Crowell M, Thomasma E, Miller E, Brindle R, Roach M, Goss D, Pitt W

Abstract accepted as a platform presentation for the 2024 American Physical Therapy Association Combined Sections Meeting

Static balance is often impaired in patients after ankle sprains. The ability to identify balance control impairments is dependent on an effective balance assessment tool. The Sway Balance Mobile Application (Sway Medical, Tulsa, OK) uses a smart phone or tablet to assess static balance and shows promise as an accessible method to quantify changes in balance control after injury. The purpose of this study was to determine the validity and responsiveness of the Sway Balance Mobile Application (SWAY) to assess balance control after an acute ankle sprain. We hypothesized the application could differentiate individuals with an ankle sprain from healthy controls, measure improvements in balance control over time, and demonstrate strong correlation with the laboratory assessments of static balance control.

The SWAY mBESS is a valid and responsive clinical tool for evaluating static balance. The tool demonstrated discriminant validity detecting balance differences between a healthy and injured group, convergent validity demonstrating moderate to good correlation with established laboratory measures, and responsiveness to changes in static balance in military Cadets during recovery from an acute ankle sprain.

Carreno L, Miller E, Goss D, Mason J, Pitt W, Crowell M

Abstract accepted as a platform presentation for the 2024 American Physical Therapy Association Combined Sections Meeting

Ankle sprains are one of the most common injuries sustained in the military, resulting in lost time from duty and persistent disability. Transcranial direct current stimulation (tDCS) is a novel intervention used to rehabilitate athletic injuries and improve sports performance and may contribute to improved outcomes following ankle sprains. The purpose of this study was to evaluate the effectiveness of tDCS in addition to standard rehabilitation compared to standard rehabilitation alone on pain, self-reported function, strength, functional performance, and postural stability following acute inversion ankle sprain.

Future studies may consider investigating tDCS targeted to patients more likely to demonstrate changes in cortical excitability or neuroplasticity in addition to whether the application of tDCS following acute ankle sprain reduces the likelihood of developing chronic ankle instability.Future studies may consider investigating tDCS targeted to patients more likely to demonstrate changes in cortical excitability or neuroplasticity in addition to whether the application of tDCS following acute ankle sprain reduces the likelihood of developing chronic ankle instability.

Goss D, Gaunaurd I, Helton M, Applegate B, Bennett C, Haltiwanger H, Reilly N, Gonnella M, Black J, Deol G, Garr E, Thompson C, Gailey R

Abstract accepted as a platform presentation for the 2024 American Physical Therapy Association Combined Sections Meeting

The Region of Limb Stability (ROLS) quantifies static lower limb (LL) balance and stability by assessing segmental excursion during single limb stance (SLS). Previous research has established that the ROLS metric predicts LL musculoskeletal (MSK) injury occurrence in Division I Collegiate Athletes. Lower Limb injuries are a prevalent reason for Soldiers seeking medical care; therefore, predicting injuries has large implications on readiness. ROLS can be used as screening tool for identifying at-risk SMs who may require additional physical therapy assessment and/or pre-injury/prehab interventions to reduce the risk of MSK injury. The purpose of this study is to characterize ROLS in Active Duty SMs.

Nearly 30% of the SMs tested were at a high risk for LL MSK injury during baseline screening. Those at highest risk included Non-Commissioned Officers (E5-E9 rank). These findings suggest that ROLS can be used as a screening assessment tool to identify individuals at risk for LL MSK injuries and proactively intervene with further assessment and/or the implementation a pre-injury/prehab intervention. Further research is warranted to determine the effectiveness of ROLS SI as a routine tool for the reduction of injuries in Active Duty SMs.

Ignacio Alejandro Gaunaurd I, Helton M, Goss D, Applegate B, Bennett C, Gonnella M, Haltiwanger H, Reilly N, DeMichele S, Linowes S, Hunt A, Troiano M, Besowshek A, Gailey R

Abstract accepted as a platform presentation for the 2024 American Physical Therapy Association Combined Sections Meeting

Service Members (SMs) are at risk for musculoskeletal (MSK) injuries, especially injuries that affect the lower limbs (LL) and the ability to perform their duties. Therefore a screening measure designed to determine risk for LL MSK injuries would be meaningful. Recently, wireless sensors have been used to measure joint kinematics with the purpose of assessing performance and by extension quantifying risk of injury. Unique metrics derived from novel algorithms, such as the Transitional Angular Displacement of Segment (TADS), have been validated to assess dynamic balance, lower limb stability, and agility during the four-meter sidestep test (FmSST) in Collegiate Athletes. The purpose of this study is to characterize TADS in Active Duty SMs.

Eight percent of the SMs tested are at a high risk for LL MSK injury based on TADS screening. This is a considerable number of SMs who potentially could be injured resulting in limited duty, increased health costs or not achieving career goals.

Whitehurst r, Romanello a, Davis s, Reilly n, Goss d

Abstract accepted for the 2024 American Physical Therapy Association Combined Sections Meeting

By the nature of their work, Soldiers are regularly subjected to vigorous physical activity and corresponding increases in musculoskeletal injury risk1,2. Holistic Health & Fitness (H2F) is an interdisciplinary approach developed for the implementation of multidimensional care and attainment of optimal performance within the U.S. Army. Specifically, H2F was developed to enhance physical, mental, spiritual, nutritional and sleep readiness for Soldiers in contrast to reactive management of injury-induced symptomology observed in many hospital settings3. This study examined the clinical outcomes and corresponding efficacy of the H2F program in comparison to standards of practice currently in place across the U.S. Military Health System.

The H2F program saw more expedient treatment operations for Soldiers with musculoskeletal injury and observed significantly improved clinical outcomes compared to standard practices conducted at major hospitals.

Mabry L, Ross M, Reilly N, Young B, Keil A, Gisselman A, Davenport T, Goss D

Abstract accepted as a platform presentation for the 2024 American Physical Therapy Association Combined Sections Meeting

The purpose of this study was to examine physical therapist awareness and utilization of diagnostic imaging referral privileges. A secondary purpose was to determine if self-reported direct access frequency impacted diagnostic imaging referral or utilization of diagnostic imaging skills.

 There is a general lack of awareness of imaging privileges among physical therapists which appears to be influenced by level of jurisdictional scope. Awareness of imaging privileges significantly impacts its likelihood of incorporation into practice. The American Physical Therapy Association (APTA) should consider working with state boards to raise imaging privilege awareness potentially via integration into a jurisprudence exam. Additionally, this study further links diagnostic imaging referral as an essential tool for direct access. This further supports expansion of physical therapist diagnostic imaging referral to all 50 states consistent with direct access authority.

Smith m, Abboud Chalhoub c, Hogaboom n, Dellanno r, St Laurent m, Yuan x, Nordstrom m

Abstract accepted for a platform presentation at the 2024 American Physical Therapy Association Combined Sections Meeting

Chronic neck pain is a common health condition for military personnel across all occupational specialties. A recent (2023) systematic review highlighted the need for higher level evidence regarding the efficacy of conservative interventions for musculoskeletal pain conditions in this population. The etiology of neck pain is often multi-factorial and can include mechanical (e.g., poor posture), occupational (e.g., desk work, manual labor), and psychosocial factors (e.g., anxiety, depression). The reduction of cervical lordosis in forward head posture (FHP) can lead to muscular imbalances, degenerative spinal changes, and heightened neck pain. The efficacy of a FHP therapy collar is being explored within the military population with chronic neck pain in an ongoing randomized waitlist-controlled trial at a military medical center.

Evaluating the treatment effect of a simple, non-invasive, wearable device for neck pain is highly relevant to the military considering the unique occupational and fitness requirements. Recent studies have suggested that current treatment strategies may be less effective within this population. This participant demonstrated improved posture, neck pain reduction and improved function after wearing the FHP therapy collar for 6 weeks in comparison to 6 weeks of no collar use. This ongoing trial will shed further light on the potential utility of this novel device in reducing neck pain due to FHP, and thereby improve functional outcomes and operational readiness.