Rosemary Isles

Normal values of balance tests in women aged 20-80.

Objectives: To determine normal values for four commonly used clinical functional balance tests from community‐dwelling women aged 20 to 80 and to identify any significant decline due to aging.

Dizziness after traumatic brain injury: Overview and measurement in the clinical setting

Traumatic brain injury (TBI) may result in a variety of cognitive, behavioural and physical impairments. Dizziness has been reported in up to 80% of cases within the first few days after injury. The literature was reviewed to attempt to delineate prevalence of dizziness as a symptom, impairments causing dizziness, the functional limitations it causes and its measurement. The literature provides widely differing estimates of prevalence and vestibular system dysfunction appears to be the best reported of impairments contributing to this symptom. The variety of results is discussed and other possible causes for dizziness were reviewed. Functional difficulties caused by dizziness were not reported for this population in the literature and review of cognitive impairments suggests that existing measurement tools for dizziness may be problematic in this population. Research on the functional impact of dizziness in the TBI population and measurement of these symptoms appears to be warranted.

Medial-lateral postural stability in community-dwelling women over 40 years of age.

Objective: To document the change in medial–lateral balance in women aged between 40 and 80 years. Design: A cross-sectional study of six measures of medial–lateral balance was undertaken. Setting: The Betty Byrne Henderson Centre for Women and Ageing, Royal Womens Hospital, Australia. Subjects: Five hundred and three community-dwelling women between 40 and 80 years of age were randomly recruited from a large metropolitan region with 366 subjects admitted after applying exclusion criteria. Measurements: The clinical measurements included the lateral reach and step tests while laboratory measurements were gathered from the Balance Master software programs for unilateral stance and limits of stability. Results: A significant decline in all measures (p < 0.02) was evident between the forties and sixties age decade cohorts. The clinical step test showed a significant (p < 0.001) decline between the forties and fifties groups. A significant correlation was shown between step test and unilateral stance (p < 0.001) and movement velocity, reaction time and end-point excursion centre of gravity (COG) on the limits of stability test (p < 0.001). Conclusions: This new evidence demonstrates that there is a significant decline in medial–lateral balance in women that occurs between their forties and sixties. Suggestions for further study were made.

Measurement of functional ability following traumatic brain injury using the Clinical Outcomes Variable Scale: A reliability study

This study determined the inter-tester and intra-tester reliability of physiotherapists measuring functional motor ability of traumatic brain injury clients using the Clinical Outcomes Variable Scale (COVS). To test inter-tester reliability, 14 physiotherapists scored the ability of 16 videotaped patients to execute the items that comprise the COVS. Intra-tester reliability was determined by four physiotherapists repeating their assessments after one week, and three months later. The intra-class correlation coefficients (ICC) were very high for both inter-tester reliability (ICC > 0.97 for total COVS scores, ICC > 0.93 for individual COVS items) and intra-tester reliability (ICC > 0 97). This study demonstrates that physiotherapists are reliable in the administration of the COVS.

Dizziness after traumatic brain injury: results from an interview study.

Background: Dizziness is a commonly reported sequel to traumatic brain injury (TBI). Objective: To better define the nature of the symptomatology and the impact that dizziness has on the TBI survivor. Setting: A community brain injury rehabilitation programme and a community access programme for TBI survivors. Method: Focus groups with TBI survivors and individual interviews with TBI survivors and some of their carers. Results: The data confirmed that dizziness is difficult for TBI survivors to define and describe and it consists of multiple symptoms. Dizziness also appears to be associated with significant functional difficulties. Additionally, many of the participants of this study reported falling. Carers reported a number of observable signs of dizziness and indicated that they believed they were able to tell when the person they cared for was dizzy. Conclusion: The results provide information which will help in the development of more appropriate outcome measurement tools for dizziness after a TBI.

The efficacy of a work-station intervention programme to improve functional ability and flexibility in ageing clients with Cerebral Palsy: a pilot study.

Purpose: Health care workers associated with the long-term care of ageing clients with Cerebral Palsy have reported on the adverse effects of less active daily activity programmes with resultant decreased functional mobility. While the negative effects of ageing have been reported in these clients, programmes have not been implemented to determine whether these adverse changes can be reversed or prevented. The efficacy of a work-station intervention programme to improve functional ability and flexibility in ageing clients with cerebral palsy was investigated. Method: A clinical intervention study using repeated measures (pre/post-intervention and at follow-up) to evaluate efficacy was undertaken. Twenty-two clients with Cerebral Palsy participated in a twice-weekly work-station programme delivered over 8 weeks. The Physical Mobility Scale items, two upper limb function measures, range limitation of hip and knee extension and gleno-humeral movement were assessed. Results: Results showed a significant improvement that was retained at follow-up in functional but not flexibility measures. Conclusion: The efficacy of a work-station exercise programme for ageing clients with Cerebral Palsy was demonstrated. Evidence was provided that the PMS is effective in showing level of dependency for these clients.

Senior physiotherapy students as standardised patients for junior students enhances self-efficacy and satisfaction in both junior and senior students

BackgroundStandardised patients are used in medical education to expose students to clinical contexts and facilitate transition to clinical practice, and this approach is gaining momentum in physiotherapy programs. Expense and availability of trained standardised patients are factors limiting widespread adoption, and accessing clinical visits with real patients can be challenging. This study addressed these issues by engaging senior students as standardised patients for junior students. It evaluated how this approach impacted self-reported constructs of both the junior and senior students.MethodsLearning activities for undergraduate physiotherapy students were developed in five courses (Neurology, Cardiorespiratory and three Musculoskeletal courses) so that junior students (Year 2 and 3) could develop skills and confidence in patient interview, physical examination and patient management through their interaction with standardised patients played by senior students (Year 4). Surveys were administered before and after the interactions to record junior students’ self-reported confidence, communication, preparedness for clinic, and insight into their abilities; and senior students’ confidence and insight into what it is like to be a patient. Satisfaction regarding this learning approach was surveyed in both the junior and senior students.ResultsA total of 253 students completed the surveys (mean 92.5% response rate). Across all courses, junior students reported a significant (all P < 0.037) improvement following the standardised patient interaction in their: preparedness for clinic, communication with clients, confidence with practical skills, and understanding of their strengths and weaknesses in relation to the learning activities. Senior students demonstrated a significant improvement in their confidence in providing feedback and insight into their own learning (P < 0.001). All students reported high satisfaction with this learning experience (mean score 8.5/10).ConclusionThis new approach to peer-assisted learning using senior students as standardised patients resulted in positive experiences for both junior and senior students across a variety of physiotherapy areas, activities, and stages within a physiotherapy program. These findings support the engagement of senior students as standardised patients to enhance learning within physiotherapy programs, and may have application across other disciplines to address challenges associated with accessing real patients via clinical visits or utilising actors as standardised patients.

Memory systems involved in professional skills: A case of dense amnesia due to herpes simplex viral encephalitis

JL, a 25-year-old physiotherapist, became densely amnesic following herpes simplex viral encephalitis (HSVE), causing bilateral damage to medial and ventral areas of her frontal and temporal lobes and their associated circuitry. Three years post-onset, her WAIS-R full scale IQ (Verbal 74, Performance 102) showed an estimated loss of ± 50 points. She displayed severe global amnesia and markedly impaired social cognition. However, her immediate memory, perceptual priming, and cognitive problem-solving abilities were relatively spared. Her retention of professional skills was assessed using simulated physiotherapy scenarios. JL was able to demonstrate some procedural skills spontaneously, but was unable to apply them precisely and flexibly to individual patient needs. She showed no memory of theoretical or propositional physiotherapy knowledge, and could neither plan treatment nor reason clinically. Her performance was well below that of four other physiotherapists who had also not practised for 4 years. Thus, despite the relative sparing of her implicit memory, JLs performance lacked the co-ordinated operation of declarative and implicit long-term memory and the links to working memory that are necessary for the flexible performance of complex professional procedures.

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.