The IndieTrainer system: a small-scale trial exploring a new approach to support powered mobility skill acquisition in children.

The IndieTrainer system, consisting of a mobility device and video-based gamified training modules, was developed to assist children in attaining power wheelchair (PWC) skills. The purposes of this small-scale trial were to explore the use of the IndieTrainer system to provide PWC skills training and document parental satisfaction with the IndieTrainer system. We hypothesized that PWC skills training provided using the IndieTrainer system would result in improvements in both children's understanding of how to use a PWC and their PWC skill execution, and that parental satisfaction would be high. An open-label, single-arm trial was conduct as follows: (a) Baseline testing (T0); (b) A 3-week intervention consisting of two, 60-min-PWC skills training sessions per week; (c) Post-intervention testing (T1); and (d) A single session retention trial held 4 weeks after completion of the intervention (T2). Outcome measures included the Assessment of Learning Powered mobility use (ALP), Wheelchair Skills Checklist (WSC), Canadian Occupational Performance Measure (COPM), and Client Satisfaction Questionnaire-8 (CSQ-8). 25 child/parent dyads participated. Between T0 and T1, statistically significant differences (p-value <.0001) with large effect sizes in mean ALP and WSC scores (ALP: d = 3.14; WSC: d = 3.25) and COPM performance and satisfaction scores (Performance: d = 4.66; Satisfaction: d = 3.24) were achieved. Mean T1 total CSQ-8 score was 31.52/32. At T2, all children maintained or improved their T1 ALP and WSC scores. This study provides initial support for the usability and feasibility of the IndieTrainer system. Futhermore, larger scaled studies using more rigorous research designs are indicated.

The IndieTrainer system allows clinicians to tailor power wheelchair skills (PWC) skills training based on an individual child's specific goals and level of understanding.Selectively combining the use of progressive video-based gamified modules and real-world power mobility experiences may support children who are learning PWC skills.When provided with progressive PWC skills training, children with severe disabilities may improve their understanding of how to use a PWC and their PWC skills.

Are preprofessional undergraduate students ready for authentic clinical case studies? An empirical study of students' perceived relevance and motivation.

Increasingly, the curricula of many clinical programs have been restructured to an integrated model in which foundational sciences such as physiology, pathophysiology, and pharmacology are taught side by side with clinical reasoning. Case studies are an excellent pedagogical strategy for enhancing such integration, especially if such cases are authentic, that is, they include a broad range of information that could influence the individualization and optimization of patient care. However, authentic cases may be too advanced and thereby dissuade preclinical students. We offered an optional semester-long authentic pharmacotherapy case study to undergraduate students in an introductory pharmacology class in a liberal arts college in the United States Midwest and sought to know what might motivate students to complete this challenging task. Connection with and relevance of the case study were assessed with an anonymous survey. Open-ended questions were analyzed qualitatively. Exploratory factor analysis and nonmetric multidimensional scaling were employed to investigate underlying commonalities and patterns in the motivations for participating in and relating to the case study. Students were motivated more by the perceived relevance and transferability of knowledge acquired to their future career than by their current clinical technician jobs or their personal lives. Rather than causing an information overload and dissuading students, this complex pharmacotherapy case assignment harnessed preclinical students' experiences from cognate cocurricular activities, created numerous points of relevant engagement with instructional content, and therefore motivated students to deeper learning.NEW & NOTEWORTHY Early introduction to clinical reasoning is widely advocated. Case studies are frequently used to enhance integration of foundational sciences with clinical reasoning. Preclinical students may be overwhelmed by complex cases because of the higher-order cognitive tasks involved. We find that complex cases permit connection with students' own experiences and aspirations. These preclinical students were motivated to engage in such challenging academic work because of the perceived transferability of knowledge to their future careers.

Predicting Persistent Developmental Stuttering Using a Cumulative Risk Approach.

PURPOSE: The purpose of this study was to explore how well a cumulative risk approach, based on empirically supported predictive factors, predicts whether a young child who stutters is likely to develop persistent developmental stuttering. In a cumulative risk approach, the number of predictive factors indicating a child is at risk to develop persistent stuttering is evaluated, and a greater number of indicators of risk are hypothesized to confer greater risk of persistent stuttering. METHOD: We combined extant data on 3- to 5-year-old children who stutter from two longitudinal studies to identify cutoff values for continuous predictive factors (e.g., speech and language skills, age at onset, time since onset, stuttering frequency) and, in combination with binary predictors (e.g., sex, family history of stuttering), used all-subsets regression and receiver operating characteristic curves to compare the predictive validity of different combinations of 10 risk factors. The optimal combination of predictive factors and the odds of a child developing persistent stuttering based on an increasing number of factors were calculated. RESULTS: Based on 67 children who stutter (i.e., 44 persisting and 23 recovered) with relatively strong speech-language skills, the predictive factor model that yielded the best predictive validity was based on time since onset (≥ 19 months), speech sound skills (≤ 115 standard score), expressive language skills (≤ 106 standard score), and stuttering severity (≥ 17 Stuttering Severity Instrument total score). When the presence of at least two predictive factors was used to confer elevated risk to develop persistent stuttering, the model yielded 93% sensitivity and 65% specificity. As a child presented with a greater number of these four risk factors, the odds for persistent stuttering increased. CONCLUSIONS: Findings support the use of a cumulative risk approach and the predictive utility of assessing multiple domains when evaluating a child's risk of developing persistent stuttering. Clinical implications and future directions are discussed.

Academic Entitlement in Physician Assistant Students.

PURPOSE: The purpose of this study was to identify the prevalence and characteristics of academic entitlement (AE) among physician assistant (PA) students in the United States. METHODS: A cross-sectional survey design was used to assess AE using 2 previously validated AE surveys. Current PA students were recruited via email, and survey data were analyzed using descriptive statistics and cumulative logistic regression. RESULTS: Overall, the 337 PA students who participated in the study reported low levels of AE. Students displayed the highest level of AE on statements related to the role of professors and the lowest level of entitlement on statements pertaining to student responsibility and grade entitlement. Students who struggled academically were more likely to report AE in relation to professors' roles. Older students were more likely to display AE related to provision of necessary resources by the university and less likely to display AE regarding the method of delivery for learning materials. Higher levels of grade-related AE were found in students in the didactic phase, female students, and students who did not identify as White. In addition, students who did not identify as White were more likely to display AE in relation to tests. CONCLUSIONS: Literature shows that AE has increased and is a major concern in higher education. Although the overall study results indicated relatively low AE, we found increased AE in certain student groups. Earlier identification of students at increased risk for AE would allow educators to intervene more effectively in a timely manner.

The associations between digit ratio, aerobic fitness, physical skills, and overall physical fitness of elite youth distance runners.

OBJECTIVE: Lower digit ratios between the lengths of fingers 2 (2D) and 4 (4D) (2D:4D) are associated with superior distance running and athletic performance. We examined relationships between 2D:4D, aerobic fitness, physical skills, and overall physical fitness of elite adolescent boy and girl distance runners. METHODS: Subjects were top five finishers for their sex and age in 10 or more races of 10 km or longer in Michigan in 1981. We calculated 2D:4D of 15 girls and 11 boys from radiographs. Subject peak O2 consumption (VO2Peak ), ventilatory threshold (VT), and point of equivalent change (PEC) were collected during intermittent treadmill protocol tests. Performances on physical skills tests (flex-arm hang, broad jump, vertical jump, figure-8-run, sit ups, and sit-and-reach test) were collected in the laboratory. We examined the interrelationships between 2D:4D, subject sex, aerobic fitness, physical skills test performance, and overall physical fitness, a composite of aerobic and physical skills performance with correlation, linear regression, t tests, and principle component analyses. RESULTS: Girls had significantly larger right hand (R) 2D:4D than boys. Boys had greater VO2Peak by mass than girls. Boys with lower R2D:4D had significantly greater VO2Peak and PEC. Girls with lower R2D:4D had significantly greater VT. Factors associated with aerobic fitness explained most of the variation in composite physical fitness scores. Composite aerobic fitness, physical skills, and overall physical fitness scores of boys were negatively correlated with R2D:4D. CONCLUSIONS: These data suggest that R2D:4D may help predict distance running performance in girls and boys and overall physical fitness in boys and provide additional insights into the innate factors influencing youth physical fitness.

Providing paediatric power wheelchairs in the USA then and now: a survey of providers.

Aims: To explore and describe current practices in the USA related to the provision of paediatric power wheelchairs (PWCs) from the perspective of professionals involved in recommending, ordering or prescribing a PWC, and to compare and contrast current PWC practices to findings of a 2001 survey.Materials and methods: This descriptive study utilized a web-based survey to collect quantitative and qualitative data related to paediatric PWC evaluation activities, recommendations, decision-making considerations and other issues related to the provision of paediatric PWCs.Results: Both child and non-child related PWC evaluation activities were reported as frequently occurring and important. Recommendations for a child who was evaluated for a PWC but who was not endorsed to receive one included extended PWC practice and determining a child's mobility prognosis. The average age of the youngest child for whom respondents had recommended a PWC was 3 years, 3.56 months. Significant differences between the responses to this 2018 survey and a 2001 survey were found suggesting possible changes in practice pertaining to PWC evaluation activities as well as to recommendations for a child who is not endorsed to receive a PWC.Conclusions: Findings of the current survey suggest that barriers exist to a child, especially a younger child, obtaining a PWC.Implications for RehabilitationFindings of the current (2018) survey suggest that barriers exist to a child obtaining a PWC.Respondents reported that the primary reasons for not recommending a paediatric PWC included cognitive, physical and behavioural factors.Respondents reported that the primary reasons a paediatric PWC was not obtained for a child who qualified to receive a PWC related to family support, transportation and home environment.Differences between responses to 2018 survey and the 2001 survey indicate changes in practice.

Validity of the WST and the WST-Q in children with spina bifida: a pilot project.

Objective: To begin exploring use of the manual wheelchair versions of the Wheelchair Skills Test (WST) and the Wheelchair Skills Test-Questionnaire (WST-Q) in children with spina bifida who use manual wheelchairs. Design: Cross-sectional, psychometric study. Setting: A university-based laboratory setting. Subjects: A total of 12 children 5-21 years of age with spina bifida participated in the study. Interventions: Assessment of manual wheelchair skills by direct observation and parent report. Main measures: The WST, the WST-Q and the manual wheelchair short scale within the Mobility domain of the Pediatric Evaluation of Disability-Computer Adapted Test (MWC PEDI-CAT), an existing validated parent-report measure of manual wheelchair skills in children. Results: Moderate to excellent positive associations were found amongst all test scores. Spearman's rank order correlations were as follows: r = 0.87 between the WST and WST-Q, r = 0.78 between the WST-Q and MWC PEDI-CAT and r = 0.62 between scores on the WST and MWC PEDI-CAT. These associations suggest that the WST and the WST-Q may be appropriate for use with children who have spina bifida and therefore should be further explored in this population. Using the WST-Q as a parent-report measure may help clinicians to assess manual wheelchair skills in children with spina bifida without adding additional time to an examination session. Implications for Rehabilitation The associations found in this pilot project suggest that the Wheelchair Skills Test and the Wheelchair Skills Test-Questionnaire (WST-Q) may be appropriate for use with children who have spina bifida. Using the WST-Q as a parent-report measure may help clinicians to assess manual wheelchair skills in children with spina bifida without adding additional time to an examination session.

College-aged women in the United States that play overhand throwing sports have masculine digit ratios.

Athletic prowess in both males and females is negatively correlated with the ratio between the lengths of the second and fourth fingers (2D:4D), a correlate of prenatal testosterone exposure. Because multiple lines of evidence suggest that prenatal testosterone exposure is associated with sports interest, motivation, and athletic performance we measured the digit ratios of 77 non-athletes, 103 varsity athletes, and 78 club sport athletes to test 8 hypotheses about the relationship between digit ratio and the athletic behavior of college-age women in the USA. Using independent samples t-tests, we found no significant differences between the digit ratios of women that (1) were athletes and non-athletes, (2) were varsity or club sport athletes, (3) had played or were currently playing individual or team sports, (4) played contact and non-contact sports, (5) played sports involving a ball and those that do not, (6) played sports where the outcome was determined by a score or the outcome of direct physical competition or subjectively by judges, or (7) were starters or reserves on their teams. However, women that played overhand throwing sports softball and water polo had significantly smaller digit ratios than did women that played other sports. These differences were not due to scaling effects. The independent samples t-test results were supported by subsequent Monte Carlo bootstrap, Bayesian, Random Forest, and multiple linear regression analyses. We suggest that the organizational consequences of prenatal testosterone exposure may influence the anatomy and physiology of women that leads to success playing overhand throwing sports.

A Home-Based Body Weight-Supported Treadmill Program for Children With Cerebral Palsy: A Pilot Study.

PURPOSE: The purpose of this pilot study was to explore the effect and feasibility of a home-based body weight-supported treadmill training (BWSTT) program on walking capacity and functional mobility in children with cerebral palsy (CP). METHODS: A within-subjects, repeated-measures design was used. Ten children with CP ages 6 to 16 years participated in pre- and postintervention testing sessions, an initial home training session, and a 12-week home-based BWSTT program conducted 3 to 4 times per week by a parent or caregiver for up to 20 minutes each session. Multiple outcome measures for walking capacity and functional mobility were used. RESULTS: As a group, participants demonstrated significant improvements in walking capacity and functional mobility at the completion the 12-week intervention program. CONCLUSIONS: Additional research regarding home-based BWSTT programs in children with CP is warranted and should focus on identifying specific parameters that promote achievement of optimal functional outcomes.

Changes in height, body weight, and body composition in American football players from 1942 to 2011.

The purpose of this study was to document changes in height (cm), body weight (kg), and body composition (%fat) of American football players from 1942 to 2011. Published articles were identified from databases and cross-referencing of bibliographies. Studies selected met the requirements of (1) having 2 of 3 dependent (height, body weight, and body composition) variables reported in the results; (2) containing a skill level of college or professional; (3) providing measured not self-reported data; and (4) published studies in English language journals. The data were categorized into groups based on skill level (college and professional). The player positions were grouped into 3 categories: mixed linemen (offensive and defensive linemen, tight ends, and linebackers), mixed offensive backs (quarterback and running backs), and mixed skilled positions (defensive backs and wide receivers). Linear regression was used to provide slope estimates and 95% confidence intervals (CIs). Unpaired t-tests were used to determine whether an individual regression slope was significantly different from zero. Statistical significance was set at p < 0.017. College level players in all position groups have significantly increased body weight over time (95% CI: mixed lineman 0.338-0.900 kg·y(-1); mixed offensive backs 0.089-0.298 kg·y(-1); mixed skilled 0.078-0.334 kg·y(-1)). The college level mixed linemen showed a significant increase over time for height (95% CI: 0.034-0.188 cm·y(-1)) and body composition (0.046-0.275% fat per year). Significant increases in body weight over time were found for professional level mixed lineman (95% CI: 0.098-0.756 kg·y(-1)) and mixed offensive backs (95% CI: 0.1800-0.545 kg·y(-1)). There were no other significant changes at the professional level. These data demonstrate that body weight of all college players and professional mixed lineman have significantly increased from 1942 to 2011.