Inpatient physical therapy rehabilitation provided for a patient with complete vision loss following a traumatic brain injury.

BACKGROUND: Data from the World Health Organization estimates the global incidence of traumatic brain injury resulting in hospitalization or mortality to be close to 10 million people each year. People who sustain a blast-related TBI are more likely to sustain visual impairment than people injured by other means. There is a lack of published literature regarding the most effective means to assist a patient's recovery from TBI with new vision loss. The aim of this report is to describe the physical therapy management of a person regaining functional mobility when newly blind following a blast-related TBI. METHOD: This case report describes the inpatient rehabilitation physical therapy (PT) services provided for a single subject who experienced a blast-related TBI with complete vision loss. OUTCOMES: The subject spent 3.5 weeks in IPR and participated in 21 PT sessions before being discharged home. Improvements in cognition, transfers and functional mobility with adaptations for vision loss were achieved, as well as caregiver training, to provide 24-hour supervision in the home. DISCUSSION: Collaborating with a blind specialist teacher assisted the rehabilitation of this subject. Further research is needed regarding the effective interventions for those with TBI and vision loss.

A Cohort Study of Relations Among Caregiver-Infant Co-Occupation and Reciprocity.

Co-occupation is the mutual engagement of two people in a shared occupation. Recent research has investigated co-occupational activities during sensitive periods to inform clinical practice. However, there remains a dearth of applied research to bridge gaps between research and practice within salient co-occupational relationships between caregivers and infants. The study applied co-occupational constructs of physicality, emotionality, and intentionality within caregiver-infant dyads across infancy. These constructs were examined in relation to caregiver-infant reciprocity in other domains (i.e., language, motor, and affective) to determine the overlapping features of reciprocal co-occupation with established aspects of reciprocity. Results suggest that as infants transitioned into toddlerhood and became more mobile and intentional in behavior, there were observable changes in caregiver-infant reciprocity. Caregiver utterances, affect, touch, and co-occupation were significantly related within and across time, highlighting the need for more studies to disentangle these relations in reference to infant development.

The Spinal Cord, Not to Be Forgotten: the Final Common Path for Development, Training and Recovery of Motor Function.

Research on learning, memory, and neural plasticity has long focused on the brain. However, the spinal cord also exhibits these phenomena to a remarkable degree. Following a spinal cord injury, the isolated spinal cord in vivo can adapt to the environment and benefit from training. The amount of plasticity or recovery of function following a spinal injury often depends on the age at which the injury occurs. In this overview, we discuss learning in the spinal cord, including associative conditioning, neural mechanisms, development, and applications to clinical populations. We take an integrated approach to the spinal cord, one that combines basic and experimental information about experience-dependent learning in animal models to clinical treatment of spinal cord injuries in humans. From such an approach, an important goal is to better inform therapeutic treatments for individuals with spinal cord injuries, as well as develop a more accurate and complete account of spinal cord and behavioral functioning.

Multivariable Artificial Pancreas for Various Exercise Types and Intensities.

BACKGROUND: Exercise challenges people with type 1 diabetes in controlling their glucose concentration (GC). A multivariable adaptive artificial pancreas (MAAP) may lessen the burden. METHODS: The MAAP operates without any user input and computes insulin based on continuous glucose monitor and physical activity signals. To analyze performance, 18 60-h closed-loop experiments with 96 exercise sessions with three different protocols were completed. Each day, the subjects completed one resistance and one treadmill exercise (moderate continuous training [MCT] or high-intensity interval training [HIIT]). The primary outcome is time spent in each glycemic range during the exercise + recovery period. Secondary measures include average GC and average change in GC during each exercise modality. RESULTS: The GC during exercise + recovery periods were within the euglycemic range (70-180 mg/dL) for 69.9% of the time and within a safe glycemic range for exercise (70-250 mg/dL) for 93.0% of the time. The exercise sessions are defined to begin 30 min before the start of exercise and end 2 h after start of exercise. The GC were within the severe hypoglycemia (<55 mg/dL), moderate hypoglycemia (55-70 mg/dL), moderate hyperglycemia (180-250 mg/dL), and severe hyperglycemia (>250 mg/dL) for 0.9%, 1.3%, 23.1%, and 4.8% of the time, respectively. The average GC decline during exercise differed with exercise type (P = 0.0097) with a significant difference between the MCT and resistance (P = 0.0075). To prevent large GC decreases leading to hypoglycemia, MAAP recommended carbohydrates in 59% of MCT, 50% of HIIT, and 39% of resistance sessions. CONCLUSIONS: A consistent GC decline occurred in exercise and recovery periods, which differed with exercise type. The average GC at the start of exercise was above target (185.5 ± 56.6 mg/dL for MCT, 166.9 ± 61.9 mg/dL for resistance training, and 171.7 ± 41.4 mg/dL HIIT), making a small decrease desirable. Hypoglycemic events occurred in 14.6% of exercise sessions and represented only 2.22% of the exercise and recovery period.

The Reciprocity Team: Development of an Interprofessional Research Collaboration.

The purpose of this article is to articulate and provide detail about an interprofessional research collaboration at a public university in a rural area of western United States. This interprofessional research collaboration was organized to explore infant and maternal reciprocity. As a part of the organization and process portion of the collaborative effort, the authors identify the unique attributes of their collaboration. Additionally, barriers to collaborative research are presented, with opportunities and recommendations made to support existing and future interprofessional collaborative efforts for basic science scholars, clinicians, and educators in health-related professions.

Dosage Parameters in Pediatric Outcome Studies Reported in 9 Peer-Reviewed Occupational Therapy Journals from 2008 to 2014: A Content Analysis.

Occupational therapists determine the dosage when establishing the plan of care for their pediatric clients. A content analysis was conducted using 123 pediatric occupational therapy outcomes studies from 9 scholarly international occupational therapy journals. The parameters of dosage were calculated using descriptive statistics in order to obtain a representation of dosage available within the current collage of pediatric occupational therapy outcomes studies. The results revealed that most studies reported portions of dosage parameters within the published studies. The average findings for the subcomponents related to dosage were session length (minutes) M = 58.7, duration of plan of care (weeks) M = 12.1, session frequency (per week) M = 3.4, and total hours of therapy (hours) M = 18.1. This first attempt at describing and calculating dosage related to pediatric occupational therapy practice indicates that evidence is lacking within the published literature to adequately guide OT dosage decisions. Further research related to dosage in pediatric occupational therapy practice is needed.

Salutary effects of combining early very low-dose systemic estradiol with growth hormone therapy in girls with Turner syndrome.

CONTEXT: Optimizing pubertal estrogen replacement in girls with Turner syndrome is important. OBJECTIVE: The study objective was to test the hypotheses that physiological estradiol replacement administered early with GH will preserve height potential as much as if administered late and that it will bring about a greater height gain than standard oral estrogen therapy combined with GH. DESIGN: The study was randomized to early or late estrogen treatment; follow-up was at 3.5 yr or later. SETTING: This was a multicenter outpatient study. PATIENTS: Turner syndrome girls 12.0-12.9 yr (n = 7) or 14.0-14.9 yr (n = 7) of age who began GH before age 12.0 yr were the patients. The girls were matched to National Cooperative Growth Study registry patients who began GH and oral conjugated estrogen at similar ages and were similarly followed to adult or near-adult height. INTERVENTIONS: Depot estradiol, 0.2 mg/month i.m., was given initially and gradually increased; GH was 0.05 mg/kg daily. MAIN OUTCOME VARIABLE: Adult or near-adult height was the main outcome variable. RESULTS: Depot estradiol treatment resulted in height significantly taller than predicted at 12 yr of age (P < 0.02). All height potential was gained in the first 2 yr of the study, during which the early group grew 3.5 cm more than the late group, which was receiving GH alone (P < 0.01). The early depot estradiol group also gained 5.9 cm more height after starting estrogen than did the early National Cooperative Growth Study group (P < 0.05). Although feminization proceeded slowly on the lowest dose of estradiol, it advanced normally thereafter. CONCLUSIONS: These results suggest that very low-dose parenteral estradiol permits relatively age-appropriate feminization without interfering with the effect of GH on the enhancement of height potential.

Advocacy Priorities and Strategies for ASAHP: A Survey of the ASAHP Membership.

The Association of Schools of Allied Health Professions (ASAHP) recently established a strategic goal to increase advocacy efforts. The purpose of this study was to identify advocacy priorities and preferred advocacy strategies among the ASAHP membership. A brief Advocacy Priorities and Strategies Survey was sent to 234 ASAHP members included in the ASAHP email list using an online survey software. Forty-eight members (20%) completed the survey. Data were analyzed using the online survey software and response frequency counts. ASAHP members identified the following federal advocacy priorities: 1) support for students entering allied health professions, 2) support for faculty seeking higher degrees to enhance quality of education in allied health programs, 3) support for higher education institutions to increase capacity of professional programs to address projected allied health workforce needs identified by the Bureau of Labor Statistics, and 4) support for research funding from federal agencies for allied health. The need for education regarding allied health professions to enhance advocacy efforts was also reported. Preferred advocacy strategies included scheduling ASAHP conferences in Washington, DC, to facilitate trips to Capitol Hill and visiting legislators in home states. Members also indicated a need to participate in advocacy training to enhance their advocacy skills.

A Call for Action: Advocating for Increased Funding for the Allied Health Professions: ASAHP Leadership Development Program.

Allied health professionals are a diverse group of health care workers who provide necessary services to patients in addition to, or in place of, services provided by physicians, nurses, and medical paraprofessionals. Two forces generating increased demand for allied health professionals are the aging of the US population and health care reform associated with the implementation of the Patient Protection and Affordable Care Act. Although the allied health professions comprise nearly 60% of the health care workforce, the funding to support workforce training, faculty development, and research in the allied health fields lags substantially behind funding for the physician and nursing professions. Increased advocacy efforts are needed to increase the awareness of what the allied health professions contribute to health care and to expand funding across all health care professions.

Impact of patient and caregiver transfer training provided by a physical therapist in the hospice setting: a case study.

BACKGROUND: As patients in hospice become increasingly dependent upon caregivers, physical therapy interventions can minimize the risk of injury to the patient or caregiver that may occur during transfers between surfaces. CASE DESCRIPTION: A 68-year-old male hospice patient was referred to physical therapy for strengthening and transfer training after a fall that resulted in the patient remaining in bed for 5 weeks due to an increased fear of falling. Treatments focused on caregiver training for correct transfer techniques. OUTCOME: During 10 treatment sessions, the patient and caregiver became independent and safe with all transfers. Although the patient's health declined, his risk for and fear of falling decreased. Confidence with transfers improved for the patient and caregiver. DISCUSSION: Physical therapy "benefits were immeasurable" for the patient and caregiver by teaching them how to safely perform patient transfers with reduced risk of injury.

Home health physical therapy intervention for an adolescent after intramedullary skeletal kinetic distractor limb-lengthening surgery: a case report.

UNLABELLED: This case report describes the physical therapy episode of care for an adolescent following surgical placement of an intramedullary skeletal kinetic distractor (ISKD) to minimize a leg-length discrepancy (LLD). METHODS: A 14-year-old female was referred to home health physical therapy 2 weeks after ISKD placement in her right femur. The initial evaluation revealed the need to instruct in ISKD limb-lengthening exercises, strength, flexibility, and endurance exercises and provide functional mobility training. RESULTS: The patient received nine treatments over 8 weeks. Her right femur length increased by 4 cm. Improvements occurred with functional mobility, the Bruinincks-Oseretsky Test of Motor Proficiency, and the Pediatric Evaluation of Disability Inventory. DISCUSSION: Home health physical therapy assisted this patient with reducing her LLD and improving her functional mobility. Further research is needed to identify the effectiveness of physical therapy interventions on functional mobility for adolescents after ISKD placements.

Paediatric occupational therapists' use of sound-based interventions: a survey study.

Sound-based interventions (SBIs) involve listening to psychoacoustically modified music as a means for promoting new neural pathways in individuals with neurological dysfunction. Multiple forms of SBIs exist and are being used by healthcare professionals despite the lack of evidence to support their efficacy. The purpose of this study was to describe how occupational therapists (OTs) are using SBIs as an intervention in paediatric practice. An online survey was conducted using SurveyMonkey® and was completed by OTs describing their use of SBIs with paediatric clients. Paediatric OTs are using SBIs in a variety of practice settings, with children with a variety of medical and developmental conditions, and primarily use a subjective assessment process for determining effectiveness. Most referrals for SBIs come from other OTs and parents, and reimbursement primarily is achieved through private-pay mechanisms. This study had a small sample size (n = 74) and an estimated response rate of 14.7%, so generalization to occupational therapy practice in the United States is not possible. Further research is needed to identify the internal and external influences on the selection of SBIs as an OT intervention in paediatric practice.