Executive Functions and Student Success During Physical Therapist Education: An Exploratory Study.

BACKGROUND: Clinical reasoning relies on executive functions (EFs) that manage attention, inhibition, organization, and decision-making. Assessment of EFs may help identify students who excel at clinical reasoning, yet data showing this relationship in physical therapy (PT) education programs are lacking. The primary purpose of this exploratory study was to examine EFs in relationship to success in PT educational programs. METHODS: Thirteen third-year PT graduate students completed two EF tests which were compared to culminating scores in the program and admissions scores. RESULTS: A relationship existed between National Physical Therapy Examination (NPTE) and comprehensive exam results and one EF test score; comprehensive exams and NPTE scores related to the other EF test. CONCLUSIONS: EF measures may provide insights into student successes, especially as they pertain to outcomes requiring clinical reasoning.

Effects of Instrument Handle Design on Dental Hygienists' Forearm Muscle Activity During Scaling.

Purpose: The purpose of this study was to determine the effects of 4 different commercially available instrument handle designs (A. 16 grams and 12.7 mm diameter, B. 23 grams and 11.1 mm diameter, C. 21 grams and 7.9 mm diameter and D. 18 grams and 6.35 mm diameter) on the muscle activity of four forearm muscles during a simulated scaling experience.Methods: A convenience sample of 27 (n=27) dental hygienists used a Columbia 13/14 curet with four different instrument handles to scale artificial calculus from typodont teeth. Each participant's muscle activity was measured using surface electromyography (sEMG).Results: Similar muscle activity was generated when scaling with instruments at 16, 18, and 21 grams with varying diameter handles. Instrument B generated significantly more muscle activity when compared to each of the other instrument handle designs (p=0.001, p=0.002, p=0.039). The lower left quadrant displayed significantly less muscle activity during scaling than the upper and lower right quadrants (p=0.026, p=0.000), although no significant interaction effect was found with instruments within quadrants. Most participants (62.96%) preferred instrument A, which was rated more comfortable based on weight when compared to the other instruments tested.Conclusions: Instrument handle design has an effect on forearm muscle activity when scaling in a simulated environment. The heaviest instrument with a relatively large diameter (B 11.1 mm and 23 g) generated significantly more overall mean muscle activity compared to the other three instruments. Similar amounts of muscle activity were produced by instruments weighing between 16 and 21 g. Participants' instrument preferences were more affected by handle diameter than weight. Results support the need for further research to determine the impact of these findings on muscle load related to risk of musculoskeletal disorders in a real-world setting.

The effect of 3 foot pads on plantar pressure of pes planus foot type.

CONTEXT: Many styles of foot pads are commonly applied to reduce immediate pain and pressure under the foot. OBJECTIVE: To examine the effect of 3 different foot pads on peak plantar pressure (PPP) and mean plantar pressure (MPP) under the first metatarsophalangeal joint (MTPJ) during slow running. DESIGN: A 4 (pad) x 4 (mask) repeated-measures design. SETTING: University athletic training clinic and fitness facility. PARTICIPANTS: 20 physically active participants, 12 men (19.7 +/- 1.3 y, 181.5 +/- 6.3 cm, 83.6 +/- 12.3 kg) and 8 women (20.8 +/- 1.5 y, 172.7 +/- 11.2 cm, 69.9 +/- 14.2 kg) with navicular drop greater than or equal to 10 mm, no history of surgery to the lower extremity, and no history of pain or injury to the first MTPJ in the past 6 months. INTERVENTIONS: PPP and MPP were evaluated under 4 areas of the foot: the rear foot, lateral forefoot, medial forefoot, and first MTPJ. Four pad conditions (no pad, metatarsal dome, U-shaped pad, and donut-shaped pad) were evaluated during slow running. All measurements were taken on a standardized treadmill using the Pedar in-shoe pressure-measurement system. MAIN OUTCOME MEASURES: PPP and MPP in 4 designated foot masks during slow running. RESULTS: The metatarsal dome produced significant decreases in MPP (163.07 +/- 49.46) and PPP (228.73 +/- 63.41) when compared with no pad (P < .001). The U-shaped pad significantly decreased MPP (168.68 +/- 50.26) when compared with no pad (P < .001). The donut-shaped pad increased PPP compared with no pad (P < .001). CONCLUSIONS: The metatarsal dome was most effective in reducing both peak and mean plantar pressure. Other factors such as pad comfort, type of activity, and material availability must also be considered. Further research should be conducted on the applicability to other foot types and symptomatic subjects.

Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects.

UNLABELLED: Walker ML, Ringleb SI, Maihafer GC, Walker R, Crouch JR, Van Lunen B, Morrison S. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects. OBJECTIVE: To determine whether the use of a low-cost virtual reality (VR) system used in conjunction with partial body weight-supported treadmill training (BWSTT) was feasible and effective in improving the walking and balance abilities of patients poststroke. DESIGN: A before-after comparison of a single group with BWSTT intervention. SETTING: University research laboratory. PARTICIPANTS: A convenience sample of 7 adults who were within 1 year poststroke and who had completed traditional rehabilitation but still exhibited gait deficits. Six participants completed the study. INTERVENTION: Twelve treatment sessions of BWSTT with VR. The VR system generated a virtual environment that showed on a television screen in front of the treadmill to give participants the sensation of walking down a city street. A head-mounted position sensor provided postural feedback. MAIN OUTCOME MEASURES: Functional Gait Assessment (FGA) score, Berg Balance Scale (BBS) score, and overground walking speed. RESULTS: One subject dropped out of the study. All other participants made significant improvements in their ability to walk. FGA scores increased from mean of 13.8 to 18. BBS scores increased from mean of 43.8 to 48.8, although a ceiling effect was seen for this test. Overground walking speed increased from mean of .49m/s to .68m/s. CONCLUSIONS: A low-cost VR system combined with BWSTT is feasible for improved gait and balance of patients poststroke.

Effects of 5 different finger rest positions on arm muscle activity during scaling by dental hygiene students.

PURPOSE: This study was conducted to determine the effects of 5 different finger rest positions: opposite arch, standard intraoral, basic extraoral, cross arch, and finger on finger on the muscle activity of 4 forearm muscles (extensor carpi radialis longus, flexor carpi ulnaris, biceps brachii, and pronator teres) during a simulated periodontal scaling experience. METHODS: A convenience sample of 32 consenting senior dental hygiene students who met inclusion criteria participated. Using a 4 x 5 counter-balanced research design, each participant used a Gracey 11/12 curet to scale one cc of artificial calculus from first permanent molar typodont teeth (#3,14,19,30). Five different typodonts were set up for each participant with fulcrums randomly assigned for use on each typodont. While scaling, the participant's muscle activity was measured by surface electromyography. Two-way analysis of variance with repeated measures was used to determine if significant differences existed in the amount of muscle activity generated with each fulcrum. RESULTS: Results revealed no statistically significant interaction effect between area of the mouth scaled, muscle activity, and fulcrum used. Similar muscle activity was produced throughout the mouth regardless of the fulcrum used. The upper right quadrant produced the most muscle activity (p= 0.0101) and the lower left quadrant produced the least (p=< .0001). When comparing the overall muscle activity generated with each fulcrum, only the cross arch fulcrum when compared to the opposite fulcrum produced statistically significant results (p=0.0110). CONCLUSIONS: Based on the results, similar muscle activity is produced when using any of the 5 fulcrums in each quadrant of the mouth. Clinicians appear to experience minimal ergonomic advantage in terms of fulcrums used and area of the mouth scaled during a simulated scaling experience.

Reference group data for the functional gait assessment.

BACKGROUND AND PURPOSE: The Functional Gait Assessment (FGA) is a clinical tool for evaluating performance in walking. The purpose of this study was to determine age-referenced norms for performance on the FGA in community-living older adults. SUBJECTS: Subjects were 200 adults, ages 40 to 89 years, living independently. METHODS: Each subject completed the FGA one time and was scored simultaneously by 2 testers. RESULTS: The intraclass correlation coefficient for interrater reliability was .93. Mean scores for the FGA ranged from 29/30 for adults in their 40s to 21/30 for adults in their 80s. DISCUSSION AND CONCLUSION: Patient performance on the FGA can be compared with age-referenced norms for expected performance. Further research is needed to determine the FGA's usefulness in tracking clinical changes or predicting falls. The FGA is a reliable test for people without disease, and it is able to detect decreases in gait performance among typical older adults.

The Short-Term Effects of Joint Mobilizations on Acute Mechanical Low Back Dysfunction in Collegiate Athletes.

Context: Although a variety of theories and studies have been cited to support the use of joint mobilization in the spine as an integral part of the treatment and rehabilitation process, information about the short-term effects of joint mobilization on acute low back injury with respect to patient pain and strength changes has been limited.Objective: To examine the short-term effects of grade 1 and 2 posteroanterior joint mobilizations at the lumbar spine on subject pain and muscle force after an episode of acute, mechanical low back pain.Design: Group (2) by time (2 or 3).Setting: Athletic training clinic.Patients or Other Participants: Male collegiate athletes (n = 19) with mechanical low back pain as assessed through a standardized evaluation were randomly assigned to a control (n = 10) or experimental (n = 9) group.Intervention(s): All subjects underwent a standardized treatment protocol of cryotherapy and stretching during data collection. Subjects completed the McGill Pain Questionnaire and a visual analog scale (the latter to assess pain levels during range-of-motion activities) and, using a handheld dynamometer, performed 3 maximum voluntary isometric contractions to determine muscle force. Grade 1 and 2 joint mobilizations were administered to the experimental group, whereas the control group was placed in a prone position of comfort for the time it took to perform the joint mobilizations.Main Outcome Measure(s): Baseline, immediate posttreatment, and 24-hour posttreatment measurements of pain and muscle force were taken.Results: Compared with the control group, the experimental group demonstrated significant decreases in the sensory subscale scores of the McGill Pain Questionnaire and in pain during lumbar extension and a significant increase in force production.Conclusions: Grade 1 and 2 joint mobilizations reduced subjects' pain and increased force production in the short-term stages of mechanical low back pain.

Reliability of the dynamic gait index in people with vestibular disorders.

OBJECTIVE: To examine the interrater reliability of the Dynamic Gait Index (DGI) when used with patients with vestibular disorders and with previously published instructions. DESIGN: Correlational study. SETTING: Outpatient physical therapy clinic. PARTICIPANTS: Subjects included 30 patients (age range, 27-88y) with vestibular disorders, who were referred for vestibular rehabilitation. INTERVENTIONS: Subjects' performance on the DGI was concurrently rated by 2 physical therapists experienced in vestibular rehabilitation to determine interrater reliability. MAIN OUTCOME MEASURES: Percentage agreement, kappa statistics, and the ratio of subject variability to total variability were calculated for individual DGI items. Kappa statistics for individual items were averaged to yield a composite kappa score of the DGI. Total DGI scores were evaluated for interrater reliability by using the Spearman rank-order correlation coefficient. RESULTS: Interrater reliability of individual DGI items varied from poor to excellent based on kappa values (kappa range,.35-1.00). Composite kappa values showed good overall interrater reliability (kappa=.64) of total DGI scores. The Spearman rho demonstrated excellent correlation (r=.95) between total DGI scores given concurrently by the 2 raters. CONCLUSION: DGI total scores, administered by using the published instructions, showed moderate interrater reliability with subjects with vestibular disorders. The DGI should be used with caution in this population at this time, because of the lack of strong reliability.