Clinical Bottom Line
“How should I apply this information?”
Blauw-Hospers and colleagues developed an observational instrument to objectively identify what physical therapists (PTs) do during treatment of infants at high risk for developmental disorders at 4 and 6 months of corrected age. The tool is based on the theoretical constructs of the most commonly used physical therapy approaches in the Netherlands: neurodevelopmental treatment and functional therapy. Actions of the PTs are classified into 8 categories and several subcategories that are listed in the Appendix, which is available online at http://links.lww.com/PPT/A8. Clinical take-home messages from this study include the following:
- There was large heterogeneity of interventions used by PTs.
- Use of video feedback during treatment sessions to identify and quantify actions of the PT with the infant and caregiver or family may be of value to the clinician, novice through expert.
- PTs were surprised by the feedback on their treatment sessions; their perceptions of how their time was being spent did not match with what they actually did.
“What should I be mindful about in applying this information?”
This study was limited to therapy based on 2 theoretical constructs in 1 country, the Netherlands, with a small sample size of 22 infants. The authors rightfully caution that the large confidence intervals do not allow the tool to be generalized to other populations.
Cautions in transferring the information in this study to clinical application are as follows:
- Video analysis of this clinical tool to measure PT actions required a sophisticated software program not typically found in practice environments.
- Although the theoretical constructs of neurodevelopmental treatment and functional therapy emphasize the role of caregivers as key persons in child development and education, this study found that only about 4% of the time was spent in family involvement and educational actions.
- In general, infants were challenged to explore only 1 movement strategy in contrast to current concepts that suggest that varied practice is beneficial to motor development.
This tool documents only observable PT actions. The following were not addressed:
- Relative “inactions” during time spent in ongoing critical observation of the child's intentions and emergent movement behaviors.
- Listening at many levels to the child and caregiver to gather information important to each and to the task at hand.
- Problem solving on-line during the session.
- Continually adapting guidance and intervention strategies based on a continuous flow of information.
From an ecological perspective, the environmental context and task are variables that the therapist can influence to affect motor outcome and function. A therapist's time and attention directed at these variables during the treatment and in the educational aspects of the child/caregiver/therapist interactions is the time well spent in terms of outcomes.
Barbara Womack, PT, MA
Kid-Ability Mobile Pediatric Physical Therapy, LLC, Phoenix, AZ
Carolyn B. Heriza, PT, EdD, FAPTA
Doctoral Programs in Pediatric Science, Rocky Mountain University of Health Professions, Provo, UT