Courses

The DPT curriculum at Belmont University is taught in a medical school model that reflects a building block design, where a foundation of basic science and applied clinical science serves as the cornerstone for further development of the clinical, social and behavioral sciences. As a student, you will develop essential skills for life-long professional practice such as critical thinking, inquiry, and ethical decision making.

The curriculum emphasizes a thorough understanding of how the human body is designed and functions, which informs the theoretical concepts underlying physical therapy practice. Students must then apply this knowledge to develop entry-level clinical skills, such as patient examination, evaluation, diagnosis, prognosis, intervention, reexamination, education/communication, outcomes, and prevention.

Acquisition of this knowledge and these skills is supported by a learning environment that is intellectually challenging, open to collective and independent educational opportunities, and experientially broad enough to encourage collaboration. Students are taught that successful communication and collaboration requires not only factual knowledge, but also the awareness and appreciation of various learning styles coupled with an understanding of individual- and population-specific social concepts, values, and ethical behaviors.

Belmont University School of Physical Therapy currently has agreements with over 300 clinical sites from coast to coast and overseas! Our students complete a total of 38 weeks in clinical experiences, which is well above the national average according to the APTA.

The School coordinates clinical education opportunities for students at locations in Tennessee and across the United States within regulatory guidelines established by each state. International opportunities are also available. Belmont University is part of the National Council for State Authorization Reciprocity Agreements (NC-SARA) which guides placement in most states.

Clinical education at Belmont University includes four eight-week full-time affiliations in acute care, rehabilitation or subacute care, and outpatient settings. Each student is expected to complete at least one of these full-time clinical rotations outside of the Middle Tennessee region. However, our location in Nashville, TN, a national health care hub with many major hospitals and medical centers, allows us to give our students excellent, varied part-time clinical experiences as well.

The Director of Clinical Education works with each student individually to best meet their educational, and in some cases, geographic needs.

Additional Resources

APTA Guidelines and Self Assessments for Clinical Education

A goal for our graduates is for each to be consumers of research, able to identify researchable problems, advocate and participate in research, and incorporate findings from professional literature into clinical practice.

When it comes to research, our faculty also lead by example. Examples of the publications, presentations, projects, and other research activities our faculty and students have participated in are listed below.

Students have opportunities to apply for residency through Belmont's many partnerships in Nashville. Residency and fellowship programs provide postprofessional education through one-to-one mentoring, structured curricular experiences, and guided learning designed to increase the quality of patient care and practitioner knowledge in specialty and subspecialty areas through best practices.

Sports Physical Therapy Clinical Residency at Tennessee Orthopaedic Alliance

Belmont University School of Physical Therapy in partnership with Tennessee Orthopaedic Alliance (TOA) offers a 13-month Sports Physical Therapy clinical residency that is designed to provide each participant with a unique experience that will enhance their ability to become advanced practitioners in the specialty area of sports physical therapy.  The mission of the Sports Clinical Residency at Belmont University & Tennessee Orthopaedic Alliance is to prepare the physical therapy resident to be an evidenced-based advanced practitioner in sports physical therapy by working collaboratively in an interdisciplinary environment. The resident will demonstrate excellence through evidence-based clinical decision-making across the full spectrum of care from initial diagnosis through treatment, rehabilitation, and education to prevent future injury.  In addition, the resident will serve as an educator, clinical researcher, and professional role model for others.

Within the Sports Physical Therapy clinical residency, the resident will split time between the classroom, clinic, and training room.  The resident will work closely with therapists who have expertise in a wide variety of sports specialty areas across the continuum of care from acute injury recognition and management through rehabilitation and return to play.  In addition, the sports resident will begin and end their residency time working in the Tennessee Titans Football summer camp.  At Belmont, the resident extends the clinical work to the classroom by teaching and providing lab instruction to doctoral students in the orthopedic content area.

Tennessee Orthopaedic Alliance (TOA) was established in 1926 and continues to set the standard for orthopedic care in Tennessee. TOA’s physicians include nationally and internationally renowned surgeons who provide specialized expertise in sports medicine, joint replacement, spine, hand, wrist and elbow, foot and ankle, shoulder, physical medicine and rehabilitation, and interventional pain management. 

 Additional Information about the Sports Physical Therapy Clinical Residency

Neurologic Clinical Residency at Vanderbilt Pi Beta Phi Rehabilitation Institute 

Belmont University School of Physical Therapy in partnership with Pi Beta Phi Rehabilitation Institute (PBPRI) at Vanderbilt University Medical Center offers a one-year-long Neurologic Clinical Residency Program. The program is designed to prepare the resident to treat patients with neurological conditions using contemporary, evidenced-based treatment approaches and provide the skills and experience needed to sit for the Neurological Clinical Specialist (NCS) certification exam with APTA.

At Belmont, the resident extends clinical work to the classroom by teaching lecture and lab instruction to doctoral students in the School of Physical Therapy in the neurologic content areas. A scholarly project will be completed during the residency. Dr. Cathey Norton is the academic coordinator for the residency.  Belmont sponsors and coordinates the resident's participation with the Neurologic Physical Therapy Professional Education Consortium.

More information about the Neurologic Clinical Residency is available at the Vanderbilt Bill Wilkerson Center website. 

Recent graduates and experienced clinicians may apply through the Residency/Fellowship Physical Therapist Centralized Application Service (RF-PTCAS). Instructions for applying are available through the RF-PTCAS Applicant Help Center.

Examination of Pediatric Balance Scale, 2^nd Edition (PBS-II) Performance in Children with Down Syndrome

Student Researchers: Maria Drake SPT, Amy Marple SPT, Cassie Mosher SPT, Macey Thornburg SPT
Faculty Mentors:  Nancy Darr PT, DSc, NCS
Objective: To examine performance of children with Down Syndrome (DS), ages 2 through 13, on the PBS-II.
Design: Descriptive statistics.
Methods: The PBS-II was administered to 15 children with DS (ages 2-13). PBS total test scores (TTS) of children with DS were examined by age and compared to PBS TTS in children with typical development (TD). Performance on select PBS-II items (alternate stepping and single limb stance) were also analyzed in children with DS to examine qualitative performance compared to peers with TD.
Results: PBS TTS in children with DS improved with age, although scores were lower in each age when compared to children with TD. These children were able to attempt all PBS-II items even if they were unable to successfully complete them; however, they were delayed compared to their peers with TD. Due to our small sample size of 15 children with DS, we do not have sufficient data to draw statistically significant conclusions regarding patterns of performance on select items across age.
Conclusions: Children with DS demonstrated motor behavior consistent with established literature. The PBS-II is a valid tool for examination and assessment of children with DS. A greater sample size is needed to strengthen the results seen in our study.
Key Words: Balance, pediatrics, Down syndrome

Normative Values for Nerve Conduction Velocity (NCV), Cross-sectional area and Circumference of Deep Fibular Nerve

Student Researchers:  Samantha Cook SPT, Royale Lopez SPT, Colleen Manning SPT, Jessie Mills SPT, Ashley Thomas SPT
Faculty Mentor:  Kathleen Galloway PT, DSc, ECS
Objective: This study will provide normative values for the deep fibular nerve (DFN) recorded from the first dorsal web space (FDWS), with stimulation over the DFN and superficial fibular nerve (SFN) and for ultrasound cross sectional area (CSA) of the DFN at the ankle to identify novel ways of identifying polyneuropathy earlier.
Design: Normative
Methods: Surface recording electrodes were attached to FDWS and stimulation was delivered over the DFN and SFN. Amplitude, latency, and velocity were recorded. We measured the CSA of the DFN using musculoskeletal ultrasound below the talocrural joint with a high resolution probe.
Results: Mean amplitude, onset latency and onset velocity values were 9.7µV, 3.1msec, 38.9m/s & 8.2µV, 3.1msec, 39.4m/s for the DFN and SFN, respectively.  DFN mean CSA was 0.09cm².We identified a response from both the SFN and DFN in 37% of the limbs tested. Those with a higher BMI had a lower amplitude nerve conduction response (P=0.04) and a larger mean CSA with ultrasound (P= 0.00).
Conclusions: Clinicians should be aware that a superficial to deep fibular sensory communication is present in a portion of the population and stimulation should be delivered to both the DFN and SFN to assess for the aberrant communication. The DFN is easily identified at the ankle with ultrasound so that it may become a useful tool in assessing nerve changes associated with polyneuropathy. BMI may impact both electrophysiologic and ultrasound recordings and needs to be considered when interpreting findings.
Key Words: deep fibular nerve, polyneuropathy, ultrasound

Accuracy of Heart Rate Monitoring in Apple and Garmin Watches

Student Researchers:  Brittany Gooch SPT, CSCS, Mackenzie Jones SPT, Maura McAfee SPT
Faculty Mentor:  Suzanne Greenwalt PT, DPT, CCS, GCS
Objective: To assess the accuracy of heart rate (HR) monitors in the Apple Watch Series 2 Nike+ and the Garmin Forerunner 35 at rest, during exercise, and post-exercise in healthy adults
Design: Repeated measures
Methods: 24 healthy adults were recruited and asked to simultaneously wear the Apple watch and Garmin watch on opposing wrists to measure HR. Participants’ HRs were recorded under 7 activity phases including 3 resting phases, 3 stages of the Bruce Protocol, and a recovery phase. Measured HRs were compared to a 12-lead electrocardiogram (EKG) to determine accuracy.  
Results: There was a significant interaction between phase of exercise and HR method (p<.001). The Apple watch HR was found to be significantly different from the EKG at phases 5 (p=.001) and 6 (p<.001) but was not significant at the other phases. At these phases, it underestimated HR by an average of 19.250 and 24.042 beats per minute (bpm) respectively. The Garmin watch HR was found to be significantly different from the EKG at phases 1 (p<.001), 5 (p=0.005), and 6 (p<.005). At phase 1, it overestimated HR by 22.125 bpm. At phases 5 and 6, it underestimated HR by 16.417 and 37.958 bpm.
Conclusions: Overall, the Apple watch was more accurate than the Garmin watch during the supine rest phase. However, both watches were inaccurate during Bruce stages 2 and 3. Both watches were accurate during all other phases. Ultimately, the accuracy of the HR measurements decreased as exercise intensity increased.
Key Words: Smart watches, heart rate, exercise

The Effect of Direct Sensory Electrical Stimulation of the Hamstring Muscles on Hamstring Extensibility

Student Researchers:  Nathan Dyer SPT, Elie Hsu SPT, Nichole Raaf SPT, Lauren Estes SPT, Courtney Vick SPT
Faculty Mentor:  Cathy Hinton PT, PhD
Objective: To examine the effect of sensory-level electrical stimulation on hamstring extensibility in those with tight hamstrings.
Design: Randomized controlled trial
Methods: Researchers found 29 subjects having less than 75 degrees of popliteal angle  available.  Participants who met all inclusion/exclusion criteria used a coin to decide between control or experimental group and which lower extremity would be tested.  Controls had the popliteal angle measured, followed by a stretch applied (30 seconds on, 30 seconds off, 3 times) to their hamstrings in the popliteal position.  They were then re-measured to obtain a post-test value.  The experimental group followed a similar protocol, however after obtaining the pre-treatment measurement sensory-level electrical stimulation was applied to their hamstrings.  They then stretched and were also re-measured.  The parameters for the electrical stimulation were asymmetrical pulsed biphasic current, pulse duration of 50 µs, frequency of 150 pps, amplitude to produce a tingling sensation, applied for 20 minutes.  The data was analyzed in SPSS using a mixed, two-way ANOVA.
Results:  The study did not find a significant difference between the control and experimental groups (p=0.732 >0.05) or in the interaction of time and group (p=0.907 >0.05).  However, a significant difference was found in pre- and post-test measurements in both the control and experimental group (p=0.000 <0.05).
Conclusions: This study did not find that sensory-level stimulation applied to the hamstrings increases extensibility but stretching them was shown to make a significant difference.  More studies are needed to explore the effects of electrical stimulation on tissue extensibility.
Key Words: Electrical stimulation, hamstring, extensibility

Does using electromyography feedback improve physical therapy students’ dry needling accuracy when asked to dry needle specific muscles?

Student Researchers:  Kendall Knisley SPT, Russell Cook SPT, Dakota Herren SPT, Michelle Klontz SPT, Spencer Petett SPT
Faculty Mentor: John Halle PT, PhD, ECS
Objective: Dry needling (DN) is a therapeutic technique used for managing neuromusculoskeletal pain and resolving movement impairments.  Since DN pierces the skin, knowledge of underlying anatomy is vital to minimize the potential of an adverse effect.  The purpose of this study was to assess physical therapy (PT) student’s accuracy at DN specific muscles and to assess confidence level with DN.
Design: Mixed 2-Way ANOVA
Methods: Thirty-one second-year Belmont PT students were divided randomly into a control and an experimental group. The experimental group participated in an intervention on electromyography (EMG) orientation and instruction before the DN course, while the control participated in a traditional DN course only. Within three-months post-DN course, all participates needled four lower extremity (LE) and four upper extremity (UE) muscles, chosen by the investigators. Participants also took a pre- and post-test questionnaire assessing the participant’s confidence level with DN.
Results: An increase in accuracy with DN the LE compared to the UE was observed in both groups (p = .002). The experimental group also showed larger mean accuracy values for both the LE and UE needle placements that approached, but did not achieve statistical significance (p = .052).  Both groups confidence increased following the DN course (p = .000).
Conclusion: DN is an effective therapeutic technique used by PTs to reduce pain and improve movement in patients. This study shows that EMG feedback could make PT students more accurate and confident at DN muscles of the LE and UE. During DN educational courses, use of an EMG machine may increase the knowledge and accuracy of the student correctly DN intended muscles.
Key Words: accuracy, confidence, dry needling, EMG, physical therapists, MTrP

Acute Effects of Blood Flow Restriction (BFR) on Physiological Variables During Low Intensity Treadmill Walking

Student Researchers:  Justin Avila SPT, Chase Batty SPT, Clay Henson SPT, Lindsay Jackson SPT, Kara Mae Sheft SPT
Faculty Mentors:  Patrick Sells DA
Objective:  Determine responses of the acute hemodynamic and myocardial changes that occur during BFR training using a treadmill walking protocol.
Design:  Repeated Measures Design
Methods:  The present study was conducted using 13 male and female participants (mean age 25 土 2.81) who took part in a 9-minute treadmill walking protocol at a constant speed of 3.0 mph and 0.0% grade, data were collected before (resting), during exercise and during recovery as indicated via  protocol.  Each subject completed the assessment under two (2) conditions, once with BFR applied and once without.  Dependent variables included; heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), rate pressure product (RPP) and rate of perceived exertion (RPE).
Results:  Results were significant increases in all variables under the  BFR condition throughout the protocol.  These results represent a significantly (p<0.05) higher myocardial and hemodynamic workload while using BFR which was equated to an approximate two MET increase in intensity at the same workload.  No participants experienced adverse reactions during the protocol.
Conclusion:  BFR training has been an area of growing interest in the fitness and rehabilitation field.  The full potential risks and benefits of BFR are unknown at this point but research such as this helps to fill those gaps.  Further research is needed to establish normative values for acute cardiac responses and to further investigate the effects of BFR training.
Key Words:  Blood Flow Restriction (BFR), Hemodynamics, myocardial demand (RPP), Vascular Occlusion

The Use of Proximal Hip Strength and Kinematic Motion to Identify Dancers at Risk for Lower Extremity Injury

Student Researchers:  Eric Bengtson SPT, MA, ATC, Kristyn Harris SPT, Meredith Massengale SPT, Ross Gentry SPT  
Faculty Mentor:  Kevin Robinson PT, DSc, OCS
Objective: Investigate the influence of hip musculature strength and lower extremity motion on injury among the professional ballet dancer population.
Design: Retrospective Cohort
Methods: Strength was tested via handheld dynamometer for the Gluteus Maximus & Gluteus Medius muscles. Motion was measured at peak knee flexion using myoMOTION^TM biomechanics analysis system for hip rotation, hip abduction, and knee abduction angles during 3 movement tasks: a single leg (SL) step down from a 12 inch block, a SL demi-plié with feet in parallel position, and a SL demi-plié with feet in turn-out position. “Injury” was defined as pain necessitating absence from a performance or rehearsal. Data was collected over a three year period during the dance company “off-season” (June-July). Injury data was collected by the company medical staff and given to the researchers at the end of each “performance-season” (August-May). Dancers were then sorted into uninjured and injured groups.
Results: 51 subjects were tested over a 3 year period. 15 sustained injuries (29.4%). There was no statistically significant difference between uninjured and injured dancers regarding strength or motion for any of the activities or joint angles. There was a statistically significant difference between right and left legs in numerous positions.
Conclusion: While statistical significance was demonstrated between legs during each of the three movement tasks, there was no statistically significant difference demonstrated between uninjured and injured dancers regarding strength or kinematic data. These results indicate the need to test dancers in a moving or fatigued state to better identify injury risk.
Key Words: Ballet, Injury screen, Strength, Motion analysis

Investigation of an Eight-Week Neuromuscular Training Intervention on Biomechanical Parameters of the Lower Quarter in Collegiate Pivoting Athletes

Student Researchers:  Tyler Hoek SPT, Tiffany Bennett SPT, Sheyenne Turk SPT, Zach Petrosky SPT
Faculty Mentors:  Craig Parker PT, DPT, Kevin Robinson PT, DSc, OCS, Patrick Sells DA, John Halle PT, PhD, ECS
Objective: Evidence supports implementing neuromuscular training (NMT) to improve biomechanics related to anterior cruciate ligament (ACL) trauma in pivoting athletes, and there is a clear link between fatigue and dynamic stability of the knee. There is a paucity of research examining the ability of NMT to improve pathomechanical movement behavior during fatigued states. This investigation assessed strength, balance, and functional biomechanics following a fatigue protocol in collegiate athletes following a NMT intervention.
Design: Repeated Measures
Methods: 23 Division II NCAA soccer players ages 18-23 participated. Hip strength was measured with hand dynamometry and single-leg stance modified balance (SLSM) was measured in multiple conditions. The Noraxon MyoMotion system assessed peak hip and knee excursion during movements following a fatigue protocol. Participants completed an eight-week, 16 session NMT intervention, and measurements were repeated.
Results:  Following the intervention, significant improvements were found in: hip abduction strength R (p=0.000), L (p=0.001); hip extension strength R (p=0.001), L (p=0.000); SLSM eyes-closed condition R (p=0.000), L (p=0.001); SLSM unilateral heel rise condition bilaterally (p=0.000); peak ROM for single-leg jump L knee flexion (p=0.037), single-leg squat knee flexion R (p=0.017), L (p=0.005), and single-leg squat R hip rotation (p=0.001), L knee abduction (p=0.005).
Conclusions:  These data indicate an eight-week NMT intervention is sufficient to elicit positive neuromuscular adaptations in the lower quarter related to ACL pathomechanics, and promote resilience with dynamic loading during states of fatigue associated with injury. More research is needed to develop the efficacy of such interventions in various at-risk populations.
Key Words:  Neuromuscular training, fatigue, injury prevention

Hip Rotational Range of Motion and Driving Distance in PGA Tour Golfers

Student Researchers:  Clint Lester SPT, Jack Davis SPT, Shelby Smith SPT, Ryan Tapp SPT
Faculty Mentor:  Mike Voight  PT, DHSc, SCS, OCS, ATC, CSCS, FAPTA
Objective: (1) investigate relationship between hip internal and external ROM and driving distance, (2) establish if hip ROM differed between top and bottom ranked golfers, (3) investigate an asymmetry between trail and lead leg ROM.
Design:  Retrospective study.
Methods: The top and bottom 25 PGA tour players in terms of driving distance were selected. Hip ROM data was obtained for 16 of the top 25 and 15 of the bottom 25 ranked golfers.  IR, ER, and total arc were compared to driving distance using a Pearson correlation.  A t-test was run to determine significance between the two groups for IR, ER, and total arc. A paired t-test between the trail and lead leg total arc was run for both groups.
Results: There was a correlation (r=0.77) between lead leg total arc ROM and driving distance, and lead leg IR and driving distance (r=0.86). Lead leg IR and total arc were significantly greater in the top golfers compared to the bottom (p=0.00; p=0.00 respectively). The top golfers had a significant increase in lead leg total arc ROM compared to trail leg (p=0.00), not observed for bottom golfers (p=0.09)
Conclusions: There was an asymmetry observed between trail and lead leg hip ROM in the top 25 golfers.  A strong correlation between both hip IR and total arc ROM and driving distance was observed.  This suggests increased hip IR and total arc might contribute to increased performance when driving a golf ball.
Key Words: Hip ROM, Golf, Driving Distance

An Animal-Assisted Intervention’s Influence on Graduate Students’ Stress and Anxiety Prior to an Examination

Student Researchers:  Kristen Emond SPT, Kara Maynord SPT, Julie Simpkins SPT, Allie Stumbo SPT, Traci Terhaar SPT
Faculty Mentor:  Christi Williams PT, DPT, OCS, Cert MDT
Objective: To observe the effects that an animal-assisted intervention has on stress and perceived anxiety in graduate-level students before a practical exam.
Design: Randomized controlled trial.
Methods: Thirty-nine graduate-level students (12 males, 27 females) from Belmont University’s pharmacy and physical therapy programs consented to participate in this study. Physiological stress levels were measured by gathering heart rate and blood pressure, and anxiety was measured using the State-Trait Anxiety Inventory (STAI). Baseline measurements were taken at times during the semester when students did not have exams in the near future. Measurements were repeated immediately before a practical examination following either an interaction with a registered therapy dog (experimental) or quiet time spent engaging in normal pre-exam routines, such as studying (control group).
Results: A significant difference was observed on exam day between the control group and the experimental group on state anxiety (P=.008). Those who experienced the therapy dog intervention reported significantly lower anxiety levels before their exam. No significant effects of the therapy dog were observed for heart rate, systolic blood pressure, or diastolic blood pressure (P>0.05).
Conclusion: The results of this study indicate that interactions with a registered therapy dog may assist in reducing the anxiety of graduate students prior to a practical examination.
Key Words: Animal-assisted intervention, Anxiety, Blood pressure, Heart rate, State-Trait Anxiety Inventory

The effect of warm-up on club head speed in recreational golfers

Student Researchers:  Jacob Huitt, SPT; Griffin Moore, SPT; Andrea Thomas, SPT
Faculty Mentors:  John S. Halle, PT, PhD, ECS
Background: Past research with low handicap golfers (indexes < 10), demonstrates that club head speed is maximal following a warm-up, with a club head speed decrease following a break of just five minutes.  Since club head speed is associated with longer drives and improved play, this research was conducted to see if the impact of warm-up on club head speed was consistent with recreational golfers with an index > 10.
Purpose: To investigate the effect of wait time after warm-up on club head speed in male and female recreational golfers.
Methods: 53 subjects (28 males, 25 females) with a United States Golf Association (USGA) index >10 participated in this study. Subjects were randomly assigned to three wait time groups (5 minutes, 10 minutes, 15 minutes). Subjects were asked to warm-up with five predetermined clubs, then strike the ball five times with a driver. A TrackMan Doppler Launch Monitor was used to measure club head speed. After waiting the allotted amount of time, subjects performed five swings with a driver and club head speed was recorded.  The three highest club head speeds were recorded and analyzed in each case.
Results: Three mixed two-way ANOVA’s were performed, analyzing change in club head speed in males, females, and the differences between males and females. The results of this study demonstrate that club head speed following warm-up generates the highest speeds, and that wait time negatively impacts club head speed gains in males (p=0.001) and females (p=0.012).
Limitations: Broad inclusion criteria of USGA index above 10 led to high skill variability, with less consistent ball-striking compared to low index golfers.
Conclusion: Golf specific warm-up leads to increased club head speed with gains in speed lost after just five minutes.

Determining Level of Agreement Between Individual Raters and Computer Observed Scores for the Balance Error Scoring System

Student Researchers:  Lauren Williams, Bruce Alter, Christopher Beavers, Stevie Hughey
Faculty Mentors:  Pat Sells  D.A.,  CCES
Background: It is estimated that there are 1.7 million sports-related traumatic brain injuries (TBI) a year, and many more go undiagnosed. Due to this increasingly prominent injury, there is a need for quick and easy diagnosis for future prognosis. The Balance Error Scoring System (BESS) has been the standard to determine postural stability for individuals post concussion while on the sideline. There continues to be debate of the intra and interrater reliability. The purpose of this research was to determine the level of agreement between individual raters and Trazer, a computer based score, when administering the BESS. Trazer is a computer based simulation that tracks up to 25 points on the human body to measure precise movements of the subject. We hypothesized that there will be no significant difference in level of agreement among raters when compared to Trazer motion analysis device.
Subjects: There were 26 total participants in the study who met the inclusion and exclusion criteria.
Methods: : Participants completed the BESS test on the Trazer system and errors were calculated from Trazer and simultaneously counted and logged by 4 other raters. ICC (2,1) and (3,2) were ran via SPSS to compare the intra and inter rater reliability for each of the 6 conditions on the BESS test.
Results:  Interrater reliability and intrarater reliability indicated “good correlation” with values of 0.715 and 0.738 respectively.
Discussion: : Although causation cannot be inferred, the results suggest that the Trazer system can be implemented independently in scoring the BESS test. Traditionally, the BESS test has been administered by individual raters, but results substantiate that this could be a stand-alone tool for concussion protocols.

The Use of Hand Dynamometry and Motion Analysis in the Preseason Injury Screen of Professional Ballet Dancers

Student Researchers:  Rebecca Bagley, SPT; Susan Keim, SPT; Colleen Gensheimer, SPT; Turner Gerbig, SPT
Faculty Mentors:  Kevin Robinson, PT, DSc, OCS, Pat Sells, DA, CCES
Background: Professional ballet dancers are at risk for lower extremity injuries due to acquired asymmetries in hip musculature from repetitive movement patterns. Currently, there are no standards for professional ballet dancers concerning isometric force production, measured in percent body weight, of hip musculature.
Objective: Examine data collected during the 2014-2016 preseason Dance USA injury screening of a professional ballet company to determine existence of asymmetries in the gluteus medius and maximus, as measured by percent body weight with hand dynamometry; and to determine asymmetries of knee joint angles in the transverse and frontal planes using Myomotion analysis.
Methods: Subjects included thirty professional ballet dancers in the first company of a professional ballet company. Each dancer underwent the Dance USA screen with the additional use of a hand dynamometer for manual muscle tests of bilateral gluteus medius and maximus. Additionally, 3D Myomotion data of the dancers’ lower extremities was analyzed while performing demi-plies in both parallel and turn out positions.
Results: : The data of the combined 2014-2016 seasons demonstrates a significant difference between right and left gluteus medius (p = .004) and maximus (p = .001) isometric force, measured in percent body weight. Additionally, a significant difference was found between right and left knee abduction and adduction angles in the frontal plane during demi-plie in parallel (p = .002) and turnout (p = .007) measured with 3D Myomotion analysis software.
Conclusions: Asymmetries in isometric force of the gluteus medius and maximus in addition to asymmetries of angles of the knee in the frontal and transverse plane may lead professional ballet dancers to be susceptible to injuries.

Investigation of a Three-week Neuromuscular Training Intervention on Biomechanical Parameters of the Lower Quarter in Female Collegiate Pivoting Athletes.

Student Researchers:  Rachel Schmidt, SPT; Erin St.Pierre, SPT; Morgan Springer, SPT; Ashley Villm, SPT
Faculty Mentors: Craig Parker, PT, DPT, Kevin Robinson, PT, DSc
Background/Purpose: Evidence has identified how neuromuscular training (NMT) can improve biomechanics related to anterior cruciate ligament (ACL) injury during dynamic pivoting movements. This investigation examined the strength, balance, and lower quarter biomechanics of select functional movements in female collegiate athletes before and after a three-week training intervention, and the influence of NMT on power-based motion correlated to sport performance.
Study Design: Non-randomized Controlled Follow-up Study 
Methods: 17 Division I NCAA female soccer players ages 18-21 participated, averaging a height of 167.79cm and weight of 65.87kg. Hip strength was measured with hand dynamometry. Single-leg stance modified balance (SLSM) was measured with eyes closed and in static heel rise conditions. A Noraxon MyoMotion system assessed peak hip and knee excursion during select movements. Vertical jump height was recorded. Six one-hour NMT sessions for lower quarter training were performed over three weeks. Tests were then repeated.
Results: Significant improvements post-intervention were found in hip abduction strength bilaterally (p=0.000) and hip extension strength right (p=0.002) and left (p=0.000); SLSM with eyes-closed on right (p=0.002) and left (p=0.000); SLSM with heel rise bilaterally (p=0.000); and vertical jump height (p=0.000). Hip abduction ROM during single-leg squat (p=0.001) and knee flexion during single-leg jump tests (p=0.001) increased significantly post-intervention.
Conclusion: Following the intervention, proximal hip strength, balance, and power with vertical jump significantly improved, indicating positive neuromuscular adaptations. The MyoMotion system identified improved kinematics during single-leg squat and single-leg jump associated with decreased injury risk. These findings support the hypothesis that improving lower quarter movement patterns an facilitate performance enhancements.

Effect of Thigh Angle on Ground Reaction Force and Maximum Vertical Jump Height During a Drop Vertical Jump Test

Student Researchers:  Emory Bearman, SPT, Andrew Bult, SPT, Drew Dudek, ATC, SPT, Travis Henry, SPT, Kevin Hovde, SPT
Faculty Mentor: Christi Williams, DPT, OCS, Cert. MDT
Background: Injuries to the anterior cruciate ligament (ACL) and lower extremity are very common in sports that require repetitive landing and quick change of direction maneuvers. High-impact maneuvers combined with deceleration and landing from a jump place a large amount of force through the knee joint. Motion capture systems and force plate technology have been used to analyze landing mechanics and ground reaction force (GRF), but this technology is expensive, immobile, and not easily accessible.
Purpose: The purpose of this study was to examine the effect of a thigh angle (TA) measurement (the angle of the femur relative to horizontal at peak knee flexion) on GRF and maximum vertical jump height (MVJ) during a drop vertical jump (DVJ) task. Our hypothesis was that individuals who land with a smaller TA will have a lower mean peak GRF
Methods: Fifty-six healthy subjects including 38 females and 18 males performed a DVJ onto a force plate followed by a MVJ. Peak GRF, MVJ height, and TA at peak knee flexion were measured. Subjects were categorized into two groups based on their TA measurement; category 0 (TA >45 degrees) and category 1 (TA ≤45 degrees).
Results: Category 1 thigh angles landed with a significantly lower GRF (3.01 times body weight) than Category 0 (3.46 times body weight) (p=.001). Mean MVJ height for category 0 TA was 15.32 inches while MVJ height for Category 1 was 16.92 inches with no statistical significance observed (p=.191).
Conclusion: Individuals with a TA < 45 degrees when landing from a DVJ demonstrated a lower GRF and therefore a TA measurement may be a quick, simple, inexpensive method to assess an individual’s ability to absorb force during landing tasks.

The impact of hip abduction elastic-resisted neuromuscular feedback on frontal plane knee kinematics in female volleyball athletes

Student Researchers: Margaret Chidester, SPT; Lexis Hardiek, SPT; Sean Macko, SPT; Zachary Sexton, SPT;
Faculty Mentor:  Mike Voight , PT, DHSC, OCS,SCS,ATC,FAPTA, Phil Page, PT, PhD
Background/Objective:  Knee valgus collapse has been identified as a risk factor for knee injury.  Knee injury prevention programs emphasizing knee separation distances have demonstrated the ability to diminish the loss of valgus control and are associated with decreasing knee injury risk.  The purpose of this study was to examine the impact of hip elastic-resisted neuromuscular feedback on frontal plane knee abduction during the performance of a counter jump maneuver. 
Methods: Twenty female volleyball athletes, mean age 16.4 +/- 1.6 years were randomly assigned into either a control (no training) or a neuromuscular intervention (training) group.  The distances between the hips, knees, and ankles were measured during a drop-jump test via Dartfish Pro video analysis software for both groups.  Prior to a practice session, the athletes in the intervention group performed 30 repetitions of a deep squat with variable resistance applied around the distal thighs and a squat guide to provide tactile feedback on proper lower quarter positioning.  Following the neuromuscular intervention, the jump landing characteristics of both groups were re-examined before practice and again at 60 minutes.
Results: After the squat training, statistically significant increases were found in the absolute (P<.001) and normalized knee and ankle separation distances (P<.001) for both phases of the jump-land sequence both immediately following the training and at 60 minutes after training.
Conclusion: After an elastic resisted neuromuscular training intervention, the trained athletes had improved knee separation distances and a more neutral limb alignment on landing and takeoff as compared to the control group.

The Effects of Neuromuscular Electrical Stimulation on Hamstring Extensibility

Student Researchers: Demmie Durham, SPT; Nakia James, SPT; Barbara Parks, SPT; Mitchell Silvers, SPT, CSCS
Faculty Mentors: Cathy Hinton, PT, PhD
Background: Limited hamstring extensibility has been shown to cause a variety of musculoskeletal issues. Previous studies focused on improving extensibility are inconclusive on the benefits of combining a stretching technique with a modality in order to increase muscle length. There is limited evidence on the effects of electrical stimulation on the hamstring extensibility.
Purpose: To investigate the effect of neuromuscular electrical stimulation prior to stretch on hamstring extensibility.
Design:  A randomized controlled trial was conducted with 50 healthy subjects (26 females, 24 males, ages 20-40).
Intervention: Subjects were randomly divided into two groups. One group received neuromuscular electrical stimulation and stretching protocol and the other received the stretching protocol only. Hamstring length was measured both pre and post treatment using the popliteal angle test. 
Results: A mixed two-way analysis of variance was conducted. There was no significant difference found in the improvement of hamstring extensibility between the treatment and the control group (p = .794).  A significant difference was observed between pre and post trials for both groups (p=.000).
Limitations: The statistical power of this study could be improved with a larger sample size. Human error could result in inaccurate goniometer measurements as well as patient error in participating in stretching protocol.   
Conclusion: The results show that there is not a significant increase in hamstring extensibility when combining a stretching protocol with neuromuscular electrical stimulation on the antagonist muscle. However, there was significance seen in both groups pretest and posttest scores regardless of intervention. These results conclude that neuromuscular electrical stimulation likely does not have an effect on hamstring extensibility.

Accuracy of the iPhysioMeter Heart Rate Monitoring Application

Student Researchers: Ellen Bogue, SPT; Angelo Bologna, SPT; Mary Alicia Bowden, SPT, EP-C; Li Yin Goode, SPT; Rachel Wolfe, SPT
Faculty Mentors: Suzanne Greenwalt, PT, DPT, CCS, GC
Background: Heart rate (HR) monitoring applications (apps) for smartphones represent an area of ongoing research. Standard HR monitoring pulse oximeters utilize light sensors to acquire HR data via photoplethysmography (PPG). By employing a smartphone’s camera and processing software, a smartphone can measure HR with PPG.  
Objective: This study investigates the accuracy of the iPhysioMeter smartphone HR monitoring app while subjects exercise on a treadmill.
Design: 28 subjects (age 21-29) participated in this study, following a repeated measures design.
Methods: HR was measured with iPhysioMeter on an iPhone 6s, a pulse oximeter, and 12 lead ECG.The first three stages of the Bruce Treadmill Protocol were followed as standardized exercise testing. HR was taken in supine, seated, standing, at every stage of the protocol, and post-exercise.
Results: ANOVA and post-hoc analysis of HR data revealed significant differences between the elevated HR readings of the ECG and pulse oximetry at Bruce 3, and between the ECG and the iPhysioMeter app at Bruce 2 and Bruce 3. No significant differences were noted in resting values or for Bruce 1 for all three devices.  
Limitations: This study focused on a controlled exercise protocol and secured the phone to the participant’s hand, which may not accurately reflect how the iPhysioMeter app would be used by the general population.  Factors such as cold testing environment, calibration issues, dynamic movement, and EKG placement could have impacted results.
Conclusion: HR monitoring apps pose an attractive alternative to expensive HR devices due to their usability and affordability. However, this study demonstrates the limited validity of both iPhysioMeter and pulse oximetry during exercise at elevated HR.

Determining the effect of BMI and gender on normal values for spinal accessory nerve conduction from upper and middle trapezius

Student Researchers:  Kathryn George, SPT; Helen Dean, SPT; Rachel Foster, SPT; Ashley Stickler, SPT
Faculty Mentors: Kathleen Galloway, PT, DSc, ECS
Background: The spinal accessory nerve (SAN) supplies the trapezius and sternocleidomastoid muscles. The SAN is commonly damaged in surgeries involving the posterior triangle of the neck as well as various traumas. Damage can cause decreased quality of life due to abnormal shoulder mechanics and pain. Diagnosis of SAN injuries is difficult due to lack of recent normal nerve conduction values including values for differing genders and BMI.
Methods: Bilateral surface SAN conduction studies were performed on 69 healthy individuals with recording from the upper and middle trapezius. Subjects were categorized by gender (male n=21; female n=48) and BMI (BMI<25 n=43; BMI>25=26).
Results: Males had significantly longer latencies than females in both the upper and middle trapezius (p=0.001; p=0.000). Individuals with normal BMI had higher amplitudes than those with high BMI in the upper and middle trapezius (p=0.000; p=0.033). The side to side percent differences for latency in the upper and middle trapezius were 7.80% and 9.55% respectively. Side to side percent differences in amplitude for the upper and middle trapezius were 18.20% and 37.63% respectively.
Discussion: Upper trapezius latency was consistent with previous studies. However, middle trapezius latency was faster than previously reported. Mean SAN amplitude values were reported in this study, but demonstrated high variability. Latency was found to be significantly affected by gender, and a mplitude by BMI, suggesting that these factors should be taken into account when interpreting surface nerve conduction findings from the SAN. The large side to side and between subject variability found for amplitude suggests that this finding alone cannot be used for diagnosis of SAN pathology.

A Comparison of Performance in Children with Known Balance Dysfunction and Children Developing Typically on the Revised Pediatric Balance Scale (PBS-II)

Student Researchers: Lauren Buck, SPT; Anna Flouras, SPT; Hannah Frazier, SPT; Shelby McIntire, SPT; Sarah Williams, SPT
Faculty Mentors: Nancy Darr, PT, DSc, NCS
Background: The PBS-II, a revised version of the original Pediatric Balance Scale, is a 20-item outcome measure used to identify children who lack age-appropriate balance, and to track improvement with intervention. The purpose of this study was to compare performance of children with known Balance  dysfunction (BD) to children with typical development (TD), as well as, to examine the effects of age and gender on children’s PBS-II performance.
Methods: The PBS–II was administered to a total of 405 children, ages 2 12to 12 years, 341 with TD and 64 with known BD.  Items were each scored on a 0 to 4 point scale and summed to determine total PBS-II total test score (TTS).  Children were grouped by age  in one year increments and sex, as well as, presence or absence of BD for data analysis.  Two-way ANOVAs with Tukey HSD post hoc analyses were used to examine the effects of age and disability status, as well as, the effects of sex and age for children with TD on PBS-II TTS.
Results: PBS TTS significantly improved between ages 2 and 12 for children with TD and for those with BD. (F=68.130, df=23, p<0.000). Age (F=51.615, df=11, p<0.000) and disability status (F=114.397, df=1, p<0.000) significantly affected PBS TTS.  In the children with TD, age (F=,149.720 df=11, p<0.000) and sex (F=6.660, df=1, p<0.010) significantly affected PBS TTS.   In the group with TD, girls significantly outperformed boys in most age groups.
Discussion: PBS data for children with TD can be used to create typical performance values based on age and gender in order to identify BD in undiagnosed children.  Expected PBS TTS performance values for children with BD could not be established  because performance in this group varied greatly between and within age groups.  

Effects of educational intervention versus standard care on functional mobility in patients using tilt-in-space (TIS) and recline

Student Researchers: Katie Burn, SPT; Sara Hogan, SPT; Cara Martin, SPT; Maria Martino, SPT;
Faculty Mentors:  Renee Brown, PT, PhD, Penny Powers, PT, MS, ATP
Background: The use of tilt in space (TIS) and recline for pressure relief by wheelchair users has proven to reduce pressure injuries, however, many patients do not properly utilize these features. The purpose of this study was to determine whether the addition of an educational program highlighting the TIS/recline features would increase patient compliance to the recommended levels.
Subjects: Sixteen full time power wheelchair users (28-75 yo) were recruited from the Seating and Mobility and MD/ALS clinics.
Methods: The experimental group (n= 4) received an education program regarding TIS/recline at their wheelchair fitting. After one month, compliance to tilt and recline recommendations was reassessed using a survey and the functional mobility assessment (FMA) was administered. Control group (n=12) received usual care.
Results: The mean FMA pre-test score for the experimental group was 45.25 and post-test score was 53.00. The mean FMA score for the control group was 50.25. The experimental subjects achieved >35 degrees of tilt, but did not achieve the recommended recline. Three subjects in the control group achieved >35 degrees of tilt and five subjects achieved >120 degrees of recline. 81% stated they tilted/reclined “because I am uncomfortable” while 50% stated “because my therapist told me to”.
Limitations: Subject recruitment was limited due to lack of transportation.
Conclusion: The results indicate the need for further education in order for patients to consistently achieve the recommended tilt and recline for adequate pressure relief to prevent pressure injuries. Further research is needed to determine the efficacy and timing of education.