Clinical supervision as an interaction between the clinical educator and the student

The interaction between clinical educators and students is regarded as the strongest element in developing expertise and in forming students' professional identity in clinical education. Although clinical education has been studied in physiotherapy, the natural interaction between clinical educators and students has remained unanalyzed. The aim of this study was to examine how supervised learning sessions during patient treatment were constructed. The focus was on the forms of interaction between clinical educators and students in natural contexts. By videotaping 12 natural patient treatment sessions, which simultaneously comprised part of the clinical education of physiotherapy students, and by using qualitative discourse analysis, three supervision discourses emerged from the data: "directing the interaction," "making limited room for the student," and "encouraging the student's participation." This study revealed that clinical educators have a dominant role in constructing supervised learning sessions during patient treatment. Depending on how the interaction is constructed, it is possible to support or prevent student participation in decision making as well as to promote or reject the rehearsal of critical thinking or self-directed learning among students. This study highlighted the importance of interactional skills in supervision practices. More research into constructing learning sessions in clinical education is needed.     

Distribution of Working Time and Contents of Physiotherapy Activities in a Clinical Setting.

The purpose of the present study was to collect personnel utilization data in the physiotherapy department of a general hospital as a basis for improving the practice of physiotherapy. Over a four-week period in a process of continuous observation 12 physiotherapists recorded their activities under predefined task categories. The percentages of total time used in the observed activities were as follows: direct patient treatment 31%, other work (planning, recording, arranging walking aids and student guidance) 10%, and cooperation (consultation, meetings, arranging patients' affairs, counselling relatives and parents) 9%. The proportion of uncategorized work amounted to half of the total working time. Physical exercise and counselling in direct patient care, preparation and records in other work and teamwork and cooperation with parents were the commonest activities recorded. The physiotherapists' time schedule in the different wards differed in terms of mean treatment time per patient and amount of patients per day. The major problems were felt to be the lack of assessment methods of follow-up and feed-back systems for patients after hospital care and uncertainty as to what the content of practise should contain. The observation method appeared to be a useful tool for collecting personnel utilization data in a physiotherapy department.     

The effect of two physiotherapy approaches on physical and cognitive functions and independent coping at home in stroke rehabilitation. A preliminary follow-up study

PURPOSE: Activating physiotherapy was used to support the principle of post stroke functional recovery as a learning process which requires both cognitive and physical actions. The purpose of the present preliminary study was to examine the influence of activating physiotherapy on stroke patients' cognitive and physical functions and independent living at home compared with traditional treatment over a 12-month follow-up. METHODS: The 40 patients who received activating physiotherapy were compared with 40 patients receiving traditional therapy. Patients' physical functional capacity was measured one week and 12 months post stroke with the Barthel Index (BI), 10-m gait speed, the Postural Control and Balance for Stroke (PCBS) test, walking distances and patients' abilities to cope without outside help. Cognitive capacity was measured with specific neuropsychological tests: language, visuospatial functions, visual inattention and memory. RESULTS: Physical functional capacity improved significantly (p = 0.001) in both groups at the 12-month follow-up, but no significant differences were found between groups. However, the patients in the activating therapy group coped better without outside help (p = 0.042) and covered longer distances outdoors (p = 0.012). At follow-up all the measured cognitive functions had improved significantly in the activating therapy group and the change in memory in the same group differed significantly from that in the traditional therapy group (p < 0.001), where no significant improvement was observed. CONCLUSIONS: Activating therapy advanced stroke patients' cognitive and physical functional recovery and supported their return to independent life at home more than did traditional physiotherapy. In this respect activating therapy seems to have a beneficial influence on long-term stroke rehabilitation.     

Galactolipid deficiency in the early pathogenesis of neuronal ceroid lipofuscinosis model Cln8mnd : implications to delayed myelination and oligodendrocyte maturation

M. Kuronen, M. Hermansson, O. Manninen, I. Zech, M. Talvitie, T. Laitinen, O. Gröhn, P. Somerharju, M. Eckhardt, J. D. Cooper, A.‐E. Lehesjoki, U. Lahtinen and O. Kopra (2012) Neuropathology and Applied Neurobiology 38, 471–486 Galactolipid deficiency in the early pathogenesis of neuronal ceroid lipofuscinosis model Cln8^mnd: implications to delayed myelination and oligodendrocyte maturation Aims: CLN8 deficiency underlies one of a group of devastating childhood neurodegenerative disorders, the neuronal ceroid lipofuscinoses. The function of the CLN8 protein is currently unknown, but a role in lipid metabolism has been proposed. In human CLN8 diseased brains, alterations in lipid composition have been detected. To further investigate the connection of CLN8 to lipid metabolism, we characterized the lipid composition of early symptomatic Cln8‐deficient mouse (Cln8^mnd) brains. Methods: For lipid profiling, Cln8^mnd cerebral cortical tissue was analysed by liquid chromatography/mass spectrometry. Galactolipid synthesis was measured through enzyme activity and real‐time mRNA expression analyses. Based on the findings, myelination and white matter integrity were studied by immunohistochemistry, stereological methods, electron microscopy and magnetic resonance imaging. The development of myelin‐forming oligodendrocytes was also studied in vitro. Results: Sphingolipid profiling showed a selective reduction in myelin‐enriched galactolipids. The mRNA expression and activity of UDP‐galactose:ceramide galactosyltransferase (CGT), the key enzyme in the galactolipid synthesis, was reduced in the Cln8^mnd brain. Expression of oligodendrocyte markers suggests a maturation defect. The amount of myelin was reduced in 1‐month‐old Cln8^mnd mice, but reached normal levels by 5 months of age. The level of Cln8 gene expression followed the developmental pattern of myelin formation and was high in primary oligodendrocytes. Conclusions: Taken together, these observations suggest that galactolipid deficiency and delayed myelin maturation characterize the early CLN8 disease pathogenesis through a maturation defect of oligodendrocytes.