THE CONCURRENT AND CONSTRUCT VALIDITY OF THE SELF CARE DOMAIN OF THE CHILD ENGAGEMENT IN DAILY LIFE MEASURE
Fritz AG, Westcott McCoy S, Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle, WA; Ward KD, Hoffman E, Palevo C, Chiarello L, Programs in Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA
PURPOSE/HYPOTHESIS: The Child Engagement in Daily Life Measure (CEDL) was developed to measure both participation in daily self care and recreational activities in young children with cerebral palsy. Rasch analysis revealed an inadequate amount of items in the self-care domain of the CEDL to accurately represent an appropriate range of abilities. New items were added to the measure, therefore the purpose of this study was to determine the concurrent and construct validity of the self care domain of the CEDL.
NUMBER OF SUBJECTS: Thirty-nine children with cerebral palsy (ages 2–9 years, mean = 6.68 years, SD = 1.78 years). Children's motor abilities varied across all Gross Motor Function Classification System (GMFCS) and Manual Abilities Classification System (MACS) levels.
MATERIALS/METHODS: Survey packets were provided to parents of children with cerebral palsy and included the self-care domain of the functional skills and caregiver assistance sections of the Pediatric Evaluation of Disability Inventory (PEDI), the self-care domain of the CEDL, and a demographic form with the GMFCS and MACS. Parents completed and mailed the survey packet to the primary researchers. Concurrent validity was determined using a Pearson correlation. Construct validity was determined using an independent t-test.
RESULTS & CONCLUSIONS: The CEDL self-care score was highly related with the PEDI self-care functional ability sum score (r = .95 p < .01) and with the caregiver assistance sum score (r = .906, p < .01). Children with higher gross motor abilities (GMFCS I/II) had significantly higher CEDL self-care scores (mean = 3.88, SD = .85) than children with lower gross motor abilities (GMFCS III/IV/V; mean = 2.48, SD = 1.10, p < .01). Children with higher manual abilities (MACS I/II) had significantly higher CEDL self-care scores (mean = 3.61, SD = .98) than children with lower manual abilities (MACS III/IV/V; mean = 2.39, SD = 1.13, p < .01).
CLINICAL RELEVANCE: The self-care domain of the CEDL has acceptable psychometric validity and appears to be a useful tool to measure functional abilities in children with cerebral palsy based on parent report. Further research needs to be conducted to determine the reliability of the self-care domain of the CEDL.
ATTITUDES AND PRACTICE PATTERNS OF SCHOOL-BASED PHYSICAL THERAPISTS REGARDING INTERVENTION FOR CHILDHOOD OBESITY
Kendall E, Idaho State University
PURPOSE/HYPOTHESIS: The purpose of the study was the development of a tool to determine a measurement for the attitudes of school-based physical therapists concerning intervention for childhood obesity, then to investigate the relationship of those attitudes with demographic variables and practice patterns of the therapists.
NUMBER OF SUBJECTS: Subjects for the study were school-based physical therapists practicing within the US. All 50 states were categorized by obesity rate. Five states were chosen from each category and six school districts were randomly chosen from each state included, for a total of 120 subjects invited to participate. Exactly half (60) completed the survey.
MATERIALS/METHODS: The assessment tools consisted of a survey with three different components: 1. A demographic questionnaire designed to determine which variables influence attitudes toward intervention, 2. The attitude survey, a 14 question (7-point Likert-type scale) investigating beliefs in the extent of the problem, the schools' responsibility to address the problem and physical therapists' responsibility to address the problem, 3. A case study questionnaire to investigate whether there is a relationship between attitudes and practice patterns with respect to addressing childhood obesity, using two fictional but plausible case descriptions, asking the therapists whether or not to treat and with what frequency.
RESULTS & CONCLUSIONS: There was a negative correlation between the attitude survey score and the age of the therapist (−.279) and the years of experience (−.305). There was also a significant difference in attitude scores dependent on entry level degree (mean difference of 8.2). There was also a negative correlation between size of the district and the attitude survey scores (-.330). There were also positive relationships: 1. Between attitude survey and percent of caseload that is overweight (.306), 2. Difference in attitude survey scores dependent upon whether PT consults or treats for obesity alone (mean difference of 14.8), 3. Difference in attitude survey scores dependent on participation in parent education about obesity (mean difference of 10.6). There was a significant difference in attitude survey scores dependent on the treatment frequency groups for the two case studies. Those therapists with higher attitude scores tended to choose to treat the children outlined in the case, and with greater frequency.
CLINICAL RELEVANCE: Childhood obesity is becoming a major concern in our country and throughout the world. The health implications, such as heart disease and diabetes, have been more carefully delineated recently. Other health issues associated with obesity have been identified. As the profession of physical therapy begins to turn attention to the concepts of wellness and disease prevention, obesity intervention is starting to occupy a more prominent place in the physical therapy literature. The results of this study further support the concept that there is a change in the attitudes of physical therapists with respect to our role in addressing this issue.
EFFECTS OF INTENSIVE, HOME-BASED TREADMILL TRAINING WITH AND WITHOUT BOTULINUM TOXIN-A INJECTIONS ON WALKING FUNCTION IN SPASTIC CEREBRAL PALSY: A SINGLE SUBJECT RESEARCH DESIGN
Mattern-Baxter K, California State University, Sacramento, CA
BACKGROUND & PURPOSE: Treadmill training (TT) has been shown to accelerate walking onset in young children with cerebral palsy (CP) with Gross Motor Function Classification System (GMFCS) I and II, however its effect is less clear in children with GMFCS level III. Furthermore, there is a lack of research on the coupled effect of botulinum toxin-A injections (BTX) in combination with intensive TT in this population. The purpose of this single subject research study was to examine the effects of an intensive TT protocol prior to and after BTX injections in a young child with spastic CP.
SUBJECT: A 31-month old boy with spastic quadriplegic CP, GMFCS level III, resulting from premature birth at 28 weeks complicated by periventricular leukomalacia. The child required maximal support for propulsion of a gait trainer at study onset, but was able to take steps when held on hands.
MATERIALS/METHODS: The child received 6 weeks of intensive home-based TT, where he engaged in TT twice/day, 5 days/week, for 6 weeks. After a wash-out period of 4 months, the subject received BTX in bilateral hamstring, hip adductor and gastrocnemius muscles, followed by a second trial of TT with the same 6-week protocol. Assessments were performed for each TT trial at pre-test, 6-week post-intervention and 2.5-month post-intervention. Outcome measures were the Gross Motor Function Measure (GMFM) Dimension D and E (blinded assessor), the 10-meter walk test (10MWT), cadence (number of steps in 10 seconds) and Pediatric Evaluation of Disability Inventory Mobility Domain (PEDI).
OUTCOMES: The child made most improvements in GMFM Dim D and E after the first trial of TT, improving by 13% and 9% respectively, but scores remained largely unchanged at each subsequent assessment. The child achieved independent walking in his gait trainer after the first trial of TT, and made continuous improvement in 10MWT and cadence during all subsequent assessments. However, walking speed and cadence accelerated after the second trial of TT compared to the first trial. The subject showed a 10-point improvement on the PEDI after the first TT trial, and showed an additional 4-point improvement after the second trial.
DISCUSSION: The results of this single subject study indicate that a young child with spastic quadriplegic CP with GMFCS III can benefit from intensive, home-based TT. Initial TT led to the ability to engage in meaningful walking with a gait trainer, but the effects of TT in combination with BTX led to accelerated improvements in walking speed and cadence even in the absence of measurable changes on the GMFM in skills related to standing and walking. Larger studies should be conducted to systematically examine intensive TT protocols and their effects on walking after BTX-A injection in the lower extremities in young children with CP.
PHYSIOLOGICAL RESPONSES IN CHILDREN DURING EXERGAMING: A SYTEMATIC REVIEW
Tremback-Ball AJ, Getz EN, Goble AR, Hingley KE, Noll RC, Misericordia University, Department of Physical Therapy, Dallas, PA
PURPOSE/HYPOTHESIS: The systematic review was done to examine available evidence comparing the physiological differences between exergaming and sedentary activities in children. In recent years, children have been spending larger quantities of time performing sedentary activities such as watching television and playing video games. This inactivity has become an increasing concern since children who are inactive are more at risk to develop health problems including obesity, heart disease, increased blood pressure, asthma and cancer.
MATERIALS/METHODS: A search of available literature was completed between February and March of 2012 and between August and September 2012 using databases including EBSCO host, MEDLINE, and PubMed. Search terms included energy expenditure, children, exergaming, pediatrics, and interactive video. The search yielded sixteen studies that met the inclusion criteria of pediatric subjects, 2003–2012 publications, video gaming, and either experimental design, quasi-experimental design, or cohort study design. Each study was reviewed using the Physiotherapy Evidence Database Scale.
RESULTS & CONCLUSIONS: The studies in this review were in the range of 4 to 6 on the Physiotherapy Evidence Database Scale. The articles overall found that the physiological effects of active video games were greater than sedentary activities and similar to exercise. Indicators of physiological responses included energy expenditure, heart rate, VO2, rating of perceived exertion, and body movement. The gaming systems and type of activity varied between studies. Commonly used gaming systems were Nintendo Wii and Xbox with Kinect. Dancing, bowling and tennis were commonly used gaming activities. Most studies looked at short term physiological response as many games do not last for more than 10 minutes.
CLINICAL RELEVANCE: Evidence suggests that certain exergames such as boxing, dancing, bowling, and hula serve as an adequate source of exercise in children. The studies found that the increases in energy expenditure, heart rate, VO2, rating of perceived exertion, and body movement were appropriate to support the use of exergaming as a supplement for activity in children. Some studies also showed that the physiological response from exergames is comparable to walking. Going forward, exergaming has potential to be beneficial when incorporated into a patient's plan of care as a supplement for traditional cardiovascular exercise.
PROVIDER'S PERCEPTIONS WHEN IMPLEMENTING THE PRIMARY SERVICE PROVIDER APPROACH IN EARLY INTERVENTION
Troyer KM, Fort Myers, FL; Long TM, Georgetown University, Washington, DC
PURPOSE/HYPOTHESIS: The transdisciplinary model is an increasingly popular system utilized by states to deliver early intervention (EI) services. Teams working within the transdisciplinary model choose a primary service provider (PSP) to be the family's main contact while other team members support the family outcomes through consultations, provider-to-provider education and team meetings. In this model the traditional disciplinary lines are not well defined. The purpose of this research was to evaluate the confidence and competence of practicing early interventionists in the southwest/gulf coast region of Florida when providing transdisciplinary, PSP services approximately two years after state implementation.
NUMBER OF SUBJECTS: Participants were recruited from a pool of 90 staff and contracted providers for the Early Steps Southwest and Gulf Coast region of Florida. Sixty-eight providers completed the survey, yielding 75.5% response rate.
MATERIALS/METHODS: Data was collected utilizing an anonymous, self-report, online 21-question survey that queried providers on their perception of their own confidence and competence when providing services under a transdisciplinary, PSP model. Questions 1–9 were demographic and practice related. Questions 10–21 were skill-based questions modeled after professional standards of care. Questions 10-21 were assessed using a 4-point Likert scale. A neutral option was not given. Response frequencies for each question were tallied then cross tabulated with demographic and practice information to determine relationships between variables.
RESULTS & CONCLUSIONS: Provider's reported high confidence when working with families to explain the model, implement strategies, incorporate strengths, review concerns and teach families how to evaluate their child's progress. Providers reported high competence when implementing evidence based practices and strategies to increase child participation across natural environment settings. Comparatively, providers reported less competence in skills associated with writing outcomes, receiving coaching during consultation with other providers, identifying what type of additional professional supports are needed and considering the need for assistive technology to enhance the child's participation in daily routines.
CLINICAL RELEVANCE: Results cross tabulated by traditional discipline and years of experience suggest the difference in provider confidence and competence are more related to their educational background than years of practice in early intervention. Early intervention providers can use this information to determine what outcomes could be targeted when providing professional support to early interventionists in a transdisciplinary, PSP model, especially in the first few years of adoption. In addition, early intervention agencies and educators can use this information to target specific disciplines, rounding out their pre and post graduate education in order to develop collaborative, inter-professional skills necessary to function within transdisciplinary and/or PSP models.