A. Russell Smith

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

The Orthopaedic Section of the American Physical Therapy Association presents this sixth set of clinical practice guidelines on Achilles pain, stiffness, and muscle power deficits that are characteristic of Achilles Tendinitis. These clinical practice guidelines are linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders. J Orthop Sports Phys Ther 2010:40(9):A1–A26. doi:10.2519/jospt.2010.0305

Process for Applying the International Classification of Functioning, Disability and Health Model to a Patient With Patellar Dislocation

Background and Purpose: The International Classification of Functioning, Disability and Health (ICF) has been proposed as a possible framework for organizing physical therapist practice. The purpose of this case report is to describe an evaluative and diagnostic process that is based on the ICF framework for a patient with a patellar dislocation. Case Description: The patient was a 23-year-old woman who sustained a right knee and patellofemoral joint injury, resulting in a sprain of the medial collateral ligament and a suspected sprain of the medial patellofemoral ligament. Evaluation at 4 weeks demonstrated a primary impairment of patellar instability associated with the primary activity limitation of limited walking distances. A plan of care to address impairments, activity limitations, and participation restrictions was developed, with modifications made on the basis of the patients health condition and personal and environmental factors. Outcomes: The patient attained all of her goals for therapy and was able to return to her normal activities and recreational pursuits without a recurrence of a patellar dislocation. Lower-Extremity Function Scale scores increased from 30 out of 80 to 76 out of 80 during the course of treatment. Discussion: The ICF model has been proposed as a framework for developing diagnostic classifications for rehabilitation professionals. The ICF model also should be assessed with regard to whether it provides a useful process for clinical decision making. The ICF model directs practitioners to address patients’ problems at the level of the whole person, with modifications made on the basis of health conditions and personal and environmental factors.

Manual Therapy: The Historical, Current, and Future Role in the Treatment of Pain

Manual therapy has been an approach in the management of patients with various disorders dating back to ancient times and continues to play a significant role in current health care. The future role of manual therapy in health care is an important area of research. This paper reviews the history of manual therapy, examines the current literature related to the use of manual techniques (including manipulation, massage, and nerve manipulation), and discusses future research topics. The literature related to manual therapy has historically been anecdotal and theoretical, and current research tends to have a generic approach with broad definitions of manual therapy and inconsistencies in the classification of specific disorders. Systematic reviews of various types of manual therapy have differed on their conclusions regarding the effectiveness of this treatment modality. The current demand in health care for evidence-based practice necessitates a movement towards more specificity in the research of the effectiveness of manual therapy, with emphasis on specific patient signs and symptoms and specific manual techniques that result in effective care.

Instructional multimedia: An investigation of student and instructor attitudes and student study behavior

BackgroundEducators in allied health and medical education programs utilize instructional multimedia to facilitate psychomotor skill acquisition in students. This study examines the effects of instructional multimedia on student and instructor attitudes and student study behavior.MethodsSubjects consisted of 45 student physical therapists from two universities. Two skill sets were taught during the course of the study. Skill set one consisted of knee examination techniques and skill set two consisted of ankle/foot examination techniques. For each skill set, subjects were randomly assigned to either a control group or an experimental group. The control group was taught with live demonstration of the examination skills, while the experimental group was taught using multimedia. A cross-over design was utilized so that subjects in the control group for skill set one served as the experimental group for skill set two, and vice versa. During the last week of the study, students and instructors completed written questionnaires to assess attitude toward teaching methods, and students answered questions regarding study behavior.ResultsThere were no differences between the two instructional groups in attitudes, but students in the experimental group for skill set two reported greater study time alone compared to other groups.ConclusionsMultimedia provides an efficient method to teach psychomotor skills to students entering the health professions. Both students and instructors identified advantages and disadvantages for both instructional techniques. Reponses relative to instructional multimedia emphasized efficiency, processing level, autonomy, and detail of instruction compared to live presentation. Students and instructors identified conflicting views of instructional detail and control of the content.

Effect of Interactive Multimedia on Basic Clinical Psychomotor Skill Performance by Physical Therapist Students

Background and Purpose. Physical therapist educators are challenged to provide quality instruction in psychomotor skills. Multimedia instruction may facilitate and enhance psychomotor skill acquisition and therefore is of significant interest to physical therapist educators. The purpose of this study was to examine the differences between physical therapist student cognitive and psychomotor performance on basic clinical skills when taught traditionally versus with interactive multimedia. Subjects. Participants were recruited from 2 physical therapist programs. Twenty‐four students volunteered to participate from Program 1 and 21 students volunteered from Program 2. Methods. Students were randomly assigned to an instructional strategy: (1) an experimental group receiving an instructional CD of clinical orthopedic techniques for the knee and practice with instructor feedback, or (2) a control group receiving live demonstration of clinical orthopedic techniques for the knee and practice with instructor feedback. Instructional strategies were then switched for instruction of clinical skills for the ankle/foot. Results. Written examination scores improved with both instructional strategies, demonstrating no differences observed between the strategies. No differences in practical examination knee scores were observed between instructional strategy groups. Practical examination ankle scores were significantly higher in participants receiving CD instruction than in participants receiving live presentation. Age and sex were found to have no effect on written or practical scores. Discussion and Conclusion. This study supports the use of multimedia instruction as an effective strategy to instruct clinical skills related to the knee and ankle. A better understanding of the role of multimedia instruction in teaching psychomotor skills will aid physical therapist educators in improving the performance of clinical skills by future clinicians.

The science of spinal motion palpation: a review and update with implications for assessment and intervention

Abstract Spinal motion palpation (SMP) is a standard component of a manual therapy examination despite questionable reliability. The present research is inconclusive as to the relevance of the findings from SMP, with respect to the patient’s pain complaints. Differences in the testing methods and interpretation of spinal mobility testing are problematic. If SMP is to be a meaningful component of a spinal examination, the methods for testing and interpretation must be carefully scrutinized. The intent of this narrative review is to facilitate a better understanding of how SMP should provide the examiner with relevant information for assessment and treatment of patients with spinal pain disorders. The concept of just noticeable difference is presented and applied to SMP as a suggestion for determining the neutral zone behavior of a spinal segment. In addition, the use of a lighter, or more passive receptive palpation technique, is considered as a means for increasing tactile discrimination of spinal movement behavior. Further understanding of the scientific basis of testing SMP may improve intra- and inter-examiner reliability. The significance of the findings from SMP should be considered in context of the patient’s functional problem. Methodological changes may be indicated for the performance of SMP techniques, such as central posterior-anterior (PA) pressure and passive intervertebral motion tests, in order to improve reliability. Instructors of manual therapy involved in teaching SMP should be knowledgeable of the neurophysiological processes of touch sensation so as to best advise students in the application of the various testing techniques.

Effects of video podcasting on psychomotor and cognitive performance, attitudes and study behaviour of student physical therapists

Purpose: Multimedia is an effective tool to teach psychomotor skills to health care students. Video podcasting is a next step as educators seek methods to present psychomotor skills efficiently. The purposes of this pilot study were (1) compare the effectiveness of video podcasting to live demonstration for teaching psychomotor skills to Doctor of Physical Therapy (DPT) students; (2) examine students’ attitudes toward podcasts and (3) examine study behaviour of DPT students. Methods: Faculty developed podcasts depicting two sets of psychomotor skills for a basic skills course. A crossover design was utilised. For skill set #1, group A received podcasts and group B received live demonstration. For skill set #2, group A received live demonstration and group B received podcasts. Results: There were no differences in exam scores between groups and study behaviour varied significantly in one instance. Students’ attitudes were discussed. Conclusions: Podcasting was as effective as live demonstration for present...Purpose: Multimedia is an effective tool to teach psychomotor skills to health care students. Video podcasting is a next step as educators seek methods to present psychomotor skills efficiently. The purposes of this pilot study were (1) compare the effectiveness of video podcasting to live demonstration for teaching psychomotor skills to Doctor of Physical Therapy (DPT) students; (2) examine students’ attitudes toward podcasts and (3) examine study behaviour of DPT students. Methods: Faculty developed podcasts depicting two sets of psychomotor skills for a basic skills course. A crossover design was utilised. For skill set #1, group A received podcasts and group B received live demonstration. For skill set #2, group A received live demonstration and group B received podcasts. Results: There were no differences in exam scores between groups and study behaviour varied significantly in one instance. Students’ attitudes were discussed. Conclusions: Podcasting was as effective as live demonstration for presenting basic skills.

A case report: Application of the upright motor control test on physical therapy intervention of an individual following a stroke

This case report shows the application of the Upright Motor Control Test in the physical therapy management of an individual following a stroke. The individual is a 43-year-old male who sustained an infarct of the right thalamus 2 days prior to inpatient rehabilitation admission. Observational gait analysis and the Upright Motor Control Test isolated the primary gait deficit as left hip and ankle extension in the stance phase of gait. Physical therapy interventions focused on specific functional tasks that challenged hip extension so that he could resume the activities in which he engaged prior to the stroke. After a 3 week length of stay in inpatient rehabilitation, the individual demonstrated an improvement in the outcome measures, functional progression with ambulation (level and stairs), and transfers sufficient to be discharged home. This case illustrates how standardized outcome measures assisted the clinician in isolating the gait impairments that limited his ability to ambulate within his home environment. Subsequently, the plan of care and physical therapy interventions focused on these deficits to maximize the functional outcomes.

Role of Manual Physical Therapy and Specific Exercise Intervention in the Treatment of a Patient with Cervicogenic Headaches: A Case Report

Abstract Headaches are a common complaint among patients seeking medical care. This case report highlights the role of physical therapy (PT) management including manual therapy and specific exercise interventions in the care of a patient with cervicogenic headaches. The patient was an 18-year-old female college student with a medical diagnosis of migraine headaches. Her history included three previous motor vehicle accidents. Treatment from her primary care physician and optometrist had had no effect on her headache intensity and frequency. Findings on the PT examination included upper cervical segmental restrictions and neuromuscular imbalances. The primary treatment strategy for this patient included cervical manipulation, neuromuscular retraining of deep neck flexors, and soft tissue manipulation. The patient demonstrated improvement with a total of seven treatment sessions over a five-week period. Neck Pain Disability Index score improved from a score of 38% perceived disability at initial examination to a score of 10% upon discharge. Headache frequency and intensity significantly improved as upper cervical segmental mobility and deep cervical flexor function improved to within normal limits. This case report demonstrates the potential role of manual physical therapy and specific exercise intervention in quickly improving function and impairments in a patient with cervicogenic headaches.