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Kumar CTLK, Kumar CN, Gangadhar BN, Math SB. Health insurance for psychotherapy in India. Indian J Psychiatry 2024; 66:466-471. [PMID: 38919572 PMCID: PMC11195739 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_979_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 06/27/2024] Open
Affiliation(s)
- CTL Kiran Kumar
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - B. N. Gangadhar
- Former Director, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Osborne M, Grimes JK. Management of chronic musculoskeletal pain in an adult with Down syndrome using a modified pain neuroscience approach: a case report. Physiother Theory Pract 2023; 39:2750-2755. [PMID: 35775495 DOI: 10.1080/09593985.2022.2095682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/04/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The use of pain neuroscience education (PNE) in the management of chronic musculoskeletal pain is well documented in the literature for the adult population. However, the use of this component within the larger biopsychosocial approach has not been examined in adults with intellectual disabilities. The purpose of this case report is to describe the utilization of a PNE approach combined with exercise in the physical therapy management of chronic musculoskeletal pain in an adult with Down syndrome. CASE DESCRIPTION The patient was a 40-year-old man with Down syndrome who presented with chronic low back pain that affected his sleep, participation at work, and social activities. Modified metaphors were used to assist the patient in understanding his pain experience as part of a multi-modal program that included exercise and aquatic therapy. OUTCOMES Upon concluding 11 weeks of treatment, the patient returned to his prior work schedule and social activities with a pain rating at worst of 3/10 on the numeric pain rating scale with only occasional pain episodes. His disability score on the Oswestry Disability Index improved by 39% relative to baseline. DISCUSSION The findings demonstrate how utilizing PNE within a physical therapy plan of care was used in the management of chronic musculoskeletal pain to improve function in an adult with Down syndrome.
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Affiliation(s)
- Maria Osborne
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
| | - Jason K Grimes
- Division of Physical Therapy, Shenandoah University, Winchester, VA, USA
- Department of Physical Therapy, Sacred Heart University, Fairfield, CT, USA
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Yamagami M, Mack K, Mankoff J, Steele KM. “I’m Just Overwhelmed”: Investigating Physical Therapy Accessibility and Technology Interventions for People with Disabilities and/or Chronic Conditions. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2022. [DOI: 10.1145/3563396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Many individuals with disabilities and/or chronic conditions (da/cc) experience symptoms that may require intermittent or on-going medical care. However, healthcare is an often-overlooked domain for accessibility work, where access needs associated with temporary and long-term disability must be addressed to increase the utility of physical and digital interactions with healthcare workers and spaces. Our work focuses on a specific domain of healthcare often used by individuals with da/cc: physical therapy (PT). Through a twelve-person interview study, we examined how people’s access to PT for their da/cc is hampered by social (e.g., physically visiting a PT clinic) and physiological (e.g., chronic pain) barriers, and how technology could improve PT access. In-person PT is often inaccessible to our participants due to lack of transportation and insufficient insurance coverage. As such, many of our participants relied on at-home PT to manage their da/cc symptoms and work towards PT goals. Participants felt that PT barriers, such as having particularly bad symptoms or feeling short on time, could be addressed with well-designed technology that flexibly adapts to the person’s dynamically changing needs while supporting their PT goals. We introduce core design principles (adaptability, movement tracking, community building) and tensions (insurance) to consider when developing technology to support PT access. Rethinking da/cc access to PT from a lens that includes social and physiological barriers presents opportunities to integrate accessibility and adaptability into PT technology.
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Affiliation(s)
- Momona Yamagami
- Department of Electrical & Computer Engineering, University of Washington, Seattle, USA
| | - Kelly Mack
- Department of Computer Science & Engineering, University of Washington, Seattle, USA
| | - Jennifer Mankoff
- Department of Computer Science & Engineering, University of Washington, Seattle, USA
| | - Katherine M. Steele
- Department of Mechanical Engineering, University of Washington, Seattle, USA
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Shrader MW, Church C, Lennon N, Shields T, Salazar-Torres JJ, Howard JJ, Miller F. Well-Being of Ambulatory Adults With Cerebral Palsy: Education, Employment, and Physical Function of a Cohort Who Received Specialized Pediatric Care. Front Neurol 2021; 12:732906. [PMID: 34616355 PMCID: PMC8488089 DOI: 10.3389/fneur.2021.732906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/16/2021] [Indexed: 01/07/2023] Open
Abstract
Introduction: The transition from pediatric health care and school systems presents enormous challenges for young adults with cerebral palsy (CP). The lack of strong societal support during this seminal life event is well-documented and leads many adults with CP to struggle with independence, higher education, and employment. Despite the relatively high prevalence of CP, information about the experiences and function of adults with CP in our society continues to be limited. The purpose of this project was to describe well-being by assessing education, employment, physical function, walking activity, and utilization of health care in an ambulatory adult cohort with CP who received specialized pediatric care at our center. Method: In this Institutional Review Board-approved prospective study, we invited former patients from our tertiary care pediatric CP center to complete a set of patient-reported outcomes including (1) the Patient-Reported Outcomes Measurement Information System domains of physical function and pain interference, (2) the Satisfaction with Life Scale, and a project-specific demographic questionnaire about education, employment, income, independence, pain, and health care utilization. Participants also wore a pedometer for 8 days to monitor community walking activity. Chi-squared pairwise or t-tests were used as appropriate to compare survey responses and walking activity data between three groups: participants who self-reported, those who reported by proxy, and published normative data from age-matched typically developing adult (TDA) samples. Results: One hundred twenty-six adults with CP consented to participate; 85 self-reported [age 29.7 ± 4.3 years; Gross Motor Function Classification System: I (28%), II (47%), and III, (25%)] and 41 reported by proxy [age 29.7 ± 4.1 years; Gross Motor Function Classification System: I (10%), II (68%), and III (22%)]. For the group who self-reported, high school graduation rate (99%) was similar to TDA (92%; p = 0.0173) but bachelor's degree achievement rate (55%) was higher than TDA (37%; p < 0.001). Despite more advanced education, the unemployment rate in this group was higher than national levels at 33% and was associated with high utilization of Social Security Disability Insurance (33%). Within the self-reporting group, 13% required a caregiver. For the group who reported by proxy, educational levels (73% high school graduates, 0 bachelor's degree) were lower than the general population (p < 0.001) and unemployment was higher than the national level, at 64%. Unemployment in this group was associated with high utilization of Social Security Disability Insurance (85%). Within the proxy-reporting group, 71% required a caregiver. The full cohort demonstrated lower levels of physical function according to the Patient-Reported Outcomes Measurement Information System and less community walking activity compared with TDA references (p < 0.001). This cohort of adults with CP reported significantly higher frequency of chronic pain (48 vs. 12% for TDA; p < 0.001), but less pain interference with daily activities than TDA based on Patient-Reported Outcomes Measurement Information System results (p < 0.001). This cohort reported good to excellent overall health (93%) and high utilization of primary care (98%), but limited utilization of specialty care, specifically orthopedic care (21%) and physical therapy (15%). Discussion: This cohort of adults with CP had similar levels of education as the general population, but had relatively high rates of unemployment, caretaker need, and Social Security Disability Insurance utilization. Although chronic pain was frequent, the impact of pain on work and independent living did not exceed reports from a typically developing reference. Better targeted societal resources for adults with physical disabilities are urgently needed to allow equitable access to employment, promote opportunities for independence, and enable full participation in community life.
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Affiliation(s)
- M Wade Shrader
- Department of Orthopedics, Nemours duPont Hospital for Children, Wilmington, DE, United States
| | - Chris Church
- Department of Orthopedics, Nemours duPont Hospital for Children, Wilmington, DE, United States
| | - Nancy Lennon
- Department of Orthopedics, Nemours duPont Hospital for Children, Wilmington, DE, United States
| | - Thomas Shields
- Department of Orthopedics, Nemours duPont Hospital for Children, Wilmington, DE, United States
| | - Jose J Salazar-Torres
- Department of Orthopedics, Nemours duPont Hospital for Children, Wilmington, DE, United States
| | - Jason J Howard
- Department of Orthopedics, Nemours duPont Hospital for Children, Wilmington, DE, United States
| | - Freeman Miller
- Department of Orthopedics, Nemours duPont Hospital for Children, Wilmington, DE, United States
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Thorpe D, Gannotti M, Peterson MD, Wang CH, Freburger J. Musculoskeletal diagnoses, comorbidities, and physical and occupational therapy use among older adults with and without cerebral palsy. Disabil Health J 2021; 14:101109. [PMID: 33933399 DOI: 10.1016/j.dhjo.2021.101109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Musculoskeletal (MSK) disorder in adults with cerebral palsy (CP) is higher than in the general population. Evidence lacks about physical therapy (PT) and occupational therapy (OT) service utilization among older adults (65> years) living with CP. OBJECTIVE We compared the presence of comorbidities and patterns of PT and OT use among older adults with and without CP seeking care for MSK disorders. METHODS A 20% national sample of Medicare claims data (2011-2014) identified community-living older adults with (n = 8796) and without CP (n = 5,613,384) with one or more ambulatory claims for MSK diagnoses. The sample matched one CP case to two non-CP cases per year on MSK diagnoses, age, sex, race, dual eligibility, and census region. Exposure variable was the presence/absence of a CP diagnosis. Outcomes were use of PT and OT services identified via CPT and revenue center codes, and the presence/absence of Elixhauser comorbidities. RESULTS In older adults with MSK diagnoses, less than a third regularly utilized PT and/or OT services, and adults with CP utilized significantly less PT than adults without CP, and for some MSK diagnoses had fewer visits than their matched peers. Older adults with CP were at greater risk for secondary conditions that influence morbidity, mortality, and quality of life compared to their age-matched peers without CP. CONCLUSIONS Older adults with CP and MSK diagnoses had a greater prevalence of numerous comorbidities and lower use of PT services relative to their non-CP peers.
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Affiliation(s)
- Deborah Thorpe
- Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Mary Gannotti
- Department of Rehabilitation Sciences, University Hartford, West Hartford, CT, USA.
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Chin-Hua Wang
- Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Janet Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
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Klobucká S, Klobucký R, Kollár B. Effect of robot-assisted gait training on motor functions in adolescent and young adult patients with bilateral spastic cerebral palsy: A randomized controlled trial. NeuroRehabilitation 2020; 47:495-508. [PMID: 33136072 DOI: 10.3233/nre-203102] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robot-assisted gait training (RAGT) allows an intensive gait training in patients with cerebral palsy (CP). There are few evidences on the effectiveness of RAGT in adults with CP. OBJECTIVE To assess the effect of RAGT on gross motor function in adolescent and adult patients with bilateral spastic CP and to compare the effect of RAGT with conventional kinesiotherapy. METHODS Forty-seven patients (mean age 21.2±5.33 years) with bilateral spastic CP were divided into two groups. Twenty-one patients underwent 20 therapeutic units of RAGT and 26 patients underwent 20 therapeutic units of conventional therapy/training (CON). The following parameters were evaluated before (V1) and after the therapy (V2): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and jumping) of the Gross Motor Function Measure (GMFM-88). In patients in the experimental RAGT group, these parameters were also evaluated 3-4 months later (V3). RESULTS Comparing the mean improvements in endpoints in both groups (RAGT vs. CON) after 20 TUs, we observed the statistically significant difference (p < 0.001) and large effect size in all GMFM dimensions and total GMFM improvement in favour of the RAGT group. In RAGT patients, the improvement persisted even 3-4 months after RAGT (p < 0.001). CONCLUSION We demonstrated that the intensive RAGT regimen is more effective than conventional therapy in terms of improvements in gross motor functions in adolescent and adult patients with bilateral spastic CP.
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Affiliation(s)
| | - Robert Klobucký
- Slovak Academy of Sciences, Institute for Sociology, Bratislava, Slovakia
| | - Branislav Kollár
- 1st Department of Neurology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
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Hospitalized Adults With Intellectual and Developmental Disabilities: Confronting Challenges. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gannotti ME, Wilson JL, Bagley AM, Oeffinger D. Adults with cerebral palsy rank factors associated with quality of life and perceived impact of childhood surgery on adult outcomes. Disabil Rehabil 2019; 43:2431-2438. [PMID: 31881158 DOI: 10.1080/09638288.2019.1701718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mary E. Gannotti
- Department of Rehabilitation, University of Hartford, West Hartford, CT, USA
| | | | - Anita M. Bagley
- Shriners Hospital for Children Sacramento, Sacramento, CA, USA
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Lilly H, Bitzel M, Pejnovic T, Schnell J, Doty A. Barriers and characteristics for successful transition to adult healthcare for individuals with cerebral palsy: a systematic review. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1662995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Hannah Lilly
- Physical Therapy Department, Walsh University, North Canton, OH, USA
| | - Mackenzie Bitzel
- Physical Therapy Department, Walsh University, North Canton, OH, USA
| | - Tatiana Pejnovic
- Physical Therapy Department, Walsh University, North Canton, OH, USA
| | - Joanna Schnell
- Physical Therapy Department, Walsh University, North Canton, OH, USA
| | - Antonette Doty
- Physical Therapy Department, Walsh University, North Canton, OH, USA
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Martins JA, Merighi MAB, Jesus MCPD, Watanabe HAW. Aging with physical disabilities: experience intersected by stigma, social isolation and finitude. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2018-0128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: To understand the experience from a perspective of elderly people with physical disabilities. Method: Qualitative study that interviewed 15 people from the Mato Grosso Association of Disabled Person. Testimonies were obtained from 2016 July to 2017 June in the metropolitan region of Cuiabá/Brazil. Data were organized in thematic categories and analyzed through social phenomenology of Alfred Schütz. Results: It was evidenced that the stigma intersects the experience of the physical deficiency including in the old age. The perpetuation of stigma translated into impaired identity, social isolation, lack of perspective and acceptance of finitude as inevitable, contributing to a negative experience in old age. Conclusion and implications for practice: The experience of aging with physical disability has an intrinsically multidimensional nature, confronting complex lives and social contexts hostile to the body diversity, which need to be considered in public policies, by service managers and professionals involved in the processes of care for the elderly with physical disability.
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11
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Berry KM. Evidence-Based Management of In-Toeing in Children. Clin Pediatr (Phila) 2018; 57:1261-1265. [PMID: 29652180 DOI: 10.1177/0009922818769483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Friedman C, Feldner HA. Physical Therapy Services for People With Intellectual and Developmental Disabilities: The Role of Medicaid Home- and Community-Based Service Waivers. Phys Ther 2018; 98:844-854. [PMID: 30010974 DOI: 10.1093/ptj/pzy082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 04/08/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Care and support for people with intellectual and developmental disabilities (IDD) in natural community contexts are increasing. Many people with IDD use physical therapy services to support their community participation. Medicaid Home- and Community-Based Services (HCBS) 1915(c) waivers are the largest providers of long-term services and supports for people with IDD. However, little is known about physical therapy provision under this program. OBJECTIVE The aim of this study was to compare the operational definitions of physical therapy service under the HCBS 1915(c) waiver system and to describe projected physical therapy service utilization, spending, and reimbursement for people with IDD across states. DESIGN This was a cross-sectional, descriptive study. METHODS This study analyzed fiscal year 2015 HCBS IDD waivers from across the nation (N = 111), focusing on physical therapy utilization (total projected spending, total participants, reimbursement rates, and average annual service provision per participant). Service definitions were also analyzed to determine trends across waivers. RESULTS Fifty-one waivers (45.9%) provided 61 different types of physical therapy services in fiscal year 2015. States utilized waivers to provide long-term remedial care rather than the acute short-term physical therapy. HCBS waiver physical therapy services were often provided in participants' homes and communities to expand physical therapy access and secure the benefits of providing physical therapy services in natural environments. Although most states have adopted similar definitions of physical therapy service, procedures and services vary. LIMITATIONS Medicaid HCBS waivers are state projections made to the federal government rather than actual utilization data. CONCLUSIONS Physical therapy service definitions, projected service utilization, spending, and reimbursement for people with IDD who use Medicaid HCBS waivers vary greatly between states. Physical therapy may be utilized less than expected given the reported benefits for people with IDD.
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Affiliation(s)
- Carli Friedman
- The Council on Quality and Leadership, Towson, MD 21204 (USA)
| | - Heather A Feldner
- Departments of Mechanical Engineering and Rehabilitation Medicine, University of Washington, Seattle, Washington
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Hartley SE. Re-imagining the role of the physiotherapist when managing people with long-term conditions. Physiother Theory Pract 2018; 35:1005-1014. [DOI: 10.1080/09593985.2018.1467989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sandra Elaine Hartley
- Department of Health Professions, Brooks Building, Birley Fields Campus, Manchester, England
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Gannotti ME, Blanchard Y, Blumberg L, LaRocco D. Shared meanings of success, happiness, and health among adults with cerebral palsy and physiotherapists: implications for practice and research. Disabil Rehabil 2018; 41:1321-1330. [PMID: 29370730 DOI: 10.1080/09638288.2018.1425488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe shared meanings of success, happiness, and health of adults with cerebral palsy and physiotherapists. MATERIALS AND METHODS Ethnography employed open ended/semi-structured interviews and structured questionnaires (Satisfaction with Life Scale, Beck Depression Inventory-II®, Oxford Happiness Questionnaire, Life Habits Questionnaire, Medical Outcomes Study-Social Support Survey, and PROMIS® Pain Interference Scale). Content analysis of qualitative data and principal components analysis of questionnaire responses identified shared meanings. RESULTS Fourteen adults with cerebral palsy and 15 physiotherapists (median age 46) had similar levels of education. For both groups, social achievements, personal goals, employment, and supporting a family defined success. Adults with cerebral palsy more frequently identified tenacity and persistence as important for success. Both groups described happiness as spending time with loved ones, recreational activities, and having purpose in life. Adults with cerebral palsy identified the importance of self-acceptance for happiness. For both, health included self-care of mind/spirit, cardiovascular and musculoskeletal wellness, and physical fitness (the ability to perform physical tasks). Analysis of questionnaire responses identified shared meanings (eigenvalue 41, 95% explained variance). CONCLUSIONS Adults with cerebral palsy and physiotherapists share similar experiences, behaviors, and feelings about success, happiness, and health. This knowledge may improve communication, enhance evidence-based practice, and foster services to support wellbeing. Implications for rehabilitation Cerebral palsy is a life-long condition, but we know little about social and physical outcomes for adults with cerebral palsy. Lack of understanding about meanings of success, happiness, and health may be a barrier for consumers accessing and for providers delivering evidence-based services. Physiotherapists and adults with cerebral palsy share similar meanings (feelings, experiences, beliefs, behaviors) of success, happiness, and health- or wellbeing. Knowledge of this common ground may result in improved communication between providers and consumers, and foster more relevant and meaningful services to support the wellbeing of adults with cerebral palsy.
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Affiliation(s)
- Mary E Gannotti
- a Department of Rehabilitation Sciences , University of Hartford , West Hartford , CT , USA
| | - Yvette Blanchard
- b Department of Physical Therapy , Sacred Heart University , Fairfield , CT , USA
| | - Lisa Blumberg
- a Department of Rehabilitation Sciences , University of Hartford , West Hartford , CT , USA
| | - Diana LaRocco
- c Social and Educational Sciences , Goodwin College , East Hartford , CT , USA
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User-Centric Feedback for the Development and Review of a Unique Robotic Glove Prototype to Be Used in Therapy. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:3896089. [PMID: 29065593 PMCID: PMC5474238 DOI: 10.1155/2017/3896089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/20/2017] [Accepted: 04/27/2017] [Indexed: 11/18/2022]
Abstract
Disability can be a great impediment to daily living in later life and is often the result of illness or trauma. Modern thoughts on treatment are orientated towards the use of robotics; however, these are often designed without consultation with the user. This paper used a 5-point questionnaire to ask former therapy patients what they felt needed further improvements from potential robotics and what features of such a system were the most important. Significant emphasis was placed on helping them to grasp (M = 4.63) as well as having a functional use. They also desired a system with clearly distinguished (M = 4.22) and easy to operate controls (M = 4.44) whilst allowing them some freedom to move around independently (M = 4.44). This provided the rationale for a prototype dual-layered vacuum glove that was sampled by healthcare staff to provide feedback that forms the basis for future improvements.
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Park EY, Kim WH. Prevalence of secondary impairments of adults with cerebral palsy according to gross motor function classification system. J Phys Ther Sci 2017; 29:266-269. [PMID: 28265154 PMCID: PMC5332985 DOI: 10.1589/jpts.29.266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/04/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the prevalence of secondary impairments in
adults with cerebral palsy. [Subjects and Methods] The study sample included 52 adults
with cerebral palsy who attended a convalescent or rehabilitation center for disabled
individuals or a special school for physical disabilities in South Korea. [Results] The
univariate analysis showed that the Gross Motor Functional Classification System level was
a significant predictor of spondylopathies, general pain, arthropathies, and motor ability
loss. The prevalence of these impairments at Gross Motor Functional Classification System
level I and II was low compared with the prevalence found at Gross Motor Functional
Classification System level III–V. The prevalence of secondary impairments among adults
with cerebral palsy at Gross Motor Functional Classification System level III–V was high:
loss of motor ability, 42.3%; spondylopathies, 38.4%; general pain, 32.7%; and
arthropathies, 28.8%. [Conclusion] In this study, adults with severe cerebral palsy showed
a high prevalence of motor ability loss, spondylopathies, arthropathies, and pain. It is
necessary to develop intervention programs to prevent secondary impairments in adults with
cerebral palsy.
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Affiliation(s)
- Eun-Young Park
- Department of Secondary Special Education, College of Education, Jeonju University, Republic of Korea
| | - Won-Ho Kim
- Department of Physical Therapy, Ulsan College, Republic of Korea
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Lawrence H, Hills S, Kline N, Weems K, Doty A. Effectiveness of Exercise on Functional Mobility in Adults with Cerebral Palsy: A Systematic Review. Physiother Can 2016; 68:398-407. [PMID: 27904240 DOI: 10.3138/ptc.2015-38lhc] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: We identified evidence evaluating the effect of exercise on functional mobility in adults (aged 18 y or older) with cerebral palsy (CP). Method: An exhaustive search was conducted using the electronic databases PubMed, MEDLINE, CINAHL, PsycINFO, SPORTDiscus, and Cochrane Database of Systematic Reviews from the earliest available evidence (1975) to the present (January 2016) for studies whose participants were ambulatory adults with CP receiving conservative treatment to address functional mobility limitations. Two independent reviewers agreed on the eligibility, inclusion, and level of evidence of each study. The Maastricht-Amsterdam List (MAL) was used to assess evidence quality. Results: Five of the six studies included were randomized controlled trials, and one was a pre-post case series. Interventions included whole-body vibration, treadmill training without body-weight support, rhythmic auditory stimulation, dynamic balance and gait activities, progressive resistance training, and interactive serious gaming for balance. All studies were considered high quality, as indicated by their MAL scores. Four studies showed no statistical difference and trivial effect sizes between the intervention and the control group. Rhythmic auditory stimulation and interactive serious gaming were found to be statistically significant in benefiting adults with CP. Conclusions: Evidence of the effect of exercise on functional mobility for ambulatory adults with CP is lacking. A need exists for quality research to determine the best interventions for adults with CP to maximize functional mobility.
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Affiliation(s)
- Hillary Lawrence
- Physical Therapy Department, Walsh University, North Canton, Ohio
| | - Sara Hills
- Physical Therapy Department, Walsh University, North Canton, Ohio
| | - Nicole Kline
- Physical Therapy Department, Walsh University, North Canton, Ohio
| | - Kyra Weems
- Physical Therapy Department, Walsh University, North Canton, Ohio
| | - Antonette Doty
- Physical Therapy Department, Walsh University, North Canton, Ohio
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Beattie PF, Silfies SP, Jordon M. The evolving role of physical therapists in the long-term management of chronic low back pain: longitudinal care using assisted self-management strategies. Braz J Phys Ther 2016; 20:580-591. [PMID: 28001268 PMCID: PMC5176195 DOI: 10.1590/bjpt-rbf.2014.0180] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/15/2016] [Indexed: 12/12/2022] Open
Abstract
Background Longitudinal studies have shown that the symptoms of chronic low back pain (CLBP) will follow an episodic trajectory characterized by periods of high and low pain intensity that can persist for many years. There is a growing belief that the contemporary approach of limiting physical therapy to short, but intense courses of treatment for (CLBP) may be sub-optimal because these limited “windows” of clinical care are not congruent with the natural history of this condition. Recent research has suggested that people with CLBP undergo substantial, and individualized long-term variations in the neural processing of nociception over time. This has led to the concept of a “unique biosignature of pain” that may explain much of the variation in a person’s clinical picture. These and other findings have led to the reconceptualization of CLBP as an individualized, and continually evolving condition that may be more suitably managed by empowering the patient toward self-management strategies that can be modified as needed over time by the PT. Objectives The purpose of this Master Class Paper is to describe an emerging approach for the treatment of CLBP that emphasizes the formation of a long-term therapeutic alliance between the patient and the PT with an emphasis on individualized, patient-preferred approaches for activity-based self-management as an alternative to the contemporary approach of short, intense episodes of care directed toward pain reduction. Conclusion Longitudinal care using assisted self-management strategies is more congruent with the natural history of CLBP than are traditional approaches for PT intervention. This approach may empower patients to undergo lifestyle changes that will favorably influence long-term outcomes; however additional research is needed.
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Affiliation(s)
- Paul F Beattie
- Doctoral Program in Physical Therapy, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sheri P Silfies
- Department of Physical Therapy & Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Max Jordon
- Physical Therapist, Mobility Research Clinic, Richland-Palmetto Health, Columbia, SC, USA
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Abstract
These are exciting times for physical therapists who treat people with chronic low back pain (CLBP). Many of the mysteries of this condition are starting to be revealed, and it appears that major breakthroughs are on the way. Advances in neuroimaging, coupled with increased understanding of the molecular and submolecular events associated with the symptoms of back pain, are helping us reconceptualize the etiologies and mechanisms of this condition. The result of these advances is that physical therapists now have a wide range of potential "treatment packages" that can include patient education, manual therapy, and a wide variety of exercise options for people with CLBP. The question is, "How can long-term, self-management programs become more effective?"
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