Physical Therapy

Rothstein, Jules, M

doi: 10.1093/ptj/71.3.181pmid: 2000433

Political issues, like the numbers associated with distant disasters, often seem to lose their relationship to human beings. But sometimes, maybe even in the dark of night, one can see beyond the practiced rhetoric of partisans to how an issue affects the lives of real people. So it was for me and the much debated topic of direct access for physical therapists. Recently, in the darkness of a hospital room, I tried to rest in a chair as my 11-year-old daughter slept off the lingering effects of general anesthesia. I could not help but overhear a history recounted by the mother of my daughter's acutely ill and recently admitted roommate. As the resident listened, the mother told of how her 19-year-old daughter had developed back pain and had sought help from both a general practitioner and a chiropractor. Both apparently treated the daughter for months for sciatica, with little effect. This content is only available as a PDF. © 1991 by the American Physical Therapy Association Inc.

Siegel, Janet, Collins;Marchetti,, Maria;Tecklin, Jan, Stephen

doi: 10.1093/ptj/71.3.183pmid: 2000434

This study compared balance skills of hearing-impaired children with those of hearing children in order to determine whether a deficit in balance exists in hearing-impaired children and to ascertain whether this deficit is age-related. Twenty-eight hearing-impaired subjects were chosen as a sample of convenience from the Pennsylvania School for the Deaf and placed into one of three age groups. Ten subjects were in the 4.5- to 6.5-year-old age group, 8 in the 8- to 10- year-old age group, and 10 in the 12.5- to 14.5-year-old age group. Selection criteria included bilateral sensorineural hearing loss of ≥65 dB and normal intelligence (IQ≥80). Balance was measured by the use of the Balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency. For each age group, a z test was used to compare the subjects' scores with the Balance subtest standard scores. The results showed that for each age group, the mean score for the hearing-impaired children was lower than the standard score. Both older groups had significantly higher scores than the youngest group, but the mean scores of the older groups were not significantly different. No difference between the subjects' balance scores and the Balance subtest standard scores was found among the age groups, suggesting that the balance deficit was not age-related. Gender differences were not found for balance scores. Child development, Equilibrium, Hearing disorders, Posture, tests and measurements, Vestibular system This content is only available as a PDF. Author notes This study was completed in partial fulfillment of the requirements for Ms Siegel's and Ms Marchetti's Master of Science in Physical Therapy degree, Beaver College, Glenside, PA 19038. This study was approved by the institutional review boards of Beaver College and the Pennsylvania School for the Deaf. © 1991 by the American Physical Therapy Association Inc.

May, Bella, J;Dennis, Jancis, K

doi: 10.1093/ptj/71.3.190pmid: 2000435

Four hundred American and 384 Australian physical therapists, nominated by their peers as expert clinicians, were studied to evaluate whether a particular cognitive style was prevalent among expert clinicians, to identify preferred sources of information for clinical decision making, and to determine the similarities and differences between American and Australian therapists. Results were based on usable survey responses from 348 American and 290 Australian therapists. Eighty-eight percent of the American therapists and 82% of the Australian therapists identified themselves as working primarily in general practice, orthopedics, or neurology. The physical therapy assessment and interviews with the patient were the preferred sources of information in both countries. The physician's referral and communications with other health care personnel were reported to be of limited value as sources of information by most respondents. Overall, both groups responded most positively to the receptive style of data gathering and the systematic style of information processing. Therapists working primarily with neurologically impaired patients responded most positively to the preceptive style of data gathering and the intuitive style of information processing. Therapists working primarily with patients with orthopedic disorders responded most positively to the systematic style of information processing. Data collection, Decision making, Physical therapy profession, international, Questionnaires This content is only available as a PDF. Author notes This article is adapted from a paper presented at the Tenth International Congress of the World Confederation for Physical Therapy, Sydney, Australia, May 17–22, 1987. © 1991 by the American Physical Therapy Association Inc.

Bullock, Margaret, I;Dalgleish,, Len

doi: 10.1093/ptj/71.3.202pmid: N/A

The accuracy of diagnosis and the effective selection of treatment approaches are vital elements in successful patient management. Studies that attempt to elucidate the methods of expert decision making in these important areas can provide guidance for the improvement in performance of clinicians and for the education of physical therapy students in these processes. May and Dennis have reported the results of a survey of clinicians perceived by their peers to be experts in an attempt to clarify the nature of information-processing phases and to describe the cognitive style preferences of expert physical therapy practitioners. It is implied that the planned description of “expert behaviors” will provide guidance for faculty in directing students to more effective learning strategies in relation to desired approaches to decision making. This content is only available as a PDF. © 1991 by the American Physical Therapy Association Inc.

Payton, Otto, D

doi: 10.1093/ptj/71.3.204pmid: N/A

May and Dennis have made significant contributions to our professional database in three areas: the sources of information used in clinical problem solving; the types of valued interdisciplinary communications used by therapists in their clinical problem solving; and the norm and variance in cognitive style preferences among clinicians in their clinical decision making, especially as they relate to areas of practice. In the introduction to this interesting paper, May and Dennis have raised important questions concerning the possible impact of direct access on the teaching of clinical decision making and the more fundamental question of the interrelationship between cognitive style and clinical decision making. Unfortunately, it is unclear how many therapists in the sample were, in fact, working in a direct-access environment, either in the United States or in Australia. This content is only available as a PDF. © 1991 by the American Physical Therapy Association Inc.

May, Bella, J;Dennis, Jancis, K

doi: 10.1093/ptj/71.3.206pmid: N/A

We appreciate Dr Payton's, Dr Bullock's, and Dr Dalgleish's careful review of our article and their thoughtful commentaries. Sharing perspective expands everyone's breadth of knowledge and understanding of research results, particularly in a complex area such as clinical decision making. Dr Payton suggested that therapists with direct access might have valued communications with physicians differently than therapists working under referral. Unfortunately, there were not enough respondents accepting patients directly, particularly in the United States, to allow for meaningful data analysis along that dimension. We agree that further study of practice similarities and differences between therapists practicing with direct access and those practicing under referral would yield interesting data. This content is only available as a PDF. © 1991 by the American Physical Therapy Association Inc.

Wolff, Melissa, S;Michel, Theresa, Hoskins;Krebs, David, E;Watts, Nancy, T

doi: 10.1093/ptj/71.3.207pmid: 2000436

Orthopedic physical therapists' knowledge of pain mechanisms and methods of pain management and their attitudes toward working with patients with benign chronic pain were studied. A random sample of 500 members of the American Physical Therapy Association's Section on Orthopaedics received by mail a 36-item questionnaire. Statistical analysis of scores, using frequencies, means, and correlations, was performed on the 119 (23.8%) usable returns. All but 4% of the respondents preferred to work with patients who are not likely to have chronic pain. Seventy-two percent believed their entry-level education in pain management and theory was very inadequate or less than adequate to deal with an orthopedic patient population. Pain knowledge scores were low (35.8 out of 46 points), and the scores on positive attitudes toward treating patients with benign chronic pain were lower (20.5 out of 36 points). The study suggests specific deficiencies in orthopedic physical therapists' knowledge of clinical pain mechanisms and management and potentially undesirable attitudes toward treating patients with chronic pain. Attitude of health personnel, Pain, Tests and measurements, general This content is only available as a PDF. Author notes This research was supported in part by a grant from the Marjorie K Ionta Fund at MGH-Institute of Health Professions, Boston, MA. This research was approved by the Massachusetts General Hospital Institutional Review Board. © 1991 by the American Physical Therapy Association Inc.

Harris, Susan, R

doi: 10.1093/ptj/71.3.215pmid: 2000437

The purpose of this article is to review research related to the use of clinical analysis of movement as an aid to the early diagnosis of cerebral palsy. A historical perspective of clinical techniques used by physicians and physical therapists in the early diagnosis of cerebral palsy will be presented first, including recent research findings on clinical signs that were most predictive of this movement disorder. Predictive neuromotor behaviors common across several recent studies will be highlighted. Future trends in the use of movement analysis, including digitized kinematic analysis of term and preterm infants and fetal ultrasound techniques, will be discussed as well. Cerebral palsy, Kinesiology/biomechanics, general, Movement, Pediatrics, development, Pediatrics, evaluation This content is only available as a PDF. © 1991 by the American Physical Therapy Association Inc.

Heriza, Carolyn, B

doi: 10.1093/ptj/71.3.222pmid: 2000438

Implications of the dynamical systems approach to understanding movement dysfunction in infants are discussed. Traditional theories of motor development attribute changes in movement to the hierarchical maturation of the central nervous system. The dynamical systems approach emphasizes that movement self-organizes as the result of the interaction of the participating subsystems in developmental and real time. In this article, I discuss, from the theoretical perspective of the dynamical systems approach, the organization of leg movements in low- and high-risk preterm and full-term infants, developmental changes in movement in low-risk preterm infants from 34 weeks' gestational age to 40 weeks' postgestational age, and differences in movement between low-risk preterm infants at 40 weeks' postgestational age and full-term infants. Preliminary data on high-risk preterm infants are presented. Based on these data, the necessity to review and reinterpret traditional concepts of motor development is explored. Suggestions are offered and questions posed on how the dynamical systems perspective may influence the practice of physical therapy in the evaluation and treatment of infants at risk for movement dysfunction. Child development, Infant, Movement, Pediatrics, development, Systems theory This content is only available as a PDF. © 1991 by the American Physical Therapy Association Inc.

Goodgold-Edwards, Shelley, A

doi: 10.1093/ptj/71.3.236pmid: 2000439

Research findings suggest that experience and cognitive strategies contribute to successful performance during perceptual-motor tasks. This article critically reviews selected literature on the effects of information-processing skills, preferred movement time, experience, and task difficulty on performance during coincident timing tasks. Theoretical information and research findings are discussed, and their applications to clinical practice are considered. Clinical recommendations include assessment of coincident timing skills and use of functional activities that provide opportunities to explore and dynamically interact with the environment. Cerebral palsy, Pediatrics, development, Perceptual-motor learning, Psychomotor performance This content is only available as a PDF. Author notes This research was completed in partial fulfillment of the requirements for Dr Goodgold-Edwards's doctor of science degree, Sargent College of Allied Health Professions, Boston University. This research was supported in part by Project 901 of the US Department of Health and Human Services, Division of Maternal and Child Health Services, and by an educational grant from the Foundation for Physical Therapy Inc. © 1991 by the American Physical Therapy Association Inc.