Divided We FallRothstein, Jules M
doi: 10.1093/ptj/77.2.130pmid: 9064686
Dreams and fantasies can stir the spirit and even provoke action, but reality? That's something else.The United States is a land of multiple realities. In the great American musical Showboat, the romantic leads meet and—with eyes glistening—sing the hope-filled duet, “Make Believe,” in which they talk of love and what could and would yet be. Minutes later, Joe, the black worker, sings of a very different world, one where “You an' me, we sweat and strain, body all achin' an' racked wid pain… Git a little drunk, an' you land in jail,” or, as Paul Robeson preferred to sing when he played the part of Joe, “Show a little spunk, an' you land in jail.” In Joe's world, hope is a stranger: “Ah gits weary, an' sick of tryin'/Ah'm tired of livin' and scared of dyin'.”
Contraction of the Abdominal Muscles Associated With Movement of the Lower LimbHodges, Paul W; Richardson, Carolyn A
doi: 10.1093/ptj/77.2.132pmid: 9037214
Background and Purpose. Activity of the trunk muscles is essential for maintaining stability of the lumbar spine because of the unstable structure of that portion of the spine. A model involving evaluation of the response of the lumbar multifidus and abdominal muscles to leg movement was developed to evaluate this function. Subjects. To examine this function in healthy persons, 9 male and 6 female subjects (mean age=20.6 years, SD=2.3) with no history of low back pain were studied. Methods. Fine-wire and surface electromyography electrodes were used to record the activity of selected trunk muscles and the prime movers for hip flexion, abduction, and extension during hip movements in each of those directions. Results. Trunk muscle activity occurring prior to activity of the prime mover of the limb was associated with hip movement in each direction. The transversus abdominis (TrA) muscle was invariably the first muscle that was active. Although reaction time for the TrA and oblique abdominal muscles was consistent across movement directions, reaction time for the rectus abdominis and multifidus muscles varied with the direction of limb movement. Conclusion and Discussion. Results suggest that the central nervous system deals with stabilization of the spine by contraction of the abdominal and multifidus muscles in anticipation of reactive forces produced by limb movement. The TrA and oblique abdominal muscles appear to contribute to a function not related to the direction of these forces.
Physical Therapy Treatment Choices for Musculoskeletal ImpairmentsJette, Alan M; Delitto, Anthony
doi: 10.1093/ptj/77.2.145pmid: 9037215
Background and Purpose. The primary goal of this investigation was to describe outpatient physical therapy treatments provided to patients with lumbar, cervical, or knee impairments. Subjects. Patients in this analysis received outpatient physical therapy for a primary orthopedic complaint during July 1993 through June 1994 from one of 68 practices participating in the Focus on Therapeutic Outcomes database. Data were available on 2,598 completed physical therapy episodes of care provided by 141 therapists. Methods. At each patient's discharge, the primary physical therapist gave information on the treatments provided to each patient during the initial, middle, and final thirds of the episode of therapy as well as information on primary source of reimbursement. Patients provided information on the date of onset of their symptoms or surgery. Results. These outpatient physical therapy episodes of care were characterized by a diverse array of modalities, exercises, and manual therapy treatments. Treatment choices varied by type of impairment and across thirds of the episode. Fee-for-service versus managed care payment arrangements were associated with increased use of devices, therapeutic massage, strengthening, and endurance exercises. Conclusion and Discussion. The study's findings revealed that although physical agents were frequently used in physical therapy episodes of care, they were applied along with exercise and manual therapy interventions. Future research should relate specific treatments to variation in patient outcomes following physical therapy.
Covert Bias in Evaluation of Physical Therapist Students' Clinical PerformanceHaskins, Awilda R; Rose-St Prix, Colleen; Elbaum, Leonard
doi: 10.1093/ptj/77.2.155pmid: 9037216
Background and Purpose. Physical therapist education programs rely on physical therapy practitioners to evaluate the performance of students during clinical affiliations. The purpose of this study was to determine whether covert bias exists in the evaluative judgments of physical therapy practitioners. Subjects. A convenience sample of 83 physical therapists attending the fall conference of the Florida Physical Therapy Association was selected. The subjects, 31 men and 52 women (73 white, 3 black, and 7 Hispanic), had a mean age of 41.5 years (SD=8.2, range=26–73). Methods. Four female physical therapist students (1 white, 1 Hispanic, 1 Asian, and 1 black) were videotaped reciting identical scripts about a patient's status. Each subject was randomly assigned to one of four groups and read a case study about the patient, viewed one videotape, and rated the student's presentation on a form developed by the researchers. Results. The white, Hispanic, and Asian students received higher ratings than the black student on two factors: clarity of presentation and overall rating. The white and Hispanic students received a higher rating than the black student on maintaining interest. The white and the Asian students received a higher rating than the black student on communication of appropriate information. The white student received a higher rating than the black student on organization of information. Conclusion and Discussion. The black student consistently received low ratings, indicating that racial or ethnic bias may influence the opinions of physical therapy practitioners. These results justify further exploration of the effect of race and ethnicity on student evaluation in the clinic.