Neurofibromatosis Type II and Facial Paralysis: Clinical Evaluation and Management.

BACKGROUND: Facial paralysis secondary to neurofibromatosis type 2 (NF2) presents the reconstructive surgeon with unique challenges because of its pathognomonic feature of bilateral acoustic neuromas, involvement of multiple cranial nerves, use of antineoplastic agents, and management. Facial reanimation literature on managing this patient population is scant. METHODS: A comprehensive literature review was performed. All patients with NF2-related facial paralysis who presented in the past 13 years were reviewed retrospectively for type and degree of paralysis, NF2 sequelae, number of cranial nerves involved, interventional modalities, and surgical notes. RESULTS: Twelve patients with NF2-related facial paralysis were identified. All patients presented after resection of vestibular schwannoma. Mean duration of weakness before surgical intervention was 8 months. On presentation, one patient had bilateral facial weakness, 11 had multiple cranial nerve involvement, and seven were treated with antineoplastic agents. Two patients underwent gracilis free functional muscle transfer, five underwent masseteric-to-facial nerve transfer (of whom two were dually innervated with a crossfacial nerve graft), and one patient underwent depressor anguli oris myectomy. Trigeminal schwannomas did not affect reconstructive outcomes if trigeminal nerve motor function on clinical examination was normal. In addition, antineoplastic agents such as bevacizumab and temsirolimus did not affect outcomes if stopped in the perioperative period. CONCLUSIONS: Effectively managing patients with NF2-related facial paralysis necessitates understanding the progressive and systemic nature of the disease, bilateral facial nerve and multiple cranial nerve involvement, and common antineoplastic treatments. Neither antineoplastic agents nor trigeminal nerve schwannomas associated with normal examination affected outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Goodness of Fit of the Clinical Instructor Teaching Effectiveness Survey (CITES) for Health Professions Students.

Student evaluations of teaching have demonstrated limited validity in traditional classrooms, but there is some evidence that they may be more useful in measuring teaching effectiveness in simulation or clinical environments. Current student evaluations of clinical teaching measure a subset of constructs designed for use by a single profession, which may limit institutional evaluation and make interprofessional evaluations challenging. The purpose of this study was to describe the multi-step creation of the CITES and to establish its internal consistency and goodness of fit for measuring students' perceptions of clinical instructor teaching effectiveness. In its second iteration, the CITES is a 25-item questionnaire that was tested among 161 physical therapy and physician assistant students. Most items, with the exception of item 5, demonstrated goodness of fit, with a standardized coefficient of 0.94. Internal consistency was high, with a Cronbach alpha of 0.96-0.97. Though this tool demonstrates internal consistency and goodness of fit, the test information curve indicated that it would be more useful as a screening tool to detect those who are very poor clinical teachers, rather than a tool to evaluate those who are highly effective at teaching.

CAN PROXIMAL HIP STRENGTH AND DYNAMIC CONTROL DIFFERENTIATE FUNCTIONAL ANKLE STABILITY CLASSIFICATIONS?

BACKGROUND: Ankle instability can be problematic in an active population with multiple risk factors associated with recurrence. PURPOSE: The aim of this study was to determine if deficits in weight-bearing and non-weight bearing assessment of hip strength or dynamic balance in lower extremity reaching tasks from flat and inclined surfaces can differentiate subjects classified as controls, ankle sprain copers, or those with chronic, recurrent ankle sprains. STUDY DESIGN: Quasiexperimental, Ex post facto. METHODS: A convenience sample of 60 subjects was classified into control, coper, or chronic ankle sprain groups based on the results of the Identification of Functional Ankle Instability Questionnaire. Subjects were tested for peak force production of their hip extensors, hip abductors, and a composite of hip extension and external rotation while in a standing position using a hand-held dynamometer. Additionally, each subject performed a modified Star Excursion Balance Test in anterior, posterolateral, and posteromedial directions from both a flat and 15 ° inverted stance position. One-way analysis of variance was calculated for between group differences of hip strength and balance reach ability and ankle stability classification. Pearson product-moment correlation coefficients were derived to evaluate relationships between hip strength and dynamic balance tests. RESULTS: Twenty-one subjects were assigned to the control group, 23 to the coper group, and 16 to the chronic group. There were no significant differences between groups in self-report of Foot and Ankle Ability Measures or Tegner activity levels. Mean hip strength was not significantly different between ankle sprain classification groups (p = 0.66 - 0.82). The mean limb symmetry index for hip strength comparing injured and uninjured ankles was nearly symmetrical in all ankle stability groups (p = 0.34 - 0.97). The same symmetry was present when comparing injured and uninjured abilities for all dynamic balance reach tasks from both flat and inclined surfaces. (p = 0.16 - 0.62). There was a fair relationship between hip extension and weight-bearing hip extension/external rotation strength and the posteromedial and posterolateral reach tasks with correlation coefficients in the range of 0.33 - 0.43. CONCLUSION: Performance measures of tri-planar, static, isometric hip strength and lower extremity reach in dynamic balance tasks could not differentiate subjects without a history of injury from those subjects with one or more lateral ligamentous ankle sprains. LEVEL OF EVIDENCE: 2b; Ex post facto.

Financial Literacy Among Health Professions Graduate Students.

AIMS: The impact of student debt management on mental health, career choices, and advanced training in allied health professions is unknown. The purpose of this project was to pilot a survey that identifies students' financial literacy and self-efficacy. METHODS: A cross-sectional survey containing 43 items related to financial habits, savings knowledge, credit and borrowing strategies, and investment knowledge was administered to assess financial literacy, self-efficacy, and career plans in a group of health professions graduate students. RESULTS: 134 of 268 surveys were completed by a variety of health professions. Financial habits and credit and borrowing categories scored the highest at 50% correct. Students scored the lowest on investment knowledge with an average of 25% correct responses. The overall mean self-efficacy score was 15.5±3.8. Three independent variables had a significant correlation of determination with overall financial literacy, which included marital status, older age, and individuals who identified as white non-Hispanic. Similarly, identification as white non-Hispanic had a significant correlation of determination with financial self-efficacy, but there were no significant differences based on age or marital status. CONCLUSIONS: Allied health students demonstrated low financial literacy and self-efficacy. Health care educators should consider delivering educational content to address these deficits.

Physical Therapists' Perspectives on Lifelong Learning.

INTRODUCTION: In today's healthcare environment, it is critical that allied health professionals maintain and grow the requisite knowledge and skills that defined their competence upon entering the field. Despite a strong emphasis on the attribute of lifelong learning in the physical therapy profession, no psychometrically sound instrument has been developed to assess it. METHODS: The Jefferson Scale of Physical Therapist Lifelong Learning (JSPTLL) was adapted from the Jefferson Scale of Physician Lifelong Learning. A national survey of physical therapists was conducted using mailing lists from state licensure boards from a geographically diverse sample. RESULTS: Out of 7,654 survey invitations sent, 540 complete surveys were returned. The mean score of the JSPTLL was 55.13 (SD 7.4), ranging from 19 to 68. Commitment to lifelong learning had a large correlation to the JSPTLL score (rs=0.51, p<0.0001). A medium correlation exists between the JSPTLL and the level of career satisfaction (rs=0.32, p<0.0001). A small correlation exists between commitment to lifelong learning and levels of career satisfaction (r=0.27). CONCLUSION: The JSPTLL provides a means to objectify the aptitude and beliefs of the physical therapist lifelong learner. Applicability to other health professions can be established with further research.

SPORTS PHYSICAL THERAPY CURRICULA IN PHYSICAL THERAPIST PROFESSIONAL DEGREE PROGRAMS.

BACKGROUND: The specialty niche of sports physical therapy has grown at a significant rate over the past 40 years. Despite this growth there is little information or direction from the physical therapy education accreditation body or professional association to guide academic programs on the interest or necessity of this type of practice content in physical therapy professional degree programs. PURPOSE: The purpose of this survey study is to report on the prevalence, attitudes, barriers, resources, and faculty expertise in providing required or elective sports physical therapy course work. STUDY DESIGN: Cross-sectional descriptive survey. METHODS: A 57-item questionnaire with branching logic was distributed via a web-based electronic data capture tool to survey all Commission on Accreditation for Physical Therapy Education (CAPTE) accredited and candidate schools in the United States. Response data was analyzed to describe typical educational program profiles, faculty demographics, and correlational factors consistent with the presence or absence of specific sports physical therapy curricular content. RESULTS: Thirty one percent of the schools responded to the survey and the program demographics were consistent with all currently accredited schools in regards to their geography, Carnegie classification, and faculty and student size. Forty three percent of programs offered a required or elective course distinct to the practice of sports physical therapy. Descriptive information regarding the sequencing, curricular make-up, resources, and assessment of content competence is reported. The odds of providing this content nearly doubles for programs that have faculty with sports clinical specialist credentials, accredited sports residency curriculums, or state practice acts that allow sports venue coverage. CONCLUSIONS: This survey provides an initial overview of sports physical therapy educational efforts in professional physical therapy degree programs. The data can used to spur further discussion on the necessity, structure, and implementation of education content that is inherent to a growing specialty practice in the physical therapy profession. LEVEL OF EVIDENCE: 4, Cross-sectional descriptive survey design.

Anthropometric measures, presence of metabolic syndrome, and adherence to physical activity guidelines among African American church members, Dallas, Texas, 2008.

INTRODUCTION: The low prevalence of physical activity among African Americans and high risk of cardiovascular disease lends urgency to assessing the association between metabolic syndrome, abdominal obesity, and adherence to current physical activity guidelines. Few studies have examined this association among African American adults. METHODS: We examined the association between demographic characteristics, anthropometric measures, and metabolic syndrome and adherence to the 2008 Department of Health and Human Services guidelines for moderate and vigorous physical activity. Participants were 392 African American church members from congregations in Dallas, Texas. Physical activity levels were assessed via a validated questionnaire (7-Day Physical Activity Recall), and metabolic syndrome was determined on the basis of the American Heart Association/National Heart, Lung, and Blood Institute diagnostic criteria. We used bivariate and multinomial logistic regression to examine the associations. RESULTS: Meeting guidelines for vigorous physical activity was significantly and independently associated with the absence of metabolic syndrome among women (odds ratio, 4.71; 95% confidence interval, 1.63-13.14; P = .003), after adjusting for covariates. No association was found between meeting moderate or vigorous physical activity guidelines and metabolic syndrome among men. Meeting physical activity guidelines was not associated with body mass index or waist circumference among this sample of predominantly overweight and obese African American church members. CONCLUSION: Results indicate that meeting the 2008 guidelines for vigorous physical activity is associated with the absence of metabolic syndrome among African American women. This finding might suggest the need to integrate vigorous physical activity into interventions for African American women as a preventive therapy for cardiovascular risk. 

Academic incentives for students can increase participation in and effectiveness of a physical activity program.

The authors sought to determine whether a greater academic incentive would improve the effectiveness and student adherence to a 12-week voluntary exercise program designed to decrease students' percentage of body fat. They randomly assigned 210 students to 1 of 2 groups with different academic reward structures. The group with the greater reward structure showed better exercise adherence and lost more body fat than those without the additional incentive. These findings suggest that an academic incentive can increase overall student adherence to a voluntary exercise program and can boost the effectiveness of the program in a university environment. The findings also have potential implications for on-campus promotion of physical activity.