Updated Integrated Framework for Making Clinical Decisions Across the Lifespan and Health Conditions.

The updated Integrated Framework for Clinical Decision Making responds to changes in evidence, policy, and practice since the publication of the first version in 2008. The original framework was proposed for persons with neurological health conditions, whereas the revised framework applies to persons with any health condition across the lifespan. In addition, the revised framework (1) updates patient-centered concepts with shared clinical decision-making; (2) frames the episode of care around the patient's goals for participation; (3) explicitly describes the role of movement science; (4) reconciles movement science and International Classification of Function language, illustrating the importance of each perspective to patient care; (5) provides a process for movement analysis of tasks; and (6) integrates the movement system into patient management.

A Framework for Movement Analysis of Tasks: Recommendations From the Academy of Neurologic Physical Therapy's Movement System Task Force.

The American Physical Therapy Association's Vision Statement of 2013 asserts that physical therapists optimize movement in order to improve the human experience. In accordance with this vision, physical therapists strive to be recognized as experts in movement analysis. However, there continues to be no accepted method to conduct movement analysis, nor an agreement of key terminology to describe movement observations.

Movement System Diagnoses for Balance Dysfunction: Recommendations From the Academy of Neurologic Physical Therapy's Movement System Task Force.

Unlabelled: The movement system was identified as the focus of our expertise as physical therapists in the revised vision statement for the profession adopted by the American Physical Therapy Association in 2013. Attaining success with the profession's vision requires the development of movement system diagnoses that will be useful in clinical practice, research, and education. To date, only a few movement system diagnoses have been identified and described, and none of these specifically address balance dysfunction.

White Paper: Movement System Diagnoses in Neurologic Physical Therapy.

Background And Purpose: The APTA recently established a vision for physical therapists to transform society by optimizing movement to promote health and wellness, mitigate impairments, and prevent disability. An important element of this vision entails the integration of the movement system into the profession, and necessitates the development of movement system diagnoses by physical therapists. At this point in time, the profession as a whole has not agreed upon diagnostic classifications or guidelines to assist in developing movement system diagnoses that will consistently capture an individual's movement problems.

An integrated framework for decision making in neurologic physical therapist practice.

Decision-making frameworks are used by clinicians to guide patient management, communicate with other health care providers, and educate patients and their families. A number of frameworks have been applied to guide clinical practice, but none are comprehensive in terms of patient management. This article proposes a unifying framework for application to decision making in the management of individuals who have neurologic dysfunction.

Item-specific functional recovery in children and youth with acquired brain injury.

Purpose: The purpose of this study was to examine changes in item-specific functional activities and caregiver support in children and youths with acquired brain injury (ABI) in an inpatient setting using the Pediatric Evaluation of Disability Inventory (PEDI).

Methods: The PEDI was administered by therapy staff at admission and discharge to a consecutive sample of 94 children and youths with brain injury (62 males and 32 females; age range = one to 19 years of age) admitted to the inpatient service at Franciscan Children's Hospital and Rehabilitation Center during a two-year, 10-month period. Individual PEDI item scores were abstracted from the medical records.

Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.

Objective: To define the minimal clinically important difference (MCID) for the FIM instrument in patients poststroke.

Design: Prospective case series discharged over a 9-month period.

Setting: Long-term acute care hospital.

A yoga-based exercise program for people with chronic poststroke hemiparesis.

Background And Purpose: This was a preliminary investigation of the effects of a yoga-based exercise program on people with chronic (greater than 9 months) poststroke hemiparesis. Many people who have had a stroke report an impaired health status because of a reduced level of activity. Proponents of yoga contend that it offers a gentle alternative exercise program that can be easily adapted for people who have had a stroke.

Can Tai Chi improve vestibulopathic postural control?

Objectives: To evaluate the rationale and scientific support for Tai Chi as an intervention for vestibulopathy and to offer recommendations for future studies.

Data Sources: A computer-aided search, including MEDLINE and Science Citation Index, to identify original Tai Chi studies published in English; relevant references cited in the retrieved articles were also included.

Study Selection: A preliminary screening selected all randomized controlled trials (RCTs), non-RCTs, case-control studies, and case series that included Tai Chi as an intervention and had at least 1 outcome variable relevant to postural stability.

Determinants of balance confidence in community-dwelling elderly people.

Background And Purpose: The fear of falling can have detrimental effects on physical function in the elderly population, but the relationship between a persons' confidence in the ability to maintain balance and actual balance ability and functional mobility is not known. The extent to which balance confidence can be explained by balance performance, functional mobility, and sociodemographic, psychosocial, and health-related factors was the focus of this study.

Subjects: The subjects were 50 community-dwelling elderly people, aged 65 to 95 years (mean=81.

Measuring functional change in children with acquired brain injury (ABI): comparison of generic and ABI-specific scales using the Pediatric Evaluation of Disability Inventory (PEDI).

Background And Purpose: The Pediatric Evaluation of Disability Inventory (PEDI) subscales are hierarchic in nature, with item placements within each subscale reflecting the general order of skill attainment in children without disabilities. The purpose of this study was to determine whether a hierarchical subscale developed in this study for children with acquired brain injuries (ABIs) corresponds to the generic PEDI subscales, and, if not, whether condition-specific (ABI-specific) PEDI subscales are more sensitive for measuring change.

Subjects: Eighty-seven children and adolescents (mean age=9.

Vestibular rehabilitation: useful but not universally so.

Objective: Although vestibular rehabilitation (VR) is gaining popularity, few data support its utility in improving locomotor stability, and no good predictors exist of whom will benefit most.

Study Design And Setting: A double-blind, placebo-controlled randomized trial of vestibular rehabilitation was conducted at a large tertiary care hospital on 124 patients (59 +/- 18 years old) with unilateral (n = 51) or bilateral (n = 73) vestibular hypofunction, of whom 86 completed a 12-week intervention. Of these 86, 27 returned for long-term (1-year) follow-up testing.

Is base of support greater in unsteady gait?

Background And Purpose: We investigated dynamic interfoot distance (IFD) throughout the gait cycle in people with unsteady gait caused by vestibulopathy and in people without known neuromuscular pathology. We expected that the subjects with unsteady gait would use a greater IFD than subjects without neuromuscular pathology and that this IFD would be correlated with other measures of locomotor stability.

Subjects And Methods: Simultaneous whole-body (11-segment) dynamic kinematic data were collected from 22 subjects with vestibulopathy and 22 subjects without known neuromuscular pathology who were matched for age, height, weight, and body mass index.