Determining the competitive nature of physical therapy education: A multi case study design

Higher education is becoming more competitive as for-profit and non-profit institutions continue to expand. Healthcare educational programs, such as physical therapy, find themselves competing for quality applicants. Understanding this competitive environment and how to thrive within is critical for program survival. The purpose of this study was to determine the competitive strategies being used by entry-level doctorate programs in physical therapy; Eight physical therapy programs, ranked in the top 15% of schools, were purposively selected for the study. Four of the programs were private institutions represented by the University of Southern California (USC), University of Miami, Northwestern University, and Creighton University. The four public campuses include Northern Arizona University (NAU), University of Iowa, University of Nebraska, Omaha (UNMC), and University of Illinois-Chicago (UIC); A qualitative, multi case design was used to evaluate the variances in competitive strategy. Programs were assessed through documented materials faculty interviews, and site assessments. Data from all three sources were triangulated revealing twelve consistent categories. A cross comparison of programs was performed assessing presence of competitive strategies; Competitive advantage can be gained through cost leadership, differentiation, and/or focus. The four public institutions (average cost of {dollar}29,500) demonstrate a significant cost leadership advantage when compared to the private institutions ({dollar}81,250). Campus and program orientation revealed significant program differentiation relative to Carnegie Classification, supportive programs, and institutional environment. Specifically, significant differentiation was noted for five research extensive institutions. In addition, the presence of a PhD program and a medical campus location were also distinguishing features. USC and Iowa exhibited all three differentiation elements. All eight programs exhibited some level of focus. Miami revealed a cost leadership focus. Each of the four public programs demonstrated significant differentiated focus through program delivery while the four private schools had a strong curricular design and recruitment focus; Although there is some overlap, institutional type fosters differences in competitive strategy. Public institutions have a significant cost leadership position that when combined with perceived value can result in a strong competitive position. These four public programs create value by taking advantage of their educational environment and providing exceptional educational delivery. In contrast, the four private programs must combat the impact of cost by creating a differentiated educational environment. The four programs in this study have combined multiple elements, such as curricular design, medical environment and research to create a perceived value that exceeds normal student expectation

A Volunteer Basketball Clinic for Children with Disabilities: Professional Development Impact on Student-Athletes and Physical Therapy Students

The purpose of this study was to assess the change in perceptions of student-athletes, physical therapy students, and parents of children who helped to facilitate an athletic skills camp for children with disabilities. Participants experienced 3 hours of basketball activity yearly. Data were collected for 3 consecutive years from a total of 51 parents, 15 student-athletes, and 22 physical therapy students. Preand post-survey data were evaluated by two independent researchers. Common themes were developed for all participant groups and cross-group comparisons were evaluated. Findings indicated a synergistic benefit for student-athletes and physical therapy students derived from their impact and children with disabilities. Perceptual changes in students included a decrease in fear in working with disabled children, an appreciation for the value of having fun, and increased growth in civic identity and desire to volunteer

Robotic task-specific training of the upper extremity in children with Cerebral Palsy

poster abstractBackground: Cerebral Palsy (CP) affects at least 2 in 1,000 children in the United States. The disorder is non-progressive, yet secondary impairments can worsen over time leading to contracture, decreased strength, increased tone and ultimately, impaired mobility and function. Robotic therapy has been found to have positive outcomes for similar impairments in stroke neuro-recovery, suggesting the need for the application of this technology to CP. Purpose: The purpose of this study was to investigate whether specific upper extremity (UE) robotic training improves UE function in children with CP. Methods: This is an ongoing study currently with 5 children (ages 4-12) with CP that have completed the treatment intervention. Inclusion criteria included a hemiplegic presentation of the UE, a modified Ashworth scale (MAS) score of 2 or less and wrist extension equal to or greater than 0o in the affected arm, and sufficient cognition to attain to a task for 40-60 minutes. Each child participated in 16 total robotic training sessions occurring twice weekly, with each session consisting of 1,040 task-specific reaching movements of the affected arm with real-time impedance control. Pre- and post-testing and a 1-month follow-up were performed for each subject. Clinical outcome measures included active range of motion (AROM), passive range of motion (PROM), manual muscle tests (MMT), and grip strength, in addition to functional tests including the MAS, adaptive Fugl-Meyer scale, and the Pediatric Evaluation of Disability Inventory (PEDI) assessed by parents. Lastly, spatial-temporal control patterns were collected during each session, allowing for a visual assessment of a child’s progress in refining UE movement patterns to 16 positions across all quadrants. Results: For AROM and PROM, 4 of 5 subjects demonstrated an increase in at least 2 joints by 1-month follow-up. The remaining measurements produced no change or change within the standard error for goniometry (+/- 5o), while no decline was noted in any subjects. Pre-test MMT revealed strength measures ranging from 3/5 to 5/5. By 1-month follow-up, 85% of all measurements were 5/5, with the remaining 15% at 4+/5. For grip strength, 3 of 4 subjects (fifth subject unavailable) doubled their strength by 1-month follow-up, with the last demonstrating symmetry with the unaffected limb. Tone, as measured by MAS, did not appear to be a limiting factor as only 1 child displayed any noticeable tone (MAS of 2) across the measured motions. For the Fugl-Meyer, 4 of 5 subjects improved coordination by more than 2 points by 1- month follow-up, while the fifth maintained throughout the study. Parents reported via the PEDI an overall improvement in performing functional tasks for all children during the study, with 4 of 5 subjects improving by 10 or more points. Lastly, spatial-temporal control patterns showed marked improvement for all subjects by 1-month follow-up. Conclusion: Early results indicate that the application of robotic training to children with CP improved several clinical measures of the affected limb. This likely resulted in increased use of the affected limb, leading to improved functional performance

The Impact of Variable Dosage Using Robotic-assisted Task-Specific Upper Extremity Training in Children with Cerebral Palsy

poster abstractBackground: Cerebral Palsy (CP) and other acquired neurological disorders result from brain lesions that alter motor function in children. The impact of these deficits can impair a child’s ability to use their upper extremity (UE) for normal daily activities such as eating and playing. Robotic-assisted therapy has been shown to improve motor function in children with CP. Training parameters such as intensity and frequency were initially based on findings from studies measuring change in adults following stroke. Based on this, high intensity (960 repetitions per session) and increased frequency (2 times per week, 9 weeks) were initially implemented for children. Early findings demonstrated improvement in UE function for children with CP; however, training sessions were long, making them difficult to complete given the shorter attention span of the pediatric population. Determining the potential impact of a shorter, more optimal, dosage of robotic-assisted therapy for children would facilitate rehab training efficiency and maximize cost effectiveness. Purpose: The purpose of this study was to identify the impact on motor impairments and movement capacity with variances in treatment intensity (number of repetitions per session) while holding constant the frequency of the application (2 times per week, 9 weeks) for robotic-assisted UE training for children with CP. Methods: Six children between the ages of 6 and 8 were analyzed from two separate studies evaluating the effectiveness of robotic-assisted training for UE functional improvement. The first study featured training at high intensity and frequency while the second study used lower intensity parameters but the same frequency. To be eligible for either study, children were required to have UE hemiplegia and the ability to participate in a task for up to 60 minutes. Twice weekly, each child participated in robotic training sessions consisting of either 960, 640, or 320 task-specific reaching movements of the affected UE. Each child completed a total of 16 robotic training sessions over a 9-week period as well as one pre- and one post-test session. Outcome measures included active range of motion (AROM), strength testing and tone using the Modified Ashworth Scale (MAS). The children’s motor capacity was evaluated using the adaptive Fugl-Meyer scale (FM). Results: Percent change scores were calculated for each participant for each outcome measurement. AROM results for the shoulder resulted in an average increase of 10.6% for flexion and a 13.3% increase for abduction in both the 320 and 640 groups. Shoulder external rotation increased by an average of 13.6% for all three groups. Arm strength increased an average of 12.3% for all three groups. The MAS had an average decrease in tone of 23.8% across all 3 groups. Scores on the FM increased an average of 23% with in-depth analysis revealing shoulder movement to be the primary area for motor capacity change at 96%. Conclusion: These findings indicate that lower intensities of robotic-assisted therapy (320 and 640 repetitions) were as effective as the larger dose originally prescribed for children with CP. Outcome measures improved in all 3 groups and did not vary between dosing groups. This suggests that longer intensity sessions of robotic-assisted therapies may not be necessary to produce AROM, strength, and motor capacity changes. Further trials with more subjects are needed to validate these results

Change in Depression, Confidence, and Physical Function Among Older Adults With Mild Cognitive Impairment

Background and Purpose Nearly a quarter of those in the US over age 71 experience mild cognitive impairment (MCI). Persons with MCI (PwMCI) battle depression and progressive disengagement from daily activities, which contribute to participation restriction and activity limitation. Daily engagement in meaningful activity (DEMA) is a tailored intervention designed to benefit PwMCI and their caregivers through preserved engagement and supported adjustment to cognitive changes. This secondary analysis was guided by the International Classification of Functioning, Disability and Health (ICF) model. Aims were to (i) explore the extent to which change in self-rated activity performance and physical function can predict change in depressive symptoms, (ii) evaluate for difference in confidence and depressive symptoms at ICF levels of activity and participation, and (iii) quantify the impact of daily engagement at the ICF level of participation on physical function. Methods A secondary analysis was conducted using data from the parent study, which was a two-group randomized trial involving PwMCI and their informal caregivers participating in the Indiana Alzheimer Disease Center DEMA program. Quantitative analysis (dyads: DEMA N = 20, Information Support N = 20) examined outcomes at posttest and follow-up. Analysis employed linear regression to model the relationship between explanatory and dependent variables and independent t-test to examine for difference in confidence, depression, and physical function. Results and Discussion At posttest, change in self-rated performance predicted change in depressive symptoms. Those in the DEMA group who engaged in activity at the ICF level of participation demonstrated a significant increase in confidence and physical function. Although not significant, the control group posttest results showed a mean decrease in confidence. Conclusions Results demonstrate a positive impact of DEMA on depressive symptoms, confidence, and physical function. Change in occupational performance predicted change in depressive symptoms. Confidence significantly improved among those who engaged at the ICF participation level. A larger, randomized controlled longitudinal trial is needed to better assess the impact of DEMA on physical function, activity, participation restriction and quality of life

Changes in Walking Spatiotemporal Parameters After Therapeutic Yoga in People with Chronic Stroke

Walking limitations after stroke can contribute to long-term functional impairments. Walking characteristics such as spatiotemporal step parameters may be associated with these persistent walking limitations. The purpose of this study was to investigate changes in specific spatiotemporal walking parameters such as: walking speed; step length; swing time; step parameter symmetry; and double support time in adults with stroke who were participating in a therapeutic yoga intervention. The therapeutic yoga intervention was offered as a post-rehabilitation wellness activity 2 times per week for 8 weeks and was led by a yoga therapist. Spatiotemporal walking data were collected using the GAITRite Walkway System on a sub sample (n=24) of participants in a randomized controlled trial testing the efficacy of therapeutic yoga for improving balance in adults with chronic stroke. These data demonstrated that therapeutic yoga may have a positive impact on some spatiotemporal walking characteristics such as comfortable walking speed, step length, and double support time, while other spatiotemporal walking characteristics did not change (step parameter symmetry) or change at a significant level (sustained walking speed). The clinical relevance of this study is that participation in therapeutic yoga as a post-rehabilitation wellness activity may have a positive impact on walking characteristics in adults with chronic stroke

Modernizing persistence–bioaccumulation–toxicity (PBT) assessment with high throughput animal-free methods

The assessment of persistence (P), bioaccumulation (B), and toxicity (T) of a chemical is a crucial first step at ensuring chemical safety and is a cornerstone of the European Union’s chemicals regulation REACH (Registration, Evaluation, Authorization, and Restriction of Chemicals). Existing methods for PBT assessment are overly complex and cumbersome, have produced incorrect conclusions, and rely heavily on animal-intensive testing. We explore how new-approach methodologies (NAMs) can overcome the limitations of current PBT assessment. We propose two innovative hazard indicators, termed cumulative toxicity equivalents (CTE) and persistent toxicity equivalents (PTE). Together they are intended to replace existing PBT indicators and can also accommodate the emerging concept of PMT (where M stands for mobility). The proposed “toxicity equivalents” can be measured with high throughput in vitro bioassays. CTE refers to the toxic effects measured directly in any given sample, including single chemicals, substitution products, or mixtures. PTE is the equivalent measure of cumulative toxicity equivalents measured after simulated environmental degradation of the sample. With an appropriate panel of animal-free or alternative in vitro bioassays, CTE and PTE comprise key environmental and human health hazard indicators. CTE and PTE do not require analytical identification of transformation products and mixture components but instead prompt two key questions: is the chemical or mixture toxic, and is this toxicity persistent or can it be attenuated by environmental degradation? Taken together, the proposed hazard indicators CTE and PTE have the potential to integrate P, B/M and T assessment into one high-throughput experimental workflow that sidesteps the need for analytical measurements and will support the Chemicals Strategy for Sustainability of the European Union

Modernizing persistence–bioaccumulation–toxicity (PBT) assessment with high throughput animal-free methods

The assessment of persistence (P), bioaccumulation (B), and toxicity (T) of a chemical is a crucial first step at ensuring chemical safety and is a cornerstone of the European Union’s chemicals regulation REACH (Registration, Evaluation, Authorization, and Restriction of Chemicals). Existing methods for PBT assessment are overly complex and cumbersome, have produced incorrect conclusions, and rely heavily on animal-intensive testing. We explore how new-approach methodologies (NAMs) can overcome the limitations of current PBT assessment. We propose two innovative hazard indicators, termed cumulative toxicity equivalents (CTE) and persistent toxicity equivalents (PTE). Together they are intended to replace existing PBT indicators and can also accommodate the emerging concept of PMT (where M stands for mobility). The proposed “toxicity equivalents” can be measured with high throughput in vitro bioassays. CTE refers to the toxic effects measured directly in any given sample, including single chemicals, substitution products, or mixtures. PTE is the equivalent measure of cumulative toxicity equivalents measured after simulated environmental degradation of the sample. With an appropriate panel of animal-free or alternative in vitro bioassays, CTE and PTE comprise key environmental and human health hazard indicators. CTE and PTE do not require analytical identification of transformation products and mixture components but instead prompt two key questions: is the chemical or mixture toxic, and is this toxicity persistent or can it be attenuated by environmental degradation? Taken together, the proposed hazard indicators CTE and PTE have the potential to integrate P, B/M and T assessment into one high-throughput experimental workflow that sidesteps the need for analytical measurements and will support the Chemicals Strategy for Sustainability of the European Union.ISSN:0340-5761ISSN:1432-073

The Impact of Yoga on Quality of Life after Stroke

poster abstractAbstract Objective: Evaluate the effect of an innovative 8 week yoga-based rehabilitation intervention on 1) stroke specific quality of life (QoL) and 2) activity and participation scores in veterans with chronic stroke. Rationale/Background: Declines in Quality of Life (QoL), activity, and participation are common after stroke. Such declines are related to increased mortality, dependence, and costs. As more people live with long-term effects of stroke, it is necessary to develop innovative and evidence-based rehabilitation and occupational therapy interventions to improve QoL, activity, and participation in people with chronic stroke. Methods: • Participants- Participants included veterans with chronic stroke (>9 months) who had completed all occupational and physical therapy after stroke, reported some residual disability or functional loss after stroke; and scored >4 out of 6 on the Short Mini Mental Status Exam. • Setting- All data were collected in the Rehabilitation and Integrative Therapy lab at an urban university. • Design- This was a mixed methods pilot study of an 8 week yoga-based rehabilitation intervention. Data were collected before and after the 8 week yoga intervention. Data collection was completed by a trained research assistant. We used paired t-tests and Wilcoxon non-parametirc tests as appropriate to compare group change in scores over the 8-weeks. • Measure(s)- Measures included the Stroke Specific Quality of Life scale (SSQoL) (high score=better QoL) to measure QoL and activity and participation were measured with the ICF Measure of Participation and Activity (IMPACT) (low score=less limitations in activity and participation). Both are valid and reliable instruments. Qualitative comments were collected during focus groups after the intervention. Supportive qualitative comments regarding improved QoL and activity and participation are included. All qualitative comments were reviewed by two researchers, and exemplar quotes are included