The Effect Of Mild Exercise Induced Dehydration On Sport Concussion Assessment Tool 3 (SCAT3) Scores: A within-subjects design.

BACKGROUND: Sports-related concussions are prevalent in the United States. Various diagnostic tools are utilized in order to monitor deviations from baseline in memory, reaction time, symptoms, and balance. Evidence indicates that dehydration may also alter the results of diagnostic tests. PURPOSE: The purpose was to determine the effect of exercise-induced dehydration on performance related to concussion examination tools. STUDY DESIGN: Repeated measures design. METHODS: Seventeen recreationally competitive, non-concussed participants (age: 23.1±3.1 years, height:168.93±10.71 cm, mass: 66.16 ± 6.91 kg) performed three thermoneutral, counterbalanced sessions (rested control, euhydrated, dehydrated). Participants were either restricted (0.0 L/hr) or provided fluids (1.0 L/hr) while treadmill running for 60 min at an intensity equal to 65-70% age-predicted maximum heart rate (APMHR). The Sport Concussion Assessment Tool 3 (SCAT3) was utilized to assess symptoms, memory, balance, and coordination. RESULTS: Statistically significant differences were seen among sessions for symptom severity and symptom total. The rested control session had significantly lower values when compared to the dehydrated session. Additionally, the symptom total in the rested control was significantly lower than the euhydrated condition as well. No statistically significant differences were seen for the BESS or memory scores. CONCLUSIONS: Mild exercise-induced dehydration results in increased self-reported symptoms associated with concussions. Clinicians tasked with monitoring and accurately diagnosing head trauma should take factors such as hydration status into account when assessing patients for concussion with the SCAT3. Clinicians should proceed with caution and not assume concussion as primary cause for symptom change. LEVEL OF EVIDENCE: Level 3.

Low-intensity Blast Wave Model for Preclinical Assessment of Closed-head Mild Traumatic Brain Injury in Rodents.

Traumatic brain injury (TBI) is a large-scale public health problem. Mild TBI is the most prevalent form of neurotrauma and accounts for a large number of medical visits in the United States. There are currently no FDA-approved treatments available for TBI. The increased incidence of military-related, blast-induced TBI further accentuates the urgent need for effective TBI treatments. Therefore, new preclinical TBI animal models that recapitulate aspects of human blast-related TBI will greatly advance the research efforts into the neurobiological and pathophysiological processes underlying mild to moderate TBI as well as the development of novel therapeutic strategies for TBI. Here we present a reliable, reproducible model for the investigation of the molecular, cellular, and behavioral effects of mild to moderate blast-induced TBI. We describe a step-by-step protocol for closed-head, blast-induced mild TBI in rodents using a bench-top setup consisting of a gas-driven shock tube equipped with piezoelectric pressure sensors to ensure consistent test conditions. The benefits of the setup that we have established are its relative low-cost, ease of installation, ease of use and high-throughput capacity. Further advantages of this non-invasive TBI model include the scalability of the blast peak overpressure and the generation of controlled reproducible outcomes. The reproducibility and relevance of this TBI model has been evaluated in a number of downstream applications, including neurobiological, neuropathological, neurophysiological and behavioral analyses, supporting the use of this model for the characterization of processes underlying the etiology of mild to moderate TBI.

Continuity of care in hospital rehabilitation services: a qualitative insight from inpatients' experience.

BACKGROUND: Few empirical studies have been conducted on the continuity of rehabilitation services, despite the fact that it may affect clinical outcomes, patient satisfaction, the perception of quality, and safety. OBJECTIVES: The aim of this study was to explore experiences and perceptions of inpatients receiving physical rehabilitation in an acute care hospital and how these experiences may have led to perceived gaps in the continuity of rehabilitation care. METHOD: Using qualitative research methods, fifteen semi-structured interviews were conducted with patients who received physical rehabilitation during hospital stay in an acute care hospital in Murcia, Spain. Interviews were transcribed verbatim, analyzed, and grouped into predetermined and emergent codes. RESULTS: Patients described three main themes in continuity of care: informational, management, and relational continuity. Several factors were described as influencing the perceived gaps in these three types of continuity. Informational continuity was influenced by the transfer of information among care providers. Relational continuity was influenced by patient-therapist relations and consistency on the part of the provider. Management continuity was influenced by consistency of care between providers and the involvement of patients in their own care. CONCLUSION: The participants in this study identified several gaps in three types of continuity of care (informational, management, and relational). Inpatients often perceive their experiences of rehabilitation as being disconnected or incoherent over time.

How the rehabilitation environment influences patient perception of service quality: a qualitative study.

OBJECTIVE: To identify elements of the environment that patients consider when evaluating the quality of a care experience in outpatient rehabilitation settings. DESIGN: A qualitative study using a modified grounded theory approach. Data collection used semistructured interviewing during 9 focus groups. SETTING: Three postacute ambulatory centers in metropolitan areas. PARTICIPANTS: Adults (N=57; 33 men, 24 women) undergoing outpatient rehabilitation for musculoskeletal conditions/injuries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Participants perceived the quality of rehabilitation service on the basis of their experiences with environmental factors, including 3 physical factors (facility design, ambient conditions, and social factors) and 4 organizational factors (duration of attendance, interruptions during delivery of care, waiting times in the sequence of treatment, and patient safety). CONCLUSIONS: This study identifies the specific environmental attributes that patients consider important when evaluating the quality of outpatient rehabilitation settings and develops a patient-based framework for assessing the overall perception of service quality. Further research should work to develop self-report questionnaires about patient experiences with the environment in rehabilitation services to provide empirical and quantitative evidence.

Educational and professional issues in physical therapy--an international study.

Very little information exists regarding physical therapy educational and professional issues in various regions of the world. A better understanding may facilitate physical therapy (PT) practice, education, and research around the globe. The purpose of this study was to gain a worldwide perspective of physical therapy educational and professional issues in 40 separate countries. Forty countries known to provide PT were chosen from a World Confederation for Physical Therapy (WCPT) list of affiliates based on language, geography, and presumed PT practice. An English survey consisting of 22 items and four primary areas (accreditation of PT educational programs, licensure, specialization, and earning potential) was translated into five different languages (Spanish, French, Portuguese, Japanese, and Korean). The survey was administered electronically to key WCPT contacts in the 40 countries. The response rate was 42.5% and revealed modest diversity in physical therapy educational and professional issues among countries with the exception that 1) all but one country had an accreditation process for PT educational programs; 2) all but one country had licensure for PTs; and 3) all but five countries had a specialization process that included a written examination. Modest diversity in physical therapy educational and professional issues appears to exist among countries except for accreditation, licensure, and specialization.

Reliability and validity of patient reports for physical therapy quality assessment: an empirical analysis regarding the use of exercises for neck pain in Spain.

OBJECTIVE: To determine usefulness and reliability of patient reports as a data source on the use of exercises for neck pain in primary healthcare. DESIGN: Survey research. SUBJECTS: A total of 176 patients with mechanical neck pain, surveyed about their physical therapy experience. METHOD: A questionnaire was constructed on the selection of exercises, instructions for carrying them out and follow-up provided by the physical therapist. The same items reported by the surveyed patients were also reviewed in the physical therapy record. We analysed the reliability and validity of the questionnaire, and used the valid information from the survey to estimate a total of 8 indicators on the quality of care provided. RESULTS: Sensitivity of the items was high (>75%), suggesting that most of the recorded information could be provided by patients, and specificity was quite low, suggesting that they also provide relevant information that was not recorded. These results, particularly low specificity, were not homogeneous among items. Estimates for the indicators demonstrate room for improvement. CONCLUSION: Patient reports could be useful as a complement to other sources of information for physical therapy quality assessment, and they can be reliable and valid substitutes for recorded data about specific aspects of the care provided.

Emerging methods for the physiological assessment of occupational stress.

Occupational stress is implicated as an etiology for a variety of diseases. Many of the etiological theories surrounding these associations incriminate some deviation of autonomic nervous system activity. New methods of analyzing cardiovascular data obtained from a Holter monitor provide a window into a worker's autonomic nervous system throughout the day, in many cases for two days. These methods allow a variety of comparisons, for example, between workers of varying job stress levels, between work days and rest days, day and night, and between high stress and low stress periods. Identifying altered autonomic nervous system activity patterns throughout the day may: 1. provide insight into the etiology of stress related pathologies; 2. allow quantification of exposure; 3. investigate possible interaction effects of different exposures; 4. lead to monitoring methods capable of identifying whether an employee's job stress is increasing his or her risk for disease.