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No description available.

Abstract available in the Gerontologist.

No description available.

No description available.

Host Maureen Clancy PT, DPT, OCS is joined by Dr. Courtney Hall PT, PhD and Dr. Sue Whitney PT, PhD, NCS, ATC, FAPTA in a dicsussion on vestibular hypofunction. This podcast reviews the medical conditions that would lead to a diagnosis of hypofunction, clincal testing, treatment, exercise prescription, and the key updates from the recent CPG on vestibular hypofunction. For additional information please go to: http://www.neuropt.org/professional-resources/anpt-clinical-practice-guidelines/vestibular-hypofunction-cpg

Background: Case reports are presented on four Veterans, aged 29–46 years, who complained of chronic dizziness and/or postural instability following blast exposures. Two of the four individuals were diagnosed with mild traumatic brain injury and three of the four were exposed to multiple blasts. Comprehensive vestibular, balance, gait, audiometry and neuroimaging procedures were used to characterize their injuries.Case report: Vestibular assessment included videonystagmography, rotary chair and cervical and ocular vestibular evoked myogenic potentials. Balance and gait testing included the sensory organization test, preferred gait speed and the dynamic gait index. Audiometric studies included pure tone audiometry and middle-ear measurements. Neuroimaging procedures included high resolution structural magnetic resonance imaging, susceptibility-weighted imaging and diffusion-tensor imaging.Findings: Based on the neuroimaging and vestibular and balance test results, it was found that all individuals had diffuse axonal injuries and all had one or more micro-hemorrhages or vascular anomalies. Three of the four individuals had abnormal vestibular function, all had abnormally slow walking speeds and two had abnormal gait and balance dysfunction.Conclusion: The use of contemporary neuroimaging studies in conjunction with comprehensive vestibular and balance assessment provided a better understanding of the pathophysiology and pathoanatomy of dizziness following blast exposures than standard vestibular and balance testing alone.

Interprofessional education (IPE), a concept that brings students from different health care professions together in the learning process, has been adopted by some physical therapy (PT) schools as an alternative to traditional PT-only curricula. Both approaches have the goal of improving patient outcomes for an increasingly diverse population. There was a void in the research comparing IPE and traditional curricula in PT education. Grounded in the theoretical frameworks of adult and social learning theory, the purpose of this study was to examine differences in students' self-efficacy, cultural competence, and perceptions of the learning environment based on curricular type and prior to their first clinical internship. The nonexperimental, causal-comparative research design was used to test a single research question about differences in the 4 dependent variables based on curriculum format (IPE or traditional) for a balanced, random sample of 218 preclinical students from 6 different PT programs. The results of Hotelling's T2 and post hoc analysis revealed statistically significant, higher self-efficacy scores for students in IPE curriculum than ones in the traditional curriculum. No significant differences were found related to cultural competence and perception of learning environment. Results suggest that future research could examine the relationship between self-efficacy and cultural competence. The positive social change implication for this research was that preclinical PT students' in an IPE curriculum had increased self-efficacy as compared to those in traditional curricula. This information can be used to provide direction for PT programs as they work toward delivering exceptional educational experiences in order to improve patient outcomes and better society.

Early mobility quality improvement (QI) projects are leading the charge to shift the prevailing culture in acute care from a culture of immobility to a culture of mobility. Low mobility and hospital acquired functional decline is a persistent problem, especially for older adults, often leading to increased post acute care costs, increased risk of hospital readmission and increased mortality. Transition of care programs designed to improve care transitions and prevent hospital readmission exist but fail to include rehabilitation professionals or to adequately consider patient functional status during hospitalization. The goal of this research was to implement and evaluate an early mobility quality improvement (QI) project that added a physical therapist and mobility technician to an existing transition of care program (Project BOOST) to increase adult patients mobility and level of physical activity during hospitalization, using both quantitative and qualitative methods. The project was implemented from August 2, 2016 to February 4, 2017. A physical therapist rounded with one of two Project BOOST teams to promote increased patient mobility performed with a mobility technician daily. The physical therapist also recommended rehabilitation consultations (physical and occupational therapy) for appropriate patients. The AM-PAC “6 Clicks” Basic Mobility Short Form was used to set mobility tier levels for intervention group patients. Quantitative evaluation used observed hospital length of stay, 30 day same hospital all-cause readmission, and change in AM-PAC score from admission to discharge as outcome measures. Results showed that observed hospital length of stay decreased 0.9 days in the intervention group and 30 day same hospital all-cause readmission decreased 4.8%. Bivariate analysis of patient observed hospital length of stay was statistically significant for intervention group patients (p=0.07) but failed to reach statistical significance for same hospital readmission in intervention group patients (p=0.18). Qualitative evaluation used a phenomenological lens to explore the context of the early mobility quality improvement project and shared experience of patients and staff members exposed to more mobility and higher levels of activity during hospitalization. Twelve participants were interviewed during implementation of the project including four patients and eight staff members (physicians, nurses and a mobility technician). One overarching theme and four supporting themes were found from the data. The essential meaning was that mobility bridged a gap in care. Staff understood the benefits of early mobility for patients. Patients expressed how important mobility was for their discharge and quality of life. Patients with greater functional independence and higher mobility level reduced nursing burden of care. When patients were consistently presented with opportunities to be mobile and active during acute illness, they expected mobility to be a part of their daily care plan. This comprehensive evaluation of an early mobility quality improvement project found the intervention bridged a gap in care for patients. Adding a physical therapist to the Project BOOST team and promoting patient mobility during hospitalization resulted in improved patient outcomes. Early mobility quality improvement projects have the potential to transform clinical practice and improve quality of care.

Physical therapy as an emerging profession is committed to establishing its identity and solidifying its role as a leader in health care. With expertise in human movement, wellness, and disease prevention, physical therapists possess invaluable knowledge and skill to influence public health and enhance patient recovery without increasing cost. Physical therapists have the opportunity to transform the delivery of public health services to meet current and future needs. A major challenge, however, is a dearth of leadership development in preparation programs. Because most physical therapists have not received formal education or explicit training in leadership, a problem of practice exists. This dissertation is a report of a mixed-methods action-research study that explores leadership development among aspiring and practicing physical therapists. It describes a series of professional development (PD) activities designed to foster transformational leadership and a community of practice among a group of clinicians in a privately-owned clinic in north Florida. Qualitative and quantitative data collection and analysis indicate positive changes were made in understanding transformational leadership, engagement in community service, relationship building among coworkers, communication, and community of practice after participation in the PD activities. Analysis of results also identified the need for continued relationship development, conflict resolution, and building strong teams. Because a paucity of literature related to leadership development in physical therapy exists, findings from this study may prove useful to the field. The results describe a feasible method of leadership development and sustainability of a community of practice to inspire transformative practitioners who lead in the clinic and the community.