The current state of anatomy education in United States doctor of physical therapy programs.

Physical therapy education has significantly evolved over the past few decades. While gross anatomy is integral to physical therapy education curricula, the current state of anatomy education within these programs is not well understood. The primary purpose of this report was to provide an update on the current state of anatomy education across United States (US) Doctor of Physical Therapy (DPT) programs. A survey was disseminated to all 261 accredited US physical therapy programs. The survey was deployed in November 2020 with a deadline to respond by January 15, 2021. The response rate was 32.6% (85/261). When teaching anatomy, 90.5% of the responding programs used dissection, 71.4% used didactic lectures, 60.7% used computer-assisted technology, 58% used prosections, 23.8% used plastinated models, and 31% reported using other methods. DPT programs have experienced declines in PhD faculty (15.7%) and Master of Physical Therapy faculty (15.3%) and notable increases in DPT (16.5%) and physician faculty (8.2%) teaching anatomy within DPT programs. Despite greater use of computer-assisted technologies, these technologies have not replaced donor-based dissection in DPT programs.

The Use of Movement Scripts for Clinical Reasoning in Physical Therapist Education and Practice.

The purpose of this Perspective is to present an application of script-based reasoning to physical therapist education and practice. Illness script-based reasoning has been described as a cognitive strategy for medical practitioners to diagnose and manage health conditions. Analogous to this medical model of patient management, "movement scripts" can be used by physical therapists in clinical reasoning. Movement scripts use features of the human movement system to recognize, categorize, and substantiate clinical problems and can be used to facilitate the development of master adaptive learners across the spectrum of physical therapist education and practice. Movement scripts are also consistent with the concept of the "human body as teacher" as the signature pedagogy proposed by the National Study of Excellence and Innovation in Physical Therapy Education. Movement of the human body, as captured by the concept of the human movement system, is a vehicle for lifelong adaptive learning for the physical therapist. Script-based learning and practice are consistent with other elements of this model, including practice-based learning and the creation of adaptive expertise. As the role of the movement system as a guide to physical therapist practice continues to evolve, movement scripts can provide a structure to facilitate development of clinical reasoning skills for physical therapist practice and education.

Effects of whole-body vibration on neuropathic pain and the relationship between pain and spasticity in persons with spinal cord injury.

OBJECTIVE: Whole-body vibration (WBV) appears to modulate reflex hyperexcitability and spasticity. Due to common underlying neural mechanisms between spasticity and neuropathic pain, WBV may also reduce chronic pain after spinal cord injury (SCI). Our objective was to determine whether there are dose-related changes in pain following WBV and to examine the relationships between neuropathic pain and reflex excitability. STUDY DESIGN: Secondary analysis of a sub-population (participants with neuropathic pain, n = 16) from a larger trial comparing the effects of two different doses of WBV on spasticity in persons with SCI. SETTING: Hospital/Rehabilitation Center in Atlanta, GA, USA. METHODS: Participants were randomized to 8-bout or 16-bout WBV groups. Both groups received ten sessions of sham intervention, followed by ten sessions of WBV. Primary measures included the Neuropathic Pain Symptom Inventory (NPSI) for pain symptom severity and H-reflex paired-pulse depression (PPD) for reflex excitability. RESULTS: Mean change in NPSI scores were not significantly different between the groups (7 ± 6; p = 0.29; ES = 0.57); however, 8-bouts of WBV were consistently beneficial for participants with high neuropathic pain symptom severity (NPSI total score >30), while 16-bouts of WBV appeared to increase pain in some individuals with high NPSI scores. A baseline NPSI cut score of 30 predicted PPD response (sensitivity = 1.0, specificity = 0.83), with higher NPSI scores associated with decreased PPD in response to WBV. CONCLUSIONS: WBV in moderate doses appears to decrease neuropathic pain symptoms and improve reflex modulation. However, at higher doses neuropathic pain symptoms may be aggravated. Lower baseline NPSI scores were associated with improved reflex modulation.

Moving from Strategy to Process: An Iterative and Formative Approach to Integrating the IASP Pain Curriculum Guidelines into an Established Physical Therapy Program.

Studies suggest that pain education in physical therapy (PT) programs is often insufficient to adequately prepare graduates to understand and manage pain. The International Association for the Study of Pain recently published updated curriculum guidelines for PT pain education (PCGs), and adoption of these PCGs will improve standardization of pain education in PT curricula. However, implementation of the PCGs will require programs to overcome key barriers including: 1) faculty competence with current pain science, 2) faculty alignment and collective commitment to addressing all domains in the PCGs, and 3) time and space in the curriculum for additional content delivery. The purpose of this article is to describe the process-driven approach used in implementing the PCGs within an established PT program, emphasizing the strategies used to overcome existing barriers. Kern's Six-Step Approach to Curriculum Development, experiential learning theory, and reflective practice were the guiding theoretical models used to develop processes and overcome existing barriers. The iterative process used for curriculum integration of the PCGs improved faculty buy-in and alignment, allowed for optimal selection of resources to support the faculty, and provided the program with qualitative and quantitative data that will continue to drive curriculum management.

Utility of the Neuropathic Pain Symptom Inventory in people with spinal cord injury.

STUDY DESIGN: Cohort/psychometric study OBJECTIVES: The primary objective was to determine the psychometric properties and the utility of the Neuropathic Pain Symptom Inventory (NPSI) in subgrouping people with moderate to severe neuropathic pain after spinal cord injury (SCI). SETTING: University-based laboratory in Miami, FL USA. METHODS: Seventy-two people with chronic SCI and neuropathic pain were included in this study. The NPSI, Numeric Rating Scale (NRS), Multidimensional Pain Inventory pain severity and perceived support subscales (MPI-PS and MPI-S, respectively), and the Coping Strategies Questionnaire were administered. The NPSI was administered twice, with a 2-4-week period between measurement sessions. RESULTS: The NPSI total score demonstrated good internal consistency with a Cronbach's alpha of 0.70. The test-retest reliability (intraclass correlations) ranged from 0.65 to 0.73 for the NPSI subscores and 0.79 for the total NPSI score. Further, construct validity was supported by moderate and significant positive correlations with the pain intensity NRS and pain severity subscale of the MPI (MPI-PS) (r > 0.40). Cluster analysis of factor scores derived from NPSI subscales, NRS, and MPI-PS scores revealed three distinct subgroups: (1) low-moderate, (2) moderate, and (3) high pain symptom severity with mean NPSI sum scores of 7.1, 17.5, and 33.8, respectively. CONCLUSION: The NPSI demonstrated good psychometric properties in people with neuropathic pain after SCI. Moreover, it has utility for establishing pain symptom phenotypes.

The Graph-DCK Scale: a measure of dorsal column function after spinal cord injury.

STUDY DESIGN: Cohort/psychometric study. OBJECTIVES: Assessment of dorsal column medial lemniscus (DCML) function is important for the clinical evaluation of people with spinal cord injury (SCI) because it provides useful information to guide rehabilitation and for prognosticating outcomes. For example, research suggests that damage to the DCML pathway may be associated with neuropathic pain after SCI. Tests for graphesthesia and directional cutaneous kinesthesia (DCK) are commonly used clinically to assess DCML function. However, the reliability and validity of these assessments in people with SCI have not been investigated. Moreover, there is a poor consistency between studies in the methodology of graphesthesia and DCK assessment. The purpose of this study was to determine the psychometric properties of the Graph-DCK Scale, which is a simple and potentially useful scale for assessing graphesthesia and DCK. The Graph-DCK Scale does not require expensive equipment and it takes less than 5 min to administer. SETTING: A university-based laboratory in Miami, FL, USA. METHODS: Sixty-seven people with chronic SCI and neuropathic pain were included in this study. The Graph-DCK Scale and vibration detection were measured twice in each participant, with a two- to four-week period between measurement sessions. RESULTS: The scale demonstrated an excellent internal consistency (Cronbach's alpha > 0.90) and test-retest reliability (ICC values > 0.80). Further, convergent validity was supported by moderate and significant positive correlations to vibration detection (r values > 0.40). CONCLUSION: The Graph-DCK Scale is quick and easy to administer, and it provides a reliable and valid assessment of DCML function in people with SCI. SPONSORSHIP: Craig Neilsen Foundation.

The effect of inspiratory muscle training on respiratory variables in a patient with ankylosing spondylitis: A case report.

Ankylosing Spondylitis (AS) presents with both musculoskeletal and cardiorespiratory pathophysiological manifestations. Inspiratory muscle training (IMT) may be a useful intervention to address deficits in respiratory and functional status. CASE DESCRIPTION: A 25-year-old male with AS initially sought treatment for low back and right hip pain, but 7 weeks of IMT was also provided due to abnormal respiratory performance. OUTCOMES: At baseline, the patient presented with a resting respiratory rate (RR) of 14.5 breaths/minute, tidal volume (TV) of 0.76 L, minute ventilation (VE) of 10.87 L/min, and end tidal CO2 (PetCO2) of 30.56 mmHg. Baseline exercise test results revealed a VO2max of 44 ml/kg/min and VE to CO2 output (VE/VCO2) slope of 30. Baseline MIP, SMIP, and MEP were 54 cm H2O, 507 PTU, and 87 cm H2O, respectively, and increased to 176 cm H2O, 807 PTU, and 151 cm H2O, respectively, after IMT. The VO2max increased to 51 ml/kg/min with decreases in the VE/VCO2 slope (29), resting RR (12 breaths/minute), resting TV (0.52 L), and resting VE (6.83 L/min) after IMT. Improvements during postural challenges were also observed. DISCUSSION: This case demonstrates the clinical utility of respiratory gas analysis and respiratory performance measures to identify functional deficits and manage a patient with AS. The improvements in respiratory performance at rest, during postural challenges, and during maximal exercise after a relatively short period of IMT highlights the role IMT may have to improve functional status in patients with AS. Further investigation of IMT in patients with AS is warranted.

Use of a squatting movement as a clinical marker of function after total knee arthroplasty.

OBJECTIVE: The aims of this study were to evaluate weight bearing during standing and 30- and 60-degree squats approximately 1 wk and 2 mos after surgery and determine whether weight bearing during squatting could be a better clinical marker than standing for identifying perceived functional limitation approximately 1 wk after surgery. A further objective was to determine whether age, body mass index, and number of outpatient visits over the course of rehabilitation predicted weight bearing during a squat approximately 2 mos after surgery. DESIGN: The percentage of body weight placed over both limbs during stand and 30- and 60-degree squats in 38 patients (25 women and 13 men) who had primary unilateral knee arthroplasty was determined. An asymmetry index would be used as a marker that could discriminate between those who perceived at least moderate difficulty with functional tasks and those who perceived only slight or no difficulty with functional activities based on the physical function dimension of the Western Ontario McMaster Universities Osteoarthritis index approximately 1 wk after surgery. Stepwise regression was conducted to determine whether clinical characteristics predicted weight-bearing asymmetry at discharge. RESULTS: At initial visit (first observation), and compared with the uninvolved side, individuals placed significantly less body weight over the involved or operated limb for stand and 30- and 60-degree squats (P < 0.0001). Results were similar at last rehabilitation visit (second observation). Identifying at least moderate self-reported difficulty with functional tasks based on the receiver operator characteristic curve for the asymmetry index for the stand position was 0.64, whereas for the 30- and 60-degree squats, the area under the curve was 0.81 and 0.89, respectively. At discharge from rehabilitation, there was a moderate to good direct relationship (r = 0.70) between the number of rehabilitation visits completed and the weight-bearing asymmetry index for the 60-degree squat. CONCLUSIONS: On the first outpatient visit, individuals who had primary unilateral knee arthroplasty placed more body weight over the uninvolved side for the three weight-bearing positions. With high probability, the asymmetry index for both squatting angles identified perceived functional difficulty. As rehabilitation visits increased, there was a direct association to improved interlimb weight-bearing symmetry when squatting to 60 degrees.

Dosis efectiva de ropivacaína vía intradural en cesáreas de emergencia del Departamento de Obstetricia en el Hospital de Supe Laura Esther Rodriguez Dulanto, Mayo - Septiembre 2013 / Effective dose of ropivacaine via intradural in caesarean section of emergency in the Department of Obstetrics at the Hospital of Supe Laura Esther Rodriguez Dulanto, May - September 2013

La investigación tiene como objetivo determinar evaluar y comparar dos dosis bajas de Ropivacaína conjuntamente con fentanilo 25 mg por vía intradural en pacientes sometidas a cesárea de emergencia del departamento de obstetricia en el Hospital de Supe Laura Esther Rodríguez Dulanto 2013. La investigación tiene diseño es no experimental, prospectivo, es de tipo descriptivo, observacional, comparativo. La muestra estuvo construido por 50 pacientes ASA I/II programadas para cesárea electiva. Las pacientes fueron distribuidos en dos grupos: 25 pacientes del grupo ROP 0,75 por ciento: ropivacaína 0,75 por ciento 1 mL con fentanilo 25ug y 25 pacientes del grupo ROP 1 por ciento: ropivacaína 1 por ciento 1 mL con fentanilo 25ug. La edad media de los pacientes con ROP 1 por ciento es de 23.2 años mientras que la edad de los pacientes con ROP 0.75 por ciento la edad media es 25.4 años, no se encontró diferencia significativas P0,05. Se encontró diferencias significativas P<0.05 en la presión arterial media en los TO, TI, T2, observándose menor tiempo en los pacientes con ROP 1 por ciento. Existe una mayor incidencia de hipotensión (60 por ciento) en el grupo...

Squatting after primary unilateral total knee arthroplasty: a pilot study examining differences between genders.

OBJECTIVE: To compare the weight bearing of men and women during standing and squatting after knee replacement surgery for osteoarthritis. DESIGN: Two-group, single-surgeon study with patients selected consecutively through a sample of convenience. Patients evaluated at first outpatient rehabilitation visit and at discharge from outpatient services. SETTING: Outpatient orthopedic institute. PARTICIPANTS: Seventeen women (average age, 71 years) and 16 men (69 years) who underwent primary unilateral knee replacement for osteoarthritis. MAIN OUTCOME MEASUREMENTS: Percentage of body weight placed over the surgical limb during standing and during 30° and 60° squats. RESULTS: The men placed a greater percentage of body weight over the surgical limb during the 30° and 60° squats, both at the initial visit and at discharge. Both women and men had similar improvements with all dependent measurements. CONCLUSION: The magnitude of change for women and men was similar, yet percentage of body weight placed over the surgical limb in women was less than in men at the initial visit and did not match that in their male counterparts by discharge.

Physical therapy management of a patient with Eagle syndrome.

The purpose of this care report was to describe the physical therapy management of a unique case involving a 50-year-old white female with complaints pertaining to the craniofacial, cervical, thoracic, and brachial regions with known Eagle syndrome as a complicating factor. Intervention consisted of manual therapy and therapeutic exercises. The Craniocervical Flexion Test (CCFT), Neck Disability Index (NDI), and subjective complaints were used as outcome measures. The patient was tested at initial visit, discharge, and at a 3-month follow-up. At discharge the patient reported complete cessation of craniofacial symptoms, her CCFT score had improved by 4 mmHg, and the NDI score had improved by 10%. At the 3-month follow-up, the patient's CCFT had improved an additional 4 mmHg and the NDI score had declined by 4%. The cumulative outcomes were an 8 mmHg improvement in the CCFT and a 6% increase on the NDI. Although subjective complaints and CCFT scores improved, clinically significant improvement with the NDI was not maintained. Limitations of this case study include the substitution of standardized equipment for the CCFT and the presence of numerous comorbidities that possibly influenced results. Further research is necessary.