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Full-Text Articles in Medicine and Health Sciences

Sensory Integrative Occupation-Based Programming For Therapeutic Horseback Riding (Thr) Summer Camp, Rebecca Mccarron-Coggin May 2023

Sensory Integrative Occupation-Based Programming For Therapeutic Horseback Riding (Thr) Summer Camp, Rebecca Mccarron-Coggin

Occupational Therapy Doctoral Capstones

Create facility implementable sensory-inclusive summer camp programming to increase occupational performance in Trinity Farm therapeutic riding summer camp participants.


Development Of Life Skills Training Modules For Adolescents With Intellectual And Developmental Disabilities, Nicole Jones May 2023

Development Of Life Skills Training Modules For Adolescents With Intellectual And Developmental Disabilities, Nicole Jones

Occupational Therapy Doctoral Capstones

The purpose of the capstone project was to develop occupation-based life skills training modules to increase self-efficacy, self-advocacy, role competency, and well-being of transition-age youth to promote better outcomes throughout the transition process into adulthood. The life skills training modules were developed at diverse learning levels and implemented at Camp BOLD to meet the needs of adolescents with intellectual and developmental disabilities.


Physical Function Across The Lifespan In Adults With Multiple Sclerosis: An Application Of The Short Physical Performance Battery, Brenda Jeng, Petra Šilić, Rachel E. Bollaert, Brian M. Sandroff, Robert W. Motl May 2023

Physical Function Across The Lifespan In Adults With Multiple Sclerosis: An Application Of The Short Physical Performance Battery, Brenda Jeng, Petra Šilić, Rachel E. Bollaert, Brian M. Sandroff, Robert W. Motl

Exercise Science Faculty Research and Publications

Background

Multiple sclerosis (MS) typically has its onset in early and middle adulthood, but the population is steadily becoming more dominated by older adults. One of the primary consequences of both MS and aging involves declines of lower extremity physical function and mobility. This cross-sectional study compared physical function status based on Short Physical Performance Battery (SPPB) summary and component scores between persons with MS and healthy controls across 6 age groups. We further examined associations between SPPB summary scores and component scores as well as associations between summary scores and measures of physical and cognitive function for identifying the …


Sex Differences In The Speed–Duration Relationship Of Elite Runners Across The Lifespan, Timothy J. Fulton, Christopher W. Sundberg, Blaine E. Arney, Sandra K. Hunter May 2023

Sex Differences In The Speed–Duration Relationship Of Elite Runners Across The Lifespan, Timothy J. Fulton, Christopher W. Sundberg, Blaine E. Arney, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Purpose

To determine if the speed–duration relationship is altered with age and sex of elite Master’s runners.

Methods

The world’s top 10 performances for men and women in three events (800, 1500, and 5000 m) across six age groups (18–34 yr, 40–49 yr, 50–59 yr, 60–69 yr, 70–79 yr, and 80–89 yr) were analyzed from public data to establish theoretical models of the speed–duration relationship. Critical speed (CS) and the curvature constant (D′) were estimated by fitting the average speeds and performance times with a two-parameter hyperbolic model.

Results

Critical speed expressed relative to the 18- to 34-yr-olds, …


Development Of A Novel Predictive Model And Prosthetic System To Assess Dynamic Leg Length Based Gait Biomechanics In Lower Limb Prosthesis Users, Therese Parr May 2023

Development Of A Novel Predictive Model And Prosthetic System To Assess Dynamic Leg Length Based Gait Biomechanics In Lower Limb Prosthesis Users, Therese Parr

All Dissertations

Individuals with transfemoral amputation often rely on a prosthesis as a replacement for their missing extremity’s structure and function. Lower-limb prosthetic devices are developed with the goal of restoring biomechanical abilities and mitigating secondary health risks for users. However, biomechanical deficits for unilateral transfemoral prosthesis users are very common and are induced by both leg length discrepancy (LLD) and current prosthetic design shortcomings. Lack of push off power as well as difficulty shortening the leg for toe clearance can result in gait compensations that lead to asymmetric limb loading, increased muscle activity, and an increased incidence of falling due to …


Exploring 5-Minute Heart Rate Variability In Spinal Cord Injury During Acute Inpatient Rehabilitation, Argyrios Stampas, Colton Malesovas, Michael Burke, Sahira Farooq, Mani Singh, Radha Korupolu, Sheng Li May 2023

Exploring 5-Minute Heart Rate Variability In Spinal Cord Injury During Acute Inpatient Rehabilitation, Argyrios Stampas, Colton Malesovas, Michael Burke, Sahira Farooq, Mani Singh, Radha Korupolu, Sheng Li

Faculty, Staff and Student Publications

To explore the use of 5-minute heart rate variability (HRV) during inpatient rehabilitation in the acute phase of traumatic spinal cord injury (SCI). Longitudinal observational study. Acute inpatient rehabilitation (AIR). 10 patients with acute traumatic SCI. 5-minute HRV supine recordings twice daily on three different days per patient. HRV values were evaluated (1) within a single day (Early versus Late); (2) across the inpatient admission (initial, mid, and discharge); (3) by SCI phenotypes and by clinical outcomes (ex. pressure injuries (PI)). Patients had an average age of 38 years, 80% male, and 40% with tetraplegia. There were no HRV differences …


Exploring 5-Minute Heart Rate Variability In Spinal Cord Injury During Acute Inpatient Rehabilitation, Argyrios Stampas, Colton Malesovas, Michael Burke, Sahira Farooq, Mani Singh, Radha Korupolu, Sheng Li May 2023

Exploring 5-Minute Heart Rate Variability In Spinal Cord Injury During Acute Inpatient Rehabilitation, Argyrios Stampas, Colton Malesovas, Michael Burke, Sahira Farooq, Mani Singh, Radha Korupolu, Sheng Li

Faculty, Staff and Student Publications

To explore the use of 5-minute heart rate variability (HRV) during inpatient rehabilitation in the acute phase of traumatic spinal cord injury (SCI). Longitudinal observational study. Acute inpatient rehabilitation (AIR). 10 patients with acute traumatic SCI. 5-minute HRV supine recordings twice daily on three different days per patient. HRV values were evaluated (1) within a single day (Early versus Late); (2) across the inpatient admission (initial, mid, and discharge); (3) by SCI phenotypes and by clinical outcomes (ex. pressure injuries (PI)). Patients had an average age of 38 years, 80% male, and 40% with tetraplegia. There were no HRV differences …


An Ergonomic Approach For Esport Athletes: The Potential For Less Injury And Increased Occupational Performance, Nicholas Nalic Pierides Jr. May 2023

An Ergonomic Approach For Esport Athletes: The Potential For Less Injury And Increased Occupational Performance, Nicholas Nalic Pierides Jr.

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of developing the case study was to determine the satisfaction of implementing an ergonomic protocol tailored to esport athletes in addition to tracking improvements in performance through KovaaK’s tracking trainer while reducing the risk of repetitive strain injuries. Occupational therapists are trained to assess individuals with a holistic lens while treating the deficits that prevent them from living a meaningful life. Occupational therapists advise ergonomically correct positioning for their clients to decrease the risk of injury and to optimize the person’s performance. There is a need for an ergonomic protocol tailored to esport athletes because of the increase …


Mental Health Education Protocol For Staff Members In An Inpatient Rehabilitation Center, Charles Nicholas Salvatera May 2023

Mental Health Education Protocol For Staff Members In An Inpatient Rehabilitation Center, Charles Nicholas Salvatera

UNLV Theses, Dissertations, Professional Papers, and Capstones

Mental health illnesses have a significant impact on the lives of individuals and society. Despite the availability of effective treatments, many people with psychosocial issues or cognitive impairments do not receive the right care. This highlights the importance of timely care and effective help-seeking opportunities. Increased mental health literacy and supportive behaviors in the social networks of people with mental health disorders can be achieved by providing hospital staff with education on mental health disorders. It is believed that improvements in these areas increase the likelihood that people will seek effective assistance. When healthcare providers are educated about mental health …


Association Between Rural Background And Physical Therapist Practice Location, Caitlin Parker, Jace-Anne Sharp May 2023

Association Between Rural Background And Physical Therapist Practice Location, Caitlin Parker, Jace-Anne Sharp

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis To examine the association between physical therapists’ rural background and their decision to practice in a rural setting. We hypothesized that years of rural upbringing and size of hometown would be related to rural practice. Number of Subjects 257 physical therapists who graduated from one of two physical therapy programs in the Western United States between 2000 and 2020. Materials and Methods A survey was emailed to 19 physical therapy schools consisting of questions regarding participants’ background, demographics, and job history. We collected total number of years of practice and total years of rural practice. Length of practice varied, …


Creating A University-Based Performing Arts Clinic: Challenges And Lessons, Carissa Limtiaco, Alan Savanapridi May 2023

Creating A University-Based Performing Arts Clinic: Challenges And Lessons, Carissa Limtiaco, Alan Savanapridi

UNLV Theses, Dissertations, Professional Papers, and Capstones

Fine artists performing at the collegiate level are at a high risk for developing performance related musculoskeletal injuries due to the unique physical demands and repetitive nature of their movements. Previous research has reported incidence rates as high as 81% and 62% for student dancers and musicians respectively. Despite the high injury rates, research has shown that student performers underreport injuries and are reluctant to seek medical management from health professionals due to unhealthy beliefs and attitudes often held by this population as well as the lack of specialized healthcare. The goal of the UNLV College of Fine Arts (CFA) …


Effects Of A 12-Week Remote Exercise Program On Balance In Adults With Down Syndrome, Kayla Kotake, Sherwin Cadiao, Nicole Kaes, Jayston Prudencio May 2023

Effects Of A 12-Week Remote Exercise Program On Balance In Adults With Down Syndrome, Kayla Kotake, Sherwin Cadiao, Nicole Kaes, Jayston Prudencio

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis Individuals with Down syndrome (Ds) tend to have deficits in balance and postural control, which negatively affects their ability to perform physical activities safely and independently. Previous research has shown that exercise can improve balance in people with Ds, however, most studies looked at balance in children with Ds. As the average life expectancy for people with Ds has increased, there is a need for research investigating balance in adults with Ds. Also, there is a need to increase exercise opportunities (eg, remote exercise programs) for adults with Ds, as physical inactivity and sedentary behavior are prevalent among individuals …


The Development Of A Pilot Program Related To The Application Of High-Intensity In Occupational Therapy, Philip Lamoreaux May 2023

The Development Of A Pilot Program Related To The Application Of High-Intensity In Occupational Therapy, Philip Lamoreaux

UNLV Theses, Dissertations, Professional Papers, and Capstones

Among the many diagnoses affecting an individual’s ability to participate in occupation, strokes are among the most common (Tsao et al., 2022). With the decrease in mortality rates by 35.8% due to advancements in medicine (Wolf & Nilsen, 2015), there is a need to remediate, adapt, or modify the life-changing impairments associated with stroke. The most significant evidence for motor learning, which is associated with regaining function, is in relation to high-intensity training in the context of ambulation (Middleton et al., 2015; Moore et al., 2020). By utilizing the neural plastic principles of repetition, salience, task-specificity, and intensity, an individual …


New-R Intervention For Clients With Severe Mental Illness And Obesity: Grant Writing For Implementation Funds Supporting Occupational Therapy Interventions, Kaitlyn Hoffman May 2023

New-R Intervention For Clients With Severe Mental Illness And Obesity: Grant Writing For Implementation Funds Supporting Occupational Therapy Interventions, Kaitlyn Hoffman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Increasing numbers of people suffer from obesity and severe mental illness co-morbidly. If these conditions remain untreated, they can harm an individual's health and well-being. Unfortunately, there are very few programs currently available that target both management and improvement of these conditions simultaneously. Even so, despite the lack of programming options, it must be noted that the NEW-R program strives to reach those goals, although there hasn't been an abundance of literature supporting the effectiveness of this program. This poses a concern for occupational therapy practitioners who hope to assist their clients in managing these conditions as occupational therapy treatments …


Cortical Effects Of Wrist Tendon Vibration During An Arm Tracking Task In Chronic Stroke Survivors: An Eeg Study, Dylan B. Snyder, Scott A. Beardsley, Allison S. Hyngstrom, Brian D. Schmit May 2023

Cortical Effects Of Wrist Tendon Vibration During An Arm Tracking Task In Chronic Stroke Survivors: An Eeg Study, Dylan B. Snyder, Scott A. Beardsley, Allison S. Hyngstrom, Brian D. Schmit

Biomedical Engineering Faculty Research and Publications

The purpose of this study was to characterize changes in cortical activity and connectivity in stroke survivors when vibration is applied to the wrist flexor tendons during a visuomotor tracking task. Data were collected from 10 chronic stroke participants and 10 neurologically-intact controls while tracking a target through a figure-8 pattern in the horizontal plane. Electroencephalography (EEG) was used to measure cortical activity (beta band desynchronization) and connectivity (beta band task-based coherence) with movement kinematics and performance error also being recorded during the task. All participants came into our lab on two separate days and performed three blocks (16 trials …


Development Of A Multifactorial Virtual Fall Prevention Tool For Community Dwelling Older Women, Eduardo Gutierrez, Jacob James Nogra, Carol Sparks, Bradley Voels May 2023

Development Of A Multifactorial Virtual Fall Prevention Tool For Community Dwelling Older Women, Eduardo Gutierrez, Jacob James Nogra, Carol Sparks, Bradley Voels

UNLV Theses, Dissertations, Professional Papers, and Capstones

Falls are the leading causes of injury-related death in adults over the age of 65, with women sustaining more than twice the rate of fall-related fractures as men. Reduced access to in-person falls prevention programs during the COVID-19 pandemic created a need for a user-friendly guide to existing online fall prevention resources targeted at this vulnerable population. The first aim of this study was to create and make widely available a website with evidence-based resources that address a range of modifiable fall risk factors, and the second was to test its feasibility in a convenience sample of older women. The …


Analyzing Equity Within The University Of Nevada, Las Vegas Physical Therapy Program Admissions Process, Rebecca Altman, Savanna Cathey, Michelle Dedmon May 2023

Analyzing Equity Within The University Of Nevada, Las Vegas Physical Therapy Program Admissions Process, Rebecca Altman, Savanna Cathey, Michelle Dedmon

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose The purpose of this study was to analyze the admissions process of the University of Nevada Las Vegas Physical Therapy (UNLVPT) program through the lens of racial equity. Methods A retrospective cohort of UNLVPT applicants between 2014-2019 was obtained from the physical therapy centralized admissions system and the UNLVPT admissions office. Applicant and application characteristics were compared by racial group. Results: Our sample included 2937 total applicants with 212 (7.2%) that were admitted and matriculated into the program. Applicants identified as 49% White, 24% Asian, 13% multiracial, 6% Hispanic, 2% Black, 0.2% American Indian, and 6% did not report …


Promoting The Benefits Of An Occupational Therapy Health And Wellness Coaching Program For Adults Living With Chronic Illnesses And Their Self-Management, Natasha Findley May 2023

Promoting The Benefits Of An Occupational Therapy Health And Wellness Coaching Program For Adults Living With Chronic Illnesses And Their Self-Management, Natasha Findley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Improved health-related outcomes for individuals 18 years or older living with a chronic condition or multiple chronic conditions can be positively impacted by health and wellness coaching. The primary purpose of this capstone project was to develop a community-based health and wellness coaching program with an occupational therapy-based approach to empower and motivate individuals in discovering their strategies, make healthier choices, and be accountable for their self-management (medication adherence, physical activity, sleep hygiene, healthy eating, stress management, and pain management). According to the American Occupational Therapy Association (2015), occupational therapy focuses on promoting health and wellness by enabling clients to …


Driving And Community Mobility: An Online Educational Program For Generalist Occupational Therapy Practitioners, Gerard Blanco May 2023

Driving And Community Mobility: An Online Educational Program For Generalist Occupational Therapy Practitioners, Gerard Blanco

UNLV Theses, Dissertations, Professional Papers, and Capstones

Driving is an important daily activity that often goes unnoticed, yet it enables individuals to engage in crucial tasks such as grocery shopping, going to work, and participating in social activities. Occupational therapy (OT) practitioners must recognize and address the significance of driving in their daily routines to promote clients' independence and fulfillment. However, despite being well-equipped to assist clients with driving-related issues, many practitioners avoid or neglect this area of occupation. A reluctance to addressing driving and community mobility (DCM) can arise from a lack of confidence, available resources, support, or fear of losing a client's trust. These barriers …


Occupational Therapy Fieldwork In An Emerging Justice-Based Setting: Hope For Prisoners, Noah Claypool May 2023

Occupational Therapy Fieldwork In An Emerging Justice-Based Setting: Hope For Prisoners, Noah Claypool

UNLV Theses, Dissertations, Professional Papers, and Capstones

This capstone occurred through a partnership with HOPE for Prisoners in Las Vegas, Nevada. As an emerging area of practice, the occupational therapy profession needs more resources and programs focused on the justice system. The lack of evidence-based resources to support future level I fieldwork students at HOPE for Prisoners poses a barrier for students to maximize their fieldwork experience and effectively engage with the organization’s population of incarcerated and formerly incarcerated men, women, and young adults in southern Nevada.This capstone experience involved a 14-week immersion at HOPE for Prisoners, including participation in training and workshops and engagement with clients, …


Ergonomic Education For Entry-Level Administrative Staff, Mitzi De La Cruz-Garcia May 2023

Ergonomic Education For Entry-Level Administrative Staff, Mitzi De La Cruz-Garcia

UNLV Theses, Dissertations, Professional Papers, and Capstones

In the United States, 2.6 million work-related musculoskeletal disorders (WMSDs) were reported in 2020, which are costly to employers, individuals, and our healthcare system. The most commonly affected workers are entry-level staff, who often do not receive training or education on office ergonomics during their onboarding process. Evidence exists on the benefits of ergonomics for workers, but there is a gap in disseminating information to these individuals. In addition, what is available on the internet can be of low quality, not based on evidence, and written at a higher-than-average reading level.There is a need for easily accessible ergonomic education and …


Feasibility Of The Every Moment Counts Initiative At A Southern Nevada Elementary School, Amber Lee Eddy May 2023

Feasibility Of The Every Moment Counts Initiative At A Southern Nevada Elementary School, Amber Lee Eddy

UNLV Theses, Dissertations, Professional Papers, and Capstones

Over the past 20 years, multiple legislative acts have been passed mandating support and services for the mental health needs of children and youth in schools; however, Nevada continues to rank last for the provision of such services. Children and youth who are mentally healthy are more likely to be successful in their homes, schools, and communities (Arbesman et al., 2013). Those who have increased mental health needs are more at risk for developmental and long-term consequences that jeopardize overall health and wellness, not to mention the immense effects that the COVID-19 pandemic has had on children and youth. With …


The Impact Of An Ostomy Training Workshop On Occupational Therapy Practitioners’ And Students’ Confidence In Client Education On Ostomy Management, Amanda Rae Shizue Shimabukuro May 2023

The Impact Of An Ostomy Training Workshop On Occupational Therapy Practitioners’ And Students’ Confidence In Client Education On Ostomy Management, Amanda Rae Shizue Shimabukuro

UNLV Theses, Dissertations, Professional Papers, and Capstones

The objective of this quality improvement study was to assess if an ostomy training workshop with a hands-on component would impact the confidence of occupational therapy practitioners and students in client education on ostomy management. The hypothesis is that the training workshop would improve the confidence of occupational therapy practitioners and students in client education on ostomy management. Participants were occupational therapists, occupational therapy assistants, or occupational therapy students in Henderson, Nevada; North Las Vegas, Nevada; or Las Vegas, Nevada. The study utilized a time-series design with a preand post-workshop survey that included a sample size of 30. Occupational therapy …


The Importance Of An Educational Occupation-Based Work Program For Young Adults With Intellectual & Developmental Disabilities, Jennifer Zielinski May 2023

The Importance Of An Educational Occupation-Based Work Program For Young Adults With Intellectual & Developmental Disabilities, Jennifer Zielinski

UNLV Theses, Dissertations, Professional Papers, and Capstones

Barriers to occupations and transitions to vocational opportunities can be difficult for adolescents and young adults with intellectual and developmental disabilities (I/DD)s to feel confident and pursue job opportunities. Some of the problems stem from the stigma related to the individual’s disability, the contexts surrounding them, and the performance of the work tasks expected. Individuals with I/DDs expressed that not having enough support in the community and the workforce creates significant obstacles to retaining a job. Occupational therapists (OT)s can play a unique role in transition and employment for individuals with an I/DD. With a focus on self-determination and successful …


A Proof Of Concept For Detection Of Palato-Lingual Contact Without Intraoral Electrodes In A Human Participant, Amitava Biswas May 2023

A Proof Of Concept For Detection Of Palato-Lingual Contact Without Intraoral Electrodes In A Human Participant, Amitava Biswas

Master's Theses

The author of this thesis conceived and investigated an unexpected electrical signal that may not be noticed during regular electroglottography (EGG) when electrodes are conventionally placed on the anterior surface of the throat. It appears that there is a measurable electrical signal from the EGG equipment when electrodes are placed over the frontal cheek (belly of zygomatic muscle), and the tongue is elevated to contact the hard palate, or the tongue is lowered to break the contact. Therefore, this phenomenon is designated as unconventional electroglottography (UEGG, Dr. Steven Cloud, private communication, July 17, 2022).

Two distinctive patterns of waveforms were …


Meeting, Moving, Mastering - A Text Analysis Of The Aesthetic Attractions Of 'Wild Swimming', Dagmar Dahl, Åsa I. Bäckström Apr 2023

Meeting, Moving, Mastering - A Text Analysis Of The Aesthetic Attractions Of 'Wild Swimming', Dagmar Dahl, Åsa I. Bäckström

International Journal of Aquatic Research and Education

Why are people fascinated by swimming in nature? This article addresses the aesthetic experiences of wild swimming as expressed by five wild swimming authors in their books. Drawing from aesthetic philosophy, we analyze the ways in which the appeal of wild swimming is described on three levels: the allure of water in the environment, the sensory encounter between water and the body, and the experience of moving in water. Furthermore, with reference to Seel’s concept of nature aesthetics (1996), the experience of wild swimming is analyzed in terms of contemplation, correspondence, and imagination. We can conclude that the special intensity …


In This Issue (14:1), Stephen J. Langendorfer Ph.D. Apr 2023

In This Issue (14:1), Stephen J. Langendorfer Ph.D.

International Journal of Aquatic Research and Education

In This Issue 14:1 introduces and overviews the research and education articles and position statement associated with the first issue of the fourteenth volume of the International Journal of Aquatic Research and Education.


Alzheimer's Dementia And Occupational Therapy, Sofia Demusaj, Averee Ortiz, Laura Swanson Apr 2023

Alzheimer's Dementia And Occupational Therapy, Sofia Demusaj, Averee Ortiz, Laura Swanson

Client Educational Handouts

This handout is an introduction to Alzheimer's dementia and the role that occupational therapy can have in the treatment of the disease. It contains facts, figures, signs, and symptoms of Alzheimer's dementia. It also contains examples of occupational therapy interventions and assessments for clients with Alzheimer's disease.


Aquatics For Individuals With Disabilities: An Analysis Of Publication Trends, Susan J. Grosse Apr 2023

Aquatics For Individuals With Disabilities: An Analysis Of Publication Trends, Susan J. Grosse

International Journal of Aquatic Research and Education

This study investigates the published literature in the field of aquatics with disabilities; more specifically, it examines literature published during the most recent two decades, 2000 through 2019. Considerations include the content focus of published articles relating to aquatics with disabilities, distribution of articles over the specified time period, publication opportunities for authors, barriers as well as enhancements to development of literature in the field, and summary recommendations.


Which Stroke Next? All Strokes Next! Part Two: Strokes For Intermediate And Advanced Swimmers, Robert Keig Stallman, Ebbe L. Horneman, Nils O. Vikander, Alexander Mwaipasi, Bente W. H. Laakso, Haakon - Paavo L. Nysted, Toni Ongala Apr 2023

Which Stroke Next? All Strokes Next! Part Two: Strokes For Intermediate And Advanced Swimmers, Robert Keig Stallman, Ebbe L. Horneman, Nils O. Vikander, Alexander Mwaipasi, Bente W. H. Laakso, Haakon - Paavo L. Nysted, Toni Ongala

International Journal of Aquatic Research and Education

The primary goal of this two-part project is to answer the rhetorical question of which strokes should be taught first, and which later (Langendorfer, 2013, Stallman, 2014a). As you have seen in Part One, we emphasize (as have many others) the need for a firm foundation before any stroke is introduced. When the learner is ready for propulsive motor competencies, there is no stroke which suits all as their first. In Part One we explored the “beginning strokes” all of which are candidates for any given learner’s first stroke. We also argued that after mastering their very first stroke the …