Browsing by Author "Butler, Robert J"
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Item Open Access Acute Effects Of Gait Change During Simulated Pregnancy Using The Empathy Belly (R)(MEDICINE AND SCIENCE IN SPORTS AND EXERCISE, 2010-05) Butler, Robert J; Elpers, Melissa; Queen, Robin MItem Open Access Changes in landing mechanics in patients following anterior cruciate ligament reconstruction when wearing an extension constraint knee brace.(Sports Health, 2014-05) Butler, Robert J; Dai, Boyi; Garrett, William E; Queen, Robin MBACKGROUND: Anterior cruciate ligament (ACL) reconstruction is associated with a high incidence of second tears (graft tears and contralateral ACL tears). These secondary tears have been attributed to asymmetrical lower extremity mechanics. Knee bracing is one potential intervention that can be used during rehabilitation that has the potential to normalize lower extremity asymmetry; however, little is known about the effect of bracing on movement asymmetry in patients following ACL reconstruction. HYPOTHESIS: Wearing a knee brace would increase knee joint flexion and joint symmetry. It was also expected that the joint mechanics would become more symmetrical in the braced condition. OBJECTIVE: To examine how knee bracing affects knee joint function and symmetry over the course of rehabilitation in patients 6 months following ACL reconstruction. STUDY DESIGN: Controlled laboratory study. LEVEL OF EVIDENCE: Level 3. METHODS: Twenty-three adolescent patients rehabilitating from ACL reconstruction surgery were recruited for the study. The subjects all underwent a motion analysis assessment during a stop-jump activity with and without a functional knee brace on the surgical side that resisted extension for 6 months following the ACL reconstruction surgery. Statistical analysis utilized a 2 × 2 (limb × brace) analysis of variance with a significant alpha level of 0.05. RESULTS: Subjects had increased knee flexion on the surgical side when they were braced. The brace condition increased knee flexion velocity, decreased the initial knee flexion angle, and increased the ground reaction force and knee extension moment on both limbs. Side-to-side asymmetry was present across conditions for the vertical ground reaction force and knee extension moment. CONCLUSION: Wearing a knee brace appears to increase lower extremity compliance and promotes normalized loading on the surgical side. CLINICAL RELEVANCE: Knee extension constraint bracing in postoperative ACL patients may improve symmetry of lower extremity mechanics, which is potentially beneficial in progressing rehabilitation and reducing the incidence of second ACL tears.Item Open Access Changes In Lower Extremity Mechanics During A Stop Jump From 6 To 12 Months Following ACL Reconstruction(MEDICINE AND SCIENCE IN SPORTS AND EXERCISE, 2013-05) Butler, Robert J; Dai, Boyi; Garrett, William E; Queen, Robin MItem Open Access Clinical examination factors that predict delayed recovery in individuals with concussion.(Archives of physiotherapy, 2020-01) Martinez, Corina; Christopherson, Zachary; Lake, Ashley; Myers, Heather; Bytomski, Jeffrey R; Butler, Robert J; Cook, Chad EBackground:Risk factors for prolonged recovery after concussion have been well researched, but specific objective clinical examination findings have not. This study examined whether clinical examination results could predict delayed recovery (DR) in individuals with concussion diagnosis. A secondary aim explored the influence of early examination on individual prognosis. Methods:The study was a retrospective, observational cohort design that included 163 individuals seen at a concussion clinic who were followed longitudinally until cleared for sports activity. Cognitive, visual, balance, vestibular, and cervical clinical testing and symptom assessment were performed at initial evaluation. DR was calculated by taking the median value associated with time to clearance for activity. Bivariate logistic regression analysis was calculated to determine odds ratios (and 95% confidence intervals) for the odds of DR with presence or absence of each clinical finding. Multivariate analyses were used to define the best predictors of DR. Results:80 of 163 individuals were considered delayed in their clearance to activity. Cognitive impairments (OR = 2.72; 95%CI = 1.40, 5.28), visual exam findings (OR = 2.98; 95%CI = 1.31, 6.80), and vestibular exam findings (OR = 4.28; 95%CI = 2.18, 8.43) all increased the odds of a DR. Multivariate modeling retained cognitive symptoms and clinical examination-vestibular testing as predictors of delayed recovery. Time to examination after injury was a mediator for DR. Conclusions:The clinical examination provides value in identifying individuals who are likely to exhibit a delayed clearance. In particular, vestibular impairments identified clinically at initial evaluation and cognitive symptoms were associated with increased odds of a DR to return to activity. Our data support that early implementation of a standardized clinical examination can help to identify individuals who may be more at risk of prolonged recovery from concussion.Item Open Access Comparison of dynamic balance in adolescent male soccer players from rwanda and the United States.(Int J Sports Phys Ther, 2013-12) Butler, Robert J; Queen, Robin M; Beckman, Brian; Kiesel, Kyle B; Plisky, Phillip JPURPOSE/BACKGROUND: Dynamic balance is an important component of motor skill development. Poor dynamic balance has previously been associated with sport related injury. However, the vast majority of dynamic balance studies as they relate to sport injury have occurred in developed North American or European countries. Thus, the purpose of this study was to compare dynamic balance in adolescent male soccer players from Rwanda to a matched group from the United States. METHODS: Twenty-six adolescent male soccer players from Rwanda and 26 age- and gender-matched control subjects from the United States were screened using the Lower Quarter Y Balance Test during their pre-participation physical. Reach asymmetry (cm) between limbs was examined for all reach directions. In addition, reach distance in each direction (normalized to limb length, %LL) and the composite reach score (also normalized to %LL) were examined. Dependent samples t-tests were performed with significant differences identified at p<0.05. RESULTS: Twenty-six male soccer players from Rwanda (R) were matched to twenty-six male soccer players from the United States (US). The Rwandan soccer players performed better in the anterior (R: 83.9 ± 3.2 %LL; US: 76.5 ± 6.6 %LL, p<0.01), posterolateral (R: 114.4 ± 8.3 %LL ; US: 106.5 ± 8.2 %LL, p<0.01) and composite (R: 105.6 ± 1.3 %LL; US: 97.8 ± 6.2 %LL, p<0.01) reach scores. No significant differences between groups were observed for reach asymmetry. CONCLUSIONS: Adolescent soccer players from Rwanda exhibit superior performance on a standardized dynamic balance test as comparison to similar athletes from the United States. The examination of movement abilities of athletes from countries of various origins may allow for a greater understanding of the range of true normative values for dynamic balance. LEVELS OF EVIDENCE: 3b.Item Open Access Is There A Single Set Of Biomechanical Variables That Predicts Jump Performance?(MEDICINE AND SCIENCE IN SPORTS AND EXERCISE, 2013-05) Russell, Mary E; Butler, Robert J; Sparling, Tawnee L; Queen, Robin MItem Open Access Percent body fat more associated with perioperative risks after total joint arthroplasty than body mass index(The Journal of arthroplasty, 2014-09-01) Ledford, Cameron K; Ruberte Thiele, Ramon A; Appleton, J Stephen; Butler, Robert J; Wellman, Samuel S; Attarian, David E; Queen, Robin M; Bolognesi, Michael PCopyright © 2014 Elsevier Inc. All rights reserved.Understanding the impact of obesity on elective total joint arthroplasty (TJA) remains critical. Perioperative outcomes were reviewed in 316 patients undergoing primary TJA. Higher percent body fat (PBF) was associated with postoperative blood transfusion, increased hospital length of stay (LOS) >3 days, and discharge to an extended care facility while no significant differences existed for BMI. Additionally, PBF of 43.5 was associated with a 2.4× greater likelihood of blood transfusion, PBF of 36.5 with a 1.9× greater likelihood for LOS >3 days, and PBF of 36.0 with a 1.4× greater likelihood for discharge to an extended care facility. PBF may be a more effective measure than BMI to use in screening for perioperative risks and acute outcomes associated with obese total joint patients.Item Open Access Plantar Loading During Cutting While Wearing a Rigid Carbon Fiber Insert.(J Athl Train, 2014-02-12) Queen, Robin M; Abbey, Alicia N; Verma, Ravi; Butler, Robert J; Nunley, James AContext : Stress fractures are one of the most common injuries in sports, accounting for approximately 10% of all overuse injuries. Treatment of fifth metatarsal stress fractures involves both surgical and nonsurgical interventions. Fifth metatarsal stress fractures are difficult to treat because of the risks of delayed union, nonunion, and recurrent injuries. Most of these injuries occur during agility tasks, such as those performed in soccer, basketball, and lacrosse. Objective : To examine the effect of a rigid carbon graphite footplate on plantar loading during 2 agility tasks. Design : Crossover study. Setting : Laboratory. Patients or Other Participants : A total of 19 recreational male athletes with no history of lower extremity injury in the past 6 months and no previous metatarsal stress fractures were tested. Main Outcome Measure(s) : Seven 45° side-cut and crossover-cut tasks were completed in a shoe with or without a full-length rigid carbon plate. Testing order between the shoe conditions and the 2 cutting tasks was randomized. Plantar-loading data were recorded using instrumented insoles. Peak pressure, maximum force, force-time integral, and contact area beneath the total foot, the medial and lateral midfoot, and the medial, middle, and lateral forefoot were analyzed. A series of paired t tests was used to examine differences between the footwear conditions (carbon graphite footplate, shod) for both cutting tasks independently (α = .05). Results : During the side-cut task, the footplate increased total foot and lateral midfoot peak pressures while decreasing contact area and lateral midfoot force-time integral. During the crossover-cut task, the footplate increased total foot and lateral midfoot peak pressure and lateral forefoot force-time integral while decreasing total and lateral forefoot contact area. Conclusions : Although a rigid carbon graphite footplate altered some aspects of the plantar- pressure profile during cutting in uninjured participants, it was ineffective in reducing plantar loading beneath the fifth metatarsal.Item Open Access Plantar loading during jumping while wearing a rigid carbon graphite footplate(Gait and Posture, 2014-02-01) Queen, Robin M; Verma, Ravi; Abbey, Alicia N; Nunley, James A; Butler, Robert JFifth metatarsal stress fractures are common in sports and often result in delayed and non-union. The purpose of this study was to examine the effect of a rigid carbon graphite footplate (CGF) on plantar loading during take-off and landing from a jump. Nineteen recreational male athletes with no history of lower extremity injury in the past 6 months and no foot or ankle surgery in the past 3 years participated in this study. Subjects completed 7 jumping tasks while wearing a standard running shoe and then the shoe plus the CGF while plantar loading data was recorded. A series of paired t-tests were used to examine differences between the two footwear conditions independently for both takeoff and landing (α=0.05). The contact area in the medial midfoot (p<.001) and forefoot (p=.010) statistically decreased when wearing the CGFP. The force-time integral was significantly greater when wearing the CGFP in the middle (p<.001) and lateral forefoot (p=.019). Maximum force was significantly greater beneath the middle (p<.001) and lateral forefoot (p<.001) when wearing the CGFP, while it was decreased beneath the medial midfoot (p<.001). During landing, the contact area beneath the medial (p=.017) and lateral midfoot (p=.004) were significantly decreased when wearing the CGFP. The force-time integral was significantly decrease beneath the medial midfoot (p<.001) when wearing the CGFP. The maximum force was significantly greater beneath the medial (p=.047) and middle forefoot (p=.001) when the subject was wearing the CGFP. The maximum force beneath the medial midfoot (p<.001) was significantly reduced when wearing the carbon graphite footplate. The results of the study indicate that the CGF is ineffective at reducing plantar loading during jumping and landing. © 2013 Elsevier B.V.Item Open Access Pre-operative Gait Speed As An Indicator Of Subjective And Functional Recovery Following Total Ankle Replacement(MEDICINE AND SCIENCE IN SPORTS AND EXERCISE, 2013-05) Queen, Robin M; Sparling, Tawnee L; Easley, Mark E; DeOrio, James K; Nunley, James A; Butler, Robert JItem Open Access Total hip arthroplasty surgical approach does not alter postoperative gait mechanics one year after surgery(PM and R, 2014-01-01) Queen, Robin M; Appleton, J Stephen; Butler, Robert J; Newman, Erik T; Kelley, Scott S; Attarian, David E; Bolognesi, Michael PObjective: To investigate the differences in gait biomechanics on the basis of surgical approach 1 year after surgery. Design: This was a descriptive laboratory study to investigate the side-to-side differences in walking mechanics at a self-selected walking speed as well as a functional assessment 1year after total hip arthroplasty (THA). Temporospatial, kinetic, and kinematic data as well as functional outcomes were collected. Two-way analysis of variance was used to assess for between-group differences and limb-to-limb asymmetries. Setting: A controlled laboratory study. Participants: This study examined 35 patients with primary, unilateral THA. The THA surgical approaches that were used in these patients included 12 direct lateral, 18 posterior, and 11 anterolateral. All the patients were assessed 1 year after THA. Patients were excluded from the study if they had contralateral hip pain or pathology, or any prior lower extremity total joint replacements. Main Outcome Measurements: Three-dimensional lower extremity kinematics and kinetics as well as spatiotemporal variables were collected. In addition, a series of physical performance measures were collected. Results: No main effects for the physical performance measures or biomechanical variables were observed among the approach groups. Significant limb-to-limb asymmetries were observed among all the patients, with decreased sagittal plane range of motion, peak extension, and peak vertical ground reaction forces on the operative side. Conclusion: The results of this study indicated that no significant differences existed among the different surgical approach groups for any study variable. However, 1 year after THA, the patients demonstrated asymmetric gait patterns regardless of surgical approach, which indicated the potential need for continued intervention through physical therapy to regain normal side-to-side symmetry after THA. © 2014 American Academy of Physical Medicine and Rehabilitation.Item Open Access Unipedal balance is affected by lower extremity joint arthroplasty procedure 1 year following surgery.(J Arthroplasty, 2015-02) Butler, Robert J; Ruberte Thiele, Ramon A; Barnes, C Lowry; Bolognesi, Michael P; Queen, Robin MLower Extremity Joint Arthroplasty (LEJA) surgery is an effective way to alleviate painful osteoarthritis. Unfortunately, these surgeries do not normalize the loading asymmetry during the single leg stance phase of gait. Therefore, we examined single leg balance in 234 TJA patients (75 hips, 65 knees, 94 ankles) approximately 12 months following surgery. Patients passed if they maintained single leg balance for 10s with their eyes open. Patients one year following total hip arthroplasty (THA-63%) and total knee arthroplasty (TKA-69%) had similar pass rates compared to a total ankle arthroplasty (TAA-9%). Patients following THA and TKA exhibit better unilateral balance in comparison with TAA patients. It may be beneficial to include a rigorous proprioception and balance training program in TAA patients to optimize functional outcomes.