Chipchase Ls

The effect of electrical stimulation on corticospinal excitability is dependent on application duration : a same subject pre-post test design

BackgroundIn humans, corticospinal excitability is known to increase following motor electrical stimulation (ES) designed to mimic a voluntary contraction. However, whether the effect is equivalent with different application durations and whether similar effects are apparent for short and long applications is unknown. The aim of this study was to investigate whether the duration of peripheral motor ES influenced its effect on corticospinal excitability.MethodsThe excitability of the corticomotor pathway to abductor pollicis brevis (APB) was measured in fourteen health subjects using transcranial magnetic stimulation before, immediately after and 10 minutes after three different durations (20-, 40-, 60-min) of motor ES (30Hz, ramped). This intervention was designed to mimic a voluntary contraction in APB. To control for effects of motor ES on the peripheral elements (muscle fibre, membrane, neuromuscular junction), maximum compound muscle actions potentials (M-waves) were also recorded at each time point. Results were analysed using a repeated measures analysis of variance.ResultsPeripheral excitability was reduced following all three motor ES interventions. Conversely, corticospinal excitability was increased immediately following 20- and 40-min applications of motor ES and this increase was maintained at least 20-min following the intervention. A 60-min application of motor ES did not alter corticospinal excitability.ConclusionsA 20-min application of motor ES that is designed to mimic voluntary muscle contraction is as effective as that applied for 40-min when the aim of the intervention is to increase corticospinal excitability. Longer motor ES durations of 60-min do not influence corticospinal excitability, possibly as a result of homeostatic plasticity mechanisms.

Using technology to enhance physical therapy students’ problem-solving skills around safe patient handling

Abstract Background: Physical therapy students are at risk of musculoskeletal injuries during patient handling. Current guidelines recommend a risk management approach to reduce the likelihood of injury associated with patient handling. Objectives: To determine the benefits of online scenarios using scenario-based learning interactive (SBLi®) to enhance students’ confidence in making decisions around patient handling techniques, including equipment, and in practical patient handling skills. Methods: Third year undergraduate and first year graduate-entry masters (GEM) students from the 2011 cohort of the physical therapy program at The University of Queensland received comprehensive training in patient handling. Only GEM students completed two SBLi patient scenarios. Students’ confidence in selecting patient handling techniques and equipment was assessed pre- and post-training with three statements scored on a 10-cm visual analogue scale anchored from strongly disagree to strongly agree. Patient handling skills were assessed with a practical skill assessment. Student satisfaction with SBLi as a learning platform was determined with three items and a focus group with eight students. Results: Students’ confidence in performing a patient risk assessment and selecting appropriate patient handling technique and equipment improved with training. However, the online scenarios provided no additional advantage to the GEM students’ confidence in these tasks or in the practical skill assessment. GEM students were moderately satisfied with SBLi as a learning platform, reporting that it assisted their clinical preparation for the clinical environment and increased their awareness for safety of themselves and others. Conclusions: The online interactive scenarios provided no additional benefit but may assist student preparation for the clinical environment.

The type and pain provoking nature of exercise prescribed for low back pain: A survey of Australian health professionals

OBJECTIVES To explore the type of exercise prescribed by Australian health professionals for LBP, and whether the exercises prescribed are pain-free or into pain. METHODS A survey of physiotherapists and exercise physiologists was conducted from all states/territories in Australia. The survey contained two chronic LBP vignettes with different pain mechanisms (dominant nociceptive or central sensitisation pain) and one acute LBP vignette. Respondents were asked if they would prescribe advice to stay active and exercise. If exercise was prescribed, respondents were asked to specify the type and pain provoking nature (exercise with no pain, exercise to the start of pain, exercise with pain at a tolerable level or exercise irrespective of pain). RESULTS The response rate was 17%(218/1276). Most respondents prescribed advice to stay active(≥95%) and exercise(≥90%) for all vignettes. Irrespective of the vignette, several exercises were prescribed [aerobic (57-85% of clinicians), motor control (62-84% of clinicians), range of motion (72-75% of clinicians)]. Strengthening exercise was prescribed more for chronic(>60%) than acute LBP(23%). Irrespective of the exercise, between 20 and 25% of respondents prescribed pain-free exercise, between 71 and 79% of respondents prescribed exercise into pain, and ≤4% prescribed exercise irrespective of pain for acute and chronic LBP. CONCLUSIONS Several exercises are prescribed for LBP, irrespective of pain mechanism or duration, with more clinicians prescribing strengthening exercise for chronic than acute LBP. Most clinicians prescribed exercise into pain for acute and chronic LBP, irrespective of the exercise. Further research should determine which exercises are beneficial based on pain mechanism and duration, and whether exercise into pain should be prescribed for LBP.

The accuracy of therapeutic ultrasound equipment: a systematic review

Abstract Objectives: Because of its importance for patient safety and treatment efficacy, the volume and methodological quality of the evidence available on the accuracy of therapeutic ultrasound equipment is examined with respect to power output and timing function. Evidence for a causal relationship between ultrasound inaccuracy and machine age, brand, frequency of use and intensity settings is also examined. Methods: A systematic literature search was performed to identify observational studies examining levels of ultrasound machine inaccuracy. Methodological quality was examined using the Sheffield University hierarchy of evidence and a modified version of the McMaster University critical appraisal tool. Data was pooled using the descriptive statistics (mean, standard deviation, percentage) available in each study. Results: Eighteen studies out of 47 were retained for review. Methodological scores ranged from 2 to 15˙5 (maximum 20). Two thirds of ultrasound machines (64˙6%; SD 23˙2; range 14–100%) were found to produce an inaccurate power input. The average percentage of timers found to be inaccurate was 30˙1 and 22˙6% at 5 and 10 min, respectively. The only variable correlated with level of machine inaccuracy was that of machine age. Discussion: The current review indicates that a significant proportion of ultrasound machines produce inaccurate power outputs or have an inaccurate timing function. This finding has implications for both clinical practice and therapeutic ultrasound research.