Motor Function in School-Aged Children With Positional Plagiocephaly or Brachycephaly.

OBJECTIVE: To determine whether children with a history of positional plagiocephaly/brachycephaly (PPB) show persistent deficits in motor development. METHODS: In a longitudinal cohort study, we completed follow-up assessments with 187 school-aged children with PPB and 149 participants without PPB who were originally enrolled in infancy. Primary outcomes were the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2) composite scores. RESULTS: Children with PPB scored lower than controls on the BOT-2. Stratified analyses indicated that differences were restricted to children who had moderate-severe PPB. No consistent differences were observed in children who had mild PPB. CONCLUSION: Children who had moderate-severe PPB in infancy show persistent differences in motor function. We suggest close developmental monitoring and early intervention to address motor deficits.

Infant/toddler motor skills as predictors of cognition and language in children with and without positional skull deformation.

PURPOSE: To estimate associations between early motor abilities (at two age points, 7 and 18 months on average) and cognitive/language outcomes at age 3. To determine whether these associations are similar for children with and without positional plagiocephaly and/or brachycephaly (PPB). METHODS: The Bayley Scales of Infant/Toddler Development 3 were given at all age points to 235 children with PPB and 167 without PPB. Linear regressions assessed longitudinal associations between fine and gross motor scales and cognition/language. Item analyses examined the contributions of specific motor skills. RESULTS: Associations between 7-month motor skills and cognition/language were modest overall (effect sizes [ES] = - 0.08 to 0.10, p = .13 to .95). At 18 months, both fine and gross motor skills were associated with outcomes for children with PPB (ES = 0.21 to 0.41, p < .001 to .01), but among those without PPB, only fine motor skills were associated with outcomes (ES = 0.21 to 0.27, p < .001 to .001). CONCLUSIONS: Toddlers' motor skills were associated with cognition and language at 3 years, particularly among children with PPB. Interventions targeting early motor development in infants and toddlers with PPB may have downstream benefits for other outcomes.

An examination of current stroke rehabilitation practice in Peru: Implications for interprofessional education.

This study aimed to better understand current clinical practice of rehabilitation professionals in Lima, Peru, and to explore the existence of and potential for interprofessional collaboration. A secondary purpose was to assess rehabilitation professionals' agreement with evidence-based stroke rehabilitation statements and confidence performing stroke rehabilitation tasks prior to and following an interprofessional stroke rehabilitation training. Current clinical practice for rehabilitation professionals in Peru differs from high-income counties like the United States, as physical therapists work with dysphagia and feeding, prosthetist orthotists serve a strictly technical role, and nurses have a limited role in rehabilitation. Additionally, while opportunity for future interprofessional collaboration within stroke rehabilitation exists, it appears to be discouraged by current health system policies. Pre- and post-training surveys were conducted with a convenience sample of 107 rehabilitation professionals in Peru. Survey response options included endorsement of professionals for rehabilitation tasks and a Likert scale of agreement and confidence. Training participants largely agreed with evidence-based stroke rehabilitation statements. Differences in opinion remained regarding the prevalence of dysphagia and optimal frequency of therapy post-stroke. Substantially increased agreement post-training was seen in favour of early initiation of stroke rehabilitation and ankle foot orthosis use. Participants were generally confident performing traditional profession-specific interventions and educating patients and families. Substantial increases were seen in respondents' confidence to safely and independently conduct bed to chair transfers and determine physiological stability. Identification of key differences in rehabilitation professionals' clinical practice in Peru is a first step toward strengthening the development of sustainable rehabilitation systems and interprofessional collaboration.

Motor Planning and Gait Coordination Assessments for Children with Developmental Coordination Disorder.

AIMS: The purposes were to examine construct validity of the Motor Planning Maze Assessment (Maze) and three items from the Functional Gait Assessment (FGA) that were modified for children (pediatric modified FGA, pmFGA), by comparing performance of children with DCD and age matched peers with typical development (TD); the construct validity of total scores of the Dynamic Gait Index (DGI) and the FGA. METHODS: Twenty pairs of children with DCD and TD, age from 5 to 12 years, participated in this study. Children in both groups were tested on the Maze, pmFGA, DGI, and FGA. Paired t-tests and agreement tables were used to compare the motor performances between two groups. RESULTS: The DCD group showed higher summary scores in the Maze (p < 0.001) and demonstrated significantly fewer steps (p ≤ 0.001) while doing the pmFGA items than the TD group. However, the FGA quality scores demonstrated minimal differences between the two groups on all three items. Children with DCD showed significantly lower DGI and FGA total scores (p < 0.001) than the TD group. CONCLUSION: The Maze, DGI, and FGA tests are easily applied in clinical settings and can differentiate motor planning and gait coordination between children with DCD and with TD.

Auditing Access to Outpatient Rehabilitation Services for Children With Traumatic Brain Injury and Public Insurance in Washington State.

OBJECTIVE: To identify insurance-based disparities in access to outpatient pediatric neurorehabilitation services. DESIGN: Audit study with paired calls, where callers posed as a mother seeking services for a simulated child with history of severe traumatic brain injury and public or private insurance. SETTING: Outpatient rehabilitation clinics. PARTICIPANTS: Sample of rehabilitation clinics (N=287): 195 physical therapy (PT) clinics, 109 occupational therapy (OT) clinics, 102 speech therapy (ST) clinics, and 11 rehabilitation medicine clinics. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Acceptance of public insurance and the number of business days until the next available appointment. RESULTS: Therapy clinics were more likely to accept private insurance than public insurance (relative risk [RR] for PT clinics, 1.33; 95% confidence interval [CI], 1.22-1.44; RR for OT clinics, 1.40; 95% CI, 1.24-1.57; and RR for ST clinics, 1.42; 95% CI, 1.25-1.62), with no significant difference for rehabilitation medicine clinics (RR, 1.10; 95% CI, 0.90-1.34). The difference in median wait time between clinics that accepted public insurance and those accepting only private insurance was 4 business days for PT clinics and 15 days for ST clinics (P≤.001), but the median wait time was not significantly different for OT clinics or rehabilitation medicine clinics. When adjusting for urban and multidisciplinary clinic statuses, the wait time at clinics accepting public insurance was 59% longer for PT (95% CI, 39%-81%), 18% longer for OT (95% CI, 7%-30%), and 107% longer for ST (95% CI, 87%-130%) than that at clinics accepting only private insurance. Distance to clinics varied by discipline and area within the state. CONCLUSIONS: Therapy clinics were less likely to accept public insurance than private insurance. Therapy clinics accepting public insurance had longer wait times than did clinics that accepted only private insurance. Rehabilitation professionals should attempt to implement policy and practice changes to promote equitable access to care.

Virtual Sensorimotor Training for Balance: Pilot Study Results for Children With Fetal Alcohol Spectrum Disorders.

PURPOSE: To examine the effects of Sensorimotor Training to Affect Balance, Engagement, and Learning (STABEL), a virtual reality system to train sensory adaptation for balance control, for children with fetal alcohol spectrum disorders (FASDs). METHODS: Twenty-three children with FASDs received STABEL training in a university laboratory, or home, or were controls. The Movement Assessment Battery for Children-2nd edition (MABC-2) and Pediatric Clinical Test of Sensory Interaction for Balance-2 (P-CTSIB-2) were analyzed by group (lab, home, and control), session (pre-STABEL, 1 week post-STABEL, and 1 month post-STABEL), and group-by-session interaction. RESULTS: Significant effects were group and session for MABC-2 Balance and interaction for MABC-2 Total Motor and P-CTSIB-2. CONCLUSION: Preliminary results support improved sensory adaptation, balance, and motor performance post-STABEL, which warrant further study with a larger, randomized sample.

Efficacy of adhesive taping as an adjunt to physical rehabilitation to influence outcomes post-stroke: a systematic review.

BACKGROUND: Adhesive taping as a therapeutic modality post-stroke has been investigated for two decades. No systematic review of the evidence to inform clinical practice exists. OBJECTIVE: To systematically review the efficacy of adhesive taping as an adjunct to physical rehabilitation on outcomes related to body function and structure, activity, and participation post-stroke. METHODS: The databases of PubMed, CINAHL, EMBASE, and Web of Science from 1966 through December 2013 were searched. Full-text articles in English from peer-reviewed journals reporting original research on the use of adhesive taping post-stroke were included. Two reviewers independently searched and then rated the quality of evidence using the PEDro evidence rating system. Randomized controlled trials were further assessed using the Consolidated Standards of Reporting Trials (CONSORT) guidelines. RESULTS: Fifteen studies met the inclusion criteria. Two used elastic tape and 13 used rigid tape. The evidence quality ranged from poor to good, and included seven shoulder, one wrist, two hip, one knee, and four ankle studies. There were four good-quality studies. CONCLUSIONS: Preliminary evidence in the domain of body function and structure suggests that use of rigid adhesive tape as an adjunct may increase the number of pain-free days at the shoulder. Evidence for the improvement of pain intensity, range of motion, muscle tone, strength, or function with taping is inconclusive. The evidence related to activity and participation is insufficient. The use of adhesive taping post-stroke needs further and more rigorous research to compare the types, methods and dosage of taping.

Development of items that assess physical function in children who use wheelchairs.

PURPOSE: To assess the content, format, and comprehension of the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric physical function related to mobility items for children who use wheelchairs (WCs). METHODS: During a cognitive interview, 14 children, aged 8 to 12 years, who use WCs, verbalized their thoughts when answering PROMIS items. The questionnaire appraisal system was used to code summarized text from the interviews. RESULTS: The children requested items be more specific and include options for reporting adaptive ways of performing and participating. How they would answer the item depended on the situation and specific environmental supports and constraints they may have experienced. CONCLUSIONS: As rehabilitation professionals develop and use self-reported outcome measures, they should explore what is important to children who use WCs regarding their views on physical functioning, the influences of the environment, and variability in the use of devices to assist with functional mobility.

Delayed or forgone care and dissatisfaction with care for children with special health care needs: the role of perceived cultural competency of health care providers.

To better understand if reported delayed/forgone care and dissatisfaction with care for children with special health care needs (CSHCN) are associated with the parent's perception of health care providers' cultural competency. National survey. Fifty United States and the District of Columbia yielding 750 families per state and District of Columbia with CSHCN ≤ 18 years participated in the 2005-06 National Survey of CSHCN. Outcome measures were delayed/forgone care in the past 12 months (yes or no) and dissatisfaction (very dissatisfied to very satisfied). Demographic/clinical characteristics and the parent's perception of health care providers' cultural competency were examined. Perception of cultural competency was defined by questions related to time spent with child, respect for family values, listening to the family, sense of partnership, and information provided. Delayed/forgone care and dissatisfaction with care were associated with perceived health care provider cultural competency. Parents whose children were older, whose children's condition affected their ability to do things, whose interviews were not conducted in English, and were from certain racial and ethnic groups reported more delayed or forgone care and were more dissatisfied with their children's health care. Delayed/forgone care and dissatisfaction with care were associated with perceived cultural competency of health care providers. This did not appear to differ consistently by racial or ethnic group. Further research using more refined instruments and longitudinal designs is needed to assess the effects of health care providers' cultural competency and other cultural factors on the delayed/forgone care for CSHCN and on the dissatisfaction with care of parents with CSHCN.

Information access and sharing among prosthetics and orthotics faculty in Ghana and the United States.

BACKGROUND: Information access is essential for quality healthcare provision and education. Despite technological advances, access to prosthetics and orthotics information in low- and middle-income countries is not ubiquitous. The current state of information access, availability, and exchange among prosthetics and orthotics faculty is unknown. OBJECTIVES: Describe information exchange networks and access at two prosthetics and orthotics programs in Ghana and the United States. STUDY DESIGN: Cross-sectional survey, social network analysis. METHODS: An online survey of faculty at two prosthetics and orthotics programs using REDCap. The survey included a social network analysis, demographics, and prosthetics and orthotics information resources and frequency of use. Descriptive statistics were calculated. RESULTS: Twenty-one faculty members completed the survey (84% response). Ghanaian faculty were on average younger (median Ghana: 27 years, United States: 43 years), had less teaching experience, and had less education than US faculty. Textbooks were the most commonly used resource at both programs. The Ghanaian network had more internal connections with few outside sources. The US network had fewer internal connections, relied heavily upon four key players, and had numerous outside contacts. CONCLUSION: Ghana and US faculty have two distinct information exchange networks. These networks identify key players and barriers to dissemination among faculty to promote successful knowledge translation of current scientific literature and technology development. Social network analysis may be a useful method to explore information sharing among prosthetics and orthotics faculty, and identify areas for further study.

Global prevalence of traumatic non-fatal limb amputation.

BACKGROUND: Reliable information on both global need for prosthetic services and the current prosthetist workforce is limited. Global burden of disease estimates can provide valuable insight into amputation prevalence due to traumatic causes and global prosthetists needed to treat traumatic amputations. OBJECTIVES: This study was conducted to quantify and interpret patterns in global distribution and prevalence of traumatic limb amputation by cause, region, and age within the context of prosthetic rehabilitation, prosthetist need, and prosthetist education. STUDY DESIGN: A secondary database descriptive study. METHODS: Amputation prevalence and prevalence rate per 100,000 due to trauma were estimated using the 2017 global burden of disease results. Global burden of disease estimation utilizes a Bayesian metaregression and best available data to estimate the prevalence of diseases and injuries, such as amputation. RESULTS: In 2017, 57.7 million people were living with limb amputation due to traumatic causes worldwide. Leading traumatic causes of limb amputation were falls (36.2%), road injuries (15.7%), other transportation injuries (11.2%), and mechanical forces (10.4%). The highest number of prevalent traumatic amputations was in East Asia and South Asia followed by Western Europe, North Africa, and the Middle East, high-income North America and Eastern Europe. Based on these prevalence estimates, approximately 75,850 prosthetists are needed globally to treat people with traumatic amputations. CONCLUSION: Amputation prevalence estimates and patterns can inform prosthetic service provision, education and planning.

Do Infant Motor Skills Mediate the Association Between Positional Plagiocephaly/Brachycephaly and Cognition in School-Aged Children?

OBJECTIVE: Positional plagiocephaly/brachycephaly (PPB) is associated with lower cognitive scores in school-aged children. This study tested the hypothesis that infant motor skills mediate this association. METHODS: Children with a history of PPB (cases, n = 187) and without PPB (controls, n = 149) were followed from infancy through approximately 9 years of age. Infant motor skills were assessed using the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3), and cognition was assessed using the Differential Ability Scales, 2nd edition (DAS-2). The Bayley-3 motor composite was examined as a mediator of the association between PPB and DAS-2 general cognitive ability (GCA) scores. In secondary analyses, mediation models were examined for the DAS-2 verbal ability, nonverbal ability, and working memory scores; models using the Bayley-3 fine versus gross motor scores also were examined. RESULTS: Cases scored lower than controls on the DAS-GCA (ß = -4.6; 95% CI = -7.2 to -2.0), with an indirect (mediated) effect of ß = -1.5 (95% CI = -2.6 to -0.4) and direct effect of ß = -3.1 (95% CI = -5.7 to -0.5). Infant motor skills accounted for approximately 33% of the case-control difference in DAS-2 GCA scores. Results were similar for other DAS-2 outcomes. Evidence of mediation was greater for Bayley-3 gross motor versus fine motor scores. CONCLUSION: Infant motor skills partially mediate the association between PPB and cognition in school-aged children. Monitoring motor development and providing intervention as needed may help offset associated developmental concerns for children with PPB. IMPACT: To our knowledge, this study is the first longitudinal investigation of the development of children with and without PPB from infancy through the early school years and the first to examine motor skills as a mediator of cognitive outcomes in this population. The findings highlight the importance of early motor skills for other developmental outcomes. LAY SUMMARY: Infants' motor skills are related to the development of PPB and its association with later cognition. If your child has PPB, physical therapists may have an important role in assessing and providing treatment to promote motor development.

The effect of balance training on balance performance in individuals poststroke: a systematic review.

BACKGROUND AND PURPOSE: Stroke is a leading cause of long-term disability, and impaired balance after stroke is strongly associated with future function and recovery. Until recently there has been limited evidence to support the use of balance training to improve balance performance in this population. Information about the optimum exercise dosage has also been lacking. This review evaluated recent evidence related to the effect of balance training on balance performance among individuals poststroke across the continuum of recovery. On the basis of this evidence, we also provide recommendations for exercise prescription in such programs. METHODS: A systematic search was performed on literature published between January 2006 and February 2010, using multiple combinations of intervention (eg, "exercise"), population (eg, "stroke"), and outcome (eg, "balance"). Criteria for inclusion of a study was having at least 1 standing balance exercise in the intervention and 1 study outcome to evaluate balance. RESULTS: Twenty-two published studies met the inclusion criteria. We found moderate evidence that balance performance can be improved following individual, "one-on-one" balance training for participants in the acute stage of stroke, and either one-on-one balance training or group therapy for participants with subacute or chronic stroke. Moderate evidence also suggests that in the acute stage, intensive balance training for 2 to 3 times per week may be sufficient, whereas exercising for 90 minutes or more per day, 5 times per week may be excessive. DISCUSSION AND CONCLUSIONS: This review supports the use of balance training exercises to improve balance performance for individuals with moderately severe stroke. Future high-quality, controlled studies should investigate the effects of balance training for individuals poststroke who have severe impairment, additional complications/comorbidities, or specific balance lesions (eg, cerebellar or vestibular). Optimal training dosage should also be further explored. Studies with long-term follow-up are needed to assess outcomes related to participation in the community and reduction of fall risk.

A systematic review in prosthetics and orthotics education research.

BACKGROUND: Formal prosthetic/orthotic education has evolved greatly since its inception in the 1950s. The International Society for Prosthetics and Orthotics has established guidelines and recognition for prosthetic/orthotic programs worldwide. However, the current state-of-the-science in prosthetic/orthotic education is largely unknown. OBJECTIVES: To evaluate and synthesize available prosthetic/orthotic education research. STUDY DESIGN: Systematic review. METHODS: Three bibliographic databases were searched and quality of included articles assessed using criteria from the National Institutes for Health Quality Assessment Tool for Observational Cohort, Cross-Sectional Studies, and the Critical Appraisal Skills Programme Qualitative Research Checklist, and Delphi quality criteria. RESULTS: This review included 25 articles from 23 studies. Included studies explored description, development, implementation, and/or assessment of the teaching/learning methods, curriculum, program, or country/region level. Studies were conducted in 18 countries and published in 14 journals. Methodological quality was rated high in 6 articles, moderate in 6, and low in 13. Content synthesis was not attempted due to the heterogeneous literature. CONCLUSION: This systematic review suggests that prosthetic/orthotic education research is only being conducted at a limited level. There is a strong need for high quality, collaborative education research to be conducted and published in peer-reviewed journals to improve prosthetic/orthotic education and build a global conversation. CLINICAL RELEVANCE: Research in prosthetic/orthotic education is limited. The current body of literature is not sufficient to inform and guide future education of prosthetic/orthotic students. Opportunities to improve prosthetic/orthotic education research include academic collaborations, a dedicated education special issue or journal, and disciplinary support for prosthetic/orthotic education research.

Cognitive Outcomes and Positional Plagiocephaly.

: media-1vid110.1542/5972296741001PEDS-VA_2018-2373Video Abstract BACKGROUND: Studies have revealed an association between positional plagiocephaly and/or brachycephaly (PPB) and development, although little is known about long-term outcomes. We examined cognition and academic achievement in children with and without PPB, testing the hypothesis that children who had PPB as infants would score lower than controls. METHODS: We enrolled 187 school-aged children with a history of PPB and 149 controls. Exposures were the presence or absence and severity of infancy PPB (mild, moderate to severe). Cognitive and academic outcomes were assessed by using the Differential Ability Scales, Second Edition and Wechsler Individual Achievement Test, Third Edition, respectively. RESULTS: Children with PPB scored lower than controls on most scales of the Differential Ability Scales, Second Edition (standardized effect sizes [ESs] = -0.38 to -0.20) and the Wechsler Individual Achievement Test, Third Edition (ESs = -0.22 to -0.17). Analyses by PPB severity revealed meaningful differences among children with moderate to severe PPB (ESs = -0.47 to -0.23 for 8 of 9 outcomes), but few differences in children with mild PPB (ESs = -0.28 to 0.14). CONCLUSIONS: School-aged children with moderate to severe PPB scored lower than controls on cognitive and academic measures; associations were negligible among children with mild PPB. The findings do not necessarily imply that these associations are causal; rather, PPB may serve as a marker of developmental risk. Our findings suggest a role for assessing PPB severity in clinical practice: providing developmental assessment and intervention for infants with more severe deformation and reassurance and anticipatory guidance for patients with mild deformation.

Self-reported health status and quality of life in youth with cerebral palsy and typically developing youth.

OBJECTIVE: To describe self-reported health status and quality of life (QOL) of ambulatory youths with cerebral palsy (CP) compared with sex- and age-matched typically developing youth (TDY). DESIGN: Prospective cross-sectional cohort comparison. SETTING: Community-based. PARTICIPANTS: A convenience sample of 81 youth with CP (age range, 10-13 y) with Gross Motor Function Classification System (GMFCS) levels I through III and 30 TDY participated. They were recruited from 2 regional children's hospitals and 1 regional military medical center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants completed the Child Health Questionnaire-Child Form (CHQ-CF87) for health status and the Youth Quality of Life for QOL. RESULTS: Youth with CP reported significantly lower health status than age- and sex-matched TDY in the following CHQ-CF87 subscales: role/social behavioral physical, bodily pain, physical function, and general health (CP mean rank, 46.8-55.2; TDY mean rank, 62.2-80.9). There were significant differences across GMFCS levels. There were no significant differences in self-reported QOL. CONCLUSIONS: Self-reported health status, but not QOL, appears sensitive to the functional health issues experienced by ambulatory youth with CP. Pain management and psychosocial support may be indicated for them.

The relationship of physical activity to health status and quality of life in cerebral palsy.

PURPOSE: To compare the influence of functional level, ambulatory, and physical activity performance on self-reported health status and quality of life (QOL) of youth with cerebral palsy (CP) and with typical development. METHODS: A cross-sectional comparison cohort design was used in 81 youth with CP, ages 10 to 13 years and 30 youth with typical development. Participants wore the StepWatch monitor for 7 days and completed the Activity Scale for Kids, Child Health Questionnaire-Child Form, and Youth Quality of Life Questionnaire. Multiple regression analysis was used. RESULTS: Self-reported activity performance influenced self-reported physical (beta = 0.36), behavioral (beta = 0.32), and emotional (beta = 0.29) health. Functional level and performance did not influence QOL. CONCLUSIONS: Measures of ambulatory and physical activity and youth-reported health status separated from the measure of QOL seem helpful in defining the specific health issues of ambulatory youth with CP and have implications for physical activity intervention.

Children with fetal alcohol spectrum disorders: a descriptive profile of adaptive function.

BACKGROUND: Children with fetal alcohol spectrum disorders (FASD) demonstrate neurobehavioral impairments that affect function and participation. Adaptive behavior deficits have been documented; however, specific functional profiles are less well described. PURPOSE: This study compared caregiver-reported adaptive and maladaptive behaviors between a clinic-referred sample of 25 five- through eight-year-old children with FASD and a sample of 23 children with typical development. FINDINGS: Children with FASD were rated significantly lower on the Scales of Independent Behavior-Revised in social interaction and communication, personal-living skills, and community-living skills and significantly higher on maladaptive behavior scales. Exploratory contrasts revealed strengths and needs within specific functional domains, along with the need for more support and supervision than peers with typical development to perform day-to-day adaptive skills and manage behavior. IMPLICATIONS: Children with FASD and their caregivers need support for daily activities involving personal and social performance. Awareness of specific strengths and needs can guide interventions that promote function and participation.

Dual-task standing and walking in people with lower limb amputation: A structured review.

BACKGROUND:: People with lower limb amputation report the need to concentrate on walking. Dual-task paradigms are often used to study such interactions between cognition and the control of balance and gait in people with lower limb amputation. OBJECTIVES:: To summarize evidence related to dual-task standing and walking in people with lower limb amputation and discuss implications for future research. STUDY DESIGN:: Structured review. METHODS:: A structured search was completed in PubMed, CINAHL, and Web of Science from database inception to May 2017. Eligible articles were in English, included participants with lower limb amputation, and assessed dual-task standing or walking. Study information was extracted by one reviewer and assessed for accuracy by a second. RESULTS:: A total of 12 articles met eligibility criteria. Seven examined differences in dual-task standing or walking, and five assessed dual-task walking across microprocessor-controlled and non-microprocessor-controlled prosthetic knee conditions. CONCLUSION:: Results suggest that (1) dual-task interference in standing is greater for people with lower limb amputation than non-amputees and (2) the use of microprocessor-controlled knees improves dual-task performance for people with limited mobility compared to non-microprocessor-controlled knees. The small number of studies, diversity of dual-task methods, and methodological limitations challenge the synthesis of study results. Future research should assess specific clinical characteristics that can affect dual-task performance in people with lower limb amputation. CLINICAL RELEVANCE: Understanding how people with lower limb amputation use increased attention in balance and gait to compensate for limb loss can inform prosthetic interventions and training. Dual-task research suggests that people with amputation use increased cognitive control for standing compared to controls and microprocessor-controlled knees improve dual-task walking in people with limited mobility.

Instilling positive beliefs about disabilities: pilot testing a novel experiential learning activity for rehabilitation students.

PURPOSE: To develop and test a novel impairment simulation activity to teach beginning rehabilitation students how people adapt to physical impairments. METHODS: Masters of Occupational Therapy students (n = 14) and Doctor of Physical Therapy students (n = 18) completed the study during the first month of their program. Students were randomized to the experimental or control learning activity. Experimental students learned to perform simple tasks while simulating paraplegia and hemiplegia. Control students viewed videos of others completing tasks with these impairments. Before and after the learning activities, all students estimated average self-perceived health, life satisfaction, and depression ratings among people with paraplegia and hemiplegia. RESULTS: Experimental students increased their estimates of self-perceived health, and decreased their estimates of depression rates, among people with paraplegia and hemiplegia after the learning activity. The control activity had no effect on these estimates. CONCLUSIONS: Impairment simulation can be an effective way to teach rehabilitation students about the adaptations that people make to physical impairments. Positive impairment simulations should allow students to experience success in completing activities of daily living with impairments. Impairment simulation is complementary to other pedagogical methods, such as simulated clinical encounters using standardized patients. Implication of Rehabilitation It is important for rehabilitation students to learn how people live well with disabilities. Impairment simulations can improve students' assessments of quality of life with disabilities. To be beneficial, impairment simulations must include guided exposure to effective methods for completing daily tasks with disabilities.