Study Design: Case report.
Objectives: Patients with peripheral nerve injury may demonstrate long-lasting impairments and functional limitations. In this case report, we describe the assessment of a patient with a peripheral nerve injury and a conventional plan of care, along with the novel intervention of neuromuscular electrical stimulation (NMES). We feel that the additional NMES intervention was instrumental in achieving more rapid functional improvements than the more traditional interventions that are reported in the literature.
Background: The patient was a 21-year-old male who sustained a forearm fracture that was complicated by injury to the anterior interosseous branch of the median nerve. He was unable to flex the interphalangeal (IP) joint of his thumb, had decreased strength of thenar eminence musculature, and was unable to perform fine motor activities with his hand.
Methods and Measures: Electrophysiological tests revealed partial denervation of the flexor pollicis longus and pronator quadratus muscles. In the fifth physical therapy session, NMES to the flexor pollicis longus and thenar muscles was added to the patient’s conventional plan of care.
Results: With a conventional ROM and strengthening plan of care, no improvement was seen in thumb IP joint flexion over a period of 2 weeks. After 3 sessions of NMES and conventional interventions, gains in active ROM were made in thumb IP joint flexion. After 9 sessions of NMES and conventional interventions, force of thumb IP flexion was registered on a pinch dynamometer. Twenty weeks after initial examination, strength and ROM measures had improved and the patient reported no functional deficits.
Conclusions: The patient showed gains in strength of the thumb IP joint after a few NMES sessions, which suggests that NMES was a helpful adjunct to the plan of care, even though the precise mechanism underlying the functional gains are not known.

J Orthop Sport Phys Ther. 2004;34(2):47-56.

Key Words: anterior interosseus nerve, neuromuscular electrical stimulation, thumb, upper extremity

Study Design: Single-group repeated-measures design.
Objectives: To compare the effects of forward walking (FW) and backward walking (BW) on heart rate (HR) and oxygen consumption (VO₂) at treadmill grades of 5%, 7.5%, and 10%.
Background: Previous studies of locomotion by humans on a treadmill have reported larger cardiovascular exertion and potential biomechanical benefits of BW as compared to FW for treadmill grades ranging from 0% to 5%. The present study extends these findings by examining the cardiovascular effects of BW and FW at treadmill grades greater than 5%.
Methods and Measures: Twenty-nine volunteers participated in this study. Two subjects were excluded, leaving 27 study subjects (15 females, 12 males; mean age ± SD, 24.0 ± 3.4 years). VO₂ and HR were measured using open-circuit calorimetry and electrocardiogram, respectively. For both forward and backward walking, subjects performed each of the 3 grades for 6 minutes, during which HR and VO₂ were measured. Two-way repeated-measures ANOVAs were employed for inferential statistical analysis.
Results: Percent maximum heart rate (HR_max) and percent maximum oxygen consumption (VO_2max) increased incrementally for treadmill grades of 5% to 7.5% to 10% for both FW and BW (P<.00001). For each of the 3 treadmill grades, percent HR_max and percent VO_2max was 17% to 20% higher for BW than for FW (P<.00001). No statistically significant interactions were detected between direction of walking and treadmill grade.
Conclusions: Backward walking on a treadmill at 67.0 m/min (2.5 mph) and grades of 5%, 7.5%, and 10% elicits a greater percent HR_max and percent VO_2max than does forward walking under the same conditions and, if incorporated into sustained training regimens, would be expected to improve aerobic endurance.

J Orthop Sports Phys Ther. 2004;34(2):65-71.

Key Words: aerobic conditioning, energy expenditure, gait, rehabilitation, retropulsion

Study Design: Within-subject repeated-measures study.
Objectives: To examine the immediate effects of counterforce forearm brace on isokinetic strength, stretch reflex, passive stretching pain threshold of the wrist extensors, and proprioception of the wrist in subjects with lateral humeral epicondylosis for different strap tensions of a forearm brace.
Background: Counterforce forearm bracing has been used for treating lateral humeral epicondylosis, but the effect of brace tension has not been well reported.
Methods and Measures: Fifteen subjects diagnosed with lateral humeral epicondylosis on their dominant arm were tested under 4 randomized conditions: (1) no brace, (2) brace with minimal tension, (3) brace with 25-N tension, and (4) brace with 50-N tension. The tests included isokinetic wrist extensors strength, passive stretching force in wrist flexion to elicit pain in the wrist extensors, wrist proprioception, and stretch reflex latency of the extensor carpi ulnaris. A repeated-measures MANOVA was used to analyze the data and significant results were further analyzed with post hoc linear contrasts (α = .05).
Results: Among the 4 conditions, significant differences were found in wrist proprioception (P = .032) and pain threshold to passive stretching of the wrist extensors (P = .05), but were not found in wrist extension isokinetic strength and stretch reflex latency of the extensor carpi ulnaris.
Conclusion: A forearm counterforce brace, as applied in this study, affects wrist joint proprioception and increases the pain threshold to passive stretching of the wrist extensors in subjects with lateral humeral epicondylosis, but it has no effect on wrist extensor strength and stretch reflex latency of the extensor carpi ulnaris.

J Orthop Sports Phys Ther. 2004;34(2):72-78.

Key Words: orthosis, pain, proprioception, tennis elbow

Study Design: Counterbalanced experimental design study comparing a group of subjects with greater than or equal to 7° of forefoot varus (MFV) to a group with less than 7° of forefoot varus (LFV).
Objectives: To investigate the effect of forefoot varus on single-limb stance postural stability (PS).
Background: Impaired PS has been implicated as a potential risk factor for sustaining acute foot and ankle injuries. The identification of variables that deleteriously affect PS may be important in the prevention of future injuries.
Methods and Measures: Postural stability of the MFV group (n = 20) and the LFV group (n = 12) was assessed during right and left single-limb stance and eyes-open and eyes-closed conditions. Standard deviations of the x-axis and y-axis ground reaction forces measured via a force platform were used to represent anteroposterior (AP) and mediolateral (ML) PS, respectively. The mean of 3 successful 5-second trials of each testing condition was calculated and used for subsequent data analysis using 3-way mixed-model ANOVAs with 1 between-subject and 2 within-subject factors.
Results: The AP PS scores of the MFV group were significantly greater than those of the LFV group (P<.05). ML PS scores, although higher in the MFV group, were not significantly different from those of the LFV group. Both groups had significantly greater AP and ML PS scores during the eyes-closed versus the eyes-open condition (P<.05).
Conclusions: The results suggest that the presence of greater than or equal to 7° of forefoot varus may significantly impair AP PS. The decreased stability associated with increased forefoot varus may be due to decreased joint congruity and consequently an increased reliance on soft tissue structures for stability.

J Orthop Sports Phys Ther. 2004;34(2):79-85.

Key Words: balance, foot structure, ground reaction force, postural control