Doctor of Physical Therapy students’ experience with microaggressions in the clinic: a call to action

As Doctor of Physical Therapy (DPT) students fulfill off-campus clinical experience requirements at healthcare institutions, they are mentored by clinical instructors who are employees of said healthcare institutions. Clinical instructors, patients, or other staff members there may commit microaggressions against physical therapy students with varying subject matters, intentions, and effects on the students. Microaggressions are brief verbal humiliations which may or may not be intentional, but nonetheless convey derogatory slights or insults towards a target group. This article explores DPT students’ real-life experiences with microaggressions within the clinical education realm and the challenges a Director of Clinical Education faced in efforts to advocate for students. It also delves into the current literature available on the topic, while identifying gaps in research. It is imperative that Doctor of Physical Therapy academic institutions and researchers gather more information on the experiences of DPT students’ experiences with microaggressions and establish corresponding policies so that the prevalence of DPT students’ experiences with microaggressions is reduced and the negative effects mitigated

Passive stretching and its effect on spasticity and range of motion in children with cerebral palsy: a systematic review

Study Design: Only research studies published in peer-reviewed journals in the last two decades and published in the English language were included. Studies centered on surgical or pharmacological interventions were not included. To examine the strengths and weaknesses of these studies, the Physiotherapy Evidence Database (PEDro) scale and Sackett’s levels of evidence were used. Objectives: The aim of this paper is to analyze literature published in the past two decades, which explores the effects of stretching when used to reduce spasticity and increase range of motion in children with spastic cerebral palsy (CP), as well as to address the effects of manual versus positional stretching as provided by physical therapists. Background: Physical therapists believe we can decrease joint degradation due to abnormal posture, as well as increase mobility and independence with a focus on the reduction of spasticity during posture and gait. A consensus in current literature seems to be that passive stretching is used widely to reduce spasticity in children with CP, but without scientific evidence to provide a justification for its use or to dictate the conditions in which to administer this treatment. Methods and Measures: The literature search for stretching in children with CP was conducted using the following key words: stretching, positioning, serial casting, spasticity, range of motion, cerebral palsy, and children. The following databases were used: Academic Search Complete, CINAHL, Cochrane Library, PEDro, Pubmed, ScienceDirect, SCOPUS, and SPORTDiscus. Results: A total of 13 articles on stretching in children with cerebral palsy were found from the years 1990 to 2011. Two individual studies were found in which manual stretching was the intervention. Nine individual studies were found in which positional stretching was the intervention, four of which serial casting was the intervention. Two systematic reviews exist in the last two decades that explore the effect of stretching in children with CP, however, neither encompass all of the studies reviewed in this paper nor do they discuss serial casting as a form of positional stretching. Conclusion: Taken together, the individual studies using positional stretching and the small randomized controlled trial using electrical stimulation in addition to manual stretching led to better outcomes for reducing spasticity and increasing passive range of motion compared to manual stretching alone. research report is a systematic review of literature pertaining to the effectiveness of interactive gaming versus traditional rehabilitation methods in balance training post cerebral vascular attack (CVA

Effects of Screen Time on Children\u27s Brain Development: A Scoping Review

In this scoping review, the effects of screen time on cognitive, linguistic, and social-emotional development in children were studied by examining peer-reviewed articles published between 2018 and 2023. A total of 17 peer-reviewed articles were used in the study. The research reported that screen media provide a learning avenue, though it could be detrimental when children spend their time watching more than appropriate screen media. Furthermore, the study indicated that excessive screen media use may harm children’s executive function, which affects academic performance and language development. Related studies have also shown a correlation between excess screen use and problems like obesity, sleep disturbances as well as emotional challenges underscoring the importance of responsible screen practices and parental support. The study also contributes to what parents and educators should do to enable good screen habits in children and further research needs

Trigger point dry needling for musculoskeletal pain and disability: a systematic review of comparative effectiveness research

Background: Dry needling (DN) has been proposed to reduce pain and improve function related to myofascial trigger points (MTrPs). Several primary studies and systematic reviews have been conducted to examine the effect of DN versus placebo. However the comparative effectiveness of DN and established interventions has yet to be established. Purpose: The purpose of this systematic review was to determine whether DN was more effective than other established therapies to treat MTrPs. Data Sources: MEDLINE Complete, EBSCO, CINAHL, Sport Discus and Cochrane library databases were searched. Study Selection: Randomized controlled trials that used DN directed to MTrPs and used at least one other intervention method were included. Studies that had a placebo or sham group were excluded. Data Extraction: Of 394 records screened, 8 studies met the established criteria. The quality of each study was assessed using the PEDro scale. Data Synthesis: When DN was compared to standard therapy programs, 3 of the 4 studies found that DN was more effective in reducing pain and 1 found no difference. When DN was compared to stretching, DN reduced pain more effectively. Dry needling was not significantly more effective than high-power pain threshold ultrasound (US), laser, non steroidal anti inflammatory drugs, and percutaneous electrical nerve stimulation (PENS). Limitations: Included studies were relatively small and some lacked sound methodology. Conclusions: The results are mixed on the effectiveness of DN over standard rehab. More large scale, high quality studies are needed before definitive decisions can be made about the role of DN in physical therapy practice

Screening of Physical Activity Levels in Older Adults at a Community-Based Health Fair: A Feasibility Study

Purpose: The purpose of this study was to assess the feasibility of activity level screenings in community-based health fairs. Additionally, we assessed relationships between participants’ sociodemographics, health-related factors and self-reported activity levels. Methods: Feasibility was assessed by the time required to conduct screenings and ease of integrating it into the health fair workflow. Physical Therapy students collected responses using Activities Specific Balance Confidence Scale (ABC) and the Physical Activity Level (PAL) items from the National Health and Nutrition Examination Survey. Results:Screenings increased service and wait times. Participants (N=37, mean age=71.5 years) reported a mean of 4.8 fall risk factors, and a mean ABC of 74.7. Twenty-four participants were active more than 2 days per week (64.9%). Eighteen participants reported more than 2 hours of sedentary time daily (47.3%). ABC was significantly less for those reporting vision impairment (p Conclusions: Activity level screening during community-based health fairs may require planning to decrease wait time. Fall risk factors were significantly associated with balance confidence. Balance confidence was not significantly predictive of activity levels. Other fall risk factors may be more predictive of self-reported compliance with activity recommendations

Physical Therapy Management for an Individual with Stiff Person Syndrome in the Acute Care Setting: A Case Report

Purpose: Stiff Person Syndrome (SPS) is a rare neurological disease which is characterized by progressive rigidity and painful spasms of axial and limb muscles. We report here on the physical therapy management as well as medical complications which impacted the physical therapy plan of care for a patient with paraneoplastic SPS in the acute care setting. Method: This case report describes rehabilitation management of a 71-year-old woman who presented in the acute care setting for complaints of progressively worsening stiffness in the bilateral lower extremities leading to multiple falls as well as dysphagia. Primary interventions for this patient included passive range of motion for stretching, bed mobility such as rolling, supine to sitting transfers, and scooting at the edge of bed, and family and patient education. Education focused on the importance of maintaining range of motion and prevention of pressure wounds and contractures. Results: By the end of the hospitalization, the patient had a marked reduction in tone and spasms as well as improved bed mobility. Progress was limited due to multiple medical complications the patient faced during treatment. Conclusion: Physical therapist intervention for SPS in the acute care setting is challenging due to the paucity of literature present. However, physical therapy remains an important aspect of patient care in order to maximize independence and function from early on

A hypothesis-oriented algorithm for symptom-based diagnosis by physical therapists: description and case series

Study Design: Case series. Subjects: Two patients referred to physical therapy with a diagnosis of lower back pain (LBP). Background: The increasing role of physical therapists in primary care settings highlights the skills needed to determine the appropriateness of physical therapy for patients. A hypothesis-oriented algorithm for symptom-based diagnosis was developed for use by physical therapists. The goal of this process is to determine a diagnostic impression to guide decisions regarding patient disposition and physical therapist management. This case series demonstrates the process in two individuals with LBP referred to a community-based outpatient physical therapy clinic. Diagnosis: Despite the fact that both patients presented to physical therapy with a similar referral diagnosis, the hypothesis-oriented algorithm revealed a difference in diagnostic impressions formed by the physical therapist, and resulted in divergent decisions regarding the appropriateness of physical therapy betvveen patients. Clinical findings based on the hypothesis-oriented algorithm directed treatment and case management. Discussion: A symptom-based diagnostic process was used to determine the appfopriateness of physical therapy for the patients described in this case series. The described approach is intended to provide physical therapists with a process to arrive at a diagnostic impression regarding the pathology underlying patients\u27 presentations, in order to determine the appropriate disposition and treatment for individuals presenting to physical therapy. Additional research will assist in validating this approach and assess its effectiveness to prepare student physical therapists in entry-level, postprofessional, and residency programs

Effectiveness of neuromuscular conditioning to prevent anterior cruciate ligament injuries in female athletes: a critical synthesis of literature

Background and Purpose: Anterior cruciate ligament (ACL) injuries are common among female athletes. The purpose of this literature review was to assess the effectiveness of neuromuscular conditioning to modify biomechanical risk factors for ACL injury. METHOD: A structured literature search was conducted to identify primary research articles. Articles were graded according to their strength of evidence and a qualitative literature review was completed. RESULTS: Seven primary research studies were available for analysis that documented the effects of neuromuscular conditioning (range of evidence grades: 1B to 3B). Lower limb kinematics, lower limb kinetics, and incidence of tears were the primary outcomes measures. DISCUSSION: The effectiveness of neuromuscular training to modify the theoretical and actual risks for ACL injury is promising but not yet adequately confirmed in the literature. CLINICAL RELEVANCE: Preliminary evidence indicates the effectiveness of neuromuscular training to reduce ACL injury risk, although mechanisms and optimal dosage of exercise remain unclear

Obstacles to Physical Therapy Clinical Instruction: A Qualitative Study of Clinical Instructors

Purpose: Clinical instructors (CIs) are essential contributors to clinical education. Limited literature exists describing CI perceptions of supervising students. The purpose of this research was to identify CI challenges and possible solutions when supervising student physical therapists and student physical therapist assistants. Methods: A convenience sample of 99 CIs in the Northern California Clinical Education Consortium participated in this study. A phenomenological approach obtained CI perceptions of the barriers to supervising students. Researchers employed a web-based survey to obtain demographic information and pose two open-ended questions that allowed for up to three responses. Thematic analysis using a coding framework was employed to analyze the qualitative data. Results: There were 205 comments in response to the first survey item and 162 comments in response to the second survey item with all the comments included in the thematic analysis. Three main themes were derived for each question with each theme containing 2-4 sub-themes. Conclusion: CIs’ perceived challenges and desires for improvements in clinical education were associated with time constraints, program responsibilities, clinical site concerns, and the CPI. This study adds to the literature by Identifying themes and multiple sub-themes for various stakeholders of clinical education to specifically target. A coordinated effort from programs, site coordinators of clinical education, and clinic managers or administrators toward decreasing the barriers CIs face when supervising students may provide for an improved CI experience and in turn contribute to strengthened program-clinical site partnerships