Effects of Yoga and High - intensity Exercise on Heart Rate Variability and Stress - A Pilot Study

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The Effects of Medical Cannabis and Physical Therapy in Patients with Chronic Pain and/or Parkinson\u27s Disease: Protocol Study

Background. There is limited research exploring how physical therapy coupled with medical cannabis use in patients with chronic pain and/or Parkinson’s disease can improve function and affect life satisfaction among patients. Objectives. The purpose of this study is to determine the effects of medical cannabis coupled with skilled physical therapy in patients with Parkinson\u27s disease and/or chronic pain. Design. This would be a randomized experimental study containing 4 separate subject groups: medical cannabis and chronic pain, no cannabis and chronic pain, medical cannabis and Parkinson’s disease, no cannabis and Parkinson’s disease. Setting. Misericordia University Pro Bono Clinic, Dallas, PA Participants. Researchers would recruit a total of 80 subjects, 40 with chronic pain and 40 with Parkinson’s disease. All participants would have a legal prescription for medical cannabis in the state of Pennsylvania. Intervention. PT interventions may include, but are not limited to: exercises to work on balance, strength or flexibility, mobility training and manual therapy. Interventions would vary based on the subjects’ needs and presentation. Measurements. The outcomes measures used in this study would be The Numeric Pain Rating scale, Life Satisfaction Questionnaire-11, postural assessment using the Posture Screen Mobile application, and the gait parameters measured on the Zeno electronic walkway. Limitations. Perceived safety of subjects, small sample size, lack of current research in this realm. Conclusion. Researchers believe this research to be vital and important to the realms of physical therapy, medical cannabis, chronic pain and Parkinson’s disease and hope it can be carried out by future researchers.https://digitalcommons.misericordia.edu/research_posters2020/1066/thumbnail.jp

Global Health Perspectives in Physical Therapy Education: A Qualitative Report on a Service Learning Experience in Guatemala

Authors: Winter F Wildt-Bailey, SPT; Adriana Sandoval, SPT; Holly J Roberts, PT, DPT, GCS, NCS Global Health Perspectives in Physical Therapy Education: A Qualitative Report on a Service Learning Experience in Guatemala Purpose: Doctor of physical therapy (DPT) students at the University of Puget Sound traveled to Zacapa, Guatemala to deliver physical therapy services for 5 days as part of an elective course introducing students to physical therapy and health care delivery from a global health perspective. Participants journaled about their experiences, responding to prompts provided by the course professor/clinical instructor. The purpose of this research was to explore the impact of the experience by identifying common themes among the journal entries. Methods: Ten student physical therapists (SPT), 9 females, 1 male, mean age 29yrs (range 25-40) at the end of their second year of a three-year DPT program consented to allow their journals to be included in this report. Two SPTs noted recurring themes that emerged in the de-identified journal entries. Results: Five common themes emerged among the journal entries: 1) Cultural Bias: recognizing cultural biases, the impact they have on patient care, and identifying strategies for addressing them; 2) Healthcare Disparities: recognizing disparities in access to healthcare, patient education, and resources between the U.S. and Guatemala; 3) Confidence and Competency: overcoming feelings of inadequacy as novice clinicians and appreciating the extent of knowledge and skill gained through didactic coursework; 4) Identity: reaffirming one\u27s decision to pursue a physical therapy career and that it aligns with one\u27s values and identity; and 5) Skills Development: adapting to working with limited resources, and developing effective communication skills with a language barrier. Conclusions: Reflection is a central tenet of service learning. The personal reflections of DPT students participating in a short-term service learning trip to Guatemala as part of an elective course in global health perspectives revealed the experience allowed students to recognize and address cultural biases, recognize healthcare disparities, build professional confidence and competence, reaffirm professional goals, and develop important skills in communication and healthcare delivery. Clinical Relevance: The results of this qualitative report are consistent with literature examining the benefits of experiential learning in healthcare education. They demonstrate the potential for an international service learning experience to facilitate development of cultural competence, clinical reasoning skills, communication skills, and confidence in one\u27s knowledge and abilities. Keywords: global health, service learning, experiential learning References: Benson JD, Provident I, Szucs KA. An experiential learning lab embedded in a didactic course: outcomes from a pediatric intervention course. Occ Ther Health Care. 2013; 27:46-57. Knecht-Sabres LJ. Experiential learning in occupational therapy: can it enhance readiness for clinical practice? J Exp Educ. 2013; 36:22-36. Paterson C, Chapman J. Enhancing skills of critical reflection to evidence learning in professional practice. Phys Ther Sport. 2013; 14:133-138. Seif G, Coker-Bolt P, Kraft S, Gonsalves W, Simpson K, Johnson E. The development of clinical reasoning and interprofessional behaviors: service-learning at a student-run free clinic. J Interprof Care. 2014; 28(6):559-564. Smith S, Crocker A. Experiential learning in physical therapy education. Adv Med Educ Pract. 2017; 8:427-433. Village D, Clouten N, Millar AL, Geigle A, et al. Comparison of the use of service learning, volunteer, and pro bono activities in physical therapy curricula. J Phys Ther Educ St Louis. 2004;18(1):22-28

International Service Learning: An Overview

International Service Learning: An Overview Kaitlynn McKirgan, SPT; Daniel Murty, SPT; Dr. Holly Roberts, PT, DPT, GCS, NCS Affiliation: 1. The School of Physical Therapy, University of Puget Sound Abstract Purpose A wide range of healthcare disciplines including nursing, public health, occupational therapy, and physical therapy (PT) now recognize global health participation and education as a necessary component of healthcare education. Increasingly, students applying to and choosing which PT program to attend must now consider the design, purpose, benefits, and potential drawbacks of such a program in their education. The purpose of this report is to provide an overview of International Service Learning (ISL) structure, its proposed benefits and concerns, and to briefly compare how the University of Puget Sound’s (UPS) pilot ISL program compared to recommendations found within the literature in order to define possible areas of improvement. Methods Literature search was performed using PubMed, Google Scholar, ProQuest, Academic Search Premiere, and Cochrane. Search terms used were: Global health, international service learning, physical therapy, experiential learning. Programs described in the literature were compared to the course structure outlined in the UPS Global Health Perspectives Course PT677 Syllabus. The course instructor was interviewed to gain any knowledge not available within the syllabus regarding program structure. Results Pechak and Thompson recommend 7 components to create a program with positive outcomes: 1. A partner that understands the role of PT; 2. Community identified needs; 3. Explicit service and learning objectives; 4. Reflection; 5. Preparations; 6. Risk Management; 7. Service learning outcome measure. Benefits to students participating in ISL programs include: increased confidence, improved communication skills, self- empowerment, independence, increased student self-assessment scores, increased experiential learning opportunities and increased understanding and confidence in professional roles when ISL project includes cooperation with other professions.  Ethical concerns are inherent and individual programs must pay close attention to the impact they have on the communities they seek to serve. Common ethical dilemmas that should be considered include the power dynamic between the community and those rendering services, the quality of care being provided, sustainability at the community and individual levels, and community need. Conclusion The UPS pilot ISL program met 6/7 components for optimal ISL outlined by Pechak and Thompson: Use of an outcome measure to evaluate the service learning experience should be applied in future programs. Other recommended improvements to the program include incorporating instruction to local care providers to increase service community self-efficacy. Finally, increased medical Spanish education in the months leading up to the ISL program is advised. Works cited Pechak CM, Thompson M. A Conceptual Model of Optimal International Service-Learning and Its Application to Global Health Initiatives in Rehabilitation. Physical Therapy. 2009;89(11):1192-1204. Smith SN, Crocker AF. Experiential learning in physical therapy education. Adv Med Educ Pract. 2017;8:427-433. doi:10.2147/AMEP.S140373. Reisch RA. International Service Learning Programs: Ethical Issues and Recommendations. Developing World Bioethics. 2011;11(2):93-98. doi:10.1111/j.1471-8847.2011.00299.x. Pechak C, Gonzalez E, Summers C, Capshaw S. Interprofessional Education: A Pilot Study of Rehabilitation Sciences Students Participating in Interdisciplinary International Service-Learning. Journal of Allied Health; Washington. 2013;42(3):e61-6. Fries KS, Bowers DM, Gross M, Frost L. Service learning in Guatemala: using qualitative content analysis to explore an interdisciplinary learning experience among students in health care professional programs. J Multidiscip Healthc. 2013;6:45-52. doi:10.2147/JMDH.S35867

Defending the Art of Physical Therapy: Expanding Inquiry and Crafting Culture in Support of Therapeutic Alliance

Title: Defending the Art of Physical Therapy: Expanding Inquiry and Crafting Culture in Support of Therapeutic Alliance Authors: Nicole Brun-Cottan1, SPT, Danny McMillian PT DSc.1, Jennifer Hastings, PT PhD. ,NCS.1 Affiliations 1. School of Physical Therapy, University of Puget Sound, Tacoma WA, USA. Theory/Body: The successful practice of physical therapy within the biopsychosocial construct requires a professional culture that places value on the interpersonal relationships that foster healing and the face time required to build those relationships. The unfortunate truth is that pressures on current practice are not facilitating this dynamic approach. The drive for increased productivity, cost effectiveness and ultimately, profit, are changing the landscape in which we practice. For-profit entities are placing an emphasis on data-driven practice patterns and tying reimbursement to performance on standardized outcomes measures. The data that drives these models is often not informed by physical therapists, and changes are being imposed by payers without adequate regard for the impact on quality of life for both patients and practitioners. This phenomenon is fueled by an overemphasis on quantitative research in evidence based medicine and an under-appreciation of clinical expertise and patient values. This imbalance undermines the holistic, patient-centered approach that has been the basis for physical therapy since its inception. In this paper an argument is presented that we are losing the art of practicing physical therapy. Authors suggests that in order to preserve defining characteristics of the profession, there is an urgent need to redirect our research agenda and PT education with a focus on the study of contextual and psycho-social factors that influence treatment outcomes. Recent research findings indicate that the effect of therapeutic alliance may be as important to outcomes as the chosen intervention. The authors suggest that excellence in DPT education must incorporate education addressing the vital importance of therapeutic alliance and also include training in the skills for developing such unique intentional relationships. References 1.Hall AM, Ferreira PH, Maher CG, Latimer J, Ferreira ML. The Influence of the Therapist Patient Relationship on Treatment Outcome in Physical Rehabilitation: A Systematic Review. Physical Therapy. 2010;90(8):1099-1110. doi:10.2522/ptj.20090245. 2.Kayes NM, McPherson KM. Human technologies in rehabilitation: “Who” and “How” we are with our clients. Disability & Rehabilitation. 2012;34(22):1907-1911 5p. doi:10.3109/09638288.2012.670044. 3. Rosin T. Fee-for-service vs. value-based care: 6 points of debate raised by health policy experts. http://www.beckershospitalreview.com/finance/fee-for-service-vs-value-based-care-6-points-of-debate-raised-by-health-policy-experts.html

Community Based Rehabilitation Programs for Resettled Muslim Women Refugees

According to the 2021 report from the United Nations High Commissioner for Refugees, 82.4 million people were forcibly displaced because of violence, wars, or persecution and over 26.4 million are currently living with refugee status. Displacement and resettlement trauma are associated with chronic disease onset and poor cognitive, physical, and mental health outcomes for refugee populations. To mitigate some of the deleterious effects of resettlement trauma, we propose a community-based rehabilitation program (CBRP) framework that is culturally sensitive, trauma-informed and focused on the vulnerabilities of women. The purpose of this novel CBRP framework is to address health inequities among a vulnerable refugee population through program development, with a focus on: (1) active participation of the refugee community throughout all levels of program planning; (2) intersectional, gender-focused analysis of power and privilege within the community and host country aimed at reducing barriers and improving access to quality CBRP programs for women; (3) trauma-informed, team-oriented, resilience programming to improve cognitive, physical, and mental health outcomes and prevent chronic disease. This paper will also discuss the need for gender transformative interventions to address specific health inequities related to CBRP feasibility and access, cultural and social influences, acceptability, and related laws and policies. Key Words: Refugee Health, Muslim Women, Community-based Rehabilitation Programs, Physical Activit

Comparing seated pressures in daily wheelchair and sports equipment and investigating the skin protective effects of padded shorts.

Background: Adaptive sports are promoted for individuals with spinal cord injury to increase overall health and prevent cardiovascular and metabolic diseases, but the potential risk of pressure ulcer development with adaptive equipment (AE) is a concern. Current research has found seated pressures in AE that exceed clinically accepted values but no studies have measured pressure with a padded short to assess for its potential pressure reducing effects. Objective: Our study sought to evaluate average and peak seating pressure in both static and dynamic sport-specific positions, with and without the presence of three types of over-the-counter padded bicycle shorts, in multiple types of adaptive equipment (AE): Hand cycle, quad rugby, basketball, and mountain hand cycle. Methods: Part One. Pre/Post test design with subjects as their own control. Eight adults with SCI (C5-T6) were pressure mapped under static and dynamic conditions in their daily use wheelchair (WC) and AE. Three conditions were mapped: Daily WC, AE without bicycle shorts, and AE with shorts. AE included: Hand-cycle, quad rugby, basketball, and mountain hand-cycle. Part Two. Static pressure readings in a hand-cycle were taken on 16 able-bodied subjects with and without an impact short and a full-coverage padded short. Part three. Single subject with T5 SCI was pressure mapped in static and dynamic conditions with and without the full-coverage padded short in a basketball chair and mountain hand-cycle. Average pressure (AP) and peak pressure (PP) recordings were taken for 60 seconds (400 frames) using the TekScan Pressure Mapping System. For static recordings the participants were instructed to sit still, while for dynamic recordings participants simulated sport or activity specific movements. Results: Part 1. Significant differences were found between the daily chair and AE for both AP and PP in the static condition (p \u3c 0.05), as well as AP in the dynamic condition (p Part 2. The impact short significantly increased static PP and AP (p0.05). Part 3. The full-coverage padded short increased AP and PP in the basketball chair, decreased AP in the mountain hand cycle and increased PP in the mountain hand cycle. Discussion: Pressure differences between daily WC and AE in static conditions suggests that athletes who are not moving or sitting on the sidelines in their AE may be at greater risk of tissue breakdown than athletes who are playing and experiencing pressure-relieving positions during movement. Padded shorts as a method to reduce PP and AP yielded variable results which may have been influenced by type of AE and posture in the AE. Thus seated posture may influence the pressure relieving capabilities of a padded short. Conclusion: Donning a padded short as a method of skin protection yields highly variable changes in PP and AP and pressure mapping should be performed prior to use in AE by the SCI population. Works Cited: Berthold, J., Dicianno, B.E. & Cooper, R.A. (2013). Pressure mapping to assess seated pressure distributions and the potential risk for skin ulceration in a population of sledge hockey players and control subjects. Disability and Rehabilitation. Assistive Technology, 8(5), 387-39http://doi.org/10.3109/17483107.2013.769123 Darrah, S.D., Dcianno, B.E., Berthold, J., McCoy, A., Haas, M., & Cooper, R.A. (2016). Measuring static seated pressure distributions and risk for skin pressure ulceration in ice sledge hockey players. Disability and Rehabilitation. Assistive Technology, 11(3), 241-246. http://doi.org/10.3109/17483107.2014.92193

Does high-intensity exercise better improve ambulation in the population with chronic stroke, as compared to standard care?: A Systematic Review of the Literature

Purpose: To assess the effectiveness of high-intensity exercise on the improvement of gait deficits in survivors of chronic stroke as compared to standard care.https://jdc.jefferson.edu/dptcapstones/1006/thumbnail.jp