An on-site physical therapy clinic at the University of Puget Sound, Tacoma, Wash, provides learning experiences for both patients and physical therapy students. One of the features of the clinic is an outdoor 4,000-square-foot mobility park with walkways, curbs, steps, and ramps that expose patients to real-life experiences. Because the mobility park exposes patients to realistic outdoor experiences, it does not provide as sterile an environment (carpets and vinyl) as the indoor clinic.
“I wanted a place where we could challenge patients,” says Roger Williams, PT, MPH, director of clinical education at the University of Puget Sound. “The park not only helps patients maintain as much function as possible, it also enables patients, who may otherwise not be able to, to receive treatment. The main benefit of the mobility park is that it is more realistic for patients and offers a safe environment in which to practice mobility skills.”
The clinic not only treats patients who learn skills to help them function in their day-to-day life despite their physical impairments, it also offers training for doctor of physical therapy students who learn clinical skills under the supervision of state-licensed therapists.
“Since we are a physical therapy clinic, we provide what is typically provided in any other physical therapy clinic,” says Williams. “We attempt to provide an area to examine, intervene, and adapt patients to any loss of function. Patients are assisted in overcoming their disabilities in a controlled environment that stimulates the home and the community.”
The clinic provides care in pediatrics, orthopedics, neurology, oncology, end-stage renal disease, and sports for individuals with multiple sclerosis, CVA, Parkinson’s disease, traumatic brain ingury, spinal cord injury, cerebral palsy, and complications from cancer. Because it is an outdoor clinic, weather challenges are always imminent.
“Rain, sun, wind, or snow does not hinder our outdoor clinic,” says Williams. “It only adds to a realistic environment in the Pacific Northwest.”
Rehabilitation Unaffected by Cognitive Impairment
Researchers from the Center for Cerebrovascular Diseases at Duke University School of Medicine in Durham, NC, report that stroke victims improve during rehabilitation at equal rates regardless of whether or not they are cognitively impaired.
The 72 subjects who participated in the trial were 65 years old. Within the group, 37% had a lacunar stroke, 58% had a partial anterior stroke, and 4% had a total anterior circulation stroke. Almost half of the patients had some level of cognitive impairment before starting rehabilitation. However, patients’ prestroke cognitive status was not known.
Investigators used the cognitive domain of the Folstein Mini-Mental Sate Evaluations (MMSE, cognition) and the impairments domain of the NIH-Stroke Scale (NIHSS, impairments) to assess the severity of overall stroke-related impairment and the severity of cognitive impairment. Assessments were made at the beginning and end of rehabilitation, and 90 days after rehabilitation ended. An MMSE of less than 24 indicated cognitive impairment.
The average baseline MMSE cognition score was 20.7. At discharge, it had risen to 22.9. At the 90-day follow-up, it was 23.3, which was not a statistically significant improvement over the discharge score.
Study: Cheerleading Injuries Are Substantial
A study published in the Journal of Orthopedic and Sports Physical Therapy by researchers in the Oklahoma State University (OSU) College of Education, Stillwater, Okla, has shown that as cheerleaders progress from the junior high level to the high-school and university levels, and as routines become more complex, acrobatic, and dangerous, injury risks increase.
“If you include cheerleading with women’s sports, at the college level, 68% of the catastrophic injuries were sustained by cheerleaders, and at the high-school level, 50% were sustained by cheerleaders,” says Bert Jacobson, professor of health and human performance at OSU. “Because cheerleading season extends for 12 months, small injuries become chronic injuries. They never get a chance to heal.”
In 1994, 16,000 emergency-department visits were reported in the United States resulting from injuries sustained by cheerleaders. By 2002, the number had increased to an estimated 23,000. Since the National Collegiate Athletic Association (NCAA) does not recognize cheerleading as a sport, rules and regulations set by the NCAA do not always apply to cheerleaders. Anyone can be a coach or sponsor, even without any training in gymnastics or tumbling.
Jacobson says that safety changes for cheerleaders will not occur unless parents take the lead and demand qualified coaches.
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