School of Physical Therapy

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    Cardiovascular Responses in Physically Elderly Active People Living with HIV
    (2023-07-27) Rosario, Martin G.; Kidwell, McKenzie; Nelson, Nicole
    Cardiovascular system (CVS) problems are one of the various complications in people living with HIV (PLHIV). In PLHIV, the CVS' capacity to adapt to activities is inadequate. Purpose: To distinguish the responses of the CVS to a step test in physically active PLHIV. Results: Significant differences between resting HR and HR after the step test were identified, while there was no significant difference between recovery HR and HR at 76% capacity. Additionally, all cardiovascular measurements were significantly higher than the recovery heart rate. Conclusion: It appears that physically active participants are experiencing some degree of autonomic dysfunction. However, physical activity seems to help slow down common CV effects.
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    Gait-associated dynamic deviations during cognitive dual tasks in physically active adults living with HIV
    (2023-11-15) Rosario, Martin G.
    Introduction: Among Human immunodeficiency virus (HIV) complications, individuals living with HIV experience cognitive deterioration that could influence gait and balance in this group. To identify gait variations during dual cognitive tasks equaled to single tasks in those living with HIV. Material and methods: 11 females and 18 male adults (age, 60.31 ± 7.82) diagnosed with HIV were recruited for the current investigation. The study instructed participants to walk 7 meters (single tasks), and the same distance while counting backward from 100 by 3 (dual cognitive tasks). During the activity, parameters, such as gait speed, stride length, and postural sway were gathered with six motion analysis sensors. Results: A significant reduction in cadence (single tasks: 108.6 ± 16.7, dual tasks: 92.3 ± 25.9; p < 0.001), gait speed (single tasks: 0.98 ± 0.28, dual tasks: 0.78 ± 0.31; p < 0.001), time during swing phase percentage (single tasks: 38.7 ± 3.9, dual tasks: 35.3 ± 7.9; p < 0.05), single-limb support time (single tasks: 38.2 ± 3.9, dual tasks: 35.4 ± 7.9; p < 0.05), and stride length (single tasks: 1.1 ± 0.2, dual tasks: 0.95 ± 0.3; p < 0.05) were observed during dual cognitive tasks when compared to single tasks. Conclusions: Gait-associated dynamic alterations were revealed as a compensatory strategy to adapt to the requirements of dual cognitive tasks for those living with HIV, even when physically active. We advise physicians to investigate the cognitive characters of all individuals with HIV, regardless of the status of the condition.
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    Reduction of diffusion barriers in isolated rat islets improves survival, but not insulin secretion or transplantation outcome
    (2010-04-01) Williams, S. Janette; Huang, Han-Hung; Kover, Karen; Moore, Wayne V; Berkland, Cory; Singh, Milind; Smirnova, Irina S.; MacGregor, Ronal; Stehno-Bittel, Lisa
    For people with type 1 diabetes and severe hypoglycemic unawareness, islet transplants offer hope for improving the quality of life. However, islet cell death occurs quickly during or after transplantation, requiring large quantities of islets per transplant. The purpose of this study was to determine whether poor function demonstrated in large islets was a result of diffusion barriers and if removing those barriers could improve function and transplantation outcomes. Islets were isolated from male DA rats and measured for cell viability, islet survival, glucose diffusion and insulin secretion. Modeling of diffusion barriers was completed using dynamic partial differential equations for a sphere. Core cell death occurred in 100% of the large islets (diameter > 150 μm), resulting in poor survival within 7 days after isolation. In contrast, small islets (diameter < 100 μm) exhibited good survival rates in culture (91%). Glucose diffusion into islets was tracked with 2-NBDG; 4.2 μm/min in small islets and 2.8 μm/min in large islets. 2-NBDG never permeated to the core cells of islets larger than 150μm diameter. Reducing the diffusion barrier in large islets improved their immediate and long-term viability in culture. However, reduction of the diffusion barrier in large islets failed to improve their inferior in vitro insulin secretion compared to small islets, and did not return glucose control to diabetic animals following transplantation. Thus, diffusion barriers lead to low viability and poor survival for large islets, but are not solely responsible for the inferior insulin secretion or poor transplantation outcomes of large versus small islets.
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    Low insulin content of large islet population is present in situ and in isolated islets
    (2011-01-01) Huang, Han-Hung; Novikova, Lesya; Williams, S. Janette; Smirnova, Irina V.; Stehno-Bittel, Lisa
    The existence of morphologically distinct populations of islets in the pancreas was described over 60 years ago. Unfortunately, little attention has been paid to possible functional differences between islet subpopulations until recently. We demonstrated that one population, the small islets, were superior to large islets in a number of functional aspects. However, that work did not determine whether these differences were inherent, or whether they arose because of the challenge of isolation procedures. Nor, were there data to explain the differences in insulin secretion. We utilized immunohistochemistry, immunofluorescence, ELISA, and transmission electron microscopy to compare the unique characteristics found in isolated rat islet populations in situ and after isolation. Insulin secretion of small isolated islets was significantly higher compared to large islets, which correlated with higher insulin content/area in small islets (in situ), a higher density of insulin secretory granules, and greater insulin content/volume in isolated islets. Specifically, the core b-cells of the large islets contained less insulin/cell with a lower insulin granule density than peripheral b-cells. When insulin secretion was normalized for total insulin content, large and small islets released the same percentage of total insulin. Small islets had a higher density of cells/area than large islets in vitro and in situ. The data provide a possible explanation for the inferior insulin secretion from large islets, as they have a lower total cell density and the b-cells of the core contain less insulin/cell.
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    Differences in insulin biosynthesis pathway between small and large islets do not correspond to insulin secretion
    (2016-02-16) Huang, Han-Hung; Stehno-Bittel, Lisa
    In a variety of mammalian species, small islets secrete more insulin per volume than large islets. This difference may be due to diffusional limitations of large islets, or inherent differences in the insulin production pathways. The purpose of this study was to identify possible differences in the early phase of glucose-stimulated insulin biosynthesis between large and small islets. Isolated small and large rat islets were challenged with 30 minutes of high glucose. The expression of insulin gene transcription factors (MafA, NeuroD/ Beta2, and PDX-1), preproinsulin mRNA, proinsulin and insulin were compared between large and small islets. Under basal (low glucose) conditions, MafA and NeuroD had higher mRNA levels and greater protein amounts in large islets compared to small when normalized to GAPDH levels. 30 minutes of high glucose stimulation failed to alter the mRNA or subsequent protein levels of either gene. However, 30 minutes of high glucose suppressed activated PDX-1 protein levels in both small and large islets. High glucose stimulation did not statistically alter the preproinsulin mRNA (insulin 1 and insulin 2) levels. At the translational level, high glucose increased the proinsulin levels, and large islets showed a higher proinsulin content per cell than small islets. Insulin content per cell was not significantly different between small and large islets under basal or high glucose levels. The results fail to explain the higher level of insulin secretion noted in small versus large islets and may suggest that possible differences lie downstream in the secretory pathway rather than insulin biosynthesis.
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    The Flaws and Future of Islet Volume Measurements
    (2018-06-28) Huang, Han-Hung; Harrington, Stephen; Stehno-Bittel, Lisa
    When working with isolated islet preparations, measuring the volume of tissue is not a trivial matter. Islets come in a large range of sizes and are often contaminated with exocrine tissue. Many factors complicate the procedure, and yet knowledge of the islet volume is essential for predicting the success of an islet transplant or comparing experimental groups in the laboratory. In 1990, Ricordi presented the islet equivalency (IEQ), defined as one IEQ equaling a single spherical islet of 150 μm in diameter. The method for estimating IEQ was developed by visualizing islets in a microscope, estimating their diameter in 50 μm categories and calculating a total volume for the preparation. Shortly after its introduction, the IEQ was adopted as the standard method for islet volume measurements. It has helped to advance research in the field by providing a useful tool improving the reproducibility of islet research and eventually the success of clinical islet transplants. However, the accuracy of the IEQ method has been questioned for years and many alternatives have been proposed, but none have been able to replace the widespread use of the IEQ. This article reviews the history of the IEQ, and discusses the benefits and failings of the measurement. A thorough evaluation of alternatives for estimating islet volume is provided along with the steps needed to uniformly move to an improved method of islet volume estimation. The lessons learned from islet researchers may serve as a guide for other fields of regenerative medicine as cell clusters become a more attractive therapeutic option.
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    Active Video Game Program for People with Type 2 Diabetes- a Pilot Study
    (2021-11-22) Huang, Han-Hung; Gathright, Brianna; Holik, Rachel; Iverson, Hannah; Saville, Emily; Curtis, Drew A.
    The objective of this study was to assess the effects of an active video game (AVG) program in physiological parameters, fitness levels, motivation to physical activity, and quality of life on people with type 2 diabetes (T2D). Eight T2D patients participated in the 8-week AVG program using Xbox Kinect and/or Nintendo Wii. Heart rate (HR) and rating of perceived exertion (RPE) were monitored during exercise. Physiological and fitness assessment included hemoglobin A1C (HbA1c), HR, blood pressure (BP), body mass index, body composition, aerobic and muscular endurance, muscular strength, and flexibility. Psychological outcome measures included the Physical Activity Measure-Revised (MPAM-R), Situational Motivation Scale (SIMS), and World Health Organization Quality of Life (WHOQOL)-BREF. Participants demonstrated a moderate level of exercise intensity during AVG based on average HR and RPE. HbA1c, BP, and lower extremity muscle strength were improved, but were not statistically significant. The changes on psychological assessment were not significant. However, most participants demonstrated positive behavior and attitudes toward health and physical activity at one-month follow-up. This pilot study demonstrated that the AVG program might be an effective and alternative way of exercise for people with T2D. A future RCT is warranted to determine the physical and psychological effects of AVG on T2D population.
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    Physical therapy prehabilitation on a reverse total shoulder replacement candidate: a case study
    (2020) Villers, James S.; Burch, Jacob; Scheller, Mark; Huang, Jan-Hung
    [Purpose] The purpose of this report is to describe the PT evaluation, prehab interventions, and outcomes of a patient pursuing reverse total shoulder replacement (rTSR) for pain reduction and functional gains. [Participant and Methods] A 62-year-old male self-referred to PT two months before his right rTSR. His chief complaints were right shoulder pain, stiffness, and functional impairment due to rotator cuff tendon tears and shoulder arthritis. He demonstrated poor posture, limited ROM, decreased strength, and diminished function. The PT prehab program consisted of an initial encounter followed by six treatment sessions across approximately one month. [Results] On the last visit, the patient’s pain had meaningfully decreased along with improved posture, AROM, and muscle strength producing a clinically significant improvement in function resulting in the postponing of his rTSR. On a three months follow-up, the patient had maintained or improved in his test and measures and functional outcomes. He expressed satisfaction with the prehab outcomes and that he had indefinitely postponed his rTSR. [Conclusion] PT prehab program improved pre-operative measures on pain, posture, joint mobility, muscle strength, and function on a patient who had been scheduled for rTSR surgery. PT prehab program may delay the need for rTSR surgery.
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    Effects of Motor-level Electrical Stimulations on Postprandial Glucose Levels in Non-Diabetic Young Individuals
    (2017) Huang, Han-Hung; Weise, Shelly D.; Ko, Man-Soo; Hansen, Trevor; Johnson, Annika; McCluskey, Charity
    Background and objectives: Motor-level electrical stimulation (MES) has been shown to improve glucose tolerance and glucose uptake in both animals and humans. Recently, MES has been shown to improve the blood glucose control in people with Type 2 Diabetes (T2D). There are several types of MES applied in physical therapy clinics. However, it is unknown what types of MES optimally decrease postprandial glucose level. The purpose of this study was to compare the effects of three different types of MES on postprandial glucose levels in healthy non-diabetic subjects. Methods: Twenty-eight subjects were randomly assigned to four groups: MES 1, MES 2, MES 3 and the control group. All subjects participated in an overnight fast of at least 8 hours and had their fasting blood glucose measured. Subjects were given a glucose supplement to drink within 10 minutes, rested in supine for 30 minutes then the second glucose level was measured. Subjects received a 30-minute MES treatment (except for the control group) followed by the third blood glucose level test. Subjects then rested an additional 30 minutes followed by obtaining the final blood glucose measurement. VO2 levels were monitored every 30 seconds, and heart rate was monitored every 3 minutes throughout the 90 minute study. Results: There were no significant differences between groups on glucose levels and heart rate throughout the study. The MES 2, Russian Current, demonstrated a statistically significant increase of 10% in VO2 toward the end of treatment. Conclusions: In this preliminary study, MES seems to have no effects on lowering postprandial glucose levels in healthy non-diabetic subjects. However, Russian Current may have a potential for optimally simulating physical activity. Future research is required with a more extended sampling method, a larger sample size, more intensive MES experimental protocols and a continuous glucose monitoring technique.
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    Patient Deception in Health Care: Physical Therapy Education, Beliefs, and Attitudes
    (2018-12-18) Curtis, Drew A.; Huang, Han-Hung; Nicks, Kendra L.
    A good professional-patient relationship is important to clinical practice, which may be compromised by deception. Deception research in physical therapy is scant. The current study investigated how the topic of patient deception is addressed in Doctor of Physical Therapy (DPT) educational curriculum, explore DPT students’ beliefs about deception and attitudes toward patient deception, and examine the effects of a pedagogical intervention on DPT students’ beliefs about deception and attitudes toward patient deception. The first objective was pursued by a descriptive survey sent to 217 DPT programs in the US. The second and third objectives were achieved by one-group pretest-posttest design provided to 17 DPT students before and after an educational workshop. Most DPT programs minimally include the topic of patient deception within their curriculum. DPT students held several inaccurate beliefs about the indicators of deception and negative attitudes toward patients who lied. After the educational intervention, students’ inaccurate beliefs were corrected and negative attitudes were reduced. Patient deception seems to be an under-addressed topic in current physical therapy education. An education workshop improved students’ beliefs about deception and attitudes toward to patient deception. Implications of deception research and theory in the applied practice of physical therapy are discussed.
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    Physical Therapy for Transverse Myelitis: A Case Report
    (2018-01-08) Buchanan, Allison; Wilkerson, Kelli J; Huang, Han-Hung
    Background and Purpose: Transverse myelitis (TM) is a rare neurological diagnosis found in 1-4 per million people. Rehabilitation is recommended secondary to steroid treatment. There is limited clinical research on physical therapy (PT) for TM. The purpose of this case report is to present PT examination and management strategies for a patient with TM. Case Description: A 25-year-old female patient diagnosed with TM was referred to PT. She presented foot drop causing ataxic gait, decreased sensation in bilateral lower extremities, significant fatigue, and low back pain. The patient required significant rest time between all tests and measures due to severely increased fatigue. PT plan of care was focused on therapeutic exercises per patient tolerance, passive range of motion (ROM) administered by the therapist, and gait training when activity tolerance was increased. Outcomes: The patient was able to tolerate bouts of exercise as prescribed through home exercise program. She responded very well to passive ROM treatment during breaks between exercises to maintain ROM and decrease rigidity. Active ROM exercise was used to build activity tolerance while being mindful of limited ability due to fatigue. Upon increased activity tolerance, the patient was able to tolerate gait training with multiple breaks and maintain corrected gait when addressed during treatment. Discussion: PT intervention was helpful for this patient with TM. Breaking down functional activities based on patient tolerance is important when treating people with TM. More experimental research is needed to support the benefits of PT for TM.
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    Exercise Increases Insulin Content and Basal Secretion in Pancreatic Islets in Type 1 Diabetic Mice
    (2011-09-11) Huang, Han-Hung; Farmer, Kevin; Windscheffel, Jill; Yost, Katie; Power, Mary; Wright, Douglas E.; Stehno-Bittel, Lisa
    Exercise appears to improve glycemic control for people with type 1 diabetes (T1D). However, the mechanism responsible for this improvement is unknown. We hypothesized that exercise has a direct effect on the insulin-producing islets. Eight-week-old mice were divided into four groups: sedentary diabetic, exercised diabetic, sedentary control, and exercised control. The exercised groups participated in voluntary wheel running for 6 weeks. When compared to the control groups, the islet density, islet diameter, and β-cell proportion per islet were significantly lower in both sedentary and exercised diabetic groups and these alterations were not improved with exercise. The total insulin content and insulin secretion were significantly lower in sedentary diabetics compared to controls. Exercise significantly improved insulin content and insulin secretion in islets in basal conditions. Thus, some improvements in exercise-induced glycemic control in T1D mice may be due to enhancement of insulin content and secretion in islets.
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    A West Texas County Food Insecurity Survey Findings
    (2020-10-08) Brown, Jay; Huang, Floyd; Brown, Ji'Lynda
    Despite living in the world’s largest food-producing nation, children and adults face poverty and hunger in every county across America. According to Feeding America [1], more than 38 million Americans are living in poverty. More than 37 million people struggle with hunger in this country, including more than 11 million children. 1 in every 9 Americans are food insecure. The situation is even worse in the state of Texas where 1 in every 7 Texans are food insecure. This makes Texas one of just 15 states with higher food insecurity than the national average [2]. In 2018, The Tom Green County Hunger Coalition (TGCHC) conducted a Food Access Survey (FAS) to help determine areas of need regarding food assistance in the city of San Angelo, Texas. The 328 respondents were divided into two groups (Food Secure and Food Insecure) based on their responses and compared. There were significant differences found between the two groups in regards to their age, household size, housing tenure, access, and assistance.
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    Exercise by playing active video gaming in overweight and obese children.
    (2017) Huang, Han-Hung; Cook, Landon; Harrison, Jessica; O'Keefe, Nicole; Schultz, Kelsey; Curtis, Drew A
    Background: Active video gaming (AVG) has been suggested as a way of combating sedentary lifestyle in children. The objective was to investigate the effects of exercise by playing AVG on fitness and motivation for physical activity in children with overweight or obesity. Methods: Fourteen children participated in an AVG program using Xbox Kinect and Nintendo Wii for one hour per session, two sessions per week for eight weeks. Three evaluations were performed at the beginning of the 1st, 9th and 16th sessions. The outcome measures include 1) physical fitness: vital signs, body mass index, body composition, muscular strength, muscular endurance, cardiovascular endurance and flexibility; 2) psychological assessments: Motives for Physical Activity Measure- Revised (MPAM-R) and Situational Motivational Scale (SIMS). In addition, real-time heart rates (HR) were monitored to assess exercise exertion throughout each session. Results: No statistically significant changes were found in each component of physical and psychological assessments. MPAM-R was shown to have a good internal consistency reliability (Cronbach’s alpha>0.8). Average and peak HR demonstrated the majority of subjects were able to achieve moderate or vigorous intensity of exercise during most AVG sessions. Conclusions: Eight-week AVG program was not sufficient to show changes in fitness or motivation for physical activity in overweight and obese children. However, AVG might be an alternative and engaging way to reach moderate or vigorous intensity of exercise for this population. Future research may focus on a larger sample size and more frequent and longer training program to determine if benefits of AVG exist for overweight and obese children.
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    Can a simulated hospital interprofessional experience between Allied Health and nursing students change self-efficacy beliefs?
    (2023) Lohman, Alicia F.; Flynn, Stacy; Aulbach, Rebecca; Brewer, Wayne
    The purpose of this study was to determine if participation in a hospital simulation experience could change the students’ self-efficacy to engage in interprofessional behaviors. This single-group pre-test and post-test design study utilized students from: Occupational Therapy, Physical Therapy, and Nursing programs. The student assumed their roles as health-care practitioners collaboratively in a simulated hospital IPE session (SHIPES) while they managed patients admitted to the hospital played by live actors. The student participants completed the Self-Efficacy for Interprofessional Experiential Learning (SEIEL) questionnaire that consists of a total score and two subscales scores (Interprofessional interaction and Interprofessional team evaluation and feedback) before and after the SHIPES. Results: significant (p<0.001) increase in the total and two subscales scores indicating an increased student self-efficacy to engage in interprofessional learning after participation in the SHIPES. Increased self-efficacy is a positive indicator of future behavior and could facilitate more interprofessional collaboration in clinical settings.
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    Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions
    (Frontiers, 2022) Alcon, Cory A.; Wang-Price, Sharon
    Chronic low back pain (CLBP) is among the leading causes of disability worldwide. Beyond the physical and functional limitations, people's beliefs, cognitions, and perceptions of their pain can negatively influence their prognosis. Altered cognitive and affective behaviors, such as pain catastrophizing and kinesiophobia, are correlated with changes in the brain and share a dynamic and bidirectional relationship. Similarly, in the presence of persistent pain, attentional control mechanisms, which serve to organize relevant task information are impaired. These deficits demonstrate that pain may be a predominant focus of attentional resources, leaving limited reserve for other cognitively demanding tasks. Cognitive dysfunction may limit one's capacity to evaluate, interpret, and revise the maladaptive thoughts and behaviors associated with catastrophizing and fear. As such, interventions targeting the brain and resultant behaviors are compelling. Pain neuroscience education (PNE), a cognitive intervention used to reconceptualize a person's pain experiences, has been shown to reduce the effects of pain catastrophizing and kinesiophobia. However, cognitive deficits associated with chronic pain may impact the efficacy of such interventions. Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in the treatment of anxiety, depression, and pain. In addition, as with the treatment of most physical and psychological diagnoses, an active multimodal approach is considered to be optimal. Therefore, combining the neuromodulatory effects of NIBS with a cognitive intervention such as PNE could be promising. This review highlights the cognitive-affective deficits associated with CLBP while focusing on current evidence for cognition-based therapies and NIBS.
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    Effectiveness of spinal stabilization exercises on dynamic balance in adults with chronic low back pain
    (North American Sportsmedicine Institute, 2023) Alshehre, Yousef; Alkhathami, Khalid; Brizzolara, Kelli; Weber, Mark; Wang-Price, Sharon
    Background: Dynamic balance is a vital aspect of everyday life. It is important to incorporate an exercise program that is useful for maintaining and improving balance in patients with chronic low back pain (CLBP). However, there is a lack of evidence supporting the effectiveness of spinal stabilization exercises (SSEs) on improving dynamic balance.
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    Effectiveness of spinal stabilization exercises on movement performance in adults with chronic low back pain
    (North American Sportsmedicine Institute, 2023) Alkhathami, Khalid; Alshehre, Yousef; Brizzolara, Kelli; Weber, Mark; Wang-Price, Sharon
    Introduction: Low back pain (LBP) is a musculoskeletal disorder that affects more than 80% of people in the United States at least once in their lifetime. LBP is one of the most common complaints prompting individuals to seek medical care. The purpose of this study was to determine the effects of spinal stabilization exercises (SSEs) on movement performance, pain intensity, and disability level in adults with chronic low back pain (CLBP).
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    Embedding play to enrich physical therapy
    (MDPI, 2023) Fiss, Alyssa LaForme; Håkstad, Ragnhild Barclay; Looper, Julia; Pereira, Silvana Alves; Sargent, Barbara; Silveira, Jessica; Willett, Sandra; Dusing, Stacey C.
    Play is an active process by which an individual is intrinsically motivated to explore the self, the environment, and/or interactions with another person. For infants and toddlers, engaging in play is essential to support development across multiple domains. Infants and toddlers with or at risk of motor delays may demonstrate differences in play or challenges with engaging in play activities compared to typically developing peers. Pediatric physical therapists often use play as a modality to engage children in therapeutic assessment and interventions. Careful consideration of the design and use of physical therapy that embeds play is needed. Following a 3-day consensus conference and review of the literature, we propose physical therapy that embeds play should consider three components; the child, the environment, and the family. First, engage the child by respecting the child’s behavioral state and following the child’s lead during play, respect the child’s autonomous play initiatives and engagements, use activities across developmental domains, and adapt to the individual child’s needs. Second, structure the environment including the toy selection to support using independent movements as a means to engage in play. Allow the child to initiate and sustain play activities. Third, engage families in play by respecting individual family cultures related to play, while also providing information on the value of play as a tool for learning. Partner with families to design an individualized physical therapy routine that scaffolds or advances play using newly emerging motor skills.
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    Evaluation of ergonomic dental stools through clinical simulation
    (Academy of General Dentistry, 2000) Parsell, Douglas E.; Weber, Mark D.; Anderson, B. Craig; Cobb Jr., George W.
    Work-related musculoskeletal pain occurs commonly within the dental community. Three stool designs were utilized in this study: a standard dental stool, a stool with dual arm supports, and a stool with dual arm supports and chest support. Electromyographic data from four muscle groups were collected on 13 clinicians during a simulated crown preparation procedure. Clinical simulation suggests that a potential musculoskeletal benefit to the clinician exists through utilization of dental stool designs which incorporate static arm supports.