Transformative Learning Emerging From Challenges First-Year Students Experienced.

INTRODUCTION: Doctor of physical therapy (PT) (DPT) programs are rigorous, and students report facing overwhelming challenges. Faculty may not be cognizant of the extent of these challenges and miss opportunities to support student learning. The purpose of this article is to describe factors affecting student coping abilities and the lessons they learned from managing their self-identified challenges. REVIEW OF LITERATURE: Given the growing body of evidence surrounding mental health issues in DPT students, educators are exploring ways to support student well-being and promote their professional development. SUBJECTS: This study is a component of a larger multisite study of first-year DPT students from 3 private universities. METHODS: Participants submitted written narratives in response to a critical incident questionnaire designed to better understand first-year challenges. Responses were deidentified, researchers were blinded to participation, and confidentiality was maintained throughout. A consensus-driven interpretivist approach to qualitative data analysis was used. Strategies to ensure trustworthiness included triangulation of researchers, peer review, prolonged engagement, and use of thick rich descriptions. RESULTS: Seventy responses were analyzed. Two major themes are presented: (1) students described factors internal and external to the learning environment that inhibited and facilitated their ability to cope with challenges and (2) students shared academic successes and lessons learned from overcoming challenges, including the development of new behaviors, enhanced self-awareness, and personal and professional growth. DISCUSSION AND CONCLUSION: Building on previous work, analysis of the lived experiences of first-year DPT students revealed a process of transformational learning through challenge. This process highlights the importance of recognizing and supporting the significant incidental learning that occurs in our students during their journey through PT school. Faculty focusing solely on content knowledge, skills, and even critical thinking may not recognize and support the incidental learning occurring and may be missing significant transformational learning opportunities.

Perturbations of ground support alter posture and locomotion coupling during step initiation in Parkinson's disease.

During the initiation of stepping, anticipatory postural adjustments (APAs) for lateral weight transfer and propulsion normally precede the onset of locomotion. In Parkinson's disease (PD), impaired step initiation typically involves altered APA ground force production with delayed step onset and deficits in stepping performance. If, as in stance and gait, sensory information about lower limb load is important for the control of stepping, then perturbations influencing loading conditions could affect the step initiation process. This study investigated the influence of changes in lower limb loading during step initiation in patients with PD and healthy control subjects. Participants performed rapid self-triggered step initiation with the impending single stance limb positioned over a pneumatically actuated platform. In perturbation trials, the stance limb ground support surface was either moved vertically downward (DROP) or upward (ELEVATE) by 1.5 cm shortly after the onset of the APA phase. Overall, PD patients demonstrated a longer APA duration, longer time to first step onset, and slower step speed than controls. In both groups, the DROP perturbation reinforced the intended APA kinetic changes for lateral weight transfer and resulted in a significant reduction in APA duration, increase in peak amplitude, and earlier time to first step onset compared with other conditions. During ELEVATE trials that opposed the intended weight transfer forces both groups rapidly adapted their stepping to preserve standing stability by decreasing step length and duration, and increasing step height and foot placement laterally. The findings suggested that sensory information associated with limb load and/or foot pressure modulates the spatial and temporal parameters of posture and locomotion components of step initiation in interaction with a centrally generated feedforward mode of neural control. Moreover, impaired step initiation in PD may at least acutely be enhanced by augmenting the coupling between posture and locomotion.

Short-term effects of posture-assisted step training on rapid step initiation in Parkinson's disease.

BACKGROUND AND PURPOSE: Anticipatory postural adjustments (APAs) for lateral weight transfer and stability precede and accompany gait initiation. Individuals with Parkinson's disease (PD) show altered APA characteristics with delays in initiating stepping that may reflect impaired interactions between posture and locomotion. The purpose of this study was to determine the short-term effects of a single session of repetitive robotic assistance training with the APA on rapid step initiation in individuals with PD in the medications "on" state and healthy control individuals. Ground reaction forces and step kinematics were recorded. METHODS: Subjects first performed baseline trials of unassisted self-paced rapid forward stepping. Next, a training acquisition series involved 50 trials with a lateral pull applied to the pelvis by a robotic system to assist with the early phase of the APA during stepping. To assess potential retention effects of training, unassisted stepping trials were evaluated immediately after acquisition trials (immediate retention) and one week later (one-week retention). RESULTS: Overall, the subjects with PD had a longer APA duration (P < 0.03), and longer first step duration (P < 0.04) than the healthy control individuals. Compared with baseline, APA duration was shorter (P < 0.001) and step onset time became earlier (P < 0.001) for acquisition trials but these effects were not retained. Step duration, which became shorter (P < 0.001) during the late acquisition trials (P = 0.002), demonstrated immediate retention (P < 0.001) and one-week retention (P < 0.001). CONCLUSION: Posture-assisted training, affecting the interaction between posture and locomotion, may have therapeutic potential for improving movement performance in individuals with PD.

Lateral balance factors predict future falls in community-living older adults.

OBJECTIVE: To prospectively determine the capacity of measures of mediolateral (ML) protective stepping performance, maximum hip abduction torque, and trunk mobility, in order to predict the risk of falls among community-living older people. DESIGN: Cross-sectional study. SETTING: A balance and falls research laboratory. PARTICIPANTS: Medically screened and functionally independent community-living older adult volunteers (N=51). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measures included: (1) protective stepping responses: percentage of trials with multiple balance recovery steps and sidestep/crossover step recovery patterns, and first step length following motor-driven waist-pull perturbations of ML standing balance; (2) hip abduction strength and axial mobility: (3) peak isokinetic hip abduction joint torque and trunk functional axial rotation (FAR) range of motion; and (4) fall incidence: monthly mail-in reporting of fall occurrences with follow-up contact for 1 year post-testing. One- and 2-variable logistic regression analysis models determined which single and combined measures optimally predicted fall status. RESULTS: The single variable model with the strongest predictive value for falls was the use of multiple steps in all trials (100% multiple steps) (odds ratio, 6.2; P=.005). Two-variable models, including 100% multiple steps and either hip abduction torque or FAR variables, significantly improved fall prediction over 100% multiple steps alone. The hip abduction and FAR logistic regression optimally predicted fall status. CONCLUSIONS: The findings identify new predictor variables for risk of falling that underscore the importance of dynamic balance recovery performance through ML stepping in relation to neuromusculoskeletal factors contributing to lateral balance stability. The results also highlight focused risk factors for falling that are amenable to clinical interventions for enhancing lateral balance function and preventing falls.

Exploring the cultural adaptability of doctoral entry-level physical therapist students during clinical education experiences.

Cultural competence is an essential component of health care education. The aim of this study was to explore the development of cultural competence in 14 physical therapist students during their final, 23 weeks of clinical education (CE) experiences. A mixed methods design was used to quantitatively measure and qualitatively describe cultural adaptability as an indicator of cultural competence. Subjects completed the Cross-Cultural Adaptability Inventory (CCAI) at the end of their didactic curriculum and again at the end of their CE experiences. Constant comparative methods were used to analyze written narrative summaries of how students made meaning of their cultural encounters. The students exhibited statistically significant changes in the total CCAI score (paired t-test: p < 0.001), and three CCAI subscales: emotional resilience (paired t-test: p < 0.002), flexibility/openness (paired t-test: p < 0.003), and perceptual acuity (paired t-test: p < 0.001). There was not a statistically significant change in the fourth CCAI subscale, personal autonomy. Qualitatively, four themes emerged that described students' cultural encounters with patients, families, and co-workers: recognizing cultural descriptors; consideration of feelings, values, attitudes and beliefs; effective communication to breakdown barriers; and awareness of strategies for current and future cross-cultural practice. Clinical cultural encounters are important in the progression toward cultural competence in physical therapist students. Changes in attitude appear to be key in effective cultural encounters as students learn to communicate and connect with anyone perceived to be different from them.

A simple model of stability limits applied to sidestepping in young, elderly and elderly fallers.

Impaired lateral balance involving the frontal plane is particularly relevant to the problem of falls with aging. Protective stepping is critical to avoiding falling, and medio-lateral (M-L) stepping involves two quite complicated action choices -- lateral side step and crossover stepping. The aims of this study were to identify differences in movement patterns between young healthy subjects and elderly fallers and non-fallers (determined prospectively over a year), and to identify performance differences for the two types of stepping response. Our tool for these evaluations was a computational model of the center of mass as a pendulum, which identifies the limits of stability beyond which additional steps are required. In response to multi-directional stepper-motor induced waist-pull perturbations of standing balance, the older groups took multiple steps more often than the young (55% compared to 9% of the trials), and the largest differences were seen in the pulls to the side. On these side pulls, crossover stepping and limb collisions increased with age and prospectively determined fall risk. Consequently the model analysis focused only on the most problematic lateral pulls, and only on pulls to the right. In both stepping off and landing, the young most closely approached the stability limits predicted by the model, followed by the older non-fallers and then fallers. In crossover stepping, all groups landed closer to their limits when multiple steps occurred, though older fallers were closest to instability. These findings revealed distinctive age differences related to fall risk and shed light on such modeling approaches for understanding the reasons why older fallers may select stepping responses and the effectiveness of such responses in recovering balance.