Cable-driven robotic resistance training may be used as an adjunct to body-weight-supported treadmill training (BWSTT) for improving overground walking function in patients with incomplete spinal cord injury (SCI), particularly those with relatively high function, say authors of an article published in Archives of Physical Medicine and Rehabilitation.   

This study took place in research units of rehabilitation hospitals in Chicago. Researchers randomly assigned patients with chronic incomplete SCI (N=10) to 1 of 2 groups. One group participated in 4 weeks of assistance training followed by 4 weeks of resistance training. The other group participated in 4 weeks of resistance training followed by 4 weeks of assistance training. Locomotor training was provided by using a cable-driven robotic locomotor training system, which is highly backdrivable and compliant, allowing patients the freedom to voluntarily move their legs in a natural gait pattern during BWSTT, while providing controlled assistance/resistance forces to the leg during the swing phase of gait.

Primary outcome measures were evaluated for each participant before training and 4 and 8 weeks after training. Primary measures were self-selected and fast overground walking velocity and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and strength.

A significant improvement in walking speed and balance in participants was observed after robotic treadmill training using the cable-driven robotic locomotor trainer. There was no significant difference in walking functional gains after resistance versus assistance training, although resistance training was more effective for higher functioning patients.

APTA member T. George Hornby, PT, PhD, is coauthor of the study.

APTA now offers a comprehensive resource to help physical therapists (PTs) understand and fulfill their role in reducing avoidable hospital readmission—a high priority of health care reform.

The Affordable Care Act's Hospital Readmissions Reduction Program, which begins in 2013, is aimed at adjusting hospital payments for those institutions that have higher-than-expected readmissions. Hospital readmission quality metrics are being introduced into other settings, such as inpatient rehabilitation facilities in 2014, and are expected to be integrated into additional settings in the near future.

PTs serve an important role in patient safety and patient care transitions. They should advocate and communicate their expertise and critical-decision making in providing recommendations for the most appropriate level of care after acute care discharge within the health care team prior to and during care transitions to help reduce hospital readmissions.

Find clinical practice resources, patient education materials, and links to related information on APTA's new Hospital Readmissions webpage.

Several new resources available at www.apta.org/GovernanceReview explain the proposed governance review recommendations adopted by the Board of Directors at its April 2012 meeting, and the next anticipated steps for member review and feedback. A 14-page illustrated brief, Update on Governance Review: Proposals for a Brighter Future, highlights the most significant elements of the Board’s proposals, and 2 podcasts, "A Conversation on Governance Review," provide additional details on the proposals related to chapters and sections (Part 1) and the Board and House of Delegates (Part 2). Feedback about governance review can be directed to governancereview@apta.org.

Two studies released this week from researchers at the Centers for Disease Control and Prevention (CDC) and National Institutes of Health show both encouraging and discouraging news about the nation's mortality and health as it relates to diabetes.      

The first study, published in Diabetes Care, found that death rates for people with diabetes dropped substantially from 1997 to 2006, especially deaths related to heart disease and stroke. Deaths from all causes declined by 23% and deaths related to heart disease and stroke dropped by 40%.

According to CDC, some healthy lifestyle changes contributed to the decline, as did improved medical treatment for cardiovascular disease and better management of diabetes. In particular, the study showed that people with diabetes were more likely to be physically active and less likely to smoke than in the past. Better control of high blood pressure and high cholesterol also may have contributed to improved health. However, obesity levels among adults with diabetes continued to increase.

The second study found a 15% prevalence rate for prediabetes/diabetes among adolescents during a survey period from 1999 to 2008. According to a Reuters Health News  article based on the study, the conditions were seen in 9% of teens in 1999-2000, but that figure rose to 23% in 2007-2008. "That was unexpected," lead researcher Ashleigh May, MS, PhD, told Reuters, because the research team found that obesity rates for teens leveled off during the study period. The rates of high blood pressure and high LDL cholesterol also remained steady.

Although the study gauged prediabetes and diabetes from a single blood sugar measurement, which may be less reliable in adolescents than in adults, May says the overall results show that children and teenagers need more help with staying physically active and following a healthy diet.

Physical therapists interested in serving on a Federation of State Boards of Physical Therapy (FSBPT) examination committee have until May 30 to submit their nominations. Under the 1989 Transfer Agreement of the physical therapy licensing examination and a more recent settlement agreement, APTA is entitled to seat candidates for at least 40% of the positions on the FSBPT Examination Development Committees. This year APTA will be providing 1 nominee for the Examination Development Committee-PTA (EDC-PTA) and 1 nominee for the Item Bank Review Committee-PT (IBRC-PT).

APTA nominees to all committees will be physical therapists and active APTA members. Experience as National Physical Therapy Examinations (NPTE) item writers or American Board of Physical Therapy Specialties (ABPTS) writers is desired but not required. For the EDC-PTA, the nominees must have expertise in neuromuscular, cardiovascular/pulmonary, musculoskeletal or pediatrics; for the IBRC-PT, the nominees must have expertise in pediatrics, musculoskeletal or neuromuscular.

To submit for nomination, complete and submit a Personal Information Form and a current résumé/CV by Wednesday, May 30, to Brandy Bradley in the Clinical Practice Department. 

From the equipment physical therapists use in patient management, and the electronic health records (EHRs) they use to document, to the evolving clinical research in areas such as robotics, genetics, and regenerative medicine, certain technologies will have profound impact on the profession and its patients. In this new podcast, hear the calls of APTA leaders and researchers to increase the profession's ability to use technology, collaborate in developing and lead in testing new technologies, and work closely with basic scientists to guide the development of clinically relevant protocols as they relate to regenerative medicine.

Check out 2 upcoming opportunities to learn more about these new technologies at PT 2012 in Tampa—Emerging Technologies: Implications for the Future of Physical Therapist Practice and The New Genomics: Applications and Implications for Physical Therapist Practice and Education.

If you work with Olympic athletes and/or will be heading to London to serve on an Olympic team's medical staff, APTA wants to hear from you. During the 2012 Summer Olympic Games, APTA would like to spotlight member physical therapists (PTs) who have helped the nation's elite athletes prepare to compete on the world's biggest stage. Contact Erin Wendel, senior media relations specialist, by e-mail or phone at 703/706-3397 by Monday, May 28, for more details. APTA also intends to use this opportunity to promote the physical therapist's role in helping athletes of all ages and skill levels reach their goals by preventing and treating sports-specific injuries.

A new policy brief from The Commonwealth Fund describes recommendations of more than 75 researchers who identified a core set of standardized measures to evaluate the patient-centered medical home (PCMH). The brief focuses on 2 domains of medical home outcomes—clinical quality and cost/utilization.

The researchers broadly agreed about the importance of assessing changes in clinical quality as part of any medical home program. They expressed con­cerns that the variation in populations and local PCMH emphasis might make uniform minimum quality mea­sure sets difficult to generalize. Therefore, they agreed to a core set of principles that all evaluators should follow when examining clinical quality. In particular, they call for select measures from each of the following core areas of primary care measurement—preventive care, chronic disease management, acute care, overuse, and safety.

The majority of researchers recommend including emergency department visits, hospital­izations, and readmissions as the primary utilization indicators in the minimum measure set. According to the group's analysis, these indica­tors were both consistent with the logic model that attempted to capture how a medical home could affect utilization, cost, and efficiency and were supported by at least some empirical evidence.

For cost measures, there was consensus that evaluations of PCMHs should always include analysis of total per-member per-month cost effects for high-risk patients, since the PCMH initiative will most likely be able to detect a measureable effect on this patient population.