IU Indianapolis ScholarWorks :: Browsing by Author "Altenburger, Peter"

Browsing by Author "Altenburger, Peter"

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Change in Depression, Confidence, and Physical Function Among Older Adults With Mild Cognitive Impairment
(Wolters Kluwer, 2019-09-01) Ellis, Jennifer L.; Altenburger, Peter; Lu, Yvonne; Physical Therapy, School of Health and Rehabilitation Sciences
Background and Purpose Nearly a quarter of those in the US over age 71 experience mild cognitive impairment (MCI). Persons with MCI (PwMCI) battle depression and progressive disengagement from daily activities, which contribute to participation restriction and activity limitation. Daily engagement in meaningful activity (DEMA) is a tailored intervention designed to benefit PwMCI and their caregivers through preserved engagement and supported adjustment to cognitive changes. This secondary analysis was guided by the International Classification of Functioning, Disability and Health (ICF) model. Aims were to (i) explore the extent to which change in self-rated activity performance and physical function can predict change in depressive symptoms, (ii) evaluate for difference in confidence and depressive symptoms at ICF levels of activity and participation, and (iii) quantify the impact of daily engagement at the ICF level of participation on physical function. Methods A secondary analysis was conducted using data from the parent study, which was a two-group randomized trial involving PwMCI and their informal caregivers participating in the Indiana Alzheimer Disease Center DEMA program. Quantitative analysis (dyads: DEMA N = 20, Information Support N = 20) examined outcomes at posttest and follow-up. Analysis employed linear regression to model the relationship between explanatory and dependent variables and independent t-test to examine for difference in confidence, depression, and physical function. Results and Discussion At posttest, change in self-rated performance predicted change in depressive symptoms. Those in the DEMA group who engaged in activity at the ICF level of participation demonstrated a significant increase in confidence and physical function. Although not significant, the control group posttest results showed a mean decrease in confidence. Conclusions Results demonstrate a positive impact of DEMA on depressive symptoms, confidence, and physical function. Change in occupational performance predicted change in depressive symptoms. Confidence significantly improved among those who engaged at the ICF participation level. A larger, randomized controlled longitudinal trial is needed to better assess the impact of DEMA on physical function, activity, participation restriction and quality of life.
Changes in Walking Spatiotemporal Parameters After Therapeutic Yoga in People with Chronic Stroke
(Iris, 2019) Miller, Kristine K.; Altenburger, Peter; Dierks, Tracy; Mason, Arianne; Van Puymbroeck, Marieke; Schmid, Arlene A.; Physical Therapy, School of Health and Rehabilitation Sciences
Walking limitations after stroke can contribute to long-term functional impairments. Walking characteristics such as spatiotemporal step parameters may be associated with these persistent walking limitations. The purpose of this study was to investigate changes in specific spatiotemporal walking parameters such as: walking speed; step length; swing time; step parameter symmetry; and double support time in adults with stroke who were participating in a therapeutic yoga intervention. The therapeutic yoga intervention was offered as a post-rehabilitation wellness activity 2 times per week for 8 weeks and was led by a yoga therapist. Spatiotemporal walking data were collected using the GAITRite Walkway System on a sub sample (n=24) of participants in a randomized controlled trial testing the efficacy of therapeutic yoga for improving balance in adults with chronic stroke. These data demonstrated that therapeutic yoga may have a positive impact on some spatiotemporal walking characteristics such as comfortable walking speed, step length, and double support time, while other spatiotemporal walking characteristics did not change (step parameter symmetry) or change at a significant level (sustained walking speed). The clinical relevance of this study is that participation in therapeutic yoga as a post-rehabilitation wellness activity may have a positive impact on walking characteristics in adults with chronic stroke.
Contributing Factors for Opioid Misuse Among U.S. Adolescents
(2019-10) Hurse, Deidre N.; Arnold, Brent; Altenburger, Peter; Goering, Elizabeth; Saha, Chandan; Agho, Augustine
The United States is amidst an opioid overdose epidemic. Even with significant gaps in surveillance data on opioid-related deaths, the problem is undeniable and requires a systemic response. Despite the dangerous effects of opioid misuse, pathways that lead to opioid abuse for young people is understudied. This study sought to understand factors related to opioid misuse among youth. An exploratory approach used data from both quantitative and qualitative sources. The convergent parallel mixed method design used secondary data from a biannual school-based survey and three oral interviews. While opioid misuse is not limited to heroin, the 2013, 2015, and 2017 Youth Risk Behavior Surveillance Survey (YRBS) was used to determine associations between predictor variables and heroin use. Oral interviews added the perspective of adolescent users and were inclusive of persons that misused prescription and other forms of opioids. The synchronization of data analysis allowed observations to impact the study direction unilaterally. Opioid misuse for youth was related to experiences, access, and divergent substance use. Traumatic stressors, such as physical dating violence and sexual dating violence, had the most substantial relationship with heroin misuse. Findings confirmed that ease of access had a relationship with misuse. It is unclear if opioid misuse was a result of polysubstance use. However, the study identified that divergent substance use was correlated with opioid misuse in this population. The study findings support the use of early intervention before high school. Prevention must be inclusive of primary, secondary, and tertiary approaches. Future prevention for youth can be enhanced by addressing resilience from trauma, reducing access to opioids and addressing alcohol, and substance use among youth. Adopting a framework that acknowledges the root causes of misuse, can mitigate the impact of the opioid crisis and save lives.
The Effect of Locomotor Assisted Therapy on Lower Extremity Motor Performance in Typically Developing Children and Children with Cerebral Palsy
(2019-05) Scheidler, Capi Seeger; Altenburger, Peter; Bahamonde, Rafael; Miller, Kristine; Hamby, Deborah
Background: Ambulation is critical to a child’s participation, development of selfconcept, and quality of life. Children with cerebral palsy (CP) frequently exhibit limitation in walking proficiency which has been identified as the primary physical disability. Traditional rehabilitative treatment techniques to improve ambulation for children with CP reveal inconsistent results. Driven gait orthosis (DGO) training is a novel approach focusing on motor learning principles that foster cortical neural plasticity. Objective: The objectives are to determine if: (i) the lower extremity muscle activation patterns of children with CP are similar to age-matched TD children in overground (OG) walking, (ii) DGO training replicates muscle activation patterns in OG ambulation in TD children, (iii) the lower extremity muscle activation patterns in OG walking of children with CP are similar to their muscle activation patterns with DGO assistance, and (iv) DGO training promotes unimpaired muscle activation patterns in children with CP. Methods: Muscle activity patterns of the rectus femoris, semitendinosus, gluteus maximus and gluteus medius were recorded in the OG and DGO walking conditions of children with CP and age-matched TD. The gait cycles were identified and the data was averaged to produce final average gait cycle time normalized values. Results: In comparing the variability of the muscle activation patterns within the subject groups, CP DGO walking was considerably lower than CP OG. In comparing the muscle activation patterns in each condition, consistent differences (p < .05) were noted in terminal stance, pre-swing and initial swing phases of gait with the DGO condition consistently revealing greater muscle unit recruitment. Conclusion: The results indicate that training in the DGO provided the ability to practice with measurably repetitive movement as evidenced by decreased variability. Consistent differences were noted in muscle activation patterns in the terminal stance, pre-swing and initial swing phases of gait when most of these muscles are primarily inactive. The alteration in ground reaction force within the DGO environment may play a role in this variance. With the goal of normalizing gait, it is important that the effect of these parameters on ground reaction forces be considered in the use of DGO rehabilitation.
The Effectiveness of Robot-Assisted, Task-Specific Ankle Training in Improving Deficits Across the Three Domains of the ICF in Children with Cerebral Palsy (CP)
(2018-11) Alotaibi, Madawi H.; Arnold, Brent; Altenburger, Peter; Munk, Niki; Dierks, Tracy
Cerebral Palsy (CP) is considered to be the leading cause of motor disability among children. Children with CP present with multiple physical impairments including decreased strength and range of motion (ROM), increased spasticity, and poor balance and coordination. These impairments often lead to limitations in ankle motor control that impacts balance and gait function, which puts children at a higher risk for developing other problems. In recent studies, robotic devices have been developed to address poor motor control of the upper and lower extremities. Aim: The aim of this study is to investigate the extent to which the robot-assisted, taskspecific ankle trainer improve deficits across the three domains of the International Classification of Functioning, Disability and Health (ICF) in children with CP. Method: This is a quasi-experimental, single group, repeated measure design with four time-testing points through a set training session/protocol. A convenience sample of 5 children with CP were enrolled in the study. All children received 6-weeks of ankle robot training that included two 45-60 minute sessions per week, for a total of 12 sessions. Data from Tardieu Scale of spasticity, Boyd and Graham selective motor control, Pediatric Balance Scale, goniometer, hand held dynamometer, gait mat analysis, accelerometer, LIFE-H for children questionnaires, ultrasound, and robotic evaluation were collected at the different time points (1 week and 1 month pre training and 1 week and 1 month post training). Descriptive statistics and repeated measure (ANOVA) were used with SPSS software for data analysis. Results: All participants showed improvement in 1. Body Function and Structures (ROM, tone, strength, balance, ankle control and performance, and muscle architecture), 2. Activity (gait and activity counts) and 3. Participations over the course of the study. Conclusion: The results revealed the potential of robot-assisted, task-specific ankle training to improve motor performance and capacity at the body function, activity and participation level. Training appeared to have a lasting impact as most gains were maintained one month following training.
The Impact of Yoga on Quality of Life after Stroke
(Office of the Vice Chancellor for Research, 2012-04-13) Schmid, Arlene A.; Van Puymbroeck, Marieke; Miller, Kristine; Altenburger, Peter; Dierks, Tracy; Schalk, Nancy; DeBaun, Erin; Damush, Teresa; Williams, Linda; Chagdes, Stephanie; Dye, Lauren; Moore, Richelle; Racine, Lisa
Abstract Objective: Evaluate the effect of an innovative 8 week yoga-based rehabilitation intervention on 1) stroke specific quality of life (QoL) and 2) activity and participation scores in veterans with chronic stroke. Rationale/Background: Declines in Quality of Life (QoL), activity, and participation are common after stroke. Such declines are related to increased mortality, dependence, and costs. As more people live with long-term effects of stroke, it is necessary to develop innovative and evidence-based rehabilitation and occupational therapy interventions to improve QoL, activity, and participation in people with chronic stroke. Methods: • Participants- Participants included veterans with chronic stroke (>9 months) who had completed all occupational and physical therapy after stroke, reported some residual disability or functional loss after stroke; and scored >4 out of 6 on the Short Mini Mental Status Exam. • Setting- All data were collected in the Rehabilitation and Integrative Therapy lab at an urban university. • Design- This was a mixed methods pilot study of an 8 week yoga-based rehabilitation intervention. Data were collected before and after the 8 week yoga intervention. Data collection was completed by a trained research assistant. We used paired t-tests and Wilcoxon non-parametirc tests as appropriate to compare group change in scores over the 8-weeks. • Measure(s)- Measures included the Stroke Specific Quality of Life scale (SSQoL) (high score=better QoL) to measure QoL and activity and participation were measured with the ICF Measure of Participation and Activity (IMPACT) (low score=less limitations in activity and participation). Both are valid and reliable instruments. Qualitative comments were collected during focus groups after the intervention. Supportive qualitative comments regarding improved QoL and activity and participation are included. All qualitative comments were reviewed by two researchers, and exemplar quotes are included.
Kinematic changes following robotic-assisted upper extremity rehabilitation in children with hemiplegia : dosage effects on movement time
(2018-04-30) Cardinal, Ryan Edward; Altenburger, Peter; Fuchs, Robyn; Massie, Crystal; Warden, Stuart
Background: Rehabilitation Robotics (RR) has become a more widely used and better understood treatment intervention and research tool in the last 15 years. Traditional research involves pre and post-test outcomes, making it difficult to analyze changes in behavior during the treatment process. Harnessing kinematics captured throughout each treatment allows motor learning to be quantified and questions of application and dosing to be answered. Objective: The aims of this secondary analysis were: (i) to investigate the impact of treatment presentation during RR on upper extremity movement time (mt) in children with hemiplegic cerebral palsy (CP) and (ii) to investigate the impact of training structure (dose and intensity) on mt in children with CP participating in RR. Methods: Subjects completed 16 intervention sessions of RR (2 x week; 8 weeks) with a total of 1,024 repetitions of movement per session and three assessments: pre, post and 6 month f/u. During each assessment and intervention, subjects completed “one-way record” assessments tracking performance on a planar task without robotic assistance. Kinematics from these records were extracted to assess subject performance over the course of and within sessions. Results: For all participants, a significant decrease in mt was found at post-test and follow-up. No significant differences were found in mt for age, severity or group placement. A significant interaction was found between treatment day, block and group (p = .033). Significant mt differences were found between the three blocks of intervention within individual days (p = .001). Specifically, significant differences were found over the last block of treatment (p = .032) and between successive treatment days (p = .001). Conclusion: The results indicate that for children with CP participating in RR, the number of repetitions per session is important. We hypothesized that children’s performance would plateau during a treatment day as attention waned, the opposite proved to be true. Despite the high-number of repetitions and associated cognitive demand, subjects’ performance actually trended upwards throughout the 1,024 repetitions suggesting that children were able to tolerate and learn from a high volume of repetitions.
A Model for Providing Free Patient Care and Integrating Student Learning and Professional Development in an Interprofessional Student-Led Clinic
(Wolters Kluwer, 2017) George, Lydia; Bemenderfer, Sara; Cappel, Maggie; Goncalves, Kathryn; Hornstein, Micaela; Savage, Chelsea; Altenburger, Peter; Bellew, James; Loghmani, Terry; Physical Therapy, School of Health and Rehabilitation Sciences
Background and Purpose. The need to reduce the barriers of access and affordability in health care is evident. The Indiana University Student Outreach Clinic (IU SOC) is a community-based, pro bono, interprofessional, student-led clinic dedicated to removing barriers to health care. The purpose of this report is to describe the implementation approach, sustainability efforts, and initial outcomes of this community-based physical therapy clinic model with the aim of making it transparent for others to replicate. Method/Model Description and Evaluation. An overview of the IU SOC, implementation and sustainability of the physical therapy clinic model, and student learning opportunities are described. Keys to successful implementation are enumerated. Learning opportunities include: clinical competency, professional values, civic engagement, interprofessional education and collaborative practice (IPECP), peer mentorship, and leadership development. Outcomes. Preliminary clinic and learning opportunity outcomes collected from patient databases and student surveys and reflections suggest the IU SOC is having a positive impact on the community it serves by providing care patients would otherwise have not received, while simultaneously supporting learning. Patient volume and student participation are expanding. Initial outcomes suggest this model is valuable for the professional growth of future physical therapists. Discussion and Conclusion. The impact of this clinic model on the community and students is just beginning to be realized and understood. Key elements of success are that it's (a) community-based, (b) interprofessional, and (c) highly collaborative. Free, student-led, interprofessional health care clinics may offer an important means for improving health care access while simultaneously preparing entrylevel professionals for practice.
A Volunteer Basketball Clinic for Children with Disabilities: Professional Development Impact on Student-Athletes and Physical Therapy Students
(Association of Schools of Allied Health Professions, 2017) Altenburger, Peter; Wilson, Anne M.; Physical Medicine and Rehabilitation, School of Medicine
The purpose of this study was to assess the change in perceptions of student-athletes, physical therapy students, and parents of children who helped to facilitate an athletic skills camp for children with disabilities. Participants experienced 3 hours of basketball activity yearly. Data were collected for 3 consecutive years from a total of 51 parents, 15 student-athletes, and 22 physical therapy students. Preand post-survey data were evaluated by two independent researchers. Common themes were developed for all participant groups and cross-group comparisons were evaluated. Findings indicated a synergistic benefit for student-athletes and physical therapy students derived from their impact and children with disabilities. Perceptual changes in students included a decrease in fear in working with disabled children, an appreciation for the value of having fun, and increased growth in civic identity and desire to volunteer.

Browsing by Author "Altenburger, Peter"

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