Dalfampridine for Mobility Limitations in People With Multiple Sclerosis May Be Augmented by Physical Therapy: A Non-randomized Two-Group Proof-of-Concept Pilot Study

Purpose: To demonstrate proof-of-concept for a combined physical therapy and pharmacological intervention and obtain preliminary estimates of the therapeutic efficacy of a motor-relearning physical therapy intervention with and without concurrent dalfampridine treatment on gait speed in people with mobility limitations due to multiple sclerosis (MS).Methods: Using a non-randomized, two-group design, 4 individuals with MS newly prescribed dalfampridine as part of their routine medical care, and 4 individuals with MS not taking dalfampridine completed a 3-week drug run-in or no-treatment baseline, respectively. After 3 weeks, all participants commenced physical therapy twice weekly for 6 weeks. Participants taking dalfampridine took the medication for the study duration. The physical therapy program comprised functional strengthening, gait training, balance training, and dual-task training. The primary outcome was Timed 25-foot Walk (T25FW) at the end of the 6-week physical therapy program.Results: For the 4 participants taking dalfampridine, average improvement in T25FW on drug only was 12.8% (95% CI 1.2 to 24.4%). During the 6-week physical therapy phase, both groups significantly improved T25FW, but the effect tended to favor the group taking dalfampridine (mean difference = −0.93 s, 95% CI −1.9 to 0.07 s, p = 0.064, d = 1.6). Whereas the physical therapy group had average T25FW improvement of 10.8% (95% CI 1.0 to 20.5%), the physical therapy plus dalfampridine group demonstrated average improvement of 20.7% (95% CI 3.8 to 37.6%).Conclusions: Further research is warranted to examine whether dalfampridine for mobility impairment may be augmented by physical therapy in people with MS.

Play in Three Acts

In some fields, written reflection is commonplace whereas in others it is uncommon. While athletic therapy education aims to produce reflective practitioners, written reflection is not a typical pedagogy employed. In 2014, the athletic therapy program at our institution began the implementation of a clinical presentation (CP) approach to facilitate competency-based curriculum requirements. This innovation to pedagogy required a reimagined approach to teaching, learning, and assessment. We describe one aspect of a larger SoTL study on this transformation, inquiring into the development of reflective practice through reflective writing. Students were asked to regularly reflect on their experiences in the clinic or field as part of their program. In this qualitative component of the study, we were able to gain insight into how students perceived the reflective process, how that evolved over their program, what were enablers and barriers to their reflection, and what was the role of feedback in their learning. The characteristics of student perceptions in each year, which followed a learning arc which we describe sequentially as “confused, conflicted, and convinced,” is explored, along with implications for pedagogy in assisting students to develope reflective professional practice.

The Ostrich Community Internet-Cognitive Behavioural Therapy Program for Distress Related to Carrying Debt

Many individuals struggling with debt will experience associated psychological stress that negatively impacts both their physical and psychological health. People in debt may be too ashamed to participate in support groups or to seek face-to-face therapy but may welcome the more anonymous help that can be made available through an internet-based therapeutic intervention. The Ostrich community internet-cognitive behavioural therapy program was specifically designed to assist individuals with distress related to carrying debt, facilitating them to move out of denial of their financial problems to managing stress symptoms and mobilizing them to be able to cope more effectively with the financial problems. Preliminary outcome studies have demonstrated the feasibility of this approach and its effectiveness.

Effects of a Forest Therapy Program on Reducing PTSD and Depression and Improving Mood States in Fire Officers

Background and objective: This study was conducted to investigate the effects of forest therapy programs on reducing post-traumatic stress disorder (PTSD), depression and improving mood states in fire officers.Methods: To determine PTSD, depression, and mood states before and after the forest therapy program, the survey results of 185 fire officers were analyzed. Frequency analysis was conducted to identify the demographic characteristics of the participants, and Wilcoxon signed-rank test to analyze the differences among group.Results: As a result of a comparative analysis of PTSD before and after the program, there was a significant decrease in PTSD from 10.65 ± 12.00 to 5.64 ± 8.29 after the program. Depression also showed a statistically significant difference from 3.21 ± 4.00 to 2.21 ± 3.47 after the program. As a result of comparatively analyzing mood states before and after the program, there was an increase in positive factors and a decrease in negative factors. Total mood disturbance (TMD) also showed a statistically significant decrease from 5.78 ± 17.37 to –7.38 ± 10.35 after the program.Conclusion: This study has significance in verifying that forest therapy programs can bring psychological changes to fire officers, and these results can be used as a basis for stress management and relief of fire officers.