Nature of clinical practice for specialists in orthopaedic physical therapy.

Clinical specialization is part of physical therapy's continued development as a profession. Clinical specialization in physical therapy has evolved with little discussion of how specialization is related to the development of professional expertise. The purposes of this paper were to compare the identified clinical competencies in orthopaedic physical therapy to selected clinical reasoning models and expertise development models in physical therapy and interpret these comparisons in light of current theoretical work in expertise. Descriptive content analysis using results from the 1993 Practice Analysis for Orthopaedic Physical Therapy Certified Specialists was done to link attributes identified in 3 selected theoretical models of clinical decision making and practice. Survey materials were linked to theories by use of a binary index (yes/no) of whether theoretical concepts were present or absent in the survey results. The attributes that characterize an expert physical therapy practitioner involve clinical reasoning, and the ability to teach patients. The skills of a master clinician were based not just on the application of knowledge, but also on thinking and reasoning that occurs with experience. We propose that knowledge is gained through the clinician's thinking and reasoning during practice which results in a transformation or change in the clinician's knowledge base. Describing the clinical specialization process in the context of expert theory provides a strong foundation for the specialization process in physical therapy.

Practice analysis survey: revalidation of advanced clinical practice in orthopaedic physical therapy.

The first orthopaedic physical therapy practice analysis survey was completed in 1983. Another practice analysis survey was conducted in 1993 to identify the advance practice of clinicians who practice in orthopaedic physical therapy settings. Since 10 years elapsed, a new practice analysis study was conducted to identify the practice of orthopaedic clinical specialists. The purpose of this report is to describe the results of this survey. Orthopaedic physical therapists, both specialists and nonspecialists, participated in group interviews, subject matter expert meetings, and a national practice survey to delineate important knowledges and responsibilities. The survey was.sent to a stratified convenience sample of 1,000 orthopaedic physical therapists, of which 325 were orthopaedic clinical specialists. The three-part survey contained 180 items. A total of 420 respondents, of which 241 were orthopaedic clinical specialists, rated the importance and application level for the items. The results of this study provide evidence for a core body of knowledge required by clinicians practicing with advanced skills in orthopaedic physical therapy and create the framework for the Orthopaedic Physical Therapy Specialty Exam.

Genioglossi muscle activity in response to changes in anterior/neutral head posture.

Clinicians have acknowledged swallowing, tongue activity, and head posture as interdependent variables that must be concurrently examined. The purpose of this study was to evaluate genioglossus activity during swallowing, rest, and maximal tongue protrusion in two head positions (HPs) with a noninvasive recording device. Eight Angle Class I subjects were evaluated. Repeated measures were performed in a single session to record surface intraoral electromyographic (EMG) activity of the genioglossus muscles. Head position was measured in angular degrees from photographs. Three variables were measured in both the neutral-head position (NHP) and anterior-head position (AHP): (1) duration of genioglossus EMG during swallowing, (2) genioglossus EMG with the tongue at rest, and (3) genioglossus EMG during maximal isometric tongue protrusion. A Wilcoxin matched-pair signed-rank statistic was used for EMG analysis, and a paired sample t test statistic was used for head posture analysis. The angles measured for NHP and AHP within each subject were significantly different verifying two different head positions. Duration of swallowing was not significantly different between head positions. Resting genioglossus EMG and maximal isometric genioglossus EMG were statistically greater in the AHP. The data suggest that head positional changes may have an effect on genioglossus muscle activation thresholds. However, small differences in resting EMG activity between head positions suggests that the clinical significance needs further investigation.

Surface intraoral genioglossus EMG recording technique for kinesiologic studies.

Electromyographic (EMG) recordings from intraoral genioglossus surface electrodes were compared to fine-wire recordings of the left genioglossus muscle during selected activities that involved (1) rest, (2) tongue protrusion without resistance, (3) isometric tongue protrusion, (4) jaw opening without resistance, (5) isometric jaw opening, and (6) swallowing. Right and left lateral protrusions of the tongue were evaluated also. Recordings from both surface and fine-wire configurations showed similar onset times, relative amplitude changes, and cessation times of EMG activity during unresisted tongue protrusion and isometric tongue protrusion. Swallowing EMG activity occurred somewhat earlier and was longer in duration in the surface electrode recordings than the fine-wire recordings; however, maximum amplitudes occurred at similar times. Neither type of electrode recorded significant EMG activity during jaw opening or isometric jaw opening. These findings support the validity of recording EMG activity of the genioglossus muscle by surface recording electrodes supported by an acrylic appliance. The development of such an appliance may be an important biofeedback tool to control genioglossus activity during such activities as tongue thrusting.