From:  ADVANCE for Physical Therapists	top
New study at Maryville University aims to help patients with chronic hemiplegia increase their hand function By Brian W. Ferrie Lending stroke patients a hand by helping them regain use of their hands is the aim of a two-year study that will be led by Joni Barry, DPT, PT, NCS, assistant professor of physical therapy at Maryville University, St. Louis. Dr. Barry received a $5,000 grant from the Missouri Physical Therapy Association as well as $12,000 from the Greater St. Louis Health Foundation to fund the study, which is slated to begin this semester. The research will divide patients who are experiencing weakness in one side of their body into two groups. Both groups will receive physical therapy at Maryville. One group will wear the SaeboFlex®, an arm brace that stimulates and supports the hand muscles, during therapy while the other group will not. Dr. Barry's research team aims to measure the difference in affected hand use between patients in the two groups. The professor has been a PT since 1989 and joined Maryville as an adjunct faculty member in 1998. Now heading into her fourth year as full-time faculty, Dr. Barry has also worked with stroke patients for 15 years at St. John Mercy's physical therapy clinic. She said the upcoming study is important because it will help determine realistic timetables for recovery rates in stroke patients. Realizing Potential "In working with stroke patients through the years, I and the patients always felt like they had more potential than they were able to show," she related. "Many times, patients will try to use their hand to grab something and won't be able to. They get discouraged and stop trying to use it." Her research is a continuation of a pilot study involving four stroke patients that she and Maryville physical therapy students conducted two years ago. Those findings were presented at the state chapter meeting in St. Louis in April 2006 as well as the national CSM conference in Boston in February 2007. "I had attended a course about the SaeboFlex brace in May 2005," Dr. Barry told ADVANCE. "That led me to pursue the pilot study, which began with just five participants and turned out to be four by the end. All four were post-stroke, some from a bleed and some from an embolism. They were all in the chronic stroke population, which we considered to be more than six months post. We didn't have funding for the pilot but we used that data to write up the grant proposal for a larger study." Improved Function The pilot study demonstrated an increase in grip strength when the statistics were reviewed, as well as some trends toward improvement in function, continued Dr. Barry. "We used the action research arm test as our functional measure. When we separated the four participants, one of them improved by nine points on that test. Ten points is considered clinically significant, so it definitely demonstrated a trend." Because the pilot study was not funded, it was run mostly by students at Maryville, added the professor. "The braces were loaned to us by Saebo Inc., we brought in the participants, took our pre-measures, got them set up with the braces and taught them a home exercise program. For six weeks, they did those exercises. We saw a few of them periodically if they had any questions or trouble with the fit of the brace, but there weren't really therapy sessions." At the end of the six-week period, the measures were repeated and the participant who had demonstrated the most improvement stated a desire to get the brace through his insurance company for further use. Study Details The upcoming study will aim for 30 total participants, with half randomized into a group that uses the SaeboFlex and comes in for therapy once a week. The other half will get therapy along with their home exercise program but will not use the brace. "We're going to do some reliability studies in the fall and hope to start the actual intervention study in January," Dr. Barry commented. "I'd like to get all the data collected in the first year. The second year will be about analyzing the data and writing it up. The Missouri PT Association has given us a two-year window from when we received the grant, which was in May, until we finish." Participants in this study do not necessarily need to have sustained a stroke. "We really are just saying chronic hemiplegia. So it could be after a head injury or a brain tumor. A lot of constraint studies have taken participants with a certain amount of ability to open their hand already. We're trying to target the more involved population. We're looking for moderate to severely involved hemiparesis so that our participants wouldn't qualify for constraint studies that have already shown a lot of potential. You have to be able to actively squeeze your hand to use the SaeboFlex, but the brace itself will help to open your hand." The ages of the four participants in the pilot study ranged from about 45 to 65. The upcoming study will seek participants who are at least 18 years old. There will not be any repeat participants because prior experience with the SaeboFlex is a disqualification. Recruiting Participants "We are getting ready to really start recruiting participants," said Dr. Barry in August. "We didn't want to recruit too soon before the study. We're going to try and get our name out there. Washington University in St. Louis has a Website where stroke studies can advertise and patients can see that we're looking for participants. We're also going to recruit through some local hospitals and stroke support groups." Dr. Barry's co-investigators in the study will include Sandy Ross, DPT, assistant professor of physical therapy; and Judy Woehrle, DPT, assistant professor of physical therapy and PT program director. After her experience with the pilot study, Dr. Barry is optimistic about what the new study could prove. "The results of the pilot study make us hopeful we will see improvement in function. We're also trying to measure quality of life. In this larger study, we're using the stroke impact scale to look at quality of life as well as the action research arm and box and blocks tests for functional results. In addition, we're going to look at what happens with grip strength. There really aren't other results out there on the SaeboFlex that we're trying to match or support. We're just trying to get some research started." Student Involvement Maryville physical therapy students will participate in the new study in a variety of ways. A student research group will help with the reliability study taking place this fall, while students in the intervention study will assist when patients come in for therapy sessions. Therapy will take place once a week for one hour, with a one-on-one ratio between participants and researchers. Dr. Barry intends to always be present for the therapy sessions, with the number of students accompanying her to depend on the number of patients at any given session. "They'll certainly get some experience with patients who have hemiparesis as well as exposure to the whole research process," the professor concluded. "I've already gone through the Institutional Review Board (IRB) process of getting approval, but as part of their participation students will pretend they're writing up the IRB as well. And their work on the reliability study will be turned into a poster for their class to present to the rest of the students and faculty here." Brian W. Ferrie is managing editor at ADVANCE and can be reached at bferrie@merion.com
From:  Gender balancing raises bar for women	top
If you follow the news about college admissions, you know that more women are applying to college than men. At some campuses, only 40 percent of the applicants are male, thereby making colleges' goal of achieving gender balance even more difficult to accomplish. Because of equal protection and Title IX laws, public colleges cannot manipulate their gender balance. However, private colleges are exempt from some admission restrictions and, in the quest to achieve gender balance, some private colleges have admitted lesser-qualified young men instead of more qualified young women. After years of fighting for educational equality, it is disheartening to think that the college admissions' bar has been raised even higher for young women. My guess is that at some private colleges with balanced gender enrollment, women are getting the short end of the admissions stick. Steven Greenberger, associate dean of faculty at the DePaul College of Law in Chicago, agrees. He believes, to some degree, this type of discrimination is happening at small colleges. He says colleges want to balance classes because "once the ratio tips too far in favor of women, they [the college] become unattractive to women because there aren't any men around." Greenberger says gender balance is less of an issue on a large campus, because with a large campus population, gender imbalances would be less discernible. College admission officers dispute the idea that they are trying to balance their classes by gender, instead claiming to assemble a class with other factors in mind. "Many colleges are making little or no concerted effort to achieve gender balance," Dan Rosenfield, dean of enrollment management at the University of Louisiana at Lafayette says. He adds: "I think it's safe to say that most colleges are far more interested in concentrating efforts, which will result in increasing the number of students with high academic potential, achieving geographic and cultural diversity, attracting students with special talents, and opening the doors to more low-income students." Patricia Rossman Skrha, director of undergraduate admission at Baldwin-Wallace College in Berea, Ohio, agrees. Rossman Skrha says most small colleges like Baldwin-Wallace admit all qualified applicants, and she says young women might feel college is inaccessible because of efforts to achieve gender balance. However, others deny that they recruit men to maintain gender balance, but admit that they support the ideals of a balanced class. Dr. Beth Triplett, vice president for enrollment at Maryville University in St. Louis, tells me that an unbalanced class "impacts the academic environment," and that males, if in the minority, "feel less comfortable, and have fewer peers with whom they can identify." Triplett also expresses concern for a society without college-bound or college-educated men. Judith Kleinfeld, professor of psychology and director of the Boys Project at the University of Alaska-Fairbanks, offers a slightly different perspective. Though the Boys Project aims to "educate families, educators and the public about the challenges our young boys are facing," Kleinfeld says that "reverse discrimination will not solve the problem. It creates unfortunate stereotypes of guys who are in demand and don't have to follow rules. I don't think that affirmative action for guys is the answer." Kleinfeld suggests that if young men are indeed retreating from college, "we should do a whole lot more than we are doing in high schools to increase the skill level of guys." Joanne Levy-Prewitt is an independent college admissions adviser. E-mail: jklprewitt@gmail.com