Time effect for in-situ dry needling on the autonomic nervous system, a pilot study.

Study design: Pilot study.Background: Dry needling has been an emerging treatment option for physical therapists over the last decade. Despite the fact that studies have demonstrated the overall benefit of dry needling, there is no clear understanding how long needles should be left in place (situ). This pilot study investigated the effects of needles remaining in situ based on autonomic responses over time.Methods: A convenience sample of 21 subjects were recruited for this study. Automated pupillometry was utilized to obtain a direct measure of autonomic nervous system activity. Directly following a baseline measurement, 8 type J Seirin Acupuncture needles were inserted paravertebral at the C7-T3 segments. A total of 8 post-needling 60 seconds pupil measurements were taken at 3 minutes intervals for 24 minutes post needling.Outcomes: A statistical significant difference in mean pupil diameter was found following the needle intervention (p < .01), which implies an increased sympathetic activity. This subject sample had a statistically significantly larger mean pupil diameter immediately after the needling, which lasted until measure point 7, at 18 minutes (P < .05). At measure point 8 there was no longer a statistical significant difference compared to the premeasurement measure.Discussion: The results of this study provide evidence that dry needling results in a significant increased activity of the sympathetic nervous system for up to 18 minutes. Between 18 and 21 minutes autonomic activity returned to a non-significant difference compared to baseline. The results of this study could assist clinicians in clinical decision making to determine needle placement time.

Reasons identified for seeking the American Physical Therapy Association-Credentialed Clinical Instructor Program (CCIP) in Florida.

UNLABELLED: The American Physical Therapy Association's (APTA) Strategic Plan strives to increase the number of APTA credentialed clinical instructors. Available to all health care providers, as of 2012, there were 39,851 credentialed clinical instructors. OBJECTIVES: Study purposes were threefold: to determine participants' a. reasons to attend the APTA Credentialed Clinical Instructor Program (CCIP); b. pre-CCIP learning goals; and c. related post-CCIP learning outcomes. METHODS: This IRB-approved study was completed with informed consent procedures followed. APTA CCIP credentialed trainers (n=5) developed a survey and pilot tested for face and content validity. The instrument included demographics, forced choice and open-ended questions. The pre/post survey was administered to 301 participants of 21 Florida APTA CCIP courses with 5 trainers from 2009-2011. Quantitative survey data were collated, tabulated, and summarized comparing pre/post data. Narrative data was analyzed for codes and themes, synthesized, re-contextualized and triangulated by trainers then cross-compared with APTA CCIP objectives and trainer expertise. The qualitative insights were presented with resulting primary themes and subthemes. RESULTS: Results informed the study purposes with a clear determination of the reasons participants attend the APTA CCIP, the pre-course goals and post learning outcomes. Participants overwhelmingly recommend the APTA CCIP and most receive support from employers with geographic course location being a prime reason for course selection. Precourse learning goals included 5 over-arching themes, with few sub-themes; while post learning outcomes generated 12 specific themes with numerous subthemes. CONCLUSIONS: APTA CCIP-credentialed clinical instructors are achieving numerous learning outcomes immediately applicable for clinical education.

Orthopaedic manual physical therapy including thrust manipulation and exercise in the management of a patient with cervicogenic headache: a case report.

It has been reported that in Western society as many as 16% of individuals experience cervicogenic headache, which can lead to significant amounts of pain and perceived disability. Cervicogenic headache is characterized by unilateral occipital-temporal pain that is increased by neck movement; it is accompanied by cervical hypomobility, postural changes, and/or increased cervical muscle tone. This case report describes the physical therapy differential diagnosis, management, and outcomes of a patient with cervicogenic headache. The patient was a 40-year-old woman referred by her physiatrist with complaints of cervical pain and ipsilateral temporal headache. The patient presented with increased muscle tone, multiple-level joint hypomobility in the cervical and thoracic spine, muscle weakness, and postural changes. Self-report outcome measures included the Visual Analog Scale for headache pain intensity and the Neck Disability Index. Management consisted of various thrust and non-thrust manipulations, soft tissue mobilizations, postural re-education, and exercise to address postural deficits and cervical and thoracic hypomobility and diminished strength. At discharge, the patient demonstrated clinically meaningful improvements with regard to pain, disability, and headache. This case report indicates that a multimodal physical therapy treatment program may be effective in the management of a patient diagnosed with cervicogenic headache.