A SYSTEMATIC REVIEW OF THE EFFECTIVENESS OF INTERACTIVE VIDEO GAME BASED THERAPY TO IMPROVE FUNCTION AND MOBILITY IN ADOLESCENTS
Allen R, Matsunaga K, Looper J. School of Physical Therapy, University of Puget Sound, Tacoma WA.
PURPOSE: of this systematic review was to assess the effectiveness of virtual reality (VR) based interventions on mobility and function in adolescents with cerebral palsy.
NUMBER OF SUBJECTS: A total of 297 articles were screened for eligibility in this review. Twenty-two articles were selected for further evaluation. Following a detailed appraisal, eight studies fulfilled the inclusion/exclusion criteria and were included in the systematic review.
MATERIALS/METHODS: A literature search of PEDRO, PubMed, CINAHL and PsychInfo was conducted to identify studies evaluating the effectiveness of interactive video game based therapy on function and mobility in adolescents with cerebral palsy. Inclusion criteria were English language, peer-reviewed articles, pediatric participants under 21 years of age, with intervention including use of an electronic device that allows for interaction with the user, provides visual and audio feedback and simulates presence in reality. Articles were excluded if they included participants who had undergone surgery within 6 months before the study. Two reviewers independently rated each study and came to a consensus on methodological quality using a 12 point scale based on the Strobe Statement.
RESULTS: The quality of the articles ranged from a 5/12 to a 10/12. The average quality assessment score was a 7. Studies focused on interactive video game based intervention to improve balance, mobility, reaching, trunk control, hand function and gross motor function. A variety of interactive video game systems were used across all studies reviewed. Studies were conducted in various settings including home-based rehabilitation. Number of participants ranged from 1-13. One study used a multi-site randomized cross-over design, one study was a case report, and one study was a repeated measures design. All other studies were AB single subject design. Outcome measures included a variety of standardized tests, range of motion using goniometry and caregiver interviews. Four studies found that interactive video game based therapy was a feasible rehabilitation option. All studies found that interactive video game based therapy was effective in improving function and mobility in adolescents diagnosed with cerebral palsy.
CONCLUSIONS: There is moderate to high quality evidence to indicate that interactive video game based therapy can improve function and mobility in adolescents diagnosed with cerebral palsy. More randomized, controlled clinical trials are needed to determine the optimal duration and frequency, type of video game system and clinical application of interactive video games. With more research, video game based therapy could potentially be one of the most effective and motivational physical therapy options to date.
Clinical Relevance: Use of an interactive video game based therapy shows promise as an adjunct to conventional physical therapy and feasible for use in home-based therapy.
THE SECTION ON PEDIATRICS MENTORING PROGRAM FOR NEW PROFESSIONALS: A PILOT PROGRAM
Battaile, B; Battaile Pediatric Physical Therapy, Bethesda, MD.
PURPOSE: The American Physical Therapy Association Section on Pediatrics (SoP) Membership Committee's Member Services Subcommittee developed a mentoring program for members who are new professionals (PTs and PTAs with less than 5 years’ of experience) with the purposes of providing support for new professionals moving into the specialty of pediatric physical therapy and a valuable benefit of Section membership that would foster early involvement in the Section. A pilot mentoring program for new professionals was launched in September of 2012.
DESCRIPTION: Experienced PT and PTA mentor volunteers were recruited through the Section newsletter, listserv, eblasts, and at the 2012 SoP Annual Conference. The program similarly advertised to find new professionals interested in being mentored (mentees). Approximately 50 mentors and 50 mentees originally signed up for a one-year commitment. Mentors and mentees were asked to list specific areas of mentoring interests for matching purposes. Pairs were matched with respect to expressed area of interest, location, clientele age group, and work setting. Participants were sent general information regarding the program and guidelines for conduct. The program coordinator was available for questions, issues/reassignments if needed, and to conduct official ‘check-ins’ three times throughout the year. A member survey was sent out to all participants toward the end of the first year to get feedback about the program and suggestions for the future of the program. Data from the survey and other feedback from participants were analyzed to assess success of the program as well as provide direction for its future.
SUMMARY OF USE: According to feedback received from mentor and mentee participants of the program during its first year, perceived success of the program/benefits of participation in the program was varied; some mentor/mentee pairings reported highly beneficial relationships, other pairings never got off the ground. Mentors were requested for numerous purposes: treatment advice, general support, career advising, transitioning to pediatrics/different specialty areas within pediatrics, entry into academia, leadership mentoring, etc. Mentees frequently requested in-area mentors to facilitate face-to-face meetings and clinical treatment sessions, but this was not usually possible due to limited number of program participants. Some participants requested that the guidelines for the program include suggested discussion topics to guide meetings and foster growth of the mentoring relationship with their partner. Numerous professionals who volunteered to be a mentor also requested their own mentor for a new venture on their part in our profession. Increasing the overall number of participants in the program is a clear need. The Section mentoring program will continue into its second year, incorporating feedback received in order to provide an increasingly successful program/Section benefit to members, and will consider branching out to include all Section members, not just new professionals.
PROCESS IMPROVEMENT STUDY FOR PREVENTION OF POSITIONAL PLAGIOCEPHALY IN A LEVEL III NEONATAL INTENSIVE CARE UNIT
Bridges J, Abbott M, Davenport MJ, Keithley R, Lennon J, Department of Physical Therapy, East Tennessee State University, Johnson City, TN; Niswonger Children's Hospital, Johnson City, TN.
PURPOSE: The prevalence of positional plagiocephaly (PP) varies between 1.5 and 15% and is commonly seen among infants in the Neonatal Intensive Care Unit (NICU). Active repositioning is a common intervention for PP and is an effective preventative strategy. This case report will describe the educational/process improvement strategies for standardization of a PP prevention program among the NICU nursing staff.
DESCRIPTION: Niswonger Children's Hospital NICU is a 42 bed, level 3 hospital located in Johnson City, Tennessee. A survey administered to the nursing staff indicated a significant knowledge deficit regarding all aspects of PP. Only 13.6% indicated significant training on PP prevention. The project spanned nine months and included three months of education and training, followed by six months of weekly monitoring of head position according to a protocol specifically designed for this study. A description of the data collection process and educational strategies used to elicit compliance with the clock method/tummy time protocol will be provided.
SUMMARY OF USE: A weekly monitoring process demonstrated an increase in percent compliance over six months. Post survey responses indicated an overall improvement in knowledge regarding all aspects of PP. Although no consistent gain was observed in compliance using the protocol, an educational gain occurred. An educational process for staff to help reduce occurrence of PP is essential. A process improvement protocol may be beneficial for other NICUs for the prevention and management of PP. Further research is needed to determine the correlation of an educational processes improvement program in relation to prevalence of PP upon discharge from the NICU.
PARENT AND CHILD-FRIENDLY SERIAL CASTING
Chole D, Rasch C, Blow C, McElroy J, Department of Physical Therapy, University of Missouri, Columbia, MO.
BACKGROUND & PURPOSE: Serial casting has been proven effective to increase ankle range of motion (ROM) in children with cerebral palsy. Urgent cast removal and decreased calf circumference (Lee 2011) are two issues of concern during serial casting. Travel or costs of an ER visit are a hardship for families living in rural areas when pain, swelling, or irritation necessitates urgent removal of traditional fiberglass casts. The purpose of this poster is to present an alternative serial casting approach that allows for parental removal of casts and improved retention of calf muscle mass. This parent and child-friendly casting approach (PCFC) utilizes a plaster inner boot with outer layers of 3M soft cast®. The soft cast® is easily removed by hand. The plaster boot is soaked in water until soft and removed with bandage scissors. The casting schedule is organized into blocks, each consisting of assessment, cast application, 5 day cast wear, home cast removal, and 2 days ambulation without the cast. Casting blocks are repeated until optimal ankle range is achieved. The benefits of PCFC are seen in a 3.5 year old child from a rural area presenting with right (R) hemiplegic cerebral palsy, GMFCS I. No prior therapies or orthotic wear were reported. Functionally, he walked and ran with frequent falls, ascended/descended stairs with support, and had difficulty standing while dressing. Initial contact on R was on the ball of the foot and persisted throughout the gait cycle. Range of motion deficits were limited to the R ankle: −10° of dorsiflexion (DF), gastrocnemius, and 0° DF, soleus. Right calf circumference was 8” measured 1” below the head of the fibula. Five casting blocks were performed in this case.
OUTCOMES: During the 3rd casting block, the child became ill and urinated into the cast. The parents were able to promptly remove the cast at home, avoiding a 1.5 hour drive to the casting facility or a costly visit to a local ER. At the end of the 5th casting block, foot flat initial contact on R was observed 75% of the time during gait. Right ankle dorsiflexion increased to +20° DF gastrocnemius and +20° DF soleus. Right calf circumference decreased by ½” after the first cast and returned to the initial 8” circumference by the end of the 5th casting block.
DISCUSSION: The major elements of PCFC are the casting materials used and the 5 day on/2 day off block approach. The 3M soft cast® and plaster casting materials allow for simple, parental cast removal. The PCFC approach affords safe and convenient serial casting for families who live in rural areas or struggle with transportation. Short periods of ambulation between casts permit exercise to minimize loss of calf muscle mass as well as allowing children to experience gait with each muscle length change. Parent and child-friendly casting appears to be effective for increasing ROM and preserving muscle mass while avoiding the hardships of traditional cast removal for the family. Further research is needed to examine the impact of between cast ambulation on muscle mass.
CLUB NF: A PHYSICAL THERAPIST'S ROLE IN MONITORING AND SUPPORTING DEVELOPMENT IN CHILDREN WITH NF1
Dunn CM, Department of Physical Therapy, St. Louis Children's Hospital, St. Louis, Missouri; Brouillet K M, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri; Gutmann DH, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
PURPOSE: Present data on gross motor development trends in children with Neurofibromatosis type 1 (NF1) from diagnosis through adolescence as well as to outline our unique, therapy-based programs focused on supporting normal development in children with NF1.
DESCRIPTION: NF1 is an autosomal dominant disorder which predisposes children to tumor development. In addition to benign and malignant tumors, it is well documented children with NF1 are at high risk for cognitive delays, attention deficits, and learning disorders. These delays are often evident during the early school years, in children over the age of six. Fine motor and visual motor delays have also been identified, but less well studied. Historically, attention to gross motor skill development has been very limited, especially in children under six years of age. Over the past two years, we have assessed motor skills in children with NF1, and found that the incidence of gross motor delays from age three to eight years mirrors the incidence of attention and academic concerns. Tracking these motor delays in children of all ages reveals that motor delays begin early in development (under the age of three) and continue well into adolescence. To support families in addressing delays, in a time when funding for therapy and school services is often limited, we have developed a comprehensive and longitudinal approach to screening and service provision. The first aspect of our approach focuses on early referral to specialists. Each child in our clinical program receives a standardized motor screen administered by a physical therapist on a yearly basis. When delays are flagged, referrals are made to the appropriate service providers. We support families in obtaining early intervention through state programs and their local school districts. We also refer to clinic-based therapy when appropriate. The second feature of our approach is facilitated through Club NF. All families are encouraged to participate in this free program, which provides social opportunities focused on fine motor, gross motor and speech and language development. The activities begin at age three with a parent-child gymnastics class and music therapy program. School-aged children participate in bi-monthly weekend activities, ranging from swimming to rock climbing to gardening. These weekend activities have an educational component for parents, while the children and their siblings participate in motor-based therapy activities. Our teen participants are encouraged to return to Club NF as volunteers, providing valuable insights to the challenges and highlights of growing up with NF1.
SUMMARY OF USE: Through the use of yearly screenings by a physical therapist, educational brochures, weekend activities and sports- and music-based programming, we provide families with formal and informal support throughout the development of their child: from preschool through high school.
TAKING THE MONKEY WRENCH OUT OF THE TOOLBOX: IMPLEMENTING OUTCOME MEASURES ACROSS THE LIFESPAN IN THE CLASSROOM AND POINT LABS
Edwards A, Johnson K, Lieb-Lundell C, University of St. Augustine, San Marcos, CA.
PURPOSE: Evidence based physical therapy practice requires the use of standardized outcome measures. Without the adoption of outcome measures in all physical therapy settings, physical therapists and other rehab professionals are unable to determine the impact of their interventions. Academic inclusion and clinical use of outcome measures has grown, but adoption across practice settings remains limited due to time restraints and lack of knowledge regarding the use of measures.
DESCRIPTION: Two curriculum changes were made to address the use of standardized outcome measures that are essential for evidence based physical therapy practice. Based on the Neurology section's regional course Neurologic Practice Essentials: A Functional Toolbox and Consensus Guidelines for Entry-level Education, entry-level students must understand how to search and implement the evidence related to outcome measures. Students were asked to search the evidence and complete a group activity on one outcome measure in both their adult course and pediatric course. With faculty mentorship, student groups presented their own version of the EDGE-Evidence Database to Guide Effectiveness document with discussion related to their previous research courses and their first internship experience. In addition, the discussion focused on understanding the levels of evidence and the clinical application of outcome measures that will be applied in the mock clinic portion of the course and in their final internships. The Adult and Pediatric Patient Oriented Integrated Neurological Treatment (POINT) labs were designed so that student groups have the opportunity to work with participants that have a neurologic diagnosis for 4 one hour lab sessions over a period of 4 consecutive weeks. The adult and pediatric hands on experience labs provide the students a perspective of neurological treatment and outcome measurement across the lifespan. In the two courses, Pediatric Physical Therapy Interventions and Adult Advanced Neuromuscular Interventions, each student team completes and examination, evaluation, outcome measures, plans and implements interventions, designs a home program and reassess outcome measurement for the discharge evaluation and present a final integrative case presentation.
SUMMARY OF USE: These curriculum changes have provided a cost effective student driven review of the evidence about outcome measures, an opportunity for students to use and apply the outcome measures in the labs, and for the students to integrate the curriculum used in the lab into their adult and pediatric case presentations. As students completing their final internships, many of the practicing clinicians ask for information about outcome measures and the student have been able to share their knowledge and several have given staff in-service education programs on outcome measures as requested by the clinicians. In addition, the students apply their knowledge of the application of outcome measures in their final research course, and written case report.
COMPARISON OF TWO REACH TASKS IN CHILDREN DEVELOPING TYPICALLY AGES TWO TO THIRTEEN YEARS
Franjoine MR, Department of Physical Therapy, Daemen College, Amherst, NY; Darr NS, School of Physical Therapy, Belmont University, Nashville, TN; Young BL, Natural Sciences Department, Daemen College, Amherst, NY.
PURPOSE/HYPOTHESIS: The Pediatric Balance Scale (PBS) is a performance-based measure designed to examine static and dynamic balance in children. It contains 14 items including 2 items, presumed to measure anticipatory balance through reach tasks. The PBS has excellent test retest (ICC 2,1 = 0.923), interrater (ICC 2,1 = 0.972), and intrarater (ICC 2,1 = 0.895-0.998) reliability in children ages 2-12 years. Preliminary investigation of discriminative validity reveals the PBS is able to identify the presence of moderate balance dysfunction in children ages 2-14 years. The PBS can also differentiate children, less than age 6 years, with mild balance dysfunction from their typically developing peers. Rasch analysis supports the presence of a ceiling effect, and revision of the scoring rubrics for the two reach tasks. Specific distance-based performance profiles do not currently exist. The purpose of the study was twofold: 1) to examine the distances a child can retrieve an object from the floor with control (ROFF) and reach forward with stability (RF), 2) to determine if there is a relationship between the two reaching tasks.
NUMBER OF SUBJECTS: Data were collected from 182 healthy children (girls: 91, boys: 91) ages 2-13 years who were developing typically per parent report.
MATERIALS/METHODS: Reach abilities were examined using modified PBS test procedures. To determine maximal ROFF distance each child was allowed two trials per distance, and distance was increased in 3-inch increments. Maximal ROFF distance was the longest distance a child could retrieve the eraser with control. To determine maximal RF distance, each child was allowed two trials; distance was recorded in 1-inch increments. Maximal RF distance was the longest distance a child could reach with stability. Descriptive statistics were calculated for each reach task and Pearson coefficients were used to examine the association between age, height, ROFF, and RF. One-way ANOVAs with Bonferroni post-hoc tests were used to identify age-specific differences in ROFF and RF.
RESULTS & CONCLUSIONS: ROFF distances ranged from 3 to 36 inches, while RF distances ranged from 0 to 19 inches. All children were able to successfully complete the ROFF task; however, 14% of the children were unable to complete the RF task. Younger children appeared challenged by the construct and intent of the RF task. Strong associations (r>0.72, p = 0.01) were noted between ROFF and RF, and between each of the test variables and age and height. Significant age differences were observed with both ROFF and RF (one-way ANOVA, p<0.01). Distances increased with age; however, maximal ROFF and RF did not differ significantly among ages 8-12 years. Maximal ROFF distance increased for thirteen-year-olds.
CLINICAL RELEVANCE: Results suggest that ROFF and RF may be effective in measuring reach capabilities in children ages 2-13 years. Performance profiles for both tasks reveal an age-based linear progression. Results suggest that ROFF may be conceptually and/or motorically an easier task for young children to understand and perform.
A PILOT STUDY TO COMPARE STANDARDIZED TEST SCORES AT 7 MONTHS CHRONOLOGICAL AGE IN TWO GROUPS OF LATE PRETERM INFANTS WHO PARTICIPATE IN A SUBURBAN HOSPITALS'S PHYSICAL THERAPY DEVELOPMENTAL FOLLOW- UP PROTOCOL FROM THE NICU
Gatlin, RL, Department of Physical Therapy, University of Tennessee Health Science Center College of Allied Health Sciences, Memphis, TN
PURPOSE/HYPOTHESIS: Research indicates that preterm infants benefit from early physical therapy. However, little research is available to identify PT benefits for late preterm infants (LPI: 34-36.6 weeks gestational age). This pilot study was to compare LPI scores on the Bayley Scale of Infant Development III (BSID-III) at 7 months chronological age for 2 groups: PT(NO) group received home exercise program only; and PT(YES) group received home exercise program plus individualized physical therapy. The researchers expected higher BSID-III scores in the PT(YES) group.
NUMBER OF SUBJECTS: A total of 15 subjects (10 males and 5 females) were included with a mean gestational age (GA) of 35.2 weeks, and a mean BW of 2663.04 grams. There were 12 Caucasian (C) and 3 African American (AA) infants. Inclusion criteria were infants born between 34.0 and 36.6 weeks gestational age (GA), greater than 2,000 grams birth weight (BW), admitted to NICU and at 1-month post NICU PT evaluation scored above the 25th percentile on the Alberta Infant Motor Scale (AIMS).
MATERIALS/METHODS: Parental consent was obtained for all subjects. A local suburban level III NICU protocol refers all NICU infants for a one month PT assessment. Infants exhibiting no abnormal movement patterns were assigned to the PT(NO) group and were provided a home exercise program (HEP) but no formal PT. HEP included tummy time importance and The Hawaiian Early Learning Profile Activity Sheets for birth thru 6 months. Infants exhibiting atypical motor patterns (identified as intolerance of prone, poor head control, dystonia, synergistic hypertonia and/or hypotonia) were assigned to the PT(YES) group. PT(YES) was provided the same HEP but also received formal PT. Formal PT varied depending on child and family needs but generally included family training, therapeutic handling and exercises. Per protocol, all infants were evaluated at 7 months using the BSID-III.
RESULTS & CONCLUSIONS: Descriptive statistics were completed for each group: PT(YES) had a total of 4 subjects with a mean GA of 35.6 weeks, 3 males and 1 female infant. PT(YES) mean BW was 2400.75 grams and all were of C ethnicity. PT(NO) had a total of 11 subjects with a mean GA of 35.1 weeks, 7 male and 4 females. PT(NO) mean BW was 2657.31 grams and ethnicity was 8 C and 3 AA. Between-group comparison of BSID-III standard scores, composite scores and percentiles were analyzed with ANOVA, Wilcoxon Rank Sum and Kruskall-Wallis ANOVA. No significant between-group differences were found.
CLINICAL RELEVANCE: It is not clear how often the LPI should receive physical therapy or if physical therapy intervention improves functional skills. This pilot study, while looking at one hospital's protocol may provide information on early individualized PT and an LPI's ability to overcome atypical motor patterns. These two groups may also provide Information about the demographics of the LPI. The Caucasian male born prior to 36 weeks appears more within this study.
ENHANCING MOBILITY AND EXPLORATION IN YOUNG CHILDREN WITH MOTOR DELAYS
Kenyon LK, Department of Physical Therapy, Farris JP, Hoque M, Radhakrishnan V, Schutte K., Sunny N, Padnos College of Engineering & Computing, Proctor K, Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI; Ripmaster C, Lincoln Developmental Center, Grand Rapids, MI.
PURPOSE: Young children with severe motor, cognitive, and communication deficits are limited in their ability to use self-initiated movement to explore and learn from the world around them. Such children are often dismissed as either too young or too physically involved to use a power wheelchair and simple power mobility options such as adapted ride-on-toys may not provide these children with the external support necessary to effectively access and use a joystick or switch. Given that self-initiated locomotion is critical in the development of numerous cognitive, perceptual, and social skills, young children who are unable to move and explore their environment may not gain the skills necessary to maximize development in these essential areas of function. Our Play & Mobility Device affords an opportunity for these children to safely explore power mobility while providing sufficient external support to optimize a child's joystick or switch access and use.
DESCRIPTION: The Play & Mobility Device is a small, highly maneuverable motorized platform that is designed for young children with severe deficits who weigh less than 40 pounds. The control system on the Play & Mobility Device interfaces with both a traditional joystick and a variety of switches which allows practitioners to adapt the power access system to meet the unique needs of each individual. Safety features of the Play & Mobility Device permit young children to freely access, explore, and learn from their environment. Acknowledging that these young users may be learning to move for the first time, individualized intervention sessions using the Play & Mobility Device are structured to include repetition of mobility tasks as well as opportunities for self-directed mobility exploration. Sessions are designed to be playful and encouraging and attempt to engage the child in personalized, motivating activities that promote the child's use of power mobility within functional play experiences. Setting up the training environment to elicit new learning and allowing sufficient time for the child to respond and problem solve are vital aspects of each training session. The small size and maneuverability of the Play & Mobility Device suggest that with appropriate parent and staff education, the Device may be suitable for use in a child's home or pre-school thus permitting the child to explore and learn from multiple environments while increasing practice time and repetition of prerequisite skills for power mobility.
SUMMARY OF USE: The Play & Mobility Device provides young children with severe motor impairments the opportunity to safely and effectively explore power mobility options within a supportive environment. Future program and research objectives include expanding use of the Play & Mobility Device into home and preschool settings, the development of child-centered instructional methods, and validation of assessment instruments to optimize use of the Play & Mobility Device in promoting self-directed mobility for this unique population.
GUESS WHO'S IN THE NICU?
Lammers, J, University of Findlay, Findlay, OH
PURPOSE/HYPOTHESIS: The purpose of this study was to investigate who is providing therapy services to premature babies in Level II or III/IV nurseries and what preparation or training they have prior to providing that service. Level II nurseries are often referred to as Special Care Nurseries (SCN) and Level III or IV nurseries are often referred to as Neonatal Intensive Care Units (NICU). Several authors have indicated that physical therapy practice in SCNs or NICUS is not appropriate for new physical therapist (PT) graduates, PT students, PT Assistants or PT generalists. The premature infants in NICU are physiologically fragile and may be inadvertently harmed during therapeutic intervention.
NUMBER OF SUBJECTS: Survey Response rate of 20% (20 responses/104 surveys sent).
MATERIALS/METHODS: A search of NICU's and SCN's in one Midwestern state was done through the joint commission website. The search revealed 52 hospitals in with level II and level III NICU's and SCN's. A total of 104 surveys were sent, both to the Director of the Rehabilitation department and the NICU Director of each of those hospitals. The main focus of the questions was to determine what therapy personnel works with neonates in the NICU and the training that they must accomplish as initial and continuing competences.
RESULTS/CONCLUSIONS: The responses came from level II and III nurseries as well as teaching hospitals, community hospitals and university medical centers. In this study we found that physical therapists, occupational therapists, and speech language pathologists all practice in SCNs and NICUs, however staffing is varied by facility. There was no association between type of hospital or level nursery and therapist preparation/training. The most common criteria for licensed therapists to work in the SCN or NICU were therapist interest. There are no common criteria of assuring competence prior to a therapist assuming a caseload in the nursery. Findings included use of in-house training, self-monitoring of competence, training outside of the facility (such as continuing education courses), and mentored training. Several facilities allow therapist assistants and students to practice in the NICU/SCN, which is against published recommendations. We were unaware of the extent of their participation.
CLINICAL RELEVANCE: Although the APTA Section on Pediatrics has published NICU practice guidelines in the Pediatric Physical Therapy Journal, it was found that our respondents do not necessarily follow those recommendations. The data collected lead us to conclude that there are no universal criteria that NICU/SCN facilities use before allowing therapists to work in the NICU or SCN. We however cannot generalize this to all NICUs and/or SCNs due to our limited response rate and limited geographic area surveyed.
TRI MY BEST TRIATHLON: A FITNESS EVENT FOR PARTICIPANTS WITH ALL LEVELS OF DEVELOPMENTAL DISABILITY
Lescantz, J. Neuro-Developmental Treatment Programs, Augusta, GA
PURPOSE: The purpose of this poster presentation is to describe our annual Tri My Best Triathlon for families and participants with special needs, in hopes that more communities might copy it to provide this fun fitness opportunity in their local area.
DESCRIPTION: The Tri My Best Triathlon had its third successful year this April. This annual event encompasses a swim/bike/run for athletes of varying abilities. Swim/bike/run is used to label categories that are much more diverse. During the swim athletes may use any floatation or assist that makes them safe to swim. During the bike, plenty of very versatile adapted bikes are on hand as well as individually owned bikes so that all can ride whether pedaling or being pushed. The run portion may be done on foot, with a walker, rolling a manual chair, driving a power chair or even being pushed in a stroller. The swimming is done in the pool and the bike and run events are done in the large parking lot that wraps around the building.
SUMMARY OF USE: Each year the triathlon has grown, in donations, volunteers and participants. Logistically it is kind of a “three ring circus” with athletes moving from one event to the next along with their personal assistant and their timer. All athletes move through the events from swim to bike to run and cross the finish line receiving their medal. A timer and personal assistant move with each athlete keeping track of their event times and assisting them through each stage (except for the pool where certified lifeguards and adaptive swim instructors assist them through the pool. Plenty of volunteers are needed at the transition stations to assist athletes getting on/off bikes, adjusting bikes, and getting off bikes onto walkers or into wheelchairs. Each participant and volunteer must register ahead of time as much planning goes into making the event run smoothly. We have offered 3 different distances in the past years and may add another longer distance in 2014. The categories include: up to 25 yard swim/quarter mile bike/200 yard run, up to 50 yard swim/half mile bike/quarter mile run, up to 100 yard swim/1 mile bike/half mile run. Questionnaires are sent out to parents to get a better idea of what type assistance their athlete will need to complete the event. This is helpful in securing floatation, bikes and any other equipment necessary to make the day a successful one for each athlete. Knowing ability levels, ages, heights, and weights also helps the race director group each athlete into an appropriate heat so that they have all the equipment they need available at the right time. This year 50 participants signed up and a waiting list had to be formed! Volunteers were plentiful which was most helpful as it takes 2-3 volunteers per participant. Goodie bags and numerous items to fill the bags were donated by local and national merchants. Food and drinks were donated that was available for athletes, families and volunteers. One of the local churches came out and provided music, balloon treats, and goodies. All families and clients need and avenue to succeed and have fun with fitness!
COORDINATION OF HEAD AND TRUNK IN SITTING POSITION OF PRETERM AND FULL-TERM INFANTS
Liu YL, School and Graduate Institute of PT, College of Medicine, Nat. Taiwan University, and Dept of Rehabilitation, Shin-Kong Wu Ho-Su Memorial Hospital; Chang SH, School and Graduate Institute of PT, College of Medicine, Nat. Taiwan University; Hsieh WS, Dept of Pediatrics, Nat. Taiwan University Hosp.; Jeng SF, School and Graduate Institute of PT, College of Medicine, Nat. Taiwan Univ, and PT Center, National Taiwan Univ. Hosp; Chen LC, School and Graduate Institute of PT, College of Medicine, Nat. Taiwan Univ, and Division of PT, Dept of Physical Medicine and Rehabilitation, Nat. Taiwan Univ. Hosp., Taipei, Taiwan
PURPOSE/HYPOTHESIS: To achieve successful postural control, one needs to utilize multiple senses and manage the many degrees of freedom of the human body in the gravitational world. Children born preterm are at risk for motor disabilities, including postural deficit. However, little is known about how preterm infants control the multi-segmented body in the upright posture during early development. Therefore, the purpose of this study was to investigate the upper body coordination in sitting posture of preterm and full-term infants and how it may be influenced by additional somatosensory information during early postural development.
NUMBER OF SUBJECTS: Three groups of infants were included in the present study: early preterm (Pte, gestational age (GA) <34 weeks, n = 12), late preterm (Ptl, GA≧34 weeks, n = 15), and full-term (Ft, n = 12).
MATERIALS/METHODS: Infants were longitudinally followed from sitting onset to 3 months post-walking at 7 developmental epochs. At each visit, the infant was tested for their quiet sitting posture in 2 conditions: with or without the hand touching a contact surface. Three-dimensional displacements of the head and trunk were recorded using an ultrasonic motion capture system. Cross-correlation analyses were conducted to analyze the spatial and temporal coordination between head and trunk motions in the medial-lateral (ML) and anterior-posterior (AP) directions. Repeated measures ANOVA was used to examine the effects of postural experience and hand touch on infants' upper body coordination in sitting position of Pte, Ptl, and Ft infants.
RESULTS & CONCLUSIONS: The results revealed that the spatial coordination between infants' head and trunk decreased after 1 month post-sitting onward in the AP direction, but the un-coupled coordination occurred only at 2 months post-sitting in the ML direction (p<0.05). Comparing to sitting onset, the temporal correlation between head and trunk decreased in all infants at 3-month post walking in the AP direction but at standing alone in the ML direction (p<0.05). Hand touch changed the spatial coordination between head and trunk only in the ML direction (p<0.05). Comparing to Ft infants, Pte, but not Ptl, infants demonstrated lower spatial and temporal coordination in the ML direction (p<0.05). Our results suggest that, with increasing upright experience, infants learn to control their sitting posture from en bloc patterns toward articulated patterns. While early development of sitting postural control occurs more obvious in the AP direction than in ML direction, hand touch allows infants to explore different dynamics of body coordination in the ML direction. Further, early preterm infants exhibit atypical patterns of body coordination in controlling their sitting posture during early development.
CLINICAL RELEVANCE: Our results suggest that the development of infants' sitting postural control occurs mainly in the sagittal plane. Long-term follow up of early preterm infants for their postural control and body coordination is necessary.
NEED FOR PHYSICAL THERAPY INTERVENTION FOR PREVENTION AND TREATMENT OF PLAGIOCEPHALY AND POSITIONAL TORTICOLLIS
Miles M, Independent School District, White Bear Lake, MN.
PURPOSE: Developmental of positional torticollis and plagiocephaly has been seen in the practice of PT with increasing frequency since the back to sleep initiatives in 1992. Physical therapy intervention can prevent plagiocephaly from progressing to the level of requiring a helmet for correction, thus saving the healthcare system money and the families of many children the unnecessary burden of getting a helmet. The purpose of this presentation is to inform Physical therapists of the need to educate the public and intervene with physical therapy to prevent the rise in use of helmets as a treatment strategy.
DESCRIPTION: Reports of increased plagiocephaly or positional deformities of the skull are up by as much as 5-6 times since1992 (Persing et al. 2003, Hummel & Fortado 2005). A two year study showed positional plagiocephaly tends to increase in severity up to 4 months, with clinical improvements generally seen by 2 years of age (Hummel & Fortado 2005). Torticollis can be seen as a secondary effect of plagiocephaly, or it can be seen as the cause of plagiocephaly in infants. Current literature for the “back to sleep” campaign includes information for positioning infants during waking periods including incorporation of “tummy time”, but two different studies found that 26% of parents had never placed their infant on their tummy for play time (Jones, 2004). Infants are susceptible to deformities because their craniums are at a rapid period of growth during this time in their lives, with the brain reaching 90%of adult size by age 1 (Hummel & Fortado, 2005). Research also points to use of infant car seats, bouncy seats, infant carriers, and infant swings as having an impact on plagiocephaly and torticollis (Littlefield,2003). Littlefield collected data on infant equipment use over a 3 year period from1998 to 2001. Results showed 56.6% of parents using equipment less than1.5 hours per day, 28.6% of parents using equipment 1.5-4.0 hours per day, and 15% of parents using equipment for over 4 hours per day (Littlefield, 2003). An additional 5.7% of children slept in an infant carrier or equipment item (Littlefield,2003). Frequent use of infant equipment (greater than 4 hours per day) resulted in a higher frequency and severity of plagiocephaly (Littlefield 2003).
SUMMARY OF USE: Prevention and treatment of deformity during the early months of life could be achieved through parental education of the importance of repositioning combined with an increase in prone positioning and side lying during supervised play times. Head control improves as a child matures, increasing the importance of educating parents to limit the time spent in infant equipment when their child is younger and has limited head control. While there is education available to the public regarding the need for repositioning infants, provided through well-child checks, “back to sleep” education pamphlets, and prenatal classes; there has not been enough education.
RELIABILITY AND VALIDITY OF A NOVEL DYNAMIC BALANCE MEASURE FOR CHILDREN
Moore JG, Kirk-Sanchez N, Nunez-Gaunaurd A, Department of Physical Therapy, University of Miami, Coral Gables, FL
PURPOSE/HYPOTHESIS: Several clinical measures of dynamic balance ability are available for use with children. A novel forward lean measure (FLM) using magnitude of shoulder displacement in the sagittal plane has been shown to be reliable and valid in previous investigations with children. The purpose of this investigation was to further establish the validity of the FLM using the Bruininks-Oseretsky Test of Motor Performance-2 (BOT-2) and the subtests of the BOT-2. We hypothesize that the FLM will relate to the balance and strength subtests of the BOT-2 and will not relate to the other subtests: fine motor precision and integration, manual dexterity, bilateral coordination, running speed and agility, and upper limb coordination.
NUMBER OF SUBJECTS: Sixty, typically developing children (48% female) whose average age was 12 years old (10-14) from the Miami-Dade public school system participated in this investigation. Medical history and consent were obtained from each subject's parent prior to participation.
MATERIALS/METHODS: Anthropometric measures were taken for each subject: height, weight. Subjects participated in a battery of tests including: FLM, short form of the BOT2 (SF BOT-2), sit to stand test, and gross measures of core strength (repeated curl-ups and push-ups). To perform the FLM, subjects stood with their feet flat and arms held parallel to the floor as they leaned forward at their ankles. Shoulder displacement was measured in centimeters using a retractable tape measure held at the subject's shoulder height. The mean score of three trials was computed. The normalized FLM was calculated by dividing the subject's mean lean score by their height (in centimeters). To determine reliability of the FLM, the ICC was calculated using the three lean trials. The Pearson or Spearman correlation coefficients were calculated to examine the relationship between the FLM and subtests of the SF BOT-2.
RESULTS/CONCLUSIONS: The mean normalized FLM for the group was 0.07 cm. (0.02-0.12). The ICC was 0.94 (95% CI 0.88-0.98). Subtests that were significantly correlated (α = 0.05) with the FLM included the percentile (r = .35) and standard (r = .37) scores of the SF BOT-2, the balance (r = .25) and strength (r = .32) subtests. FLM was also significantly correlated to the 60 second sit to stand test (r = .47) and number of curl-ups performed (r = .37). As hypothesized, the remaining subtests on the SF BOT-2 and number of push-ups performed were not correlated to the FLM. Previous investigations have demonstrated a relationship between the FLM and center of pressure excursion. This study demonstrates that the FLM has good reliability and supports the validity of the FLM as a measure of dynamic balance. Further investigation examining its effectiveness in identifying changes in dynamic balance ability following an intervention is warranted.
CLINICAL RELEVANCE: The FLM is an easy to administer clinical measure that has been shown to be a reliable and valid measure of dynamic balance. It can be used as one part of an overall assessment of balance function in children.
“BABYFIT: A SPECIFIC TRAINING FOR PARENTS AND THEIR INFANTS (0-12 MONTHS) TO AVOID OBESITY AND LACK OF PHYSICAL ACTIVITY”
Neuhaus C, Appenzeller K. The University Children's Hospital, Basel, Switzerland.
PURPOSE: Worldwide 20 million children under the age of five are overweight. Only a few prevention programs to reduce infant obesity exist in Switzerland. The goal is to educate and sensitize parents of newborns about balanced nutrition and healthy motor development. The goal is to educate and sensitize parents of newborns about balanced nutrition and healthy motor development.
DESCRIPTION: Pediatric physical therapists developed the unique project “Early life in motion”. It will give children the possibility of a normal motor development and a healthy well-balanced nutrition. “Early life in motion” provides exercise and nutrition classes for parents and their children (0-12months) called “babyfit”. We hypothesize that sensitization early in life reduces prevalence of overweight in children and decreases deficiencies in motor development. We evaluated satisfaction of participating parents as well as correspondence with scientific knowledge regarding pedagogic information transfer, sensory-motor development and balanced nutrition using a questionnaire and standardized lesson observations. For example, 82.4% of the participants experienced the course positively and expressed interest in additional courses for over one-year-olds; structure and information transfer were judged good or very good; 53% of participants fully carried out the exercises at home and 47% partially. These results from a master thesis indicate that parents have an increased awareness of healthy nutrition and normal motor development. Participants carried out the exercises at home, reflecting behavioral adaptation - an important prevention goal. In-migrated people could only partially be reached through the courses, the course concept for these participants should be adapted. Pediatric physical therapists are an important group not only for treatment in children but also for primary prevention programs in Public Health.
SUMMARY OF USE: The course, “babyfit” is a unique education program for parents with newborns. Trained course-leaders give one lecture per week for 45 minutes. We offer two different courses, one for 0-6 month and another one for 7-12 month-old children. Every lecture is standardized (e.g. instruction of infant handling, important milestones in the development of the first 2 months, useful devices and toys for infants) based on a best practice course-book.
MOTOR PROFICIENCY IS ASSOCIATED WITH AUTISM SPECTRUM DISORDER PHENOTYPIC BEHAVIOR
Olzenak DL, Dept of Public Health Sciences; Hyman S L, Department of Pediatrics; Davidson, PW, Dept of Pediatrics; Univ of Rochester, Rochester, NY; Shamlaye, C F, Ministry of Health, Republic of Seychelles, Seychelles; van Wijngaarden E, Department of Public Health Sciences, Univ of Rochester, Rochester, NY
PURPOSE/HYPOTHESIS: Although autism spectrum disorder (ASD) is not considered to be a syndrome with obvious motor deficits, motor planning impairments have been recognized. Nevertheless, it remains unclear whether children who show possible deficits in cognition, communication and social interaction also display impairments in movement skill or goal-directed movements, such as balance, coordination, dexterity and apraxia. We examined the relationship between motor proficiency and ASD phenotypic behavior in the Main Cohort of the Seychelles Child Development Study (SCDS). We hypothesized that children who demonstrate better motor proficiency would have lower scores on an instrument screening for ASD phenotypic behaviors.
NUMBER OF SUBJECTS: A cohort of 779 mother–child pairs.
MATERIALS/METHODS: The SCDS is a double-blind, longitudinal epidemiological study examining the potential adverse effects of prenatal MeHg exposure on neurodevelopmental outcomes. Mother-child pairs in the Main Cohort were enrolled in 1989-1990. The Social Responsiveness Scale (SRS) was administered at 10 years of age to obtain information on ASD phenotypic behaviors. Measures of motor proficiency were administered at several points during follow up, and include the Bayley Scales of Infant Development (BSID) Psychomotor Scale (19 and 29 months), Bender Gestalt (66 months), and the Bruininks Oseretsky Test of Motor Proficiency (BOT), Grooved Pegboard and the Finger Tapping Test (FTT) (107 months). Multivariable linear regression was performed to examine the relationship between motor skill level, as measured by the five distinct motor assessments, and SRS scores while controlling for child's sex, maternal age, and socioeconomic status.
RESULTS & CONCLUSIONS: A total of 421 to 514 participants had data on SRS and one or more motor tests. Lower performance on the BOT and Bender tests, measuring fine, gross, and visual motor skills, were statistically significantly associated with greater SRS scores. Scores on other motor function tests were also related to SRS scores in the hypothesized direction, but not significantly so. Similar patterns were observed for SRS subscales measuring social awareness, social information processing, reciprocal social responses, social anxiety, and repetitive traits. These findings suggest that motor skill ability has potential relevance for the diagnosis and treatment of ASD-related symptoms. However, our research is limited by use of the SRS which is a screening rather than a diagnostic instrument for ASD.
CLINICAL RELEVANCE: Motor skills are the first observable skills in children. Furthermore, gross motor skill development is essential for development of fine motor skills and progression of overall motor skill level. Impaired cognitive, communicative, and social behaviors are the primary concerns in ASD. However, early motor skill ability may be correlated with impaired communication and social behavior later in childhood. Therefore, it would be imperative to assess these skills in young children with ASD which may guide the development of treatment plans.
THE STABILITY OF MASTERY MOTIVATION AND ITS RELATIONSHIP WITH MOTOR COMPETENCE INFLUENCED BY GENDER IN PRESCHOOLERS
Wang PJ, School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan; Hwang AW, Graduate Institute of Early Intervention, Chang Gung University, Tao-Yan, Taiwan; Chen, PC, Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan; Morgan GA, Education and Human Development, Colorado State University, Fort Collins, CO; Liao HF, School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
PURPOSE/HYPOTHESIS: Mastery motivation (intrinsic drives to explore and master one's environment) is a key aspect of development in children. However, evidence about the stability of parental perceived mastery motivation and its relations with motor competence affected by gender was inconclusive. The aims of this study were to investigate the influence of gender on (1) the stability of mastery motivation; and (2) the associations between motor competence and parental perceived mastery motivation from 2-year to 5-year of ages in children developing typically.
NUMBER OF SUBJECTS: Data of 94 children developing typically from a birth cohort study at Northern Taiwan from 2- to 5-year old.
MATERIALS/METHODS: Mastery motivation measured by four indicators (Object Persistence; Gross Motor Persistence; Mastery Pleasure; Negative Reaction) from the Dimensional Mastery Questionnaires at 2 and 5 years of age. Motor competences were measured by motor developmental quotients from the Comprehensive Developmental Inventory for Infants and Toddlers at 2 years of age. Pearson correlations were used to examine the two purposes (α = 0.05; two-tailed).
RESULTS & CONCLUSIONS: There was moderate stability of mastery motivation from 2 years to 5 years of age (r = 0.36-0.41, p <0.05), and girls' stability was higher than boys'. The 2-year motor competence could significantly predict 5-year Gross Motor Persistence for boys (r = 0.33, p <0.05), but no predictive relationship for girls. It seemed that boys' early motor competence influence later parental perceived mastery motivation.
CLINICAL RELEVANCE: Children's gender would influence the stability of the perceived mastery motivation and the relationships between motor competence and parental perceived mastery motivation. Such information could help clinicians in parental education.
UTILIZATION OF PHYSICAL THERAPY SERVICES IN INDIVIDUALS WITH AUTISM SPECTRUM DISORDER
Wilson K, Drennan R, McElroy J, Department of Physical Therapy, University of Missouri, Columbia, MO.
PURPOSE/HYPOTHESIS: Autism Spectrum Disorder (ASD) was estimated to affect 1 in 88 children in the United States (CDC, 2008). A high incidence of gross motor deficits has been reported in children diagnosed with ASD, the most common being hypotonia (HT), toe walking (TW), and gross motor delay. Ming et al. (2007) examined a group of children with ASD and found that utilization rates for physical therapy (PT) services were highest for children with gross motor delays. Utilization was low for children with TW or HT. Though Ming et al. did not report an overall rate of access to PT services, Thomas et al. (2007) reported an access rate of 30% in a local cohort. The purpose of this study was to examine access rates, age distributions, and identification of TW and HT as they relate to utilization of PT services for children diagnosed with ASD.
NUMBER OF SUBJECTS: Study surveys were completed by 73 families of individuals with an ASD diagnosis. The ages of individuals with ASD ranged from 3-38 years (mean 12.9 yrs.).
MATERIALS/METHODS: Surveys were distributed to families attending a local autism clinic. The survey instrument addressed age of respondents, gross motor diagnoses, and utilization of PT services. Descriptive statistics were used to analyze the data.
RESULTS & CONCLUSIONS: Thirty-five (47%) of the participants received PT services. Gross motor deficits for the entire cohort were: TW (44.7%), HT (27.1%), and other unspecified gross motor deficits (UGMD) (16.4%). Utilization or non-utilization (NPT) of PT services was: UGMD 12 PT/13 NPT, TW 7 PT/21 NPT, HT 6 PT/3 NPT, and TW accompanied by HT 10 PT/1 NPT. The percentages of respondents receiving PT services grouped by age were: 0-4 yrs. 1.4%, 5-8 yrs. 14.3%, 8-11 yrs. 10.0%, 11+ yrs. 20.0%. Compared to previously published data, our cohort was weighted toward older individuals and our data showed a higher utilization of PT services by individuals with ASD. Whether increased utilization of PT services was a function of our older cohort, a general trend, or a local phenomenon could not be determined from this study. Utilization of PT services was highest for the UGMD group. The size of the UGMC group may have been attributed to inclusion of gross motor delay or coordination deficits not recognized by parents as gross motor diagnoses. Though toe walking was the most commonly identified gross motor diagnosis, individuals with TW and HT together were more likely to receive PT services than individuals with TW or HT alone. Overall, referral for PT services does not appear strongly guided by any single gross motor diagnosis.
CLINICAL RELEVANCE: Utilization of physical therapy services is increasing but continues to be low for children with ASD who have identified gross motor diagnoses, particularly toe walking. For PT practitioners to meet the needs of the rapidly expanding ASD population, further research is needed to understand parental gross motor concerns and priorities for their children as well as identification of successful PT interventions.