Expanding Rehabilitation Beyond the Clinic—Strategies to Increase Total Restorative Therapy Time for Adults with Hemiplegia

Background: Positive neuroplastic changes involving cortical reorganization after stroke are experience dependent and are facilitated more effectively when rehabilitation occurs with high volume. Structured experiences to promote adaptive changes can be implemented during scheduled therapies in any rehabilitation setting. However, time spent in supervised restorative therapy is limited regardless of setting. Time spent in therapeutic activity can be extended by a variety of options that patients can engage in independently, that are low-cost, and that have evidence to support their use as a supplement to physical and occupational therapy. Purpose: The purpose of this paper is to present four such options for supplemental therapeutic activities to support restorative rehabilitation, including mental practice, mirror therapy, low cost virtual reality, and community group exercise classes. A sample of the evidence supporting their feasibility and effectiveness is presented. Practical guidelines for implementation are provided based on the evidence. Recommendations: Evidence based interventions can be used to extend total restorative rehabilitation time as an extension of therapy activities performed in the clinic. They are feasible and effective and can support positive neuroplastic changes in individuals with hemiplegia. These strategies can and should be implemented across practice settings by physical therapists, occupational therapists, and speech language pathologists

Exploring the Use of Video-Recorded Practical Examination Performance to Enhance Student Self-Assessment

ABSTRACT Purpose: The purposes of this study were to explore the ability of doctor of physical therapy students to self-assess performance during a video-recorded practical examination, to evaluate student perceptions of the experience, and to determine their perception of their ability to self-assess. Method: A cross-sectional design with students from 2 consecutive cohorts was utilized. Participants worked in groups of three conducting a video-recorded gait training session. Students graded their own performance immediately upon completing the practical examination. Students then regraded their performance from the video recording. The instructor graded each student’s video-recorded performance using the same rubric as the students. Following the experience, students completed a 7-question survey administered via Survey Monkey. Data were analyzed using Friedman’s ANOVA with post-hoc Wilcoxon signed-rank test to compare median scores. Cohen’s Kappa and percent agreement calculations assessed inter- and intra-rater reliability. Student perception data were analyzed using descriptive statistics and non-parametric Wilcoxon signed-rank test. Results: The only significant difference in scores was between student-live and faculty examiner assessments for Cohort 2. Inter-rater reliability (.09-.17) and percent agreement (20.7%-26.3%) were low across all comparisons. Intra-rater reliability (.12-.23) and percent agreement (23.7%-34.5%) were also low for both cohorts. Students rated their ability to self-assess from the video-recorded performance significantly higher than from the live performance (pConclusions:Students’ ability to self-assess performance does not appear to be well developed in the early stages of physical therapy education. The use of video-recorded performance, in conjunction with instructor feedback, could enhance this ability, ideally leading to independent and effective self-assessment as students proceed through the curriculum

Accessibility: Global Gateway to Health Literacy

Abstract available at publisher's web site