Institutional members access full text with Ovid®

Share this article on:

Designing a Clinical Framework to Guide Gross Motor Intervention Decisions for Infants and Young Children With Hypotonia

Darrah, Johanna PhD; O'Donnell, Maureen MD, MSc, FRCPC; Lam, Joyce BScOT; Story, Maureen BSR, PT; Wickenheiser, Diane BScPT, PT; Xu, Kaishou PhD; Jin, Xiaokun MD

doi: 10.1097/IYC.0b013e3182986bd3
Original Study

Clinical practice frameworks are a valuable component of clinical education, promoting informed clinical decision making based on the best available evidence and/or clinical experience. They encourage standardized intervention approaches and evaluation of practice. Based on an international project to support the development of an enhanced service system for infants and young children with neuromotor disabilities in Guangzhou, China, this article describes the processes used to develop a practice framework to guide therapists' intervention choices to encourage the gross motor abilities of infants and children (0–3 years of age) exhibiting hypotonia and gross motor delays. The goal was to provide a practice framework that aligns with contemporary interest in activity-focused intervention approaches and that considers both a child's abilities and the influence of environmental context in the achievement of gross motor skills. The final product, the Hypotonia Wheel, is presented. It may be useful for therapists and early intervention providers who work with infants and young children with hypotonia. The process used to design the Hypotonia Wheel also could be used as a template to develop intervention guidelines for other clinical conditions.

Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada (Dr Darrah); Department of Pediatrics, University of British Columbia, Vancouver, Canada (Dr O'Donnell); Centre for International Child Health (Dr O'Donnell and Ms Lam) and Child Health BC (Dr O'Donnell), BC Children's Hospital (Dr O'Donnell), Vancouver, British Columbia, Canada; Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada (Dr O'Donnell and Mss Story and Wickenheiser); and Rehabilitation Department, Guangzhou Women and Children's Medical Center, People's Republic of China (Drs Xu and Jin).

Correspondence: Johanna Darrah, PhD, Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada (

Sources of funding include the following: Fu Tak Iam Foundation Hong Kong; anonymous donation to BC Children's Hospital Foundation.

Dr C. P. Larson, MD, FRCP(C), is Director of the Centre for International Child Health, BC Children's Hospital, and is the Canadian lead on the collaborative project with Guangzhou Women and Children's Medical Centre. Dr J. Mai, MD, is Chair of the Department of Pediatrics for Guangzhou Women and Children's Medical Centre and is the Guangzhou project lead.

The authors declare no conflict of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.