Pediatric Physical Therapy:
A number of years ago, I had the good fortune to be able to travel around the United States as part of a small group of physical therapists gathering information on the body of knowledge that underpins our profession. After several meetings of a large group of faculty members, highly regarded for their knowledge of foundational and clinical sciences of physical therapy, a smaller group of individuals traveled to a series of smaller regional meetings. At these meetings, practicing clinicians provided insight into their areas of practice and the foundational knowledge that they used frequently as they examined, assessed, and established goals and intervention plans for their clients. Such opportunities to gain regional perspectives are of untold value in helping to shape our own perceptions of the profession, and they often guide our views for years to come.
Of the many diverse viewpoints expressed during those regional meetings, one repeatedly comes to mind. It was a colleague's frustration over a very basic bit of foundational knowledge that she found to be decidedly absent in many new physical therapist graduates: the knowledge and skill to obtain precise and reliable measures of patients' impairments and functional skills. I can still recall her impassioned plea for academic and clinical faculty to take seriously the need for our next generation of therapists to be trained to obtain reliable measures during their examinations and reexaminations.
One source of the problem that she lamented arose from a lack of precision in carrying out well-defined measurement techniques, such as careful use of measurement tools and proper positioning of our patients when taking standard measures, even those as common and fundamental as range of motion. I remember her concern that good decisions could not be made on the basis of sloppy measurement. Her plea had as much to do with ensuring that therapists valued reliability and precision in measurement as it did with gaining skill in obtaining the measures.
Another source of the problem was the failure of therapists to use standardized tests when they were available to them. Of course, at the time, we did not have a wide array of tests and measures available to us that address specific concerns of pediatric physical therapists. But since that time, we have witnessed an era of development of reliable and valid measures specific to our practice. Therapists now have the advantage of being able to select among tests and measures those most appropriate to the pediatric patient populations they serve.
In this issue, the development and utility of a variety of test and measures designed for use by pediatric physical therapists is a major theme. From the introduction of the SATCo (segmental assessment of trunk control) for the measurement of trunk control1 and the development of a test for children with acquired brain injury who are high functioning2 to the reports of expanded uses for the Pediatric Evaluation of Disability Inventory3 and the Alberta Infant Motor Scale,4 we are reminded of the rich array of measures that have been carefully developed to document our patients' abilities.
Yet, my colleague's plea still resonates with me. In this issue, Swiggum and colleagues5 report that therapists do not use standardized pain measures that are readily available. Gray, Ng, and Bartlett6 note that little is written about the clinical use of the Gross Motor Function Classification System. The plea for therapists to value and use precise, reliable measures in their practice seems to be as relevant today as it was back in the 1980s.
It will not be long before we will be able to enter our measures into national or international electronic databases that will allow study of the effectiveness of our interventions for specific groups of patients, and my colleague's plea will move front and center. At that point, we will have to face the problem of valuing standardized classification schemes and measures and their precise and reliable administration. And, I envision the cultural change in our practice that will result and that would make my colleague smile.
Ann F. Van Sant, PT, PhD, FAPTA
1. Butler P, Saavedra S, Sofranac M, Jarvis S, Woollacott M. Refinement, reliability, and validity of the segmental assessment of trunk control. Pediatr Phys Ther. 2010; 22(3):246–257.
2. Ibey R, Chung R, Benjamin N, et al. Development of a challenge assessment tool for high-functioning children with an acquired brain injury. Pediatr Phys Ther. 2010; 22(3):268–276.
3. Eigsti H, Chandler L, Robinson C, Bodkin A. A longitudinal study of outcome measures for children receiving early intervention services. Pediatr Phys Ther. 2010; 22(3):304–313.
4. Pin T, de Valle K, Eldridge B, Galea M. Clinimetric properties of the Alberta Infant Motor Scale in infants born preterm. Pediatr Phys Ther. 2010; 22(3):278–286.
5. Swiggum M, Hamilton ML, Gleeson P, Roddey T, Mitchell K. Pain assessment and management in children with neurological impairment: a survey of pediatric physical therapists. Pediatr Phys Ther. 2010; 22(3):330–335.
6. Gray L, Ng H, Bartlett D. The Gross Motor Function Classification System: An update on impact and clinical utility. Pediatr Phys Ther. 2010; 22(3):315–320.