"Are we there yet?" expectations and experiences with lower limb robotic exoskeletons: a qualitative evaluation of the therapist perspective

PURPOSE

Lower limb robotic exoskeletons can assist movement, however, clinical uptake in neurorehabilitation is limited. The views and experiences of clinicians are pivotal to the successful clinical implementation of emerging technologies. This study investigates therapist perspectives of the clinical use and future role of this technology in neurorehabilitation.

METHODS

Australian and New Zealand-based therapists with lower limb exoskeleton experience were recruited to complete an online survey and semi-structured interview. Survey data were transposed into tables and interviews transcribed verbatim. Qualitative data collection and analysis were guided by qualitative content analysis and interview data were thematically analysed.

RESULTS

Five participants revealed that the use of exoskeletons to deliver therapy involves the interplay of human elements - experiences and perspectives of use, and mechanical elements - the device itself. Two overarching themes emerged: the "journey", with subthemes of clinical reasoning and user experience; and the "vehicle" with design features and cost as subthemes, to explore the question "Are we there yet?"

CONCLUSION

Therapists expressed positive and negative perspectives from their experiences with exoskeletons, giving suggestions for design features, marketing input, and cost to enhance future use. Therapists are optimistic that this journey will see lower limb exoskeletons integral to rehabilitation service delivery.

An exploration of factors influencing physiotherapists' involvement in student clinical education

BACKGROUND

The demand for physiotherapy student clinical placements is increasing in many countries, including Australia, and there is continued reliance on physiotherapists to assume the student clinical educator role. Exploring factors influencing physiotherapists' decision to be involved in clinical education is essential to maintaining and building clinical education capacity for the future.

OBJECTIVE

To explore factors influencing Australian physiotherapists' decision to be involved in student clinical education.

METHODS

A qualitative study using data collected from a valid and reliable online survey tool. Respondents were physiotherapists representing public and private workplaces across varied geographical settings in Australia. Data were thematically analyzed.

RESULTS

Surveys were completed by 170 physiotherapists. Most respondents were employed in hospital (81/170, 48%) and private (53/170, 31%) settings in metropolitan locations (105/170, 62%). Six themes representing factors influencing physiotherapists' involvement in student clinical education were identified, including perceptions of: professional duty, personal benefits or gains, suitability of workplace, support requirements, role related challenges, and readiness to be a clinical educator.

CONCLUSION

Many factors influence physiotherapists' decisions to assume the clinical educator role. This study could assist clinical education stakeholders to provide practical and targeted strategies to overcome challenges, and optimize support, for physiotherapists in the clinical educator role.

The lived experience of receiving services as a National Disability Insurance Scheme participant in a rural area: Challenges of choice and control

OBJECTIVE

To explore the lived experience of people with a physical disability residing in a rural area and receiving services under the NDIS.

SETTING

Rural areas of New South Wales classified as Modified Monash Categories 3-7.

PARTICIPANTS

Semistructured interviews were conducted with seven purposively sampled participants who self-identified as having a physical disability, were receiving NDIS funding and lived in a rural area of NSW.

DESIGN

Data collection and analysis were guided by hermeneutic phenomenology.

FINDINGS

We interpreted three interrelated themes; Uncertainty of Access, Battling Bureaucracy and Improving Relationships and Independence. The themes articulate the essence of this phenomenon, Challenges to choice and control.

DISCUSSION

The findings of this study suggest that while people with a physical disability living in rural NSW acknowledged positive changes to their everyday lives through the NDIS, there remains a sense of confusion, frustration and disconnection with the system. Burdensome, inconsistent and untimely communication with NDIS staff caused uncertainty with the process and required negotiation to resolve issues such as delays in funding, essential services or equipment modifications. The essence of Challenges to choice and control articulates what the person had to negotiate within their lifeworld. Further guidance and clarity for people with disabilities to access the NDIS system would ensure confidence to navigate the system and receive the essential supports they need.

Lived experience of parents and carers of people receiving services in rural areas under the National Disability Insurance Scheme

OBJECTIVE

The purpose of this study was to investigate the lived experience of parenting or caring for a person with a disability receiving services under the National Disability Insurance Scheme in rural Australia.

DESIGN

Qualitative study guided by the phenomenology of practice.

SETTING

Rural areas of New South Wales (MM 3-7).

PARTICIPANTS

Participants were 5 parents and one carer of people receiving National Disability Insurance Scheme services who resided in rural New South Wales.

DESIGN

Participants engaged in a semi-structured interview about their lived experiences caring for someone accessing services under the National Disability Insurance Scheme in rural New South Wales. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

RESULTS

Three themes emerged from the data analysis. 'More than a disability' described the absence of understanding of family and carer challenges when National Disability Insurance Scheme plans were designed and implemented. 'Fighting for funding and services' described that while the National Disability Insurance Scheme increased funding support, parents and carers experienced limited support navigating the National Disability Insurance Scheme. 'Cold as Ice' encompassed parents' and carers' descriptions of their relationship with National Disability Insurance Scheme staff. These challenges were further impacted by the limited choice and availability of health service providers in rural areas.

CONCLUSION

Participants felt that the National Disability Insurance Scheme had created additional stress and confusion in their lives and at times had hindered the achievement of the goals of their family member with a disability. The voices of parents and carers is a critical one, and it is essential that rural parents' and carers' needs are considered and supported in future planning of the National Disability Insurance Scheme.

Rationale and protocol for the Nursing and Allied Health Graduate Outcomes Tracking (NAHGOT) study: a large-scale longitudinal investigation of graduate practice destinations

INTRODUCTION

Inequitable distribution of health workforce limits access to healthcare services and contributes to adverse health outcomes. WHO recommends tracking health professionals from their points of entry into university and over their careers for the purpose of workforce development and planning. Previous research has focused on medical students and graduates' choice of practice location. Few studies have targeted nursing and allied health graduates' practice intentions and destinations. The Nursing and Allied Health Graduate Outcomes Tracking (NAHGOT) study is investigating factors affecting Australian nursing and allied health students and graduates' choice of graduate practice location over the course of their studies and up to 10 years after graduation by linking multiple data sources, including routinely collected university administrative and professional placement data, surveys of students and graduates, and professional registration data.

METHODS

By using a prospective cohort study design, each year a new cohort of about 2000 students at each participating university (Deakin University, Monash University and the University of Newcastle) is tracked throughout their courses and for 10 years after graduation. Disciplines include medical radiation practice, nursing and midwifery, occupational therapy, optometry, paramedicine, pharmacy, physiotherapy, podiatry and psychology. University enrolment data are collected at admission and professional placement data are collected annually. Students' practice destination intentions are collected via questions added into the national Student Experience Survey (SES). Data pertaining to graduates' practice destination, intentions and factors influencing choice of practice location are collected in the first and third years after graduation via questions added to the Australian Graduate Outcomes Survey (GOS). Additionally, participants may volunteer to receive a NAHGOT survey in the second and fourth-to-tenth years after graduation. Principal place of practice data are accessed via the Australian Health Practitioner Regulation Agency (Ahpra) annually. Linked data are aggregated and analysed to test hypotheses comparing associations between multiple variables and graduate practice location.

RESULTS

This study seeks to add to the limited empirical evidence about factors that lead to rural practice in the nursing and allied health professions. This prospective large-scale, comprehensive study tracks participants from eight different health professions across three universities through their pre-registration education and into their postgraduate careers, an approach not previously reported in Australia. To achieve this, the NAHGOT study links data drawn from university enrolment and professional placement data, the SES, the GOS, online NAHGOT graduate surveys, and Ahpra data. The prospective cohort study design enables the use of both comparative analysis and hypothesis testing. The flexible and inclusive study design is intended to enable other universities, as well as those allied health professions not regulated by Ahpra, to join the study over time.

CONCLUSION

The study demonstrates how the systematic, institutional tracking and research approach advocated by the WHO can be applied to the nursing and allied health workforce in Australia. It is expected that this large-scale, longitudinal, multifactorial, multicentre study will help inform future nursing and allied health university admission, graduate pathways and health workforce planning. Furthermore, the project could be expanded to explore health workforce attrition and thereby influence health workforce planning overall.

Delivering introductory physiotherapy clinical placements incorporating simulated learning experiences in rural settings

OBJECTIVE

To investigate the delivery, in rural settings, of introductory physiotherapy clinical placements incorporating simulation and describe the impact of these placements on the uptake of longer-term rural immersion opportunities.

DESIGN

Retrospective cohort design.

SETTING

The University of Newcastle and the University of Newcastle Department of Rural Health (UONDRH), New South Wales, Australia.

PARTICIPANTS

Data from undergraduate physiotherapy students were included.

INTERVENTION

Second-year University of Newcastle physiotherapy students undertake an introductory placement which includes one week of simulated learning followed by a two-week traditional health care placement. Supervisor training and active promotion of placements were undertaken to increase the capacity of rural sites to deliver these placements, including both simulation and immersion components.

MAIN OUTCOME MEASURE(S)

Data relating to numbers of students undertaking introductory placements and final-year rural immersion experiences in the UONDRH between 2012 and 2020 were described. A simple review of the placement strategy was also undertaken.

RESULTS

Introductory placements incorporating simulation were successfully implemented in the UONDRH settings and have continued annually. Physiotherapy staff in the UONDRH have been upskilled and have supported local clinicians to increase their supervisory capacity. The proportion of students undertaking introductory placements supported by the UONDRH has increased considerably as has the number of students completing full-year rural immersion experiences in the UONDRH.

CONCLUSIONS

Delivering introductory physiotherapy placements incorporating simulation in rural settings was feasible and this strategy leads to increased placement capacity. Early rural clinical placement opportunities can increase students' uptake of longer-term rural immersion experiences which, in turn, can positively influence rural practice intentions.

Destinations of nursing and allied health graduates from two Australian universities: A data linkage study to inform rural placement models

OBJECTIVE

Combined, nursing and allied health constitute most of the Australian health workforce; yet, little is known about graduate practice destinations. University Departments of Rural Health have collaborated on the Nursing and Allied Health Graduate Outcomes Tracking to investigate graduate entry into rural practice.

DESIGN

Data linkage cohort study.

SETTING

Monash University and the University of Newcastle.

PARTICIPANTS

Graduates who completed their degree in 2017 across seven disciplines.

MAIN OUTCOME MEASURE(S)

The outcome variable was Australian Health Practitioner Regulation Agency principal place of practice data. Explanatory variables included discipline, age, gender, location of origin, and number and duration of rural placements.

RESULT

Of 1130 graduates, 51% were nurses, 81% females, 62% under 21 years at enrolment, 23% of rural origin, 62% had at least one rural student placement, and 23% had over 40 cumulative rural placement days. At the time of their second Australian Health Practitioner Regulation Agency registration, 18% worked in a 'Rural principal place of practice.' Compared to urban, rural origin graduates had 4.45 times higher odds ratio of 'Rural principal place of practice.' For graduates who had <20 cumulative rural placement days, compared to zero the odds ratio of 'Rural principal place of practice' was the same (odds ratio = 1.10). For those who had 20-40 rural placement days, the odds ratio was 1.93, and for >40 rural placement days, the odds ratio was 4.54).

CONCLUSION

Rural origin and more rural placement days positively influenced graduate rural practice destinations. Outcomes of cumulative placements days may compare to immersive placements.

Profile and rural exposure for nursing and allied health students at two Australian Universities: A retrospective cohort study

Objective

Linking enrolment and professional placement data for students' from 2 universities, this study compares characteristics across universities and health disciplines. The study explores associations between students' location of origin and frequency, duration and type of placements.

Design

Retrospective cohort data linkage.

Setting

Two Australian universities, Monash University and the University of Newcastle.

Participants

Students who completed medical radiation science, nursing, occupational therapy, pharmacy or physiotherapy at either university between 2 February 2017 and 28 February 2018.

Interventions

Location of origin, university and discipline of enrolment.

Main outcome measure(s)

Main measures were whether graduates had multiple rural placements, number of rural placements and cumulative rural placement days. Location of origin, discipline and university of enrolment were the main explanatory variables. Secondary dependent variables were age, sex, socio‐economic indices for location of origin, and available placements.

Results

A total of 1,315 students were included, of which 22.1% were of rural origin. The odds of rural origin students undertaking a rural placement was more than 4.5 times greater than for urban origin students. A higher proportion of rural origin students had multiple rural placement (56.0% vs 14.9%), with a higher mean number of rural placement days. Public hospitals were the most common placement type, with fewer in primary care, mental health or aged care.

Conclusions

There is a positive association between rural origin and rural placements in nursing and allied health. To help strengthen recruitment and retention of graduates this association could be further exploited, while being inclusive of non‐rural students

Exploring the Lived Experience of Parenting a Child with Developmental Dysplasia of the Hip

Aim: Parenting a child with a health issue such as hip dysplasia (DDH) can be complicated and stressful. We aimed to explore in depth, the lived experience of parenting a child with DDH.Methods: Guided by phenomenology of practice, six mothers and one father of children with DDH were engaged in semi-structured interviews about their parenting experiences. Data were audio-recorded, transcribed verbatim and analyzed thematically.Results: Two themes emerged. Surrendering the parenting prerogative, which described participants' accounts of losing parenting autonomy while needing to rely on others to meet the needs of their child. The second theme; Struggling to adjust day-to-day, described the impact that DDH had on parenting and how participants struggled daily to meet the needs of their child.Conclusion: The management of DDH impacted both the emotional and practical aspects of parenting. Health professionals are ideally placed to support the parenting of children with DDH, but need to understand the parents' particular needs to provide this support empathetically.

Powerless facing the wave of change: the lived experience of providing services in rural areas under the National Disability Insurance Scheme

INTRODUCTION

Australia's National Disability Insurance Scheme (NDIS) is the catalyst for a significant shift in the delivery of disability services to people with a disability and their families, including those residing in rural and remote parts of Australia. Allied health services in rural areas of Australia are often limited, existing services are characterised as being of a generalist nature and demand for services often exceeds service capacity. This shift in the delivery of disability services with the rollout of NDIS could have a poignant impact on the rurally based allied health providers delivering these services. The aim of this study was to explore in depth the experiences of providing clinical services under the NDIS in a rural area.

METHODS

Accessing the publicly available NDIS register, the authors purposively sampled service providers delivering services in rural or remote areas of the state of New South Wales (NSW). Participants consented by email to participate in a semi-structured interview during which they were asked about their lived experience providing services under the NDIS in rural NSW. Data collection and analysis were guided by phenomenology of practice. Interviews were audio-recorded and transcribed verbatim, and data were then thematically analysed.

RESULTS

Eight service providers were interviewed, representing the disciplines of occupational therapy, nutrition and dietetics, speech pathology and physiotherapy. The locations of their service delivery varied across a range of rural and remote areas of NSW. Data analysis yielded three themes: (1) 'Beyond my depth', which described service providers' limited influence on the funding process their clients were now required to navigate as participants of the NDIS; (2) 'A sea of uncertainty', which described the inconsistencies demonstrated by the NDIS and its impact on service providers; and (3) 'Drowning in the wave', which described increases in service demand and changes to case mix as experienced by service providers. Additionally, the essence of providing services within the NDIS in a rural area was identified as 'Powerless facing the wave of change'.

CONCLUSION

These findings offer insights into the particular challenges for rural clinicians in providing services under the NDIS. While there is improved funding support for people with a disability, this places additional pressure on rural clinicians who are already likely to be working at or beyond their workload capacity. Issues with recruitment and retention of new clinicians into rural and remote areas appear to be ongoing, which was identified as compounding the impact of the NDIS on existing service providers. Supporting the rural and remote workforce appears critical to avoid de-registration of existing NDIS service providers.

Immersive placement experiences promote rural intent in allied health students of urban and rural origin

Introduction

Pre-vocational placement experiences are known to considerably influence the career preferences of health graduates and are a key factor in growing the rural allied health workforce. This paper explores the rural placement experiences and future work intentions of students who attended a placement with the University of Newcastle Department of Rural Health.

Methods

Part of a larger longitudinal mixed methods study of students’ placement experiences and subsequent career choices, this study explored students’ placement evaluations responses. Following each placement, students were invited to complete an online survey which asked about their placement experiences and future work intentions. Counts and proportion tests were performed for frequencies of quantitative variables. Wilcoxon signed rank tests were conducted on the paired pre- and post-rural intent scores to determine any perceived differences in intent before and after placement for students both with and without a rural background. Qualitative data from short answer questions were analyzed thematically guided by qualitative content analysis. Data were comparatively analyzed for students of a rural or urban background.

Results

Four hundred and forty end of placement surveys were completed by 275 students (response rate 69.8%). There was a positive shift in intention to work rurally for students of both rural and urban background post-placement, but this was only statistically significant in the group from an urban background (p≤0.001). From the qualitative analysis three themes emerged: immersed rural supported placement experience, immersed interaction in rural life with other students, and immersed interaction in the rural community. Students from both rural and urban backgrounds indicated similar benefits and challenges.

Conclusion

While the positive impact of rural placement experiences and rural background on future rural practice is well known, this study highlights the importance of positive supported placement experience for students from both rural and urban backgrounds.

Garment Therapy does not Improve Function in Children with Cerebral Palsy: A Systematic Review

AIMS

To conduct a systematic review asking, does garment therapy improve motor function in children with cerebral palsy?

METHODS

A systematic review with meta-analysis was conducted to review the literature. Inclusion criteria involved the wearing of therapy suits/garments in children with cerebral palsy. The primary outcome of interest was movement related function and secondary outcomes included impairment, participation, parental satisfaction and adverse outcomes of garment wear.

RESULTS

14 studies with 234 participants were included, of which 5 studies were included for meta-analysis. Garment therapy showed a nonsignificant effect on post-intervention function as measured by the Gross Motor Function Measure when compared to controls (MD = -1.9; 95% CI = -6.84, 3.05). Nonsignificant improvements in function were seen long-term (MD = -3.13; 95% CI = -7.57, 1.31). Garment therapy showed a significant improvement in proximal kinematics (MD = -5.02; 95% CI = -7.28, -2.76), however significant improvements were not demonstrated in distal kinematics (MD = -0.79; 95% CI = -3.08, 1.49).

CONCLUSIONS

This review suggests garment therapy does not improve function in children with cerebral palsy. While garment therapy was shown to improve proximal stability, this benefit must be considered functionally and consider difficulties associated with garment use.

Surviving, not thriving: a qualitative analysis of parents' perceptions of physical activity participation for rurally residing children with a disability

INTRODUCTION

Preliminary research suggests that rurally residing children with a disability seldom participate in the recommended 60 minutes of moderate-to-vigorous physical activity per day and face multiple barriers to participation. The purpose of this study was to explore parents' perceptions of physical activity participation of rurally residing children with a disability, including barriers and any factors that may facilitate their participation.

METHODS

Participants were parents or carers of a school-aged child with a disability residing in a rural or remote area of the state of New South Wales, Australia. Data were collected using semi-structured focus group interviews, which were audio-recorded and transcribed. Qualitative data were analysed inductively using qualitative content analysis.

RESULTS

Focus group interviews were conducted with 10 parents. Thematic analysis yielded the overarching description of the study, surviving, not thriving, which described the participants' limited success in augmenting the health of their child with a disability, despite their desire to do so. Within this description, three main themes emerged. (1) A parent's predicament described the parents' struggle to support their child's participation in physical activity, despite understanding its numerous benefits. (2) Barriers to participation described the various barriers to physical activity participation that were perceived to be hampering their child's potential to thrive. Some of these barriers were related to the child's disability, while others were specific to the rural context. (3) Facilitators to participation described the factors that served to motivate and enable children with a disability to participate in physical activity.

CONCLUSIONS

This investigation of parents' perceptions suggests that the physical activity participation of rurally residing children with a disability is currently insufficient to adequately support the health of this population. It appears service providers need to address the factors that impede participation, including issues surrounding access, ability and isolation, but should also support the parents' behaviours, community opportunities and the child's own drive to participate. Existing support structures aimed at promoting physical activity should be enhanced and more inclusive, and accessible strategies should be developed.

Physical activity of rurally residing children with a disability: A survey of parents and carers

BACKGROUND

Children residing in rural areas face unique barriers to physical activity participation. Further, while children with a disability who reside in metropolitan areas face barriers hindering physical activity, rurally residing children with a disability may face the augmented combination of these barriers that could have negative health implications. Parents are often the key advocates for children with disabilities and are likely to have valuable insight into the opportunities and barriers to physical activity for their child.

OBJECTIVE

The aim of this study was to investigate parents' perceptions of physical activity opportunities for their child with a disability in a rural area.

METHODS

A mixed method survey examining parent's perceptions of their child's physical activity and possible barriers to participation was mailed to rurally residing parents of children with a disability. Quantitative data were analyzed descriptively using frequencies and proportions. Qualitative data were analyzed using qualitative content analysis.

RESULTS

There were 34 completed surveys, a response rate of 37%. Participants' responses indicated 74% of children were not meeting daily recommendations of physical activity. Participation barriers including emotional, physical and environmental issues. Three main themes emerged from qualitative data; segregation, access to facilities and resources and barriers specific to the child.

CONCLUSION

The children in this study were from rural areas and face similar barriers to children in metropolitan areas. However, they are also confronted with the same barriers children without a disability in rural areas face, participating in physical activity. This may have detrimental effects on their health and development.

Longitudinal Tracking of Workplace Outcomes for Undergraduate Allied Health Students Undertaking Placements in Rural Australia

Creating positive experiences in rural practice at the undergraduate level can influence allied health students' attitudes to working rurally. This study aimed to evaluate allied health students' experiences of their short-term, medium-term, or long-term rural placement and to follow their career outcomes.

METHODS

The study used a mixed-methods design that utilised qualitative and quantitative data. Students from six allied health degree programs undertaking placements in Tamworth and Taree were invited to participate. Participation comprised of a series of surveys and an individual in-depth semi-structured interview.

RESULTS

198 students completed 257 end-of-placement surveys as of June 2014, with 72.7% reporting an intention to work rurally after placement. Fifty-five percent (n=51) of the 92 students who had never lived in a rural area had a more favourable attitude towards working rurally following placement. After 1 year, 50% of graduates were working in a rural or remote location, compared to 23.7% of all graduates from these disciplines.

CONCLUSIONS

Preliminary findings indicated a positive perception of the rural placement experience and impact on intention to work rurally or in a rural location, particularly from those who had not previously spent time in a rural area. Future directions are to investigate longer-term workforce outcomes and the impact on the rural health workforce.

The changing landscape of physiotherapy student clinical placements: An exploration of geographical distribution and student performance across settings

OBJECTIVE

To describe the geographical distribution of physiotherapy clinical placements and investigate the relationship between geographical setting and clinical placement marks in physiotherapy students.

DESIGN

A retrospective cohort design was used for this study.

SETTING

The University of Newcastle, New South Wales.

PARTICIPANTS

Data from entry-level Bachelor of Physiotherapy student clinical placements.

MAIN OUTCOME MEASURE(S)

Data from all clinical placements in the Physiotherapy program between 2003 and 2014 were included. For all clinical placements, student assessment mark, year of study, type of placement and placement location were collected. Placement location was then classified using the Modified Monash Model (MMM) categories: one (most metropolitan) to seven (most remote).

RESULTS

Over the 12 year period of the study 3964 placements were completed. Between 2003 and 2005 the average proportion of clinical placements occurring in metropolitan areas (MMM1) was 78% and in rural areas (MMM categories 3-6) was 22%. In 2014 these proportions had changed to 59% (MMM1) and 40% (MMM3-6). There were significant differences in clinical placement grades between MMM1 and all other categories except MMM2, with lower assessment marks in MMM1 than other categories.

CONCLUSIONS

The changing distribution of physiotherapy clinical placements may be reflective of increasing student numbers and greater efforts to support students completing rural and remote placements. This change may lead to a positive effect on the rural and remote physiotherapy workforce. Further research is required to determine the specific training and support needs of students and clinical educators in rural and remote settings.

In vivo fibreoptic confocal imaging (FOCI) of the human ocular surface

Recent developments in the miniaturization of confocal imaging technology have resulted in the development of a hand-held confocal microscope probe. There are many structures of interest in the human eye that are within reach of a fluorescence-mode confocal microscope; this study assessed the feasibility of in vivo human ocular imaging. Safety analysis was undertaken to ensure that the laser light applied to the ocular surface structures constituted no threat to patient safety. A fibreoptic confocal imaging (FOCI) probe using an illumination wavelength of 488 nm was applied to the ocular surface of four volunteers after topical administration of sodium fluorescein. Stabilization of the probe on the ocular surface was difficult, but movement artefacts could be minimized to a satisfactory level in most subjects by a variety of procedures. High-quality images of conjunctival epithelial and goblet cells, lamina propria structures, accessory lacrimal glands, lacrimal ducts and superficial sclera were obtained. Lateral resolution was 1-1.5 microm and axial resolution was approximately 30 microm; individual erythrocytes could be seen in conjunctival vessels. The rete ridges and intervening epithelial components, including the probable location of corneal limbal stem cells, could be viewed, although it was not possible to distinguish cell subgroups. The study showed that fluorescence-mode imaging of the ocular surface is a viable and promising tool for assessment of diseases and processes involving superficial ocular structures. Refinement of equipment and techniques, particularly probe stabilization, is necessary to realize fully the potential of FOCI for ocular use.