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Patricia J Manns, Johanna DarrahDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, CanadaBackground and purpose: Scenarios are used as the basis from which to evaluate the use of the components of evidence-based practice in decision making, yet there are few examples of a standardized process of scenario writing. The aim of this paper is to describe a step-by-step scenario writing method used in the context of the authors’ curriculum research study.Methods: Scenario writing teams included one physical therapy clinician and one academic staff member. There were four steps in the scenario development process: (1) identify prevalent condition and brainstorm interventions; (2) literature search; (3) develop scenario framework; and (4) write scenario.Results: Scenarios focused only on interventions, not diagnostic or prognostic problems. The process led to two types of scenarios – ones that provided an intervention with strong research evidence and others where the intervention had weak evidence to support its use. The end product of the process was a scenario that incorporates aspects of evidence-based decision making and can be used as the basis for evaluation.Conclusion: The use of scenarios has been very helpful to capture therapists’ reasoning processes. The scenario development process was applied in an education context as part of a final evaluation of graduating clinical physical therapy students.Keywords: physical therapists, clinical decision making, evaluation, curriculum

Metal-oxide nanoparticles (MO-NPs), such as the highly bioreactive copper-based nanoparticles (CuO-NPs), are widely used in manufacturing of hundreds of commercial products. Epidemiological studies correlated levels of nanoparticles in ambient air with a significant increase in lung disease. CuO-NPs, specifically, were among the most potent in a set of metal-oxides and carbons studied in parallel regarding DNA damage and cytotoxicity. Despite advances in nanotoxicology research and the characterization of their toxicity, the exact mechanism(s) of toxicity are yet to be defined. We identified chlorination toxicity as a damaging consequence of inflammation and myeloperoxidase (MPO) activation, resulting in macromolecular damage and cell damage/death. We hypothesized that the inhalation of CuO-NPs elicits an inflammatory response resulting in chlorination damage in cells and lung tissues. We further tested the protective action of LGM2605, a synthetic small molecule with known scavenging properties for reactive oxygen species (ROS), but most importantly, for active chlorine species (ACS) and an inhibitor of MPO. CuO-NPs (15 µg/bolus) were instilled intranasally in mice and the kinetics of the inflammatory response in lungs was evaluated 1, 3, and 7 days later. Evaluation of the protective action of LGM2605 was performed at 24 h post-challenge, which was selected as the peak acute inflammatory response to CuO-NP. LGM2605 was given daily via gavage to mice starting 2 days prior to the time of the insult (100 mg/kg). CuO-NPs induced a significant inflammatory influx, inflammasome-relevant cytokine release, and chlorination damage in mouse lungs, which was mitigated by the action of LGM2605. Preventive action of LGM2605 ameliorated the adverse effects of CuO-NP in lung.

Purpose. To understand the contribution of educational, employment, transportation, and assured income service programs to the successful transition to adulthood of young persons with motor disabilities. Method. Personal interviews of 76 young adults ages 20 to 30 years with a diagnosis of cerebral palsy ( n = 54) or spina bifida ( n = 22) varying in functional mobility. Content analysis of transcribed interviews was conducted and themes identified. Results. 'Paradox of Services' emerged as a dominant theme across all four service sectors. Services designed to encourage independence and full participation for the young adults in their communities often restricted their independence and employment options in young adulthood. Conclusions. Services need to be more individualized and flexible to accommodate the environmental and personal needs of the young adults. Rehabilitation professionals have important roles at both an individual family level and the systems level to ensure the 'best fit' between persons with motor disabilities and the services available to them. Contemporary views of disability support rehabilitation intervention targeting both individual and environmental factors. [ABSTRACT FROM AUTHOR]

Contemporary rehabilitation literature emphasises functional goals for children with disabilities and use of a collaborative goal-setting process grounded in principles of family centred service delivery. Purpose. To explore parents' experiences with goals and goal setting. Method. We conducted a qualitative study with 11 focus groups and two individual interviews with 39 parents of children with cerebral palsy living in western Canada. We used an inductive, thematic analysis to identify prominent themes. Results. The analysis revealed five themes representing goals that were meaningful to parents and provided insight into parents' experiences with goal-setting processes in occupational and physical therapy: (1) movement as the means to functional success; (2) physical health and fitness are important therapy goals; (3) the importance of leading happy, fulfilling lives and being accepted by others; (4) 'We can't do it all': balancing therapy with the demands of everyday life; and (5) shifting roles and responsibilities in goal setting. Conclusions. The variability noted both in parents' desired role in goal setting and in goals important to parents highlights the importance of establishing trusting relationships with families so that family goals, values, individual circumstances, and desired level of participation in goal setting can be openly discussed. [ABSTRACT FROM AUTHOR]

Purpose. This commentary draws on a recent workshop hosted by the Canadian Children's Rehabilitation Research Network that brought together stakeholders to critically examine assumptions embedded in children's rehabilitation in order to advance current debates and suggest areas for further inquiry. Method. Six issues are discussed: (1) the wisdom of dichotomising 'fix' versus 'function'; (2) the ethics of 'it might help and it won't hurt' therapy approaches; (3) the emphasis on early intervention rather than a lifespan approach; (4) the challenges of providing care for new rehabilitation populations; (5) discrepancies between performance outcomes and patient satisfaction; and (6) innovative partnerships to support care transitions of adolescents and their families. Results. Issues identified include: finding the right balance between therapies that focus on 'fixing' children versus enhancing function, judicious design of therapy programs as to not overburden children and families, adopting lifespan approaches to meet the needs of multiple 'paediatric' populations, cautious interpretation of measures and approaches that link well-being with physical performance, and the benefits of including parent and youth facilitators on children's rehabilitation teams. Conclusions. Ongoing debate, discussion and research are needed in each of these areas to ensure that rehabilitation services are enhancing the well-being of children and families. [ABSTRACT FROM AUTHOR]

Objective: To identify the personal, family, and community factors that facilitate or hinder employment for young adults with developmental motor disabilities. Methods: Quantitative methods with an embedded qualitative component were used. Seventy-six persons between the ages of 20 and 30 years of age (Mean = 25, SD = 3.1) with a diagnosis of either cerebral palsy or spina bifida completed questionnaires addressing factors such as depression, and participated in a semi-structured interview that allowed participants to describe their experiences with education, employment, transportation, and other services. Results: Almost half of the participants (n = 35) were not currently employed. Hierarchical regression analyses indicated that gender (females were less likely to be employed), IQ (lower IQ associated with unemployment), and transportation dependence accounted for 42% of the variance in employment. Themes emerging from content analysis of the interviews supported the findings related to transportation barriers. Social reactions to disability limited employment opportunities, and participants often felt stuck in terms of employment options with limited opportunities for advancement. Conclusions: Transportation is a significant barrier to employment and innovative solutions are needed. Issues related to gender need to be considered when addressing employment inequities for persons with primarily motor disabilities. [ABSTRACT FROM AUTHOR]

Norms for the Peabody Developmental Motor Scales (PDMS) and the Peabody Developmental Motor Scales, second edition (PDMS-2) are based on cross-sectional data that do not provide information on how the scores of individual children vary over time. This study examined intra-individual variability of PDMS fine and gross motor scores of 77 typically developing children at 9, 11, 13, 16, and 21 months of age and PDMS and PDMS-2 fine and gross motor scores at 4 years. Correlations between scores over time ranged from .13 to .45. PDMS and PDMS-2 scores were correlated at .71 and .75 with significantly different means, indicating that the two versions are not equivalent for 4-year-old children. Most children scored above the 16th percentile, the suggested cut-off on the PDMS, at both 21-month and 4-year assessments, but their percentile ranks fluctuated considerably. Use of confidence intervals contributes to accurate interpretation of scores by differentiating true change in a child's score from change due to measurement error. [ABSTRACT FROM AUTHOR]

Health policy and demographic trends have produced considerable changes to the delivery of health care in recent years. This focus group study conducted in Alberta and Saskatchewan, Canada, involved 49 occupational therapists and physical therapists who discussed their experiences of current health services in relation to rehabilitation practice.Therapists' experiences were that regional rehabilitation service provision was variable and that there were client groups that gained from the shift to community-based rehabilitation and those that did not. Therapists reported changes to occupational therapy and physical therapy practice, including an increased focus on assessments, but fewer interventions being carried out and limited input into the provision of services to support clients in maintaining their health. The findings will be of interest to all practitioners and service providers. [ABSTRACT FROM AUTHOR]

Exercise for children with cerebral palsy (CP) is gaining popularity among pediatric physical therapists as an intervention choice. Exercise in water appeals to children with CP because of the unique quality of buoyancy of water that reduces joint loading and impact, and decreases the negative influences of poor balance and poor postural control. In this paper, research of land-based exercise and aquatic exercise for children with CP is reviewed. Clinically relevant considerations for aquatic exercise programming for children with CP are discussed. [ABSTRACT FROM AUTHOR]

This qualitative study focused on the experiences of six 20- to 23-year-old persons with cerebral palsy and their parents during the transition to adulthood and explored perceived changes in their relationship. Using semi-structured interviews, three interrelated themes emerged: (a) perceptions of readiness for increased autonomy, (b) opportunities for the young adults to make independent decisions and learn from life experiences, and (c) shifting parental roles. The youths' autonomy related to parental perceptions of their readiness and push for autonomy, the parent's personal beliefs and readiness to support the changing relationship, and the parents' needs for separation from the child. In some families of youths requiring ongoing support for personal care, finances were a barrier to altering relationships with their child. [ABSTRACT FROM AUTHOR]

Physical therapists and occupational therapists frequently assist parents with the exploration and use of powered wheelchairs for their children with physical disabilities. The purpose of this study was to explore parents' experiences and perceptions of their children's experiences with the receipt and use of powered mobility. Qualitative methods were used to gain insight into the experiences of five mothers of children with physical disabilities who use powered wheelchairs. Information was collected during individual interviews with the mothers. Data analyses revealed five higher-level themes identified across the participants. Results of this study suggest that mothers initially perceive powered mobility as a 'last resort' mobility option. The perceived effects of their children's use of powered mobility were significant and included increased personal control, independence, and opportunities to participate in age appropriate, meaningful activities. The mothers perceived that increased independence positively affected others' attitudes toward their children and allowed their children to develop more 'legitimate' relationships with their peers. [ABSTRACT FROM AUTHOR]

Information about the use of research by rehabilitation professionals to make clinical decisions in everyday practice is limited. This study compared perceived research use and knowledge sources across professions, practice situations, and work environments. Participants were 165 randomly selected Canadian occupational therapists, physical therapists, and speech-language pathologists. Self-report ratings during an interview, an interviewer rating, and questionnaire scores (Edmonton Research Orientation Survey, General Use of Research, Knowledge Acquisition Survey) were compared. Speech-language pathologists had the most education and the highest research use ratings. Research use was highest during program planning. Programs to encourage research use must consider the research available to guide practice and therapists' education level. Facility size and location (rural, urban) do not affect perceived research use. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the use of powered mobility by young individuals with physical disabilities. The four study objectives were to: (a) describe the characteristics of children and adolescents who received powered wheelchairs at eighteen years of age or younger, (b) evaluate the longitudinal use or disuse of powered mobility by these participants, (c) describe the extent and locations of powered mobility use, and (d) explore environmental (i.e., physical, social and attitudinal) barriers and facilitators to successful powered mobility use with the participants and their families. Sixty-six families shared information during a structured telephone interview. The results of this study confirm that younger children are now receiving powered wheelchairs. The results also suggest that powered mobility is reserved for children with the most severe disabilities. Physical and occupational therapists can work collaboratively with more families to explore powered mobility as one of an array of early movement options. [ABSTRACT FROM AUTHOR]

Abstract: The primary objective of this study was to determine the inter-rater reliability of the revised version of the Edmonton Functional Assessment Tool (EFAT-2). A second objective was to determine whether both formally trained and self-trained therapists had an acceptable level of inter-rater reliability. The EFAT-2 was administered to consenting palliative care patients by one of two independent physical therapist rater pairs; one pair self-trained (R1, R2) and the other formally trained (R3, R4). The intraclass correlation [ICC (1,1)] for R1, R2 was 0.97 [95% confidence interval (CI) 0.94–0.99] and for R3, R4 was 0.95 (95% CI 0.90–0.98). The standard error of measurement was 1.09 and 1.44, respectively. The Kappa statistic for the rater pairs on individual EFAT items ranged from 0.17 to 0.96. The results suggest that both formally trained and self-trained therapists obtain an acceptable level of inter-rater reliability when using the EFAT-2. [ABSTRACT FROM AUTHOR]