Vestibular Rehabilitation for a Child With Posterior Fossa Syndrome: A Case Report.

PURPOSE: This case report assesses gaze stability, postural control, and balance pre- and post-physical therapy intervention, including vestibular rehabilitation, in a 4-year-old child with posterior fossa syndrome following gross total resection of a juvenile astrocytoma brain tumor. SUMMARY OF KEY POINTS: The child in this case study had improved balance and gaze stability, as determined by the Pediatric Balance Scale and the Dynamic Visual Acuity test upon completion of the 10-week intervention. STATEMENT OF CONCLUSION AND RECOMMENDATIONS FOR CLINICAL PRACTICE:: This case provides preliminary support of the need for vestibular screening in children with a diagnosis of posterior fossa syndrome. The success of the intervention suggests that vestibular rehabilitation exercises can be modified for use in preschool-aged children, and the specific intervention outlined in this case report can be easily replicated in a variety of treatment settings.

Does Dosing of Pediatric Experiential Learning Impact the Development of Clinical Reasoning, Self-Efficacy, and Critical Thinking in DPT Students?

AIMS: The purpose of this study was to explore the changes in clinical reasoning, self-efficacy, and critical thinking of a group of Doctor of Physical (DPT) students who completed a high and low dose of pediatric experiential learning (EL) as a component of their semester-long pediatric course. METHODS: A convenience sample of students at two DPT programs in the United States were recruited. A pre-test post-test comparison group design was used to examine the change in students' clinical reasoning, self-efficacy, and critical thinking following completion of a pediatric course that contained a high or low dose of EL. Students completed the Self-Assessment of Clinical Reflection and Reasoning, Physical Therapy Self-Efficacy Scale, and Health Science Reasoning Test during the first and last weeks of the semester. Students in the high-dose group reported a significant increase (p=0.000) over time in self-perceived clinical reasoning and self-efficacy. Overall critical thinking abilities significantly improved (p=0.044) over time in both groups. CONCLUSION: A high dose of pediatric EL seems to aid students in the development of self-perceived clinical reasoning and self-efficacy. Providing students with EL opportunities prior to pediatric rotations may help to bolster these important skills, leading to improved clinical performance.

History of concussion and risk of subsequent injury in athletes and service members: A systematic review and meta-analysis.

Risk of secondary injury after a primary concussion in sports and military contexts is an emerging area of interest in research. The purpose of this review was to provide an evidence synthesis describing risk of injury in athletic and military populations with and without a history of concussion. Electronic database searches were completed through September 7, 2018 in PubMed, EMBASE, CINAHL and SCOPUS. Peer-reviewed observational studies of any design with participants who were athletes or service members; measured the outcome of any type of injury; and compared injury between those with and without a history of concussion were included. Risk of bias was assessed using the Q-Coh II. Twenty-seven articles were included. Seventeen meta-analyses were completed for risk of any injury, risk of concussion, and risk of extremity injury using odds, hazard, and rate ratios. The results indicate significantly increased odds of all injuries (OR = 2.55; 95%CI 1.85,3.52); concussion (OR = 3.73; 95%CI 2.41,5.78); and lower extremity injuries (OR = 1.60; 95%CI 1.32,1.94) in those with a history of concussion compared to those without. Additional analyses reveal this increased risk is apparent when looking at time to event data and rate of injury based on number of exposures. While the reasons for the increased incidence of secondary injury associated with a concussion are not yet understood, there are potentially behavioral attributes and motor control deficits that contribute. It is suggested that research is needed to determine if active therapeutic treatment for disturbances in sensorimotor and neuromotor control after concussion could attenuate the increased risk for injury.

Sensorimotor training for injury prevention in collegiate soccer players: An experimental study.

OBJECTIVES: Deliver a sensorimotor training intervention; quantify the change in clinical measurements of sensorimotor control; and compare injury rate to a historical control. DESIGN: One-arm experimental pilot; Level 3. SETTING: NCAA Division II university athletic facilities. PARTICIPANTS: 75 collegiate soccer players (38 males; 37 females) were enrolled, including 30 (40%) with history of concussion, and participated in eight training sessions. OUTCOMES: Change in pre-to post-intervention for: static balance on the Sway app, near-point convergence, self-reported symptoms on the Post-Concussion Symptom Scale, cervical flexor neuromotor control/endurance, measured by the Cranial-Cervical Flexion Test and Joint Position Error test, and gaze stability on the Dynamic Visual Acuity Test. Injury incidence rate in 2018 was calculated using the number of traumatic injuries across the season and athlete exposure counts, as compared to a historical control. RESULTS: Significant improvements were obtained in static balance, cervical flexor neuromotor control/endurance, and near-point convergence (p-values<0.01-0.03). Increases in symptom report (p = 0.02) and a decline in dynamic gaze stability (p < 0.01) were observed. There were 11.8 injuries/1000 athlete exposures in 2017 and 8.9 injuries/1000 athlete exposures in 2018 after the treatment (p = 0.18). CONCLUSION: This intervention holds promise as a preventive strategy for sports-injury as a comprehensive population-based intervention.