A preliminary investigation of digital media supplements for head and neck anatomy: Does production format matter?

From cassettes to digital, use of video in education has evolved. Supplemental digital media is a common educational adjunct within gross anatomy courses. As these aids have advanced technologically, so has production cost. Traditional lecture (T-lect) productions tend to be more efficient. Traditional gross anatomy laboratory (T-lab) productions requiring cadaver dissection and high-definition video are comparatively less efficient. This preliminary study pragmatically assessed T-lect and T-lab supplemental learning tools in a head and neck anatomy course for first-year dental students. Two videos of similar length were developed for different anatomical regions. Learning objectives were similar while format differed. A carotid triangle supplement was created using a T-lab production format and an infratemporal fossa aid was created using a T-lect format. Both incorporated recommended elements for facilitating learning. Development time and costs were documented. Student exam performance on topic specific questions was collected along with survey data. Group mean exam score comparisons between students who viewed (n = 74 T-lect, n = 70 T-lab) versus did not view (n = 27 T-lect, n = 30 T-lab) each aid revealed higher scores for the "viewed" group. The T-lab production cost ($15,190 versus $10,003) and time (19 hr. versus 18 hr) were greater than T-lect. Descriptive survey data did not reveal a format preference. Students valued previews/summaries and structure highlighting/labeling within the supplements. Students appreciated the supplemental learning aids and mean exam scores were higher for users. Since production format did not noticeably alter exam performance and satisfaction was similar, production efficiency should take precedence.

Effects of Leg Length, Sex, Laterality, and the Intermediate Femoral Cutaneous Nerve on Infrapatellar Innervation.

Background: An iatrogenic injury to the infrapatellar branch of the saphenous nerve (IPBSN) is a common precipitant of postoperative knee pain and hypoesthesia. Purpose: To locate potential safe zones for incision by observing the patterns and pathway of the IPBSN while examining the relationship of its location to sex, laterality, and leg length. Study Design: Descriptive laboratory study. Methods: A total of 107 extended knees from 55 formalin-embalmed cadaveric specimens were dissected. The nerve was measured from palpable landmarks: the patella at the medial (point A) and lateral (point B) borders of the patellar ligament, the medial border of the patellar ligament at the patellar apex (point C) and tibial plateau (point D), the medial epicondyle (point E), and the anterior border of the medial collateral ligament at the tibial plateau (point F). The safe zone was defined as 2 SDs from the mean. Results: Findings indicated significant correlations between leg length and height (r P = 0.832; P < .001) as well as between leg length and vertical measurements (≥45°) from points A and B to the IPBSN (r P range, 0.193-0.285; P range, .004-.049). Male specimens had a more inferior maximum distance from point A to the intersection of the IPBSN and the medial border of the patellar ligament compared with female specimens (6.17 vs 5.28 cm, respectively; P = .049). Right knees had a more posterior IPBSN from point F compared with left knees (-0.98 vs-0.02 cm, respectively; P = .048). The majority of knees (62.6%; n = 67) had a nerve emerging that penetrated the sartorius muscle. Additionally, 32.7% (n = 35) had redundant innervation, and 25.2% (n = 27) had contribution from the intermediate femoral cutaneous nerve (IFCN). Conclusion: We identified no safe zone. Significant innervation redundancy with a substantial contribution to the infrapatellar area from the IFCN was noted and contributed to the expansion of the danger zone. Clinical Relevance: The location of incision and placement of arthroscopic ports might not be as crucial in postoperative pain management as an appreciation of the variance in infrapatellar innervation. The IFCN is a common contributor. Its damage could explain pain refractory to SN blocks and therefore influence anesthetic and analgesic decisions.

Stylohyoid Syndrome.

A 26-year-old male presented with an ache deep to the angle of the left mandible and moderate, constant pain with swallowing, symptoms that had begun 3 years earlier. He was diagnosed with Eagle syndrome, characterized by cervical oropharynx pain due to an elongated styloid process. The patient consulted a physical therapist, who instructed the patient on a home exercise program based on imaging and examination findings. Six weeks later, the patient reported that he was able to swallow with only minimal, intermittent discomfort. J Orthop Sports Phys Ther 2019;49(8):621. doi:10.2519/jospt.2019.8759.

A comparative evaluation of teaching methods in an introductory neuroscience course for physical therapy students.

BACKGROUND: The use of computer-based instruction (CBI) in physical therapy education is growing, but its effectiveness compared to lecture is undefined. This study compared CBI to lecture in an introductory neuroscience course for students in their first year of a 3 year professional program leading to the Doctor of Physical Therapy Degree. SUBJECTS: Twenty-eight students participated in 2003 and 34 in 2004. METHODS: A randomized, cross-over design was employed. The course was divided into two sections with an exam after each. Students in one group participated in CBI during the first half of the course and lecture during the second half with the order of participation reversed for the other group. A 6 months post-course review exam was also administered. Exam scores, study time, and student opinions regarding teaching methods were collected after each half of the course. Course development costs for both teaching approaches were also documented. RESULTS: There were no statistically significant differences in exam scores between participant groups. CBI students spent less time studying. Student did not distinguish a major preference for either instruction method. Many students preferred that CBI be used as a complementary rather than mutually exclusive instructional method. Lecture-based instruction was much less expensive than CBI. CONCLUSION: Lecture-based instruction was more cost effective than CBI, but CBI was more time efficient in terms of student learning.

Heterotopic Ossification Following Hip Arthroscopy.

A 21-year-old woman initiated physical therapy 4 days following hip arthroscopic labrum debridement and osteochondroplasty. During postoperative rehabilitation, the patient's status regressed. With persistent symptoms, at 10 weeks postsurgery a computed tomography scan revealed, as confirmed by radiographs, heterotopic ossification development. J Orthop Sports Phys Ther 2018;48(4):344. doi:10.2519/jospt.2018.7420.

An Anatomic Investigation of the Ober Test.

BACKGROUND: Recent studies have questioned the importance of the iliotibial band (ITB) in lateral knee pain. The Ober test or modified Ober test is the most commonly recommended physical examination tool for assessment of ITB tightness. No studies support the validity of either Ober test for measuring ITB tightness. PURPOSE/HYPOTHESIS: The purpose of this study was to assess the effects of progressive transection of the ITB, gluteus medius and minimus (med/min) muscles, and hip joint capsule of lightly embalmed cadavers on Ober test results and to compare them with assessment of all structures intact. In addition, thigh position change between gluteus med/min transection and hip capsule transection was also assessed for both versions of the Ober test. It was hypothesized that transection of the ITB would significantly increase thigh adduction range of motion as measured by an inclinometer when performing either Ober test and that subsequent structure transections (gluteus med/min muscles followed by the hip joint capsule) would cause additional increases in thigh adduction. STUDY DESIGN: Controlled laboratory study. METHODS: The lower limbs of lightly embalmed cadavers were assessed for midthigh ITB transection versus intact by use of the Ober (n = 28) and modified Ober (n = 34) tests; 18 lower limbs were assessed for all conditions (intact band, followed by sequential transections of the ITB midthigh, gluteus med/min muscles, hip joint capsule) by use of both Ober tests. Paired t tests were used to compare changes in Ober test results between conditions. RESULTS: No significant changes in thigh position (adduction) occurred in either version of the Ober test after ITB transection. Significant differences were noted for intact band versus gluteus med/min transection and intact band versus hip joint capsule transection (P < .0001) for all findings for both tests. Mean inclinometer measurements for the modified Ober were 4.28° (n = 34 for intact vs ITB transection comparisons), 3.33° (n = 18 for subsequent intact vs gluteus muscle and hip capsule transection comparisons), 5.00° (n = 34 for midthigh ITB transection), 11.20° (gluteus med/min transection), and 13.20° (hip capsule transection). For the Ober test, measures were -2.90° (n = 28 for intact vs ITB transection comparisons), -2.20° (n = 18 for subsequent intact vs gluteus muscle and hip capsule transection comparisons), -2.20° (n = 34 for midthigh ITB transection), 6.50° (gluteus med/min transection), and 9.53° (hip capsule transection). Statistically significant differences were also noted between test findings comparing gluteus med/min transection to hip capsule transection (Ober, P < .0001; modified Ober, P = .0036). CONCLUSION: The study findings refute the hypothesis that the ITB plays a role in limiting hip adduction during either version of the Ober test and question the validity of these tests for determining ITB tightness. The findings underscore the influence of the gluteus medius and minimus muscles as well as the hip joint capsule on Ober test findings. CLINICAL RELEVANCE: The results of this study suggest that the Ober test assesses tightness of structures proximal to the hip joint, such as the gluteus medius and minimus muscles and the hip joint capsule, rather than the ITB.

Effects of specific exercise instructions on abdominal muscle activity during trunk curl exercises.

STUDY DESIGN: A repeated-measures, counterbalanced design. OBJECTIVES: To test whether subjects could learn and retain the ability to alter the relative activity of abdominal muscle groups when performing trunk curl exercises. BACKGROUND: Although trunk curl exercises are widely prescribed, a disadvantage of trunk curls is that they primarily activate rectus abdominis, while the internal and external oblique abdominis muscles are considered to be more important contributors to lumbar stability. METHODS AND MEASURES: A convenience sample of 25 subjects performed trunk curl exercises in accordance with 3 different sets of instructions: nonspecific instructions (NS), instructions intended to emphasize rectus abdominis activity (RE), and instructions intended to emphasize oblique abdominis activity (OE). Electromyographic (EMG) activity was recorded from the upper and lower rectus and the internal and external oblique abdominis muscles while a physical target was used to insure that the trunk was raised to the same height for all conditions. Normalized root-mean-square EMG amplitude measures were used to test for instruction-dependent changes in the relative EMG activity of the rectus and oblique muscle groups. RESULTS: Following a single, brief, instruction session, subjects performing trunk curls had significantly greater normalized oblique:rectus EMG ratios when following OE instructions (mean [+/- SD] oblique-rectus ratio, 1.45 +/- 0.34) than when following RE (mean [+/- SD] oblique-rectus ratio, 0.76 +/- 0.24) or NS (mean [ISD] oblique-rectus ratio, 0.63 +/- 0.23) instructions. Retesting 1 week later indicated that subjects retained this skill. CONCLUSIONS: With minimal instruction, subjects are able to volitionally alter the relative activity of the oblique and rectus abdominis muscles when performing trunk curls. Incorporating instructions emphasizing oblique abdominis activity into lumbar stabilization programs appears promising and has potential advantages over other approaches to altering abdominal muscle activity during trunk

T1 radiculopathy.

The patient was a 40-year-old man who had experienced a constant deep ache over his left T1-2 paravertebral muscle region. Following 2 weeks of physical therapist intervention with no improvement, the patient self-referred to a neurosurgeon. Magnetic resonance imaging of the cervical and upper thoracic spine regions was ordered and revealed a left paracentral disc protrusion at T1-2 that resulted in moderate left foraminal stenosis.

A patient with internal carotid artery dissection.

BACKGROUND AND PURPOSE: The purpose of this case report is to raise physical therapist awareness of Horner syndrome as a "red flag" for immediate medical referral. CASE DESCRIPTION: A 45-year-old man sought physical therapy for examination and treatment of neck pain and headache symptoms 5 days after experiencing a whiplash-type injury while waterskiing. His complaints were similar to a prior condition diagnosed as occipital neuralgia that had successfully responded to education, cervical and thoracic joint mobilization, and exercise provided by a physical therapist. The initial examination findings also were similar to those of the previous episode. However, signs consistent with Horner syndrome were noted on the second visit. This finding raised immediate concern on the part of the treating clinician and resulted in prompt physician referral, medical diagnosis, and intervention. OUTCOMES: A magnetic resonance imaging angiogram revealed an internal carotid artery dissection. A successful outcome was achieved over the course of 6 months through medical intervention, which consisted of anticoagulant therapy and modification of activity levels. DISCUSSION: In this case, the patient's sudden onset of signs of Horner syndrome was indicative of a medical emergency-internal carotid artery dissection.

Use of the Human Activity Profile for estimating fitness in persons with arthritis.

OBJECTIVE: To evaluate the usefulness of the Human Activity Profile (HAP) in predicting estimated maximal oxygen uptake (VO(2max)) in persons with arthritis and to evaluate the ability of 2 classification systems to distinguish individuals with arthritis who have poor fitness from those with average and above fitness. METHODS: Forty-four subjects with arthritis completed the HAP and a submaximal treadmill test. The adjusted activity score (AAS) was derived from responses on the HAP. VO(2max) was estimated from the submaximal treadmill test. The ability of the AAS and age to predict estimated VO(2max) was determined with multiple regression analysis. Subjects were also assigned to a fitness category based on their AAS and estimated VO(2max), and agreement of these categories was assessed using the kappa statistic. Two classification systems were used, including one proposed by the original authors and one we proposed based on more recent normative data. RESULTS: Sixty-six percent of the variance in estimated VO(2max) could be accounted for by the AAS and age. The kappa statistic for our proposed classification system was 0.35, indicating fair agreement, whereas the kappa statistic for the original classification system was incalculable. The sensitivity of the proposed classification system to identify persons with average and above fitness was 84%, with a specificity of 50%. CONCLUSION: We suggest that the HAP is useful in estimating fitness level when standard exercise testing is not feasible.