Searching for a talking face: the effect of degrading the auditory signal

Previous research (e.g. McGurk and MacDonald, 1976) suggests that faces and voices are bound automatically, but recent evidence suggests that attention is involved in a task of searching for a talking face (Alsius and Soto-Faraco, 2011). We hypothesised that the processing demands of the stimuli may affect the amount of attentional resources required, and investigated what effect degrading the auditory stimulus had on the time taken to locate a talking face. Twenty participants were presented with between 2 and 4 faces articulating different sentences, and had to decide which of these faces matched the sentence that they heard. The results showed that in the least demanding auditory condition (clear speech in quiet), search times did not significantly increase when the number of faces increased. However, when speech was presented in background noise or was processed to simulate the information provided by a cochlear implant, search times increased as the number of faces increased. Thus, it seems that the amount of attentional resources required vary according to the processing demands of the auditory stimuli, and when processing load is increased then faces need to be individually attended to in order to complete the task. Based on these results we would expect cochlear-implant users to find the task of locating a talking face more attentionally demanding than normal hearing listeners

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

Patient-Reported, Not Performance Based, Outcome Measures Are Correlated With Future Falls in Community Dwelling Older Adults

Background: One-third of community-dwelling older adults fall at least once a year, yet many commonly used performance-based outcome measures for falls have ceiling effects. Additionally, psychological factors such as fear of falling and avoidance behaviors may contribute to fall risk. Purpose: To determine whether balance confidence, fear of falling avoidance behaviors, or performance on high-level mobility outcome measures can predict falls in community-dwelling older adults. Methods: Eighty-nine participants (76 ± 7 years) completed the Activities-specific Balance Confidence Scale (ABC), Fear of Falling Avoidance Behaviors Questionnaire (FFABQ), Functional Gait Assessment (FGA), and Community Balance & Mobility Scale (CB&M) and then recorded their falls for 6 months. Spearman’s rho, a Point-Biserial Correlation, and Receiver Operating Curves were used to analyze the relationship of the selected outcome measures, past falls, and future falls. Results: There were statistically significant correlations between falls and both the ABC (r2=-.235, p=.022) and the FFABQ (r2=.286, p=.019). There was a positive correlation between history of falls and future falls (r=.323, p=.002). The ABC (area under curve [AUC] =.632, p=.038) and the FFABQ (AUC=.655, p=.015) were significant predictors of future falls. The optimal cutoff scores for determining individuals who experienced falls were: ABC-96% (79% sensitivity, 66% specificity) and FFABQ-1.50 (79%, 55%). Conclusion: No single outcome measure was found to be strongly correlated with falls. The ABC, FFABQ, and history of falls were weakly correlated with future falls. A cutoff score of 96% on the ABC and 1.50 on the FFABQ had adequate sensitivity, but low specificity for predicting falls

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

The topology, structure and PE interaction of LITAF underpin a Charcot-Marie-Tooth disease type 1C

BACKGROUND: Mutations in Lipopolysaccharide-induced tumour necrosis factor-α factor (LITAF) cause the autosomal dominant inherited peripheral neuropathy, Charcot-Marie-Tooth disease type 1C (CMT1C). LITAF encodes a 17 kDa protein containing an N-terminal proline-rich region followed by an evolutionarily-conserved C-terminal 'LITAF domain', which contains all reported CMT1C-associated pathogenic mutations. RESULTS: Here, we report the first structural characterisation of LITAF using biochemical, cell biological, biophysical and NMR spectroscopic approaches. Our structural model demonstrates that LITAF is a monotopic zinc-binding membrane protein that embeds into intracellular membranes via a predicted hydrophobic, in-plane, helical anchor located within the LITAF domain. We show that specific residues within the LITAF domain interact with phosphoethanolamine (PE) head groups, and that the introduction of the V144M CMT1C-associated pathogenic mutation leads to protein aggregation in the presence of PE. CONCLUSIONS: In addition to the structural characterisation of LITAF, these data lead us to propose that an aberrant LITAF-PE interaction on the surface of intracellular membranes contributes to the molecular pathogenesis that underlies this currently incurable disease.Wellcome-Beit Prize; Intermediate Clinical Fellowship (093809/Z/10/Z); Wellcome Trust Strategic Award 100140; Wellcome Trust grant 09302

Influences of Balance Confidence, Fear of Falling, and Fall History on Physical Activity Levels in Community-Dwelling Older Adults

Background: Physical activity levels generally decline with increasing age. Few studies have examined the influences of balance confidence, fear of falling, and fall history on physical activity levels in older adults. Purpose: To determine the relationships between balance confidence, fear of falling, fall history, and physical activity level in community-dwelling older adults. Methods: Eighty-eight participants completed the Activities-specific Balance Confidence Scale (ABC), Fear of Falling Avoidance Behavior Questionnaire (FFABQ), and a self-reported fall history. They reported their monthly activity levels using the Physical Activity Scale for the Elderly (PASE). Pearson correlation coefficients (r) were used to analyze the relationships between the outcome measures, including the PASE (PASEi), and the mean of 3 monthly PASE scores (PASE3). Results: Moderate positive correlations were found between ABC scores and the PASEi (r=0.398) and PASE3 (r=0.384). There were moderate negative correlations between FFABQ scores and the PASEi and PASE3 (r=-0.362, r=-0.349, respectively). Fall history was not correlated with the PASEi or PASE3 (r=-0.148, r=-0.202, respectively). Conclusion: Community-dwelling older adults who reported higher levels of balance confidence and lower fear of falling avoidance behaviors reported higher levels of physical activity. Fall history was not correlated with physical activity scores. Clinicians should consider assessing balance confidence and fear of falling when encouraging physical activity for older adults

Comparison of Balance Confidence, Balance Performance, and Falls Among Age Groups for Community-Dwelling Older Adults

Background: Balance confidence and performance is crucial for fall prevention among the elderly but the correlation with age is unknown. Purpose: Identify changes in balance confidence, balance performance and falls of older age. Methods: 90 community-dwelling older adults (76+7 years, 54 female, 34 fallers) completed the Activity Specific Balance Confidence Scale (ABC), Fear Avoidance Beliefs Questionnaire (FABQ), Community Balance and Mobility Scale (CB&M), and Functional Gait Assessment (FGA), and self-reported falls for 6 months. Scores on outcome measures and fall rates were compared using a one-way repeated measures ANOVA for age groups 65-74, 75-84, and 85+. Results: There were no differences in the monthly fall rate between age groups (1.3+2.42,1.15+3.04, and 1.87+2.64, respectively). FGA scores differed between the 65-74 group (27.02+.73) and the 75-84 group (23.15+.815) (P=.003), in addition to the 65-74 group and the 85+ group (18.33+1.21) (P=.000). CBM scores differed between the 65-74 group (71.54+2.97) and the 75-84 group (48.18+3.31) (P=.000), in addition to the 65-74 group and 85+ group (30.67+4.92) (P=.000). Scores on ABC and FFABQ did not differ among age groups. Conclusion: Older community-dwelling adults scored lower on performance-based outcome measures for dynamic balance and gait than younger adults, though fall rate did not differ. Based on a previously established FGA cut-off score of 22, adults 85+ may be at risk for falls.However, scores on patient-reported outcome measures for balance confidence and fear of falling avoidance behavior were similar among age groups. This indicates that balance performance, not balance confidence, may decline with age

Discovering Barriers to Diversity in Physical Therapy

Introduction APTA defines diversity: “the racial and ethnic populations that are underrepresented in physical therapy education relative to their numbers in the general population, as well as individuals from geographically underrepresented areas, lower economic strata, and educationally disadvantaged backgrounds” 9.7 percent of DPT students identified as URM nationally. In Minnesota, 96.75 percent of persons with PT licenses self identify as White. This study is the directive of the MNPTA Methods Participants were PT/PTA professionals or students from Minnesota. Average Age: 34.17 STD 12.47 Four 120 minute focus groups moderated by a PI. Discussed successes, barriers, and experiences encountered throughout their professional, educational, and personal life. Audio was de identified, transcribed, cleaned, and coded line by line into NVIVO 12 (QSR International Pty Ltd, Victoria, Australia) software. Conclusions Primary Themes from the focus groups were: Barriers, Diversity, Grit, Divine Intervention, and Suggestions to Improve Diversity. Subthemes were: Societal Challenges, Academic Experiences/Challenges, Financial Challenges, Diversity Challenges/Struggles, Awareness of Diversity, Need for Diversity in PT, Outreach, Mentorship, and Exposure. Focus group research provided more in depth perspectives regarding diversity within the physical therapy profession. Implications Recommend early and ongoing mentorship and outreach initiatives beginning in primary school to increase awareness of the profession. Sub themes within this study will hopefully assist the MNPTA to create effective programs for URM individuals pursuing the PT/PTA profession. Address health disparities that limit URM from accessing physical therapy services. Future research: to continue this study design with participants from the LGBTQ+ community and the socioeconomically and educationally disadvantaged population

From Classroom to Practice: Implementing the Core Set of Outcome Measures in a Student-Led Clinic

Background: Literature suggests that Clinical Practice Guidelines (CPGs) are insufficient for facilitating behavior change in clinicians. However, translating research to clinical practice is essential for evidence-based practice. Prior to publication of the Core Set of Outcome Measures (CSOMs) for Adults with Neurologic Conditions CPG, all recommended outcome measures (OMs) were included in the University of Puget Sound curriculum. Beginning Fall 2018, didactic instruction adjusted such that clinical decision-making for the CSOMs was instructed as outlined in the CPG. Purpose: To determine whether utilization of CSOMs in a student-led neurologic outpatient physical therapy clinic changed after students received intentional didactic instruction on CPG utilization. The secondary aim was to determine whether OM utilization frequency changed. Methods: Patient diagnosis, patient ambulatory status, and frequencies of OMs administered were collected for all patients who attended a student-led neurologic physical therapy clinic between 2017 and 2022. Descriptive and inferential statistical tests were conducted using non-parametric methods. Results: Utilization of the CSOMs increased by 41% overall and 59% for ambulatory patients. Prior to Fall 2018, the most frequently utilized OMs were the Timed Up and Go (TUG), 5 Times Sit to Stand (5xSTS), Dynamic Gait Index, and Four Square Step Test. Following publication and instruction of the CPG, the most frequently utilized OMs were the TUG, 5xSTS, Activities-Specific Balance Confidence Scale, and Functional Gait Assessment. The frequency of overall OM utilization did not change. Conclusion: Students increased utilization of CSOMs after intentional didactic instruction. Frequency of overall OM utilization remained unchanged

COVID Restrictions Did Not Decrease Physical Activity in Community-Dwelling Older Adults

Background Understanding the long-term impacts of COVID-19-related stay-at-home orders on physical activity can help clinicians prepare for consequences that may impact their patient populations. Purpose This study examined effects of the 2020 COVID-19 stay-at-home orders on physical activity levels in community-dwelling older adults including the number of hours they spent walking outside of the home and working/volunteering in the community. Methods Eighty-nine participants completed a monthly Physical Activity Scale for the Elderly (PASE) for 10 months. One-way repeated measures ANOVAs with post hoc analyses were calculated to determine differences among PASE scores, PASE item 2 scores, and work/volunteer hours at baseline and for seven months following the implementation of COVID restrictions. Paired t-tests were calculated to determine differences in outcomes in the months prior to and after COVID restrictions. Results The mean baseline PASE score and PASE item 2 score were 131.96+56.49 and 23.39+21.10, respectively. Participants worked or volunteered 3.10+5.76 hours per week. There were no differences among monthly PASE scores (F=2.98, p=.018) except scores at baseline score and in August (107.26+60.19, p=.034). There were no differences in PASE item 2 scores or work/volunteer hours (F=1.03, p=.424; F=1.35, p=.246, respectively). No differences were found between pre- and post-restriction PASE scores, PASE item 2 scores, or work/volunteer hours (p=.732, .391, and .711, respectively). Conclusion Pre-COVID PASE scores did not differ from scores during seven months of COVID-19 restrictions. Participants maintained a similar amount of time walking in their communities during the pandemic. The number of work/volunteer hours did not change during the COVID-19 restrictions