Physical therapy and pharmacy interprofessional education in the context of a university pro bono physical therapy setting.

Interprofessional care is the standard for quality in healthcare. Interprofessional education (IPE) is an accreditation requirement in many health-care fields. This qualitative study evaluated the benefits of an interprofessional education program for Doctor of Physical Therapy (DPT) and Doctor of Pharmacy (PharmD) students in the context of a pro bono physical therapy setting focused on reducing fall risk among older adults. For each pro bono participant, PharmD and DPT students worked together to analyze fall risk of the participating older adults. PharmD students completed a medication review while the DPT students completed balance assessments. Each profession recommended adjustments to care and presented their findings to peers, faculty, and participants. Following completion of the IPE program, students completed a voluntary evaluation with seven questions requiring semi-structured written reflection regarding their IPE experience. Student reflective responses from 2014-2016 were coded by IPE faculty using a coding guide collaboratively developed by the study team. Descriptive analysis included a summary of code frequency by year, discipline and Interprofessional Education Collaborative core competency: Values and Ethics, Communication, Teams and Teamwork, and Roles and Responsibilities. Values and Ethics were the most frequently coded core competency. Students consistently noted the importance of valuing the other profession, understanding each other's roles, having good interprofessional communication, and working within a health-care team. Additional codes emerged during the analysis process. Written reflective findings suggest that hands-on collaboration, focused on a real-world problem (fall risk) relevant to both PharmD and DPT students, enabled interprofessional care that benefited students through real-world practice of skills learned during coursework, and benefited clinical participants through increased awareness of physical function and medication factors that could affect fall risk. Findings indicate that a pro bono physical therapy setting can provide hands-on learning that meets IPE accreditation requirements and student learning needs while addressing a public health concern.

The Effect of a Low-Cost Body Weight-Supported Treadmill Trainer on Walking Speed and Joint Motion.

Background and Objectives: Gait training with body weight-support has been shown to improve the walking speed of individuals with movement disorders. The AccesSportAmerica Gait Trainer is a low-cost, pre-market gait rehabilitation device that alters the stride characteristics of participants walking on a standard treadmill. The purpose of this study was to examine the biomechanical outcomes that training on this device has for people with brain injuries that affect motor functioning. It was hypothesized that there would be an increase in walking speed post-intervention, and that there would be an increase in step length and joint range-of-motion. Materials and Methods: An intervention study was conducted with 11 people with ambulatory difficulty caused by post-stroke hemiparesis (n = 7), traumatic brain injury (n = 3), and cerebral palsy (n = 1). The average time using the AccesSportAmerica Gait Trainer was 34.5 (SD = 6.0) minutes per session for 36.9 (SD = 21.8) sessions. Gait speed, step length and time, and joint flexion were measured during the 10 Meter Walk Test. Results: From pre- to post-intervention, there was a mean increase in walking speed of 0.19 m/s (SD = 0.06, p = 0.016, d = 0.40) and a decrease in step time of both affected and unaffected legs (affected: p = 0.011, d = 0.37; unaffected: p = 0.004, d = 0.67). There was no significant change in stride length or joint angles. Conclusions: The AccesSportAmerica Gait Trainer has the potential to improve the walking speed of people with ambulatory difficulty.

Healthy body, healthy mind: A mixed methods study of outcomes, barriers and supports for exercise by people who have chronic moderate-to-severe acquired brain injury.

BACKGROUND: Few people with chronic moderate-to-severe brain injury are following recommended physical activity guidelines. OBJECTIVE: Investigate effects of planned, systematic physical activity while cultivating social and emotional well-being of people with chronic moderate-to-severe brain injury. HYPOTHESIS: Moderate-to-intensive physical activity would be associated with improvements in impairment and activity limitation measures (endurance, mobility, gait speed) immediately post-intervention and six weeks later (study week 12). METHODS: The intervention was a single group pre-/post-intervention study with 14 people with chronic moderate-to-severe brain injury who live in brain injury group homes and exercised 60-90 min, 3 days per week for 6 weeks at a maximum heart rate of 50-80%. Pre-post measures (administered weeks 0, 6 and 12) were the 6 Minute Walk Test, High-level Mobility Assessment Tool and 10 Meter Walk Test. The qualitative component used a brief survey and semi-structured interview guide with participants, family members, and staff. RESULTS: Following program completion, post-intervention group changes were noted on all outcome measures and greater than minimal detectable change for people with brain injury. Three transitioned from low to high ambulatory status and maintained this change at 12 weeks. During interviews, participants agreed the program was stimulating. More than eighty percent liked working out in a group and felt better being active. CONCLUSIONS: Program impact included physical, cognitive and social/emotional aspects. Social aspects (group format, trainers) were highly motivating and supported by residents, family, and staff. Investments in transportation and recruiting and training interns to assist participants are critical to program sustainability and expansion.

Pilot study of intensive exercise on endurance, advanced mobility and gait speed in adults with chronic severe acquired brain injury.

BACKGROUND AND PURPOSE: Effects of high-intensity exercise on endurance, mobility and gait speed of adults with chronic moderate-to-severe acquired brain injury (ABI) were investigated. It was hypothesized that intensive exercise would be associated with improvements in impairment and activity limitation measures. PARTICIPANTS: Fourteen adults with chronic ABI in supported independent living who could stand with minimal or no assist and walk with or without ambulation device were studied. Eight presented with low ambulatory status. METHODS: This was a single group pre- and post-intervention study. Participants received a 6-week exercise intervention for 60-90 minutes, 3 days/week assisted by personal trainers under physical therapist supervision. Measures (6MWT, HiMAT and 10MWT) were collected at baseline, post-intervention and 6 weeks later. Repeated measures T-test and Wilcoxon Signed Ranks test were used. RESULTS: Post-intervention improvements were achieved on average on all three measures, greater than minimal detectable change (MDC) for this population. Three participants transitioned from low-to-high ambulatory status and maintained the change 6 weeks later. DISCUSSION AND CONCLUSION: People with chronic ABI can improve endurance, demonstrate the ability to do advanced gait and improve ambulatory status with 6 weeks of intensive exercise. Challenges to sustainability of exercise programmes for this population remain.