Physical therapy for correcting postural and coordination deficits in patients with mild-to-moderate traumatic brain injury.

The purpose of this study was to test the effects of a conventional exercise program designed for correcting postural and coordination abnormalities in patients with mild-to-moderate traumatic brain injury (TBI). Using principles of motor learning applied to functional exercise training, exercises were performed while lying, sitting, standing and walking, with the goal of improving intra- and inter-limb coordination in the upper and lower extremities, postural stability and gait pattern. Twenty-two participants with TBI-related deficits received therapy in a supervised outpatient clinic. Therapy included 20 sessions, each approximately 55 to 60 min in duration, scheduled four to five times a week over four consecutive weeks. Each participant was evaluated with a battery of clinical tests at baseline and immediately after therapy. Upon completion of the therapy, participants improved static and dynamic postural stability and gait, evaluated with the Berg Balance Scale (from 45.2 ± 5.9 to 49.2 ± 4.2 points) and the Functional Gait Assessment (from 22.8 ± 4.1 to 26.9 ± 3.4 points). They also reduced truncal, upper and lower extremity ataxia, evaluated with the Ataxia Scale (from 7.3 ± 4.5 to 5.9 ± 4.2 points). Results will be used to refine the current version of the exercise therapy, which focused on whole body coordination and balance, and to design a large-scale clinical trial establishing effectiveness of this intervention and for comparison with other forms of therapy.

The first two years of practice: a longitudinal perspective on the learning and professional development of promising novice physical therapists.

BACKGROUND: Physical therapists work in complex health care systems requiring professional competence in clinical reasoning and confidence in decision-making skills. For novice physical therapists, the initial practice years are a time for developing professional identity and practical knowledge. OBJECTIVES: The study purpose was to extend previous research describing the experiences, learning, and professional development of 11 promising novice therapists during their first year of practice. The present study examined the continued development of the same therapists during their second year of clinical practice. DESIGN: Seven researchers from 4 physical therapist educational programs in the eastern and midwestern United States used a longitudinal, qualitative, multiple case study approach. METHODS: Eleven physical therapist graduates identified as "promising novices" were recruited using purposive sampling. Participants ranged in age from 24 to 29 years and entered varied practice settings. Data were collected for 2 years using semistructured interviews, reflective journals, and participant observation. RESULTS: A conceptual model describing the participants' ongoing development during the second year of practice emerged. The 3 themes were formal and informal learning, increasing confidence and expansion of skills, and engagement in an environment characterized by collaborative exchange and opportunities for teaching. The second year represented consolidation and elaboration of practice-based learning and skills. The expansion of confidence, skills, and responsibilities and the externalization of learning the participants experienced promoted professional role formation. Learning previously directed inward and self-focused turned outward, fueled by growing self-confidence. CONCLUSIONS: Research illuminating the professional role formation experienced during early clinical practice is not widely available. The current study and further research into the learning and development of novice practitioners may assist educators in the design of pedagogical strategies and learning environments that enhance the professional development of physical therapists.

Challenging stability limits in old and young individuals with a functional reaching task.

OBJECTIVES: The aim of this study was to evaluate the extent to which adding a challenge to a reach test would increase the limit of stability (LOS) in young and old individuals. DESIGN: While standing on a force plate, with infrared markers on bony landmarks for motion analysis, 15 old (mean [SD], 70 [7] yrs old) and 15 young (mean [SD], 24 [2] yrs old) participants completed the modified functional reach test, in which they were asked to touch the farthest target possible in a series. They were then challenged to touch additional targets (functional reach challenge test) until they lost balance. RESULTS: The young participants reached farther than the old participants on both the modified functional reach and functional reach challenge tests (P = 0.005 and P = 0.003), but no group differences were found in absolute distance gains seen with the addition of the challenge. The participants in both groups displaced the center of pressure farther and used 10% more of their anatomic stability allowance in the functional reach challenge test than in the modified functional reach test. The young participants increased the LOS from 80.5% to 90.9% of their anatomic allowance, whereas the old participants increased theirs from 72.1% to 82.8%. CONCLUSIONS: The challenge improved reaching and LOS similarly in the young and old participants, but the old participants used smaller absolute percentages of LOS. Knowing the flexibility of LOS is useful for rehabilitation practitioners in assessing balance and designing therapeutic exercises that challenge stability during performance of functional arm movements and train individuals to use their LOS safely.

Vaginal weights for pelvic floor training: a multiple participant case report.

Activity-related incontinence is a problem for women, many with limited access to specialty clinics and practitioners. Incontinence inhibits participation in health-promoting levels of physical activity. Vaginal weights are a treatment option available without a prescription for home use that may help some of these women. This multiple baseline across-participant case study investigated the use of weights in a 'hands-off' pelvic floor exercise program for pre-menopausal women. Three of four participants improved, but did not cure, their incontinence with use of the weights. A fourth participant was unable to successfully use the weights. Referral to a women's health physical therapist was suggested for her. Poor adherence was noted at follow-up in two of three participants, with the one who maintained practice demonstrating continued improvement and increased physical activity. Weights provide a low-cost exercise adjunct to women interested in a flexible and independent incontinence management program. For continued improvement, behavioral factors promoting adherence should also be addressed. Weights are one of the options for women wanting a low-cost solution for activity-related urinary leakage. Problems using the weights or failure to benefit from their use may be indicators of a need for more advanced evaluation by women's health specialists.

A pointing task to improve reaching performance in older adults.

OBJECTIVE: The objective of this study was to evaluate whether adding a pointing task would influence functional reach test performance in younger and older adults. DESIGN: While standing on a force plate, 20 older (73 ± 8 yrs) and 20 younger (23 ± 1 yrs) adults were randomly administered a modification of the functional reach test and the functional point test. Functional pointing involved reaching and pointing at the farthest possible target in a series of 1.27-cm colored craft pom-poms attached at 2.54-cm intervals on a yardstick. RESULTS: Both older adults (P = 0.001) and younger adults (P = 0.043) reached farther using the functional point test. Older adults also increased their anterior center of pressure displacement with this test (P = 0.037). CONCLUSIONS: The addition of a pointing task can make the original clinical test more functional and increase reaching distance in both older and younger adults. Further research is needed to determine whether functional pointing challenges subjects' stability limits more than the traditional test does and offers greater sensitivity in the evaluation of functional balance and fall risk.

The first year of practice: an investigation of the professional learning and development of promising novice physical therapists.

BACKGROUND: The goal in studying expertise is not merely to describe ways in which experts excel but also to understand how experts develop in order to better facilitate the development of novices. The study of novice progression helps us to understand what successful versus unsuccessful learning looks like. This understanding is critical, as autonomous practice places increased demands for advanced clinical judgments and the ability to assume professional responsibilities. OBJECTIVES: The purpose of this study was to explore the experiences, learning, and development of promising novice therapists throughout their first year of practice in the United States. DESIGN AND METHODS: A longitudinal, multiple-site qualitative case study method was used for within-case and across-case analysis. A purposive sample of 11 promising new graduates from 4 physical therapist education programs participated. Investigators followed the graduates throughout their first year of practice. Data sources included: (1) semistructured interviews conducted at baseline and every 3 months thereafter for 1 year, (2) reflective journals completed at regular intervals, and (3) review of academic and clinical education records and résumés. RESULTS: Four themes emerged: (1) the clinical environment influenced the novice physical therapists' performance, (2) participants learned through experience and social interaction and learning was primarily directed toward self, (3) growing confidence was directly related to developing communication skills, and (4) therapists were engaged in professional identity formation and role transitions. CONCLUSIONS: The findings suggest there are common experiences and themes that emerge as novice physical therapists develop. Although research has been conducted on expertise in physical therapy, few longitudinal investigations have explored the development of therapists across transitions from graduate to novice to expert practitioner. This study explored and described the learning and development of graduates during their first year of practice.