Early targeted heart rate exercise is safe and May hasten return-to-duty in service members with acute concussion, a preliminary study.

OBJECTIVE: To evaluate the feasibility of an exercise tolerance assessment and intervention added to the Progressive Return to Activity Clinical Recommendations (PRA-CR) in acutely concussed service members (SMs). METHODS: This non-randomized, pilot trial was performed at one center. SMs in the experimental group (ERG) performed the Buffalo Concussion March-in-place Test (BCMT) at every clinic visit and were prescribed at least 20 minutes/day of targeted exercise in addition to PRA-CR. Data for the control group (SCG) were extracted from the same clinic immediately prior to ERG. SMs in both groups were assessed by the same clinician to determine return-to-duty. RESULTS: BCMT identified concussion-related exercise intolerance in 100% (n = 14) at screening visit (mean 3.4 days after injury) and in 0% (n = 7) who had recovered. No adverse effects were associated with BCMT. The estimated recovery time for ERG who performed the exercise intervention (n = 12) was 17.0 (12.8, 21.2) days and for SCG (n = 15) was 23.7 (19.9, 27.5) days (p = 0.039). CONCLUSION: Assessment of exercise tolerance was feasible and could be incorporated into the PRA-CR. Future definitive, randomized controlled trials should be performed to assess the effectiveness of exercise reset program for SMs after concussion.

The Lack of LGBTQIA Cultural Competency in Physical Therapy Education.

Lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) populations are more susceptible to overall poorer health and greater healthcare disparities than heterosexuals. LGBTQIA communities have higher rates of substance and tobacco abuse, sexually transmitted infections, certain types of cancer, and mental health disorders such as anxiety, depression, and suicide. For equitable, culturally competent care to be provided to the LGBTQIA communities, healthcare workers, including physical therapists, need to be equipped with the knowledge to perform skillful, patient-centered examinations, evaluations, and procedural interventions. This training begins during a student's entry-level education, and it is imperative for programs to incorporate LGBTQIA topics into psychosocial courses to elevate the level of cultural competence in new physical therapy graduates. Although the Commission on Accreditation in Physical Therapy Education (CAPTE) provides some directives on covering LGBTQIA topics, there are limited data that this information is explicitly covered in entry-level curriculums or that faculty have sufficient training. Without definitive pedagogical principles or specific, evidence-based curriculums highlighted in the literature, future research is needed to determine what material is conferred related to cultural competence and the LGBTQIA population so that educators can decide if current content meets the requirements of CAPTE and the American Physical Therapy Association.

Influence of wheelchair type on Wheelchair Propulsion Test performance in community-dwelling, adult wheelchair users1.

BACKGROUND: The clinimetric properties of the Wheelchair Propulsion Test (WPT) have not been developed thoroughly. OBJECTIVE: To determine inter-rater reliability and reference values for the Wheelchair Propulsion Test (WPT) for active wheelchair users and to compare WPT performance between various types of manual wheelchairs at different paces. METHODS: This was a cross-sectional, descriptive study. Participants propelled a manual wheelchair 10 m while time and the number of pushes were recorded. Trials were performed in three different manual wheelchairs (a lightweight wheelchair (LW), an ultralightweight wheelchair (ULW), and the participant's personal, customized wheelchair) at a comfortable pace and a fast pace. RESULTS: The ICC values ranged from 0.861 to 0.999 for both speed and number of pushes. Comfortable wheelchair propulsion speed ranged from 1.51 (0.31) m/s to 1.65 (0.33) m/s depending on the wheelchair utilized. Across both pace conditions, participants were significantly faster when using their personal wheelchair compared to the ULW (P < 0.001) and LW (P < 0.001). Push frequency was significantly greater during the fast pace condition compared to the comfortable pace condition (P < 0.001). CONCLUSIONS: Reference values for the WPT in active wheelchair users have been identified. Participants who utilize their personal wheelchair demonstrate faster wheelchair propulsion speeds complemented by greater push frequencies.