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Pediatric Physical Therapy:
doi: 10.1097/PEP.0b013e318250141d
Abstracts

Abstracts From the Dutch Society for Pediatric Physical Therapy

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INTRODUCTION

The Dutch Association for Pediatric Physical Therapy (NVFK) is proud to share Pediatric Physical Therapy with the Pediatric Section of the American Physical Therapy Association as the NVFK's journal for more than a year now. To use the noneditorial pages of the journal, the NVFK made a communication plan which covers 2 issues per year for selected posters of our bi-annual scientific meetings and 2 issues with selected abstracts from research that was performed for the master thesis of the Master of Applied Science in Pediatric Physical Therapy (PPT) by Dutch students. With this initiative the NVFK will achieve 2 goals. First, we offer Dutch scientists and the most talented of the Dutch students an international platform to present their preliminary work to an international readership, and second, the pages serve as a showcase for the quality and research directions of the Dutch Masters for Applied Science in PPT and the level of pediatric physical therapy in the Netherlands.

On this occasion I would like, as the president of the NVFK, to introduce the Dutch Association of Pediatric Physical Therapy briefly. The NVFK services almost 1100 members, while 1500 pediatric physical therapists are currently certified to practice as pediatric physical therapists in the Netherlands (population: 16 million). The Royal Dutch Association of Physical Therapy administers certification after a successful 3 years' part-time Master of Applied Science in PPT. Since 1984 the Dutch system for Higher Education has provided a 3 years' part-time comprehensive program for pediatric physical therapy that has evolved into a Master of Applied Science with a study weight of 95 European Credits (1 European Credit = 28 hours). Currently the physical therapy entry level is at the bachelor of science degree level; this will change to a master of science level in the coming 5 years.

As the president of the NVFK, I'm confident that the readers of Pediatric Physical Therapy will appreciate the contribution of their Dutch colleagues and I hope this will be a further step in sharing knowledge and collaboration in the field of pediatric physical therapy.

Janjaap van der Net, PhD, PT, PCS

President of NVFK

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ABSTRACTS

BOT2 AND BEERY VMI, DO THEY MEASURE THE SAME CONCEPT?
Sandra Luten, MPT, PCS; Physical therapists' practice ‘De Kinderpraktijk' Meppel/Ruinerwold, The Netherlands Manon Bloemen, MSc, PCS; Lecturer Master Physical Therapy, Pediatric Physical Therapy program, University of Applied Sciences Utrecht, the Netherlands Ida Bosga-Stork, MRes, PCS; Lecturer Master Physical Therapy, Pediatric Physical Therapy program, University of Applied Sciences Utrecht, the Netherlands

SETTING OF THE STUDY: To enhance the process of clinical reasoning pediatric physical therapists have a wide selection of tests available that may be used for diagnostic purposes, e.g. to detect problems in visual-motor and fine motor integration in school aged children. For reasons of efficacy and effectiveness, choices must be made between available assessment batteries. The Bruininks-Oseretsky Test of Motor Proficiency, 2nd ed. (BOT2) and the Beery-Buktenica Developmental Test of Visual-Motor Integration, 5th ed. (Beery VMI) have specific areas in common. Both instruments measure overlapping general aspects of visual-motor and fine motor integration. The BOT2 contains the subtest Fine Motor Integration (FMI) and corresponds with the Beery VMI. Both instruments also contain items in which controlled finger- and hand movements are required, for the BOT2 the subtest Fine Motor Precision (FMP), for the Beery VMI the supplemental test Motor Coordination (MC). The FMP and MC share ‘connecting dots'-items, whereas the FMP adds ‘coloring', ‘cutting' and ‘folding'-items. The administration of the two subtests of the BOT2 and the Beery VMI including the supplemental test MC is equally time consuming, though by using the FMI and FMP (BOT2) a wider pallet of skills can be observed and measured. From this summary it is not clear if the subtests of the BOT2 and the Beery VMI (including the supplemental test MC) measure the same concept. A better understanding of the relationship between the scores derived from both tests might direct the pediatric physical therapists' choices for testing visual-motor and fine motor integration. This study was part of a thesis dissertation from the pediatric physical therapy Master's program at the University of Applied Sciences Utrecht.

PURPOSE: The aim of this study was to determine in a clinical sample whether the specific subtests of the BOT2 and the Beery VMI and its supplemental test of MC, share the same concept. For this purpose we compared the subtest FMI of the BOT2 with the Beery VMI and the FMP of the BOT2 with the supplemental test of MC.

METHODS: Twenty-two third and fourth graders (13 boys, 9 girls; mean age 7,6 years; range 6,4 to 9,1 years) from a variety of elementary schools, which were referred to a pediatric physical therapy practice, were included. Reason for referral was a suspected delay of their fine motor abilities. Children with known co-morbidities were excluded from this study. The BOT2 and the Beery VMI were administrated within a time span of one week. Following the scoring system of the tests, the raw scores were converted in standard deviations, which were categorized in three groups: average, below average and well below average. Kendall's tau-b coefficient was used to determine the correlation between FMI and Beery VMI and between FMP and MC.

RESULTS: There was a moderate relationship between the FMI and the Beery VMI (r = .40, p = .05) and between the FMP and the MC (r = .54, p = .01).

CONCLUSIONS: Based on the strength of the correlation, the subtests of the BOT2 (FMI and FMP) do not seem to measure the same concept as the Beery VMI (including its supplemental test of MC). The BOT2-FMP has the advantage of a larger number of motor tasks and therefore might be of added value alongside the Beery VMI and its supplemental test of MC. Further studies are necessary to understand the differences between the concepts of both tests.

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COMPARISON OF THE MOVEMENT-ABC 2 NL AND THE BSID-III MOTOR SCALE SCORE IN 36 TO 42 MONTHS OLD CHILDREN
C Veltman, MPT, PCS, Physical Therapy Practice Boekestein, Lisse, the Netherlands R van Empelen PhD, MA, PCS, Child Development and Exercise Center, Division of Pediatrics, University Children's Hospital and Medical Center Utrecht, Utrecht University, the Netherlands J Nuysink, MSc, PCS, Head Pediatric Physical Therapy program, Master Physical Therapy, University of Applied Sciences Utrecht, the Netherlands

PURPOSE: With the arrival of the Movement Assessment Battery for children 2 (M-ABC 2 NL, Dutch version) and the third edition of the Bayley Scales of Infant and Toddler Development (BSID-III), there are now two instruments available for measuring motor performance in children between the ages of 3 and 3½ years. This study examined the level of agreement between the M-ABC 2 NL and the BSID-III in this population. This study was part of a thesis dissertation from the pediatric physical therapy Master's program at the University of Applied Sciences Utrecht.

METHODS: Ten children with no confirmed pathological conditions underwent both motor assessments. The BSID III fine motor subtest results were compared with the standard scores for manual dexterity from the M-ABC 2 NL. The total percentile scores and clinical classifications from both tests were also compared. Statistical significance was set at p ≤ 0.05. Level of agreement between the tests was assessed using a Bland-Altman plot and Cohen's Kappa (κ).

RESULTS: The mean difference between the BSID III fine motor subtest standard score and the M-ABC 2 NL manual dexterity component score was 1.3 (95% limits of agreements [LOA]: 0.34–2.26). Clinical classification on these subscales demonstrated moderate agreement (κ = 0.54; p = 0.013). More specifically, in 7/10 children the clinical classification for this scale was similar. Of the remaining three children, two were classified as significantly delayed using the M-ABC 2, and mildly delayed on the BSID III; and one child was classified mildly delayed on the M-ABC 2, but within normal limits on the BSID III. The mean difference between the total percentile scores on both tests was 5.79 (95% LOA: −2.91–11.87), with the M-ABC 2 percentile being lower than that of the BSID III. The measurement of agreement in overall clinical classification between the total scores was moderate (κ = 0.42; p = 0.034). Within the group overall clinical classification was similar in six children, while two children were classified as significantly delayed on the M-ABC 2, but mildly delayed on the BSID III; one child was classified as significantly delayed on the M-ABC 2, and within normal limits on the BSID III. When the cut-off points for both tests were changed to similar values, the κ increased, but remained within the moderate agreement range (κ = 0.55; p = 0.010).

CONCLUSION: There was a moderate level of agreement between the scores reported from the M-ABC 2 and the BSID III for the fine motor and manual dexterity subscales, as well as total percentile scores. This was evidenced by a mean difference of more than 10%, wherein the M-ABC 2 scores tended to be lower than those of the BSID III. With respect to classification, agreement between the tests was moderate; however, more children were classified as being significantly delayed when using the M-ABC 2. Given de small sample size, the results of this study ought to be interpreted with care.

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MOTOR ABILITIES OF CHILDREN WITH CLUBFEET AT PRIMARY SCHOOL: PERFORMANCE ON THE SIX MINUTES WALKING TEST
Lohle-Akkersdijk J.J. MPPT,*1,2, Rameckers E.A.A. PPT PhD1,3,4, Andriesse H. PT PhD5, Reus de I. MPPT1, Erve van R.H.G.P. MD PhD7

1Master in Pediatric Physical Therapy, AVANS+, Breda, The Netherlands

2Private Practice, Fysiode, Deventer, The Netherlands

3Adelante, Rehabilitation Centre, Valkenburg, The Netherlands

4Rehabilitation Medicine, University Maastricht, The Netherlands

5Department of Orthopedics, University Hospital of Lund, Sweden

6Department of Orthopedics, Beter Lopen Medisch, Deventer, The Netherlands

PURPOSE: In this cross sectional study the performance of children with uni-, and bilateral clubfeet on the 6 Minute Walking Test (6MWT) was investigated. The outcome of the 6MWT was correlated with the functional status of the foot, measured with the Clubfoot Assessment Protocol (CAP)1,2 and its uni- or bilateral presence.

NUMBER OF SUBJECTS: 44 Healthy children with either conservative - or surgical corrected clubfeet, between four and 12 years old, participated. Mean age 8.57 years, SD +/− 2.45, 28 males and 16 females. Twenty-eight children were bilateral affected, 16 - unilateral. Excluded were children with any co-morbidity, that could influence the outcome of the test, like cardiopulmonary diseases or Down syndrome.

MATERIALS/METHOD: The height and weight of the children were measured. Age and gender were indicated as well as clubfoot presentation (uni-, or bi-lateral). Walking distance was measured with the 6 MWT, whereby children were asked to walk six minutes over a distance of 10 m up and down. The functional status of the foot was measured with the CAP on different variables indicated in percentage: Passive joint mobility (seven items), muscle function (two-), morphology (four-) and functional activities (six -). A total outcome of 75% was considered to be good in case of bilateral - and of 88% in case of a unilateral clubfoot. The outcome of the 6MWT was compared with the outcome of children without clubfeet, using the predicted 6MWT equations of Geiger et al.3 The Mann-Whitney Rank Sum test (U) was used to check the difference in outcome between children with unilateral-, and bilateral clubfeet. The correlation between the 6MWT and the CAP (total score and on the different sub-items) was calculated with the Spearmans Rho (rs). The statistical significance level was set at p< .05. SPSS18.0 was used to analyze data.

RESULT: More than 75% of the subjects showed “good” correction according to the CAP on all subtest', apart from the subtest “muscle function”. Mean distance walked was 79% of the reference equations of Geiger (Mean:484 m, SD = +/− 72,1) with no difference between children with uni-, and bilateral clubfeet (Mdn:475, U = 218.00, p = .884). A significant fair correlation (Portney and Watkins) was found between the 6MWT and the CAP on sub-test morphology (rs = .327, p = .030) and activities (rs = .307, p = .043).

CONCLUSIONS: From this study one may conclude that children with clubfeet are able to perform a 6MWT, that children with clubfeet show a mild limitation on the 6MWT distance. And, that there is no statistical difference between children with unilateral- and bilateral clubfeet. There is a correlation between performance on the 6MWT and the items morphology and activities of the CAP.

CLINICAL RELEVANCE: This study aims to provide information for evidence based advice to parents and (their) children with clubfeet on their expectations regarding daily activities and sport. The 6MWT may be used in future research to evaluate interventions or for goal setting in clinical practice.

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THE CONCURRENT VALIDITY OF THE TEST OF INFANT MOTOR PERFORMANCE (TIMP) AND THE HAMMERSMITH NEONATAL NEUROLOGICAL EXAMINATION (DUBOWITZ) IN DUTCH CHILDREN BORN PREMATURE <33WEEKS GA OR DYSMATURE <2000GRAMS, EXAMINED AT 40 WEEKS GA
Dam van M1, MPPT, Seuren M2, MPPT, Rameckers E2,3,4, PhD PT.

1Maxima Medisch Centrum Physical Therapy/Paramax Veldhoven, The Netherlands

2Avans+, Master of Pediatric Physical Therapy, Breda, The Netherlands

3Adelante, Rehabilitation Centre for Children, Valkenburg, The Netherlands

4Department of Rehabilitation Medicine, University Maastricht, The Netherlands

PURPOSE: The aim of this study is to examine concurrent validity between the TIMP and the Dubowitz in premature or dysmature born infants tested at 40 weeks GA. The Timp is an instrument to assess postural and selective motor control needed for functional performance in daily life during early infancy (32 weeks GA until 4 months PT). The Dubowitz is a neuromotor examination useable from 32–40 weeks GA, consisting 34 items, grouped in 6 categories; tone, tone patterns, reflexes, movements, abnormal signs and behavior.

METHOD: Subjects were 21 infants, born premature <33weeks (mean age 311) or dysmature <2000grams (mean weight 1509g) at Maxima Medisch Centrum Veldhoven (NL). Infants were examined at 40 weeks GA with both the TIMP and the Dubowitz. Non-parametric correlation (Spearman's rho) was used to assess the relation between the TIMP and the Dubowitz.

RESULTS: A significant correlation between the TIMP and the Dubowitz is found (rs = .86, p<0,01). Sensitivity 100% (95%CI: .21–1.00), Specificity 90% (95%CI: .70-.97)

CONCLUSIONS: The TIMP shows good concurrent validity to the Dubowitz to assess motor development in premature or dysmature born infants at 40 weeks GA. The TIMP is recommended as motor developmental test for preterm or dysmature born infants. It covers an age range where the Dubowitz examination is not suitable anymore, and the Alberta Infant Motor Scale is not yet appropriate. So the TIMP can have added value to complete the range of tests for early detection of delayed neuromotor development or developmental disorders in early infancy. Using the Dubowitz at 40 weeks, a ceiling effect is visible in test-results.

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COLLABORATION BETWEEN PEDIATRIC PHYSICAL THERAPISTS AND THE CENTER FOR YOUTH AND HEALTH
H.E. Jansen MPPT1,2, A. Eisink-Weg MPPT2,3

1Franciscus Ziekenhuis Roosendaal, Roosendaal, the Netherlands

2Master of Specialised Physical Therapy, Avansplus, Breda, the Netherlands

3Private practice Onder de Linden, Lochem, the Netherlands

BACKGROUND: In the Netherlands, Centers for Youth and Health (CYH) are a novel initiative in the primary care system to support, advice and when necessary provide integrative healthcare for children in the age of -9 months to 23 years and their parents and/or caregivers. Currently pediatric physical therapists (PPTs) have to cooperate with Child Care and Youth Health providers, social workers and others on an independent level. However, the in initiative of CYH provides new opportunities to engage in formal arrangements such as a ‘covenant for collaboration'. The Dutch association for Pediatric Physical Therapy (NVFK) currently develops a guide that supports Dutch pediatric physical therapists in entering a formal collaboration with the CYH.

PURPOSE: An inventory of facilitating and impeding determinants that influence a formal collaboration between PPT's and CYH.

METHODS: A survey was conducted amongst PPTs working in the primary healthcare sector and coordinators from the CYH. Out of the 739 PPTs approached, 112 did respond (15%). Out of the 250 branches of the CYH that were approached, 23 did respond (9%). Responses were analyzed in a quantitative manner.

RESULTS: From the PPTs 32% already work together with the CYH, but only 1% under a formal covenant. The PPTs (92%) and the CYH (74%) want and see the need for a ‘covenant for collaboration' with formal arrangements. The most mentioned important arrangements are: - ‘bilateral agreement about target groups', - ‘increase of preventive healthcare programs', -'multidisciplinary case conferences', - ‘exchange of information material', - ‘access to “referred” youth healthcare', - ‘develop an overview of registered PPTs in the community', - ‘access for the PPTs to the “social map” of the CYH', - ‘opportunity for consultation' and - ‘agreement about indication and reporting'. ‘Time investment' and ‘financial compensation' are impeding determinants for the PPTs. An impeding factor for the CYH is their ‘knowledge' about the expertise of the PPTs, 57% is poorly informed about the expertise of PPT's. Individual PPTs and individual CYH experience different determinants as facilitating or impeding. For them it is important to accommodate the collaboration on individual needs. It is important that colleagues contribute to the implementation of the collaboration.

CONCLUSION: This research shows that CYH are organized different in each community, modified to the local needs. That also there is a strong internal awareness of the possible benefits of a formal collaboration between the professions that interact in a CYH. Recommendations are: - to structurally inform the coordinators of CYH about the capabilities of PPt's and - to search for more financial resources to sufficiently reimburse PPT's that work in collaboration with CYH. The NVFK guide for collaboration should focus on the above findings to facilitate formal collaboration between PPT's and CYH.

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MOTOR CAPACITY AND PERFORMANCE IN CHILDREN WITH DEVELOPMENTAL COORDINATION DISORDER
RM Alsemgeest, MPT, PPT Physical Therapy Practice ‘Maatschap Fysiotherapie Dollardlaan', Den Helder, the Netherlands I Bosga-Stork, MRes, PPT; Lecturer Master Physical Therapy, Pediatric Physical Therapy program, University of Applied Sciences Utrecht, the Netherlands M Bloemen, MSc, PPT; Lecturer Master Physical Therapy, Pediatric Physical Therapy program, University of Applied Sciences Utrecht, the Netherlands

SETTING OF THIS STUDY: Participation has become an important topic in paediatric physical therapy. Children with Developmental Coordination Disorder (DCD), have an increased risk of limited participation in everyday activities. For children, participation is vital for normal development since experience and peer contact provide autonomy and give room to a self-supporting adulthood. The Movement Assessment Battery for Children 2 (M-ABC 2, Dutch version), measures several motor activities. It is a test reflecting motor capacity and identifies children with movement difficulties. The Children's Assessment of Participation and Enjoyment (CAPE) is a questionnaire-based assessment that measures several dimensions of participation including intensity. It reflects actual performance in daily life. An important goal during physical therapy is improving motor capacity, so it is interesting to know if improvement in capacity transfers to performance. This study was part of a thesis dissertation from the pediatric physical therapy Master's program at the University of Applied Sciences Utrecht.

PURPOSE: To determine the relation between motor capacity (M-ABC 2) and performance (CAPE) in children with DCD.

METHODS: Inclusion criteria were elementary school children (6 – 12 years), diagnosed with DCD (DSM-IV criteria), from a private practice paediatric physical therapy. Excluded were children with a known co-morbidity. At first - and second contact the M-ABC 2 and CAPE were administered by the author (RA). Following the scoring system of the M-ABC2 the total raw score was converted in percentile scores and was used as a measure of motor capacity. Participation intensity of the CAPE was calculated as prescribed by the scoring system and used as the measures of overall performance. The same procedure was followed for physical activities and skill-based activities. The Spearman's rank correlation coefficient (rs) was used to determine the correlation between motor capacity and performance. A correlation of > 0.75 was interpreted as a strong correlation, > 0.50 and < 0.75 as a moderate correlation and < 0.50 as a weak correlation. Significance was set at p < 0.05.

RESULTS: Ten children were included, (9–12 years, eight male, four female). No relationships were found between the total score of the M-ABC 2 and the overall intensity score of the CAPE (rs = 0.02, p = 0.96) nor for the total score of the M-ABC 2 and the intensity score of physical activities (rs = .03, p = 0.93) and skill-based participation (rs = −.12, p = 0.73).

CONCLUSION: Motor capacity was not related to performance in children with DCD. If the therapeutic goal in children with DCD is to improve participation, an intervention focussed on improving motor capacity seems not sufficient.

© 2012 Lippincott Williams & Wilkins, Inc.

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