Pediatric Physical Therapy

Before highlighting articles in this issue of Pediatric Physical Therapy, I would like to offer a very warm welcome to our new subscribers from Canada and New Zealand. Both the Pediatric Division of the Canadian Physiotherapy Association and the Pediatric Special Interest Group of the New Zealand Society of Physiotherapists are now providing electronic access to the journal to all of their members.  We are delighted to have them as partners and look forward to their continuing contributions to Pediatric Physical Therapy.

In this issue we have a case report by McManus, Chambliss and Rapport that illustrates their application of the Neonatal Intensive Care Unit Guidelines to examine the quality of the services provided through their neonatal intensive care unit (NICU). This article is freely available to our readers. The authors provide an excellent model of how the guidelines might be used not only to examine care given to one child, but also to extend its use to review the policies and procedures that have been adopted within a NICU.  After completing a process of examining their NICU procedures, the authors recommend the use of the NICU Guidelines to others who might wish to review the quality of care given at their institutions.

Also within this issue are three research articles addressing the further development of measurement tools. The work of Kerfeld and colleagues extends the work of Dumas et al and Tucker et al and the Patient Reported Outcomes Measurement Information System (PROMIS). Kerfeld and her colleagues addressed the acknowledged limitation of prior work by using cognitive interviews of children who use wheelchairs to examine test items in the PROMIS data bank. The responses of children to these items is very important reading for pediatric physical therapists and provides direction for developing outcome measures suitable for children who use wheelchairs.

Hielkema and co-investigators report on their examination of the Gross Motor Function Measure (GMFM) for use with young infants at risk for cerebral palsy. Their work is exploratory but they offer suggestions for modification of the GMFM to provide greater sensitivity of the instrument for those under two years of age.  Any suggested modifications to the GMFM would, of course, require additional research to examine the reliability and validity of such modifications.

Finally, Krosschell and colleagues report on the adaption of the Test of Infant Motor Performance Screening Items (TIMPSI) for use with children with Spinal Muscular Atrophy Type I (SMA-I). Their findings support the use of this instrument with this special population. The authors found this shorter version of the Test of Infant Motor Performance (TIMP) to be feasible for use with infants with SMA-I as well as good inter- and intrarater reliability. In addition they report on both convergent and discriminative validity of the TIMPSI. 

The work of these 3 sets of authors is a strong reminder to us that well known and well developed tests are designed for use with very specific populations. Extension of assessment in whole or in part to a new population requires additional study of the reliability and validity of the measurement, before they can be used with that new population of children. In these articles examining the PROMIS databank of test items for children, the GMFM, and the TIMPSI, the new populations which the authors address are children who use wheelchairs, young children at risk for CP, and children with SMA-I. As pediatric physical therapists we have increasing access to valid and reliable tools, and we need to use them appropriately and wisely in order to document outcomes and assess change as a result of our interventions. I recommend a careful and deep reading of each of these articles, and the Clinical Bottom Lines that accompany them.

Ann F. Van Sant, PT, PhD, FAPTA
Editor-in-Chief