Physical Therapy, Department of

Study protocol: an early intervention program to improve motor outcome in preterm infants: a randomized controlled trial and a qualitative study of physiotherapy performance and parental experiences

Wed, 15 Feb 2012 06:00:00 GMT

Study protocol: an early intervention program to improve motor outcome in preterm infants: a randomized controlled trial and a qualitative study of physiotherapy performance and parental experiences Øberg, Gunn Kristin; Campbell, Suzann K.; Girolami, Gay L.; Ustad, Tordis; Jørgensen, Lone; Kaaresen, Per Ivar Background: Knowledge about early physiotherapy to preterm infants is sparse, given the risk of delayed motor development and cerebral palsy. Methods/Design: A pragmatic randomized controlled study has been designed to assess the effect of a preventative physiotherapy program carried out in the neonatal intensive care unit. Moreover, a qualitative study is carried out to assess the physiotherapy performance and parents’ experiences with the intervention. The aim of the physiotherapy program is to improve motor development i.e. postural control and selective movements in these infants. 150 infants will be included and randomized to either intervention or standard follow-up. The infants in the intervention group will be given specific stimulation to facilitate movements based on the individual infant’s development, behavior and needs. The physiotherapist teaches the parents how to do the intervention and the parents receive a booklet with photos and descriptions of the intervention. Intervention is carried out twice a day for three weeks (week 34, 35, 36 postmenstrual age). Standardized tests are carried out at baseline, term age and at three, six, 12 and 24 months corrected age. In addition eight triads (infant, parent and physiotherapist) are observed and videotaped in four clinical encounters each to assess the process of physiotherapy performance. The parents are also interviewed on their experiences with the intervention and how it influences on the parent-child relationship. Eight parents from the follow up group are interviewed about their experience. The interviews are performed according to the same schedule as the standardized measurements. Primary outcome is at two years corrected age. Discussion: The paper presents the protocol for a randomized controlled trial designed to study the effect of physiotherapy to preterm infants at neonatal intensive care units. It also studies physiotherapy performance and the parent’s experiences with the intervention. Trial registration: ClinicalTrials.gov NCT01089296 © 2012 Øberg et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License. (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: 10.1186/1471-2431-12-15

A Catalyst-for-Change Approach to Evaluation Capacity Building

Wed, 01 Jun 2011 05:00:00 GMT

A Catalyst-for-Change Approach to Evaluation Capacity Building García-Iriarte, Edurne; College Dublin, Trinity; Suarez-Balcazar, Yolanda; Taylor-Ritzler, Tina; Luna, Maria; Valor, El Evaluation capacity building (ECB) has become a popular approach for helping community-based organizations (CBO) to meet their funders’ demands for accountability. This case study reports the ECB process with one staff member using a catalyst-for-change approach. We analyzed the role of the catalyst in diffusing evaluation knowledge and skills and in promoting evaluation mainstreaming and use within the CBO; and the outcomes achieved as a result of the catalyst’s role in the process of building evaluation capacity. Implications based on the study findings are discussed. © 2011 by SAGE Publications, American Journal of Evaluation doi: 10.1177/1098214010387114

Auxiliary Sensory Cues Improve Automatic Postural Responses in Individuals With Diabetic Neuropathy

Sat, 01 Jan 2011 06:00:00 GMT

Auxiliary Sensory Cues Improve Automatic Postural Responses in Individuals With Diabetic Neuropathy Rao, Noel; Aruin, Alexander S. Background. A loss of sensation in the lower limbs, observed in individuals with diabetes as well as the elderly, contributes to postural instability, altered gait patterns, increased risk of falling, and decreased quality of life. Objective. To find out if somatosensory cues delivered to the intact tissues of the lower limbs above the ankle joints enhance the control of posture in individuals with peripheral neuropathy. Methods. Twelve individuals with sensory neuropathy due to diabetes participated in static and dynamic balance tests with and without auxiliary sensory cues provided to the lower limbs without stabilizing the ankle joints. During the tests the subjects were required to stand on a fixed or moving computer-controlled platform with their eyes open or closed. Equilibrium scores and response latency were obtained. Results. For all tests, equilibrium scores were significantly larger in experiments with auxiliary sensory cues in comparison to conditions without cues (p < 0.05). Smaller latency scores were recorded in conditions with available auxiliary sensory information. The results indicate that auxiliary sensory cues provided to the intact tissues of the lower extremities could improve automatic postural responses in individuals with diabetic peripheral neuropathy. Conclusions. The observed enhancement of automatic postural responses has clinical implications that aid in the understanding of postural control in individuals with peripheral neuropathy. The study outcome also provides a basis for future investigations on whether specially designed assistive means that provide auxiliary sensory cues could improve balance, mobility, and the performance of ADLs in individuals with peripheral neuropathy. Post print version of article may differ from published version. The definitive version is available through SAGE Publications at DOI: 10.1177/1545968310376760

Two types of slip-induced falls among community dwelling older adults

Sun, 01 Apr 2012 05:00:00 GMT

Two types of slip-induced falls among community dwelling older adults Yang, Feng; Espy, Debbie; Bhatt, Tanvi; Pai, Yi-Chung Little is known about the landing behavior of the trailing (recovery) foot and ensuing types of falls following a forward slip in walking. The purposes of this study were to 1) determine if community-dwelling older adults experienced bilateral slips at the same rate as had been previously observed for young adults during over-ground walking; 2) determine if fall rate in older adults was dependent on slip type (unilateral vs. bilateral); and 3) identify differences in spatiotemporal variables of the trailing leg step between unilateral and bilateral slips. One hundred-seventy-four participants experienced an unannounced, unrehearsed slip while walking on a 7-m walkway. Each trial was monitored with a motion capture system and bilateral ground reaction force plates. Although the experimental design, developed with original data from a young adult population, favored bilateral slips, more older adults (35%) than anticipated (10% previously observed in young, p<0.001) displayed a unilateral slip. The probability of fall was equal in the two types of slips. Eighty-two people recovered from the slip, while the remaining 92 (53%) fell. These 92 were classified into two exclusive categories based on the heel distance at the time of fall arrest using cluster analysis: those which resembled a fall into a "splits" position (n=47) or a feet-forward fall (n=45). All (100%) unilateral slips led to splits falls, as expected. Yet, not all bilateral slips (only 83%) resulted in feet-forward falls. A longer forward recovery step with a prolonged step time led to both feet slipping, nearly together, hence a feet forward fall. NOTICE: this is the author’s version of a work that was accepted for publication in Journal of Biomechanics. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Biomechanics, Vol. 45, Issue 7, (April 2012). doi.org/10.1016/j.jbiomech.2012.01.036,