Finding Your Calling: An Online Seminar for Undergraduate Nursing Students.

ABSTRACT: The aim of this study was to assess if an evidence-based educational program focused on vocation and calling could improve undergraduate nursing students' sense of meaning in life and sense of calling/vocation. Using a mixed-methods, quasi-experimental design, a statistically significant increase occurred in sense of meaning in life and calling/vocation. Qualitative responses revealed growth in self-knowledge, importance of individual pathways, and recognition of nursing as one's calling. Courses on calling may encourage nursing students to commit to nursing as a calling.

Spiritual care of the child with cancer at the end of life: a concept analysis.

AIM: The aim of this paper is to report an analysis of the concept of spiritual care of a child with cancer at the end of life. BACKGROUND: Spirituality is a vital dimension of a child's experience at the end of life; providing comfort; support; and a sense of connection. Spiritual care is paramount to address the substantial spiritual distress that may develop. DESIGN: Rodgers' method of evolutionary concept analysis guided the review process. DATA SOURCES: The literature search was not limited by start date and literature through the end of 2012 was included. English, peer-reviewed texts in the databases CINAHL, ATLA and PubMed were included. METHODS: Critical analysis of the literature identified surrogate terms, related concepts, attributes, antecedents and consequences. RESULTS: The analysis identified six attributes: assessing spiritual needs; assisting the child to express feelings; guiding the child in strengthening relationships; helping the child to be remembered; assisting the child to find meaning; and aiding the child to find hope. Antecedents include existential questions and spiritual distress. Consequences include a peaceful death, spiritual growth, a relationship of trust and enhanced end-of-life care. CONCLUSION: Spiritual care is a vital aspect of holistic nursing care; however, gaps in knowledge and practice prevent children from receiving adequate spiritual care at the end of life. Nurses would benefit from increased awareness, skills and knowledge about spiritual care. Research is needed to identify interventions that exert the greatest effect on patient care outcomes.

Wilms tumor presenting with Lambert-Eaton myasthenic syndrome.

Paraneoplastic syndromes may affect the central and peripheral nervous system of adults and children with cancer. Neurological symptoms may resolve with treatment of the underlying neoplasm. We report the case of a child with Wilms tumor who presented with generalized weakness, fatigue, ptosis, hypokinesis, dysarthria, urinary retention, facial diplegia, ophthalmoplegia, and autonomic dysfunction. Routine electrodiagnostic testing, including repetitive nerve stimulation, was normal. Clinical features and stimulation single-fiber electromyogram were consistent with a neuromuscular junction transmission disorder, likely Lambert-Eaton myasthenic syndrome. The child's neurological status returned to normal with successful treatment of the tumor.

Guidelines for intensive care unit design.

OBJECTIVE: To develop a guideline to help guide healthcare professionals participate effectively in the design, construction, and occupancy of a new or renovated intensive care unit. PARTICIPANTS: A group of multidisciplinary professionals, designers, and architects with expertise in critical care, under the direction of the American College of Critical Care Medicine, met over several years, reviewed the available literature, and collated their expert opinions on recommendations for the optimal design of an intensive care unit. SCOPE: The design of a new or renovated intensive care unit is frequently a once- or twice-in-a-lifetime occurrence for most critical care professionals. Healthcare architects have experience in this process that most healthcare professionals do not. While there are regulatory documents, such as the Guidelines for the Design and Construction of Health Care Facilities, these represent minimal guidelines. The intent was to develop recommendations for a more optimal approach for a healing environment. DATA SOURCES AND SYNTHESIS: Relevant literature was accessed and reviewed, and expert opinion was sought from the committee members and outside experts. Evidence-based architecture is just in its beginning, which made the grading of literature difficult, and so it was not attempted. The previous designs of the winners of the American Institute of Architects, American Association of Critical Care Nurses, and Society of Critical Care Medicine Intensive Care Unit Design Award were used as a reference. Collaboratively and meeting repeatedly, both in person and by teleconference, the task force met to construct these recommendations. CONCLUSIONS: Recommendations for the design of intensive care units, expanding on regulatory guidelines and providing the best possible healing environment, and an efficient and cost-effective workplace.

Spiritual Care: Minimizing the Vulnerability of Parents Whose Children With Cancer Face the End of Life.

There is a distinct lack of literature related to the spiritual care of parents whose children with cancer are at the end of life. This has led to a dearth in evidence about how nurses may intervene with spiritual care interventions to best support these vulnerable parents. The purpose of this scoping review was to examine the evidence regarding the value of spirituality/spiritual care in minimizing the vulnerability of parents whose children were diagnosed with cancer and who faced the end of life. The Arksey and O'Malley methodological framework guided the analysis of the reviewed quantitative and qualitative literature. Spirituality and spiritual care provided bereaved parents and parents of children with cancer with necessary support and enhanced coping to allow them to better deal with this devastating experience. Spirituality and spiritual care instilled hope, assisted in the search for meaning and purpose, and guided parents to develop continuing bonds with their child. Through skillful communication, pediatric oncology nurses may guide parents of children who face the end of life to strengthen relationships that offer support, plan activities that provide opportunities for hope and connection, and identify sources of meaning in their experiences.

Care of the Spirit: Effects of an Interdisciplinary Undergraduate End-of-Life Course on Knowledge, Competence, and Response Empathy.

The purpose of this pilot was to identify the effects of a 4-credit interdisciplinary undergraduate course focused on communication strategies to enhance spiritual care at the end of life. The course provided students with opportunities to enhance their ability to communicate empathically with individuals facing the end of life. Evidence-based content focused on ways to live each day with hope and gratitude, strengthen relationships, create a legacy, and find meaning and purpose in life and death. Narayanasamy's (1999) Actioning Spirituality and Spiritual Care Education and Training in Nursing model guided project development. The study used a prospective, pretest/posttest design. Participants included undergraduate students (n = 34) from nursing, premedicine, athletic training, business, economics, and religious studies at a Midwest liberal arts college. Statistically significant differences were found in students' attitudes toward and knowledge of spirituality/spiritual care (P < .0001, Cohen's d = 0.59), spiritual care competence (P < .0001, Cohen's d = 0.79), and level of response empathy through role play (P < .0001, Cohen's d = 0.92). Many students referred to this course as "life changing" and "healing." As our students go out into the community, they may intimately touch the lives and hearts of future patients, family, and friends who face the end of life with their compassionate words.

Validation of spinal motion with the spine reposition sense device.

BACKGROUND: A sagittal plane spine reposition sense device (SRSD) has been developed. Two questions were addressed with this study concerning the new SRSD: 1) whether spine movement was occurring with the methodology, and 2) where movement was taking place. METHODS: Sixty-five subjects performed seven trials of repositioning to a two-thirds full flexion position in sitting with X and Y displacement measurements taken at the T4 and L3 levels. The thoracolumbar angle between the T4 and the L3 level was computed and compared between the positions tested. A two (vertebral level of thoracic and lumbar) by seven (trials) mixed model repeated measures ANOVA indicated whether significant differences were present between the thoracic (T4) and lumbar (L3) angular measurements. RESULTS: Calculated thoracolumbar angles between T4 and L3 were significantly different for all positions tested indicating spinal movement was occurring with testing. No interactions were found between the seven trials and the two vertebral levels. No significant findings were found between the seven trials but significant differences were found between the two vertebral levels. CONCLUSION: This study indicated spine motion was taking place with the SRSD methodology and movement was found specific to the lumbar spine. These findings support utilizing the SRSD to evaluate changes in spine reposition sense during future intervention studies dealing with low back pain.

A new measurement method for spine reposition sense.

BACKGROUND: A cost effective tool for the measurement of trunk reposition sense is needed clinically. This study evaluates the reliability and validity of a new clinical spine reposition sense device. METHODS: The first part of this three part investigation included 45 asymptomatic subjects examined in the first 20 repeated trials portion assessing spine reposition sense. The second portion, test-retest, examined 57 asymptomatic subjects. Initial testing consisted of subjects sitting on the device and performing 20 trials of a self-determined 2/3 trunk flexion position. The second portion of the study involved 7 trials of trunk flexion performed twice. The angular position for each trial was calculated and the mean reposition error from the initial 2/3 position was determined. For the third portion, the new device was compared to the Skill Technologies 6D (ST6D) Imperial Motion Capture and Analysis System. RESULTS: ICC (3,1) for trials 4-7 was 0.79 and 0.76 for time one and time two, respectively and the test-retest ICC (3,k) was 0.38. Due to the poor test-retest ICC, the Bland Altman method was used to compare test and retest absolute errors. Most measurement differences were small and fell within the 95% confidence interval. Comparable measures between the two methods were found using the Bland Altman method to compare the reposition sense device to the ST6D system. CONCLUSION: The device may be a cost effective clinical technique for sagittal trunk reposition sense measurement.

Long-term locomotor training for gait and balance in a patient with mixed progressive supranuclear palsy and corticobasal degeneration.

BACKGROUND AND PURPOSE: Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are slowly progressive tauopathies characterized by impaired balance, disturbances in gait, and frequent falls, among other features. Wheelchair dependence is an inevitable outcome in people with these disorders. Insufficient evidence exists regarding the effectiveness of exercise in the management of people with these disorders. This case report describes a program of exercise and long-term locomotor training, using a treadmill (both with and without body-weight support), to reduce falls and improve the balance and walking ability of a patient with mixed PSP and CBD features. CASE DESCRIPTION: Six years after diagnosis with mixed PSP and CBD features, the client, a 72-year-old dentist, was seen for physical therapy for asymmetric limb apraxia, markedly impaired balance, and frequent falls during transitional movements. INTERVENTION: Over a 2.5-year period, intervention included routine participation in an exercise group for people with Parkinson disease (mat exercise and treadmill training) and intermittent participation in individual locomotor training on a treadmill. The exercise group met for 1 hour, twice weekly. The individual treadmill sessions lasted 1 hour, once weekly, for two 14-week periods during the follow-up period. OUTCOMES: Over the 2.5-year period, fall frequency decreased, and tests of functional balance showed improved limits of stability (functional reach tests) and maintained balance function (Berg Balance Scale). Tests of walking performance showed only slight declines. A 4-wheeled walker was introduced and accepted by the client early in the intervention period. The client, with supervision, remained ambulatory with this wheeled walker in the community. DISCUSSION: In this case report of a person with mixed PSP and CBD features, a physical therapy intervention, which included locomotor training using a treadmill and a long-term exercise program of stretching and strengthening, appears to have improved some dimensions of balance, slowed the rate of gait decline, prevented progression to wheelchair dependence, and decreased falls. Contrary to the expected decline in function, this client maintained independent mobility over a 2.5-year period. An ongoing, intensive program of exercise and locomotor training may help people with PSP and CBD maintain upright balance, decrease falls, and decrease the rate of decline of ambulation.

Reliability of lumbar spinal palpation, range of motion, and determination of position.

BACKGROUND: The study purposes were to investigate the level of agreement of palpation of lumbar spinous processes between examiners, test-retest repeatability of lumbar spine range of motion, and the reliability of upright position measures in asymptomatic subjects. METHODS: The modified CA 6000 spinal motion apparatus with a new skin fixation system was used by three operators for the test-retest spine measurements (3 days apart), and to obtain measures at one session of spinal position. Mean ranges of motion in all planes for 22 asymptomatic subjects were reported using the Intra-class Correlation Coefficient. RESULTS: Overall, differences in palpation agreement for lumbar segments occurred in three subjects and did not affect range of motion values. For upright spinal position, ICC (2,3) values for sagittal, coronal, and horizontal plane positions were 0.96, 0.80, and 0.98 respectively. There were statistically significant differences between examiners for position values, determined by the Bonferroni t-test (p < 0.05), but the magnitude of the differences were 2 degrees or less, and not considered clinically important. CONCLUSION: Results suggest that lumbar spinal motion measurements and position determination between different operators can be consistent particularly if utilizing the modified instrument. Static lumbar position also appears to be recorded reliably between different operators. Results justify progression to multi-center lumbar research using the modified CA 6000 and the work is considered relevant to medical clinicians working with spinal dysfunction, surgical interventions, or occupational health.

The reliability and minimal detectable change of the cardiovascular response and self-selected exercise intensity during forward and backward treadmill exercise in individuals with Parkinson disease.

OBJECTIVE: This study examined test-retest relative (intraclass correlation coefficient) and absolute (minimum detectable change) reliabilities for heart rate, blood pressure, rate of perceived exertion, and the cerebral oxygen response during both forward and backward treadmill walking in clients with Parkinson disease. In addition, the intensity of exercise based on the individual's heart rate response during forward and backward walking treadmill work was assessed. DESIGN: Test-retest reliability study. SUBJECTS: A total of 22 clients with Parkinson disease (Hoehn and Yahr stages 1-3). MAIN MEASURES: Outcome measures of heart rate, blood pressure, and cerebral oxygen response were assessed during forward and backward walking on a treadmill for a total of 20 minutes up to an intensity based on the clients' prior treadmill work and their rate of perceived exertion. RESULTS: Good to excellent 6-8 day test-retest findings for both forward (intraclass correlation coefficient(2,1), 0.89-0.99) and backward (intraclass correlation coefficient(2,1), 0.82-0.99) treadmill walking were found for heart rate, blood pressure, cerebral oxygen response, and the participants' rate of perceived exertion. Low minimum detectable change (MDC)95 values were found for heart rate (4.9 and 4.8), rate of perceived exertion (1.0 and 1.6), and cerebral oxygen response (1.2 and 0.92), during forward and backward walking, respectively. All treadmill exercise heart rates attained by participants were within an intensity of 54%-87% of the client's predicted maximal heart rate. CONCLUSION: Treadmill exercise training can be included in Parkinson disease exercise programs with relative confidence in test-retest reliability of cardiovascular response. It was also demonstrated that individuals with Parkinson disease previously involved with exercise consistently self-select walking speeds which induce heart rates within recommended guidelines for positive cardiovascular adaptation.

Reliability and Minimal Detectable Change for Sit-to-Stand Tests and the Functional Gait Assessment for Individuals With Parkinson Disease.

BACKGROUND AND PURPOSE: This study examined test-retest relative (intraclass correlation coefficient [ICC]) and absolute (minimum detectable change [MDC]) reliabilities for the 5 times sit-to-stand (5×STS), 30-second sit-to-stand (30sSTS), and the functional gait assessment (FGA) tests in people with Parkinson disease (PD). In addition, correlation of these functional tests with a history of falls was examined over a 6-month period, and the internal consistency of the FGA was established. METHODS: Twenty-two patients with PD (Hoehn and Yahr stages 1-3) completed 3 functional tests over 2 test-retest periods of 6 to 8 days. Falls were self-reported for the prior 6 months. RESULTS AND DISCUSSION: Moderate-to-excellent test-retest ICC(2,2) and MDC95 values were found for the 30sSTS (0.94, 3 times) and ICC(2,1) and MDC95 values were found for the FGA (0.86, 4 points). The 5×STS demonstrated a lower ICC(2,2) and a high MDC95 value (0.74, 10 seconds). A significant correlation was only found between past falls and the FGA test (r =-0.48, P < .05) during session 1. Cronbach α values for the 10-item FGA during session 1 and session 2 were 0.75 and 0.85, respectively. CONCLUSIONS: To assess for change over time, we found the 30sSTS and the FGA tests can be used reliably in patients with PD. A lower FGA score was associated with a higher chance of falls, and good internal consistency of the FGA was found.

An Online Educational Program Improves Pediatric Oncology Nurses' Knowledge, Attitudes, and Spiritual Care Competence.

This study evaluated the potential impact of an online spiritual care educational program on pediatric nurses' attitudes toward and knowledge of spiritual care and their competence to provide spiritual care to children with cancer at the end of life. It was hypothesized that the intervention would increase nurses' positive attitudes toward and knowledge of spiritual care and increase nurses' level of perceived spiritual care competence. A positive correlation was expected between change in nurses' perceived attitudes toward and knowledge of spiritual care and change in nurses' perceived spiritual care competence. A prospective, longitudinal design was employed, and analyses included one-way repeated-measures analysis of variance, linear regression, and partial correlation. Statistically significant differences were found in nurses' attitudes toward and knowledge of spiritual care and nurses' perceived spiritual care competence. There was a positive relationship between change scores in nurses' attitudes toward and knowledge of spiritual care and nurses' spiritual care competence. Online spiritual care educational programs may exert a lasting impact on nurses' attitudes toward and knowledge of spiritual care and their competence to provide spiritual care to children with cancer at the end of life. Additional studies are required to evaluate the direct effects of educational interventions patient outcomes.

Spirituality and Spiritual Care of Adolescents and Young Adults with Cancer.

OBJECTIVES: To review research on spiritual perspectives and spiritual care of adolescents and young adults (AYA) living with cancer. DATA SOURCES: Peer-reviewed publications, book chapters, and websites of professional organizations. CONCLUSION: There is a paucity of research specifically investigating AYA spirituality and lack of AYA-sensitive instruments to measure spirituality. Research that applies robust scientific methods to the study of AYA spirituality is needed. Research that provides evidence on which to base best practices for spiritual care that supports AYA spiritual well-being is likewise necessary. IMPLICATIONS FOR NURSING PRACTICE: Nurses can influence AYA health-related outcomes and experiences by providing ethical and evidence-based spiritual nurture.

Reliability of classifications derived from Cyriax's resisted testing in subjects with painful shoulders and knees.

STUDY DESIGN: Intrarater and interrater reliability. OBJECTIVES: Examine intrarater and interrater reliability of the resisted-testing component of Cyriax's selective tension testing for patients with painful shoulders and knees. BACKGROUND: Clinicians make diagnostic and intervention decisions about lesions in contractile tissues based on resisted testing. Diagnostic and intervention decisions require reliable data gathering, especially when more than 1 physical therapist manages a patient. No studies have examined agreement of the results of the resisted tests used in selective tension testing, either within or between physical therapists, in subjects having pathology. METHODS AND MEASURES: Subjects with pain in 1 knee (18 male, 22 female; mean age +/- SD = 31.8 +/- 9.5 years) or shoulder (21 male, 25 female; mean age +/- SD = 34.3 +/- 12.9 years) were examined twice. Referring diagnoses included ligament injuries, overuse syndromes, joint instability, and postsurgical symptoms, with some subjects seeking initial diagnosis. Two physical therapists used standardized positions to evaluate 2 knee motions or 6 shoulder and elbow motions. Evaluators applied maximal isometric manual resistance and rated the contraction as strong or weak while subjects identified the presence or absence of pain during the contraction. Evaluators did not interview the subjects and were masked to previous test results. Analyses included percentage of agreement, kappa coefficients, confidence intervals, and maximum kappa coefficients. RESULTS: Intrarater kappa coefficients ranged from 0.44 to 0.82 and interrater coefficients ranged from 0.00 to 0.46. The small number of subjects who were classified as weak affected the kappa coefficients. In the intrarater condition, evaluators averaged 91% of maximum kappa for the knee and 66.5% for the shoulder. In the interrater condition, they averaged 60.4% of the maximum kappa for both the knee and the shoulder. CONCLUSIONS: Based on 2 physical therapist evaluators with previous education in the selective tension system and an additional 6 hours of formal training on the methods, intrarater reliability of resisted tests was generally acceptable for the knee but not for the shoulder. Interrater reliability of these tests, however, was generally not acceptable. Results were limited by subjects who were younger and had mostly chronic conditions that were mildly to moderately severe and by the small subject samples in the analyses. Reliability might be improved by more intensive training of the evaluators and by standardizing the magnitude of the applied resistance and stabilization of the subjects.

Palliative and end-of-life care: precepts and ethics for the orthopaedic population.

Since the emergence of reports such as the and the , there continues to be a growing recognition of the multiple adverse effects of serious illness and chronic conditions, as well as the potential benefits of receiving palliative or end-of-life care. As modern technology expands its ability to support life, ethical dilemmas may be encountered in the provision of palliative or end-of-life care. Through integration of the precepts of palliative care and consideration of the relevant ethical principles, orthopaedic nurses may best meet their patients' comprehensive needs at an exceedingly difficult time.

Long-term exercise training for an individual with mixed corticobasal degeneration and progressive supranuclear palsy features: 10-year case report follow-up.

BACKGROUND AND PURPOSE: This case report describes the effects of long-term (10-year) participation in a community exercise program for a client with mixed features of corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP). The effects of exercise participation on both functional status and brain volume are described. CASE DESCRIPTION: A 60-year-old male dentist initially reported changes in gait and limb coordination. He received a diagnosis of atypical CBD at age 66 years; PSP was added at age 72 years. At age 70 years, the client began a therapist-led community group exercise program for people with Parkinson disease (PD). The program included trunk and lower extremity stretching and strengthening, upright balance and strengthening, and both forward and backward treadmill walking. The client participated twice weekly for 1 hour for 10 years and was reassessed in years 9 to 10. OUTCOMES: Falls (self-reported weekly over the 10-year period of the study by the client and his wife) decreased from 1.9 falls per month in year 1 to 0.3 falls per month in year 10. Balance, walking endurance, and general mobility declined slightly. Gait speed (both comfortable and fast) declined; the client was unable to vary gait speed. Quantitative brain measurements indicated a slow rate of whole brain volume loss and ventricular expansion compared with clients with autopsy-proven CBD or PSP. DISCUSSION: This client has participated consistently in a regular group exercise program for 10 years. He has reduced fall frequency, maintained balance and endurance, and retained community ambulation using a walker. Combined with the slow rate of brain volume loss, this evidence supports the efficacy of a regular exercise program to prolong longevity and maintain function in people with CBD or PSP.

The Effect of Parkinson Drug Timing on Cardiovascular Response during Treadmill Exercise in a Person with Parkinson Disease and Freezing of Gait.

PURPOSE: To examine the response of cerebral oxygenation during treadmill walking in a person with Parkinson disease (PD) who experiences freezing of gait (FOG) and to determine whether the oxygen response was related to the timing of his PD medication. Client Description: A 61-year-old man with PD performed two bouts of treadmill testing on the same day, during the on- and off-phases of his PD medication. Measures and Outcome: The client experienced two FOG episodes during the first testing session (on-phase with hypokinetic movement session). Cerebral oxygen response (measured by near-infrared spectroscopy) was stable until the FOG episodes occurred, at which point it decreased until the FOG episode was over. No electrocardiogram (ECG) changes or lightheadedness were noted; blood pressure (BP) remained stable. During the second exercise testing session (off-phase with dyskinetic movement session), the client did not experience any FOG episodes, and his cerebral oxygen response remained stable. Toward the end of the second testing session, he experienced lightheadedness and a drop in BP of approximately 30 mmHg, along with significant ST segment depression on his ECG. IMPLICATIONS: Haemodynamic and cerebral oxygen changes occurred that were specific to the timing of the client's PD medication and to his FOG episodes. This case study shows a person with PD demonstrating decreased cerebral oxygenation during FOG, which may be based on his variable response to levodopa medication or may be attributable to as yet unidentified physiologic mechanisms.

Objectif : Analyser la réaction de l'oxygénation cérébrale au cours de la marche sur tapis roulant chez une personne souffrant de la maladie de Parkinson (MP) aux prises avec un blocage de la marche (freezing of gait, FOG), puis déterminer si la réaction de l'oxygène cérébral est liée à l'horaire selon lequel ses médicaments pour la MP sont administrés. Description du client : Un homme de 61 ans souffrant de la MP. Il a accompli deux tests sur tapis roulant la même journée, lorsque ses médicaments pour la MP étaient en phase et lorsqu'ils étaient hors-phase. Mesures et résultat : Le client a vécu deux épisodes de FOG au cours de la première séance de tests (en phase, avec séance de mouvements hypocinétiques). La réaction de l'oxygène cérébral (mesurée par spectroscopie proche infrarouge) était stable jusqu'à ce que le trouble de la démarche se manifeste; elle a alors décru et est demeurée telle jusqu'à la fin de l'épisode de FOG. Aucun changement à l'électrocardiogramme (ECG) ni aucun étourdissement n'ont été observés et la tension artérielle (TA) est demeurée stable. Au cours de la deuxième séance de tests avec exercice (hors phase, avec séance de mouvements dyscinétiques), le client n'a pas subi d'épisodes de FOG et la réaction de l'oxygène cérébral est demeurée stable. À la fin de la deuxième séance, il a ressenti des étourdissements et sa tension artérielle a chuté d'environ 30 mmHg, et on a aussi constaté un fléchissement appréciable du segment ST de son ECG. Conséquences : Les changements survenus à l'oxygène hémodynamique et à l'oxygène cérébral étaient directement liés au moment de la prise des médicaments pour la MP par le patient et à ses épisodes de FOG. Cette étude de cas démontre que la baisse de l'oxygénation cérébrale au cours des épisodes de FOG chez une personne souffrant de MP peut s'expliquer par sa réaction variable à la lévodopa, ou peut être attribuable à des mécanismes physiologiques non encore identifiés.

Community-based exercise and wellness program for people diagnosed with Parkinson disease: experiences from a 10-month trial.

OBJECTIVE: This study considered whether a therapy community could create an infrastructure for developing and maintaining a service delivery model grounded in a clinic-based physiotherapy model. A longitudinal clinical study was conducted to assess the abilities of participants with Parkinson disease in a 10-month community exercise program. METHODS: Fifteen individuals averaging stage 3 on the Hoehn and Yahr scale, 6 years since Parkinson disease diagnosis, and 72 years old, participated. RESULTS: Graphical analysis of ambulation endurance demonstrated the strongest improvement over time (11%). Walking speeds, balance, and mobility showed a maintenance effect over the 10 months. The total unified Parkinson disease rating scale, activities of daily living subscale, and motor subscale remained statistically unchanged in the study. Scores on the unified Parkinson disease rating scale mentation, behavior, and mood subscale improved by 38%. None of the scores met or exceeded the minimal detectable change, MDC95 but two scores demonstrated more than 10% change. CONCLUSION: This clinical study implemented previous short-term research findings into an ongoing community wellness program for individuals with Parkinson disease. No community-based studies have demonstrated an ability to maintain a group for an extended time frame. Group exercise including forward and backward treadmill training, designed and monitored by a physical therapist, may improve or maintain functional outcomes.

Upper limb neurodynamic test of the radial nerve: a study of responses in symptomatic and asymptomatic subjects.

STUDY DESIGN: Clinical measurement. INTRODUCTION: Nonspecific cervical pain is a common clinical presentation. The role of upper limb neurodynamic tests (ULNT), for evaluation and treatment intervention, is not well defined for this population. PURPOSE OF THE STUDY: This study's purpose was to determine if the radial-biased (RB)-ULNT discriminates any response differences between symptomatic subjects with a positive (+) RB-ULNT (n=36), symptomatic subjects with a negative (-) RB-ULNT (n=24), and asymptomatic subjects (n=60). METHODS: Sixty asymptomatic and 60 subjects presenting with nonspecific cervical and/or unilateral upper extremity pain were compared using the RB-ULNT. Symptomatic subjects were further divided in (+) and (-) RB-ULNT groups due to their response to the RB-ULNT. Within the symptomatic population, a positive response to the RB-ULNT was defined by the symptomatic subject reporting their sensations were increased with contralateral cervical lateral flexion and decreased with ipsilateral cervical lateral flexion. Sensation provocation and location were evaluated using the RB-ULNT in all the subjects during each stage of the testing. RESULTS: Significant differences on stage of reproduction and type of sensations were identified between 1) the (+) RB-ULNT symptomatic subjects, 2) the (-) RB-ULNT symptomatic subjects, and 3) the asymptomatic subjects. The (+) RB-ULNT group showed significantly increased pain responses during the first stage of the RB-ULNT compared with the (-) RB-ULNT group and the asymptomatic subjects. The (+) RB-ULNT also showed significantly decreased glenohumeral abduction passive range of motion when compared with the asymptomatic group. CONCLUSION: Clinically, the differences found between the groups in their response to the RB-ULNT suggest heightened mechanosensitivity in the (+) RB-ULNT group. LEVEL OF EVIDENCE: 3a.