Reach the person behind the dementia: physical therapists' reflections and strategies when composing physical training

Dementia is a disease characterized by cognitive impairment and physical decline that worsens over time. Exercise is one lifestyle factor that has been identified as a potential means of reducing or delaying progression of the symptoms of dementia, maximizing function and independence. The purpose of this study was to explore physical therapists' (PTs) experiences and reflections on facilitating high-intensity functional exercise with older people living with dementia, in residential care home settings. The study used a qualitative design based on interviews, individually or in small groups, with seven PTs engaged as leaders in the training of older people with dementia. The interviews were analyzed with a modified Grounded Theory method with focus on constant comparisons. To increase trustworthiness the study used triangulation within investigators and member checking. The core category "Discover and act in the moment-learn over time" reflects how the PTs continuously developed their own learning in an iterative process. They built on previous knowledge to communicate with residents and staff and to tailor the high intensity training in relation to each individual at that time point. The category "Be on your toes" highlights how the PTs searched for sufficient information about each individual, before and during training, by eliciting the person's current status from staff and by interpreting the person's body language. The category "Build a bond with a palette of strategies" describes the importance of confirmation to build up trust and the use of group members and the room to create an interplay between exercise and social interaction. These findings highlight the continuous iterative process of building on existing knowledge, sharing and reflecting, being alert to any alterations needed for individuals that day, communication skills (both with residents and staff) and building a relationship and trust with residents in the effective delivery of high intensity functional exercise to older people living with dementia in care settings

A systematic review of musculoskeletal disorders among school teachers

<p>Abstract</p> <p>Background</p> <p>Musculoskeletal disorders (MSD) represent one of the most common and most expensive occupational health problems in both developed and developing countries. School teachers represent an occupational group among which there appears to be a high prevalence of MSD. Given that causes of MSD have been described as multi-factorial and prevalence rates vary between body sites and location of study, the objective of this systematic review was to investigate the prevalence and risk factors for MSD among teaching staff.</p> <p>Methods</p> <p>The study involved an extensive search of MEDLINE and EMBASE databases in 2011. All studies which reported on the prevalence and/or risk factors for MSD in the teaching profession were initially selected for inclusion. Reference lists of articles identified in the original search were then examined for additional publications. Of the 80 articles initially located, a final group of 33 met the inclusion criteria and were examined in detail.</p> <p>Results</p> <p>This review suggests that the prevalence of self-reported MSD among school teachers ranges between 39% and 95%. The most prevalent body sites appear to be the back, neck and upper limbs. Nursery school teachers appear to be more likely to report suffering from low back pain. Factors such as gender, age, length of employment and awkward posture have been associated with higher MSD prevalence rates.</p> <p>Conclusion</p> <p>Overall, this study suggests that school teachers are at a high risk of MSD. Further research, preferably longitudinal, is required to more thoroughly investigate the issue of MSD among teachers, with a greater emphasis on the possible wider use of ergonomic principles. This would represent a major step forward in the prevention of MSD among teachers, especially if easy to implement control measures could be recommended.</p

Drama as a pedagogical tool for practicing death notification-experiences from Swedish medical students

<p>Abstract</p> <p>Background</p> <p>One of the toughest tasks in any profession is the deliverance of death notification. Marathon Death is an exercise conducted during the fourth year of medical school in northern Sweden to prepare students for this responsibility. The exercise is designed to enable students to gain insight into the emotional and formal procedure of delivering death notifications. The exercise is inspired by Augusto Boal's work around Forum Theatre and is analyzed using video playback. The aim of the study was to explore reflections, attitudes and ideas toward training in delivering death notifications among medical students who participate in the Marathon Death exercise based on forum play.</p> <p>Methods</p> <p>After participation in the Marathon Death exercise, students completed semi-structured interviews. The transcribed interviews were analyzed using the principles of qualitative content analysis including a deductive content analysis approach with a structured matrix based on Bloom's taxonomy domains.</p> <p>Results</p> <p>The Marathon Death exercise was perceived as emotionally loaded, realistic and valuable for the future professional role as a physician. The deliverance of a death notification to the next of kin that a loved one has died was perceived as difficult. The exercise conjured emotions such as positive expectations and sheer anxiety. Students perceived participation in the exercise as an important learning experience, discovering that they had the capacity to manage such a difficult situation. The feedback from the video playback of the exercise and the feedback from fellow students and teachers enhanced the learning experience.</p> <p>Conclusions</p> <p>The exercise, Marathon Death, based on forum play with video playback is a useful pedagogical tool that enables students to practice delivering death notification. The ability to practice under realistic conditions contributes to reinforce students in preparation for their future professional role.</p

What Facilitates Return to Work? Patients Experiences 3 Years After Occupational Rehabilitation

Objective We have limited knowledge about the specific elements in an occupational rehabilitation programme that facilitate the process leading to return to work (RTW) as perceived by the patients. The aim of the study was to explore individual experiences regarding contributing factors to a successful RTW, 3 years after a resident occupational rehabilitation programme. Methods The study is based on interviews of 20 individuals who attended an occupational rehabilitation programme 3 years earlier. Ten informants had returned to work (RTW) and ten were receiving disability pension (DP). Data were analysed by systematic text condensation inspired by Giorgi’s phenomenological analysis. Results The core categories describing a successful RTW process included positive encounters, increased self-understanding and support from the surroundings. While the informants on DP emphasized being seen, heard and taken seriously by the professionals, the RTW group highlighted being challenged to increase self-understanding that promoted new acting in every-day life. Being challenged on self-understanding implied increased awareness of own identity, values and resources. Support from the surroundings included support from peer participants, employer and social welfare system. Conclusion Successful RTW processes seem to comprise positive encounters, opportunities for increased self-understanding and support from significant others. An explicit focus on topics like identity, own values and resources might improve the outcome of the rehabilitation process

Laboratory- and field-based testing as predictors of skating performance in competitive-level female ice hockey

Tommy Henriksson,1,2 Jason D Vescovi,3 Anncristine Fjellman-Wiklund,4 Kajsa Gilenstam1 1Sport Medicine Unit, Department of Community Medicine and Rehabilitation, 2The National Graduate School of Gender Studies, Ume&aring; University, Ume&aring;, Sweden; 3Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; 4Physiotherapy Unit, Department of Community Medicine and Rehabilitation, Ume&aring; University, Ume&aring;, Sweden Objectives: The purpose of this study was to examine whether field-based and/or laboratory-based assessments are valid tools for predicting key performance characteristics of skating in competitive-level female hockey players.Design: Cross-sectional study.Methods: Twenty-three female ice hockey players aged 15&ndash;25&nbsp;years (body mass: 66.1&plusmn;6.3&nbsp;kg; height: 169.5&plusmn;5.5&nbsp;cm), with 10.6&plusmn;3.2&nbsp;years playing experience volunteered to participate in the study. The field-based assessments included 20&nbsp;m sprint, squat jump, countermovement jump, 30-second repeated jump test, standing long jump, single-leg standing long jump, 20&nbsp;m shuttle run test, isometric leg pull, one-repetition maximum bench press, and one-repetition maximum squats. The laboratory-based assessments included body composition (dual energy X-ray absorptiometry), maximal aerobic power, and isokinetic strength (Biodex). The on-ice tests included agility cornering s-turn, cone agility skate, transition agility skate, and modified repeat skate sprint. Data were analyzed using stepwise multivariate linear regression analysis. Linear regression analysis was used to establish the relationship between key performance characteristics of skating and the predictor variables.Results: Regression models (adj R2) for the on-ice variables ranged from 0.244 to 0.663 for the field-based assessments and from 0.136 to 0.420 for the laboratory-based assessments. Single-leg tests were the strongest predictors for key performance characteristics of skating. Single leg standing long jump alone explained 57.1%, 38.1%, and 29.1% of the variance in skating time during transition agility skate, agility cornering s-turn, and modified repeat skate sprint, respectively. Isokinetic peak torque in the quadriceps at 90&deg; explained 42.0% and 32.2% of the variance in skating time during agility cornering s-turn and modified repeat skate sprint, respectively.Conclusion: Field-based assessments, particularly single-leg tests, are an adequate substitute to more expensive and time-consuming laboratory assessments if the purpose is to gain knowledge about key performance characteristics of skating. Keywords: exercise physiology, test methodology, sport, physiological characteristic

Playing-related Musculoskeletal Disorders and Stress-related Health Problems Among Percussionists

This cross-sectional study examined the prevalence of self-reported playing-related musculoskeletal disorders (PRMDs) and stress-related health problems among percussionists. Data for the present study were extracted from the University of North Texas Musician Health Survey (UNT-MHS) data set. Subjects (n = 279) were included if they identified auxiliary percussion (i.e., tambourine, triangle, bells, rattle, wood block), drum set, marimba, steel drum, timpani, vibraphone, xylophone, or other percussion as their primary instrument. Prevalence rates for PRMDs and stress-related health problems were determined for the total percussion group and for separate instrument categories. Of the total group, 77% reported one or more PRMDs. The keyboard percussionists (marimba, vibraphone, xylophone, and steel drum) reported the significantly highest prevalence (89%), followed by auxiliary and other percussionists (79%) and membranophone percussionists, including drum set and timpani (74%). The highest region-specific prevalence of PRMDs for the whole group was found in the bilateral hand and low back regions. Stress due to work environment was considered moderate to high by 75% of the respondents. Regarding stress-related health problems, percussionists reported primarily problems with fatigue, depression, and stage fright. The overall findings of this study show that PRMDs and stress-related health problems are a major concern for percussionists and warrant further research.</jats:p

THE RELATIVE AGE EFFECT IN WOMEN’S ICE HOCKEY: INTERNATIONAL AND POSITIONAL COMPARISONS

A relative age effect (RAE), or chronological age differences among individuals within the same age group, has been observed in 14 sports (Cobley et al., 2009), including men’s ice hockey (Barnsley et al., 1985). In contrast, research on RAE in women’s ice hockey is limited (Wattie et al., 2007; Weir et al., 2010) and findings are equivocal. PURPOSE: To determine whether there is a RAE in women’s ice hockey, and if it varies by country or player position. METHODS: Participants were 117 female ice hockey players (age=19.9±2.3 yr) on 2 Swedish elite-level club teams (n=54) and 4 Canadian university teams (n=63). Players reported birthdate and position (Forward=F, Defenseman=D, Goalie=G). Birthdates were coded by quartiles (Q1: Jan.-March, Q2: April-June, Q3: July-Sept., Q4: Oct.-Dec.) and by half-year, and were submitted to chi-square (x2) analyses for the sample, by country, and by position. SPSS 17.0 for Windows was used for all analyses (significance level: p\u3c0.05). RESULTS: A significant RAE was observed for the entire sample by quartile (Q1: 28.2%, Q2: 34.2%, Q3: 25.6%, Q4: 12.0%; x2=12.402, p=0.006). More players were born in the first half of the year than the second (62.4% vs. 37.6%, respectively; x2=7.188, p=0.007). In contrast, Q4 was underrepresented for the sample and by country (Canada: 12.7%, Sweden: 11.1%). A RAE was present for the Canadian players by quartile (x2: 13.381, p=0.004) and half-year (x2: 9.921, p=0.002); however, no RAE was observed for Swedish players. In addition, a significant RAE was observed for the entire sample by position for G and D by quartiles (G - x2: 10.077, p=0.018; D - x2: 8.444, p=0.038) and half year (G - x2: 6.231, p=0.013; D - x2: 4.000, p=0.046), but not for F. CONCLUSIONS: The significant RAE in this sample is consistent with that in men’s ice hockey. RAE absence in Swedish players may reflect lower participant number, competitive level, and sociocultural support, as well as greater variation in skill level. The significant RAE observed in Canadian players and by position supports the findings of Weir et al. (2010), but the positional differences found were inconsistent, perhaps due to differences in sample size and competitive level between studies