Virtual Faculty and Peer Mentoring to Promote Social Belonging among Minoritized Physical Therapist and Nursing Students.

Minoritized health sciences students report experiencing social isolation and discrimination, and cite the lack of faculty representation as barriers to their success. While virtual mentoring can increase sense of belonging and connectedness, these effects have not been examined in minoritized health sciences students. The purpose of this study was to investigate whether virtual mentoring from faculty and peers could decrease social isolation and promote social belonging among minoritized first-year physical therapy and nursing students. Using a mixed methods explanatory sequential design, racial and ethnic minority physical therapy and nursing students (n = 8) received virtual mentoring and attended virtual networking events while students from across the health profession programs served as a comparison group (n = 16). While virtual mentoring relationships took longer to establish, there was an increase in satisfaction with mentoring for the intervention group compared with no improvement for the comparison group who received traditional academic advising. Qualitative data analysis revealed that mentors served as role models who had overcome barriers and persevered, decreasing feelings of isolation, and bolstering mentee confidence. A virtual multiple-mentor model can decrease isolation and promote social belonging for minoritized students and offer support for students even after the pandemic.

Movement System Diagnoses for Balance Dysfunction: Recommendations From the Academy of Neurologic Physical Therapy's Movement System Task Force.

The movement system was identified as the focus of our expertise as physical therapists in the revised vision statement for the profession adopted by the American Physical Therapy Association in 2013. Attaining success with the profession's vision requires the development of movement system diagnoses that will be useful in clinical practice, research, and education. To date, only a few movement system diagnoses have been identified and described, and none of these specifically address balance dysfunction. Over the past 2 years, a Balance Diagnosis Task Force, a subgroup of the Movement System Task Force of the Academy of Neurologic Physical Therapy, focused on developing diagnostic labels (or diagnoses) for individuals with balance problems. This paper presents the work of the task force that followed a systematic process to review available diagnostic frameworks related to balance, identify 10 distinct movement system diagnoses that reflect balance dysfunction, and develop complete descriptions of examination findings associated with each balance diagnosis. A standardized approach to movement analysis of core tasks, the Framework for Movement Analysis developed by the Academy of Neurologic Physical Therapy Movement Analysis Task Force, was integrated into the examination and diagnostic processes. The aims of this perspective paper are to (1) summarize the process followed by the Balance Diagnosis Task Force to develop an initial set of movement system (balance) diagnoses; (2) report the recommended diagnostic labels and associated descriptions; (3) demonstrate the clinical decision-making process used to determine a balance diagnosis and develop a plan of care; and (4) identify next steps to validate and implement the diagnoses into physical therapist practice, education, and research. IMPACT: The development and use of diagnostic labels to classify distinct movement system problems is needed in physical therapy. The 10 balance diagnosis proposed can aid in clinical decision making regarding intervention.

Best Practices in the Clinical Management of Progressive Supranuclear Palsy and Corticobasal Syndrome: A Consensus Statement of the CurePSP Centers of Care.

Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS; the most common phenotype of corticobasal degeneration) are tauopathies with a relentless course, usually starting in the mid-60s and leading to death after an average of 7 years. There is as yet no specific or disease-modifying treatment. Clinical deficits in PSP are numerous, involve the entire neuraxis, and present as several discrete phenotypes. They center on rigidity, bradykinesia, postural instability, gait freezing, supranuclear ocular motor impairment, dysarthria, dysphagia, incontinence, sleep disorders, frontal cognitive dysfunction, and a variety of behavioral changes. CBS presents with prominent and usually asymmetric dystonia, apraxia, myoclonus, pyramidal signs, and cortical sensory loss. The symptoms and deficits of PSP and CBS are amenable to a variety of treatment strategies but most physicians, including many neurologists, are reluctant to care for patients with these conditions because of unfamiliarity with their multiplicity of interacting symptoms and deficits. CurePSP, the organization devoted to support, research, and education for PSP and CBS, created its CurePSP Centers of Care network in North America in 2017 to improve patient access to clinical expertise and develop collaborations. The directors of the 25 centers have created this consensus document outlining best practices in the management of PSP and CBS. They formed a writing committee for each of 12 sub-topics. A 4-member Steering Committee collated and edited the contributions. The result was returned to the entire cohort of authors for further comments, which were considered for incorporation by the Steering Committee. The authors hope that this publication will serve as a convenient guide for all clinicians caring for patients with PSP and CBS and that it will improve care for patients with these devastating but manageable disorders.

Pathological Examination of Plicated Medial Rectus Muscle for Treatment of Re-recurrent Exotropia.

Plication and resection are surgical procedures commonly used for the treatment of strabismus. Further studies are needed to understand the postoperative effects of plication on muscle tissue. This case report examines a pathological section of a plicated medial rectus muscle, revealing myocyte injury and replacement with fibroconnective tissue. [J Pediatr Ophthalmol Strabismus. 2018;55:e20-e21.].

Prevalence and Predictors of Anxiety in Doctor of Physical Therapy Students.

Anxiety is a condition with multiple physical manifestations and sequelae, including negatively impacting learning. The prevalence of anxiety and the factors that predict it in health professions students are unknown. The current study assessed the prevalence of anxiety in DPT students and examined the predictors of anxiety. The findings showed high student anxiety levels that were analogous to military recruits. Female gender and low GPA were predictors of anxiety in the sample. Further research is necessary to determine other factors that contribute to anxiety so that interventions to reduce anxiety in health professions students can be initiated.

Physical therapist practice in the emergency department observation unit: descriptive study.

BACKGROUND: An upward trend in the number of hospital emergency department (ED) visits frequently results in ED overcrowding. The concept of the emergency department observation unit (EDOU) was introduced to allow patients to transfer out of the ED and remain under observation for up to 24 hours before making a decision regarding the appropriate disposition. No study has yet been completed to describe physical therapist practice in the EDOU. OBJECTIVE: The objectives of this study were: (1) to describe patient demographics, physical therapist management and utilization, and discharge dispositions of patients receiving physical therapy in the EDOU and (2) to describe these variables according to the most frequently occurring diagnostic groups. DESIGN: This was a descriptive study of patients who received physical therapist services in the EDOU of Massachusetts General Hospital during the months of March, May, and August 2010. METHODS: Data from 151 medical records of patients who received physical therapist services in the EDOU were extracted. Variables consisted of patient characteristics, medical and physical therapist diagnoses, and physical therapist management and utilization derived from billing data. Descriptive statistics were used to analyze data. RESULTS: The leading EDOU medical diagnoses of individuals receiving physical therapist services included people with falls without fracture (n=30), back pain (n=27), falls with fracture (n=22), and dizziness (n=22). There were significant differences in discharge disposition, age, and total physical therapy time among groups. LIMITATIONS: This was a retrospective study, so there was no ability to control how data were recorded. CONCLUSIONS: This study provides information on common patient groups seen in the EDOU, physical therapist service utilization, and discharge disposition that may guide facilities in anticipated staffing needs associated with providing physical therapist services in the EDOU.

Use of the International Classification of Functioning, Disability and Health as a framework for analyzing the Stroke Impact Scale-16 relative to falls.

OBJECTIVE: To determine if subscores based on grouping Stroke Impact Scale 16 (SIS-16) items according to International Classification of Functioning, Health and Disability (ICF) components are more accurate in identifying individuals with a history of falls than the total SIS-16 score. DESIGN: Case series. SUBJECTS: 43 community-dwelling people with chronic stroke. METHODS: Participants were grouped based on six month fall history (no fall versus one or more falls). The SIS-16 items were categorized as belonging to the Body Structure and Function (BSF), Activity (ACT) or Participation (PART) component of the ICF. SIS-16 total score and ICF component subscores were analyzed for their association with falls. Receiver Operating Characteristic Curves were (ROC) analyzed. RESULTS: There were significant differences between groups on SIS-16 total (p = 0.006), BSF (p = 0.041) and ACT (p = 0.003) scores. The BSF and ACT component subscores had the highest specificity (0.91) and sensitivity (0.80), respectively, for categorizing participants according to fall history. The BSF + ACT component subscore demonstrated greater accuracy than the total SIS-16 for identifying people with falls (area under the curve = 0.78). CONCLUSION: The ICF may be a useful model for analysis of fall screening tools for people with chronic stroke. ICF component subscores are more accurate than the SIS-16 total score for this purpose.

Minimal clinically important difference of the functional gait assessment in older adults.

BACKGROUND: The Functional Gait Assessment (FGA) is commonly used to measure walking balance. The minimal clinically important difference (MCID) has yet to be determined for the FGA. OBJECTIVE: The purposes of this study were to determine: (1) the MCID in the FGA for older community-dwelling adults relative to patients' and physical therapists' estimates of change and (2) the extent of agreement between patients' and physical therapists' estimates of change. DESIGN: This study was a prospective case series. METHODS: Patients and physical therapists rated the amount of change in balance while walking after an episode of physical therapy for balance retraining on a 15-point global rating of change (GROC) scale. Weighted kappa statistics were calculated to express agreement between patients' and physical therapists' GROC ratings. Functional Gait Assessment change scores were plotted on receiver operating characteristic curves. A cutoff of +3 on the GROC was the criterion used for important change. The optimal FGA change cutoff score for MCID was determined, and sensitivity (SN), specificity (SP), and likelihood ratios (LRs) were calculated. RESULTS: One hundred thirty-five community-dwelling older adults (average age=78.8 years) and 14 physical therapists participated. There was poor agreement between the patients' and therapists' ratings of change (weighted kappa=.163). The estimated MCID value for the FGA using physical therapists' ratings of change as an anchor was 4 points (SN=0.66, SP=0.84, LR+=4.07, LR-=0.40). No accurate value for the FGA MCID could be determined based on the patients' ratings of change. LIMITATIONS: The small sample size was a limitation. CONCLUSION: Poor agreement between therapists' and patients' ratings indicate the need for further communication relative to patient goals. The 4-point MCID value for the FGA can be used for goal setting, tracking patient progress, and program evaluation.