Louisa Remedios

Feldenkrais Method balance classes are based on principles of motor learning and postural control retraining: a qualitative research study

BACKGROUND Feldenkrais Method balance classes have been found to be effective in improving balance in recent studies, but there has been little research into possible mechanisms behind the effectiveness of these classes. Indeed, there has been little research into the content of any balance training classes. OBJECTIVES To analyse the content of a series of Feldenkrais Method balance classes to gain an understanding of how the results in these studies may have been achieved and the principles through which the method may be effective. DESIGN Qualitative research approach (content analysis). METHOD Feldenkrais Method Awareness Through Movement lessons were transcribed and the contents were analysed. An intercoder reliability study was undertaken. RESULTS The content analysis revealed that the classes used motor skill acquisition elements of internal feedback, repetition and variability of practice using an exploratory learning approach. Postural control skills of intersegmental coordination of ankle/hip/trunk synergies were practised, with control of the centre of mass over the base of support explored in anterior/posterior, medio/lateral, diagonal, rotational and circular directions. Key findings were the extensive involvement of trunk flexibility and control in the balance activities, and also the intensive attention to internal feedback which was linked to body awareness training. CONCLUSION The Awareness Through Movement lessons contained many elements consistent with current theories of motor skill acquisition and postural control, providing a sound theoretical basis for the effectiveness of the Feldenkrais approach in improving balance. The methodology used in this study may provide a useful model for similar investigations into other balance training approaches.

Framing Collaborative Behaviors: Listening and Speaking in Problem-Based Learning.

Abstract PBL is described as small-group collaborative learning; however, literature on how col-laboration is enacted in PBL contexts is limited. A two-year ethnographic study exam-ined the experiences and responses of Asian students to the obligations of PBL in aWestern context. Participant-observation, videotape data, and video-stimulated recallinterviews provided insights into collaborative behaviors in PBL classrooms. Eventhough students recognized that listening and speaking were important to collabora-tion, speaking was clearly privileged over listening in this PBL setting. A framework wasdeveloped that incorporated both collaborative and noncollaborative listening andspeaking behaviors. This Collaborative Listening/Speaking (CLS) framework provides astructure for tutors to scaffold the novice learners’ collaborative skills, and thereforemore effectively facilitate the group’s learning through collaboration. Introduction Small-group collaborative learning is a fundamental component of the problem-basedlearning (PBL) approach (Barrows & Tamblyn, 1980; Savery, 2006). In the context of PBL,collaborative learning has been described as “the process by which individuals,workingfrom different perspectives, come to an understanding of rich, complex concepts”(Kelson & Distlehorst, 2000, p. 172). The collaborative nature of PBL is mentioned as a

Replacing stressful challenges with positive coping strategies: a resilience program for clinical placement learning

Clinical education is foundational to health professional training. However, it is also a time of increased stress for students. A student’s perception of stressors and their capacity to effectively manage them is a legitimate concern for educators, because anxiety and decreased coping strategies can interfere with effective learning, clinical performance and capacity to care for patients. Resilience is emerging as a valuable construct to underpin positive coping strategies for learning and professional practice. We report the development and evaluation of a psycho-education resilience program designed to build practical skills-based resilience capacities in health science (physiotherapy) students. Six final year undergraduate physiotherapy students attended four action research sessions led by a clinical health psychologist. Resilience strategies drawn from cognitive behavioural therapy, and positive and performance psychology were introduced. Students identified personal learning stressors and their beliefs and responses. They chose specific resilience-based strategies to address them, and then reported their impact on learning performance and experiences. Thematic analysis of the audio-recorded and transcribed action research sessions, and students’ de identified notes was conducted. Students’ initial descriptions of stressors as ‘problems’ outside their control resulting in poor thinking and communication, low confidence and frustration, changed to a focus on how they managed and recognized learning challenges as normal or at least expected elements of the clinical learning environment. The research suggests that replacing stressful challenges with positive coping strategies offers a potentially powerful tool to build self-efficacy and cognitive control as well as greater self-awareness as a learner and future health practitioner.

The use of the International Classification of Functioning, Disability and Health to understand the health and functioning experiences of people with chronic conditions from the person perspective: a systematic review

Abstract Purpose: This systematic review examines the literature to identify the context and extent of implementation of the International Classification of Functioning, Disability and Health (ICF) model to understand the experience of health and functioning in persons with chronic conditions from the person perspective. Method: The literature search was conducted through five electronic databases between 2001 and December 2012. Reference lists of included papers were also searched. Articles in which the ICF was used to understand the health and functioning experience of adults with chronic conditions from the person-perspective were included. Data were extracted and analysed to identify the year of publication, geographical location, health condition, context of ICF use, authors’ remarks and identified limitations of the ICF. Results: Thirty-seven qualitative and mixed-methods studies were included representing 18 countries and a range of chronic conditions. The ICF was found to be used to elicit and analyse people’s narratives, with the majority of studies reporting that the ICF provides a comprehensive analysis of experiences and needs from the person perspective. Some limitations to its use and the need to classify the “personal factors” component were reported. Conclusion: The ICF has been used to provide a comprehensive understanding of health and functioning in persons with chronic conditions from the person perspective, although there are currently relatively few studies which have used the ICF in this context. Limitations regarding its use were reported which should be considered by users of the model and during its revision process. Implications for Rehabilitation The ICF encourages a bio-psycho-social and person-centred approach to healthcare and may provide a useful tool for guiding clinical assessment and encouraging clinicians to consider the multitude of factors which impact health, which may result in more specific and individualised treatment targeted at individual needs. Using a common framework that can be understood across health disciplines may enhance interdisciplinary communication and collaboration, improving health care delivery. The ICF may be used to compare perspectives of individuals and their health professionals and to identify people’s needs that are not adequately being addressed, which may have significant implications for improving healthcare provided and overall health outcomes.

The use of the international classification of functioning, disability and health (ICF) in indigenous healthcare: a systematic literature review

IntroductionThe International Classification of Functioning, Disability and Health (ICF) was endorsed by the World Health Organisation (WHO) in 2001 to obtain a comprehensive perspective of health and functioning of individuals and groups. Health disparities exist between Indigenous and non-Indigenous Australians and there is a need to understand the health experiences of Indigenous communities from Indigenous Australian’s perspectives in order to develop and implement culturally appropriate and effective intervention strategies to improve Indigenous health. This systematic review examines the literature to identify the extent and context of use of the ICF in Indigenous healthcare, to provide the foundation on which to consider its potential use for understanding the health experiences of Indigenous communities from their perspective.MethodsThe search was conducted between May and June 2012 of five scientific and medical electronic databases: MEDLINE, Web of Science, CINAHL, Academic Search Complete and PsychInfo and six Indigenous-specific databases: AIATSIS, APAIS-health, ATSI-health, health and society, MAIS-ATSIS and RURAL. Reference lists of included papers were also searched. Articles which applied the ICF within an Indigenous context were selected. Quantitative and qualitative data were extracted and analysed by two independent reviewers. Agreement was reached by consensus.ResultsFive articles met the inclusion criteria however two of the articles were not exclusively in an Indigenous context. One article applied the ICF in the context of understanding the health experience and priorities of Indigenous people and a second study had a similar focus but used the revised version of the International Classification of Impairments, Disability and Handicap (ICIDH-2), the predecessor to the ICF. Four of the five papers involved Indigenous Australians, and one of the paper’s participants were Indigenous (First Nation) Canadians.ConclusionLiterature referring to the use of the ICF with Indigenous populations is limited. The ICF has the potential to help understand the health and functioning experience of Indigenous persons from their perspective. Further research is required to determine if the ICF is a culturally appropriate tool and whether it is able to capture the Indigenous health experience or whether modification of the framework is necessary for use with this population.RésuméIntroductionLa Classification Internationale du Fonctionnement, de l’Incapacité et de la Santé (ICF) a été apprové par l’Organisation Mondiale de la Santé (OMS) en 2001 pour obtenir une perspective complète de la santé et du fonctionnement des individus et des groupes. Des disparités de santé existent entre les Australiens indigènes et non-indigènes et il y a un grand besoin de comprendre les états de santé des communautés indigènes vus de leur propre perspective afin de développer et mettre en application des stratégies d’intervention culturellement appropriées et efficaces pour améliorer leur santé. Cette révision systématique vérifie toute documentation pour identifier l’ampleur et le contexte de l’utilisation de l’ICF dans les soins des Indigènes permettant ainsi de considérer son utilisation potentielle pour comprendre les expériences de santé des communautés indigènes vues de leur propre perspective.MéthodesLa recherche a été accomplie entre mai et novembre 2012 à partir de cinq bases de données électroniques scientifiques et médicales: MEDLINE, Web of Science, CINAHL, Academic Search Complete, PsychInfo et six bases de données spécifiquement indigènes: AIATSIS, APAIS-health, ATSI-health, health and society, MAIS-ATSIS et RURAL. Les listes de références des documents inclus ont été également examinées. Les articles qui s’appliquaient à l’ICF dans le contexte indigène ont été sélectionnés. Des données quantitatives et qualitatives ont été extraites et analysées par deux critiques indépendants et les désaccords ont été résolus par consensus.RésultatsCinq articles ont bien répondu aux critères d’inclusion, bien que deux des articles n’aient pas fait exclusivement partie d’un contexte indigène. L’un des articles a appliqué l’ICF pour comprendre les expériences et les priorités de santé des Indigènes et une deuxième étude a fait de même mais a employé une nouvelle version de la Classification Internationale de l’ Infirmité, l’Incapacité et le Handicap (ICIDH-2), le prédécesseur de l’ICF. Tous les documents concernaient les Indigènes australiens à l’exception d’un dont les participants étaient des Indigènes (Premières Nations) canadiens.ConclusionLa documentation se rapportant à l’utilisation de l’ICF avec des populations indigènes est limitée. L’ICF a le potentiel d’aider à comprendre les expériences de santé et le fonctionnement des Indigènes vus de leur propre perspective. Davantage de recherche est essentielle pour déterminer si l’ICF est culturellement appropriée et peut capturer les expériences de santé des Indigènes ou si une modification de cadre est nécessaire pour son utilisation avec cette population.

Chinese Students' Perception of Out-of-class Groupwork in Australia

Despite increasing number of mainland Chinese students studying in western tertiary settings, there is limited information available on their learning experiences and responses to popular educational practices in these contexts. There is an assumption in the literature that Chinese students respond well to the collaborative demands of groupwork due to the collectivist nature of their culture, however there are few reports to substantiate this claim. This paper reports on mainland Chinese students’ perception of groupwork in two Australian tertiary settings. Thirteen students from mainland China were interviewed on their groupwork experiences. All interviews were completed in either Mandarin or Cantonese. Two types of groupwork were identified: assignment groupwork (AGW) and student generated groupwork (SGGW). Three criteria for collaboration: level of interaction, construction of knowledge and a shared goal were used to search for signs of collaborative elements in the Chinese students’ recall of their groupwork experience. Indicators of collaboration were identified in the reports of AGWs but were less consistent in SGGWs. The findings of this study suggest that Chinese students perceive out-of-class groupwork in an Australian context as a positive learning experience, reporting enhanced understanding of academic contents, application of knowledge and socializing with other Chinese students.

Identifying pedagogy and teaching strategies for achieving nationally prescribed learning outcomes

ABSTRACT With the globalisation of university education, national frameworks are commonly used to prescribe standardised learning outcomes and achieve accountability. However, these frameworks are generally not accompanied by guiding pedagogy to support academics in adjusting their teaching practices to achieve the set outcomes. This paper reports the results of a scoping review of health science literature aimed at identifying pedagogy and teaching strategies relevant to achieve the learning outcomes specified by the Australian Qualifications Framework at a masters degree level. Eight practical teaching messages emerged from the review and three broad pedagogical trends were identified: the need to use authentic disciplinary-based learning activities; ensure that students are able to discover different perspectives about future practice and bring student reflection about their own knowledge into curricula. More critically, the review highlights that academics attempting to translate national learning outcome frameworks into their teaching practices face a complex and time-consuming task which may involve searching beyond their own disciplinary focus to identify practical teaching strategies to meet prescribed learning outcomes.

Communication in Indigenous healthcare: extending the discourse into the physiotherapy domain

Considering the high mortality andmorbidity associated with chronic conditions amongst Indige-nous communities, it is essential to provide Indigenous Austra-lians access to equitable healthcare. Physiotherapists are wellpositioned to play an important role in preventing and managingmany health conditions that are prevalent amongst IndigenousAustralians.TheAustralianPhysiotherapyAssociation(APA)hasaPosition Statement on Indigenous Health

The REACH project: Implementing interprofessional practice at Australia's first student-led clinic

Background: REACH (Realising Education and Access in Collaborative Health) is an initiative of  students of the University of Melbourne to improve access to primary health care services. It is driven by the voluntary commitment of over 120 students and is built upon the principles of collaboration, interprofessionalism and client-centered care. Summary of work: The feasibility of student-led clinics has been demonstrated with the operation of over 100 such clinics in North America. Senior students from Medicine, Physiotherapy, Nursing and Social Work attended a student-run clinics conference in Jacksonville, Florida, USA in 2010. On return, research was conducted to identify a local underserviced community appropriate for a clinic. On review of the literature, it was determined an interprofessional model of care would best serve this community. The student body engaged a local community health service as a project partner. The model of care at the REACH Clinic was developed by senior students from the schools of Medicine, Physiotherapy, Nursing and Social Work and managed by an interconnected student committee structure. The final consultation model involves a triage process and simultaneous consultation by two disciplines. This model of care was successfully implemented during a 4-week pilot period in October 2011. Results: Several issues were identified during the REACH pilot, with dissonance between the at-times competing principles in health care of interprofessionalism, client-centered care and efficient care. Conclusions: An interprofessional model of care was developed and successfully implemented in a 4-week pilot student-run clinic within an established community health service. While providing a free health service, this model facilitated interprofessional learning at both a clinical and management level and highlighted logistical and ideological challenges that served as the basis for further refinement of this model of community service .

Evidence, education and multi-disciplinary integration are needed to embed exercise into lung cancer clinical care: A qualitative study involving physiotherapists

ABSTRACT Aims: To explore physiotherapists perceptions regarding barriers and enablers to embedding exercise into routine lung cancer clinical care. Design: Qualitative study (content analysis). Eight physiotherapists working in the area of lung cancer at five hospitals participated. The focus group was conducted, transcribed verbatim and independently crosschecked. Thematic analysis was utilized. Results: The data generated four major themes: evidence justifying exercise; staffing and services; maximising the efficacy of interventions; and hospital culture. Physiotherapists perceived that barriers included lack of evidence, lack of physiotherapy time and funding, inconsistencies in patient access to outpatient exercise programs, lack of clear referral pathways, limited knowledge about exercise by the wider multi-disciplinary team, and poor culture of physical activity in the inpatient setting. Recommendations included developing a stronger evidence-base, establishing set patient pathways into exercise programs, re-allocating physiotherapy services to high-risk patients, and integrating/involving the multi-disciplinary team particularly through education and communication. Conclusion: This study has identified barriers to, and potential strategies for, the embedding of exercise into lung cancer clinical practice. Evidence, education and multi-disciplinary integration are viewed by physiotherapists as critical for success. A targeted gradual approach, by applying these strategies at defined stages across the lung cancer pathway, is recommended to facilitate future practice change.