Physical Therapy Tasks Research Articles

Cardiovascular and Pulmonary Entry-Level Physical Therapist Competencies: Update by Academy of Cardiovascular & Pulmonary Physical Therapy Task Force

Purpose: Competency-based education and creation of profession-based entrustable professional activities are current trends in physical therapist (PT) education. The purpose of this project is to determine the current entry-level PT competencies for cardiovascular & pulmonary (CVP) physical therapy. Methods: The Academy of Cardiovascular & Pulmonary Physical Therapy Competency Task Force was established to update and expand previous competencies. A mixed method approach of Subject Matter Expert (SME) consensus (modified Delphi process) and a broader survey process was used to develop these entry-level competencies. With SME guidance, a modified version of the levels of competence, None-to-Proficient, was adopted based on previous competency work by the American Council of Academic Physical Therapy. Results: Twenty-nine SME members engaged in the consensus process, and 268, 194, 305, and 222 respondents completed the 4 surveys, respectively. Six hundred fifty-one competency items were rated across most Commission on the Accreditation of Physical Therapy Education Standard 7 Curriculum areas, following the patient–client management model. Conclusions: These competencies establish specific expected levels of knowledge, skills, and behaviors essential for entry-level CVP PT practice. Adopting these competencies will help lay the groundwork for future competency-based PT education and aid in the development of the physical therapy profession's core entrustable professional activities.

Defining Excellence in Physical Therapist Education: A Comparison of 2 Theoretical Perspectives

Background and Purpose. Defining excellence and assessing quality in physical therapist education are challenging for many reasons, including the variable nature of curricular approaches, program structure and settings, teaching approaches, and institutional culture. In addition, the stakeholders differ depending on the unique program mission or outcome one considers. Thus, there are tensions about measuring inputs, processes, or outcomes, using quantitative versus qualitative data, and the value of program diversity. Recently, 2 approaches to measuring physical therapist education program excellence have been reported in the literature. Although these studies were not connected, the foundations of each suggest some unifying core concepts. This paper evaluates the 2 approaches to assessing program excellence, comparing clusters and attributes of the Engagement Theory of Program Quality applied by the American Council of Academic Physical Therapy task force for benchmarking excellence with the dimensions and elements for education reform proposed by the study of Excellence and Innovation in Physical Therapist Education. Position and Rationale. The Engagement Theory of Program Quality is a generic model designed to assess graduate programs, whereas the theoretical model proposed by the study of Excellence and Innovation in Physical Therapist Education is specific to physical therapist education. The models, however, demonstrate considerable correspondence, suggesting that excellence in graduate programs in higher education has common roots regardless of type of program. Discussion and Conclusion. There is clear convergence of major constructs across the 2 theoretical models. The most salient commonalities include the emphases on shared vision; leadership; collaborative relationships/partnerships; adequate resources to support students, faculty, and infrastructure; and the capacity for transformation of the people and institutions involved in the educational endeavor. These commonalities suggest a basis for initial consensus of a professional shared vision, as well as the foundation for further efforts at defining excellence and developing structures and processes for appraising quality in physical therapist education programs. We urge development of a culture of assessment to move our physical therapist education programs closer to achieving excellence.

Towards On-Demand Virtual Physical Therapist: Machine Learning-Based Patient Action Understanding, Assessment and Task Recommendation.

In this paper, we propose a machine learning-based virtual physical therapist (PT) system to enable personalized remote training for patients with Parkinson's disease (PD). Three physical therapy tasks with multiple difficulty levels are selected to help patients with PD improve balance and mobility. Patients' movements are captured by a Kinect sensor. Criteria for each task are carefully designed by our PT co-author such that the patient's performance can be evaluated in an automated manner. Given the patient's motion data, we propose a two-phase human action understanding algorithm TPHAU to understand the patient's movements, and an error identification model to identify the patient's movement errors. To enable automated task recommendation, a machine learning-based model is trained from real patient and PT data to provide accurate, personalized, and timely task update recommendation for patients with PD, thereby emulating a real PT's behavior. Real patient data have been collected in the clinic to train the models. Experiments show that the proposed methods achieve high accuracy in patient action understanding, error identification and task recommendation. The proposed virtual PT system has the potential of enabling on-demand virtual care and significantly reducing cost for both patients and care providers.

The cardiac autonomic nervous system response to different daily demands among patients at the sub-acute phase post ischemic stroke and healthy controls.

Autonomic disturbances are a common phenomenon in patients' post-stroke, characterized by hypo function of the para-sympathetic and/or overactive sympathetic system. The impact of autonomic disturbances on physical therapy tasks during the rehabilitation period has not yet been assessed. To describe the response of the cardiac autonomic nervous system during different tasks, among patients and age-matched healthy controls. Nineteen patients in the subacute phase post first-ever ischemic stroke, and 16 controls. The Polar advanced heart rate monitor (RS800CX) was used to record RR intervals at rest, during paced breathing exercise, while performing different types of muscle contractions, and during single and dual task conditions. RR intervals and heart-rate variability (HRV) parameters were significantly lower among patients post stroke, both at rest and during most of the activities tested. Among the control group a significant autonomic adaptation was seen in the form of reduced RR intervals and HRV during muscle contraction and a significant increase in these parameters during slow breathing, no significant changes were observed among patients post stroke. Patients post-stroke experience hyper sympathetic function at rest and less adaptive cardiac autonomic control during different activities, which all may have an impact on rehabilitation outcomes.

Education Research in Physical Therapy: Visions of the Possible.

Education research has been labeled the "hardest science" of all, given the challenges of teaching and learning in an environment encompassing a mixture of social interactions, events, and problems coupled with a persistent belief that education depends more on common sense than on disciplined knowledge and skill. The American Educational Research Association specifies that education research-as a scientific field of study-examines teaching and learning processes that shape educational outcomes across settings and that a learning process takes place throughout a person's life. The complexity of learning and learning environments requires not only a diverse array of research methods but also a community of education researchers committed to exploring critical questions in the education of physical therapists. Although basic science research and clinical research in physical therapy have continued to expand through growth in the numbers of funded physical therapist researchers, the profession still lacks a robust and vibrant community of education researchers. In this perspective article, the American Council of Academic Physical Therapy Task Force on Education Research proposes a compelling rationale for building a much-needed foundation for education research in physical therapy, including a set of recommendations for immediate action.

Multidisciplinary stroke rehabilitation delivered by a humanoid robot: Interaction between speech and physical therapies

Background: A great number of stroke patients pursue rehabilitation services in multiple domains (e.g., speech, physical, occupational). Although multidisciplinary and interdisciplinary approaches to stroke rehabilitation are considered desirable, it is largely unknown how the intervention in one domain affects the progress in others. Aims: The current study investigated the interaction between speech therapy and physical therapy. Additionally, the feasibility of utilising a humanoid robot in stroke rehabilitation was described. Methods & Procedures: A 72-year-old male chronically challenged by aphasia and hemiparesis completed speech and physical therapy tasks in the sole condition (Speech Only, Physical Only) and in the sequential condition (Speech & Physical). The therapy activities were delivered by a humanoid robot. Outcomes & Results: Greater gains in speech and physical functions were obtained during the sole condition than in the sequential condition, suggesting a competitive interaction between speech and physical therapies. Conclusions: The cross-domain competition can be accounted for by fatigue, participant characteristics, and task characteristics. Objective data on speech and physical functions and subjective data on perceived quality of life indicate positive outcomes in this single case. These findings warrant further research on the feasibility and utility of humanoid robots in stroke rehabilitation.

THE EFFECTS OF CHOICE ON SELF‐CONTROL

Three adolescents with traumatic brain injury performed a physical therapy task in the absence of programmed consequences or duration requirements. Next, the experimenter gave the participants the options of a smaller immediate reinforcer with no response requirement or a larger delayed reinforcer with a response requirement. Self-control training exposed participants to a procedure during which they chose between a smaller immediate reinforcer and a progressively increasing delayed reinforcer whose values varied and were determined by a die roll. The participants chose whether they or the experimenter rolled the die. All participants initially demonstrated low baseline durations of the physical therapy task, chose the smaller immediate reinforcer during the choice baseline, and changed their preference to the larger delayed reinforcer during self-control training.

Work-Related Musculoskeletal Disorders in Physical Therapists: A Prospective Cohort Study With 1-Year Follow-up

Work-related musculoskeletal disorders (WMSDs) have a significant impact on physical therapists, but few studies have addressed the issue. Research is needed to determine the scope of the problem and the effects of specific risk factors. The objectives of this study were: (1) to determine the 1-year incidence rate of WMSDs in physical therapists and (2) to determine the effects of specific risk factors. This was a prospective cohort study with 1-year follow-up. Subjects were randomly selected American Physical Therapy Association members (N=882). Exposure assessment included demographic data, physical risk factors, job strain, and specific physical therapy tasks. The primary outcome was WMSDs, with a severity rating of at least 4/10 and present at least once a month or lasting longer than a week. The response rate to the baseline questionnaire was 67%. Ninety-three percent of the subjects who responded to the baseline questionnaire responded to the follow-up questionnaire. The 1-year incidence rate of WMSDs was 20.7%. Factors that increased the risk for WMSDs included patient transfers, patient repositioning, bent or twisted postures, joint mobilization, soft tissue work, and job strain. The primary limitation of this study was the number of therapists who had a change in their job situation during the follow-up year. Work-related musculoskeletal disorders are prevalent in physical therapists. Physical therapy exposures, patient handling, and manual therapy, in particular, increase the risk for WMSDs.

Enhancing Physical Therapy Exercises in Persons with Acquired Brain Injury through a Self-Control Training Procedure

The purpose of the present study was to increase engagement in physical therapy tasks with two adults with acquired traumatic brain injuries while promoting self-control choices. Participants were directed to engage in a designated physical therapy task without programmed reinforcement. Next, participants were presented with two choices: a small amount of a preferred reinforcer delivered immediately and a larger portion of the same reinforcer delivered after a specified level of task engagement. When the participants still exhibited impulsive behavior, a third condition was introduced that involved an additional choice of a large progressively delayed reinforcer. With one of the participants, additional manipulations were required in order to bring about self-control responding. These included modifications of delay values and the implementation of a series of forced choices while the delay associated with the choice was systematically increased. Both participants eventually exhibited a preference for the progressive delay option even as the duration of the delay surpassed that of the fixed delay option. Results are discussed in terms of teaching life enhancing skills and the enhancement of optimal choice making.