Introduction and Background: Interprofessional education (IPE) is outlined in many health professions education standards creating an increased demand for its inclusion in already crowded curricula with limited faculty and financial resources. The Interprofessional Education Collaborative (IPEC) developed “Core Competencies for Interprofessional Collaborative Practice” that outline a framework for meaningful IPE experiences. Case-based learning activities have been used to foster improvements in interprofessional role clarity, communication, and rapport among student groups. The authors describe one trial of incorporating interprofessional and team work activities in a shared professional course and report on student learning outcomes in the context of IPEC competencies. Course Design: In an existing shared professional course, athletic training (AT) and physical therapy (PT) students were exposed to an interprofessional teaching team and engaged in team work activities during lab sessions. Students were also assigned to interprofessional (IP) and uniprofessional (UP) teams to complete four case-based learning activities regarding the application of therapeutic modalities in various patient cases. Students then wrote critical reflections of their experiences working in teams. Instructors evaluated these reflections in the context of eight relevant IPEC sub-competencies. Outcomes: Both IP and UP groups of students were able to articulate the demonstration of each of the eight IPEC sub-competencies, suggesting that incorporating a variety of interprofessional and team work activities in a shared professional course may offer a valuable IPE experience that promotes development of students’ collaboration skills. Discussion and Conclusion: Embedding IPE in existing curricula could be a viable way to overcome many of the challenges faced by health professions programs, meet IPE accreditation standards, and prepare students for interprofessional collaborative practice.

Prosthetic development recently has focused mainly on myoelectrically controlled electric hands despite a majority of upper extremity amputees actively choosing body powered devices. Myoelectric hands utilize a small electric pulse generated in muscles when flexing as a signal to the hand to close. Finger flexion in these devices is controlled by electromechanical servos, requiring no strength input from the user. Body powered devices use a cable attached to a shoulder harness which causes mechanical closure of the device via tension placed on a control cable by a shoulder shrug motion or arm extension. Outfitting of active duty service personnel has recently tended to follow the electronic hands which have fragile electronics, have a poor response to user input, and are not fit for harsh outdoor environments. This report will detail the current development of a re-design of a custom left hand prosthesis for an active duty Navy SEAL and the transition from electronic controls to full body power function.

The purpose of this literature review was to identify any adaptations that could be made to the rehabilitation process for Traumatic Transfemoral Amputees. Traumatic Transfemoral Amputation is particularly debilitating with the amputees encountering many obstacles throughout the rehabilitation process. These obstacles can prevent the return to pre-morbid functioning. With an ever-increasing number of amputees within the United States, it is imperative the rehabilitation process be addressed. This literature review addresses possible adjustments in the initial stages of rehabilitation examining the post-operative, pre-prosthetic, and prosthetic rehabilitation stage to enhance the physical functioning for the amputee. This comprehensive literature review encompassing 63 academic and medical journals analyzes the research literature regarding each of the three stages of the post-operative procedure. The literature review synthesizes the research findings to see how procedures may be adapted to reduce the risk of further co-morbidities such as loss of bone mineral density and disuse atrophy. Loss of bone mineral density and disuse atrophy are the major contributing factors to the amputees decreased mobility. Reducing this loss can be addressed within the initial post-operative, pre-prosthetic, and prosthetic rehabilitation stages. Further research is required to examine the efficacy of these alterations in relation to this specific population.

<p>The purpose of this thesis was to improve the understanding of pain measurement and management in people with knee OA through: 1) Developing a theoretical model that may help in pain management and measurement; 2) Exploring the knee OA individuals’ views about three pain measures and 3) To determine if low frequency (≤100 Hz) pulsed subsensory threshold electrical stimulation produced either through pulsed electromagnetic field (PEMF) or pulsed electrical stimulation (PES) versus sham PEMF/PES intervention is effective in improving pain and physical function in the knee OA population.</p> <p>After pain theories literature review, a theoretical model was developed to address the gap between pain theories and clinical pain measurement and management. The patient’s views about three pain measures were not explored before 96 participants were recruited and completed the Verbal Numerical Rating Scale (VNRS), Intermittent and Constant Osteoarthritis pain Questionnaire (ICOAP) and the Short Form-McGill Pain Quetionnaire-2 (SF-MPQ-2). Participants were asked how well each pain measure describes their pain on a 10 cm Visual Analogue Scale (0 = does not describe your pain at all, and 10 = describes your pain completely. The time taken to complete and score the pain measure as well as the number of errors and questions while filling the pain measures were recorded. Systematic electronic searches were performed. Duplicate title, abstract and full text screening, risk of bias assessment, data extraction and grading the quality of evidence were performed. Data analysis was performed using Revman 5 software.</p> <p>Our sample of individuals with knee OA showed that VNRS, SF-MPQ-2 and ICOAP describe knee OA pain experience with no preference of one over the others. The systematic review conclusion was that PEMF/PES may be beneficial to improve physical function but not pain in people with knee OA with low and very low quality of evidence respectively</p> / Master of Health Sciences (MSc)

Many women who have experienced breast cancer (BC) report continued impairments in upper extremity (UE) function beyond the time required for normal healing after surgical treatment. Most research supporting this has not made comparisons between survivors of breast cancer (BCS) to a sample of healthy women. This lack of comparison to a healthy cohort prevents an understanding of whether continued deficits in UE function are due to normal aging or the BC treatment. The purpose of this research was to compare quality of life (QOL) and UE function among long term breast cancer survivors and similar aged women without cancer. Both self-report and objective measurements of UE function were used to create an understanding of UE functional abilities in both populations. Data on self-reported QOL and UE function, ROM, strength, and muscular endurance were collected on 79 healthy women ages 30-69, stratified by decade. Comparisons between decades and between dominant and non-dominant limbs were made. Findings supported no effect of aging on measures, and that dominance does affect some objective measures of motion, strength, and muscular endurance. A group of 42 survivors of breast cancer (BCS) were compared to the data from healthy controls on the same measures. BCS reported lower levels of QOL and UE function, and demonstrated less motion and strength than the healthy cohort, particularly when cancer occurred on the non-dominant limb. The values of the measures, however, are not clinically relevant, and reveal that BCS 6 years after treatment recover UE function to levels similar to healthy controls. In view of a lack of clinically feasible measures of UE muscular endurance, a new test to assess this was designed and implemented: the modified Upper Body Strength and Endurance test (mUBSE). It was believed this new test would be less variable than the Functional Impairment Test – Hand and Neck, Shoulder, Arm – FIT-HaNSA. Seventeen BCS and 17 matched controls were compared on the mUBSE and FIT-HaNSA. Findings were similar for both tests. Furthermore, BCS who are 6 years post BC treatment appear to recover muscular endurance levels to normal ranges.

PURPOSE The purpose of this study was to determine if performing static active knee extension hamstring stretching using the Pneumex Pro-Vibe vibrating platform increased acute hamstring range of motion (ROM) greater than traditional static active knee extension hamstring stretching. METHODS: A within subject design was utilized with subjects undergoing static stretching with vibration and without vibration (conditions counterbalanced). Pre- and post-test active and passive ROM was measured for the right leg, with subjects first undergoing a 5-minute warm-up on a stationary bicycle. Supine active knee extension was performed on the Pro-Vibe platform with and without vibration. The stretch was held 3 times each for 30 seconds, with a 20-second rest period between each stretch. Vibration was set at 30 Hz at the “high” amplitude setting. Active hamstring ROM was measured via active knee extension using a goniometer with the leg in 90° of hip flexion. Passive ROM was measured via clinician-assisted knee extension with the leg in 90° of hip flexion. RESULTS: A 2-way repeated measures ANOVA was performed for passive ROM, and revealed a significant main effect for condition, F (1, 23) = 0.5875, p < 0.05, and time, F (1, 23) = 5.029, p < 0.05. Another repeated measures ANOVA was performed for active ROM with the same factors, and revealed a significant time by condition interaction, F (1, 23) = 4.730, p < 0.05, and a significant main effect for time, F (1, 23) = 18.612, p < 0.001. Post-hoc paired samples t-tests determined the difference between the pre-test and post-test measurements for each condition. Active ROM showed a significant difference pre-test to post-test for the vibration condition, t (23) = -5.41, p < 0.001. The vibration condition also resulted in significantly different pre-test vs. post-test measurements on passive ROM, t (23) = -2.55, p < 0.05. In both cases the average ROM was higher for the post-test. DISCUSSION: Three 30-second active knee extension hamstring stretches using a vibrating platform are sufficient to cause significant acute increases in hamstring ROM. These findings suggest this device may be useful when desiring increased hamstring ROM.

Various models of simulated weightlessness and resulting cardiovascular effects have been researched in the last 50 years of space exploration. Examples of such models are the Alter-G (Alt-G) treadmill used for body unweighting and head-up-tilt (HUT) model each providing similar cardiovascular effects, but differing in their stimulation of vestibular centers . Advantages of using the Alt-G include: use of lower body positive pressure (LBPP) to simulate hypogravity, it acts as a countermeasure to alleviate negative cardiovascular effects of standing and provides a constant vestibular stimulus. In addition, the Alt-G shorts themselves may be providing a certain degree of LBPP, acting as a compression garment. Therefore the purpose of this study was to determine the cardiovascular effects of Alt-G shorts and how effective they are as countermeasure to deconditioning effects of space flight. This study tested cardiovascular changes in 12 men and women at 0 and 80 degrees head-up-tilt (HUT0 / HUT80) with and without Alt-G shorts using 5-lead ECG, 10-lead impedance, heart rate, systolic and diastolic blood pressure measurements at finger and arm. The tilt-induced increase in mean heart rate (HR) was significantly smaller when subjects wore the Alt-G shorts. Shorts ended up reducing HR by 2.3 bpm in supine control and by 6.7 bpm at HUT80 (p0.05. Other cardiovascular variables did not show any significant effect from shorts. In conclusion, this study was in line with results from other studies that used compression garments to determine cardiovascular effects of LBPP.

<p>Multiple sclerosis (MS) is an immune-mediated neurodegenerative disease that results in a myriad of physical and mental symptoms. Current disease-modifying therapies do not prevent long-term disability accumulation and are particularly ineffective for patients with a progressive disease onset. Exercise may represent an alternative strategy for managing symptoms and disability accumulation, particularly in progressive MS.</p> <p>Whereas the benefits of exercise have been established primarily in ambulatory MS patients with a relapsing disease course, few studies have investigated the benefits of exercise for patients with progressive MS with greater impairment. Therefore, the purpose of this dissertation was to determine the short-term, long-term, and maintenance effects of adapted exercise interventions for patients with progressive MS of high disability which was addressed by conducting two adapted exercise interventions.</p> <p>The first intervention examined the effects of 24 weeks of body weight supported treadmill training (BWSTT) on outcomes of physical and mental functioning, fatigue, quality of life, and brain health. Outcomes were evaluated at baseline, 12, and 24 weeks following the intervention, and again 12 weeks post-intervention. The second intervention evaluated and compared the effects of 12 weeks of total-body recumbent stepper training (TBRST) to BWSTT on outcomes of safety, physical and mental functioning, fatigue, quality of life, and equipment preference.</p> <p>Safety of BWSTT and TBRST was established. Significant improvements in fatigue and QoL were observed with both training modalities; however, neither significantly improved physical function. There was some evidence to suggest long-term BWSTT may improve cognitive performance and brain health, and that TBRST was the preferred exercise modality. Furthermore, most beneficial effects of long-term BWSTT tended not to be maintained when exercise was discontinued.</p> <p>This dissertation established evidence for the potential benefits of BWSTT and TBRST in patients with progressive MS with high disability. BWSTT and TBRST may represent viable alternative strategies for disease management.<strong></strong></p> / Doctor of Philosophy (PhD)

<p><strong>Introduction:</strong> Client-Centred Care (CCC) is emerging as a best practice in health care organizations around the world. Partnerships between patient, family, and health professionals in planning and delivery of health care services are known to improve outcomes and satisfaction with care. Studies report lack of understanding of the elements involved in creating this partnership, and identify the need for valid and reliable measures of client-centredness for adults</p> <p><strong>Objectives:</strong> 1) To explore the historical evolution and current state of CCC as these were used in adult health care settings; 2) to evaluate the performance of the adapted MPOC for Adults (MPOC-A) and MPOC-SP (A) as measures of client-centredness from the perspectives of adult clients and their HCPs, respectively; and 3) to develop an in-depth understanding of health professionals’ and clients’ experiences of engaging in CCC.</p> <p><strong>Methods: </strong>A narrative review was completed to explore the development and conceptualization of CCC. Two validation studies looked at psychometric properties of the Measure of Processes of Care for Adults (MPOC-A) in orthopedic surgery and in-patient neurological rehabilitation settings, and the Measure of Processes of Care for Service Providers working with Adults (MPOC-SP (A)) in in-patient neurological rehabilitation programs. A qualitative study using Grounded Theory methodology explored experiences of CCC, barriers, and supports to developing successful partnerships from patients’, families’, and health care professionals’ perspectives.</p> <p><strong>Results: </strong>The narrative review presented theoretical conceptualizations and definitions of CCC and identified areas that needed further development, e.g., clinical implementation of CCC principles into adult health care, development of valid and reliable outcome measures for adult clients, etc. In the validation studies, good to excellent internal consistency and moderate to good correlations between domains supported internal reliability of the tools. Results of confirmatory factor analysis of MPOC-SP (A) supported the original multi-dimensional structure of the tool.</p> <p>Being on common ground was the main category identified by both clients and HCPs in the qualitative study. All participants repeatedly highlighted the importance of good communication and information flow among all the parties.</p> <p><strong>Conclusions: </strong>The MPOC-A and MPOC-SP (A) will be useful in assisting with program evaluation and quality control. The qualitative components of this study will help to improve our understanding of attributes of programs and health professionals that clients consider important for good quality care, and will provide some practical recommendations for clinicians on implementation of CCC into practice.</p> / Doctor of Rehabilitation (RhD)

<p>Sensation threshold assessment is an important component of physical assessment. Current literature has either limited information on the clinical measurement properties of sensory threshold tests, or has demonstrated concerns in reliability, validity, responsiveness and/or clinical utility. The Ten Test (TT) is an easy and quantifiable test of moving light touch sensation requiring no equipment, however; evidence regarding its reliability and validity are limited. In this thesis, I explored the test-retest reliability and concurrent validity of the Ten Test. I also developed a new, visual version of the Ten Test which was assessed for concurrent validity and patient preferences. The results showed that the Ten Test has excellent test-retest reliability (ICC: 0.83 – 0.91), with acceptable minimal detectable change scores (MDC90 = 1.57 – 2.15). Ten Test scores did not correlate with current perception threshold or vibration perception threshold scores. The visual version of the Ten Test demonstrated high concurrent validity to the original version of the Ten Test (Spearman’s rank correlation coefficient r = 0.74 – 0.90), and was preferred by participants (85.7%).</p> / Master of Science Rehabilitation Science (MSc)