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The 2020 COVID lockdown provoked the early childhood team at Manukau Institute of Technology to radically rethink how practicum was assessed. The usual approach of an “in-centre” observation followed by a triadic discussion was replaced by weekly “virtual” meetings and an online triadic. A reflective framework was developed to guide students to think about and articulate their understanding of the assessment of practice criteria. At the conclusion of the virtual practicums, a small qualitative research study was conducted with the aim of examining the impact of these changes. Thematic analysis of the online questionnaire sent to students, associate teachers, and visiting lecturers revealed many students had experienced deep learning, had developed personal confidence, and had taken greater ownership of their learning. These findings informed practicum assessment in the newly developed Bachelor of Education (early childhood teaching) programme.

The practicum components in early childhood field-based programmes form a core part of achieving praxis, or the balance between theory and practice, which is interwoven with values, beliefs and experiences that form a teacher identity. The practicum assessment involves achieving competency against a set of discipline-based criteria during a period of observation by an external, registered teacher. This paper reports on responses to the national Covid-19 lockdown restrictions, under which the requirements of the traditional practicum could not be met and an alternative version of the assessment had to be developed. The methodology for this project was constructivist grounded theory coupled with a socio-constructivist ethos. The method of data collection was an anonymous survey of students, lecturers and centre-based teachers. The findings indicate an unexpected growth in student empowerment in discussing their own practice.

The international pandemic and the national lockdown during semester one of 2020 meant the Manukau Institute of Technology Early Childhood teams needed to revisit the existing requirements of their programmes and particularly in terms of practicum. In response, the teams developed ‘virtual’ meetings to replace the usual observation visit by a visiting lecturer. In this revised approach, the students and lecturers engaged in weekly conversations and in these meetings the role of the Visiting Lecturer was significantly changed. By using communication software (Microsoft Teams with cell phone back up) the student and Visiting Lecturer engaged in critically reflective conversations that mentored the student in thinking about their practice, setting goals to work on and articulating their learning. By using the software in this way, the Visiting Lecturers changed their role from merely assessor of practice to firstly, mentor and guide. In the online triadic meetings (also using Microsoft Teams and cell phone back-up) it became clear that the traditional model of the student being told how the assessor felt they had met the practicum criteria was replaced with one where the student was able to articulate for themselves. At the end of the semester, students and lecturers were invited to give feedback via a survey. The responses focused on the deep learning experienced, ownership of learning, and the confidence the students felt at the on-line triadic. Much more unexpected was the correlation between survey responses and much of the literature. Drawing on these findings, this presentation poses some possibilities for what both the practicum and a reconceptualised relationship between visiting lecturer, associate teacher and students could look like in the ‘new normal’.

Objectives The purpose of this study was to document the baseline neurophysiological status (skin conductance activity levels) of patients presenting for physiotherapy with acute and subacute low back pain (symptoms of up to 12 weeks’ duration) and to observe the magnitude and direction of sympathetic nervous system (SNS) changes (skin conductance responses [SCRs]) occurring as a result of receiving guideline-endorsed physiotherapy treatment. Methods A pragmatic, prospective, longitudinal, observational study recording SNS skin conductance (SC) responses and patient reported outcome measure changes to a program of guideline-endorsed physiotherapy treatment for low back pain symptoms of up to 12 weeks’ duration. Sixty patients received a guideline-endorsed physiotherapy treatment program. Continuous neurophysiological recordings of SC activity levels were taken throughout each treatment. Patient reported outcome measure data were extracted from inception, midpoint, and discharge. Within and between treatment analyses determined the nature of SC changes and correlations to longitudinal changes in pain and function. Skin conductance changes were measured within and between treatment episodes at treatment inception, midpoint, and discharge and observed correlations between the magnitude of SCRs, pain abatement (numeric pain rating scale), and functional restoration (Oswestry Disability Index). Results Skin conductance changes were significant during all “treatment” periods (P = .044), with the greatest magnitude of sympathoexcitatory responses occurring at inception (219%). The treatment modality providing the maximum SNS response was a high-velocity lumbar rotation manipulation. Positive correlations were identified between SCRs, Oswestry Disability Index improvements (r = 0.82, P Conclusions Patients with low back pain exhibited neurophysiological treatment responses indicative of a symptom-related neuroplastic state of dorsal horn sensitization that may be receptive to early manual therapy intervention.

The 2020 pandemic and ensuing lockdowns came as a shock nationally and internationally. As a result, the change in approaches to teaching for many was fast and absolute. One minute the face-to-face ethos was humming along as 'normal', the next it was fully on line and taking teachers and students into a story many would never have considered. This brought with it the challenge of continuing to build and maintain relationships with the students in order to support their road to success. Storytelling has always been an important part of my practice in developing relationships through sharing my own experiences and encouraging the students to share theirs. In this way, we co-construct understanding of the class content and get to know each other. Going into fully online teaching would potentially change this. Given the speed of the changes required, this project was never meant to be overtly innovative but was designed to allow me to continue using narratives of content and practice to build communities of learning in the online environment. As a teacher, Power Point was familiar, so I started there and simply changed to saving them as mp4 files. The presentation plots this journey as a teacher taking storytelling from a face-to-face classroom across the lockdown in a way that continued supporting relationships and learning. The first attempts showed me that online stories are not the same as class power points where I physically created the narrative that linked the slides together. As I viewed my first attempt, it became clear that I was trying to tell a story that was in my head but not translated to the screen and I needed to adopt an approach that clearly spoke to a listener/audience i.e. my community of learning. I learned that, up to this point, I had used power point as a guide as I wove a story around the weekly content in a face-to-face classroom. In other words, the whole thing was heavily dependent on me. In this new environment, the story had to be told in a different way. It had to stand as a discrete artefact on its own, speaking to anyone that logged on, enabling me to reach out to that other human being without the unique connection that develops between story-teller and listener in the face to face world. Through three more cycles of research, I found that this new kind of story depended on a delicate balance between visual and oral, the context, content and the affective and how each was portrayed. Ultimately, the focus had to remain on the relationships I could build and the impact they could have. Therefore, this project came to be about keeping storytelling, whether face-to-face or online, “a uniquely human experience through which people make sense of past experience, convey emotions and ultimately connect with each other” (Christianson, 2011, p. 289).

Manual therapy (MT) and exercise therapy techniques are commonly utilised, guideline recommended treatment strategies in the management of non-specific low back pain (LBP). Preliminary evidence on asymptomatic participants indicates that two manual therapy techniques; repeated lumbar extension in lying exercise (EIL); and segmental rotational grade V manipulation (manipulation), have significant effects on the sympathetic nervous system (SNS) as detectable with skin conductance (SC) responses. However, it is not known if these responses occur in patients with LBP. A randomised, independent group's design was utilised to investigate the immediate SC responses in 50 patients with LBP of less than 12 weeks duration. Patients received either the manipulation technique (n = 25) or the EIL exercise (n = 25) and SC activity was recorded, in a single treatment session, pre-, peri- and post-treatment. Both treatments resulted in a sympatho-excitatory response during the intervention period with the manipulation technique having a 255% increase (p < 0.005), and the EIL technique a 94% increase (p = 0.019) with both treatments having responses that were sustained into the final rest period (p < 0.005). Between-group comparisons indicate that the manipulation technique had a significantly greater magnitude of effect (p < 0.001). The results support the sympatho-excitatory responses seen in normative studies but challenge the assumption that normative and patient populations are analogous with respect to the magnitude of effect observed and suggest that SC responses may be a feasible, proxy method of detecting dorsal horn sensitisation and neuro-plastic adaptations occurring in the presence of LBP.

Physiotherapy management of lumbar disorders, based on Mulligan's mobilization techniques, is a treatment of choice by many physiotherapists, however, there is only limited evidence of any neurophysiological effects and much of this has focused on the cervical spine and upper limbs. This study aims to extend the knowledge base underpinning the use of a modified Mulligan's spinal mobilisation with leg movement technique (SMWLM) by exploring its effects on the peripheral sympathetic nervous system (SNS) of the lower limbs. Using a single blind, placebo controlled, independent groups study design, 45 normal naive healthy males were randomly assigned to one of three experimental groups (control, placebo or treatment; SMWLM). SNS activity was determined by recording skin conductance (SC) obtained from lower limb electrodes connected to a BioPac unit. Validation of the placebo technique was performed by post- intervention questionnaire. Results indicated that there was a significant change in SC from baseline levels (30%) that was specific to the side treated for the treatment group during the intervention period (compared to placebo and control conditions). This study provides preliminary evidence that a modified SMWLM technique results in side-specific peripheral SNS changes in the lower limbs.

“One Text Once a Week”: Beginning the Story With Mobile Learning Teaching and Learning has been changing over the past years to include mobile spaces where study is about small bites of learning completed ‘on-the-go’ while the student is either mobile themselves or in a mobile environment. This has coincided with new teaching and learning models like the ‘Flipped Classroom’ (Bergmann & Sams, 2012) where content is delivered before class and later student engagement focuses on the application of that content in practical activities. This presentation details a project where, faced with lack of engagement with the pre-class work, the initial content was moved on to a text platform to better reach-out to the students. This was done using ‘WhatsApp’ and ‘Messages’ apps to deliver weekly content to two different classes. The research question was Can I Flip My Classroom Using Mobile Learning through ‘WhatsApp’ and ‘Messages’ and thus improve my practice”? Both pieces of software were appropriate for the task but the size of the class had an impact on choices. The methodology was constructivist grounded methodology and self-study to fully explore this environment and to focus on teachers-as-agents-of-change. Three questions that emerged from this were first, how to move beyond simple delivery of content to engagement in construction of knowledge, second what that knowledge then looks like and what pedagogy would best support these interactions. Bergmann, J., & Sams, A. (2012). Flip Your Classroom: Reach Every Student in Every Class Every Day. Eugene, OR: International Society for Technology in Education.

Objective The purpose of this study was to investigate the effects of a manual mobilization technique on indirect measures of sympathetic nervous system activity. Methods Forty-five healthy volunteers participated in this randomized, single-blinded, parallel-group 3-arm design (experimental, sham [placebo], and control group), comprising 15 subjects each. For the experimental group, lumbar mobilization involving an active movement, the Mulligan sustained natural apophyseal glide (SNAG), was applied on L4 spinous process by an experienced manual therapist. Sustained natural apophyseal glides were performed in sitting with active flexion (6 times × 3 sets). The sham technique simulated the SNAG without applying any force. In the control group, participants were placed in a static sitting position throughout the experiment. Measures of skin conductance in the lower limbs (L4 dermatome) were recorded to reflect sympathetic nervous system activity in the preintervention, periintervention, and postintervention periods. Differences in percentage change of skin conductance were analyzed with analysis of variance and post hoc tests. Results Lumbar SNAG produced sympathoexcitation compared with the control group in the intervention period (P = .04). No significant difference was found between SNAG and sham groups, and no statistically significant difference was found between groups in the final rest period. Conclusion The results of this study showed that, in asymptomatic participants, both lumbar SNAG and sham techniques performed on L4/5 intervertebral joint with active flexion induced a sympathoexcitatory response in lower limbs compared with the control group.

The hamstring muscles are regularly implicated in recurrent injuries, movement dysfunction and low back pain. Links between limited flexibility and development of neuromusculoskeletal symptoms are frequently reported. The Bowen Technique is used to treat many conditions including lack of flexibility. The study set out to investigate the effect of the Bowen Technique on hamstring flexibility over time. An assessor-blind, prospective, randomised controlled trial was performed on 120 asymptomatic volunteers. Participants were randomly allocated into a control group or Bowen group. Three flexibility measurements occurred over one week, using an active knee extension test. The intervention group received a single Bowen treatment. A repeated measures univariate analysis of variance, across both groups for the three time periods, revealed significant within-subject and between-subject differences for the Bowen group. Continuing increases in flexibility levels were observed over one week. No significant change over time was noted for the control group.

Two commonly utilised manual therapy techniques; McKenzie's lumbar extension exercises (EE); and segmental rotational grade V manipulation were investigated to determine their magnitude of neurophysiological effect. Proxy measures of sympathetic nervous system (SNS) activity (skin conductance) were utilised to ascertaining neurophysiological response. This study determined the neurological effects of these two treatment techniques in addition to establishing the Biopac System as a reliable measure of neurophysiological changes. A quasi-experimental, independent group's design was utilised, with random allocation of 50 normal, healthy participants into a manipulation or an EE group. Neurophysiological measurements of skin conductance were taken in the lower limbs before, during and after the administration of the techniques. Results were converted into percentage change calculations for the intervention and the post-intervention periods. Both treatments increased SNS activity during the intervention period, 63% for the manipulation group (p = 0.0005) and 42% for EE group (p = 0.0005) with the manipulative technique having significantly greater effect (p = 0.012). Further analysis of the manipulation group found no difference between the 'opening' and the 'closing' side of the technique (p = 0.76). Biopac System is a reliable method for measuring SNS activity with minimum measurement variability. Preliminary evidence now exists supporting the neurophysiological effects of two lumbar techniques.

Physiotherapeutic management of lumbar disorders often utilises specific segmental joint mobilisation techniques; however, there is only limited evidence of any neurophysiological effects and much of this has focused on the cervical spine and upper limbs. This study aims to extend the knowledge base underpinning the use of a unilaterally applied lumbar spinal mobilisation technique by exploring its effects on the peripheral sympathetic nervous system (SNS) of the lower limbs. Using a double blind, placebo controlled, independent groups study design and based upon power calculations, 45 normal naïve healthy males were randomly assigned to one of three experimental groups (control, placebo or treatment; a unilaterally applied postero-anterior mobilisation to the left L4/5 zygopophyseal joint). SNS activity was determined by recording skin conductance (SC) obtained from lower limb electrodes connected to a BioPac unit. Validation of the placebo technique was performed by post-intervention questionnaire. Results indicated that there was a significant change in SC from baseline levels (13.5%) that was specific to the side treated for the treatment group during the intervention period (compared to placebo and control conditions). This study provides preliminary evidence that a unilaterally applied postero-anterior mobilisation technique performed, at a rate of 2 Hz, to the left L4/5 lumbar zygopophyseal joint results in side-specific peripheral SNS changes in the lower limbs.

Background Oscillatory Maitland mobilisations are commonly used in the management of lower back pain with research suggesting that mobilisations at 2 Hz may excite the sympathetic nervous system (SNS) more than sustained pressure glides or 0.5 Hz oscillatory mobilisations. Objectives Investigate the effects of increasing the oscillation frequency greater than 2 Hz. Design A double-blind, placebo-controlled, independent group experimental design. Method Sixty healthy male volunteers were randomly allocated to one of four groups; a control group (no contact), placebo group (sustained static pressure to L4 vertebra), and two intervention groups receiving a centrally applied postero-anterior mobilisation applied at either 2 Hz or 3 Hz for three 1-min periods. SNS activity was recorded by a blinded data collector by continuous skin conductance (SC) activity levels in the feet using a Biopac MP35 electrodermal amplifier. Participants were blinded to their group allocation which was further validated by a post-experiment questionnaire ( p > 0.05). Results The magnitude of sympathoexcitatory response was greatest for the 3 Hz mobilisation (20%) compared with the 2 Hz mobilisation (12%), placebo (−1%) and control conditions (3%). Only the 3 Hz group demonstrated statistical significance when compared to placebo intervention ( p = 0.002), and the control group ( p = 0.02). Conclusion SC changes reflect those of previous studies using lumbar mobilisations at 2 Hz, however the 3 Hz group was found to have a greater magnitude of effect worthy of consideration within research and clinical settings. These findings provide preliminary evidence to support the use of 3 Hz oscillatory mobilisations to affect a greater magnitude of SNS activity than those previously reported (0.5, 1.5 and 2 Hz).

This study aimed to explore the professional and personal impact that a clinical Masters program of manipulative therapy education had on the lives of individuals who had undertaken the course and was a follow-on study of participants’ career pathways following Masters education (Green et al., 2008). Seven graduates from the program took part in a focus group. The narrative data obtained was independently verified prior to two researchers conducting a systematic, thematic content analysis. Three key themes were identified and the ‘knowledge acquisition model’ developed. Findings revealed that studying at Master’s level is a ‘life changing’ and rewarding experience that develops individuals in three key domains; professionally, personally and intellectually. During Masters education students described a journey of multi-compartmental development whereby their knowledge-base was challenged and their existing cognitive framework deconstructed. Progression through the program resulted in the development of a new, clearer framework for thinking and understanding that extended, universally, into all aspects of their lives; clinically, managerially, emotionally, politically and intellectually. Participants also described two cultures for career progression in the UK National Health Service (NHS). Findings could help students considering undertaking Masters level education, employers and clinical mentors of these practitioners and academic educators.

Joint mobilisation to the T4 vertebra has been advocated as a treatment for T4 syndrome. To date no controlled studies have investigated the effects of thoracic spinal manual therapy (SMT) applied to T4 on sympathetic activity in the hands. This study investigated whether a grade III postero-anterior rotatory joint mobilisation technique applied to the T4 vertebra at a frequency of 0.5 Hz had demonstrably greater effects than a validated placebo intervention on skin conductance (SC) in the hands of healthy subjects. A power analysis calculation was performed and using a double blind, placebo-controlled, independent groups design, 36 healthy subjects (18-35 years) were randomly assigned to two groups (placebo intervention or treatment intervention). A BioPac unit recorded continuous SC measures before, during and after each experimental intervention. An exit questionnaire was used to validate the expectancy effects of the placebo intervention. Results demonstrated a significant difference between groups in SC in the right hand during the post-treatment rest period (F = 4.888, p = 0.034); with the treatment intervention being sympathoexcitatory in nature. A trend towards a significant difference between groups was also demonstrated in the left hand during the rest period (F = 4.072, p = 0.052). This study provides preliminary evidence that joint mobilisation applied to the T4 vertebra at a frequency of 0.5 Hz can produce sympathoexcitatory effects in the hand. Further research is recommended in a patient population.

Over the last decade there has been potential for manual therapists to extend their roles and develop their careers. In order to explore the career pathways of a group of postgraduate manual therapists and to identify the influence of Master's education on those careers, a postal questionnaire was sent to all graduates from a clinically based programme (response rate 62.3%, n = 48 , with representation from each year over a 10-year period). All the respondents were still working in physiotherapy and the majority had a clinical element to their role (83%). The new career framework, which seeks to enable therapists to progress their careers and retain a clinical work load is demonstrated within this sample, with 6.2% achieving Consultant Therapist roles, 14.4% in Extended Scope Practitioner posts and 16.6% working as Clinical Specialists. Positive contributions from Master's education were the status of the qualification, improved clinical skills and increased confidence. Negative factors were less clinical ‘hands-on' within their roles, lack of time and an increase in management responsibilities. Findings suggest that Master's education has enabled the participants to take on the new roles that have resulted from a raft of political imperatives but further work could explore the issues around positive and negative drivers.