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ABSTRACTS

Abstracts of the Academy of Pediatric Physical Therapy Platform Presentations at the Combined Sections Meeting

doi: 10.1097/PEP.0000000000000358
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PERFORMANCE OF PRESCHOOL AGE CHILDREN ON THE PEDIATRIC BALANCE SCALE: A COMPARISON OF CAPABILITIES AMONG CHILDREN WITH TYPICAL DEVELOPMENT AND CEREBRAL PALSY GMFCS LEVELS I, II, AND III

Franjoine, M. R, Darr N, Young, B. Physical Therapy, Belmont University, Nashville, Tennessee, United States

PURPOSE/HYPOTHESIS: The Pediatric Balance Scale (PBS), a 14-item, criterion-referenced measure of functional balance, has demonstrated excellent psychometric properties in children with typical development (TD) and in children with balance dysfunction. Typical performance values have been published for children with TD, ages 2 to 13 years; however, examination of PBS performance in children with motor impairments has been limited. The purpose of this study was to examine PBS performance in preschool-age children with TD as compared to children with Cerebral Palsy (CP) at Gross Motor Function Classification System (GMFCS) Levels I, II, and III.

NUMBER OF SUBJECTS: The study included 471 healthy children, ages 2 to 4 years, 11 months. 252 children presented with TD as per parent report, and 219 children were diagnosed with CP (GMFCS level I [n = 139], Level II [n = 35], and Level III [n = 45]). All children were able to stand for 4 seconds and follow simple directions.

MATERIALS/METHODS: Data were analyzed retrospectively from two studies, in which the PBS was administered to each child individually and PBS total test scores (TTS) were calculated as per protocol developed by Franjoine, et al. Data were grouped in 6-month age increments and by GMFCS level for analysis. Descriptive statistics and two-way ANOVAs with Tukey HSD post hoc analyses were used to examine the relationships between age, presence/absence of CP diagnosis, GMFCS level, gender, and PBS TTS.

RESULTS: No gender differences were observed in TTS; however, TTS improved significantly in all children between ages 2 and 4 years, 11 months (F = 18.80, df = 6, p<0.0001), and scores were significantly higher in children with TD (F = 43.37, df = 1, p<0.0001) than in children with CP. GMFCS level significantly impacted PBS TTS at all ages (F = 504.43, df = 3, p<0.0001), with significantly lower scores in children at GMFCS levels II and III. From ages 2 years to 4 years, 11months mean TTS improved for GMFCS level I (32.0 to 47.3), level II (10.5-25), level III (6.8-10.4), and in children with TD (28.4-51.4). In the 2 and 2.5 year age groups, children with CP GMFCS level 1 slightly outperformed children with TD; however, children with TD ages 3 and older outperformed children with CP at all GMFCS levels.

CONCLUSIONS: The PBS can be successfully administered to preschool-age children with CP at GMFCS levels I, II, and III, as well as, to children with TD. As expected, children with TD outperformed children with CP GMFCS levels II and III at all ages, and children with CP GMFCS level I at ages 3 years and older. The 2 year-old children were difficult to test due to behaviors typical of this age group; however, children with CP may be more accustomed to motor testing and following instructions from therapists.

CLINICAL RELEVANCE: This study provides PBS expected performance values for children with CP, ages 2 to 5 years, at GMFCS levels I, II and III and provides comparisons to children with TD.

EARLY PARENT-ADMINISTERED PHYSICAL THERAPY FOR PRETERM INFANTS: A RANDOMIZED CONTROLLED TRIAL

Girolami G, Ustad T, Oberg G, Campbell S, Helbostad J, Evensen K. A, Jorgensen L, Kaaresen P. Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, United States

PURPOSE/HYPOTHESIS: We hypothesized that infants who received a parent administered PT protocol would demonstrate greater improvements in motor performance from baseline to 37 weeks than infants in the control group.

NUMBER OF SUBJECTS: A pragmatic parallel group multicenter randomized controlled trial that included 153 infants born at gestational age (GA) ≤32 weeks randomized to an intervention (n = 74) or a control group (n = 79).

MATERIALS/METHODS: Parents, supervised by a physical therapist, conducted the intervention 10 minutes twice a day for three weeks from 34 to 36 weeks postmenstrual age (PMA). The intervention promoted postural control, head control and midline orientation. The control group received usual care. Motor performance was assessed using the Test of Infant Motor Performance Screening Items (TIMPSI) at baseline and the Test of Infant Motor Performance (TIMP) post-intervention (week 37 PMA). Linear mixed models were used to assess change in motor performance between groups. Effect size was measured by Cohens d.

An important goal of the intervention was to enhance parent-infant interactions. Parents were given several therapist consultations to ensure confidence in administering the intervention. In addition they were taught to assess infants' readiness to participate, to wait for the infants' responses and to modify the support according to the infants' reactions to handling to ensure that the infants were actively participating during intervention.

RESULTS: The mean baseline TIMPSI z-score was 0.06 (95% CI: -0.48-0.60). After the intervention there was a significant group difference indicating a change in motor performance from week 34 to 37 PMA favoring the intervention group, with an estimated difference in z-scores of 0.42 (95% CI: 0.13-0.72), p = 0.005. The effect size was 0.40.

CONCLUSIONS: This is the first pragmatic randomized controlled study addressing the effect of a parent-administered PT to improve motor performance conducted solely before 37 weeks PMA. Parent-administered physical therapy conducted before term-equivalent age improved motor performance at 37 weeks PMA more than conventional care. All infants will be followed-up until two years corrected age to evaluate the long-term effects of this intervention.

CLINICAL RELEVANCE: A three-week parent-administered physical therapy protocol implemented prior to term-equivalent age improved short-term motor performance for very preterm infants. The intervention was feasible and well tolerated by the infants.

BONE AND MUSCLE HEALTH IN CHILDREN WITH CEREBRAL PALSY

Goldsbury C, Prange P, Raciti S, Altenburger P, Gannotti M, Warden S, Fuchs R. Physical Therapy, Indiana University, Indianapolis, Indiana, United States

PURPOSE/HYPOTHESIS: Children diagnosed with cerebral palsy (CP) have smaller, weaker bones and altered muscle mass regardless of their degree of functional impairment when compared to typically developing children. The annual fracture incidence is 4% in children with CP compared to 2.5% in healthy children. The aim of this study was to assess bone and muscle health in children with a clinical diagnosis of CP using peripheral quantitative computed tomography (pQCT) and dual-energy x-ray absorptiometry (DXA). We hypothesized that children with CP would have reduced bone mass at the spine and distal femur, and reduced muscle mass of the lower leg (tibia) when compared to age and sex matched typically developing controls.

NUMBER OF SUBJECTS: Boys and girls between the ages of 4-9 yrs, classified as Tanner stage 1 (pre-pubertal) were recruited from local hospitals. Data are presented for n = 7 children with CP, and n = 7 typically developing children.

MATERIALS/METHODS: Testing sessions took place at the Translational Musculoskeletal Research Laboratory in the School of Health and Rehabilitation Science. Eligible children completed the following: 1) Health & nutrition questionnaire; 2) Tardieu scale; 3) sexual maturation questionnaire; 4) gross motor function classification system; 5) bone loading physical activity history questionnaire; 6) anthropometric measures, 7) DXA; bone mineral density (aBMD; g/cm2) of the distal femur and lumbar spine; and; 8) pQCT of the tibia. to assess volumetric bone mineral density (BMD; g/cm3), structure, estimated strength, muscle area, and intramuscular fat.

RESULTS: We report no significant differences for age, height, weight or BMI between children with CP and typically developing children, with no clinical presentation. All children were classified as pre-pubertal. Children from both groups had similar activity levels. Children with CP displayed significantly lower trabecular BMD (g/cm2) of the distal femur as assessed by DXA (P <0.05). There were no difference between CP and typically developing children for BMD of the lumbar spine as assessed by DXA (p <0.05). Children with CP had a trend towards reduced bone strength (pSSI; mm3) of the involved limb, with significantly reduced muscle area and greater fat area when compared to the typically developing children (p <0.05).

CONCLUSIONS: We report children with CP to have reduced bone mass, lower muscle mass, and higher intramuscular fat when compared to typically developing children. Children with CP may have compromised bone strength as measured by pSSI (mm3), which can contribute to fracture risk during adolescence and adulthood.

CLINICAL RELEVANCE: Our long-term findings will make an immediate and significant contribution towards understanding changes in bone and muscle health during growth in children with CP as a means to improve patient care, and provide normative data. Understanding factors that impact bone health in children with CP is an important first step towards addressing the increased bone fragility and fracture risk associated with CP.

RELATIONSHIPS BETWEEN GROSS MOTOR DEVELOPMENT, PROBLEM DAYTIME BEHAVIOR AND QUALITY OF LIFE IN YOUNG CHILDREN WITH AUTISM SPECTRUM DISORDER

Hedgecock J, Shui A, Dannemiller L, Rapport M. J, Katz T. Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

PURPOSE/HYPOTHESIS: Incidence of autism spectrum disorder (ASD) is increasing, and many children with this diagnosis have gross motor impairments that are related to activity limitations and participation restrictions. Many young children with ASD, however, are not referred to physical therapy for remediation of gross motor delay (GMD). The purpose of this investigation was to determine the inter-relationships between GMD, problem daytime behavior (PDB) and quality of life (QoL) in young children with ASD.

NUMBER OF SUBJECTS: 3,155 children aged 2-6:11 years with confirmed diagnosis of ASD enrolled in the Autism Treatment Network database were included in the study, excluding those with comorbid neurological/genetic diagnosis or positive neurological clinical signs (i.e., tone abnormality) and Vineland Adaptive Behavior Scale - 2 gross motor v-scale score (VABS) less than 12.

MATERIALS/METHODS: Retrospective analysis using multiple linear regression analysis was used to determine the relationships between GMD using the VABS, PDB using the Child Behavior Checklist (CBCL) and QoL using the Pediatric Quality of Life Inventory (pQoL). Sex, age, race, ethnicity, IQ, caregiver educational level and data collection site were included as covariates in adjusted regression models.

RESULTS: GMD worsens with increased age, and about 60% of children in the sample had measureable GMD (VABS <17th percentile). VABS was significantly related to CBCL internalizing and externalizing subscales (β = -0.91, p<0.0001; β = -0.55, p<0.0001) and pQoL (β = 2.18, p<0.0001). CBCL internalizing and externalizing subscales were both related to pQoL as well (β = -0.40, p<0.0001; β = -0.36, P<0.0001). VABS of children with only externalizing PDB did not differ compared to scores of children with neither PDB (β = 0.25, p = 0.1249). However, children with only internalizing PDB and those with both internalizing and externalizing PDB had significantly lower VABS than those of children with neither classification of PDB (β = -0.59, p<0.0001; β = -0.55, p<0.0001). VABS moderated the relationship of pQoL and CBCL internalizing and externalizing scores (interaction β = -0.026, p<0.0001; β = -0.018, p = 0.0081).

CONCLUSIONS: Young children with ASD have measureable GMD that worsens with age. GMD significantly and independently relates to internalizing and externalizing PDB and QoL. Children with internalizing only or both internalizing and externalizing PDB have higher levels of GMD than those with neither classification of PDB. Gross motor developmental level is a factor that impacts the independent relationships between internalizing and externalizing PDB and QoL.

CLINICAL RELEVANCE: Young children with ASD have significant GMD that is negatively related to PDB of ASD and QoL. GMD worsens with age in this population. Identifying children with ASD and internalizing PDB may allow for more efficient evaluation and initiation of physical therapy intervention for gross motor impairments in this population.

PARTICIPATION IN CHILDREN WITH DEVELOPMENTAL COORDINATION DISORDER

Hsu L, McCoy S. Rehabilitation Medicine, University of Washington, Seattle, Washington, United States

PURPOSE/HYPOTHESIS: Participation in home, school, and community activities is an important indicator for children's health and development. Developmental Coordination Disorder (DCD) is a chronic condition involving impairment in gross motor, postural, and/or fine motor performance that affects children's ability to perform the skilled movements necessary for daily living, including the performance of academic and self-care tasks. Some studies indicate children with DCD might have concerns with participation, but there is limited research. The purpose of this study is to describe participation in home, school, and community activities in children with DCD by using the Participation and Environment Measure for Children and Youth (PEM-CY) and compare to normative data.

NUMBER OF SUBJECTS: Fifteen children with DCD verified by the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-V) criteria, age from 5 to 12 years, participated this study.

MATERIALS/METHODS: Parents of all children with DCD completed the PEM-CY during the testing session. The PEM-CY measured levels of participation frequency and involvement, environmental support and environmental resources, in each of the following 3 settings: home, school, and community. Repeated measure ANOVAs were used to compare children with DCD's participation among the different settings. Children's scores were also compared with the normative data from test developers.

RESULTS: Children with DCD showed significantly lower frequency (p< 0.05) and lower involvement (p<0.05) in the school and community activities compare to home activities. They also demonstrated significantly lower environmental resources support in the school and community compare to at home (p<0.05). There were no significant differences in participation between the community and the school settings. Compared to normative data, children with DCD showed no differences in frequency and involvement in the home activities. They showed lower frequency (school: DCD = 3.7, norm = 5.0; community: DCD = 2.9, norm = 4.5) and involvement (school: DCD = 2.9, norm = 4.3; community: DCD = 2.8, norm = 4.2) in the school and community activities. The environmental support (home: DCD = 78.5, norm = 92.5; school: DCD = 75.8, norm = 91.4; community: DCD = 76.7, norm = 93.5) and resources (home: DCD = 89.7, norm = 90.4; school: DCD = 78.8 norm = 93.2; community: DCD = 81.7, norm = 92.3) were lower in all three settings.

CONCLUSIONS: Results suggest that children with DCD participated less in important school-related and community activities as compared to home activities. They also had less access to environmental resources in school and community settings compare to the home setting. Furthermore, compared to the norm, children with DCD showed generally less participation and fewer environmental supports in all settings.

CLINICAL RELEVANCE: The PEM-CY can provide detailed information about participation in children. However, more psychometric research needs to be done for children with DCD. Based on comparisons to the norm, therapists should consider focusing on participation in all settings for this population.

PARENTING INTERACTIONS DURING PLAY BETWEEN MOTHERS AND YOUNG CHILDREN IN THE ALABAMA GULF COAST REGION OF THE United States (US)

Kennedy E, Eaton K, Bannister A, Cleavelin L, Philips M. C. Dept of Physical Therapy, University of South AL, Mobile, Alabama, United States

PURPOSE/HYPOTHESIS: Positive parenting interactions during play are known to enhance developmental outcomes. Intervention for the young child has shifted from a narrow patient-centered approach to a family-centered or contextual approach. A consistent predictor of developmental outcomes is quality of mother-child interactions. The purpose of this pilot study was to explore using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO) to measure maternal interactions during play as other measures lack reliability and/or practicality for practice. The PICCOLO is a strength-based tool with a focus on identification of positive parenting interactions in the following four domains: affection (A), responsiveness (R), encouragement (E), and teaching (T).

NUMBER OF SUBJECTS: Twenty-nine English speaking mother-child dyads (child age 10 months to 57 months, maternal birth age 20 to 31 years) were recruited through snowball sampling from regions of Mississippi, Alabama, and northwest Florida (2015-16). The maternal population was predominantly healthy Caucasian, with mean education level of some college.

MATERIALS/METHODS: The mother-child dyads engaged in a play session, 10-15 minutes, in a location and activity of their choosing. Observed interactions were scored using the PICCOLO by trained investigators. Interrater and intratater reliability was established and maintained (r = .80). Demographic information and consent was obtained. An Ages and Stages Questionnaire® (ASQ-3) was completed to screen for developmental delay with none noted.

RESULTS: The data was not normally distributed (Shapiro-Wilk p<0.001) with differences noted between domains (Friedman Testp <0.001). Six post tests were run with (T) domain statistically significant (p = 0.000) when compared to the domains of (A), (R), and (E) (Wilcoxon Signed Ranks). A Bonferroni correction was performed; splitting the original p value (0.05) across the six comparisons. Max score available was 14 for (A), (R), and (E) domains and 16 for (T) domain. All mothers scored in the top 25% of possible domain scores in (A) (range 10-12, median 13), (R) (range 11-14, median 14), and (E) (range11-14, median 13) with only 10% of participants scoring in the top 25% of possible scores in (T) domain (range 2-14, median 11)

CONCLUSIONS: Mothers displayed less of the positive behaviors from the teaching domain when compared to showing affection, responsiveness and encouragement as emphasized in the PICCOLO scores. Further research is implicated to examine the meaning of the lower scores in teaching with relevance to the support of motor skill acquisition. The limitations of this study include small sample size and lack of diverse ethnicities and socioeconomic populations.

CLINICAL RELEVANCE: The PICCOLO is psychometrically sound, reliable, with predictive capabilities –making it a useful assessment and outcome measure. The PICCOLO is also inexpensive and practical to use, which makes it easy to use in a clinical setting to maximize therapeutic outcomes for children with disabilities.

PARENT-CHILD INTERACTION AND THE SUPPORTING PLAY EXPLORATION AND EARLY DEVELOPMENT INTERVENTION (SPEEDI) IMPROVE INFANT COGNITIVE

Marcinowski E, Tripathi T, Parson H, Hendricks-Munoz K, Dusing S. Physical Therapy, Virginia Commonwealth University, Richmond, Virginia, United States

PURPOSE/HYPOTHESIS: Research has shown that physical exploration of the environment gives rise to cognitive development throughout infancy. One purpose of this clinical trial was to change parent-infant interactions to enhance opportunities for physical exploration of the environment to improve the development of cognition.

NUMBER OF SUBJECTS: Ten of 14 infants enrolled in the NICU participated in 3 assessments after intervention ended. Infants were eligible if they were born at <29 weeks of gestation or had a brain injury and were medically stable by 40 weeks.

MATERIALS/METHODS: Infants were randomized into usual care (UC) or SPEEDI intervention group following a baseline assessment in the NICU. SPEEDI focused on teaching parents how to encourage motor and cognitive development through parent-child interaction. Therapists coached parents on how to optimize interactions at 5 sessions in the NICU. Following graduation from the NICU, parents and infants engaged in 5 sessions of play intervention per week for 12 weeks with therapist support at 5 home visits. Assessments were completed at 3 follow-up visits (end of intervention, 1 month later and 3 months later). Researchers video-recorded the Parent-Child Interaction (PCI) and Early Problem-Solving Indicator (EPSI) tasks. EPSI assessed number of explores on a standard set of toys over 6 minutes. The PCI was a 5 minute observation of parents and infants interacting. Reliable coders quantified the duration of infant toy-looking and parent toy behavior during the PCI. Using linear regression (α<.10), models of the 3 follow-ups tested a) how parent changes in cognitive engagements (change from 3-4 months) predicted infant behavior (duration of toy-looking on PCI, number of toy explores on EPSI), and b) if parent behavior (number of cognitive engagements, duration that toys are presented within the infant's reach) or infant behavior (number of toy explorations) differed by group (SPEEDI/UC).

RESULTS: Parents who positively changed cognitive engagements in the month following intervention had infants who looked at toys longer during the PCI at 4 months (p = .03). Additionally, parents who positively changed cognitive engagements in the month following intervention had infants who explored (p<.01) EPSI toys more. Finally, parents in SPEEDI presented toys within reach of infants for longer (p<.01) and positively changed their cognitive engagements to infants more in the month following intervention (p = .02), than parents in the UC group.

CONCLUSIONS: Parents who engaged their infants with toys more had infants who explored toys more. The SPEEDI intervention, which increased parent cognitive engagement, may enhance infant's exploration skills and cognitive development.

CLINICAL RELEVANCE: Interventions that target interactions between parents and infants in the first months of life may be efficacious at improving infant cognition.

INFLUENCE OF WEIGHT STATUS & PHYSICAL FITNESS ON ACADEMIC ACHIEVEMENT IN ALL-FEMALE COLLEGE PREP HIGH SCHOOL

Stolzman S, Hoeger Bement M, Hunter S, Harkins A, Kaugars A. H. Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States

PURPOSE/HYPOTHESIS: Increasing weight status is associated with lower educational outcomes (school absences, repeating a grade, and lower school engagement). In contrast, physical fitness can positively impact academic achievement. This study aimed to identify how differences in weight status and physical fitness are associated with academic achievement and biopsychosocial health characteristics among females attending a college-prep high school where high academic achievement is encouraged.

NUMBER OF SUBJECTS: 243 females (15.8±1.1 yr)

MATERIALS/METHODS: Students completed onsite-testing: 1) Biometrics for weight status, body composition (waist:hip circumference), salivary cortisol, fasting blood sample (glucose, total cholesterol [TChol], high-density lipoprotein [HDL], and non-HDL), 2) Physical Fitness (aerobic capacity [FitnessGram Progressive Aerobic Cardiovascular Endurance Run], strength [curl-ups & push-ups], leg flexibility [sit & reach]), and 3) Psychosocial Assessments (body image [Body Appreciation Scale], quality of life [PedsQL], stress [Perceived Stress Scale], and physical activity [Physical Activity Questionnaire]). The school provided academic achievement information (grade point average [GPA]) and standard test scores of college readiness [ACT & PSAT].

RESULTS: Weight group representation was 68.1% normal weight (NW), 21.0% overweight (OW), 8.4% obese (OB), and 2.5% underweight. A waist circumference >80% (age & gender) was seen in 20.6% with freshman (0.75±0.04)>juniors (0.73±0.05, p = 0.04) for waist:hip ratio. Blood sample analysis showed high levels of TChol (14.5%), non-HDL (12.3%), AM cortisol (13.0%), and PM cortisol (9.3%) and low levels of HDL (31.5%); only HDL was significantly greater in NW (53.5±13.0 mg/dL) than OW (46.3±10.3, p = 0.008) and OB (46.4±10.4, p = 0.04). Aerobic capacity was below the Healthy Fitness Zone for 38.0%. OB (2.94±0.76) demonstrated lower GPA than NW (3.43±0.48, p<0.001) but no differences in ACT or SAT scores. Students with higher weight status and central adiposity demonstrated lower academic achievement (p<0.001), physical fitness levels (p<0.01), and HDL (p<0.001) along with less positive views of their bodies (p<0.001) and poorer emotional functioning (p<0.05). Students with higher physical fitness levels demonstrated greater college readiness (p<0.001) and reported more positive views of their bodies (p<0.01), better quality of life (p<0.05), more physical activity participation (p<0.01), and less stress (p<0.05).

CONCLUSIONS: Female adolescents who are overweight or obese may experience lower academic achievement and poorer emotional functioning; however, higher physical fitness levels can positively influence a student's ability for higher academic achievement and college readiness along with better quality of life.

CLINICAL RELEVANCE: Pediatric PTs should encourage opportunities to improve physical fitness and weight status because of the positive effects on academic achievement and psychosocial functioning of female adolescents.

HAND ARM BIMANUAL INTENSIVE THERAPY (HABIT) IMPROVES FRONTAL CORTEX ACTIVATION DURING MOTOR ACTIONS OF CHILDREN WITH HEMIPLEGIC CEREBRAL PALSY

Surkar S, Hoffman R, Willett S, Flegle J, Harbourne R, Kurz M. Physical Therapy, MMI, University of Nebraska Medical Center, Omaha, Nebraska, United States

PURPOSE/HYPOTHESIS: Children with hemiplegic cerebral palsy (HCP) have various functional limitations that restrict activities of daily living and affect participation in educational, vocational, and social roles. Until recently, action execution problems were considered primarily responsible for movement dysfunction. However, compelling evidence suggests that movement dysfunction in children with HCP is not solely due to the action execution problems, but largely due to deficits in the planning of motor actions. Despite this, therapeutic interventions have been focused on action execution problems. However, the potential beneficial effects of therapeutic programs on action planning and the changes in cortical activation have never been scrutinized. The purpose of this study was to explore the pre- and post-intervention changes in the prefrontal cortex activation, and bimanual coordination in children with HCP.

NUMBER OF SUBJECTS: 6

MATERIALS/METHODS: 6 children with HCP (age = 4.7 + 1.2 yrs), MACS Levels I-IV participated in the study. The children received 50 hrs of HABIT (4 hrs/day, 5 days/week for 2 weeks + 1 hr home exercise program/day). Pre- and post-intervention, we assessed frontal cortical activation using functional near infrared spectroscopy (fNIRS) while children performed an action-planning task in a block paradigm (30 s task and 30 s rest). The average changes in the oxygenated hemoglobin (OxyHb) were quantified. We also performed the Assisting Hand Assessment (AHA) to assess bimanual coordination, the Box and Blocks Test (BBT) and Nine-Hole Peg Test (NHPT) to assess manual dexterity and speed.

RESULTS: There was 52.5% decrease in OxyHb concentration (frontal cortex activation) from pre- (0.40+0.07 μmol) to post-intervention (0.19+0.04 μmol) when the children performed the task with the affected hand. OxyHb decreased by 23% from pre- (0.26+0.01 μmol) to post-intervention (0.20+0.03 μmol) when the task was performed with the non-affected hand. The task performance on the affected hand improved by 63.2% (pre = 3.8+2.3, post = 6.2+1.4 shapes) and 20.6% on the non-affected side (pre = 6.3+1.3, post = 7.6+0.9 shapes). There was significant difference (P = 0.01) in the AHA score between pre- (52+14.2) and post-intervention (62.5+14.9). There was significant difference in the BBT (P = 0.05) from pre- (9.6+4.3 blocks) to post-intervention (12.3+4.9 blocks) and the NHPT (P = 0.05) from pre- (128+37.2 s) to post-intervention (90.8+18.6 s) on the affected hand.

CONCLUSIONS: The frontal cortex activation while performing the motor actions decreased after HABIT in children with HCP. The decrease in the frontal cortical activation paralleled the improvements in task performance, bimanual coordination, manual dexterity and speed. The decreased neural activity in the frontal cortex after HABIT in children with HCP potentially indicates an improvement in action planning.

CLINICAL RELEVANCE: HABIT may potentially improve the neural correlates that underlie the action planning and bimanual coordination in children with HCP.

NEURAL ACTIVATION WITHIN THE FRONTAL CORTICES DURING THE MOTOR ACTIONS OF CHILDREN WITH HEMIPLEGIC CEREBRAL PALSY

Surkar S, Hoffman R, Harbourne R, Kurz M. Physical Therapy, MMI, University of Nebraska Medical Center, Omaha, Nebraska, United States

PURPOSE/HYPOTHESIS: Until recently, action execution problems were considered primarily responsible for movement dysfunction in children with hemiplegic cerebral palsy (HCP). However, compelling evidence suggests that movement dysfunction in children with HCP is also partially due to deficits in the planning of motor actions. Behavioral studies have been insufficient in identifying whether a problem of the action execution system, or a problem of the action planning system affects movement execution. Measuring the neural activity of the frontal cortices, an area of the brain linked to action planning, can be used to assess the planning component of motor actions. The purpose of this study was to explore whether children with HCP have an increased frontal cortical activation during an action-planning task compared to typically developing (TD) children.

NUMBER OF SUBJECTS: 25

MATERIALS/METHODS: 15 TD children (age = 5.9+1.2 yrs) and 10 children with HCP (age = 7.1+3.3 yrs), MACS Levels I-IV participated in the study. We assessed frontal cortical activation of the children in both groups using functional near infrared spectroscopy (fNIRS). The children with HCP performed the task with their affected hand, while the TD children performed the task with their non-dominant hand. The children performed a sequential-shape matching task with a block paradigm (30 s task and 30 s rest). The task was repeated for four times and the average change in the oxygenated hemoglobin (OxyHb) was assessed. A larger concentration of OxyHb was associated with greater neural activity within the frontal cortices. We also performed the Box and Blocks Test (BBT) and Nine-Hole Peg Test (NHPT) to assess manual dexterity and speed.

RESULTS: There was significant difference (P = 0.01) in OxyHb between children with HCP (0.35+0.04 μmol) and TD children (0.10+0.01 μmol). There was significant difference (P = 0.01) in task performance (number of shapes matched) between children with HCP (4.7+0.7 shapes) and TD children (7.9+0.5 shapes). There was significant difference in the BBT performance (P = 0.03) between HCP (9.8+3.2 blocks) and TD children (33.0+ 1.3 blocks). Similarly, time to complete the NHPT was significantly different (P = 0.001) between children with HCP (128+28 s) and TD children (42.6+2.6 s). There was significant negative correlation between the BBT and OxyHb (ρ = -0.7, P = 0.01) positive correlation between NHPT and OxyHb (ρ = 0.6, P = 0.01).

CONCLUSIONS: Children with HCP had higher activation within the frontal cortices while performing a sequential shape-matching task as compared to TD children. Higher cortical activation was associated with the longer time to complete the NHPT and smaller number of blocks on BBT. The increased neural activity in the frontal cortex in children with HCP as compared to TD children potentially indicates a deficit in action planning.

CLINICAL RELEVANCE: Focusing on movement planning component during therapeutic intervention, rather than solely focusing on movement execution strategies, could potentially improve the functional motor outcomes of children with HCP.

INITIAL EFFICACY OF SUPPORTING PLAY EXPLORATION AND EARLY DEVELOPMENT INTERVENTION (SPEEDI): A DEVELOPMENTAL INTERVENTION PROVIDED IN THE NICU AND COMMUNITY IMPROVES PROBLEM SOLVING ABILITIES IN INFANTS BORN VERY PRETERM OR WITH BRAIN INJURY

Tripathi T, Owens A, Thacker L, Hendricks-Munoz K, Dusing S. Rehabilitation and Movement Sciences Program, Virginia Commonwealth University, Richmond, Virginia, United States

PURPOSE/HYPOTHESIS: The purpose of this clinical trial was to evaluate the initial efficacy of SPEEDI at enhancing problem solving.

NUMBER OF SUBJECTS: Fourteen infants, born at less than 29 weeks of gestation or with a brain injury and medically stable by 40 weeks of gestation were included.

MATERIALS/METHODS: Following a baseline assessment at 35-40 weeks of gestation, infants were randomized to the SPEEDI or Usual care (UC) group. During SPEEDI phase 1, 5 therapist-parent-infant collaborative education/intervention sessions focusing on planning appropriate developmental interactions with the infant. During phase 2, parents provided 20 minutes of intervention per day, 5 times a week for 12 weeks. SPEEDI phase 2 focused on developing a play routine and providing opportunities for motor and social play. Activities progressed based on parent- therapist discussion and infant's performance during a physical therapist visiting every two weeks. The Early Problem Solving Indicator (EPSI) was used to assess the problem solving ability at end phase 2 (EP2), follow up 1(F1) and follow up 2 (F2), 1 and 2 months post EP2 respectively. Analysis included mixed linear model (MLM) with a time, group, and interaction term. A priori, p-value of 0.10 was determined to be significant for this initial efficacy study. Cohen's d effect size was calculated and interpreted as small if< .20, medium < .50, large <.80 and very large <1.30).

RESULTS: MLM analysis of the frequency of the sum of all problem solving behaviors (look, explore, function and solutions) showed significant main effect of Group (p = 0.08) and Time (p = 0.002) and no interaction effect. Post hoc t-test showed no significant group differences at EP2, and F1 but significant group differences at F2 where infants in the SPEEDI group had a higher average score compared to infants in the UC group (p = 0.07). Cohen's d effect size were 1.30, 0.64, and 0.89 at EP2, F1 and F2 respectively. MLM analysis of the look and explore behaviors revealed no Group effect for look, significant main Group effect for explore (p = 0.06) and significant main Time effect for look and explore, (p = 0.002 and p = 0.001 respectively). Post hoc t-test showed infants in the SPEEDI group had a higher frequency of explore behavior at F2 compared to infants in the UC group (p = 0.04), with Cohen's d effect sizes of 1.4, 0.65, and 0.98 at EP2, F1, and F2, respectively.

CONCLUSIONS: Our findings suggest that while both groups improved in their problem-solving abilities during the study. The medium to large effect sizes at all time points and significant p-values at the end of the study suggest infants in the SPEEDI group outperformed infants in the UC group in their early problem solving abilities.

CLINICAL RELEVANCE: NICU physical therapist and EI need to help parents in providing daily opportunities for learning in the form of motor and social play in the NICU and continuing at home in the first weeks post NICU discharge.

COMPARISON OF METABOLIC SYNDROME GUIDELINES IN AN ADOLESCENT POPULATION

Vandenberg Z, Stolzman S, Hoeger Bement M. Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States

PURPOSE/HYPOTHESIS: Metabolic syndrome (MetS) is a diagnosis based on biometric factors in the categories of obesity, glycemic homeostasis, arterial pressure, and dyslipidemia. Guidelines for MetS in the adolescent population come from World Health Organization (WHO), International Diabetes Foundation (IDF), and the Gurka model. This study's purpose is to compare the 3 guidelines for MetS (WHO, IDF, and Gurka) in a cohort of adolescents across weight status. We hypothesize that the continuous model of Gurka will be more sensitive to diagnose MetS.

NUMBER OF SUBJECTS: Fifty-nine adolescents (15.27 years, 32 females) were classified as normal weight (n = 34, BMI z-score < 1.0) or overweight/obese (n = 27, BMI z-score > 1.0).

MATERIALS/METHODS: All adolescents completed biometric testing including height, weight, waist circumference (WC), resting systolic/diastolic blood pressure (SBP/DBP), and fasting blood sample (glucose, triglycerides [TG], high-density lipoprotein [HDL]). A hierarchical multiple regression analysis was completed to determine significant predictors of MetS status using the variables in the Gurka model (BMI, fasting glucose, SBP, TG, HDL).

RESULTS: MetS was diagnosed in 2 (3%) adolescents using the IDF model, 3 (5%) with WHO model, and 15 (25%) with the Gurka model. All of the adolescents diagnosed with MetS were overweight/obese using the IDF and WHO models. One normal weight and 14 overweight/obese adolescents were diagnosed using the Gurka model. From regression analysis, BMI alone predicted 66% of MetS, while the other variables accounted for an additional 27%.

CONCLUSIONS: The continuous nature of the Gurka model is more sensitive than the categorical nature of WHO and IDF. Weight status is a strong predictor for the diagnosis of MetS.

CLINICAL RELEVANCE: The continuous aspect of the Gurka model allows PTs to identify adolescents along the continuum for MetS and track progress.

© 2017 Wolters Kluwer Health, Inc. and Academy of Pediatric Physical Therapy of the American Physical Therapy Association