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.

Function and Emotion in Everyday Life With Type 1 Diabetes (FEEL-T1D): Protocol for a Fully Remote Intensive Longitudinal Study.

BACKGROUND: Although short-term blood glucose levels and variability are thought to underlie diminished function and emotional well-being in people with type 1 diabetes (T1D), these relationships are poorly understood. The Function and Emotion in Everyday Life with T1D (FEEL-T1D) study focuses on investigating these short-term dynamic relationships among blood glucose levels, functional ability, and emotional well-being in adults with T1D. OBJECTIVE: The aim of this study is to present the FEEL-T1D study design, methods, and study progress to date, including adaptations necessitated by the COVID-19 pandemic to implement the study fully remotely. METHODS: The FEEL-T1D study will recruit 200 adults with T1D in the age range of 18-75 years. Data collection includes a comprehensive survey battery, along with 14 days of intensive longitudinal data using blinded continuous glucose monitoring, ecological momentary assessments, ambulatory cognitive tasks, and accelerometers. All study procedures are conducted remotely by mailing the study equipment and by using videoconferencing for study visits. RESULTS: The study received institutional review board approval in January 2019 and was funded in April 2019. Data collection began in June 2020 and is projected to end in December 2021. As of June 2021, after 12 months of recruitment, 124 participants have enrolled in the FEEL-T1D study. Approximately 87.6% (7082/8087) of ecological momentary assessment surveys have been completed with minimal missing data, and 82.0% (82/100) of the participants provided concurrent continuous glucose monitoring data, ecological momentary assessment data, and accelerometer data for at least 10 of the 14 days of data collection. CONCLUSIONS: Thus far, our reconfiguration of the FEEL-T1D protocol to be implemented remotely during the COVID-19 pandemic has been a success. The FEEL-T1D study will elucidate the dynamic relationships among blood glucose levels, emotional well-being, cognitive function, and participation in daily activities. In doing so, it will pave the way for innovative just-in-time interventions and produce actionable insights to facilitate tailoring of diabetes treatments to optimize the function and well-being of individuals with T1D. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30901.

Weight Change 2 Years After Termination of the Intensive Lifestyle Intervention in the Look AHEAD Study.

OBJECTIVE: This study evaluated weight changes after cessation of the 10-year intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study. It was hypothesized that ILI participants would be more likely to gain weight during the 2-year observational period following termination of weight-loss-maintenance counseling than would participants in the diabetes support and education (DSE) control group. METHODS: Look AHEAD was a randomized controlled trial that compared the effects of ILI and DSE on cardiovascular morbidity and mortality in participants with overweight/obesity and type 2 diabetes. Look AHEAD was converted to an observational study in September 2012. RESULTS: Two years after the end of the intervention (EOI), ILI and DSE participants lost a mean (SE) of 1.2 (0.2) kg and 1.8 (0.2) kg, respectively (P = 0.003). In addition, 31% of ILI and 23.9% of DSE participants gained ≥ 2% (P < 0.001) of EOI weight, whereas 36.3% and 45.9% of the respective groups lost ≥ 2% of EOI weight (P = 0.001). Two years after the EOI, ILI participants reported greater use of weight-control behaviors than DSE participants. CONCLUSIONS: Both groups lost weight during the 2-year follow-up period, but more ILI than DSE participants gained ≥ 2% of EOI weight. Further understanding is needed of factors that affected long-term weight change in both groups.

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 relationship of social support with treatment adherence and weight loss in Latinos with type 2 diabetes.

OBJECTIVE: Little is known about the effects of social support on weight loss in Latinos. This study determined whether sex moderated and treatment adherence mediated the association between social support and weight loss. METHODS: Data from 278 Latino males and females with type 2 diabetes in the Intensive Lifestyle Intervention of the Look AHEAD trial were analyzed. Multivariable modeling tested for moderation and parallel multiple mediator modeling simultaneously tested the mediating effects of adherence to physical activity, diet, and session attendance on the relationship between baseline social support and percent weight loss at 1 year. RESULTS: Social support for physical activity (having family and friends join in physical activity) was related to weight loss. Adherence to physical activity was related to both social support for physical activity and weight loss. Sex did not moderate these relationships. Adherence to physical activity completely mediated the relationship between social support for physical activity and weight loss. CONCLUSIONS: Increasing companionship for physical activity may be an effective intervention strategy to promote behaviors important for weight loss among Latinos.

Identification of large NF1 duplications reciprocal to NAHR-mediated type-1 NF1 deletions.

Approximately 5% of all patients with neurofibromatosis type-1 (NF1) exhibit large deletions of the NF1 gene region. To date, only nine unrelated cases of large NF1 duplications have been reported, with none of the affected patients exhibiting multiple café au lait spots (CALS), Lisch nodules, freckling, or neurofibromas, the hallmark signs of NF1. Here, we have characterized two novel NF1 duplications, one sporadic and one familial. Both index patients with NF1 duplications exhibited learning disabilities and atypical CALS. Additionally, patient R609021 had Lisch nodules, whereas patient R653070 exhibited two inguinal freckles. The mother and sister of patient R609021 also harbored the NF1 duplication and exhibited cognitive dysfunction but no CALS. The breakpoints of the nine NF1 duplications reported previously have not been identified and hence their underlying generative mechanisms have remained unclear. In this study, we performed high-resolution breakpoint analysis that indicated that the two duplications studied were mediated by nonallelic homologous recombination (NAHR) and that the duplication breakpoints were located within the NAHR hotspot paralogous recombination site 2 (PRS2), which also harbors the type-1 NF1 deletion breakpoints. Hence, our study indicates for the first time that NF1 duplications are reciprocal to type-1 NF1 deletions and originate from the same NAHR events.

Immediate effects of a heel-pain orthosis and an augmented low-dye taping on plantar pressures and pain in subjects with plantar fasciitis.

OBJECTIVE: To determine the effects of augmented low-dye (ALD) taping and a heel-pain orthosis (HPO) on pain, peak plantar pressure (PPP), and mean plantar pressure (MPP) while walking and jogging. DESIGN: Cross-over study design. SETTING: University clinical laboratory. PARTICIPANTS: Seventeen physically active or sedentary individuals with plantar fasciitis. INTERVENTIONS: Both PPP and MPP were evaluated after 45 seconds of walking and jogging during the 3 interventions (control, ALD, HPO) under 4 areas of the foot: lateral rearfoot and forefoot, and medial rearfoot and forefoot. Pain was assessed during each intervention (at 60-second mark) using the visual analog scale (VAS). MAIN OUTCOME MEASURES: Peak plantar pressure, MPP, and VAS. RESULTS: The ALD produced a decrease in walking MPP (44.66 ± 14.46) under the lateral rearfoot compared with the control (57.92 ± 22.18; P = 0.024) and in jogging MPP (55.05 ± 18.27) compared with the control (67.22 ± 20.95; P = 0.002) and HPO (68.51 ± 17.57; P = 0.002). Scores of VAS decreased with the application of HPO (7.12 ± 10.08; P < 0.002 and 12.15 ± 15.61; P < 0.003) and ALD (6.24 ± 5.71; P < 0.006 and 10.09 ± 8.87; P < 0.001) while walking and jogging when compared with the control (17.32 ± 17.86 and 26.65 ± 22.38). CONCLUSIONS: Although the HPO and ALD produced statistically and clinically decreased VAS scores while walking and jogging, further research is needed beyond these preliminary findings to determine long-term outcomes related to pain relief.

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.

Redefined genomic architecture in 15q24 directed by patient deletion/duplication breakpoint mapping.

We report four new patients with a submicroscopic deletion in 15q24 manifesting developmental delay, short stature, hypotonia, digital abnormalities, joint laxity, genital abnormalities, and characteristic facial features. These clinical features are shared with six recently reported patients with a 15q24 microdeletion, supporting the notion that this is a recognizable syndrome. We describe a case of an ~2.6 Mb microduplication involving a portion of the minimal deletion critical region in a 15-year-old male with short stature, mild mental retardation, attention deficit hyperactivity disorder, Asperger syndrome, decreased joint mobility, digital abnormalities, and characteristic facial features. Some of these features are shared with a recently reported case with a 15q24 microduplication involving the minimal deletion critical region. We also report two siblings and their mother with duplication adjacent and distal to this region exhibiting mild developmental delay, hypotonia, tapering fingers, characteristic facial features, and prominent ears. The deletion and duplication breakpoints were mapped by array comparative genomic hybridization and the genomic structure in 15q24 was analyzed further. Surprisingly, in addition to the previously recognized three low-copy repeat clusters (BP1, BP2, and BP3), we identified two other paralogous low-copy repeat clusters that likely mediated the formation of alternative sized 15q24 genomic rearrangements via non-allelic homologous recombination.

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.

Unexpected survival in a case of prenatally diagnosed non-mosaic trisomy 22: Clinical report and review of the natural history.

Over 30 cases of complete non-mosaic trisomy 22 have been reported in the literature in the last 20 years [Crowe et al., 1997: Am J Med Genet 71:406-413]. Twenty-two infants were liveborn with an average life expectancy of four days. Of these, nine survived beyond the first two weeks of life. The life span ranged from minutes to 3 years of age. We report a case of an infant diagnosed prenatally with complete non-mosaic trisomy 22. Options such as aggressive medical/surgical intervention or limiting interventions to symptomatic care including home hospice were discussed openly. Given this information, the family elected to provide minimal supportive measures with pediatric hospice. The infant lived for 2 months with her family before her death. Numerous medical and surgical complications are associated with this disorder. Both the family and the medical team must be prepared for in utero fetal demise, stillbirth, or for limited life expectancy. Proper management, therefore, depends upon an understanding of the diagnosis.