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PURPOSE: To identify causes of balance impairment in children undergoing treatment for cancer and childhood cancer survivors. METHODS: A systematic search was performed according to PRISMA guidelines. Studies were included if participants were 0-19 years of age with a current/past diagnosis of cancer, an objective balance measure was reported, and a cause of balance impairment was either stated or implied. RESULTS: The 64 full text studies included identified balance impairments as sequelae secondary to CNS tumors, and/or as an effect of medical treatment including chemotherapy, radiation, and/or surgery. Cancer treatment can result in damage to the visual, vestibular and/or somatosensory systems which in turn can contribute to balance dysfunction. CONCLUSIONS: Balance impairments were caused by the cancer itself or the result of medical treatment. Oncology professionals are integral in recognition and treatment of factors affecting balance impairments in childhood cancer; however, further research is needed to identify interventions targeting specific causes of balance impairment.

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BACKGROUND: Compared to other health professions, physiotherapy is a relatively new profession in Malawi and the United States, yet in both countries, past colonialism has influenced current physiotherapy education and research. The authors of this article are from Malawi and the United States, and they worked collaboratively to explore the impact of colonialization on physiotherapy education and research in their respective locations, and to discuss the similarities and contextual differences. Decolonializing physiotherapy education and research must begin by identifying how colonialization currently manifests within the profession. PURPOSE: The purpose of this article is to spark discussion about colonialization in physiotherapy education and research. DISCUSSION: Although decolonialization literature specific to physiotherapy is limited, the literature gathered about physiotherapy and other health professions prompted generative discussion and reflection among the authors. These discussions and reflections led to student-driven recommendations that are outlined in this article and could be included in the decolonialization efforts in physiotherapy. CONCLUSION: We propose that reflecting on how colonialism has influenced physiotherapy education and research could lead to international collaborations that support decolonialization in physiotherapy.

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The COVID-19 pandemic has negatively impacted the health of people from communities of color and people of limited socioeconomic means in a disproportionate way due to social determinants of health (SDoH). The Centers for Disease Control defines SDoH as the "conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes." A related construct, social determinants of learning (SDoL), includes contextual conditions and variables that impact students' ability to optimally participate in their education, including academic and clinical development. SDoL directly impact students' ability to participate in the educational process. During the COVID-19 pandemic, students struggling with SDoH and, by extension SDoL, may be more likely to have sick family members, caregiving responsibilities, food and housing insecurity, and obligations to supplement lost family wages. SDoL are also influenced by individual experiences within and outside of the classroom. Beyond bringing this matter to the attention of our profession, especially clinical and academic educators, we must take action to reach and support students who are at higher academic risk due to the SDoL. The purpose of this paper is to (1) define SDoL, (2) explain how SDoL are impacting doctor of physical therapy and physical therapist assistant students, and (3) discuss actions that physical therapists and physical therapist assistants can take to mitigate the effects of SDoL on current doctor of physical therapy and physical therapist assistant students. IMPACT: This Perspective is one of the first explorations of how SDoL affect physical therapy students during the pandemic and provides concrete suggestions on how educators in both academic and clinical settings can help students succeed when they are negatively affected by SDoL.

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Intrauterine spinal cord infarcts (IUSCI) with resulting tetraplegia are extremely rare, and there is minimal evidence describing outcomes in this population. This case describes the functional progress of a 3-year-old girl born with IUSCI who participated in activity-based therapies (ABT). Children have developing nervous systems and are particularly suited to benefit from ABT. Over the course of treatment, the child in this case has demonstrated improvements in developmental milestone achievement including fine and gross motor skills and social/cognitive development. Intense, interdisciplinary ABT should be considered for the treatment of children with IUSCI.

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BACKGROUND: There is a lack of evidence regarding the psychosocial characteristics of individuals with spinal cord injury (SCI) undergoing activity-based restorative therapy (ABRT) treatment. OBJECTIVES: This study seeks to describe the hopefulness of a sample of ABRT participants and describe the relationship between hopefulness and level of rehabilitation engagement. METHODS: A prospective cross-sectional cohort study was conducted using a convenience sample of 73 individuals with SCI (mean time since injury = 66.6 months) seeking out-patient, post-acute rehabilitation at a metropolitan ABRT center. Outcome measures included a demographic survey, The Hope Scale, the Patient Health Questionare-9 and the Hopkins Rehabilitation Engagement Rating Scale. RESULTS: The ABRT group reported higher levels of hope (M = 54.78, SD = 7.13) than have been reported in a sample of individuals with SCI seeking traditional rehabilitation in the acute (M = 24.58, SD = 4.06) setting. Rehabilitation engagement was not related to hopefulness in the ABRT group. CONCLUSIONS: The ABRT group demonstrated high levels of hopefulness. The difference in hopefulness noted between this group and previous studies could be due to the time elapsed since injury, the presence of choice in the rehabilitation process, or the possibility that individuals who chose to participate in ABRT may have inherently different hopefulness characteristics than the broader SCI population.

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CONTEXT: patients with spinal cord injury (SCI) have many factors that are associated with pressure ulcer formation, including paralysis, loss of sensation, poor nutrition, anemia, and skin maceration related to incontinence. Treatment of these ulcers involves relieving pressure, improving nutrition and skin hygiene, treating infections, removing necrotic tissues, and applying the appropriate dressings. However, some cases are not responsive to the above treatment. Electrical stimulation (ES) is thought to enhance soft tissue healing through promotion of protein synthesis, inhibition of bacterial growth, facilitation of epithelial tissue migration, improvement of blood flow, and tensile strength. This data is mainly based on evidence from animal studies and very few rigorously controlled studies conducted in humans. OBJECTIVE: To demonstrate the effectiveness of ES in the treatment of recalcitrant pressure ulcers. METHODS: Retrospective case series describing the care of adults with SCI and recalcitrant pressure ulcers. ES was applied directly into the wound bed: 60 minutes per session, 3-5 times per week; with an intensity of 100 milliamperes and a frequency of 100 pulses per second. Polarity was negative initially and was switched weekly. The amplitude and wave form were maintained throughout. RESULTS: The long-standing (11-14 months) pressure ulcers were completely healed after 7 to 22 weeks of treatment with high-voltage ES. CONCLUSION/CLINICAL RELEVANCE: This case series demonstrates the effectiveness of ES for enhanced healing of Stage III-IV ulcers otherwise unresponsive to standard wound care. Further study is needed to identify the most effective protocol for ES therapy in the treatment of recalcitrant pressure ulcers.

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