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Permanent Physiatry Job in Ontario County, New York New York with Enterprise Medical Service

Excellent new PMR opportunity is available in New York located 45 miles of Rochester. Outpatient opportunity with NO CALL. Work Monday - Friday, 8a - 5p. Salary is $230,000 plus full benefits. This

Permanent Physiatry Job in 70 Miles to Myrtle Beach, SC South Carolina with Enterprise Medical Service

Excellent Physical Medicine & Rehabilitation opportunity is available in South Carolina, located within 70 miles of Myrtle Beach. PMR physician looking for some to join his busy practice. Will consider

Permanent Physiatry Job in Northern Alabama Alabama with Enterprise Medical Service

PMR/Pain Management opportunity is now available in Alabama. Physician will be joining a well-established orthopedic group. Must be trained in clinical blocks and Pain Management located in Alabama.

Permanent Physiatry Job in Beautiful Coast Community South Carolina with Enterprise Medical Service

Excellent new PMR opportunity, mostly an outpatient, office based opportunity is available in South Carolina. Employed position offering full benefits and incentives. Beautiful community on the beach.

Permanent Physiatry Job in PMR-Director Position in St. Louis, MO Missouri with Enterprise Medical Service

PMR/Medical Director opportunity is available in St. Louis! Inpatient Rehabilitation, very little outpatient work. New physician will be joining 2 other PMR physicians in 35-bed inpatient unit, beautiful

Permanent Physiatry Job in East Central Indiana Location Indiana with Enterprise Medical Service

Excellent New PMR opportunity available in East Central Indiana. Physiatrist will be joining two Orthopedic Surgeons in a new medical office building affiliated with a 233-bed hospital. Salary is based

Permanent Physiatry Job in Close proximity to Tucson Arizona with Enterprise Medical Service

Excellent PMR opportunity is available in sunny Arizona in a location close to Tucson. PMR provider will join a group which is owned by the hospital. This new position will also involve a Medical Directorship

Permanent Physiatry Job in Outstanding Opportunity in Southern Illinois for P Illinois with Enterprise Medical Service

Outstanding PMR opportunities are available in Southern Illinois. Need for general PMR physician and an Interventional Pain Fellowship trained physician. Very active and successful practice!! Inpatient/Outpatient

Permanent Physiatry Job in Outstanding Opportunity in Southern Illinois Illinois with Enterprise Medical Service

Permanent Physiatry Job in Chicagoland Area Illinois with Enterprise Medical Service

Excellent Physical Medicine & Rehabilitation opportunity is available in the Chicago area! This will be an inpatient/outpatient practice setting. Group will be offering a generous income package with

Permanent Physiatry Job in Northeast Kentucky - Near West Virginia Kentucky with Enterprise Medical Service

Inpatient and Outpatient Physical Medicine & Rehabilitation opportunities are now available in Kentucky. For the Inpatient practice, would prefer someone with background in Stroke. For the Outpatient

Permanent Physiatry Job in North Central Location Indiana with Enterprise Medical Service

Excellent physical medicine and rehab opportunity is now available in Indiana, near South Bend. This practice is 90% outpatient and 10% inpatient work. Full benefits and loan forgiveness repayment are

Permanent Physiatry Job in West Coast of Michigan Michigan with Enterprise Medical Service

Excellent PMR opportunity located in a beautiful lakeside community in Michigan. Group practice is busy with many referrals. Will also consider a Pain Fellow. Guarantee Income and full benefits included.

Permanent Physiatry Job in 1 Hour to Chicago Indiana with Enterprise Medical Service

Excellent Physical Medicine and Rehabilitation position is how available in Indiana, only 100 miles from Chicago. This practice opportunity will mainly focus on LTAC, AIRF, and SNF/ECF patients. Outstanding

Permanent Physiatry Job in Gulfport, MS area opportunity Mississippi with Enterprise Medical Service

Join an established hospital based Physical Medicine & Rehabilitation practice. No ER call. Will only take call in practice patients which is 1:4. MGMA based salary with an RVU bonus structure. Contact:

Permanent Physiatry Job in West Tennessee Tennessee with Enterprise Medical Service

Join a Single Specialty group practicing traditional General PMR. Current Director of Rehabilitation plans to add new physician due to vacancy within practice. Workload consists of largely outpatient

Permanent Physiatry Job in Pain fellow needed in West Tennessee Tennessee with Enterprise Medical Service

Need fellowship trained physician to join with an Outpatient Orthopedic Clinic. There are 5 ORS in this group. All military trained physians except for one. Very busy practice with numerous referrals.

Permanent Physiatry Job in Upper Peninsula of Michigan Michigan with Enterprise Medical Service

Join this Single Specialty Group of 3 physicians due to growth in the area. Ideal candidate has interest in Pain Management. Group is offering salary based on MGMA guidelines and full benefits package.

Permanent Physiatry Job in 15 miles from Detroit Michigan with Enterprise Medical Service

Join a small multi-specialty group of 10 that includes two Physical Medicine & Rehabilitation providers, seven Neurologists and one Neurology Psychiatrist. Salary offered is competitive and based on

Permanent Physiatry Job in middletown New York with New England Physician Recruitment Center

PMR to join oneinterested in Pain. TOP Salaries and Incentives- New Yorks finest group e top money-interviewing early We are looking for PMR to join oneinterested in Pain. Would you have an interest

Electro-acupuncture versus sham electro-acupuncture for auditory hallucinations in patients with schizophrenia: a randomized controlled trial

Objective: To compare the efficacy of electro-acupuncture with that of sham electro-acupuncture for auditory hallucinations in patients with schizophrenia partially responsive or non-responsive to risperidone.Design: Patient- and assessor-blinded randomized controlled trial.Setting: Hospital-based practice.Participants: Schizophrenia patients with auditory hallucinations who are partially responsive or non-responsive to risperidone monotherapy (n = 60).Interventions: All patients were randomly allocated to a real electro-acupuncture group or a sham electro-acupuncture group and treated for 30 sessions within six weeks.Main outcome measures: The primary outcome measure was the Psychotic Symptom Rating Scales Auditory Hallucination Subscale. Secondary outcomes included the Positive and Negative Syndrome Scale and side-effects. A clinical response was defined as >20% reduction score (from baseline) on the total score of the Psychotic Symptom Rating Scales Auditory Hallucination Subscale.Results: Sixty patients were selected for randomized real electro-acupuncture treatment (n = 30) or sham electro-acupuncture treatment (n = 30). Patients in the real electro-acupuncture group experienced greater improvement in the Psychotic Symptom Rating Scales Auditory Hallucination Subscale total score, physical characteristics factor score and the Positive and Negative Syndrome Scale positive symptom score than the sham electro-acupuncture group at both week 4 and week 6. The clinical response rates in the real electro-acupuncture group and sham electro-acupuncture group were 43.3% (n = 30) and 13.3% (n = 30), respectively (2 = 6.648, P =0.027). There was no significance between-group difference in side-effects.Conclusion: Electro-acupuncture might provide improvement in auditory hallucinations and positive symptom for patients with schizophrenia partially responsive or non-responsive to risperidone monotherapy.

Exercise intervention in brain injury: a pilot randomized study of Tai Chi Qigong

Objective: To examine the effects of a brief Tai Chi Chuan Qigong (`Qigong') exercise intervention on individuals with traumatic brain injury.Design: A single-centre randomized controlled trial pilot study.Setting: A registered charity day centre in the community.Subjects: Twenty individuals with traumatic brain injury.Intervention: Intervention participants attended a Qigong exercise session for one hour per week over eight weeks. Control participants engaged in non-exercise-based social and leisure activities for the same intervention period.Measures: Outcome was assessed at baseline and post intervention using the General Health Questionnaire-12, the Physical Self-Description Questionnaire and the Social Support for Exercise Habits Scale, to measure perceived mood, self-esteem, flexibility, coordination, physical activity and social support.Results: Groups were comparable at baseline. After the intervention, mood was improved in the exercise group when compared with controls (U = 22.0, P =0.02). Improvements in self-esteem (Z = 2.397, P =0.01) and mood (Z = —2.032, P =0.04) across the study period were also evident in the exercise group only. There were no significant differences in physical functioning between groups. In view of the sample size, these findings are inconclusive.Conclusions: This study provides preliminary evidence that a brief Qigong exercise intervention programme may improve mood and self-esteem for individuals with traumatic brain injury. This needs to be tested in a large-scale randomized trial.

Self- and manual mobilization improves spine mobility in men with ankylosing spondylitis -- a randomized study

Aims: To evaluate effects of physiotherapeutic intervention in terms of self- and manual mobilization on chest expansion, vital capacity, posture, spine mobility and experienced consequences of the disease in patients with ankylosing spondylitis.Design: A prospective, randomized controlled study.Methods: Thirty-two men, aged between 23 and 60 years, with ankylosing spondylitis were randomized to active or no treatment for eight weeks. Physiotherapeutic intervention included individualized self- and manual mobilization for 1 hour twice a week and individually adjusted home exercises. Two blinded investigators made the assessments of chest expansion, posture and spinal mobility before and after the treatment period. The patient filled in three and the physiotherapist one of the four Bath Ankylosing Spondylitis scales (BAS scales).Results: In the treatment group chest expansion increased at the level of processus xiphoideus (P<0.01), with no difference in vital capacity compared with the control group. The posture improved in the cervical (C7—wall distance) (P<0.001) and in the thoracic spine (P<0.05). Thoracic and lumbar spine flexion improved (P<0.01) as did sagittal range of motion P<0.001 and P<0.01, respectively. The Bath Ankylosing Spondylitis Metrology Index total scoring improved (P<0.001) in the treatment group compared with the control group. The other three BAS scales showed no differences between groups. At four months follow-up of the treatment group, cervical spine posture, lumbar flexion and range of motion as well as BAS Metrology Index were still improved.Conclusion: This study shows that eight weeks of self- and manual mobilization treatment improved chest expansion, posture and spine mobility in patients with ankylosing spondylitis.

Effects of balance training on gait parameters in patients with chronic ankle instability: a randomized controlled trial

Objective: To examine the effects of a four-week balance training programme on ankle kinematics during walking and jogging in those with chronic ankle instability. A secondary objective was to evaluate the effect of balance training on the mechanical properties of the lateral ligaments in those with chronic ankle instability. Design: Randomized controlled trial.Setting: Laboratory.Subjects/patients: Twenty-nine participants (12 males, 17 females) with self-reported chronic ankle instability were randomly assigned to a balance training group or a control group.Intervention: Four weeks of supervised rehabilitation that emphasized dynamic balance stabilization in single-limb stance. The control group received no intervention.Main outcome measures: Kinematic measures of rearfoot inversion/eversion, shank rotation, and the coupling relationship between these two segments throughout the gait cycle during walking and jogging on a treadmill. Instrumented ankle arthrometer measures were taken to assess anterior drawer and inversion talar tilt laxity and stiffness.Results: No significant alterations in the inversion/eversion or shank rotation kinematics were found during walking and jogging after balance training. There was, however, a significant decrease in the shank/rearfoot coupling variability during walking as measured by deviation phase after balance training (balance training posttest: 13.1°± 6.2°, balance training pretest: 16.2° ± 3.3°, P = 0.03), indicating improved shank/rearfoot coupling stability. The control group did not significantly change. (posttest: 16.30° ± 4.4°, pretest: 18.6° ± 7.1°, P40.05) There were no significant changes in laxity measures for either group.Conclusions: Balance training significantly altered the relationship between shank rotation and rearfoot inversion/eversion in those with chronic ankle instability.

Early loading in physiotherapy treatment after full-thickness rotator cuff repair: a prospective randomized pilot-study with a two-year follow-up

Objective: To describe the clinical changes following two different physiotherapy treatment protocols after rotator cuff repair.Design: A prospective, randomized pilot study with a two-year follow-up.Subjects: Five women and nine men, 55 (40—64) years old, were included.Intervention: The progressive group (n = 7) started with dynamic, specific muscle activation of the rotator cuff the day after surgery as well as passive range of motion. After four weeks of immobilization the loading to the rotator cuff increased and in a progressive manner throughout the rehabilitation. In the traditional group (n = 7) the rotator cuff was protected from loading. Patients were immobilized for six weeks and started with passive range of motion the day after surgery. No specific exercises to the rotator cuff were introduced during this period.Main measures: A clinical evaluation was made preoperatively, 3, 6, 12 and 24 months after surgery. Pain rating during activity and at rest, patient satisfaction, active range of motion and muscle strength, Constant score, hand in neck, hand in back and pour out of a pot, as well as Functional Index of the Shoulder were used.Results: At two years follow-up, the progressive group and traditional group scored pain during activity visual analogue scale (VAS) 2/0 mm and pain at rest 0/0 mm, respectively. The groups attained 170/175° in active abduction in standing and 70/90° in passive external rotation while lying in supine. Using Constant score, the groups attained 82/77 points respectively.Conclusion: The present study showed that the progressive protocol produced no adverse effects compared with the traditional protocol.

Clinical examination tools for lateropulsion or pusher syndrome following stroke: a systematic review of the literature

Objective: To examine the clinimetric properties and clinical applicability of published tools for `quantifying' the degree of lateropulsion or pusher syndrome following stroke.Data sources: Search through electronic databases (MEDLINE, EMBASE, CINAHL, Science Citation Index) with the terms lateropulsion, pushing, pusher syndrome, validity, reliability, internal consistency, responsiveness, sensitivity, specificity, posture and stroke. Databases were searched from their inception to October 2008.Review methods: Abstracts were selected by one author. A panel of experts then determined which should be included in this review. Five abstracts were reviewed and the panel agreed to omit one abstract because those authors did not write a full manuscript. The panel critiqued manuscripts according to predetermined criteria about clinical and clinimetric properties.Results: Four manuscripts referencing three tools for examining lateropulsion were found. Validity and reliability data support the clinical use of the Scale for Contraversive Pushing, the Modified Scale for Contraversive Pushing and the Burke Lateropulsion Scale. The Scale for Contraversive Pushing has the most extensive testing of clinimetric properties. The other tools show promising preliminary evidence of clinical and research utility. More testing is needed with larger, more diverse samples.Reviewers' conclusions: The Scale for Contraversive Pushing, the Modified Scale for Contraversive Pushing and the Burke Lateropulsion Scale are reliable and valid measures with good clinical applicability. Larger, more varied samples should be used to better delineate responsiveness and other clinimetric properties of these examination tools.

Spasticity, an impairment that is poorly defined and poorly measured

Objective: To explore, following a literature review, whether there is a consistent definition and a unified assessment framework for the term `spasticity'. The congruence between the definitions of spasticity and the corresponding methods of measurement were also explored.Data sources: The search was performed on the electronic databases Web of Science, Science Direct and MEDLINE.Review methods: A systematic literature search of publications written in English between the years 1980 and 2006 was performed with the following keywords: spasticity and tone. The search was limited to the following keywords: stroke, hemiplegia, upper, hand and arm.Results: Two hundred and fifty references contributed to this review (190 clinical trials, 46 literature reviews, and 14 case reports). Seventy-eight used the Lance definition; 88 equated spasticity with increased muscle tone; 78 provided no definition; and six others used their own definitions for spasticity. Most papers used a single measure and some used more than one. Forty-seven papers used neurophysiological methods of testing, 228 used biomechanical methods of measurement or assessment, 25 used miscellaneous clinical measures (e.g. spasm frequency scales) and 19 did not explicitly describe a measure.Conclusion: The term spasticity is inconsistently defined and this inconsistency will need to be resolved. Often, the measures used did not correspond to the clinical features of spasticity that were defined within a paper (i.e. internal validity was compromised). There is need to ensure that this lack of congruence is addressed in future research.

Gait adjustments in obstacle crossing, gait initiation and gait termination after a recent lower limb amputation

Objective: To describe the adjustments in gait characteristics of obstacle crossing, gait initiation and gait termination that occur in subjects with a recent lower limb amputation during the rehabilitation process.Design: Prospective and descriptive study.Subjects: Fourteen subjects with a recent transfemoral, knee disarticulation or transtibial amputation.Methods: Subjects stepped over an obstacle and initiated and terminated gait at four different times during the rehabilitation process.Outcome measures: Success rate, gait velocity and lower limb joint angles in obstacle crossing, centre of pressure shift and peak anteroposterior ground reaction force in gait initiation and termination.Results: In obstacle crossing amputees increased success rate, gait velocity and swing knee flexion of the prosthetic limb. Knee flexion in transfemoral and knee disarticulation amputees was not sufficient for safe obstacle crossing, which resulted in a circumduction strategy. In gait initiation and termination amputees increased the anteroposterior ground reaction force and the centre of pressure shift in the mediolateral direction in both tasks. Throughout the rehabilitation process the centre of pressure was shifted anteriorly before single-limb stance on the trailing prosthetic limb in gait initiation, whereas in gait termination the centre of pressure in single-limb stance remained posterior when leading with the prosthetic limb.Conclusion: Subjects with a recent amputation develop adjustment strategies to improve obstacle crossing, gait initiation and gait termination. Innovations in prosthetic design or training methods may ease the learning process of these tasks.

Using a partnership between academic faculty and a physical therapist liaison to develop a framework for an evidence-based journal club: a discussion

Evidence-based practice (EBP) in rehabilitation is increasingly recognized as important. Despite the importance of EBP, physical therapists' knowledge of EBP varies. Journal clubs have been used to educate clinicians about EBP. This discussion paper describes the partnership between academic faculty members and a physical therapist at a community hospital, and the process used to develop a framework to implement an evidence-based journal club. The partnership blended the expertise of academic faculty members and a physical therapist with knowledge of EBP who served as the liaison between members of the partnership team and the clinicians at the community hospital. The three-step framework developed enabled the clinicians to learn about critical appraisal, participate in guided practice of critical appraisal with the liaison, and lead critical appraisal of a paper with the assistance of the liaison as needed. This process could be easily replicated by other partnerships between academic faculty members and clinicians. Developing partnerships like the one described enables academicians to provide service to the profession, may enhance physical therapists' knowledge of the principles of EBP and may encourage EBP. Copyright © 2009 John Wiley & Sons, Ltd.

Reproducibility and validity of digital inclinometry for measuring cervical range of motion in normal subjects

Background and Purpose. Measurements of cervical range of motion (CROM) have been extensively reported in the past decade employing simple (goniometers) as well as sophisticated (electro-, magneto- and ultrasonography-based) systems. The recent introduction of the simple, user-friendly and relatively cheap digital inclinometer (DI) has opened a potentially new venue for measurement of this segment's motion. The purpose of the present study was to assess intra-tester reproducibility of DI-based findings as well as its validity in comparison to the ultrasonography-based Zebris CMS 70P (Zebris Medizintechnik GmbhTM, Isny, Germany) for measuring CROM in normal subjects. Methods. Active CROM of healthy women (n = 15) and men (n = 15) aged 24.2(2.4) years was measured on two sessions, Test 1 and Test 2, spread over 7.2(±0.7) days apart. On Test 1, the six primary movements of the neck (flexion, F; extension, E; right and left lateral flexion, RLF and LLF; and right and left rotations, RR and LR) were measured using the DI and the Zebris. On Test 2, the same measurements were performed using the DI only. All measurements were conducted by the same tester, with the subject in the seated position. The only exception was DI measurement of cervical rotation that was performed in the supine position due to the DI gravity-dependence, rendering DI measurements in the transverse plane irrelevant. Results. No significant differences were revealed between the two instruments with respect to the sagittal and frontal planes, whereas the DI-based CROM in rotation was significantly greater then its Zebris-based counterpart. The inter-device interclass correlation coefficients (ICCs) for the frontal were 0.72 (RLF) and 0.62 (LLF), and 0.77 (F) and 0.83 (E). Poor correlations were indicated for the rotations. The intra-tester reproducibility derived from the test-retest DI measurement indicated good to excellent reproducibility in all planes with ICCs ranging from 0.82 (LLF) to 0.94 (E). The Standard Error of Measurement ranged from 1.6° (RR) to 2.6° (F). Conclusion. DI-based CROM measurements are reproducible and valid for recording sagittal and frontal plane motions in healthy subjects. The higher range in rotations, relative to the Zebris-based findings, is most probably attributable to the test position. Being relatively cheap, portable and convenient for tester and subject alike, the DI seems to be an effective instrument for assessing CROM. Copyright © 2009 John Wiley & Sons, Ltd.

Quality of life issues following surgery for vulval cancer: a case report

Background and Purpose. Surgical intervention for vulvar cancer and vulvar intraepithelial neoplasia causes mutilation of the genital area and can impose significant bladder, bowel and sexual dysfunction. This case report outlines how conservative interventions such as pelvic floor muscle training (PFMT) may reduce the long-term morbidities of such dysfunction. Method. The patient underwent 16 weeks of PFMT in conjunction with advice on fluid intake and bladder training. Results. An increase in pelvic floor muscle strength and endurance were recorded. Improved bladder control as demonstrated by a reduction in frequency of voiding (from 15 to 7 per 24 hours), and number of pads used (from 6 to 3 per 24 hours) was evident. The impact of urinary incontinence on everyday life was much less at the end of the treatment period as measured by the Incontinence Impact Questionnaire with a change in score from 21 (maximum impact) to 10. Conclusions. These positive results indicate that further research is needed to investigate the effect of PFMT on bladder function following such surgery. Copyright © 2009 John Wiley & Sons, Ltd.

Complementary and alternative medicine inclusion in physical therapist education in the United States

Purpose. The purpose of this study was to determine the current prevalence, and at what level, complementary and alternative medicine (CAM) content is included in physical therapist (PT) education in the United States. This survey study provides self-report data regarding reasons why faculty members choose to include or not include CAM into programme content. Background/Significance. This study investigates the current prevalence of CAM content, and what level of inclusion (minimal, moderate, advanced) in PT curricula will assist programmes as they modify existing curricula and develop new programmes. Subjects. All 196 US-accredited programmes were included in our survey. Materials and Methods. An IRB-approved (Investigational Review Board), pilot-tested, two-page survey was emailed to all programme chairpersons of accredited PT programmes. A hard copy survey was mailed to non-responding programmes. Analyses. Returned surveys were analyzed descriptively to characterize the data shape, tendency and variability. Data were summarized in a frequency distribution and graphically depicted in a histogram for each category. In addition, qualitative analysis was completed for the explanatory data. Results. Forty-seven per cent (92) of all accredited PT programmes (196) responded. Most commonly included CAM areas were: manipulative and body-based methods, alternative medical systems and biologically based therapies. Most frequent responses to limitations to including CAM in PT curriculum were: limited curriculum time, lack of evidence supporting CAM practices and trouble locating qualified CAM presenters. Conclusions. This survey suggests the following: CAM techniques are included in entry-level PT education in the United States; the majority of these techniques are offered at the minimum or exposure level; manipulative and body-based methods, alternative medical systems and biologically based therapies are the most frequently included CAM techniques. Copyright © 2009 John Wiley & Sons, Ltd.

Prevalence, risk factors and preventive strategies in work-related musculoskeletal disorders among Israeli physical therapists

Background and Purpose. Although physical therapists (PTs) have extensive knowledge of body mechanisms and injury prevention, work-related musculoskeletal disorders (WRMD) are quite common in this population. The purposes of this study were: to determine the prevalence and impact of WRMD among Israeli PTs; to investigate WRMD risk factors and to identify preventive strategies used by PTs; and to compare the risk of injuries in two professional settings: rehabilitation centres (RCs) and outpatient clinics (OPCs). Method. A validated, modified Cromie questionnaire, translated into Hebrew, was distributed to the PTs at their workplaces. The relationship between WRMD symptoms and professional settings was analysed by Pearson chi-square. The risk models were developed by logistic regression. One hundred and twelve PTs working in OPCs and RCs who defined themselves as healthy individuals were the subjects of this study. Results. Lifetime prevalence of WRMD was 83%. The highest prevalence of WRMD was in the lower back area (80%). Rehabilitation treatment was associated with an increased risk of lower back (odds ratio [OR] = 1.05) and shoulder symptoms (OR = 1.04); manual treatment was associated with an increased risk of wrist/thumb symptoms (OR = 1.11). Discussion. Work in RCs was associated with an increased prevalence of lower back/shoulder symptoms, whereas work in OPCs was associated with an increased prevalence of thumb/wrist symptoms. PT's used different strategies to reduce risk of WRMD, including altering practice technique. The respondents recommended administrative and ergonomic changes in the workplace. Conclusion. Workplace-specific interventions to reduce WRMD in PTs should be developed and tested in future studies. Copyright © 2009 John Wiley & Sons, Ltd.

TENS and FES for sensory impairment and gait dysfunction following removal of spinal cord ependymoma - a case report

Background. Sensory deficits are commonly reported following the resection of spinal cord tumours. The use of transcutaneous electrical nerve stimulation (TENS) as augmented sensory input is described in the research literature but rarely in the clinical literature. Functional electrical stimulation (FES) is used for people with motor impairments rather than sensory impairments. Method and results. This case report describes the use of TENS and FES for a patient with severe sensory loss and mild weakness in the right leg following the removal of an intramedullary spinal cord tumour. The patient was able to walk more quickly and more confidently when using TENS and FES in combination. She consistently reported greater benefits from TENS alone compared to FES alone and continued to use TENS delivered via a sock electrode at six months after surgery. Conclusion. The use of TENS as a sensory stimulus was an invaluable component of this patient's treatment, allowing her to engage in a more challenging balance and gait programme at an earlier stage in her rehabilitation. Combining FES with TENS was also useful and allowed treatment to address motor and sensory impairments concurrently during functional activity. Copyright © 2009 John Wiley & Sons, Ltd.

The perceptions of Athenian physiotherapists on the referral service in Greece and its impact on professional autonomy

Background and Purpose. The attainment of professional autonomy is considered a priority of any profession. The development of autonomy in physiotherapy has differed among countries, with some achieving a high degree of autonomy while others have struggled. The current literature reveals little about the autonomy of physiotherapists in Greece, although it would appear they face both external and internal threats to autonomous practice and to the development of their profession. This exploratory study investigated Athenian physiotherapists' experiences of the referral system in Greece and its impact on professional autonomy. Methods. A qualitative, phenomenological approach was chosen, using a cluster sampling method. Ten physiotherapists participated in a 30-minute, one-to-one, semi-structured interview. The interview audio tapes were transcribed and an inductive analysis was carried out. When all transcripts had been coded, categories and themes were compared to record commonalities and differences to construct a hierarchy of essential themes expressing general views. Results. Physiotherapists were frustrated by the physiotherapy referral system in Greece. They revealed that their practice was restricted by factors, which included a long-standing dominance by the medical profession, bureaucratic process and the public perception of the profession in addition to restrictions from within the profession itself. To overcome the perceived restrictions to practice and the development of autonomy, participants had adopted strategies in an attempt to effectively address the patients' needs. Conclusions. There are clear issues related to the management and delivery of the physiotherapy referral system in Greece which impact on professional autonomy. Physiotherapists are forced to manipulate the referral system to provide a more appropriate level of care, resulting, however, in an inequitable service across the physiotherapy provision. If professional autonomy of physiotherapists in Greece is to move forward, these issues need to be acknowledged by governmental and professional bodies, as therapists can not be expected to undertake this journey alone. Copyright © 2009 John Wiley & Sons, Ltd.

A prospective qualitative exploration of views about attending pulmonary rehabilitation

Background and Purpose. Pulmonary rehabilitation has been found to be an effective strategy for managing chronic obstructive pulmonary disease (COPD). However, attendance at such programmes is not optimal, therefore, this study aimed to develop an in-depth understanding of views regarding attendance at pulmonary rehabilitation and experiences which may have shaped these views. Methods. An inductive qualitative study was carried out within the framework of Interpretative Phenomenological Analysis. Five female and four male individuals with COPD who had been referred for pulmonary rehabilitation participated in semi-structured interviews. Interviews were conducted prior to participation in pulmonary rehabilitation. Results. Three main themes were identified that related to views about attending pulmonary rehabilitation. The first is entitled 'Desired benefits of attending pulmonary rehabilitation', which described realistic hopes about impact on daily life. The second theme was called 'Evaluating the threat of exercise', and it encompassed both positive and negative evaluations; some interviewees described fear and avoidance of exercise, while others were determined to overcome symptoms. These attitudes extended to views about pulmonary rehabilitation. The third theme was called 'Attributing value to pulmonary rehabilitation'. Contrasting opinions about the value of attending pulmonary rehabilitation appeared to be influenced by the nature of prior interactions with health personnel and systems as well as information about the programme provided at referral. The referrer's attitude towards pulmonary rehabilitation appeared to be particularly influential. Conclusion. In summary, when considering rehabilitation attendance, potential participants are able to identify possible benefits, but previous experiences of symptoms and attitudes towards their condition can influence views both positively and negatively. Information and enthusiasm conveyed by the referring clinician, as well as previous interactions with health professionals can have powerful impact on views about attending. Referral practices should be informative and enthusiastic to increase the likelihood of uptake. Copyright © 2009 John Wiley & Sons, Ltd.

The use of the comprehensive International Classification of Functioning, Disability and Health Core Set for low back pain in clinical practice: a reliability study

Background and Purpose. The comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for low back pain (LBP) can be used to describe functioning and the influence of the environment of patients with LBP with a selection of 78 categories, from the ICF components 'body functions', 'body structures', 'activities and participation' and 'environmental factors'. The reliability of the qualifiers' scale of the ICF Core Set for LBP has not yet been studied. Methods. Reliability study was conducted in three study centres in the German-speaking part of Switzerland. In the first step, two physiotherapists independently assessed 31 patients with LBP with the original qualifier scale of the 78 ICF categories from the comprehensive ICF Core Set for LBP. After the first 31 patients, inter-rater reliability was assessed and the response options were reduced based on a Rasch analysis. The second sample (n = 30) was assessed by the physiotherapists with the modified qualifier scale and inter-rater reliability was calculated again. Results. The percentage agreement for the ICF categories ranged from 19% to 87%, mean 44% (nominal kappa from -0.73 to 0.54, median 0.22; weighted kappa -0.2 to 0.69, median 0.38) in the first round with the original qualifier scale. In the second round with the reduced response options, the percentage agreement ranged from 23% to 90%, mean 49% (nominal kappa from -0.15 to 0.71, median 0.24; weighted kappa -0.16 to 0.81, median 0.25). The overall percentage agreement was 44% in the first round and 49% with the reduced response categories. The overall kappa value in the first round was 0.29 and in the second round 0.32. There was a small but statistically significant improvement in the agreement. Conclusion. The low-to-moderate reliability found in this study requires an improved operationalization (e.g. the definition and description of each response category) and improved instructions for the ICF Core Set for LBP. Copyright © 2009 John Wiley & Sons, Ltd.

Fear-avoidance beliefs and pain as predictors for low physical activity in patients with leg ulcer

Background and Purpose. Previous studies have shown that patients with chronic venous insufficiency are deconditioned and physically inactive. The present study aimed to examine the occurrence of fear-avoidance beliefs in patients with chronic venous insufficiency, and to investigate the role of fear-avoidance beliefs and pain severity in predicting the low level of physical activity in these patients. Method. Data were collected by a postal questionnaire sent to 146 patients with chronic venous insufficiency and current or previous venous leg ulcer. Complete data were collected from 98 patients aged 60-85 years - 63% women - giving a response rate of 67%. Fear-avoidance beliefs were assessed by the Fear-Avoidance Beliefs Questionnaire, physical activity subscale. Pain and physical activity were assessed by the Six-point Verbal Rating Scale of Pain Assessment and the Physical Activity Questionnaire, respectively. Results. Fear-avoidance beliefs were present in 81 (83%) of the patients with chronic venous insufficiency (range 0-24, median 12). Forty patients (41%) had strong fear-avoidance beliefs. One-third of the patients with healed ulcers had strong fear-avoidance beliefs. Patients with low physical activity had significantly stronger fear-avoidance beliefs and more severe pain than patients with high physical activity. Multiple logistic regression showed that the odds ratio (OR) for low physical activity were about three times higher for patients with strong fear-avoidance beliefs (OR 3.1, 95% confidence interval 1.1-8.3; p = 0.027) than for patients with weak fear-avoidance beliefs. Conclusions. Fear-avoidance beliefs were present in most patients with chronic venous insufficiency and were associated with low physical activity. Clinical implications ought to include a better recognition of fear-avoidance beliefs, early information about the negative consequences of such beliefs, and the importance of physical activity to counteract poor mobility. Copyright © 2009 John Wiley & Sons, Ltd.

Cri-du-chat

Stereotypies and repetitive/restrictive behaviours in infants with autism and pervasive developmental disorder

Management of spasticity and dystonia in children with acquired brain injury with rehabilitation and botulinum toxin A

Screening for motor deficits using the Pediatric Evaluation of Disability Inventory (PEDI) in children with language impairment

Cyberbullying among students with intellectual and developmental disability in special education settings

Social and communication behaviours in infants and toddlers with autism and pervasive developmental disorder-not otherwise specified

Development and evaluation of a minimum data set for children with airway support for transfers between acute and post-acute care

A comparison between traditional economical and demand curve analyses of relative reinforcer efficacy in the validation of preference assessment predictions

Reducing acute stress in a 16-year old using trauma-focused cognitive behaviour therapy and eye movement desensitization and reprocessing

KID syndrome patient with toe walking: A case report

Does the ASD label have validity?

The use of electropalatography (EPG) in the assessment and treatment of motor speech disorders in children with Down's syndrome: Evidence from two case studies

Assessment of executive functioning in children after TBI with a naturalistic open-ended task: A pilot study

Upper limb orthoses and assistive technology utilization in children with hemiplegic cerebral palsy recruited from a population register

Balance abilities and gait characteristics in post-traumatic brain injury, cerebral palsy and typically developed children

Speech-language performance in Sjögren-Larsson syndrome

Self-report measures of physical function for children with spinal cord injury: A review of current tools and an option for the future

A personal account of the rehabilitation system in Japan

Field trial of ICF version for children and youth (ICF-CY) in Sweden: Logical coherence, developmental issues and clinical use

Predicting social and functional outcomes for individuals sustaining paediatric traumatic brain injury

Technology-based intervention options for post-coma persons with minimally conscious state and pervasive motor disabilities

Virtual enriched environments in paediatric neuropsychological rehabilitation following traumatic brain injury: Feasibility, benefits and challenges

Virtual reality-based paediatric interactive therapy system (PITS) for improvement of arm and hand function in children with motor impairment—a pilot study

Traumatic brain injury in childhood: Rehabilitation considerations

Narrowing the divide

Depression in young people: Description, assessment and evidence-based treatment

Remediation of learning difficulties in children after treatment for a cerebellar medulloblastoma: A single-case study

The use of pulse oximetry as a screening assessment for paediatric neurogenic dysphagia

Regional changes in bone mineral density following spinal cord injury in children

Actual vs. best practices for young children with cerebral palsy: A survey of paediatric occupational therapists and physical therapists in Quebec, Canada

Treatment of articulatory impairment in a child with spastic dysarthria associated with cerebral palsy

Book review

Open thinking in neurorehabilitation

Correlates of therapy use and expenditures in children in the United States

The dichotomy

The Teletón Centers of Child Rehabilitation Mexico: 'El amor y la ciencia al servicio del hombre'

Imaging white matter diffusion changes with development and recovery from brain injury

Psychosocial and intellectual functioning in childhood narcolepsy

Development and validation of the Paediatric Care and Needs Scale (PCANS) for assessing support needs of children and youth with acquired brain injury

Visuo-motor coordination in 8-year-old children born pre-term before and after 28 weeks of gestation

Book review

Essay Competition Winner

Goal-oriented rehabilitation of preschoolers with cerebral palsy—a multi-case study of combined use of the Canadian Occupational Performance Measure (COPM) and the Goal Attainment Scaling (GAS)

Nutrient intake and anthropometry in children and adolescents with Down syndrome-a preliminary study

Parental report of cognitive difficulties, quality of life and rehabilitation in children with epilepsy or treated for brain tumour

Association between motor and mental functioning in toddlers with cerebral palsy

Book review

Editorial - Special Issue “Physical Therapy Practice in the 21st Century: A New Evidence-Informed Paradigm and Implications”

Foreword from the Special Issue Editor

Physical therapy in the 21st century (Part I): Toward practice informed by epidemiology and the crisis of lifestyle conditions

Physical therapy in the 21st century (Part II): Evidence-based practice within the context of evidence-informed practice

Advice as a smoking cessation strategy: A systematic review and implications for physical therapists

Strategies for optimizing nutrition and weight reduction in physical therapy practice: The evidence

Building motivation and sustainability into the prescription and recommendations for physical activity and exercise therapy: The evidence

Sleep health and its assessment and management in physical therapy practice: The evidence

Psychological stress measure (PSM-9): Integration of an evidence-based approach to assessment, monitoring, and evaluation of stress in physical therapy practice

Telephone focus groups in physiotherapy research: Potential uses and recommendations

Centralization of symptoms and lumbar range of motion in patients with low back pain

Learning physiotherapy in clinical practice: Student interaction in a professional context

A national study of the availability and use of electrophysical agents by Australian physiotherapists

Static progressive splinting to improve wrist stiffness after distal radius fracture: A prospective, case series study

A return to running program for the postpartum client: A case report

Pole walking for patients with breast cancer-related arm lymphedema

Effects of hippotherapy on people with cerebral palsy from the users' perspective: A qualitative study

A grounded-theory investigation of patient education in physical therapy practice

Effect of Maitland mobilization and exercises for the treatment of shoulder adhesive capsulitis: A single-case design

Intrasession reliability and influence of breathing during clinical assessment of lumbar spine postural control

Atypical suboccipital vertebral artery blood flow in healthy subjects: Case studies using real-time ultrasound

An evaluation of two different exercise regimes during the first year following stroke: A randomised controlled trial

Can vastus medialis oblique be preferentially activated? A systematic review of electromyographic studies

Exploring aftercare programs following outpatient musculoskeletal physical therapy: A case series report

Validity and reliability of the muscle function scale, aimed to assess the lateral flexors of the neck in infants

Assessment of sitting balance of patients with stroke undergoing inpatient rehabilitation

Effects of age on passive range of motion of selected peripheral joints in healthy adult females

Physical therapists' perspectives on practice errors in geriatric, neurologic, or orthopedic clinical settings

Quality of life of stroke survivors and apparently healthy individuals in southwestern Nigeria

Effectiveness of pulsed electrical stimulation in the management of osteoarthritis of the knee: Three case reports

Interobserver reproducibility of the Berg Balance Scale by novice and experienced physiotherapists

Management of sacroiliac dysfunction and lower extremity lymphedema using a comprehensive treatment approach: A case report

Management of a female with chronic sciatica and low back pain: A case report

An ethnographic study of physiotherapists' perceptions of their interactions with patients on a chronic pain unit

After-hour physiotherapy services in a tertiary general hospital

Philosophy of science and physiotherapy: An insight into practice

Further arguments in support of a social humanistic perspective in physiotherapy versus the biomedical model

Comparison of cervical vertebral separation in the supine and seated positions using home traction units

Documentation of daily sit-to-stands performed by community-dwelling adults

Further arguments in support of a social humanistic perspective in physiotherapy versus the biomedical model

Philosophy of science and physiotherapy: An insight into practice

An ethnographic study of physiotherapists' perceptions of their interactions with patients on a chronic pain unit

After-hour physiotherapy services in a tertiary general hospital

Comparison of cervical vertebral separation in the supine and seated positions using home traction units

Documentation of daily sit-to-stands performed by community-dwelling adults

Manuscript Reviewers

Effects of 5-Form, Yang Style Tai Chi on older females who have or are at risk for developing osteoporosis

The role of the cerebellum in procedural learning—Are there implications for physiotherapists' clinical practice?

Educational and professional issues in physical therapy—An international study

Test-retest reliability of cervicocephalic relocation test to neutral head position