Improvement After Constraint-Induced Movement Therapy: Recovery of Normal Motor Control or Task-Specific Compensation?

Background. Constraint-induced movement therapy (CIMT) has proven effective in increasing functional use of the affected arm in patients with chronic stroke. The mechanism of CIMT is not well understood. Objective. To demonstrate, in a proof-of-concept study, the feasibility of using kinematic measures in conjunction with clinical outcome measures to better understand the mechanism of recovery in chronic stroke patients with mild to moderate motor impairments who undergo CIMT. Methods. A total of 10 patients with chronic stroke were enrolled in a modified CIMT protocol over 2 weeks. Treatment response was assessed with the Action Research Arm Test (ARAT), the Upper-Extremity Fugl-Meyer score (FM-UE), and kinematic analysis of visually guided arm and wrist movements. All assessments were performed twice before the therapeutic intervention and once afterward. Results. There was a clinically meaningful improvement in ARAT from the second pre-CIMT session to the post-CIMT session compared with the change between the 2 pre-CIMT sessions. In contrast, FM-UE and kinematic measures showed no meaningful improvements. Conclusions. Functional improvement in the affected arm after CIMT in patients with chronic stroke appears to be mediated through compensatory strategies rather than a decrease in impairment or return to more normal motor control. We suggest that future large-scale studies of new interventions for neurorehabilitation track performance using kinematic analyses as well as clinical scales.

Source: http://nnr.sagepub.com/cgi/content/abstract/27/2/99?rss=1

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Team of Orthopaedic Surgeons Explores Spinal Column Injuries Sustained by Soldiers.

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Page: 7-8

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Abstracts* of Poster Presentations at the 2012 Section on Pediatrics Annual Conference.

Author:

Page: 371-381

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Immediate and short-term effects of Mulligan's mobilization with movement on knee pain and disability associated with knee osteoarthritis – A prospective case series

Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-9, Early Online.

Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.702854?ai=1mo2&mi=3s94u5&af=R

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Problem Based Learning in physiotherapy education: a practice perspective

December 2012
Publication year: 2012
Source:Physiotherapy, Volume 98, Issue 4



Background Problem Based Learning (PBL) has been integrated into a range of health education curricula; however there is limited research evaluating the application of skills developed through PBL in clinical practice. Aim This study aimed to provide evidence of how skills gained through PBL are applied in practice by student physiotherapists, from the perspective of their placement supervisors. Method A qualitative one-to-one semi-structured interview methodology was used, purposively recruiting a sample of 10 qualified physiotherapists with experience of placement supervision of students studying on a PBL physiotherapy undergraduate degree. Results The supervisors felt that PBL offered positive benefits for both student education and clinical practice. There was evidence of the application of skills and attributes associated with PBL, including positive learning behaviours and a high level of motivation and self-direction. Supervisors felt that proactive students were able to apply transferable skills inherent in the PBL approach to clinical practice, including a holistic, problem-solving approach and effective team-working but that there was considerable variation between students. Conclusions There is evidence of variable application of skills associated with PBL in clinical practice in this study group. Further research would be useful to explore the factors that enable students to successfully apply the attributes developed using a PBL approach into practice.

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Inspiratory Loading and Lactate Clearance after Exercise.

Author: Chiappa, Gaspar R. PT, ScD; Roseguini, Bruno T. PT, PhD; Neder, J. Alberto MD, PhD; Ribeiro, Jorge P. MD, ScD

Page: 212-213

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The intra- and inter-rater reliability of the tragus wall distance (TWD) measurement in non-pathological participants ages 18–34

Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-7, Early Online.

Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.727528?ai=1mo2&mi=3s94u5&af=R

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Move to Improve: The Feasibility of Using an Early Mobility Protocol to Increase Ambulation in the Intensive and Intermediate Care Settings

Background

Prolonged bed rest in hospitalized patients leads to deconditioning, impaired mobility, and the potential for longer hospital stays.

Objective

The purpose of this study was to determine the effectiveness of a nurse-driven mobility protocol to increase the percentage of patients ambulating during the first 72 hours of their hospital stay.

Design

A quasi-experimental design was used before and after intervention in a 16-bed adult medical/surgical intensive care unit (ICU) and a 26-bed adult intermediate care unit (IMCU) at a large community hospital.

Method

A multidisciplinary team developed and implemented a mobility order set with an embedded algorithm to guide nursing assessment of mobility potential. Based on the assessments, the protocol empowers the nurse to consult physical therapists or occupational therapists when appropriate. Daily ambulation status reports were reviewed each morning to determine each patient's activity level. Retrospective and prospective chart reviews were performed to evaluate the effectiveness of the protocol for patients 18 years of age and older who were hospitalized 72 hours or longer.

Results

In the 3 months prior to implementation of the Move to Improve project, 6.2% (12 of 193) of the ICU patients and 15.5% (54 of 349) of the IMCU patients ambulated during the first 72 hours of their hospitalization. During the 6 months following implementation, those rates rose to 20.2% (86 of 426) and 71.8% (257 of 358), respectively.

Limitations

The study was carried out at only one center.

Conclusion

The initial experience with a nurse-driven mobility protocol suggests that the rate of patient ambulation in an adult ICU and IMCU during the first 72 hours of a hospital stay can be increased.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20110400v2?rss=1

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Test–retest reliability, smallest real difference and concurrent validity of six different balance tests on young people with mild to moderate intellectual disability

December 2012
Publication year: 2012
Source:Physiotherapy, Volume 98, Issue 4



Objectives Some studies have reported that people with intellectual disability may have reduced balance ability compared with the population in general. However, none of these studies involved adolescents, and the reliability and validity of balance tests in this population are not known. The purpose of this study was to examine the reliability of six different balance tests and to investigate their concurrent validity. Design Test–retest reliability assessment. Settings All subjects were recruited from a special school for people with intellectual disability in Bollnäs, Sweden. Participants Eighty-nine adolescents (35 females and 54 males) with mild to moderate intellectual disability with a mean age of 18 years (range 16 to 20 years). Interventions All subjects followed the same test protocol on two occasions within an 11-day period. Main outcomes Balance test performances. Results Intraclass correlation coefficients greater than 0.80 were achieved for four of the balance tests: Extended Timed Up and Go Test, Modified Functional Reach Test, One-leg Stance Test and Force Platform Test. The smallest real differences ranged from 12% to 40%; less than 20% is considered to be low. Concurrent validity among these balance tests varied between no and low correlation. Conclusion The results indicate that these tests could be used to evaluate changes in balance ability over time in people with mild to moderate intellectual disability. The low concurrent validity illustrates the importance of knowing more about the influence of various sensory subsystems that are significant for balance among adolescents with intellectual disability.

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Shoulder Instability: A Comprehensive Approach.

Author:

Page: 216

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Outcomes of a Clinic-Based Pediatric Constraint-Induced Movement Therapy Program

Physical & Occupational Therapy in Pediatrics, Volume 32, Issue 4, Page 355-367, October 2012.

Source: http://informahealthcare.com/doi/abs/10.3109/01942638.2012.694991?ai=1ozx&mi=3s94u5&af=R

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A Higher-Order Analysis Supports Use of the 11-Item Version of the Tampa Scale of Kinesiophobia in People With Neck Pain

Background.

Despite increasing clinical and research use of the 11-item version of the Tampa Scale of Kinesiophobia (TSK-11) in people with neck pain, little is known about its measurement properties in this population.

Objective.

The purpose of this study was to rigorously evaluate the measurement properties of the TSK-11 when used in people with mechanical neck pain.

Design.

This study was a secondary analysis of 2 independent databases (N=235) of people with mechanical neck pain of primarily traumatic origin.

Methods.

The TSK-11 was subjected to Rasch analysis and subsequent evaluation of concurrent associations with the Neck Disability Index and a numeric rating scale for pain intensity.

Results.

The TSK-11 conformed well to the Rasch model for interval-level measurement, but less so for acute or nontraumatic etiologies. A transformation matrix suggested that small changes at the extremes of the scale are more meaningful than in the middle. Cross-sectional convergent validity testing suggested relationships of expected magnitude and direction compared with pain intensity and neck-related disability. The use of the linearly transformed TSK-11 led to potentially important differences in distribution of data compared with use of the raw scores.

Limitations.

The sample size was slightly smaller than desired for Rasch analysis. The 2 databases were similar in terms of symptom duration, but differed in pain intensity and age.

Conclusions.

The TSK-11 can be considered an interval-level measure when used in people with neck pain. It provides potentially important information regarding the nature of neck-related disability. Clinically important difference may not be consistent across the range of the scale.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120255v2?rss=1

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Kinesio tape management for superficial radial nerve entrapment: A case report

Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-10, Early Online.

Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.717589?ai=1mo2&mi=3s94u5&af=R

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Erratum: Erratum

Physical & Occupational Therapy in Pediatrics, Volume 0, Issue 0, Early Online.

Source: http://informahealthcare.com/doi/abs/10.3109/01942638.2012.744577?ai=1ozx&mi=3s94u5&af=R

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Reliability and Responsiveness of the Gross Motor Function Measure-88 in Children With Cerebral Palsy

Background

The "Gross Motor Function Measure" (GMFM-88) is a commonly used measure for evaluating gross motor function in children with cerebral palsy (CP). The relative reliability of GMFM-88 has been assessed in children with CP. However, little information is available about the absolute reliability or responsiveness of GMFM-88.

Objective

The objective of this research was to determine the absolute and relative reliability and responsiveness of the GMFM-88 in evaluating gross motor function in children with CP.

Design

A clinical measurement design.

Methods

Ten raters scored GMFM-88 of 84 children from video records across all GMFCS levels to establish inter-rater reliability. Two raters participated to assess intra-rater reliability. Responsiveness was determined from three additional assessments after the baseline assessment. The inter- and intra-rater intraclass correlation coefficient (ICC) with 95% confidence intervals, standard error of measurement (SEM), smallest real difference (SRD), effect size (ES), and standardized response mean (SRM) were calculated.

Results

The relative reliabilities of the GMFM were excellent (ICCs = 0.986-1.000). The SEM and SRD for total score of the GMFM were acceptable (1.60 and 3.14, respectively). Additionally, the goal total scores of the ES and SRM increased gradually in the three follow-up assessments (GMFCS level I–II: ES = 0.5, 0.6, and 0.8, SRM = 1.3, 1.8, and 2.0; GMFCS III–V: ES = 0.4, 0.7, and 0.9, SRM = 1.5, 1.7, and 2.0).

Limitations

Children over 10 years of age with CP were not included in this study, so the results should not be generalized to all children with CP.

Conclusions

This study indicates that both reliability and responsiveness of the GMFM-88 are reasonable for measuring gross motor function in children with CP.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20110374v1?rss=1

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Which Prognostic Factors for Low Back Pain Are Generic Predictors of Outcome Across a Range of Recovery Domains?

Background.

Recovery from low back pain (LBP) is multidimensional and requires the use of multiple-response (outcome) measures to fully reflect these many dimensions. Predictive prognostic variables that are present or stable in all or most predictive models that use different outcome measures could be considered "universal" prognostic variables.

Objective.

The aim of this study was to explore the potential of universal prognostic variables in predictive models for 4 different outcome measures in patients with mechanical LBP.

Design.

Predictive modeling was performed using data extracted from a randomized controlled trial. Four prognostic models were created using backward stepwise deletion logistic, Poisson, and linear regression.

Methods.

Data were collected from 16 outpatient physical therapy facilities in 10 states. All 149 patients with LBP were treated with manual therapy and spine strengthening exercises until discharge. Four different measures of response were used: Oswestry Disability Index and Numeric Pain Rating Scale change scores, total visits, and report of rate of recovery.

Results.

The set of statistically significant predictors was dependent on the definition of response. All regression models were significant. Within both forms of the 4 models, meeting the clinical prediction rule for manipulation at baseline was present in all 4 models, whereas no irritability at baseline and diagnosis of sprains and strains were present in 2 of 4 of the predictive models.

Limitations.

The primary limitation is that this study evaluated only 4 of the multiple outcome measures that are pertinent for patients with LBP.

Conclusions.

Meeting the clinical prediction rule was prognostic for all outcome measures and should be considered a universal prognostic predictor. Other predictive variables were dependent on the outcomes measure used in the predictive model.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120216v2?rss=1

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Efficacy of the Addition of Modified Pilates Exercises to a Minimal Intervention in Patients With Chronic Low Back Pain: A Randomized Controlled Trial

Background

The Pilates method has been used to improve function and reduce pain in patients with chronic nonspecific low back pain, although there is little scientific evidence that describes its efficacy.

Objective

The purpose of this study was to investigate the effectiveness of the addition of modified Pilates exercises to minimal intervention in patients with chronic low back pain.

Design

A randomized controlled trial was conducted.

Setting

The study was done in an outpatient physical therapy department in Brazil.

Patients

Eighty-six patients with chronic nonspecific low back pain participated in the study.

Intervention

All participants received an education booklet containing information about low back pain and were randomly allocated to receive 12 sessions, over 6 weeks, of exercises based upon Pilates principles (n=43) or of education alone (n=43).

Measurements

Primary outcomes were pain intensity and disability measured at 6 weeks and 6 months. Secondary outcomes were patient-specific functional disability, global impression of recovery, and kinesiophobia measured at 6 weeks and 6 months. All outcomes were measured by a blinded assessor in all time points.

Results

There was no loss to follow-up at any of the time points. Improvements were observed in pain (mean difference=2.2 points, 95% confidence interval [CI]=1.1 to 3.2), disability (mean difference=2.7 points, 95% CI=1.0 to 4.4), and global impression of recovery (mean difference=–1.5 points, 95% CI=–2.6 to –0.4) in favor of the Pilates group after intervention, but these differences were no longer statistically significant at 6 months.

Limitations

Treatment provider and participants could not be blinded to the interventions.

Conclusions

The addition of modified Pilates exercises to an educational booklet provides small benefits compared with education alone in patients with chronic nonspecific low back pain; however, these effects were not sustained over time.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120190v2?rss=1

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Clinician's Commentary on Wilhelm et al.1

Clinician's Commentary on Wilhelm et al.¹

• Content Type Journal Article
• Category Articles
• Pages 395-396
• DOI 10.3138/ptc.2011-31-CC
• Authors
  • Norma J. MacIntyre

• Journal Physiotherapy Canada
• Online ISSN 1708-8313
• Print ISSN 0300-0508
• Journal Volume Volume 64
• Journal Issue Volume 64, Number 4 / 2012

Source: http://www.metapress.com/content/0lt202n051r73130/

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Abstracts* of Poster Presentations at the 2012 Section on Pediatrics Annual Conference.

Author:

Page: 371-381

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Influence of Hamstring and Abdominal Muscle Activation on a Positive Ober's Test in People with Lumbopelvic Pain

Purpose: To assess the immediate effect of hamstring and abdominal activation on pain levels as measured by the Numeric Pain Scale (NPS) and hip range of motion as measured by Ober's Test in people with lumbopelvic pain. Methods: Thirteen participants with lumbopelvic pain and positive Ober's Tests completed an exercise developed by the Postural Restoration Institute to recruit hamstrings and abdominal muscles. Results: There was a significant increase in passive hip-adduction angles (p<0.01) and decrease in pain (p<0.01) immediately after the intervention. Conclusion: Specific exercises that activate hamstrings and abdominal muscles appear to immediately improve Ober's Test measurements and reduce pain as measured by the NPS in people with lumbo-pelvic pain. Hamstring/abdominal activation, rather than iliotibial band stretching, may be an effective intervention for addressing lumbopelvic pain and a positive Ober's Test.

• Content Type Journal Article
• Category Advance Online Article
• Pages 1-8
• DOI 10.3138/ptc.2011-33
• Authors
  • H. Rich Tenney, Yavapai Regional Medical Center, Prescott, Ariz., USA
  • Kyndall L. Boyle, Appalachian State University, Boone, N.C., USA
  • Aaron DeBord, Yavapai Regional Medical Center, Prescott, Ariz., USA

• Journal Physiotherapy Canada
• Online ISSN 1708-8313
• Print ISSN 0300-0508

Source: http://www.metapress.com/content/23j487748j216332/

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Ethical issues in physiotherapy – Reflected from the perspective of physiotherapists in private practice

Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-17, Early Online.

Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.700388?ai=1mo2&mi=3s94u5&af=R

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To establish whether McKenzie lumbar flexion and extension mobility exercises performed in lying affect central as well as systemic hemodynamics: A crossover experimental study

Available online 30 November 2012
Publication year: 2012
Source:Physiotherapy



Objective Examine systemic and central hemodynamic responses following McKenzie lumbar flexion and extension mobility exercises performed in lying (FIL and EIL). Design Crossover experimental study. Setting Clinical laboratory. Participants Healthy male volunteers (n =25) (mean(SD) age: 28(3)years; range 21 to 34). Interventions Based on alternating assignment of either FIL or EIL to participants, three sets of the first exercise (10, 15, 20 repetitions) were performed with 5-minute rest between sets; after 15-minute rest, the protocol was repeated for the other exercise. Main outcome measures Systemic hemodynamic parameters included heart rate (HR), and systolic and diastolic blood pressures (SBP, DBP). Central hemodynamic parameters included abdominal aortic diameter (AD), peak systolic velocity (PSV/AD), end diastolic velocity (EDV/AD) and resistive index (RI). Measures recorded after each exercise set. Results FIL RPP at baseline was 9.1 (1.4), after 20 repetitions 18.3 (2.5), mean difference 8.9 (95% confidence interval (CI) 7.9 to 9.8) compared to EIL at baseline 9.1 (1.5), after 20 repetitions 13.0 (3.1), mean difference 4.1 (95% CI 3.3 to 5.0). FIL RI at baseline was 0.78 (0.03), after 20 repetitions 0.87 (0.03), mean difference 0.08 (95% CI 0.06 to 0.10) compared to EIL at baseline 0.78 (0.03), after 20 repetitions 0.83 (0.03), mean difference 0.05 (95% CI 0.04 to 0.07). Conclusions Although 10 repetitions of FIL and EIL may be regarded as safe, our findings support screening patients with lifestyle risk factors, and cautioning about adhering to recommended repetition number given associated increased work of the heart. The extent of AD mechanical perturbation remains unclear.

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The Paralympic Movement: Using Sports to Promote Health, Disability Rights, and Social Integration for Athletes With Disabilities

November 2012
Publication year: 2012
Source:PM&R, Volume 4, Issue 11



Competitive sports for people with disabilities has grown rapidly over the past several decades, and opportunities for participation are increasingly available throughout the spectrum from developmental to elite. The Paralympic Games, seen as the pinnacle sporting event that represents the broader Paralympic Movement, has provided a platform to showcase the abilities of people with disabilities while also serving as a catalyst for disability rights through ensuring integration, equality of opportunity, and accessibility of the built environment. Concurrently, media coverage of the Paralympic Games has led to an increased awareness of opportunities for sport participation for individuals with disabilities and, with it, the adjustment of norms regarding expectations for exercise as a component of preventive health. In addition, there is evidence of the power of sports to stimulate confidence, self-efficacy, and a self-perceived high quality of life for individuals with disabilities above and beyond the basic benefits to cardiometabolic fitness. When taken together, the promotion of health, disability rights, and social integration through sports has the power to transform the lives of those who participate and to further stimulate the expansion of opportunities available to the next generation of athletes with disabilities.

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Exercise to Enhance Neurocognitive Function After Traumatic Brain Injury

November 2012
Publication year: 2012
Source:PM&R, Volume 4, Issue 11



Vigorous exercise has long been associated with improved health in many domains. Results of clinical observation have suggested that neurocognitive performance also is improved by vigorous exercise. Data derived from animal model–based research have been emerging that show molecular and neuroanatomic mechanisms that may explain how exercise improves cognition, particularly after traumatic brain injury. This article will summarize the current state of the basic science and clinical literature regarding exercise as an intervention, both independently and in conjunction with other modalities, for brain injury rehabilitation. A key principle is the factor of timing of the initiation of exercise after mild traumatic brain injury, balancing potentially favorable and detrimental effects on recovery.

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Individualized Behavioral Assessments and Maternal Ratings of Mastery Motivation in Mental Age-Matched Toddlers With and Without Motor Delay

Background

Mastery motivation is a precursor of future developmental outcomes. Evidence about whether toddlers with motor delay have lower mastery motivation is inconclusive.

Objective

The purpose of this study was to examine differences between mental age–matched toddlers with and without motor delay on various mastery motivation indicators.

Design

A mental age– and sex-matched case-control study was performed.

Methods

Twenty-two children with motor delay, aged 23 to 47 months, and 22 children who were developing typically, aged 15 to 29 months, were recruited. Persistence and mastery pleasure were measured with behavioral tasks that were moderately challenging for each child and with maternal ratings using the Dimensions of Mastery Questionnaire (DMQ). The DMQ was rated by each child's mother based on her perception of her child's motivation. Two types of structured tasks (a puzzle and a cause-effect toy selected to be moderately challenging for each child) were administered in a laboratory setting and recorded on videos. Paired t tests or Wilcoxon signed rank tests were used to examine group differences in persistence and mastery pleasure (α=.007, 2-tailed).

Results

Children with motor delay were rated lower on DMQ persistence than the typically developing group, but they did not show significantly lower persistence on the structured tasks. There were no significant differences in mastery pleasure between the 2 groups on either measure.

Limitations

Large within-sample variability on the tasks and small sample size makes subgroup analysis (eg, different severities) difficult.

Conclusions

Toddlers with motor delay did not show lower persistence and pleasure when given tasks that were moderately challenging; however, their mothers tended to view them as having lower motivation. Clinicians and parents should provide appropriately challenging tasks to increase children's success and motivation.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120068v2?rss=1

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Perceived value of stroke outcome measures across the post-acute care continuum: A qualitative case study

Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-9, Early Online.

Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.727205?ai=1mo2&mi=3s94u5&af=R

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Kinesio tape management for superficial radial nerve entrapment: A case report

Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-10, Early Online.

Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.717589?ai=1mo2&mi=3s94u5&af=R

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Respiratory Muscle Pressure Development during Breath Holding in Apnea Divers.

Author: CROSS, TROY J. 1,2; BRESKOVIC, TONI 3; SABAPATHY, SURENDRAN 1; MASLOV, PETRA ZUBIN 3; JOHNSON, BRUCE D. 2; DUJIC, ZELJKO 3

Page: 93-101

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Physical Activity in Students of the Medical University of Silesia in Poland

Background

Medical students and other health care professionals have substantial knowledge of the benefits of regular physical activity (PA). Furthermore, they can influence their patients using their ethical obligation to prescribe suitable exercises, moreover, having positive attitude about their lifestyle, they become role models for their patients. Physiotherapists, who are primary care practitioners, have great potential for promoting PA, however, their role is still underestimated by patients and health care professionals.

Objective

The objective of this study was to evaluate PA level in students of the Medical University of Silesia in Poland and to focus on the role of physiotherapy students in promoting physical activity.

Design

Cross-sectional study.

Methods

The final analysis included 300 students from the schools of physiotherapy, midwifery, nursing, pharmacy, cosmetology, and medicine at the Medical University of Silesia in Poland. The short form of the International Physical Activity Questionnaire (IPAQ) was used to evaluate PA level.

Results

Physiotherapy students demonstrated the highest level of PA, as 46% reported high and 54% moderate level of PA, while none of physiotherapy students reported low PA level. The largest group of students with low PA level was observed among students from the school of medicine (26%).

Limitations

The number of respondents was relatively small. The main study limitations included its cross-sectional nature and the possibility of self-report biases. Further research is warranted to expand the study nationally and determine which factors influence PA.

Conclusions

There was a largest group of medical students who, despite being aware of PA benefits, did not meet the recommended level of PA. Physiotherapy students are well-trained and qualified to promote healthy habits and encourage individuals to undertake regular physical activity.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120065v1?rss=1

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Can a Single Phrase Identify Sciatica?.

Author:

Page: 10

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The care needs of Pakistani families caring for disabled children: how relevant is cultural competence?

December 2012
Publication year: 2012
Source:Physiotherapy, Volume 98, Issue 4



Objective To identify factors that Pakistani parents living in the UK and caring for children with learning disabilities felt were important components of their care and to discuss the relevance of the concept of cultural competence in the light of these findings. Design A qualitative study taking a constructivist approach to gain insight into participants’ experiences of health care provision. In depth interviews were used to explore the ways in which personal understandings and life experiences shaped the characteristics of the therapeutic encounter that participants identified as important. Data were analysed thematically. Setting A Northern city in England. Interviews took place in participant's homes or work places. Participants Eleven Pakistani parents and one grandparent from nine different families, all caring for children with learning disabilities. Findings The study identified features of the therapeutic encounter that were important to Pakistani parents and highlighted that there is nothing to suggest that these are different to those of the majority population. Conclusions The utility of the concept of cultural competence may be limited where it depends on concepts of ethnic groups as relatively fixed cultural groups with distinct and clearly defined sets of health beliefs and behaviours. Physiotherapists cannot prejudge health status and behaviours from an individual's ethnic status. Instead there is a need to actively seek the understandings that are relevant to practice. In addition health service providers must develop and operate systems that ensure access, use and quality of care are the same at the point of delivery regardless of patient ethnicity.

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Weight Status and Gross Motor Skill in Kindergarten Children.

Author: Roberts, Dawn PT, PhD; Veneri, Diana PT, EdD; Decker, Robert PhD; Gannotti, Mary PT, PhD

Page: 353-360

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Physical Rehabilitation of Patients in the Intensive Care Unit Requiring Extracorporeal Membrane Oxygenation: A Small Case Series

Background and Purpose

Neuromuscular weakness and impaired physical function are common and long-lasting complications experienced by intensive care unit (ICU) survivors. There is growing evidence that implementing rehabilitation therapy shortly after ICU admission improves physical function and reduces health care utilization. Recently, there is increasing interest and utilization of extracorporeal membrane oxygenation (ECMO) to support patients with severe respiratory failure. Patients receiving ECMO are at great risk for significant physical impairments and pose unique challenges for delivering rehabilitation therapy. Consequently, there is a need for innovative examples of safely and feasibly delivering active rehabilitation to these patients.

Case Description

This case report describes 3 patients with respiratory failure requiring ECMO who received physical rehabilitation to illustrate and discuss relevant feasibility and safety issues.

Outcomes

In case 1, sedation and femoral cannulation limited rehabilitation therapy while on ECMO. In the 2 subsequent cases, minimizing sedation and utilizing a single bicaval dual lumen ECMO cannula placed in the internal jugular vein allowed patients to be alert and participate in active physical therapy while on ECMO, illustrating feasible rehabilitation techniques for these patients.

Discussion

Although greater experience is needed to more fully evaluate the safety of rehabilitation on ECMO, these initial cases are encouraging. We recommend systematically and prospectively tracking safety events and patient outcomes during rehabilitation on ECMO to provide greater evidence in this area.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120336v2?rss=1

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User perceptions of gaming interventions for improving upper extremity motor function in persons with chronic stroke

Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-7, Early Online.

Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.717591?ai=1mo2&mi=3s94u5&af=R

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Lack of Negative Correlation in Glucose Dynamics by Nonexercise Activity Thermogenesis Restriction in Healthy Adults.

Author: OGATA, HITOMI 1; NAKAMURA, KAZUTERU 1; SATO, MAKI 1; TOKUYAMA, KUMPEI 1; NAGASAKA, SHOICHIRO 2; EBINE, NAOYUKI 3; KIYONO, KEN 4; YAMAMOTO, YOSHIHARU 5

Page: 60-66

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Is supervised exercise training safe in patients with anorexia nervosa? A meta-analysis

Available online 21 August 2012
Publication year: 2012
Source:Physiotherapy



Background Anorexia nervosa is an eating disorder that is often preceded by excessive physical activity. As such, exercise is not often prescribed in the clinical management of individuals with anorexia nervosa. Objective To examine the effects of supervised exercise training in patients with anorexia nervosa. Data sources Five databases were searched from their inception to Week 14 of 2011 using the subject headings ‘anorexia’ and ‘exercise’ to identify relevant studies. Eligibility criteria PRISMA guidelines were followed. Studies that investigated the effects of inclusion of supervised exercise training in clinical management with usual management in patients diagnosed with anorexia nervosa were included in this review. Case reports were excluded. Data extraction and synthesis Two reviewers independently extracted data using a standardised assessment form. Quality assessment was rated for the controlled trials and single-group studies using the PEDro scale and Downs and Black scale, respectively. Fixed or random effect approaches were used to determine effect size, depending on the heterogeneity of the studies. Results Pooled randomised controlled trials and quasi-randomised studies showed no significant effect of supervised exercise training on selected anthropometric measurements, while the single-group studies showed significant improvement in weight and body fat. Although Short Form-36 revealed no training effect, distorted feelings about food and exercise were reduced. Cardiovascular fitness also improved with no decrease in weight. Limitations Heterogeneity of exercise training programmes, small sample size (n ≤20) for 67% of the trials, and inability to exclude publication bias. Conclusions Inclusion of supervised exercise training in the comprehensive management of patients with anorexia nervosa appears to be safe, as no detrimental effect was observed in anthropometry. Strength and cardiovascular fitness were also shown to improve.

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Neuropsychiatric Symptoms and the Use of Complementary and Alternative Medicine

Available online 23 October 2012
Publication year: 2012
Source:PM&R



Objectives To assess the prevalence of complementary and alternative medicine (CAM) use by U.S. adults reporting neuropsychiatric symptoms and whether this prevalence changes based on the number of symptoms reported. Additional objectives include identifying patterns of CAM use, reasons for use, and disclosure of use with conventional providers in U.S. adults with neuropsychiatric symptoms. Design Secondary database analysis of a prospective survey. Participants A total of 23,393 U.S. adults from the 2007 National Health Interview Survey. Methods We compared CAM use between adults with and without neuropsychiatric symptoms. Symptoms included self-reported anxiety, depression, insomnia, headaches, memory deficits, attention deficits, and excessive sleepiness. CAM use was defined as use of mind−body therapies (eg, meditation), biological therapies (eg, herbs), or manipulation therapies (eg, massage) or alternative medical systems (eg, Ayurveda). Statistical analysis included bivariable comparisons and multivariable logistical regression analyses. Main Outcome Measures The prevalence of CAM use among adults with neuropsychiatric symptoms within the previous 12 months and the comparison of CAM use between those with and without neuropsychiatric symptoms. Results Adults with neuropsychiatric symptoms had a greater prevalence of CAM use compared with adults who did not have neuropsychiatric symptoms (43.8% versus 29.7%, P < .001); this prevalence increased with an increasing number of symptoms (trend, P < .001). Differences in the likelihood of CAM use as determined by the number of symptoms persisted after we adjusted for covariates. Twenty percent of patients used CAM because standard treatments were either too expensive or ineffective, and 25% used CAM because it was recommended by a conventional provider. Adults with at least one neuropsychiatric symptom were more likely to disclose the use of CAM to a conventional provider (47.9% versus 39.0%, P < .001). Conclusion More than 40% of adults with neuropsychiatric symptoms commonly observed in many diagnoses use CAM; an increasing number of symptoms was associated with an increased likelihood of CAM use.

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Improvement After Constraint-Induced Movement Therapy: Recovery of Normal Motor Control or Task-Specific Compensation?

Background. Constraint-induced movement therapy (CIMT) has proven effective in increasing functional use of the affected arm in patients with chronic stroke. The mechanism of CIMT is not well understood. Objective. To demonstrate, in a proof-of-concept study, the feasibility of using kinematic measures in conjunction with clinical outcome measures to better understand the mechanism of recovery in chronic stroke patients with mild to moderate motor impairments who undergo CIMT. Methods. A total of 10 patients with chronic stroke were enrolled in a modified CIMT protocol over 2 weeks. Treatment response was assessed with the Action Research Arm Test (ARAT), the Upper-Extremity Fugl-Meyer score (FM-UE), and kinematic analysis of visually guided arm and wrist movements. All assessments were performed twice before the therapeutic intervention and once afterward. Results. There was a clinically meaningful improvement in ARAT from the second pre-CIMT session to the post-CIMT session compared with the change between the 2 pre-CIMT sessions. In contrast, FM-UE and kinematic measures showed no meaningful improvements. Conclusions. Functional improvement in the affected arm after CIMT in patients with chronic stroke appears to be mediated through compensatory strategies rather than a decrease in impairment or return to more normal motor control. We suggest that future large-scale studies of new interventions for neurorehabilitation track performance using kinematic analyses as well as clinical scales.

Source: http://nnr.sagepub.com/cgi/content/abstract/27/2/99?rss=1

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Academy News

November 2012
Publication year: 2012
Source:PM&R, Volume 4, Issue 11

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Exercise Adherence Interventions for Adults With Chronic Musculoskeletal Pain

This excerpt was created in the absence of an abstract.

<LEAP> highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medications, surgery, education, nutrition, exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature.¹ Each article in this PTJ series will summarize a Cochrane review or other scientific evidence resource on a single topic and will present clinical scenarios based on real patients to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on exercise adherence interventions among adults with chronic musculoskeletal pain. Which, if any, approaches foster exercise adherence among adults with chronic musculoskeletal pain?

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20110140v1?rss=1

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Amount and Focus of Physical Therapy and Occupational Therapy for Young Children with Cerebral Palsy

Physical & Occupational Therapy in Pediatrics, Volume 32, Issue 4, Page 368-382, October 2012.

Source: http://informahealthcare.com/doi/abs/10.3109/01942638.2012.715620?ai=1ozx&mi=3s94u5&af=R

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Effect of Externally Cued Training on Dynamic Stability Control During Sit-to-Stand in Patients With Parkinson Disease

Background

Previous studies have shown that people with Parkinson's disease (PwPD) have difficulty performing the sit-to-stand task, due to mobility and stability-related impairments. Despite its importance, limited literature exists on quantification of dynamic stability control in PwPD during this task.

Objective

To examine (1) differences in the control of dynamic stability between PwPD and healthy controls, and (2) the extent to which externally-cued training can improve such control during sit-to-stand in PwPD.

Design

Quasi-experimental controlled trial.

Methods

Performance of 21 PwPD was compared with 12 community-dwelling older adults. PwPD were randomly assigned to a non-training control group or a group receiving audio-visual-cued training for speeding up sit-to-stand performance, 3 times/week for 4 weeks. Outcome measures recorded at baseline and after 4 weeks included the center-of-mass position, its velocity, and the stability against either backward or forward balance loss (backward and forward stability) at seat-off and movement termination.

Results

Compared to healthy controls, PwPD had a greater backward stability resulting from a more anterior center-of-mass position at seat-off and lower velocity (p < 0.05). This feature, combined with a decreased forward stability at movement termination, increased their risk of forward balance loss at movement termination. Post-training, the PwPD achieved greater backward stability (p < 0.05) by increasing their forward center-of-mass velocity at seat-off; while achieving a posterior shift in center-of-mass position to reduce their likelihood of forward balance loss at movement termination.

Conclusions

PwPD increase their postural stability against backward balance loss during task initiation at the expense of possible forward balance loss at task termination. Task-specific training with preparatory audio-visual cues improves their overall dynamic stability against both forward and back balance loss.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20100423v1?rss=1

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Can a Single Phrase Identify Sciatica?.

Author:

Page: 10

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Development of a Novel Eccentric Arm Cycle Ergometer for Training the Upper Body.

Author: Elmer, Steven J. 1,2; Danvind, Jonas 1; Holmberg, Hans-Christer 1

Page: 206-211

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Exercise in Cardiovascular Diseases

November 2012
Publication year: 2012
Source:PM&R, Volume 4, Issue 11



Abstract Analysis of extensive data has shown that exercise training provides significant impact on prevention and modification of cardiovascular diseases and mortality. In general, exercise recommendations for patients with cardiovascular diseases are based on individual aerobic capacity and comorbidities. Patients with acute syndromes benefit from participating in a cardiac rehabilitation program, whereas patients with chronic syndromes benefit from a life-long home-based program. In general, exercise prescription should involve aerobic activities in combination with resistance, flexibility, and balance exercises. This review will discuss an exercise prescription for patients with coronary artery disease, heart failure, and after heart transplantation. Detailed precautions for particular groups of patients will be discussed.

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Using digital photography to document rectus femoris flexibility: A reliability study of the modified Thomas test

Physiotherapy Theory and Practice, Volume 0, Issue 0, Page 1-9, Early Online.

Source: http://informahealthcare.com/doi/abs/10.3109/09593985.2012.731140?ai=1mo2&mi=3s94u5&af=R

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Reliability of Six Physical Performance Tests in Older People With Dementia

Background

Physical performance tests are important to assess the effect of physical activity interventions in older people with dementia, but their psychometric properties have not been systematically established within this specific population.

Objective

The purpose of this study was to determine the relative and absolute test-retest reliability of the 6-m walk test, the Figure-of-Eight Walk Test (F8W), the Timed "Up & Go" Test (TUG), the Frailty and Injuries: Cooperative Studies of Intervention Techniques–4 (FICSIT–4) Balance Test, the Chair Rise Test (CRT), and the Jamar dynamometer. These tests are used to assess gait speed, dynamic balance, functional mobility, static balance, lower-limb strength, and grip strength, respectively.

Design

This investigation was a prospective, nonexperimental study.

Methods

Older people with dementia (n=58, age range=70–92 years) performed each test at baseline and again after 1 week. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and log-transferred limits of agreement of Bland-Altman plots were calculated.

Results

The relative reliability of the F8W, TUG, and Jamar dynamometer was excellent (ICC=.90–.95) and good for the 6-m walk test, FICSIT–4, and CRT (ICC=.79–.86). The SEMs and MDCs were large for all tests. The absolute reliability of the TUG and CRT was significantly influenced by the level of cognitive functioning (as assessed with the Mini-Mental State Examination [MMSE]).

Limitations

The specific etiology of dementia was not obtained.

Conclusions

The physical performance tests evaluated are useful to detect differences in performance between older people with mild to moderate dementia and, therefore, are suitable for cross-sectional or controlled intervention studies. They appear less suitable to monitor clinically relevant intra-individual performance changes. Future studies should focus on the development of more sensitive tests and the identification of criteria for clinically relevant changes in this rapidly growing population.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20110164v2?rss=1

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Why Do People Delay Accessing Health Care for Knee Osteoarthritis? Exploring Beliefs of Health Professionals and Lay People

Purpose: In knee osteoarthritis (OA), opportunity for non-surgical intervention is reduced by time lost between symptom onset and diagnosis. The study's purpose was to understand, from the perspective of various stakeholders, the reasons for delay and useful strategies to enhance early awareness of knee OA. Method: In this qualitative study, focus groups of health professionals (n=6) and community-dwelling individuals (n=7) discussed questions relating to knowledge, attitudes, and beliefs about OA; experiences with people with OA; health care seeking behaviour; and access to services, and suggested strategies to enhance public awareness. Qualitative analyses identified dominant themes. Results: Reasons for delay from the layperson's perspective included lack of knowledge about risk factors and prevention and a belief that knee pain is expected with age. Reasons related to the health care system included long wait times and frustration getting appointments. Health professionals were unclear on which discipline should discuss prevention and risk factors. Suggested strategies included advocating a healthy lifestyle, developing prevention programs, and using celebrities to inform the public. Conclusions: Participants identified multiple reasons for delays and strategies to counter them. Knowledge about gaps in the OA care process can facilitate physiotherapists' participation in developing strategies for early intervention.

• Content Type Journal Article
• Category Advance Online Article
• Pages 1-8
• DOI 10.3138/ptc.2011-50
• Authors
  • Shreya S. Prasanna, School of Physical and Occupational Therapy, McGill University, Montreal
  • Nicol Korner-Bitensky, School of Physical and Occupational Therapy, McGill University, Montreal
  • Sara Ahmed, School of Physical and Occupational Therapy, McGill University, Montreal

• Journal Physiotherapy Canada
• Online ISSN 1708-8313
• Print ISSN 0300-0508

Source: http://www.metapress.com/content/42q11g4n3565v374/

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What Characterizes People Who Have an Unclear Classification Using a Treatment-Based Classification Algorithm for Low Back Pain? A Cross-Sectional Study

Background

A treatment-based classification algorithm for low back pain (LBP) was created to help clinicians select treatments that a patient is most likely to respond to. To allow the algorithm to classify all people with LBP, additional criteria are provided to assist therapists' decisions for patients who do not clearly fit a subgroup (ie, unclear classifications). Recent studies have found that ~34% of LBP patients have unclear classifications.

Objective

To guide improvements to the algorithm, it is imperative to determine if these patients are different from those with clear classifications.

Study Design

Secondary analysis of data from three previous studies investigating the algorithm.

Methods

Baseline data from 529 consecutively-recruited LBP patients were used (3 discrete cohorts). The primary outcome was the type of classification: ‘clear’ or ‘unclear’. Univariate logistic regression was used to determine which participant variables were related to having an unclear classification.

Results

People who received an unclear classification had greater odds of being older (OR=1.01; 95%CI=1.003-1.033), having a longer duration of LBP(OR=1.001; 95%CI=1.000-1.001), having had previous LBP (OR=1.61; 95%CI=1.04-2.49), having less fear avoidance beliefs related to both work (OR=0.98; 95%CI=0.96-0.99) and physical activity (OR=0.98; 95%CI=0.96-0.996), and having less LBP-related disability (OR=0.98; 95%CI=0.96-0.99) than people with clear classifications.

Limitations

The studies from which patient data were drawn had different inclusion criteria and clinical settings.

Conclusions

People receiving unclear classifications appear to be less affected by their LBP (lower disability and fear avoidance beliefs), despite typically having a longer duration of LBP. Future studies should investigate if modifying the algorithm to possibly exclude these people or provide them with a different intervention improves outcomes.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120263v1?rss=1

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