Assessing Quality of Program Environments for Children and Youth with Autism: Autism Program Environment Rating Scale (APERS).

The purpose of this study was to examine the psychometric properties of the Autism Program Environment Rating Scale (APERS), an instrument designed to assess quality of program environments for students with autism spectrum disorder. Data sets from two samples of public school programs that provided services to children and youth with autism spectrum disorder were utilized. Cronbach alpha analyses indicated high coefficients of internal consistency for the total APERS and moderate levels for item domains for the first data set, which was replicated with the second data set. A factor analysis of the first data set indicated that all domain scores loaded on one main factor, in alignment with the conceptual model, with this finding being replicated in the second data set. Also, the APERS was sensitive to changes resulting from a professional development program designed to promote program quality.

Delirium in the orthopaedic patient.

Published incidence of delirium in orthopaedic patients ranges from 5.1% to 61%. Delirium may present before or after the patient undergoes the surgical procedure and has demonstrated increased risk, including mortality. Yet, delirium goes unrecognized by both physicians and nurses. This article focuses on the literature on delirium in the orthopaedic patient, including incidence, how to identify those patients at risk, patient outcomes, nonpharmacological and pharmacological interventions, and provides an example of how one tertiary care hospital implemented a prevention and management program of delirium in orthopaedic patients.

Loading response following anterior cruciate ligament reconstruction during the parallel squat exercise.

OBJECTIVE: To determine if individuals 1.5-15 months post-anterior cruciate ligament reconstruction demonstrated an equal loading response on their involved and uninvolved lower extremity during a parallel squat exercise versus a control group. DESIGN: Four-group repeated measures design with one between-subject factor (time post-anterior cruciate ligament reconstruction) and two within-subject factors (knee angle and added weight). BACKGROUND: It has been a clinical observation that post-anterior cruciate ligament reconstruction, individuals do not place equal amounts of weight upon each lower extremity during double-leg exercises. METHODS: Twenty-four subjects were in each of the experimental groups, 1.5-4 months, 6-7 months, and 12-15 months post-anterior cruciate ligament reconstruction, while 24 subjects without history of lower extremity pathology/injury served as the control group. Pedar in-shoe sensors were placed inside the subjects' shoes to record loading response patterns during the exercises. All performed 3 sets of 9 randomized squats to each of the three knee flexion angles (30 degrees, 60 degrees, and 90 degrees ) with the three different weights (20.45 kg bar only, 35%, and 50% body mass) using a Smith squat rack. A three-way repeated measures ANOVA (P < 0.050) was used to compare the differences between groups in loading response statically between the uninvolved and involved lower extremity for each of the different weights at each knee flexion angle during the squat exercise. RESULTS: The three-way repeated measures ANOVA revealed that there was a significant group effect (P < 0.001). Thus, the amount of time post-anterior cruciate ligament reconstruction affected the difference in the subjects' loading response for the uninvolved and involved lower extremities. There was also a three-way interaction, indicating that the difference in loading response was dependent on the group, amount of knee flexion, and amount of added weight (P = 0.010). CONCLUSION: These data suggest that subjects significantly load their uninvolved lower extremity until 12-15 months post-anterior cruciate ligament reconstruction. RELEVANCE: Based on the results of this study, caution may be warranted when adding resistance during the parallel squat for an individual's first year post-anterior cruciate ligament reconstruction, particularly with less knee flexion to avoid compensation and injury.