Introduction: Entry-level physical therapist education on pain has been described as lacking. Calls have been made to include pain science courses to address this knowledge gap. Methods: Physical therapist students’ pain knowledge and attitudes were measured using the revised Neurophysiology of Pain Questionnaire (rNPQ) and Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT), respectively. Univariate ANOVAs, with post hoc pairwise comparison and effect sizes, were used to measure these aspects over time. Results: Pain knowledge and clinician beliefs were significantly different (p < 0.001) at various curricular timepoints. rNPQ scores increased from 1st to 2nd year (effect size: 1.10), remained similar between years 2 and 3, and improved following the pain course (effect size: 1.25). Biomedical beliefs were similar during years 1, 2 and 3, and declined following the pain course (effect size: 1.56). Conversely, psychosocial belief scores increased from 1st to 2nd year (effect size: 0.82), remained similar between years 2 and 3, and increased following the pain course (effect size: 1.08). Discussion/Conclusions: Physical therapist education, without a dedicated pain science course, may be insufficiently preparing students to treat patients in pain. Educators should consider adopting a dedicated pain science course or substantially bolstering embedded curricular pain content to promote best practice in pain treatment.

Objectives: To determine the beliefs and describe the health care experiences of patients with complex regional pain syndrome. Methods: A survey tool for patients with complex regional pain syndrome was designed for this study. The survey tool collected self-reported measures associated with pain, disability, health care experiences, education, beliefs, and treatments. Results: Thirty-one patients attending physical therapy for complex regional pain syndrome (mean age 40.48; female n = 20) completed the survey. Patients with presented with high levels of pain and disability and reported various changes associated with altered neuroplasticity such as confused body part recognition, left/right discrimination, neglect, and spreading pain. The patients’ experiences with diagnostic testing and interventions are not in line with the current pain science research and/or evidence-based practice. Overall, patients are ill-informed, confused, and receive conflicting information. Discussion: The suffering associated with complex regional pain syndrome is real, as told by patients. This suffering coincides with a lack of consensus by health care providers and conflicting information on complex regional pain syndrome. Overall, patient experiences show health care providers are not up to date with the current best-evidence regarding complex regional pain syndrome.

Background: Left/right judgment (LRJ) measurement is a potential way to identify dysfunction in cortical body maps, and to measure improvement related to corresponding treatments. Few studies have explored the reliability of various methods for LRJ measurement. Objectives: To determine measurement reliability of LRJ utilizing two methods: card-based (CB) and tablet-based (TB). Establish minimal detectable difference (MDD) for accuracy and reaction time for both assessments. Methods: Testing was done over two different days. Session 1 consisted of testing LRJ utilizing CB assessment with photos of left and right hands over two trial periods. The TB format was also tested over two trial periods. Session 2 tested with the CB assessment for two trial periods. 40 images were used in the basic upright position for both CB and TB formats. Results: Fifty participants (N = 50; female = 35) with an average age of 24.3 (range 19–35) were studied. ICC (2,k) for reaction time for both methods were >0.84. The MDD for reaction time was between 0.19 and 0.49 s for various test points for both methods. Combined left and right accuracy ICC (2,k) for both methods were >0.51, with MDD between 5 and 14%. Conclusions: This study examined the reliability and MDD for the LRJ measurement for card and tablet-based assessments. Generally, LRJ reaction time had good reliability, while accuracy had moderate reliability and varied between testing methods.

Background Persistent musculoskeletal pain is a multi-factorial entity, influenced by biological, genetic and psychosocial factors. Psychosocial factors, such as individuals' beliefs and experiences, need to be considered in the management of such pain. While extensive research has explored beliefs of individuals with spinal pain, less is known about individuals' beliefs regarding shoulder pain. Objectives To explore beliefs about the cause of pain in individuals with persistent rotator cuff-related pain, as well as the experiences of the effect of pain on their daily lives. Design A mixed methods design, using semi-structured interviews and validated outcome questionnaires. Method Five men and five women, aged 47–68 years, with shoulder pain for at least three months were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim and analysed using the general inductive approach. Results/findings Four key themes emerged. The cause of pain, ‘Understanding the pain’, was described in terms of anatomical factors within the context of the participants' lives. The pain impacted all areas of life, creating another theme, ‘It affects everything’. Participants responded to their pain by adopting certain, ‘Pain-associated behaviours’ and sought information for diagnosis, general management and exercise prescription, ‘Emotional responses and the future’. Conclusions The participants with rotator cuff-related pain believed the cause of their pain to be local to the shoulder region. However, they also described various stressors in their work-, sports- and family-related lives. Rehabilitation may need to include educating the individual, expanding their understanding regarding pain mechanisms and appropriate interventions, based on individual goal-setting.

Purpose: To explore perceptions and initial outcomes of patients with rotator cuff-related pain to a pain education session. Materials and Methods: Ten individuals with persistent rotator cuff-related pain (≥3 months duration) attended an individual pain education session. They completed patient-reported outcomes measures on a weekly basis, three weeks prior and three weeks following the session. Individual semi-structured interviews were conducted three weeks following the pain education. Interviews were recorded, transcribed verbatim, and analyzed using the General Inductive Approach. Results: There were two over-arching key themes: firstly, ‘Participants’ Perspectives’ of the session generated four themes: Improved understanding of ‘the whole’; Mindful self-awareness; Taking charge; “The pain is still there”. Their understanding of pain was reconceptualised, evident by their ability to describe the role of neurophysiological mechanisms, stress and general well-being towards their pain. The second over-arching key theme, ‘Participants’ Recommendations’, had two themes: Integrating neuroscience with pathoanatomical knowledge and Educating other health professionals. Pain levels decreased post-pain education compared to pre-pain education. Conclusions: Following the pain education session, participants had greater understanding of factors influencing their shoulder pain. Pain education, in addition to pathoanatomical information may be useful as part of treatment for persistent rotator cuff-related pain.

Background: This study, the first of its kind, originated with the need for a brace (an ankle foot orthosis), to constrain ankle plantarflexion and dorsiflexion within a motion threshold of <5°. A conventional thermoplastic, solid brace failed during a quasi-static loading study, informing the investigation and development of an experimental carbon composite brace, maximizing stiffness and proximity of shank and foot cylindrical shells to provide the required degree of control. Methods: Two experiments were conducted: a quasi-static loading study, using cadaveric limbs (n = 2), and a gait study with healthy subjects (n = 14). Conditions tested were STOP, FREE, and CONTROL. Data for all studies were collected using six motion-capture cameras (Vicon, Oxford, UK; 120 Hz) tracking bone-anchored markers (cadaveric limbs) and skin-anchored markers (subjects). In the quasi-static loading study, loading conditions were congruent with the gait study. Study 1 involved a quasi-static loading analysis using cadaveric limbs, compared motion data from a conventional thermoplastic solid brace and the experimental brace. Study 2 involved quantifying ankle plantarflexion and dorsiflexion in subjects during treadmill walking, in brace STOP, FREE, and CONTROL conditions. Findings: The experimental brace in STOP condition consistently constrained ankle plantarflexion and dorsiflexion below the motion threshold of <5°, across all studies. Interpretation: Collectively, these findings demonstrate (1) that a conventional thermoplastic, solid brace was ineffective for clinical applications that required significant motion control, and (2) that ankle motion control is most effective when considered as a relationship between the brace, the ankle-foot complex, and the external forces that affect them both.

Dizziness is very common, but it is never normal. Dizziness can make performing daily activities, work, and walking difficult. Inner ear balance problems can make people dizzy when they turn their head, which can cause problems during walking and make people more likely to fall. Most of the time dizziness is not from a life-threatening disease. Often, dizziness is related to a problem of the vestibular (or inner ear balance) system. Vestibular disorders can be caused by infections in the ear, problems with the immune system, medications that harm the inner ear, and rarely from diabetes or stroke because of a lack of blood flow to the inner ear. Stress, poor sleep, migraine headaches, overdoing some activities, and feeling anxious or sad can increase symptoms of dizziness. Updated guidelines for the treatment of inner ear disorders are published in this issue of the Journal of Neurologic Physical Therapy. The guideline recommends which exercises are best to treat the dizziness and balance problems commonly seen with an inner ear problem.

Despite our understanding of the impact of noise-induced damage to the auditory system, much less is known about the impact of noise exposure on the vestibular system. In this article, we review the anatomical, physiological, and functional evidence for noise-induced damage to peripheral and central vestibular structures. Morphological studies in several animal models have demonstrated cellular damage throughout the peripheral vestibular system and particularly in the otolith organs; however, there is a paucity of data on the effect of noise exposure on human vestibular end organs. Physiological studies have corroborated morphological studies by demonstrating disruption across vestibular pathways with otolith-mediated pathways impacted more than semicircular canal-mediated pathways. Similar to the temporary threshold shifts observed in the auditory system, physiological studies in animals have suggested a capacity for recovery following noise-induced vestibular damage. Human studies have demonstrated that diminished sacculo-collic responses are related to the severity of noise-induced hearing loss, and dose-dependent vestibular deficits following noise exposure have been corroborated in animal models. Further work is needed to better understand the physiological and functional consequences of noise-induced vestibular impairment in animals and humans.

Background Since anthropometric variables are critical to the creation of pulmonary nomograms for FVC, FEV1, and other volumes and capacities, it is logical that anthropometric variables also influence the values of the maximal respiratory pressures (MRPs). Since nomograms are race-specific, it is important that tribe-specific tables of normal maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) be developed. To date normal tables for MRPs do not exist for Navajo children. Objective Therefore the purpose of this study was to derive MRP normative reference values for Navajo children in the age range of 6-14 years. Methods - Participants and Measurements A cross-sectional study was undertaken with a representative sample of 534 healthy children, ages 6-14 years, attending Navajo Nation elementary schools in Arizona. MIP and MEP were measured. Results Test results from 275 girls and 259 boys met American Thoracic Society quality control standards and showed that MRPs all increased with height. Mean MIP in cm H2O was 77 for boys and 67 for girls with lower limits of 44 and 40, respectively. Mean MEP in cm H2O was 75 for boys and 66 for girls with the lower limits of 42 and 38, respectively. Conclusion Since the data were collected from the population of interest, the resulting MIP and MEP reference equations should be used when testing Navajo children ages 6-14 years.

Background Since anthropometric variables are critical to the creation of pulmonary nomograms for FVC, FEV1, and other volumes and capacities, it is logical that anthropometric variables also influence the values of the maximal respiratory pressures (MRPs). Since nomograms are race-specific, it is important that tribe-specific tables of normal maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) be developed. To date normal tables for MRPs do not exist for Navajo children. Objective Therefore the purpose of this study was to derive MRP normative reference values for Navajo children in the age range of 6-14 years. Methods - Participants and Measurements A cross-sectional study was undertaken with a representative sample of 534 healthy children, ages 6-14 years, attending Navajo Nation elementary schools in Arizona. MIP and MEP were measured. Results Test results from 275 girls and 259 boys met American Thoracic Society quality control standards and showed that MRPs all increased with height. Mean MIP in cm H2O was 77 for boys and 67 for girls with lower limits of 44 and 40, respectively. Mean MEP in cm H2O was 75 for boys and 66 for girls with the lower limits of 42 and 38, respectively. Conclusion Since the data were collected from the population of interest, the resulting MIP and MEP reference equations should be used when testing Navajo children ages 6-14 years.