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  • News From NEXT: Understanding Personality Types Can Enhance the PT-Patient Relationship

    Understanding one’s own personality, as well as the personalities of coworkers and patients, can make physical therapists (PTs) and physical therapist assistants (PTAs) more successful in both their workplace and home life, according to Jacky Arrow, PT, DPT. Arrow presented “He Said, She Said: How personality and communication can improve patient education” on June 14 at the 2019 NEXT Conference and Exposition.

    She pointed out that in communication between the PT and the patient, “It’s not their responsibility to come to us or to meet us half way. It’s our responsibility to meet them.”

    She first recommended that the attendees determine their own personality types. She mentioned several tests but focused on the Myers-Briggs Type Indicator, which places a person on 4 scales: extraversion vs introversion, sensing vs intuitive, thinking vs feeling, and judging vs perceiving.

    For example, Arrow explained, an introvert typically waits to be asked a question and then needs time to construct an answer. Extraverts, on the other hand, tend to be talkative and fast-paced. Regarding body language, extraverts tend to lean forward and talk with their hands, while introverts pause before answering and often sit back, sometimes with arms crossed. When treating patients who are introverts, she suggested, provide information in advance or tell them you plan on asking specific questions. Be prepared for follow-up questions either later in a session or at the next session. A strategy to working with extraverts includes active listening, thinking out loud, and planning talking points.

    Another example she provided related to judgers vs perceivers. Judgers respect rules and deadlines such as structured activity, she said, and they prefer a specific plan of care with milestones. Perceivers tend to be flexible with rules and deadlines and are open to adjustments in a plan of care. For those reasons, judgers do better with a written program calendar, while perceivers like to link progress to big-picture goals. To illustrate, she suggested that if the goal is to have a patient do an exercise for 30 seconds, tell a judger to exercise for 30 seconds. Tell a perceiver to sing the song “Twinkle Twinkle Little Star” to gauge the elapsed time.

    Understanding the personality types of colleagues also can be beneficial. “Knowing the other personality types fosters better working relationships. And it allows PTs and PTAs to practice their skills with those of other personality types,” Arrow said.

    News From NEXT: Attendees Rebuild Toy Cars to Aid Children’s Mobility

    PVC ratchet cutters, screwdrivers, and wire strippers may not be among the tools usually used by physical therapists (PTs) and physical therapist assistants. But at the APTA NEXT Conference and Exposition session "Go Baby Go: Mobility Research, Design, and Technology," those and other devices---such as electrical tape, collections of screws, a power drill, and myriad other items---were literally part of a clinician’s toolbox.

    Jason Craig, PT, DPhil, and Skye Donovan, PT, PhD, led the session, which addressed the importance of mobility for young children. The program---conducted on both June 13 and 14---primarily focused on actually converting 9 battery-powered children’s ride-on cars into effective, affordable mobility devices. Go Baby Go is a national program developed by Cole Galloway, PT, PhD.

    The cars that arrive from the toy manufacturer are designed to be operated with a foot pedal. But Craig explained, "Most kids can't operate a pedal, so we have a large button that can be positioned anywhere on the car." Usually the button is in the steering wheel---which was where conference participants placed them in the 9 onsite cars---but the location can change based on the child’s need. "We've placed it behind the head when the goal is to improve a child's posture," Craig said. "We placed one on the seat so the car would move only when the child stood up; it stopped as soon as he sat down."

    In addition to enhancing interventions, the modified toys serve another purpose. "This is about providing the children an experience they haven't had. By providing these cars, the children can explore the world," he said.

    It's also affordable. The cars as modified cost approximately $150 "versus thousands for a motorized wheelchair."

    Pointing to an array of unmodified, rideable cars on tables in the room, Craig then told the session attendees: "We need you to build these, because the kids are coming in later today for their cars." Each car was accompanied by an information sheet on the child---including his or her name, age, diagnosis, and interests.

    The session attendees worked in teams of 4 to 6 to modify the cars---disconnecting the pedal power control and connecting the large red plastic button the size of a small plate to the center of the steering wheel. The task was challenging not only because many PTs weren't familiar with the hardware tools and wiring schematics but also because of variations in both the cars and the needs of the children.

    About an hour into the session, the children and their parents began arriving, with the children telling the PT team working on "their" car what customizations and decals they wanted. Most of the cars were finished that day---a few needed additional work---and the session ended with the children test-driving their cars around the room and down the hotel's halls.

    'Allow Mistakes': Study of Infants With CP Emphasizes Importance of Balanced Approach to Movement Learning

    Infant prone mobility, considered strongly linked to later mobility gains and psychological development, can be difficult for children with cerebral palsy (CP), putting them at a disadvantage later in childhood. Now authors of a new study believe that pairing special assistive technology with a careful combination of movement learning strategies could facilitate important gains in this population. The study was published as part of a special issue of PTJ (Physical Therapy) focused on the intersection of pediatric physical therapy and development science.

    Researchers were particularly interested in impacts of 2 separate learning "mechanisms" that have been shown to have positive effects on skill learning in adults with neurological deficits: reinforcement learning (RL) and error-based learning (EBL). RL is aimed at optimizing the reception of rewards or penalties, focusing on the outcome; in contrast, EBL focuses on the errors made in movement.

    Both EBL and RL can be useful approaches, authors write, but they each have pros and cons: EBL promotes faster learning but is easier to forget; RL tends to be a longer process with more exploration (and variability) involved but is better retained. Authors of the study hypothesized that infants with CP would achieve better prone mobility gains through a combination of the 2 mechanisms than from RL alone.

    To test their hypothesis, researchers used the Self-Initiated Prone Progression Crawler (SIPPC), a device developed by study coauthor Thubi Kolobe, PT, PhD. The SIPPC resembles a skateboard outfitted with special motors and monitors. Infants are placed on them in a prone position that allows them to move their arms and legs. The SIPPC can then be programmed to sense and respond to movement the child initiates.

    Thanks to the addition of a specially wired onesie, the SIPPC's movement response was able to work as both an RL and EBL mechanism. Calibrated one way, the SIPPC reinforced RL by rewarding a movement that is consistent with achieving a goal—for instance, moving toward a toy. Set another way, the SIPCC could add an EBL element by picking up on movements that are not consistent with the goal achievement and move the infant in unintended directions.

    For the study, researchers divided 30 infants aged 4.5–6.5 months into 3 groups: infants with CP who received SIPPC sessions with the special suit that could combine RL and EBL, infants with CP who received only an RL experience through the SIPPC, and typically developing infants who received the RL experience only through the SIPPC. The sessions involved 3 5-minute trials that included caregiver-led movement of the SIPPC and of the infants' arms and legs as well as periods during which the infant was encouraged to move independently toward either a toy or the caregiver. Sessions were conducted twice a week for up to 12 weeks.

    Researchers found that after 12 weeks, infants in the combined RL and EBL group made improvements over the RL-only group in the areas of rotational amplitude—essentially, the amount of trial-and-error used—and the length of linear paths achieved. Wrist and foot path lengths remained about the same between the groups, but the combined group registered significantly higher scores than the RL-only group in the Movement Observation Coding Scheme (MOCS), a measure of goal-directed movement.

    "Overall the findings support the differential effect of RL and EBL in skill learning in infants with CP," authors write, adding that the greater use of trial-and-error methods among the combined group reflects the ways that infant learning of new motor skills may at times require RL but at the same time involve uncoordinated movements, a cognitively demanding process "that is likely to respond better to EBL." The ultimate result: greater travel distances and more goal-directed movement among the combined group.

    In a video interview at the 2019 APTA NEXT Conference and Exposition, Kolobe boiled down the essential findings of the study. [Scroll down for video]

    "Allow mistakes," Kolobe said, "because that's part of [infants'] repertoire of learning how to do something. Allow them to go after other options, because eventually they get the right one."

    Kolobe also believes the study scratches the surface of another important consideration—the complex nature of cognitive elements during movement learning.

    "A lot of cognition enters into [learning movement]," Kolobe said. "Infants do strategize. There's a lot of executive function required to move."

    Authors believe the executive function demands may be of special note among infants with CP. In their study population, they write, "adapted behaviors were not readily repeated at the next sessions"—a finding that partly may be attributable to the ease with which EBL can be forgotten and partly attributable to the type of brain insult associated with CP. The memory decay "highlights the need to carefully balance RL and EBL approaches," they add.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.