Sandra J Olney | Queen's University at Kingston (original) (raw)

Papers by Sandra J Olney

This chapter summarizes physical therapy assessment as an approach toward rehabilitation of strok... more This chapter summarizes physical therapy assessment as an approach toward rehabilitation of stroke patients. This chapter reviews treatment effectiveness, and provides an overview of the future trends in physical therapy management. A number of functional limitations are primarily treated by physical therapists. These include the ability to move in bed, get in and out of bed, move from sitting to standing, “transfer” from bed to chair, walk, and negotiate environmental barriers such as stairs, slopes, curbs, and rough ground. Arm function and physical endurance are also of primary concern to the physical therapist. The levels of disablement are assessed using a variety of standardized and nonstandardized measurements. A number of functional limitations are primarily assessed and treated by other team members but are themselves affected by concurrent physical therapy. These include activities of daily living, kitchen activities, driving, vocational and leisure activities, and communication skills. The treatment plan is directed by a thorough analysis of findings and by outcome goals set by the patient and family in conjunction with the therapist. Process goals, or short-term goals, are used to direct individual treatment sessions and are related directly to the outcome goals.

Acta Fisiátrica, Apr 11, 1996

RESUMO Onze pacientes portadores de osteoartrite foram avaliados para investigar a interferência ... more RESUMO Onze pacientes portadores de osteoartrite foram avaliados para investigar a interferência do alinhamento estático obtido através do Raio-X nas medidas cinéticas e cinemáticas da articulação do joelho durante a marcha. Um procedimento radiográfico preciso e padronizado (QPR) foi utilizado para medir o alinhamento estático do membro inferior, e um sistema óptico-eletrônico tridimensional foi utilizado para medir a performance biomecânica do joelho durante a marcha. Correlações entre as medidas angulares estáticas obtidas através do QPR com as medidas angulares dinâmicas e medidas de momentos articulares durante a marcha foram calculadas. Uma correlação significativa foi observada entre os parâmetros radiológicos, ângulos articulares e momentos de força na marcha, sugerindo que existe uma complexa intercalação entre o alinhamento estático, alinhamento dinâmico e medidas cinéticas dinâmicas. Esses achados sugerem que medidas de alinhamento estático associadas com medidas cinéticas e cinemáticas devem ser utilizadas em conjunto para melhor justificar as alterações biomecânicas na articulação do joelho em pacientes com osteoartrite. RELEVÂNCIA Dados de alinhamento estático e de medidas dinâmicas obtidas durante a marcha em um grupo de pacientes portadores de osteoartrite moderada do joelho são apresentados. Os achados indicam que as medidas estáticas tanto no plano coronal quanto sagital foram associadas com a intensidade dos momentos de força articulares, ângulos articulares e tempo dos eventos. UNITERMOS Biomecânica. Marcha. Ângulo articular. Momento de força. Joelho. Osteoartrite. SUMARY Eleven osteoarthritic elderly subjects were tested to analyze the relationships between static radiographic alignment and dynamic kinematic and kinetic measures at the knee in gait. A standard precision radiograph procedure (QPR) was used to measure the static lower limb alignment and a 3D optoelectronic system was used to measure the biomechanical performance of the knee in level walking. Relationships were calculated between the static radiographic angular measures and the dynamic knee angular measures, and dynamic knee moments during gait. A closer relationship was observed between QPR parameters, dynamic knee joint angles, and joint moments in gait, implying that complex interrelationships may exist between static alignment, dynamic

Archives of physical medicine and rehabilitation, 1979

The pedynograph is a simple, inexpensive piece of equipment which can be used in the clinical set... more The pedynograph is a simple, inexpensive piece of equipment which can be used in the clinical setting to monitor amputee gait. Strain gauges applied to the pylon of a modular prosthesis and incorporated in an appropriate electrical circuit provide measurements of axial load which are displayed on an oscilloscope during ambulation. Preliminary experience with the described equipment has shown that it is of value in monitoring and regulating weight bearing in patients with healing or maturing stumps or impairment of stump sensation. Gait and prosthetic problems can be analyzed, their correction documented and a permanent record of amputee performance provided.

Orthopaedic Proceedings, Jul 1, 2011

Purpose: Hip muscle weakness may result in impaired frontal plane pelvic control during gait, lea... more Purpose: Hip muscle weakness may result in impaired frontal plane pelvic control during gait, leading to greater medial compartment loading, as measured by the knee adduction moment, in persons with knee osteoarthritis (OA). The purpose of this study was to evaluate the influence of an 8-week home-based strengthening program for the hip abductor muscles on hip muscle strength and the external knee adduction moment during gait in individuals with medial knee OA compared to an asymptomatic control group. Secondary objectives were to determine if hip abductor strengthening exercises would improve physical function and knee symptoms in this sample of people with knee OA. Method: Forty participants with knee OA were age and gender-matched with an asymptomatic control group. Three-dimensional gait analysis was performed to obtain peak knee adduction moments in the first 50% of stance phase. Isokinetic concentric strength of the hip abductor muscles was measured using a Biodex Isokinetic Dynamometer. Functional performance was evaluated using the Five-Times-Sit-to-Stand test. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) provided an assessment of knee pain. Following initial testing, participants with knee OA were instructed in a home program of hip abductor strengthening exercises. All participants were re-evaluated after 8 weeks. Results: There was no significant difference in isokinetic hip abductor muscle strength between groups at baseline or at follow-up. An improvement in hip abductor strength occurred in the OA group following the intervention (p = 0.036). The OA group had higher peak knee adduction moments than the control group (p = 0.006), but there was no change in the knee adduction moment over time in either group (p > 0.05). The OA group performed the sit-to-stand test more slowly than the control group (p = 0.001). At final testing, functional performance on the sit-to-stand test had improved in the OA group compared to the control group (p = 0.021). The OA group showed a trend towards decreased knee pain (p = 0.05). Conclusion: An 8-week home program of hip abductor muscle strengthening did not reduce knee joint loading, but improved function, in a group of participants with medial knee OA.

PubMed, Jun 1, 1990

Recent developments in the ability to identify discrete disturbances in gait patterns have led to... more Recent developments in the ability to identify discrete disturbances in gait patterns have led to the development of a computer-assisted feedback system which can provide continuous visual and auditory feedback to a walking subject concerning some discrete aspect of his gait. The purpose of this study was to determine if able-bodied subjects could use this feedback to modify their gait according to externally imposed targets set for exaggerated joint motions or muscle activity, or for changes in the timing of these movements, or for both parameters together. Two groups of able-bodied older adults were presented with either knee and ankle joint angle feedback or quadriceps electromyographic feedback over four identical sessions. Records were kept of performance relative to the targets set for amplitude, timing, and for both parameters together. Results indicated that able-bodied subjects could modify the amplitude and timing of movements in the presence of feedback; they also suggested that the use of this approach in the reeducation of pathologic gait patients should be explored.

Physical therapy, Jun 1, 2010

Background. Hip abductor muscle weakness may result in impaired frontal-plane pelvic control duri... more Background. Hip abductor muscle weakness may result in impaired frontal-plane pelvic control during gait, leading to greater medial compartment loading in people with knee osteoarthritis (OA). Objective. This study investigated the effect of an 8-week home strengthening program for the hip abductor muscles on knee joint loading (measured by the external knee adduction moment during gait), strength (force-generating capacity), and function and pain in individuals with medial knee OA. Design. The study design was a nonequivalent, pretest-posttest, control group design. Setting. Testing was conducted in a motor performance laboratory. Patients. An a priori sample size calculation was performed. Forty participants with knee OA were matched for age and sex with a control group of participants without knee OA. Intervention. Participants with knee OA completed a home hip abductor strengthening program. Measurements. Three-dimensional gait analysis was performed to obtain peak knee adduction moments in the first 50% of the stance phase. Isokinetic concentric strength of the hip abductor muscles was measured using an isokinetic dynamometer. The Five-Times-Sit-to-Stand Test was used to evaluate functional performance. Knee pain was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. Results. Following the intervention, the OA group demonstrated significant improvement in hip abductor strength, but not in the knee adduction moment. Functional performance on the sit-to-stand test improved in the OA group compared with the control group. The OA group reported decreased knee pain after the intervention. Limitations. Gait strategies that may have affected the knee adduction moment, including lateral trunk lean, were not evaluated in this study. Conclusions. Hip abductor strengthening did not reduce knee joint loading but did improve function and reduce pain in a group with medial knee OA.

Archives of Physical Medicine and Rehabilitation, 2006

Objectives: To identify the determinants of self-report mobility measures in people with knee ost... more Objectives: To identify the determinants of self-report mobility measures in people with knee osteoarthritis (OA) and to compare self-report measures with physical performance. Design: Cross-sectional, prospective. Setting: Motor performance laboratory and human mobility research center. Participants: A convenient sample of 54 participants with medial compartment knee OA (32 women, 22 men; age 68.3Ϯ8.7y; range, 50-87y). Three participants were excluded because of the presence of lateral knee OA on radiographs. Interventions: Not applicable. Main Outcome Measures: Self-reports were recorded by using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Performance measures included the six-minute walk test (6MWT), Timed Up & Go (TUG) test, and a standardized stair-climbing task (STR). Results: Stepwise linear regression analysis identified models that included pain, quadriceps and hamstrings strength, and depression to explain 62% to 73% of the variance in scores on the physical functioning subscale of the WOMAC and the SF-36. These self-report measures had a moderate relation (r range, .46-.64) with performance measures (6MWT, TUG, STR). Conclusions: Self-report measures were strongly related to pain; physical performance measures were strongly related to self-efficacy. Regression models showed that self-report scores reflect pain, knee strength, and depression. The relation between self-report and performance measures was moderate, suggesting that these examine different aspects of mobility.

The Journals of Gerontology, Oct 1, 2007

Background. Self-efficacy is a determinant of walking performance in older adults with knee osteo... more Background. Self-efficacy is a determinant of walking performance in older adults with knee osteoarthritis. We examined whether self-efficacy mediated the effect of age, psychosocial, impairment, and mechanical factors on walking performance. Methods. Fifty-four participants with knee osteoarthritis completed the Six Minute Walk test and Arthritis Self-Efficacy Scale. Independent variables reflected age, psychosocial (depressive symptoms), impairment (pain, stiffness), and mechanical (strength, obesity) factors. Results. Self-efficacy fully mediated the effect of age and impairments on walking. The effects of strength were only partially mediated by self-efficacy. Depressive symptoms and obesity were not mediated by self-efficacy. Conclusions. These findings are consistent with Social Cognitive Theory, according to which age may alter outcome expectations, and impairments like pain and stiffness provide negative physiological feedback to influence performance. Mechanical factors like strength and obesity may better represent a person's capabilities and interact with other variables to influence physical performance in older adults with knee osteoarthritis.

PubMed, May 1, 1991

The purpose of this study was to provide a kinematic description of the task of stair ascent and ... more The purpose of this study was to provide a kinematic description of the task of stair ascent and descent. Fifteen women were divided into short, medium, and tall subject groups. Three testing staircases of different riser and tread dimensions were used. Temporal and cinematographic data were collected simultaneously via switchmats and a high-speed camera, respectively. Measures of stairclimbing gait cycle duration, swing and stance phase durations, cadence, and velocity appeared to be systematically related to subject height. Stance (19% to 64%) and swing (36% to 81%) phase durations varied considerably depending on stair dimensions during stair descent. Less variation was observed in stance (50% to 60%) and swing (40% to 50%) values during tasks of stair ascent. Individuals appeared to adjust to stair dimensions by varying the flexion/extension patterns of the knee rather than those of the ankle or hip. Depending on the staircase climbed, knee flexion angles ranging from 83 degrees to 105 degrees were required. Stair dimensions, therefore, appeared to influence the temporal and angular kinematics of the lower limb during stairclimbing.

Archives of Physical Medicine and Rehabilitation, Feb 1, 1986

Clinical Biomechanics, Jul 1, 1994

Twelve normal elderly subjects were tested to analyse the relationships between static radiograph... more Twelve normal elderly subjects were tested to analyse the relationships between static radiographic alignment and dynamic kinematic and kinetic measures at the knee in gait. A standard precision radiograph was used to measure the static lower limb alignment and a 3D optoelectric system was used to measure the biomechanical performance of the knee in level walking. Relationships were calculated between static radiographic angular measures and dynamic knee angular measures, dynamic knee joint forces, and dynamic knee joint moments during gait in corresponding motion planes; and between dynamic knee angular measures and dynamic knee joint forces and dynamic knee moments during gait and in corresponding motion planes. The results showed that the static lower-limb alignment measures did not closely correlate with the kinetic measures of the knee in gait although about half of the static angular alignment measures were significantly related to some of the dynamic knee angular measures. Instead, six of nine dynamic angular measures of the knee were significantly related to the dynamic forces and moments of force in the corresponding motion planes. These results suggest that static alignment measures alone at the present time are not sufficient to predict the dynamic knee joint forces in intact knees. Relevance Normal values for radiographic alignment and variables obtained during walking are provided for a group of elderly subjects. Joint forces and moments obtained during walking were not closely related to radiographic alignment.

Physical therapy, Sep 1, 1987

Clinical Biomechanics, Dec 1, 2006

Background. Although gait characteristics have been well documented in people with knee osteoarth... more Background. Although gait characteristics have been well documented in people with knee osteoarthritis, little is known about the relationships between gait characteristics and performance or disability. Our purpose was to examine the role of knee kinematics and kinetics on walking performance and disability in people with knee osteoarthritis. We also examined whether pain mediated the relationship between the knee adduction moment and performance or disability. Methods. Three-dimensional gait analysis was conducted on 54 people with medial compartment knee osteoarthritis. Performance was quantified with the Six Minute Walk test and disability was self-reported on the Short Form-36. The pain subscale of the Western Ontario McMaster Universities Osteoarthritis Index and the functional self-efficacy subscale of the Arthritis Self-Efficacy scale were completed. Findings. A step-wise linear regression demonstrated that the variance in Six Minute Walk test scores was explained by functional selfefficacy (50%) and the range of knee motion (8%). The variance in Short Form-36 was explained by pain (36%), the peak extension angle (19%) and the range of knee motion (4%). Pain was unrelated to the knee adduction moment so analyses of pain as a mediator of the adduction moment on either performance or disability were halted. Interpretation. Kinematic output from the motor control system is useful in understanding some variance in current performance and disability in people with knee osteoarthritis. The knee adduction moment was unrelated to these variables and pain did not mediate between the knee adduction moment and performance or disability. Therefore this moment does not explain current clinical status in people with knee osteoarthritis based on the measures of performance and disability used in this study.

Arthritis & Rheumatism, 2006

Objective. Self efficacy, the confidence an individual has to perform a task, is an important det... more Objective. Self efficacy, the confidence an individual has to perform a task, is an important determinant of physical performance in individuals with knee osteoarthritis (OA). The purpose of this study was to determine what personal, pathophysiologic, and impairment factors relate to self efficacy for physical tasks in community-dwelling adults with knee OA. Methods. Fifty-four persons with radiographically confirmed knee OA (mean ؎ SD age 68.3 ؎ 8.7 years, range 50-87 years) participated. The Functional Self-Efficacy subscale of the Arthritis Self-Efficacy Scale was the dependent measure. Independent measures included age, education, scores from the Center for Epidemiologic Studies Depression and State-Trait Anxiety Inventory questionnaires, medial joint space and varus/valgus tibiofemoral angle from radiographs, body mass index, and isokinetic quadriceps and hamstrings strength. Knee pain and stiffness, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, were independent measures. Results. Fifty-one percent of the variance of Functional Self Efficacy was explained by knee stiffness, hamstrings strength, age, and depression scores. Pain, education, anxiety, radiographic joint space, and body weight did not significantly contribute to the variance in Functional Self-Efficacy scores. Substituting quadriceps strength for hamstrings strength resulted in a regression model that included only stiffness, age, and depression, which explained nearly as much variance as the original model. Conclusion. Self efficacy for physical tasks is related to the sensation of stiffness, hamstrings strength, age, and level of depressive symptoms in persons with knee OA. Clinicians and researchers could consider these variables when assessing the level of self efficacy for physical tasks in persons with knee OA.

Journal of Biomechanics, 1985

A deterministic model was developed and validated to calculate instantaneous ankle and knee momen... more A deterministic model was developed and validated to calculate instantaneous ankle and knee moments during walking using processed EMG from representative muscles, instantaneous joint angle as a correlate of muscle length and angular velocity as a correlate of muscle velocity, and having available total instantaneous joint moments for derivation of certain model parameters. A linear regression of the moment on specifically processed EMG, recorded while each subject performed cycled isometric calibration contractions, yielded the constants for a basic moment-EMG relationship. Using the resultant moment for optimization, the predicted moment was proportionally augmented for longer muscle lengths and reduced for shorter lengths. Similarly, the predicted moment was reduced for shortening velocities and increased if the muscle was lengthening. The plots of moments predicted using the full model and those calculated from link segment mechanics followed each other quite closely. The range of root mean square errors were: 3.2-9.5 Nm for the ankle and 4.7-13.0 Nm for the knee.

Journal of Biomechanics, 2006

Topics in Geriatric Rehabilitation, Sep 1, 1991