Equine facilitated psychotherapy (EFP), a new field in psychology, is an alternative method of therapy that uses horses to facilitate therapeutic outcomes. There is minimal peer reviewed literature and few published studies examining efficacy. The conceptual lens of this study was grounded theory, as there is insufficient evidence of theoretical frame-works guiding equine assisted therapy. The purpose of this exploratory concurrent mixed methods study was to examine the theoretical foundation of practitioners; program make up; client populations; efficacy of program; and why the horse serves as the therapeutic catalyst of this model. A 43-item survey was sent to 800 programs, current members of the North American Riding for the Handicapped Association, Equine Assisted Learning and Growth Association, and the Equine Facilitated Mental Health Association who use equine assisted therapy. Twenty nine percent (n=232) of the surveys were returned. Chi square and cross tabulations were utilized to examine relationships between specific theoretical orientations of therapists and the therapeutic role served by the horses. Results illustrated that therapists who used experiential theory were more likely to use horses for development of confidence, development of self-efficacy, mirroring of behavior, and manner in which the therapist treats the horse. Open coding of qualitative questions was followed by axial coding into emergent themes were used to confirm and expand the quantitative results. Results illustrated the primary orientation within EFP was experiential theory; and that horses were universally considered essential aspects of the program because specific characteristics of the species facilitate key therapeutic processes. This study contributes to social change by providing the EFP field with a comprehensive analysis of current conceptual orientations and practice that can inform efforts to unify and extend this emerging therapy.

With over 7% (20 million) people in the United States affected by diabetes mellitus (DM), DM has emerged as a significant health problem. The hallmark of DM is multi-system involvement and the lower limbs are frequently involved in the form of foot ulcers. Inability to heal foot ulcers and maintain healing contributes to the high rate of amputation seen in individuals with DM. The development of foot ulcers has been strongly linked with mechanical stress. Changes in muscle characteristics and segmental foot mobility have been postulated to limit forward progression of the leg on the fixed foot during walking. This in turn may result in prolonged and excessive loading on the ball of the foot. However the extent and site of the impairments and their functional consequences are not well understood. The purpose of this work is to examine determinants of dynamic foot function and plantar loading in individuals with DM. Our results revealed that in spite of differences in passive ankle dorsiflexion and stiffness, subjects with DM demonstrated ankle motion, stiffness and plantar pressures, similar to control subjects, while walking at the identical speed, 0.89 m/s (2 mph). In terms of segmental mobility, reductions were particularly dramatic in the calcaneus (20%) compared to the forefoot and first metatarsal. Decreases in frontal plane calcaneal motion were accompanied by reduced midfoot mobility. Sagittal motion of the first metatarsal and forefoot, and frontal motion of the calcaneus, in subjects with DM, was negatively associated with the magnitude of plantar loading under the respective segment. This information is important because it may help elucidate underlying mechanisms and add to our understanding of the disease process and its effects. In addition, these results may help develop more focused intervention strategies.

Doctor of Philosophy / A perspective in critical social science is concerned with knowledge, power and critique. This thesis explores the question: What would physiotherapy practice look like if it were informed by critical social science? This question originated from four observations: (1) physiotherapists work with constantly changing health care demands, (2) traditional practice approaches underpinned by rational objectivity widen the gap between theory and practice, (3) professional judgments are based on more than objective, rational thinking, and (4) concluding from the first three observations clinical physiotherapists rely more and more on thinking for themselves. If physiotherapists were to adopt a critical social science perspective they would question their practice, identify taken-for-granted, unreflected assumptions and unnecessary system constraints and liberate themselves, their practice and patients, thereby enhancing both the quality of patient care and the practitioner’s professional work experience. Following the hermeneutic tradition I constructed texts from pertinent literature as well as transcripts from participants’ interviews, action plans and field notes. I developed an integrative design to interpret these texts drawing from philosophical and critical hermeneutics as well as action research. The question and answer dialogue methodology consisted of four cycles including deep, critical and transformative dimensions. These I labelled critical transformative dialogues. The first dialogue was with the critical social science literature and with the Gadamer-Habermas and Foucault- Habermas debates in particular. These debates addressed issues of rationality, knowledge and power. Further, I reviewed relevant education, nursing and health promotion literature that addressed these critical social science themes. This first dialogue crystallised my identification of key CSS dimensions relevant to physiotherapy practice. The second dialogue comprised physiotherapy literature that related to these identified critical social science dimensions, as well as transcripts from physiotherapists’ interviews. This dialogue critically interpreted current practice models in their historical, educational and practice contexts. It highlighted the finding that physiotherapy practice is currently dominated by instrumental thinking rather than critical thinking, and that there is a lack of engagement of physiotherapy practice with CSS. The third dialogue was with physiotherapists trialling CSS in practice. Physiotherapists of this trialling group designed action learning “contracts” where they set out to change their practice in the sense of adopting CSS principles and activities in their practice. I explored with these participants how CSS could work or fit in their practice and practice contexts and how this would be experienced. Through this action learning project of endeavouring to transform their practice towards a CSS model I explored participants’ capacity to learn about posing problems concerning their practice, recognise practice contradictions, experience practice challenges and recognise their motivations and interests. This exploration illuminated the viability of CSS in their practice. The fourth dialogue was with physiotherapists who operationalised CSS values or who could visualise a CSS framework for their practice whether they used this terminology or not. This dialogue brought critical understanding of the advantages and potential limitations of realising a CSS-centred physiotherapy practice. I conclude the thesis with twelve propositions arising from these four critical transformative dialogues. Based on the trialling, transforming and visioning of CSS as a model for physiotherapy practice, the relevance of these propositions for critical physiotherapy practice is asserted and implications for education and further research are discussed. The contribution that CSS can make to physiotherapy practice is to add critical transformative dialogues as a strategy to advance practice that is patient-centred and multidisciplinary in approach, inclusive of sociopolitical environments, mindful of professional power and open about professional values.

Background There are more than 300,000 persons in the U.S. living with transfemoral amputation (TFA). Persons with TFA use a knee prosthesis for gait and mobility. Presently, the C-Leg microprocessor knee prosthesis is the standard of care. C-Leg has significantly improved safety and cost efficacy and has created modest gains in gait efficiency. Recently, a new prosthesis has introduced a new sensor array and processor that reportedly improves knee motion, stair function and standing stability. Early claims of the reported functional benefits of the new Genium knee (formerly X2) have not been validated in a rigorous clinical trial. Therefore, the purpose of this project was to determine if the Genium knee improves safety, function and quality of life compared to the current standard of care (C-Leg). Methods The study is a randomized AB crossover with a control group. Subjects must have used (and still be using) a C-Leg for a minimum of 1yr prior to enrollment. Inclusion criteria beyond this are unilateral transfemoral or knee disarticulation amputation for any etiology, community level ambulation (Medicare level 3 or above), independent ambulation and ability to independently provide written, informed consent. Once enrolled subjects utilize their same socket but receive a study foot (Trias or Axtion). Subjects are randomly assigned to either stay with their C-Leg or be fit with a Genium knee. Subjects accommodate and test (A phase) then crossover to the other knee condition and repeat the testing (B phase). A follow up phase of the study beyond the B phase is ongoing to study longer term preference. For AB assessment, three domains were assessed: Safety, function and quality of life. For safety, the PEQ-A survey of stumbles and falls, posturography (Biodex SD limits of stability and postural stability tests), 4 square step test and 2 minute ramp stand test were completed. For function, a series of timed walking tests, the amputee mobility predictor, kinematic gait assessment and physical functional performance-10 tests were conducted. For quality of life, the socioemotional and situational satisfaction domains of the population specific and validated PEQ (prosthesis evaluation questionnaire) were completed. Results Safety: Posturographic assessment revealed impairment between transfemoral amputees and non-amputees. Stumbles and semi-controlled falls decreased with Genium but were not significantly different. Four square step testing was significantly (p 0.05) improved from 12.2s(3.3) to 11.1s(3.4) for the C-Leg and Genium respectively. Function: Kinematic asymmetry was minimally different between knee conditions. The AMP mean(SD) scores while subjects used C-Leg was 40.8(3.6; 33-45) and 43.3(2.6) [p<0.001]. PFP scores (cumulative), upper body function and endurance scores were improved with Genium compared with C-Leg at 9.1%(p=0.03), 8.7%(0.01) and 10.3%(0.04) respectively. Quality of Life: For quality of life, situational satisfaction favored Genium (p<0.001) which included subject's satisfaction with gait, training and quality of life in general. Conclusion C-Leg and Genium promote static weight bearing beyond asymmetric values reported in the literature. In terms of limits of stability, TFA's are clearly impaired, primarily over the amputated side posteriorly however the Genium seems to enable posterior compensations that coincide with multi-directional stepping improvements. Anteriorly, the C-Leg's toe triggering requirements seem to improve limits of stability but come at the cost of discomfort on ramp ascent. With regard to safety, it seems that both knee systems represent good options for the community ambulating TFA. The largest improvements with Genium were in the activities of daily living assessment; predominantly balance and upper body function. It seems that the combination of multi-direction stepping with starts and stops and stair ascent are key areas of improvement. In conclusion, the sensor array in the Genium knee prosthesis promotes improved function in activities of daily living. Specifically improved in this context were balance, endurance, multi-directional stepping, stair ascent and upper limb function in highly active transfemoral amputees.

This thesis offers new insights into physiotherapy practice by asking 'how is physiotherapy discursively constructed?' Physiotherapy is a large, well-established, orthodox health profession. Recent changes in the economy of health care in developed countries, added to an increasing prevalence of chronic illness amongst aging populations, and growing public distrust for the established health professions, are now challenging physiotherapists to consider how best to adapt to the future needs of health care consumers. / Thesis (PhD)--University of South Australia, 2008

This thesis offers new insights into physiotherapy practice by asking 'how is physiotherapy discursively constructed?' Physiotherapy is a large, well-established, orthodox health profession. Recent changes in the economy of health care in developed countries, added to an increasing prevalence of chronic illness amongst aging populations, and growing public distrust for the established health professions, are now challenging physiotherapists to consider how best to adapt to the future needs of health care consumers. / Thesis (PhD)--University of South Australia, 2008

Doctor of Philosophy / A perspective in critical social science is concerned with knowledge, power and critique. This thesis explores the question: What would physiotherapy practice look like if it were informed by critical social science? This question originated from four observations: (1) physiotherapists work with constantly changing health care demands, (2) traditional practice approaches underpinned by rational objectivity widen the gap between theory and practice, (3) professional judgments are based on more than objective, rational thinking, and (4) concluding from the first three observations clinical physiotherapists rely more and more on thinking for themselves. If physiotherapists were to adopt a critical social science perspective they would question their practice, identify taken-for-granted, unreflected assumptions and unnecessary system constraints and liberate themselves, their practice and patients, thereby enhancing both the quality of patient care and the practitioner’s professional work experience. Following the hermeneutic tradition I constructed texts from pertinent literature as well as transcripts from participants’ interviews, action plans and field notes. I developed an integrative design to interpret these texts drawing from philosophical and critical hermeneutics as well as action research. The question and answer dialogue methodology consisted of four cycles including deep, critical and transformative dimensions. These I labelled critical transformative dialogues. The first dialogue was with the critical social science literature and with the Gadamer-Habermas and Foucault- Habermas debates in particular. These debates addressed issues of rationality, knowledge and power. Further, I reviewed relevant education, nursing and health promotion literature that addressed these critical social science themes. This first dialogue crystallised my identification of key CSS dimensions relevant to physiotherapy practice. The second dialogue comprised physiotherapy literature that related to these identified critical social science dimensions, as well as transcripts from physiotherapists’ interviews. This dialogue critically interpreted current practice models in their historical, educational and practice contexts. It highlighted the finding that physiotherapy practice is currently dominated by instrumental thinking rather than critical thinking, and that there is a lack of engagement of physiotherapy practice with CSS. The third dialogue was with physiotherapists trialling CSS in practice. Physiotherapists of this trialling group designed action learning “contracts” where they set out to change their practice in the sense of adopting CSS principles and activities in their practice. I explored with these participants how CSS could work or fit in their practice and practice contexts and how this would be experienced. Through this action learning project of endeavouring to transform their practice towards a CSS model I explored participants’ capacity to learn about posing problems concerning their practice, recognise practice contradictions, experience practice challenges and recognise their motivations and interests. This exploration illuminated the viability of CSS in their practice. The fourth dialogue was with physiotherapists who operationalised CSS values or who could visualise a CSS framework for their practice whether they used this terminology or not. This dialogue brought critical understanding of the advantages and potential limitations of realising a CSS-centred physiotherapy practice. I conclude the thesis with twelve propositions arising from these four critical transformative dialogues. Based on the trialling, transforming and visioning of CSS as a model for physiotherapy practice, the relevance of these propositions for critical physiotherapy practice is asserted and implications for education and further research are discussed. The contribution that CSS can make to physiotherapy practice is to add critical transformative dialogues as a strategy to advance practice that is patient-centred and multidisciplinary in approach, inclusive of sociopolitical environments, mindful of professional power and open about professional values.

Thesis (Ph. D.)--University of Sydney, 2007. / Title from title screen (viewed 17 Apr. 2007). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Physiotherapy, Faculty of Health Sciences. Includes bibliographical references. Also available in print form.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Hong Kong, 1991.