Preparation, roles, and responsibilities of Filipino occupational therapists in disaster preparedness, response, and recovery.

PURPOSE: Despite the increasing number of literature that identifies the roles of various rehabilitation professionals in disaster-related work, there is still limited evidence that examines how these professionals prepare for and function in the various phases of disasters. This study describes the roles and responsibilities practiced by Filipino occupational therapists in disaster preparedness, response, and recovery. The study also describes the preparations undertaken for the therapists to assume these roles. MATERIALS AND METHODS: A survey was conducted among licensed occupational therapists with prior experiences in disaster response. The survey consisted of 23 items - seven were related to preparedness, ten to disaster response, and six to the recovery phase. The participants were asked to indicate their degree of involvement in specific roles and responsibilities using a 5-point Likert scale. The questionnaire also explored their personal preparation for disaster-related work. RESULTS: The participants were mostly engaged in roles related to the recovery phase, followed by the response phase, and were least engaged in the preparedness phase. The roles most frequently performed include: encourage connectedness and social interactions among survivors (recovery); provide supportive mental health services to survivors and their families (response); and attend trainings in disaster response to be part of a response team (preparedness). The majority of the participants received training in mental health responses and orientation prior to deployment. They identified the need to gain additional knowledge on emergency response and the effects of human displacement in disaster situations. CONCLUSIONS: Given additional training and orientation, occupational therapists are able to perform various roles and responsibilities in the different phases of disasters. They can serve as additional resources for government and non-government organizations to address the needs of vulnerable populations in disasters. The study results could inform professional organizations on how rehabilitation professionals could be further trained to address disaster-related concerns.IMPLICATIONS FOR REHABILITATIONWith additional orientation and training, occupational therapists could serve as an important health human resource especially in providing mental health services to people with special needs in disasters.There is a need to intentionally integrate disaster preparedness in the scope of practice of rehabilitation professionals to prepare people with special needs for disasters.Additional knowledge and skills in humanitarian action need to be integrated with clinical expertise to benefit government and non-government disaster management activities.

Proprioceptive neuromuscular facilitation to improve motor outcomes in older adults with chronic stroke.

This case series described changes in motor outcomes across 4 cases of older adults (mean age - 64.75) with chronic stroke (more than 6 months) after implementation of a 6-week proprioceptive neuromuscular facilitation-based program. Findings of this study were compared with a previously reported case. At baseline, all cases presented with motor impairments that increased their fall risk such as impaired balance, lower extremity strength, and mobility. Outcomes were measured using the Mini-BESTest, posturography, 5 times sit-to-stand test, upright motor control test, and 10-meter walk test. All cases completed 1 hour of therapy 3 times a week for 6 consecutive weeks at a university-based outpatient rehabilitation clinic. Positive outcomes in balance, strength, and mobility were seen in all cases. Proprioceptive neuromuscular facilitation can modify motor outcomes to decrease fall risk in older people with chronic stroke. Chronicity of stroke, age, and co-morbidities may influence the degree of improvements expected in these motor outcomes.

Effects of proprioceptive neuromuscular facilitation on balance, strength, and mobility of an older adult with chronic stroke: A case report.

This study described the effects of a proprioceptive neuromuscular facilitation (PNF) program on balance, strength, and mobility in an older adult with chronic stroke. The patient was male, aged 69 years, with right hemiplegia for 17 years, and had diminished balance, balance confidence, lower extremity (LE) strength, and gait velocity. He received 1 h of PNF-based therapy thrice a week for six weeks. Outcome measures were: Mini-BESTest, limits of stability (LOS), Activities-Specific Balance Confidence Scale (ABC), Five Time Sit-to-Stand Test (FTSST), Upright Motor Control Test (UMCT), and 10 Meter Walk Test (10 MWT). The patient improved on the Mini-BESTest (25/28, from 21/28), FTSST (27.47 s, from 30.27 s), UMCT knee extension (moderate, from weak), and 10 MWT (0.82 m/s, from 0.67 m/s); and positive changes in LOS dimensions. PNF was effective in enhancing balance, strength, and mobility in an older adult with chronic stroke and may mitigate falls risk in this population. More research is needed to determine its impact in a larger sample of older people with chronic stroke.

Clinimetrics of the Upright Motor Control Test in chronic stroke.

INTRODUCTION: Insufficient literature exists regarding the clinimetric properties of the Upright Motor Control Test Knee Extension and Flexion subtests (UMCT-KE and UMCT-KF, respectively). This study examined the interrater and test-retest reliability of these subtests, and determined the relationship between the UMCT-KE and a clinical measure of muscle function in a sample of adults with chronic stroke. METHODS: Three raters independently administered the UMCT-KE and UMCT-KF on adults with chronic stroke with spasticity/abnormal movement patterns. Testing of each participant occurred on two occasions (T1 and T2) separated by a two-week interval. A fourth rater independently administered the Five Times Sit to Stand Test (FTSST), a measure of lower extremity muscle function (power), on T2. RESULTS: Twenty-nine adults aged 55 ± 8 years, comprising 21 men (72%), and who were 9 ± 5 years poststroke, completed the study. Most of the participants (66%, 19/29) did not require an assistive device during walking. The UMCT-KE and UMCT-KF demonstrated substantial interrater reliability (W = 0.63-0.67 and 0.72-0.75, respectively) and substantial to almost perfect test-retest reliability across the raters (W = 0.75-0.82 and 0.85-0.87, respectively). The UMCT-KE showed positive inverse correlation with the FTSST (ρ = -0.52, p = .003). CONCLUSIONS: Scores on both subtests are reproducible within raters and across different raters. The relationship of UMCT-KE scores with FTSST scores implies that the UMCT-KE can provide information that relates with the construct of muscle function in a weight-bearing position.

Measurement properties of the upright motor control test for adults with stroke: a systematic review.

BACKGROUND: The Upright Motor Control Test (UMCT) has been used in clinical practice and research to assess functional strength of the hemiparetic lower limb in adults with stroke. It is unclear if evidence is sufficient to warrant its use. The purpose of this systematic review was to synthesize available evidence on the measurement properties of the UMCT for stroke rehabilitation. METHODS: Electronic databases that indexed biomedical literature were systematically searched from inception until October 2015 (week 4): Embase, PubMed, Web of Science, CINAHL, PEDro, Cochrane Library, Scopus, ScienceDirect, SPORTDiscus, LILACS, DOAJ, and Google Scholar. All studies that had used the UMCT in the time period covered underwent hand searching for any additional study. Observational studies involving adults with stroke that explored any measurement property of the UMCT were included. The COnsensus-based Standards for the selection of health Measurement INstruments was used to assess the methodological quality of included studies. The CanChild Outcome Measures Rating Form was used for extracting data on measurement properties and clinical utility. RESULTS: The search yielded three methodologic studies that addressed criterion-related validity and contruct validity. Two studies of fair methodological quality demonstrated moderate-level evidence that Knee Extension and Knee Flexion subtest scores were predictive of community-level and household-level ambulation. One study of fair methodological quality provided limited-level evidence for the correlation of Knee Extension subtest scores with a laboratory measure of ground reaction forces. No published studies formally assessed reliability, responsiveness, or clinical utility. Limited information on responsiveness and clinical utility dimensions could be inferred from the included studies. CONCLUSIONS: The UMCT is a practical assessment tool for voluntary control or functional strength of the hemiparetic lower limb in standing in adults with stroke. Although different levels of evidence suggest that the Knee Extension and Knee Flexion subtests may possess criterion and construct validity, the lack of published literature examining content validity, reliability, and responsiveness raises questions regarding the use of the UMCT in routine clinical practice. These key findings highlight the need to further investigate the UMCT's measurement properties toward enhancing its standardization.

Improving cultural diversity awareness of physical therapy educators.

In a climate of increasing diversity in the population of patients requiring physical therapy (PT) services, PT educators must prepare students and future clinicians to work competently in culturally diverse environments. To be able to achieve this goal, PT educators must be culturally competent as well. The purposes of the study were to develop a valid and reliable instrument to assess cultural diversity awareness and to develop an educational workshop to improve cultural diversity awareness of PT academic and clinical educators. Phase 1 of the study involved the development of an instrument to assess cultural diversity awareness. The Cultural Diversity Awareness Questionnaire (CDAQ) was developed, validated for content, analyzed for reliability, and field and pilot tested. Results indicated that the CDAQ has favorable psychometric properties. Phase 2 of the study involved the development and implementation of the Cultural Diversity Workshop (CDW). The seminar contents and class materials were developed, validated, and implemented as a one-day cultural diversity awareness seminar. A one-group, pretest-posttest experimental design was used, with participants who completed the CDAQ before and after the workshop. Results indicated that the workshop was effective in improving cultural diversity awareness of the participants. Results of the workshop evaluation affirmed the achievement of objectives and effectiveness of the facilitator. This study provided a solid initial foundation upon which a comprehensive cultural competence program can be developed.