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The purpose of this study was to: 1) examine existing interprofessional pain management curricula in a DPT and MOT program by mapping pain subject matter to the IASP interprofessional content to determine gaps, vertical and horizontal coherence and integration 2) evaluate pain knowledge and attitudes early and late curriculum within the current pre-licensure Doctor of Physical Therapy (DPT) and Master of Occupational Therapy (MOT) students, and 3) to define changes needed within the existing interprofessional pain management curricula to better prepare students for clinical experiences and professional practice. Pain content was mapped to the IASP core competencies to identify gaps in content and coherence. Students were evaluated on existing pain knowledge and attitudes using the City of Boston's Rehabilitation Professional's Knowledge and Attitudes Survey Regarding Pain (COBS). Two hundred and forty physical and occupational therapy students completed the study. The mean percentage of correct responses of 70.6% +/-25.6% did not significantly change across didactic terms. Curricular mapping can inform planning, design, implementation, and evaluation of the curriculum and alignment with IASP guidelines.

While many university health science programs include physics courses to raise knowledge and understanding of physical science concepts, they are still far from addressing the needs of that science health profession. This study aimed to investigate the effect of an introductory physics course on first-year physiotherapy and rehabilitation (PR) students' conceptual understanding of simple electric circuits. The study participants were students enrolled in the Physics II course. Eighty-two students registered for the course. Sixty students (73%) took the pretest, and 67 (81%) completed the posttest. 53 students (64%) took the pretest and posttest. This study adopts an exploratory research methodology that includes a one-group pretest-posttest design. The Simple Electric Circuits Diagnostic Test (SECDT) was used to assess students' conceptual understanding. The prevalence of misconceptions was relatively low (before and after instruction), and very few students developed sound conceptual understanding after instruction. The local reasoning model was the most frequent misconception PR students held. After instruction, students' overall confidence in their SECDT responses increased significantly. Interestingly, when the students were grouped into three achievement groups, the medium-achievement group fell into more misconceptions as their achievement increased compared to low- and high-achievement groups. These findings suggested that students' low SECDT scores were due to a lack of knowledge rather than misconceptions.

The focus of attention literature has shown robust findings for the benefits of providing statements that focus on the movement effect or outcome (external focus of attention [EFOA]) as opposed to focusing on the movement kinematics (internal focus of attention). Observational studies, however, have revealed that physiotherapists use fewer EFOA statements than internal focus of attention statements in their practice. Most evidence in this regard has been from non-Canadian physiotherapists working in stroke rehabilitation; consequently, we sought to examine whether Canadian physiotherapists working with various rehabilitation populations also use EFOA statements to a lesser extent than internal focus of attention statements. The "Therapists' Perceptions of Motor Learning Principles Questionnaire (TPMLPQ)" was thus designed and data from 121 Canadian physiotherapists showed low relative frequencies of EFOA use (31.3% ± 14%) averaged across six hypothetical scenarios. A higher EFOA was reported, however, for two of the six scenarios: a functional reaching scenario (55.5% ± 37.0%) and pelvic floor task (65.6% ± 32.9%). This data suggest that the findings of EFOA benefits have not been widely translated into Canadian physiotherapy settings; furthermore, the findings of the scenario-dependency warrant future investigation into factors, such as task characteristics, that may influence physiotherapists' FOA use.

Background: At the start of the COVID-19 pandemic, the in-person clinical exposure of Physical Therapy (PT) interns in various regions of the world, including the Philippines, was suspended for safety reasons. To resume internship training, telerehabilitation was adopted in several academic institutions, such as the Cebu Doctors' University (CDU). However, our Rehabilitation Sciences faculty and students were unprepared for the sudden shift to virtual teaching-learning methods. Objective: We hereby present our local experience in incorporating telerehabilitation in our clinical training and patient service. Methods: We conducted the following steps toward redesigning our PT internship curriculum: (1) review of existing national guidelines on flexible learning; (2) analysis of capabilities and limitations of our students and teachers to engage in flexible learning; and (3) planning for means to capacitate them for shifting to flexible learning. Findings: In our curricular redesign, we adapted the Flexible Learning Framework, consisting of the following components: students' virtual experience, faculty and staff development, flexible learning instructional design, shared and aligned governance, institutional policy and infrastructure, and quality assurance. Conclusion: Due to the lack of formal inclusion of telerehabilitation in the national PT internship curriculum pre-pandemic and the need to quickly update our clinical program during the pandemic, our experience in evaluating and building our capacities toward developing a telerehabilitation program can serve as an example for other rehabilitation disciplines and academic institutions amid and beyond the pandemic.

The aim of this Swedish study was to explore and describe physiotherapists and occupational therapists' attitudes and understanding of the place of play in habilitation. This was a qualitative study, using semi-structured interviews exploring ten habilitation professional's experiences and attitude towards play. Interviews were analysed using content analysis. The analysis of the interviews resulted in four categories (1) "Play in the present or exercise for the future" (2) "Play is a useful tool" (3) "Play needs different prerequisites" (4) "Play is a shared responsibility." The categories represent the professional's attitudes and understanding of play in habilitation. Results demonstrated that enabling play for the sake of play was a low priority in habilitation, despite the acknowledgement that it is a primary concern for children. The professionals focus was mainly on interventions that were remedial: about doing the right thing for the physical body and preparing the child for his/her life as an adult. There is a need to change perspective and incorporate interventions aimed at childhood as well as adulthood. Habilitation professionals need to reframe their anxiety for the future child and reconsider the place of play in practice.

In previous research, Canadian physiotherapists identified barriers to effective external focus promotion and recommended the delivery of a focus of attention workshop as a solution. Accordingly, the current research entailed the virtual delivery of such a workshop, consisting of asynchronous Website modules followed by a synchronous group session, to 15 Canadian physiotherapists working mainly with musculoskeletal rehabilitation clients. Assessment of the workshop outcomes was guided by constructs of social cognitive and adult learning theory, and organized based on the four levels of the Kirkpatrick model (KP1-Reaction, KP2-Learning, KP3-Behavior, and KP4-Results). Specifically, participants received links to questionnaire packages at three time points: 1-week preworkshop, immediately postworkshop, and 1-week postworkshop. Results showed that participants (a) reported high satisfaction, engagement, and perceived relevance of the workshop (KP1); (b) experienced significant improvements to their knowledge, skills, attitudes, and self-efficacy from pre- to immediately postworkshop (KP2); and (c) self-reported increases to their external focus promotion in the week following the workshop (modified KP3), and perceived improvements to their clients' outcomes as a result of this external focus encouragement (modified KP4). Taken together, these results serve as a chain of evidence supporting the usefulness of the workshop in translating focus of attention findings into Canadian physiotherapy.

Background: Peer tutoring is a learning strategy where students take on the role of teacher. There are many reported benefits of this model however it is not well described in rehabilitation science curriculums. The aim of this review is to describe the scope of available literature for rehabilitation science education. Methods: A systematic scoping review using PubMed, CINAHL, Scopus, and ERIC databases. Inclusion criteria included the English language, peer-reviewed articles that report outcomes of a peer-tutoring program for students enrolled in occupational therapy, physical therapy, speech therapy and or athletic training programs. Consensus between two authors was used for article inclusion and data extraction. Results: Sixteen articles were included in the review. Peer tutoring was described in athletic training, occupational therapy, physical therapy, and speech language pathology programs. Peer tutors were students further along in their training in 75% of the included studies. The most common content taught was anatomy (38%) followed by clinical assessment (19%). Just under half (44%) of the included studies incorporated interprofessional education with tutors and tutees representing different fields of study. Outcomes of peer tutoring programs were most commonly assessed with surveys (75%) developed by the research team with only 38% reporting objective measures of learning by the participants. Conclusion: Results of this review demonstrate that peer tutoring is used in rehabilitation science curriculums, however, there are a limited number of reports. The learning strategy is well described in other health science education models with many potential benefits. This review can be used to inform the development and evaluation of future peer tutoring programs in rehabilitation sciences curriculums.

Although researchers have consistently demonstrated the potential benefit of an external focus of attention for rehabilitation, research has shown that this finding has yet to be translated into Canadian physiotherapy. Further, specific barriers to external focus use have been reported by Canadian physiotherapists, and as a solution toward increasing physiotherapists' use of external focus, these same physiotherapists recommended the development of an educational workshop on focus of attention. Considering this, described herein is the process of developing such a workshop, which involved (a) gathering input from physiotherapists concerning content and format via one-on-one interviews and (b) engaging in discussion about content with focus of attention researchers. Analysis of the interview data featured key content for the workshop, the types of activities to include, and a recommended sequencing for the activities: specifically, sharing didactic information on focus of attention research, then providing instruction and demonstration of external focus use, and finally, finishing with opportunities for generating and delivering external focus statements. This input, along with that of the researchers, led to the development of a two-component focus of attention workshop, which includes an asynchronous component, featuring seven self-directed learning modules and a synchronous component, which consists of a virtual group session. [For Part 2, see EJ1398983.]

Although researchers have highlighted the benefits of adopting an external focus of attention for rehabilitation, studies have consistently revealed low external focus use by physiotherapists. Consequently, the purpose of this research was to explore factors influencing physiotherapists' focus of attention use and to gain insight into the barriers, and potential solutions, related to effective external focus use. Eight physiotherapists, working with musculoskeletal rehabilitation clients, first completed the Therapists' Perceptions of Motor Learning Principles Questionnaire and then participated in virtual one-on-one interviews. The interviews followed a semistructured interview guide and were analyzed using a total quality framework approach to qualitative content analysis. Data showed that physiotherapists' focus of attention use was influenced by physiotherapist, client, and task characteristics/experiences, as well as focus of attention statement provision strategies. Furthermore, the main barriers discussed related to educational experiences, reinforcement of internal focus of attention statement use and aspects related to research. Solutions presented to these barriers included the incorporation of focus of attention content into both the Canadian physiotherapy curriculum and continued education. Overall, these results advance our knowledge of factors underlying physiotherapists' focus of attention use and barriers that must be overcome to successfully translate the focus of attention research into physiotherapy. [For Part 1, see EJ1387168.]

Writing transfer research often illuminates the writing abilities, attitudes, and assumptions college writers bring to a writing assignment, but faculty members across the disciplines may not have the tools for understanding what the students in their particular classes bring to their particular writing assignments. In this proposed model, students respond to a series of reflective prompts before, during, and after completion of a major upper-division writing assignment. Faculty members then reflect on how these responses might change the way they assign writing and teach course content. The disciplinary and course-based threshold concepts emerging from this process suggest a dynamic and situated approach that both facilitates faculty understanding of transfer and offers a method for responding to it.

Interdisciplinary service learning opportunities are recognized as valuable educational tools for health care students. The Farm Worker Family Health Program, based on a community academic partnership model, enables health care students to treat migrant workers in rural Georgia during the annual farmworker migration. The present article describes how this opportunity has been incorporated into a graduate curriculum, including examining the challenges and successes associated with implementing this type of program. An additional aim is to explore the implications of merging interdisciplinary service learning and community partnerships with physical therapy education, specifically how student volunteers and migrant workers may be impacted by their participation.

The dynamic society we live in requires constant adaptation and innovation on every aspect of our daily lives, allowing us to improve the necessities of different people by doing it. For this study, we used a new approach with project-based learning to go beyond the typical environment in higher education and bring solutions to real-life scenarios. The project was developed with undergraduate engineering students in collaboration with a rehabilitation institute in Mexico City to design a physical therapy routine using the NAO robot. It allowed interaction between young patients in real time and fostered empathy while developing a final usable product. The study measured the usability of the robotic platform during the rehabilitation sessions and the reproducibility of the project through Cronbach's alpha evaluation. The usability results show a higher interest in the project from both the patients and the medical staff involved while constructing the material needed to develop a product that matches the standards given by the rehabilitation institute.

Objective: Exercise is beneficial for individuals who have been diagnosed with cardiovascular disease or cancer. Healthcare providers are well placed to discuss exercise with their patients, but their referral practices and the content of exercise recommendations remain unclear. Method: Cardiologists and oncologists completed an online survey comprising four closed-ended questions and one open-ended question to assess exercise recommendation and referral practices. Chi-square tests were used to compare the frequency of closed-ended responses, and open-ended responses were coded and analysed using qualitative content analysis. Results: Of the 154 surveys, 58 were returned (n = 25; 43.1% cardiologists, and n = 33; 56.9% oncologists). Respondents (M[subscript age] = 45.5 ± 11.1) were mostly men (62.1%). The majority of cardiologists (95.8%) and oncologists (78.1%) reported referring patients to hospital-based exercise programmes. In this study, the cardiologists were more likely to refer patients to certified exercise physiologists (X[superscript 2](1) = 6.140, p = 0.021), whereas oncologists were more likely to refer to physical therapists (X[superscript 2](1) = 11.764, p = 0.001). Conclusion: Findings reveal that cardiologists and oncologists discussed and recommended exercise to their patients at least some or most of the time; there were differences in the type of exercise professionals they were referred to; and exercise recommendations were variable and infrequently concurred with established guidelines.

Background: There is an agreement that the methodological quality of randomized trials should be assessed in systematic reviews, but there is a debate on how this should be done. We conducted a construct validation study of the Physiotherapy Evidence Database (PEDro) scale, which is widely used to assess the quality of trials in physical therapy and rehabilitation. Methods: We analyzed 345 trials that were included in Cochrane reviews and for which a PEDro summary score was available. We used one- and two-parameter logistic item response theory (IRT) models to study the psychometric properties of the PEDro scale and assessed the items' difficulty and discrimination parameters. We ran goodness of fit post estimations and examined the IRT unidimensionality assumption with a multidimensional IRT (MIRT) model. Results: Out of a maximum of 10, the mean PEDro summary score was 5.46 (SD = 1.51). The allocation concealment and intention-to-treat scale items contributed most of the information on the underlying construct (with discriminations of 1.79 and 2.05, respectively) at similar difficulties (0.63 and 0.65, respectively). The other items provided little additional information and did not distinguish trials of different quality. There was substantial evidence of departure from the unidimensionality assumption, suggesting that the PEDro items relate to more than one latent trait. Conclusions: Our findings question the construct validity of the PEDro scale to assess the methodological quality of clinical trials. PEDro summary scores should not be used; rather, the physiotherapy community should consider working with the individual items of the scale.

Background: Balance alterations are one of the main problems in people with intellectual disabilities (ID), increasing their risk of falls and impacting their life. Aims: To describe a vestibular rehabilitation programme (VRP) and evaluate its effects on the ability to maintain balance and risk of suffering a fall. Methods: Forty-seven adults with mild to moderate ID were randomly assigned to two groups--a control group (CG, N = 24), which performed a general physical exercise only, and an experimental group (EG, N = 23) which also completed a VRP. The variables, used pre- and post-training and 1 month after the intervention, were as follows: Center of Pressure Displacement, Berg Scale, Timed Up and Go Test, and the Modified Clinical Test of Sensory Interaction and Balance. Results: The EG improved significantly in each variable. The CG did not show changes for any of the parameters. Conclusions: A programme based on VRP may improve balance and reduce the risk of falling.

The COVID-19 pandemic has led to an unprecedented shift in how health science education is delivered (Sandars et al., 2020). With face-to-face learning, such as lab and classroom interactions, largely unavailable during the pandemic, institutions have been required to quickly shift the learning environment to a fully virtual format. While in-person clinical training for students effectively came to a halt, the University of Saint Augustine for Health Sciences (USAHS) leveraged its technology infrastructure, clinical simulation resources and expertise, digital learning resources, and innovative culture to implement a continuity plan for both faculty and students. Due to federal and local regulations related to social distancing during the COVID-19 pandemic, programs in the medical and rehabilitative sciences have been faced with the unique challenge of converting hands-on laboratory activities to an online format. This conversion has been complicated by rapidly evolving standards regarding activities acceptable to meet accrediting body guidelines for fieldwork and/or clinical education. However, most accrediting bodies have sanctioned the use of virtual labs to maintain continuity of instruction by preparing and in some cases substituting virtual for hands-on learning activities. This paper will provide an overview of the strategic learning framework that is being employed by the University in response to the COVID-19 pandemic and share practical case examples of how faculty have used university resources and support to not only maintain academic continuity, but to deliver excellence during virtual instruction.

Children with disabilities require coordinated services to optimise transition into school. This study compared type, frequency and approach to service utilisation for children with primary language impairment transitioning from rehabilitation to the educational system, and examined parent satisfaction. Parents responded to a telephone questionnaire to determine services received during Kindergarten. The Measure of Processes of Care examined parental satisfaction with services received at school. Preschool services received in the rehabilitation setting were extracted from the hospital database. There was a reduction in all services received in the school system with the exception of special education, which was provided to a greater number of children and on a full time basis. More children received occupational therapy and special education individually at the rehabilitation centre. Few factors were associated with a change in received services. Rehabilitation clinicians must provide necessary services to assist children when transitioning to school.

The majority of children with cerebral palsy in developing countries have no access to trained therapists; for example, in Pakistan, there is less than one trained general physiotherapist per million population. In Pakistan, cerebral palsy handling skills were taught to a group of parents, teachers, and paraprofessionals in a series of practical training sessions. A pediatric physiotherapist led the group, in which a total of 37 children, with an average age of 6 years, took part in one or more 3-hour sessions. Assessment of each child was continuous throughout the handling and observation by the therapist. The sessions, designed to meet the needs of the poor and nonliterate mothers, covered developmental patterns, exercises, purposeful positioning for daily living activities, feeding techniques, and appropriate play materials. It was believed that the feeling of group support may have helped sustain and motivate the mothers. Clinic staff enhanced their skills in the group sessions as well, in order to provide more ongoing support for the families. As some mothers traveled long distances to come to the clinic, their attendance was erratic, requiring the group leader to assess as quickly and accurately as possible the degree of disability, the child's mental level, and the family's capacity to absorb and implement a practical plan. (Contains 12 references.) (JDD)

This study aims to explore the factors in a patient's rehabilitation achievement after a total knee replacement (TKR) patient exercises, using a PCA-ANFIS emotion model-based game rehabilitation system, which combines virtual reality (VR) and motion capture technology. The researchers combine a principal component analysis (PCA) and an adaptive network-based fuzzy inference system (ANFIS) to present a predicting, artificial emotion model with a Plutchik emotional wheel in a 3D Gesture gamification rehabilitation system, and illustrate the value of the Plutchik emotional wheel. Also, this study tries to improve a rehabilitant's self-efficacy, based on interesting games and the use of Kinect technology to capture a rehabilitant's motion. This quasi-experimental design required two months to collect the PRS rehabilitation treatment data from the study's participants, who were divided into experimental and control groups. The experimental group, rehabilitated with a PRS, filled out a questionnaire and evaluated whether the system operations and self-efficacy changes affected their rehabilitation achievement. These findings could be referenced for related researchers designing auxiliary tools and for helping physical therapists improve rehabilitants' performance. Meanwhile, these findings recommend that patients have the operation in the early stages and that they form regular exercise habits for a better rehabilitation outcome.

Background: This study aimed to analyse the self-evaluations of physicians and physiotherapists, from different specialisations, about their preparedness for work with people with intellectual disability (ID), and what they considered were the most significant barriers in working with people with ID. Both the physicians and physiotherapists pointed to initiatives that they found useful, such as the Healthy Athletes Program of the Special Olympics, which prepares them for everyday work with people with disability. Methods: The research was carried out in Poland with a group of 120 physicians and physiotherapists working in healthcare institutions. The research was based on the authors' original questionnaire, which consists of 12 questions. Results: The research participants rated their preparation for work with people with ID as 3.56 on a 4-point scale; their opinion of other representatives of the medical community was 3.44. Conclusions: The physicians and physiotherapists identified gaps in their preparation to provide highly specialised medical and rehabilitation care to people with ID. They also pointed out that barriers to communication were the most significant difficulty encountered. Professionals' engagement in a program such as the Healthy Athletes Program may go some way toward improving the quality of the services they provide to people with ID.

In order to identify optimal rehabilitation strategies for spinal cord injury (SCI) participants, assessment of impaired walking is required to detect, monitor and quantify movement disorders. In the proposed assessment, ten healthy and seven SCI participants were recruited to perform an over-ground walking test at slow walking speeds. SCI participants were given assistance from physiotherapists, if required, while they were walking. In agreement with other research, larger cadence and smaller step length and swing phase of SCI gait were observed as a result of muscle weakness and resultant gait instability. Muscle activation patterns of seven major leg muscles were collected. The EMG signal was processed by the RMS in frequency domain to represent the muscle activation power, and the distribution of muscle activation was compared between healthy and SCI participants. The alternations of muscle activation within the phases of the gait cycle are highlighted to facilitate our understanding of the underlying muscular activation following SCI. Key differences were observed (p-value = 0.0006) in the reduced activation of tibialis anterior (TA) in single stance phase and rectus femoris (RF) in swing phase (p-value = 0.0011). We can then conclude that the proposed assessment approach of gait provides valuable information that can be used to target and define therapeutic interventions and their evaluation; hence impacting the functional outcome of SCI individuals. (Contains 3 figures and 5 tables.)

The aim of this work was to survey the contemporary facilities for early post-stroke rehabilitation in Poland. The main research questions were as follows: what is the availability of inpatient rehabilitation for post-stroke patients in neurological departments and in rehabilitation departments? The growing costs of healthcare are encouraging healthcare planners to look for new organizational solutions of services that could enable rehabilitation as early as possible after disease onset. Early post-stroke rehabilitation includes many elements that provide for early-onset rehabilitation and its continuation after discharge from the stroke unit. Two questionnaires evaluating neurorehabilitation of individuals who had stroke were designed and distributed: the first questionnaire was distributed to 221 neurological wards and the second questionnaire was distributed to 154 rehabilitation departments in Poland. We obtained information about delay before admission from neurological wards to rehabilitation departments, the number of sessions per day, the time duration of one session, the number of sessions per week, the average length of stay in department, the methods of outcome measurement, etc. We sent out 375 questionnaires and received 129 (35%) responses, 78 from neurological wards and 51 from rehabilitation departments. Only 25% of all patients were moved from neurological wards to the rehabilitation department after stroke (15% directly). Of those moved to rehabilitation departments, only 54% were treated early after stroke; that is, within 3 months of stroke. Considering that about half of stroke survivors will require rehabilitation (30 days after stroke onset), the current facilities of early post-stroke rehabilitation in Poland cannot meet this need. We should do our best to introduce rehabilitation services such as early home-supported discharge after stroke, which is currently not available in Poland. Although we have focused on resources in Poland, we anticipate that similar patterns may be found in other countries in the region. (Contains 3 tables.)

A single-group pre- and post-test design was used to evaluate functional outcomes of a constraint-induced movement therapy (CIMT) protocol implemented in an outpatient therapy center. The participants were 29 children with hemiplegia, ages 1.6-19.1 years old. The less-involved upper limb was placed in a cast that was worn 24 hr a day, 7 days a week. Individual therapy sessions took place 5 days/week. Children received 3 or 6 hr therapy sessions for 16-19 days followed by 2-5 days in which bimanual tasks were performed. Outcomes were assessed at baseline and following CIMT. Statistically significant gains were made on the Melbourne Assessment of Unilateral Upper Limb Function, Quality of Upper Extremity Skills Test (except the Protective Extension subtest), Assisting Hand Assessment, and the Canadian Occupational Performance Measure. The effect sizes varied from 0.46 to 0.70 indicating a moderate effect size. The results support the effectiveness of CIMT provided through a center-based program. (Contains 2 tables and 4 figures.)

To increase the rigor of pediatric rehabilitation research, there is a need to evaluate the degree to which an intervention is conducted as planned (i.e., fidelity). Generic fidelity measures evaluate more than one intervention and often include nonspecific attributes of the therapy process common to both interventions. The objective of this study was to describe the characteristics of generic fidelity measures and examine how these attributes fit with pediatric rehabilitation. A review of generic fidelity measures was conducted utilizing health and education databases. Five generic fidelity measures are described and examined for their applicability to pediatric rehabilitation. The measures were used in nine studies meeting the inclusion criteria, involving people ages from 11 years to greater than 65 years undergoing psychotherapy. From the 76 nonspecific items, 37 items were judged to be applicable to pediatric rehabilitation. Common characteristics of nonspecific attributes with pediatric rehabilitation are discussed, and investigator plans to conduct future testing. (Contains 3 tables and 1 figure.)

Recent evidence points to white-matter abnormalities as a key factor in autism physiopathology. Using Diffusion Tensor Imaging, we studied white-matter structural properties in a convenience sample of twenty-two subjects with low-functioning autism exposed to long-term augmentative and alternative communication, combined with sessions of cognitive and behavioral therapy. Uncinate fasciculus structural properties correlated significantly with therapy length and early onset, as well as to clinical outcome, independently from IQ, age or symptoms severity at therapy onset. Moreover, adherence to therapy was linked with better clinical outcome and uncinate fasciculus structural integrity. The results point to the capability of a long-term rehabilitation of subjects with low-functioning autism to produce white-matter structural modifications, which could thus play a role in the rehabilitative outcome.

Limited weight bearing of the lower extremity is a commonly applied procedure in orthopaedic rehabilitation after reconstructive forefoot surgery, trauma surgery and joint replacement. The most frequent limitations are given as percentage of body weight (BW) and represent 10 or 50% BW. The extent of foot loading under these graduations of partial weight bearing has not yet been described in detail. The objective of this study was to investigate forces at the foot-sole interface, which occur under graduated limitations of weight bearing. Peak pressure, maximum force, pressure-time integral and force-time integral (Pedar Cable) were assessed for a total of three trials with 10 healthy individuals. The results from limited weight bearing with 10 or 50% BW as taught by an experienced physiotherapist with a bathroom scale were referred to results of a normal gait. The limitation of weight bearing to 10% BW was equal to a bisection of peak pressure and maximum force for the total foot. Halved BW left a remaining 82% of peak pressure and 59% of maximum force for the total foot. We concluded that weight-bearing limitations to 10 and 50% BW lead to discernible differences in foot loading and may be applied to graduate forces of the lower limb for rehabilitation purposes. Foot loading with partial weight bearing exerts the percentage of BW and should be monitored to avoid an exertion of strains on the lower limb.

A multivariate model of determinants of change in gross-motor ability and engagement in self-care and play provides physical and occupational therapists a framework for decisions on interventions and supports for young children with cerebral palsy and their families. Aspects of the child, family ecology, and rehabilitation and community services may influence children's activity and participation. Aspects of the child include primary and secondary impairments, associated and comorbid health conditions, and adaptive behaviors. Literature support for the model is reviewed. A clinical scenario illustrates the use of the model as a framework for practice. The model encourages therapists to broaden the focus of rehabilitation services for young children with CP to include not only development of motor abilities but also comprehensive interventions and supports to enhance participation in daily activities and routines. Therapists are encouraged to consider how child, family, and service factors interact when planning interventions and evaluating outcomes. (Contains 1 figure.)

The wars in Afghanistan and Iraq have been notable for the high rates of traumatic brain injury (TBI) that have been incurred by the troops. Visual impairments often occur following TBI and present new challenges for rehabilitation. We describe a neurological vision rehabilitation therapy that addresses the unique needs of patients with vision loss that is due to TBI. (Contains 1 figure.)

Hippotherapy (HPOT) is a therapy that uses horse movement. This pilot investigation objectively evaluated the efficacy of HPOT in improving head/trunk stability in children with cerebral palsy (CP). The participants were six children with spastic diplegia and six children without disability. Head and trunk stability was challenged by using a motorized barrel and measured by a video motion capture system before and after a 12-week intervention of 45 min of HPOT a week. The variables measured were anterior-posterior (AP) translation of the head, and spine at five points and average AP head angles. At pre-testing, children with CP demonstrated significant differences in AP translation and AP head rotation compared with children without disability. Following HPOT, children with CP demonstrated significant reductions in head rotation and AP translation at C7, eye, and vertex. At post-testing, translation at C7 did not differ significantly between children with CP and children without disability. After HPOT intervention, children with CP reduced their AP head rotation and translation, suggesting that they had increased stability of the head and trunk in response to perturbations at the pelvis. The findings suggest that HPOT might improve head and trunk stability in children with CP. (Contains 1 table and 9 figures.)

These case reports describe a stationary cycling intervention and outcomes for two child participants (P1 and P2) with spastic diplegic cerebral palsy. Each child completed a 12-week, 30-session cycling intervention consisting of strengthening and cardiorespiratory fitness phases. P1 exhibited higher training intensities, particularly during the cardiorespiratory phase. Average training heart rates were 59% and 35% of maximum heart rate for P1 and P2, respectively. Lower extremity peak knee flexor and extensor moments, gross motor function (Gross Motor Function Measure (GMFM-66)), preferred walking speed (thirty-second walk test), and walking endurance (600-yard walk-run test) were measured pre- and postintervention. Changes in outcome measurements corresponded with differences in exercise intensity. Greater gains in peak knee extensor moments, GMFM-66 scores (+4.2 versus +0.9), 600-yard walk-run test (-29% versus 0%) occurred for P1 versus P2, respectively. Preferred walking speeds did not increase substantially for P1 and decreased for P2. (Contains 2 tables and 3 figures.)

Background: One of the major barriers to effective team working among healthcare professionals is a lack of knowledge of each other's roles. The importance of understanding Irish healthcare students' attitudes towards team working and each other's roles led to the development of this study. Aims: The aims were to investigate allied health professional students' perceptions and experiences of the stroke rehabilitation team and the role of the Speech and Language Therapist (SLT). Methods & Procedures: A survey first developed by Felsher and Ross (1994) and further developed by Insalaco et al. (2007) was adapted to the Irish healthcare setting. The survey was administered to final-year Occupational Therapy (n = 23), Speech and Language Therapy (21) students and Physiotherapy (20) students (64 in total) (a 98.5% response rate). Outcomes & Results: Results indicate that students had a good understanding of teamwork in the healthcare setting and the possible benefits and challenges it presents. Students had a strong appreciation for interprofessional collaboration, with the majority (79%) choosing shared leadership as their preferred option for the stroke rehabilitation team. Further to this, the team approaches that students felt were most appropriate for the stroke rehabilitation setting were the more collaborative approaches of interdisciplinary (43.5%) and transdisciplinary (37.1%). The students had clear perceptions of the SLT's role in aphasia, dysphagia, dysarthria, apraxia and auditory agnosia, but were less knowledgeable of the SLT's role in the acquired disorders of alexia and agraphia (p less than 0.05). More than half of all students perceived that the SLT is involved in the treatment of hemispatial neglect (55.5%), depression (71.5%) and visual agnosia (59.4%). Conclusions & Implications: The results provide valuable information for further developments in interprofessional education at an undergraduate level. Further opportunities should be provided to students to collaborate with each other, particularly in their final year of training as, by then, students have a well-established knowledge of their own roles and would be more capable of sharing this role with other professions. Through this collaboration students would also gain valuable insight into the importance of teamwork, which they could take with them into their professional careers. (Contains 1 figure and 4 tables.)

One learning strategy that, at present, has not been widely used in graduate Physical Therapy education is "video based cases". The use of visually unfolding case-base experience provides students a unique opportunity to experience real patient scenarios in their classroom environment. The purpose of this paper is to provide data on student perceptions of usefulness of the video based case experience in promoting their ability to organize, prioritize, and integrate content knowledge for the development of effective critical thinking skills. (Contains 3 tables.)

Context: Injured athletes rely on athletic trainers to assist them when recovering from injury. Over the last 20 years, the use of psychological skills to speed recovery has become increasingly popular. Objective: Explore athletic training students' perceptions of the importance and effectiveness of psychological skills in the rehabilitation of sport injury as well as their academic preparation in their use, and examine the differences in perceived effectiveness for those with and without formal training in the skill. Design: Survey. Setting: Athletic training students enrolled in CAATE-accredited athletic training programs. Participants: 180 athletic training students (males, n = 76; females, n = 104) from nine universities. Data Collection & Analysis: The survey included 15 questions from the Attitudes About Imagery (AAI) survey and a demographic section including questions about their educational preparation, use of, and interest in psychological skills training. Two chi-square analyses, two ANOVAs, and a MANOVA were computed to investigate differences in athletic training students' educational preparation, use of, and interest in psychological skills training. Results: While athletic training students agreed that it is important to treat the psychological aspects of injury (mean = 4.47 out of 5), only 50.6% reported that they had taken a course in sport psychology or psychological skills training. No differences in the perception of effectiveness were found between students that reported formal training in psychological skills compared to those that did not ([chi][squared][subscript 4,176] = 7.48, P = 0.11). Overall, the ratings of the effectiveness of psychological skills were positive as indicated by mean AAI scores between 4.31 to 6.17. Conclusions: We found positive perceptions of psychological skills. However, the students' mean AAI scores were generally lower than previously surveyed athletic trainers and physical therapists. (Contains 3 tables.)

The objective of this study was to evaluate a new intervention for chronic dysphonias, consisting of a 2-week outpatient treatment period using intensified voice therapy combined with elements of physical medicine, including physiotherapy (orthotherapy, detonisation and training of the trunk muscles, respiratory therapy and others), manual therapy (mobilization of the cervical spine), inhalations, vibration massages, thermotherapy, classical massages and active relaxation (e.g. autogenic training, progressive muscle relaxation). In addition, the autonomous regulation was influenced by hydrotherapy according to Kneipp. A handicap questionnaire was given to 37 patients with diverse aetiologies of dysphonia before and after intervention. The change score was compared between baseline handicap levels (none, mild, moderate, severe), and between patients with organic and functional dysphonias. The questionnaire was also given to 40 healthy volunteers for comparison with patients' baseline values. Overall handicap was significantly reduced in patients with moderate baseline handicap values, whereas no significant changes could be detected in patients with severe handicap; patients with mild handicap values did receive some benefit. A significant difference in the intervention outcome was found between patients with organic and functional dysphonias. In conclusion, the results suggest that ambulatory rehabilitative measures are most effective in patients with moderate functional dysphonias, and that severe dysphonias with organic backgrounds may require longer rehabilitation phases.

The study aimed to examine the experience of inpatient physiotherapy intervention delivered after stroke in Ireland from two different perspectives: that of the person with stroke and that of the physiotherapist. A qualitative study was conducted involving semistructured interviews with 10 people with stroke and two focus groups with 10 senior physiotherapists working in the area of neurology. All transcriptions were analysed using the grounded theory approach. People with stroke and physiotherapists agreed that people with stroke could benefit from more physiotherapy than is routinely provided in the rehabilitation setting. However, the timing of the intervention was disputed. Family-mediated exercise therapy was identified as an acceptable adjunct to routine physiotherapy after stroke. People with stroke identified walking and lower-extremity exercises as the most important components of their programme. Furthermore, they identified honesty and encouragement as two important traits in a physiotherapist working with people with stroke. Obtaining the perspective of patients is an important and valuable way of evaluating healthcare services. Physiotherapists need to be cognizant of the elements of rehabilitation that are important to people with stroke. Methods of delivery of stroke care need to evolve and incorporate families not only for practical purposes but also from a psychological aspect. Family-assisted exercise therapy after stroke may enhance the carry-over outside formal physiotherapy, giving patients and their families the opportunity to maximize recovery.

Painful stiffening of the shoulder, "frozen shoulder" is a common cause of shoulder pain and disability. Continuous passive motion (CPM) is an established method of preventing joint stiffness and of overcoming it. A randomized, comparative prospective clinical trial was planned to compare the early response with different rehabilitation methods [CPM vs. conventional physiotherapy treatment (CPT) protocol] for adhesive capsulitis taking into consideration the clinical efficacy. A total of 57 patients with frozen shoulder were included in this study. Patients were assigned randomly to receive daily CPM treatments or CPT protocol. Parameters were measured at baseline, and at weeks 4 and 12. All patients were evaluated with respect to pain (visual anologue scale) at rest, pain at movement, pain at night, measurement of range of motion (shoulder flexion, abduction, internal-external rotation were assessed), constant functional shoulder score and the shoulder pain and disability index. The first group (n=29) (CPM group) received CPM treatments for 1 h once a day for 20 days during a period of 4 weeks. The second group (n=28) (CPT group) had a daily physiotherapy treatment protocol including active stretching and pendulum exercises for 1 h once a day for 20 days during a period of 4 weeks. All patients in both groups were also instructed in a standardized home exercise programme consisting of passive range of motion and pendulum exercises to be performed every day. In both groups, statistically significant improvements were detected in all outcome measures compared with baseline. Pain reduction, however, evaluated with respect to pain at rest, at movement and at night was better in CPM group. In addition the CPM group showed better shoulder pain index scores than the CPT group. CPM treatment provides better response in pain reduction than the conventional physiotherapy treatment protocol in the early phase of treatment in adhesive capsulitis.

The aim of this study was to assess the effect of physiotherapy on ventilator dependency and lengths of intensive care unit (ICU) stay. Patients were divided into two groups. The control group, which received standard nursing care, was a retrospective chart review. The data of control patients who were not receiving physiotherapy were obtained from the hospital records. The intervention group was prospectively taken into the chest physiotherapy program. This study was planned on mechanically ventilated patients who were admitted to a six-bed multidisciplinary internal medicine intensive care unit of the university hospital. A total of 510 patients who were hospitalised in the ICU were included in the study. Demographics, diagnostic profiles, co-existing chronic diseases, respiratory parameters on admission, patient's overall severity by Acute Physiology and Chronic Health Evaluation II score, patient outcome, duration of stay in ICU, duration of ventilator support, and complications were assessed. The extubation time and length of ICU stay were compared between the two groups. Control patients had a longer period of ventilator dependency than the intervention patients and this difference was statistically significant (P less than 0.05). It was noted that the resulting length of stay in the ICU was significantly lower in the intervention group than in the control group (P less than 0.05). Although the patients had similar diagnoses and physical features, the length of stay in the ICU was significantly lower in the intervention group. The results show that physiotherapy has a great impact on ventilatory dependency and length of stay in the ICU.

In January 2004 faculty from the University of Scranton traveled to Mexico to establish relationships with universities, clinic personnel, hospital personnel, school personnel, and parents in order to increase their understanding of the role disability play in that country. This interdisciplinary group of professionals in special education, occupational therapy, physical therapy and hospital administration, visited 17 university, government, and community-based agencies to gather data regarding the provision of healthcare, education and rehabilitation services to children with disabilities in Mexico. This article focuses on the role the family plays when they have a child with disabilities. Professionals and parents were interviewed and as in the United States the dichotomy between professional and parent are evident.

It is estimated that 3.2% of Cuba's population of 11.4 million persons has a severe disability of some kind. Recent economic difficulties have, it may be assumed, had a negative impact on health service provision--which is free to all--and thus, on population health outcomes and nutritional levels. There is a traditional culture of family care for children and adults with intellectual disabilities (IDs), although it is apparent that unfounded beliefs about the etiology of disabling conditions as well as social stigma persist. The Constitution indicates that it is necessary to provide education for children with intellectual and other disabilities in primary schools, while other ministerial resolutions create special schools. ID is construed chiefly as a social problem. Children with IDs are the responsibility of the Minister of Education; it is possible that children with severe levels of disability may not attend school and rely on family support. For adults, rehabilitation includes physiotherapy and other services such as "defectology"; strategies for adults who are evaluated include both segregated and institutional elements. The author suggests that two key issues are related to policy and practice in Cuba. One is the minimal content on special education in teacher preparation programs, and the other, that despite a cultural tradition of family care, family involvement in special education, or in rehabilitative services, remains limited.

A program relying on microswitch clusters (i.e., combinations of microswitches) and preferred stimuli was recently developed to foster adaptive responses and head control in persons with multiple disabilities. In the last version of this program, preferred stimuli (a) are scheduled for adaptive responses occurring in combination with head control (i.e., head upright) and (b) last through the scheduled time only if head control is maintained for that time. The first of the present two studies was aimed at replicating this program with three new participants with multiple disabilities adding to the three reported by Lancioni et al. [Lancioni, G. E., Singh, N. N., O'Reilly, M. F., Sigafoos, J., Didden, R., Oliva, D., et al. (2007). "Fostering adaptive responses and head control in students with multiple disabilities through a microswitch-based program: Follow-up assessment and program revision." "Research in Developmental Disabilities", 28, 187-196]. The second of the two studies served to carry out an expert validation of the program's effects on head control and general physical condition with the three participants of Study I as well as the three participants involved in the Lancioni et al. study mentioned above. The expert raters were 72 new physiotherapists and 72 experienced physiotherapists. The results of Study I supported previous data and indicated that the program was effective in helping the participants increase the frequency of adaptive responses in combination with head control and the length of such control. The results of Study II showed that the raters found the effects of the new program more positive than those of other intervention conditions and also considered such program a useful complement to formal motor rehabilitation programs. (Contains 3 figures and 3 tables.)

Introduction: Videoconferencing (VC) is becoming a common method for the delivery of continuing education (CE) to clinicians in remote locations. The purpose of this study was to compare the effectiveness, acceptability, and costs of a full-day training workshop (TW) delivered through two different formats: face-to-face (FTF) and VC. The TW was designed to teach administration and scoring guidelines for the Chedoke-McMaster Stroke Assessment, an outcome measure used by rehabilitation professionals. Methods: The TW was delivered simultaneously in FTF and VC formats to a total of five remote communities on two separate occasions. Participants completed a test of scoring competency at the beginning (pretest) and end (posttest) of the TW as well as a feedback questionnaire. A cost comparison was also undertaken. Results: Forty-four physical and occupational therapists participated. No significant between-group differences were found in posttest scoring competency related to delivery format (FTF or VC): (F[subscript 1,38] = 0.6, MSE = 3.6, p greater than 0.4), or for the two workshops: (F[subscript 1,38] = 1.4, MSE = 3.6, p greater than 0.2). Despite technical difficulties, participant experience was rated as "good" to "excellent." The VC method offered considerable cost savings to participants and their organizations, at a minimum of $7,437 (Canadian). Conclusion: Clinicians participating in the TW via VC performed as well as those in the FTF group on the competency test. Videoconferencing improves access to CE, is well received by participants, and provides a cost-effective method of course delivery. Further evaluation of other CE events delivered through VC is indicated. (Contains 1 figure and 4 tables.)

Group achievements and social change are rooted in self-efficacy. This concept has important implications for career development in a changing environment. Associations that represent professionals involved with physical rehabilitation in the United States have identified activities that they feel are essential for the survival of the rehabilitation professions. The purpose of this study was to describe how confident rehabilitation professionals are to perform these activities. Results showed that most rehabilitation professionals did not feel totally confident to perform these activities. These results suggest that rehabilitation professionals may not be optimally prepared to adapt to the changing health care environment and suggest methods to facilitate professional development of these professionals. (Contains 2 tables.)