Tsuyoshi Matsuo is a physician who worked in a psychiatric institution in Japan for four years.

Introduction: High tibial osteotomy in cases of early osteoarthritis and spontaneous osteonecrosis of the knee may enable joint preservation and knee function recovery.Opening wedge high tibial osteotomy using a locking compression plate and Beta-tricalcium phosphate is a technique that provides excellent early fixation and enablesshorter postoperative rehabilitation with fewer serious complications.We performed opening wedge high tibial osteotomy on 135 patients between 2010 and 2013.
Methods: Here we report our postoperative rehabilitation program after opening wedge high tibial osteotomy and describe the postoperative complications.A total of 135 patients (39 men, 96 women) underwent opening wedge high tibial osteotomy between January 2010 and December 2013.
Results: Our rehabilitation program, which included active movement of the ankle, was started on postoperative day 1. Weight bearing was permitted starting on day 2 to the extent that it did not cause pain and the patients started transitioning to a wheelchair. Joint range of motion training focusing on active movement was also started. On day 3, patients started using parallel bars or a walker for gait training to the extent that it did not cause pain. The aim was for each patient to be able to walk on crutches 1 week after surgery and on a single crutch 2 weeks after surgery.Postoperative complications included leg discrepanciesin 64 cases, intraoperative fracture in 20, infection in four, cutaneous necrosis of the surgical wound in three, and non-union in one.In most cases, leg discrepancy was within the 1–2 cm range and was correctable with a silicone shoe insole. Intraoperative fracture did not necessitate any changes to the postoperative rehabilitation program as long as it did not involve the joint surface. If a fracture involved the joint surface, 2–3 weeks without weight bearing was required. The infections were all merely superficial and did not affect postoperative rehabilitation, but repeat surgery was necessary for the patient with non-union.
Conclusions: We believe that opening wedge high tibial osteotomy, which we introduced in 2010, is a surgical procedure that requires only a short period of limited movement and features very few potential postoperative complications requiring changes to the postoperative rehabilitation program.

Cathy Ciolek has a bachelor’s degree in physical therapy from Ithaca College and DPT from AT Still University. She has been board certified as a geriatric clinical specialist since 1996. She is an assistant professor and director of clinical education at the University of Delaware where she teaches geriatrics and principals of adult education and learning theory. She was recently awarded the Lucy Blair Service award from the American Physical Therapy Association.

In 2011, approximately 65% of PT students were American Physical Therapy Association (APTA) members with even less participating as actively engaged members. Given this limited engagement, improved strategies are required to elucidate the benefits associated with professional involvement. Barriers to student engrossment in the APTA anecdotally include expense, lack of time, and decreased awareness of opportunities. To address these barriers, a conceptual framework, modeled after the International Classification of Function (ICF), was developed to demonstrate linkages between related concepts in the process of professional growth. Students explored this new professional development model simultaneous to their education on the ICF. Both models embodied a similar visual structure and “ablement” focus. Use of a graphic, interconnected model allowed students to appreciate the opportunities associated with professional development and reinforced the multifaceted and individualized nature of establishing goals and maximizing outcomes. For example, the model demonstrated how “PT interests” (affinity to a specialty or practice setting) directly influence “PT-related activities” (opportunities reflective of professional goals), and further elucidated how mere “activity” attendance is not “participation” without active engagement and value recognition. The model further demonstrated how individual interests can impact activity selection which, in turn, can facilitate ongoing participation within the activity or organization. Through use of similar precepts to the ICF, this development model provided a useful and vivid depiction of the factors most influential in the establishment and obtainment of professional goals to ultimately promote involvement within the professional organization. Applicability to other rehabilitative professions is most probable.

Gabrielle Shumrak, is Director of the Johns Hopkins Acute Care Residency and is the Center Coordinator for PT Clinical Education. She practices in the area of acute care neurologic physical therapy.

There is an essential need to elevate physical therapy practice in the hospital setting to meet the Institute for Healthcare Improvement’s Triple Aim. Per this initiative, programs should be implemented that improve patient satisfaction with care delivery, focus on health promotion, and decrease overall health-related expenses. A means by which to accomplish these aims is through enriched clinical training. A novel residency program focusing on the advanced clinic skills required to manage medically complex patient populations in the acute care setting was therefore created. The Johns Hopkins Hospital Acute Care Physical Therapy Residency is a 12-month training opportunity for licensed physical therapists desiring specialization in the treatment of medically complex patients. Establishment of an optimal care plan and post-acute intervention strategy requires physical therapists to possess advanced understanding of pathophysiology/differential diagnosis, pharmacology, imaging, physiologic monitoring technologies, inter-professional team dynamics, and the impact of multifarious socio-economic/cultural influences. The ultimate program objective is to graduate a resident proficient in the delivery of advanced, innovative, and evidence-based practice that will drive recovery, reduce risk for hospital-acquired complications, and direct post-acute plans that maximize functional outcomes while decreasing readmission rates for this population. The carefully designed curriculum, including mentored clinical care, research assignments and graduate teaching assignments, will develop the highly specialized skills required to meet the Triple Aim. This residency will serve as a framework upon which future residencies can be developed to advance hospital-based physical therapy practice.

Eric Stewart, PT, DPT is the Director of Clinical Education and also Assistant Professor at UD. He publishes and presents in clinical education, acute care, and cardiopulmonary PT.

Many healthcare educational programs have increased the amount of simulated patient experiencesoffered to students.Evidence suggests that early, authentic patient experiences enhance learning. However, the appropriateness of allowingnew learners to practice on “real” patients prior to obtainment of all required knowledge and skill has come into question. Greater emphasis has also been placed on the importance of inter-professional educational experiences as a means to achieve the Institute for Healthcare Improvement’s Triple Aim Initiative. To provide inter-professional opportunities for nursing and physical therapy students, a simulation activity was created to promote collaborative patientcare. The case was designed with a degree of challenge appropriate to the educational level of the participating students. Portrayal of patients and caregivers by theatre students infused realism into the encounter and promoted a safe environment for identification and correction of errors prior to entering the “true” clinical environment where such consequences are magnified. Survey data from the 34 Doctor of Physical Therapy students who participated in 2013 revealed a strong and favorable response to the value of the learning experience. Mixed response in perceived confidence levels was received specific to patient interaction, collaboration with nursing, communication, and effective management of medical lines. These dichotomous results may reflect the increasedconfidence ofthose students who already possessed such skills and the uncertainty of those students naïve to inter-professional and direct patient care encounters. This cost-effective, safe, collaborative experience allowedearly learners to demonstrate knowledge, skills, and behaviors that were discipline-specific and reflective of integrative practice.

Karla Ann Bell PT, DPT, OCS, OCS: Director of Clinical Education/Assistant Professor/Clinical Instructor at UD. Dr. Bell publishes and presents in clinical education, orthopedics, and geriatrics. She was the 2012 recipient of the APTA Signe Brunnstrom Award for Excellence in Clinical Teaching.

The student experience may be enhanced when learners take an active role in creating environments that maximize their engagement in the learning process. As academic curricula and faculty efforts are often stretched beyond full capacity, students must determine effective means of synthesizing, integrating, and evaluating imparted knowledge and skills with quick pace and high performance expectations. Study with Buddies (SWiB) forums allow Doctor of Physical Therapy students in different academic years to engage in review of classroom material and psychomotor skills under the advisement of faculty. Allowing students who have navigated beyond particular curricular benchmarks to mentor those currently in process not only fostered integration and retention of presented material for all participants, but also modeled the collaboration expected in the professional role of physical therapist. Peer mentors also provide support to clinic-naïve students participating in integrated clinical education (ICE) experiences. In no situation do peer mentors provide substituted clinical judgment for the participating student. Likert scale survey data regarding SWiB sessions identified 100% of respondents as “very likely” to attend and recommend future sessions; 96% to have improved study skills; 98% to have increased confidence; and 97% to have resolution of content uncertainties. ICE mentor survey data revealed 67% viewed the experience as value-added; 77% noted improved confidence being a mentor; and 66% favored serving as a mentor within their future professional role. Student-led initiatives promoting commitment to and enthusiasm for learning fostered a culture of collaboration that facilitated development of the essential leadership, organization, and communication skills required of future clinical practice.

Rick Zock, MPT, CEAS II, CSPHP: Injury Prevention Educator at Christiana Care Health System. Mr. Zock publishes and presents in safe patient handling for PT/OT and orthopedic nursing.

Given occupational demands, the prevalence of Work-Related Musculo-Skeletal Disorders (WMSD) among physical therapists (PTs) has been reported as high as 63%. Despite this, many therapists have declined use of lifting technologies. In large part, this reflects their belief that such equipment minimizes active engagement of the patient during mobility tasks, thereby hampering functional improvements. Another barrier is the belief that lifting equipment should be reserved for nurses who are less trained in skillful transfers. However, when lifting equipment is appropriately utilized, the risk of injury to both the therapist and the patient can be diminished without compromising treatment effectiveness. For example, by modulating the degree of assistance provided by the lifting device, the exertion level of the patient can be controlled, safety of all participants ensured, and the PT made available for “hands-on” facilitation. Pilot data revealed lifting equipment reduced PT fatigue levels, while patient exertion levels were found to be comparable to those experienced during non-equipment assisted mobility. This data provides preliminary evidence to support use of lifting equipment within traditional physical therapy interventions. Further, minimizing PT fatigue levels may enhance treatment session productivity through earlier patient progression to surfaces, positions, and equipment that would not otherwise be safe or possible. Despite these favorable outcomes, a philosophical shift is required if incorporation of lifting technologies into mainstream practice will one day occur. To this end, an educational initiative is currently underway to integrate lifting technologies into the didactic training of PT students for implementation during evidence-based interventions.

Trent Jackman is a assistant professor at Idaho State University, USA. His research interests Interest includes Clinical education, professionalism, ethics, ergonomics.

Background: Ankle fractures result in 10% of all falls, are predominant among the elderly, and occur at an incident of 184 per 100,000 persons a year. Falls result in fractures that can lead to many complications and multiple hospital readmissions. Physical therapy, including discharge planning,may benefit a patient under these circumstances. This case study describes physical therapy of a patient who had multiple readmissions in the acute care setting.
Case Description: The patient is an 80-year-old male who fell and sustained a right bimalleolar ankle fracture, which required surgical repair. His impairments included non-weight bearing on the right lower extremity, poor balance, pain, decreased range of motion and joint mobility, and difficulties with ambulation, bed mobility and transfers. Physical therapy intervention consisted of bed mobility, gait training, and lower extremity strengthening one to two times per day for up to one-hour treatments over four episodes of care throughout a five-week time frame.
Discussion:Multiple factors influenced this patient’s extent of episode and affected his readmission rate. Due to the patient’s comorbidities and refusal to follow medical advise,he had multiple readmissionscaused from sepsis, cellulits, and a fall, which all resulted in a poor outcome. This may have been a reflection of inadequate management of the rehabilitation team and the patient’sadamant refusal to follow medical advice.
Conclusion:This case illustrates the course of events of readmissions in acute care. The patient’s comorbidities may have influenced his request to discharge home following his hospital stay and mayhave affected his outcome and readmission episodes. The rehabilitation team should encourage communication between health care providers, create a safe and effective discharge plan, and educate patients.

Stanley was recently awarded an MPPT travel grant to attend the American Physical Therapy Association conference. He has many presentations and awards in the field of physical medicine.The robustness of the study results as well as providing Stanley with a unique opportunity for international research experience

Purpose:Choosing an appropriate outcome measure for the assessment of balance among people with cerebellar ataxia is currently challenging as there are no guidelines available. There is a need for further investigation with clinical experts in order to derive a set of standardized outcome measures with high clinical utility and acceptable psychometric properties.
Background:Forty-five outcome measures used for the assessment of balance among people with cerebellar ataxia were identified.(1) A subsequent systematic review identified 16 clinic-based outcome measures that have been psychometrically tested with persons with cerebellar ataxia. Of these 16 outcome measures, 10 were generic balance assessment scales and six were cerebellar specific outcome measures with balance assessment as sub component. Testing of psychometric properties was limited in the generic balance assessment scales and had been tested mostly in participants with multiple sclerosis. The cerebellar-specific outcome measures had been subject to more robust psychometric property testingin large sample sizes among participants with pure cerebellar lesions. However, not all psychometric properties have been determined.(2)We conducted a Delphi study to obtain expert opinion on the selection of appropriate clinic-based balance outcome measures Subjects:Thirty experts representing 10 countries were recruited. The experts included neurologists, physiotherapists involved in research and clinical physiotherapists with at least 2 years of experience working with people with cerebellar ataxia.
Methods and Materials:A two-round internet-based Delphi survey was used to address the study objective. A steering committee was formed to: 1. Frame the questions to be asked during the survey, 2. Discuss the outcomes of each round of the survey and 3. Decide on the number of rounds of survey. Each round was pilot tested with an independent group of participants to ensure clarity of questions. Expert participants were allotted a random study ID to ensure blinding and were invited to submit their responses electronically.
Analyses:Mean and ranges were determined for demographic data and percentages were estimated for calculating consensus on the findings.The level of consensus for considering the responses for results was set at 75%. We aimed to identify a maximum of three outcome measures.
Results:Twenty six experts responded for the first round indicating a high response rate of 87%.Experts suggested 49 outcome measures that were appropriate for balance assessment of which 10 outcome measures were not relevant to the study objective and therefore removed by the steering committee. Eighteen outcome measures were eligible for the second round. Response rate for round 2 was 96%. At the end of round 2 the Berg Balance Scale (BBS), Timed up and go test (TUG) and the Scale for the Assessment and Rating of Ataxia (SARA) reached a consensus of 75% or more. As the predetermined number of three outcome measures was identified the Delphi survey was concluded at this stage.
Conclusion:The BBS, TUG and SARA were endorsed by expert clinicians to be the most appropriate outcome measures for the clinical assessment of balance among people with cerebellar ataxia.
Key words: cerebellar ataxia, balance assessment, Delphi. Future direction:The three outcome measures identified through the Delphi survey (BBS, TUG and SARA) and one further measure identified through a systematic review, the International Co-operative Ataxia Rating Scale (ICARS) will be tested further for reliability and validity among people with cerebellar ataxia.

He has experience for 3years outpatient care at Faxton Hospital, 13 years manager/owner outpatient private practice. He is the Director of Clinical Education and urrently teaches in Modules I & II of entry level program which covers musculosketal and neuromuscular content of the curriculum.

Low-level laser therapy (LLLT) is a form of light therapy is used as a therapeutic modality. Many studies have examined the effectiveness of LLLT in treating patients with musculoskeletal impairments of the shoulder such as pain, decreased range of motion (ROM), and decreased strength. Some studies conclude that LLLT is effective in decreasing these impairments, while others indicate that LLLT has no effect. Therefore, the present systematic review and meta-analysis explores the most current evidence on LLLT and musculoskeletal pathologies of the shoulder in order to determine the effectiveness of this modality and to establish the best dosage parameters and methods of application. A literature search of databases was performed and 9 eligible randomized controlled studies (RCT’s) met the criteria for analysis. The effectiveness of the studies was determined using outcome measures which included pain, ROM, strength and functional assessment questionnaires. A meta-analysis was performed to determine the weighted effect sizes for each relevant outcome measure. For the purpose of this systematic review and meta-analysis, the authors found some degree of improvement for pain and overhead ROM. There is less evidence of similar improvement for internal and external rotation range of motion and function. However, statistical significance (p≤0.05) was found only for pain and ROM in flexion/abduction. For dosage parameters, a wavelength of 820 nm which falls within the guidelines given by World Association of Laser Therapy (WALT) for the Gallium Aluminum Arsenide (GaAlAs) laser, was found to have consistent positive results in reducing musculoskeletal impairments of the shoulder.

He research Interest is physical Medicine and Published many paper presentations.

Introduction: Many recent studies report postoperative complications and adjacent intervertebral segments following spinal instrumentation, but few have focused on postoperative patient activity levels. In this study, we investigated life-space assessment (LSA) scores and intervertebral angles in patients after spinal instrumentation. Methods: We studied 19 patients who underwent lateral functional spinal radiography after spinal instrumentation. Each subject’s amount of activity was scored using an LSA, and the patients were divided into Group A (70 points;n = 11) and Group B (70 points;n = 8). Intervertebral angles were measured for the segments superior and inferior to the fused segment with the limbs in the basic, anterior flexed, and posterior flexed positions. A Mann-Whitney U test was used for the statistical comparisons, with values of p  0.05 considered significant. Results: In Group A, with the limbs in the basic position, the mean superior and inferior intervertebral angles were 9.9º 4.4º and 17.1º 12.4º, respectively. In the anterior flexed position, the mean superior and inferior intervertebral angles were 5.0º  4.6º and 11.4º  9.0º, respectively. In the posterior flexed position, the mean superior and inferior intervertebral angles were 13.2º  5.7º and 21.9º  11.7º, respectively. In Group B, with the limbs in the basic position, the mean superior and inferior intervertebral angles were 5.1º  5.0º and 16.6º  6.2º, respectively. In the anterior flexed position, the mean superior and inferior vertebral angleswere4.6º  4.7º and 10.5º  8.2º, respectively. In the posterior flexed position, the mean superior and inferior vertebral angles were 6.4º  5.0º and 20.9º  6.2º, respectively. Statistical analysis revealed significant differences between both groups in the superior intervertebral angle with the limbs in the basic and posterior flexed positions. The other values showed no significant differences. Conclusions: The results of previous studies and the current study show that the load on the adjacent vertebrae increases after spinal instrumentation. Patients with a high postoperative activity level require monitoring of and guidance about activities of daily living (ADL), whereas patients with a low postoperative activity level require functional and ADL training.

Naifu Jiang has obtained his Masterdegree from Beijing Institute of Technology in 2013and is studying in the University of Hong Kong for Ph.D. degree. His research interests are the low back pain quantitative assessment, measurement and analysis on the surface EMG.

Chronic low back pain (LBP)is very popular among people. In order to assist in the treatment of this pain, surface electromyography (SEMG) is applied to the treatment. Based on SEMG, the dynamic SEMG topography is a new objective and quantitative assessment tool toassess the LBP level.Thus, how to analyze the prognostic value of the SEMG topography for identifying the patients’ LBP level during rehabilitation more effectively is significant. 38 chronic non-specific LBP patients without previous history of acute LBP and 43 healthy subjects were recruited. They were required to accomplish the lumbar flexion and extension movement and the SEMG signal could be obtained from the relevant lumbar muscles. According to the patients’ rehabilitation level after physiotherapy, the patients were divided into “responding” and “non-responding” groups. The former’s recoverywas good whereas the latter’swas not. Through applying the root-mean-square difference (RMSD) to the quantitative analysis on the time-varying SEMG topography, the LBP level of the “responding” group could be differentiated from the “non-responding” group because the RMSD of RA and RW at lumbar flexion and extension in the “non-responding” group were significantly higher than those in the “responding” group (p<0.05). Meanwhile, the discrimination accuracy of these two groups could also be tested by using the ROC curve. The areas under ROC curves of RMSD RA and RMSD RW were greater than 0.7 (p<0.05). In conclusion, it is effective and useful to assess the LBP level through the RMSD RA and RMSD RW value from the SEMG topography.

Gill Solberg is a clinical kinesiologist since 1985. During his graduate studies he specialized in clinical kinesiology and postural disorders. He is a diagnostician and head therapist in his private physical therapy clinic and is a leading lecturer at various academic colleges in Israel. His book "Postural disorders and musculoskeletal dysfunction: Diagnosis prevention and treatment" was published by "Elsevier" and is now being an academic textbook, all over the world (3 languages) .His last development in the field of movement therapy is "Functional Anatomy of Yoga" , a new software that is the first of its kind in the world.

This poster presentation connects theoretical and practical aspects of human movement and posture. Its purpose is to expand and enrich the use of movement both therapeutically and in regular activity for improving postural patterns in daily functioning. The presentation delves into the anatomy and kinesiology of the Locomotor / musculo-skeletal system and reviews common pathologies and postural disorders. In addition to offering ways to diagnose posture, it details therapeutic applications utilizing adapted physical activity for special needs. The material in the poster is based on research data underpinned by contemporary professional literature. It is also illustrated by explanatory visuals.
The poster presents comprehensive integrative approach to treating postural disorders and sought to set down most of the basic information needed by physical therapists and movement instructors working with various cases of postural disorders. The poster is intended to raise awareness about a subject that has been shunted to the sidelines and to a certain extent snubbed by many professionals. Orthopaedists recognize the existence of posture, but except for cases requiring treatment entailing a brace or surgery, in many cases the attitude is one of general avoidance. Physical therapy treats posture with a modicum of respect but its daily routine encounters such a broad range of musculoskeletal problems that there is little time to deal with posture. The poster provides the thread that connects these domains.