Exploring the Experiences and Impacts of Research Role-Emerging Placements in Physiotherapy.

Purpose: Research role-emerging placements (RREPs) have been integrated into placement offerings in Canadian physiotherapy programmes. The purpose of the present study is to describe the experiences and impacts of RREPs completed by graduates of Canadian physiotherapy programmes. Methods: Participants were recruited by purposive sampling and completed semi-structured interviews to explore their RREP experiences. Themes were identified using thematic analysis and collaboratively analyzed using the DEPICT model. Results: Eleven participants who completed RREPs during their Canadian physiotherapy programmes (three men, eight women; aged 26.9 [SD 2.7] years) took part in this study. The participants expressed the RREP was a valuable experience. Four themes emerged from the data: (1) Motivators for selecting an RREP included interest in research or a medical injury, (2) The RREP experience involved benefits and challenges, (3) Impacts of completing an RREP, and (4) RREP participant suggestions. Conclusions: RREPs are valuable placement opportunities for learners in Canadian physiotherapy programmes facilitating the development of essential competencies in a non-traditional setting. RREPs could be considered as a placement opportunity for other allied health programmes, as the skills gained are beneficial for all health care professionals.

Objectif: les stages de recherche dans un rôle émergent (SRRÉ) sont intégrés aux offres de stage des programmes de physiothérapie canadiens. La présente étude visait à décrire les expériences et les effets des SRRÉ effectués par les diplômés des programmes de physiothérapie canadiens. Méthodologie: les chercheurs ont recruté les participants par échantillonnage dirigé et ont effectué des entrevues semi-structurées pour explorer leurs expériences de SRRÉ. Ils ont extrait les thèmes au moyen d'une analyse thématique et en ont fait une analyse coopérative à l'aide du modèle DEPICT. Résultats: onze participants qui ont effectué des SRRÉ pendant leur programme de physiothérapie au Canada (trois hommes, huit femmes; 26,9 ± 2,7 ans) ont participé à l'étude. Ils ont trouvé que leur SRRÉ avait été une expérience précieuse. Ils ont tiré quatre thèmes des données : 1) les motivations pour sélectionner un SRRÉ incluaient l'intérêt pour la recherche ou une lésion médicale, 2) l'expérience du SRRÉ comportait des avantages et des difficultés, 3) les répercussions d'avoir effectué un SRRÉ et 4) les suggestions des participants aux SRRÉ. Conclusions: les SRRÉ sont de précieuses occasions de stage pour les apprenants des programmes de physiothérapie canadiens, ce qui a facilité l'acquisition de compétences essentielles dans un milieu non traditionnel. Les SRRÉ pourraient être considérés comme des occasions de stage dans des programmes de santé connexes, car les compétences acquises sont bénéfiques pour tous les professionnels de la santé.

Cutaneous Sensitivity Across Regions of the Foot Sole and Dorsum are Influenced by Foot Posture.

Understanding the processing of tactile information is crucial for the development of biofeedback interventions that target cutaneous mechanoreceptors. Mechanics of the skin have been shown to influence cutaneous tactile sensitivity. It has been established that foot skin mechanics are altered due to foot posture, but whether these changes affect cutaneous sensitivity are unknown. The purpose of this study was to investigate the potential effect of posture-mediated skin deformation about the ankle joint on perceptual measures of foot skin sensitivity. Participants (N = 20) underwent perceptual skin sensitivity testing on either the foot sole (N = 10) or dorsum (N = 10) with the foot positioned in maximal dorsiflexion/toe extension, maximal plantarflexion/toe flexion, and a neutral foot posture. Perceptual tests included touch sensitivity, stretch sensitivity, and spatial acuity. Regional differences in touch sensitivity were found across the foot sole (p < 0.001) and dorsum (p < 0.001). Touch sensitivity also significantly increased in postures where the skin was compressed (p = 0.001). Regional differences in spatial acuity were found on the foot sole (p = 0.002) but not dorsum (p = 0.666). Spatial acuity was not significantly altered by posture across the foot sole and dorsum, other than an increase in sensitivity at the medial arch in the dorsiflexion posture (p = 0.006). Posture*site interactions were found for stretch sensitivity on the foot sole and dorsum in both the transverse and longitudinal directions (p < 0.005). Stretch sensitivity increased in postures where the skin was pre-stretched on both the foot sole and dorsum. Changes in sensitivity across locations and postures were believed to occur due to concurrent changes in skin mechanics, such as skin hardness and thickness, which follows our previous findings. Future cutaneous biofeedback interventions should be applied with an awareness of these changes in skin sensitivity, to maximize their effectiveness for foot sole and dorsum input.

Foot sole cutaneous stimulation mitigates neuromuscular fatigue during a sustained plantar flexor isometric task.

Neuromuscular fatigue impairs motor coordination, movement stability, and proprioception, which further decreases performance. A neuromechanical coupling exists between foot sole cutaneous mechanoreceptors and motoneurons of the lower limb, however, the contribution of skin sensory input on muscle fatigue remains unclear. The purpose of this study was to determine if the presence of cutaneous stimulation could mitigate the effect of fatigue of the plantar flexor muscles during a sustained isometric task at 30% maximal voluntary contraction (MVC). Participants (N = 16, age 24.1 ± 2.6 yr) underwent a 30% isometric plantar flexor fatiguing task in a seated position with hip, knee, and ankle angle at 80°, 100°, and 90°, respectively, with intermittent MVCs until task failure. Failure was defined as when the participant could no longer maintain 30% MVC for a minimum of two seconds. Throughout the protocol, electrical stimulation was applied to either the right heel, right metatarsals, or no stimulation. A subset of participants (N = 6) underwent an additional condition with electrical stimulation applied to the left arm. MVCs were also conducted intermittently throughout recovery for 30 min. Foot sole cutaneous stimulation mitigated fatigue, as demonstrated by an ~15% increased time to task failure (TTF) compared with the control condition. When normalized to TTF, MVC torque amplitude was not different at each time epoch, which indicated that each %MVC was maintained longer into the fatigue task during the heel and metatarsal stimulation conditions However, there was no significant effect of cutaneous stimulation on recovery. The results indicate that cutaneous stimulation may serve as a feasible means to mitigate fatigue.NEW & NOTEWORTHY Cutaneous coupling with lower limb motor neurons has long been known. We set out to establish whether this pathway could serve a purpose other than muscular modulation during standing and walking. We found that during a submaximal contraction of the plantar flexor muscles, the addition of intermittent cutaneous stimulation to the skin of the foot sole resulted in an increase in time to task failure by 15%, which was over a minute longer in duration. We conclude that skin stimulation may serve as a mechanism to mitigate fatigue.

Effects of foot position on skin structural deformation.

As the largest and most superficial organ, the skin is well positioned for receiving sensory information from the environment. It is conceivable that changes in posture could result in deformations of the skin and subsequent changes in skin material properties. Specifically, the ankle and metatarsophalangeal joints have the capability to undergo large postural alterations with the potential to induce large structural deformations in the skin of the foot. The purpose of this study was to determine the extent to which alterations in foot posture may influence measures of foot sole and dorsum skin stretch, hardness, and thickness in vivo. Ten young and healthy individuals were tested while three static foot postures (plantar flexion, neutral and dorsiflexion) were maintained passively. Skin stretch deformation was quantified across each posture using an 11 × 4 point matrix of 3D kinematic markers affixed to the skin of the foot sole and dorsum. Skin hardness was assessed across each posture at specific locations of the foot sole (1st metatarsal, 5th metatarsal, medial arch, lateral arch and heel) and foot dorsum (proximal, middle and distal) using a handheld Shore durometer. Skin (epidermal + dermal) thickness was measured in each posture from the same test locations using ultrasound images obtained for the foot sole and dorsum. In the plantar flexion ankle posture, the foot sole skin was observed to relax/retract on average (± standard errorr of the mean (SEM) by 9 ± 2% to become both 20 ± 6% softer and 10 ± 6% thicker. In this posture, the foot dorsum skin stretched on average by 7 ± 2% resulting in 84 ± 8% harder and 5 ± 4% thinner skin. In the dorsiflexion ankle posture, the skin of the foot sole was observed to stretch on average by 5 ± 1% to become both 20 ± 8% harder and 4 ± 7% thinner. In this posture, the skin of the foot dorsum relaxed/retracted on average by 9 ± 1% resulting in the skin becoming 27 ± 12% softer and 7 ± 5% thicker. Notably, all of the sites responded with movement in a similar direction, but each site responded to a variable extent. Importantly, it was clear that the majority of skin structural deformation of the foot sole occurred within the 1st metatarsal, 5th metatarsal, and medial arch regions, while deformation was more evenly distributed across regions of the foot dorsum. The results suggest there is location specificity in the retraction and stretch characteristics of the foot skin. While not tested directly, this may suggest that local stretch distributions could be in part due to the underlying dermal and hypodermal structures in these foot regions. With these observed changes in the mechanical structure of the foot sole and dorsum skin tissue matrix, it is possible that corresponding posture-dependent changes in cutaneous mechanoreceptor activation may be present.

Spine Posture Influences Tactile Perceptual Sensitivity of the Trunk Dorsum.

The purpose of the current work was to quantify the influence of posture-mediated skin deformation on trunk dorsum tactile perceptual sensitivity. Twelve young and healthy individuals were assessed while adopting three different spine postures (extension, neutral and flexion). Tactile sensitivity threshold tests (T10 and L4 vertebral levels) included measures of touch sensitivity, spatial acuity and stretch sensitivity. The results demonstrate that tactile sensitivity can differ due to changes in body posture. The skin of the trunk dorsum had increased thresholds for touch sensitivity, longitudinal spatial acuity and transverse stretch sensitivity in spine flexion. Furthermore, spine flexion also resulted in a reduced sensory threshold to stretching stimuli in the longitudinal direction. The opposite trends occurred when participants adopted spine extension. It is suggested that posture-mediated skin deformation generates changes in the amount of strain experienced by individual skin mechanoreceptors, and the relative spacing between mechanoreceptors. Furthermore, it is suggested that "pre-stretch" of the skin brings mechanoreceptors closer to their stretch activation thresholds, thereby increasing an individual's sensitivity to skin stretch when in spine flexion.