A Know-Brainer: The Power of Cadaver-Based Instruction to Teach Clinical Neuroanatomy.

PURPOSE: Learning experiences that incorporate cadaver prosection or dissection of the brain have shown to enhance the acquisition and retention of neuroanatomy and improve standardized examination scores when included within medical curriculum. However, the role of cadaver-based instruction within allied health fields, and particularly in the field of communication sciences and disorders (CSD), remains limited and less understood. METHOD: The effectiveness of a cadaver-based lab compared to lecture to teach neuroanatomy within an undergraduate/postbaccalaureate clinical neuroscience course for CSD majors was explored within a crossover design. Fifty-four participants were stratified by class rank between two initial training sessions: lab-first versus lecture-first. Neuroanatomical knowledge was tested via labeling tasks at baseline, after the first allocated training, and at 1-week follow-up after crossover training had been completed. RESULTS: Both cohorts demonstrated significant gains in neuroanatomical knowledge following training, yet after the initial training session, students that received cadaver-based instruction produced a significantly greater number (p < .001) and more accurate (p < .001) anatomical labels than students that received lecture. After completion of the crossover design, students receiving cadaver-based instruction prior to lecture continued to demonstrate superior labeling accuracy at follow-up testing (p = .022). CONCLUSIONS: Cadaver-based instruction was more effective in improving students' ability to identify neuroanatomy compared to lecture for CSD students. Interestingly, cadaver-based demonstrations were also most effective in bolstering students' retention of structural knowledge when conducted before, instead of after, a lecture. Clinical training programs, specifically student learning outcomes, benefit from cadaver-based instruction that provides both three-dimensional orientation and a deep appreciation of the human elements of clinical anatomy. Furthermore, both the acquisition and retention of anatomical concepts may be enhanced through strategic instructional design, particularly in regard to the order of lecture and lab experiences.

Identifying Meaningful Patient Outcomes After Lower Extremity Injury, Part 1: Patient Experiences During Recovery.

CONTEXT: Determining meaningful aspects of health is crucial for outcome assessment; however, limited literature exists on the aspects of health that are deemed meaningful by the athletic patient population. OBJECTIVE: To identify experiences and meaningful outcomes after lower extremity (LE) musculoskeletal injury among collegiate athletes. DESIGN: Qualitative study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: A purposive sample of 20 athletes (10 men, 10 women; age = 20.1 ± 1.83 years) from a National Collegiate Athletic Association Division I institution in the Midwest who had sustained an LE injury. DATA COLLECTION AND ANALYSIS: Semistructured face-to-face interviews and inductive data analysis were conducted. Trustworthiness of the data was established using member checks and peer debriefing. RESULTS: Four themes emerged from the data, revealing that physical changes, psychological changes, personal and lifestyle changes, and support were the most meaningful outcomes among athletes with an LE injury. The 4 themes were associated with 21 subthemes, indicating the complexity with which LE injury affects individuals. CONCLUSIONS: Our findings demonstrate the importance of caring for the whole person. Athletic trainers must broaden their focus to provide the best patient care and consider the person's activities and life demands outside of athletic participation. The themes identified in this study provide a basis for selecting appropriate health markers and outcome measures.

Identifying Meaningful Patient Outcomes After Lower Extremity Injury, Part 2: Linking Outcomes to the International Classification of Functioning, Disability and Health.

CONTEXT: The International Classification of Functioning, Disability and Health (ICF) provides a framework and common language for describing and understanding health that incorporates function and disability, as well as contextual factors. However, whether the meaningful patient outcomes reported by collegiate athletes who have sustained a lower extremity (LE) injury correspond to the ICF model is uncertain. OBJECTIVES: To determine if the patient outcomes reported by collegiate athletes after LE injury corresponded with the ICF classification and to identify the most relevant ICF categories and domains. DESIGN: Themes and subthemes from the qualitative analysis were linked to the ICF using established linking rules. The frequencies of the linked ICF categories were identified. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty collegiate athletes (10 men, 10 women; age = 20.1 ± 1.83 years) from a National Collegiate Athletic Association Division I institution in the Midwest who had sustained an LE injury. DATA COLLECTION AND ANALYSIS: Semistructured face-to-face interviews and ICF linking process. RESULTS: The data from the qualitative interviews were successfully linked to 63 ICF second-level domains (eg, moving around, d455) across all 4 ICF categories: body functions (b), body structures (s), activities and participation (d), and environmental factors (e). The 63 second-level domains corresponded with 20 first-level domains (eg, mobility, d4). CONCLUSIONS: The ICF provided a common language for describing health and disability, as all outcomes reported by our collegiate athletes after LE injury were linked with the ICF classification. Athletic trainers should use the results of this study for assessing and monitoring collegiate athletes' health and function after an LE injury.

The Effectiveness of Manual Lymphatic Drainage in Patients With Orthopedic Injuries.

CLINICAL SCENARIO: Managing edema after trauma or injury is a primary concern for health care professionals, as it is theorized that delaying the removal of edema will increase secondary injury and result in a longer recovery period. The inflammatory process generates a series of events, starting with bleeding and ultimately leading to fluid accumulation in intercellular spaces and the formation of edema. Once edema is formed, the lymphatic system plays a tremendous role in removing excess interstitial fluid and returning the fluid to the circulatory system. Therefore, rehabilitation specialists ought to use therapies that enhance the uptake of edema via the lymphatic system to manage edema; however, the modalities commonly used are ice, compression, and elevation. Modalities such as these may be effective at preventing swelling but present limited evidence to suggest that the function of the lymphatic system is enhanced. Manual lymphatic drainage (MLD) is a manual therapy technique that assists the lymphatic system function by promoting variations in interstitial pressures by applying light pressure using different hand movements. FOCUSED CLINICAL QUESTION: Does MLD improve patient- and disease-oriented outcomes for patients with orthopedic injuries?

Development of a core-stability model: a delphi approach.

CONTEXT: Despite widespread acceptance, there is currently no consensus on the definition, components, and the specific techniques most appropriate to measure and quantify core stability. OBJECTIVE: To develop a comprehensive core-stability model addressing its definition, components, and assessment techniques. DESIGN: Delphi technique. SETTING: University laboratory. PARTICIPANTS: 15 content experts from United States and Canada, representing a variety of disciplines. MAIN OUTCOME MEASURE: The authors distributed an open-ended questionnaire pertaining to a core-stability definition, components, and assessment techniques specific to each expert. They collected data over 2 rounds of telephone interviews. They concluded data collection once a consensus was achieved that equated with 51% agreement among respondents. RESULTS: The authors developed a working definition of core stability as the ability to achieve and sustain control of the trunk region at rest and during precise movement. Eighty-three percent of the experts considered the definition satisfactory. Therefore, the definition was accepted. Furthermore, the experts agreed that muscles (14/15 = 93.3%) and neuromuscular control (8/12 = 66.7%) were components of core stability. Assessment techniques were identified and inconsistencies were highlighted; however, no consensus was established. CONCLUSIONS: A consensus core-stability definition was created and 2 components were identified. However, of the initial definitions provided by the experts, no 2 were identical, which revealed the inconsistencies among experts and the importance of this study. Nonetheless, the goal of obtaining a consensus definition was obtained. Although a consensus for the assessment techniques of core stability could not be reached, it was a beneficial starting point to identify the inconsistencies that were discovered among the content experts.