Functional School-Based Physical Therapy Management For A Child With Pallister-Killian Syndrome: A Case Report

Background and Purpose: Pallister-Killian Syndrome (PKS) is a rare genetic disorder resulting from an additional short arm in chromosome 12. This condition leads to varying levels of multi-system impairments that impact a child’s development in gross motor skills yielding functional limitations. Pediatric physical therapy (PT) management is crucial for these children to facilitate improvements in sitting, standing, and ambulation. The purpose of this case report was to describe functional school-based PT management for a child with PKS. Case Description: The child was a seven-year-old male diagnosed with PKS at 20 weeks’ gestation. The child was seen for PT five times a week in a specialized school setting for six weeks. The child presented with hypotonia, delayed gross motor skills, generalized weakness, and impaired posture. The child’s level of function was classified as Gross Motor Function Classification System Level V. The child required minimum assistance in sitting and maximum assistance for standing and ambulating. Interventions included: standing exercise, body-weight support treadmill training (BWSTT), overground gait training, and a standing program. Outcomes: The child’s standing time progressed from 16 seconds to 3:05 minutes, reciprocal stepping during BWSTT improved from 3 to 63 steps, and overground gait training progressed from 0 to 6 steps. Improvements in observational posture and strength were also seen. The standing program was not tolerated by the child, therefore removed from the plan of care (POC). Discussion: This six-week POC resulted in improved standing time, reciprocal steps, strength, and posture for a child with PKS. Further research is warranted on the benefits of these interventions to elicit improvements in gross motor function and declines in disability for children with PKS

Effects of Cueing on Sit to Stand Transfers in Parkinson Disease

Problem Statement: Individuals with Parkinson Disease (PD) often experience difficulty transferring from sit to stand (STS). Current evidence suggests cues which promote an external attentional focus improve gait and transfers for individuals with PD. However, this research utilizes cues which are difficult to replicate in clinical or natural environments making the findings difficult to generalize or implement. Purpose: The primary purpose of this study is to determine the effect of 3 different explicit cues on STS for individuals with PD. Additionally we sought to determine if, in this population, a relationship exists between latency of movement initiation and postural sway in early standing, changes in joint angle between conditions and postural sway in early standing, and cue provided during the transfer and postural sway in early standing. Procedures/Methodology: Thirteen individuals in both the experimental and control groups participated in this cross-over design study. Both groups completed trials of self-initiated uncued STS transfers. Those in the experimental group also completed trials of STS transfers in 3 conditions: with an external attentional focus of reaching to targets, with an external attentional focus of concurrent modeling, and with an explicit cue for an internal attentional focus. Data was collected by trained testers and utilized valid and reliable body worn inertial measurement unit sensors. ANOVAs were used to compare performance between conditions and to the performance of the healthy control group. Bonferroni corrections were completed to reduce the likelihood of accepting a false positive. Results: Both cues that elicit an external attentional focus improved motor control during the sit to stand transfer. However, only modeling was able to improve both motor control and postural control. Cueing that promoted an internal attentional focus resulted in decreased motor control and postural control. Additionally, a moderate positive correlation was found between standing taller than typical and postural sway. Clinical Implications: Our results provide evidence for clinicians to better tailor treatment methodologies to the needs of individuals with PD. Optimal cueing can be utilized as compensations that reduce caregiver burden and increase independence of individuals with PD

The role of non-verbal communication in second language learner and native speaker discourse

It is undeniable that non-verbal signals exert a profound impact on communication. Many researchers proved that people, when they are hesitating, analyze non-verbal signals to comprehend the meaning of a message (Allen, 1999), because they prioritize non-verbal aspects of communication over the verbal ones. The role of non-verbal communication is much more profound when native/non-native discourse is taken into consideration (Allen, 1999; Gregersen, 2007). The aim of the present paper is to analyze non-verbal communication of a native speaker and a second language learner. The main emphasis is put especially on the differences between the non-verbal signals of second language learners and native speakers. Some of these differences may disturb or prevent the interlocutors from conveying a message in learner/native speaker discourse (Marsh et al., 2003) so it is necessary to raise awareness of cultural differences and underline the tremendous role of non-verbal communication in second language learning. Furthermore, the present paper also covers some suggestions for foreign language teachers in order to improve their knowledge of the body language of their learners in the target language and help them to raise awareness of the significance of non-verbal communication in second language discourse

Mechanisms of memory retrieval in slow-wave sleep : memory retrieval in slow-wave sleep

Study Objectives: Memories are strengthened during sleep. The benefits of sleep for memory can be enhanced by re-exposing the sleeping brain to auditory cues; a technique known as targeted memory reactivation (TMR). Prior studies have not assessed the nature of the retrieval mechanisms underpinning TMR: the matching process between auditory stimuli encountered during sleep and previously encoded memories. We carried out two experiments to address this issue. Methods: In Experiment 1, participants associated words with verbal and non-verbal auditory stimuli before an overnight interval in which subsets of these stimuli were replayed in slow-wave sleep. We repeated this paradigm in Experiment 2 with the single difference that the gender of the verbal auditory stimuli was switched between learning and sleep. Results: In Experiment 1, forgetting of cued (vs. non-cued) associations was reduced by TMR with verbal and non-verbal cues to similar extents. In Experiment 2, TMR with identical non-verbal cues reduced forgetting of cued (vs. non-cued) associations, replicating Experiment 1. However, TMR with non-identical verbal cues reduced forgetting of both cued and non-cued associations. Conclusions: These experiments suggest that the memory effects of TMR are influenced by the acoustic overlap between stimuli delivered at training and sleep. Our findings hint at the existence of two processing routes for memory retrieval during sleep. Whereas TMR with acoustically identical cues may reactivate individual associations via simple episodic matching, TMR with non-identical verbal cues may utilise linguistic decoding mechanisms, resulting in widespread reactivation across a broad category of memories

Collaboration Between Physical Therapy and Music Therapy: A Case Study of the Interventions and Their Effects on Parkinson\u27s Disease

Background and Purpose: Parkinson\u27s Disease is a chronic and progressive neurological disorder that causes motor dysfunction leading to dyskinesia, bradykinesia, muscular rigidity, resting tremors, postural impairments, and gait impairments. These impairments can have a tremendous negative impact on a person\u27s everyday life. This case study demonstrates the collaboration of physical therapy and music therapy interventions and its effects on a female with Parkinson\u27s Disease. Case Description: The patient is a 72-year old female diagnosed with Parkinson\u27s Disease around 2010. Her primary reason for seeking treatment is due to an increase in freezing of gait and overall decrease in mobility that affects her activities of daily living. She presents with a hand tremor, dyskinesia, freezing of gait, shuffling steps, muscle stiffness, difficulty maneuvering in small spaces, difficulty maintaining balance or taking a step when reaching, decreased endurance, and a history of falls. She ambulates with a single end cane and hand hold assist from her husband when ambulating in the community. Interventions: A combination of physical therapy and music therapy interventions were utilized to improve weight shifting, gait, balance, and address patient concerns such as bed mobility. Music therapy interventions included metronome pacing, guitar pacing, guitar strumming for initiation cues, clarinet cuing, paddle drums, and singing. A combination of auditory and visual cues were incorporated to improve the patient\u27s symptoms and promote patient safety. Outcomes: The patient improved her score on the Parkinson\u27s Disease Questionaire- 39, Freezing of Gait Questionnaire, Berg Balance Scale, Timed Up and Go. The patient had improved step length bilaterally for several of the gait activities including fast paced walking and walking with a metronome. Discussion: In this case study there was an overall improvement in balance and quality of life that was considered significant based on minimal detectable change. Although other measures did not produce significant changes, outcomes of this case study showed that the patient had an increased safety awareness, balance, gait, and confidence improved based on clinical observation and judgement. Due to the complexity and variability of PD, weekly interventions varied based on the patient\u27s ability and the patient could improve over the course of treatment sessions with proper cues. Videos, pictures, and increased detail on documentation would be beneficial in future case studies for increase accuracy in measuring outcomes

Development of a head-mounted, eye-tracking system for dogs

Growing interest in canine cognition and visual perception has promoted research into the allocation of visual attention during free-viewing tasks in the dog. The techniques currently available to study this (i.e. preferential looking) have, however, lacked spatial accuracy, permitting only gross judgements of the location of the dog’s point of gaze and are limited to a laboratory setting. Here we describe a mobile, head-mounted, video-based, eye-tracking system and a procedure for achieving standardised calibration allowing an output with accuracy of 2-3º. The setup allows free movement of dogs; in addition the procedure does not involve extensive training skills, and is completely non-invasive. This apparatus has the potential to allow the study of gaze patterns in a variety of research applications and could enhance the study of areas such as canine vision, cognition and social interactions

Physiotherapy for Parkinson's disease: a comparison of techniques (Review)

Background: Despite medical therapies and surgical interventions for Parkinson's disease (PD), patients develop progressive disability. The role of physiotherapy is to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. The overall aim is to optimise independence, safety and wellbeing, thereby enhancing quality of life. Trials have shown that physiotherapy has short-term benefits in PD. However, which physiotherapy intervention is most effective remains unclear. Objectives: To assess the effectiveness of one physiotherapy intervention compared with a second approach in patients with PD. Search methods: Relevant trials were identified by electronic searches of numerous literature databases (for example MEDLINE, EMBASE) and trial registers, plus handsearching of major journals, abstract books, conference proceedings and reference lists of retrieved publications. The literature search included trials published up to the end of January 2012. Selection criteria: Randomised controlled trials of one physiotherapy intervention versus another physiotherapy intervention in patients with PD. Data collection and analysis: Data were abstracted independently from each paper by two authors. Trials were classified into the following intervention comparisons: general physiotherapy, exercise, treadmill training, cueing, dance and martial arts. Main results: A total of 43 trials were identified with 1673 participants. All trials used small patient numbers (average trial size of 39 participants); the methods of randomisation and concealment of allocation were poor or not stated in most trials. Blinded assessors were used in just over half of the trials and only 10 stated that they used intention-to-treat analysis.A wide variety of validated and customised outcome measures were used to assess the effectiveness of physiotherapy interventions. The most frequently reported physiotherapy outcomes were gait speed and timed up and go, in 19 and 15 trials respectively. Only five of the 43 trials reported data on falls (12%). The motor subscales of the Unified Parkinson?s Disease Rating Scale and Parkinson?s Disease Questionnaire-39 were the most commonly reported clinician-rated disability and patient-rated quality of life outcome measures, used in 22 and 13 trials respectively. The content and delivery of the physiotherapy interventions varied widely in the trials included within this review, so no quantitative meta-analysis could be performed. Authors' conclusions: Considering the small number of participants examined, the methodological flaws in many of the studies, the possibility of publication bias, and the variety of interventions, formal comparison of the different physiotherapy techniques could not be performed. There is insufficient evidence to support or refute the effectiveness of one physiotherapy intervention over another in PD.This review shows that a wide range of physiotherapy interventions to treat PD have been tested . There is a need for more specific trials with improved treatment strategies to underpin the most appropriate choice of physiotherapy intervention and the outcomes measured