Background: Baseball players exhibit a more posteriorly oriented humeral head or humeral retrotorsion (HRT) in the dominant arm, likely representing an adaptive response to the stress of throwing. This adaptation is thought to occur while skeletally immature, however there is limited research detailing how throwing while young influences the development HRT. In addition, it is currently unclear how this changing osseous orientation influences shoulder motion within young athletes. Purpose: To determine the influence of throwing and age on the development of asymmetry in HRT and shoulder range of motion (ROM); and analyze the relationship between HRT and ROM. Study Design: Cross-sectional age matched study Methods: Healthy athletes (8-14 years-old) were categorized into two groups based upon sports participation; throwing group (n=85) and non-throwing group (n=68). Bilateral measurements of HRT, shoulder external (ER), internal rotation (IR) and total range of motion (TROM) at 90° were performed using diagnostic ultrasound and digital inclinometer. A two-way analysis of variance was performed with throwing status (yes/no) and age group (youth (8-10.5), junior (10.51-12) and senior (12.01-13.99)) as primary factors. Dependent variables were asymmetry (dominant-non-dominant) in HRT,ER, IR and TROM. The relationship between ROM and HRT was analyzed using Pearson correlation coefficients. Results: Throwing athletes demonstrated a larger degree of HRT on the dominant side, resulting in greater asymmetry (8.7° versus 4.6°). Throwing athletes demonstrated a gain of ER (5.2°), a loss of IR (6.0°) and no change in TROM when compared to the non-dominant shoulder. Pairwise comparisons identified altered HRT and shoulder ROM in all age groups of throwers. A significant but weak relationship between HRT and shoulder ROM existed. Conclusion: Throwing causes adaptive changes in HRT and shoulder ROM in youth baseball players at a very young age. Other factors in addition to HRT influence shoulder motion within this population. Clinical Relevance: In baseball players, an altered arc of motion can be expected at a young age. This adaptation is in part due to changes in osseous structures, however a larger component of change is likely due to other factors.

Background: Individuals with Subacromial Pain Syndrome (SPS) often present with a variety of contributing factors. It is possible that a subgroup exists within SPS that has primary impairments of scapular mobility and/or muscle strength. In an attempt to better identify scapular contributions in SPS, the Scapular Assistance Test (SAT) and Scapula Reposition Test (SRT) have been described. Additionally, thoracic spine thrust manipulation has been shown to be effective for shoulder pain. Problem Statement: It is currently unknown whether or not there are impairments in scapulothoracic muscle force generation or scapular mobility in individuals with SPS who have positive results on the SAT and SRT. It also remains unknown whether individuals with SPS respond differently in the immediate effects on scapular motion, scapulothoracic muscle force generation, pain, or function following different manipulation techniques. Methodology: Sixty subjects with shoulder pain were enrolled in the study. Baseline measures were obtained for scapular upward rotation and posterior tilt, scapulothoracic muscle force generation, pectoralis minor muscle length, pain, and function. Participants were randomized to receive a seated thrust manipulation, supine thrust manipulation, or sham manipulation. Measures were reassessed immediately after treatment and the Penn Shoulder Score (PSS) was reassessed at 48 hours. Results: The results indicated no significant differences in scapular upward rotation or posterior tilt, or muscle force generation based on the results of the SAT or SRT. There was a small but significant difference in pectoralis minor muscle length based on the result of the SAT. There were no significant between-group differences in scapular motion, muscle force generation, or pectoralis minor muscle length based on the treatment received. There were no significant differences in 48-hour improvement in pain, function, satisfaction, and total PSS scores. Small but significant within group changes existed on several measures. Discussion: The SAT and SRT may be ineffective in differentiating scapular movement associated impairments. Thoracic spine thrust manipulation resulted in no greater immediate improvements in scapular motion, strength, pectoralis minor muscle length, pain, or function compared to a sham treatment. The improvements in pain and function are likely not biomechanical in nature and are likely not derived from the manipulative thrust.

Problem Statement: Stepping is a common strategy after a perturbation. Stroke survivors display a predilection for stepping with non-paretic leg. Insight into induced stepping between stroke survivors and age-matched control may guide our understanding for reactive postural control training post stroke. Purpose: To investigate the difference in perturbation-induced stepping between chronic stroke survivors and age-matched controls at three phases of the stepping response: preparation, execution, and landing and association with clinical outcome measures. Procedure: Twenty-one community-dwelling chronic stroke survivors (mean age 59y/o ±13yrs) and 17 age- and gender-matched controls (mean age 54.4y/o ±17yrs) completed this study. Clinical measures of gait, balance, range, sensation, and motor control were assessed. A mechanical weight drop of 10% body weight (BW) was used to create the anterior waist pull perturbation during three stance symmetry positions: equal stance (EQ) and two asymmetrical stance (70% BW on dominant leg and 70% BW on nondominant leg). Ten perturbation trials plus two catch trials at 2% BW were given in a standard randomly order at the three stance positions. Kinematic and kinetic data was collected for perturbation steps. Results: The asymmetrical trials resulted in two types of stepping response, steps with the leg bearing 70% BW (loaded steps – LS) and steps with the leg that had 30% BW (unloaded steps – ULS). All subjects initiated steps more often with their unloaded leg (ULS) in the asymmetrical stance trials. In the stroke group the ULS increased paretic leg stepping compared to EQ (p=0.001) and LS (p=0.001). The stroke group had significantly earlier APA onset with both non-paretic leg (p=0.003) and paretic leg (p=0.028), took significantly more steps with paretic (p=0.01) and non-paretic (p=0.07), shorter step length (paretic, p=0.025 and non-paretic p=0.003), and less change in momentum at landing with paretic leg (p=0.01) compared to controls. Conclusion: Reacting to a perturbation is more challenging for chronic stroke survivors than age- and gender-matched control subjects in the preparation, execution, and landing phase of the stepping response regardless of the leg used. Perturbation training should include stepping with both non-paretic and paretic leg.

Background. Today’s baccalaureate nursing students need to be prepared to care for patients in an ever-changing, high acuity environment. Many programs offer a capstone immersive clinical experience. However, the benefits of this experience have not been fully explored, and the effect on patient care is unknown. Purpose. The purpose of the study was to determine if there was a change in levels of Emotional Intelligence (EI) and empathy in senior students who completed a capstone immersive clinical experience in the final semester of a baccalaureate nursing program. Theoretical Framework. The theoretical framework for this study was the Mayer and Salovey’s (1997) four-branch model of EI which evaluated EI and empathy of the senior nursing student. Methods. This quasi-experimental study was conducted at a baccalaureate degree program in the Mid-South. A convenience sample was utilized to examine the means of EI and empathy before and after a capstone immersive clinical experience. Results. Significance was found in students’ EI levels after the immersive experience. No significance was found in students’ empathy levels. Significance was not found in students’ EI or empathy with regards to gender and prior health care experience. In students with prior health care experience, empathy declined with increased exposure to clinical experience. Conclusions. EI and empathy along with caring and compassion need to be recognized as important concepts in nursing education. Implementation of EI and empathy in educational activities and evaluation of their effectiveness in nursing curricula will improve students’ preparedness as they complete their education and enter practice.

Background: Advance directives allow patients to put in writing the type of health care they want if they are unable to make decisions due to their medical condition. Purpose: The purpose of this study was to determine if there were differences in senior nursing students’ knowledge, attitudes, and confidence based on when the information is positioned in the curriculum. Theoretical: Social cognitive learning theory and Zimmerman’s self-regulation model provided the theoretical framework. Methods: This study reflected a non-experimental, exploratory design, with a convenience sample of senior nursing students from 2 different nursing programs in central Illinois. One program offers advance directive education in the first year and the other program offers the information in the second year. A total of 131 students participated in the study that used subscales of the Knowledge, Attitudinal, Experiential Survey on Advance Directives. Results: The group that received the information the second year rated themselves as having more confidence with advance directives. However, both groups scored low in the area of knowledge of advance directives, the Patient Self-Determination Act, and Illinois law. Students who reported higher knowledge levels had higher attitudes about end-of-life care. There was no difference in attitudes between the two groups. Conclusion: The results of this study highlight the need to review nursing curricula specifically relating to end-of-life care content and its placement in the curriculum.

Background: International Service Learning (ISL) is becoming widely used in nursing education as a means to provide global learning opportunities. Concrete outcomes for these experiences have not been clearly supported in previous research. Determining if ISL experience facilitate the development of Professional Nursing Values (PNV) can support the use of ISL as a viable pedagogy. Purpose: The purpose of the study was to determine if there were a difference in PNV development in students who participate in ISL as part of their clinical experiences compared to those who do not. The hypothesis was that there was a difference in the two groups. Theoretical framework: The study utilized Kolb’s experiential learning theory, which has a focus on the experiences of students as an impetus for learning. Methods: The research was a quasi-experimental study with a pretest, posttest design. Consecutive sampling was utilized for the experimental group and stratified random sampling for the control group. Results: Pretest analysis did not demonstrate any significant difference in the two groups at baseline. Post-test analysis indicated that while the mean PNV of the ISL group was higher, the results were not statistically significant. However, the difference in the pretest and posttest scores across all participants was statistically significant. Conclusions: While the findings were not significant in determining a difference between the two groups, the findings indicated that experiential learning in itself does support the development of PNV. Further research using a larger sample size may support the difference in these two groups and support the use of ISL as a viable pedagogy.

Background: Recent studies indicate a rise in the prevalence of obesity in children of various age groups. Obesity was officially recognized as a disease by the American Medical Association (AMA) in June 2013. It has been acknowledged as a progressive epidemic public health crisis in the United States for the past 20 years. This is a health care concern that needs examination and the development of new and more effective prevention and treatment modalities for obesity in children. Environmental, hereditary, behavioral, and socioeconomic factors play a significant role in the prevalence of obesity (Rooney, Mathiason, & Schauberger, 2011). Childhood obesity can generate serious emotional and physical consequences, thereby compromising the quality of life among children. Purpose: The purpose of this capstone project was to assess health care providers’ cultural competency by assessing the management of Hispanic parents with children diagnosed with obesity. A culturally diverse survey was developed to evaluate pediatric health care providers’ daily practice and management of Hispanic parents of children with obesity. Theoretical Framework: Madeleine Leininger’s Theory of Culture Care Diversity and Universality and the Health Belief Model constitute the theoretical framework of this capstone project. Methods: The research project gained support from the private pediatric primary care office for the completion of a questionnaire to assess health care providers’ knowledge of childhood obesity. Results: The data analysis revealed that the health care providers surveyed had at times omitted the evaluation of parameters that were vital in managing the health care of obese or overweight children. Certain parameters, such as weight, were always considered. The data analysis revealed gaps in the care of Hispanic pediatric overweight or obese patients and Hispanic caregivers. As a result of the findings, a better understanding of the importance of providing culturally competent health care was gained. Conclusion: This survey increased health care providers’ awareness of the importance of taking culture into consideration. It identified the gaps, and measures are now being evaluated to improve the quality of care provided to these children.

Integrating evidence-based practice into healthcare education has been a recommendation for the past 16 years. Despite this, barriers still exist with the utilization of evidence-based practice. The purpose of this study was to describe the current state of EBP scholarship in the curriculum of baccalaureate pre-licensure nursing programs. Essential Competencies for Evidence-Based Practice in Nursing (Stevens, 2009) was utilized to measure the state of EBP scholarship. The research question stated: how is evidence-based practice scholarship addressed within baccalaureate pre-licensure nursing programs? The research design was guided by Rogers’ diffusion of innovations theoretical framework and the star model of knowledge transformation ©. The study was a non-experimental descriptive design, and a convenience sample of n=96 surveys from program leaders was evaluated. The findings from this study fill an identified gap in nursing literature and show that EBP is addressed within baccalaureate pre-licensure nursing programs, described by the leaders in the programs. Keywords: evidence-based practice competencies, baccalaureate pre-licensure nursing programs

BACKGROUND: Physical therapists (PTs) may care for full-term or premature newborns in all levels of hospital nurseries. There is some endorsement in the published physical therapy literature for restricting practice in the nursery setting to only those PTs with specialized training.1-4 PURPOSE: The purpose of this study was to understand the experiences of becoming and being a physical therapist in a special care nursery (SCN) or neonatal intensive care unit (NICU) from the therapists’ perspective. METHODS: The participants were physical therapists who have practiced in a SCN or NICU in the United States. A phenomenological approach was used and data was collected through interviews. The constant comparative method was used to analyze the data and identify common themes to describe therapists’ beliefs about becoming and being a physical therapist in a hospital nursery. RESULTS: These four themes include: 1) Never Alone, which reflects the unique collaborative culture of the NICU; 2) Families First, which speaks to the need to focus on the family, avoid judgment, and facilitate their involvement in the care of their child; 3) Take a Deep Breath, which reflects the need to be mindful and cautious because of the potential to do harm due to the extreme fragility of the infant; and 4) Know What You Don’t Know, which reflects the depth and breadth of knowledge necessary to work in the NICU/SCN. CONCLUSIONS: This project was the first to systematically research practicing therapist’s beliefs and perspectives regarding PT practice in the SCN and NICU. It is evident that current practice does not align with the adopted statements from APTA and APPT, as well as other professional associations. Much evidence draws attention to the fragility of premature neonates, yet our PT practice and education does not appropriately address these concerns.

Background: Biomechanical stiffness has been linked to risk of injury and found to be a measureable characteristic in musculoskeletal disorders. Specific identification of stiffness may clarify who is most likely to benefit from the trigger point dry needling (TDN). The purpose of this study is to investigate the reliability and concurrent validity of the MyotonPRO® to the criterion of shear wave ultrasound elastography for the measurement of biomechanical stiffness in the infraspinatus, erector spinae, and gastrocnemius of healthy subjects over increasing muscle contraction. Second purpose is to investigate the biomechanical effects of TDN to latent myofascial trigger points (MTrPs) in the infraspinatus, erector spinae, or gastrocnemius. Research Design and Method: The first phase of the study investigated 30 subjects who completed three levels of muscle contraction in standardized test positions for the infraspinatus, erector spinae and gastrocnemius. Biomechanical stiffness measures were collected using shear wave elastography and MyotonPRO®. The second phase of the study investigated 60 new subjects who were categorized into infraspinatus, erector spinae, or gastrocnemius group based on an identified latent MTrP. These subjects underwent TDN while monitoring biomechanical stiffness at baseline, immediately post TDN, and 24 hours later. Analysis: Discriminate ability, reliability, and correlations were calculated for measured stiffness variable across the three conditions of contraction in the first phase of the study. Differences between stiffness at baseline and after TDN were calculated in the second phase of the study. Results: Correlation of the two measurement methods in the three muscle regions was significant and strongest in the gastrocnemius. MyotonPRO reliability was excellent, and demonstrated ability to discriminate between the three levels of muscle contraction. In the second phase, immediate decreased stiffness was observed in the MTrP following TDN treatment. Significant decreased stiffness was found in in the erector spinae and gastrocnemius group who also demonstrated a localized twitch response during TDN. Stiffness returned to near baseline values after 24 hours. Discussion: The MyotonPRO® stiffness measurement was found to be reliable and discriminate across predefined muscle contraction intensities. TDN may cause an immediate change in stiffness but this change was not observed at 24 hours. It is not known whether these effects are present in a symptomatic population or related to improvements in other clinical outcomes. Future studies are necessary to determine if a decrease in biomechanical stiffness is an indication of patient improvement in pain and function.