Promoting pupil attainment and social inclusion by enhancing the spoken language skills of children in Moss Bay Ward: Phase One Report for Samuel Lindow Foundation

The aim of this project is to promote educational attainment and social inclusion of children in an area of high deprivation, by enhancing their skills in spoken language. The target for this stage of the phased project is to develop a research proposal for a pilot study that comprises a community-based language enrichment intervention initiative, which is tailored to the unique needs of the local community. It is anticipated that the pilot project outputs may subsequently be used to inform recommendations and planning for a wider roll-out of the initiative across the Region. In addition, the project findings will be used to underpin a bid for more substantial funding to assure future sustainability and more in-depth research into factors influencing effectiveness of the language enrichment initiative

Adapting to trauma: disengagement as a holding strategy

Purpose – The purpose of this paper is to draw upon a range of material to improve the understanding of disengagement with everyday life, by some individuals who have learning disabilities and mental health difficulties. Illustrative incidents from historical clinical cases are utilised, to consider whether this reframing may enhance the interpretation of presenting behaviours. Design/methodology/approach – Key recurring themes within transpersonal literature were reviewed, relevant to adults with behaviour indicating a degree of disengagement from everyday life. These were grouped into Physical Realm, Psychosocial Realm and Realm of Being. Illustrative examples of behaviour are reviewed and re-interpreted within this framework. Findings – These examples generated plausible interpretations for the presenting behaviours within this framework of the Three Realms. These interpretations support a fresh understanding of the quality of the individual’s inner experience. This paper suggests a potential framework to consider the way in which some individuals may experience a different quality of consciousness than the usual. Practical implications – Use of the Three Realms for behaviour interpretation should result into a more empathetic and client-centred approach that could reduce the need for aversive approaches, lessening risk for the client and any employing organisation. The identification of behaviours that signal participation in the Realm of Being could be defined and evaluated with the potential to be used to inform the nature and content of the support provided. Originality/value – This paper, rooted in clinical examples, offers an original synthesis with reasons to include the immaterial realm in the perspective of the human condition. This could benefit people with substantial episodes of disconnection from the Physical Realm and everyday culture and those who support them

The qual-CAT: applying a rapid review approach to qualitative research to support clinical decision-making in speech-language pathology practice

Systematic reviews and meta-syntheses of qualitative research produce ‘a sum greater than its parts’. Qualitative findings are examined alongside one another, and new insights are discovered about the topic under consideration. However, a barrier to clinicians undertaking these reviews is the time and knowledge required. Rapid review approaches, such as the Critically Appraised Topic (CAT), have recently been promoted in speech-language pathology, encouraging strategic, clinically driven examination of key research in focused topic areas, with the aim of supporting clinical decision-making. A strength of the CAT approach is that it supports interpretation and use of evidence by people who are not experts in the methodologies used. Additionally, CATs reduce the time input required by focusing on the best evidence available, and take a pragmatic approach to analysis across studies. While CAT methodologies have been detailed in relation to quantitative research, qualitative CAT methodologies have not specifically been discussed. Searching, ranking of research strength, appraisal and analysis methods are all likely to vary for qualitative CATs. This paper proposes and details a methodology for a “qual-CAT” approach, providing examples and steps that support the use of this methodology in practice

What do parents think about their involvement in speech-language pathology intervention? A Qualitative Critically Appraised Topic

A critically appraised topic (CAT) is one form of rapid review that can be particularly useful for informing practice. The purpose of this CAT was to determine what caregivers of preschool-aged children with speech, language or communication disorders (2–5 years of age) think of their involvement in speech-language pathology intervention in community-based settings. In addition to this CAT, the authors present and discuss a methodology for qualitative critically appraised topics (this issue). The authors propose an update to this CAT in June 2021

Promoting pupil attainment and social inclusion by enhancing the spoken language skills of children in Moss Bay Ward: Phase two Report for Samuel Lindow Foundation

The aim of this project is to promote educational attainment and social inclusion of children in an area of high deprivation, by enhancing their skills in spoken language. The target for this stage of the phased project is to develop a research proposal for a pilot study that comprises a community-based language enrichment intervention initiative, which is tailored to the unique needs of the local community. It is anticipated that the pilot project outputs may subsequently be used to inform recommendations and planning for a wider roll-out of the initiative across the Region. In addition, the project findings will be used to underpin a bid for more substantial funding to assure future sustainability and more in-depth research into factors influencing effectiveness of the language enrichment initiative

Mental Health staff views on improving burnout and mental toughness

Purpose- Burnout in mental health staff is acknowledged as a major problem. The purpose of this paper is to gain an understanding of mental health staff views on improving burnout and mental toughness in mental health staff. Design/methodology/approach-Ten participants from two mental health rehabilitation units across the North West of England took part in a Nominal Group Technique (NGT). Participants consisted of mental health workers from varied roles in order to capture views from a multidisciplinary team. The main question posed to the staff was “What strategies and techniques do you think could help improve burnout and mental toughness in mental health staff”. Findings- The study revealed that the top three ideas to take forward to help improve burnout and mental toughness in mental health staff were improving the culture/organisation, improving staff wellbeing and education. Additionally, staff were highly motivated and enthusiastic about engaging in discussion about what could be done to improve their wellbeing and the importance of taking this forward. Originality/Value- This study is unique in involving mental health staff in discussing their ways of improving their mental health. It is also unique as it has found the nine strategies to do this and these could be used in targeted training for mental health staff

An online survey using social media investigating the use of kinesiology type tape and McConnell type tape with clinicians who treat cycling related knee pain

Background: The Tour de France will undoubtedly showcase various cycling related injuries in its Yorkshire opening stages in 2014. Patello-Femoral Pain (PFP) is responsible for over 25% of all road cycling injuries and over 65% of injuries in the lower limb (Callaghan, 2005: Journal of Bodywork and Movement Therapies, 9, 226-236). Alongside trauma related pain it remains the main injury affecting experienced and elite cyclists and is commonly treated using taping (broadly categorised into McConnell and kinesiology type tape - KTT). To date it is unknown as to the extent and rationale behind the use of tape in cycling related knee pain. Purpose: To determine clinicians’ current use of taping in elite and experienced cyclists with cycling related knee pain in order to inform a 3D motion analysis study into current taping techniques. To date very little work has been undertaken in this area and although it is presumed that taping is used extensively throughout cycling, it is unknown as to how much it is actually used and the rationale behind its use. Methods: An online survey (Survey Monkey™) determined current taping techniques used by clinicians treating elite and experienced cyclists. A preferred taping application was determined and reported from a choice of 4 (fig 1). Data were collected from clinicians (n=30), identified as having an area of special clinical interest in cycling related knee pain within the target group. Recruitment was predominantly through the social network Twitter™. Data collected included; treatment methods, clinical taping usage, specific applications, perceived effectiveness of treatment, clinical rationale, formal training, clinical importance and outcome measures. Results: The data collected indicated a clear preference from clinicians for the use of KTT (figure 2) at >80%. 59% of clinicians used taping to manage pain, 46% for re-aligning patella, and 29% for activation of musculature, (figure 3). Clinicians preferred to initially apply tape, then test in-situ before re-applying (74%) and adapt to each cyclist (87%) - (figure 4). Reported outcome objectives were predominately pain management and biomechanical changes. When asked to score the effects of clinical taping, participants felt that pain; biomechanical changes and proprioception were effective to ‘some degree’ (figure 5). Proprioception was considered very influential by over 50% (figure 5). Reasons for use that scored highly were clinical effectiveness, ease of use and longevity (figure 6). Rating of efficacy and effectiveness scored high in ‘success of outcome’, ‘repeatability & reliability’, and ‘comfort’ (figure 7). >50% felt that placebo had some effect (figure 5). Discussion: KTT is clearly the tape of choice in cycling today. This is in contrast to the use of McConnell type tape in traditional physical therapy setting. There was considerable variability in clinician’s reasoning for taping use, reflecting gaps in the current knowledge base. Its clinical adaptation usage is in line with previous work by McConnell even though its longevity and comfort appears to separate its practice in cycling. The reported perception of placebo effect from KTT tape is an intriguing adjunct to the findings and should be considered in future research designs for effectiveness using this type of tape. This (placebo effect) was specified as a separate effect from that of proprioception however, which scored highly as a clinical effect. Notably, proprioception in cycling has not been effectively measured to date. Interestingly, clinicians felt it was an effect to some degree (fig 5) whilst also scoring it as not at all important clinically (Figure 7). The use of social media to recruit participants establishes a new and innovative approach to recruitment. This can be seen as timely due to its prevalence in today’s society and increased use amongst clinicians globally for both networking and evidence based practice debate and knowledge transfer. Conclusions. KTT appears the preferred application in cycling related knee pain. The data provide a clear rationale for the testing of specific taping techniques and indicate how clinicians are currently using taping in the treatment of cycling related knee pain. These results give a clear focus for a follow up study, which would aim to determine the biomechanical efficacy and clinical effectiveness of KTT. This work would determine any biomechanical changes in the PFJ during cycling as well as looking at any effects from neutral and no tape. In addition, a focus on pain and placebo would be interesting outcome measures of future work

Evaluation of an educational intervention that aims to improve the keep/refer decision-making abilities of Austrian undergraduate physiotherapy students: a randomised pilot study

Background/Aims An ongoing discussion about direct access to physiotherapy for patients with musculoskeletal pain disorders in Austria requires the development of a curriculum that educates physiotherapy students to make autonomous decisions to treat the patient without the need for medical referral (keep), to treat the patient with additional medical check-up (keep and refer) or to send the patient for medical evaluation without physiotherapeutic management (refer), and to recognise the presence of serious pathologies. The aim of this study was to examine the feasibility, acceptability and potential effectiveness of an educational intervention that was provided to Austrian physiotherapy students in their final semester of the 3-year undergraduate (bachelor) degree. Methods An educational intervention was given to Austrian physiotherapy students in their final semester of the 3-year undergraduate (bachelor) degree, which consisted of a single, 1-hour face-to-face case-based lecture on the principles of differential diagnosis, screening for possible red flag pathologies and review of the body systems. A control group did not receive the intervention, but both groups completed 11 validated vignettes. Results Half of Austrian universities (n=6/12) and 116 final year Austrian undergraduate physiotherapy students took part in the study. All students from the intervention group were satisfied with the intervention and 77.6% found the intervention beneficial for making keep/refer decisions based on clinical vignettes. Overall, 89.7% did not find the intervention too time consuming. A potential effectiveness of the intervention could not be demonstrated. Conclusions Future similar studies need to investigate if more teaching hours and/or if different educational methods are capable of improving the keep/refer decision-making abilities of Austrian undergraduate physiotherapy students

Keep/refer decision making abilities and screening for serious pathologies as integral components of the physiotherapy education and profession: The perspective of Austrian physicians

Background: Over the last few years, several surveys examined the attitude of physiotherapists towards direct access, increased practice autonomy and the necessity to detect the presence of serious pathologies. Objective: To gain insight into the attitude of Austrian physicians towards Austrian physiotherapists taking more responsibility when making clinical decisions. Method: In autumn 2017, an online survey was distributed by e-mail among 1000 general practitioners and 395 orthopaedic surgeons working in private practice in Austria. Results: 76 general practitioners (7.6%) and 40 orthopaedic surgeons (10%) completed the survey. 90% of responding general practitioners and 68% of participating orthopaedic surgeons believe that Austrian physiotherapists should make autonomous keep/refer decisions. Conclusion: Study participants are overwhelmingly positive towards Austrian physiotherapists taking an advanced level of practice autonomy and make independent keep/refer decisions

An investigation of the biomechanical efficacy and clinical effectiveness of patello-femoral taping in elite and experienced cyclists

Background: From high profile events such as the Tour De France and the Olympics, it is noticeable that kinesiology type taping (KTT) is used widely within elite cycling for treatment of knee pain. Taping is a clinical treatment for the over-use/overload pathology of patello-femoral pain (PFP) in elite and experienced cyclists, however it is unknown as to whether it effects any biomechanical change that can be useful in a clinical setting. PFP in cycling is often referred to as cyclists’ knee or anterior knee pain, and has been reported to occur in over 25% of all cyclists. (Callaghan, 2005: Journal of Bodywork and Movement Therapies, 9, 226-236). Some cyclists are pre-disposed to excessive knee movement during the pedal stroke (Bailey et al, 2003: Journal of Sports Sciences, 21 (2), 649–657), and consequently at different power levels and cadences this movement may affect biomechanical factors at the knee. An increased understanding of taping and the biomechanics of the knee during cycling could greatly improve the active prevention and treatment of overuse problems during cycling. Purpose: To determine and evaluate any biomechanical changes around the knee in elite and experienced cyclists both with and without knee pain, using established taping techniques at varying powers.Methods: 12 asymptomatic participants and 8 symptomatic participants conducted three separate tests at three powers (100w, 200w & 300w) on a static trainer using a Powertap™ rear wheel and their own bike (fig 1). The study was conducted under three randomised conditions a) no tape, b) placebo tape, c) Kinesiology type tape (fig 2). Kinematic data were collected using a 10-camera Qualysis motion analysis system (fig 3). Reflective markers were placed on the foot, shank, thigh and pelvis using the CAST technique (fig 4). Visual 3D software was used to export to SPSS (fig 5&6). Results: Measurements and statistical analysis were undertaken in the knee, hip and ankle/foot. Mixed methods and repeated-measures two-way ANOVA test were performed together with posthoc Pairwise comparison with Bonferroni adjustment to examine differences in three-dimensional movement under the different conditions/powers. Results were presented in kinematic pattern, range of motion (ROM) and statistical differences (fig 6,7,8) for comprehensive clinical application and relevance. Alongside this, a new approach was investigated to measure the knee ‘in relation to’ both the hip/pelvis and ankle/foot (fig 6). Results indicate statistical differences between conditions and powers (Fig 7) however at this stage their clinical significance has not yet been fully determined. The lower powers indicate instability and the higher powers indicate changes both distally and proximally to the knee. There appears to be a separation in the differences between cyclists tested with and without pain, however this does not necessarily indicate that KTT produces this in isolation. The differences vary across conditions and powers. Discussion: It is noticeable that the knee is not the only implicated joint in cycling related knee pain and taping. In fact all the recent evidence in this area indicate that distal and proximal to the knee are key factors (Powers et al, 2013: Journal Orthop Sports Physical Therapy. 42 (6), A1-54). In line with this evidence both the hip/pelvis and foot indicate changes that may be relevant to clinical application of taping with cyclists. It remains possible that there is a link between these movement patterns and cycling related knee pain however further work is required to fully determine this. The answer to the question does tape change what is happening at the knee is yes. Does it do different things with those with pain? Again, yes, to some degree. That said however, the clinical relevance requires a deeper analysis of the kinematic pattern data alongside the range of motion. The work undertaken to date in this project indicates the complexities of both human movement and the variables of a highly repetitive sport. The statistical change in the sagittal plane may indicate a muscular effect from taping however there were also changes by neutral taping which is interesting considering the specific nature of the KTT technique. Perhaps this specificity is not as critical as often indicated by manufacturers? Conclusion: Cycling related knee pain is a complex and under-researched area and we understand little of its treatment efficacy and effectiveness. Further work is required to investigate the relationship within the kinematics measured in this study. Distal and proximal effects are broadly in line with gait-based evidence. For clinical significance the statistics, kinematic patterns and ROM need to be considered as a whole. Specific application of tape technique may not be critical to achieve a measurable change