Early Identification of Students at Risk for Academic Difficulty in a Doctor of Physical Therapy Program.

PURPOSE: Physical therapy education programs use preadmission factors to admit qualified applicants. These factors have limited ability to predict academic outcomes and 5% of enrolled students do not graduate. The purpose of this study was to investigate whether early assessment scores in a Human Gross Anatomy course can be used to identify students at greater risk of academic difficulty. METHODS: This is a retrospective analysis of data from 272 students enrolled in a Doctor of Physical Therapy program 2011-2013 and 2015-2019. Independent variables included scores on assessments in a Human Gross Anatomy course. Dependent variables included course score and first-year GPA. Receiver operating characteristic (ROC) curves were generated to evaluate each assessment's ability to differentiate between students who did and did not have academic difficulty and determine cutoff scores. RESULTS: 4% and 11% of students were found to have academic difficulty in the course and the program, respectively. Practical Exam #2 (AUC 0.95, 95% CI 0.89-1.00, p<0.001) best differentiated between students who did and did not have academic difficulty. The calculated cutoff score of 61.5% had the same sensitivity (90.91%) and greater specificity (91.95%) than the standard passing score of the program of (sensitivity 90.91%, specificity 72.41%). Scoring < 61.5% on Practical Exam #2 increased the odds of academic difficulty in the course and first year of the program. CONCLUSIONS: This study demonstrated a method that could be used to identify students at greater risk of academic difficulty before submission of any course grades. Using this evidence-based approach can benefit students and programs.

Neuroanatomical Models of Muscle Strength and Relationship to Ambulatory Function in Spinal Muscular Atrophy.

BACKGROUND: Individuals with spinal muscular atrophy (SMA) III walk independently, but experience muscle weakness, gait impairments, and fatigue. Although SMA affects proximal more than distal muscles, the characteristic pattern of selective muscle weakness has not been explained. Two theories have been proposed: 1) location of spinal motor neurons; and 2) differences in segmental innervation. OBJECTIVE: To identify neuroanatomical models that explain the selective muscle weakness in individuals with SMA and assess the relationship of these models to ambulatory function. METHODS: Data from 23 ambulatory SMA participants (78.2% male), ages 10-56 years, enrolled in two clinical studies (NCT01166022, NCT02895789) were included. Strength was assessed using the Medical Research Council (MRC) score; ambulatory function was measured by distance walked on the 6-minute walk test (6 MWT). Three models were identified, and relationships assessed using Pearson correlation coefficients and linear regression. RESULTS: All models demonstrated a positive association between strength and function, (p < 0.02). Linear regression revealed that Model 3B, consisting of muscles innervated by lower lumbar and sacral segments, explained 67% of the variability observed in 6 MWT performance (ß= 0.670, p = 0.003). CONCLUSIONS: Muscles innervated by lower lumbar and sacral segments, i.e. hip extensors, hip abductors, knee flexors and ankle dorsiflexors, correlated with and predicted greater ambulatory function. The neuroanatomical patterns of muscle weakness may contribute to a better understanding of disease mechanisms and enable delivery of targeted therapies.

Effects of Alternating Dissection with Peer Teaching and Faculty Prosected Cadaver Demonstrations in a Physical Therapy and Occupational Therapy Gross Anatomy Course.

The most effective method to teach gross anatomy is largely unknown. This study examined two teaching methods utilized in a physical therapy and occupational therapy gross anatomy course, (1) alternating dissection with peer teaching every other laboratory session and (2) faculty demonstrations during laboratory sessions. Student (n = 57) subgroup (A or B) academic performance was determined using written, laboratory practical, and palpation practical examinations. Subgroup A performed significantly better on laboratory practical examination questions pertaining to dissected, in comparison to peer-taught structures (67.1% vs. 60.2%, P = 0.008). Subgroup B performed significantly better on laboratory practical examination questions pertaining to peer-taught, in comparison to dissected structures (64.1% vs. 57.9%, P = 0.001). When Subgroup A was compared to Subgroup B, there were no statistically significant differences on laboratory practical examination question types, whether the subgroup learned the structure through dissection or peer teaching. Based on within and between subgroup comparisons, faculty demonstrations had no effect on written, laboratory practical, or palpation practical examination scores. Although limited, data suggest that the student roles when alternating dissection with peer teaching every other laboratory session appear to be equally effective for learning gross anatomy. The benefits of this method include decreased student/faculty ratio in laboratory sessions and increased time for independent study. Faculty demonstrations during laboratory sessions do not seem to improve student academic performance.

Long-Term Neurobehavioral Symptoms and Return to Productivity in Operation Enduring Freedom/Operation Iraqi Freedom Veterans With and Without Traumatic Brain Injury.

OBJECTIVE: To describe Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans who underwent the Comprehensive Traumatic Brain Injury Evaluation (CTBIE), differences between the traumatic brain injury (TBI) and non-TBI subgroups, and factors associated with return to productivity (RTP). DESIGN: Retrospective medical record review. SETTING: Medical center. PARTICIPANTS: Medical records of OEF/OIF veterans (N=236) who underwent the CTBIE between 2009 and 2013. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic characteristics, injury history, clinical presentation, and factors associated with RTP. RESULTS: Veteran sample included 90.7% men, was 45.3% white and 34.7% black, with half of Hispanic origin, and had a mean age of 33 years. The mean time since injury was approximately 4 years. Reported symptoms were high, with >90% reporting anxiousness, irritability, sleep difficulty, forgetfulness, and headaches. TBI diagnosis was found in 163 veterans (69%). The TBI subgroup was younger (TBI: 32.5y vs non-TBI: 34.9y; P=.02), reported a greater number of injuries (P<.001), and had significantly higher rates of half of the reported symptoms. Greatest differences were noted with forgetfulness (TBI: 95.7% vs non-TBI: 79.5%; P<.001), poor concentration (TBI: 90.2% vs non-TBI: 76.7%; P=.007), and headaches (TBI: 93.9% vs non-TBI: 83.6%; P=.014). RTP was 60.6% for the total veteran population. Factors associated with RTP were race (white) (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.13-3.55; P=.018), sensitivity to light (OR, 2.58; 95% CI, 1.17-5.66; P=.018), and fatigue (OR, 3.68; 95% CI, 1.51-8.95; P=.004). Veterans that did RTP were 3 times less likely to report depression (OR, .32; 95% CI, .12-.85; P=.022). CONCLUSIONS: Veterans reported a substantial number of lingering symptoms, with a higher prevalence in veterans with TBI. Veterans with reported depression were less likely to RTP. Future research should focus on the relation between depression and non-RTP and the effectiveness of Department of Veterans Affairs services.

The acute care physical therapy HIV/AIDS patient population: a descriptive study.

This study was based on an analysis of an existing database compiled from 475 medical records of people living with HIV/AIDS admitted to an acute-care hospital in New York City in 2004. The characteristics of patients with HIV infection that received physical therapy were determined. Differences between patients with HIV infection that did and did not receive physical therapy, as well as predictors of receipt of physical therapy, were identified. The physical therapy subgroup (n = 69) had a mean age of 48.3 years, consisted of more men than women, and was predominately black, with public health insurance. Admissions were commonly due to non-AIDS-defining illness as the primary diagnoses, accompanied by several comorbidities. Admissions often presented with functional deficits, incurred a prolonged length of stay, and required assistance at discharge. Differences existed between the physical therapy subgroup and the non-physical therapy subgroup (n = 406). Predictors of receipt of physical therapy were functional status on admission and length of stay.

Effect of artificial rearing on the contractile properties and myosin heavy chain isoforms of developing rat tongue musculature.

This study's purpose was to examine the influence of an altered activity level, via artificial rearing, on the contractile properties, myosin heavy chain phenotypes (MHC), and muscle fiber sizes of the developing rat tongue retractor musculature. Artificially reared rat pups were fed through a gastric cannula, eliminating nutritive suckling from postnatal day 4 to postnatal day 14. Rat pups were observed immediately following artificial rearing (postnatal day 14) and after a 1-mo resumption of function (postnatal day 42). The contractile characteristics of the tongue retractor musculature were measured in response to stimulation of the hypoglossal nerve. At postnatal day 14, artificially reared rat pups demonstrated significantly longer twitch half-decay times, lower fusion frequencies, and a marked decrease in fatigue resistance. These contractile speed and fatigue characteristics were fully recovered following a 1-mo resumption of function. MHC phenotypes of the styloglossus muscle (a tongue retractor) were determined by gel electrophoresis. At postnatal day 14, artificial rearing had not altered the MHC phenotype or muscle fiber sizes of the styloglossus muscle. However, following a 1-mo resumption of function artificially reared rat pups demonstrated a small but significant increase in MHCIIa expression and decrease in MHCIIb expression compared with dam-reared rats. These results support artificial rearing as a useful model for altering the activity level of the tongue and suggest that normal suckling behavior is necessary for the normal postnatal development of the tongue retractor musculature. This may also be the case for premature infants necessarily fed artificially.