CoHP - SoPT - Faculty Works

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A SURVEY STUDY EXPLORING THRUST JOINT MANIPULATION CURRICULUMS WITHIN ENTRY-LEVEL DOCTOR OF PHYSICAL THERAPY PROGRAMS
(2024-04-18) Howland, Chad
Background and Purpose: The Commission of Accreditation in Physical Therapy Education (CAPTE) requires entry-level Doctor of Physical Therapy (DPT) programs to produce students competent in delivering physical therapy interventions, which include thrust joint manipulation (TJM). However, no mandate exists concerning TJM curricular design or what constitutes entry-level competency. This study sought to explore the current state of TJM education and provide an update on curriculum characteristics and standards. Methods and Results: An online-based survey was distributed to accredited entry-level DPT programs between September 2022 to August 2023. Eligible respondents were physical therapist educators serving as the primary instructor in musculoskeletal coursework for the spine or pelvis. The survey collected data on program demographics, instructor demographics, TJM curriculum design, and perceived competency of students specific to TJM of the spine or pelvis. Survey respondents’ data was analyzed using descriptive statistics (n = 78). Survey results showed the highest percentage (78.%) of respondents were board-certified orthopedic specialists (OCS), with less than one-half reporting advanced certifications in spinal manipulative therapy (47.4%). Nearly all respondents (94.8%) viewed TJM as an entry-level skill and considered their students satisfactory or above satisfactory by graduation. Most respondents view TJM of the upper cervical spine as a post entry-level skill (Figure). A disparity between spinal regions taught in TJM curricula was observed, with lumbar TJM representing the highest percentage of responses (98.7%). Conclusion: Compared to a decade ago, a higher percentage of physical therapist educators teaching TJM reported advanced certifications in orthopedics or manual therapy. However, both program and TJM curriculum characteristics appear comparable to previous reports. The results from this study may not be generalizable to all entry-level DPT programs given the low response rate.
BLOOD FLOW RESTRICTION TRAINING FOR PERSISTENT KNEE EXTENSOR WEAKNESS
(2023-04-20) Scott, Wayne; Michaud-Gardner, Alyssa; Sylvia, Jack; Topiwala, Dave
This case study presents the effects of 8 weeks of blood flow restriction training (BFRT) for persistent knee extensor weakness following a long standing repaired ACL injury. A 20 year old female with no history of knee injury prior to the initial ACL tear in 2020 received a patellar bone graft 6 months later. The patient received traditional physical therapy for 6 weeks, which was inconsistent due to COVID-19 interruptions. The participant presented with an antalgic gait and difficulty performing stairs as a result of persistent knee extensor muscle weakness. The participant's knee extensor strength was tested using a Biodex force dynamometer. Initial testing demonstrated that the involved side knee extensors could only produce 68.7% of the muscle torque of the uninvolved side knee extensors. The participant underwent BFRT at a frequency of 2 sessions per week for a total of 8 weeks. The participant performed unilateral knee extensions, step ups, and leg presses for sets of 30, 15, 15 and 15 reps. Blood flow was restricted with a tourniquet inflated to 80% of the pressure which caused full arterial blood flow occlusion for the duration of each exercise with 2 minutes of cuff deflation between exercises. Following 8 weeks of training, the participant’s knee extensors on the involved side were able to produce 82.9% of the muscle torque of the uninvolved side knee extensors. In this case, BFRT demonstrated the ability to improve persistent knee extensor weakness following ACL repair. This improvement in strength was maintained at 3 and 6 month follow up testing. Significantly, the patient’s antalgic gait and difficulty performing stairs resolved during the 8 weeks of training.
CAN BLOOD FLOW RESTRICTION TRAINING REVERSE LONG-STANDING QUADRICEPS WEAKNESS?
(2024-04-18) Gregoire, Jacob; Hammill, Elizabeth; Lemay, Amber; Olsen, Madison; Sargent, Hannah; Scott, Wayne
Background: Blood Flow Restriction Training (BFRT) involves the application of a tourniquet device during resistance exercises, offering a method for muscle strengthening with low-load training, which reduces stress on joints and tissues. BFRT is commonly employed in rehabilitating injuries of the knee including ligament injuries and damage to the menisci. Previous studies suggest that BFRT induces hypertrophy through a combined response to metabolic stress and mechanical tension. Purpose: This study investigated if BFRT could address long-standing quadriceps weakness following ACL, medial meniscus and MCL injury, commonly referred to as the "unhappy triad." Study Design: A case study was conducted on a 24-year-old female soccer player, five years postoperative ACL and meniscus repair, who reported knee pain, weakness, and instability during functional activities and sports. Methods: The participant underwent BFRT sessions twice a week for eight weeks. Exercises were performed with 80% blood flow restriction on the affected limb, interrupting arterial blood flow during 3 exercises with a 2-minute rest break in between exercises during which the cuff was deflated. Exercises included unilateral knee extensions, step-ups, and leg presses, comprising four sets of each exercise with repetitions of 30, 15, 15, and 15, with 30 seconds of rest in between each set. Results: Our study revealed improvements in maximal volitional isometric contraction (MVIC) torque, burst torque, self-reported confidence, and thigh symmetry. MVIC torque of the affected limb increased by 8.5% and burst torque increased by 23% indicating enhanced strength. Conclusion: The case study highlights promising outcomes of BFRT in improving strength in the knee extensor muscles of persons with chronic weakness. Future research should explore qualitative assessments and BMI, skinfold measurements, and functional evaluations to provide a comprehensive understanding of BFRT's efficacy.
CAN WALKING THE PLANK IMPROVE GAIT?
(2024-04-18) Andrews, Evan; Driscoll, Alyssa; Matte, Kayla; Newcomb, Ryley; Payeur, Mikaylah; Scott, Danielle; Wheelock, Ryan; Sidaway, Ben
Purpose: This study examined the effect of balance practice on narrow planks on the fall risk, balance confidence and gait characteristics of older adults. Participants and methods: The Dynamic Gait Index (DGI), the Activities-specific Balance Confidence (ABC) scale and fear of falling were recorded in 10 older adults (73-91 years). The participants then walked over a 6 m long computerized gait mat at normal and quick walking speeds enabling various gait parameters to be recorded. Following these pretests participants practiced walking along planks that decreased in width with practice. Participants practiced for 30 minutes twice a week for 4 weeks. A post-test was conducted at the end of practice and a retention test was administered a week following practice. Data were analyzed using t-tests and analyses of variance (ANOVA). Results: Practice walking on planks significantly improved DGI and ABC scores. The DGI mean improved from “fall risk” to “no risk” and from “moderate physical functioning” to “high physical functioning.” Analysis of gait parameters revealed significant increases in gait velocity at both speeds along with an increase in stride length. The increase in stride length was accompanied by a significant decrease in stride length variability and stance percentage. Conclusion: Quantitative gait markers of fall risk in older adults showed significant improvement following the plank training. The balance training improved dynamic postural control enabling participants to reduce stance time and thus take longer strides consequently increasing gait speed. The improvement in DGI and ABC scores demonstrate clinically meaningful impacts in both gait performance and self-reported balance confidence.
ERROR ESTIMATION AND KNOWLEDGE OF RESULTS IN LEARNING A NOVEL MOTOR TASK
(2023-04-20) Duffy, Hannah; Lees, Jennifer; Shamaly, Shannon; Sidaway, Ben
When learning a new motor skill, feedback on the errors in performance, or knowledge of results, is important in order to make adjustments to the future response attempts. However, previous studies have shown that when high frequencies of feedback are provided to a learner such feedback can suppress intrinsic error detection and corrections processes resulting in poorer performance when that feedback is no longer available. Other studies have shown that requiring error estimation during practice prior to feedback being provided enhances learning of the skill. Such research though has not investigated the role of different frequencies of error estimation on learning nor has the combined effect of requiring error estimation while providing different frequencies of knowledge of results been investigated. It remains unknown whether there is an optimal frequency of error estimation for motor learning or whether error estimation may interact with the frequency of feedback. The present study included 6 randomly assigned intervention groups of young adults (18-35 years) that were differentiated on the basis of knowledge results (0%, 33%, or 100%) and error estimation (0%, 33%, or 100%) frequency. Each group was taught a shuffle-board like skill aiming at a target that was hidden from view. Each group performed a series of ten blocks of 12 practice trials followed by three retention tests (5 min, 1 day, 1 week), and a transfer test. Response error (absolute, constant, and variable) was calculated for each phase of the experiment along with the accuracy of error estimation. Preliminary results show that requiring overt error estimation of learners ameliorates the negative impact of high frequencies of knowledge of results feedback on skill learning. Discussion focuses on the potential interaction of error estimation and feedback for motor learning in clinical practice.
IMPROVING QUALITY OF LIFE FOR CANCER SURVIVORS THROUGH THE IMPLEMENTATION OF A WELLNESS WORKSHOP
(2024-04-18) Cummings, Ashley; Gott, Mallory; Hanning, Amelia; Rowe, Madison; Wasson, Courtney; Slike, Michelle
Research suggests that cancer survivors living in rural communities struggle with adequate resources related to survivorship. Proper education and intervention has been shown to improve life post-diagnosis. The purpose of this project was to design and implement an evidence-based, educational workshop to improve the quality of life for cancer survivors in rural areas of Maine. Following a needs assessment completed through a rural health facility and the YMCA, focus was placed on the following educational topics: physical and mental well-being, fatigue, lymphedema management, and chemo-induced peripheral neuropathy. Two workshops, one in-person and one virtual, were completed in an effort to reach residents in rural areas of Maine. Both workshops were two hours long and were designed and taught by entry-level doctor of physical therapy (DPT) students. Content was delivered using a PowerPoint presentation and active learning strategies. A total of 12 participants completed the workshop, 9 in-person and 3 virtual. Assessment of teaching effectiveness was completed utilizing pre- and post-test assessments, satisfaction surveys, and follow-up phone call interviews 6 months following the competition of the workshop. Strengths identified by the participants during the assessment included organization, informative content, and detailed resources that could be used following the workshops. Weaknesses identified included PowerPoint presentation style and the preference of in-person versus virtual learning. Notably, education on oncology rehabilitation, lymphedema, fatigue management, and chemo-induced peripheral neuropathy led to awareness of resources and enhanced self-care abilities. Wellness resources are lacking for cancer survivors in rural locations throughout the United States. This demand can be met through educational workshops similar to this project. Providing cancer survivors with educational information can improve their quality of life, reduce the risk of recurrence of cancer, and improve the effect of chronic conditions often experienced by cancer survivors.
IS DUAL TASK ABILITY FULLY RECOVERED IN ATHLETES WHO HAVE COMPLETED THE CONCUSSION RETURN-TO-PLAY PROTOCOL?
(2023-04-20) Hartman, Zachary; Marquis, Gabrielle; Siegel, Sondra
Purpose: This study investigated deficits in dual task ability in collegiate athletes with acute concussions who have completed the return-to-play protocol. While previous research has demonstrated the persistence of deficits using standard cognitive tests, this study specifically addressed performance in a contextually relevant, sports-related challenge. Methods: Concussed and non-concussed college athletes completed a demographics and history questionnaire, and were assessed for balance using the Balance Error Scoring System test. For the novel test, gait parameters were measured under three conditions using an instrumented gait mat. Conditions included: walking at a comfortable pace, walking while watching a sport-related video and performing a cognitive task, and walking while watching the video and performing the cognitive and a secondary physical task. The cognitive task was also performed by the participant in a standing position. Response accuracy on the cognitive task was recorded for all conditions. Outcome Measures: Measures included gait speed, cadence, stance percentage, step variability, and response accuracy for the cognitive task. Results: The control group demonstrated better performance than the experimental group with comfortable gait and with gait plus the cognitive task, with significant differences in stride width percentage, percentage of stance time, and cadence. There were no apparent differences between the two groups for the condition of gait combined with cognitive and physical tasks. There were no significant differences in response accuracy between the groups; participants demonstrated near 100% accuracy under all conditions. Conclusions: Greater impairments in gait were seen in all participants as the cognitive and physical task became more challenging, but accuracy in the cognitive task was not sacrificed in either group. Gait parameters measured during a sport-related cognitive task may be sufficient to discern a difference in performance between concussed and non-concussed athletes and may be more relevant to a return-to-play decision than standard cognitive tests.
RELIABILITY OF THE BALANCE ERROR SCORING SYSTEM IN STUDENTS: REAL TIME VS. ASYNCHRONOUS ANALYSIS
(2024-04-18) Arnold, Anne E.; Bubar, Britney A.; Caputo, Alyssa A.; Morin, Tyler J.; Siegel, Sondra
Purpose/Hypothesis: Postural control in stance is often assessed following a concussion using the Balance Error Score System (BESS). The BESS includes observation of a person’s balance in 6 different positions. The rater counts how many balance errors occur during each condition. If a patient makes a large number of errors in rapid succession, it may be difficult for the rater to count them accurately, leading to a decrease in reliability. Thus the purpose of this study was to determine whether reliability of the BESS could be improved by using a videorecording of the test, allowing raters to manipulate the recording as needed. Previous studies have shown that the reliability of the BESS is good for novice raters and much higher for experts. Our hypothesis was that viewing a video recording of a participant performing the BESS would improve the reliability for novice raters. Methods: Two pairs of two student researchers were trained by the primary investigator in the scoring of the BESS. Forty-six healthy participants were then recruited by word of mouth and fliers. Each participant performed the BESS while being video recorded and observed by one pair of students. Each student independently scored the participant’s performance. Six weeks later, each student independently scored the video recordings of the same participants. Intraclass Coefficients (ICC) were generated to determine interrater and intrarater reliability. Results: For both pairs, the ICC showed greater agreement for the total BESS scores of the live sessions (.72 and .90) as compared to the recorded sessions (.52 and .74). ICCs for intrarater reliability ranged from .34 to .71. Conclusions: Watching and manipulating a recording of a BESS test does not lead to improved reliability among novice raters. Scoring of the BESS test should be done based on the live session.
THE EDUCATION DESIGN AND IMPLEMENTATION OF THE CONTINUING EDUCATION COURSE IN ANATOMY FOR REHABILITATION SPECIALISTS
(2023-04-20) Brown, Colby; Conant, Kaicey; Durant, Jordan; Hooker, Cora; Robichaud, Shelby; Smith, Ashely; Howland, Chad
Purpose: Continuing education (CE) is essential to evidence-informed practice for healthcare providers such as licensed physical therapists. However, evidence suggests that approximately 1/3rd of physical therapists have participated in an anatomy-related CE course within the previous three years.1 Our teaching and learning project sought to design and implement a CE course specific to musculoskeletal anatomy for allied health professionals and physical therapy students. Description: A two-day CE course in functional and clinically oriented anatomy was designed and taught by a collaborative team of physical therapy educators and entry-level DPT students. The course implemented components of adult learning theory through experiential learning, peer-to-peer teaching, and collaborative learning in small groups.2,3 Summary of Use: Twenty-three registrants attended the CE anatomy course, with a significant percentage being student physical therapist assistants from a local community college (>70%). Nearly all attendees participated in the entire two-day session for twelve contact hours. After completing the final day of the CE course, all attendees completed the post-course survey. The results showed excellent ratings for an overall learning experience (95.5% of respondents), the quality of course instruction (100% of respondents), and course organization (86.4%). The CE course earned $ 8,120.00, and funds were allocated to DPT student scholarships and educational resources. Conclusion: Entry-level physical therapy education programs can meet the demand through collaborative teaching and learning projects between faculty and DPT students. When targeting a consumer population of healthcare providers, institutions need to consider the needs of the healthcare providers and correlate human anatomy to their area of clinical practice.
THE EFFECT OF PATIENT EDUCATION ON OUTCOMES IN PATIENTS WITH RHEUMATOID ARTHRITIS: AN UMBRELLA REVIEW
(2024-04-18) Belanger, Jordan; Cushing, Mary; Edberg, Grey; Grafas, Maria; Steinbarger, Kimberly
Background: According to the World Health Organization in 2019, 18 million people worldwide were living with rheumatoid arthritis (RA). Self-management education is intended to allow persons with RA to manage some aspects of their disease independently, such as function, mental health, pain management, and quality of life. The purpose of this umbrella review was to clarify the efficacy of patient education on function, pain, self-efficacy, and quality of life of those with RA. Methods: A review of existing literature was conducted following the JBI Manual and PRISMA guidelines, utilizing the PICO question ‘In adults with RA, does patient education compared to no education affect the outcomes of function, pain, self-efficacy, and quality of life?’. The following databases were searched: ERIC, Medline/PubMED, Cochrane, Ovid, and CINAHL. A total of 220 articles were initially selected. After abstract and full article screening by the 5 researchers, a total of 9 systematic reviews were included. Results: The most consistent evidence in support of patient education was for the outcomes of reducing pain and depression in patients with RA. Self-management techniques demonstrated strong evidence for the improvement of joint pain. Under quality of life, specifically for depression, there was moderate evidence in support of patient education. Conclusion: Although there was evidence suggesting patient education had positive effects on depression and pain, gaps in the literature remained. Limitations to this study included possible missed article extraction due to words/phrases searched, inherent bias in appraisal and article selection, reporting of existing reviews, and nonconformity of outcome measures utilized in the literature. Recommendations included a focus on patient education techniques for those with pain and depression as their dominant symptoms. Further research was suggested regarding the effect of education on quality of life and function, as well as the efficacy of specific modes of education available.
THE VALUE OF EXPERIENTIAL LEARNING IN CAPE COAST, GHANA FOR DOCTOR OF PHYSICAL THERAPY STUDENTS
(2024-04-18) Banks, Emily; Fonger, Sierra; Kelsey, Heather; Malinen, Hannah; LaPrino, Stephanie
Background & Purpose: This project explores the reflections of final year Husson University (HU) doctor of physical therapy (DPT) students following a three-week immersion experience in the physiotherapy (PT) department at Cape Coast Teaching Hospital (CCTH) in Cape Coast, Ghana. International experiential learning has many benefits regarding healthcare including: expansion of skills, increased knowledge of different healthcare systems, improved critical thinking for treatment approaches, and appreciation for uncommon diagnoses. Experiential learning additionally aids in personal development, including improved social and communication skills, adaptability, self-awareness, and cultural awareness. Methods: HU partnered with Child Family Health International (CFHI) for this learning experience and completed preparatory work prior to arrival including a zoom meeting with CFHI’s local medical director and modules focused on increasing cultural awareness, safety and insight into service-learning. During the three-week immersion at CCTH, students independently rotated between three different PT settings including inpatient, pediatric outpatient, and orthopedic outpatient. Each student also participated in the weekly club-foot clinic and were given the opportunity to collaborate with Ghanaian physical therapists, gaining insight into the educational and occupational differences in the PT profession. Additionally, DPT students performed a needs assessment of the clinic, creating a list of items and resources needed for improved treatment. Reflection & Limitations: The partnership with CFHI and CCTH gave HU DPT students great insight into the expectations of global learning. The pros and cons discussed in literature are aligned with the experience of HU’s DPT students, seen through positive interactions and lasting relationships formed with staff in the PT department. Revealed limitations include language preparation, prior clinical knowledge and differences in healthcare system structure, reducing optimal communication effectiveness. Future student recommendations include more prior clinical experience, an introduction into the local dialect, and potential meetings with CCTH staff prior to arrival to discuss caseloads, the clinic environment, and expectations.

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