studies are intended to help in the understanding and thus potential treatment of chronic muscle pain including such conditions as fibromyalgia, myofascial pain and low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NMES FOR OLDER INDIVIDUALS AFTER TOTAL KNEE ARTHROPLASTY Principal Investigator & Institution: Snyder-Mackler, Lynn; Professor; Physical Therapy; University of Delaware Newark, De 19716 Timing: Fiscal Year 2002; Project Start 15-MAR-2002; Project End 28-FEB-2007 Summary: Reduced muscle strength from illness or injuries often leads to loss of function and independence in the elderly. The recovery of muscle strength and function in disabled elderly individuals is a major challenge in rehabilitation. The etiology of the muscle weakness with injury or age is fully elucidated. Training programs designed to maximize strength gains in young individuals may not be optimal in the elderly because the cause of the weakness and the morphology of the muscle may be different for young vs. old people. The overall goal of this work is to determine if physiologically and morphologically based rehabilitation programs are more effective than traditional rehabilitation to counter changes in muscle strength and function in older individuals. Neuromuscular electrical stimulation (NMES) may be used to improve strength and function following injury or surgery. This study provides motivation for exploring the use of NMES with the elderly. We posit that using NMES to augment a traditional rehabilitation program for elderly patients with osteoarthritis following total knee arthroplasties (TKA) will result in greater strength and functional gains than using only traditional rehabilitation. Elderly patients with osteoarthritis who undergo TKAs serve as ideal subjects for testing the effectiveness of rehabilitation programs become those patients almost always exhibit marked quadriceps weakness that is resistant to traditional physical rehabilitation. More than 300,000 TKAs are performed each year in the United States to treat osteoarthritis of the knee in older individuals. Neuromuscular electrical stimulation (NMES) may be used to improve strength and function following injury or surgery. This study provides motivation for exploring the use of NMES with the elderly, We posit that using NMES to augment a traditional rehabilitation program for elderly patients with osteoarthritis following total knee arthroplasties (TKA) will result in greater strength and functional gains than using only traditional rehabilitation. Elderly patients with osteoarthritis who undergo TKAs serve as ideal subjects for testing the effectiveness of rehabilitation programs become those patients almost always exhibit marked quadriceps weakness that is resistant to traditional physical rehabilitation. More than 300,000 TKAs are performed each year in the United States to treat osteoarthritis of the knee in older individuals. So, the successful rehabilitation of elder patients following TKA is an important and challenging problem. The specific aims of this proposal are: 1) To assess the effectiveness of high-level neuromuscular electrical stimulation is an

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adjunct to ongoing intensive, early rehabilitation in restoring quadriceps strength and improving the functional outcome after primary TKA, and 2) To identify the physiological and morphological bases for improvements in quadriceps strength and functional outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OPTIMIZING MUSCLE FUNCTION IN CEREBRAL PALSY Principal Investigator & Institution: Damiano, Diane L.; Associate Professor; BarnesJewish Hospital Ms 90-94-212 St. Louis, Mo 63110 Timing: Fiscal Year 2001; Project Start 01-SEP-1997; Project End 31-AUG-2003 Summary: Cerebral palsy (CP) is the most prevalent physical disability occurring in childhood, for which no cure is available. All current treatments such a surgery and physical therapy aim solely to alleviate the peripheral effects of this central nervous system disorder, often with limited and inconsistent success. A prevalent clinical system that has long been recognized, but rarely addressed therapeutically in this population is muscle weakness. While strength training is routinely used in the adult orthopaedic population and in athletes to increase force production or alter muscle imbalance, this type of intervention is grossly under- utilized in pediatric rehabilitation, and in particular children with CP. No evidence exists to support the clinical prejudice against strength training and testing in cerebral palsy. In fact, research findings are accumulating toe the contrary, demonstrating that individuals with CP are indeed weak, the degree of weakness has a direct relationship to motor performance, and strengthening programs can produce positive functional outcomes. However, the neurophysiological and biomechanical bases of weakness in CP remain poorly understood. An additional concern is that the two major surgical interventions in ambulatory children with spastic diplegia, muscle-tendon lengthening (orthopaedic surgery) and selective dorsal rhizotomy (neurosurgery), often serve to exacerbate or unmask the symptom of weakness, which can be problematic in children who are already weak. The ultimate goal of this project is to improve motor outcomes in CP by first exploring the mechanisms that lead to diminished force production and defining the relative role of weakness in the functional motor deficit in spastic CP. This will be accomplished by isokinetic and electromyographic evaluation to examine voluntary and involuntary muscle responses in children with CP at the knee and ankle joint throughout the range of motion and at different movement speeds. Muscle performance will then be related to validated pediatric measures of functional status and disability. Lastly, the interaction of strength with surgical interventions will be determined by quantifying the effects of orthopaedic and neurosurgery on strength and functional measures, and assessing whether the addition of a strengthening program enhances surgical outcomes. Strength is an essential component of normal motor control that is deficient in CP, but can be altered through training. Continued research, as proposed here, needs to be conducted to verify and solidify the role of strengthening in the rehabilitation of children with CP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PAIN MANAGEMENT AND FUNCTIONAL RECOVERY IN OLDER ADULTS Principal Investigator & Institution: Morrison, R Sean.; Geriatrics & Adult Development; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2007

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Summary: (provided by applicant): Uncontrolled pain is a major impediment to postoperative functional recovery. Despite major advances in the understanding and treatment of pain, under treatment of pain, particularly post-operative pain remains a persistent problem in the United States. Although data exist regarding the adverse outcome of untreated pain in younger adults as well as the beneficial effects of treating it, relatively little is known about the impact of post-operative pain on older adults - the most rapidly growing segment of the population. Older adults who undergo lower extremity orthopedic surgery (e.g., hip arthroplasty, knee arthroplasty, open reduction and internal fixation (ORIF)) experience intense post-operative pain and are at high risk for sub-optimal analgesic therapy. Higher pain levels following elective hip/knee arthroplasty and ORIF have been associated with increased lengths of stay in both acute care and rehabilitation hospitals, increased complications, delays in ambulation, aberrant gait patterns, impaired functional recovery at 6 months, and increased suffering. Given the paucity of data with respect to the effective treatment of pain in the geriatric patient, the rapid growth of the elderly population, and the increasing number of geriatric patients undergoing surgery - particularly orthopedic procedures- we propose to examine the effect of a multi-component and inter-disciplinary intervention designed to improve the detection and management of pain on functional and clinical outcomes in older adults admitted to an acute rehabilitation hospital following lower extremity orthopedic surgery. The intervention includes rigorous assessment of pain both at rest and with physical therapy, scheduled titration of analgesic medications to ensure patients are comfortable at rest and that pain does not interfere with transfers and ambulation, and pre-emptive analgesia prior to physical therapy to maximize the duration and intensity of rehabilitation. The analgesic protocol will be placed on one of 3 acute rehabilitation units at Mount Sinai Hospital. Patients from the intervention unit and 2 control units will be enrolled by means of a prospective matching strategy. The project will examine the impact of this generalizable intervention on pain levels, lower extremity performance, functional status, health related quality of life, and utilization. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHYSICAL AND OCCUPATIONAL THERAPY FOR OLDER PERSONS Principal Investigator & Institution: Freburger, Janet K.; None; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 29-SEP-2004 Summary: (provided by applicant): Community based older persons, especially those with functional limitations and disability, use a variety of health care providers to maintain and/or improve their health and functional capabilities. Physical and occupational therapists represent one group of health care providers that primarily focus on improving, maintaining, or limiting decline in the functional capabilities of the older person. The broad objective of the proposed study is to advance our understanding of the access to and effectiveness of physical and occupational therapy for community based older persons. This study will be population based, analyzing several years of data from the Medicare Current Beneficiary Survey. The first aim of the study is to identify determinants of therapy use. Analyses will be conducted to identify predisposing, enabling, and need characteristics associated with the use of physical and occupational therapy. Determinants of therapy use in the home or outpatient setting will also be identified. And finally, the relationship between predisposing, enabling, and need characteristics and intensity of therapy use will be examined. The second aim of the study is to examine the relationship between therapy use and changes in functional

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status. Users of physical and occupational therapy will be identified and analyses will be conducted to examine the relationship between intensity of therapy use and changes in functional status, while controlling for patient characteristics and illness severity. The feasibility of examining changes in functional status among users and nonusers of physical and occupational therapy will also be explored using instrumental variable estimation or a case-control approach. Little is known about whether community based older persons have appropriate access to therapy services. Data on the effectiveness of physical and occupational therapy for community based older persons is also limited. Because recent changes in Medicare reimbursement have had a direct impact on the provision of therapy services, examining issues surrounding the use and effectiveness of these services is timely and may inform future Medicare policy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHYSICAL CAM THERAPIES FOR CHRONIC LOW BACK PAIN Principal Investigator & Institution: Eisenberg, David M.; Instructor in Medicine; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 28-FEB-2002 Summary: Back problems are among the most prevalent conditions afflicting adults in general and the second most common condition reported by persons over age 65. Furthermore, back pin in general is the leading reason for the use of complimentary or alternative medicine (CAM) therapies by adults of all ages. Despite the common use of CAM therapies for back pain, little is known about how they compare with each other or with conventional medical therapies in terms of effectiveness and cost. Studies evaluating back pin treatments for older adults (greater than or equal to 65 years old) are particularly rare. This study will lay the groundwork for a full-scale trial that evaluates the relative effectiveness and costs of the three most commonly used physical CAM therapies (acupuncture, chiropractic, and massage) for both older and younger adults with chronic low back pain. During Phase I, we will develop, test and refine specific components of a randomized clinical trial evaluating acupuncture, chiropractic and massage for chronic low back pain. This will include specification of treatment and comparison groups, subject selection criteria, recruitment and retention strategies, and development of Phase I to conduct a pilot study designed to evaluate the three physical CAM treatments. Thirty persons with chronic low back pain will be randomized to each of the following groups: acupuncture, chiropractic, massage, and continued usual care. The subjects randomized to each intervention will be equally divided between persons over and under age 65. (Recruitment will include subjects in their 70s, 80s, and older.) The pilot study will permit us to identify and resolve unanticipated problems and to estimate the sample sizes required for an adequately powered full-scale trial. At the conclusion of this project, we will be prepared to write a competitive grant proposal to evaluate the most commonly used CAM therapies for treating both older and younger adults with chronic low back pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PHYSICAL THERAPY, AN ANTIFLAMMATORY SIGNAL ON ARTHRITIS Principal Investigator & Institution: Agarwal, Sudha; Associate Professor; Dental Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 19-SEP-2001; Project End 30-JUN-2004

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Summary: (provided by applicant): Osteoarthritis and rheumatoid arthritis are diseases of complex etiopathology associated with progressive inflammation and cartilage destruction. Rehabilitative physical therapies such as continuous passive motion (CPM)/exercise yield beneficial effects on arthritic joints as well as on post-surgical arthritic joints by an as-yet-unknown mechanism, but one that is likely to involve mechanical activation of cells. Since inflammatory cytokines like IL-1B play a major role in cartilage destruction, it is the hypothesis that mechanical strain exerts antiinflammatory effects on arthritic joints by blocking proinflammatory signals and subsequent gene induction induced by IL-1. This is based on the facts that, in vitro, chondrocytes respond to cyclic tensile strain (CTS) by suppression of IL-1-dependent proteins that are responsible for cartilage degradation. CTS simultaneously induces gene exression of proteins inhibited by IL- 1B, that are reparative in nature. These effects of CTS are mediated via inhibition of IL-1B-induced nuclear factor (NF)-kB translocation to the nucleus, as well as the synthesis of its subunit. CTS exerts these effects at concentrations of IL-1B similar to those present in inflamed synovial joints, suggesting the clinical relevance of actions of mechanical strain. In this proposal the PIs wish to confirm in vitro findings using an in vivo model system of antigen induced arthrits (AIA) and an apparatus that subjects arthritic joints to CPM. Long term goals are to understand the molecular mechanisms of stress-induced anti-inflammatory responses that limit the degeneration in joint diseases and constitute the basis for rehabilitative physical therapies like CPM. Specifically, the PIs will (i) determine if CPM therapy exerts its beneficial effects on the arthritic joints by regulating the synthesis of catabolic proteins or their inhibitors. (ii) determine if CPM therapy exerts its beneficial effects on arthritic joints via induction of matrix-associated proteins. (iii) determine if the intracellular mechanisms of CPM in vivo are mediated via inhibition of nuclear factor (NF)-kB subunits p65 and p50 synthesis in the tissues of knee joints from CPM treated and untreated rabbits with AIA. This understanding of the signalling pathways that mediate the beneficial effects of mechanical strain is necessary for defining the biological basis for the efficacy of CPM/exercise, for the development of defined parameters for safe application of physical therapies to accelerate cartilage repair as well as for the use of CPM in novel non-invasive rehabilitative therapies for not only cartilage repatr but also for other diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHYSICAL, COGNITIVE AND MENTAL HEALTH IN SOCIAL CONTEXT Principal Investigator & Institution: Marsiske, Michael; Associate Professor; Ctr for Gerontological Studies; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2008 Summary: (provided by applicant): The Institute on Aging (IoA) at the University of Florida (UF) seeks funding to support its predoctoral research-training program in aging of physical, cognitive and mental health in social contexts. With the co-location and cooperation between UF's health sciences and liberal arts campuses, as evinced by the strong levels of collaboration documented in this proposal, located close to urban and rural environments, UF is uniquely positioned to offer training in the psychosocial elements of health and disease (e.g., sensorimotor antecedents of cognitive decline in aging), in a socially diverse State. The training program is led by a Training Director with over seven years of experience with a particular model that includes multidisciplinary research training coupled with strong disciplinary education. UF has recently reinvigorated its investment in aging research, although its institutional

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commitment to aging (as evidenced by the establishment of its first Center on aging) is over 50 years old. In the past two years alone, 14 new aging faculty (to date) have been hired at UF. At present, over 40 faculty have identified themselves as "Core Training Faculty" in the IoA, representing the disciplines of psychology, sociology, nursing, physical therapy, occupational therapy, medicine, geography, audiology, linguistics, interior design, and others. This group is committed to mentoring students in a program that includes simultaneous admission to a disciplinary department (for the Ph.D.) and to the IoA Predoctoral Research Training program. The core components of the IoA training program include: (1) assignment of each student of multi-disciplinary mentoring team, literally on their first day of arrival, including a primary mentor form the performance model, in which students begin each academic year with their mentoring team to set career plan-relevant quantifiable goals in the domains of research, education, and service. Mentoring team meetings throughout the year to assess and support goal progress; (3) a weekly campus-wide colloquium series featuring atop national speakers, local researchers in aging, and professional development sessions; and (4) required supplemental coursework in Aging and Statistics/Methodology. In addition, our mentoring team approach allows us to actively engage energetic newer faculty in primary mentoting roles, while supplementing and complementing them with seasoned, productive senior investigators. Our students are therefore poised not only for research in traditional departments, but also in clinical research facilities, and multidisciplinary gerontology environments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHYSIOLOGICAL ADAPTATIONS TO EXERCISE IN BURNED CHILDREN Principal Investigator & Institution: Suman, Oscar E.; Surgery; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2002; Project Start 02-APR-2002; Project End 31-MAR-2007 Summary: (Applicant's abstract) Dr. Suman's long-term career goals and interests are to understand the mechanism(s) by which adaptations occur in the cardiovascular, pulmonary and skeletal muscle systems in response to exercise. Broadly, he foresees himself establishing a scientific investigative career in physiology and using exercise as an interventional tool against functional disability and disease. His immediate career goals involve investigating the adaptations to exercise that occur in severely burned children. Currently, Dr. Suman proposes to continue his research at the University of Texas Medical Branch and Shriners Hospitals for Children, in collaboration with Dr. David N. Herndon, Dr. Robert R. Wolfe and Dr. Daniel L. Traber. Research: The physiological response to a severe burn injury includes a persistent and extensive skeletal muscle catabolism and weakness that leads to a low physical capacity. In nonburn individuals, exercise training induces adaptations that include improvement of cardiovascular (CV) and muscle function. However, whether exercise confers these adaptions in burned children in currently unknown. A better understanding of the adaptations to exercise training is important and relevant in burns, where alterations in cardiovascular and muscle function are major obstacles in the return to physical activities of daily living. The proposed study will test the hypothesis that exercise, in severely burned children, will improve CV and muscle performance by increasing cardiac function, oxygen uptake and utilization, and skeletal muscle mass. Specific Aim 1 will assess whether decreases in CV and skeletal muscle function in severely burned children are due to compromised cardiac performance and skeletal muscle oxidative function and decreased concentration of myosin heavy chain. Specific Aim 2 will assess

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whether the compromised level of CV and muscle function will be improved with exercise training. Specific Aim 3 will assess whether administration of an anabolic agent (oxandrolone) to burned children will further enhance the effects of exercise on CV and skeletal muscle functional capacity. We expect these Specific Aims to serve as a springboard for future studies in the treatment and long-term rehabilitation of burned children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PILOT--CONSTRAINT INDUCED MOVEMENT THERAPY IN SA STROKE Principal Investigator & Institution: Levin, Harvey S.; Professor/Director of Research; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001 Summary: This 2-year project evaluates the feasibility and efficacy of constrain induced (CI) movement therapy to enhance recovery of motor function in the affected upper limp of patients with ischemic stroke. Motor weakness of the limbs contralateral to the cerebral hemisphere involved in unilateral stroke is a frequent deficit which is a major cause of disability. Animal models and clinical observations have indicated that individuals learn to disuse their paretic limbs and rely more on their intact limbs. Studies in animals and previous clinical trials have shown that constraining the intact limb while training the affected limb improves motor function. However, the feasibility and efficacy of initiating CI Movement therapy during the subacute phase of recovery from ischemic stroke have not been reported. This project is a randomized parallel group design to evaluate the feasibility and efficacy in instituting 2 weeks of daily CI movement therapy combined with training of the impaired upper limb beginning on the eighth day after ischemic stroke. Twenty-eight right handed patients admitted to the Memorial-Herman Hospital Stroke unit who satisfy the selection and exclusion criteria and control condition with the distal motor score of the NIH Stroke Scale and age as stratification variables. Daily training of the impaired limb will also be carried out in both treatment arms during the 2 week period. Two physical therapists will administer all treatment with 1 therapist treating half of the patients in each condition. Outcome measures of upper limb motor function, which include Actual Amount of Use, Motor Activity Log, Grooved Pegboard, Wolf Motor Function Tests, and the motor subscale of the Functional Independence Measure, will be performed by a third physical therapist who is blinded to the patients' treatment condition. In view of animal model studies indicating that lesion volume can enlarge when the intact limb is restrained during the first week after injury, this project includes magnetic resonance imaging (MRI) to measure change in lesion volume from pre-treatment to 3 months post-injury. Reorganization of cortical motor function is studied by functional MRI at 3 months after stroke. The Functional Neuroimaging Core at UCLA will assist with designing the acquisition and analysis of fMRI data. Data management and analysis will be performed in the Cognitive Neuroscience Laboratory with assistance from the Experimental Design and Statistics Core of the University of Washington. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PRESERVING MOBILITY OF JRA CHILDREN USING NOCTURNAL TES Principal Investigator & Institution: Mcguire, John R.; Phys Med and Rehabilitation; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532264801

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Timing: Fiscal Year 2001; Project Start 20-SEP-1997; Project End 31-AUG-2003 Summary: Therapeutic electrical stimulation (TES) is a modified form of traditional electrical stimulation which involves the use of low-intensity, sub- threshold electrical stimulation applied during sleep. TES is well tolerated and has been used since 1988 in Canada for children with a variety of neuromuscular conditions. The efficacy of TES has not yet been examined in the child with juvenile rheumatoid arthritis (JRA). The purpose of this R29 proposal is to develop and test this innovative use of low-level muscle electrical stimulation as an adjunctive therapy to minimize or prevent movement limitations in the child with juvenile rheumatoid arthritis. Twenty JRA children with bilateral knee joint involvement will be studied during six months while using nocturnal TES as an adjunct to a physical therapy home program. This low-level subthreshold stimulation is done while the child is sleeping six nights a week. This study is very realistic for the child with juvenile rheumatoid arthritis as it done during sleep, the technology is noninvasive, easy to learn and does not add to "the burden of care." The electrical stimulation will be done unilaterally to allow the other leg to serve as a control. The child will be monitored in three major ways: clinical exam, quantitative muscle strength and muscle bulk, and functional assessments. The monthly clinical exam will document bilateral lower extremity A/PROM, MMT of key functional lower extremity muscle groups, leg length, thigh circumference and the Kraus-Weber flexibility test score. The quantitative muscle strength will be assessed by monthly isometric knee extensor torque measurements. The functional assessment will include monthly Childhood Health Assessment Questionnaire (CHAQ), and a modified Pediatric Evaluation of Disability Inventory (PEDI). At the beginning and end of the 6 month period, a gait analysis study including physiologic cost index as well as ultrasound measurement of quadriceps muscle thickness will be done. Our hypothesis is that nocturnal therapeutic electrical stimulation will minimize quadriceps weakness and/or atrophy thereby reducing the potential impairments of muscle weakness, knee flexion contracture and gait deviations which may contribute to long-term disability in the JRA population. If the efficacy of this intervention in preserving mobility is demonstrated, future research would explore the underlying neuromuscular and neuroendocrine mechanisms responsible for the clinical effect. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREVENTION OF FUNCTIONAL DISABILITY IN AT RISK ELDERS Principal Investigator & Institution: Gill, Thomas M.; Associate Professor; Internal Medicine; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001; Project Start 01-JAN-1998; Project End 31-DEC-2002 Summary: (Adapted from applicant's abstract). According to the applicant intervention strategies to date have focused largely on the restoration of function among disabled elderly persons in the context of rehabilitation after an acute medical event, such as a stroke or hip fracture. There have been few attempts to develop strategies aimed at "prehabilitation" (PREHAB), which is the prevention of functional dependence and decline among persons who have not sustained an acute illness or injury. The overall objective of this project is to test the efficacy of a home-based PREHAB strategy to prevent functional decline in a high-risk group of physically impaired, communityliving elderly persons who do not have severe memory loss or impaired orientation. Community-living persons, over 75 years will be screened for eligibility during nonurgent clinic visits at two large primary care sites. After comprehensive home assessment, 160 physically impaired elders will be randomized, using a blocked design that is stratified by clinic site, severity of physical impairment, and age to receive either

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the control group strategy (EDUCATE), a 6-month education program covering several content areas in general health practices and health promotion, or a home-based intervention strategy (PREHAB) -- which is a 6-month training program of physical therapy, to include muscle strengthening, joint range of motion, foot care, and balance, gait, transfer, and stair training, plus functional therapy to include training and instruction in safe and effective performance of the task needed to complete ADLs and selected IADLs, provision of appropriate adaptive equipment, and environmental modifications. Functional assessments will be completed in all participants at baseline and at six and twelve months by trained staff who will be kept unaware of group assignments. The specific aims of the project are 1) to determine whether the homebased PREHAB strategy is superior to the EDUCATE strategy in preventing decline in ADL-IADL function, and in decreasing the use of formal and informal care, including home care and nursing home care; 2) if the PREHAB strategy proves successful to identify the predictors of response to the intervention and to determine whether its benefit is mediated, as hypothesized, by improvements in both physical capability and functional self-efficacy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PT/PHD PREDOCTORAL TRAINING PROGRAM Principal Investigator & Institution: Binder-Macleod, Stuart A.; Professor & Chair; Physical Therapy; University of Delaware Newark, De 19716 Timing: Fiscal Year 2003; Project Start 20-AUG-1996; Project End 30-APR-2008 Summary: (provided by applicant): Recent advances in behavioral, biological, and engineering sciences provide exciting opportunities to attack important problems faced by people with disabilities. Scientists with strong backgrounds in rehabilitation, who bring multidisciplinary research approaches to answer important questions related to rehabilitation, are scarce. The goal of this pre-doctoral training program is to improve the quality and quantity of individuals who will contribute to the knowledge base and practice of physical rehabilitation. This training program, coordinated through the Department of Physical Therapy, includes faculty members from the Mechanical Engineering and Physical Therapy Departments at the University of Delaware. The program fuses two independent training programs: an entry level Doctorate in Physical Therapy (DPT), designed to train clinical physical therapists, and the PhD in Biomechanics and Movement Sciences (BMSC). Research concentrations during the PhD portion of the program include: Applied Physiology, Exercise Physiology, Biomechanics, Motor Control, and Rehabilitation Technology. The program is analogous to the MD/PhD programs that are designed to train medical scientists. Students in the proposed program become both physical therapists and research scientists. Trainees are selected from a pool of outstanding students with diverse undergraduate backgrounds who enter the DPT program. Many of these students express an interest in research before admission to the program. Unfortunately, because of the sizable debt incurred during graduate school and the opportunity to earn the salaries that clinical physical therapists enjoy, very few of these students go on to pursue the PhD. This training program attracts individuals who have a sincere interest in physical rehabilitation research and tracks them early in their training into research careers. The need for these individuals is enormous. Both new and established programs need doctorally trained individuals for teaching and research positions. Graduates of this training program are ideal faculty members who will foster excellence in rehabilitation research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: QUANTATIVE MEASUREMENT OF LOW BACK IMPAIRMENT Principal Investigator & Institution: Kotzar, Geoffrey M.; Research Scientist; Biomec, Inc. 1771 E 30Th St Cleveland, Oh 44114 Timing: Fiscal Year 2002; Project Start 19-SEP-2002; Project End 31-AUG-2003 Summary: (provided by applicant): Injuries to the lower back are the second most prevalent disorder presented to medical practitioners today (second only to upper respiratory ailments) and are often the most difficult to diagnose or treat. The myriad of current methods used in evaluating lower back injuries and disorders (LBDs) are very subjective. Consequentially, the number of insurance claims and the amount of each claim push this ailments costs over the $100 billion mark in the US alone. There are no clinical methods/devices that remove the subjectivity from the assessment of impairment due to LBDs for most patients. A quantitative laboratory research tool (device) has been developed and shown to add objectivity to the evaluation of LBDs. One objective of this project is to update the technology, making a device suitable for clinical use. Another objective is to assess the new tool against the current one in the laboratory to assure that no feature of the original device has been lost or compromised. Based on this assessment, a clinically viable device will be available for the quantitative evaluation of LBDs, which promises to reduce the subjectivity of the clinical evaluation and the subsequent costs in treating the disorder. PROPOSED COMMERCIAL APPLICATION: According to the U.S. Center for Healthcare Statistics, 80% of adults seek care for low back pain at some time in their lives, and 50% of adults have an episode of low back pain in any given year. The problem is wide spread, difficult to diagnose and expensive to treat. The potential markets for the device we propose to develop are physical therapy clinics, insurance companies, government organizations (NIOSH, OSHA, etc.), manufacturing companies (workplace assessment), orthopedic clinics, and companies that make office equiment (ergonomic assessment). Focussing only on the physical therapy clinics, there are over 98,000 such clinics according to data from the American Physical Therapy Association and the American Hospital Association. This number has remained relatively stable and could be expected to remain static over a forecast period of the next five years. Even with a small market penetration of only 0.1% per year, our sales can be expected to reach $2 million the first year and increase by $2 million per year over the next five years, for a total of 0.5% penetration and $10 million annually at the end of five years. At this rate, market saturation will not occur in any forseeable future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REHABILITATION ADHERENCE AND ACL RECONSTRUCTION OUTCOME Principal Investigator & Institution: Brewer, Britton W.; Psychology; Springfield College 263 Alden St Springfield, Ma 01109 Timing: Fiscal Year 2001; Project Start 11-SEP-1998; Project End 31-AUG-2003 Summary: An acute tear of the anterior cruciate ligament (ACL) is one of the more prevalent and debilitating of the 3-17 million sport- and recreation-related injuries that occur each year in the United States. Physical therapy protocols following surgical reconstruction of the ACL have become increasingly aggressive in recent years. There is scant evidence, however, that adherence to these "accelerated" rehabilitation regimens is related to postsurgical outcome. Accordingly, the primary purpose of the proposed study is to examine the relationship between adherence to an accelerated physical therapy protocol and rehabilitation outcome following ACL reconstruction. Secondary

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purposes of the proposed study are to identify potential demographic and injury-related moderators of the adherence-outcome relationship and to evaluate the correspondence between patient self-report and objective assessment of adherence to a home exercise regimen after surgical reconstruction of the ACL. To accomplish the aims of the study, measures of adherence and outcome will be taken following ACL reconstruction. Selfreports of home exercise completion, objective assessment of home exercise completion, attendance at physical therapy appointments, and practitioner ratings of adherence during physical therapy appointments will be measured for six weeks postsurgery. Rehabilitation outcomes, including range of motion, laxity, functional ability, and subjective symptoms, will be measured preoperatively and at six months, one year, and two years postsurgery. Findings from the proposed study will have implications for rehabilitation practices following ACL reconstruction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REHABILITATION FOR SELF-MANAGEMENT OF PARKINSONS DISEASE Principal Investigator & Institution: Wagenaar, Robert C.; Professor; Phsyical Therapy; Boston University Charles River Campus 881 Commonwealth Avenue Boston, Ma 02215 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2006 Summary: (provided by applicant): The overall goal of the proposed research is to determine whether rehabilitation that focuses on self-management of health helps to improve the day-to-day functioning and quality of life of community-living clients with Parkinson's disease (PD), beyond the effects of medical treatment alone. Typically for people with PD, medical treatment declines in effectiveness over a variable number of years, and these individuals face a relentless progression into disability and lowered quality of life that can end in a need for custodial care. If a rehabilitation program can ameliorate disability and support a high quality of life by positively influencing mobility, communication, and healthful daily living skills, it is possible that more intensive use of medication could be postponed. As a result, people with this disease might benefit longer from medication and be less quickly referred to costly inpatient rehabilitation and long term care facilities. The proposed research uses rigorous methodology, which is rare for studies of rehabilitation with this population, and builds on our previous research toward understanding the role of rehabilitation in promoting health in people with PD. In a randomized controlled design, people with PD will be assigned to one of three conditions for a duration of 6 weeks: (i) medication only, (ii)medication plus 2 outpatient group rehabilitation sessions and 1 social activity session per week, or (iii)medication plus 2 outpatient group rehabilitation sessions and 1 home/community rehabilitation session per week. Rehabilitation will occur through integrated physical, occupational, and speech therapy services specialized to the selfmanagement of health needs of people with PD. The first specific aim of the proposed study is to determine if increasing "doses" of self-management rehabilitation (from Conditions i to ii to iii) result in increasingly positive quality of life outcomes. The second aim is to document change in rehabilitation effects at 2 and 6 months postintervention. The third aim is to describe possible active ingredients in the rehabilitation by measuring neuromuscular and voice function outcomes. The fourth aim is to provide evidence for the validity of self-management outcome measures for use with PD. It is hypothesized that there will be beneficial and lasting effects of rehabilitation for quality of life outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REHABILITATION FOR STROKE AND HIP FRACTURE Principal Investigator & Institution: Munin, Michael C.; Physical Medicine and Rehabilitation; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Hip fracture is one of the leading healthcare problems requiring rehabilitation services in older Americans. Three models of rehabilitation treatment are available for patients recovering from hip fracture that include acute inpatient rehabilitation (AR), nursing home rehabilitation (NHR) and home care rehabilitation (HCR). These settings differ based on the timing, duration and intensity of services provided. No prior randomized study has been performed to determine the optimum rehabilitation treatment to improve the rate of functional recovery and return home to the community for patients with hip fracture. This planning grant will complete work in the following key domains during the two-year grant cycle to perform a randomized controlled trial (1) coordinating facilities to assist subject recruitment using state of the art bioinformatics systems within the University of Pittsburgh Medical Center Health System; (2) performing focus interviews to better understand patient, family, physician and therapist values concerning the randomization process; (3) determining the best method to risk stratify patients to different treatment settings that include random assignment to a home rehabilitation arm; (4) refining physical and occupational therapy algorithms using similar treatment goals at each location; (5) incorporating outcomes that are validated, objective and reliable measures of self-reported function and observed physical performance; and (6) standardizing data measurements in all rehabilitation environments through the implementation of quality control procedures. Co-investigators from the RAND Corporation will refine methods for data analysis using their extensive expertise in outcome assessment. At the end of this two-year planning grant, the investigators expect to be well positioned to perform a randomized controlled trial. Primary hypotheses will test whether AR subjects have higher function and a lower percentage of extended care facility placements than patients receiving NHR or HCR. Using novel methodology developed by the research team, secondary hypotheses will evaluate the relationship of functional outcomes and intensity of therapy to level of participation in therapy and physical activity measured by an activity monitor. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REHABILITATION INTENSIFICATION POST HIP FRACTURE Principal Investigator & Institution: Binder, Ellen F.; Medicine; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001; Project Start 01-AUG-1998; Project End 31-MAY-2003 Summary: (Adapted from the Applicant's Abstract): Hip fractures are a common problem among older adults, and can have a devastating impact on the ability of older patients to remain independent. A significant functional decline following a hip fracture has been documented, even among individuals who were functioning at high levels before the event. High risk patients include those with deficits in skeletal muscle strength during the post-fracture period. Standard ambulation is achieved with or without an assistive device. However, many patients have persistent strength and mobility deficits at the end of treatment which impair their capacity for independent function, and increase their risk of recurrent falls. The aim of this study is to evaluate the efficacy of a graduated physical therapy and weight-training program for community-

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dwelling older post-hip fracture patients who have persistent deficits in mobility, gait and performance of activities of daily living (ADLs) upon completion of standard physical therapy. Participants will be recruited from area hospitals and home care programs to participate in a randomized trial of the intensive exercise program. Screening of participants will begin near the end of their standard physical therapy, and they will enter the program upon completion of therapy. Participants in the intervention group will attend supervised exercise sessions on site, 3 times per week for 6 months. The intensive exercise program consists of 3 months (36 sessions) of flexibility, balance, agility and light resistance exercises, followed by 3 months (36 sessions) of intensive weight training. Subjects in the control group will perform balance and flexibility exercises at home for 3 months. All participants will be evaluated at baseline, 3 months, and 6 months. The primary outcome measure will be performance on an Objective Physical Performance Test. Secondary outcome measures will include measures of skeletal muscle strength, measures of gait and balance, muscle mass of the thigh by MRI, measures of bone quantity and quality by XA and BUA, self-report of performance of ADLs, and measures of quality of life. If successful, such a model of rehabilitation "intensification" could be applied to outpatient and nursing home settings and targeted at hip fracture patients at high risk for persistent disability and functional decline. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REHABILITATION TRAINING PRODUCTS FOR HOME HEALTH AIDES Principal Investigator & Institution: Betros, Cecil G.; Communication Concepts and Consulting Consulting, Inc. Birmingham, Al 35209 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 30-JUN-2002 Summary: There is little evidence that training programs for home health aides as extenders of skilled therapy services improves aide performance and/or patient outcome. Training models are needed that encourage independent functioning and discourage over-dependency. The proposed project will create and field test a multicomponent home health aide training program that incorporates maintenance and repetitive care techniques, behavioral strategies, and basic knowledge of physical therapy. Phase I of the project will include innovative educational techniques delivered through video education, hands-on training, and supplemented with a formal system to encourage skill acquisition and performance. Training will include "Therapeutic Interaction Skills for the Home Health Aide" and a "Primer in Physical Therapy for the Home Health Aide." Home health aide tasks will be integrated into physical therapy plans of care via training manuals and communication tools developed as a part of this project. The program will include analysis of pre- and post-instructional knowledge and skill acquisition. Performance of skills learned will be verified by observation. The videotapes developed in Phase I will serve as a prototype for expansion to CD-ROM (multimedia) technology in Phase II. The project will also be expanded to include both occupational therapy and speech-language pathology services in Phase II. PROPOSED COMMERCIAL APPLICATION: NOT AVAILABLE Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REORGANIZATION OF MOTOR CORTEX FOLLOWING BRAIN INJURY Principal Investigator & Institution: Nudo, Randolph J.; Professor; None; University of Kansas Medical Center Msn 1039 Kansas City, Ks 66160

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Physical Therapy

Timing: Fiscal Year 2001; Project Start 01-JUN-1993; Project End 30-APR-2002 Summary: (adapted from the Abstract): The long-term goals of this project are to examine the capacity for functional reorganization in the motor cortex of adult primates following brain injury, such as that occurring after stroke. These studies will use neurophysiological, neuroanatomical, optical imaging, and behavioral training techniques to examine functional reorganization in the primary motor cortex and the premotor cortex after focal vascular infarct, and the effects of physical use of affected muscles on the areal extent and time course of reorganization. In their previous studies, the researchers showed that lesions within the hand area of the primary motor cortex result in a further loss of hand representations in the adjacent, intact tissue. However, physical therapy introduced within days after the infarct prevented this secondary, dysfunctional loss of spared hand representations. To determine whether critical periods exist for the effects of rehabilitative therapy on behavioral and neurophysiological recovery, the researchers will compare functional maps of motor cortex before and a few months after the focal vascular infarct. They will introduce physical therapy at various time points after infarct to define an optimal window for rehabilitation. Further, they will examine the long-term effects of physical rehabilitation with respect to both plasticity in cortical motor maps and behavioral capacity. They will determine whether the effects of early rehabilitative therapy are persistent. In other experiments, the researchers will examine the neurophysiological bases for behavioral relapse that occurs about two weeks after infarct. Further, they will examine the structural bases for adaptive plasticity in the motor cortex after injury by studying changes in intracortical connectivity. Finally, the researchers will extend these studies to explore more widespread effects of focal infarcts on other cortical motor areas that are interconnected with the primary motor cortex. These studies have strong clinical relevance for understanding stroke and rehabilitation. The correlation of neurophysiological and neuroanatomical reorganization with functional recovery after brain damage may eventually lead to new approaches to rehabilitative medicine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESEARCH PROGRAM TO PROMOTE OPTIMAL AGING IN PLACE Principal Investigator & Institution: Gitlin, Laura N.; Professor and Director; Community/Homecare Res Div; Thomas Jefferson University Office of Research Administration Philadelphia, Pa 191075587 Timing: Fiscal Year 2001; Project Start 01-MAY-2000; Project End 30-APR-2005 Summary: This is an application for a Geriatric Academic Career Leadership award (K07) submitted to the National Institute on Aging. The applicant, Dr. Laura N. Gitlin, seeks funding to advance the research and training capacity in aging of the newly formed Senior Health Institute of Thomas Jefferson University (TJU) and the Jefferson Health System (JHS). The Senior Health Institute (SHI) represents the integration of an academic institution with a large health system in the Philadelphia region. It involves individuals from TJU and JHS with a long-standing commitment to geriatrics and gerontology and strong track records for funded research. However, an infrastructure to coordinate and advance aging research and education activities across departments and institutions is lacking. With this award Dr. Gitlin seeks to enhance and integrate the capacity of the SHI for multidisciplinary social, behavioral, clinical and biological research; advance a program of research on community and home-based interventions; and expand and integrate academic training in aging for medical, nursing, occupational therapy, and physical therapy students, and geriatric fellows. A central focus of the proposed research program is on independent living and includes topics related to

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functional performance and its measurement, physical and psychological consequences of age-related illness and disability, and innovative health and human service interventions for successful aging in place among diverse populations. To achieve these goals, five specific aims will be pursued: 1) build an infrastructure that links TJU and JHS researchers in aging and establishes system-wide mechanisms to support research; 2) implement a "research to practice" program that guides formation of research questions relevant to intervention research on independent living, 3) expand the capacity to conduct intervention research on community and home care issues; 4) expand undergraduate and graduate education for health professional students to include certificate training; and 5) integrated and enhance training of geriatric fellows in intervention research. To accomplish these objectives, a set of integrated activities is planned that includes developing a web page and newsletter; forming multidisciplinary research teams on topics related to independent living; conducting a needs assessment of research and outcome needs of community-based service programs; developing guidelines for accessing community populations; providing pilot research and mentorship experiences; conducting continuing education and faculty development workshops; and developing a seminar series on intervention methodology. It is anticipated that at the conclusion of the grant program the SHI will have an active research program that is multidisciplinary, nationally recognized, and addresses critical issues in independent living. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RETT SYNDROME--PATHOGENESIS, GENETICS, AND SEARCH FOR A MARKER Principal Investigator & Institution: Naidu, Sakkubai R.; Professor of Neurology and Pediatrics; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 30-NOV-2001 Summary: Hypothesis & Rationale: The purpose of the study is to evaluate the natural history of Rett syndrome ( RS), and determine if it is a progressive neurodegenerative disorder, or a neurodevelopmental disorder of early infancy followed by a static course. We would also be starting a therapeutic trial of anticholinesterase drugs, such as donezepil (Aricept) to increase brain acetylcholine content which has been shown to be reduced in RS. Nasal biopsies to study olfactory receptor neurons as a neuronal marker for the abnormalities in RS will be pursued. Methodology: The patients are compared at different time points, with a minimum of 2 years between evaluations. Neurological, developmental, neuropsychological, speech, physical & occupational therapies are compared. For more objective evidence, MRI volumetric assessment, EEG, and anthropometric measures are used. Positron Emission Tomography (PET) studies using markers that bind to vesicles containing acetylcholine in synaptic terminals will be performed to confirm reduced brain levels in vivo and justify our treatment approach with donezepil. These studies will also help to determine effectiveness of therapy. Nasal biopsies to determine the status of olfactory receptor neurons as a marker of neuronal dysfunction in RS has been valuable. The marked reduction in mature neurons suggests reduced viability or inability to reach maturity. Future studies will focus on characteristics of these neurons in culture to determine the stage at which pathological changes occur, and interventions required to prevent or overcome them. These results would have implications for future therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ROBOTIC REHABILITATION OF STROKE WITH ANIMAL MODELS Principal Investigator & Institution: Matsuoka, Yoky; Assistant Professor; Center for Neural Basis of Cognition; Carnegie-Mellon University 5000 Forbes Ave Pittsburgh, Pa 15213 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2004 Summary: (provided by applicant) In this proposed research, we intend to develop two new techniques which will be used to identify a highly effective robotic rehabilitation strategy. Animal models will be used to address issues that cannot be addressed using human patients. Currently, several robotic stroke rehabilitation techniques are being evaluated to determine their effect on human patients' short and long term recovery performance. Robots, for example, are being attached to patients' limbs and applying force to move them as physical therapists routinely do. Such robotic techniques, however, are simple extensions of what physical therapists are already doing, and the only outcome measurements available are patients' behavioral changes. Robots are currently being used on a limited basis in stroke rehabilitation research because it is not ethical to test a variety of robot force fields or techniques on humans if these fields or techniques have not been proven to have a positive effect on them. Therefore, we believe that evaluating robotic rehabilitation techniques on animal models is crucial. To our knowledge, animal models have never been used to evaluate robotic rehabilitation of stroke. To use animal models, we must develop two new techniques that have not yet been explored. First, we will develop a technique to produce a precise lesion in an animal that simulates a stroke without risking the animal's survival rate. To do this, we will use a non-invasive photochemical technique. Second, we will design, construct, and test a new robot controller technology for animals. We will rehabilitate animals using this new robotic controller which will later be applicable to human rehabilitation techniques. We will combine these techniques to establish the superiority of robotassisted intervention over non-assisted rehabilitation, explore the optimal training schedules, and identify gene products that are selectively modulated following robotic rehabilitation. The results generated in this project will be used as preliminary results to apply for an R01 grant in which effective robotic force assistance will be investigated to identify the optimal therapeutic solution for robotic rehabilitation. We have no doubt that the experimental results we produce with these techniques will significantly affect the field of rehabilitation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SPASTICITY AND STRENGTH AS INDICATORS FOR RHIZOTOMY Principal Investigator & Institution: Engsberg, Jack R.; Associate Professor; BarnesJewish Hospital Ms 90-94-212 St. Louis, Mo 63110 Timing: Fiscal Year 2001; Project Start 15-AUG-1997; Project End 31-JUL-2002 Summary: (Adapted from the Applicant's Abstract): The long term goal is to improve function in children with cerebral palsy (CP). A selective dorsal rhizotomy (SDR) is performed to improve function by minimizing spasticity. A contraindication and limitation of the SDR is muscle weakness. Muscle weakness is related to reduced function. Thus, determining the degree of spasticity and strength/weakness in a child is a key consideration in the SDR selection process. Objective measures to assess spasticity and strength are not presently used in the process. In this study, objective measures to quantify spasticity and strength will be utilized to determine relationships between presurgery spasticity and strength and post-surgery functional measures. Based upon these relationships, an objective clinical tool to improve the selection of SDR candidates will

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be developed. In addition, comparisons of the measures among 4 different groups of children (n=40/group) will be made, those: 1) undergoing a SDR (SDR group), 2) undergoing physical therapy (PT) identical to the SDR group (PT group), 3) undergoing no change in current intervention (CP controls) and 4) having able bodies (AB controls). Specific Aim 1: Evaluate the importance of pre-surgery spasticity and strength as predictors of functional change due to SDR. Children from the SDR group will be tested on a dynamometer for spasticity and strength, evaluated using the Gross Motor Function Measure, have a gait analysis performed and answer a disability questionnaire. These assessments will be made 6 weeks and again 2 days prior to surgery, and at 8 and 20 months post surgery. Stepwise multiple regression with repeated measures will test the hypothesis that composite pre-surgery spasticity and strength from the ankles, knees, and hips in the SDR group will predict functional changes as a result of the SDR. Specific Aim 2: Compare impairment and functional measures among the SDR group, PT group and CP controls. The same assessments and testing sequence as the SDR group will be followed for these groups, but no surgery will be performed. ANOVA and ANCOVA will test the null hypotheses that the 3 CP groups will not change in impairment and function over all sessions and will not be different from one another. Specific Aim 3: Compare impairment and functional measures from 3 CP groups with those from AB controls. The children with able bodies will be assessed for spasticity, strength, and gait. ANOVA will test the null hypothesis that the CP groups will not be significantly different from the AB controls across all sessions. Descriptive statistics will describe the extent of differences from AP controls. The intent is that this investigation will improve the current methods for selecting SDR patients, thereby improving patient outcomes and reducing costs. It will also compare the efficacy of 3 modes of treatment for CP: SDR with intensive PT, intensive PT without SDR, and standard intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SUBGROUPS OF FMS--SYMPTOMS, BELIEFS & TAILORED TREATMENT Principal Investigator & Institution: Turk, Dennis C.; John & Emman Bomica Professor Of; Anesthesiology; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 20-JUL-1998; Project End 30-JUN-2003 Summary: Fibromyalgia syndrome (FMS) is a prevalent, chronic musculoskeletal pain disorder. Despite extensive research the etiology and pathophysiologic mechanisms of FMS are not well understood, and no treatment has been shown to be universally effective. In this project, we propose that FMS is a complex disorder involving multiple factors, both physical and psychosocial-behavioral. In our previous research, we have demonstrated that FMS patients are heterogeneous in the psychosocial-behavioral axis and can be classified into 3 distinct subgroups on a basis of their psychosocial adaptation to symptoms. In this application we will extend our previous research and attempt to match treatments to patients psychosocial-behavioral characteristics. Specifically, we will test the efficacy of uniquely tailored treatment for each psychosocial subgroup. Three groups of FMS patients will be treated with one of the 3 treatment protocols with standard physical therapy and varying psychological treatments. A total of 312 FMS patients will undergo a 6 half-day interdisciplinary treatment sessions consisting of physical therapy and psychological treatments. All protocols include a standardized physical therapy but include either cognitive-behavioral pain management therapy, interpersonal skill training, or supportive counseling. In addition to the treatment outcome study, various symptoms of FMS will be assessed prospectively in the patients natural habitats to better understand covariations of FMS

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symptoms. The repeated daily monitoring using the palm-top computer (ecological momentary assessment) will permit us to evaluate the value of process ratings compared to retrospective reports. Overall, the results of these studies should establish the benefit of matching treatments to subject characteristics, and enhance our understanding of the roles of cognitive-affective-behavioral adaptation of FMS patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TESTING REHABILITATION

A

FUNCTIONAL

APPROACH

TO

SUBACUTE

Principal Investigator & Institution: Nelson, David L.; Occupational Therapy; Medical College of Ohio at Toledo Research & Grants Admin. Toledo, Oh 436145804 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2004 Summary: (provided by applicant): The proposed project is part of an ongoing program of research to develop evidence-based practice for occupational therapy and physical therapy in subacute rehabilitation. Two distinct approaches to therapy are routinely practiced: (a) a functional approach involving participation in daily living tasks; and (b) a rote exercise approach whereby the patient is instructed to follow exercise protocols. In the proposed project, these two approaches will be compared in subacute rehabilitation patients with hip fracture. Subacute rehabilitation is a neglected site for research, even though it is one of the most common settings for therapy practice. Hip fracture, frequently occurring in frail elderly persons with multiple health problems, is one of the most important diagnoses in this setting. The two specific aims are to determine if there is a difference between the functional approach to rehabilitation and the rote exercise approach to rehabilitation in terms of improvement in (a) the motor abilities required for daily living tasks, and (b) self-reported physical health status. The design is a randomized trial (pretest-posttest design) with blind assessment of outcomes. The final sample size of 104 provides adequate power. The two dependent variables are derived from the Assessment of Motor and Process Skills and the SF-36. Protocols for the two interventions include specifications for each intervention as well as lists of daily living tasks or exercises appropriate to each intervention. Pre-training and ongoing training of interventionists emphasizes equivalent attention and balance across conditions while preventing inadvertent contamination across conditions. Intervention fidelity will be tested by an independent, blind reviewer of clinical notes. Each specific aim will be tested by analysis of covariance, with the pretest as a covariate and with other relevant covariates including co-morbidities, cognitive status, hours of therapy, age, and gender. Alpha will be set at.05 for a two-tailed test. The proposed project follows logically from a smaller project funded by the American Occupational Therapy Foundation, and leads logically to a multi-site clinical trial of these two commonly used but untested approaches to rehabilitation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THINK REHABILITATION

BIG,

FROM

VOICE

TO

LIMB

MOVEMENT

Principal Investigator & Institution: Koshland, Gail F.; Physiology; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-JAN-2005 Summary: We will test the efficacy of an innovative treatment technique that could induce a radical paradigm shift in movement rehabilitation for people with Parkinson disease (PD). Based upon an extremely successful speech treatment for people with

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idiopathic PD (the Lee Silverman Voice Treatment (LSVT(R)), people with PD will undergo intensive practice of high effort/large amplitude arm movements and learn to transfer their "big effort" to everyday movements. Unlike other physical therapy approaches with unclear efficacy, the LSVT(R) approach has clearly demonstrated both short and long term efficacy up to two years. In addition, LSVT(R) is supported by hypotheses put forth to explain hypokinesia and bradykinesia in people with PD, therefore, it is easily applied to limb movements. Fifty subjects will be randomly assigned to one of two interventions with similar intensity regimens, think big therapy (novel) or traditional physical therapy (control). Speech studies have shown that a treatment with a simple focus (think loud) may generalize to affect motor output in other systems (e.g., articulation, speaking rate, swallowing, respiratory mechanics). Thus, we predict that learning to perform bigger arm movements will also improve arm speed, based upon the well described relationship between movement speed and amplitude. In addition, we will document the generalizability of this technique to improve arm and leg function. Although both groups may show improvements given the intense work schedule, we predict that improvements in the think big therapy will be greater than in the traditional physical therapy (control) group. Measurements will include physiological tests for assessing arm movement speed and amplitude using kinematic techniques. As "sense of effort" is the primary proposed mechanism underlying this treatment approach, we will measure sense of effort. Additional measurements will include tests of arm and leg function (strength, timed ADL tasks, gait, handwriting), a standardized clinical assessment (UPDRS), and a subjective rating scale. If successful, we plan to 1) further validate retention of treatment effects and generalizability of this technique (speech to limb; limb to speech) and 2) develop a standardized protocol that can be used for training physical therapists. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF DEPRESSION WITH MASSAGE IN END OF LIFE AIDS Principal Investigator & Institution: Poland, Russell E.; Professor and Director of Research; Cedars-Sinai Medical Center Box 48750, 8700 Beverly Blvd Los Angeles, Ca 90048 Timing: Fiscal Year 2001; Project Start 27-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant): This is an Exploratory/Developmental Research (R21) grant application to the National Center for Complementary and Alternative Medicine in response to RFA AT-O1-002 to assess the usefulness of massage therapy for treatment of depression and improvement in the quality of life in patients with end of life AIDS. This study will define the clinical and biologic response to massage therapy in patients with AIDS and depression who are clinically stable and on a fixed medical regimen. Depression is a co-morbid condition in individuals with advanced HIV disease and has a negative impact on quality of life. Depression in HIV-infected patients also has been associated with a decrease in adherence to medications and progression of clinical disease. While pharmacologic therapy for depression have resulted in variable success in managing this problem, it is associated with an increase in the number of medications that these patients are required to take, potential for additional drug-drug interactions, and many adverse events. In patients with advanced stage HIV disease, palliative care is often a priority and identifying new treatment modalities that do not require additional medications while improve clinical symptoms and overall quality of life is of the utmost importance. Pilot studies with massage therapy have been performed in HIV-infected and uninfected individuals. These studies have shown a

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reduction in depression scores in HIV-uninfected subjects. In HIV-infected patients, massage therapy has been shown to improve quality of life measures and decrease plasma cortisol levels. The specific aims of this proposal are 1) to determine the effect of massage therapy on depression in subjects with advanced HIV disease, 2) to investigate the effect of massage therapy on quality of life in subjects with advanced HIV disease, and 3) to investigate the effect of massage therapy on plasma cortisol levels in subjects with advanced HIV disease. This study will randomize advanced stage HIV-infected subjects with depression in a 1:1:1 manner to massage therapy, "sham massage" or no physical intervention. The massage and "sham massage" groups will be treated for one hour, twice per week, for 8 weeks. All enrolled subjects will have depression measured (Hamilton Depression Scale) at baseline, weeks 1, 2, 4, 6 and 8, and quality of life (SF36), and pain assessments (Gracely Pain Scale) at baseline, weeks 4 and 8. In addition, 24-hour urine free cortisol, lymphocyte subsets and HIV RNA measurements will be assessed at baseline and weeks 4 and 8. This will be a rigorously controlled clinical trial using validated measures to assess the clinical (depression and quality of life), and biologic (cortisol levels) effect of massage therapy on subjects with advanced stage HIV disease and clinical depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UM-SPAHS ENDOWMENT FUND PROGRAM Principal Investigator & Institution: Forbes, David S.; None; University of Montana University Hall 202 Missoula, Mt 598124104 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2004 Summary: (provided by applicant): The University of Montana School of Pharmacy and Allied Health Sciences has a long standing history and commitment to the recruitment and training of minority students (principally Native American Indians) for degrees in pharmacy and physical therapy. The recently obtained Native American Center of Excellence (NACOE) grant builds on strength from funding obtained for the HHSHealth Careers Opportunity Program (HCOP), the NIH-Bridges to Baccalaureate Program (BRIDGES), and the NSF-EPSCoR Program to provide both the environment and the infrastructure necessary to offer degree training for under-represented minorities in pharmacy (Pharm.D.), physical therapy (M.S. and D.P.T.), and more recently in graduate education (M.S., Ph.D.). Research infrastructure has dramatically increased in the School's Department of Pharmaceutical Sciences in the past ten years to the point where the School is ranked 1lth of 85 schools/Colleges of Pharmacy in NIH funding per Ph.D. faculty. The Department has created two state-approved research centers and offers two M.S. and two Ph.D. programs. The primary goal of the Endowment Fund Program is to add at least two tenure track minority faculty through training and recruitment efforts, while perpetuating recent success in the recruitment, retention, and training of minority students in Pharmacy, Physical Therapy, and Graduate programs. Focus on minority health disparities research will continue to be expanded. These goals will be accomplished as follows: 1) creating new tenure track faculty lines for minority faculty (preferably Native American Indians), 2) Enhancing opportunities for minority students who earn the Pharm.D. or D.P.T. degree to obtain postdoctoral fellowship training in clinically relevant areas, 3) Enhancement of opportunities for minority students to pursue graduate training leading to the Ph.D. degree. 4) Perpetuation of a strong program to recruit and train undergraduate minority students, 5) Use of endowment income to leverage additional institutional/state and federal support, and 6) Progressive growth of the endowment corpus. Priorities for use of the endowment income are A) Recruitment and training of two minority PhD,

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students and one minority post Pharm.D. Fellow (Years 1-3) and B) Complete training and/or recruitment of two minority faculty with priority given to Native American Faculty candidates, particularly those involved in health disparities research (Years 3-5). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UPPER BODY STRENGTH TRAINING IN COPD Principal Investigator & Institution: Larson, Janet L.; Professor and Department Head; Medical-Surgical Nursing; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant): People with moderate to severe chronic obstructive pulmonary disease (COPD) experience intense symptoms of dyspnea when they use their arms and shoulders. To control the dyspnea people avoid the use of their upper extremities and ultimately experience a significant loss of upper body (UB) strength and a decrease in functional performance, reflected by a decrease in the level of activities performed on a daily basis. The purpose of this research is to examine the effects of UB strength training with a self-efficacy intervention to enhance adherence. This is an experimental study with random assignment of subjects to one experimental and two control groups: (a) UB strength training with self-efficacy intervention (experimental), (b) UB strength training with health education (control 1) and (c) armchair fitness exercises with health education (control 2). The interventions are four months in duration with three booster sessions scheduled during a 12 month follow up period. Each subject will be studied for a total of 16 months. The primary specific aims are to compare the short (4 months) and long term (12 months after termination of structured training) effects of the above interventions in terms of the following dependent variables: UB strength (one-repetition maximum), dyspnea during physical activities (Chronic Respiratory Disease Questionnaire) and functional performance (Functional Performance Inventory). Secondary aims are to examine the effects in terms of inspiratory muscle strength, exercise-related self-efficacy, and adherence to UB strength training. Additionally dual energy x-ray absorptiometry will be used to document changes in UB muscle mass (fat free soft tissue). Dual accelerometers (arm and waist) will be used to verify self-report of exercise adherence at home during the 12 months follow-up. The sample will be 120 people with moderate to severe COPD who experience dyspnea with UB activities, 40 per group. Researchers performing strength tests will be blinded to group assignment. This research is innovative in that it examines the effects of a comprehensive upper body strength training with weight lifting (8 exercises) and combines it with a theory-based self-efficacy intervention to promote adherence to training. This is important because people with COPD experience exacerbations that adversely affect adherence. Previous research in this area does not address the effect of multiple weight lifting exercises and long-term adherence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VIRTUAL REALITY ANALGESIA FOR REHABILITATION IN CHILDREN Principal Investigator & Institution: Sharar, Sam R.; Anesthesiology; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 03-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant): One of the most frequent, yet challenging secondary problems experienced by children who require rehabilitation from disabling conditions

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is pain. Pain occurs at rest and/or with rehabilitation activities and arises in both chronic settings (e.g., cerebral palsy) and subacute settings (e.g., repetitive wound care and physical therapy during extended treatment of cutaneous burns). Conventional pharmacologic analgesic strategies, although widely used and efficacious in children with acute pain, are avoided in these chronic and subacute settings due to associated complication (e.g. tolerance) and lack of efficacy (development of central neuropathic pain syndromes). This project will explore two non-pharmacologic analgesic techniques for children ages 8-20 years, emphasizing 1) virtual reality (VR) analgesia, a highly innovative technology with newly demonstrated efficacy in such settings, and 2) its novel combination with hypnosis. The analgesic mechanisms of VR and hypnosis are incompletely understood, although they share a common thread distraction of conscious attention from environmental stimuli, leaving less of this cognitive resource to devote to pain perception. The goal of this project is to develop a program that will effectively investigate the analgesic mechanisms and optimize the clinical use of VR and combined VR/hypnosis in disabled children with pain and/or who require rehabilitation activities. The specific aims of the project are 1) to develop an effective, multidisciplinary group capable of posing and answering appropriate study questions with tangible outcome measures, 2) to design and fabricate VR hardware ad software, and develop VR protocols necessary to address mechanistic questions and perform future clinical trials, and 3) to perform pilot clinical studies to assess the efficacy of repetitive application of VR, and to investigate the efficacy of and the interactions between VR and hypnosis when used simultaneously. The anticipated immediate benefits of this project include establishing the specialized research team and equipment necessary to perform future mechanistic studies and clinical trials of VR and VR/hypnosis, as well as collect pilot clinical data to direct future investigations. Long-term benefits include the establishment of indications and clinical protocols for the use of VR and/or hypnosis in the treatment of rehabilitation-induced and disability-related pain in this challenging patient population, with more widespread application to a variety of age groups, greater ease of use, and potential economic benefit. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VIRTUAL REALITY IN BALANCE DISORDERS Principal Investigator & Institution: Whitney, Susan L.; Physical Therapy; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2007 Summary: (provided by applicant): The overall goal of this patient-oriented research career development award is to prepare the candidate to perform quantitative research as an independent investigator in the field of vestibular rehabilitation. The candidate has background as a clinical physical therapist and academician. She has prepared herself over the last few years to transition from a clinician to a clinician scientist. The candidate intends to use this award to receive focused coursework and research training related to persons at risk for falling and those with vestibular dysfunction. The candidate intends to augment her education in physical therapy and motor learning/control with coursework in three core areas: 1) the psychology of persons with anxiety/panic disorders, 2) research design, especially the use of randomized clinical trials, and 3) augment her knowledge of virtual reality, the special senses (including vestibular physiology and anatomy), and optic flow. Dr. Joseph Furman, Dr. Rolf Jacob, and Dr. Mark Redfern will mentor the candidate's research development. With their guidance, the candidate will receive intensive training in postural control, vestibular anatomy and physiology, panic/anxiety, and research methods related to persons with

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vestibular disorders. The primary objectives of this research are to increase the understanding of how virtual reality affects postural control in persons with vestibular disorders, to compare virtual reality therapy to conventional physical therapy, and to determine if virtual reality scenes used in a virtual reality cave can be effectively adapted for use with head mounted devices for application in rehabilitation. The proposed research will examine postural sway, anxiety self-report, and gain/clinical balance measures following exposure to virtual reality (VR) scenes. The data derived from the above three goals will help direct a randomized clinical trial that will assist in determining if virtual reality is an effective method of intervention with persons with vestibular dysfunction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VIRTUAL REALITY REHABILITATION OF HAND USE AFTER STROKE Principal Investigator & Institution: Adamovich, Sergei V.; None; Rutgers the State Univ of Nj Newark Blumenthal Hall, Suite 206 Newark, Nj 07102 Timing: Fiscal Year 2003; Project Start 01-MAR-2003; Project End 28-FEB-2005 Summary: (provided by applicant): For millions of people with disabilities after stroke, current physical therapy treatment often cannot induce long lasting improvements in arm and hand control. Recent studies show that intensive, repeated practice may be necessary to induce significant treatment effects. However, current service delivery models cannot provide the necessary intensity of practice. One technique that may overcome these limitations is VR. A computerized VR-based system for rehabilitation of hand motor functions has been recently developed. The system creates an interactive, motivating environment where intensity of practice and feedback can be manipulated to create individualized treatment sessions. However, it is presently not clear how this VR training affects finger coordination in real world movements. Moreover, the basics of finger coordination deficits in hemiplegia are poorly understood. The investigators propose a small grant project to obtain preliminary data on the ability of the VR system to induce improvements in the quality of hand motion and finger coordination in functional natural movements. The data collection will be performed before and after four weeks of rehabilitation therapy. Through well-established sophisticated quantitative analyses of finger and hand motion, they will analyze the kinematics of five-finger precision prehension of the hemiparetic arm in chronic post-stroke patients. Subjects will be asked to grasp objects of different sizes, shapes and weights, both stationary and moving. Specific Aim 1 of the study will be to identify deficits in finger kinematics and interjoint coordination prior to training. A main focus will be on the evolution of hand preshaping during movement and its interaction with more proximal degrees of freedom including motion of the trunk. Specific Aim 2 will be to obtain new knowledge of principles of transfer/generalization of VR training to functional realworld movements including grasping. The study will be geared towards obtaining pilot data that will be used to generate an R01 grant application for a more intensive analysis of the topic. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “physical therapy” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for physical therapy in the PubMed Central database: •

A Manual of Physical Therapy. by Stecher RM.; 1944 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=194423

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Mapping the literature of physical therapy. by Wakiji EM.; 1997 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=226272

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with physical therapy, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “physical therapy” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for physical therapy (hyperlinks lead to article summaries): •

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A comparison of physical therapy students with and without instructions in ultrasound pressure application. Author(s): Gann N, Rogers C, Dudley A. Source: Journal of Allied Health. 2002 Summer; 31(2): 103-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12040992&dopt=Abstract

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. Author(s): Cherkin DC, Deyo RA, Battie M, Street J, Barlow W. Source: The New England Journal of Medicine. 1998 October 8; 339(15): 1021-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9761803&dopt=Abstract

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A comparison of productivity and learning outcome in individual and cooperative physical therapy clinical education models. Author(s): Ladyshewsky RK, Barrie SC, Drake VM. Source: Physical Therapy. 1998 December; 78(12): 1288-98; Discussion 1299-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9859948&dopt=Abstract

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A distance learning model in a physical therapy curriculum. Author(s): English T, Harrison AL, Hart AL. Source: Journal of Allied Health. 1998 Fall-Winter; 27(4): 228-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9879030&dopt=Abstract

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A long and valuable partnership: the Maternal and Child Health Bureau and pediatric occupational and physical therapy. Author(s): McEwen IR. Source: Physical & Occupational Therapy in Pediatrics. 2003; 23(1): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703381&dopt=Abstract

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A new wellness center concept: integration of the physical therapy and the morale, welfare, and recreation departments. Author(s): Woodhead AB 3rd. Source: Military Medicine. 1998 May; 163(5): 307-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9597847&dopt=Abstract

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A primer on physical therapy. Author(s): Cwynar DA, McNerney T. Source: Lippincott's Primary Care Practice. 1999 July-August; 3(4): 451-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10624279&dopt=Abstract

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A quantitative analysis of research publications in physical therapy journals. Author(s): Miller PA, McKibbon KA, Haynes RB. Source: Physical Therapy. 2003 February; 83(2): 123-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12564948&dopt=Abstract

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A randomized controlled trial to evaluate the efficacy of community based physical therapy in the treatment of people with rheumatoid arthritis. Author(s): Bell MJ, Lineker SC, Wilkins AL, Goldsmith CH, Badley EM. Source: The Journal of Rheumatology. 1998 February; 25(2): 231-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9489812&dopt=Abstract

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A valuable and timely analysis of research publications in 4 premiere physical therapy journals. Author(s): Jette AM. Source: Physical Therapy. 2003 February; 83(2): 131-2; Discussion 133. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12587598&dopt=Abstract

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Academic self-concept, academic achievement, and leadership in university students studying in a physical therapy program. Author(s): Gottlieb RJ, Rogers JL. Source: Journal of Allied Health. 2002 Summer; 31(2): 99-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12041004&dopt=Abstract

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Acute hospitalization and discharge outcome of neurologically intact trauma patients sustaining thoracolumbar vertebral fractures managed conservatively with thoracolumbosacral orthoses and physical therapy. Author(s): Melchiorre PJ. Source: Archives of Physical Medicine and Rehabilitation. 1999 February; 80(2): 221-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10025501&dopt=Abstract

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Adhesive capsulitis of the shoulder: an open study of 40 cases treated by joint distention during arthrography followed by an intraarticular corticosteroid injection and immediate physical therapy. Author(s): Laroche M, Ighilahriz O, Moulinier L, Constantin A, Cantagrel A, Mazieres B. Source: Rev Rhum Engl Ed. 1998 May; 65(5): 313-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9636950&dopt=Abstract

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Adjuvant physical therapy versus occupational therapy in patients with reflex sympathetic dystrophy/complex regional pain syndrome type I. Author(s): Oerlemans HM, Oostendorp RA, de Boo T, van der Laan L, Severens JL, Goris JA. Source: Archives of Physical Medicine and Rehabilitation. 2000 January; 81(1): 49-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10638876&dopt=Abstract

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An analysis of the relationship between the utilization of physical therapy services and outcomes of care for patients after total hip arthroplasty. Author(s): Freburger JK. Source: Physical Therapy. 2000 May; 80(5): 448-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10792855&dopt=Abstract

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An evaluation of the usefulness of noncognitive variables as predictors of scores on the national physical therapy licensing examination. Author(s): Guffey JS, Farris JW, Aldridge R, Thomas T. Source: Journal of Allied Health. 2002 Summer; 31(2): 78-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12041001&dopt=Abstract

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Analysis of practice-role perceptions of physical therapy, occupational therapy, and speech-language therapy students. Author(s): Conner-Kerr TA, Wittman P, Muzzarelli R. Source: Journal of Allied Health. 1998 Fall; 27(3): 128-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9785179&dopt=Abstract

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Analysis of the relationship between the utilization of physical therapy services and outcomes for patients with acute stroke. Author(s): Freburger JK. Source: Physical Therapy. 1999 October; 79(10): 906-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10498968&dopt=Abstract

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Application and interpretation of simple odds ratios in physical therapy-related research. Author(s): Levangie PK. Source: The Journal of Orthopaedic and Sports Physical Therapy. 2001 September; 31(9): 496-503. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11570733&dopt=Abstract

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Association of low back pain with self-reported risk factors among patients seeking physical therapy services. Author(s): Levangie PK. Source: Physical Therapy. 1999 August; 79(8): 757-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10440662&dopt=Abstract

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Back care instructions in physical therapy: a trend analysis of individualized back care programs. Author(s): Kerssens JJ, Sluijs EM, Verhaak PF, Knibbe HJ, Hermans IM. Source: Physical Therapy. 1999 March; 79(3): 286-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10078772&dopt=Abstract

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Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Author(s): Geiger RA, Allen JB, O'Keefe J, Hicks RR. Source: Physical Therapy. 2001 April; 81(4): 995-1005. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11276182&dopt=Abstract

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Basic pharmacokinetics and the potential effect of physical therapy interventions on pharmacokinetic variables. Author(s): Ciccone CD. Source: Physical Therapy. 1995 May; 75(5): 343-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7732078&dopt=Abstract

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Basics of physical therapy. Author(s): Millard L. Source: J Ark Med Soc. 1975 August; 72(3): 140-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=125741&dopt=Abstract

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Behavior modification in physical therapy. Author(s): Gouvier WD, Richards JS, Blanton PD, Janert K, Rosen LA, Drabman RS. Source: Archives of Physical Medicine and Rehabilitation. 1985 February; 66(2): 113-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3882077&dopt=Abstract

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Behavioral physical therapy and spina bifida: a case study. Author(s): Rapport MD, Bailey JS. Source: Journal of Pediatric Psychology. 1985 March; 10(1): 87-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3886870&dopt=Abstract

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Beyond lecture and laboratory in the physical therapy classroom. Author(s): Day JA. Source: Physical Therapy. 1985 August; 65(8): 1214-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4023070&dopt=Abstract

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Bicycle pedal modifications for use in a physical therapy department. Author(s): Handling KA. Source: Physical Therapy. 1982 July; 62(7): 997. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7089065&dopt=Abstract

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Biofeedback use of common objects: the bathroom scale in physical therapy. Author(s): Peper E, Robertson JA. Source: Biofeedback Self Regul. 1976 June; 1(2): 237-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=990352&dopt=Abstract

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Biomechanics and physical therapy. A perspective. Author(s): Smidt GL. Source: Physical Therapy. 1984 December; 64(12): 1807-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6505022&dopt=Abstract

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BOTOX and physical therapy in the treatment of piriformis syndrome. Author(s): Fishman LM, Anderson C, Rosner B. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 December; 81(12): 936-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12447093&dopt=Abstract

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Breathing exercises in chest physical therapy. Author(s): Kigin CM. Source: Chest. 1987 July; 92(1): 190-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3595240&dopt=Abstract

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Bronchopulmonary hygiene physical therapy for chronic obstructive pulmonary disease and bronchiectasis. Author(s): Jones AP, Rowe BH. Source: Cochrane Database Syst Rev. 2000; (2): Cd000045. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796474&dopt=Abstract

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Bronchopulmonary hygiene physical therapy in bronchiectasis and chronic obstructive pulmonary disease: a systematic review. Author(s): Jones A, Rowe BH. Source: Heart & Lung : the Journal of Critical Care. 2000 March-April; 29(2): 125-35. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10739489&dopt=Abstract

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Broomstick plaster with a removable abduction bar: a simple technique that facilitates early postoperative physical therapy and handling. Author(s): Jones S, Chell J, Davies G. Source: Journal of Pediatric Orthopedics. 2000 September-October; 20(5): 640-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11008745&dopt=Abstract

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Burns: analysis of results of physical therapy in 681 patients. Author(s): Dobbs ER, Curreri PW. Source: The Journal of Trauma. 1972 March; 12(3): 242-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5012820&dopt=Abstract

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Can a program of manual physical therapy and supervised exercise improve the symptoms of osteoarthritis of the knee? Author(s): Iudica AC. Source: The Journal of Family Practice. 2000 May; 49(5): 466-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10836782&dopt=Abstract

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Challenging myths in physical therapy. Author(s): Harris SR. Source: Physical Therapy. 2001 June; 81(6): 1180-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11380273&dopt=Abstract

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Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy. Author(s): Engsberg JR, Ross SA, Park TS. Source: Journal of Neurosurgery. 1999 November; 91(5): 727-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10541227&dopt=Abstract

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Changes in hip spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy. Author(s): Engsberg JR, Ross SA, Wagner JM, Park TS. Source: Developmental Medicine and Child Neurology. 2002 April; 44(4): 220-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11995889&dopt=Abstract

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Changes in lymphatic function after complex physical therapy for lymphedema. Author(s): Hwang JH, Kwon JY, Lee KW, Choi JY, Kim BT, Lee BB, Kim DI. Source: Lymphology. 1999 March; 32(1): 15-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10197323&dopt=Abstract

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Changing trends in program assessment in physical therapy education: perceptions of program directors. Author(s): Boucher B. Source: Journal of Allied Health. 1999 Fall; 28(3): 165-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10507500&dopt=Abstract

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Characteristics, perceptions, and factors influencing the decision making of physical therapy chairpersons in 2000. Author(s): Page CG. Source: Journal of Allied Health. 2001 Summer; 30(2): 92-105. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11398235&dopt=Abstract

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Chest physical therapy (CPT). Author(s): Oberle GM. Source: Rehab Manag. 2002 April; 15(3): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12741272&dopt=Abstract

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Chest physical therapy in patients with acute exacerbation of chronic bronchitis: effectiveness of three methods. Author(s): Bellone A, Lascioli R, Raschi S, Guzzi L, Adone R. Source: Archives of Physical Medicine and Rehabilitation. 2000 May; 81(5): 558-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10807091&dopt=Abstract

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Chest physical therapy. Author(s): Spero K. Source: Rehab Manag. 2002 April; 15(3): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12741273&dopt=Abstract

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Clinical specificity and the non-generalities of science. On innovation strategies for neurological physical therapy. Author(s): Lettinga A, Mol A. Source: Theoretical Medicine and Bioethics. 1999 December; 20(6): 517-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10765489&dopt=Abstract

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Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women. Author(s): Pages IH, Jahr S, Schaufele MK, Conradi E. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2001 July; 80(7): 494-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11421517&dopt=Abstract

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Comparison of Flutter device and chest physical therapy in the treatment of cystic fibrosis pulmonary exacerbation. Author(s): Gondor M, Nixon PA, Mutich R, Rebovich P, Orenstein DM. Source: Pediatric Pulmonology. 1999 October; 28(4): 255-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10497374&dopt=Abstract

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Comparison of multicultural literature in three health professions: physical therapy, nursing & social work. Author(s): Black RM. Source: J Cult Divers. 2001 Spring; 8(1): 3-15. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11855011&dopt=Abstract

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Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. Author(s): Bang MD, Deyle GD. Source: The Journal of Orthopaedic and Sports Physical Therapy. 2000 March; 30(3): 12637. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10721508&dopt=Abstract

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Comparison of the efficacy of local corticosteroid injection and physical therapy for the treatment of adhesive capsulitis. Author(s): Arslan S, Celiker R. Source: Rheumatology International. 2001 September; 21(1): 20-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11678298&dopt=Abstract

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Concepts of disablement in documents guiding physical therapy practice. Author(s): Raman S, Levi SJ. Source: Disability and Rehabilitation. 2002 October 15; 24(15): 790-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437865&dopt=Abstract

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Connective tissues: matrix composition and its relevance to physical therapy. Author(s): Culav EM, Clark CH, Merrilees MJ. Source: Physical Therapy. 1999 March; 79(3): 308-19. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10078774&dopt=Abstract

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Considerations for planning and conducting clinic-based research in physical therapy. Author(s): Fitzgerald GK, Delitto A. Source: Physical Therapy. 2001 August; 81(8): 1446-54. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11509074&dopt=Abstract

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Contemporary trends and practice strategies in pediatric occupational and physical therapy. Author(s): Jirikowic T, Stika-Monson R, Knight A, Hutchinson S, Washington K, Kartin D. Source: Physical & Occupational Therapy in Pediatrics. 2001; 20(4): 45-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11382205&dopt=Abstract

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Describing expert practice in physical therapy. Author(s): Shepard KF, Hack LM, Gwyer J, Jensen GM. Source: Qualitative Health Research. 1999 November; 9(6): 746-58. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10662257&dopt=Abstract

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Determinants of clinical performance in a physical therapy program. Author(s): Watson CJ, Barnes CA, Williamson JW. Source: Journal of Allied Health. 2000 Fall; 29(3): 150-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11026116&dopt=Abstract

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Determining medical necessity of outpatient physical therapy services. Author(s): Moorhead JF, Clifford J. Source: American Journal of Medical Quality : the Official Journal of the American College of Medical Quality. 1992 Fall; 7(3): 81-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1493381&dopt=Abstract

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Developing cultural competence in occupational therapy and physical therapy education: a field immersion approach. Author(s): Ekelman B, Bello-Haas VD, Bazyk J, Bazyk S. Source: Journal of Allied Health. 2003 Summer; 32(2): 131-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801027&dopt=Abstract

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Development of a computer-assisted method for the collection, organization, and use of patient health history information in physical therapy. Author(s): Zimny NJ, Tandy CJ. Source: The Journal of Orthopaedic and Sports Physical Therapy. 1993 February; 17(2): 84-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8467338&dopt=Abstract

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Development of the physical therapy outpatient satisfaction survey (PTOPS). Author(s): Roush SE, Sonstroem RJ. Source: Physical Therapy. 1999 February; 79(2): 159-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10029056&dopt=Abstract

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Diagnosis and treatment in physical therapy: an investigation of their relationship. Author(s): Dekker J, van Baar ME, Curfs EC, Kerssens JJ. Source: Physical Therapy. 1993 September; 73(9): 568-77; Discussion 577-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8356106&dopt=Abstract

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Diagnostic classification of patients with low back pain: report on a survey of physical therapy experts. Author(s): Binkley J, Finch E, Hall J, Black T, Gowland C. Source: Physical Therapy. 1993 March; 73(3): 138-50; Discussion 150-5. Erratum In: Phys Ther 1993 May; 73(5): 330. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8438002&dopt=Abstract

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Differential diagnosis in physical therapy evaluation of thigh pain in an adolescent boy. Author(s): Pellecchia GL, Lugo-Larcheveque N, Deluca PA. Source: The Journal of Orthopaedic and Sports Physical Therapy. 1996 January; 23(1): 51-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8749750&dopt=Abstract

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Disability and functional status in patients with low back pain receiving workers' compensation: a descriptive study with implications for the efficacy of physical therapy. Author(s): Di Fabio RP, Mackey G, Holte JB. Source: Physical Therapy. 1995 March; 75(3): 180-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7870750&dopt=Abstract

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Discharge criteria from perioperative physical therapy. Author(s): Brooks D, Parsons J, Newton J, Dear C, Silaj E, Sinclair L, Quirt J. Source: Chest. 2002 February; 121(2): 488-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11834662&dopt=Abstract

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Discharge videotaping: a means of augmenting occupational and physical therapy. Author(s): Gallagher J, Lakatos M, Goldfarb IW, Slater H. Source: The Journal of Burn Care & Rehabilitation. 1990 September-October; 11(5): 470-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2246318&dopt=Abstract

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Discordance between cardiopulmonary physiology and physical therapy. Author(s): O'Callaghan C. Source: Chest. 1994 January; 105(1): 322-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8275773&dopt=Abstract

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Discordance between cardiopulmonary physiology and physical therapy. Author(s): Lewis S, Besselink MC, Chisholm K, Wong A, LeBlanc P. Source: Chest. 1993 August; 104(2): 656. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8339685&dopt=Abstract

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Discordance between cardiopulmonary physiology and physical therapy. Toward a rational basis for practice. Author(s): Dean E, Ross J. Source: Chest. 1992 June; 101(6): 1694-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1600794&dopt=Abstract

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Do physical therapy and occupational therapy reduce the impairment percentage in reflex sympathetic dystrophy? Author(s): Oerlemans HM, Goris JA, de Boo T, Oostendorp RA. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1999 November-December; 78(6): 533-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10574168&dopt=Abstract

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Does improved spinal mobility correlate with functional changes in spondyloarthropathy after short term physical therapy? Author(s): Heikkila S, Viitanen JV, Kautiainen H, Kauppi M. Source: The Journal of Rheumatology. 2000 December; 27(12): 2942-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11128694&dopt=Abstract

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Does physical therapy improve symptoms of fibromyalgia? Author(s): Smith M, Gokula RR, Weismantel A. Source: The Journal of Family Practice. 2003 September; 52(9): 717-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12967546&dopt=Abstract

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Dorsal rhizotomy and physical therapy. Author(s): Lin JP. Source: Developmental Medicine and Child Neurology. 1998 April; 40(4): 219. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9593492&dopt=Abstract

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Dysvascular amputee rehabilitation. The role of continuous noninvasive cardiovascular monitoring during physical therapy. Author(s): Roth EJ, Wiesner SL, Green D, Wu YC. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1990 February; 69(1): 16-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2302333&dopt=Abstract

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Economic impact of on-site physical therapy. Author(s): Scruby DJ, Denham S, Larkin GN. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2001 August; 43(8): 670-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11515248&dopt=Abstract

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Educating patient educators: enhancing instructional effectiveness in physical therapy for low back pain patients. Author(s): Kerssens JJ, Sluijs EM, Verhaak PF, Knibbe HJ, Hermans IM. Source: Patient Education and Counseling. 1999 June; 37(2): 165-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14528543&dopt=Abstract

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Effect of high-frequency oral airway and chest wall oscillation and conventional chest physical therapy on expectoration in patients with stable cystic fibrosis. Author(s): Scherer TA, Barandun J, Martinez E, Wanner A, Rubin EM. Source: Chest. 1998 April; 113(4): 1019-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9554641&dopt=Abstract

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Effect of physical therapy on limited joint mobility in the diabetic foot. A pilot study. Author(s): Dijs HM, Roofthooft JM, Driessens MF, De Bock PG, Jacobs C, Van Acker KL. Source: Journal of the American Podiatric Medical Association. 2000 March; 90(3): 12632. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10740995&dopt=Abstract

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Effectiveness of early physical therapy in low back musculoskeletal disorders. Author(s): Lucey C. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2002 June; 44(6): 490; Author Reply 490-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12085471&dopt=Abstract

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Effectiveness of early physical therapy in the treatment of acute low back musculoskeletal disorders. Author(s): Zigenfus GC, Yin J, Giang GM, Fogarty WT. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2000 January; 42(1): 35-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10652686&dopt=Abstract

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Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Author(s): Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Source: Annals of Internal Medicine. 2000 February 1; 132(3): 173-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10651597&dopt=Abstract

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Effectiveness of occupational medicine center-based physical therapy. Author(s): Linz DH, Shepherd CD, Ford LF, Ringley LL, Klekamp J, Duncan JM. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2002 January; 44(1): 48-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11802465&dopt=Abstract

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Effectiveness of physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm. Author(s): Wang WT, Olson SL, Campbell AH, Hanten WP, Gleeson PB. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2003 March; 82(3): 203-18; Quiz 219-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12595773&dopt=Abstract

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Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy. Author(s): Goodwin PC, Morrissey MC, Omar RZ, Brown M, Southall K, McAuliffe TB. Source: Physical Therapy. 2003 June; 83(6): 520-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775198&dopt=Abstract

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Effectiveness of two conservative modes of physical therapy in women with urinary stress incontinence. Author(s): Arvonen T, Fianu-Jonasson A, Tyni-Lenne R. Source: Neurourology and Urodynamics. 2001; 20(5): 591-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11574936&dopt=Abstract

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Effects of backward bending on lumbar intervertebral discs. Relevance to physical therapy treatments for low back pain. Author(s): Adams MA, May S, Freeman BJ, Morrison HP, Dolan P. Source: Spine. 2000 February 15; 25(4): 431-7; Discussion 438. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10707387&dopt=Abstract

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Effects of physical therapy on cytokines and two color analysis-lymphocyte subsets in patients with cerebrovascular diseases. Author(s): Kurabayashi H, Machida I, Handa H, Yoshida Y, Akiba T, Itoh K, Tamura J, Kubota K. Source: J Med. 1999; 30(1-2): 31-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10515238&dopt=Abstract

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Effects of physical therapy on patients with Kashin-Beck disease in Tibet. Author(s): Mathieu F, Suetens C, Begaux F, De Maertelaer V, Hinsenkamp M. Source: International Orthopaedics. 2001; 25(3): 191-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11482539&dopt=Abstract

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Ethical dilemmas in occupational therapy and physical therapy: a survey of practitioners in the UK National Health Service. Author(s): Barnitt R. Source: Journal of Medical Ethics. 1998 June; 24(3): 193-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9650115&dopt=Abstract

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Evaluating physical therapy utilization under PPS. Author(s): Anemaet WK, Krulish LH, Lindstrom KC, Herr R, Carr MN. Source: Home Healthcare Nurse. 2001 August; 19(8): 502-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11982187&dopt=Abstract

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Exercise and physical therapy in elderly, more severely incapacitated patients in cardiac rehabilitation. Author(s): Mathes P. Source: Coronary Artery Disease. 1999; 10(1): 33-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10196685&dopt=Abstract

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Exercise in the prevention and treatment of osteoporosis: the role of physical therapy and nursing. Author(s): Hertel KL, Trahiotis MG. Source: Nurs Clin North Am. 2001 September; 36(3): 441-53, Viii-Ix. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11532659&dopt=Abstract

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Experiences of older women with cancer receiving hospice care: significance for physical therapy. Author(s): Mackey KM, Sparling JW. Source: Physical Therapy. 2000 May; 80(5): 459-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10792856&dopt=Abstract

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Expert practice in physical therapy. Author(s): Jensen GM, Gwyer J, Shepard KF. Source: Physical Therapy. 2000 January; 80(1): 28-43; Discussion 44-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10623958&dopt=Abstract

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Factors influencing high school students' knowledge of physical therapy. Author(s): Tsuda HC, Kiser BC, Shepard KF. Source: Physical Therapy. 1982 August; 62(8): 1157-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7100273&dopt=Abstract

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Factors influencing manual muscle tests in physical therapy. Author(s): Nicholas JA, Sapega A, Kraus H, Webb JN. Source: The Journal of Bone and Joint Surgery. American Volume. 1978 March; 60(2): 186-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=641082&dopt=Abstract

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Factors related to change in global health after group physical therapy in ankylosing spondylitis. Author(s): Hidding A, van der Linden S. Source: Clinical Rheumatology. 1995 May; 14(3): 347-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7641514&dopt=Abstract

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Factors related to physical therapy students' decisions to work with elderly patients. Author(s): Coren A, Andreassi M, Blood H, Kent B. Source: Physical Therapy. 1987 January; 67(1): 60-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3797479&dopt=Abstract

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Fat embolism in childhood. Review with report of a fatal case related to physical therapy in a child with dermatomyositis. Author(s): Shulman ST, Grossman BJ. Source: Am J Dis Child. 1970 November; 120(5): 480-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5474760&dopt=Abstract

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Fatal pulmonary hemorrhage associated with chest physical therapy. Author(s): Hammon WE, Martin RJ. Source: Physical Therapy. 1979 October; 59(10): 1247-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=493347&dopt=Abstract

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Fractures during physical therapy. Author(s): Miller M. Source: Pediatric Radiology. 2002 July; 32(7): 536-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12214570&dopt=Abstract

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From laboratory to clinic: noradrenergic enhancement of physical therapy for stroke or trauma patients. Author(s): Feeney DM. Source: Adv Neurol. 1997; 73: 383-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8959228&dopt=Abstract

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Frozen shoulder: correlation between the response to physical therapy and follow-up shoulder arthrography. Author(s): Mao CY, Jaw WC, Cheng HC. Source: Archives of Physical Medicine and Rehabilitation. 1997 August; 78(8): 857-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9344306&dopt=Abstract

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Functional approach to chest physical therapy. Author(s): Reinisch ES. Source: Physical Therapy. 1978 August; 58(8): 972-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=674383&dopt=Abstract

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Fundamentals of acute burn care and physical therapy management. Author(s): Wright PC. Source: Physical Therapy. 1984 August; 64(8): 1217-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6379690&dopt=Abstract

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Gender and physical therapy career success factors. Author(s): Rozier CK, Raymond MJ, Goldstein MS, Hamilton BL. Source: Physical Therapy. 1998 July; 78(7): 690-704. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9672543&dopt=Abstract

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Geographical challenges for physical therapy continuing education: preferences and influences. Author(s): Tassone MR, Speechley M. Source: Physical Therapy. 1997 March; 77(3): 285-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9062570&dopt=Abstract

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Geriatrics emphasis in physical therapy. A historical survey. Author(s): Wong RA. Source: Physical Therapy. 1988 March; 68(3): 360-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3279438&dopt=Abstract

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Gerontological instruction in entry-level physical therapy education. Author(s): Strasburg DM. Source: Gerontol Geriatr Educ. 1984 Summer; 4(4): 65-73. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6534794&dopt=Abstract

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GM-1 ganglioside administration combined with physical therapy restores ambulation in humans with chronic spinal cord injury. Author(s): Walker JB, Harris M. Source: Neuroscience Letters. 1993 October 29; 161(2): 174-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8272262&dopt=Abstract

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Graduate Record Examination Analytical scores as predictors of academic success in four entry-level master's degree physical therapy programs. Author(s): Day JA. Source: Physical Therapy. 1986 October; 66(10): 1555-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3763709&dopt=Abstract

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Grip strength and grip endurance in physical therapy students. Author(s): Nwuga VC. Source: Archives of Physical Medicine and Rehabilitation. 1975 July; 56(7): 297-300. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1147747&dopt=Abstract

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Guide to Physical Therapist Practice. Second Edition. American Physical Therapy Association. Author(s): American Physical Therapy Association. Source: Physical Therapy. 2001 January; 81(1): 9-746. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11175682&dopt=Abstract

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Hemicorporectomy: a case study from a physical therapy perspective. Author(s): Porter-Romatowski TL, Deckert J. Source: Archives of Physical Medicine and Rehabilitation. 1998 April; 79(4): 464-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9552117&dopt=Abstract

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Home continuous passive motion machine versus professional physical therapy following total knee replacement. Author(s): Worland RL, Arredondo J, Angles F, Lopez-Jimenez F, Jessup DE. Source: The Journal of Arthroplasty. 1998 October; 13(7): 784-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9802665&dopt=Abstract

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Home health physical therapy: practice patterns in western New York. Author(s): Collins J, Beissner KL, Krout JA. Source: Physical Therapy. 1998 February; 78(2): 170-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9474109&dopt=Abstract

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Home program of physical therapy: effect on disabilities of patients with total hip arthroplasty. Author(s): Sashika H, Matsuba Y, Watanabe Y. Source: Archives of Physical Medicine and Rehabilitation. 1996 March; 77(3): 273-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8600871&dopt=Abstract

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Hospitalization, inpatient physical therapy and institutionalization after hospital discharge of prostate cancer patients in south Florida. Author(s): Krongrad A, Lai H, Lai S. Source: The Journal of Urology. 1998 March; 159(3): 888-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9474176&dopt=Abstract

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How effective are exercise and physical therapy for chronic low back pain? Author(s): Carter IR, Lord JL. Source: The Journal of Family Practice. 2002 March; 51(3): 209. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11978228&dopt=Abstract

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How effective is a programmed text in teaching physical therapy aides? Author(s): Kristy J, McDaniel LV. Source: Physical Therapy. 1967 February; 47(2): 118-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6045282&dopt=Abstract

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How much physical therapy for patients with stroke? Author(s): Knox J, Horrocks P. Source: British Medical Journal. 1978 June 24; 1(6128): 1696-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=656876&dopt=Abstract

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How much physical therapy for patients with stroke? Author(s): Brocklehurst JC, Andrews K, Richards B, Laycock PJ. Source: British Medical Journal. 1978 May 20; 1(6123): 1307-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=647253&dopt=Abstract

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Human resources in physical therapy: opportunities for service in a rapidly changing health system. Author(s): Selker LG. Source: Physical Therapy. 1995 January; 75(1): 31-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7809196&dopt=Abstract

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Hypnotically hallucinated physical therapy with a multiple sclerosis patient. Author(s): McCord H. Source: Am J Clin Hypn. 1966 April; 8(4): 313-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5909214&dopt=Abstract

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Impact of managed care on physical therapy education and practice in Missouri: focus group reports. Author(s): Oliver R. Source: Journal of Allied Health. 1997 Winter; 26(1): 41-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9136062&dopt=Abstract

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Impact of physical therapy weekend coverage on length of stay in an acute care community hospital. Author(s): Rapoport J, Judd-Van Eerd M. Source: Physical Therapy. 1989 January; 69(1): 32-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2911615&dopt=Abstract

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Importance of Physical Therapy grows. Author(s): Bohannon RW. Source: Physical Therapy. 1988 April; 68(4): 584. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3353467&dopt=Abstract

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Improvement in attitudes toward the elderly following traditional and geriatric mock clinics for physical therapy students. Author(s): Brown DS, Gardner DL, Perritt L, Kelly DG. Source: Physical Therapy. 1992 April; 72(4): 251-7; Discussion 258-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1584858&dopt=Abstract

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Improvements following short term home based physical therapy are maintained at one year in people with moderate to severe rheumatoid arthritis. Author(s): Lineker SC, Bell MJ, Wilkins AL, Badley EM. Source: The Journal of Rheumatology. 2001 January; 28(1): 165-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11196519&dopt=Abstract

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Improving outcomes in hip fracture patients: using QA tools in a skilled nursing facility physical therapy clinic. Author(s): Flemming P. Source: J Healthc Qual. 1993 July-August; 15(4): 21-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10127221&dopt=Abstract

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Improving physical functioning in the elderly dialysis patient: relevance of physical therapy. Author(s): Pianta TF, Kutner NG. Source: Anna J. 1999 February; 26(1): 11-4; Quiz 15-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10222852&dopt=Abstract

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Inefficiency of chest percussion in the physical therapy of chronic bronchitis. Author(s): Wollmer P, Ursing K, Midgren B, Eriksson L. Source: Eur J Respir Dis. 1985 April; 66(4): 233-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4018176&dopt=Abstract

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Initial health status of patients at outpatient physical therapy clinics. Author(s): Mossberg KA, McFarland C. Source: Physical Therapy. 1995 December; 75(12): 1043-51; Discussion 1051-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7501707&dopt=Abstract

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Integrated care of patients with fractured hip by nursing and physical therapy. Author(s): Pachter S, Flics SS. Source: Nln Publ. 1987 December; (20-2191): 441-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3122172&dopt=Abstract

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Integrating movement science and physical therapy. Author(s): Bohannon RW. Source: Physical Therapy. 1991 April; 71(4): 344-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2008457&dopt=Abstract

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Integration of complementary disciplines into the oncology clinic. Part II. Physical therapy. Author(s): Mondry TE. Source: Current Problems in Cancer. 2000 July-August; 24(4): 194-212. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11001325&dopt=Abstract

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Intensive physical therapy after hip fracture. A randomised clinical trial. Author(s): Lauridsen UB, de la Cour BB, Gottschalck L, Svensson BH. Source: Dan Med Bull. 2002 February; 49(1): 70-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11894727&dopt=Abstract

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Interpersonal skills education in entry-level physical therapy programs. Author(s): Guccione AA, DeMont ME. Source: Physical Therapy. 1987 March; 67(3): 388-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3823153&dopt=Abstract

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Interrater reliability of the Tinetti Balance Scores in novice and experienced physical therapy clinicians. Author(s): Cipriany-Dacko LM, Innerst D, Johannsen J, Rude V. Source: Archives of Physical Medicine and Rehabilitation. 1997 October; 78(10): 1160-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9339170&dopt=Abstract

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Investigation of the effects of a model of physical therapy on mother-child interactions and the motor behaviors of children with motor delay. Author(s): Chiarello LA, Palisano RJ. Source: Physical Therapy. 1998 February; 78(2): 180-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9474110&dopt=Abstract

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Is group physical therapy superior to individualized therapy in ankylosing spondylitis? A randomized controlled trial. Author(s): Hidding A, van der Linden S, Boers M, Gielen X, de Witte L, Kester A, Dijkmans B, Moolenburgh D. Source: Arthritis Care and Research : the Official Journal of the Arthritis Health Professions Association. 1993 September; 6(3): 117-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8130287&dopt=Abstract

Studies

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Is manual physical therapy distinct from physical therapy clinical practice? Author(s): Deyle GD, Henderson NE, Garber MB, Matekel RL, Ryder MG, Allison SC. Source: Physical Therapy. 2002 March; 82(3): 287-8; Author Reply 288-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11869157&dopt=Abstract

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Is pathokinesiology synonymous with physical therapy? Author(s): Schlegel R. Source: Physical Therapy. 1986 March; 66(3): 366-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3952151&dopt=Abstract

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Is physical therapy effective? Catch-22 of meta-analysis. Author(s): Di Fabio RP. Source: The Journal of Orthopaedic and Sports Physical Therapy. 2000 April; 30(4): 1689. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10858067&dopt=Abstract

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Job satisfaction among academic coordinators of clinical education in physical therapy. Author(s): Harris MJ, Fogel M, Blacconiere M. Source: Physical Therapy. 1987 June; 67(6): 958-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3588684&dopt=Abstract

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Joint position biofeedback facilitation of physical therapy in gait training. Author(s): Koheil R, Reg PT, Mandel AR. Source: Am J Phys Med. 1980 December; 59(6): 288-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7457592&dopt=Abstract

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Knowledge of results and motor learning--implications for physical therapy. Author(s): Winstein CJ. Source: Physical Therapy. 1991 February; 71(2): 140-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1989009&dopt=Abstract

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Lasting recovery of motor function, following brain damage, with a single dose of amphetamine combined with physical therapy; changes in gene expression? Author(s): Bach-y-Rita P, Bjelke B. Source: Scandinavian Journal of Rehabilitation Medicine. 1991; 23(4): 219-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1785033&dopt=Abstract

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Lasting resolution of chronic thoracic neuritis using a martial-arts-based physical therapy. Author(s): Massey PB, Perlman A. Source: Alternative Therapies in Health and Medicine. 1999 May; 5(3): 104, 103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10234874&dopt=Abstract

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Learning style preferences: physical therapy students in the United States. Author(s): Payton OD, Hueter AE, McDonald ME. Source: Physical Therapy. 1979 February; 59(2): 147-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=760123&dopt=Abstract

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Legislative change to permit direct access to physical therapy services: a study of process and content issues. Author(s): Taylor TK, Domholdt E. Source: Physical Therapy. 1991 May; 71(5): 382-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2027894&dopt=Abstract

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Letter: Physical therapy. Author(s): Barach AL. Source: Am Rev Respir Dis. 1975 December; 112(6): 887. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1203001&dopt=Abstract

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Letter: physical therapy. Author(s): Sheehan GA. Source: Jama : the Journal of the American Medical Association. 1975 June 16; 232(11): 1127. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1173612&dopt=Abstract

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Letter: Seven-day physical therapy. Author(s): Kerr DH. Source: Physical Therapy. 1974 July; 54(7): 776. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4420064&dopt=Abstract

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Letters to the editor: Electronic data processing of physical therapy services. Author(s): Kane J. Source: Physical Therapy. 1974 September; 54(9): 995-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4420285&dopt=Abstract

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Levodopa and physical therapy in treatment of patients with Parkinson's disease. Author(s): Stern PH, McDowell F, Miller JM, Robinson M. Source: Archives of Physical Medicine and Rehabilitation. 1970 May; 51(5): 273-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5420013&dopt=Abstract

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Licensure examination in physical therapy. Author(s): Fazio K. Source: Physical Therapy. 1973 January; 53(1): 5-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4682701&dopt=Abstract

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Loads on an internal spinal fixation device during physical therapy. Author(s): Rohlmann A, Graichen F, Bergmann G. Source: Physical Therapy. 2002 January; 82(1): 44-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11784277&dopt=Abstract

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Long-term transcutaneous electrical nerve stimulation (TENS) use: impact on medication utilization and physical therapy costs. Author(s): Chabal C, Fishbain DA, Weaver M, Heine LW. Source: The Clinical Journal of Pain. 1998 March; 14(1): 66-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9535316&dopt=Abstract

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Looking for physical therapy outcomes. Author(s): Kane RL. Source: Physical Therapy. 1994 May; 74(5): 425-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8171104&dopt=Abstract

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Lower-extremity surgery for children with cerebral palsy: physical therapy management. Author(s): Harryman SE. Source: Physical Therapy. 1992 January; 72(1): 16-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1728044&dopt=Abstract

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Lumbar disc disease: comparative analysis of physical therapy treatments. Author(s): Zylbergold RS, Piper MC. Source: Archives of Physical Medicine and Rehabilitation. 1981 April; 62(4): 176-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6453571&dopt=Abstract

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Lymphedema management training for physical therapy students in the United States. Author(s): Augustine E, Corn M, Danoff J. Source: Cancer. 1998 December 15; 83(12 Suppl American): 2869-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9874413&dopt=Abstract

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Making the physical therapy referral. Author(s): Saladin LK, Morrisette DC, Brotherton SS. Source: Jaapa. 1999 February; 12(2): 18-20, 23, 27-32 Passim. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10728066&dopt=Abstract

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Management of patients with chronic renal failure. Role of physical therapy. Author(s): Gray PJ. Source: Physical Therapy. 1982 February; 62(2): 173-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7036195&dopt=Abstract

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Management of shoulder dysfunction with an alternative model of orthopaedic physical therapy intervention: a case report. Author(s): Holmes CF, Fletcher JP, Blaschak MJ, Schenck RC. Source: The Journal of Orthopaedic and Sports Physical Therapy. 1997 December; 26(6): 347-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9402572&dopt=Abstract

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Manual physical therapy and exercise improved function in osteoarthritis of the knee. Author(s): Mohomed NN. Source: The Journal of Bone and Joint Surgery. American Volume. 2000 September; 82(9): 1324. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11005525&dopt=Abstract

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Manual therapy for lumbar spinal stenosis: a comprehensive physical therapy approach. Author(s): Rademeyer I. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 103-10, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622485&dopt=Abstract

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Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial. Author(s): Hoving JL, Koes BW, de Vet HC, van der Windt DA, Assendelft WJ, van Mameren H, Deville WL, Pool JJ, Scholten RJ, Bouter LM. Source: Annals of Internal Medicine. 2002 May 21; 136(10): 713-22. Summary for Patients In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12020139&dopt=Abstract

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Manual therapy: a critical assessment of role in the profession of physical therapy. Author(s): Farrell JP, Jensen GM. Source: Physical Therapy. 1992 December; 72(12): 843-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1454860&dopt=Abstract

Studies

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Mapping the literature of physical therapy. Author(s): Wakiji EM. Source: Bulletin of the Medical Library Association. 1997 July; 85(3): 284-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9285129&dopt=Abstract

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Measurement validity in physical therapy research. Author(s): Sim J, Arnell P. Source: Physical Therapy. 1993 February; 73(2): 102-10; Discussion 110-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8421716&dopt=Abstract

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Mechanics and energetics of breathing in newly diagnosed infants with cystic fibrosis: effect of combined bronchodilator and chest physical therapy. Author(s): Hardy KA, Wolfson MR, Schidlow DV, Shaffer TH. Source: Pediatric Pulmonology. 1989; 6(2): 103-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2927967&dopt=Abstract

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Medical and physical therapy of temporomandibular joint disk displacement without reduction. Author(s): Stiesch-Scholz M, Fink M, Tschernitschek H, Rossbach A. Source: Cranio. 2002 April; 20(2): 85-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12002834&dopt=Abstract

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Medical history profile: orthopaedic physical therapy outpatients. Author(s): Boissonnault WG, Koopmeiners MB. Source: The Journal of Orthopaedic and Sports Physical Therapy. 1994 July; 20(1): 2-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8081405&dopt=Abstract

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Mental imagery and its potential for physical therapy. Author(s): Warner L, McNeill ME. Source: Physical Therapy. 1988 April; 68(4): 516-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3281175&dopt=Abstract

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Mixing one part common sense with each part statistics in planning the design and reporting the results of clinical research in physical therapy. Author(s): Lehmkuhl LD. Source: Physical Therapy. 1987 December; 67(12): 1851-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3685111&dopt=Abstract

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Model for physical therapy in the NICU. Author(s): Jonkey BW, Solava DG. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1990 June; 10(2): 185-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2358904&dopt=Abstract

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Modeling physical therapy clinical research centers. Author(s): Soderberg GL, Walter JM. Source: Physical Therapy. 1991 October; 71(10): 734-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1946612&dopt=Abstract

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Modern treatment of lymphoedema. I. Complex physical therapy: the first 200 Australian limbs. Author(s): Casley-Smith JR, Casley-Smith JR. Source: The Australasian Journal of Dermatology. 1992; 33(2): 61-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1294054&dopt=Abstract

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Motor disabilities in the Rett syndrome and physical therapy strategies. Author(s): Hanks SB. Source: Brain & Development. 1990; 12(1): 157-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2344013&dopt=Abstract

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Movement disorders in people with Parkinson disease: a model for physical therapy. Author(s): Morris ME. Source: Physical Therapy. 2000 June; 80(6): 578-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10842411&dopt=Abstract

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Movement science and its relevance to physical therapy. Author(s): Winstein CJ, Knecht HG. Source: Physical Therapy. 1990 December; 70(12): 759-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2236219&dopt=Abstract

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Nature of clinical practice for specialists in orthopaedic physical therapy. Author(s): Milidonis MK, Godges JJ, Jensen GM. Source: The Journal of Orthopaedic and Sports Physical Therapy. 1999 April; 29(4): 2407. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10322597&dopt=Abstract

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New challenges for physical therapy practitioners in educational settings. Author(s): Mullins J. Source: Physical Therapy. 1981 April; 61(4): 496-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6451876&dopt=Abstract

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Ninth Mary McMillan Lecture. Tomorrow now: the master's degree for physical therapy education. Author(s): Daniels L. Source: Physical Therapy. 1974 May; 54(5): 463-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4420711&dopt=Abstract

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Nonpharmacological treatment for migraine: incremental utility of physical therapy with relaxation and thermal biofeedback. Author(s): Marcus DA, Scharff L, Mercer S, Turk DC. Source: Cephalalgia : an International Journal of Headache. 1998 June; 18(5): 266-72; Discussion 242. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9673806&dopt=Abstract

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Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy. Author(s): Whitman JM, Flynn TW, Fritz JM. Source: Phys Med Rehabil Clin N Am. 2003 February; 14(1): 77-101, Vi-Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622484&dopt=Abstract

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Nonverbal communication during physical therapy. Author(s): Perry JF. Source: Physical Therapy. 1975 June; 55(6): 593-600. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1135254&dopt=Abstract

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Nursing, occupational therapy, and physical therapy preparation in rheumatology in the United States and Canada. Author(s): Jette AM, Becker MC. Source: Journal of Allied Health. 1980 November; 9(4): 268-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7462089&dopt=Abstract

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Objective evaluation of hand function in scleroderma patients to assess effectiveness of physical therapy. Author(s): Askew LJ, Beckett VL, An KN, Chao EY. Source: British Journal of Rheumatology. 1983 November; 22(4): 224-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6652386&dopt=Abstract

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Obstetrical physical therapy. Review of the literature. Author(s): Gleeson PB, Pauls JA. Source: Physical Therapy. 1988 November; 68(11): 1699-702. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3054943&dopt=Abstract

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Obstructive lung disease. Treatment by physical therapy. Author(s): Halpern D. Source: Minn Med. 1969 September; 52(9): 1489-95. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5824159&dopt=Abstract

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On developing expert-based decision-support systems in physical therapy: the NIOSH low back atlas. Author(s): Delitto A, Shulman AD, Rose SJ. Source: Physical Therapy. 1989 July; 69(7): 554-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2525787&dopt=Abstract

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Opinions of physical therapy education program directors on essential functions. Author(s): Ingram D. Source: Physical Therapy. 1997 January; 77(1): 37-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8996462&dopt=Abstract

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Orthopaedic physical therapy: do we have a research vision? Author(s): Boissonnault W. Source: The Journal of Orthopaedic and Sports Physical Therapy. 1996 September; 24(3): 113-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8983458&dopt=Abstract

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Outcome study of ulnar nerve compression at the elbow treated with simple decompression and an early programme of physical therapy. Author(s): Nathan PA, Keniston RC, Meadows KD. Source: Journal of Hand Surgery (Edinburgh, Lothian). 1995 October; 20(5): 628-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8543870&dopt=Abstract

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Outcomes research: shifting the dominant research paradigm in physical therapy. Author(s): Jette AM. Source: Physical Therapy. 1995 November; 75(11): 965-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7480126&dopt=Abstract

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Outpatient views on direct access to physical therapy in Indiana. Author(s): Durant TL, Lord LJ, Domholdt E. Source: Physical Therapy. 1989 October; 69(10): 850-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2780811&dopt=Abstract

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Oxygen transport deficits in systemic disease and implications for physical therapy. Author(s): Dean E. Source: Physical Therapy. 1997 February; 77(2): 187-202. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9037219&dopt=Abstract

Studies

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Parental experience of participation in physical therapy for children with physical disabilities. Author(s): Jansen LM, Ketelaar M, Vermeer A. Source: Developmental Medicine and Child Neurology. 2003 January; 45(1): 58-69. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12549757&dopt=Abstract

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Patient satisfaction with outpatient physical therapy: instrument validation. Author(s): Beattie PF, Pinto MB, Nelson MK, Nelson R. Source: Physical Therapy. 2002 June; 82(6): 557-65. Erratum In: Phys Ther 2002 August; 82(8): 827. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12036397&dopt=Abstract

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Pelvic floor physical therapy for patients with prostatitis. Author(s): Potts JM, O'Dougherty E. Source: Curr Urol Rep. 2000 August; 1(2): 155-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12084330&dopt=Abstract

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Pelvic floor physical therapy in urogynecologic disorders. Author(s): Kotarinos RK. Source: Curr Womens Health Rep. 2003 August; 3(4): 334-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12844459&dopt=Abstract

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Physical therapy after arthroscopic partial meniscectomy: is it effective? Author(s): Goodwin PC, Morrissey MC. Source: Exercise and Sport Sciences Reviews. 2003 April; 31(2): 85-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715972&dopt=Abstract

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Physical therapy alters recruitment of the vasti in patellofemoral pain syndrome. Author(s): Cowan SM, Bennell KL, Crossley KM, Hodges PW, McConnell J. Source: Medicine and Science in Sports and Exercise. 2002 December; 34(12): 1879-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12471291&dopt=Abstract

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Physical therapy and exercise in osteoarthritis of the knee. Author(s): Mayer ME. Source: Annals of Internal Medicine. 2000 June 6; 132(11): 923. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10836925&dopt=Abstract

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Physical therapy and exercise in pain management. Author(s): Gloth MJ, Matesi AM. Source: Clinics in Geriatric Medicine. 2001 August; 17(3): 525-35, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11459719&dopt=Abstract

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Physical therapy for a patient in acute respiratory failure. Author(s): Wong WP. Source: Physical Therapy. 2000 July; 80(7): 662-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10869128&dopt=Abstract

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Physical therapy for animals from people trained as human physiotherapists. Author(s): Ann Intern Med. 2002 May 21;136(10):I36 Source: Aust Vet J. 2002 March; 80(3): 130. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12020157

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Physical therapy for benign paroxysmal positional vertigo patients with movement disability. Author(s): Sato S, Ohashi T, Koizuka I. Source: Auris, Nasus, Larynx. 2003 February; 30 Suppl: S53-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543161&dopt=Abstract

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Physical therapy for vulvar vestibulitis syndrome: a retrospective study. Author(s): Bergeron S, Brown C, Lord MJ, Oala M, Binik YM, Khalife S. Source: Journal of Sex & Marital Therapy. 2002 May-June; 28(3): 183-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11995597&dopt=Abstract

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Physical therapy in a patient with bilateral obturator nerve paralysis after surgery. A case report. Author(s): Kirdi N, Yakut E, Meric A, Ayhan A. Source: Clin Exp Obstet Gynecol. 2000; 27(1): 59-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10758804&dopt=Abstract

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Physical therapy in spasticity. Author(s): Richardson D. Source: European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies. 2002 May; 9 Suppl 1: 17-22; Dicussion 53-61. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11918645&dopt=Abstract

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Physical therapy management of HIV disease: a retrospective study. Author(s): Galantino ML, McReynolds MA. Source: J Int Assoc Physicians Aids Care. 1995 June; 1(5): 15-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11362601&dopt=Abstract

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Physical therapy management of pelvi/perineal and perianal pain syndromes. Author(s): Markwell SJ. Source: World Journal of Urology. 2001 June; 19(3): 194-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11469607&dopt=Abstract

Studies

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Physical therapy outcomes for persons with bilateral vestibular loss. Author(s): Brown KE, Whitney SL, Wrisley DM, Furman JM. Source: The Laryngoscope. 2001 October; 111(10): 1812-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11801950&dopt=Abstract

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Physical therapy was effective for patellofemoral pain. Author(s): Litchfield RB. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 August; 85-A(8): 1625. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12925661&dopt=Abstract

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Predicting physical therapy visits needed to achieve minimal functional goals after arthroscopic knee surgery. Author(s): O'Connor DP, Jackson AS. Source: The Journal of Orthopaedic and Sports Physical Therapy. 2001 July; 31(7): 34052; Discussion 353-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11451305&dopt=Abstract

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Preliminary comparison of treatments of shoulder injuries using the FitLinxx computer feedback system and standard physical therapy. Author(s): Annesi JJ. Source: Psychological Reports. 2001 June; 88(3 Pt 2): 989-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11597092&dopt=Abstract

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Quality assurance experiences within a physical therapy curriculum. Author(s): Schenck JM. Source: Physical Therapy. 1980 July; 60(7): 882-U. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7413732&dopt=Abstract

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Quality physical therapy: one Chapter's approach. Author(s): Allsop KG, Wortley DW. Source: Physical Therapy. 1977 September; 57(9): 1016-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=561411&dopt=Abstract

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Quantitative effects of physical therapy on muscular and functional performance in subjects with osteoarthritis of the knees. Author(s): Fisher NM, Gresham GE, Abrams M, Hicks J, Horrigan D, Pendergast DR. Source: Archives of Physical Medicine and Rehabilitation. 1993 August; 74(8): 840-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8347069&dopt=Abstract

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Reasons given by California physical therapists for not belonging to the american physical therapy association. Author(s): McGinty SM, Cicero MC, Cicero JM, Schultz-Janney L, Williams-Shipman KL. Source: Physical Therapy. 2001 June; 81(6): 1224-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11380278&dopt=Abstract

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Recognition of job experience for educational credit in physical therapy--a challenge process. Suggestion from the field. Author(s): Grube KJ, Henry JN. Source: Physical Therapy. 1987 January; 67(1): 58-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3797478&dopt=Abstract

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Re-engineering physical therapy. Author(s): Shields MC, Steinmetz J, Weber D. Source: Medical Group Management Journal / Mgma. 1997 May-June; 44(3): 8, 10, 39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10167632&dopt=Abstract

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Reflex sympathetic dystrophy in an 8-year-old: successful treatment by physical therapy. Author(s): Hood-White R, Gainor J. Source: Orthopedics. 1997 January; 20(1): 73-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9122058&dopt=Abstract

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Reflex sympathetic dystrophy in children. A physical therapy approach. Author(s): Wesdock KA, Stanton RP, Singsen BH. Source: Arthritis Care and Research : the Official Journal of the Arthritis Health Professions Association. 1991 March; 4(1): 32-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11188585&dopt=Abstract

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Rehabilitation of carpal tunnel surgery patients using a short surgical incision and an early program of physical therapy. Author(s): Nathan PA, Meadows KD, Keniston RC. Source: The Journal of Hand Surgery. 1993 November; 18(6): 1044-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8294740&dopt=Abstract

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Relationship between academic achievement and clinical performance in a physical therapy education program. Author(s): Rheault W, Shafernich-Coulson E. Source: Physical Therapy. 1988 March; 68(3): 378-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3279441&dopt=Abstract

Studies

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Reliability of the assessment of impairments and disabilities in survey research in the field of physical therapy. Author(s): van Triet EF, Dekker J, Kerssens JJ, Curfs EC. Source: Int Disabil Stud. 1990 April-June; 12(2): 61-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2147677&dopt=Abstract

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Reliability of the auditing process at the University of Montana's Physical Therapy Department. Author(s): Rase CW, Tognetti-Stuff RK. Source: Physical Therapy. 1984 July; 64(7): 1088-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6610884&dopt=Abstract

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Respiratory physical therapy in the treatment of chronic bronchitis. Author(s): Burford JG, George RB. Source: Seminars in Respiratory Infections. 1988 March; 3(1): 55-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3283882&dopt=Abstract

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Results of a physical therapy manpower survey adaptable to other areas of health care. Author(s): Daniels LA, Suttle E. Source: Hospital Topics. 1986 May-June; 64(3): 28-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10276702&dopt=Abstract

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Results of physical therapy for idiopathic clubfoot: a long-term follow-up study. Author(s): Bensahel H, Guillaume A, Czukonyi Z, Desgrippes Y. Source: Journal of Pediatric Orthopedics. 1990 March-April; 10(2): 189-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2312698&dopt=Abstract

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Retrospective analysis of acute and chronic pain control in physical therapy and rehabilitation with T.E.N.S. Author(s): Graziano JM. Source: Basal Facts. 1985; 7(1): 75-80. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3160335&dopt=Abstract

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Rheumatologist-patient communication about exercise and physical therapy in the management of rheumatoid arthritis. Author(s): Iversen MD, Fossel AH, Daltroy LH. Source: Arthritis Care and Research : the Official Journal of the Arthritis Health Professions Association. 1999 June; 12(3): 180-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10513508&dopt=Abstract

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Rheumatology education in an undergraduate program of physical therapy. A new outlook. Author(s): Downing DS, Rippey R, Peterson M, Weinstein A, Sheehan TJ. Source: Physical Therapy. 1987 September; 67(9): 1393-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3628494&dopt=Abstract

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Risk factors for anti-inflammatory-drug- or aspirin-induced gastrointestinal complications in individuals receiving outpatient physical therapy services. Author(s): Boissonnault WG, Meek PD. Source: The Journal of Orthopaedic and Sports Physical Therapy. 2002 October; 32(10): 510-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12403202&dopt=Abstract

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Role and functions of the academic coordinator of clinical education in physical therapy education: a survey. Author(s): Philips BU Jr, McPhail S, Roemer S. Source: Physical Therapy. 1986 June; 66(6): 981-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3714819&dopt=Abstract

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Role of physical therapy in management of pulmonary alveolar proteinosis. A case report. Author(s): Bracci L. Source: Physical Therapy. 1988 May; 68(5): 686-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3362982&dopt=Abstract

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Role of physical therapy in the management of common low back pain. Author(s): Tan JC, Roux EB, Dunand J, Vischer TL. Source: Baillieres Clin Rheumatol. 1992 October; 6(3): 629-55. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1477895&dopt=Abstract

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Role of physical therapy in the treatment of cervical disk disease. Author(s): Tan JC, Nordin M. Source: The Orthopedic Clinics of North America. 1992 July; 23(3): 435-49. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1620537&dopt=Abstract

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Scale to measure patient satisfaction with physical therapy. Author(s): Monnin D, Perneger TV. Source: Physical Therapy. 2002 July; 82(7): 682-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12088465&dopt=Abstract

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Selection of instruments in the core set for DC-ART, SMARD, physical therapy, and clinical record keeping in ankylosing spondylitis. Progress report of the ASAS Working Group. Assessments in Ankylosing Spondylitis. Author(s): van der Heijde D, Calin A, Dougados M, Khan MA, van der Linden S, Bellamy N. Source: The Journal of Rheumatology. 1999 April; 26(4): 951-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10229426&dopt=Abstract

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Selection of physical therapy students: interview methods and academic predictors. Author(s): Levine SB, Knecht HG, Eisen RG. Source: Journal of Allied Health. 1986 May; 15(2): 143-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3721994&dopt=Abstract

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Self-reported measurement of heart rate and blood pressure in patients by physical therapy clinical instructors. Author(s): Frese EM, Richter RR, Burlis TV. Source: Physical Therapy. 2002 December; 82(12): 1192-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12444878&dopt=Abstract

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Simultaneous feedforward recruitment of the vasti in untrained postural tasks can be restored by physical therapy. Author(s): Cowan SM, Bennell KL, Hodges PW, Crossley KM, McConnell J. Source: Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society. 2003 May; 21(3): 553-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706031&dopt=Abstract

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Special features of physical therapy in the claw hand of leprosy. Author(s): Kulkarni VN, Mehta JM. Source: Lepr India. 1983 October; 55(4): 694-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6668927&dopt=Abstract

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Spiritual care rights and quality of care: perspectives of physical therapy students. Author(s): Highfield ME, Osterhues D. Source: J Healthc Qual. 2003 January-February; 25(1): 12-5; Quiz 15-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12879625&dopt=Abstract

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Spondylarthropathy treatment: progress in medical treatment, physical therapy and rehabilitation. Author(s): Dougados M, Revel M, Khan MA. Source: Baillieres Clin Rheumatol. 1998 November; 12(4): 717-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9928504&dopt=Abstract

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Standing balance, lower extremity muscle strength, and walking performance of patients referred for physical therapy. Author(s): Bohannon RW. Source: Percept Mot Skills. 1995 April; 80(2): 379-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7675565&dopt=Abstract

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Stanley Paris Award Lecture. Reflections on the history and future of orthopaedic physical therapy. Author(s): Wadsworth C. Source: The Journal of Orthopaedic and Sports Physical Therapy. 1998 September; 28(3): 174-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9742475&dopt=Abstract

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Stereotyping between physical therapy students and occupational therapy students. Author(s): Streed CP, Stoecker JL. Source: Physical Therapy. 1991 January; 71(1): 16-20; Discussion 21-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1984248&dopt=Abstract

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Stroke treatment: comparison of integrated behavioral-physical therapy vs traditional physical therapy programs. Author(s): Basmajian JV, Gowland CA, Finlayson MA, Hall AL, Swanson LR, Stratford PW, Trotter JE, Brandstater ME. Source: Archives of Physical Medicine and Rehabilitation. 1987 May; 68(5 Pt 1): 267-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3579530&dopt=Abstract

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Structure of ethics teaching in physical therapy: a survey. Author(s): Purtilo RB. Source: Physical Therapy. 1979 September; 59(9): 1102-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=472026&dopt=Abstract

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Sudeck's atrophy of the left tibiotarsal joint in a renal transplant patient: effects of medical and physical therapy. Author(s): Campieri C, Prandini R, Giudicissi A, Sestigiani E, De Giovanni P, Dalmastri V, La Manna G, Di Grazia A, Zompatori M, Scolari MP, et al. Source: Nephron. 1995; 71(1): 122-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8538841&dopt=Abstract

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Survey of burn education in entry-level physical therapy programs. Author(s): Johnson CL, Trotter MJ. Source: Physical Therapy. 1988 April; 68(4): 530-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3353462&dopt=Abstract

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Survey of curriculum content related to geriatrics in physical therapy education programs. Author(s): Granick R, Simson S, Wilson LB. Source: Physical Therapy. 1987 February; 67(2): 234-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3809250&dopt=Abstract

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Survey of physical therapy provided to infants uder three months of age. Author(s): Pringle ME, Kaminski SA, Raymond GL. Source: Physical Therapy. 1978 September; 58(9): 1055-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=684081&dopt=Abstract

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Survival of physician self-referral to physical therapy centers with physician-held owner interest. Author(s): Dean RS. Source: Coll Rev. 1995 Spring; 12(1): 27-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10182657&dopt=Abstract

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Systematic clinical placement of physical therapy students. Author(s): Van Swearingen JM. Source: Physical Therapy. 1987 March; 67(3): 394-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3823154&dopt=Abstract

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Systematic curricular development in physical therapy. Author(s): Chidley MJ, Kisner CB. Source: Physical Therapy. 1979 April; 59(4): 409-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=432279&dopt=Abstract

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The APTA electrical stimulation lawsuit and its aftermath. American Physical Therapy Association. Author(s): Kloth LC. Source: Adv Wound Care. 1999 November-December; 12(9): 472-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10687560&dopt=Abstract

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The development and testing of APTA Clinical Performance Instruments. American Physical Therapy Association. Author(s): Task Force for the Development of Student Clinical Performance Instruments. Source: Physical Therapy. 2002 April; 82(4): 329-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11922850&dopt=Abstract

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The effect of manual physical therapy in patients diagnosed with interstitial cystitis, high-tone pelvic floor dysfunction, and sacroiliac dysfunction. Author(s): Lukban J, Whitmore K, Kellogg-Spadt S, Bologna R, Lesher A, Fletcher E. Source: Urology. 2001 June; 57(6 Suppl 1): 121-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11378106&dopt=Abstract

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The effects of the number and frequency of physical therapy treatments on selected outcomes of treatment in patients with anterior cruciate ligament reconstruction. Author(s): De Carlo MS, Sell KE. Source: The Journal of Orthopaedic and Sports Physical Therapy. 1997 December; 26(6): 332-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9402570&dopt=Abstract

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The future of physical therapy. Author(s): Bryan JM, Bursch G, Greathouse DG. Source: Rehab Manag. 1998 December-January; 11(1): 48-50, 52, 54. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10175968&dopt=Abstract

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The influence of personality type on decision making in the physical therapy admission process. Author(s): Bezner JR, Boucher BK. Source: Journal of Allied Health. 2001 Summer; 30(2): 83-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11398234&dopt=Abstract

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The power of cueing to circumvent dopamine deficits: a review of physical therapy treatment of gait disturbances in Parkinson's disease. Author(s): Rubinstein TC, Giladi N, Hausdorff JM. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 2002 November; 17(6): 1148-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12465051&dopt=Abstract

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The relationship between duration of physical therapy services in the acute care setting and change in functional status in patients with lower-extremity orthopedic problems. Author(s): Roach KE, Ally D, Finnerty B, Watkins D, Litwin BA, Janz-Hoover B, Watson T, Curtis KA. Source: Physical Therapy. 1998 January; 78(1): 19-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9442192&dopt=Abstract

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The role of physical therapy and physical modalities in pain management. Author(s): Minor MA, Sanford MK. Source: Rheumatic Diseases Clinics of North America. 1999 February; 25(1): 233-48, Viii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10083966&dopt=Abstract

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The role of physical therapy in dentistry. Author(s): Brown CR. Source: Pract Periodontics Aesthet Dent. 1998 March; 10(2): 194-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9582654&dopt=Abstract

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The role of physical therapy in improving physical functioning of renal patients. Author(s): Pianta TF. Source: Adv Ren Replace Ther. 1999 April; 6(2): 149-58. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10230882&dopt=Abstract

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The role of physical therapy in occupational low back injuries. Author(s): Blitz SG, Chapman DK, Fendrick AM. Source: Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2002 June; 44(6): 489-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12085470&dopt=Abstract

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The role of physical therapy in patients with facial paralysis: state of the art. Author(s): Beurskens CH, Oosterhof J, Elvers JW, Oostendorp RA, Herraets ME. Source: European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (Eufos) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 1994 December; : S125-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10774330&dopt=Abstract

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The use of distance education for a bachelor's degree to master's degree transition program in physical therapy. Author(s): Swisher AK, Mandich M. Source: Journal of Allied Health. 2002 Winter; 31(4): 217-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12491950&dopt=Abstract

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The utilization of physical therapy in a palliative care unit. Author(s): Montagnini M, Lodhi M, Born W. Source: Journal of Palliative Medicine. 2003 February; 6(1): 11-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710571&dopt=Abstract

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Unapproved treatments or indications in dermatology: physical therapy including balneotherapy. Author(s): Millikan LE. Source: Clinics in Dermatology. 2000 January-February; 18(1): 125-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10701094&dopt=Abstract

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Uniqueness of physical therapy tasks and its relationship to complexity and delegation: a survey of Pennsylvania physical therapists. Author(s): Figueroa-Soto I, Furmansky S, Hughes C, Quintas E, Schifter C. Source: Journal of Allied Health. 1999 Fall; 28(3): 148-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10507498&dopt=Abstract

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Use of orthoses and early intervention physical therapy to minimize hyperpronation and promote functional skills in a child with gross motor delays: a case report. Author(s): Buccieri KM. Source: Physical & Occupational Therapy in Pediatrics. 2003; 23(1): 5-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703382&dopt=Abstract

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Use of survey research methods to study clinical decision making: referral to physical therapy of children with cerebral palsy. Author(s): Campbell SK, Anderson JC, Gardner HG. Source: Physical Therapy. 1989 July; 69(7): 610-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2740450&dopt=Abstract

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Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine. Author(s): Steiner WA, Ryser L, Huber E, Uebelhart D, Aeschlimann A, Stucki G. Source: Physical Therapy. 2002 November; 82(11): 1098-107. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12405874&dopt=Abstract

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Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. Author(s): Hoffman HG, Patterson DR, Carrougher GJ. Source: The Clinical Journal of Pain. 2000 September; 16(3): 244-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11014398&dopt=Abstract

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Use of webboards for distance learning: a physical therapy model. Author(s): Teyhen DS, Flynn T, Allison S. Source: Military Medicine. 2001 April; 166(4): 311-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11315469&dopt=Abstract

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Using health-related quality of life measures in physical therapy outcomes research. Author(s): Jette AM. Source: Physical Therapy. 1993 August; 73(8): 528-37. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8337240&dopt=Abstract

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Utility of the Sussman Wound Healing Tool in predicting wound healing outcomes in physical therapy. Author(s): Sussman C, Swanson G. Source: Adv Wound Care. 1997 September; 10(5): 74-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9362585&dopt=Abstract

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Utilization of hydrocortisone phonophoresis in United States Army Physical Therapy Clinics. Author(s): Pottenger FJ, Karalfa BL. Source: Military Medicine. 1989 July; 154(7): 355-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2503775&dopt=Abstract

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Validity of the Peabody Developmental Gross Motor Scale as an evaluative measure of infants receiving physical therapy. Author(s): Palisano RJ, Kolobe TH, Haley SM, Lowes LP, Jones SL. Source: Physical Therapy. 1995 November; 75(11): 939-48; Discussion 948-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7480124&dopt=Abstract

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Video production skills--a must in the physical therapy curriculum. Author(s): Oremland BS. Source: J Biocommun. 1997; 24(2): 6-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9316791&dopt=Abstract

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Voice recognition goes home. Arizona physical therapy practice successfully uses voice recognition with the advantage of portability. Author(s): Parry A. Source: Health Management Technology. 2003 January; 24(1): 56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12564145&dopt=Abstract

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Walking the trail of physical therapy research. Author(s): Smidt GL. Source: Physical Therapy. 1986 March; 66(3): 375-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3952154&dopt=Abstract

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What goes on in physical therapy. Author(s): Mullendore JW. Source: Rn. 1982 May; 45(5): 54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6919204&dopt=Abstract

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What is a suitable dosage of physical therapy treatment? Author(s): Jull G, Moore A. Source: Manual Therapy. 2002 November; 7(4): 181-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12419653&dopt=Abstract

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What is the essence of physical Therapy? A grand theory is needed for the future. Author(s): O'Hearn M. Source: Physical Therapy. 2000 July; 80(7): 714-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10869135&dopt=Abstract

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What works: speech recognition. Talking it through. Busy physical therapy practice converts from manual transcription to voice recognition. Author(s): Simmons J. Source: Health Management Technology. 2002 February; 23(2): 38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11842579&dopt=Abstract

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Which patients with chronic reflex sympathetic dystrophy are most likely to benefit from physical therapy? Author(s): Kemler MA, Rijks CP, de Vet HC. Source: Journal of Manipulative and Physiological Therapeutics. 2001 May; 24(4): 272-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11353938&dopt=Abstract

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Who is responsible for the science of orthopaedic and sports physical therapy? Author(s): Powers CM. Source: The Journal of Orthopaedic and Sports Physical Therapy. 1998 May; 27(5): 32930. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9580891&dopt=Abstract

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CHAPTER 2. ALTERNATIVE MEDICINE AND PHYSICAL THERAPY Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to physical therapy. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “physical therapy” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

Shiatsu Source: Positive Health. Number 24: 61-64. December-January 1998. Summary: This journal article presents a general overview of Shiatsu, which is a physical therapy applied at floor level with minimum physical effort by the therapist. Shiatsu uses Oriental Medicine as its theoretical framework and is a method of selfdevelopment that has the effect of focusing the mind and grounding the body and the mind. The history, environment, tools, and theoretical basis of Shiatsu are discussed. Three broad categories of Shiatsu technique are detailed: tonification, dispersal, and calming. According to the author, there are several essential techniques of Shiatsu: motivation; steadiness of breath; keeping a low center of gravity; relaxation and comfort; empty mind; support rather than force; positive connection; correctly angled pressure; technical ability, continuity, and fluency; and empathy. The article also lists

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contraindications to Shiatsu, including acute fevers; contagious diseases; internal bleeding; blood clots; touch phobia; severe burns; bruises or swellings; fracture sites and areas of acute muscle or ligament injuries; cuts, local inflammation, and infection; twisted intestines; and varicose veins during pregnancy. This journal article contains 4 photographs and details on 2 resources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to physical therapy and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “physical therapy” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to physical therapy: •

“Hey John”: signals conveying communicative intention toward the self activate brain regions associated with “mentalizing,” regardless of modality. Author(s): Kampe KK, Frith CD, Frith U. Source: The Journal of Neuroscience : the Official Journal of the Society for Neuroscience. 2003 June 15; 23(12): 5258-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832550&dopt=Abstract

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Pelvic floor physical therapy in urogynecologic disorders. Author(s): Kotarinos RK. Source: Curr Womens Health Rep. 2003 August; 3(4): 334-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12844459&dopt=Abstract

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Spiritual care rights and quality of care: perspectives of physical therapy students. Author(s): Highfield ME, Osterhues D. Source: J Healthc Qual. 2003 January-February; 25(1): 12-5; Quiz 15-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12879625&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to physical therapy; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Alzheimer's Disease Source: Integrative Medicine Communications; www.drkoop.com Appendicitis Source: Integrative Medicine Communications; www.drkoop.com Ascariasis Source: Integrative Medicine Communications; www.drkoop.com Burns Source: Integrative Medicine Communications; www.drkoop.com Carpal Tunnel Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Cystic Fibrosis Source: Healthnotes, Inc.; www.healthnotes.com Cystic Fibrosis Source: Integrative Medicine Communications; www.drkoop.com Guinea Worm Disease Source: Integrative Medicine Communications; www.drkoop.com Hemophilia Source: Integrative Medicine Communications; www.drkoop.com Hookworm Source: Integrative Medicine Communications; www.drkoop.com

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Intermittent Claudication Alternative names: Peripheral Vascular Disease Source: Prima Communications, Inc.www.personalhealthzone.com Loiasis Source: Integrative Medicine Communications; www.drkoop.com Low Back Pain Source: Integrative Medicine Communications; www.drkoop.com Lyme Disease Source: Integrative Medicine Communications; www.drkoop.com Lymphatic Filariasis Source: Integrative Medicine Communications; www.drkoop.com Motion Sickness Source: Integrative Medicine Communications; www.drkoop.com Osteoarthritis Source: Healthnotes, Inc.; www.healthnotes.com Osteoarthritis Source: Integrative Medicine Communications; www.drkoop.com Pain Source: Healthnotes, Inc.; www.healthnotes.com Parkinson's Disease Source: Healthnotes, Inc.; www.healthnotes.com Pinworm Source: Integrative Medicine Communications; www.drkoop.com Reiter's Syndrome Source: Integrative Medicine Communications; www.drkoop.com River Blindness Source: Integrative Medicine Communications; www.drkoop.com Roundworms Source: Integrative Medicine Communications; www.drkoop.com Tendinitis Source: Integrative Medicine Communications; www.drkoop.com Tension Headache Source: Healthnotes, Inc.; www.healthnotes.com Threadworm Source: Integrative Medicine Communications; www.drkoop.com

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Trichinosis Source: Integrative Medicine Communications; www.drkoop.com Vertigo Source: Healthnotes, Inc.; www.healthnotes.com Visceral Larva Migrans Source: Integrative Medicine Communications; www.drkoop.com Whipworm Source: Integrative Medicine Communications; www.drkoop.com Yellow Nail Syndrome Source: Healthnotes, Inc.; www.healthnotes.com •

Alternative Therapy Applied Kinesiology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,711,00.html Aromatherapy Source: Integrative Medicine Communications; www.drkoop.com Art Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,671,00.html Hydrotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,705,00.html Myotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,931,00.html Qigong Therapy Alternative names: buqi buqi therapy external qigong external Qigong healing External Qi Healing medical Qigong Qi An Mo Qigong healing Qi healing Qi Massage wai Qi liao fa Wai Qi Zhi Liao Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/q.html Tai Chi Source: Integrative Medicine Communications; www.drkoop.com

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Traditional Chinese Medicine Source: Integrative Medicine Communications; www.drkoop.com Trager Approach Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,741,00.html •

Herbs and Supplements Carisoprodol Source: Healthnotes, Inc.; www.healthnotes.com Cyclobenzaprine Source: Healthnotes, Inc.; www.healthnotes.com Eleuthero Alternative names: Siberian Ginseng, Eleuthero; Acanthopanax/Eleutherococcus senticosus Rupr. & Maxim. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Ginkgo Source: Prima Communications, Inc.www.personalhealthzone.com

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Food and Diet Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com Tendinitis Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 3. DISSERTATIONS ON PHYSICAL THERAPY Overview In this chapter, we will give you a bibliography on recent dissertations relating to physical therapy. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “physical therapy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on physical therapy, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Physical Therapy ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to physical therapy. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A Comparison of a Model Demonstration and a Role-playing Simulation on the Transfer of Learning to a Clinical Evaluation and History in Physical Therapy Students by Protas, Elizabeth J., PhD from State University of New York at Buffalo, 1980, 178 pages http://wwwlib.umi.com/dissertations/fullcit/8114705

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A Comparison of Postbaccalaureate Entry-Level Physical Therapy Students' Learning Styles and Perceptions of the Higher Educational Environment by Pisarski, Edward Michael, EDD from Columbia University Teachers College, 1994, 126 pages http://wwwlib.umi.com/dissertations/fullcit/9424536

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A Comparison of the Incidence and Process of Mentoring among Male and Female Academicians in the Field of Physical Therapy (Professional, Development) by Stanton, Pamela English, EDD from Northeastern University, 1985, 162 pages http://wwwlib.umi.com/dissertations/fullcit/8515754

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A Comparison of Two Methods of Laboratory Instruction in a Course in Human Anatomy for Senior Physical Therapy Students by Alexander, Justin, PhD from New York University, 1968, 132 pages http://wwwlib.umi.com/dissertations/fullcit/6911731

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A Comparison of Two Physical Therapy Approaches in Individuals with Shoulder Dysfunction by Vongsirinavarat, Mantana; PhD from Texas Woman's University, 2003, 219 pages http://wwwlib.umi.com/dissertations/fullcit/3084191

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A Cost Analysis of a Physical Therapy Education Program Using Pert by Martin, Jerome Lee, PhD from University of Pittsburgh, 1978, 95 pages http://wwwlib.umi.com/dissertations/fullcit/7917433

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A Cost-Benefit Study of Clinical Education in an Entry-level Master's Degree Program in Physical Therapy by Granick, Risa Ann, EDD from Nova University, 1989, 117 pages http://wwwlib.umi.com/dissertations/fullcit/9101309

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A Cross-Sectional Descriptive Study of the Social History of Inpatient Adults Experiencing a Fall Prior to Admission at Middlesex Hospital and Referral to Physical Therapy (Connecticut) by Luoma, Helen Kimberly; MPH from Southern Connecticut State University, 2002, 63 pages http://wwwlib.umi.com/dissertations/fullcit/1409791

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A Descriptive Analysis of Acute Post-Operative Physical Therapy Management of Patients Following Total Knee Replacement by Shyu, Ying-shan; MS from MGH Institute of Health Professions, 2002, 61 pages http://wwwlib.umi.com/dissertations/fullcit/1406849

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A Descriptive Study of Integrated Physical Therapy Services in School Systems by Roberts, Pamela Louise, EDD from Clark University, 1996, 360 pages http://wwwlib.umi.com/dissertations/fullcit/9625334

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A Design for Physical Therapy Teacher Preparation. by Nunley, Rachel Loyd, PhD from Duke University, 1976, 252 pages http://wwwlib.umi.com/dissertations/fullcit/7711842

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A Faculty Survey on Entry-Level Women's Health Physical Therapy Curricular Content by Boissonnault, Jill Schiff; PhD from The University of Wisconsin - Madison, 2003, 154 pages http://wwwlib.umi.com/dissertations/fullcit/3089577

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A History of Physical Therapy Education in the United States: an Analysis of Development of the Curricula by Pinkston, Dorothy, PhD from Case Western Reserve University, 1978, 238 pages http://wwwlib.umi.com/dissertations/fullcit/7816554

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A Marketing Approach to the Physical Therapy Faculty Shortage in Higher Education by Pearl, Marcia Joan, PhD from Georgia State University, 1987, 186 pages http://wwwlib.umi.com/dissertations/fullcit/8727203

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A Multivariate Process Model to Evaluate Undergraduate Physical Therapy Students Admitted by Stratified Sample and by Ordinal Rank Pre-Selection by Shalik, Harold, PhD from University of Florida, 1978, 101 pages http://wwwlib.umi.com/dissertations/fullcit/7817458

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A Needs Assessment and Faculty Development Plan for New Faculty in Physical Therapy by Pagliarulo, Michael Anthony, EDD from Syracuse University, 1988, 207 pages http://wwwlib.umi.com/dissertations/fullcit/8914586

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A Problem-Solving Curriculum Design in Physical Therapy by Barr, Jean Scott, PhD from The University of North Carolina at Chapel Hill, 1975, 427 pages http://wwwlib.umi.com/dissertations/fullcit/7529004

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A Qualitative Study of the Physical Therapy Clinical Affiliation by Gutterman, Sharon Schwartz, PhD from The Ohio State University, 1983, 225 pages http://wwwlib.umi.com/dissertations/fullcit/8403521

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A Study of Cognitive Complexity in the Selection of Students in Physical Therapy by Di Stefano, Mary J., PhD from Case Western Reserve University, 1971, 109 pages http://wwwlib.umi.com/dissertations/fullcit/7206283

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A Study of Role Conflict in Chairpersons of Academic Departments of Occupational Therapy and Physical Therapy in Canadian Universities by Schaffer, Robin Harriet, EDD from University of Toronto (Canada), 1985 http://wwwlib.umi.com/dissertations/fullcit/f1522133

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A Study of Role Conflict in Chairpersons of Academic Departments of Occupational Therapy and Physical Therapy in Canadian Universities by Schaffer, Robin; EDD from University of Toronto (Canada), 1985 http://wwwlib.umi.com/dissertations/fullcit/NL23516

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A Study of the Essential Functions Required of Physical Therapy Students (Disabilities) by Ingram, Deborah Ann, EDD from The University of Tennessee, 1994, 172 pages http://wwwlib.umi.com/dissertations/fullcit/9527211

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A Study of the Forces and Influences Leading to the Development of Specialization in the Profession of Physical Therapy in the United States by Richardson, Janice Karen, PhD from University of Pittsburgh, 1983, 159 pages http://wwwlib.umi.com/dissertations/fullcit/8411702

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Acute Physical Therapy Management of Patients Following Stroke by Busick, Laura Plummer; MS from MGH Institute of Health Professions, 2002, 65 pages http://wwwlib.umi.com/dissertations/fullcit/1410073

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Acute Post-Operative Physical Therapy Following Total Knee Revision Surgery by Rodriguez, Madeline Costello; MS from MGH Institute of Health Professions, 2002, 48 pages http://wwwlib.umi.com/dissertations/fullcit/1407947

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Allied Health Clinical Education Affiliations: a Study of Medical Technology, Occupational Therapy and Physical Therapy Programs by Srugys, Karina Sabina, EDD from Loyola University of Chicago, 1984, 267 pages http://wwwlib.umi.com/dissertations/fullcit/8405315

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An Analysis of Cognitive Levels Found in Written Physical Therapy Examinations (Physical Therapy Education, Test Items) by McCandless, Richard Irwin, EDD from University of Pittsburgh, 1992, 116 pages http://wwwlib.umi.com/dissertations/fullcit/9226509

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An Analysis of Physical Therapy Graduates from Baccalaureate Degree Programs and Basic Master's Degree Programs by Hanten, William Philip, EDD from University of Houston, 1980, 194 pages http://wwwlib.umi.com/dissertations/fullcit/8105351

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An Analysis of Selected Physical Therapy Clinical Performances and Success on the National Licensing Examination by Dreeben, Olga; PhD from Nova Southeastern University, 2003, 106 pages http://wwwlib.umi.com/dissertations/fullcit/3077389

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An Analysis of Self-perceived Multicultural Competencies among Entry Level Physical Therapy Students by Jaffee Gropack, Stacy Michelle; PhD from New York University, 2001, 116 pages http://wwwlib.umi.com/dissertations/fullcit/3004908

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An Analysis of the Effects of Visual and Somatosensory-Vestibular Input on the Postural Reactions of Infants Having Down Syndrome (Physical Therapy) by Effgen, Susan K., PhD from Georgia State University, 1984, 151 pages http://wwwlib.umi.com/dissertations/fullcit/8417130

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An Analysis of the Proposed Influences of Multiple Factors on the Learning Characteristics of Physical Therapy Students in Three Countries by Farina, Nancy Taylor Gorham, EDD from The George Washington University, 1997, 256 pages http://wwwlib.umi.com/dissertations/fullcit/9806396

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An Analysis of the Relationship between Value Congruence and Customer Satisfaction in Outpatient Physical Therapy Facilities in Florida and Georgia by RoneAdams, Shari Ann; DBA from Nova Southeastern University, 2002, 118 pages http://wwwlib.umi.com/dissertations/fullcit/3042268

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An Ethnography of Physical Therapy Practice: a Source for Curriculum Development by Yarbrough, Patricia, PhD from Georgia State University, 1980, 274 pages http://wwwlib.umi.com/dissertations/fullcit/8027113

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An Evaluation of a Learning Module on Applying Behavioral Methods in Pediatric Physical Therapy by Linn, Dorothy McDonald, PhD from University of Pittsburgh, 1987, 264 pages http://wwwlib.umi.com/dissertations/fullcit/8808253

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An Examination of the Concerns Theory and Its Application in Physical Therapy Education by McCulloch, Joseph Marion, Jr., PhD from University of New Orleans, 1981, 78 pages http://wwwlib.umi.com/dissertations/fullcit/8125885

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An Exploration of the Relationship between Organizational Effectiveness and Type of Authority Boundary in Outpatient Physical Therapy Clinics by Rieth, Theresa Lynn; PhD from Fielding Graduate Institute, 2002, 160 pages http://wwwlib.umi.com/dissertations/fullcit/3064044

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An Investigation into Faculty Development Practices in Graduate Physical Therapy Education Programs by Priest, Andrew William; EDD from Texas Tech University, 2001, 92 pages http://wwwlib.umi.com/dissertations/fullcit/3005276

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An Investigation into Problem-Solving in Physical Therapy Education: Prerequisites and Curriculum (Critical Thinking, WGCTA, GRSLSS) by Arand, Judith Utz, PhD from Loyola University of Chicago, 1984, 294 pages http://wwwlib.umi.com/dissertations/fullcit/8417225

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An Investigation of the Relationships between Academic Performance, Clinical Performance, Critical Thinking and Success in a Physical Therapy Education Program by Vendrely, Ann Marie; EDD from Loyola University of Chicago, 2002, 105 pages http://wwwlib.umi.com/dissertations/fullcit/3063265

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Analysis of Factors Influencing Selection of Entry-Level Physical Therapy Programs in the United States by Wilcox, Kimberly J. Curbow; PhD from The University of Mississippi, 2003, 171 pages http://wwwlib.umi.com/dissertations/fullcit/3089849

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Attitudes of University of Missouri Physical Therapy Graduates toward the Professionalization of Their Occupation by Sanford, Marilyn King, PhD from University of Missouri - Columbia, 1987, 166 pages http://wwwlib.umi.com/dissertations/fullcit/8726955

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Attrition from Physical Therapy Clinical Practice (Education, Turnover, Career Satisfaction) by Gwyer, Janet Lynn, PhD from The University of North Carolina at Chapel Hill, 1984, 130 pages http://wwwlib.umi.com/dissertations/fullcit/8415813

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Becoming Adult Learners: Student Learning in Dual-Campus Physical Therapy Program Using Distance Education by Chesbro, Steven Bryce; EDD from Oklahoma State University, 2000, 215 pages http://wwwlib.umi.com/dissertations/fullcit/9987327

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Career Paths of Board-Certified Clinical Specialists in Geriatric Physical Therapy with Implications for Higher Education by Thompson, Mary E., PhD from University of North Texas, 1996, 142 pages http://wwwlib.umi.com/dissertations/fullcit/9638505

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Case Studies of Accreditation in an Emerging Profession: Process and Purpose in Physical Therapy Education by Jensen, Gail Marie, PhD from Stanford University, 1987, 404 pages http://wwwlib.umi.com/dissertations/fullcit/8723028

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Changing Conditions in the Health Care Industry, the Profession, and the Academy: the Effects of the Environment on the Work of Physical Therapy Faculty by Collins, Jennifer Eileen; EDD from The University of Rochester, 2001, 224 pages http://wwwlib.umi.com/dissertations/fullcit/3026216

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Clinical Teaching of Physical Therapy Students in Clinical Education by Scully, Rosemary Margaret, EDD from Columbia University, 1974, 177 pages http://wwwlib.umi.com/dissertations/fullcit/7418734

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Communication Apprehension and Interpersonal Skills in Physical Therapy Students: A Comparative Study of Problem-Based Learning and Traditional Curricula by Fein, Beverly Diane; EDD from University of Bridgeport, 2003, 187 pages http://wwwlib.umi.com/dissertations/fullcit/3079370

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Comparison of Master and Novice Physical Therapy Teachers: Planning, Teaching, and Post-Lesson Reflections (Master Teachers, Novice Teachers) by Gandy, Jody Shapiro, PhD from Temple University, 1993, 435 pages http://wwwlib.umi.com/dissertations/fullcit/9316481

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Conceptual Development in Physical Therapy Students by Graham, Cecilia Louise, PhD from Texas A&M University, 1994, 119 pages http://wwwlib.umi.com/dissertations/fullcit/9506640

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Demographic and Recruitment Factors Affecting Career Choice of Minority and Nonminority Physical Therapy Students in the United States with Implications for Minority Recruitment Programs by Finneran, Jane, EDD from North Carolina State University, 1993, 111 pages http://wwwlib.umi.com/dissertations/fullcit/9413208

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Determinants of Job Turnover of Professionals in Organizations: Physical Therapy Faculty in Colleges and Universities by Radtka, Sandra Ann, PhD from University of California, Berkeley, 1985, 286 pages http://wwwlib.umi.com/dissertations/fullcit/8525100

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Determinants of Patient Satisfaction with Outpatient Physical Therapy Services in the Southern United States As Measured by the Physical Therapy Outpatient Satisfaction Survey: Precision by Replication by Scott, Cynthia Kunkel; PhD from The University of Mississippi Medical Center, 2002, 131 pages http://wwwlib.umi.com/dissertations/fullcit/3091794

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Development of a Self-Efficacy Instrument for Patients with Chronic Low Back Pain and Its Use As a Predictor of Physical Therapy Outcome by Du Bois, Kimberley Anne; PhD from The University of Connecticut, 2002, 368 pages http://wwwlib.umi.com/dissertations/fullcit/3042900

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Effectiveness of Physical Therapy Treatments in Relation to a Patient's Time on Mechanical Ventilation by Morales-Estuart, Monina Vicencio; MS from Texas Woman's University, 2002, 101 pages http://wwwlib.umi.com/dissertations/fullcit/1410090

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Effects of Learning Style and Learning Environment on Achievement of Physical Therapy Graduate Students in Distance Education by Daniel, John Anchuthengil; EDD from Texas Tech University, 1999, 165 pages http://wwwlib.umi.com/dissertations/fullcit/9951523

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Environmental Scanning Behavior in Physical Therapy Private Practice Firms: Its Relationship to the Level of Entrepreneurship and Legal Regulatory Environment by Schafer, D. Sue, PhD from University of North Texas, 1988, 136 pages http://wwwlib.umi.com/dissertations/fullcit/8900376

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Environmental Scanning in Physical Therapy Education by Strubhar, Andrew James; PhD from Illinois State University, 2000, 188 pages http://wwwlib.umi.com/dissertations/fullcit/9995670

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Essential Considerations for Planning the Clinical Education Curricular Component of the Entry-Level Doctor of Physical Therapy Degree by Lewando, Carol Ann; PhD from The University of Southern Mississippi, 2002, 136 pages http://wwwlib.umi.com/dissertations/fullcit/3071076

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Factors Effecting Outcome in Patients Receiving Physical Therapy for Low Back Pain by Bell, Christine Ann; MS from MGH Institute of Health Professions, 2002, 76 pages http://wwwlib.umi.com/dissertations/fullcit/1410035

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Factors Influencing Academic Success for Black Physical Therapy Students (Retention, Socialization) by Woodruff, Lynda Darnell, PhD from Georgia State University, 1984, 144 pages http://wwwlib.umi.com/dissertations/fullcit/8425856

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Factors Influencing Job Satisfaction and Mobility of Physical Therapy Faculty: Implications for Recruitment by Caston, Janet Montwieler, PhD from University of Denver, 1990, 242 pages http://wwwlib.umi.com/dissertations/fullcit/9022047

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Factors Influencing Program Selection and Professional Expectations of Physical Therapy Students by Johanson, Marie Anne; PhD from Georgia State University, 2003, 275 pages http://wwwlib.umi.com/dissertations/fullcit/3095176

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Factors That Influence Research Productivity in Physical Therapy Academic Departments by Anderson, Judith Claire, PhD from University of Illinois at Chicago, 1994, 328 pages http://wwwlib.umi.com/dissertations/fullcit/9516657

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Finding Vocation in Academic Work: Early Career in the Evolving Field of Physical Therapy by Thompson, Kristine Ann; PhD from Michigan State University, 2000, 299 pages http://wwwlib.umi.com/dissertations/fullcit/9985476

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How Service Learning Experiences Benefit Physical Therapy Students' Professional Development: a Grounded Theory Study by Reynolds, Pamela; EDD from Duquesne University, 2000, 191 pages http://wwwlib.umi.com/dissertations/fullcit/9993768

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Identification of Basic Structures and Development of a Continuous Progress Curriculum for Physical Therapy Assistants by May, Bella J., EDD from University of Miami, 1970, 215 pages http://wwwlib.umi.com/dissertations/fullcit/7104311

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Identification of Preadmission Characteristics Leading to Clinical Success in Physical Therapy by Melzer, Barbara Ann, PhD from The University of Texas at Austin, 1989, 213 pages http://wwwlib.umi.com/dissertations/fullcit/8920780

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Implications of Perceptions Regarding Needed Knowledges and Competencies for Inservice Education of Physical Therapy Clinical Faculty by Smith, Harold Graeme, EDD from University of Georgia, 1988, 235 pages http://wwwlib.umi.com/dissertations/fullcit/8823846

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Inclusion of Gregorc's Mind Styles Concepts in Physical Therapy Curriculum and Instruction in Selected Baccalaureate and Post-baccalaureate Programs (Baccalaureate Programs) by Gaden, Keith Raymond, PhD from Andrews University, 1992, 205 pages http://wwwlib.umi.com/dissertations/fullcit/9235604

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Inequality of Enrollment and Graduation in United States Physical Therapy Programs by Dal Bello-Haas, Vanina Pia Maria; PhD from Cleveland State University, 2002, 193 pages http://wwwlib.umi.com/dissertations/fullcit/3073999

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Interculturalization and the Education of Professionals: a Grounded Theory Investigation of Diversity, Multiculturalism and Conviction in the Physical Therapy Profession by Kachingwe, Aimie Fitzgerald; EDD from Northern Illinois University, 2000, 326 pages http://wwwlib.umi.com/dissertations/fullcit/9997588

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Interdisciplinary Standards for Practice in Early Intervention: Perceptions of Pediatric Academic Educators in Professional Physical Therapy Programs by Megrath, Kimberley Lewis; PhD from University of Oregon, 2000, 344 pages http://wwwlib.umi.com/dissertations/fullcit/9963451

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Interinstitutional Agreements for Clinical Education in Physical Therapy by Moore, Margaret Lee, EDD from Duke University, 1971, 204 pages http://wwwlib.umi.com/dissertations/fullcit/7207483

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Investigating the Effects of Tonic Reflex Activity on Upper Limb Function in Persons with Cerebral Palsy (Handicapped, Physical Therapy) by Jenkins, Christopher James, PhD from University of Oregon, 1986, 206 pages http://wwwlib.umi.com/dissertations/fullcit/8705877

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Just Ask 'How High?': a Case Study of a Small Private University's Transition to Offering a Doctorate in Physical Therapy by Roller, Joellen Marie; EDD from University of St. Thomas (Minnesota), 2002, 222 pages http://wwwlib.umi.com/dissertations/fullcit/3068102

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Leadership Attitudes and Job Satisfaction in Physical Therapy Clinical Education by Thompson, Elizabeth Anne Weekley, EDD from Georgia Southern University, 1998, 148 pages http://wwwlib.umi.com/dissertations/fullcit/9906229

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Learning Communication and Interpersonal Skills Essential for Physical Therapy Practice: a Study of Emergent Clinicians by Plack, Margaret M.; EDD from Columbia University Teachers College, 2003, 384 pages http://wwwlib.umi.com/dissertations/fullcit/3091286

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Learning Styles of Physical Therapy Students by Hick-Rheault, Wendy Lee, PhD from The University of Chicago, 1989 http://wwwlib.umi.com/dissertations/fullcit/T-31045

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Levels of Reflection of Physical Therapy Students Using Structured Journals during a 9-Week Clinical Education Experience by McGinty, Susan Mae Young; EDD from University of San Francisco, 2001, 145 pages http://wwwlib.umi.com/dissertations/fullcit/3035639

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Management, Faculty, and Accreditation Outcomes: a Survey of Physical Therapy Faculty and Program Directors by Peterson, Cathryn A.; EDD from University of San Francisco, 2002, 156 pages http://wwwlib.umi.com/dissertations/fullcit/3045023

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Methodological Research of a Developing Minimal Data Set That Measures Outcomes of Students Receiving School-based Occupational Therapy and Physical Therapy by Arnold, Sandra H.; PhD from The University of Oklahoma Health Sciences Center, 2003, 197 pages http://wwwlib.umi.com/dissertations/fullcit/3095288

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Multigroup Assessment of Criteria Used to Evaluate Entry Level Physical Therapy Educational Programs by Borden, Richard A., PhD from The Union for Experimenting Colleges and Universities, 1988, 194 pages http://wwwlib.umi.com/dissertations/fullcit/8821937

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Nontraditional Variables As Predictors of Academic Success for Students Enrolled in Baccalaureate Level Physical Therapy Programs by Chapman, Denise Michelle, PhD from The University of Iowa, 1987, 128 pages http://wwwlib.umi.com/dissertations/fullcit/8729450

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Patients, Practitioners, and Policy: an Assessment of Patient Education Curricula in Physical Therapy Education Programs by Katzanek, Robin Jean; PhD from University of Denver, 2000, 262 pages http://wwwlib.umi.com/dissertations/fullcit/9973618

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Perceived Maternal Knowledge and Attitudes toward Physical Therapy during Early Intervention in Two Ethnic Groups (Cuban-Americans, African-Americans, Florida) by Masin, Helen L., PhD from University of Miami, 1992, 151 pages http://wwwlib.umi.com/dissertations/fullcit/9301241

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Perceptions of Physical Therapy Graduates' Readiness for Professional Activities, by the Graduates, Their Supervisors, and Their Faculty by Nayer, Marla Sharon; PhD from University of Toronto (Canada), 1999, 391 pages http://wwwlib.umi.com/dissertations/fullcit/NQ41255

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Physical Therapy and Occupational Therapy Services Evaluation Instrument for School Settings by Bartlett, Cheryl Sanger, PhD from The University of Alabama, 1996, 250 pages http://wwwlib.umi.com/dissertations/fullcit/9633913

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Physical Therapy Clinicians' Perspectives of Important Cardiopulmonary Competencies for Clinical Practice by Stubbs, Paula Laird; PhD from The University of Mississippi, 2003, 178 pages http://wwwlib.umi.com/dissertations/fullcit/3089847

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Physical Therapy Diagnosis Using Models of Disablement Represented by Impairment Variables Predicting Performance of Six-minute Walk Test, a Measure of Activity Limitation, in Individuals with Lower Limb Amputation by Raya, Michele Alexandria; PhD from University of Miami, 2003, 180 pages http://wwwlib.umi.com/dissertations/fullcit/3096368

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Physical Therapy in the Rehabilitation of Elderly Hip Surgery Patients in the Acute Setting by Beeson, Diane Ruth, PhD from University of California, San Francisco, 1981, 249 pages http://wwwlib.umi.com/dissertations/fullcit/8304202

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Physical Therapy Students' Approaches to Learning: Faculty Beliefs and Other Educational Factors That Influence Them by Sellheim, Debra Ough; PhD from University of Minnesota, 2001, 290 pages http://wwwlib.umi.com/dissertations/fullcit/3010578

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Physical Therapy Students' Learning Outcomes, Learning Styles, and Satisfaction: Comparison of Web-based to Lecture-based Delivery Model by Hauer, Patrick Leo; EDD from University of South Dakota, 2002, 84 pages http://wwwlib.umi.com/dissertations/fullcit/3055150

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Physical Therapy: A Study in Professional Orientations by Seyler, Mary Jo McClain, PhD from The Ohio State University, 1968, 159 pages http://wwwlib.umi.com/dissertations/fullcit/6911705

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Practice Variation in Physical Therapy: Development of a Causal Model Using the Disorders Adhesive Capsulitis of the Shoulder and Sciatica by Jewell, Dianne Ruth Valle; PhD from Virginia Commonwealth University, 2003, 218 pages http://wwwlib.umi.com/dissertations/fullcit/3084230

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Practitioners' Reflections of Morality and Ethical Decision-Making in Physical Therapy by Greenfield, Bruce Howard; PhD from Georgia State University, 2003, 203 pages http://wwwlib.umi.com/dissertations/fullcit/3095173

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Predicting a Physical Therapy Career Working with Elderly Patients by Nosse, Larry John, PhD from Marquette University, 1998, 165 pages http://wwwlib.umi.com/dissertations/fullcit/9912732

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Problem-Solving in Physical Therapy Implications for Curriculum Development by Thomas-Edding, Dorothy O; PhD from University of Toronto (Canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL39263

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Professional Behavior Development in Physical Therapy Students: Perceptions of Faculty and Students by Tsoumas, Linda J.; EDD from University of Hartford, 2002, 308 pages http://wwwlib.umi.com/dissertations/fullcit/3041817

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Professional Development of Academic Coordinators/Directors of Clinical Education in Physical Therapy: Portraits of Persistence by Salzman, Alice Jane; EDD from Northern Illinois University, 2003, 280 pages http://wwwlib.umi.com/dissertations/fullcit/3092266

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Professional Education and the Liberal Arts: Physical Therapy Programs at Liberal Arts Institutions by Domholdt, Elizabeth, EDD from Indiana University, 1987, 209 pages http://wwwlib.umi.com/dissertations/fullcit/8808206

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Professional Socialization in Physical Therapy: Influences and Perceived Outcomes by Dutton, Lisa Lynnae; PhD from Bowling Green State University, 2001, 233 pages http://wwwlib.umi.com/dissertations/fullcit/3038431

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Professional Socialization in Physical Therapy: Cooperative Work Experience and Student Perceptions of the Role of the Physical Therapist by Blackmer, Betsey Wyman, EDD from Northeastern University, 1988, 233 pages http://wwwlib.umi.com/dissertations/fullcit/8904849

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Program Evaluation of the University of North Dakota Department of Physical Therapy: A Case Study (Physical Therapy Education) by Mabey, Renee L. Rud, PhD from The University of North Dakota, 1995, 127 pages http://wwwlib.umi.com/dissertations/fullcit/9537554

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Quality Improvement in Physical Therapy Education: What Contributes to High Firsttime Pass Rates on the National Physical Therapy Examination? by Palmer, Phillip B.; PhD from University of North Texas, 2001, 218 pages http://wwwlib.umi.com/dissertations/fullcit/3041920

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Quality in Physical Therapy Education by Bertram, Stacie Carroll; PhD from Illinois State University, 2001, 199 pages http://wwwlib.umi.com/dissertations/fullcit/3064478

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Relations among Patient Management Problems, Critical Thinking Abilities and Professional Knowledge Levels Attained by Physical Therapy Students by MacKinnon, Joyce Leslie, EDD from North Carolina State University, 1987, 220 pages http://wwwlib.umi.com/dissertations/fullcit/8718908

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Role Conceptions of Faculty and Clinicians in the Field of Physical Therapy by Echternach, John Lennox, EDD from The College of William and Mary, 1976, 139 pages http://wwwlib.umi.com/dissertations/fullcit/7628436

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Selected Characteristics and Employment Practices: 1972-1976 Physical Therapy Graduates by Entry Level Professional Education by Perry, Catherine E., EDD from Boston University School of Education, 1979, 261 pages http://wwwlib.umi.com/dissertations/fullcit/7923891

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Selection of Students for Physical Therapy Education by Landen, Betty Ruth, PhD from Georgia State University, 1977, 110 pages http://wwwlib.umi.com/dissertations/fullcit/7729331

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Stresses and Strains in Physical Therapy (Massachusetts; Professionalization, Bureaucracy, History, Organization) by Holness, Alison E., PhD from Boston University, 1985, 229 pages http://wwwlib.umi.com/dissertations/fullcit/8513598

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The Allied Health Professions Admission Test: Its Roles in Selection for Physical Therapy Programs by Lilly-Masuda, Deona Mae, PhD from University of Southern California, 1984 http://wwwlib.umi.com/dissertations/fullcit/f2141317

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The Clinical Reasoning Process As an Educational Strategy for Entry-level Physical Therapy Professionals by Burt-duPont, Blanche Anne, PhD from University of Florida, 1990, 195 pages http://wwwlib.umi.com/dissertations/fullcit/9106408

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The Comparison of Three Barriers to Inclusive Physical Therapy in the School Setting by Hart, Laurie M.; EDD from University of Kansas, 2000, 69 pages http://wwwlib.umi.com/dissertations/fullcit/9998081

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The Development of Physical Therapy Assistant Programs in Junior Colleges by Brawley, Gloria Marie, PhD from The Catholic University of America, 1970, 118 pages http://wwwlib.umi.com/dissertations/fullcit/7022135

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The Effect of a Behavioral Management Package on Adherence to Home Exercise Programs in Physical Therapy by Shoaf, Lisa Donegan; PhD from Virginia Commonwealth University, 2002, 279 pages http://wwwlib.umi.com/dissertations/fullcit/3042806

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The Effect of Frequency of Physical Therapy Visits on Balance and Falls in the Frail Elderly by Hardy, Julie Ann; MS from Texas Woman's University, 2002, 74 pages http://wwwlib.umi.com/dissertations/fullcit/1411434

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The Effect of Minority Recruitment and Retention Strategies and Programs on the Number of Minority Students Applying To, Enrolled in and Graduated from Accredited Entry-Level Physical Therapy Education Programs by Haskins, Awilda R., EDD from Florida International University, 1991, 231 pages http://wwwlib.umi.com/dissertations/fullcit/9134616

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The Effect of Training on Physical Therapy Student Raters Evaluating Videotaped Motor Skill Performances by Holekamp, Margaret J. M., PhD from University of Missouri - Columbia, 1986, 145 pages http://wwwlib.umi.com/dissertations/fullcit/8716706

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The Movertm Curriculum: An Application of Contemporary Theories of Physical Therapy and Education by Barnes, Stacie Brown; EDD from The University of West Florida, 1999, 133 pages http://wwwlib.umi.com/dissertations/fullcit/9981950

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The Perceived Effectiveness of Physical Therapy Programs in Michigan Public Schools by Smith, Ernestine Rebecca Collins, PhD from The University of Michigan, 1982, 205 pages http://wwwlib.umi.com/dissertations/fullcit/8215086

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The Perceptions of Physical Therapy Students Regarding the Provision of Transcultural Care by Kraemer, Theresa Jean, PhD from Virginia Commonwealth University, 1999, 335 pages http://wwwlib.umi.com/dissertations/fullcit/9927534

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The Predictive Validity of Student Selection Variables in Physical Therapy Education by Clark, Mary Ann Fedun, EDD from University of Houston, 1983, 77 pages http://wwwlib.umi.com/dissertations/fullcit/8322112

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The Professionalization of Physical Therapy and the Educational Preparation of Physical Therapists for Professional Autonomy. by Banaitis, Daiva Audenas, PhD from Southern Illinois University at Carbondale, 1975, 202 pages http://wwwlib.umi.com/dissertations/fullcit/7603296

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The Professionalization of Physical Therapy in the United States by Karow, Peter Joel, PhD from New York University, 1991, 272 pages http://wwwlib.umi.com/dissertations/fullcit/9134709

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The Relationship of Physical Therapy Student Characteristics and Clinical Site Characteristics to the Students' Performance on the National Physical Therapy Examination by Edmondson, Deborah Ann; EDD from Tennessee State University, 2001, 155 pages http://wwwlib.umi.com/dissertations/fullcit/3007561

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The Relative Value of Multiple Physical Therapy Admission Criteria in Predicting Clinical, Didactic, and Licensure Performance by Gross, Michael Todd, PhD from The University of North Carolina at Chapel Hill, 1986, 100 pages http://wwwlib.umi.com/dissertations/fullcit/8628227

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The Research Domain of Physical Therapy by Johnson, Geneva Richard, PhD from University of Pittsburgh, 1971, 147 pages http://wwwlib.umi.com/dissertations/fullcit/7126167

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The Role of Health Promotion in Physical Therapy by Rea, Brenda Lynn; DRPH from Loma Linda University, 2003, 104 pages http://wwwlib.umi.com/dissertations/fullcit/3094852

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The Role of Participating in a Clinical Instructor Training Curriculum in Preparing Clinical Instructors to Comply with the American Physical Therapy Association Guidelines for Clinical Instructors by Kettenbach, Virginia K.; PhD from Saint Louis University, 1999, 386 pages http://wwwlib.umi.com/dissertations/fullcit/9973366

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The Role of the Academic Physical Therapy Department Chair As Perceived by Physical Therapy Teaching Faculty and Chairs by Perry, Wayne Louis; PhD from Andrews University, 2000, 204 pages http://wwwlib.umi.com/dissertations/fullcit/9968523

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The Scope of Physical Therapy Practice in Idaho Public School Systems by Oriel, Kathryn Nicole; EDD from Idaho State University, 2003, 128 pages http://wwwlib.umi.com/dissertations/fullcit/3094892

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The Transition to Post-baccalaureate Education in Physical Therapy by Malone, Terry Richard, EDD from Duke University, 1985, 211 pages http://wwwlib.umi.com/dissertations/fullcit/8605521

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The Use of Games in Physical Therapy by Ruvin, Harold, EDD from Yeshiva University, 1966, 178 pages http://wwwlib.umi.com/dissertations/fullcit/6612090

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The Use of Physical Therapy in Orthopedagogical Aid - A Study in Physical Pedagogics. (Afrikaans Text) by De Bruyn, Nicolaas Johannes, DED from University of Pretoria (south Africa), 1982 http://wwwlib.umi.com/dissertations/fullcit/f3191797

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Training Special Education Teachers in Physical Therapy Techniques by Means of Programmed Demonstrations by Swack, Myron Jerome, PhD from The University of Michigan, 1965, 61 pages http://wwwlib.umi.com/dissertations/fullcit/6606716

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Utility of the Modified Haberman Interview in Higher Education (Physical Therapy Faculty) by Storey, Rebecca Sue, PhD from The University of Texas at Austin, 1995, 184 pages http://wwwlib.umi.com/dissertations/fullcit/9534968

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Value Negotiation As the Basis for Professional Socialization: the Example of Physical Therapy by Stiller-Sermo, Christine, PhD from Michigan State University, 1998, 270 pages http://wwwlib.umi.com/dissertations/fullcit/9922379

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What Do Physical Therapy Educators Define As Clinical Decision-Making and How Are These Definitions Evidenced in Their Teaching? by Geigle, Paula Richley; PhD from University of Delaware, 2002, 107 pages http://wwwlib.umi.com/dissertations/fullcit/3038313

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 4. CLINICAL TRIALS AND PHYSICAL THERAPY Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning physical therapy.

Recent Trials on Physical Therapy The following is a list of recent trials dedicated to physical therapy.7 Further information on a trial is available at the Web site indicated. •

Efficacy of Acupuncture with Physical Therapy for Knee Osteo-Arthritis Condition(s): Osteoarthritis Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This study will examine the efficacy of acupuncture in combination with exercise physical therapy for moderate osteoarthritis (OA) of the knee. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00035399

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Motor Recovery in Recent Stroke Patients Treated with Amphetamine and Physical Therapy Condition(s): Cerebrovascular Accident; Paralysis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of this study is to determine if giving amphetamines along with standard rehabilitation speeds motor recovery after a stroke. In addition, if

7

These are listed at www.ClinicalTrials.gov.

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motor recovery is improved, the study will also identify the areas of the brain involved with the recovery. Researchers will use motor function ratings, PET scans, functional MRI (fMRI), electroencephalographs, and transcranial magnetic stimulation (TMS) to evaluate patients. Patients participating in the study will be placed in one of two groups; 1. Patients receiving dextroamphetamine and routine Rehabilitation Medicine 2. Patients receiving a placebo "sugar pill" and routine Rehabilitation Medicine Patients that have improved motor recovery will undergo neuroimaging and neurophysiological studies to identify areas of the brain involved. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001783

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “physical therapy” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 5. PATENTS ON PHYSICAL THERAPY Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “physical therapy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on physical therapy, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Physical Therapy By performing a patent search focusing on physical therapy, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 8Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on physical therapy: •

Adjustable mobile orthosis seat appliance Inventor(s): Kitchen; Carol (Clinton, MI), Perrin; Melody Ann (Clinton, MI) Assignee(s): Macomb Intermediate School District (Clinton Township, MI) Patent Number: 6,217,057 Date filed: October 2, 1997 Abstract: A therapeutic support appliance for a patient disposed in a seating orthosis is provided with a base portion with casters coupled to its underside. A plurality of stanchions extend upwardly from the base member for engaging an adjustable handle and an adjustable orthosis support member, respectively. The handle can be adjusted to a height determined in response to a physical size characteristic of an operator or a therapist, and the orthosis support can be raised, lowered, or tipped in response to a physical size characteristic of the patient, the height of a table, or the administration of physical therapy. In one embodiment the appliance is formed of a vinyl coated steel tubular elements joined to one another. Excerpt(s): This invention relates generally to therapeutic seating appliances for invalid or handicapped patients, and more particularly, to a seat appliance that accommodates an orthosis and a patient. There is a need for a seat appliance that securely accommodates an orthosis, such as a GILLETTE seating orthosis, that conforms to the body of an individual patient, such as a child, to maintain body alignment and prevent deformities. The term "orthosis" as used herein includes, in addition to custom molded arrangements adapted to the specific physiology of a particular patient, other seating inserts for patients, such as students, that require more support than is provided by a conventional chair. The prior art provides various forms of walkers, table potty chairs, wheelchairs, and the like, which fall short of fulfilling certain needs of invalid or otherwise handicapped children. For example, it is desired that an invalid or handicapped child or student disposed on a seating appliance be positioned such that the student is brought closer to his or her peers. Such proximity provides significant psychological advantage to the student as it reduces the psychological impact of the ever-present hospital-like structures, including the seating appliance, the orthosis, etc. Known arrangements often include associated work tables for the students, because the structure of such known appliances often requires predetermined cut-outs in the table to accommodate the student and the seating appliance. Thus, in a conventional setting, the handicapped or invalid students are separated from one another and perform their classroom work on individual tables associated with their respective seat appliances. Such isolation limits interaction between the students, and since conventional seating appliances are bulky, the students cannot avoid the constant reminder of the hospitallike environment. There is additionally a need for a mobile orthosis seat arrangement wherein a broader range of physical therapies can be administered to the patients than can be administered in a conventional handicapped seating arrangement. Such a seat should provide easy access for therapists to facilitate desired movements or hand-overhand patterning for the patient. Such enhanced ergonomics would reduce the possibility of injury to the patients. In addition, there is a need for a streamlined orthosis seat appliance wherein a student can be brought, at an appropriate height, to a table work surface, such as a classroom table, with or without a cut-out. In addition, the improved seating appliance should facilitate the spatial orientation of the orthosis with the patient

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thereon to facilitate the administration of therapies to improve muscle tone and head and neck control. Web site: http://www.delphion.com/details?pn=US06217057__ •

Adjustable physical therapy apparatus Inventor(s): Mekjian; John H. (35959 Elmira, Livonia, MI 48150) Assignee(s): none reported Patent Number: 5,879,272 Date filed: August 15, 1997 Abstract: An adjustable physical therapy apparatus consisting of a support base. A horizontally oriented bounding platform assembly support bar is selectively mounted on the support base so as to be vertically adjustable with respect thereto. A bounding platform assembly consists of two pivotally connected bounding platforms which are selectively draped over the support bar so that the free ends thereof rest upon the floor. The angle of inclination of the pivotally connected bounding platforms is selectivley variable by vertically adjusting the support bar with respect to the support base so as to provide bounding surfaces for vigorous lateral rehabilitation exercises by the patient.A modified adjustable physical therapy apparatus is provided whereby two adjustable physical therapy units are fixedly attached in an end-to-end relationship so as to provide adjacent bounding platforms with a reverse angle of inclination so as to provide bounding surfaces for vigorous medial rehabilitation exercises by the patient. Excerpt(s): This invention relates to an adjustable physical therapy apparatus which is specifically adaptable for selective rehabilitation exercises by a patient to improve the strength and stability of injured joints in the lower body extremities, i.e. the ankles, knees and hips. This invention also relates to an adjustable physical therapy apparatus having opposed inclined platforms which enable the patient to perform selective bilateral bounding activity on the inclined platforms by pushing off with one leg from one inclined platform and landing with the other leg on the opposite inclined platform with resultant beneficial rehabilitating stress along the lateral aspects of the joints as the bounding activity is repeated with resultant increased strength in the injured joint. This invention further relates to an adjustable physical therapy apparatus provided with variable angle of inclination control means whereby the angle of inclination of the opposed inclined or slanted platforms can selectively be varied from a low level of incline to a high level of incline so as to selectively increase the stress level as the patient's rehabilitation improves to a full recovery of the injured joint. Web site: http://www.delphion.com/details?pn=US05879272__

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Ambulation and mobility apparatus for therapeutic exercise Inventor(s): Cohen; Charles (Fair Lawn, NJ) Assignee(s): Hausmann Industries, Inc. (Northvale, NJ) Patent Number: 5,924,960 Date filed: October 7, 1997 Abstract: A therapeutic exercise apparatus for providing ambulation and mobility physical therapy includes a flat platform and two parallel handrails with ladder steps

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arranged on the platform at the place where the patient would place their feet, so that the gait of the patient is controlled and increased movement of the patient's feet is required in order to permit the patient to traverse the length of the platform. A balance beam extending along the length of the platform can be placed on the platform in lieu of the ladder steps. The steps are removably attached to the platform by means of dowel pins fitting in corresponding holes bored in the surface of the platform. Excerpt(s): This invention relates generally apparatus for use in physical therapy and, more particularly, to apparatus for use in ambulation therapy. The field of physical therapy has been getting more and more attention upon the recognition that recuperation and recovery from surgery and accidents can be implemented by the patient performing various exercises and the like. For example, walking is found to help many recovering patients and disabled persons. Nevertheless, in many cases the patient could not simply walk on their own. Therefore, there have been known some systems having handrails that resemble the parallel bars in gymnastic equipment and that permit the patient to hold on with their hands and arms to the handrails as they walk along. In such previously proposed systems, the handrails or parallel bars are provided with uprights or standards similar to those of the gymnastic equipment that are simply placed on the floor of the physical therapy training area. Accordingly, it is an object of the present invention to provide an improved apparatus that can increase the effectiveness of the previously known ambulatory therapy device by requiring more complicated movements of the patient's feet, while still providing handrail support. Web site: http://www.delphion.com/details?pn=US05924960__ •

Continuous passive motion device that accelerates through the non-working range of motion Inventor(s): Blanchard; Frederick W. (Portage, MI), Brown; Stephen L. (Chattanooga, TN), Hofstatter; Dwayne (Woodstock, GA), Linville; D. Chris (Hixson, TN), Pohl; Jeffrey K. (Chattanooga, TN), Vetter, Jr.; James R. (Soddy Daisy, TN) Assignee(s): Chattanooga Group, Inc. (Hixson, TN) Patent Number: 6,221,033 Date filed: November 9, 1999 Abstract: A therapeutic device which may be used in providing physical therapy for a patient's knee by moving the patient's leg through a plurality of cycles of motion in a treatment session. The device includes a "Fast Back" range of motion feature that permits the machine to be operated at more than one speed or rate per cycle, wherein the patient's knee may pass through a critical or working range of motion at a first rate, and through a non-critical or non-working range of motion at a second rate, so as to increase the portion of time of a treatment session that is spent in the working of the range of motion, as compared to conventional CPM machines. The preferred embodiment of the invention also has "soft turns" capability, wherein the carriage holding the patient's leg is decelerated, at a controlled rate over a controlled distance, from the operational speed to zero, as the carriage approaches an extension or flexion limit, and wherein the carriage is accelerated in the same fashion as the carriage moves away from the extension or flexion limit. Excerpt(s): The present invention relates generally to medical rehabilitation devices, and more particularly to a device which may be used to flex the knee joint of a patient as part of a therapeutic or rehabilitative program. Knee injuries are an unfortunate

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byproduct of today's emphasis on sports and physical fitness; however, effective surgical techniques have been developed to repair injuries such as to the anterior cruciate ligament (ACL) and other components of the knee. In addition, many members of our aging population are candidates for total knee replacement surgery because of disease and/or injury. All of these surgical procedures must be followed by a period of rehabilitation in order for recovery to be complete. Furthermore, some injuries to the knee may not require surgery but instead may require an extensive rehabilitation period. Such rehabilitation generally requires that the knee be flexed and the leg be extended such as occurs in normal walking; however, it is frequently undesirable for a recovering patient to bear weight on his leg while rehabilitating his knee. In addition, when a knee has suffered a trauma or other injury, or after surgery, a person often lacks the necessary muscle control, strength or will to flex his knee and straighten his leg. Consequently, there is a need for a rehabilitation device that can be used to mobilize the joint over period of time as a part of the orthopedic care which follows an injury, illness or surgical procedure. The therapeutic use of an external force to flex and extend the limb to induce motion is referred to as passive motion. The application of continuous passive motion to a joint following a period of immobilization, injury, surgery or the like, has been shown to reduce post-operative pain, decrease the number of adhesions, decrease the amount of atrophy experienced by the surrounding and supporting muscle, promote the speed of recovery, improve the range of motion in a much shorter time, and reduce the risk of deep vein thrombosis and post-traumatic osteopenia. Depending on the nature and severity of the knee injury or the nature and extent of the surgical procedure performed, therapeutic treatment sessions involving continuous passive motion may be carried out on a daily basis for several days or several weeks. Web site: http://www.delphion.com/details?pn=US06221033__ •

Cyclic ergometer Inventor(s): Brown; David Alan (9358 Forestview, Evanston, IL 60203) Assignee(s): none reported Patent Number: 6,551,219 Date filed: May 13, 1999 Abstract: An exercise or physical therapy apparatus provides both tonic and phasic exercise to selected muscle groups of a user, such as the muscles of the arms or legs. The phasic exercise may be accomplished by a cycle. The tonic exercise is accomplished by subjecting the muscle group to a constant load, such as a user- or therapist-selected portion of the user's body weight, by springs, or by weights. A measurement device measures the degree of displacement of the user's torso, it being an objective of the user to keep the torso stationary. Excerpt(s): The present invention relates in general to physical rehabilitation and exercise apparatus, and more particularly to physical therapy and exercise apparatus that provide both phasic and tonic exercise to a muscle group. There are many exercise devices that are used to strengthen muscles of the lower or upper extremities. In regard to the legs, it is important to find exercises for increasing strength in functional weightbearing tasks such as walking, running and jumping, while minimizing the damage to joints that may occur with repetitive training of these tasks. Currently available bicycle ergometers, although providing a good exercise for minimizing joint loading stress, all involve some seating mechanism that absorbs most of the body weight, such that weight-bearing on the exercised extremities is minimized. One device, the cardiac stress

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table disclosed in U.S. Pat. No. 4,372,551, was developed to aid in the diagnostic imaging of the heart during different levels of cardiac stress. This device can tilt an individual about the approximate hip center and uses a shoulder pad system to retain the trunk in selected tilt positions. The device uses seated pedaling and therefore does not place significant tonic loads on the legs. Web site: http://www.delphion.com/details?pn=US06551219__ •

Inflatable device and method for using the device Inventor(s): Weck; David S. (New York, NY) Assignee(s): D. W. Fitness, LLC (Madison, NJ) Patent Number: 6,422,983 Date filed: October 4, 1999 Abstract: An inflatable device can be used for physical therapy, conditioning or training. The device has a support platform and a flexible member. The flexible member is affixed to, and has a bowl-shaped distention projecting from, one side of the platform. This flexible member is inflatable to a pressure for supporting a person. The device is inflated before placing at least some of the weight of a person on the device. When the person wishes to later change the characteristics of the device, the pressure in the inflatable device can be changed to change its stability. Excerpt(s): The present invention relates to devices for physical therapy, conditioning or training, and in particular to inflatable devices. Many devices are known for facilitating exercises done for therapy, conditioning or physical training. Other than variable resistance training equipment, these devices have not usually offered much adjustability to allow for exercises at different degrees of difficulty. Also, many of these devices have been dedicated to very specific exercises and therefore do not justify a significant investment of space and financial resources for such a narrow purpose. Some exercise devices require a person to maintain balance and equilibrium. A large inflatable ball (for example, 65 cm), known as a Swiss ball, has been used for this purpose. While the ball is useful for certain stability training exercises, standing upon the ball or staying atop the ball requires a high degree of skill and is inappropriate for most. Web site: http://www.delphion.com/details?pn=US06422983__

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Interactive workstation for creating customized, watch and do physical exercise programs Inventor(s): Biron; James F. (Longmeadow, MA), Ditmar; Terry D. (Longmeadow, MA), Elia; Geoff F. (Somers, CT), Graham; Donald L. (Longmeadow, MA), Green; Gregory A. (Marlboro, MA), Sklar; Joseph H. (Longmeadow, MA) Assignee(s): OmniMedia Systems, Inc. (Great Barrington, MA) Patent Number: 5,949,951 Date filed: November 8, 1996 Abstract: An interactive touchscreen workstation is disclosed for generating patientspecific physical therapy videotapes. The workstation generally includes an appropriately programmed, digital central processing unit; first storage means for storing digital video exercise data; second storage means for storing digital audio

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exercise data; third storage means for storing digital patient data; fourth storage means for storing digital audio music data; user interface controls for directing the operation of the central processing unit so as to (i) generate a sequence of digital video frames from the data contained in the first storage means, with that sequence corresponding to a particular physical therapy regimen prescribed for that patient, and (ii) generate a digital audio track from the digital audio exercise data contained in the second storage mean, and/or the digital audio music data contained in the fourth storage means, with the digital audio track generated by the central processing unit corresponding to the sequence of digital video frames generated by the central processing unit; and output means for recording the sequence of digital video frames generated by the central processing unit and digital audio track generated by the central processing unit on a standard videotape, which videotape can thereafter be used by a patient to conduct "watch-and-do" physical therapy by playing back the videotape while simultaneously carrying out the regimen of physical therapy exercises specified in, and illustrated by, that same videotape. Excerpt(s): This invention relates to the provision of physical therapy in general, and more particularly to the provision of physical therapy using patient-specific videotapes. Physical therapy typically requires that a patient undertake a prescribed series of repetitive exercises so as to strengthen or otherwise treat a portion of that patient's body. These prescribed exercises are patientspecific, in the sense that they must take into account the general health of the patient, the specific therapy to be achieved, etc. Since the patient typically performs at least some of the exercises out of view of the therapist, it is common for the therapist to provide the patient with a set of written guidelines to be followed when carrying out the prescribed exercise regimen. Among other things, this set of written guidelines may include paper drawings of the exercises which are to be performed by the patient. Unfortunately, it can be very difficult for the physical therapist to provide the patient with all of the desired instructions via the aforementioned written guidelines, even where these guidelines include paper drawings. Web site: http://www.delphion.com/details?pn=US05949951__ •

Isotonic or isometric exercise and therapy system Inventor(s): Gordon; James R. (Benton, IL) Assignee(s): Gordon Research & Development, Inc. (Pinckneyville, IL) Patent Number: 5,674,166 Date filed: October 24, 1996 Abstract: This isometric/isotonic exercise and physical therapy system is based on a series of elongated exercise rods made of urethane or other resilient, elastomeric resin that is both bendable and twistable. The exercise or therapy afforded by the system depends on the resilient exercise rod or rods; for a relatively limp, low-resistance rod the exercise is essentially isotonic, but with stiffer rods isometric exercise or therapy is provided. The system includes devices that mount the rod or rods on the person using the system for varied exercises of the knee, elbow, hip, wrist, back, or virtually any other portion of the user's anatomy. Excerpt(s): This invention is directed to a versatile system of devices for isometric or isotonic exercise and physical therapy. The invention has many of the operational attributes of the exercise and physical therapy apparatus described and claimed in the

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applicant's co-pending U.S. applications entitled "Exercise and Therapy Apparatus", and "Isotonic/Isometric Device for Exercise and Physical Therapy", Ser. Nos. 08/364,280 and 08/364,281, both filed Dec. 27, 1994, though the earlier inventions are rather different in structure. This invention usually uses a solid or tubular urethane rod of circular cross section as the principal exercise element, but can utilize a flat plate, a rectangular rod, or the adjustable elastomer torsion device described and claimed in the applicant's copending U.S. patent application for "Adjustable Elastomer Torsion Device", Ser. No. 08/262,511, filed Jun. 20, 1994. A wide variety of different mechanisms have been devised for use in physical therapy for various parts of the human anatomy. Typically, an injured or otherwise impaired arm or wrist requires exercise (physical therapy) to enable the impaired person to recover from the impairment. The same situation may apply to a leg, an ankle, a foot, a back, or some other part of the human anatomy. For some impairments, particularly those involving broken bones, isometric exercises affording substantial resistance are preferred. In trainer's jargon, "no pain, no gain". For other impairments, such as those entailing muscular inflammation, zero or near-zero progressive resistance (isotonic) exercise is often deemed preferable. Many mechanisms can be used for both exercise and therapy purposes. It is difficult, if not impossible, to distinguish between their exercise and therapy attributes. A principal problem with many exercise and physical therapy devices and systems has been that they usually are not sufficiently versatile to meet the numerous different physical problems to which human beings are prone and to provide either isotonic or isometric exercise, at a desired level, for a given part of the human anatomy. Sometimes this problem is overcome, at least in part, by appropriate provision for changing the component parts of a device to suit the needs of the person requiring exercise or physical therapy. Changeover of this kind may be difficult and time consuming, particularly in a complex exercise device. Furthermore, due to the wide disparity of individual humans as regards their physical attributes such as strength, weight, size, degree of impairment, etc., an apparatus that is quite appropriate and suitable for use by one individual may be totally unacceptable to another person having the same basic impairment, regardless of modification of the device. That is, a therapeutic exercise device may be lacking in the versatility necessary for conversion to use by different individuals even though those individuals have the same basic impairment. Web site: http://www.delphion.com/details?pn=US05674166__ •

Joint brace hinges Inventor(s): Bastyr; Charles A. (Del Mar, CA), Simmons; Kevin D. (San Diego, CA), Tillinghast; Theodore V. (Carlsbad, CA) Assignee(s): Smith & Nephew, Inc. (Memphis, TN) Patent Number: 5,921,946 Date filed: October 22, 1997 Abstract: Hinges for orthopedic and rehabilitation braces allow intuitive, convenient and positive control and adjustment of the limits to which the braces may extend or flex. Such hinges also allow convenient locking of such braces. A flexion switch and an extension switch allow convenient repositioning of stops or limits which limit flexion and extension of the brace. Such switches may be repositioned, however, only with repositioning pressure for moving the switch to a new position combined with safety pressure for unlocking the switch. A brace locking switch may also be included. Such hinges promote more effective post-operative and rehabilitation results because they

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among other things allow users easily to change the flexion, extension and fixation limitations of their braces conveniently and in real time such as during post-operative and physical therapy sessions and workouts. Excerpt(s): The present invention relates to hinges for knee braces and for other braces such as those for the shoulder, elbow, hip or other body joints. Such hinges feature switches which may be intuitively, conveniently and positively positioned in order to limit joint flexion and extension or to fix the joint in a locked position for post-operative, rehabilitation or other desired purposes. The hinges preferably employ cammed surfaces and notches which cooperate with such switches for elegant and improved adjustable control of brace flexion, extension and fixation. Knee braces and braces for other joints are commonly employed after surgery or for treatment of injury to the joint. Such braces generally serve two major purposes. First, they brace or stabilize the joint in order generally to control its movement. Second, they limit joint flexion and/or extension in a controllable and adjustable fashion to prevent reinjury of the knee and to promote therapeutic and rehabilitation objectives. Many braces have been devised to stabilize the knee and other joints and anatomical structures about various axes. Hinges which limit flexion and extension of the joint, such as those according to the present invention, may be employed, as a general matter, with or in any of such devices. Web site: http://www.delphion.com/details?pn=US05921946__ •

Medical device for physical therapy treatment Inventor(s): Hill; Jack (2522 Blossom St., Columbia, SC 29205) Assignee(s): none reported Patent Number: 6,371,894 Date filed: February 18, 2000 Abstract: A medical device for physical therapy treatment to enable patients confined to a bed to increase upper and lower extremity strength and promote a quicker return to standing and walking activities. The medical device can be a generally wedge-shaped article constructed of a resiliently compressible material designed to consistently return to its original shape after repeatedly being compressed. The medical device can have an expansive front support base, an expansive, taller rear support base, a generally flat bottom surface, left and right sides and a top surface which slopes from the expansive front support base to the taller rear support base at an angle designed to provide a proper range of motion for a patient's legs when performing a certain therapeutic exercise. The left and right sides can be provided with opposing indentations therein at about the mid portion of the medical device. For stability while performing exercises, the front and rear support bases preferable have expansive surfaces which can be placed between a patient's feet and the footboard of a bed to permit the article to be compressed between the patient's feet and the footboard in order to perform therapeutic exercises. The left and right sides can be compressed either between the patient's thighs or between the outside of the patient's thigh and the side rail of a bed to perform therapeutic exercises. The indentations can be positioned along the sides of the article to provide an anatomically comfortable fit for the patient's thigh and knee. Excerpt(s): The invention relates to a medical device for physical therapists, particularly for performing upper and lower extremity exercises for the physical rehabilitation of bed-bound patients. More particularly, the invention relates to a generally wedge shaped compressible article for allowing patients to perform exercises while lying down,

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most likely confined to their hospital bed, which will aid them in increasing upper and lower extremity strength which is essential for returning to standing and walking activities. The medical device is preferably disposable, in that the article should not be shared between patients. In the acute and sub-acute rehabilitation setting, the patients may be very ill and often are confined to a hospital bed. This proves to be a very challenging situation from a therapeutic standpoint and limits a physical therapist to basic bedside exercises. In addition, physical therapists are limited by the amount of time due to the number of patients they see and resources that are available. Lack of time and resources coupled with the poor health of the patients in these settings can leave the patients at great risk for developing secondary complications such as pneumonia, muscle atrophy, decubiti, and osteoporosis due to inactivity or severely decreased activity. This type of situation normally requires that the patient recover from a very tenuous medical state before initiating aggressive physical therapy and typically requires a relatively lengthy period of hospitalization. Initiating early physical therapy that can be performed in bed by the patient can permit the patient to begin strengthening all of the major upper and lower extremity muscle groups such as shoulder flexors, adductors and abductors; elbow extensors; hip and knee flexors and extensors; hip adductors and abductors; and ankle plantar flexors. Web site: http://www.delphion.com/details?pn=US06371894__ •

Method and system for providing physical therapy services Inventor(s): Burgess; Barry (118 W. MacDonald Ave., Richmond, CA 94801) Assignee(s): none reported Patent Number: 6,007,459 Date filed: April 14, 1998 Abstract: A method and system for providing physical therapy to a human client having a physical condition includes the steps of providing an electronic communication link between the client and a therapist, instructing the client to move in a particular manner, or to assume a sustained posture or perform a test. Then, feedback is requested from the client. The feedback relates to bodily sensation corresponding to the movement or sustained posture and can be audio, video, and/or data type feedback. The communication link communicates the feedback to the therapist. Accordingly, the therapist utilizes the feedback to assess the physical condition of the client. The therapist also communicates remedial movements or a remedial sustained posture to the client to address the physical condition. Various postural measurements and testing devices are be used in conjunction with the present invention to facilitate assessment and help address the physical condition in accordance with accepted physical therapy techniques. Excerpt(s): The present invention pertains to methods for providing physical therapy, and more particularly to providing physical therapy services via an electronic communication system. During the past few decades the demand for physical therapy services has risen. Therapists have grown in number. Injury victims, including those experiencing pain or immobility, commonly see a physical therapist during medical treatment and expect the therapist to address the pain or immobility. During a typical physical therapy session, the therapist assesses a client's physical situation by reviewing relevant medical records and by direct observation of the client. Often the therapist's remedial techniques include hands-on treatment. Such treatment may include massage, joint manipulation and postural adjustments. Often the client's response to hands-on

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treatment is used to enable the therapist to further understand, and remedy the client's condition. Web site: http://www.delphion.com/details?pn=US06007459__ •

Method and therapy software system for preventing computer operator injuries Inventor(s): Heuvelman; John A. (7951 N. Pl., Tucson, AZ 85741) Assignee(s): none reported Patent Number: 6,142,910 Date filed: June 11, 1999 Abstract: A method and therapy software system for preventing computer operator injuries combines a computer with a software system and prevents or rehabilitates computer operator injuries resulting from the prolonged use of a computer keyboard or mouse associated with the computer by reminding said computer operator to perform physical therapy exercises that are designed to reduce the potential injuries that can result from prolonged uninterrupted use of a computer keyboard or mouse. Excerpt(s): The present invention, a Method and Therapy Software System for Preventing Computer Operator Injuries, relates generally to a computer based system and software program for preventing computer operator injuries. More specifically, the present invention is a computer program that monitors a computer operator's mouse and keyboard activity to determine when a particular computer operator should perform user-specific, professionally developed therapeutical physical exercises. The invention temporarily transforms a computer system into an exercise machine by suspending ongoing computer operations in order to use the computer's audio and visual peripherals to present a digitally stored, animated audio/visual interactive presentation of therapeutic physical exercises. The data generated by the exercise sessions is subsequently recorded for administrative and medical review and may be used for managing employee health programs intended to reduce or even eliminate computer operator injuries. The wide spread use of computer systems in the work place and at home has sparked a corresponding rise in physical injuries known generally as Repetitive Stress Injury ("RSI") or Occupational Overuse Syndrome ("OOS") and Cumulative Stress Syndrome; and Toxic Neck Reflex among computer users. Typically, these injuries arise from a condition, which at the onset, is symptomatically little more than a minor irritation to a muscle(s) or joint(s). However, through the continued reuse of the afflicted area or through the continued repetition of the aggravating motion, the minor aggravation is transformed into a much more serious, sometimes debilitating condition. In extreme cases, the condition may require immobilization for extended periods or even surgery. In some cases, although infrequently, the subject of a chronic affliction is prevented from performing certain physical actions for the duration of their life. Web site: http://www.delphion.com/details?pn=US06142910__

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Methods and apparatus for portable delivery of electrical physical modalities to a patient Inventor(s): Bock; Christopher (3435 NE. Clackamas St., Portland, OR 97232), Geist; Steven (Portland, OR) Assignee(s): Bock; Christopher (Portland, OR) Patent Number: 6,393,319 Date filed: November 5, 1999 Abstract: Data defining electrical waveforms for physical therapy is created on a computer and stored in a removable machine-readable medium such as a CD-ROM or semiconductor memory module. The data is played back, for example on a portable CDROM player, to produce the physical therapy waveforms at any time and location convenient or desired by the patient. An interface circuit amplifies and conditions the resulting waveforms for applying them to the skin of the patient via leads and electrodes. Since most therapies use waveforms within the audio frequency range, ubiquitous low-cost audio playback equipment can be used. Advantages of the invention are providing physical therapy at any location and at low cost, without requiring presence of a clinician or other health care professional on location. Excerpt(s): The general subject matter is methods and apparatus for use in physical therapy to alleviate pain, improve mobility, etc., for a human patient who suffers from a disease or injury treatable by physical therapy. Various physical therapy machines are known in the prior art. Specifically, the present invention is related to machines that apply electrical energy to the affected part of the body. It has been found that the application of electrical energy at particular amplitudes and frequencies can be a helpful physical therapy modality. It also appears that many of these treatment modalities apply electrical energy that oscillates at frequencies in the audio range, i.e., from about 20 Hz to about 20,000 Hz. In general, a physical therapy machine is set to provide particular electrical signals, an these are applied to the body through electrodes or "pads" which are applied to the skin in various locations. Known physical therapy machines are bulky, expensive and require training and expertise to operate. For these reasons, their use is generally limited to the doctor's office or physical therapy clinic. The present invention does not provide new physical therapy modalities. Rather, it is directed to new ways to specify (prescribe) appropriate modalities for a patient, and new ways to deliver therapy, i.e. electrical energy to the patient's body in accordance with the prescribed modalities. As illustrated in the enclosed drawings, the clinician has access to a computer (PC) of the type that are in common use today, including a CD ROM drive and a "sound card." Sound cards are known in the prior art for generating audio output, e.g., music, to internal or external speakers of headphones. According to one aspect of the present invention, the appropriate waveforms, amplitudes and frequencies, are specified in the personal computer and generated by the sound card in response to those specifications. However, rather than output these audio signals through speakers or headphones, the output from the sound card is directed through a novel "interface" via wires to electrode or pads which are applied to the patient's body for deliver of a corresponding electrical stimuli. The interface contains suitable electronics for transmitting these signals to the electrodes, and for limiting the signals so as to prevent voltage or energy levels that would be unsafe. Accordingly, one aspect of the invention is an apparatus for administering electrical physical therapy to a patient. The apparatus includes: a playback device for reading prerecorded information defining at least one electrical waveform and reproducing the waveform; an interface circuit for amplifying the resulting waveform so as to form one or more output signals; at least two

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electrodes for applying the output signal to the skin of the patient; and a lead for interconnecting each of the electrodes to the interface circuit to convey the corresponding output signal to a respective one of the electrodes. In one example, the playback device can be a computer with a CD-ROM drive, or a portable CD-ROM player. Solid-state or semiconductor memory can be used to record the therapy data as well. The prerecorded information can include two interferential audio frequency analog signals stored on a the machine-readable medium. Web site: http://www.delphion.com/details?pn=US06393319__ •

Monitor putty with increasing stiffness Inventor(s): Gibbon; Robert M. (Fort Worth, TX) Assignee(s): JMK International, Inc. (Fort Worth, TX) Patent Number: 5,693,689 Date filed: June 7, 1995 Abstract: An exercise putty kit for providing manipulative physical therapy of increasing difficulty comprises a container (12) of a large mass (14) of borosiloxane putty and a package (16) of borosiloxane or siloxane putty. At least one small mass (18-32) is provided to the patient along with the large mass (14), the small mass and large mass being manipulated by the patient until a uniform color and stiffness are achieved in the combined mass (38). Preferably, a plurality of small masses (18-32) having a variety of colors are available for successive manipulation with the combined mass (38). The kit provides a means by which the difficulty of manipulative physical therapy may be monitored and increased. As more small masses (18-32) are added to the combined mass (38), the stiffness increases, requiring more manipulation to fully blend the masses. Excerpt(s): The present invention relates in general to therapeutic exercise putties and more particularly to a method and exercise putty kit for increasing the level of difficulty in manipulative therapy using the exercise putty. Borosiloxanes are a class of compounds which are chain-extending reaction products of polysiloxanes and boron containing compounds such as trimethyl boroxane, pyroboric acid, boric anhydride, ethyl borate, esters of boric acid and others. Their formulation is well known, and is described in U.S. Pat. No. 2,541,851. Borosiloxanes have the peculiar property of exhibiting a resistance to deforming force which is proportional to the force applied to them, giving them the term "bouncing putties." The property also makes them useful as a constituent of exercise putty for use in physical therapy, where enhanced flexibility, dexterity and/or strength of the hands is desired. In addition to there being no easy way for physical therapists to monitor the progress of patients with such exercise putties, addressed by color blending or dispersal in application Ser. No. 08/111,689, there is no easy way to increase the difficulty of the exercise without losing the ability to visually monitor progress. There is therefore a need for a method and exercise putty kit for increasing the difficulty of manipulative exercises without losing the ability to visually determine when the exercise is complete. Web site: http://www.delphion.com/details?pn=US05693689__

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Passive/active fluid exercise device Inventor(s): Barzelay; Abraham (c/o Advanced Data System Corp., 255 Spring Valley Ave., Maywood, NJ 07607) Assignee(s): none reported Patent Number: 6,413,195 Date filed: April 10, 2001 Abstract: A passive/active hydraulic exercise device having a base portion, an upright support and a pivot bard is selectively placed in either a passive push and pull type resistance mode or an active velocity type mode. In the passive mode, a pump can be off or on during "idling". A solenoid valve is energized to an open position, and a servo valve sets a resistance for the fluid flow in the system. A check valve compensates for the differential areas of the cylinder. The active mode is useful for physical therapy applications. In this mode, a constant cycling operation is provided at absolute minimum force levels. The load cell senses the actual force generated, and the position feedback senses actual movement of the exercise bar. As long as the subject is providing enough force to move the bar, the feedback device confirms movement to the computer which adjusts the resistance of the electronic pressure control valve to a value which will allow the subject to continue moving the bar. This force is measured by the load cell and controlled by the servo-valve. Excerpt(s): The present invention relates to a passive/active fluid exercise device. More particularly, the invention relates to a passive/active fluid exercise device which includes computerized control of fluid flow through a fluid system, and includes force (resistance) and movement sensors. For purposes of this disclose, the term fluid is intended to include hydraulic fluid as well as pneumatic fluid. Exercise devices of the type having a variety of controls, sensors, and hydraulic or pneumatic arrangements, are known in the prior art. Web site: http://www.delphion.com/details?pn=US06413195__

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Patient controlled therapy table Inventor(s): Butner; Tarry Adair (19 N. Ridge Rd., McHenry, MD 21541) Assignee(s): none reported Patent Number: 5,667,529 Date filed: February 28, 1995 Abstract: The invention is a physical therapy table having moveable sections allowing the patient to be placed in different physical positions as part of an individual physical therapy regimen wherein the patient himself applies and controls extension, traction and mobilization therapy. Excerpt(s): The invention is a physical therapy table having moveable sections allowing the patient to be placed in different physical positions as part of an individual physical therapy regimen. Through the use of manually operated means, the patient, supported on the top surface of the table, moves various sections of the table without the assistance of an attending therapist. The Lorang patent U.S. Pat. No. 2,851,320 discloses a chiropractic table provided with hydraulic means allowing the entire table top surface to be moved up, down or tilted at a desired angle by the therapist (see col. 1, line 33-38). Sections of the table cannot be moved independent of one another and the patient

Patents 135

cannot operate the moving means while positioned on the table surface. The operation of the Table in the H. C. Perold U.S. Pat. No. 4,059,255 is similar to that of Lorang above in that hydraulic means are used to raise, lower or tilt the table surface. These movements cannot be made by the patient. Web site: http://www.delphion.com/details?pn=US05667529__ •

Physical therapy apparatus Inventor(s): Jensen; Michael L (454 N. 600 W., American Fork, UT 84003) Assignee(s): none reported Patent Number: 6,045,486 Date filed: May 22, 1998 Abstract: An apparatus for physical therapy is disclosed herein. The device comprises a rectangular framework portion, including two long and two short sides, in which the long and short sides each have upper surfaces, lower surfaces, and surfaces interior and exterior to the rectangle, thus defining an interior area within said rectangle. A pair of linear cross support members, each having opposite end portions are disposed about the framework in a direction perpendicular to the length dimension of the rectangle defined by the framework. Each cross support member is attached at its opposite ends to the interior surfaces of both of said long sides of said framework, and thus defines a first inner polygon portion, a second inner polygon portion, and a third inner polygon portion within the interior area of said framework. Within the first and third polygon portions are contained miniature versions of trampolines, which comprise a sheet of fabric connected to the perimeter of the polygon by means of a plurality of springs. In the centermost polygon is located a holster means adapted for receiving a limb of a human subject, such as the foot or ankle, wherein the holster means is attached the perimeter of the centermost polygon of the framework by means of a plurality of elastomeric fasteners. The device further comprises a rail for the user to hold on to, in order to stabilize their position. A wide variety of exercises are provided by the device. New exercises not provided for in the prior art are permitted through use of the device. By the instant invention, patients may be rehabilitated quicker than when using prior art devices. Excerpt(s): This invention relates to equipment useful in the medical field for persons Undergoing physical therapy as part of a rehabilitation program following trauma or surgical procedures. More particularly, the invention concerns a device for exercising and strengthening the muscles of the legs, back, arms, torso, and neck. The device is compact in size and is capable of providing a wide variety of physical exercises of varying stress level dependent upon the needs and progress of the user. Also disclosed herein are methods for using the device. The field of physical therapy is an ancient art dating back in history to the first times when individuals suffered physical bodily injury and were nurtured back to a condition of physical fitness. Generally speaking, physical therapy consists in its simplest form as the healing and/or re-strengthening of bodily tissues which have experienced some form of damage as a result of a traumatic experience, surgical procedure, or atrophy. In modern times, a multitude of events responsible for requiring physical therapy for rejuvenation and rehabilitation of an individual are frequently encountered, including without limitation sports injuries, vehicular accidents, and surgeries. In addition to being a major inconvenience to the patients themselves, when the number of occurrences of such events are coupled with the amount of "down time" experienced by each patient, the annual loss to the gross

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national product (GNP) is staggering. Therefore, many attempts have been made to devise an apparatus useful for rehabilitating such afflicted individuals in a minimum amount of time and in a way which maximizes the pleasure and ease of the rehabilitation experience. Generally, it is a consideration for inventors of devices useful in physical therapy to make them as compact as possible in order to make the most efficient use of floor space available, as well as provide for the ease of portability of the devices. Examples of devices useful in physical therapy are set forth in U.S. Pat. Nos. 4,225,131; 4,564,193; 4,598,905; 4,824,100; 5,374,225; 5,533,948 5,586,962; and 5,645,510, the entire contents of all of the foregoing patents are now indicated as being expressly incorporated herein by reference thereto. These and other various devices and apparatus have been developed for therapy and comprehensive body conditioning programs, and in general such devices provide a means for resistance against which muscular effort must be applied. Web site: http://www.delphion.com/details?pn=US06045486__ •

Physical therapy device for correcting gait and balance problems Inventor(s): Padula, I; William V (8037 Bellevista Ct., Spring Hill, FL 34606-7210), Padula, III; William V (90 Bargate Tr, Killingworth, CT 06419), Padula, Od, II; William V (P.O. Box 1408, Guilford, CT 06437) Assignee(s): none reported Patent Number: 6,135,931 Date filed: June 1, 1999 Abstract: A physical therapy device for correcting gait and balance. The device generally includes a rectangular frame having front, back, right and left sides, a vertical member extending downwardly from a center of the back side of the frame and longitudinal grips extending downwardly from intersections of the front side with each of the left and right sides. In use, the user stands within the generally rectangular frame with his forearms extending forward perpendicularly from the body and gripping the longitudinal grip members with the back side of the frame extending substantially horizontally across the shoulder blades of the user and the vertical member extending downwardly between the shoulder blades of the user. Excerpt(s): This invention relates to physical therapy devices and particularly to physical therapy devices used for correcting gait and balance problems caused by neurological dysfunction. Following neurological damage caused by a cerebrovascular accident (CVA), traumatic brain injury (TBI), cerebral palsy (CP), multiple sclerosis (MS) and others, persons will often experience neuromotor difficulties as well as visual dysfunctions which interfere with posture, balance and gait. These visual dysfunctions then have a significant detrimental effect upon the ambulation or mobility of the person. Studies have determined that visual midline shift syndrome (VMSS) as a visual syndrome will affect balance, posture and ambulation. Persons with visual midline shift syndrome will shift their concept of the visual midline of their body away from the center causing them to lean, in most cases, in the direction of the midline shift. This can cause a tendency to lean or drift when walking to the right or the left. In addition, anterior and posterior shift of the axis may cause the individual to lean forward or backward. Visual midline shift syndrome not only affects ambulation but also posture while seated. Web site: http://www.delphion.com/details?pn=US06135931__

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Physiotherapy method Inventor(s): Zhang; Xue-shan (33 Woodshire Ter., Towaco, NJ 07082), Zhou; Lin (33 Woodshire Ter., Towaco, NJ 07082) Assignee(s): none reported Patent Number: 5,849,026 Date filed: August 29, 1997 Abstract: The present invention relates to a radiation generating apparatus for physical therapy and a process for its manufacture. The apparatus generates a characteristic radiation spectrum to treat and effectively treat or cure diseases of the blood circulating system, skin diseases, surgical wounds, arthritis, bronchitis, asthma, functional disorders of the stomach and/or intestines, gynecological and obstetric disorders such as dysmenorrhoea, hypertension, stress and for promoting the healing of wounds. The apparatus employs a radiation generator comprising a substrate, a transducing layer and a radiation generating layer. A dual purpose radiation treatment and lighting lamp is also described. Excerpt(s): The present invention relates to an apparatus for physical therapy and a process for its manufacture. The apparatus emits a characteristic energy spectrum to effectively treat and cure surface wounds and skin diseases, such as chilblains, frostbites, burns and scalds, chronic skin ulcer, and herpes; arthritis, periarthritis of the shoulder, inflammation of the cervical vertebra, contusion of soft tissue, bronchitis, pneumonia, asthma, functional disorders of the stomach and/or intestines such as diarrhea, gynecological and obstetric disorders such as dysmenorrhoea, inflammation of the vagina, hypertension, stress and for promoting the healing of wounds, and maintaining health. Presently, popular physiotherapeutic equipment in use include mainly those which employ electricity, ultrasonic wave, infrared rays, ultraviolet rays, microwave, laser beams, or heat for the treatment of various disease conditions. Many of these employ electromagnetic radiation to act on the body. For example, various types of equipment employ ultrasonic wave frequencies of 20,000 Hz or above, or infrared rays having a spectrum of between about 780 to 30,000 millimicrons, or ultraviolet rays having a spectrum of between about 180 to 300 millimicrons, or microwave energy with wavelengths of about 1 to 100 millimeters. Electrical conductance, laser beams and heat have also been employed to treat various disease conditions. These physiotherapy methods have all been beneficial in conquering pain and suffering with varying degrees of success. (1) Limited curative effects. Each physiotherapy methods can only be used to treat a limited number of disease conditions. Some common diseases, such as chilblains, frostbites, rhinitis, colds, etc., cannot be treated rapidly or effectively at all. Web site: http://www.delphion.com/details?pn=US05849026__

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Portable tables for massage and physical therapy Inventor(s): Grady; Kevin Mark (244 Justin Morrill Memorial Hwy., Strafford, VT 05072), Tatum; Chris (1631 SW. 170th St., Newberry, FL 32669) Assignee(s): none reported Patent Number: 5,974,979 Date filed: June 19, 1998

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Abstract: Portable folding tables which are particularly adapted for massage and other body therapy uses wherein each table includes two top sections which are hingedly connected at one end and which are supported by legs which are pivotally connected thereto. Each leg is reinforced by either a longitudinal pivotally folding brace, a guide assembly or a positive stop member. The legs, and reinforcing braces when used, are automatically deployed and stabilized by cable systems which extend both longitudinally and diagonally relative to the table legs. Excerpt(s): The present invention is directed to portable tables of the type which are particularly adapted for use for massage and physical therapy and which include hingedly connected top sections which are supported by pivotal leg assemblies. The leg assemblies are designed to be collapsed into a stored position beneath the top sections so that the two top sections may be folded into a compact and portable configuration. Further, the present invention is directed to cable truss systems which automatically deploy the table leg assemblies when the top sections are unfolded relative to one another and the cables thereafter positively reinforcing and stabilizing the leg assemblies while providing maximum leg clearance beneath the tables. Portable tables of the type which are utilized by massage and other body therapists not only must be lightweight to facilitate portability but also must be durable enough to provide a safe support for those receiving treatment. In this respect, in U.S. Pat. No. 4,333,638 to Gillotti, a massage worktable is disclosed which includes a reinforcing truss system incorporating cables, cords or wire ropes which connect each leg to an area adjacent a pivot joint of foldable tabletop sections with the cables extending generally parallel along each side of the table. Such a structure decreases the overall weight of the portable table, however, the truss design associated therewith is insufficient to provide adequate reinforcement to the table legs and further obstructs clearance for the practitioner beneath the table. A similar cable reinforcing structure is disclosed in U.S. Pat. No. 4,943,041 to Romein. To further increase stability of foldable massage tables, U.S. Pat No. 4,833,998 to Everett et al. discloses providing pivotable leg braces for connecting each of the legs of a table to a point adjacent a hinge joint of the top sections of the table. With the Everett et al. structure, flexible cables are utilized to secure the upper portion of the legs adjacent their pivot point to an intermediate portion of an adjacent leg brace with the cables extending beneath additional cable supports that are mounted at the midpoint of the table such that the cables extend generally parallel with respect to one another along the opposite sides of the table. The leg braces associated with the Everett et al. structure provide increased rigidity, however, the cable system, like that of the cable system disclosed in Gillotti, requires that the cables extend along each of the elongated sides of the table in such as a manner as to possibly interfere with the movement of the practitioner about the table. Further, the cable system only provides rigidity lengthwise of the table but not laterally with respect to the length. Somewhat similar structures for cable trusses are disclosed in U.S. Pat. Nos. 5,009,170 to Spehar, 5,524,555 to Fanuzzi, and 5,676,062 to Lloyd. Web site: http://www.delphion.com/details?pn=US05974979__ •

Pulmonary therapy device and method Inventor(s): Gordon; Gregg E. (Katonah, NY), Leban; Stanley (Islandia, NY) Assignee(s): Millennium Devices, L.L.C. (Islandia, NY) Patent Number: 6,053,879 Date filed: January 26, 1999

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Abstract: A method and device for administering pulmonary physical therapy to a patient. The device comprises a control console comprising a sound generator for generating sounds, and a patient contact board. The control console has knobs for adjusting the frequency, wavelength, duration and volume of the sounds from the sound generator, and a power cord for connecting the control console to a power source. The patient contact board is connected to the control console. The contact board has a plurality of speakers mounted on the front face of the board and connected to said sound generator for transmitting the sounds generated by said sound generator. There is a soundproof lining along the back face of the board. The method involves holding the board to the patient's chest or having the patient lean against the board and administering low frequency sound waves to the patient's chest via the control console to loosen chest secretions. Excerpt(s): This invention relates to a method and device for administering pulmonary therapy. In particular, this invention relates to a device that administers acoustic waves to break up secretions in a patient's lungs. It is often necessary to administer pulmonary physical therapy in order to prevent atelectasis, poor pulmonary ventilation, and pneumonia. Chest percussion via "clapping" is often used to promote postural drainage. Clapping generates asacoustic shock waves that vibrate the lung tissue and loosen accumulated secretions. This technique has several disadvantages, however. Clapping can be very uncomfortable to the patient due to the impact of the therapist's hand or the percussor against the patient's chest. Clapping can also cause physical damage including broken ribs in predisposed patients, such as the elderly. Furthermore, this technique requires the time and energy of a skilled therapist and is consequently very expensive. It would therefore be desirable to devise an instrument that can mobilize airway secretions without pain, physical trauma to the chest wall or the expense of a trained therapist. Web site: http://www.delphion.com/details?pn=US06053879__ •

Real time, dry mechanical relaxation station and physical therapy device simulating human application of massage and wet hydrotherapy Inventor(s): Becher; James (437 Carlls Path, Deer Park, NY 11729) Assignee(s): none reported Patent Number: 6,494,851 Date filed: April 19, 2000 Abstract: A relaxation station for inducing user relaxation includes a couch having a frame and a reclining surface attached to said frame for accommodating a user in a reclining position. The frame has a plurality of preferably pairs of massage grippers connected to and extending generally upward therefrom. These massage gripper pairs are elongated members projecting generally upward from the frame and the gripper pairs are capable of moving reciprocally between an open and a closed position to simulate finger manipulated massage. In a closed position, they cradle and contact the body or a portion thereof of a user. These massage gripper pairs having motive actuators for producing movement between said open and said closed positions, such as scissors extenders or flexible cables The massage gripper elongated members produce massage motions in at least one massage contact pad. The contact pads preferably have a temperature regulator and a dry hydrotherapy supply for enhancing the relaxation of a user and to simulate human massage.

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Excerpt(s): This application is based upon Disclosure Document No. 464469, filed Nov. 1, 1999. This invention relates to relaxation and therapeutic massage apparatuses and, more particularly, to an integrated multi-functional system housed in one ergonomically designed enclosure. The dry, mechanical system closely simulates therapeutic massage provided by manual manipulation of a human massage provider and/or a wet, water based hydrotherapy device. As the work environment and the complexity of contemporary human interaction are increasingly influenced by technologies such as the use of computers and telecommunications devices, incidences of acute stress are more prevalent. Rejuvenation of the individual through stress relief methods is frequently sought since rest alone is often inadequate to the task. The prior art has addressed stress relief with several devices, systems and methods. The prior art also includes conventional hand-provided massage by a physical therapist or masseuse. However, most simulated massage systems are harshly vibratory and dry, and can irritate injured muscles without providing significant relief, especially for persons with head and neck related injuries such as temporal mandibular joint (TMJ) syndrome. Web site: http://www.delphion.com/details?pn=US06494851__ •

Self-retaining exercise/physical therapy device Inventor(s): Marcum; Martie S. (334 W. Huron St., Milford, MI 48281) Assignee(s): none reported Patent Number: 5,816,989 Date filed: August 25, 1997 Abstract: An exercise and/or physical therapy device which has legs for self-retaining the device on a human body adjacent to the muscle to be exercised while the muscle is being exercised. Each leg is configured to adhere to the body so that the device is retained without further manual assistance to stay in the position where the user initially places it. One leg embodiment is weighted and cone-shaped with a non-skid surface. Another leg embodiment is U-shaped and bendable. The device includes a flexible, slightly arched, hollow tube containing multiple fluids having different flow characteristics when the tube is moved. Excerpt(s): The present invention relates to a device for exercising and strengthening muscles of a body without straining the muscles. Healthy and injured individuals exercise muscles with the aid of supplemental devices. It has been known to use devices filled with non-gaseous, flowable material to enhance the results of exercising. For example, Johnson U.S. Pat. No. 3,756,592 issued Sep. 4, 1973, describes an exercise apparatus comprised of a hollow container partially filled with a fluent mass such as sand and having rigid handles for a user to hold while manipulating the device. Piccini U.S. Pat. No. 4,378,113 issued Mar. 29, 1983, discloses a device for warming up an athlete's wrists which includes a hollow club filled with non-gaseous flowable material, preferably water. Blome U.S. Pat. 4,659,078 issued Apr. 21, 1987, discloses an exercise device having a partially liquid-filled flexible enclosure with two handle assemblies to be gripped by hand. Carlisle U.S. Pat. No. 4,685,665 issued Aug. 11, 1987, discloses a hand exercising device constructed of thermoplastic sheet material having two chambers filled with fluid that can be shifted from one chamber to the other through a narrow passageway that is offset from the center of the device. Hull U.S. Pat. No. 4,986,535 issued Jan. 22, 1991, discloses a therapeutic and exercise device which is substantially a two-step hollow ladder partially filed with a viscous fluid and containing ballast such as ball bearings. Amesquita U.S. Pat. No. 5,244,445 discloses an exercise

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wand including a hollow tube closed at each end and containing a plurality of movable spheres. Matthews U.S. Pat. No. 5,364,325 issued Nov. 15, 1994, discloses an exercise/physical therapy device comprised of a cell tube which may be artistically colored and which encloses a plurality of weighted spheres within a fluent material. Fischer U.S. Pat. No. 5,393,285 issued Feb. 28, 1995, describes an exercise device having a rigid body defining a chamber with at least one fluid movable within the chamber and one or more handles for gripping the device by one or two hands during exercise. The device is comprised of a flexible, slightly arched, hollow elongated tube. There are two legs attached, one at each end of the tube. The legs are mounted to the elongated tube with ball joints so the legs can adjust to conform to the configuration or shape of various portions of the user's body. Web site: http://www.delphion.com/details?pn=US05816989__ •

Staged expandable swim fin Inventor(s): Muller; Peter H. (135 Charles St., Los Gatos, CA 95032), Perry; Alan (2600 Heritage Park Cir., San Jose, CA 95132) Assignee(s): none reported Patent Number: 6,568,975 Date filed: January 16, 2002 Abstract: An enhanced swim fin is provided comprising a flipper blade having an increased effective surface area during movement in a first direction, and a decreased effective surface area during movement in a second direction. The swim fin preferably comprises a staged opening during movement in the first direction, in which the opened flipper blade provides increased flexion as the effective surface area is increased. The swim fin preferably comprises a staged closing during movement in the second direction, in which the opened flipper blade provides decreased flexion as the effective surface area is decreased. In some embodiments of the staged swim fin, a central hinge, generally located longitudinally along the blade on the fin, provides staged opening and flexion. Various embodiments provide fin opening and closing for either forward or backward kicks. The enhanced swim fin is typically attached to a foot, such as for performance, for training, or for physical therapy. Alternate embodiments of the expandable fin blade may be attached to a hand or to an oar or paddle shaft. Excerpt(s): The invention relates to the field of athletic equipment. More particularly, the invention relates to a flipper device for aiding a swimmer. Propulsion in swimming typically involves a combination of different forces. Swimmers are propelled primarily by drag forces and assisted by some lift. There is no fixed point in the water from which a swimmer may push. To move the body forward, a swimmer moves water backwards with hands and legs. Lift forces in swimming are primarily caused by the angle of attack of the hands, legs, and feet. The force thus contributed to propulsion is explained by Newton's third law of motion, wherein for each and every action there is an equal and opposite reaction. The movement of the leg and foot of a swimmer contributes significantly to the propulsion of a swimmer. As the surface of the foot is angled and moved during a kick, the water it encounters is deflected and forced away. Friction causes the leg and foot movements to slow, as the force of the kick is imparted to the water. A force or pressure is thus created that acts upon the surfaces of the leg and foot in an equal and opposite direction. This pressure produces the main force in swimming that propels the body forward.

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Web site: http://www.delphion.com/details?pn=US06568975__ •

Stretch machine for physical therapy Inventor(s): Neveux; Patrick (1102 Republic Ct., Pompano Beach, FL 33073-1849) Assignee(s): none reported Patent Number: 5,762,592 Date filed: August 29, 1996 Abstract: A leg multi-muscle stretch apparatus for physical therapy includes a foot carriage mounted to a carriage guide track and permitting the foot carriage to move back and forth along a carriage path, for therapeutically stretching a user foot and user leg with reciprocating motion, and a user support structure pivotally connected the carriage track. The apparatus preferably additionally includes user handle grips, and two elongate arm members pivotally connected to the carriage guide track, where the handle grips are connected to the elongate arm members. The user support structure preferably includes a platform structure including two parallel and laterally spaced apart beam members and a planar web member extending between and supported by the beam members. The apparatus preferably additionally includes two cable and cable pulley mechanisms, each including a series of cables forming a cable loop extending along the user support structure, along the carriage guide track and along the arm members, and then back to the user support structure, and a series of pulleys rotatably mounted to the user support structure and to the carriage guide track for guiding the cable loop, the cable loop being connected to the foot carriage to reciprocate with the foot carriage. Excerpt(s): The present invention relates generally to the field of physical therapy administering equipment. More specifically, the present invention relates to a leg stretch apparatus which provides a user body supporting frame made up of several frame portions. The frame portions are pivotally inter-connected to permit reconfiguration of the frame to position the user body in any of several specific stretch poses, while presenting a slidable foot carriage for guiding a user leg in a series of reciprocating leg movements. The apparatus includes a torso support platform on which the user rests his or her chest or back for various stretch poses. Pivotally extending from a first end of the support platform is a foot carriage track made up of two parallel and laterally spaced apart guide rails on which a reciprocatable foot carriage rides. A pair of elongate tubular arm members pivotally extend from the carriage track opposite the support platform. Each arm member has a pivoting handle and grip structure at its free ends. A cable loop formed of an interconnected series of cables extends along the platform, along the carriage guide track and along the arm members, and then back to said user support platform. A series of pulleys are rotatably mounted to the platform, the guide track and arm members for guiding the cable loop. The cable loop is connected to the foot carriage to reciprocate with the foot carriage. There have long been physical therapy devices for working various parts of the human body to help gain back full movement following an injury or in response to some other ailment. There are, for example, well-designed leg stretching. Yet there has been an absence of leg stretch devices which are well suited to the requirements of physical therapy with multi configuration capability. Web site: http://www.delphion.com/details?pn=US05762592__

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Therapeutic method with capsaicin and capsaicin analogues Inventor(s): Campbell; James N. (707 Hillstead Dr., Lutherville, MD 21093), Meyer; Richard A. (10084 Shaker Dr., Columbia, MD 21046), Pappagallo; Marco (2809 Boston St. Aplt. 151, Baltimore, MD 21224) Assignee(s): none reported Patent Number: 5,962,532 Date filed: March 12, 1998 Abstract: Methods and compositions for treating pain at a specific site with an effective concentration of capsaicin or analogues thereof are described. The methods involve providing anesthesia to the site where the capsaicin or analogues thereof is to be administered, and then administering an effective concentration of capsaicin to the joint. The anesthesia can be provided directly to the site, or at remote site that causes anesthesia at the site where the capsaicin is to be administered. For example, epidural regional anesthesia can be provided to patients to which the capsaicin is to be administered at a site located from the waist down. By pretreating the site with the anesthetic, a significantly higher concentration of capsaicin can be used. Effective concentrations of capsaicin or analogues thereof range from between 0.01 and 10% by weight, preferably between 1 and 7.5% by weight, and more preferably, about 5% by weight. This provides for greater and more prolonged pain relief, for periods of time ranging from one week to several weeks. In some cases the pain relief may be more sustained because the disease that underlies the pain may improve due to a variety of factors including enhancement of physical therapy due to less pain in the soft tissues which may foster enhanced mobilization of soft tissues, tendons, and joints. Excerpt(s): This application is directed to compositions and methods for relieving pain at a specific site, for example, associated with inflammation of joints, tendons, nerves, muscle, and other soft tissues, nerve injury and neuropathies, and pain from tumors in soft tissues or bone. Capsaicin, a pungent substance derived from the plants of the solanaceae family (hot chili peppers) has long been used as an experimental tool because of its selective action on the small diameter afferent nerve fibers (C fibers and A-delta fibers) that are believed to signal pain. From studies in animals, capsaicin appears to trigger C fiber membrane depolarization by opening cation channels permeable to calcium and sodium. Recently one of the receptors for capsaicin effects has been cloned. Although detailed mechanisms are not yet known, capsaicin mediated effects include: (i) activation of nociceptors in peripheral tissues; (ii) eventual desensitization of peripheral nociceptors to one or more stimulus modalities; (iii) cellular degeneration of sensitive A-delta and C fiber afferents; (iv) activation of neuronal proteases; (v) blockage of axonal transport; and (vi) the decrease of the absolute number of nociceptive fibers without affecting the number of non-nociceptive fibers. Web site: http://www.delphion.com/details?pn=US05962532__

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Thermal treatment apparatus radiating low and high temperature Inventor(s): Yoon; Hee-Sun (#A-101 Miju Apartment, 302-54 Dongbuichon-Dong, Yongsan-Gu, Seoul, KR 140-031), Yoon; Jung-Sun (#310-303 Shinbanpo 8cha Hanshin Apartment, Chamwon-Dong, Seocho-Gu, Seoul, KR 137-797) Assignee(s): none reported Patent Number: 6,640,051 Date filed: January 11, 2002 Abstract: Disclosed is a thermal treatment apparatus radiating low and high temperature, which includes a low-temperature radiating section and a hightemperature radiating section, and can rotatably scan affected parts. Both the low and the high temperature radiating sections are rotatable. The thermal treatment apparatus according to the present invention further includes a controller, with which a user can adjust the period of time for radiating low and high temperature as well as for rotation of the low-temperature radiating section and the high-temperature radiating section. The low-temperature radiating section is connected to a cryo-pump, while the hightemperature radiating section comprises an infrared ray lamp or a far infrared ray lamp. The present invention is applicable to medical treatment, physical therapy, sterilization of cosmetics or pharmaceuticals, or to tests of critical temperature for survival of cells. Excerpt(s): The present invention relates to a thermal treatment apparatus radiating low and high temperature. More particularly this invention relates to a thermal treatment apparatus radiating low and high temperature, which can repeatedly turn the period of time for radiating low temperature and high temperature by integrating a hightemperature radiating section with a low-temperature radiating section, and can rotatable treat the affected parts. The conventional physical treatment apparatuses mostly radiate high temperature using infrared ray, etc., although there also exist some apparatuses radiating low temperature serving for particular purposes. Those apparatuses normally comprise a heat radiating section for radiating high or low temperature to affected parts, a stand for supporting the heat radiating section, and a control section for controlling the temperature or a period of time for thermal irradiation. However, the conventional apparatuses radiating either high or low temperature only pose the problem of requiring two separate apparatuses for radiating both low and high temperature. Web site: http://www.delphion.com/details?pn=US06640051__

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Traction apparatus for physical therapy of herniated nucleosus pulposus or sprain and strain Inventor(s): Park; Chang Joon (244-326, Sangdo-4-dong, Dongiak-ku, Seoul, KR) Assignee(s): none reported Patent Number: 5,823,982 Date filed: January 17, 1997 Abstract: Traction apparatus for medically and physically treating herniated nucleosus pulposus or sprain and strain is disclosed. The traction apparatus comprises an upper support frame, a lower support frame, and a plurality of tubes. The traction apparatus further includes an exercising device. The upper support frame encircles the upper part of the therapy region and has two free ends positioned in space relation. The lower

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support frame encircles the lower part of the therapy region and hits two free ends positioned in space relation. The tubes are expandable to provide traction on the therapy region and are filled up with fluid which is generated by a fluid generating device. Preferably, the fluid generating device is a programmed controller including additionally pressure regulating function, timing function, intermittent ON and OFF function, etc. Excerpt(s): The present invention relates to a medical aid appliance, and more particularly to a traction apparatus for physical therapy of herniated nucleosus pulposus or sprain and strain. The herniated nucleosus pulposus (hereinafter referred to as "HNP"), which is limited to the explanations thereof with omitting the explanations of the sprain and strain, is one of vertebral diseases. The HNP is caused by the herniation of the nucleosus pulposus of disk which is interposed between one vertebra and one adjacent vertebra. Excessive loads and external impacts trigger a person to the HNP. The HNP takes place at cervical region, thoracic region, or lumbar region of a vertebral column. The HNP sufferers undergo lumbago most of all because the nerves root and is pressed also undergo radiating pain as the lower half of sufferers' body. If the sufferers take a turn for the worse, they cannot perform their normal activities and, moreover cannot lead a normal daily life. Accordingly, as number of attempts have been made to treat the NHP. Various therapy techniques, for example, operating therapy technique, physical therapy technique including bed rest therapy, therapy by hot heat, optical therapy, electrotherapy, traction therapy, and mediation technique, may have been used for the treatment of the HNP. Web site: http://www.delphion.com/details?pn=US05823982__ •

Traction device for physical therapy Inventor(s): D'Amico; Anthony T. (362 Eckford, Troy, MI 48084) Assignee(s): none reported Patent Number: 5,957,876 Date filed: August 7, 1997 Abstract: A cervical traction device which can be used on a support surface such as a bed which applies a tractive force to the back of the patient's skull approximate to the occipital bone through the use of contoured blocks which can preferably be positioned behind the patient's head and mounted on a head rest assembly. The tractive force can be administered in a continuous cyclical or intermittent manner controlled by the patient during a cervical traction session. The device has an integrated damping system which permits return of tractive force to the patient during each cycle in a gradual fashion. This gradual return enables this unit to closely simulate cyclic, and cyclic intermittent traction performed in the more expensive in-office equipment used by physical therapists. The head rest assembly slides on the bed or similar surface and can be vertically and laterally adjusted to vary the flexion-extension angle. The cervical traction device can be operated by the patient with or without the help of a second party. The mechanism is configured with gas springs to control the rate of descent of the weight and apply a constant tractive force to the patient in a manner which maximizes safety. Excerpt(s): The present invention is related to physical therapy devices. More particularly, the present invention is related to devices for administering cervical traction to the neck region of a patient. Even more particularly, the present invention is

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related to cervical traction devices for home-use which provide the option of administering cervical traction in a cyclical, intermittent or non-cyclical manner. The need for simple, low cost cervical traction devices which can be used at home to administer cervical traction to provide relief to patients with various musculo-skeletal disorders of the neck and back is well recognized. Heretofore there have been developed a great number of head halters or other devices which apply cervical traction through the head of the patient. Many of these devices engage the jaw of the patient while surrounding the head. These type of halters not only inhibit the ability of the patient to talk, they also cause aggravation of the temporomandibular (TMJ) points. As a device for administering cervical traction, these devices are less than desirable. Jaw-type head halters of this type pull from an axis offset from the spine and thereby apply an undesirable twisting moment (cervical extension) to the patient's head and neck contrary to most types of desired cervical traction. In most types of cervical traction situations, it is desirable to engage the head of the patient at the occipital area of the head rather than the chin so that the pulling axis is in straight alignment with the spine and so that the pulling force is concentrated along the posterior of the head where it is most beneficial. Other types of devices for engaging the head to correct neck problems are cervical braces. Such braces, which are referred to as "halo type", actually contact the patient's head with pointed screws which are forced inward through the skin to make contact with the bone of the skull. Aside from the obvious pain which a patient must endure when this type of brace is employed, the potential for infection to the person's head at the points where the skin is broken is ever present. Web site: http://www.delphion.com/details?pn=US05957876__ •

Versatile physical therapy apparatus Inventor(s): Steinbach; Emil C. (Charlotte, NC), Steinbach; John M. (Charlotte, NC) Assignee(s): Bedside Rehabilitation Technology, Inc. (Charlotte, NC) Patent Number: 6,228,004 Date filed: June 26, 1998 Abstract: A versatile physical therapy apparatus is disclosed. Beneficially, the apparatus, when mounted, is adapted to be supported by an end of a bed, and includes an angularly positionable guide wheel for variation in exercise and in the muscles exercised. Excerpt(s): This invention relates to an exercise apparatus adapted to be mounted to a bed. Many types of exercise apparatus exist as illustrated by U.S. Pat. No. 3,118,441 to George. However, there are few exercise apparatus designed for use by a bed-ridden patient, whether in a hospital, nursing home, or at home. Moreover, as exemplified by U.S. Pat. No. 2,601,686 to Roessler and U.S. Pat. No. 5,005,829 to Caruso, versatility and portability are features lacking in a physical therapy apparatus for a bed-ridden patient. In accordance with the present invention, there is provided a versatile physical therapy apparatus preferably to be used with the aid of a physical therapist. The apparatus beneficially includes a mounting member adapted to be supported by an end of a bed, a resistance element attached to the mounting member, and a guide wheel rotatably mounted in a pulley block and normally spaced apart from the resistance element. Normally, the resistance element is in a contracted or relaxed position, but in use, is extended or elongated and may as a result, closely approach the guide wheel. Web site: http://www.delphion.com/details?pn=US06228004__

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Weighted exercise and therapeutic suit Inventor(s): Raines; Mark T. (304 Fawn Field Dr., Cedar Park, TX 78613) Assignee(s): none reported Patent Number: 5,937,441 Date filed: August 5, 1996 Abstract: Weighted suit to be used in athletic training, physical therapy, muscle toning and weight reduction. The suit has a bottom and top that can be adjusted to accommodate the physical characteristics of the wearer, as well as the activity to be performed by the wearer while the suit is worn. The suit also has weighted gloves which may be attached to the sleeve portion of the top of the suit. The suit is constructed from spandex material that accommodates stretch in one direction and resists it in another direction approximately perpendicular to the first. Weight compartments are located about the suit into which weight units may be installed. Variable weight packets may be used to selectively apply different resistance experienced during the user's activity. The weights are located away from the user's joints, and protective components may be integrally included into the suit to cover vulnerable knee and elbow joints. The suit is reinforced with support strapping that is continuously sewn to the suit for supporting the weight packets against gravity and inertial forces during use. A support belt for the user's back may be optionally included as an integral component. The suit clings snugly to the user's physique and therefore may be worn beneath other clothing, such as a business suit. Excerpt(s): This invention pertains to athletic and therapeutic wearing apparel, and more particularly to weighted suits for applying variable resistance during user activity. Persons training for athletics and undergoing physical therapy often include work-outs with weights to increase and speed their progress. To meet this need, wearing apparel has been developed that incorporates weights into various designs. By inclusion of the weights in the garment itself, the wearer enjoys further benefits from the added resistance. An example is U.S. Pat. No. 5,144,694 entitled Exercise Apparel and Weight Packets issued to Conrad Daoud et al. Therein, a garment is disclosed that includes a vest, pants, spine strap, belt, wrist bands, ankle bands and weight packets. The weight packet includes plural rows and plural columns of weight members that are installed in pockets; the pockets position the weights about the wearer's body. The placement of the weight is solely maintained by the snugness of the garment's fit to the wearer's body. Web site: http://www.delphion.com/details?pn=US05937441__

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Weighted footwear garment for exercise, training and/or therapy Inventor(s): Glass; Alvin (151 Tamalpais Ave., Mill Valley, CA 94941) Assignee(s): none reported Patent Number: 5,893,223 Date filed: November 25, 1997 Abstract: A readily removable two piece stretch fabric garment (3) with four pockets (4,5,6,7) for containing weights (4a, 5a, 6a 7a) is attached to the users athletic or conventional shoe (2) for the purpose of exercise, training and/or physical therapy. The weights are contoured to match the shape of that portion of the shoe which they overly and they are secured in their respective pockets by releasable Velcro (R) closures. A

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durable rubber or vinyl sole (8) connected to the toe portion of the footwear garment grips the toe segment of the shoe and forms a partial under surface for the garment to the shoe. Excerpt(s): This invention relates to a removable garment that contains weights which fit around an athletic or conventional shoe and allows for total unrestricted mobility for use in exercise, training and/or therapy. There are a number of weight devices for exercising that can be connected to a leg or attached to a shoe or foot and used principally for the purpose of improving strength in this are ankle cuff weights which are used by some runners and power walkers and do allow for unrestricted mobility of the limb. However, they usually cannot be sufficiently secured to the ankle to avoid some movement while running, jumping or walking. The movement of the cuff weights while engaged in such activities often results in skin irritations as well as other potential injuries. U.S. Pat. No. 5,514,056 to Ronca addresses this issue by firmly securing a weight apparatus to the lower leg proximal to the ankle. The fact that both of these weight devices are located at the ankle or proximal to it precludes their capability of strengthening the lower leg muscles whose tendons insert on the foot and/or toes. In addition both of these devices are likely to be perceived as unnatural encumbrances around the lower limbs of their users. In regard to prior art there are four weight devices that can be attached to a shoe and one weighted shoe that allows for unrestricted mobility of the foot and limb while performing aerobic exercises including activities such as running and/or walking. They are U.S. Pat. No. 3,114,982 to McGowan, G.B. patent 2139103 to Rogers, U.S. Pat. No. 4,458,432 to Stempski, U.S. Pat. No. 757,983 to Vaile and FR patent 2,535,211 to Deschamps. Web site: http://www.delphion.com/details?pn=US05893223__

Patent Applications on Physical Therapy As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to physical therapy: •

Adaptable range-of-motion exercise apparatus Inventor(s): Harmon, Larry Shane; (Sausalito, CA) Correspondence: Grant R Clayton; Clayton Howarth & Cannon, PC; P O Box 1909; Sandy; UT; 84091-1909; US Patent Application Number: 20020169058 Date filed: June 13, 2002 Abstract: A resistance exercise apparatus is provided which includes structures for receiving a body extremity of a user, the means for receiving a body extremity subject to a force provided by the body extremity, structures for maintaining the means for receiving a body extremity in a predefined plane during movement; and resistance providing devices to impose resistance against the movement of the body extremity. Versions of the apparatus may positioned on a floor, on a wall, or be free standing. Various embodiments of the invention are particularly suited to provide range-of-

9

This has been a common practice outside the United States prior to December 2000.

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motion exercises for legs, arms, and hands of the user for both recreational strengthening and physical therapy applications. Excerpt(s): 1. The Field of the Invention. This invention relates generally to exercise apparatus and more specifically to a novel apparatus for exercising the human body which provides beneficial range-of-motion exercises. 3. The Background Art. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Article and method for self-administered physical therapy to alleviate back pain Inventor(s): Pecora, Ralph R.; (Baltimore, MD) Correspondence: Royal W. Craig; A Professional Corporation; Suite 153; 10 North Calvert Street; Baltimore; MD; 21202; US Patent Application Number: 20020193714 Date filed: June 13, 2002 Abstract: A therapeutic device for alleviating mid-to-upper back pain. The device comprises a hard cylindrical body wrapped in a cushioning sleeve. The sleeve is sufficiently firm to resist deforming, thereby maintaining its round shape and enabling it to roll easily along the ground. At the same time, the sleeve comfortably supports the user and transfers the force of the hard inner element to the user's back muscles and joints without causing pain or injury. The device can be used by individuals suffering from mid-to-upper back pain associated with muscle spasms, soreness, or injury. The device enables the individual to self-administer therapy to the back muscles and joints to relieve back pain and reduce the likelihood of future incidences of pain. Excerpt(s): The present application derives priority from U.S. Provisional Patent Application 60/297,803, filed: Jun. 13, 2001. The present invention relates to physical therapy devices, and, more particularly, to a therapeutic device for alleviating mid-toupper back pain resulting from muscle spasms or tired, stiff muscles. Worldwide back pain is estimated to afflict 60-80% of the human population at some point in their lives, and it afflicts 2-5% of the population at any given time. Anatomically, the back is divisible into three regions defined by the vertebrae of the spinal column. Beginning at the neck, the first 7 descending vertebrae are the cervical vertebrae. Next, the thoracic region consists of 12 vertebrae, and finally the lumbar region comprises five vertebrae of the lower back. The trapezius and the latissimus dorsi represent two large muscle groups in the back most commonly associated with muscular back pain. The present invention is directed to alleviating the discomfort and debilitating effects of mid-toupper back pain, generally corresponding to regions of the thoracic and cervical vertebrae. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Assistive clothing Inventor(s): Simmons, John C.; (Germantown, TN) Correspondence: John C. Simmons; 7993 Caversham Wood LN; Germantown; TN; 38138; US Patent Application Number: 20030120183 Date filed: July 22, 2002

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Abstract: An apparatus and process for empowering those in wheelchairs and others with loss of limb control to walk, climb stairs, sit in ordinary chairs, use normal bathroom facilities and stand at normal height with their peers. It also provides a means to speed rehabilitation of the injured and a means to deliver more comfortable and effective prostheses while providing superior physical therapy without draining professional resources which includes new simulation and training means. Most of the apparatus is worn under normal clothing allowing them to enjoy a normal appearance. Additional advancements include improved actuator design, user interface, visual means and advanced responsive virtual reality. Excerpt(s): The present application is a Continuation-in-Part of U.S. utility patent application Ser. No. 09/960,293 titled "Wheel-less Walking Support and Rehabilitation Device" which application was filed Sep. 20, 2001 and which claims the benefit of provisional application 60/234,191 which was filed on Sep. 20, 2000. 1. The current design of a wheelchair, except for the addition of power, is not much improved in functionally over the original invented by Eric Von Bulenheimer in 1672. 2. Perhaps the greatest advancement since then has been a chair on wheels that can climb stairs but must be navigated backwards, doesn't work on many staircases including but not limited to spiral staircases and short depth staircases, depends on the traction of its wheels even on slippery stairs for stability, requires some strength to manage the handrail and is still a heavy (202 pounds) wheelchair that must be accommodated (lugged) everywhere the user goes including airplanes, cars, escalators, bathrooms, etc. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Electrical drive assembly for an exercise machine Inventor(s): Ho, Shou-Shan; (Taichung Hsien, TW) Correspondence: Jones, Tullar & Cooper, P.C.; Suite 1002; 2001 Jefferson Davis Highway; Arlington; VA; 22202; US Patent Application Number: 20030153436 Date filed: February 11, 2002 Abstract: An drive assembly for an exercise bike consists of an electrical motor (10), a driven wheel (20), a unidirectional clutch (30), a flywheel (40), a shaft (47) and a crank wheel (50). The shaft (47) penetrates the driven wheel (20), the unidirectional clutch (30) and the flywheel (40). The driven wheel (20) is driven by the electrical motor (10) and then passes on the rotating momentum via the clutch (30), the flywheel (40), the belt wheel and the crank wheel (50) in sequence when the electrical motor (10) is switched on. The exercise bike can rotate in an automatic way to make the ordinary exercise bike into a physical therapy training bike. Excerpt(s): The present invention relates to an electrical drive assembly, and more particularly to a drive assembly used in an exercise machine, which allows the exercise machine to be used in an active or passive way. Indoor sports and exercise have become much more popular in modern urban societies because people do not have enough time or space for outdoor sports. Thus the use of aerobic exercise machines such as exercise bikes, steppers, treadmills and fitness flyers has mushroomed, but the use of the individual exercise machines is limited. Take the exercise bike as an example, the exercise bike is a zero-impact exercise device and can be used by all people of different ages to exercise. However, the exercise bike is only used in a passive mode. That is to say, the exercise bike only works when a user rotates the exercise bike pedals. Therefore,

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an injured people who is unable to operate the exercise bike but needs physical therapy to recover from an injury cannot use the exercise bike for physical therapy. Toward the objective of using an exercise bike to improve the range of motion in and strength of a patient's legs, the present invention provides a modified electrical drive assembly for an exercise bike that allows the exercise bike to be operated in either an automatic or passive mode. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Exercise apparatus and method Inventor(s): Weitzman, Bernard; (New York, NY) Correspondence: Darby & Darby P.C.; Post Office Box 5257; New York; NY; 10150-5257; US Patent Application Number: 20030096685 Date filed: November 15, 2002 Abstract: This invention relates to health and fitness, and more particularly to exercise methods and devices. More particularly, the invention is directed to stretching exercises and physical therapy, for example an apparatus and exercises for lower back pain. The exercise apparatus comprises at least three cells abutting each other on a common base or frame. Each cell can be independently inflated and deflated to provide an adjustable support cushion having a range of shapes and firmness. An articulated frame is optionally provided for additional independent movement of the cells. Users lie down on the cushion and produce precise stretches and exercises by controlling the rate and degree of inflation or deflation of each cell or group of cells, and optionally, articulated movement of the frame. Stretching can occur passively, as when the body conforms to the shape of the cushion, or actively by exercising in concert with the conformation of the cushion. Excerpt(s): This application claims priority from Provisional Application No. 60/335,854 filed on Nov. 16, 2001. This invention relates to health and fitness, and more particularly to exercise methods and devices. More particularly, the invention is directed to stretching exercises and physical therapy, for example an apparatus and exercises for lower back pain. Lower back pain is widespread in our civilization. It has been estimated, for example by the US government, that its cost to the economy is second only to upper respiratory infection. Many forms of treatment are employed. These include verbal, psychotherapeutic or educational interventions, massage, exercise, physical therapy, and surgery. The usefulness of all of these approaches is real, but limited. Some people are helped by each of them; many are not. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Game and exercise device and method Inventor(s): Carlson, Carl A.; (Bensalem, PA) Correspondence: Dann Dorfman Herrell & Skillman; Suite 720; 1601 Market Street; Philadelphia; PA; 19103-2307; US Patent Application Number: 20030073541 Date filed: September 30, 2002

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Abstract: The invention is directed to apparatus and a method of playing a skill game, conducting exercise, or learning movements such as dance steps. Ordinarily, it would be used for contact by the feet, but it could be used for contact by the hands, particularly in connection with physical therapy activity or the like. The contact surfaces are arranged in a coordinated pattern that may consist of a matrix of adjacent colored illuminatable tiles or simply stepping stones positioned in a random array perhaps quite different from a regular matrix. The contact surfaces are illuminated normally one at a time so as to cue sequential steps in a random pattern and at varying speeds in a game. Changes may also be made in a regular repeatable pattern with predetermined timing rhythms of a dance or may be made variable so that they may be slowed or quickened in therapy as the patient progresses. Illumination may be internal as with the tiles, which may be translucent and illuminated from beneath, or may be provided by a movable beam provided with suitable directing means to reposition the beam from one contact surface to another. Switch means are needed for individual fixed lights and may be operated by a switch panel, for example, push buttons which may be provided, one for each contact surface, and arranged in a pattern corresponding to the contact pattern of the surfaces, e.g., a matrix. Other situations for controlling lights may have a means for controlling the lights in a predetermined sequence along a guided path for the controller which preferably can be moved back and forth and over longer or shorter distances as desired. Where beam lighting is employed, a single source of light conceivably could be used, but ordinarily coordinated lights directed to a single contact surface and moved together from one selected contact surface to another are required. These may be coordinated and moved by suitable mechanical drive means controlled by some manually adjusted actuator or by a computer. When tiles are employed they may be built into a frame which permits solid support as well as wiring for illumination and even folding of the frame to provide more convenient portability. Excerpt(s): Applicant claim the benefit of priority of U.S. Provisional Application Ser. No. 60/329,471, filed on Oct. 11, 2001. The present invention has to do with a system useful for games as well as for exercise routines. In its simplest form it provides an array of surfaces, either regularly or randomly distributed sufficiently proximate to one another that an individual may reach all, or many, of the surfaces with his hands or feet. The object of the game or exercise is to move from one to another of the surfaces as they are illuminated, in succession with his feet, or hands, or both. The movements in a game might be random testing of the skill and agility of the player. In exercise or dance, the movements might be repetitive, but subject to change in a predetermined pattern, for example. In the prior art, systems for teaching dancing have been devised using either fixed or movable marks or footprints arranged, or capable of arrangement into in the pattern of the dance steps to be followed by the feet of a student learning the dance. Games, such as hop scotch, have been devised using a pattern to designate hand or foot positions to be successively assumed. Alternatively, a contortionist game, using a game board with numbered positions for hands or feet, has been played by randomly selecting numbered successive sites for positioning a hand or foot by a spinning pointer or by dice toss. However, when using such prior art, there is normally no pace set for the user, but movement is in response to random directions, obtained sporadically, often by the player himself. In the case of dance patterns, music may direct movement at some stage, but the user must know the pattern to follow. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Gravity-independent constant force resistive exercise unit Inventor(s): Colosky, Paul E. JR.; (Houston, TX), Ruttley, Tara M.; (Houston, TX) Correspondence: James K. Poole, ESQ.; P.O. Box 925; Loveland; CO; 80539; US Patent Application Number: 20020025891 Date filed: August 16, 2001 Abstract: This invention describes a novel gravity-independent exercise unit designed for use in microgravity, or on the ground, as a means by which to counter muscle atrophy and bone degradation due to disuse or underuse. Modular resistive packs comprising constant torque springs provide constant force opposing the withdrawal of an exercise cable from the device. In addition to uses within the space program, the compact resistive packs of the CFREU allow the unit to be small enough for easy use as a home gym for personal use, or as a supplement for rehabilitation programs. Resistive packs may be changed conveniently out of the CFREU according to the desired exercise regimen. Thus, the resistive packs replace the need for expensive, heavy, and bulky traditional weight plates. The CFREU may be employed by hospitals, rehabilitation and physical therapy clinics, and other related professional businesses. Excerpt(s): This application claims priority from Applicants' provisional application, U.S. Ser. No. 60/225,871, filed Aug. 17, 2000. This invention describes a novel gravityindependent exercise unit designed for use in microgravity, or on the ground, as a means by which to counter muscle atrophy and bone degradation due to disuse or underuse. Exposing humans to weightlessness during space flight induces significant structural and functional changes in the musculoskeletal system. These changes are manifested as muscle atrophy and bone degradation accompanied by neuromuscular changes including muscle fatigue and weakness, abnormal reflex behavior, and diminished neuromuscular efficiency, as noted by Nicogossian in "Countermeasures to space deconditioning," Space Physiology and Medicine, Third Ed., eds. Nicogossian et al., Williams & Wilkins, Baltimore (1994), pp. 447-469. Support-unloading and structural changes of the muscle and bone seem to be the main causes of these functional abnormalities. See Booth & Criswell, "Molecular events underlying skeletal muscle atrophy and the development of effective countermeasures," Int. J. Sports Med. 18[4], s265-s269 (1997); Convertino, "Exercise as a countermeasure for physiological adaptation to prolonged spaceflight," Med. Sci. Sports Exerc. 28[8], 999-1014 (1996); and Leblanc et al., "Muscle atrophy during long duraction bed rest," Int. J. Sports Med. 18, s283-s285 (1997). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Inflatable cushioning device with manifold system Inventor(s): Wilkinson, John W.; (Bennington, VT) Correspondence: Arlen L. Olsen; Schmeiser, Olsen & Watts; 3 Lear Jet Lane; Suite 201; Latham; NY; 12110; US Patent Application Number: 20010023511 Date filed: May 29, 2001 Abstract: A cushioning device for a body support such as a mattress, seat, sofa, or the like where support is obtained from a fluid. The cushioning device is self-inflating, selfadjusting, and provides a low interface pressure under the entire contact surface of a

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patient. Shear force scraping damage is prevented by a sleeve apparatus. A support system apparatus provides separately adjustable pressure support zones. For physical therapy, an alternating pressure system provides alternating lifting and lowering pressure zones under a patient. Excerpt(s): The present invention relates generally to an inflatable cushioning device for body supports such as a mattress, sofa, or chair cushion. In particular, the present invention relates to a body support for preventing the formation of pressure induced soft tissue damage. Heretofore, inflatable cushioning devices for use with body supports, such as a mattress, sofa, seat, or the like, typically included a plurality of air cells or bladders that are inflated to support a person. The air cells provide support to the person, and can be inflated to a desired pressure level to provide the person with a predetermined level of comfort and support. In the medical field, cushioning devices including a plurality of air cells are often used to provide different levels of support under various portions of a patient's body. For example, a mattress may include separate air cells located in the upper, middle, and lower portions of the mattress. These air cells can be inflated to different pressures to support the upper, middle, and lower portions of the patient's body with different pressures. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Kick bag for physical therapy Inventor(s): Bouvier, Ronald O.; (Phillipston, MA) Correspondence: Blodgett Blodgett; 43 Highland Street; Worcester; MA; 016092797 Patent Application Number: 20020010057 Date filed: January 17, 2001 Abstract: A striking bag assembly which includes a primary bag suspended from a fixed support and an anchor bag suspended from the primary bag. The anchor bag is smaller and heavier and, therefore, considerably denser than the primary bag. More specifically, the anchor bag is pivotally connected to the primary bag and the primary bag is pivotally connected to the fixed support. Excerpt(s): This application claims the benefit under 35 U.S.C.sctn.119(e) of prior U.S. Provisional Application No. 60/217,267 filed Jul. 11, 2000; all of which is hereby incorporated by reference. The present invention is directed to a striking bag or kick bag for physical training. The physical training can be for activities such as boxing, martial arts, aerobics, or as part of an overall physical fitness program. The bag is not limited to kicking and may be punched as in the case of training by a boxer. Kick bags are relatively heavy as compared to "punching bags" which are most often associated with boxing. For this reason, kick bags are frequently referred to as "heavy bags", and range from 25 pounds to 100 pounds. Most kick bags are suspended from a fixed support and swing when kicked. The weight of the bag provides resistance to kicking and, therefore, promotes timing and strengthening of the muscles involved in delivering a kick. Kick bags are a popular and widely used training tool for a wide range of physical activities. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Machine for upper limb physical therapy Inventor(s): Colello, Matthew S.; (Tranquility, NJ), Hardy, Christopher; (Montclair, NJ), Mahoney, Richard M.; (Westmont, NJ), Siffeti, Aman; (Livingston, NJ), Wunderly, Craig; (Hackettstown, NJ), Zuckerman, Daniel; (Bloomfield, NJ) Correspondence: Richard M. Mahoney; Rehabilitation Technologies Division; Applied Resources CORP.; 1275 Bloomfield AVE.; Fairfield; NJ; 07004; US Patent Application Number: 20030028130 Date filed: August 5, 2002 Abstract: This invention relates to an electromechanical arm and accessories which are mountable on a battery powered wheelchair and used to grasp objects in the personal environment of the operator. The device is designed for simplicity of operation and comprises lower arm, mid arm, and forearm components which are rotationally and pivotally interconnected and selectively rotated through the utilization of a controller which is preferably disposed upon the battery powered wheelchair. The accessories include end-effectors (also called grippers), with features that are task specific or for general manipulation, other tools and means of holding tools, baskets, pouches, holders and other means of storing objects and tools, a variety of input devices that are tailored to the needs of the operator, a sleeve for protection, aesthetics, and increased functionality (with pockets and other means of holding objects), and mounting hardware for the electromechanical arm and associated components. Excerpt(s): The present application is related to and claims priority from U.S. Provisional Patent Application 60/310,107 filed Aug. 4, 2001. People who have experienced a severe stroke often have significant impairment of muscle function of the arms, legs, and hands, resulting in severe disability. Other types of diseases, traumatic accidents, and neurological disorders result in similar deficiencies in strength, coordination, and range of motion. In order to recover or retain functional ability after a stroke or injury, people normally enter into a rehabilitation program at a rehabilitation facility, under the treatment of a physical and/or occupational therapist. Although the invention described here applies to all rehabilitation programs of this type for upper limb therapy, it is described in terms of its applicability to stroke patients because stroke is the number one disability for which rehabilitation services are provided in the United States. For upper limb rehabilitation, the nature of the disability requires that the Therapist carry out a program whereby he or she will move the patient's arms through a range of motion that is comfortable to the patient as appropriate given the level of recovery of their strength and coordination. Typical therapy programs administered by a Therapist can also involve functional tasks and movements using one or both arms. As the patient's functional ability increases, the Therapist modifies the regiment to provide less assistance, to extend the range of motion, and to increase the types and difficulty of functional tasks. Such a rehabilitation program requires that the Therapist assess the physical ability of the person on an ongoing basis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Medical apparatus for the treatment and prevention of heel decubitus Inventor(s): Gluskin, Lawrence E.; (Buffalo Grove, IL), Grabell, Marc; (Buffalo Grove, IL), Simms, Barbara; (Lombard, IL) Correspondence: Leydig Voit & Mayer, Ltd; 6815 Weaver Road; Rockford; IL; 611148018; US Patent Application Number: 20010016960 Date filed: May 10, 2001 Abstract: A heel supporting medical apparatus for the treatment and prevention of decubitus or pressure ulcers. The present invention provides a medical and physical therapy apparatus adapted to elevate heels of individuals subjected to substantial bed rest. By elevating the heels, the skin of the heel will not be in constant contact with the bed mattress, and thus pressure ulcers or bedsores will be substantially avoided. Moreover, the present invention provides an apparatus by which the legs of the individual can be substantially immobilized while at the same time elevating the heel. The apparatus also provides adjustably cushioned support from several angles to increase the comfort of the individual. Excerpt(s): The present invention generally relates to medical and physical therapy apparatus, and more particularly relates to the apparatus for the treatment and prevention of decubitus, or pressure ulcers, specifically on the heel of the foot. When individuals are injured, ill, or otherwise infirm, they are often subjected to relatively long periods of rest wherein the body maintains the substantially same position for relatively long periods of time. For example, if the individual is injured and confined to bed rest, the body will rest on the bed or mattress in the relatively same position and be supported by discreet portions of the body, including the heel of each foot. As a result of this sedentary position, the heels will continually rub against the bed or mattress and result in a pressure ulcer, sometimes referred to as a bedsore, or decubitus. If left untreated, such decubitus can present a serious health concern and subject the individual to substantial pain and discomfort. As a result of the foregoing, a number of mechanisms and methods have been developed to limit the formation of such decubitus. If the patient is mobile or sufficiently healthy to allow it, he or she will be required to move about to a sufficient degree to avoid such formation. Alternatively, pillows or other impromptu elevation devices can be used to elevate the heel away from the mattress. In addition, still further devices, such as foam cushions, can be wrapped around the leg or placed below the leg to elevate the heel. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and apparatus for treating poor laryngeal-elevation disorder with sequentialhigh voltage electrical stimulation Inventor(s): Geater, Alan; (Hatyai, TH), Leelamanit, Vitoon; (Hatyai, TH), Limsakul, Chusak; (Hatyai, TH) Correspondence: Reed Smith Hazel & Thomas Llp; Suite 1400; 3110 Fairview Park Drive; Falls Church; VA; 22042; US Patent Application Number: 20020133194 Date filed: January 29, 2001

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Abstract: The sequential stimulator for the treatment of dysphagic patients incorporates a unit which is capable of detecting a swallowing signal from the glossal or temporalis surface electromyography (SEMG). When a swallowing signal is recognized, a trigger signal is sent to the stimulation generation unit to release high voltage stimuli sequentially to the suprahyoid muscles or the masseter muscles and the pharyngeal muscles in order to assist in the elevation of the larynx. This enables the pharyngeal lumen to open more widely so that food can pass through the patient's pharynx and into the oesophagus more easily during swallowing. Thus the sequential stimulator is a device for assisting swallowing in patients with dysphagia due to a variety of causes, for instance, brain injury, cerebrovascular accident, injury of the cervical nerves, muscles weakness, or old age. The stimulator is operative only when the patient attempts to swallow and provides a physiologic stimulus and provides a means of immediate relief of the swallowing difficulty. The device is also useful for physical therapy whereby the muscles under the chin, the masseter muscles and the pharyngeal muscles can be reeducated to contract in the normal coordinated sequence. Excerpt(s): The present invention relates generally to a method and an apparatus for treating poor laryngeal-elevation disorder with sequential-high voltage electrical stimulation. Phase 1: is the oral phase, during which food in the oral cavity is masticated and mixed. Phase 2: is the pharyngeal phase, during which the masticated and mixed food bolus is propelled from the oral cavity into the pharyngeal lumen and thence into the upper oesophagus. The second phase of swallowing involves the use of the glossal muscles and the pharyngeal muscles (suprahyoid and thyrohyoid) and a lowering of the base of the tongue. The tongue muscles then propel food bolus from the oral cavity into the pharyngeal lumen. At this stage, the muscles of the pharynx contract in sequence, raising elevating the larynx and moving it forward in order to open the pharyngeal lumen and the upper oesophageal sphincter so that the bolus can pass readily into the upper oesophagus. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and system for creating customized exercise routines Inventor(s): Leeds, Gary; (Rancho Santa Fe, CA) Correspondence: Neil K. Nydegger; Nydegger & Associates; 348 Olive Street; San Diego; CA; 92103; US Patent Application Number: 20020082143 Date filed: October 23, 2001 Abstract: A method for creating a customized visual presentation of a physical therapy routine includes an initial step of evaluating the capability of the individual for performing the routine. Once the evaluation is complete, the individual is categorized according to the evaluated performance capability. Based on the category of the individual, the physical therapist identifies a sequence of physical exercises for the individual which defines the individualized physical therapy routine. The therapist then accesses an archives which includes a plurality of digital excerpts that each demonstrate the performance of a particular physical exercise. The physical therapist selectively retrieves digital excerpts from the archives which visually demonstrate the physical exercises that will make up the routine. These digital excerpts are edited appropriately and are provided to the individual over the Internet, in a printout, on a CD or on a videotape.

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Excerpt(s): This application is a continuation-in-part of U.S. Pat. Application Ser. No. 09/360,225 filed Jul. 23, 1999, which is currently pending. The contents of U.S. Pat. Application Ser. No. 09/360,225 are incorporated herein by reference. The present invention pertains generally to instructional aids for work and exercise routines. More particularly, the present invention pertains to a method and a system for using an Internet type communication system to automatically create a customized presentation of a work and exercise routine for an individual tailored to the specific physical characteristics of the individual and that is commensurate with the capabilities of the individual. The present invention, is particularly, but not exclusively, useful as an automated method for creating a customized visual presentation of a physical therapy routine for an individual that can be viewed over the Internet, in a printout, on a CD or on a videotape. Physical therapy routines for individuals are well known in the prior art and typically consist of a series of physical exercises. They are usually prescribed and assigned to an individual by physical therapists for rehabilitation from a disease and/or injury. When determining a proper routine, the physical therapist or exercise instructor also needs to account for individual factors such as age, fitness level, and medical history, in addition to the type of diseases or injury, the individual may be experiencing. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Patient positioning device Inventor(s): Murphy, Edward T.; (Douglasville, GA), Murphy, George W.; (Franklin, MA), Murphy, Stephen P.; (Westfield, MA) Correspondence: Woodcock Washburn Llp; One Liberty Place - 46th Floor; Philadelphia; PA; 19103; US Patent Application Number: 20030154550 Date filed: February 21, 2002 Abstract: The patient positioning device of this invention relates to an apparatus used to assist a patient into a supine position and additionally through which traction is applied to the spine, such as physical therapy and chiropractic treatment. The patient positioning device is preferably a stand alone portable device that can be readily transported and adapted to almost any horizontal surface, such as a treatment table. A primary application of the leg support of this invention is in raising and supporting a patient's lower legs during before, during, and after traction is applied to a patient. The device includes a lower support frame, vertical supports, and a leg support coupled to a top frame. The patient positioning device may also have a motor which powers the leg support to rotate from a lowered position, in which a patient's lower legs rest on the leg support, to an elevated position in which a patient's lower legs are elevated. Once in the elevated position, traction can be applied to the lower back preferably with a cable and a board that is placed across the front of a patient's thighs. Excerpt(s): The invention relates to an apparatus used to position a patient into the supine position. This invention also relates to a system that positions a patient and applies traction to the spine, such as physical therapy and chiropractic treatment. In order to place a patient in the supine position, the clinician first places the patient on a treatment table with the patient's back resting on the table and with the patient's legs extended straight and essentially level. The clinician then assists the patient in raising his/her legs onto a stool that is placed on the table between the patient's lower legs and the table such that the upper legs are close to vertical and the lower legs are parallel to the plane of the table. Stools are available from the Chattanooga Group, Inc. The

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clinician can then adjust the patient's lower legs' elevation by loosening and then retightening a vertical adjustment clamp while supporting the patient's legs so the stool does not collapse to its minimum height. Difficulties arise with this treatment method in the case of obese, elderly or pregnant patients. With obese patients, for instance, the harness belt is frequently difficult to tighten sufficiently to capture the pelvis, which results in the force from the traction head being distributed through the soft tissues throughout the pelvis. This results in (1) discomfort to the patient; (2) slippage of the belts; and (3) uncertainty as to the actual spinal treatment force. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Physical therapy chair-bed for paralytic patients Inventor(s): Charoenchit, Chakri; (Bangkok, TH) Correspondence: MR. Chakri Charoenchit; 6/77 Moo 5 Boromrajchonnee Road; Bangkok; 10170; TH Patent Application Number: 20030224915 Date filed: June 4, 2002 Abstract: A physical therapy chair-bed is a patient bed consisting of three parts, the first, the second and the third parts. The first can also be used as backrest of a physical therapy chair with its flanking parts arranged as armrests. The second part can also form a seat. The third part can be kept inside a case underneath the first and the second parts. All the other components are kept inside the case. There are wheels and wheellocks mounted under the case at each corner. The chair-bed is equipped with a foot-leg exercise set having a footwear set to help the seat occupant exercise his feet and legs in a bicycling manner. The armrests can move to have the patient's arms exercise. Rack guards and footrests are provided. The chair-bed can be mechanically or electrically and electronically controlled where a remote control may be applied. Excerpt(s): This invention is designed to help paralyzed patients or partially paralyzed patients developing or maintaining the muscle tone of their arms and legs, in addition to preventing joint stiffness. There are a lot of exercise machines using variable resistance mechanisms such as fluid types which use the viscosity of fluid and a turbine to create resistance and friction. Some machines use magnets in close proximity to a piece of metal. Many exercise machines are mostly designed for users who is standing or sitting or stay beside the machines, for example, U.S. Pat. No. 5,820,532. Only large stationary overhead beams and levers are used which is not sufficient for bedridden patients to permit bending and flexing of the knees and elbows. U.S. Pat. No. 5,820,519 has combined a `nordic type` exercise with a feature of adjustable rope mechanisms in small increments by means of the special handles and stirrups to apply the drum friction type resistance machine. Yet the machine still is too hard for those paralytic or partially paralytic patients to do the exercise to maintain their muscle tone. The present invention describes a machine using electrical and mechanical system to help paralytic or unconscious patients who can not perform a normal exercise on their own to move gently the parts of their body and improve their blood circulation, in addition to maintain or improve their muscle tone of their extremities. A physical therapy chair-bed consists of three parts, the first, the second and the third parts. The first can either lie flat and be used as part of a patient bed or be held up and used as backrest of a physical therapy chair with its flanking parts on the left and right side arranged as armrests. The second part forms a middle part of a patient bed or a seat of the physical therapy chair. The third part forms the other end of the patient bed which can be slid to be kept in a

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case underneath the first and the second parts. All the other components except the first and the second parts of the bed are kept inside the case. There mounted under the case at each corner a wheel to assist moving where wheel-lock may be installed to fix the case in place when in use. The chair-bed is further equipped with a foot-leg exercise set comprising a motor to drive a shaft to rotate a footwear set that helps the seat occupant wearing the footwear exercise his feet and legs in a bicycling manner where the level of footwear can be adjusted for each individual. The armrests can move to have the patient arms exercise to prevent stiff-joint. Rack guards and footrests are also provided. The chair-bed can be mechanically or electrically and electronically controlled where a remote control system may also be applied. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Recumbent total body exerciser Inventor(s): Hildebrandt, Mark D.; (Ann Arbor, MI), Sarns, Steve W.; (Dexter, MI), Sutton, Todd A.; (Grand Rapids, MI) Correspondence: Brinks Hofergilson & Lione; P.O. Box 10395; Chicago; IL; 60610; US Patent Application Number: 20020151415 Date filed: February 19, 2002 Abstract: A recumbent apparatus for exercise and physical therapy providing a lower body workout, an upper body workout, and cardiovascular conditioning having an improved seat mechanism for mounting and dismounting the recumbent apparatus. The seat mechanism comprises a plurality of levers and pins that restrict seat motion in a longitudinal direction along the recumbent apparatus while permitting the rotation of the seat for mounting and dismounting. Excerpt(s): This application is a divisional application of Ser. No. 09/492,556, filed Jan. 27, 2000, allowed on Jan. 16, 2002, which is a divisional application of Ser. No. 09/162,607, filed Sep. 29, 1998, now U.S. Pat. No. 6,042,518, issued on Mar.28, 2000. The present invention generally relates to equipment for physical therapy and/or general exercise. More particularly, this invention relates to a recumbent exercise machine which provides for the exercising and strengthening of major muscle groups in addition to cardiovascular conditioning. In so doing, the present invention includes lower body exercises coordinated with upper body exercising. Elderly patients, patients undergoing physical therapy, and other patients in similar circumstances, whether at home, in the hospital or in another clinical setting, have special needs when it comes to physical therapy equipment. Often, the patients have limited mobility, age related illnesses, decreased ranges of appendage movement, disabilities, low endurance and need for therapy with respect to more than one particular movement or muscle group. All of these factors must be taken into consideration when designing or providing equipment for their use. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Training apparatus for physical therapy, therapeutic riding in particular Inventor(s): Ettenhofer, Michael; (Ann Arbor, MI) Correspondence: John G. Posa; Gifford, Krass, Groh; Suite 400; 280 N. Old Woodward AVE.; Birmingham; MI; 48009; US Patent Application Number: 20030073504 Date filed: October 15, 2001 Abstract: Apparatus to qualify individuals for equine-assisted physical therapy is controlled entirely by a trainer or therapist, thereby regimenting the process for consistent and transferable results. The preferred embodiment includes a rigid frame with a plurality of upright, spaced-apart vertical members, and a rideable body within the frame, preferably suspended from the vertical uprights using multiple springs. At least one handle, rigidly affixed to the rideable body, enables the trainer or therapist to direct the motion of the body with a rider thereon, to determine how the individual will adapt to riding on a living horse, or to train the client with no actual riding experience. The rideable body is horseback shaped, enabling a saddle to be received thereon. The outer surface of the rideable body is also substantially smooth, however, enabling the individual to mount the body in bareback-style, if so desire. The apparatus preferably further includes a structure connecting the vertical members relative to their lower ends, such that the spaces between the vertical members remains open to the ground, enabling the trainer/therapist to stand close to or away from the rider without physical impediment. Attachment points are preferably provided, enabling a plurality of springs or other elastic members to be attached from each vertical member to the body, thereby facilitating adjustment for different riders of varying weight. Excerpt(s): This invention relates generally to physical therapy and, in particular, to apparatus and methods for qualifying candidates for equine-assisted therapeutic regimes. Equine activities are now recognized for providing valuable physical and psychological therapeutic benefits. Such activities include hippotherapy (physical therapy on horseback, using the horse as the therapist) and therapeutic riding, which is particularly directed to the disabled and handicapped. Therapeutic riding, also known as equine assisted therapy, equine facilitated therapy, and riding for the disabled, may be used to achieve a variety of therapeutic milestones, including cognitive, physical, emotional, social, educational and behavioral goals. Horseback riding has been found to be particularly beneficial for nonambulatory persons, who have no natural means of locomotion. The action of the horse relaxes and stimulates unused muscles, building muscle tone and improving coordination and balance. The action of a horse mimics that of human body action, such that when a person rides a horse, they are forced to move their trunk, arms, shoulders, head and the rest of their body to maintain balance. In other words, as the horse moves, the rider's muscles move in synchronization. To maximize the derived benefits, it is not uncommon for physical and occupational therapists to integrate therapeutic exercise techniques with the movement of the horse to stimulate unused or underused muscles. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with physical therapy, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “physical therapy” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on physical therapy. You can also use this procedure to view pending patent applications concerning physical therapy. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON PHYSICAL THERAPY Overview This chapter provides bibliographic book references relating to physical therapy. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on physical therapy include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “physical therapy” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on physical therapy: •

Physical Therapy in Craniomandibular Disorders Source: Carol Stream, IL: Quintessence Publishing Company, Inc. 1992. 80 p. Contact: Available from Quintessence Publishing Company, Inc. 551 North Kimberly Drive, Carol Stream, IL 60188-1881. (800) 621-0387 or (630) 682-3223; Fax (630) 682-3288; E-mail: [email protected]; http://www.quintpub.com. PRICE: $36.00 plus shipping and handling. ISBN: 0867151927. Summary: This book on physical therapy (PT) in craniomandibular disorders (CMD) outlines practical strategies for physical therapists and dentists who strive to provide treatment using a team approach. The authors hope to help standardize the management of CMD, and familiarize dentists with the positive role of the PT in CMD therapy. The three main chapters each start with a textual description, then provide extensive black and white clinical photographs illustrating the concepts covered. Topics

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include protocol; treatment of hypermobility, hypomobility, bruxism, and the abused protrusion; and specific problems, including the anterior displacement of the temporomandibular joint (TMJ) disc without reduction, postoperative pain, osteoarthritis, and acute TMJ arthritis. The authors focus on the pure mechanical corrections for determined unilateral overloading of the stomatognathic system. The authors emphasize that the patient should be actively involved in the treatment with the emphasis at first on posture, stretching, and strengthening. One appendix provides recordkeeping forms for the physical therapy examination. 144 figures. 18 references. (AA-M).

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “physical therapy” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “physical therapy” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “physical therapy” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

A Guide to Success: Review for Licensure in Physical Therapy by Scott M. Giles (2002); ISBN: 1890989126; http://www.amazon.com/exec/obidos/ASIN/1890989126/icongroupinterna

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Birth Balls : Use of Physical Therapy Balls in Maternity Care by Paulina Perez; ISBN: 0964115964; http://www.amazon.com/exec/obidos/ASIN/0964115964/icongroupinterna

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Cardiopulmonary Physical Therapy: A Guide to Practice by Scot Irwin, Jan S. Tecklin (2004); ISBN: 0323018408; http://www.amazon.com/exec/obidos/ASIN/0323018408/icongroupinterna

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Differential Diagnosis in Physical Therapy by Catherine Cavallaro Goodman, Teresa E. Kelly Snyder (2000); ISBN: 0721681840; http://www.amazon.com/exec/obidos/ASIN/0721681840/icongroupinterna

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Documenting Physical Therapy: The Reviewer Perspective by Angela M. Baeten, et al; ISBN: 0750699507; http://www.amazon.com/exec/obidos/ASIN/0750699507/icongroupinterna

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Examination in Physical Therapy Practice: Screening for Medical Disease by William G. Boissonnault (Editor); ISBN: 0443089566; http://www.amazon.com/exec/obidos/ASIN/0443089566/icongroupinterna

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Geriatric Physical Therapy: A Clinical Approach by Carole B. Lewis, Jennifer M. Bottomley; ISBN: 0838588751; http://www.amazon.com/exec/obidos/ASIN/0838588751/icongroupinterna

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Handbook of Pediatric Physical Therapy by Toby M. Long, et al (2001); ISBN: 0781727995; http://www.amazon.com/exec/obidos/ASIN/0781727995/icongroupinterna

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Introduction to Physical Therapy by Michael A. Pagliarulo (Editor), Mosby Publishing; ISBN: 0323010571; http://www.amazon.com/exec/obidos/ASIN/0323010571/icongroupinterna

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Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods by Darlene Hertling, Randolph M. Kessler; ISBN: 0397551509; http://www.amazon.com/exec/obidos/ASIN/0397551509/icongroupinterna

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Opportunities in Physical Therapy Careers by Bernice R. Krumhansl, Kathy Siebel; ISBN: 0844218049; http://www.amazon.com/exec/obidos/ASIN/0844218049/icongroupinterna

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Orthopedic and Sports Physical Therapy by Terryy R. Malone (Editor), et al; ISBN: 0815158866; http://www.amazon.com/exec/obidos/ASIN/0815158866/icongroupinterna

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Pediatric Physical Therapy by Jan Stephen Tecklin (Editor); ISBN: 0781710103; http://www.amazon.com/exec/obidos/ASIN/0781710103/icongroupinterna

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PHYSICAL THERAPY AND MASSAGE FOR THE HORSE by Jean-Marie Denoix, et al; ISBN: 1570762031; http://www.amazon.com/exec/obidos/ASIN/1570762031/icongroupinterna

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Physical Therapy Board Review by Michael Dunaway, Brad Fortinberry (2002); ISBN: 1560534974; http://www.amazon.com/exec/obidos/ASIN/1560534974/icongroupinterna

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Physical Therapy for Children by Suzanne Campbell (Editor), et al; ISBN: 0721683169; http://www.amazon.com/exec/obidos/ASIN/0721683169/icongroupinterna

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Physical Therapy of the Shoulder by Robert Donatelli (Editor); ISBN: 0443087318; http://www.amazon.com/exec/obidos/ASIN/0443087318/icongroupinterna

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Physical Therapy Professional Foundations: Keys to Success in School and Career by Kathleen A. Curtis; ISBN: 1556424116; http://www.amazon.com/exec/obidos/ASIN/1556424116/icongroupinterna

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Physical Therapy Research: Principles and Applications by Elizabeth Domholdt; ISBN: 0721669638; http://www.amazon.com/exec/obidos/ASIN/0721669638/icongroupinterna

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Pocket Atlas of the Moving Body: For All Students of Human Biology, Medicine, Sports and Physical Therapy by Mel Cash (2000); ISBN: 0091865123; http://www.amazon.com/exec/obidos/ASIN/0091865123/icongroupinterna

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Principles and Practice of Cardiopulmonary Physical Therapy by Donna L. Frownfelter (Editor), Elizabeth Dean (Contributor) (1996); ISBN: 0815133405; http://www.amazon.com/exec/obidos/ASIN/0815133405/icongroupinterna

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Quick Reference Dictionary for Physical Therapy by Jennifer M., Ph.D. Bottomley (Editor) (2003); ISBN: 1556425805; http://www.amazon.com/exec/obidos/ASIN/1556425805/icongroupinterna

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The American Physical Therapy Association Book of Body Maintenance and Repair by Marilyn Moffat, et al (1999); ISBN: 0805055711; http://www.amazon.com/exec/obidos/ASIN/0805055711/icongroupinterna

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The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “physical therapy” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10 •

Courses of training, scholarships and bursaries in countries represented in the World Confederation for Physical Therapy. Author: World Confederation for Physical Therapy.; Year: 1965; [London?] 1961

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Handbook for physical therapy teachers. Author: American Physical Therapy Association (1921- ); Year: 1962; New York [1967]

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Handbook of physical therapy. Author: Shestack, Robert.; Year: 1964; New York, Springer [1967]

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Opportunities in physical therapy. Author: Krumhansl, Bernice.; Year: 1965; New York, Universal Pub. and Distributing Corp. [c1968]

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Physical Therapy Department of New York University Medical Center, Institute of Rehabilitation Medicine: organization programs, information. A handbook for affiliates and staff. Author: New York University. Medical Center. Institute of Rehabilitation Medicine. Physical Therapy Dept.; Year: 1964; [New York, 1967]

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Physical therapy practice act with rules and regulations. Author: California. Laws, statutes, etc.; Year: 1964; Sacramento, 1968

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Physician's physical therapy manual [by] Robert Shestack [and] Edward W. Ditto. Author: Shestack, Robert.; Year: 1964; Englewood Cliffs, N. J., Prentice-Hall [c1964]

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The Illinois physical therapy registration act. Author: Illinois. Laws, statutes, etc.; Year: 1965; Springfield, Dept. of Registration and Education, 1965

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Your career in physical therapy, by Patricia Darby and Ray Darby. Author: Darby, Patricia.; Year: 1965; New York, Julian Messner [c1969]; ISBN: 67132179X

Chapters on Physical Therapy In order to find chapters that specifically relate to physical therapy, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and physical therapy using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “physical

10

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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therapy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on physical therapy: •

Pros and Cons of Passive Physical Therapy Modalities for Neck Disorders Source: in Allen, M.E., Ed. Musculoskeletal Pain Emanating From the Head and Neck: Current Concepts in Diagnosis, Management and Cost Containment. Binghamton, NY: The Haworth Medical Press. 1996. p. 125-134. Contact: Haworth Document Delivery Service, Haworth Press, Inc., 10 Alice Street, Binghamton, NY 13904-1580. (800) 342-9678. (800) 895-0582 (fax). Summary: This chapter for health professionals presents the pros and cons of passive physical therapy modalities, on the basis of the existing body of evidence, for the management of neck disorders. Evidence suggests that the pros of these modalities are that they provide a unique occasion to reassure the patient and to remind him or her about the necessity of keeping active and staying at work as long as it does not further harm the neck condition. The cons of passive modalities are that they may lead the patient into adopting a passive role and reinforce inactivity and disability behavior. Of all the passive physical therapy modalities, only mobilization/manipulation have shown some evidence of effectiveness. The impression that manual therapy and physiotherapy may be more efficacious than medicine in the management of neck disorders may be explained by the patient's desire for a more holistic approach which includes personal and physical contact. 18 references and 4 tables. (AA-M).

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CHAPTER 7. MULTIMEDIA ON PHYSICAL THERAPY Overview In this chapter, we show you how to keep current on multimedia sources of information on physical therapy. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on physical therapy is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “physical therapy” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “physical therapy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on physical therapy: •

Health Care Professionals' Guide to Oral Cancer Source: Fairburn, GA: Oral Health Education Foundation. 1996. (videocassette). Contact: Available from American Dental Hygienists' Association (ADHA). 444 North Michigan Avenue, Suite 3400, Chicago, IL 60611. (800) 243-2342 (press 2) or (312) 4408900. Fax (312) 467-1806. Website: www.adha.org. PRICE: $15.00 each. Item Number 3673 DEV. Summary: The diagnosis, treatment, rehabilitation, and maintenance of oral cancer patients are explored in this multi-disciplinary educational video for health care professionals. Throughout the video, the importance of early detection and diagnosis is emphasized. The program discusses risk factors, including age and lifestyle factors such as alcohol and tobacco use. The video reviews epidemiology, including the most common types of oral cancer. The program describes typical symptoms, appearance, and classification of oral cancers and precancerous conditions including leukoplakia and erythroplakia. The potential role of diet in reducing risk for oral cancer is discussed. The

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program addresses diagnostic issues, including step-by-step guidelines for performing an oral cancer examination, the common presenting signs of oral cancer, the role of histologic confirmation of suspected lesions, and the use of imaging. Treatment considerations discussed include radiation therapy, surgery, chemotherapy, indications for surgery, the benefits and disadvantages of surgery, the importance of speech and swallowing assessments prior to surgery, and the need for dental evaluation and possible treatment before surgery. Rehabilitation and maintenance issues described includes prostheses, cosmetic surgery, speech and swallowing rehabilitation, audiologic monitoring, physical therapy, psychological testing and counseling, and ongoing oral health and dental care. The program briefly mentions the SPOHNC (Support for People with Oral and Head and Neck Cancer) organization and its newsletter. Each segment provides recommendations for referral services and the program concludes by reiterating the importance of coordination among health care providers involved in the care of patients with oral cancer. •

AIDS: Issues for Health Care Workers Contact: Churchill Media, 6677 North NW Hwy, Chicago, IL, 60631, (773) 775-9550. Summary: This videorecording addresses the issues that will be faced by health care workers in treating Acquired immunodeficiency syndrome (AIDS) patients. The importance of treating patients with courtesy and respect is stressed. Attitudes toward AIDS patients and the fear of accidentally contracting the Human immunodeficiency virus (HIV) are explored. Good technique, cleanliness and hand washing, and reporting accidents are all important in protecting health care workers. The universal guidelines for handling blood and body fluids are explained, as are the guidelines for patients in isolation. Proper techniques are given for blood collection, laboratory and pathology tests, respiratory and physical therapy, housekeeping, surgical cleanup, food handling, and dishwashing.

•

Chronic Myofascial Pain Syndrome. A Guide to the Trigger Points Contact: Available from New Harbinger Publications, Inc., 5674 Shattuck Avenue, Oakland, CA 94609. PRICE: $49.95 in the U.S. Summary: This videorecording for health professionals and individuals with chronic myofascial pain syndrome is a companion to a book on fibromyalgia and chronic myofascial pain syndrome, and it serves as a guide to trigger points. The video begins by demonstrating trigger points and their specific pain patterns, focusing on the head; shoulder and neck; elbow to finger; torso; lower back and pelvis; hip, thigh, and knee; and the lower leg and foot. It identifies perpetuating factors, including Morton's foot, paradoxical breathing, and repetitious exercise. In addition, the video offers guidelines for assessing the severity of one's condition, presents examples of self-care physical therapy techniques, and provides suggestions for designing a treatment program.

•

Controlling Pain Source: Princeton, NJ: Films for the Humanities and Sciences. 199x. (videocassette). Contact: Available from Films for the Humanities and Sciences. P. O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126; (609) 452-1128. PRICE: $149.00 for purchase; $75.00 for rental. Order Number TF-2052. Summary: This videotape focuses on the nature of pain and on pain control, showing how nerve impulses travel through the spinal cord to the brain, explaining the function

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of pain, and discussing the role of endorphins in pain control. The program explains the differences between pain relieving medicines, and demonstrates various methods and techniques such as physical therapy, exercise, ice massage, ultrasound, and biofeedback. (AA-M). •

Managing Your Symptoms Source: Portland, OR: Vestibular Disorders Association. 2000. (videocassette). Contact: Available from Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428. E-mail: [email protected]. Website: www.vestibular.org. PRICE: $25.00 plus shipping and handling. Summary: This videotape program on vestibular disorders helps viewers understand dizziness and vertigo; related problems with memory and concentration, vision, and imbalance; and how to cope with recurring symptoms. The video features interviews with patients who have overcome most of their vestibular symptoms. The video also includes interviews with professionals in the areas of diagnosis, treatment, diet, vision, and physical therapy. The program encourages viewers to become active in their own recovery process and to allow enough time for compensation to occur. The videotape is closed captioned.

Bibliography: Multimedia on Physical Therapy The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in physical therapy (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on physical therapy: •

A New approach to physical therapy in Parkinsonism [motion picture] Source: Eaton [Laboratories]; Year: 1971; Format: Motion picture; Norwich, N. Y.: Eaton; [for loan by Norwich-Eaton Pharmaceuticals, Film Library], 1971

•

Attitudes in physical therapy for the patient with cancer [videorecording] Source: New York University, Department of Physical Therapy in cooperation with Memorial Sloan-Kettering Cancer Center; produced by Visual Information Systems; Year: 1975; Format: Videorecording; New York: The University: [for sale by Bernard Weiss & Associates, c1975]

•

Chest physical therapy [videorecording] Source: George Washington University, Medical Center; Year: 1977; Format: Videorecording; [Washington]: The University: [for sale by its Medical Center Audio-Visual Services Dept., 1977]

•

Physical therapy for ulnar nerve lesion [videorecording] Source: Dept. of Rehabilitation Medicine, Faculty of Medicine, University of Toronto and the Workmen's Compensation Board of Ontario; Year: 1976; Format: Videorecording; [Toronto]: Division of Instructional Media Services, Faculty of Medicine, University of Toronto, c1976

•

Physical therapy management of the pre- and post-operative open heart patient [motion picture] Source: Institute of Physical Medicine and Rehabilitation, New York University Medical Center; produced by Public Health Service Audiovisual Facility;

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Year: 1966; Format: Motion picture; [New York]: The Institute; [Atlanta: for loan by National Medical Audiovisual Center], 1966

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CHAPTER 8. PERIODICALS AND NEWS ON PHYSICAL THERAPY Overview In this chapter, we suggest a number of news sources and present various periodicals that cover physical therapy.

News Services and Press Releases One of the simplest ways of tracking press releases on physical therapy is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “physical therapy” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to physical therapy. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “physical therapy” (or synonyms). The following was recently listed in this archive for physical therapy: •

U.S. Physical Therapy sees profit below estimates Source: Reuters Industry Breifing Date: September 22, 2003

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•

Physical therapy as good as corticosteroid injection for acute shoulder pain Source: Reuters Industry Breifing Date: May 16, 2003

•

Bush Administration to delay Medicare physical therapy caps Source: Reuters Industry Breifing Date: December 30, 2002

•

Bush admin. to delay Medicare physical therapy caps Source: Reuters Health eLine Date: December 30, 2002

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Physical therapy slows functional decline in frail elderly Source: Reuters Medical News Date: October 02, 2002

•

Physical therapy helps elderly stave off disability Source: Reuters Health eLine Date: October 02, 2002

•

Physical therapy better in classes than at home Source: Reuters Health eLine Date: April 25, 2002

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Physical therapy classes better than home-based program for knee rehab Source: Reuters Medical News Date: April 24, 2002

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Weight loss, physical therapy can help back pain Source: Reuters Health eLine Date: December 05, 2001

•

Benefit sustained from short-term physical therapy for rheumatoid arthritis Source: Reuters Medical News Date: February 12, 2001

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Physical therapy, exercise program helps knee arthritis Source: Reuters Health eLine Date: February 01, 2000

•

Physical therapy, exercise improves osteoarthritis of the knee Source: Reuters Medical News Date: February 01, 2000

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Early physical therapy cost-effective for work-related acute low back injuries Source: Reuters Medical News Date: January 18, 2000

•

Early physical therapy helps work-related back injuries Source: Reuters Health eLine Date: January 12, 2000 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date

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at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “physical therapy” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “physical therapy” (or synonyms). If you know the name of a company that is relevant to physical therapy, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “physical therapy” (or synonyms).

Newsletters on Physical Therapy Find newsletters on physical therapy using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “physical therapy.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “physical therapy” (or synonyms) into the “For these words:” box. The following list was generated using the options described above:

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•

Pain and the Cervical Spine Source: Bulletin on the Rheumatic Diseases. 50(10): 1-4. 2001. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (800) 268-6942 or (404) 872-7100. Fax (404) 872-9559. Website: www.arthritis.org. Summary: This newsletter provides health professionals with information on the diagnosis and treatment of neck pain. The most important historical items in the initial approach to a neck pain problem are duration, trauma history, and musculoskeletal symptoms elsewhere. Physical examination maneuvers consist of range of motion and pain on motion in flexion extension, lateral flexion, and rotation. Plain radiographs of the cervical spine may indicate degenerative disease and subluxations resulting from inflammatory arthritis and the results of serious trauma. Computed tomography may be helpful when plain films are inadequate. Conservative therapies are used to treat uncomplicated joint diseases, soft tissue injuries, and poorly understood pain syndromes in the neck. Soft collars and contour pillows may be helpful. Physical therapy may also help, but interrupted traction is typically the most beneficial therapy. The article describes the features of special neck syndromes, including whiplash, degenerative disc and joint disease, inflammatory arthritis, rheumatoid arthritis, ankylosing spondylitis, and juvenile polyarthritis. 1 table and 25 references.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “physical therapy” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on physical therapy: •

Role of Physical Therapy in the Rehabilitation of Patients with Oral and Head and Neck Cancer Source: News from SPOHNC. News from Support for People with Oral and Head and Neck Cancer, Inc. 9(3): 4-5. November 1999. Contact: Available from Support for People with Oral and Head and Neck Cancer, Inc. (SPOHNC). P.O. Box 53, Locust Valley, NY 11560-0053. (516) 759-5333. E-mail: [email protected]. Website: www.spohnc.org. Summary: This newsletter article reviews the role of physical therapy in the rehabilitation of patients with oral and head and neck cancer. Despite the likelihood of an eventual return to normalcy, patients enduring neck dissections may face many possible physical challenges. The physical therapist can play an important role in helping a survivor to meet these challenges and to overcome many limitations. The author reports a case study of a 68 year old female who was treated for cancer of the jaw and floor of the mouth. The author describes her rehabilitation and then offers suggestions to support patients who may proceed through rehabilitation with problems. For example, arm exercises are described, as are strategies for exercising in bed (for patients having difficulty beginning an exercise program). The author reminds readers

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that preventing muscle atrophy and long term disability requires hard, persistent work from the patient with the guidance of a physical therapist.

Academic Periodicals covering Physical Therapy Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to physical therapy. In addition to these sources, you can search for articles covering physical therapy that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for physical therapy. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with physical therapy. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

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The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to physical therapy: Baclofen •

Systemic - U.S. Brands: Lioresal http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202080.html

Cyclobenzaprine •

Systemic - U.S. Brands: Flexeril http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202172.html

Dantrolene •

Systemic - U.S. Brands: Dantrium http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202181.html

Orphenadrine •

Systemic - U.S. Brands: Antiflex; Banflex; Flexoject; Mio-Rel; Myolin; Myotrol; Norflex; Orfro; Orphenate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202426.html

Skeletal Muscle Relaxants •

Systemic - U.S. Brands: Carbacot; EZE-DS; Maolate; Paraflex; Parafon Forte DSC; Relaxazone; Remular; Remular-S; Robaxin; Robaxin-750; Skelaxin; Skelex; Soma; Strifon Forte DSC; Vanadom http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202523.html

Tizanidine •

Systemic - U.S. Brands: Zanaflex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/207060.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information

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adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

11

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

12 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “physical therapy” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “physical therapy” (or synonyms) into the “For these words:” box. The following is a sample result: •

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report Source: Obesity Research. 6(Supplement 2): 51S-209S. September 1998. Contact: Available from North American Association for the Study of Obesity (NAASO). 8630 Fenton Street, Suite 412, Silver Spring, MD 20910. (301) 563-6526. Fax (301) 587-2365. Summary: This journal provides clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. The guidelines offer a state of the art review of the scientific basis of the relationship between obesity and major disease endpoints and of the scientific rationale for the management of overweight and obese patients. Section one presents the rationale for guidelines development, the objectives of the guidelines, guidelines development methodology, and a statement of assumptions. Intended users of the guidelines are also identified. Section two provides background information on overweight and obesity, focusing on the health and economic costs of overweight and obesity, the prevention of overweight and obesity, the health risks of overweight and obesity, weight loss and mortality, and environmental and genetic influences on the development of overweight and obesity. Section three examines randomized controlled trial evidence demonstrating the effect of weight loss on blood pressure, serum and plasma lipids and lipoproteins, fasting blood glucose and fasting insulin, and abdominal fat. This section also reviews evidence on the effectiveness of dietary therapy, physical therapy, combined diet and physical therapy, behavior therapy, pharmacotherapy, surgery, and other interventions for overweight and obesity treatment. Section four presents treatment guidelines. Topics include assessment and classification of overweight and obesity, assessment of risk status, evaluation of treatment strategy, exclusion from weight loss therapy, patient motivation, goals of weight loss and management, strategies for weight loss and management, smoking cessation, and the role of health professionals in weight loss therapy. Section five presents a summary of recommendations. Section six addresses the issue of future research, focusing on intervention approaches; causes and mechanisms of overweight and obesity; abdominal fat, body weight, and disease risk; and assessment methods. Section seven presents appendices. The journal also includes evidence report

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endorsements, a reference list, North American Association for the Study of Obesity (NAASO) standards of conducts, and NAASO policies and procedures for membership discipline. 8 appendices. 7 figures. 17 tables. 769 references. •

Specialty Home Health and Hospice: Physician's Guide Contact: Specialty Home Health and Hospice, Corporate Office, 311 W Idaho St, Boise, ID, 83702, (208) 336-1331. Summary: This physician-education pamphlet discusses the benefits of home health care and hospice services for patients. The pamphlet lists the skilled nursing, physical therapy, occupational therapy, speech therapy, medical social work, and home health aide activities that can be provided at home and presents criteria to help the physician determine which patients would benefit from home health care. Information on paperwork, insurance coverage, and eligibility is included.

•

Special Report: Arthritis Source: Boston, MA: Harvard Medical School. 1999. 46 p. Contact: Available from Harvard Medical School. Health Publications Group, Department SR, P.O. Box 380, Boston, MA 02117-0380. PRICE: $16.00 plus shipping and handling. Summary: This report provides people who have arthritis with information on the features, diagnosis, and treatment of osteoarthritis (OA), rheumatoid arthritis (RA), and ankylosing spondylitis (AS). The report begins by explaining the difference between arthritis and rheumatism. This is followed by an overview of the joints and the immune system in rheumatic diseases. Topics include types of joints, joint design, the functioning of the immune system, the occurrence of inflammation in arthritis, and the role of genetics. The report then discusses OA, RA, and AS in terms of their evolution, symptoms, possible causes, diagnosis, and treatment. Other seronegative spondyloarthropathies, including Reiter's syndrome, psoriatic arthritis, and enteropathic arthritis, are described. A section of the report is devoted to the diagnosis of rheumatic diseases, focusing on obtaining a medical history; assessing pain and stiffness; conducting a physical examination by observing how the patient moves, examining the joints for abnormalities, and moving the joints through their range of motion to detect pain, resistance, unusual sounds, and instability; and performing studies such as blood tests, radiography, other imaging techniques, and arthrocentesis. Another section focuses on using physical therapy to treat people who have arthritis. Modalities discussed are heat and cold therapy, exercise, diathermy, and transcutaneous electrical nerve stimulation. In addition, the report provides suggestions on living with arthritis. They focus on diet; rest during periods of acute inflammation; exercise; joint protection; and ways of coping with depression, stress, and sexual needs. The report also includes a glossary and a list of resources. 1 appendix and 8 figures.

The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, 14

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

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providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “physical therapy” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 98099 2876 1329 77 24 102405

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “physical therapy” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or

15

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

18

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 19 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 20 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story.

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more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

21

After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on physical therapy can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to physical therapy. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to physical therapy. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “physical therapy”:

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•

Other guides Disabilities http://www.nlm.nih.gov/medlineplus/disabilities.html Hearing Disorders & Deafness http://www.nlm.nih.gov/medlineplus/hearingdisordersdeafness.html Rehabilitation http://www.nlm.nih.gov/medlineplus/rehabilitation.html Stroke http://www.nlm.nih.gov/medlineplus/stroke.html Vision Disorders & Blindness http://www.nlm.nih.gov/medlineplus/visiondisordersblindness.html

Within the health topic page dedicated to physical therapy, the following was listed: •

General/Overviews Frequently Asked Questions about Physical Medicine and Rehabilitation Source: American Academy of Physical Medicine and Rehabilitation http://www.aapmr.org/condtreat/faq.htm

•

Diagnosis/Symptoms Functional Capacity Evaluation Source: American Occupational Therapy Association http://www.aota.org/featured/area6/links/link02o.asp

•

Treatment Aquatic Therapy Source: National Center on Physical Activity and Disability http://www.ncpad.org/Factshthtml/aquatictherapy.htm General Considerations in the Clinical Application of Electrical Stimulation Source: International Functional Electrical Stimulation Society http://www.ifess.org/Services/Consumer_Ed/general_considerations.htm Massage Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=SA00082 Modalities Source: Harvard Medical School http://huhs.harvard.edu/CWHC/WellnessPrograms/CWHCWellnessProgramsInf ormationonModalities.htm Pain Centers and Clinics Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=PN00047

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Alternative Therapy Using Complementary Therapy to Relieve Pain Source: National Pain Foundation http://www.painconnection.org/MyEducation/News_Complementary.asp

•

Coping Choosing a Rehabilitation Unit / CARF (Commission of Accreditation of Rehabilitation Facilities) Source: University of Utah, Health Sciences Center http://www.med.utah.edu/healthinfo/adult/rehab/choose.htm Effects of Rehabilitation on the Family Source: University of Utah, Health Sciences Center http://www.med.utah.edu/healthinfo/adult/Rehab/effects.htm

•

Specific Conditions/Aspects Art Therapy Frequently Asked Questions Source: American Art Therapy Association http://www.arttherapy.org/aboutarttherapy/faqs.htm Community Re-Entry Source: University of Utah, Health Sciences Center http://www.med.utah.edu/healthinfo/adult/rehab/commin.htm Maintaining Quality of Life with Low Vision Source: American Occupational Therapy Association http://www.aota.org/featured/area6/links/link02at.asp Modifying Your Home for Independence Source: American Occupational Therapy Association http://www.aota.org/featured/area6/links/link02ca.asp Occupational Therapy Services at the Workplace: Transitional Return to Work Programs Source: American Occupational Therapy Association http://www.aota.org/featured/area6/links/link02ac.asp Occupational Therapy Services in the Workplace: Ergonomics Source: American Occupational Therapy Association http://www.aota.org/featured/area6/links/link02ar.asp Occupational Therapy Services in Work Rehabilitation: Work Hardening/Work Conditioning Source: American Occupational Therapy Association http://www.aota.org/featured/area6/links/link02ad.asp Recovering from Stroke Source: American Occupational Therapy Association http://www.aota.org/featured/area6/links/link02aa.asp Returning to Work: Multiply Your Career Options Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01145

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Therapeutic Recreation Services Source: National Center on Physical Activity and Disability http://www.ncpad.org/Factshthtml/theraprec.htm What Is a Physical Therapist? Source: American Physical Therapy Association http://www.apta.org/pt_magazine/oct99/closer.html •

Children Going to a Physical Therapist Source: Nemours Foundation http://kidshealth.org/kid/ill_injure/aches/physical_therapy.html Going to a Speech Therapist Source: Nemours Foundation http://kidshealth.org/kid/feel_better/people/speech_therapist.html Going to an Occupational Therapist Source: Nemours Foundation http://kidshealth.org/kid/feel_better/people/occupational_therapist.html Healthy Computing for Today's Kids Source: American Occupational Therapy Association http://www.aota.org/featured/area6/links/link02af.asp Learning Through Play Source: American Occupational Therapy Association http://www.aota.org/featured/area6/links/link02v.asp Occupational Therapy Source: Nemours Foundation http://kidshealth.org/parent/system/ill/occupational_therapy.html Occupational Therapy for Children with Psychosocial Deficits Source: American Occupational Therapy Association http://www.aota.org/featured/area6/links/link02aj.asp Parents Ask About Occupational Therapy Services in Schools Source: American Occupational Therapy Association http://www.aota.org/featured/area6/links/link02x.asp Physical Therapy Source: Nemours Foundation http://kidshealth.org/parent/system/ill/phys_therapy.html Tying Shoes Source: Children's Hemiplegia and Stroke Association http://www.hemikids.org/tyingshoes.htm

•

Law and Policy Accommodation Information By Disability Source: Office of Disability Employment Policy http://www.jan.wvu.edu/media/atoz.htm

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New Medicare Limits on Therapy Services: Starting on September 1, 2003, Medicare Limits How Much It Covers for Outpatient http://www.medicare.gov/publications/pubs/pdf/10988.pdf Rehabilitation Services (Medicaid) Source: Centers for Medicare & Medicaid Services http://cms.hhs.gov/medicaid/services/rehab.asp State Vocational Rehabilitation Services Source: American Foundation for the Blind http://www.afb.org/info_document_view.asp?documentid=910 Understanding Insurance Coverage Source: American Physical Therapy Association http://www.apta.org/pt_magazine/oct99/consumer.html •

Organizations Access Board http://www.access-board.gov/ American Occupational Therapy Association Consumer Information Source: American Occupational Therapy Association http://www.aota.org/featured/area6/index.asp Assistivetech.net Source: Center for Assistive Technology & Environmental Access http://www.assistivetech.net/ DisabilityInfo.gov Source: Office of Disability Employment Policy http://disabilityinfo.gov/ National Center on Physical Activity and Disability http://www.ncpad.org/ Rehabilitation Services Administration http://www.ed.gov/about/offices/list/osers/rsa/

•

Prevention/Screening Alternative Keyboards http://www.cdc.gov/niosh/pdfs/97-148.pdf

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.

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The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on physical therapy. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Physical Therapy: The Challenge of AIDS Contact: New York University, School of Education, Health, Nursing, and Arts Professionals, Department of Education, Human Sexuality Program, 32 Washington Pl 2nd Fl, New York, NY, 10003, (212) 998-1212. Summary: This videorecording and accompanying curriculum guide address the importance of physical and recreational therapy for Persons with AIDS (PWAs). The video reviews the basics of HIV and AIDS, and the progression of disease in the infected person. It then stresses the importance of a structured leisure and recreation program to sustain the emotional and physical health of PWAs. The spotlight is on two New York City programs that utilize trained volunteers and staff to provide leisure and recreational services to PWAs. These services include arts and crafts, physical therapy, athletics, exercise therapy, theater outings, and variety of other activities that allow PWAs to enjoy their lives and maintain self-respect and self-esteem. The curriculum guide provides AIDS educators with an instructional model for the training of physical therapists so as to increase their knowledge and sills so that they will deliver competent and effective care to the increasing number of clients with HIV and AIDS. Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Directory of State Physical Therapy Boards Summary: Alphabetical listing of states with links to the addresses of the physical therapy board for each. Source: Federation of State Boards of Physical Therapy http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4111

•

Medicaid Physical Therapy, Occupational Therapy, and Services for Individuals with Speech, Hearing, and Language Disorders Summary: This article defines physical, occupational, speech, hearing, and language therapies that may be provided by the State. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=478

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News Page - American Physical Therapy Association Summary: Visit this site for current News and events related to this organization's services. Source: American Physical Therapy Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1547

•

Online Directory of Certified Clinical Specialists in Physical Therapy Summary: The American Board of Physical Therapy Specialties (ABPTS) certifies practitioners who have demonstrated advanced clinical knowledge and skills in physical therapy specialty areas. Source: American Physical Therapy Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4112 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to physical therapy. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

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Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to physical therapy. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with physical therapy. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about physical therapy. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “physical therapy” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “physical therapy”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “physical therapy” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

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The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “physical therapy” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

22

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

23

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

211

PHYSICAL THERAPY DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal fat: Fat (adipose tissue) that is centrally distributed between the thorax and pelvis and that induces greater health risk. [NIH] Abduction: Forcible pulling of a limb away from its natural position, a risk in road accidents and disasters; move outwards away from middle line. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acupuncture Points: Designated locations along nerves or organ meridians for inserting acupuncture needles. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adductor: A muscle that draws a part toward the median line. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjunctive Therapy: Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and

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biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Aggravation: An increasing in seriousness or severity; an act or circumstance that intensifies, or makes worse. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alienation: Disruption of feeling of belonging to a larger group such as, for example, the deepening of the generation gap or increasing of a gulf separating social groups from one

Dictionary 213

another. In a more limited sense breaking down of a close relationship. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU]

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Androgenic: Producing masculine characteristics. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Ankle Joint: The joint that is formed by the inferior articular and malleolar articular surfaces of the tibia, the malleolar articular surface of the fibula, and the medial malleolar, lateral malleolar, and superior surfaces of the talus. [NIH] Anterior Cruciate Ligament: A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Anus: The opening of the rectum to the outside of the body. [NIH]

Dictionary 215

Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Approximate: Approximal [EU] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Arthritis, Rheumatoid: A chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures. Etiology is unknown, but autoimmune mechanisms have been implicated. [NIH] Arthrography: Roentgenography of a joint, usually after injection of either positive or negative contrast medium. [NIH] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Articular: Of or pertaining to a joint. [EU] Articulation: The relationship of two bodies by means of a moveable joint. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Atelectasis: Incomplete expansion of the lung. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Audiology: The study of hearing and hearing impairment. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Axonal: Condition associated with metabolic derangement of the entire neuron and is manifest by degeneration of the distal portion of the nerve fiber. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Injuries: General or unspecified injuries to the posterior part of the trunk. It includes injuries to the muscles of the back. [NIH]

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Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Bed Rest: Confinement of an individual to bed for therapeutic or experimental reasons. [NIH] Behavior Therapy: The application of modern theories of learning and conditioning in the treatment of behavior disorders. [NIH] Behavioral Symptoms: Observable manifestions of impaired psychological functioning. [NIH]

Belladonna: A species of very poisonous Solanaceous plants yielding atropine (hyoscyamine), scopolamine, and other belladonna alkaloids, used to block the muscarinic autonomic nervous system. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH]

Dictionary 217

Biotic: Pertaining to living organisms in their ecological rather than their physiological relations. [NIH] Bladder: The organ that stores urine. [NIH] Blast phase: The phase of chronic myelogenous leukemia in which the number of immature, abnormal white blood cells in the bone marrow and blood is extremely high. Also called blast crisis. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Boron: A trace element with the atomic symbol B, atomic number 5, and atomic weight 10.81. Boron-10, an isotope of boron, is used as a neutron absorber in boron neutron capture therapy. [NIH] Boron Neutron Capture Therapy: A technique for the treatment of neoplasms, especially gliomas and melanomas in which boron-10, an isotope, is introduced into the target cells followed by irradiation with thermal neutrons. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brace: Any form of splint or appliance used to support the limbs or trunk. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [NIH]

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Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinesia: Abnormal slowness of movement; sluggishness of physical and mental responses. [EU] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchiectasis: Persistent abnormal dilatation of the bronchi. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchodilator: A drug that relaxes the smooth muscles in the constricted airway. [NIH] Bruxism: A disorder characterized by grinding and clenching of the teeth. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Capsicum: A genus of Solanaceous shrubs that yield capsaicin. Several varieties have sweet or pungent edible fruits that are used as vegetables when fresh and spices when the pods are dried. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU]

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Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Arteries: The arteries supplying the cerebral cortex. [NIH] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called

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the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Chilblains: Recurrent localized itching, swelling and painful erythema on the fingers, toes or ears, produced by exposure to cold. It is also called pernio. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chondrocytes: Polymorphic cells that form cartilage. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Fatigue Syndrome: Fatigue caused by the combined effects of different types of prolonged fatigue. [NIH] Chronic lymphocytic leukemia: A slowly progressing disease in which too many white blood cells (called lymphocytes) are found in the body. [NIH] Chronic myelogenous leukemia: CML. A slowly progressing disease in which too many white blood cells are made in the bone marrow. Also called chronic myeloid leukemia or chronic granulocytic leukemia. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chronic phase: Refers to the early stages of chronic myelogenous leukemia or chronic lymphocytic leukemia. The number of mature and immature abnormal white blood cells in the bone marrow and blood is higher than normal, but lower than in the accelerated or blast phase. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH]

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Civilization: The distinctly human attributes and attainments of a particular society. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clinical Protocols: Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clubfoot: A deformed foot in which the foot is plantarflexed, inverted and adducted. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collagen disease: A term previously used to describe chronic diseases of the connective tissue (e.g., rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis), but now is thought to be more appropriate for diseases associated with defects in collagen, which is a component of the connective tissue. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the

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alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computer Systems: Systems composed of a computer or computers, peripheral equipment, such as disks, printers, and terminals, and telecommunications capabilities. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or

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treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Contusion: A bruise; an injury of a part without a break in the skin. [EU] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortices: The outer layer of an organ; used especially of the cerebrum and cerebellum. [NIH] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cost-benefit: A quantitative technique of economic analysis which, when applied to radiation practice, compares the health detriment from the radiation doses concerned with the cost of radiation dose reduction in that practice. [NIH]

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Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniomandibular Disorders: Diseases or disorders of the muscles of the head and neck, with special reference to the masticatory muscles. The most notable examples are temporomandibular joint disorders and temporomandibular joint dysfunction syndrome. [NIH]

Curative: Tending to overcome disease and promote recovery. [EU] Custodial Care: Board, room, and other personal assistance services generally provided on a long term basis. It excludes regular medical care. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cystitis: Inflammation of the urinary bladder. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Decubitus Ulcer: An ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time. The bony prominences of the body are the most frequently affected sites. The ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deglutition: The process or the act of swallowing. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Depersonalization: Alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self-estrangement, in changes of body image, or in a feeling that one does not control his own actions and speech; seen in depersonalization disorder, schizophrenic disorders, and schizotypal personality disorder. Some do not draw a distinction between depersonalization and derealization, using depersonalization to include both. [EU]

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Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Derealization: Is characterized by the loss of the sense of reality concerning one's surroundings. [NIH] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Dexterity: Ability to move the hands easily and skillfully. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diabetic Foot: Ulcers of the foot as a complication of diabetes. Diabetic foot, often with infection, is a common serious complication of diabetes and may require hospitalization and disfiguring surgery. The foot ulcers are probably secondary to neuropathies and vascular problems. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diathermy: The induction of local hyperthermia by either short radio waves or highfrequency sound waves. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disabled Persons: Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations. [NIH] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal

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points. [NIH] Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dominance: In genetics, the full phenotypic expression of a gene in both heterozygotes and homozygotes. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duodenum: The first part of the small intestine. [NIH] Dynamometer: An instrument for measuring the force of muscular contraction. [NIH] Dysmenorrhoea: Painful menstruation. [EU] Dysphagia: Difficulty in swallowing. [EU] Dyspnea: Difficult or labored breathing. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures

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that are advantageous to the patient but not urgent. [EU] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endorphin: Opioid peptides derived from beta-lipotropin. Endorphin is the most potent naturally occurring analgesic agent. It is present in pituitary, brain, and peripheral tissues. [NIH]

Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxin: Toxin from cell walls of bacteria. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Energetic: Exhibiting energy : strenuous; operating with force, vigour, or effect. [EU] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most

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species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Ergometer: An instrument for measuring the force of muscular contraction. [NIH] Ergonomics: Study of the relationships between man and machines; adjusting the design of machines to the need and capacities of man; study of the effect of machines on man's behavior. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythroplakia: A reddened patch with a velvety surface found in the mouth. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exercise Therapy: Motion of the body or its parts to relieve symptoms or to improve function, leading to physical fitness, but not physical education and training. [NIH] Exon: The part of the DNA that encodes the information for the actual amino acid sequence of the protein. In many eucaryotic genes, the coding sequences consist of a series of exons alternating with intron sequences. [NIH] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Facial: Of or pertaining to the face. [EU] Facial Paralysis: Severe or complete loss of facial muscle motor function. This condition may

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result from central or peripheral lesions. Damage to CNS motor pathways from the cerebral cortex to the facial nuclei in the pons leads to facial weakness that generally spares the forehead muscles. Facial nerve diseases generally results in generalized hemifacial weakness. Neuromuscular junction diseases and muscular diseases may also cause facial paralysis or paresis. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fathers: Male parents, human or animal. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fibroblast Growth Factor: Peptide isolated from the pituitary gland and from the brain. It is a potent mitogen which stimulates growth of a variety of mesodermal cells including chondrocytes, granulosa, and endothelial cells. The peptide may be active in wound healing and animal limb regeneration. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatus: Gas passed through the rectum. [NIH] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Flexor: Muscles which flex a joint. [NIH] Food Handling: Any aspect of the operations in the preparation, transport, storage, packaging, wrapping, exposure for sale, service, or delivery of food. [NIH] Foot Care: Taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing

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shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. [NIH] Foot Ulcer: Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Frail Elderly: Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH] Functional Disorders: Disorders such as irritable bowel syndrome. These conditions result from poor nerve and muscle function. Symptoms such as gas, pain, constipation, and diarrhea come back again and again, but there are no signs of disease or damage. Emotional stress can trigger symptoms. Also called motility disorders. [NIH] Functional magnetic resonance imaging: A noninvasive tool used to observe functioning in the brain or other organs by detecting changes in chemical composition, blood flow, or both. [NIH]

Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gamma-Endorphin: An endogenous opioid peptide derived from the pro-opiomelanocortin precursor peptide. It differs from alpha-endorphin by one amino acid. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglioside: Protein kinase C's inhibitor which reduces ischemia-related brain damage. [NIH]

Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH]

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Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycogen Storage Disease: A group of inherited metabolic disorders involving the enzymes responsible for the synthesis and degradation of glycogen. In some patients, prominent liver involvement is presented. In others, more generalized storage of glycogen occurs,

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sometimes with prominent cardiac involvement. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart Transplantation: The transference of a heart from one human or animal to another. [NIH]

Helminths: Commonly known as parasitic worms, this group includes the acanthocephala, nematoda, and platyhelminths. Some authors consider certain species of leeches that can become temporarily parasitic as helminths. [NIH] Hemiparesis: The weakness or paralysis affecting one side of the body. [NIH] Hemiplegia: Severe or complete loss of motor function on one side of the body. This condition is usually caused by BRAIN DISEASES that are localized to the cerebral hemisphere opposite to the side of weakness. Less frequently, BRAIN STEM lesions; cervical spinal cord diseases; peripheral nervous system diseases; and other conditions may manifest as hemiplegia. The term hemiparesis (see paresis) refers to mild to moderate weakness involving one side of the body. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Refers to the liver. [NIH] Hepatomegaly: Enlargement of the liver. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Herniated: Protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen compressing the nerve root. [NIH] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH]

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Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH] Housekeeping: The care and management of property. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Humour: 1. A normal functioning fluid or semifluid of the body (as the blood, lymph or bile) especially of vertebrates. 2. A secretion that is itself an excitant of activity (as certain hormones). [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydrocortisone: The main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hypesthesia: Absent or reduced sensitivity to cutaneous stimulation. [NIH] Hypokinesia: Slow or diminished movement of body musculature. It may be associated with basal ganglia diseases; mental disorders; prolonged inactivity due to illness; experimental protocols used to evaluate the physiologic effects of immobility; and other conditions. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Illusion: A false interpretation of a genuine percept. [NIH]

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Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunogenic: Producing immunity; evoking an immune response. [EU] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infestation: Parasitic attack or subsistence on the skin and/or its appendages, as by insects, mites, or ticks; sometimes used to denote parasitic invasion of the organs and tissues, as by helminths. [NIH]

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Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infrared Rays: That portion of the electromagnetic spectrum usually sensed as heat. Infrared wavelengths are longer than those of visible light, extending into the microwave frequencies. They are used therapeutically as heat, and also to warm food in restaurants. [NIH]

Ingestion: Taking into the body by mouth [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the

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large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ipsilateral: Having to do with the same side of the body. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Isotonic: A biological term denoting a solution in which body cells can be bathed without a net flow of water across the semipermeable cell membrane. Also, denoting a solution having the same tonicity as some other solution with which it is compared, such as physiologic salt solution and the blood serum. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Lacerations: Torn, ragged, mangled wounds. [NIH]

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Language Development: The gradual expansion in complexity and meaning of symbols and sounds as perceived and interpreted by the individual through a maturational and learning process. Stages in development include babbling, cooing, word imitation with cognition, and use of short sentences. [NIH] Language Development Disorders: Conditions characterized by language abilities (comprehension and expression of speech and writing) that are below the expected level for a given age, generally in the absence of an intellectual impairment. These conditions may be associated with deafness; brain diseases; mental disorders; or environmental factors. [NIH] Language Disorders: Conditions characterized by deficiencies of comprehension or expression of written and spoken forms of language. These include acquired and developmental disorders. [NIH] Language Therapy: Rehabilitation of persons with language disorders or training of children with language development disorders. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Laterality: Behavioral manifestations of cerebral dominance in which there is preferential use and superior functioning of either the left or the right side, as in the preferred use of the right hand or right foot. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukoplakia: A white patch that may develop on mucous membranes such as the cheek, gums, or tongue and may become cancerous. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Library Technical Services: Acquisition, organization, and preparation of library materials for use, including selection, weeding, cataloging, classification, and preservation. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or

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cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Loneliness: The state of feeling sad or dejected as a result of lack of companionship or being separated from others. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lubricants: Oily or slippery substances. [NIH] Lumbago: Pain in the lumbar region. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer. Also called lymph node dissection. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphedema: Edema due to obstruction of lymph vessels or disorders of the lymph nodes. [NIH]

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Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Subsets: A classification of lymphocytes based on structurally or functionally different populations of cells. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Masseter Muscle: A masticatory muscle whose action is closing the jaws. [NIH] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Masticatory: 1. subserving or pertaining to mastication; affecting the muscles of mastication. 2. a remedy to be chewed but not swallowed. [EU] Mechanoreceptors: Cells specialized to transduce mechanical stimuli and relay that information centrally in the nervous system. Mechanoreceptors include hair cells, which mediate hearing and balance, and the various somatosensory receptors, often with nonneural accessory structures. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH]

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Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Middle Cerebral Artery: The largest and most complex of the cerebral arteries. Branches of the middle cerebral artery supply the insular region, motor and premotor areas, and large regions of the association cortex. [NIH] Midwifery: The practice of assisting women in childbirth. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration,

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pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoamine Oxidase: An enzyme that catalyzes the oxidative deamination of naturally occurring monoamines. It is a flavin-containing enzyme that is localized in mitochondrial membranes, whether in nerve terminals, the liver, or other organs. Monoamine oxidase is important in regulating the metabolic degradation of catecholamines and serotonin in neural or target tissues. Hepatic monoamine oxidase has a crucial defensive role in inactivating circulating monoamines or those, such as tyramine, that originate in the gut and are absorbed into the portal circulation. (From Goodman and Gilman's, The Pharmacological Basis of Therapeutics, 8th ed, p415) EC 1.4.3.4. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morale: The prevailing temper or spirit of an individual or group in relation to the tasks or functions which are expected. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor Cortex: Area of the frontal lobe concerned with primary motor control. It lies anterior to the central sulcus. [NIH] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Fatigue: A state arrived at through prolonged and strong contraction of a muscle. Studies in athletes during prolonged submaximal exercise have shown that muscle fatigue increases in almost direct proportion to the rate of muscle glycogen depletion. Muscle fatigue in short-term maximal exercise is associated with oxygen lack and an increased level of blood and muscle lactic acid, and an accompanying increase in hydrogen-ion concentration in the exercised muscle. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Musculoskeletal System: Themuscles, bones, and cartilage of the body. [NIH] Mutagenic: Inducing genetic mutation. [EU]

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Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopathy: Any disease of a muscle. [EU] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Narcolepsy: A condition of unknown cause characterized by a periodic uncontrollable tendency to fall asleep. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Neck dissection: Surgery to remove lymph nodes and other tissues in the neck. [NIH] Neck Pain: Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Needs Assessment: Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU]

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Neuritis: A general term indicating inflammation of a peripheral or cranial nerve. Clinical manifestation may include pain; paresthesias; paresis; or hypesthesia. [NIH] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neuronal Plasticity: The capacity of the nervous system to change its reactivity as the result of successive activations. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neurotrophins: A nerve growth factor. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nociceptors: Peripheral receptors for pain. Nociceptors include receptors which are sensitive to painful mechanical stimuli, extreme heat or cold, and chemical stimuli. All nociceptors are free nerve endings. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH]

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Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nurse Midwives: Professional nurses who have received postgraduate training in midwifery. [NIH] Obturator Nerve: A nerve originating in the lumbar spinal cord (L2 to L4) and traveling through the lumbar plexus to the lower extremity. The obturator nerve provides motor innervation to the adductor muscles of the thigh and cutaneous sensory innervation of the inner thigh. [NIH] Occupational Medicine: Medical specialty concerned with the promotion and maintenance of the physical and mental health of employees in occupational settings. [NIH] Occupational Therapy: The field concerned with utilizing craft or work activities in the rehabilitation of patients. Occupational therapy can also refer to the activities themselves. [NIH]

Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Olfactory Bulb: Ovoid body resting on the cribriform plate of the ethmoid bone where the olfactory nerve terminates. The olfactory bulb contains several types of nerve cells including the mitral cells, on whose dendrites the olfactory nerve synapses, forming the olfactory glomeruli. The accessory olfactory bulb, which receives the projection from the vomeronasal organ via the vomeronasal nerve, is also included here. [NIH] Olfactory Receptor Neurons: Neurons in the olfactory epithelium with proteins (receptors, odorant) that bind, and thus detect, odorants. Olfactory receptor neurons are bipolar. They send to the surface of the epithelium apical dendrites with non-motile cilia from which project odorant receptor molecules. Their unmyelinated axons synapse in the olfactory bulb of the brain. Unlike other neurons, they can be generated from precursor cells in adults. [NIH]

Oncology: The study of cancer. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opioid Peptides: The endogenous peptides with opiate-like activity. The three major classes currently recognized are the enkephalins, the dynorphins, and the endorphins. Each of these families derives from different precursors, proenkephalin, prodynorphin, and proopiomelanocortin, respectively. There are also at least three classes of opioid receptors, but the peptide families do not map to the receptors in a simple way. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Orthopedic Procedures: Procedures used to treat and correct deformities, diseases, and

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injuries to the skeletal system, its articulations, and associated structures. [NIH] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Oxandrolone: A synthetic hormone with anabolic and androgenic properties. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Paradoxical: Occurring at variance with the normal rule. [EU] Paralysis: Loss of ability to move all or part of the body. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Paresthesias: Abnormal touch sensations, such as burning or prickling, that occur without

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an outside stimulus. [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parietal Lobe: Upper central part of the cerebral hemisphere. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perianal: Located around the anus. [EU] Periarthritis: Inflammation of the tissues around a joint. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution,

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and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Pharyngeal Muscles: The muscles of the pharynx are the inferior, middle and superior constrictors, salpingopharyngeus, and stylopharyngeus. [NIH] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU] Phobic Disorders: Anxiety disorders in which the essential feature is persistent and irrational fear of a specific object, activity, or situation that the individual feels compelled to avoid. The individual recognizes the fear as excessive or unreasonable. [NIH] Phonophoresis: Use of ultrasound to increase the percutaneous adsorption of drugs. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physician Self-Referral: Referral by physicians to testing or treatment facilities in which they have financial interest. The practice is regulated by the Ethics in Patient Referrals Act of 1989. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH]

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Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Placebo Effect: An effect usually, but not necessarily, beneficial that is attributable to an expectation that the regimen will have an effect, i.e., the effect is due to the power of suggestion. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyarthritis: An inflammation of several joints together. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Postural: Pertaining to posture or position. [EU] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the

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convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Prejudice: A preconceived judgment made without adequate evidence and not easily alterable by presentation of contrary evidence. [NIH] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prone: Having the front portion of the body downwards. [NIH] Pro-Opiomelanocortin: A precursor protein, MW 30,000, synthesized mainly in the anterior pituitary gland but also found in the hypothalamus, brain, and several peripheral tissues. It incorporates the amino acid sequences of ACTH and beta-lipotropin. These two hormones, in turn, contain the biologically active peptides MSH, corticotropin-like intermediate lobe peptide, alpha-lipotropin, endorphins, and methionine enkephalin. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Proprioception: The mechanism involved in the self-regulation of posture and movement through stimuli originating in the receptors imbedded in the joints, tendons, muscles, and labyrinth. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatitis: Inflammation of the prostate. [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va

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and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychotomimetic: Psychosis miming. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pulposus: Prolapse of the nucleus pulposus into the body of the vertebra; necrobacillosis of rabbits. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons,

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and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radio Waves: That portion of the electromagnetic spectrum beyond the microwaves, with wavelengths as high as 30 KM. They are used in communications, including television. Short Wave or HF (high frequency), UHF (ultrahigh frequency) and VHF (very high frequency) waves are used in citizen's band communication. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Rarefaction: The reduction of the density of a substance; the attenuation of a gas. [NIH] Reaction Time: The time from the onset of a stimulus until the organism responds. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Odorant: Proteins, usually projecting from the cilia of olfactory receptor neurons, that specifically bind odorant molecules and trigger responses in the neurons. The large number of different odorant receptors appears to arise from several gene families or

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subfamilies rather than from DNA rearrangement. [NIH] Recovery of Function: A partial or complete return to the normal or proper physiologic activity of an organ or part following disease or trauma. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recuperation: The recovery of health and strength. [EU] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Rehabilitative: Instruction of incapacitated individuals or of those affected with some mental disorder, so that some or all of their lost ability may be regained. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Respiratory Mechanics: The physical or mechanical action of the lungs, diaphragm, ribs, and chest wall during respiration. It includes airflow, lung volume, neural and reflex controls, mechanoreceptors, breathing patterns, etc. [NIH] Restitution: The restoration to a normal state. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines

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with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rheumatic Diseases: Disorders of connective tissue, especially the joints and related structures, characterized by inflammation, degeneration, or metabolic derangement. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH]

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Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shoulder Impingement Syndrome: Tenosinovitis in the shoulders and arms of persons having a poor posture while working with visual display terminals. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU]

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Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Isolation: The separation of individuals or groups resulting in the lack of or minimizing of social contact and/or communication. This separation may be accomplished by physical separation, by social barriers and by psychological mechanisms. In the latter, there may be interaction but no real communication. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Soft Tissue Injuries: Injuries of tissue other than bone. The concept is usually general and does not customarily refer to internal organs or viscera. It is meaningful with reference to regions or organs where soft tissue (muscle, fat, skin) should be differentiated from bones or bone tissue, as "soft tissue injuries of the hand". [NIH] Solanaceae: Family of flowering plants (order Solanales). Among the most important are potatoes, tomatoes, capsicum (green and red peppers), tobacco, and belladonna. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatosensory Cortex: Area of the parietal lobe concerned with receiving general sensations. It lies posterior to the central sulcus. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH]

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Space Flight: Travel beyond the earth's atmosphere. [NIH] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Speech-Language Pathology: The study of speech or language disorders and their diagnosis and correction. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH] Spinal Stenosis: Narrowing of the spinal canal. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splint: A rigid appliance used for the immobilization of a part or for the correction of deformity. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body.

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[NIH]

Standardize: To compare with or conform to a standard; to establish standards. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stomatognathic System: The mouth, teeth, jaws, pharynx, and related structures as they relate to mastication, deglutition, and speech. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical activity. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Substrate: A substance upon which an enzyme acts. [EU] Supine: Having the front portion of the body upwards. [NIH] Supine Position: The posture of an individual lying face up. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the

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beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Talus: The second largest of the tarsal bones and occupies the middle and upper part of the tarsus. [NIH] Telecommunications: Transmission of information over distances via electronic means. [NIH]

Telencephalon: Paired anteriolateral evaginations of the prosencephalon plus the lamina terminalis. The cerebral hemispheres are derived from it. Many authors consider cerebrum a synonymous term to telencephalon, though a minority include diencephalon as part of the cerebrum (Anthoney, 1994). [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporomandibular Joint Dysfunction Syndrome: A symptom complex consisting of pain, muscle tenderness, clicking in the joint, and limitation or alteration of mandibular movement. The symptoms are subjective and manifested primarily in the masticatory muscles rather than the temporomandibular joint itself. Etiologic factors are uncertain but

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include occlusal dysharmony and psychophysiologic factors. [NIH] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Tibia: The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. [NIH] Ticks: Blood-sucking arachnids of the order Acarina. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH]

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Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Tracer: A substance (such as a radioisotope) used in imaging procedures. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transcutaneous: Transdermal. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Trusses: A surgical device designed for retaining a hernia in a reduced state within the abdominal cavity. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH]

Dictionary 261

Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulnar Nerve: A major nerve of the upper extremity. In humans, the fibers of the ulnar nerve originate in the lower cervical and upper thoracic spinal cord (usually C7 to T1), travel via the medial cord of the brachial plexus, and supply sensory and motor innervation to parts of the hand and forearm. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Ultraviolet Rays: That portion of the electromagnetic spectrum immediately below the visible range and extending into the x-ray frequencies. The longer wavelengths (near-UV or biotic or vital rays) are necessary for the endogenous synthesis of vitamin D and are also called antirachitic rays; the shorter, ionizing wavelengths (far-UV or abiotic or extravital rays) are viricidal, bactericidal, mutagenic, and carcinogenic and are used as disinfectants. [NIH]

Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving

262 Physical Therapy

around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vibrissae: Stiff hairs projecting from the face around the nose of most mammals, acting as touch receptors. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Walkers: Walking aids generally having two handgrips and four legs. [NIH] Weight Lifting: A sport in which weights are lifted competitively or as an exercise. [NIH] Weight-Bearing: The physical state of supporting an applied load. This often refers to the weight-bearing bones or joints that support the body's weight, especially those in the spine, hip, knee, and foot. [NIH] Wheelchairs: Chairs mounted on wheels and designed to be propelled by the occupant. [NIH]

White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or

Dictionary 263

brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

265

INDEX A Abdominal, 28, 188, 211, 225, 245, 257, 260 Abdominal fat, 188, 211 Abduction, 59, 211 Aberrant, 33, 211 Acetaminophen, 19, 211 Acetylcholine, 45, 211, 243 Acoustic, 139, 211 Acrylonitrile, 211, 253 Actin, 211, 242 Activities of Daily Living, 11, 12, 17, 24, 36, 43, 211, 225 Acupuncture Points, 19, 211 Adaptation, 9, 47, 153, 211, 235, 248 Adductor, 211, 244 Adhesions, 125, 211 Adipose Tissue, 211 Adjunctive Therapy, 38, 211 Adjustment, 7, 10, 128, 159, 161, 211 Adrenal Cortex, 212, 223, 233 Adrenal Medulla, 212, 219, 227, 243 Adrenergic, 212, 226, 228, 258 Adsorption, 212, 247 Adverse Effect, 212, 254 Aerobic, 11, 12, 17, 148, 150, 212, 228 Aerobic Exercise, 11, 12, 148, 150, 212 Afferent, 30, 143, 212 Affinity, 212, 255 Age Groups, 52, 212 Aged, 80 and Over, 212 Aggravation, 131, 146, 212 Agonist, 212, 226 Agoraphobia, 212, 245, 247 Airway, 66, 139, 212, 218 Algorithms, 42, 212, 216 Alienation, 27, 212 Alimentary, 213, 235 Alkaline, 213, 218 Alkaloid, 213, 218 Allergen, 213, 225 Alpha Particles, 213, 250 Alternative medicine, 34, 175, 213 Ameliorating, 26, 213 Amino acid, 213, 214, 228, 230, 246, 249, 250, 253, 254, 260 Amino Acid Sequence, 213, 214, 228, 249 Amniotic Fluid, 213, 231 Amphetamine, 8, 17, 75, 117, 213, 225

Anabolic, 37, 213, 245 Anaesthesia, 213, 234 Anal, 24, 213, 229 Analgesic, 33, 52, 211, 213, 227 Analog, 133, 213 Analogous, 39, 213, 260 Anatomical, 20, 129, 213, 215, 220, 234, 254 Androgenic, 214, 245 Androgens, 212, 214, 223 Anesthesia, 30, 143, 212, 214 Animal model, 31, 37, 46, 214 Ankle, 32, 60, 128, 130, 135, 147, 148, 214, 261 Ankle Joint, 32, 214 Anterior Cruciate Ligament, 40, 92, 125, 214 Antibacterial, 214, 256 Antibiotic, 214, 256 Antibodies, 214, 239 Antibody, 212, 214, 221, 233, 234, 236, 241, 251, 256, 263 Antigen, 35, 212, 214, 221, 233, 234 Anti-inflammatory, 35, 88, 211, 214, 215, 223, 231 Anti-Inflammatory Agents, 214, 215, 223 Antineoplastic, 214, 223 Antipyretic, 211, 214 Anus, 213, 214, 217, 235, 246, 252 Anxiety, 52, 215, 245, 247 Anxiety Disorders, 215, 245 Aorta, 215, 261 Apolipoproteins, 215, 238 Applicability, 10, 155, 215 Approximate, 126, 145, 215 Aqueous, 215, 216, 227 Arterial, 11, 12, 215, 220, 233, 250, 258 Arteries, 215, 217, 219, 223, 236, 238, 240, 242 Artery, 68, 215, 223, 236, 240, 250 Arthritis, Rheumatoid, 176, 215 Arthrography, 56, 69, 215 Arthroplasty, 33, 57, 71, 215 Articular, 214, 215, 245 Articulation, 49, 215 Aspirin, 88, 215 Atelectasis, 139, 215 Atrium, 215, 261

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Atrophy, 38, 90, 125, 130, 135, 153, 177, 215 Audiology, 36, 215 Autoimmune disease, 215, 241 Autonomic, 211, 215, 216, 243, 246, 258 Axonal, 143, 215 Axons, 215, 242, 244 B Back Injuries, 29, 40, 93, 174, 215 Back Pain, 4, 29, 34, 40, 149, 151, 174, 216 Bacteria, 212, 214, 216, 227, 229, 240, 256, 260, 261 Bacterial Physiology, 211, 216 Bactericidal, 216, 261 Basal Ganglia, 216, 233 Basal Ganglia Diseases, 216, 233 Base, 39, 122, 123, 129, 134, 151, 157, 216, 224, 236, 258 Bed Rest, 145, 153, 156, 216 Behavior Therapy, 188, 216 Behavioral Symptoms, 25, 216 Belladonna, 216, 255 Benign, 84, 216, 251 Bereavement, 27, 216 Bifida, 216 Bilateral, 31, 38, 84, 85, 123, 216, 245 Bile, 216, 230, 233, 238, 257 Biochemical, 216, 245, 254 Biomechanics, 16, 39, 59, 216 Biotechnology, 54, 166, 175, 187, 216 Biotic, 217, 261 Bladder, 217, 222, 224, 230, 234, 241, 249, 261 Blast phase, 217, 220 Blood Coagulation, 217, 218 Blood Glucose, 188, 217, 235 Blood pressure, 11, 12, 89, 188, 217, 219, 233, 241, 255 Blood vessel, 217, 219, 220, 227, 236, 238, 240, 246, 255, 257, 259, 261 Body Fluids, 170, 217, 255 Body Mass Index, 217, 245 Bolus, 157, 217 Bolus infusion, 217 Bone Marrow, 217, 220, 238 Bone scan, 217, 253 Boron, 133, 217 Boron Neutron Capture Therapy, 217 Bowel, 213, 217, 225, 230, 257 Bowel Movement, 217, 225, 257 Brace, 128, 129, 138, 146, 217 Brachial, 217, 261

Brachial Plexus, 217, 261 Brachytherapy, 218, 235, 236, 251, 263 Bradykinesia, 49, 218 Branch, 36, 207, 218, 231, 238, 250, 256, 259 Breakdown, 218, 225, 230 Bronchi, 218, 228, 260 Bronchiectasis, 59, 218 Bronchitis, 61, 73, 87, 137, 218, 220 Bronchodilator, 79, 218 Bruxism, 164, 218 Burns, 36, 52, 59, 98, 99, 137, 218 Burns, Electric, 218 C Calcium, 143, 218, 221 Capsaicin, 143, 218 Capsicum, 218, 255 Carbohydrate, 218, 223, 231, 248 Carbon Dioxide, 218, 229, 230, 252 Carcinogenic, 218, 257, 261 Cardiac, 11, 22, 28, 36, 68, 125, 218, 227, 228, 232, 242, 257 Cardiac Output, 11, 218 Cardiomyopathy, 28, 218 Cardiopulmonary, 22, 64, 111, 164, 165, 218 Cardiorespiratory, 212, 218 Cardiovascular, 11, 12, 17, 36, 65, 160, 213, 219, 228, 254 Cardiovascular disease, 17, 219 Carnitine, 28, 219 Case report, 78, 84, 88, 94, 219, 221 Case series, 81, 219, 221 Catabolism, 36, 219 Catecholamine, 22, 219, 226, 247 Caudal, 219, 248 Causal, 111, 219, 235 Cell Division, 216, 219, 239, 248, 249 Cell membrane, 219, 225, 236, 247 Cellulose, 219, 248 Central Nervous System, 11, 13, 20, 32, 211, 213, 219, 225, 230, 241, 248, 254 Cerebellum, 219, 223, 248 Cerebral Arteries, 219, 240 Cerebral Cortex, 20, 219, 228, 229 Cerebral Palsy, 20, 32, 46, 52, 60, 77, 94, 110, 136, 219, 256 Cerebrovascular, 67, 117, 136, 157, 216, 219 Cerebrum, 219, 223, 258 Cervical, 88, 137, 145, 149, 157, 176, 217, 220, 232, 242, 261 Cervix, 220, 229

Index 267

Character, 220, 224 Chemotherapy, 26, 170, 220 Chest wall, 66, 139, 220, 252 Chilblains, 137, 220 Chin, 146, 157, 220, 239 Chiropractic, 30, 34, 55, 134, 158, 220 Cholesterol, 216, 220, 223, 238, 257 Cholesterol Esters, 220, 238 Chondrocytes, 35, 220, 229 Chronic Fatigue Syndrome, 26, 220 Chronic lymphocytic leukemia, 220 Chronic myelogenous leukemia, 217, 220 Chronic Obstructive Pulmonary Disease, 24, 51, 59, 220 Chronic phase, 14, 220 Chronic renal, 78, 220 Chylomicrons, 220, 238 Civilization, 151, 221 Clamp, 159, 221 Clinical Protocols, 52, 221 Clinical study, 8, 221, 223 Clinical trial, 5, 7, 14, 18, 19, 26, 37, 48, 52, 53, 74, 117, 118, 187, 221, 223, 250, 251 Cloning, 216, 221 Clubfoot, 87, 221 Cofactor, 221, 250 Collagen, 213, 215, 221, 233 Collagen disease, 221, 233 Collapse, 159, 218, 221 Complement, 221, 222 Complementary and alternative medicine, 26, 97, 98, 102, 222 Complementary medicine, 98, 222 Compliance, 17, 23, 26, 222 Computational Biology, 187, 222 Computed tomography, 176, 222, 253 Computer Systems, 131, 222 Conduction, 9, 222 Cone, 140, 222 Confounding, 13, 222 Connective Tissue, 217, 221, 222, 229, 230, 238, 240, 253, 259 Consciousness, 213, 222, 250 Constipation, 222, 230 Constriction, 222, 236 Consumption, 23, 222, 245 Contamination, 48, 222 Contracture, 38, 222 Contraindications, ii, 12, 98, 222 Contralateral, 30, 37, 223 Contrast medium, 215, 223

Control group, 7, 10, 19, 30, 39, 43, 51, 223, 251 Controlled clinical trial, 50, 223 Controlled study, 22, 94, 223 Contusion, 137, 223 Coordination, 11, 12, 15, 19, 53, 155, 161, 170, 219, 223, 241 Coronary, 68, 219, 223, 240, 242 Coronary heart disease, 219, 223 Coronary Thrombosis, 223, 240, 242 Corpus, 50, 223 Cortex, 21, 44, 223, 240 Cortical, 6, 10, 14, 20, 30, 37, 44, 223, 254 Cortices, 30, 223 Corticosteroid, 56, 62, 174, 223 Cortisol, 50, 223 Cost-benefit, 26, 104, 223 Cranial, 219, 224, 243, 246 Craniomandibular Disorders, 163, 224 Curative, 137, 224, 259 Custodial Care, 41, 224 Cutaneous, 52, 224, 233, 244 Cyclic, 35, 125, 145, 224 Cystitis, 92, 224 Cytokine, 22, 224 D Data Collection, 53, 224 Decision Making, 21, 60, 92, 94, 224 Decompression, 82, 224 Decubitus, 24, 156, 224 Decubitus Ulcer, 24, 224 Degenerative, 176, 224, 245, 253 Deglutition, 224, 257 Dendrites, 224, 243, 244 Density, 11, 12, 16, 217, 224, 238, 244, 251, 255 Dental Care, 170, 224 Dentists, 163, 224 Depersonalization, 224, 245, 254 Depolarization, 143, 225 Derealization, 224, 225, 245 Dermatology, 80, 94, 225 Desensitization, 143, 225 Dexterity, 133, 225 Dextroamphetamine, 118, 213, 225 Diabetic Foot, 66, 225 Diagnostic procedure, 121, 175, 225 Diaphragm, 225, 252 Diarrhea, 137, 225, 230 Diastolic, 225, 233 Diathermy, 189, 225 Digestion, 213, 216, 217, 225, 238, 257

268 Physical Therapy

Digestive system, 119, 225 Dilatation, 218, 225, 249 Diploid, 225, 248 Direct, iii, 10, 14, 32, 34, 52, 53, 76, 82, 130, 152, 161, 179, 225, 226, 241, 252, 258 Disabled Persons, 124, 225 Discrete, 225, 259 Discrimination, 21, 225 Disparity, 128, 225 Dissection, 28, 226, 238 Distal, 37, 215, 226, 227, 250 Distention, 56, 126, 226 Dizziness, 171, 226, 245, 262 Dominance, 226, 237 Dopamine, 92, 213, 225, 226, 241, 243 Dorsal, 32, 46, 60, 65, 226, 248 Drive, ii, vi, 132, 150, 152, 160, 163, 226 Drug Interactions, 49, 180, 181, 226 Drug Tolerance, 226, 259 Duodenum, 216, 226, 257 Dynamometer, 47, 226 Dysmenorrhoea, 137, 226 Dysphagia, 157, 226 Dyspnea, 51, 226, 245 Dystrophy, 56, 65, 86, 96, 226 E Effector, 211, 221, 226 Efficacy, 7, 8, 18, 19, 23, 26, 35, 37, 38, 42, 47, 48, 51, 52, 56, 62, 64, 108, 117, 226, 260 Elastic, 161, 226, 255 Elasticity, 12, 226 Elective, 33, 226 Electrode, 132, 227 Electrolyte, 223, 227, 240, 255 Electromyography, 23, 157, 227 Embolism, 69, 227 Embryo, 227, 234 Emphysema, 220, 227 Emulsion, 227, 229 Endocrine System, 227, 243 Endogenous, 226, 227, 230, 244, 261 Endorphin, 227, 230 Endothelial cell, 227, 229 Endotoxic, 227, 237 Endotoxin, 227, 260 End-stage renal, 220, 227 Energetic, 36, 227 Environmental Health, 186, 188, 227 Enzymatic, 213, 218, 221, 227, 252 Enzyme, 28, 226, 227, 240, 241, 257, 262 Epidural, 13, 143, 227

Epinephrine, 212, 226, 227, 243, 260 Epithelium, 228, 244 Ergometer, 17, 125, 228 Ergonomics, 122, 195, 228 Erythema, 220, 228 Erythroplakia, 169, 228 Esophagus, 225, 228, 247, 257 Evoke, 228, 257 Excitability, 9, 228 Exercise Test, 22, 228 Exercise Therapy, 19, 198, 228 Exon, 28, 228 Extensor, 17, 38, 228 External-beam radiation, 228, 236, 251, 262 Extracellular, 222, 228, 240, 255 Extracellular Space, 228, 240 Extraction, 11, 228 Extrapyramidal, 226, 228 F Facial, 93, 228 Facial Paralysis, 93, 228 Family Planning, 187, 229 Fat, 51, 69, 188, 211, 217, 223, 224, 229, 237, 241, 245, 253, 255 Fathers, 7, 229 Fatigue, 26, 220, 229, 241 Feces, 222, 229, 257 Femur, 11, 12, 214, 229, 259 Fibroblast Growth Factor, 18, 229 Fibrosis, 10, 61, 66, 79, 99, 222, 229, 254 Fibula, 214, 229, 259 Fixation, 33, 77, 129, 229 Flatus, 229, 230 Flexion, 38, 124, 128, 129, 141, 145, 176, 229 Flexor, 130, 228, 229 Food Handling, 170, 229 Foot Care, 39, 229 Foot Ulcer, 225, 230 Foramen, 220, 230, 232 Forearm, 155, 217, 230, 261 Fovea, 229, 230 Frail Elderly, 15, 48, 113, 174, 230 Friction, 141, 159, 230 Frontal Lobe, 230, 241 Functional Disorders, 137, 230 Functional magnetic resonance imaging, 14, 30, 230 Fundus, 229, 230

Index 269

G Gait, 8, 11, 12, 15, 23, 33, 38, 39, 43, 47, 49, 75, 92, 124, 136, 230 Gallbladder, 211, 225, 230 Gamma Rays, 230, 250, 251 Gamma-Endorphin, 230 Ganglia, 211, 216, 230, 242, 246, 258 Ganglioside, 70, 230 Gas, 145, 218, 229, 230, 233, 243, 250, 251, 252 Gas exchange, 230, 252 Gastric, 219, 230 Gastrin, 230, 233 Gastrointestinal, 88, 228, 230, 254 Gene, 28, 35, 46, 75, 166, 216, 226, 231, 248, 251 Gene Expression, 29, 75, 231 General practitioner, 78, 231 Generator, 9, 137, 139, 231 Genetic Counseling, 5, 25, 231 Genetic testing, 25, 231 Genetics, 25, 189, 226, 231 Genital, 13, 231 Genotype, 231, 247 Gestational, 7, 231 Gestational Age, 7, 231 Gland, 212, 231, 238, 245, 248, 249, 254, 257 Glucocorticoid, 231, 233 Glucose, 12, 217, 219, 231, 235 Glucose tolerance, 12, 231 Glucose Tolerance Test, 231 Glycogen, 28, 231, 241 Glycogen Storage Disease, 28, 231 Glycoprotein, 232, 260 Governing Board, 232, 248 Gravidity, 232, 246 Groin, 26, 232 Growth, 10, 18, 33, 50, 214, 229, 232, 242, 248 H Haploid, 232, 248 Health Education, 5, 25, 51, 232 Health Promotion, 39, 114, 232 Health Status, 10, 48, 73, 232 Heart attack, 219, 232 Heart Transplantation, 22, 232 Helminths, 232, 234 Hemiparesis, 9, 232 Hemiplegia, 14, 20, 53, 196, 232 Hemorrhage, 69, 232, 257 Hepatic, 231, 232, 241

Hepatomegaly, 28, 232 Heredity, 231, 232 Hernia, 232, 260 Herniated, 144, 145, 232 Herpes, 137, 232 Herpes Zoster, 232 Homologous, 233, 258 Hormonal, 215, 223, 233 Hormone, 12, 223, 227, 230, 233, 235, 245, 253 Hormone Replacement Therapy, 12, 233 Hospice, 68, 189, 233 Housekeeping, 170, 233 Humoral, 22, 233 Humour, 233 Hybrid, 4, 233 Hydrocortisone, 95, 233 Hydrogen, 216, 218, 233, 240, 241, 243, 250 Hydrophobic, 233, 237 Hyperalgesia, 30, 233 Hypersensitivity, 213, 225, 233, 253 Hypertension, 11, 12, 137, 219, 233 Hyperthermia, 225, 233 Hypesthesia, 233, 243 Hypokinesia, 49, 233 I Id, 98, 194, 195, 199, 206, 208, 233 Idiopathic, 49, 87, 233 Illusion, 233, 261 Immersion, 63, 234 Immune response, 214, 215, 223, 234, 262 Immune system, 189, 234, 239, 241, 261, 262 Immunodeficiency, 170, 234 Immunodeficiency syndrome, 170, 234 Immunogenic, 234, 237 Immunologic, 231, 234, 251 Immunotherapy, 225, 234 Impairment, 6, 14, 17, 19, 20, 23, 38, 40, 47, 65, 111, 128, 155, 215, 234, 237, 239 Implant radiation, 234, 235, 236, 251, 262 In vitro, 28, 35, 234 In vivo, 35, 45, 234, 240 Incision, 86, 234, 236 Incontinence, 23, 234 Indicative, 164, 234, 261 Induction, 35, 214, 225, 234 Infancy, 45, 234 Infant, Newborn, 212, 234 Infarction, 234 Infection, 98, 146, 151, 225, 234, 237, 238, 239, 253, 257, 262

270 Physical Therapy

Infestation, 26, 234 Infrared Rays, 137, 235 Ingestion, 231, 235, 248 Inlay, 235, 252 Innervation, 6, 217, 235, 244, 261 Inotropic, 226, 235 Insight, 29, 235 Institutionalization, 7, 24, 71, 235 Insulator, 235, 241 Insulin, 12, 188, 231, 235 Insulin-dependent diabetes mellitus, 235 Intensive Care, 7, 235 Intermittent, 100, 145, 146, 235, 238 Internal Medicine, 30, 38, 66, 78, 83, 235, 253 Internal radiation, 235, 236, 251, 262 Interstitial, 92, 218, 228, 235, 236, 262 Intervention Studies, 14, 235 Intervertebral, 67, 232, 235, 238 Intervertebral Disk Displacement, 235, 238 Intestinal, 231, 235 Intestines, 98, 137, 211, 229, 230, 235 Intoxication, 236, 262 Intracellular, 35, 234, 236 Intrinsic, 9, 212, 236 Invasive, 26, 30, 35, 46, 236, 239 Involuntary, 32, 216, 236, 242, 252, 255, 257 Ion Channels, 31, 236 Ionizing, 213, 236, 251, 261 Ions, 216, 227, 233, 236 Ipsilateral, 30, 236 Irradiation, 26, 144, 217, 236, 263 Ischemia, 17, 215, 224, 230, 236 Ischemic stroke, 37, 236 Isotonic, 127, 236 K Kb, 186, 236 L Labyrinth, 236, 249, 262 Lacerations, 13, 236 Language Development, 237 Language Development Disorders, 237 Language Disorders, 198, 237, 256 Language Therapy, 57, 237 Large Intestine, 225, 236, 237, 252, 255 Laryngeal, 156, 157, 237 Larynx, 84, 157, 237, 260 Laterality, 30, 237 Length of Stay, 72, 237 Leprosy, 89, 230, 237

Leukocytes, 217, 237, 260 Leukoplakia, 169, 237 Library Services, 5, 206, 237 Library Technical Services, 6, 237 Ligament, 98, 214, 237, 249, 256 Lipid, 12, 215, 235, 237, 241 Lipid A, 12, 237 Lipopolysaccharides, 237 Lipoprotein, 12, 237, 238 Liver, 28, 211, 216, 219, 225, 227, 229, 230, 231, 232, 238, 241, 253 Liver scan, 238, 253 Localized, 220, 229, 232, 234, 238, 241, 242, 248, 254, 260 Locomotion, 23, 161, 238, 248 Locomotor, 18, 23, 238 Loneliness, 10, 238 Long-Term Care, 22, 36, 238 Loop, 142, 232, 238 Low Back Pain, 4, 29, 31, 34, 40, 55, 57, 63, 64, 65, 67, 71, 88, 100, 102, 108, 238 Low-density lipoprotein, 238 Lubricants, 13, 238 Lumbago, 145, 238 Lumbar, 29, 67, 77, 78, 81, 145, 149, 216, 235, 238, 244 Lumen, 157, 238 Lymph, 25, 220, 227, 233, 238, 242 Lymph node, 220, 238, 242 Lymphadenectomy, 26, 238 Lymphatic, 26, 60, 100, 234, 238, 240, 248, 256, 259 Lymphatic system, 238, 256, 259 Lymphedema, 25, 60, 77, 238 Lymphocyte, 50, 67, 214, 239 Lymphocyte Subsets, 50, 67, 239 M Magnetic Resonance Imaging, 22, 37, 239, 253 Malnutrition, 215, 239 Mandible, 220, 239 Manifest, 215, 232, 239 Masseter Muscle, 157, 239 Mastication, 239, 257 Masticatory, 224, 239, 258 Mechanoreceptors, 239, 252 Medial, 123, 214, 239, 259, 261 Mediate, 35, 226, 239 Medical Records, 130, 239, 253 MEDLINE, 187, 239 Meiosis, 239, 258

Index 271

Membrane, 143, 219, 222, 225, 228, 236, 237, 239, 240, 247, 252, 253, 258, 260 Memory, 38, 132, 133, 171, 239 Meninges, 219, 239, 256 Menstruation, 226, 239 Mental, iv, 4, 7, 35, 79, 119, 186, 190, 218, 219, 220, 225, 229, 233, 237, 239, 244, 247, 250, 252, 253 Mental Disorders, 119, 233, 237, 239, 250 Mental Health, iv, 4, 35, 119, 186, 190, 239, 244, 250 Mental Processes, 239, 250 Mentors, 22, 240 Mesenchymal, 215, 240 Meta-Analysis, 75, 240 Metabolic disorder, 231, 240 MI, 122, 123, 124, 140, 145, 160, 161, 209, 240 Microbiology, 211, 240 Microdialysis, 30, 240 Microorganism, 221, 240, 262 Middle Cerebral Artery, 18, 240 Midwifery, 240, 244 Mineralocorticoids, 212, 223, 240 Mobility, 7, 9, 24, 38, 41, 42, 58, 65, 66, 109, 123, 132, 136, 148, 160, 240 Mobilization, 30, 134, 143, 167, 240 Modeling, 14, 23, 24, 80, 240 Modification, 58, 128, 213, 240, 250 Molecular, 28, 30, 35, 153, 187, 191, 216, 222, 240, 253, 260 Molecule, 214, 216, 221, 226, 240, 251 Monitor, 22, 28, 42, 133, 240, 243 Monoamine, 213, 225, 241 Monoamine Oxidase, 213, 225, 241 Monoclonal, 236, 241, 251, 263 Mononuclear, 241, 260 Morale, 55, 241 Morphological, 32, 227, 241 Morphology, 31, 241 Motility, 230, 241, 254 Motion Sickness, 100, 241, 242 Motor Activity, 14, 30, 37, 241 Motor Cortex, 44, 241 Multiple sclerosis, 20, 72, 136, 241 Muscle Fatigue, 23, 153, 241 Muscle Fibers, 241, 242 Muscular Diseases, 229, 241 Muscular Dystrophies, 226, 241 Musculature, 15, 233, 241, 256 Musculoskeletal System, 30, 153, 241, 244 Mutagenic, 241, 261

Myelin, 241, 242 Myocardial infarction, 24, 223, 240, 242 Myocardium, 240, 242 Myopathy, 28, 242 Myosin, 36, 242 N Narcolepsy, 225, 242 Nausea, 19, 242, 245 NCI, 1, 118, 185, 242 Neck dissection, 176, 242 Neck Pain, 66, 78, 176, 242 Needs Assessment, 45, 105, 242 Neonatal, 7, 242 Neoplastic, 233, 242 Nerve Endings, 242, 243 Nerve Fibers, 143, 217, 242 Nerve Growth Factor, 242, 243 Nervous System, 6, 21, 212, 213, 216, 219, 239, 242, 243, 246, 258 Neural, 10, 18, 46, 212, 233, 239, 241, 242, 252 Neuritis, 76, 243 Neuroendocrine, 38, 243 Neurologic, 9, 17, 243 Neuromuscular, 20, 23, 31, 38, 41, 153, 211, 229, 243 Neuromuscular Junction, 211, 243 Neuronal, 13, 18, 45, 143, 243 Neuronal Plasticity, 18, 243 Neurons, 13, 45, 224, 230, 242, 243, 244, 251, 258 Neurophysiology, 9, 225, 243 Neurosis, 243, 247 Neurosurgery, 8, 32, 60, 243 Neurotransmitter, 211, 213, 226, 236, 243 Neurotrophins, 13, 243 Neutrons, 213, 217, 236, 243, 250 Nitrogen, 213, 214, 229, 243 Nociceptors, 143, 243 Norepinephrine, 212, 226, 243 Nuclear, 35, 216, 230, 243 Nuclei, 213, 229, 239, 243, 244, 250 Nucleus, 35, 216, 224, 230, 235, 239, 241, 243, 244, 249, 250 Nurse Midwives, 13, 244 O Obturator Nerve, 84, 244 Occupational Medicine, 66, 244 Odds Ratio, 57, 244 Olfactory Bulb, 244 Olfactory Receptor Neurons, 45, 244, 251 Oncology, 74, 244

272 Physical Therapy

On-line, 5, 209, 244 Opacity, 224, 244 Ophthalmology, 229, 244 Opioid Peptides, 244 Oral Health, 169, 170, 244 Orthopaedic, 32, 57, 62, 63, 64, 75, 78, 79, 80, 82, 85, 88, 89, 90, 92, 96, 244 Orthopedic Procedures, 33, 244 Osteoarthritis, 19, 31, 35, 60, 66, 78, 83, 85, 100, 117, 164, 174, 189, 245 Osteoporosis, 68, 130, 245 Outpatient, 33, 41, 43, 63, 73, 82, 83, 88, 106, 108, 197, 245 Overweight, 188, 245 Oxandrolone, 37, 245 Oxygen Consumption, 228, 245, 252 P Palliative, 27, 49, 93, 245, 259 Palsy, 32, 245 Pancreas, 211, 225, 235, 245 Pancreatic, 219, 245 Panic, 52, 245 Panic Disorder, 52, 245 Paradoxical, 170, 245 Paralysis, 84, 117, 229, 232, 245, 256 Parasite, 245 Parasitic, 26, 232, 234, 245 Paresis, 229, 232, 243, 245 Paresthesias, 243, 245 Parietal, 246, 255 Parietal Lobe, 246, 255 Parity, 7, 13, 246 Paroxysmal, 84, 246 Patch, 228, 237, 246 Patient Compliance, 23, 246 Patient Education, 65, 111, 198, 204, 206, 209, 246 Patient Satisfaction, 88, 108, 246 Pelvic, 23, 83, 92, 98, 246, 249 Pelvis, 159, 170, 211, 238, 246, 261 Peptide, 213, 229, 230, 244, 246, 249, 250 Perception, 10, 52, 222, 224, 246, 254 Percutaneous, 246, 247 Perfusion, 30, 246 Perianal, 84, 246 Periarthritis, 137, 246 Perineal, 13, 84, 246 Perineum, 13, 246 Perioperative, 64, 246 Peripheral Nervous System, 232, 243, 245, 246

Peripheral Nervous System Diseases, 232, 246 Phallic, 229, 246 Pharmacokinetic, 58, 246 Pharmacologic, 49, 52, 214, 247, 260 Pharmacotherapy, 188, 247 Pharyngeal Muscles, 157, 247 Pharynx, 157, 247, 257 Phenotype, 28, 247 Phobia, 98, 247 Phobic Disorders, 247 Phonophoresis, 95, 247 Phospholipids, 229, 238, 247 Phosphorus, 218, 247 Physical Examination, 189, 231, 247 Physical Fitness, 15, 125, 135, 154, 228, 247 Physician Self-Referral, 91, 247 Physiologic, 10, 22, 26, 38, 157, 212, 233, 236, 239, 247, 251, 252 Physiology, 7, 22, 30, 36, 39, 48, 52, 64, 122, 153, 243, 247 Pilot study, 8, 27, 34, 66, 248 Pituitary Gland, 223, 229, 248, 249 Placebo Effect, 19, 248 Plants, 143, 213, 216, 218, 231, 241, 243, 248, 255, 260 Plasma, 12, 50, 188, 214, 219, 220, 231, 240, 248, 254 Plasticity, 6, 10, 18, 21, 30, 44, 248 Platinum, 238, 248 Plexus, 217, 244, 248 Pneumonia, 130, 137, 139, 223, 248 Poisoning, 236, 242, 248 Polyarthritis, 176, 248 Polysaccharide, 214, 219, 248 Pons, 229, 248 Posterior, 136, 146, 213, 215, 216, 219, 226, 242, 245, 248, 255 Postmenopausal, 245, 248 Postoperative, 59, 164, 248 Post-traumatic, 125, 248 Postural, 23, 29, 52, 89, 106, 130, 139, 248 Practicability, 248, 260 Practice Guidelines, 19, 190, 248 Precancerous, 169, 249 Precursor, 226, 227, 230, 243, 244, 249, 260 Pregnancy Tests, 231, 249 Prejudice, 32, 249 Premalignant, 249 Prevalence, 16, 24, 244, 249 Probe, 240, 249 Progression, 23, 28, 41, 49, 198, 214, 249

Index 273

Progressive, 28, 35, 45, 50, 128, 220, 226, 232, 241, 245, 249 Prone, 128, 249 Pro-Opiomelanocortin, 230, 244, 249 Prophase, 249, 258 Proportional, 24, 133, 249 Proprioception, 15, 29, 249 Prospective study, 16, 29, 249 Prostate, 26, 71, 249 Prostatitis, 83, 249 Protein C, 213, 215, 237, 249 Protein S, 166, 216, 250, 253 Proteins, 35, 213, 214, 215, 219, 221, 240, 243, 244, 246, 248, 250, 251, 254 Protocol, 10, 17, 23, 28, 33, 40, 49, 164, 250 Protons, 213, 233, 236, 250 Proximal, 11, 12, 53, 148, 226, 250 Psychiatry, 229, 250 Psychic, 239, 243, 250, 254 Psychoactive, 250, 262 Psychology, 5, 6, 36, 40, 52, 58, 250 Psychotomimetic, 213, 225, 250 Public Health, 5, 29, 171, 190, 250 Public Policy, 187, 250 Pulmonary, 10, 22, 36, 61, 69, 88, 138, 139, 217, 222, 228, 250, 261 Pulmonary Artery, 217, 250, 261 Pulmonary Ventilation, 139, 250 Pulposus, 144, 145, 235, 250 Pulse, 241, 250 Q Quality of Life, 10, 11, 12, 20, 22, 24, 26, 27, 33, 41, 43, 49, 95, 195, 250 R Race, 7, 250 Radiation, 137, 170, 223, 228, 230, 233, 235, 236, 250, 251, 253, 262 Radiation therapy, 170, 228, 235, 236, 250, 263 Radio Waves, 225, 251 Radioactive, 217, 233, 234, 235, 236, 238, 243, 251, 253, 263 Radiography, 189, 231, 251 Radioisotope, 251, 260 Radiolabeled, 236, 251, 263 Radiopharmaceutical, 231, 251 Radiotherapy, 218, 236, 251, 263 Random Allocation, 251 Randomization, 27, 30, 42, 251 Randomized clinical trial, 7, 9, 18, 20, 26, 34, 52, 251 Rarefaction, 215, 251

Reaction Time, 12, 251 Receptor, 18, 45, 211, 214, 222, 226, 244, 251, 254 Receptors, Odorant, 244, 251 Recovery of Function, 13, 18, 252 Rectal, 26, 252 Rectum, 214, 217, 225, 229, 230, 234, 237, 249, 252 Recuperation, 124, 252 Refer, 1, 221, 226, 229, 232, 238, 243, 244, 252, 255, 260, 262 Reflex, 9, 29, 56, 65, 86, 96, 110, 131, 153, 252 Refraction, 252, 256 Regeneration, 229, 252 Regimen, 8, 23, 26, 41, 49, 127, 134, 153, 221, 226, 246, 247, 248, 252 Rehabilitative, 13, 14, 30, 35, 44, 124, 252 Relapse, 44, 252 Reliability, 74, 87, 252 Research Design, 26, 52, 252 Respiration, 218, 240, 252 Respiratory failure, 84, 252 Respiratory Mechanics, 49, 252 Restitution, 14, 252 Restoration, 38, 247, 252, 262 Retina, 252, 253 Retinal, 222, 225, 252 Retrospective, 26, 48, 84, 87, 253 Retrospective study, 84, 253 Rheumatic Diseases, 93, 176, 189, 253 Rheumatism, 189, 253 Rheumatoid, 4, 35, 38, 56, 73, 87, 174, 189, 221, 253 Rheumatoid arthritis, 4, 35, 38, 56, 73, 87, 174, 189, 221, 253 Rheumatology, 19, 56, 62, 65, 68, 73, 81, 88, 89, 253 Rhinitis, 137, 253 Ribosome, 253, 260 Rigidity, 138, 248, 253 Risk factor, 29, 57, 88, 169, 249, 253 Risk patient, 42, 253 Rod, 127, 128, 221, 253 Rubber, 148, 211, 253 S Salivary, 225, 253 Salivary glands, 225, 253 Scans, 118, 253 Schizoid, 253, 262 Schizophrenia, 253, 254, 262

274 Physical Therapy

Schizotypal Personality Disorder, 224, 254, 262 Scleroderma, 81, 254 Sclerosis, 221, 241, 254 Screening, 43, 164, 221, 254 Secretion, 223, 233, 235, 240, 254 Sedentary, 156, 254 Seizures, 246, 254 Self Care, 211, 254 Semen, 249, 254 Senile, 245, 254 Sensibility, 213, 233, 254 Sequencing, 28, 254 Serotonin, 241, 243, 247, 254 Serum, 188, 221, 236, 238, 240, 254, 260 Shock, 139, 233, 254, 260 Shoulder Impingement Syndrome, 62, 254 Side effect, 18, 179, 212, 254, 259 Signs and Symptoms, 252, 255 Skeletal, 11, 12, 22, 36, 42, 146, 153, 180, 214, 221, 241, 245, 255 Skeleton, 11, 12, 211, 229, 236, 255, 259 Skull, 145, 146, 255, 258 Small intestine, 220, 226, 233, 236, 255 Smoking Cessation, 188, 255 Smooth muscle, 218, 241, 255 Sneezing, 255, 257 Social Environment, 250, 255 Social Isolation, 24, 254, 255 Social Work, 25, 61, 189, 255 Sodium, 143, 240, 255 Soft tissue, 51, 137, 143, 154, 159, 176, 217, 255 Soft Tissue Injuries, 176, 255 Solanaceae, 143, 218, 255 Somatic, 233, 239, 246, 255 Somatosensory Cortex, 20, 255 Sound wave, 139, 222, 225, 255 Space Flight, 153, 256 Spastic, 32, 60, 256 Spasticity, 46, 60, 84, 256 Spatial disorientation, 226, 256 Specialist, 200, 256 Species, 216, 218, 228, 232, 233, 239, 241, 245, 250, 256, 260, 262 Specificity, 61, 212, 256 Spectrum, 137, 235, 251, 256, 261 Speech-Language Pathology, 43, 256 Sphincter, 157, 237, 256 Spina bifida, 58, 256 Spinal Cord Diseases, 232, 256 Spinal Stenosis, 78, 81, 256

Spleen, 238, 256 Splint, 217, 256 Spondylitis, 68, 74, 89, 176, 189, 256 Sprains and Strains, 238, 256 Staging, 253, 256 Standardize, 163, 257 Steel, 122, 221, 257 Sterilization, 144, 257 Steroid, 223, 257 Stimulant, 17, 213, 225, 257 Stimulus, 143, 157, 226, 227, 235, 236, 246, 247, 251, 252, 257, 259 Stomach, 137, 211, 225, 228, 230, 231, 233, 235, 242, 247, 255, 256, 257 Stomatognathic System, 164, 257 Stool, 158, 234, 237, 257 Stress, 23, 35, 61, 67, 123, 125, 131, 135, 137, 140, 189, 219, 223, 230, 242, 253, 257 Stress incontinence, 23, 61, 67, 257 Styrene, 253, 257 Subacute, 4, 26, 37, 48, 52, 234, 257 Subclinical, 234, 254, 257 Substrate, 137, 257 Supine, 23, 158, 257 Supine Position, 158, 257 Support group, 25, 257 Suppression, 35, 223, 257 Survival Rate, 46, 257 Sympathetic Nervous System, 243, 258 Sympathomimetic, 213, 225, 226, 227, 243, 258 Symphysis, 220, 249, 258 Symptomatic, 19, 27, 258 Synapse, 212, 243, 244, 258, 260 Synapsis, 258 Synaptic, 45, 243, 258 Synergistic, 27, 258 Synovial, 35, 215, 258 Synovial Membrane, 215, 258 Systemic, 82, 180, 215, 217, 221, 228, 234, 236, 251, 254, 258, 263 Systemic disease, 82, 215, 258 Systolic, 233, 258 T Talus, 214, 258, 259 Telecommunications, 140, 222, 258 Telencephalon, 216, 219, 258 Temporal, 140, 258 Temporomandibular Joint Dysfunction Syndrome, 224, 258 Tendon, 32, 256, 259 Therapeutics, 96, 181, 241, 259

Index 275

Thermal, 81, 144, 217, 243, 259 Thigh, 22, 38, 43, 64, 129, 170, 232, 244, 259 Thoracic, 76, 145, 149, 216, 217, 225, 259, 261, 262 Thorax, 211, 238, 259 Threshold, 38, 228, 233, 259 Thrombosis, 125, 250, 257, 259 Thrombus, 223, 234, 236, 259 Thymus, 238, 259 Tibia, 214, 229, 259 Ticks, 234, 259 Tolerance, 52, 231, 259 Tomography, 45, 222, 253, 259 Tone, 92, 123, 159, 161, 256, 259 Tonic, 110, 125, 259 Tonicity, 236, 259 Tonus, 259 Tooth Preparation, 211, 259 Torsion, 128, 234, 259 Toxic, iv, 131, 257, 259, 260 Toxicity, 226, 260 Toxicology, 188, 260 Toxin, 227, 259, 260 Trace element, 217, 260 Tracer, 26, 260 Trachea, 218, 237, 247, 260 Traction, 134, 144, 145, 150, 158, 176, 221, 260 Transcutaneous, 77, 189, 260 Transfection, 216, 260 Translation, 26, 213, 260 Translational, 26, 260 Translocation, 35, 260 Transmitter, 211, 226, 236, 243, 260 Transplantation, 220, 260 Trauma, 13, 56, 59, 69, 125, 135, 139, 176, 216, 252, 260 Treatment Outcome, 24, 47, 260 Trees, 253, 260 Trusses, 138, 260 Tumor Necrosis Factor, 22, 260 Tyrosine, 226, 260 U Ulcer, 137, 156, 224, 260, 261 Ulceration, 224, 261 Ulnar Nerve, 82, 171, 261 Ultrasonography, 231, 261

Ultraviolet Rays, 137, 261 Unconscious, 159, 233, 261 Urethra, 249, 261 Urinary, 23, 61, 67, 224, 234, 261 Urine, 24, 50, 217, 234, 257, 261 Uterus, 220, 223, 229, 230, 239, 261 V Vaccine, 250, 261 Vagina, 137, 220, 239, 261 Vaginal, 13, 261 Varicose, 98, 261 Varicose vein, 98, 261 Vascular, 44, 100, 225, 234, 256, 259, 261 Vasodilator, 226, 261 Vein, 125, 243, 261 Venous, 250, 261 Ventricle, 22, 250, 258, 261 Ventricular, 11, 261 Vertebrae, 149, 235, 256, 261 Vertebral, 56, 145, 216, 256, 261 Vertigo, 84, 101, 171, 261 Vestibular, 52, 85, 106, 171, 262 Vestibule, 262 Veterinary Medicine, 187, 262 Vibrissae, 20, 262 Virus, 170, 262 Viscosity, 159, 262 Vitro, 29, 35, 262 Vivo, 35, 262 Volition, 236, 262 W Walkers, 122, 148, 262 Weight Lifting, 11, 12, 51, 262 Weight-Bearing, 125, 262 Wheelchairs, 17, 122, 150, 262 White blood cell, 214, 217, 220, 237, 238, 239, 262 Windpipe, 247, 262 Withdrawal, 153, 262 Wound Healing, 95, 229, 262 X Xenograft, 214, 262 X-ray, 22, 51, 222, 223, 230, 236, 243, 250, 251, 253, 261, 262 X-ray therapy, 236, 262 Y Yeasts, 247, 263

276 Physical Therapy