Mary Thompson

Predicting the probability of falls in community dwelling persons with brain injury: a pilot study.

Primary objectives: To determine the usefulness of select balance and functional mobility measures in predicting fall risk in community dwelling persons with brain injury (BI) and to develop a model to quantify fall risk. Research design: An exploratory pilot study to predict fall risk in persons with BI. Non-manipulated independent variable was fall status with two levels, non-faller and faller. Dependent variables were scores on the Berg Balance Scale (BBS), the Dynamic Gait Index (DGI) and the Falls Efficacy Scale (FES); age, gender, supervision required and assistive device use. Methods and procedures: Twenty-six participants recruited from support groups and community re-entry programmes were divided into two groups, fallers and non-fallers. The FES, BBS and DGI were administered. Main outcomes and results: T-tests and chi-square tests revealed between group differences for age, FES, BBS, DGI and assistive device use. Spearmans rho statistic showed moderate relationships among the variables, FES, BBS, DGI and assistive device use. Logistic regression determined the DGI to best predict fall risk. Conclusions: This study developed a predictive model that could be used by therapists to determine an individuals fall risk in the home or outpatient settings. Assessing risk allows therapists to identify individuals who would benefit from intervention designed to improve balance and gait ability, possibly preventing future falls and a second head injury.

A Conceptual Model of Optimal International Service-Learning and Its Application to Global Health Initiatives in Rehabilitation

Background There is growing involvement by US clinicians, faculty members, and students in global health initiatives, including international service-learning (ISL). Limited research has been done to examine the professions increasing global engagement, or the ISL phenomenon in particular, and no research has been done to determine best practices. This study was intended as an early step in the examination of the physical therapy professions role and activities in the global health arena within and beyond academics. Objectives The purposes of this study were: (1) to identify and analyze the common structures and processes among established ISL programs within physical therapist education programs and (2) to develop a conceptual model of optimal ISL within physical therapist education programs. Design A descriptive, exploratory study was completed using grounded theory. Methods Telephone interviews were completed with 14 faculty members who had been involved in international service, international learning, or ISL in physical therapist education programs. Interviews were transcribed, and transcriptions were analyzed using the grounded theory method. Results Four major themes emerged from the data: structure, reciprocity, relationship, and sustainability. A conceptual model of and a proposed definition for optimal ISL in physical therapist education were developed. Seven essential components of the conceptual model are: a partner that understands the role of physical therapy, community-identified needs, explicit service and learning objectives, reflection, preparation, risk management, and service and learning outcome measures. Essential consequences are positive effects on students and community. Conclusions The conceptual model and definition of optimal ISL can be used to direct development of new ISL programs and to improve existing programs. In addition, they can offer substantive guidance to any physical therapist involved in global health initiatives.

Treadmill training post stroke: are there any secondary benefits? A pilot study

Objective: To explore the secondary benefits of treadmill training for people in the chronic stage of recovery from stroke. Design: Modified random assignment, matched-pair control group design with repeated measures. Setting: Outpatient stroke centre. Participants: Twenty individuals post first stroke who acknowledged walking slower than pre stroke. Participants matched by side of hemiparesis and motor impairment. Interventions: Twelve 20-minute sessions of walking on a treadmill or weekly phone call. Main outcome measures: Depression (Beck Depression Index), mobility and social participation (Stroke Impact Scale 3.0 subscales) were assessed initially, at the end of 12 treatments (four weeks) and six weeks later. Results: No significant difference was found between groups for any dependent measure. The ANOVA to investigate main effects in each group found no significant findings in the control group; however in the treatment group significant improvements over time for depression (P=0.005, P<0.001), mobility (P=0.008) and social participation (P= 0.004) were demonstrated. Conclusions: A task-specific intervention designed to improve gait speed may potentially provide secondary benefits by positively impacting depression, mobility and social participation for people post stroke.

Relationships among measures of knee musculoskeletal impairments, gross motor function, and walking efficiency in children with cerebral palsy.

Purpose: The study was designed to determine whether relationships exist among knee muscle spasticity, isometric knee muscle strength, knee muscle balance, gross motor function, and walking efficiency in children with spastic cerebral palsy and to evaluate the relative contributions of impairment measures to functional outcome measures. Methods: Twenty-seven children with spastic diplegic cerebral palsy participated. Knee muscle strength and spasticity were measured by a hand-held dynamometer and the Ashworth Scale, respectively. Functional abilities were assessed by the Gross Motor Function Measure and by calculating the energy expenditure index from data collected during two three-minute walk tests (comfortable and fast speeds). Results: Significant relationships were found between impairments and functional abilities (r = 0.42–0.85, p < 0.05). Isometric hamstring strength and quadriceps spasticity explained 81.5% of total Gross Motor Function Measure score variance. Quadriceps spasticity explained 56.7% of energy expenditure index variance during comfortable walking. Conclusion: Hamstring strength and quadriceps spasticity explain much of the variance in gross motor function and comfortable walking efficiency.

Quality of life and physical performance in land- and water-based pulmonary rehabilitation

PURPOSE: Traditional land-based pulmonary rehabilitation (PR) has been shown to provide improvement in physical performance and quality of life in patients with chronic obstructive pulmonary disease (COPD). The training effects of a water environment in pulmonary patients have only been briefly investigated. The purpose of this retrospective study was to compare quality of life and physical performance in land- and water-based PR. METHODS: The study included participants of a land- or water-based PR program. Twenty land- and water-based participants with stable COPD disease were retrospectively matched within 20 mL of their forced expiratory ventilation in 1 second. A multivariate analysis of variance was performed on each groups 6-minute walk test distance; 6-repetition maximum strength tests for the knee, hip, and shoulder; and mental and physical health summary scores of the Medical Outcomes Short-form 36. RESULTS: Each group significantly improved in all outcome measurements, but there was no difference found in the improvements between the land- or water-based groups. CONCLUSION: Clinicians can consider water-based PR exercise program as another treatment option, if available, for patients with COPD and expect similar benefits to traditional land-based PR programs including improved walk distances, strength, and perception of well-being.

Forward and lateral sitting functional reach in younger, middle-aged, and older adults.

Purpose: We adapted the original Functional Reach so that sitting balance could be quantifiably measured in 2 directions. Purposes of the study were to determine if sitting forward or lateral reach: (1) are reliable among younger, middle‐aged, and older adults without balance problems; (2) provide reference values for clinicians; and (3) examine factors (age and anthropometrics) that may influence such measures. Methods: This descriptive study involved 146 apparently healthy adults in 3 age groups: 62 younger (21 to 39 yr), 41 middle‐aged (40 to 59 yr), and 43 older (60 to 97 yr). After anthropometric measurements were obtained, participants reached forward and laterally (shoulder elevated 90°) with a closed fist while sitting in a chair. Intrarater reliability was calculated on a subset of 84 participants. Results: Intrarater reliability of sitting forward and lateral reach measured with a yardstick was excellent (ICC3,1 = .98 and .96 respectively). Means and standard deviations by age group and sex are reported. Regression analysis showed that body segment anthropometrics did not affect performance. Differences between age groups for both the sitting reaches were found. Post hoc analysis revealed that older participants differed from both younger and middle‐aged participants. Conclusions: Forward and lateral reach from the seated position can be reliably measured and offer therapists a way to quantify sitting balance. This study provides reference values for younger, middle‐aged, and older adults for clinical use. While anthropometrics do not affect performance, older adults perform differently from younger and middle‐aged adults.

Going global in physical therapist education: International service-learning in US-based programmes†

BACKGROUND AND PURPOSE  Internationalization is expanding its presence in higher education in the United States. Reflecting this trend that includes incorporating global perspectives in the curricula, physical therapist education programmes increasingly offer international opportunities such as International Service-Learning (ISL) to their students. Service-learning, a teaching strategy that integrates community service with structured learning activities, has gained broad acceptance in health professions education including physical therapy, and is therefore the focus of this paper. The specific purposes of this paper were to identify and analyse the commonalities that existed among established ISL programmes within physical therapist education programmes in terms of structures and processes, and to consider its broader implications for physical therapist education.  METHODS  A descriptive, exploratory study was performed using grounded theory. Snowball and purposive, theoretical sampling yielded 14 faculty members with experience in international service, international learning or ISL in physical therapist education programmes. Faculty were interviewed by phone. Interview transcriptions and course documents were analysed applying grounded theory methodology. Data from eight programmes which met the operational definition of established ISL were used to address the purposes of this paper.  RESULTS  Five phases of establishing an ISL programme were identified: development, design, implementation, evaluation, and enhancement. Although no single model exists for ISL in physical therapist education; commonalities in structures and processes were identified in each phase. However, attention to service objectives and outcomes is lacking.  CONCLUSIONS  While analysis revealed that each programme shared commonalities and demonstrated differences in structures and processes compared with the other programmes, the study demonstrated a general lack of focus on formal community outcomes which raises ethical concerns. Future research and dialogue is warranted to explore ethics and good practice in ISL and other global health initiatives in physical therapy. This study may facilitate reflections and creative solutions by individual faculty and the profession.

Aerobic Exercise in People with Multiple Sclerosis: Its Feasibility and Secondary Benefits

The aims of this study were to explore the feasibility of structured aerobic exercise followed by a period of unstructured physical activity and determine the impact of such exercise on cognition, mood, and quality of life in people with multiple sclerosis (MS). A convenience sample of 9 individuals with relapsing-remitting MS performed 30 minutes of aerobic exercise (upper- and lower-extremity ergometry and treadmill ambulation) twice weekly for 8 weeks, followed by 3 months of unstructured physical activity. Eight participants completed the intervention and posttest; 6 returned for the 3-month follow-up. Cardiovascular fitness, cognition, mood (measured with the Beck Depression Inventory-II; BDI-II), and quality of life (measured with the Multiple Sclerosis Quality of Life-54; MSQOL-54) were assessed. Participants completed 27.9 minutes of exercise per session, with an 85.1% attendance rate. Evaluation using the Wilcoxon signed rank test revealed no deleterious effects and improved results on the BDI-II and MSQOL-54 mental subscale. Analysis of change scores using the one-sample t test revealed that the BDI-II and MSQOL-54 were changed from zero after structured exercise, but only the BDI-II maintained improvement after unstructured physical activity. Further analysis of BDI-II subscales revealed that improvement occurred only in the Somato-Affective subscale. In this study, program feasibility was demonstrated in several ways. There were no declines in cognitive function over the 5-month period. Despite unchanged cognitive function, participants may value the improved mood enough to continue both the structured and unstructured physical activity. The role of unstructured physical activity in concert with periodic structured exercise programs merits further investigation.

International Service-Learning and Other International Volunteer Service in Physical Therapist Education Programs in the United States and Canada: An Exploratory Study

Background and Purpose. Reflecting increasing globalization, some physical therapist educators are incorporating international service and learning opportunities in curricula. This study had 3 purposes: (1) to determine the frequency/location of international service‐learning (ISL) and other international volunteer service (OIVS) in United States and Canadian physical therapist education programs; (2) to explore the program differences between those with and without ISL or OIVS; and (3) to examine facultys perceptions of barriers to and benefits of ISL. Subjects. The program directors from 213 physical therapist education programs in the United States and Canada were surveyed. Methods. A questionnaire was developed, frequencies were calculated, and chi‐square analysis was utilized to compare programs with and without ISL and/or OIVS. Results. Ninety‐five questionnaires were returned, for a response rate of 44.6%. In the past 10 years, 29.5% of the programs had ISL, 23.2% had OIVS, and 43.2% had ISL and/or OIVS. Of those that did not utilize ISL in the past 10 years, 14.9% planned to add ISL in the next 2 years. No significant differences were found between the programs with ISL and/or OIVS compared to those without either ISL or OIVS in terms of private versus public, Carnegie classification, and professional degree. Lack of funding and faculty time were the greatest perceived barriers. The greatest perceived benefits of ISL were positive effect on student personal development and cultural competence. Discussion and Conclusion. Despite significant barriers, ISL exists in United States and Canadian physical therapist education programs, and modest growth is expected. Perceived benefits are consistent with core professional values of altruism, professional duty, and social responsibility. With the transition towards a doctoring profession, programs may consider promoting physical therapys role in the global health arena through incorporating ISL into their curricula.

Screening for Falls and Osteoporosis: Prevention Practice for the Hand Therapist

Fractures of the upper extremity are considered a hallmark of underlying osteopenia or osteoporosis and strong predictors of subsequent fractures. Falling is the strongest single risk factor for fractures in older adults. Studies have shown that interventions to prevent falls can significantly reduce this risk factor. Hand therapists working with patients with an upper extremity injury from a fall cannot assume that screening for osteoporosis or the likelihood of falls has been addressed by other health care professionals. The purposes of this article are to 1) summarize osteoporosis and falls risk screening, 2) describe how fall prevention strategies can be integrated into hand therapy practice, and 3) present evidence for federal and professional organizational support of prevention practice.