MGH Institute for Health Professions

Background Transcranial magnetic stimulation (TMS) is extensively studied as a neuromodulation tool in neurological disorders. However, its use with the central vestibular disorders is limited. Objective To evaluate the utility of TMS as an assessment and treatment of chronic vestibular disorders and propose recommendations for future work. Methods A comprehensive search of four electronic databases (PubMed, CINAHL, PsycINFO, and Rehabilitation and Sports Medicine Source) identified 206 records of which 16 studies were included. Results One study used TMS as a neurophysiological assessment tool and 15 used repetitive TMS (rTMS) as a neuromodulatory intervention. Mal de Debarquement syndrome was the most frequently explored diagnosis. Dorsolateral prefrontal cortex and the cerebellum were the most frequent sites for rTMS application. Statistically significant improvements were noted on the Dizziness Handicap Inventory (3/7 studies) but clinically significant improvements were not observed. Postural control (7/7 studies) showed improvements along with VOR gain (1/1 studies). Conclusions TMS shows promise as both a neurophysiological assessment tool and a neuromodulatory intervention for chronic vestibular disorders. Methodological limitations of the studies warrant caution while interpreting the results. Larger sample sizes, control groups, optimal neuroanatomical targeting, and dosing along with active rehabilitation are required to determine effectiveness in chronic vestibular disorders.

Purpose Telehealth expansion offers physical therapists new opportunities; however, conducting virtual assessments raises concerns about validity, reliability, and safety. This study aimed to establish the concurrent validity, reliability, and correlations of the 2-minute step test (TMST) delivered virtually in community-dwelling older adults. Methods A cross-sectional design was used. A sample of community-dwelling older adults underwent single-session testing of the TMST. Scoring was conducted simultaneously by an in-person rater and a synchronous telehealth rater. Video recordings were scored by an asynchronous rater on day 1 and day 30 to assess interrater and intrarater reliability. Concurrent validity was calculated using the 95% level of agreement, intracorrelation coefficient (ICC), and Pearson correlation coefficient between the in-person and remote TMST score. Interrater and intrarater reliability were obtained for virtual raters by calculating the ICC 2-way mixed model. Pearson correlation coefficient was used to identify the correlation between the virtual TMST and fall risk outcome measures. Results Thirty older adults participated. Two-minute step test showed high levels of agreement between in-person and remote formats (ICC = 0.95–0.99, Pearson r = 0.96), good interrater reliability (ICC = 0.79), excellent interrater (ICC = 0.99), significant positive moderate relationship with the 30-second chair stand test, fair correlation with the activities-specific balance confidence scale, and a negative fair relationship with the Timed Up and Go test. Conclusions Two-minute step test is a valid, reliable, and safe tool for virtual aerobic testing in older adults. Assessing the TMST virtually requires considerations of fall risk, physiological exercise responses, influences of the environment, camera positioning, and internet connectivity.

Purpose Conversational latency entails the temporal feature of turn-taking, which is understudied in autistic children. The current study investigated the influences of child-based and parental factors on conversational latency in autistic children with heterogeneous spoken language abilities. Method Participants were 46 autistic children aged 4–7 years. We remotely collected 15-min naturalistic language samples in the context of parent–child interactions to characterize both child and parent conversational latency. Conversational latency was operationally defined as the time it took for one individual to respond to their conversational partner using spoken language. Naturalistic language samples were transcribed following the Systematic Analysis for Language Transcripts convention to characterize autistic children's spoken language and parental spoken language input. Autistic children's spoken language was measured using number of different words (NDW). The quality and quantity of parental spoken language input was assessed using NDW, mean length of utterance in morphemes (MLUm), and frequency of words per minute (WPM). Additional child-based factors, including receptive language and socialization skills, were evaluated using the Vineland Adaptive Behavior Scales. Spearman correlation and regression analyses were conducted to investigate the relationships between those child-based and parental factors and child conversational latency. Results Older autistic children showed longer conversation latencies. Longer parent conversational latency was associated with longer child conversational latency after controlling for age. Greater parental WPM was associated with shorter child conversational latency after controlling for age. Child conversational latency was not associated with their spoken language, receptive language, or socialization skills. Child conversational latency was not associated with parental NDW and MLUm. Conclusions Our findings highlight the interaction loop between autistic children and their parents in everyday interactions. Parents adjusted their timing and quantity of spoken language input to ensure smooth conversational turn-taking when interacting with their autistic children.

Juniperus oxycedrus (J. oxycedrus) is a traditional culinary spice and medicinal herb with a longstanding history of ethnopharmacological applications across diverse cultures. While prior research has explored the biological activities and phytochemical constituents of extracts derived from its leaves and seed cones, the present study systematically investigates their mineral and phenolic profiles alongside their multifunctional bioactive potential. Inductively coupled plasma-atomic emission spectroscopy (ICP-AES) analysis revealed a substantial abundance of essential macro- and microelements. Reversed-phase high-performance liquid chromatography (RP-HPLC) further identified high concentrations of phenolic acids (e.g., p-coumaric acid) and flavonoids (e.g., rutin and quercetin). The extracts exhibited potent radical scavenging activity against 2,2-diphenyl-1-picrylhydrazyl (DPPH), robust antioxidant capacity against hydrogen peroxide, and significant inhibition of xanthine oxidase (XO) activity. Notably, both extracts demonstrated marked antibacterial efficacy. In silico molecular docking studies suggested that the antimicrobial activity may stem from the phenolic constituents, which exhibited favorable binding affinities to the active site of bacterial target proteins. These findings underscore J. oxycedrus as a promising reservoir of bioactive natural compounds, warranting further exploration for therapeutic and nutraceutical applications.

Background Chronic low back pain (CLBP) is a complex condition with significant physical, psychological, and social impacts. The Cognitive Behavior Questionnaire for Nonspecific Chronic Low Back Pain (CBQ-NSCLBP) was developed to assess cognitive-behavioral factors. Objective The aim of this study was to translate the CBQ-NSCLBP into Turkish (CBQ-NSCLBP-Tr), evaluate its psychometric properties, and also to assess the clinicometric properties of the instrument, including its validity, reliability, and effectiveness in assessing cognitive-behavioral factors in Turkish-speaking individuals with chronic low back pain. Methods A total of 120 participants with CLBP aged 18–65 years were recruited. Construct validity was evaluated by correlating CBQ-NSCLBP-Tr scores with established measures, including the Oswestry Disability Index(ODI), Fear Avoidance Beliefs Questionnaire(FABQ), Tampa Kinesiophobia Scale(TKS), Back Pain Attitudes Questionnaire(Back-PAQ), Beck Anxiety Inventory(BAI), and Beck Depression Inventory(BDI). Test-retest reliability was assessed using the intraclass correlation coefficient(ICC), and internal consistency was determined using Cronbach's alpha. Results The CBQ-NSCLBP-Tr demonstrated excellent reliability (ICC = 0.89) and strong internal consistency significant correlations with established measures, such as the Oswestry Disability Index (ODI, r = 0.44) and Fear Avoidance Beliefs Questionnaire (FABQ, r = 0.48). According to these results, the CBQ-NSCLBP-Tr is a reliable instrument for evaluating cognitive-behavioral variables affecting chronic low back pain in Turkish-speaking individuals. Conclusions The CBQ-NSCLBP-Tr is a reliable and valid instrument for assessing cognitive-behavioral factors in Turkish-speaking CLBP populations. It captures critical psychological dimensions influencing pain perception and disability, complementing existing measures.

To better serve an increasingly racially and ethnically diverse United States population, the physical therapy profession has been focused on increasing the diversity of the physical therapy workforce and increasing recruitment of racially and ethnically minoritized (REM) students in Doctor of Physical Therapy (DPT) programs. In contributing to the goal of a diverse, equitable, and inclusive profession, DPT programs must admit, support, retain, and graduate individuals who represent diversity in its many aspects. However, factors such as a lack of REM mentors and decreased sense of belonging, contribute to disparate academic outcomes for REM DPT students. Although educators must act to implement innovative strategies to support a sense of belonging among students who have been historically marginalized, a systematic approach to decision-making, action, and analysis is needed when dealing with a complex problem with multifaceted causes and multiple possible solutions. Improvement science is a continuous improvement approach that uses a series of data-informed processes and the expertise of multiple stakeholders to promote equity in education, offering a framework for seeing the problem from the perspective of REM DPT students. Plan-Do-Study-Act (PDSA) cycles offer the opportunity to introduce educational changes on a smaller scale to evaluate variation prior to applying it to a larger setting. This perspective highlights a series of PDSA cycles trialing interventions aimed at decreasing barriers to success and improving a sense of belonging for REM DPT students. Even in the face of structural and institutionalized barriers, leveraging an improvement science framework can help to ensure that change is meaningful and lasting.

This case report describes a decoding intervention that was developed for and implemented with a 15-year-old female with significant word-level reading challenges. The intervention integrated multiple evidence-based approaches to improve decoding, including instruction in (a) phonemes-graphemes (sounds-symbols) that the participant did not know at pre-test, (b) high-frequency morphemes, and (c) flexible syllabication. In addition to this, midway through the nine-session intervention, reading fluency opportunities were introduced through non-repetitive reading fluency practice with researcher feedback. Post-test assessments revealed improvements across all measures compared with pre-test scores including on oral and written language, decoding, spelling, sound-symbol knowledge, reading level, self-concept as a reader, and self-efficacy in reading. Particularly noteworthy was her growth of 1.5 standard deviations on a standardized decoding measure, two standard deviations on sound-symbol knowledge, and five grade-levels of her reading level. This intervention demonstrates promise as an efficacious and efficient way to treat adolescents’ decoding skills.

Purpose The purpose of this project was to enhance self-efficacy of speech-language pathologists (SLPs) who provide feeding interventions for infants with congenital heart disease (CHD). We determined whether a targeted educational intervention could improve the self-efficacy of SLPs treating feeding/swallowing disorders in infants with CHD. Method Thirty-three SLPs participated in a 5-hr continuing education course focused on feeding infants with CHD. Data regarding participant experience and practice setting were collected via survey, and the physiotherapist self-efficacy (PSE) questionnaire was used and modified to assess self-efficacy. Results Thirty pre- and postsurveys were completed, revealing diverse clinical experiences and practice settings among the participants. The postsurvey results using the PSE showed notable increases in participants' confidence and competence for treating feeding and swallowing disorders in infants with CHD. The p values were noted to be < .001 on all 13 components of the PSE. Conclusion Our findings highlight a gap in education and confidence for SLPs treating infants with CHD and support the benefit of a dedicated postgraduate continuing education course in improving the self-efficacy of SLPs treating this population.

Background Communication is critical to sexuality and sexual health. It is therefore reasonable to assume that acquired communication impairments would impact sexuality, but research is sparse. The research that does discuss these impacts can be difficult to find, as studies are spread across a wide variety of literature bases, and sexual topics are often combined with other concerns. Coupled with clinicians’ discomfort in addressing sexual issues, this leads to a lack of clinical support for patients’ sexual concerns. Aims This scoping review aimed to map and summarize the existing literature on sexuality and acquired communication impairments. Methods & Procedures Six databases were searched: CINAHL, PubMed, MEDLINE, PsycINFO, Web of Science and Scopus. To find studies from the literature on acquired communication impairments and their aetiologies that addressed sexuality and communication, a combination of sexuality and communication impairment terms was used. A total of 97 articles met inclusion criteria. Main Contribution Across aetiologies and literature bases, acquired communication impairments have been found to negatively affect sexuality. However, researchers rarely evaluate the nature of the communication impairment or its effects on sexuality directly. People with communication impairments are more often systematically excluded from acquired disability research on sexuality. Using the reviewed literature, we present recommendations for including sexuality‐related topics in communication disorder research and including people with communication impairments in sexuality‐related research. We also present recommendations for speech–language pathologists to begin incorporating sexuality‐related topics in their clinical practice. Conclusions & Implications The effects of communication impairments on sexuality are insufficiently researched. The literature that does exist points to substantial impacts. This area of research deserves more concerted attention so that clinicians may have guidance and support in addressing the issue with their clients. WHAT THIS PAPER ADDS What is already known on the subject Though researchers have long posited reasons why acquired communication impairments would logically affect sexuality and intimacy, the literature on the topic has been difficult to find. Such research is spread across disorder areas. Sexuality effects are often hidden amid multiple quality‐of‐life indicators, or communication impairment impacts are described as one of many independent variables. What this paper adds to the existing knowledge This scoping review is the first of its kind to provide an overview of the research into communication impairments’ effects on sexuality. It describes the effects that communication impairments can have on sexuality. What are the potential or actual clinical implications of this work? This scoping review will help clinicians to find relevant research for their clients’ needs and help researchers conduct more thorough research in this area. It also provides clinical recommendations for helping clients with communication impairments access this important part of life.

Aim: To assess patient perspectives following evaluation in a multidisciplinary pharmacogenomics clinic run by a clinical pharmacist, genetic counselor, and physician. Methods: A survey was distributed to 187 adults seen in the Brigham and Women's Hospital Pharmacogenomics Clinic. Participants who completed the survey were invited to complete a semi-structured interview. Interview subjects were selected based on order of responses, scheduling availability, and range of participant experiences with testing and the clinic process. Surveys were analyzed with descriptive statistics, and interview transcripts were analyzed with thematic analysis. Results: Forty-two survey responses were received; 13 participants were interviewed. Quantitative data demonstrated high satisfaction with the multidisciplinary clinic model and belief that pharmacogenomic testing has value. Qualitative analysis identified four themes: 1) Self-Advocacy as a Patient Responsibility in the Utilization of Pharmacogenomic Results, 2) High Satisfaction with Multidisciplinary Pharmacogenomics Clinic Model and Team, 3) Utility of Pharmacogenomics, and 4) Desire for Pharmacogenomics Resources. Conclusion: Patients value the care provided by a multidisciplinary pharmacogenomics clinic team, but they need to advocate for the use of their results with other healthcare professionals.

Background Medical and health professions students use digital media in their educational pursuits. No studies have examined the process or utility of reviewing digital recordings of a clinical encounter. This pilot study examined how physical therapy students varied in their approach when compared to practicing physical therapists, in their self-reflection and assessment of a recorded physical therapist (PT) encounter with a standardized patient (SP). Methods A single site, cross-sectional, mixed-methods design was used. Participants reviewed an 11-minute digital recording of a patient encounter and completed survey questions. Post-survey interview sessions were used to gain additional perspective from participants. Results Ninety-two physical therapy students across three levels of training and twenty-seven physical therapists participated in the study. Self-ratings of perceived clinical ability increased with each year of training. First-year students (PY1) gave higher performance ratings to the PT than other groups. Seventy-five percent of respondents found the review of the digital recording to be a useful tool for reflection. A variety of approaches in the review process were found across groups, especially between clinicians and students. Conclusion Review of a recording of a physical therapist’s encounter with an SP can be a useful educational tool for reflection across training levels of students and clinicians.

Background We identified participant‐level risks and safeguards in social‐behavioural research with adults with developmental disabilities. Method We conducted a qualitative systematic review on risks and safeguards in peer‐reviewed research with adults with developmental disabilities. We identified research reporting on risks and safeguards published between 2009 and 2023 by searching eight databases and conducting hand searches of reference lists. We conducted thematic analysis using independent data extraction and coding, and investigator triangulation. Results From 23 manuscripts, we identified: (1) risks associated with research participation of adults with developmental disabilities (e.g., physical, relational, psychological, and social risks as well as a loss of privacy and confidentiality) and (2) safeguards (e.g., using guiding frameworks, reducing participant burden, securing privacy and confidentiality, and fostering psychological and relational well‐being). Conclusions We encourage researchers to foster positive experiences so research participants feel valued and respected, and enjoy having the experience and opportunity to contribute to scientific discoveries.

Introduction Strength After Breast Cancer (SABC) is a safe and effective physical-therapist-led group exercise program for survivors of breast cancer. However, implementation outcomes including patient/provider acceptability and how to overcome implementation barriers are unclear. This study examined the feasibility and acceptability of implementing SABC in a hospital-based outpatient rehabilitation clinic and characterized program adaptations made to overcome anticipated and unanticipated barriers. Methods SABC was offered as a billable clinical program with the option to provide consent for research activities. Three rounds of SABC were conducted, each with two concurrent groups of up to four participants. Feasibility was determined by enrollment, retention, and, for consented participants, survey completion. Participant acceptability was assessed via survey and one-on-one semistructured interviews. Clinician acceptability was assessed through group interviews after each round of SABC. Program observation, investigator and clinician self-report, and clinician interviews were used to identify and characterize program adaptations. Results Of 38 women referred to SABC, 33 (87%) were approached, and of those, 23 (70%) enrolled. Participants attended an average of 4.2 (standard deviation 0.97) of 5 group sessions. Twelve participants consented to research activities and completed SABC; all (100%) completed baseline surveys, 10 (83%) completed post-program surveys, and 6 participated in interviews. Participant satisfaction scores were high. Qualitative data supported both participant and clinician acceptability while also revealing implementation barriers, including time constraints, challenges enacting/supporting exercise behavior change, and payment. In total, 11 adaptations were made; all adaptations were fidelity consistent. Conclusion SABC can be feasibly and acceptably implemented as a group-based exercise program in an outpatient rehabilitation clinic. Program adaptations were effective in overcoming previously identified implementation barriers; however, several new barriers were identified. Future research is needed to enhance equitable access to SABC, reduce clinician burden, identify program adaptations to optimize behavior change, and minimize participant burden related to payment.

Background: Academic programs seeking to increase diversity must consider the potential that prerequisite requirements disproportionately burden individuals from diverse backgrounds. To assess this within one physician assistant program, demographics were compared between those who completed their prerequisites and those who did not. Our aim was to identify any relationship between whether applicants had completed prerequisite coursework at time of application and the applicants’ race/ethnicity, gender, and first-generation status. Methods: We conducted a retrospective review of de-identified applicants over 4 consecutive admissions cycles at one physician assistant program in the Northeast. Applicants self-reported their race/ethnicity, first-generation status, and gender. Prerequisite status for the 6 required content areas was assessed by the program. A series of logistic regression models were fit, predicting the influence of each of the demographic variables on the likelihood of prerequisites being complete. Results: Compared to White students, Black students were less likely to have completed prerequisites. Male applicants, along with applicants who did not report their gender, were less likely than female applicants to have prerequisites completed. Conclusions: These findings suggest prerequisite requirements may present a barrier for Black applicants, that is not experienced by those who are White. Findings also suggest a barrier for male applicants, and applicants who don’t report their gender, that is not experienced by females. While this data is specific to one physician assistant program, other programs and disciplines may consider similar data in their applicant pools in an exploration of strategies to support under-represented applicants to academic programs in health disciplines.

Purpose This study uses a voice production model to estimate muscle activation levels and subglottal pressure (PS) in patients with phonotraumatic vocal hyperfunction (PVH), based on ambulatory measurements of sound pressure level (SPL) and spectral tilt (H1–H2). In addition, variations in these physiological parameters are evaluated with respect to different values of the Daily Phonotrauma Index (DPI). Method The study obtained ambulatory voice data from patients diagnosed with PVH and a matched control group. To infer physiological parameters, ambulatory data were mapped onto synthetic data generated by a physiologically relevant voice production model. Inverse mapping strategies involved selecting model simulations that represented ambulatory distributions using stochastic (random) sampling weighted by probability with which different vowels occur in English. A categorical approach assessed the relationship between different values of DPI and changes in estimated physiological parameters. Results Results showed significant differences between the PVH and control groups in key parameters, including statistical moments of H1–H2, SPL, PS, and muscle activity of lateral cricoarytenoid (LCA) and cricothyroid (CT) muscles. Higher DPI values, reflecting more severe PVH, were associated with increased mean LCA activation and decreased LCA variability, along with decreased mean CT activation and increased median PS. These findings highlight the relationship between muscle activation patterns, PS, and the severity of vocal pathology as indicated by the DPI. It is hypothesized that a major driver of muscle activation and PS changes is the variation in maladaptive adjustments (vocal effort) when compensating for the presence of vocal pathology. Conclusions This study demonstrated that noninvasive ambulatory voice data could be used to drive a voice production modeling process, providing valuable insights into underlying physiological parameters associated with PVH. Future research will focus on refining the predictive power of the modeling process and exploring the implications of these findings in further delineating the etiology and pathophysiology of PVH, with the ultimate goal to develop improved methods for the prevention, diagnosis, and treatment of PVH. Supplemental Material https://doi.org/10.23641/asha.28352720