Pediatric Physical Therapy:
Clinical Bottom Line
MGH Institute of Health Professions and Pediatric Neuromuscular Clinic, Massachusetts General Hospital Boston, Massachusetts
Massachusetts General Hospital Boston, Massachusetts
The authors declare no conflicts of interest.
“How should I apply this information?”
The Test of Infant Motor Performance and its shorter, screening version (the Test of Infant Motor Performance Screening Items [TIMPSI]) are valuable motor performance measures with strong psychometric properties for evaluating infants born premature through 4 months corrected age who are at high risk for poor motor performance. As physical therapists, we are uniquely positioned to bring our expertise in infant movement and postural control to a multidisciplinary pediatric health care team, supported by use of these standardized instruments. With the findings of this study, Krosschell and colleagues extend the TIMPSI use to spinal muscular atrophy (SMA) type I and provide crucial first steps in establishing the tool's use for evaluating infants diagnosed with this neuromuscular disease.
The feasibility analysis presented here suggests that with a few modifications (careful monitoring of fatigue and oxygen saturation, as-needed suctioning and rests, and eliminating 2 poorly tolerated items), the TIMPSI can be used in infants aged 0.5 to 10.5 months with SMA type I . The solid inter- and intrarater and test-retest reliability suggest that pediatric physical therapists can provide standardized administration by completing both the standard Test of Infant Motor Performance or the TIMPSI training and video-based group training specific to SMA-1.
“What should I be mindful about in applying this information?”
Continued analysis of the TIMPSI's psychometric properties is needed to further support its value in research and clinical settings. One of the most important questions for follow-up study relates to tool responsiveness, the ability to detect meaningful change over time. As new pharmacological therapies emerge for progressive neuromuscular diseases, the ability to capture and quantify disease progression and intervention effects is crucial. The National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health, supports an ongoing Common Data Element Project to help investigators and research teams collect and record standardized clinical data. As part of the Common Data Element Project, a working group of clinicians and researchers has developed recommendations for neuromuscular disease outcome measures, including SMA (see http://www.commondataelements.ninds.nih.gov/nmd.aspx#tab=Data_Standards).
Although a handful of performance-based motor function tests are recommended for types II and III SMA, options for infants with type I SMA are limited. Thus, Krosschell et al are leading the way in identifying much needed measures for infants with type I SMA. Stay tuned for continued reports on the TIMPSI and other tools for evaluating neuromuscular disease outcomes.
Elise Townsend, PT, DPT, PhD, PCS
MGH Institute of Health Professions and
Pediatric Neuromuscular Clinic, Massachusetts General Hospital
Patricia Anne Chastain, PT, DPT, PCS
Massachusetts General Hospital
© 2013 Lippincott Williams & Wilkins, Inc.