Karen Mcculloch

University of North Carolina at Chapel Hill | UNC · Department of Allied Health Sciences

Objective: To evaluate the feasibility of an exercise tolerance assessment and intervention added to the Progressive Return to Activity Clinical Recommendations (PRA-CR) in acutely concussed service members (SMs). Methods: This non-randomized, pilot trial was performed at one center. SMs in the experimental group (ERG) performed the Buffalo Conc...

Objective Evaluate effectiveness of early-stage multi-dimensional rehabilitation (MDR) on return to sport (RTS). Design Two-arm randomized unblinded trial (NCT02988596). Setting Professional, collegiate, and interscholastic sports (28 sites in USA, Canada, and New Zealand). Participants Consented participants with provider-diagnosed concussion (...

Physical Therapists affiliated with Intrepid Spirit Centers evaluate and treat Active Duty Service Members (ADSM) who have duty-limiting post-concussion symptoms to improve the ability to perform challenging tasks associated with military service. The Complex Assessment of Military Performance (CAMP) is a test battery that more closely approximates...

Introduction: Assessment of functional recovery of service members following a concussion is central to their return to duty. Practical military-relevant performance-based tests are needed for identifying those who might need specialized rehabilitation, for evaluating the progress of recovery, and for making return-to-duty determinations. One such...

Introduction Return-to-duty (RTD) readiness assessment for service members (SM) following concussion requires complex clinical considerations. The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a functional assessment which improves on previous laboratory-based RTD assessments. Methods Sixty-four SM diagnosed with concussion and 60 hea...

Background: Guidelines for clinicians treating military concussion recommend exertional testing before return-to-duty, yet there is currently no standardized task or inclusion of an objective physiological measure like heart rate variability (HRV). Methodology & results: We pilot-tested two clinically feasible exertional tasks that include HRV m...

Background and purpose: Despite evidence that falls can be prevented with specific exercise interventions such as the Otago Exercise Program (OEP), translation of these programs into practice is limited in rural and medically underserved areas. The Community Health and Mobility Partnership (CHAMP) addresses this problem through a community-based i...

Purpose of Review Studies that focus on geriatric mild traumatic brain injury (mTBI) are limited, although these injuries occur commonly as a result of falls in the older adult population. This review aims to explore current literature in this area and summarize common practices in diagnosis and treatment of this condition. Recent Findings Older a...

Over the last decade, numerous concussion evidence-based clinical practice guidelines (CPGs), consensus statements, and clinical guidance documents have been published. These documents have typically focused on the diagnosis of concussion and medical management of individuals post concussion, but provide little specific guidance for physical therap...

Objectives To evaluate relationships between beliefs about the impact of rest and the level of activities and symptoms over time among active duty Service Members sustaining concussion, and whether these relationships vary by provision of concussion education. Design Longitudinal study using multilevel modeling to assess the relationship between b...

Objective: “Return to duty” (RTD) is often used as an outcome metric in military concussion research, but is inconsistently defined across studies and presents several key problems to researchers. Using results from the Defense and Veterans Brain Injury Center’s (DVBIC) Progressive Return to Activity (PRA) study, we highlight problems with RTD, and...

Background Chronic low back pain (CLBP) is characterized by an alteration in pain processing by the central nervous system that may affect autonomic nervous system (ANS) balance. Heart rate variability (HRV) reflects the balance of parasympathetic and sympathetic ANS activation. In particular, respiratory sinus arrhythmia (RSA) solely reflects para...

Background Clinical recommendations for concussion management encourage reduced cognitive and physical activities immediately after injury, with graded increases in activity as symptoms resolve. Empirical support for the effectiveness of such recommendations is needed. Purpose To examine whether training medical providers on the Defense and Vetera...

Despite advances in the assessment, diagnosis, prognosis, and management of the patient with mild traumatic brain injury (mTBI) or concussion, the condition continues to frustrate clinicians and researchers. The November 2019 special issue of the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) supports and represents an interdisciplinary a...

Background: Sports-related concussion (SRC) is a complex injury with heterogeneous presentation and management. There are few studies that provide guidance on the most effective and feasible strategies for recovery and return to sports participation. Furthermore, there have been no randomized studies of the feasibility, safety, and efficacy of earl...

Synopsis: Concussions are a public health concern that affect individuals across the lifespan. The multifaceted effects of concussion warrant an interdisciplinary management strategy that may include physical therapy. Physical therapists may feel underprepared for clinical decision-making following a concussive event. Therefore, we propose a new t...

At least 3 million Americans sustain a mild traumatic brain injury (mTBI) each year, and 1 in 5 have symptoms that persist beyond one month. Standards of mTBI care have evolved rapidly, with numerous expert consensus statements and clinical practice guidelines published in the last five years. This Special Communication synthesizes recent expert co...

Objective: To evaluate the impact on symptom resolution of activity acutely following a concussion and the role of acute-phase symptoms on this relationship among active duty service members (SMs). Setting: Three military installations. Participants: Sixty-two SMs aged 18 to 44 years who sustained a concussion within 72 hours of enrollment. D...

Background Chronic low back pain (CLBP) is characterized by an alteration in pain processing by the central nervous system that may affect autonomic nervous system (ANS) balance. Heart rate variability (HRV) reflects the balance of parasympathetic and sympathetic ANS activation. In particular, respiratory sinus arrhythmia (RSA) solely reflects para...

Background: Previous research demonstrates that early rest and gradual increases in activity after concussion can improve symptoms; however, little is known about the intensity and type of activity during post-acute time periods—specifically months post-injury—that may promote optimal recovery in an active duty service member (SM) population. Objec...

Introduction The Assessment of Military Multitasking Performance (AMMP¹) consists of six dual-task and multitask military-relevant performance-based assessments which were developed to provide assistance in making return-to-duty decisions after concussion or mild traumatic brain injury (mTBI.) The Run-Roll-Aim (RRA) task, one component of the AMMP,...

Chronic pain is associated with maladaptive reorganization of the central nervous system. Recent studies have suggested that disorganization of large-scale electrical brain activity patterns such as neuronal network oscillations in the thalamo-cortical system plays a key role in the pathophysiology of chronic pain. Yet, little is known about if and...

Background: Person-centered rehabilitation requires that meaningful life activities are identified on a case-by-case basis, but the discovery process can be inaccessible for clients with aphasia. Card-sorting methodology addresses core barriers and help clients communicate their preferences. Aims: To characterize life activities that people with ap...

Introduction: Determining duty-readiness after mild traumatic brain injury (mTBI) remains a priority of the United States Department of Defense as warfighters in both deployed and non-deployed settings continue to sustain these injuries in relatively large numbers. Warfighters with mTBI may experience unresolved sensorimotor, emotional, cognitive...

Objective: To assess the discriminant validity of the Patrol-Exertion Multitask (PEMT), a novel, multi-domain, functional return-to-duty clinical assessment for Active Duty military personnel. Design: Measurement development study SETTING: Non-clinical indoor testing facility, Fort Bragg NC PARTICIPANTS: 51 healthy control (HC) Service Members a...

The Assessment of Military Multitasking Performance (AMMP) is a battery of functional dual-tasks and multitasks based on military activities that target known sensorimotor, cognitive, and exertional vulnerabilities after concussion/mild traumatic brain injury (mTBI). The AMMP was developed to help address known limitations in post concussive return...

This article describes lessons learned in the planning, development, and administration of a collaborative militarycivilian research project, the Assessment of Military Multitasking Performance, which was designed to address a gap in clinical assessment for active duty service members with mild traumatic brain injury who wish to return to active du...

The large number of U.S. service members diagnosed with concussion/mild traumatic brain injury each year underscores the necessity for clear and effective clinical guidance for managing concussion. Relevant research continues to emerge supporting a gradual return to pre-injury activity levels without aggravating symptoms; however, available guidanc...

Background and purpose: The use of standardized outcome measures (OMs) is essential in assessing the effectiveness of physical therapy (PT) interventions. The purposes of this article are (1) to describe the process used by the TBIEDGE task force to assess the psychometrics and clinical utility of OMs used with individuals with moderate to severe...

Previously published mild traumatic brain injury (mTBI) management guidelines provide very general recommendations to return individuals with mTBI to activity. This lack of specific guidance creates variation in military rehabilitation. The Office of the Army Surgeon General in collaboration with the Defense and Veterans Brain Injury Center, a comp...

OBJECTIVES. Executive functioning deficits may result from concussion. The Charge of Quarters (CQ) Duty Task is a multitask assessment designed to assess executive functioning in servicemembers after concussion. In this article, we discuss the rationale and process used in the development of the CQ Duty Task and present pilot data from the prelimin...

Within the last decade, over 220,000 Service Members (SM) have sustained traumatic brain injury (TBI) in support of military operations in Iraq and Afghanistan. Mild TBI may result in subtle cognitive and sensorimotor deficits that adversely affect Warfighter performance, creating significant challenges for SM, Commanders and clinicians. In recent...

Mild traumatic brain injury (mTBI), a principal injury of the wars in Iraq and Afghanistan, can result in significant morbidity. To make accurate return-to-duty decisions for soldiers with mTBI, military medical personnel require sensitive, objective, and duty-relevant data to characterize subtle cognitive and sensorimotor injury sequelae. A milita...

Recent evidence has revealed deficiencies in the ability to divide attention after concussion. To examine the effects of a single vs a dual task on cognition and balance in healthy subjects and to examine reliability of 2 dual-task paradigms while examining the overall feasibility of the tasks. Pretest-posttest experimental design. Sports medicine...

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Important basic science research is being conducted that has direct implications for the rehabilitation of patients, but the translation of this research to change clinical practice does not occur automatically. Advisory panels to the National Center for Medical Rehabilitation Research acknowledge a need for basic and applied research related to th...

Large numbers of SM have experienced mild traumatic brain injury (mTBI) in OEF/OIF, many of whom require rehabilitation services. Traditional rehabilitation assessments both lack face validity for military stakeholders and sensitivity to duty-relevant vulnerabilities after mTBI. Therefore, a research team was funded to use existing research literat...

Several exercise-based falls prevention interventions produced significant long-term reductions in fall rate, but few demonstrate long-term improvements in falls risk factors. A strong body of evidence supports a protective effect of aerobic or strength-training exercise on cognition. Individuals participating in an exercise-based balance improveme...

To obtain a better understanding of the issues that influence hip protector use among community-dwelling older adults. The study used a longitudinal, crossover design. A convenience sample of 32 participants used four different brands of hip protectors, each for a 1-week period. Data were collected by weekly telephone interviews and a mailed questi...

To examine the relationship between balance, attention, and dual-task performance in individuals with acquired brain injury. Cross-sectional study. Rehabilitation center and supported living program. Twenty-four individuals aged 18 to 58 years (mean = 39 years) with acquired brain injury who were able to ambulate 40 ft with (29%) or without an assi...

Mild traumatic brain injuries (MTBIs) are of increasing concern in both the military and civilian populations as the potential long-term effects and costs of such injuries are being further recognized. Injuries from conflicts in Afghanistan and Iraq have increased public awareness and concern for TBI. The Proponency Office for Rehabilitation and Re...

Objectives:: (1) To examine the reliability of a new clinical measure of simultaneous walking with performance of a working memory task, the Walking and Remembering Test (WART). (2) To compare older adult to younger adult WART performance to illustrate preliminary validity. Subjects:: Convenience sample of 25 young adults (ages 22‐35) and 25 older...

(1) To examine the reliability of a new clinical measure of simultaneous walking with performance of a working memory task, the Walking and Remembering Test (WART). (2) To compare older adult to younger adult WART performance to illustrate preliminary validity. Convenience sample of 25 young adults (ages 22-35) and 25 older adults (ages 65-86) perf...

The aim of this article is to consider how impairments in attention may affect the performance of two tasks during balance or walking in individuals recovering from acquired brain injury (ABI). Guidelines from the experimental dual-task paradigm from cognitive psychology are reviewed. In this paper, dual-task conditions are described as the use of...

Participant recruitment is considered the most difficult aspect of the research process. Despite the integral role of recruitment in randomized clinical trials, publication of data defining the recruitment effort is not routine in rehabilitation initiatives. The recruitment process for the Extremity Constraint-Induced Therapy Evaluation (EXCITE) tr...

In research on Constraint-Induced Movement (CI) therapy, a structured interview, the Motor Activity Log (MAL), is used to assess how stroke survivors use their more-impaired arm outside the laboratory. This article examines the psychometrics of the 14-item version of this instrument in 2 chronic stroke samples with mild-to-moderate upper-extremity...

A variety of standardized assessments are available for use following brain injury. A number of these tools are proposed for use in a National Information System (NIS) for traumatic brain injury. Familiarity with tools proposed for use in the NIS allows physical therapists to play a more active role in outcomes evaluation at a program level. Recogn...

To continue and expand determination of the reliability, validity, and sensitivity to change of the Arm Motor Ability Test (AMAT), an instrument for assessing deficits in activities of daily living (ADL). The AMAT was administered twice to patients, with an interest interval of either 1 or 2 weeks, by one of two examiners assigned to patients in co...

Functional recovery measurement following traumatic brain injury presents a significant challenge for health professionals in a variety of treatment settings. This article examines the role of functional upper extremity assessment in this process, highlighting factors to consider in the evaluation process, the basic components of upper extremity mo...