The Impact of Education on Implementation of Mirror Box Therapy Across Occupational Therapy Practice Settings

Mirror box therapy has been found to be effective in changing motor and sensory outcomes in patients with cerebrovascular accident (CVA). It has many benefits to use for occupational therapists such as ease of use, ease of transportation, capability to be used across practice settings, and ability to be incorporated into conventional therapy treatment. However, therapists included in this study may not have been using the intervention due to lack of knowledge or availability of the intervention equipment. The purpose of this capstone project was to determine the impact education would have on occupational therapists’ attitudes and behaviors towards the use of mirror box therapy. It also served to determine the impact the use of mirror box therapy would have on changing functional outcomes individuals recovering from across occupational therapy practice settings. This study utilized a mixed methods approach and was divided in to two parts. Part A utilized a two-part educational series for occupational therapists analyzed by a quantitative pre-test/post-test assessment of learning. This was followed by a qualitative focus group to determine impression of the learning. Part B included using mirror box therapy with seven patients with acute CVA during admission stays over the course of four weeks to collect pre-test/post-test data on changes in range of motion, muscle strength, sensation of the affected limb, and Functional Independence Measure (FIM) levels. This was followed by a qualitative focus group for therapists who had implemented mirror box therapy. Part A of this study found significant changes in learning about mirror box therapy by occupational therapists. Through the educational series, they identified how they learned, what motivates them to learn, barriers to job performance due to the environment, and overall excitement to learn. Part B of this study found changes in occupational performance for all seven patients with acute CVA. Patients identified sensory changes throughout the use of the mirror box and presented with changes in motor function resulting in improvements in FIM scores. Using mirror box therapy with patients with CVA facilitated growth by the therapists in their confidence to use, motivation to use to continue to help patients, evolution of becoming leaders in their respective practice settings, motivation to utilize evidence-based practice and critical thinking about changes in their environment that would be needed to successfully incorporate mirror box therapy into daily practice. Education that addresses preferences in learning, motivates the therapist to want to learn, and provides support for adaptation of the person, the environment, and the occupation can be successful in creating changes in occupational performance of occupational therapists. Learning to use mirror box therapy by incorporation into practice increased confidence of use in occupational therapists. As confidence improved, the therapists evolved into leaders in their practice settings by modeling the use of the mirror box and sharing an understanding of the benefits to use of the intervention with their peers. Utilizing mirror box therapy also changed impressions of use of evidence-based practice with demonstrated future desire to use and support treatment. Using mirror box therapy with patients with acute CVA can lead to changes in functional outcomes by improving motor function and sensory awareness resulting in improved occupational performance. Short periods of use of the intervention can be effective throughout occupational practice settings to initiate recovery of the affected limb

The Rho-Rock-Myosin Signaling Axis Determines Cell-Cell Integrity of Self-Renewing Pluripotent Stem Cells

Background: Embryonic stem (ES) cells self-renew as coherent colonies in which cells maintain tight cell-cell contact. Although intercellular communications are essential to establish the basis of cell-specific identity, molecular mechanisms underlying intrinsic cell-cell interactions in ES cells at the signaling level remain underexplored. Methodology/Principal Findings: Here we show that endogenous Rho signaling is required for the maintenance of cell-cell contacts in ES cells. siRNA-mediated loss of function experiments demonstrated that Rock, a major effector kinase downstream of Rho, played a key role in the formation of cell-cell junctional assemblies through regulation of myosin II by controlling a myosin light chain phosphatase. Chemical engineering of this signaling axis by a Rock-specific inhibitor revealed that cell-cell adhesion was reversibly controllable and dispensable for self-renewal of mouse ES cells as confirmed by chimera assay. Furthermore, a novel culture system combining a single synthetic matrix, defined medium, and the Rock inhibitor fully warranted human ES cell self-renewal independent of animal-derived matrices, tight cell contacts, or fibroblastic niche-forming cells as determined by teratoma formation assay. Conclusions/Significance: These findings demonstrate an essential role of the Rho-Rock-Myosin signaling axis for the regulation of basic cell-cell communications in both mouse and human ES cells, and would contribute to advance i

Divergent reprogramming routes lead to alternative stem-cell states

Pluripotency is defined by the ability of a cell to differentiate to the derivatives of all the three embryonic germ layers: ectoderm, mesoderm and endoderm. Pluripotent cells can be captured via the archetypal derivation of embryonic stem cells or via somatic cell reprogramming. Somatic cells are induced to acquire a pluripotent stem cell (iPSC) state through the forced expression of key transcription factors, and in the mouse these cells can fulfil the strictest of all developmental assays for pluripotent cells by generating completely iPSC-derived embryos and mice. However, it is not known whether there are additional classes of pluripotent cells, or what the spectrum of reprogrammed phenotypes encompasses. Here we explore alternative outcomes of somatic reprogramming by fully characterizing reprogrammed cells independent of preconceived definitions of iPSC states. We demonstrate that by maintaining elevated reprogramming factor expression levels, mouse embryonic fibroblasts go through unique epigenetic modifications to arrive at a stable, Nanog-positive, alternative pluripotent state. In doing so, we prove that the pluripotent spectrum can encompass multiple, unique cell states