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Americans with disabilities represent the largest historically underserved and marginalized health disparity population in the United States. This perspective piece will raise the awareness of physical therapist faculty and clinicians on gaps in health care provider knowledge about disability and provide actionable strategies, frameworks, and resources available to improve disability competence to make changes in clinical education and practice. In this perspective piece, 3 contributions are made. First, health disparities experienced by Americans with disabilities as a result of health care providers' biased assumptions about disability and lack of disability competence are described through an in-depth illustration of lived experiences of people with disabilities. Second, a discussion of disability competence in physical therapist education is provided. Finally, critical and evidence-based insights and actionable frameworks and resources to address disability competence training gaps and to promote anti-ableist practice are provided. Keywords: Disability, Education: Competency-Based, Health Disparities, Introduction: Disability, Health Disparities, and Lack of Disability Competence Disability is a ubiquitous human experience. About 1 in 4 Americans report having a disability, belonging to what is the largest [...]

People living with chronic primary or secondary musculoskeletal pain conditions such as low back pain, fibromyalgia, and inflammatory arthritis typically experience wide-ranging impacts on their physical function, activity participation, and psychosocial wellbeing. These can extend to negative impacts on a person's sexual function and their intimate relationships. While sexual function is an important component of wellbeing, it is often not considered within musculoskeletal pain care. Without awareness or targeted training, physical therapists may lack the confidence and skills to screen, assess, and manage the impacts that pain may be having on a person's sexual function and can miss the opportunity to tailor their care and optimize wellbeing. This article seeks to raise awareness among physical therapists of how living with chronic musculoskeletal pain can impact a person's sexual function and intimate relationships, and provide guidance on how to consider these issues within a person-centered approach to care. It describes why considering sexual function and intimate relationship issues as part of a person's lived musculoskeletal pain experience may be relevant, outlines the use of validated patient-reported outcome measures to assess sexual dysfunction, and suggests practical strategies for sensitively raising sexual function in consultations. Management approaches and possible referral pathways are also presented, to assist physical therapists in understanding available care options. This article seeks to support holistic care by improving physical therapists' knowledge and understanding of sexual dysfunction and its management in people living with chronic musculoskeletal pain. Impact. Considering sexual function as a valued functional activity, together with other activities of daily living, will assist physical therapists to provide more holistic and person-centered care. This article covers the main considerations for raising sexual function and intimate relationship issues with people living with chronic musculoskeletal pain, as well as management options and potential referral pathways. Physical therapists are encouraged to seek targeted training to improve their confidence and skills in this area, and to use inclusive, respectful language for discussions around sexual function and intimate relationships. Keywords: Clinical Assessment, Intimate Relationships, Musculoskeletal Pain, Physical Therapy, Referral Pathways, Sexual Function, Introduction In this article, we aim to inform readers about the prevalence and impact of sexual dysfunction (difficulty or impairment in undertaking sexual activity or in experiencing sexual pleasure and [...]

Rett Syndrome (RTT) is a rare neurodevelopmental disorder primarily affecting females with an incidence of 1 per 9000 female births. (1) Mutations in the MECP2 gene have been found in [...], Background. Girls and women with Rett Syndrome (RTT) have low levels of daily physical activity and high levels of sedentary time. Reducing sedentary time and enhancing 'uptime' activities, such as standing and walking, could be an important focus for interventions to address long-term health and quality of life in RTT. Objective. The aim of the study was to evaluate the feasibility and health-related effects of an individualized 12-week uptime participation (U-PART) intervention in girls and women with RTT. Design. The study used a single-group pretest-posttest design with 4 assessments (2 baseline, postintervention, and follow-up). Methods. A participation-based intervention employing a whole-day approach was used. During a 12-week intervention period, individualized programs focused on participation in enjoyable uptime activities in home, school/day center, and community settings. Feasibility was assessed with a study-specific questionnaire. Primary outcome measures were sedentary time and daily step count. Secondary outcomes were gross motor skills, walking capacity, quality of life, and goal attainment scaling. Results. Fourteen girls and women who were 5 to 48 years old and had RTT participated. The U-PART intervention was perceived as feasible by caregivers. Similar scores were observed at baseline assessments in all outcomes. Positive effects with small to medium effect sizes (0.27-0.54) were seen in sedentary time (-4%), daily step count (+ 689 steps/d), walking capacity (+ 18.8 m), quality of life (+ 2.75 points), and goal attainment scaling after the intervention. Positive effects were maintained in sedentary time (-3.2%) and walking capacity (+ 12.1 m) at short-term follow-up. Limitations. This study was limited by the lack of a control group. However, participants acted as their own control, and the stable baseline period partially mitigated this issue. Conclusions. The U-PART intervention was found to be feasible and effective in the short term in girls and women with RTT.

Approximately 8 million Americans have intellectual and developmental disabilities (IDD), comprising about 3% of the US population. (1) IDD describes developmental disability as 'a severe or chronic condition that is [...], Background. Care and support for people with intellectual and developmental disabilities (IDD) in natural community contexts are increasing. Many people with IDD use physical therapy services to support their community participation. Medicaid Home- and Community-Based Services (HCBS) 1915(c) waivers are the largest providers of long-term services and supports for people with IDD. However, little is known about physical therapy provision under this program. Objective. The aim of this study was to compare the operational definitions of physical therapy service under the HCBS 1915(c) waiver system and to describe projected physical therapy service utilization, spending, and reimbursement for people with IDD across states. Design. This was a cross-sectional, descriptive study. Methods. This study analyzed fiscal year 2015 HCBS IDD waivers from across the nation (N = 111), focusing on physical therapy utilization (total projected spending, total participants, reimbursement rates, and average annual service provision per participant). Service definitions were also analyzed to determine trends across waivers. Results. Fifty-one waivers (45.9%) provided 61 different types of physical therapy services in fiscal year 2015. States utilized waivers to provide long-term remedial care rather than the acute short-term physical therapy. HCBS waiver physical therapy services were often provided in participants' homes and communities to expand physical therapy access and secure the benefits of providing physical therapy services in natural environments. Although most states have adopted similar definitions of physical therapy service, procedures and services vary. Limitations. Medicaid HCBS waivers are state projections made to the federal government rather than actual utilization data. Conclusions. Physical therapy service definitions, projected service utilization, spending, and reimbursement for people with IDD who use Medicaid HCBS waivers vary greatly between states. Physical therapy may be utilized less than expected given the reported benefits for people with IDD.

Autism spectrum disorders (ASDs) are a group of multisystem neurodevelopmental disorders characterized by impairments in social interactions and communication skills and the presence of repetitive and stereotypical behaviors and interests. [...], Recent evidence suggests that childhood obesity is increasing in children who are developing typically as well as in children with developmental disabilities such as autism spectrum disorders (ASDs). Impairments specific to autism as well as general environmental factors could lead to an imbalance between the intake and expenditure of energy, leading to obesity. In this article, we describe the mechanisms by which autism-specific impairments contribute to obesity. The evidence on exercise interventions to improve physical fitness, address obesity, and reduce autism-specific impairments in children and adolescents with ASDs is discussed. Limited evidence is currently available for exercise interventions in individuals with ASDs. Therefore, literature on other pediatric developmental disabilities and children who are developing typically was reviewed to provide recommendations for clinicians to assess physical activity levels, to promote physical fitness, and to reduce obesity in children and adolescents with ASDs. There is a clear need for further systematic research to develop sensitive assessment tools and holistic multisystem and multifactorial obesity interventions that accommodate the social communication, motor, and behavioral impairments of individuals with ASDs.

Children and youth with Down syndrome display a very stable pattern of physical inactivity, which gets worse with age. Less than 10% of children with Down syndrome who are 8 [...], Background. People with Down syndrome (DS) display consistent patterns of physical inactivity. If these sedentary behaviors continue over extended periods of time, there will be negative health consequences. Objective. The objective of this study was to investigate the physical activity and health-related outcomes of teaching children with DS to ride a 2-wheel bicycle. Design. This study was a randomized intervention in which the control group waited 1 year to receive the intervention. Setting. This intervention study was conducted in a community setting. Participants. The participants were children who were 8 to 15 years of age and who had been diagnosed with DS. Intervention. The participants were randomly assigned to an experimental group (bicycle intervention) or a control group (no intervention). Measurements. Measurements were obtained in the month before the intervention (preintervention), at 7 weeks after the intervention, and at 12 months after the preintervention measurement for all participants. Results. The results indicated no group differences at the preintervention session. Fifty-six percent of the participants in the experimental group successfully learned to ride a 2-wheel bicycle during the 5-day intervention. Analysis showed that participants who learned to ride spent significantly less time in sedentary activity at 12 months after the preintervention measurement and more time in moderate to vigorous physical activity than participants in the control group. Body fat appeared to be positively influenced over time in participants who learned to fide. Limitations. It is unknown how frequently the children in the experimental group rode their bicycles after the intervention. Conclusions. Most children who are 8 to 15 years of age and who have been diagnosed with DS can learn to ride a 2-wheel bicycle. Learning to ride can reduce time spent in sedentary activity and increase time spent in moderate to vigorous physical activity, which may influence the health and functioning of these children.