Pediatric Physical Therapy:
Section Information: Abstracts of Platform and Poster Presentations for the 2005 Combined Sections Meeting: Poster Presentations
Physical Therapy, Wichita State University, Wichita, KS, USA (Wondra)
Rainbows United Inc., Wichita, KS, USA (Pitetti)
PURPOSE/HYPOTHESIS: Pitetti & Wondra (2003) reported improvements in gross motor skills in 25 children with gross motor delays when tested initially and following 2 months of wearing a minimum controlled dynamic foot orthotic (PattiBob, Cascade, Inc). In this study (Pitetti & Wondra, 2003), gross motor skills were evaluated using the Peabody Developmental Motor Scales Test-2 (PDMS-2). Whether or not these improvements or gains in gross motor skills were sustained in these children who continued to wear the PattiBob (PB) was not analyzed. The purpose of this study was to report the PDMS-2 motor age-equivalent scores at 4-months for 18 and at 12-month for 8 of the original 25-children.
NUMBER OF SUBJECTS: Eighteen children (age = 45.3 + 11.8 mo; 2 Down syndrome [DS], 2 Cerebral Palsy [CP], 14 Developmental Delayed [DD], z scores = -1.50 + .97) were evaluated upon initial fitting.
MATERIALS/METHODS: The PB is (a) a shoe insert consisting of a thin layer of plastic on the bottom of dense foam (aliplast-like material) contoured and shaped to fit the plantar surface of the foot, (b) is constructed of low density polyethylene (LDPE), (c) is flexible at the toe, semi-flexible at the arch, and rigid around the heel, and (d) features include an arch support, a metatarsal head depression, heel cup, and toe rise for toes two through five.Initial evaluations consisted of one evaluation without the PB inserts, and a retest following 7 days of wearing the PB. For the 18 children, evaluations were repeated at two months and four months post-initial evaluation. Eight of these children (age = 38.8 + 11.0 mo; 1 DS, 1 CP, 6 DD; z scores = -1.75 + .56) were evaluated 12 months post-initial evaluation. Raw scores from the locomotion section of the gross motor scales of the PDMS-2 from each evaluation were converted into an age-equivalent score (in months). Gains (in months) from initial age-equivalent scores before fitting (i.e. without PB) were followed.
RESULTS: For the initial evaluations, there was a significant (P < 0.05) increase in age-equivalent scores following 7 days of wearing the PB (without PB = 24.6 + 8.1 mo, with PB 25.7 + 8.9 months) with a mean gain of 1.22 mo. Mean gains from initial age-equivalent scores without PB of 4.5 + 4.0 months and 4.7 + 2.9 months were seen at 2 months and 4 months, respectively. For the eight children who were evaluated at 12 months, mean gains from initial age-equivalent scores without PB were 8.0 + 2.6 mo.
CONCLUSIONS: The limitations of this study that prevent definitive Conclusions include (a) the small number of participants, (b) no controls; and (c) differences in disabilities. However, this study represents the first attempt to report outcomes (i.e. measured improvements in gross motor skills) for children with gross motor delays who wear orthotics similar to the PB.
CLINICAL RELEVANCE: The results of this study and that of Pitetti & Wondra (1993) suggest that othotics similar to the PB does improve the gross motor skills of children with gross motor delays.