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ABSTRACTS

Abstracts of the Academy of Pediatric Physical Therapy Annual Conference 2019

doi: 10.1097/PEP.0000000000000657
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ADULTS WITH DOWN SYNDROME: IMPACT OF YOGA ON FUNCTIONAL MOBILITY

Adams S, Warning C, Wade T, Furgal K, Norris E, Mergenthal R. Western Kentucky University

PURPOSE/HYPOTHESIS: Current research suggests that strength and balance training programs for individuals with intellectual disabilities leads to improved functional ability and increased physical activity (PA) enjoyment. However, there is a lack of research exploring the impact of yoga on adults diagnosed with Down syndrome (DS). The purpose of this study is to determine the effects of a Hatha yoga program on the functional mobility and PA enjoyment of adults with DS. It was hypothesized that adults with DS will demonstrate increased balance, functional mobility and PA enjoyment following completion of a yoga program.

NUMBER OF SUBJECTS: 15 participants aged 19-42 years with a diagnosis of DS were recruited from a day programming center in Bowling Green, Kentucky. Participants did not engage in any type of yoga for at least 8 months prior to implementation of the yoga intervention, with no new activities during the study.

MATERIALS/METHODS: A quasi-experimental design was utilized in which a yoga program consisting of 16 sessions was delivered twice weekly for eight weeks for all participants. Baseline and post-intervention outcome measures included the Physical Activity Enjoyment Scale (PACES), Timed Up and Go (TUG), Floor-to-Stand Test (FtST), Modified Clinical Test of Sensory Interaction and Balance (CTSIB-M), and the Forward Reach Test (FRT). Administered tests evaluated PA enjoyment, functional mobility, static balance, and dynamic balance. Ratio level data was analyzed using a paired t-test comparing baseline scores to post-intervention scores. Nominal level data was analyzed with non-parametric statistics for PA enjoyment. The Eston-Parfitt Rating of Perceived Exertion Scale was administered during each session to assess perceived exertion for safety, but not analyzed.

RESULTS: There was a significant improvement in FtST (p=0.03, mean difference = 0.76 seconds, SD 1.25), and CTSIB-M condition four (eyes closed on a foam pad) (p=0.03, mean difference = 8.06 seconds, SD 12.82). TUG and FRT scores improved, however, statistical significance was not attained (TUG: p=0.19, mean difference = 0.90 seconds, SD 2.56), (FRT: p=0.71, mean difference 0.73 centimeters, SD 7.38). Positive responses to PA of yoga remain the same pre to post intervention as indicated by the total score responses of the 18-item PACES Scale (p=0.57).

CONCLUSIONS: Implementation of an eight-week yoga intervention program improved static and dynamic balance and functional mobility, of adults diagnosed with DS.

CLINICAL RELEVANCE: The results of the current study show that a yoga program incorporating static postures performed in quadruped and standing positions positively impact functional mobility and balance in adults diagnosed with DS. These participants also reported PA enjoyment related to yoga, contributing to high attendance compliance and an expressed motivation to continue participation in yoga.

PEDIATRIC TRANSFERS AND HANDLING TECHNIQUES IN PHYSICAL THERAPY EDUCATION: A COMPARISON OF PEDIATRIC FACULTY AND CLINICAL INSTRUCTORS

Anderson BS, Wolden M, Madsen J. University of Jamestown

PURPOSE/HYPOTHESIS: Safe physical management of pediatric patients requires skillful transfer and handling techniques. Doctor of Physical Therapy (DPT) students are trained on safe and effective transfer and handling techniques by practicing on adults. Practice on adults, however, cannot directly translate to pediatric patients due to the developmental differences between children and adults. There is limited information about how DPT students attain entry-level competency in pediatric transfer and handling techniques and the expectations of students' knowledge and competency with these techniques.

The purpose of our study was to examine current practices and expectations regarding pediatric transfer and handling techniques, specifically: 1. What pediatric transfer and handling techniques are taught in the classroom and clinical environments and 2. The expectations of students' performance in these skills.

NUMBER OF SUBJECTS: 106 DPT faculty and 47 CIs responded to our survey.

MATERIALS/METHODS: As approved by the institutional review board, DPT faculty who teach pediatric curricular content and pediatric clinical instructors (CIs) were invited to participate in our anonymous electronic survey. An independent t-test was performed to assess statistical differences between DPT faculty and CIs.

RESULTS: There was a significant difference (p < .01) between the pediatric transfers DPT faculty teach in the classroom and the transfers that CIs perform regularly in clinical practice; specifically the dependent two-person lift from wheelchair to/from the floor and transfers using lift equipment (Hoyer). There were no significant differences when comparing pediatric handling techniques DPT faculty teach in the classroom and the pediatric handling techniques CIs perform regularly in clinical practice. There was no significant difference in DPT faculty and CIs expectations of students' performance of pediatric transfers. However, DPT faculty had significantly higher (p < .01) expectations than CIs for students' performance of handling techniques.

CONCLUSIONS: Pediatric transfer techniques taught in the classroom are significantly different then what is performed in the clinic. To align DPT education with clinical practice, classroom performance of the dependent two-person lift from wheelchair to/from the floor and transfers using lift equipment (Hoyer) may not be required for the entry-level practitioner. In regards to the expectation of student performance of pediatric transfer and handling techniques, DPT faculty have significantly higher expectations of students' performance of handling techniques than CIs. Our findings indicate that there is a need for improved transparency and communication between DPT faculty and Cis to allow for consistent expectations of students clinical performance.

CLINICAL RELEVANCE: To align with current clinical practice, DPT programs should review current pediatric transfer and handling techniques taught in the classroom. Transparency and communication of student expectations on the performance of pediatric transfer and handling techniques is needed between DPT faculty and CIs.

PRELIMINARY FEASIBILITY RESULTS OF PEDBOTHOME: AN ANKLE REHABILITATION ROBOT DESIGNED TO MAKE HOME EXERCISE FUN

Belschner JL (Children's National Health System), Kovelman S (Children's National Health System), Coley C (Children's National Health System), Cleary K (Sheikh Zayed Institute for Pediatric Surgical Innovation), Evans S (Children's Hospital of Philadelphia), Fooladi H (Sheikh Zayed Institute for Pediatric Surgical Innovation), Salvador T (Sheikh Zayed Institute for Pediatric Surgical Innovation), Monfaredi R (Sheikh Zayed Institute for Pediatric Surgical Innovation), Alyamani S (Sheikh Zayed Institute for Pediatric Surgical Innovation)

PURPOSE/HYPOTHESIS: The purpose of this study is to determine the feasibility of an in-home ankle rehabilitation robot for a home exercise program.

NUMBER OF SUBJECTS: Four participants, ages 13 to 15 years old with cerebral palsy, have completed the feasibility study to date. All participants had previously participated in a PedBotLab feasibility or efficacy study. IRB approval was completed prior to study initiation and consent was obtained. The study is a joint effort between Physical Medicine and Rehabilitation at Children's National Health System and the Sheikh Zayed Research Institute and is supported through DHHS, NHI, and AACPDM funding.

MATERIALS/METHODS: PedBotHome is a three degree of freedom robot consisting of a foot plate surrounded by motors that can provide resistance/assistance, a smartphone to track movement, a chair, a personal computer, and a video display. The system allows the participant to control real time game play via movement of their ankle. The video game is a first person airplane simulation in which the objective is to fly through hoops in various positions. Game parameters can be modified so the objective of the game is to move in pitch, yaw, or roll or any combination thereof. Assistance or resistance can be added through motorized support of the robot. Each week, a physical therapist and software engineer reviewed the gaming data and modified the prescribed exercises in order to advance the participants ankle strength and ROM. PedBotHome was installed into each participant's home for 28 days and data was collected via participant log sheet, as well as direct game play data from PedBotHome.

RESULTS: The primary outcome measure is days of use with twenty days considered successful. Three of the four participants utilized the system over 20 sessions. The one participant who did not complete 20 sessions had significant issues with connectivity of PedBotHome. Passive and active ROM and strength were additionally assessed with positive results in all domains. All participants reported enjoyment of and engagement in the game and device. Upon post survey two parents reported that they would greatly desire to have a system permanently in their home.

CONCLUSIONS: PedBotHome is demonstrating feasibility of a home based rehab robot model that is remotely monitored by a therapy team. Participants are interactive in their home exercise plan and reported that they felt like they did more exercise with PedBotHome than they would have done with a traditional exercise program. The feasibility study of PedBotHome is currently ongoing and will transition to an efficacy study.

CLINICAL RELEVANCE: Adherence to a home exercise program is essential in positive outcomes with physical therapy. Historically it has been difficult to motivate and engage younger clients in isolated exercises, especially in populations with chronic conditions. The utilization of a rehab robot that promotes completion of home exercise and is engaging could be a clinically useful tool.

IMPROVED OUTCOMES FOLLOWING AN 8-WEEK LAND AND AQUATIC POWER TRAINING PROGRAM FOR CHILDREN WITH NEUROLOGIC CONDITIONS

Brilmyer J, Malacarne M. The Children's Institute

BACKGROUND & PURPOSE: Power movements are physical activities performed quickly and explosively (Verschuren et al., 2013). Power based movements are important during play, recreation, sports, and daily activities in children. Power is work over time and characterized by quick bursts of high intensity physical activity followed by short rest periods. Power improvements may increase the quality of participation in daily activities. The Power Training Program was developed at The Children's Institute to address power impairments in children with various neurologic conditions. To our knowledge, the evidence has not thoroughly explored the benefits of power training in populations other than cerebral palsy. No program has explored the use of aquatic power interventions. Based on the current evidence, there is good potential to impact function in children with neuromuscular conditions with the use of power training.

CASE DESCRIPTION: Children included were 3 years of age or older and had a neurologic condition such as cerebral palsy, spina bifida, brain injury, or hypotonia. They completed three 1-hour sessions per week over 8 weeks. Two sessions were land based and one session was aquatic. The session structure was a modified protocol based on the power training protocol described by Van Vulpen et al. (2017). Children completed 6-8 repetitions of each exercise at maximal effort over a distance or 25 second time period. They were allotted 30-50 seconds of rest in between each repetition (Table 1).

The outcome measures were the muscle power sprint test (Verschuren et al., 2013), the timed up and down stairs test (Zaino et al., 2004), and the goal attainment scale (King et al., 2000).

OUTCOMES: The results of four children between the ages of 4-10 were analyzed. All children improved the muscle power sprint test, timed up and down stairs, and goal attainment scale scores between the pretest and posttest (Figure 1). The greatest changes were observed in the timed up and down stairs and goal attainment scale, with the goal attainment scale change being the most significant (p=.01).

DISCUSSION: Participants demonstrated improvement in all areas following The Power Training Program. The mean power output improved by 5.2 watts within the group. The mean change in the timed up and down stairs assessment was 29.5 seconds. The goal attainment scale score improved by 50%. Based on these results, the Power Training Program was successful at eliciting improvements which were captured by the discussed outcome measures.

The outcomes from the Power Training Program suggest that the use of power activities in both land and aquatic environments may produce functional power based outcomes. These findings suggest that power based training programs should be considered in other children with neurologic conditions in addition to children with cerebral palsy. Physical Therapists should incorporate power-based interventions into both aquatic and land sessions for children with neurologic conditions to improve outcomes at the impairment, activity, and participation levels.

THERAPIST USE OF MODIFIED RIDE ON CARS IN CLINICAL PRACTICE: A SURVEY

Broggi MB, Pachman S, Rehr M, Waffenschmidt B. Quinnipiac University

PURPOSE/HYPOTHESIS: The purpose of this survey-based study was to investigate and describe the use of modified ride on cars (MROC) as an intervention strategy in regular pediatric clinical practice.

NUMBER OF SUBJECTS: Thirty seven physical therapists representing 20 states and a variety of clinical settings completed the survey, representing at least 113 clients.

MATERIALS/METHODS: Pediatric physical therapists were contacted electronically via email and/or social media and asked to participate in a short survey. The survey was administered electronically and distributed through a variety of national professional groups including the Academy of Pediatric Physical Therapy, and a pediatric therapy listserv.

RESULTS: Data from the survey was analyzed using descriptive statistics. The majority of clients represented were between the ages of 2 and 3 years old, and had been diagnosed with a wide variety of health conditions. Physical Therapists reporting using MROCs as a direct intervention about 25% of the time, and often included it as part of a home activity program. Therapists estimated that 41% of families used the MROC at least one time per week outside of therapy sessions. The goals cited most commonly for use of the MROC were: development of independent mobility, promotion of motor development and preparation for power mobility. A variety of additional developmental benefits were reported, including increased motivation for movement, interaction with peers/environment and visual scanning. Ultimately 100% of survey participants deemed MROCs to have a positive impact on their clients.

CONCLUSIONS: The results of the survey suggest that pediatric physical therapists across a variety of settings have adopted use of MROCs in clinical practice. Therapists report using the MROC to address specific impairment and activity limitation goals, as well as for improving clients' participation in their environment.

CLINICAL RELEVANCE: MROCs appear to be well received by therapists as part of a comprehensive intervention program for children with mobility limitations. Therapists also report families utilize the MROC outside of therapy on a regular basis, and with a frequency that compares favorably to reports of consistency with more traditional home programs. The MROC appears to be a unique intervention that can address goals that span the ICF.

ZOO TROOP FOR ALL IN ACTION: A PILOT FOR INCLUSIVE EDUCATIONAL PROGRAMMING AT THE ZOO

Butler E. Cincinnati Children's Hospital Medical Center

PURPOSE: Very few zoo programs around the country provide inclusive educational programming to children with developmental disabilities. Staff at the Cincinnati Zoo and Botanical Garden (CZBG) has previously received training in working with individuals with developmental disabilities, however, they have not yet translated this training to their educational programming for children. In partnership with zoo staff, our objective was to implement a pilot class for inclusive educational programming for children with developmental disabilities called Zoo Troop for All (ZTFA).

DESCRIPTION: Our team worked with CZBG staff to adapt the Zoo Troop curriculum to meet the needs of the participants. Adaptations included adding an additional week to introduce key concepts; creating visual supports, such as visual schedules and wait cards to use in the classroom; modifying hike locations around the zoo to ensure accessibility for all participants; and providing direct support and consultation regarding seating options, behavior management, and sensory experiences. The pilot class consisted of eight participants: five boys and three girls, aged five to eight years, with medical diagnoses of Down syndrome (4), spina bifida (1), autism spectrum disorder (2), and global developmental delay (1). The primary instructor of the course demonstrated a 19% increase in confidence to lead the ZTFA class according to the Zoo Troop for All Confidence Scale. The Zoo Troop for All Student Observation Scale showed increases in attention, independence, and participation, and decreases in disruptive behavior among participants. On the Zoo Troop for All Caregiver Satisfaction Survey, 100% of caregivers reported that they strongly agree with statements regarding satisfaction with the overall experience, the staff's knowledge about their child's needs, the positive impact on their child, and feeling comfortable with their child participating in future ZTFA classes.

SUMMARY OF USE: Outcome measures indicate that the pilot ZTFA class was successful in meeting the needs and expectations of ZTFA participants, their caregivers, and CZBG staff. The ZTFA team plans to consult with CZBG leadership to determine options for future classes, such as different tracks for children with developmental disabilities to meet their individual needs and parent preference for safety and supports.

IMPORTANCE TO MEMBERS: Children with developmental disabilities often experience less opportunities for participation with their peers compared to children without development disabilities. Pediatric physical therapists are uniquely situated to lend their expertise to community organizations to develop more inclusive programming and participation opportunities for this population. The successful pilot class of ZTFA indicates that professionals in the field of developmental disabilities can be successful in implementing these types of programs with community partners.

FUNCTIONAL IMPROVEMENTS FOLLOWING RESISTANCE TRAINING USING THE UNIVERSAL EXERCISE UNIT IN A CHILD WITH LEVEL V CEREBRAL PALSY: A CASE REPORT

Carrozzi A (California Children's Services), Chou N (Kaiser), Widener F (Samuel Merritt University)

BACKGROUND & PURPOSE: Resistance training for children with severe cerebral palsy (CP) is not well researched, particularly in children with non-ambulatory CP. While there is research supporting that resistance training leads to increased strength in children with CP, it has been questioned whether these strength gains translate into functional improvements. The Universal Exercise Unit (UEU) is a piece of equipment used to provide resistance training for those who have difficulty with isolated motor control. There is evidence that intervention in the UEU may lead to improved gross motor function. The purpose of this case report is to a) report the functional outcomes after physical therapy (PT) intervention for a 12-year-old-child with Gross Motor Functional Classification System (GMFCS) level V CP and b) describe the potential of the UEU for resistance and functional training for a child with CP.

CASE DESCRIPTION: PN was a 12-year-old male with level V spastic quadriplegic CP with limited functional gains following traditional rehabilitation. He had limited isolated motor control and significant extensor spasticity. His family's goals were to improve sitting ability, trunk control, and assisted ambulation in order to better interact with family and participate at school. Over 6 weeks, 2-3 times per week, PN performed strength training in the UEU focused on hip, knee, and trunk extension strength followed by functional sitting activities, sit to stand exercises, and ambulation in the gait trainer. Sessions lasted about one hour.

OUTCOMES: Following resistance training in the UEU, PN made functional improvements. Both before and after the six weeks, he was only able to complete 9 items on the Gross Motor Functional Measure (GMFM), and improved by 5 points (minimally clinically important difference [MCID] = 3.71 points). He improved by 2 points on 10 out of the 12 items (MCID = 2 points) on the Canadian Occupational Performance Measure (COPM). In a modified 6 Minute Walk Test (6MWT) using his gait trainer, he improved by 14 meters (minimal detectable change [MDC] = 47 meters in ambulatory children with CP).

DISCUSSION: In this case, a 12-year-old child with level V spastic CP was able to make small, but meaningful, functional gains after 6 weeks of resistance training using the UEU. Functional gains included improved reciprocity of steps and endurance when ambulating in his gait trainer, improved sitting endurance, and decreased assistance for standing. His improved scores on the GMFM, COPM, and modified 6MWT indicate improvements in the impairment, activity, and participation realms of function. Resistance training using the UEU coupled with functional training is a promising intervention that improved functional outcomes in this child with severe CP. With limited evidence for intervention in this population, there is a possibility that older children with severe CP may be undertreated. Further research into intervention strategies and outcome measures specific for these children is needed.

HEARING THE CHILDS VOICE: GOAL-SETTING WITH CHILDREN WITH AUTISM SPECTRUM DISORDER AS PART OF INTERVENTION FOR PROMOTING PARTICIPATION

Chen Y, Liu C, Lin Y, Kang L. Chang Gung University

PURPOSE: This report seeks to explore the goals and priorities of children with Autism spectrum disorder (ASD) for community participation by involving them in a collaborative goal-setting process which informs their further intervention.

DESCRIPTION: Participation has been described as a key rehabilitation outcome. Research showed that participation of children with ASD was more restricted in the community than at home or school. Physical and occupational therapists in pediatrics nowadays are working toward participation-based practices in collaboration with the child and family. Therapists often collaborate with parent rather than the child in goal setting. Children do not have enough opportunity to express what and how they would like to participate in the community. In order to hear the child's voice, we interviewed 13 children with ASD 6-10 years old with normal intelligence (i.e. IQ score above 70). Our research group involves 2 physical therapists and 2 occupational therapists. The Picture My Participation (PMP) developed by Imms, Granlund, Bornman, and Elliot (2014) was adapted and used for interview. The PMP is a picture-supported interview which asks children to identify participation frequencies, levels of involvement, and barriers and facilitators to the children's participation. We selected the 11 community activities out of 22 overall activities. Therapists encouraged children to express themselves, and identify 3 activities they desire to do the most, either from the 11 community activities or other self-selected activities. Children's opinions were used to inform parents and therapists in intervention planning.

SUMMARY OF USE: All 13 children were able to identify their goals for community participation. Among the 11 activities interviewed, the top three activities the children participated most often were organized leisure activities, family celebrations, and shopping. The levels of involvement for these activities were from somewhat involved to very involved. The activities the children desired to do the most are overnight trips, family celebrations, and organized leisure activities. Apparently children tended to select prioritized activities in which they often do and have good experiences with, and thus would like to do more. Therapists then informed the parents about their child's opinions after the interview. Though the child's priorities did not meet the parents' expectations, the parents respected and were willing to collaborate in planning strategies considering children's priorities.

IMPORTANCE TO MEMBERS: Supportive attitudes of therapists with the use of an appropriate tool make it feasible to enable children with ASD in identify their own goals. Children have the rights to give their views, and their views are important in decision making about their own intervention plan. Involving children in goal identification may in turn increase their motivation and engagement in intervention process. Despite many challenges in clinical practices such as time constraint and insufficient education to the therapists and family, children can take an active role in therapeutic goal setting with appropriate support.

AN EVIDENCE-BASED EVALUATION ALGORITHM AND TREATMENT GUIDELINES FOR CHILDREN WITH DEVELOPMENTAL COORDINATION DISORDER

Christensen C, Grisez L. Nationwide Children's Hospital

PURPOSE: Developmental coordination disorder (DCD) is a chronic health condition that when present, affects children's motor skills, activities of daily living, socialization, and participation. Although DCD is typically identified during childhood, the consequences of this condition can lead to lifelong health problems including decreased fitness, increased cardiovascular risk factors, obesity, and psychological concerns. Through appropriate evaluation and treatment, physical therapists play a vital role in improving the lifelong health and wellbeing of individuals with DCD.

DESCRIPTION: Following a literature review of over 200 studies, resources were developed for physical therapists to use during the evaluation and treatment of children with DCD. For the evaluation section, tools were established to assist in the identification of children with DCD using the DSM V criteria; methods to screen for other medical concerns were synthesized; and standardized assessments to evaluate balance and coordination were recommended. The evaluation results guide treatment recommendations. This information is organized in an algorithm format to allow therapists quick and efficient access in a busy clinic environment. Additionally, the effectiveness of various treatment techniques are presented in a table format. Within the table, treatment techniques are listed as recommended, unclear, or not recommended for use based on (1) the literature, (2) the child's presenting body structure or function, activity, or participation restriction, and (3) the patient and family goal.

SUMMARY OF USE: Summarizing the vast amount of literature published on the evaluation and treatment of children with DCD, allows therapists to use an evidence-based approach to improve the lives of children with this condition. The development of an algorithm and a treatment technique table, permits therapists to access vital information quickly, accurately, and efficiently in a fast-paced clinic environment. The tools created guide therapists to the four action steps that can lead to enhanced outcomes for children with DCD including: 1) facilitating a diagnosis of DCD when appropriate 2) providing PT intervention 3) increasing community involvement and 4) educating adults working with this child to provide the most complete care for a child with coordination concerns.

IMPORTANCE TO MEMBERS: The DCD literature is varied and vast in nature making it challenging for physical therapists to identify appropriate evaluation and treatment techniques. The tools developed and presented in this poster will allow therapists to quickly access the most up-to-date information on the evaluation and treatment of children with DCD. Through the appropriate evaluation and treatment of children with this condition, the vicious cycle of motor delays leading to decreased participation and therefore enhanced motor delays further may be avoided. This cycle can lead to long-term health risks that can affect an individual throughout a lifetime. Thus, appropriately identifying and treating individuals with DCD is import work that can have a lasting impact on the lives of people with this condition.

THE EFFECT OF EXERCISE AND MOTOR INTERVENTIONS FOR CHILDREN AND ADOLESCENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA: A SYSTEMATIC REVIEW

Coombs A (University of Southern California/Children's Hospital of Los Angeles), Sargent B (University of Southern California)

PURPOSE/HYPOTHESIS: Acute lymphoblastic leukemia (ALL) is the most prevalent cancer among children and adolescents in the United States, representing 20% of all childhood cancers. Children with ALL experience deficits in flexibility, strength, endurance, function, and participation both during and after medical intervention for ALL. Exercise and motor interventions may prevent or manage these limitations. The objective of this systematic review is to evaluate the effect of exercise and motor interventions on motor outcomes of children with ALL.

NUMBER OF SUBJECTS: Sixteen studies were included in this review with a total of 444 children.

MATERIALS/METHODS: Nine databases were searched from 1998 to 2018 for clinical trials and cohort studies on the motor outcomes of exercise and motor interventions for children with ALL. Level of evidence and risk of bias were assessed.

RESULTS: Sixteen studies were included: 9 randomized clinical trials and 7 prospective cohort studies. A total of 444 children with ALL ranging in age from 1 to 18 years participated in the studies. Interventions were provided during acute chemotherapy (n=1), maintenance chemotherapy (n=8), remission (n=3), or across all three phases (n=4). Intervention occurred either through direct intervention (n=7) or a supervised home program (n=9). Interventions included: relaxation training, stretching, strength training, aerobic training, and motor skill training. Risk of bias was moderate to high across studies. Outcomes at the body structure and function level (strength, flexibility, endurance) were measured in 68% of studies, with 81% of outcomes resulting in statistically significant improvements. Outcomes at the activity and participation level were measured in 68% of studies, with 54% of outcomes resulting in statistically significant improvements.

CONCLUSIONS: This review found low to moderate quality evidence for the efficacy of exercise and motor interventions on motor outcomes of children and adolescents with ALL.

CLINICAL RELEVANCE: Further research is needed on efficacy of exercise and motor interventions for children with ALL. In addition, further research is required to investigate best practices for family centered-care, support of exercise behavior change and optimal exercise dosing across the spectrum of treatment.

TEACHING PHYSICAL THERAPY WITHIN THE DPT CURRICULUM: STRIVING FOR QUALITY THROUGH A COLLABORATIVE PROCESS

Dannemiller LA, Rapport MJ. University of Colorado Physical Therapy Program

PURPOSE: The purpose of this poster is to highlight the Education Summit process used by the APPT to engage a representative group of educators in dialogue, discussion, and collaboration around the educational outcomes of all DPT graduates related to acquisition of knowledge, skills and abilities in pediatric physical therapy. Secondary objectives are to analyze the outcomes of this collaborative process focusing on the products that have emanated from the Summit meetings and work groups.

DESCRIPTION: The Academy of Pediatric Physical Therapy (APPT) of the American Physical Therapy Association has made efforts to improve pediatric physical therapy (PPT) education, however there has been a lack of collective understanding of the specific pediatric content that needs to be taught, how best to teach it, and how to measure educational outcomes. In response to this need, APPT leadership committed support for collaboratively engaging educators in the scholarship of teaching and learning (SOTL). An Education Summit was held in 2012 that resulted in the publication of Essential Core Competencies in Pediatric Physical Therapy. Since 2014, this paper was cited at least 40 times and interest in entry-level DPT education has continued to grow. Seeking continued advancement, the APPT held Education Summit II, in November 2017 by convening selected PPT educators from across the US to discuss current gaps in education research and explore collective project ideas. Criteria for participation in each Summit were established and a submission process insured that participants would represent the array of pediatric physical therapy education. Selected participants had pre-work to prepare for each Summit. The construction of each Summit focused on a creative process of collaboration and representative decision-making to engage participants in the Scholarship of Teaching and Learning (SOTL) projects, resulting in completion and dissemination of several guiding manuscripts and additional evidence to support decisions in teaching pediatric content in entry-level curriculum.

SUMMARY OF USE: Two successful Education Summit meetings occurred over 4 years, attended by a diverse group of pediatric physical therapist academic and clinical educators representing a broad geographic area, multiple perspectives, different practice settings and varied years of experience. Four working groups were established at Education Summit 2 and remain actively engaged in their respective research projects. To date, there have been 24 products disseminated through multiple local and national networks including presentations and publications in peer-reviewed journal.

IMPORTANCE TO MEMBERS: APPT members can be assured that funding from the APPT to support efforts around pediatric physical therapy education are being well spent by yielding ongoing collaborations, working groups and multiple avenues for dissemination. This poster will provide members with an opportunity to learn more about the process and the ongoing outcomes related to pediatric physical therapy education.

TEACHING COLLABORATIVE TRANSITION SERVICES VIA AN INTERPROFESSIONAL DISCHARGE PLANNING MEETING SIMULATION

Del Rossi L, Furphy K, Cox L, Stump D. Stockton University

PURPOSE/HYPOTHESIS: Transition planning routinely requires a collaborative interprofessional (IP) team approach. Despite the expectations of competency in interaction as an IP team member, entry-level students in physical therapy (PT), occupational therapy (OT), and social work (SW) typically learn about this process through discipline specific lectures. Authors implemented an IP discharge meeting simulation and hypothesized this experience would increase student confidence in transition planning participation and collaboration.

NUMBER OF SUBJECTS: The total sample size was 81 students. (n=19 in SW; n=33 in OT; n=29 in PT)

MATERIALS/METHODS: The goal of the simulation experience was for student teams to create a feasible transition plan for a client with a C4 ASIA A spinal cord injury (SCI) aging out of a pediatric long-term care center (LTC) and moving to her family's apartment. Students completed a pre-test measuring their confidence in participating in a team planning meeting and their understanding of the roles and responsibilities of other healthcare team members. Researchers provided a short presentation of de-identified photos, schematic drawing of the home, and medical information to the multidisciplinary student group. Students were assigned to heterogeneous groups of 8-10 students, representing PT, OT and SW. Students had one hour to answer guiding questions about barriers to discharge and durable medical equipment (DME). Student groups shared recommendations and questions were reviewed via instructor facilitated discussion. The clients discharge plan, specific DME recommendations and family training considerations were shared with all. Students individually completed a written post-test and reflection. Institutional review board approval was obtained.

RESULTS: Quantitative responses were measured with a Likert scale on the domains of understanding roles and responsibilities and confidence in communication and collaboration as a member of an IP team. Social work students had statistically significant lower means than did OT and PT students on the domains of communication and collaboration. All students had higher scores on the post-test for all three domains. Initial qualitative thematic analyses measured students' perceptions/confidence in preparation for future clinical practice.

CONCLUSIONS: Students gained essential skills grounded in the Interprofessional Education Collaborative (IPEC) Core Competencies. The American Physical Therapy Association (APTA), American Occupational Therapy Association (AOTA) and Council on Social Work Education (CSWE) participate in IPEC and are accountable to these accrediting bodies' requirements of didactic and clinical curricula that include IPE.

CLINICAL RELEVANCE: Student participation in IPE activities aimed at developing clinical expertise and collaboration skills can prepare students to engage in effective interprofessional collaborative practice (IPCP).

EFFECTS ON CARDIOVASCULAR AND MUSCULAR ENDURANCE FOLLOWING PARTICIPATION IN A CIRCUIT TRAINING INTERVENTION PROGRAM FOR A PATIENT WITH INTERSTITIAL LUNG DISEASE: A CASE REPORT

Dickens A (Nicklaus Children's Hospital & University of Miami), Moore J (University of Miami), Cahalin L (University of Miami), Bloyer M (University of Miami), Gimenez C (Nicklaus Children's Hospital)

BACKGROUND & PURPOSE: Interstitial Lung Disease (ILD) remodels the lung interstitium and distal airspace resulting in reduced functional capacity, dyspnea, and exercise induced hypoxia. Factors known to cause ILD in infants and children are different than those that cause ILD in adults. Therefore, the effects of intervention strategies used with adults with ILD may differ in children. There is a lack of evidence in the current literature on physical therapy or exercise intervention in the pediatric population for those diagnosed with ILD. The purpose of this case report is to determine the feasibility and describe the effects following participation in an 8-week circuit training intervention (CTI) on the cardiovascular and musculoskeletal systems of a patient diagnosed with interstitial lung disease.

CASE DESCRIPTION: An 8-year 7-month old boy with a diagnosis of ILD was referred to outpatient physical therapy (PT) to address endurance, strength, balance, and coordination deficits. In January 2018, the patient was placed on supplemental oxygen via nasal cannula at 2 liters/minute and was also placed on the organ transplant waiting list. Following six months of skilled PT intervention he made significant improvements cardiovascular performance resulting in reduction in supplemental oxygen to 1.5 liters/minute and removal from the transplant list. At that time an 8-week CTI was introduced. The 15-minute CTI included a 5-minute warm-up (treadmill at a set speed and 0% incline) followed by five, 2-minute stations. The five stations included: step ups on a 7-inch step, abdominal strengthening, sit to stands and throw a 2-pound ball, side shuffle holding a 2-pound ball, and standing broad jump passing a 12-inch marker. Rest breaks were provided at the end of each station or as needed, and rest time was recorded. Following the completion of each station the patient's heart rate, rate of perceived exertion via Borg Rate of Perceived Exertion (RPE) Scale, and oxygen saturation range were recorded.

OUTCOMES: Primary outcome measures taken pre and post 8-week intervention included: aerobic capacity (6 Minute Walk Test (6MWT)(meters)), quadriceps strength (Hand Held Dynamometry (kilograms)), chest wall expansion (centimeters), forced vital capacity (cubic centimeters), maximal inspiratory pressure (centimeters of H2O), body mass index (percentile), forward jump distance (inches), strength/endurance (60 second timed sit ups (number), and balance (single limb stance time (seconds). Improvements were observed across all outcome measures tested following CTI. The most remarkable change observed was in the 6MWT. He improved in distance ambulated in the 6MWT from 395 m to 457.2 m, a difference 62.2 m. The reference value for the 6MWT in healthy children, 8 years of age, is 577.8 m.

DISCUSSION: This case report demonstrated that it is feasible to implement an 8-week CTI designed to target cardiovascular and muscular strength and endurance. In addition, positive changes were observed in aerobic capacity, respiratory function, and strength indicating that the CTI was not only feasible yet also effective.

WHAT ARE THE EPIDEMIOLOGICAL AND DEMOGRAPHIC FACTORS OF CHILDREN BORN BETWEEN 2008 AND 2018 WITH NEONATAL ABSTINENCE SYNDROME (NAS) OR SUBSTANCE EXPOSURE (SE) IN THE SOUTHWEST VIRGINIA COMMUNITY?

DiResta K, Bradley E, Gatlin R. Emory & Henry College

PURPOSE/HYPOTHESIS: The purpose of this survey-based study was to investigate and describe the use of modified ride on cars (MROC) as an intervention strategy in regular pediatric clinical practice.

NUMBER OF SUBJECTS: Thirty seven physical therapists representing 20 states and a variety of clinical settings completed the survey, representing at least 113 clients.

MATERIALS/METHODS: Pediatric physical therapists were contacted electronically via email and/or social media and asked to participate in a short survey. The survey was administered electronically and distributed through a variety of national professional groups including the Academy of Pediatric Physical Therapy, and a pediatric therapy listserv.

RESULTS: Data from the survey was analyzed using descriptive statistics. The majority of clients represented were between the ages of 2 and 3 years old, and had been diagnosed with a wide variety of health conditions. Physical Therapists reporting using MROCs as a direct intervention about 25% of the time, and often included it as part of a home activity program. Therapists estimated that 41% of families used the MROC at least one time per week outside of therapy sessions. The goals cited most commonly for use of the MROC were: development of independent mobility, promotion of motor development and preparation for power mobility. A variety of additional developmental benefits were reported, including increased motivation for movement, interaction with peers/environment and visual scanning. Ultimately 100% of survey participants deemed MROCs to have a positive impact on their clients.

CONCLUSIONS: The results of the survey suggest that pediatric physical therapists across a variety of settings have adopted use of MROCs in clinical practice. Therapists report using the MROC to address specific impairment and activity limitation goals, as well as for improving clients' participation in their environment.

CLINICAL RELEVANCE: MROCs appear to be well received by therapists as part of a comprehensive intervention program for children with mobility limitations. Therapists also report families utilize the MROC outside of therapy on a regular basis, and with a frequency that compares favorably to reports of consistency with more traditional home programs. The MROC appears to be a unique intervention that can address goals that span the ICF.

PROGNOSTIC INDICATORS FOR RECOVERING INDEPENDENT WALKING ABILITY IN CASES OF PEDIATRIC TRANSVERSE MYELITIS: A SYSTEMATIC REVIEW

Drews J, Broomand Y, McCole L, Quartano J. Brooks Rehabilitation

PURPOSE/HYPOTHESIS: Transverse myelitis is inflammation of the spinal cord, caused by infections, immune system disorders and other demyelinating disorders. Symptoms progress over hours to days and can include pain, muscle weakness, sensory abnormalities and paralysis, leading to functional impairments including gait abnormalities or inability to ambulate. Transverse myelitis differs in disease process and symptomatology from other inflammatory conditions, including neuromyelitis optica and acute disseminated encephalomyelitis, as it is isolated to the spinal cord.

It is comparable to traumatic spinal cord injuries as both present with sensory and motor weakness below the lesion level, leading to impaired function. In contrast, transverse myelitis is a demyelinating disorder, and with standard treatment, children can regain myelination and thus function. There are varied reports of disease course and recovery in the literature. However, there is currently no systematic review looking at consensus on positive prognostic indicators for recovery of function, specifically recovery of independent ambulation.

PURPOSE: The purpose of this systematic review was to examine the prognostic indicators of recovery of independent walking in the acute phase of pediatric transverse myelitis.

NUMBER OF SUBJECTS: 9 articles

MATERIALS/METHODS: A systematic literature search of PubMed, CINAHL and ProQuest was conducted, to find articles published between January 1999 and April 2019. The search was guided by the PRISMA 2009 Flow Diagram, a known tool used to systematically narrow down articles for a systematic review or meta-analysis. Researchers created exclusion criteria to evaluate each title and abstract. All four researchers reviewed titles and abstracts to determine which studies to include. Further criteria were created to evaluate the studies and determine final article inclusion.

RESULTS: The literature search yielded nine articles, which are currently included in the review. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the study quality. Results will be determined upon review of articles, to be completed.

CONCLUSIONS: The current literature on pediatric transverse myelitis is limited. There is no previous systematic review of literature to determine prognostic indicators of independent ambulation following acute transverse myelitis in the pediatric population. Conclusions will be accumulated upon review of results, to be completed.

CLINICAL RELEVANCE: There is currently no comprehensive indication of the prognostic factors which can determine return of independent ambulation following acute transverse myelitis in the pediatric population.

THE EFFECTS OF A PRENATAL TUMMY TIME COURSE ON POSITIONING ON PARENTAL KNOWLEDGE AND EXPERIENCE

Emmel L, Kautsky J, Kim C, Ruscheinsky C, Johnson K. University of Mary

PURPOSE/HYPOTHESIS: The purpose of this research study was to investigate the effects of the implementation of a Tummy Time Prenatal Education course addressing infant positioning.

NUMBER OF SUBJECTS: There were 13 individuals who met inclusion criteria and provided informed consent for participation in this study.

MATERIALS/METHODS: Participants that were 18 years and older and a selected partner were invited to attend a free prenatal class entitled, Tummy Time Prenatal Education. Following completion of the 1-hour course, participants completed the UpStart Parent Survey-Prenatal to allow the research team to analyze demographic information and responses to determine if improvements in Parenting Knowledge and Parenting Experience occurred as a result of attending this prenatal course. In the survey, parents rated their knowledge on a Likert ordinal scale from one to seven, one being strongly disagree and seven being strongly agree. The class was held in a lecture and lab format taught by a pair of third year doctor of physical therapy students. The instructors explained key concepts of plagiocephaly, torticollis, and positioning as well as demonstrated the techniques described. Parents were able to practice the demonstrated techniques with dolls. Questions were answered and discussed throughout the class as well as during the time reserved for questions at the end of the course. Parents were provided resources regarding what to do and who to contact should their child develop signs of plagiocephaly or torticollis, including the Children's Hospital of Atlanta Tummy Time Tools, with permission of the author. With consideration for attendees' health information literacy, the script for the class was designed for a 5th grade literacy level. Information was presented in a PowerPoint, a handout, and demonstrated to ensure all learning styles were addressed.

RESULTS: Results were calculated using a Nonparametric Wilcoxon Signed Rank Test to compare parental knowledge and experience prior to and after attending the tummy time course. The results in Table 1 show a significant change in both Parenting Knowledge (Z=−2.199, p=0.028) and Parenting Experience was reported after attendance at the class (Z= −2.06, p= 0.39).

CONCLUSIONS: Our results demonstrate increases in parents and caregivers parenting knowledge and parenting experience through attending the prenatal education course.

CLINICAL RELEVANCE: Attendance at a prenatal tummy time and positioning course may equip parents to meet the recommendation by the American Academy of Pediatrics to being tummy time on the infant's first day home from the hospital. The clinically important factor in our study is that a prenatal tummy time course may be effective in teaching parents the tools that they need to decrease the rates of plagiocephaly and torticollis in their children.

CLINICIAN PERSPECTIVES OF A NOVEL PEDIATRIC DEVELOPMENTAL MONITROING SYSTEM FOR CHILDREN WITH CEREBRAL PALSY: ACCEPTABILITY, APPROPRIATENESS, AND FEASIBILITY

Feldner HA (University of Washington), Fiss A (Mercer University), Jeffries LM (Oklahoma University Health Sciences Center), Westcott McCoy S (University of Washington)

PURPOSE/HYPOTHESIS: For children with cerebral palsy (CP) and their families, providing effective, evidence-based rehabilitation is complex due to widely variable presentations of CP. We developed the On Track Developmental Monitoring System (DMS) to monitor development, impairment, performance of self-care, and participation in recreation and leisure. On Track-DMS includes: 1) a comprehensive group of clinically-feasible and valid measures; 2) longitudinal developmental trajectories for children with CP based on Gross Motor Function Classification System level; and 3) reference percentiles for each developmental construct. This system provides a succinct, accessible set of measurements and data to assist rehabilitation professionals and families in shared decision-making, prognostic discussions, and goal setting to improve data-driven service delivery and outcomes. The purpose of this study was to assess the acceptability, appropriateness, and feasibility of the On Track-DMS and to understand the barriers and facilitators to effective implementation within pediatric physical therapist practice.

NUMBER OF SUBJECTS: 21 pediatric physical therapists representing a variety of practice settings participated in this study.

MATERIALS/METHODS: We used the Knowledge to Action Framework to guide training development and establish training goals, which included determining the know/do gap in pediatric physical therapist practice, adapting training materials to local contexts, and assessing barriers and facilitators to knowledge use. We then conducted daylong, On Track-DMS trainings (n=32 participants) in three diverse US geographical regions. Subsequently, we led focus groups with attendees (n=21 participants) to assess the On Track-DMS across four areas: 1) delivery of training and relevance to practice setting; 2) tests and measures comprising On Track-DMS; 3) reporting tools such as graphs, trajectories, and calculator; and 4) shared decision-making/family engagement resources. Focus groups were audio recorded, transcribed verbatim, and coded for thematic analysis via constant comparison.

RESULTS: Three themes emerged from the focus group discussions: 1) Valuing the On Track Approach to Intervention; 2) Setting-Specific Needs and Challenges to Implementation; and 3) Training Material/Tool Strengths and Limitations.

CONCLUSIONS: The On Track-DMS appears to be valued and accessible for pediatric physical therapists in a variety of practice settings. Feedback on the system and training methods will be used to tailor and implement On Track-DMS as a pilot program within a large healthcare system partner.

CLINICAL RELEVANCE: On Track-DMS can facilitate data-driven practice and support therapist/family collaboration to improve health outcomes for children with CP. Understanding the know/do gap, adapting training to local contexts, and assessing barriers and facilitators to knowledge use are first steps in successfully implementing On Track-DMS.

CERVICAL AUSCULTATION IN NEONATAL FEEDING AND SWALLOWING EXAMINATIONS: AN INNOVATIVE APPLICATION IN NEONATAL PHYSICAL THERAPY PRACTICE

Flegel J, Sweeney JK. Rocky Mountain University of Health Professions

PURPOSE: The APTA Clinical Practice Guidelines for Neonatal Physical Therapy (Parts I and II) include examination and evaluation of oral motor development and feeding patterns as expected advanced practice competencies. Cervical auscultation (CA) has been used by neonatal therapists as an adjunct to behavioral observations for detecting breath sounds and also timing and quality of swallowing. The purpose of this case report is to describe the use of cervical auscultation in the clinical feeding and swallowing examination and in determining feeding plans for neonates at Seattle Children's Hospital.

DESCRIPTION: Two neonatal cases are presented to illustrate the use of cervical auscultation during a swallowing and feeding examination:

  1. Infant A had a diagnosis of severe Treacher Collins syndrome, an atypical airway, and a tracheostomy. At 23 days adjusted age, cervical auscultation was used by the neonatal therapist to determine if swallow function could be detected.
  2. Infant B was admitted for management of cyanosis and apnea. At 23 days adjusted age, a feeding examination including cervical auscultation was performed during breast feeding to determine risk of aspiration.

Outcomes:

  1. Infant A: four swallow sounds were appreciated via cervical auscultation. It was determined that infant A could begin judiciously paced taste trials safely.
  2. Infant B: high suspicion of aspiration during cervical auscultation in bedside clinical examination during breast feeding with Video-fluoroscopic swallow study (VFSS) recommended. The VFSS was conclusive in diagnosing the aspiration with thin liquids suspected during cervical auscultation.

SUMMARY OF USE: Cervical auscultation is a valuable adjunct to other bedside examination techniques in neonatal feeding and swallowing management. Placed below the mandible on the antero-lateral neck region, the stethoscope can contribute to the neonatal clinical swallowing examination by assisting the practitioner in differentiating between swallow and airway sounds and in detecting breath sounds (clearness) after a swallow.

IMPORTANCE TO MEMBERS: With these examination findings, the neonatal physical therapist can design carefully sequenced feeding plans or recommend further diagnostic testing.

CHARACTERIZATION OF REACH KINEMATICS AS A FUNCTION OF SHOULDER ABDUCTION TORQUE PRODUCTION IN INDIVIDUALS WITH CHILDHOOD-ONSET HEMIPLEGIA

Hill NM, Dewald J. Northwestern University

PURPOSE/HYPOTHESIS: An early, unilateral lesion to the developing brain can result in childhood-onset hemiplegia. Contributing diagnoses include cerebral palsy and perinatal or postnatal stroke resulting from a cortical/subcortical lesion before (PRE), during (PERI), or soon after (POST) birth. Individuals with hemiplegia can present with involuntary coupling of shoulder abduction and elbow flexion (flexion synergy) making tasks, such as forward reaching, challenging. The flexion synergy has been shown to vary based on timing of injury under isometric conditions in individuals with later injuries showing greater coupling at maximal shoulder abduction torque generation. Due to the retention of high resolution ipsilateral corticospinal projections, it is hypothesized that individuals with earlier injuries (PRE) will be less impeded by the flexion synergy during a lift and reach task compared to individuals with later injuries (PERI and POST). The specific aim of this study was to measure reach distance as a function of shoulder abduction effort to quantify the expression of the flexion synergy and determine its variance based on timing of injury.

NUMBER OF SUBJECTS: 22

MATERIALS/METHODS: Participants included 15 individuals with hemiplegia (ages 6-19 years old; 9 PRE, 5 PERI, 2 POST) and 7 typically developing (TD) controls (ages 7-19 years old). Shoulder abduction maximum voluntary torque (MVT) was measured isometrically for each participant. Participants completed a set of lift and ballistic reach tasks using an admittance controlled haptic robotic device which allows arm movement in three dimensions. A virtual target was set near full arm extension and visual feedback of the arm was provided. Test conditions included fully supported on a haptic table and lifting a percentage of shoulder abduction MVT up to 80%. To compare results between participants, reach distance was normalized by the maximum distance achieved across all trials.

RESULTS: The reach distance deficit was calculated for the dominant arm (TD) and paretic arm (hemiplegia) for each condition where 0% indicates full reach achieved and −100% indicates no reach achieved. Mean reach deficits at a low effort condition (20% MVT): −6.2% (TD), −11.9% (PRE), −9.1% (PERI), and −15.5% (POST). Mean reach deficits at a high effort condition (80% MVT): −14.4% (TD), −18% (PRE), −14.3% (PERI), and −77.8% (POST). These initial results show a trend towards greater deficits at larger shoulder abduction MVTs in individuals with later injuries.

CONCLUSIONS: Use of retained ipsilateral corticospinal projections may enable the relative maintenance of reach ability seen across shoulder abduction levels in individuals with earlier brain injuries. In contrast, an increased reliance on more diffuse reticulospinal projections may explain the decreased reach ability seen in later injuries.

CLINICAL RELEVANCE: Knowledge gained from this study will enable the development of targeted therapies to address the underlying causes of motor impairments in different subpopulations of childhood-onset hemiplegia.

LESS PHYSICAL THERAPY, MORE PHYSICAL PARTICIPATION: A MINIMAL CONSULTATIVE MODEL OF CARE FOR CHILDREN WITH DISABILITIES

Jacobson RP. George Fox University

PURPOSE: To describe a consultative pediatric physical therapy model of care utilizing Doctor of Physical Therapy (DPT) students as minimally-trained volunteer facilitators of community participation side-by-side with caregivers.

DESCRIPTION: Children with permanent disabilities were served in a university-based physical therapy clinic by faculty clinicians. In fall 2018, the model of care for these children was changed to a minimal consultative service focused on increasing child participation in community-based physical activity.

SUMMARY OF USE: All children referred for physical therapy received a full evaluation. Those deemed as not in a critical period of continuous progress toward goals and/or not requiring significant ongoing clinical decision making participated in this minimal consultative model of physical therapy care. The initial evaluation emphasized discussion with the child and family about priorities for participation in community-based physical activity. Using motivational interviewing, various participation tracks were explored together (e.g. Get Fit and Strong! or Try a Sport!). At the next physical therapy visit 2 weeks later, families committed to a track that best aligned with their priorities, participation goals were established, and a participation prescription was completed. Over the next 6 weeks, the family and volunteers (in this case 2 DPT students) ventured into the community once-per-week to engage activities that aligned with goals. Volunteer students were mentored to help families identify and access community activities, to help remove barriers (real and perceived), and to focus efforts on simply having fun in physical play. Student volunteers did not provide skilled physical therapy intervention. Following these 6 weeks, physical therapy reassessment occurred to determine goal attainment, retest functional outcomes measures, and decide on a plan moving forward. At this point, all families have opted to continue pursuing community activities on their own while also scheduling a 3-month physical therapy follow-up. Examples of substantive successes include a 14 year old girl with global developmental delay overcoming fear and weakness to climb a two-story climbing wall and start attending a ninja gym with her dad, and a 13 year old boy with CP (GMFCS level 3) gaining confidence and control to participate fully in PE class basketball without assistance from his aide for the first time.

IMPORTANCE TO MEMBERS: While clinic-based pediatric physical therapy undoubtedly improves outcomes for children with disabilities, two substantive challenges persist: 1) translation of gains to meaningful real-life routines, and 2) instilling long-term habits of physical activity. Most clinicians are not able to venture into the community with patients, and families often face substantial barriers to doing so on their own. Using minimally-trained volunteers, this intervention model demonstrated that meaningful improvements in physical function and participation can be attained in children with disabilities without regular direct physical therapy.

WORK CAPACITY EVALUATION: CONCEPTS TO MAXIMIZE PARTICIPATION IN VOCATIONAL ACTIVITIES FOR YOUTH WITH DISABILITIES

Johnson C, Blake T. Fairfax County Public Schools

THEORY/BODY: This poster describes a physical and occupational therapy assessment framework to be used for work capacity evaluation for youth with disabilities in secondary settings. In this framework, the therapist considers work capacity definitions (from ergonomic and occupational health literature), landscape (cost for care, lack of fitness and physical activity), relationship between components of fitness/work tasks and task analysis. Using guiding models (Person, Environment, Occupation, Performance and The International Classification of Functioning, Disability and Health), the therapist utilizes standardized and ecological assessment strategies to perform work capacity evaluations for youth with disabilities in school settings. This structured approach emphasizes collecting objective data and using standardized measures where possible.

CLINICAL RELEVANCE: Youth with disabilities experience far lower levels of employment and fitness than peers without disabilities. Pediatric physical and occupational therapists have the tools and evaluation constructs that support evaluation of these skills to increase participation in work and work related activities. The intent of education, and especially special education, is to educate students for their future, which includes work for many students. Stakeholders (i.e. school districts, local education agencies, teachers, educators, employment transition specialists, parents) supporting high school students in vocational/work awareness training, need to develop programs which build work capacity of their students by maximizing fitness levels, physical attributes, attention levels, and self-advocacy skills. Thoughtful evaluation using existing models and test tools help IEP teams gather baseline data with which to support student's transition plans. As therapists, it is our obligation to optimally prepare students for work and life after they graduate. Using a strengths based approach, participants will have resources to assess the needs of youth in school settings in order to assist school teams with programming that meets the educational needs of students in order to prepare them for competitive, integrated employment.

VALIDATION OF SCHOOL ACTIVITIES AND PARTICIPATION ANALYSIS FOR ELEMENTARY (SAPA-E) AND SCHOOL ACTIVITIES AND PARTICIPATION ANALYSIS FOR SECONDARY (SAPA-S) - PILOT STUDY

Johnson R, Harmon L. Gannon University

PURPOSE/HYPOTHESIS: Can SAPA-E and SAPA-S serve as valid instruments to assess functional motor performance in children with physical disability in an educational environment.

NUMBER OF SUBJECTS: Subjects include 30 PT raters, 150 elementary school and 150 secondary school students.

MATERIALS/METHODS: SAPA-E has 9 domains including Arrival and Dismissal, School Building, Classroom, Lunchroom, Free Play/Recess, Personal Care, General Music, Instrumental Music and Art and Auditorium. SAPA-S has 11 domains including Arrival and Dismissal, School Building, Classroom, Lunchroom, Personal Care, Science Lab, Engineering and Technology, Family and Consumer Science and/or Life Skills, Music and Auditorium, Art and Photography and Physical Education. Each domain has between 10 and 25 activities. A 7-point Likert scale, ranging from a student unable to perform the activity to independent movement is used for both assessments. This pilot project includes 4 phases. Phase I, developed an electronic version of SAPA-E and SAPA-S. The electronic version permits raters to obtain the outcome measures and to upload results for each student. Phase I is completed. Phase II includes recruitment of school districts, PTs and students with disability. Students recruited for the study will fall within the IDEA classifications of Multiple Disability and Orthopedic Impairment. Recruitment will be on-going until the student number is obtained. Testing will be completed by September 30, 2019. Phase III will include an initial item analysis using Rasch Analysis. The goal is to have a collection of items for each domain that has internal consistency of .80 or higher, demonstrate Rasch model requirements for uni-dimensionality and local independence, show no differential item functioning (DIF), have rating scales that function according to Rasch model requirements, and have item difficulty and threshold estimates that cover the full range of observed activity performance estimates. Phase IV results in revisions to the current SAPA-E and SAPA-S.

RESULTS: The anticipated results will include a reduction of activities in each domain. Each activity will then be ranked in order of difficulty. The 7-point scale may be consolidated following analysis. Assessments will have a modular design with each domain validated separately.

CONCLUSIONS: This pilot study will lead to significant revisions in each domain. These revisions will then result in a nationwide study to determine construct validity for both assessments.

CLINICAL RELEVANCE: When completed, the SAPA-E and SAPA-S outcome measures will assist physical therapists in determining the need for physical therapy service, and how often the service should be provided. This information will be based on a student's functional ability and participation rather than developmental norms. Providing an objective performance-based outcome measure for children who are physically challenged may lead to a greater understanding and confidence in the appropriateness of recommendations for physical therapy service.

DOSING PEDIATRIC THERAPY SERVICES USING THE MODIFIED TREATMENT FREQUENCY AND DURATION GUIDELINES

Joines K (Touro University Nevada), Mathieson K (A.T. Still University), Catalino T (Touro)

PURPOSE/HYPOTHESIS: The purpose of the study was to investigate outpatient pediatric therapists and their awareness, implementation, and barriers in the use of the modified treatment, frequency, and duration guidelines (TFDG).

NUMBER OF SUBJECTS: The study included 58 total participants who met the criteria.

MATERIALS/METHODS: Snowball sampling was used to recruit pediatric therapist in the outpatient setting. Participants completed a one-time, anonymous electronic survey that took approximately 5-10 minutes to complete. A quantitative descriptive approach was used to collect data on the frequency of the TFDG use by therapists.

RESULTS: Sixteen participants knew of the TFDG (25.8%), and 42 participants (74.2%) were not aware of the TFDG. Only 31% of the therapists implement the TFDG, compared to 50% who do not. Out of the 13 participants who answered whether the TFDG assisted in facilitating their work, only 7 (43.8%) agreed or strongly agreed while 2 participants (12.5%) disagreed. The results revealed a more significant lack of support from both colleagues (25%) and workplace (75%). Therapists also expressed concern that the TFDG was too much like a recipe (not affording individualized treatment plans) (18.8%). The TFDG was also too general and unspecific (25%) for each diagnosis that therapists encountered.

CONCLUSIONS: Currently, dosing of services varies between therapists in the outpatient pediatric setting, which are based on therapists experience and expertise, caregiver and child needs, and insurance companies dictating the number of visits based on the evaluation provided by the therapist or physician (Bailes, Reder, & Burch, 2008; Hayhurst, 2014; Issac & Franceschi, 2008; Mullen & Streiner, 2004). The descriptive quantitative study suggests that even though some therapists are aware of the TFDG, it may not be implemented in their clinical decision-making for dosing therapeutic services. Therapists identified barriers to achieving the use of TFDG. Some reasons were the TFDG may be too general or unspecific to the population they treated, therapists lacked support from their colleagues or workplace, therapists were unaware or did not know where to find the TFDG, and the TFDG is like following a recipe that the therapists were unable to use their clinical decision skills to determine appropriate dosage.

CLINICAL RELEVANCE: Providing therapists with Guides and guidelines to determine intensity, frequency, and duration for each episode of care with an end-point and that is evidence-based can assist in streamlining effective utilization of therapy time for successful evidence-based practice (EBP), and apply practical and efficient therapeutic interventions.

USE OF AN AQUATIC INTERVENTION TO PROMOTE CARDIOVASCULAR ECERCISE AND EXAMINE RELATED OUTCOMES IN A YOUNG ADULT WITH AMYOPLASIA ARTHROGRYPOSIS MULTIPLEX CONGENITAL: A CASE STUDY

Keller C, Fogner A, Hunter A, Dodds C. Medical University of South Carolina

BACKGROUND & PURPOSE: Amyoplasia is the most common form of Arthrogryposis Multiplex Congenita (AMC), which occurs one in every 3000 live births. It is characterized by hypoplastic muscles and multiple joint contractures across the four limbs that results from fetal akinesia. Because of these body structure and function impairments, children and young adults with amyoplasia AMC demonstrate functional activity limitations and participatory restrictions including physical activity.

The World Health Organization (WHO) defines physical activity as any bodily movement produced by the skeletal muscles that results in a substantial increase over resting energy expenditure. The Centers for Disease Control recommend that children and adults, including those with disability, participate in 60 minutes of moderate to vigorous activity a day and 150 to 300 minutes of moderate activity a week. Although physical activity offers well-documented health benefits to all individuals, for children and adults with amyoplasia AMC these recommendations can be challenging to achieve.

In this case study, the 19-year-old participant had a diagnosis of amyoplasia AMC, understood the important health benefits of physical activity, and wished to explore physical activity opportunities that could generate energy expenditure and a subsequent cardiovascular response. Because of multiple impairments and marked functional limitations, the ideal strategy identified was a modified aquatic intervention.

OBJECTIVES: Following review of this poster, the learner will:

  • Know specific physical activity recommendations for children/adults with amyoplasia AMC.
  • Understand a modified aquatic intervention is a physical activity opportunity towards the CDC physical activity recommendation for children/adults with amyoplasia AMC.
  • Recognize a modified aquatic intervention can improve cardiovascular endurance.
  • Develop and translate modified physical activity interventions for individuals with amyoplasia AMC.

CASE DESCRIPTION: A brief history, body function and structure impairments, activity limitations, and participation restrictions will be presented. The daily outline of the modified aquatic intervention and aquatic environment will be highlighted.

OUTCOMES: Changes in pre- and post-test outcomes, including heart rate variability, heart rate, blood pressure, 6-minute swim test, and 12-Item Short Form Health Survey will be shared.

DISCUSSION: This case study provides preliminary evidence that by modifying physical activity interventions, individuals with amyoplasia AMC can participate in physical activity as defined by the WHO. This opportunity may lead to improved health outcomes for children and adults with amyoplasia AMC. For this participant with amyoplasia AMC, the modified aquatic intervention did stimulate changes in repeated-measured cardiovascular outcomes. Additional unexpected outcomes (i.e., in-water safety) will also be reported because of impact on community participation. Promoting wide spread development and implementation of modified physical activity interventions for individuals with amyoplasia AMC will have positive health and participatory benefits.

HAND HELD DYNAMOMETRY AND SEATED REACH TESTING IN AMBULATORY AND NON-AMBULATORY CHILDREN WITH DUCHENNE MUSCULAR DYSTROPHY

Kern R, Carvell K. Children's Healthcare of Atlanta

PURPOSE/HYPOTHESIS: The purpose of this study is to: (1) assess feasibility of outcome measures that can be utilized for children with Duchenne Muscular Dystrophy (DMD) in the ambulatory and non-ambulatory phases of the disease; and (2) determine the relationship between trunk strength, sitting balance, and level of disability. The hypothesis is that children with DMD will be able to complete strength testing via hand held dynamometry (HHD) and seated reach test making them feasible and meaningful to utilize with children who have DMD.

NUMBER OF SUBJECTS: 18

MATERIALS/METHODS: Eighteen male participants, 11 ambulatory and 7 non-ambulatory, with mean age of 10 (3.78 SD), had their trunk strength measured using HHD while in a seated position resisting anterior, posterior, and lateral movements. The HHD was placed on the sternum, thoracic spine, and bilateral acromion. Each direction was tested twice and the average recorded. Each participant had their sitting balance measured using the seated reach test, which measures the distance each child was able to lean forward in a sitting position in centimeters. There were two trials and the average recorded. Upper extremity strength was measured using the Brooke Upper Extremity Scale. The PEDI was used to measure functional skill level as reported by caregiver proxy. This is a cross-sectional observational study where each participant was recruited from a transdisciplinary clinic setting and measured during their scheduled appointment time.

RESULTS: All 18 children were able to complete the seated trunk strength measurements and 16/18 children were able to complete the seated reach test. Trunk strength in the flexion direction was significantly correlated (p=0.03) and predictive of higher functional independence as reported on the PEDI when adjusted for age. No significance was noted when adjusted for weight alone. Higher independence was also correlated (p=0.07) to a greater seated reach score.

CONCLUSIONS: These findings are consistent with the hypothesis that these seated measures are feasible at all levels of disease progression in this population. Secondly, there is a significant positive correlation between trunk flexion strength and the PEDI in ambulatory and non-ambulatory children with DMD.

CLINICAL RELEVANCE: The use of these standardized and objective measures is feasible for children with DMD. These same measures can be used from initial diagnosis through loss of ambulation as important tools to aid in determining functional prognosis as well as guide best practice interventions that have the potential for greatest impact on a patient's quality of life. This study shows that objective measures of strength and balance can be utilized throughout the continuum of this condition to provide information to patients.

INFANTS BORN FULL-TERM AND PRETERM GENERATE MORE SELECTIVE HIP-KNEE MOVEMENT DURING A SCAFFOLDED LEARNING TASK

Kim J, Sargent B, Fetters L. Division of Biokinesiology and Physical Therapy, University of Southern California

PURPOSE/HYPOTHESIS: Infants born preterm (PT) are at increased risk for motor impairments, including impaired selective joint movement. Selective movement is the ability to isolate the movement of one joint from the other joints within the limb (e.g., flexing the hip while extending the knee). In previous research, infants born full-term (FT) and PT both learned to activate a kicking-activated mobile, but only infants born FT who learned the task generated more selective hip-knee movements. To encourage infants born PT to generate more selective hip-knee movement, we scaffolded the mobile task by requiring the infants to lift their feet higher to activate the mobile. The aims of this study were to determine: (1) if infants born FT and PT learn the scaffolded mobile task, and (2) if infants who learn the task exhibit more selective hip-knee movements during the task compared to spontaneous kicking.

NUMBER OF SUBJECTS: 14 infants born FT, 14 infants born PT (<32 weeks gestation)

MATERIALS/METHODS: Infants participated in the scaffolded mobile task for 2 to 3 consecutive days at 4 months of age, corrected for prematurity. Day 1 consisted of a 2-min baseline spontaneous kicking condition, followed by an 8-min mobile condition during which the mobile activated when the infant lifted either foot vertically over an individualized threshold. Day 2 consisted of a 10-min mobile condition, during which the threshold height was systematically increased. If infants did not learn the task on Day 2, they were invited to participate in a 10-min mobile condition again on Day 3, which became their last day of participation. Learning was quantified as mobile active time (MAT) ratio, the duration that infants activated the mobile during the mobile condition on their last participation day, compared to the time that the infant performed leg movements that would have activated the mobile during Day 1 baseline. Selective hip-knee movement was quantified as the hip and knee angle correlation coefficient of kicks (Hip-Knee CC). Mixed regression models using repeated measures were used to test differences of the variables between the Day 1 baseline condition and the mobile condition on the last day of participation.

RESULTS: Learning: Both the FT group and PT group demonstrated learning based on significant increases in the MAT ratio (p < .001). Using individualized learning criteria, each infant was then classified as a Learner or Non-Learner. Selective hip-knee movement: FT Learners (n=11) and PT Learners (n=10) both demonstrated more selective movements based on significant decreases in the Hip-Knee CC (p < .05) of kicks during the mobile condition on their last participation day compared to Day 1 baseline.

CONCLUSIONS: These findings are consistent with our hypotheses that infants born FT and PT will learn the task, and that Learners will generate more selective movements.

CLINICAL RELEVANCE: Our data informs the capability of infants born PT to generate selective hip-knee movement when participating in a scaffolded learning task. These findings support that infant born PT may require scaffolding to encourage more age-appropriate movement patterns during child-active therapeutic interventions.

PERSPECTIVES ON WORKING IN THE NICU: IMPLICATIONS FOR PHYSICAL THERAPIST PRACTICE

Lammers J (University of Findlay), Tovin M (Nova Southeastern University), Fernandez-Fernandez A (Nova Southeastern University), Dutton L (St. Catherine University)

PURPOSE/HYPOTHESIS: The purpose of this qualitative study was to understand the experience of becoming and being a physical therapist in the special care nursery (SCN) or neonatal intensive care unit (NICU).

NUMBER OF SUBJECTS: 12

MATERIALS/METHODS: A phenomenological research approach was utilized. The design of the study included procedures to ensure rigor and trustworthiness of findings by establishing transferability, credibility, dependability, and confirmability. Physical therapists working in the SCN/NICU for at least 2 years participated in the study. Data were collected through one-on-one in-depth interviews to elicit the experiences, opinions, feelings, and knowledge of these therapists. All participants were asked the same questions from the interview guide, with follow-up probing questions as needed to gain deeper understanding. All interviews, ranging from 25 to 50 minutes, were recorded and transcribed and the transcripts were carefully analyzed line-by-line. Meaningful units were identified, coded and categorized used the constant comparison method for data analysis. Data collection and analysis continued until no new themes emerged and data saturation was assured.

RESULTS: Qualitative analysis of the interview transcripts yielded four themes: 1) Never Alone, which reflects the unique collaborative culture of the NICU; 2) Families First, which speaks to the need to focus on the family, avoid judgment, and facilitate their involvement in the care of their child; 3) Take a Deep Breath, which reflects the need to be mindful and cautious because of the potential to do harm while caring for fragile infants; 4) Know What You Don't Know, which reflects the depth and breadth of knowledge necessary to work in the NICU/SCN.

CONCLUSIONS: This project was the first to systematically research practicing therapists' beliefs and perspectives regarding PT practice in the SCN and NICU. Current practice does not align with the adopted statements from APTA and APPT establishing NICU as an advanced practice setting. Much evidence draws attention to the fragility of premature neonates, yet our PT practice and education do not appropriately address these concerns. This study has implications for physical therapists, hospital administrators, physical therapy educators, and policy makers.

CLINICAL RELEVANCE: Therapists who entered the NICU without prerequisite knowledge acknowledge that they were unaware of their limitations. This project presents significant implications for PT practice in the areas of expertise related to staffing NICUs, examination and intervention, family-centered care and inter-professional interactions. There is significant incongruence between the published guidelines and current practice.

POOR ABDOMINAL STABILITY AND CONTROL MAY BE A PREDICTOR OF RECTUS FEMORIS AVULSION FRACTURE IN THE ADOLESCENT SOCCER PLAYER: A CASE REPORT

Lasky-McFarlin CE (University of North Carolina), Thomas M (University of North Carolina Health Care), Newman J (University of North Carolina Health Care), Thorpe DE (The University of North Carolina at Chapel Hill)

BACKGROUND & PURPOSE: Youth sport specialization is common in the United States, increasing the risk of injuries in skeletally immature athletes. With an increased emphasis on prevention of knee injuries, literature has focused on improving lower quarter neuromuscular control with little attention devoted to abdominal strength, stability, and control. Likewise, objective measures of abdominal function are lacking. In children presenting with groin pain after a forceful kick or sprinting, it is imperative to include pelvic avulsion fracture in the differential diagnosis to ensure proper management, as youth are at a higher risk for this injury due to skeletal immaturity. Few rectus femoris avulsion fractures have been reported bilaterally and are commonly misdiagnosed. Improper treatment can lead to long term limitations in sport, with some patients reporting extra-articular hip impingement. Proper identification of poor abdominal function may predict this avulsion fracture and allow for injury prevention.

CASE DESCRIPTION: A 12-year-old male of mesomorph body type playing soccer year-round, presented to physical therapy (PT) with healing bilateral avulsion fractures of the rectus femoris secondary to injury during soccer. PT focused on restoration of range of motion, hip strength, and return to sport. Family goals were to return to soccer. Identification of substantial abdominal weakness occurred shortly after initiation of PT. The patient demonstrated an inability to perform a sit up and decreased balance with increased postural sway due to impaired abdominal control during single leg activities. Focus of future treatment included functional abdominal activities. Over eight weeks, 11 PT sessions were attended in a hospital-based outpatient pediatric setting.

OUTCOMES: The patient met all goals, returning to soccer without residual impairments. Evidence of strength gains in abdominals were: increased number of sit-ups performed in 60 seconds, increased hold times for static abdominal testing, and greatly improved stability in single leg activities without compensations. Four months following discharge, he reported full participation in soccer without complications and continued adherence to abdominal exercises. He maintained the gains from his PT plan of care.

DISCUSSION: Abdominal muscles act as stabilizers of the body, allowing for adequate transfer of force to the extremities and protecting from overuse injuries. Without sufficient trunk stabilization for transfer of force when kicking, increased force production from the hip flexors and knee extensors is required to perform the task, increasing the load at the secondary ossification center at the anterior inferior iliac spine. High force production at open ossification centers is more likely to result in a fracture. A lack of research examining the role of the abdominals in youth sports injuries limits the ability to correlate poor abdominal function with injury. If decreased abdominal function is identified as a risk factor and screened in all athletes, specific abdominal exercises can be incorporated into training to decrease the likelihood of this injury in youth athletes.

THE EFFECTIVENESS OF A SERVICE DELIVERY MODEL IN A HOSPITAL SETTING FOR USE OF RIDE ON CARS BY INFANTS AND CHILDREN

Liquori B (Shriners Hospitals for Children-Springfield), Santana Yvette (Shriners Hospitals for Children-Springfield), Brown ME (Shriners Hospitals for Children-Springfield), Kwaczala A (Western New England University), Gannotti M (Shriners Hospitals for Children-Springfield)

BACKGROUND & PURPOSE: GoBabyGo! programs provide modified ride on cars to infants and children with limited mobility either through community events or university programs. These models may result in variability in safety standards, seating adaptations, monitoring of car use, or long waits for car delivery. An interdisciplinary hospital based program may be able to provide timely delivery of cars, safety standards, customized seating, and track car use and enjoyment. We designed a program at Shriners Hospital for Children Springfield that evaluated satisfaction, time in car, and engagement in daily life of participants during a 3 month program.

CASE DESCRIPTION: Four participants ages 4.7, 2.3, 4.3 and 2.7 years in a tertiary health care setting, with a variety of neurodevelopmental diagnoses who were not able to ambulate independently participated in the program. An individualized service delivery model was utilized to provide ride on cars to eligible children in an outpatient, hospital based, 3-month program. Program eligibility criteria were: ages between 10 months and <5 years, ability to track objects visually, demonstrate cause and effect, and inability to ambulate independently. An occupational therapist, physical therapist, and engineer completed screening, assessment, and customized fitting of the car in 1 to 3 visits. Caregivers and children were trained on safety and use of the car. Regular phone check-ins and follow up clinic visits assessed car usage. At 1 month and 3 months, the Measures of Processes of Care (MPOC), Child Engagement in Daily Life (CEDL), and calendars evaluated satisfaction, engagement, and time. After three months of car use, caregivers were given the option to continue to use the car or return it.

OUTCOMES: Two children completed the three-month program and two children completed the one-month follow up. There has been no safety or mechanical problems with the cars. Two cases have not turned in the time logs. Monthly use reported was 5.16 and 3 hours. Caregivers were all highly satisfied at 1 month and 3 month visits (MPOC range 6.7-7). Child frequency of engagement for all children ranged from 51.7-66.1 on CEDL, with little change from one month to three months in the two that completed the program. Child enjoyment ranged from somewhat to a great deal for one month and three month visits. Items concerned with outdoor play had lower scores on the three-month follow up.

DISCUSSION: The individualized service delivery model is feasible, safe, and caregivers are highly satisfied. Children report consistent enjoyment and participation using the car on a monthly basis. Cold weather was a factor in frequency of use and outdoor engagement. Key elements of the service delivery model include an interdisciplinary assessment, optimal individualized seating and positioning needs, training of the child and caregiver, and ongoing follow up phone calls and clinic visits. This type of service delivery model can provide a safe, therapeutic ride on car experience for the child and caregiver.

PROMOTING COMMUNITY PARTICIPATION AND FAMILY EMPOWERMENT FOR CHILDREN WITH AUTISTIC SPECTRUM DISORDER AND THEIR PARENTS: A PILOT INTERVENTION STUDY

Liu C, Lin Y, Chen Y, Kang L. Chang Gung University

PURPOSE/HYPOTHESIS: Children with autistic spectrum disorder (ASD) often encounter more challenges in community participation than at home and school. Research showed that families of children with ASD participated in a narrower range of social or community-based activities and did so less frequently. Participation-based intervention has been developed for optimizing participation based on the goal-oriented, family-centered, collaborative, strength-based, and ecological and self-determined principles, while considering the attributes of family, child and environment. This pilot study explored the effects of participation-based intervention for promoting community participation and family empowerment for children with ASD and their parents.

NUMBER OF SUBJECTS: Four children with ASD 6-10 years old and their mothers participated. All children had an IQ score of above 70. Three children attended regular and resource classes, and the other one attended the regular class only. The mothers ages were ranged from 35 to 44 years old, two mothers were employed while the other two were stay-home mothers.

MATERIALS/METHODS: A pre-test/post-test pilot study was conducted. Each family received a 12-week participation-based intervention with a trained therapist. The intervention involves 5 steps: building collaborative relationship, setting child and family goals for participation, assessing strengths and needs, implementation of intervention plan, and evaluating outcomes. Two outcome measures, Canadian Occupational Performance Measure (COPM) and The Parent Empowerment and Efficacy Measure (PEEM), were administered before and after intervention. COPM is a semi-structured interview to identify what family wants and what needs to be changed, and parents score 1 to 10 for the performance and satisfaction. PEEM is a 20-item parent-report questionnaire to assess parental confidence in the role as a parent, and the ability to link with resources. Each item scores 1 to 10, with a summary score of 200 being the highest.

RESULTS: The 4 families have identified 11 goals related mostly to promoting sports or physical activities, while other activities involve in-depth tourism, gardening, and leisure. For COPM, all children had improved on performance (mean change scores were 4, 4.34, 3.5, and 6.34 respectively) and satisfaction (mean change scores were 4, 5, 5, 4.66 respectively). Improvements in COPM performances for all identified goals reached clinical significance. For PEEM, all 4 mothers had increased summary scores (change scores were 28, 29, 19, and 13 respectively).

CONCLUSIONS: The pilot study provided feasibility and initial effects of participation-based intervention on promoting community participation and parental efficacy for children with ASD. Future study is needed to examine the efficacy of participation-based intervention.

CLINICAL RELEVANCE: This study informs approach of family-professional collaboration. The structured steps in the participation-based intervention might facilitate families and therapists to identify goals that are meaningful in the family life. Families had the opportunities to build capacity to advocate for children's full inclusion in society.

COMMUNITY-BASED, GROUP EXERCISE PROGRAMS TO ADDRESS SENSORY-BASED MOTOR DISORDERS

Manning R. The University of Texas at El Paso

PURPOSE: The purpose of this presentation is to provide therapists with a novel approach to treatment of sensory-based motor disorders, especially focusing on dyspraxia. More children are being diagnosed with sensory processing disorders every year. Due to the lack of diagnostic coding specific to this disorder, practitioners must code for symptoms of the disorder which are slow to progress and show small gains over time. Despite this “lack of progress”, milestones that are achieved through guided and supported exercise are significant to the child and the family, and may have overarching benefits to the mental health, peer perception, and self-esteem of the child. With reductions in reimbursement rates become the norm, therapists need an efficient and cost effective way to address the needs of this growing population.

DESCRIPTION: “Motor Madness” is a program developed to address the needs of children aged six to thirteen (6-13) years who demonstrate high functioning sensory processing modulation/discrimination disorders, and sensory-based motor disorders. The program meets three (3) times per week for one-hour sessions. The exercise sessions are led by a licensed physical therapist with support from students of physical therapy in the community. Activities are designed to encourage children to practice motor skills that provide a “just right challenge.” Since there are a variety of ages and abilities in the group, children have the opportunity to succeed and support others at times, and learn new skills in a safe environment. Many of the children require support in socialization and appropriate responses to frustration and group participation. In the small group setting, the physical therapist is able to guide responses and correct both motor and social behaviors in the moment; an opportunity that may not present in one-on-one therapy sessions.

SUMMARY OF USE: Activities alternate between general strengthening with an emphasis on core stability, cardiovascular endurance, motor planning, motor control, and dual task activities. This provides the participants with a variety of exercises that challenge the whole range of developmental challenges children face in real life situations. An example of motor planning and motor control exercises are jumping rope and jumping jacks. Children with these motor challenges often cannot learn these skills in physical education activities. They require a more targeted breakdown of the skill focusing on the elements that the child cannot integrate independently. Additionally, due to the difficulty in attaining the skill these children require additional encouragement to practice these skills as they tend to have a lower frustration threshold than age matched peers. In a group of children with similar challenges, there is less opportunity for negative social consequences and increased likelihood for success.

IMPORTANCE TO MEMBERS: This model of treatment provides therapists with a cost and time effective method supporting children who may not otherwise qualify for services in a more traditional therapy model.

THE EFFECT OF A NEWBORN BEHAVIORAL OBSERVATION SYSTEM (NBO) MODEL OF CARE IN EARLY INTERVENTION (EI)

McManus B (Colorado School of Public Health), Blanchard Y (Sacred Heart), Murphy N (Colorado School of Public Health), Singer J (Children's Hospital Boston), Nugent K (Children's Hospital Boston)

PURPOSE/HYPOTHESIS: This study aimed to evaluate the effect of an NBO-EI care model, which intentionally promotes parent-infant interaction, versus a usual-EI (UC-EI) model of care on maternal depressive symptoms, infants' adaptive skills and infants' cognitive and social-emotional development.

NUMBER OF SUBJECTS: Participating parent-child dyads were randomly assigned to either the NBO (n=16) or UC (n=22) groups.

MATERIALS/METHODS: This multi-site pragmatic trial randomized newborns into either an NBO or UC EI group. Infants in the NBO-EI group received weekly home visits from a NBO-certified provider up to 12 weeks corrected age. At each visit the NBO-EI provider administered the NBO with the parents and discussed the infants' self-regulatory efforts and how the infants' neurobehaviors contributed to the parent-infant social interactional encounter. The UC-EI group received traditional home-based age appropriate developmental services from a provider not certified in the NBO. Outcome measures included the Center for Epidemiologic Studies Depression Scale (CES-D), Battelle Developmental Inventory-2 (BDI-2) and Bayley Scales of Infants Development-III (BSID-III) Adaptive scale. We used scaled BDI-2 and BSID-III scores (mean=10 SD=3). The CES-D and BSID were collected at 3- and 6-months and the BDI-2 was collected at EI entry and 6-months. We used median quantile regression to estimate group differences [95% CI] for 3-month and 6-month outcomes. Median regression accounts for the skewed outcome data (i.e. very high/low scores). Regression models adjusted for program differences.

RESULTS: There were no statistically significant differences in CES-D or BSID-III scores at 3-months although BSID-III Leisure (b=1.8 [−0.3, 3.8]) and Motor (b=2 [−0.98, 5.0]) scores were marginally statistically significantly (p=.10) higher in the NBO group. At 6-months, the NBO-EI group had greater gains in BSID-III Communication (b=1 [0.2, 1.8]), BSID-III Self-Care (b=2 [0.1, 3.9]), BDI-2 Perception and Concepts (b=2 [0.4, 3.6]), and BDI-2 Social Role (b=2 [1.2, 3.6]) scores than the UC-EI group. The NBO-EI group also had greater decline in maternal postnatal depressive symptoms (b=-2.0 [−3.7, −0.3]) than the UC-EI group.

CONCLUSIONS: Infants receiving individualized, developmentally supportive NBO care had greater gains in social and cognitive development at 6-months than infants in the UC-EI group. Caregivers receiving NBO-EI care also had greater improvements in maternal depressive symptoms than caregivers receiving UC-EI services. Our results suggest NBO effects in infants' early interaction and movement skills, which possibly are foundational for gains in social and cognitive skills and maternal well-being at 6-months, an area for further research.

CLINICAL RELEVANCE: The NBO is an individualized, developmentally supportive model of care that can improve early social and cognitive trajectories and maternal well-being for families of a high-risk infant. Moreover, the NBO-EI care model was readily adapted into actual EI intervention, assessment, and care planning suggesting its feasibility and clinical utility for improving service delivery for high-risk infants and their families.

IS ELECTRICAL STIMULATION A USEFUL ADJUNCT MODALITY IN FACILITATING THE RETURN OF MOTOR FUNCTION IN A PEDIATRIC PATIENT WITH A PERIPHERAL NERVE INJURY? A CASE REVIEW

Mendonca B, Buxton R. Children's Hospital of Los Angeles

BACKGROUND & PURPOSE: We extrapolated the use of NMES to the rehabilitation of a pediatric patient with a sciatic nerve compression mononeuropathy resulting in total loss of motor function and atrophy in all muscles below the left knee. Our purpose was to investigate whether the use of NMES in addition to conventional physical therapy would be a useful adjunct modality in facilitating the return of motor function in denervated muscles. The most challenging aspect of implementing ES as a therapeutic intervention in the pediatric setting, besides the usual need to identify what key muscle action to address, is the lack of clinician comfort with exploration of parameters to balance comfort versus desired motor outcome when administering and progressing ES interventions with pediatric patients. Utility of including ES in the physical therapy intervention plan for the rehabilitation of a patient with a peripheral nerve injury is explored within the context of this pediatric case study.

CASE DESCRIPTION: We present the unusual case of a sciatic nerve mononeuropathy in an 8-year-old female patient (ZJ). ZJ was admitted to the PICU from an outside hospital for higher level care for complications associated with right middle lobe pneumonia. During her hospitalization, she was evaluated by Neurology secondary to neuropathic pain on the left foot and loss of motor function below the left knee. EMG studies, NCV test, and MRI of lumbar spine and left knee findings were consistent with sciatic neuropathy secondary to prolonged compression. NMES intervention was gradually introduced once full rapport was established between therapist and patient. ES was incorporated with therapeutic intervention, keeping in mind principles of motor learning and with care to avoid muscle fatigue. Additional interventions used included desensitization for neuropathic pain at the beginning of ZJs physical therapy course, AFO modifications in collaboration with ZJs orthotist, and home exercise program.

OUTCOMES: ZJ demonstrated significant gains in motor function as evidenced by an improvement in strength ranging from an increase of 1.0 to 2.5 MMT grades across all major left ankle muscle groups at both reassessments. Significant gains were also observed at the activity and participation levels as her 6 MWT (left Cascade DAFO 3.5 donned and no assistive device) improved from 236 meters to 410 meters at first reassessment and 477.5 meters at the second reassessment.

DISCUSSION: Is it possible that the motor return seen in this patient is a result of the natural healing course of the nerve? Given the slow rate of nerve regeneration of 1 to 2 cm per day and the distance between the site of injury and affected muscles, we believe that the use of NMES as an intervention to actively facilitate motor return may have contributed to a more effective recovery. Facilitating muscle use with active focus and enhanced patient awareness by incorporating ES using appropriate progression of parameters to meet the patients' needs, resulted in recovery beyond what the medical team believed would be possible.

IDIOPATHIC TOE WALKING: WHAT DOES IT MEAN?

Murphy-Simmons DL (Exeter Hospital), Robertson HN (MCPHS University)

PURPOSE/HYPOTHESIS: The project explored the hypothesis that idiopathic toe walking is an indication of a neurological deviation which could include persistent primitive reflexes and/or sensory processing issues. A review of selected literature explored research findings addressing connections between toe walking, retained primitive reflexes and sensory processing in children. The findings of this project will inform and support the need for physical and occupational therapy collaboration for assessment, treatment and facilitation of outcomes for children diagnosed with idiopathic toe walking.

NUMBER OF SUBJECTS: 21 articles were reviewed between the two projects which included current primary research on toe walking, retained primitive reflexes and sensory processing.

MATERIALS/METHODS: The toe walking project search was limited to full text English articles, in peer reviewed journals from 1996 to 2016. Inclusion criteria was research on toe walking or idiopathic toe walking in children above the age of two and studies on the: prevalence or prognosis, toe walking characteristics, sensory processing, psychosocial dysfunction and or neurological impairment.

The reflex integration project search was limited to full text English articles, in peer reviewed journals from 2005-2018. Inclusion criteria was research on retained primitive reflexes and reflex integration in children with neurotypical development.

RESULTS: The findings of these studies support the hypothesis that persistent toe walking in children could be a predictor or marker for sensory processing disorders, persistent primitive reflexes, developmental issues and/or neuropsychiatric disorders. Evidence supports that those children who do not have resolution of toe walking gait, require a physical therapy evaluation to identify underlying pathologies and or comorbidities, including assessment of primitive reflexes and sensory processing dysfunction to determine what interventions and supports are necessary to maximize a child's performance.

CONCLUSIONS: Articles concluded that persistent toe walking children had identifiable risk factors that were greater than the normative population and primitive reflex retention and sensory processing dysfunction interfere with the child's typical development, including persistent toe walking, as the protective reflex patterns remain intact, overriding the child's ability to move without the influence of the reflex. Given the evidence, physical therapy evaluations of toe walking children should include neurological assessments along with standardized testing of motor skill development, primitive reflex and sensory processing. Continued research in these areas is necessary to guide clinicians in clinical decision making.

CLINICAL RELEVANCE: Physical Therapists treating children with toe walking need to assess both orthopedic and neurological systems. Pediatric physical therapists evaluating children with a diagnosis of toe walking should collaborate with occupational therapists when neurological markers of sensory processing dysfunction and/or persistent primitive reflexes are identified.

THE WHEELS ON THE CAR GO ROUND AND ROUND: FEASIBILITY OF MODIFIED RIDE ON CARS IN SCHOOL ENVIRONMENTS

Nelson DN, Bergeron JM, Kruger AW, Corr BB, Sogin T, Willett S. Munroe-Meyer Institute, UNMC

PURPOSE/HYPOTHESIS: The feasibility of using Modified Ride on Cars (MROCs) in the school environment has not been explored. School is the ideal setting to support mobility, social interaction and learning. MROCs are a cost-effective option that afford children supported mobility to participate and interact socially with peers. This study aims to investigate the feasibility of MROCs in the natural school environment, by exploring teachers' perception of car use and identifying potential barriers that may need to be addressed for successful integration into classroom routines.

NUMBER OF SUBJECTS: Seven special education teachers from five public schools in two districts were included. Eighteen students with mobility impairments shared seven cars assigned to these sites during PE, gross motor time and transitioning in the hallway. All teachers were identified by the school physical therapist as being receptive and interested in using the MROCs.

MATERIALS/METHODS: After initial teacher and student training, baseline data was collected from teachers using a five-point Likert scale survey of nine items. Survey themes included: child motivation, value, positioning, ease of use, safety, scheduling, maintenance, and storage. For eight weeks, teachers tracked activities participated in and duration of car use. Following implementation, teachers completed the same survey to determine changes in perception. Semi-structured interviews were conducted to further probe feasibility and barriers associated with MROCs in the school setting.

RESULTS: The Likert scale ratings assessed child and environmental factors that determined use of MROCs. While perceptions of child factors (positioning, safety and value to child) improved, perceptions on environmental factors (scheduling, storage, maintenance, classmate safety and ease of use) decreased and emerged as barriers. Perceptions on child's motivation remained high and unchanged. In interviews, teachers reported the most significant barriers to usage were staffing for supervision and available space. Teacher's also reported that the greatest advantages were motivation and socialization with peers.

CONCLUSIONS: Teachers perceived MROCs in the school setting with multiple users as positive and beneficial to children. The greatest barriers were classroom staff support and environment set up. The greatest advantages were motivation of drivers and socialization with peers.

CLINICAL RELEVANCE: Children with limited mobility need alternative methods to allow for exploration and improved participation in school activities. Students are motivated to use MROCs, but potential barriers need to be addressed as potentially influencing the feasibility of MROCs in the school environment.

IMPACT OF INTRODUCTION OF CARE INTERVENTION IN AN EXTREMELY PRETERM INFANT: A CASE STUDY

Niski JE (Creighton University), Figeuroa R (Creighton University), Fleisher R (Creighton University), Gonya J (Nationwide Children's Hospital)

BACKGROUND & PURPOSE: Extremely preterm infants are at high risk for multi-dimensional neurodevelopmental delays.1,2,3 These delays are due in part to the cortisol response associated with perceived stress which limits neuroplasticity and impacts brain development.4,5 Infant physiologic responses and behavior can be utilized to determine an infant's experience of stress,6,7,8,9 and developmental care is an established practice to minimize stress in extremely preterm infants.2,10 However, there is limited evidence as to the efficacy of specific interventions to minimize stress. Intentional Introduction of Care (IOC) is gentle hand containment for 5-10 seconds to prepare and support infant regulation prior to beginning other caregiving tasks. The purpose of this case study is to gather preliminary data as to the efficacy of this intervention.

CASE DESCRIPTION: A multiple baseline, single case research design with an A-B-A-B withdrawal model was utilized to examine the efficacy of the IOC intervention in an extremely preterm infant. Forty-seven caregiving interactions were recorded via video and vital sign monitoring for 48-hour periods on 3 consecutive weeks. Behavioral data was analyzed for 30 baseline and 10 intervention interactions while heart rate and oxygen saturation data were collected for 26 baseline interactions and 6 intervention interactions. Both data sets included data analysis for 5 minutes prior and 10 minutes following each interaction.

OUTCOMES: Data analysis reveals a positive relationship between the number of tasks completed during a caregiving event and the frequency of both regulation and dysregulation behaviors. Also noted is a positive relationship between the frequency of regulation and dysregulation behaviors during caregiving events. In response to the IOC intervention, there was a 56% increase in total time for the caregiving event and a 38% increase in the time spent per task. A 29% decrease in the frequency of dysregulation behaviors per minute and a 38% increase in the frequency of regulatory behaviors during cares was noted when IOC was used. Additionally, a 23% decrease in the frequency of dysregulation behaviors and a 38% decrease in the frequency of regulatory behaviors is noted after cares in which IOC was used. Finally, cares in which IOC was used resulted in a lowered and more stabilized heart rate and higher and more stabilized oxygen saturations following care giving activities.

DISCUSSION: A simple 5-10 second IOC can have a positive impact on the stress response in extremely preterm infants. In this case study, IOC is shown to increase time spent per task during routine care giving and increase the frequency of regulatory behaviors following cares. Heart rate and oxygen saturation are optimized and stabilized following care when IOC is utilized. Together, these data suggest that IOC may effectively attenuate the stress response associated with routine caregiving activities and demonstrate the possible benefit of IOC to extremely preterm infants in the NICU. Further studies are warranted to investigate the impact of this simple intervention on short-term and long-term developmental outcomes.

THE IMPACT OF AN AQUATIC SOCIAL SKILLS PROGRAM ON CHILDREN WITH AUTISM SPECTRUM DISORDER

Oriel K, Scesa M, Kanupka J, Deardorff A, Grow S, Lane L, Poltonavage O. Lebanon Valley College

PURPOSE/HYPOTHESIS: Physical activity has been shown to improve a variety of common issues in children with Autism Spectrum Disorder (ASD), including behavior, self-regulation, sleep, and academic responding. Unfortunately, parents of children with Autism Spectrum Disorder often avoid community-based physical activity programs for their children due to a lack of social skills, when in fact these types of programs may assist in improving social interactions. The purpose of this study was to explore the impact of a program combining aquatic exercise and social skill instruction for children with ASD.

NUMBER OF SUBJECTS: Participants included 13 children (6 males and 7 females) between the ages of 7-10 years (mean age=7.6 years) with ASD.

MATERIALS/METHODS: Participants were recruited through local ASD support classrooms and support groups for participation in a 1X/weeks for 8 weeks aquatic exercise program. The program was designed to give participants an opportunity to exercise in the water, with 1:1 supervision, while also encouraging social interaction with peers. The program was designed by an inter-professional team of physical therapy, speech-language pathology, and education faculty and students. Quantitative data were collected from families with ASD using the Childhood Autism Rating Scale (CARS), and the Home and Community Social Behavior Scale (HCSBS). Parents were also asked to complete the Intervention Rating Profile-15 (IRP-15) to determine the social validity of the program. Qualitative data were collected from parents through a questionnaire at the completion of the program.

RESULTS: Results of the CARS indicated that 6 participants were in the mild-to-moderate severity group, while 7 participants were in the severe severity group. Statistically significant improvements were observed on the HCSBC in both the peer relations (p=0.007) and social competence (p=0.047) categories using a paired t-test. All IRP-15 scores were above the 52.5 cut score, indicating that the intervention was socially valid. Qualitative questionnaire data supported the quantitative findings.

CONCLUSIONS: Results of this study suggested that a structured community-based aquatic exercise program targeted at improving social skills in children with ASD may lead to quantifiable improvements in peer relations and social competence.

CLINICAL RELEVANCE: Pediatric physical therapists should consider thoughtfully embedding social skills training into interventions, both in the clinic and in community-based settings. Inter-professional collaboration with colleagues in speech-language pathology and education is recommended in order to best identify social skills needs and specific strategies for improvement.

LOCATION OF SCHOOL-BASED THERAPY: DOES IT MATTER WHEN EXAMINING PARTICIPATION OUTCOMES?

Porter A (Oklahoma City University), Jones M (Oklahoma City University), Kolobe T (University of Oklahoma Health Sciences Center), Arnold S (University of Oklahoma)

PURPOSE/HYPOTHESIS: The purpose of this study was to determine the effect of school-based occupational therapy (OT) and physical therapy (PT) service location on student participation outcomes, as measured by the School Outcomes Measure (SOM). The study also examined the amount of variance in SOM scores that could be explained by student level of motor function, as classified by the Gross Motor Function Classification System (GMFCS), and grade level. We hypothesized that students who receive school-based OT and PT in the natural education environment would have higher participation scores, as measured by the SOM, than students who received therapy in an isolated therapy room, and that for both locations a significant portion of the variance would be explained by GMFCS level and grade level.

NUMBER OF SUBJECTS: The total number of participants included in the analysis was 407 students.

MATERIALS/METHODS: The SOM was the primary outcome measure for this study. The data were separated into two distinct student location groups categorized by most frequent environment for intervention: 1) natural educational environment or 2) therapy room at school. Analyses were completed to determine if differences existed in participation scores between the location of OT or PT intervention.

RESULTS: The results of the ANCOVA showed no significant effect of location on SOM total mean scores after controlling for GMFCS level and grade level (F(1, 403)= .009, alpha = .923). For the students who received OT and PT services in the natural education environment, the students GMFCS level and grade level accounted for a significant amount of the variance in the SOM total mean score (r2=-.724 and r2=.150 respectively). The variance in SOM total mean score of students seen in a therapy room were explained by the students level of motor function, but not grade level (r2 = -.772, p< .001).

CONCLUSIONS: There was no difference in participation outcome scores, as measured by the SOM, between the students who received therapy in the natural educational environment and students who received therapy in a therapy room. A significant amount of variance was explained by the level of motor function in both locations and by the grade level in the natural environment. In the natural education environment, students' participation outcome scores increased as the students' grade increased.

CLINICAL RELEVANCE: Although, motor learning principles and IDEA support OT and PT intervention in the natural educational environment for all students, this research suggested that students' level of motor function and students' grade level may influence participation outcomes when services are provided in different school locations. Although further research is warranted, therapists should consider student demographics, specifically GMFCS classification and grade level, when making decisions about the most appropriate location for their services.

APPLICATION OF THE ICF MODEL IN THE PEDIATRIC CURRICULUM OF AN ENTRY-LEVL DPT PROGRAM

Roback K, Armstrong D. Western University of Health Sciences

THEORY/BODY: The ICF model is an important classification system used to develop a common, international language that stresses health in the presence of disability (Goldstein et al., 2004, p.115). It shifts healthcare professionals focus from disablement terms to enablement language, and in children redefines participation as a social construct. The ICF-CY (Child and Youth Version) version covers ages 0-18 years and recognizes disability and development as parallel processes and recognizes how environmental influences change over time with a developing child, and provides a way to include the environment when developing a PT diagnosis (Effgen, 2013).

The ICF-CY also helps guide development of clinical reasoning skills in entry level PT students and plays an important role in assisting development of examination skills and building treatment plans to enhance participation in desired activities for children with disabilities. Due to the importance of the ICF within the Guide to PT Practice and the core competencies in entry level pediatric PT (Rapport et al., 2014), it has been used as a significant component of a written assignment within the pediatric curriculum at one university's entry level PT program to facilitate student understanding of pediatric PT.

The assignment described occurs within the standalone pediatrics course of the curriculum in an entry level DPT program at a private University. Each student has the opportunity to visit and observe treatment sessions at 3 different local pediatric facilities, with treatment settings including: out-patient, school-based, early intervention, NICU, equine, aquatic, and home-based. The ages and diagnoses of the children observed varies greatly. After each observation, students chose one patient they observed and wrote a 3-4 page paper about the child. Assignment requirements include describing the current child's activity and participation levels and abilities, naming at least 3 different impairments of body function and the involved systems, and the activity and participation limitations that result from the child's impairments. Students use the ICF-CY model, their course textbook and supplemental journal articles to determine the required elements.

CLINICAL RELEVANCE: After each graded observation paper is returned, the students are expected to learn from the corrections and suggestions made by the instructor in order to improve their knowledge about application of the ICF elements on each subsequent paper. By the conclusion of the course, students are expected to be able to understand and apply all elements of the ICF-CY to pediatric patients with any diagnosis, including setting goals, developing treatment planning and either progressing or regressing treatment as needed. This assignment has been a core component of the course for over 15 years, and over the course of each semester, there were consistently noted improvements in students' understanding and application of the model. Additionally, during each semester, there was an overall increase in student interest in the pediatric setting following the observations.

ASSISTING FAMILIES IN DISTASTER PLANNING

Schlessman, A. University of Findlay

PURPOSE: The purpose of this special interest report is to explore the role of the pediatric physical therapist in assisting families in disaster planning for children with disabilities.

DESCRIPTION: Families who have a child with a disability should have a detailed emergency evacuation plan.1 Rehabilitation professionals should self-assess their proficiency in emergency preparedness and develop opportunities to incorporate emergency preparedness into routine practice with clients.2

SUMMARY OF USE: For this platform, the agencies involved in evacuating individuals with disabilities will be presented and the four elements of evacuation information that individuals with disabilities and their families need will be reviewed. Components of building an evacuation plan for individuals with mobility, visual, or hearing impairments will be considered. Strategies for assisting families in the development a personal emergency evacuation checklist will be shared.

IMPORTANCE TO MEMBERS: This platform presentation is designed to increase pediatric physical therapists knowledge of and participation in emergency evacuation planning to assist children with disabilities and their families.

EXPERIENTIAL LEARNING ASSESSMENT TOOL ANALYSIS: A PILOT STUDY

Schreiber J (Chatham University), Gagnon K (Baylor University), Kendall E (Plymouth State University), Fiss A (Mercer University), Jane RM (University of Colorado-Denver), Wynarczuk KD (Kean University)

PURPOSE/HYPOTHESIS: The purpose of this project is to develop valid and reliable survey assessment tools to assess the impact of pediatric focused experiential learning activities on students' acquisition of pediatric knowledge and skills during entry level physical therapy education. The first step in the process is to pilot these survey assessment tools and gather data to ascertain the feasibility, reliability, and validity of the tools. The hypothesis is that the survey tools are feasible and provide a meaningful measure of knowledge and skill for entry level physical therapy students.

NUMBER OF SUBJECTS: 18 students and 14 clinical instructors from three different programs completed the surveys during the first week of the student pediatric clinical experience.

MATERIALS/METHODS: Participation in these surveys was voluntary. After obtaining IRB approval, eligible students and their clinical instructors were contacted via email one week into the completion of their pediatric clinical experience to request participation. The surveys were electronic and were coded in such a way to ensure anonymity for the student and the clinical instructor, and to allow comparison of individual student self-assessment scores to the scores provided by their clinical instructor. Survey data was also aggregated to compare group data between student self-assessments and clinical instructor assessments.

RESULTS: Most students and clinical instructors scored the students at the familiar (The student is familiar with this skill/task but is not yet able to perform it with pediatric patients/clients) or basic skill level (The student is able to perform this skill with mildly involved/low challenge pediatric patient/clients). In most survey items, a greater percentage of clinical instructors scored students at the moderate or advanced skill levels as compared to individual student self-assessment scores.

CONCLUSIONS: This pilot data suggests that the survey tool has good potential as a valid assessment of the impact of experiential learning activities on physical therapy students. Comments from clinical instructors indicate that completion of the survey during the first week of the student clinical experience may have been too early to allow an adequate assessment of the students' knowledge and skills.

CLINICAL RELEVANCE: Additional research is necessary to establish validity and reliability for this survey as an assessment of student knowledge and skills following experiential learning activities. However, this preliminary data suggests that the survey may be a good option for pediatric educators as a means to assess the impact of experiential learning before and following these activities.

THE EFFECT OF A GROUP FITNESS PROGRAM FOR INDIVIDUALS WITH DOWN SYNDROME: A CASE SERIES

Schwartzkopf-Phifer K, Lindemann K, Calderero T, Winely L. University of Evansville

BACKGROUND & PURPOSE: Obesity is common in individuals with Down syndrome (DS), with reported rates up to 70% compared to peers without DS (Bertapelli, 2016). While the cause of these increased rates is multifactorial, barriers to fitness often play a role. Some reported barriers include financial burden of participation in fitness programs, lack of inclusivity, and support required for participation (Shields and Synnot, 2016). The purpose of this case series is to describe the effects of a free group fitness program in individuals with DS.

CASE DESCRIPTION: Case 1 is a 7-year-old male who is 46 inches tall and weighs 46 lbs (BMI=14). He is in kindergarten and participates in youth sports with typically developing peers. His medical history includes DS, atrioventricular septal defect repair, and hypothyroidism. Case 2 is a 36-year-old male who is 67 inches tall and weighs 273 lbs (BMI=38.1). His medical history includes DS, hypothyroidism, and hearing loss. Both cases were enrolled in a free fitness program for individuals with special needs called AceBuddies, which a 60 minute long, weekly program led by physical therapy students and a local amateur bodybuilder, Collin Clarke (who also has DS). Each session begins with a 10 minute warm up, followed by 40 minutes of exercises and games, and ends with a 10 minute cool down. Participants are encouraged to continue exercises learned each week at home and document compliance in exercise journals. Weekly prizes (ex: cape, jump rope) were offered as incentives for compliance. Fitness outcomes were measured using the anterior reach of the Y Balance Test (YBT), the Timed Up and Go test (TUG), and jumping jacks. Self-reported improvements were captured using a modified Perceived Physical Ability Scale for Children (PPASC).

OUTCOMES: The changes observed in the outcome measures for Case 1 do not exceed minimal detectable change; however his participation increased from approximately 25% to 100% of each session. Modified PPASC scores increased to all 3s at posttest, indicating increased confidence in all captured domains of movement. Case 2 demonstrated improvements in the YBT, increasing reach distance by 8.5 cm on the right, and 12.5 cm on the left. Case 2 also had substantial improvements in the PPASC. Most notable subscale improvements were for speed, fatigue, and running, which increased from 1 at pre-test to 3 at posttest, indicating improved confidence in each area. While not the primary focus of the program, it should be noted that Case 2 lost 10lbs during his participation in the group fitness program.

DISCUSSION: Improvements were noted in some of the outcome measures in Case 1 and Case 2. This free group program may address the risk of obesity and perceived barriers to fitness, while improving accessibility to fitness activities and participant self-efficacy.

ACEBUDDIES: BRIDGING THE GAP BETWEEN PHYSICAL THERAPY AND PHYSICAL FITNESS

Schwartzkopf-Phifer K, Lindemann K, Winely L, Betsy M. University of Evansville

PURPOSE: The purpose of this presentation is to describe a student-run, pro-bono fitness program promoting physical activity in children and adults with intellectual and developmental delays. This presentation will summarize resource utilization, participant recruitment, and program details.

DESCRIPTION: AceBuddies is a follow up to the pilot program that was presented at APPTAC in 2017. AceBuddies is a free, 60 minute long, weekly fitness program led by physical therapy students and a local amateur bodybuilder, Collin Clarke (who happens to have Down syndrome). Each session has a specified theme (ex: pirates, superheroes) and begins with a 10 minute warm up, followed by 40 minutes of theme-specific, functional exercises and games, and ends with a 10 minute cool down. Themes and exercises are developed by a student leadership committee, who collaborate with Collin to develop home exercise programs and compliance journals. Participants are encouraged to continue exercises learned each week at home and document daily performance in their journals. Each week when the journal is returned, participants earn a new prize (ex: cape, jump rope). The age of participants ranges from 3-38 years old. Common diagnoses of the participants are Down syndrome, autism spectrum disorder, cerebral palsy, and Prader-Willi syndrome. All participants are matched with 1-2 buddies, who are current physical therapy students. Sessions are supervised by licensed physical therapists at a ratio of 1 per 10 participants. Each season lasts 6 weeks and occurs in both the fall and spring semesters. AceBuddies serves 16-24 participants per season and utilizes more than 50 student volunteers. The future plans for expansion of the AceBuddies program include interprofessional collaborations with local occupational therapy and physician assistant programs, as well as outreach to local elementary schools with a high proportion of children from low socioeconomic status households to promote a more collaborative and inclusive environment.

SUMMARY OF USE: AceBuddies is used to address multiple areas of concern. First, it provides fun fitness opportunities to an underserved population that often struggles to meet weekly activity requirements. Secondly, it provides group interactions that may promote socialization for participants and their families. Finally, it provides clinical and leadership experiences for physical therapy students.

IMPORTANCE TO MEMBERS: Many barriers to physical fitness exist for children and adults with intellectual and developmental delays. AceBuddies can serve as a template for fun, fitness-based community outreach to this population through utilization of student and physical therapist volunteers.

FAMILY ATTITUDES ABOUT INFANT SCREEN TIME

Silsby K, Podvin S, Hirsh A, McDonald T, Wentz EE. Upstate Medical University

PURPOSE/HYPOTHESIS: Increasing evidence demonstrates that screen time has negative effects on child development including less healthy eating habits, decreased physical activity levels, and slower language development. Importantly, evidence suggests that body composition and physical activity habits formed in infancy likely persist into adulthood. Little evidence, however, focuses on the effects of screen time in young infants 18 months of age and less. The purpose of this study was to explore parental attitudes about screen time in young infants. We hypothesized that families are exceeding the 0 minutes of daily screen time recommended by the American Academy of Pediatrics (AAP) for children under 2 years of age, that pediatricians are not routinely discussing these recommendations with families, and that maternal education level would influence attitudes on screen time beneficence as well as amount of infant screen time infants are engaging in.

NUMBER OF SUBJECTS: 149

MATERIALS/METHODS: Parents in Atlanta, Philadelphia and Syracuse completed a 10-question survey (Likert based) regarding amount of screen time, advice from their pediatrician, their attitudes related to screen time (television, tablet, smart phone) use with their young infant. Demographic information on infant age, maternal age, marital status, and mother's highest level of education was collected.

RESULTS: 79% of the sample allowed their young infant to engage in screen time exceeding AAP recommendations 65% of the sample reported not receiving recommendations from their pediatrician for screen time use with their young infant, regardless of infant age or maternal education level. Parent attitudes about the benefits of infant screen time were moderately correlated to infant screen time (rho = −.383, p < .001). Maternal education level significantly influenced parent attitudes about infant screen time but not actual infant screen time usage. (ANOVA, p < .001)

CONCLUSIONS: Many parents are engaging their young infants in daily screen time that exceeds the current AAP guidelines. Many parents report not receiving information on AAP recommendations for infant screen time from their pediatricians. While maternal education level influences parental attitudes about infant screen time, it does not impact actual minutes of screen time infants are engaging in. This suggests that regardless of guidelines and maternal education, there may be additional factors that influence how much screen time young infants are engaging in.

CLINICAL RELEVANCE: Current AAP recommendations may not be communicated in a manner which overcomes the marketing and/or convenience of engaging young infants in screen time. Physical therapists should integrate professional knowledge in addition to consideration of the other variables regarding infant screen time to educate parents on how to promote lifelong physical activity and interactive play beginning in infancy.

DETERMINING APPROPRIATE FREQUENCY IN THE PEDIATRIC ACUTE CARE SETTING

Solo L, Benincasa J. Boston Children's Hospital.

PURPOSE: The purpose of this poster is to describe guidelines that can be utilized when determining frequency of physical therapy treatments in the pediatric acute care setting.

DESCRIPTION: The guidelines were developed by the leadership group at a large urban pediatric teaching hospital and are meant to be used by the inpatient physical therapy department. The leadership team considered current literature and adapted the guidelines published by the APTA to meet the specific needs of the patient population served at the hospital. Case based examples were used to illustrate the need to change the plan of care due to potential fluctuations of the patient's status during a single episode of care.

SUMMARY OF USE: The variety of medical diagnoses encountered in the inpatient pediatric setting combined with the expectations of the medical teams and parents, presents a unique challenge in the determination of appropriate physical therapy dosing. We found, often times the recommended physical therapy frequency was largely dependent on the physical therapist that performed the evaluation. As a result, the guidelines were developed to promote consistency between physical therapists. In addition, the guidelines can assist newer therapists in determining appropriate physical therapy dosing, serving to promote clinical discussions regarding the rationale for determining specific therapy frequencies. This determination will be directly related to the patient's progress towards established goals as well as expected and observed functional outcomes.

IMPORTANCE TO MEMBERS: Pediatric specific guidelines for dosing of physical therapy interventions is important not only to pediatric therapists but to physical therapy as a profession. Physical therapists have worked diligently to advance the profession and become autonomous in their practice. As such, a unified and clinically based thought process should be presented to patients, families and other health care professionals as it pertains to determining the appropriate dosing of therapy. When the guidelines are used in determining frequency of therapy, it results in the same or similar frequency determination being established by all therapists in a given department. With the use of these guidelines, physical therapy dosing is based on the patient's current functional and medical status, prior level of function and expected functional gains. The guidelines encourage physical therapists to feel empowered to modify the frequency of care according to objective findings, and progress or lack of progress towards established goals. The guidelines also serve to instruct less experienced physical therapists on the use of a clinical presentation and outcomes when developing habits of practice as it pertains to determining frequency of care.

IMPROVING LEVEL OF ACTIVITY WHILE ADDRESSING BARRIERS AND POTENTIAL ADVERSE EVENTS DURING EARLY MOBILITY IN THE PEDIATRIC INTENSIVE CARE UNIT (PICU) AT CHILDRENS OF ALABAMA (COA)

Sones A (Children's of Alabama), Powell M (Children's of Alabama), Gupta N (University of Alabama at Birmingham), Robbins J (Children's of Alabama), Wilson S (Children's of Alabama), Schmidtke AG (Children's of Alabama), Hill A (Children's of Alabama), Thomas C (Children's of Alabama), Armstrong A (Children's of Alabama), Woolley A (Children's of Alabama), Hayes L (University of Alabama at Birmingham), Swanson-Kimani E (University of Alabama at Birmingham).

PURPOSE: To increase the level of therapeutic interventions being provided to critically ill patients while taking a proactive approach to patient safety with Early Mobility in the PICU at COA.

DESCRIPTION: JUST MOVE: an Early Mobility Program in the PICU at COA was established in 2017. In order to increase overall mobility and therapeutic interventions being provided to critically ill patients in the unit, Activity Level Guidelines were implemented. As part of the implementation, a Failure Modes and Effects Analysis (FMEA) was created to address potential adverse events. The multidisciplinary team involved in Early Mobility participated in a Simulation Lab as a proactive approach to address potential adverse events with the goal to improve patient and employee safety with Early Mobility in the PICU.

SUMMARY OF USE: Baseline data revealed that 52.6% of patients received the lowest level of intervention when based on medical criteria only 2.8% of patients should have received this level of activity. By optimizing use of our activity level scoring tool we will shift toward better concordance between the desired criteria-based activity level and the actual activity level achieved. We recognize that increasing mobility in critically ill children has the potential to lead to patient safety events as well as employee safety events. We have thoughtfully taken proactive steps to assess the potential for patient harm events by performing a Failure Modes and Effect Analysis with our Early Mobility Team and other frontline providers within the PICU to identify opportunities to create standard work to prevent harm. We have used this proactive patient safety tool to inform the development of specific in-situ Simulation scenarios which address identified high-risk, frequent opportunity events.

IMPORTANCE TO MEMBERS: Patient safety is a main priority during Early Mobility performed in any intensive care setting. The results of the Simulation Lab performed in the PICU at COA will ensure that the Early Mobility team in our institution will be equipped to prevent adverse events and promote early return to function as level of therapeutic intervention provided to critically ill patients is increased. It will also help efficiently and effectively deal with an adverse event should one arise. Given that research of Early Mobility in pediatric settings is limited, the information gathered through our quality improvement project will help guide other pediatric early mobility programs.

DEFINING STUDENTS WITH MEDICAL COMPLEXITIES: DEFINITION AND CASE EXAMPLE

Stauffer A (Lancaster Lebanon IU13), Myers T (Warwick School District), Gradziel L (The Center for Discovery), Szabo J (Arizona State School for the Deaf and Blind), Johnson R (Gannon University).

PURPOSE: A six member subcommittee, entitled “Students with Medical Complexity”, was formed within the Academy of Pediatric Physical Therapy's (APPT) School-based Special Interest Group to support and improve the educational needs and clinical practice of pediatric physical therapists serving students with medical complexity. To best serve educational and clinical needs of physical therapists serving this population, a well-developed definition is necessary. This special interest poster will highlight the developed definition of students with medical complexity and include a case example.

DESCRIPTION: This poster will describe in detail the developed definition of students with medical complexity using the International Classification of Functioning, Disability and Health as well as the American Physical Therapy Association's Movement System. A specific case example will be provided to improve clarity of the definition. Assessment and goals suggestions will also be briefly highlighted.

SUMMARY OF USE: Importantly, during this poster presentation, feedback from pediatric physical therapy stakeholders concerning this definition will be solicited. This feedback will refine and improve the definition of students with medical complexity in order to build consensus. Once finalized, this definition will then support the future development of fact sheets to support the educational and clinical needs of pediatric physical therapists serving children with medical complexity. Future fact sheets will address assessments and interventions specifically for students with medical complexity.

IMPORTANCE TO MEMBERS: Creating a clear and well-accepted definition of students with medical complexity will facilitate the future and ongoing development of much needed fact sheets to address the educational needs and clinical practice of pediatric physical therapists serving students with medical complexity.

NEURODEVELOPMENTAL CARE AND MULTIDISCIPLINARY DEVELOPMENTAL ROUNDING IN THE PEDIATRIC CARDIOTHORACIC INTENSIVE CARE UNIT

Tales K. University of Michigan – C.S. Mott Children's Hospital

PURPOSE: Our purpose was to begin a collaboration between our Rehabilitation Team and our Pediatric Cardiothoracic Team including Physicians, Nurse Practitioners, Pediatric Cardiothoracic Intensive Care Unit (PCTU) Nursing and Child Life to create a model for neurodevelopmental care for our patients with Congenital Heart Defects (CHD).

DESCRIPTION: The American Heart Association and the American Academy of Pediatrics published a statement in 2012 identifying that children with CHD are at high risk for both gross motor and fine motor delays requiring ongoing surveillance, screening and evaluation. Following birth, most children with CHD require hospitalization and surgery. Whether diagnosed pre-natally or post-natally, this creates stress on new parents and limits their contact and bonding with their infant. Members of above teams joined together to assist in the formation of a nursing clinical practice guideline (CPG) with an aim to prevent developmental delays.

SUMMARY OF USE: For PCTU nursing staff, patient care has been focused on maintaining medical stability following surgery. Upon review of the literature, the therapists noted the need for prevention of future deficits. In the development of the nursing CPG, we provided recommendations for developmentally appropriate care with specific instruction on positioning, providing an opportunity for developmental strengthening, skin to skin and positive oral experiences. As a part of the care team, we developed education for both families and staff such as posters with positioning guidelines for infants at multiple ages and levels of acuity. In addition, we continue to model multi-handed care, instruct staff in use of positioning devices and contribute to weekly developmental rounding. Our rounding focuses on the environment, pain management, positioning, opportunity for parent bonding/skin to skin, appropriate gross/fine motor acquisition and feeding. We initiate rounding on babies zero to three months of age who have been in the PCTU for more than five days or have suffered a neurological event. CHD patients will continue to be rounded on weekly throughout their admission. Following discharge, patients follow up at nine months in our neurodevelopmental clinic with a neuropsychologist, developmental nurse and cardiologist as well as a PMR physician to make additional recommendations for services. The goal of both rounding and the follow up clinic is to provide an opportunity for education with families to prevent any delay in their baby's development. In the inpatient environment, we continue to grow and restructure our model based on feedback from families and staff.

IMPORTANCE TO MEMBERS: As Physical Therapists, we have a critical role in empowering families and providing education for age appropriate gross motor milestone acquisition for children with CHD as they are known to be at risk for delays. This model of care for prevention and education has been effective in our acute care setting. As our model of care evolves, it will be essential to expand our interprofessional collaboration among settings to ensure appropriate follow up to continue to improve outcomes.

EVIDENCE BASED INTERPROFESSIONAL INTERVENTION FOR PEDIATRIC FUNCTIONAL FECAL INCONTINENCE USING BIOFEEDBACK FOR THE PELVIC FLOOR

Tremback-Ball A, Kilmer D. Misericordia University

PURPOSE: Functional fecal incontinence (FFI) is defined as voluntary and involuntary passage of feces in inappropriate places in a child four years old or older. Children with FFI often have chronic constipation and painful bowel movements. This may be due to averting the bathroom and/or failing to maintain adequate intraabdominal pressure during defection. Children with FFI can experience emotional anguish due to soling in public and are at higher risk for peer rejection and teacher alienation. This may result in emotional issues such as humiliation, decreased self-esteem, and withdrawal from social activities. Biofeedback therapy for this population is a readily available, noninvasive technique in treating pediatric pelvic floor dysfunction. A systematic review on biofeedback for treating children with FFI determined that significant relief can be attained when biofeedback therapy is used in conjunction with other interventions. The purpose of this project was to examine best practices for collaborating with primary care providers.

DESCRIPTION: A physical therapist and nurse practitioner examined the findings of a systematic review on biofeedback for FFI and collaborated to develop a recommended plan of care for children with FFI.

SUMMARY OF USE: Biofeedback is best complimented by assessing the root cause of the FFI. The clinical expression of a functional gastrointestinal disorders is dependent on individuals autonomic, affective, and intellectual developmental stage and on concomitant organic and psychological disturbances. Treatment differs depending on whether the patient has stool impactions, suffers from constipation or has normal bowel movements but defecates in places other than the toilet. The goal for treatment is to establish a regular bowel routine, identify the root cause and collaborate with a diversified treatment team. Effective management is also dependent on a therapeutic support system for the child such as an alliance with parents. Stool toileting refusal is when a child demonstrates a pattern of successfully using the toilet to urinate but refuses to use the toilet for bowel movements. The child will usually defecate in a diaper, or training pants or in some cases the child will retain stool or defecate outside the toilet. Standard therapy includes five components including providing information about the dysfunction and demystifying it, providing instruction on resolving the dysfunction, advising the patient on life-style changes, teaching the patient how to use a voiding diary and providing support and encouragement from caregivers. Standard urotherapy can also include pelvic floor retraining, behavioral therapy and psychotherapy if the standard proves ineffective for the child.

IMPORTANCE TO MEMBERS: Therapists and other medical professionals should consider collaborative approaches in combination with biofeedback with a team of healthcare professionals to best address the patients' goals and limitations. Biofeedback provides a viable, non-invasive treatment for children with FFI and is most effective when collaborating with the primary provider and/or a specialty provider in a strategic plan of care.

THE IMPORTANCE OF THE INTEGRATED CLINICAL EXPERIENCES IN POST SECONDARY EDUCATION FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES: CONSIDERATIONS WHEN CHOOSING A CAREER AND PROGRAM

Tremback-Ball A, Morgano S. Misericordia University

THEORY/BODY: Many children with developmental disabilities who are transitioning to adulthood are choosing a career like their typically developing counterparts. In the junior year of high school, most students are choosing their career path. In the senior year, students are choosing a post-secondary school. For students who are considering entering the health care professions, most have limited volunteer and shadowing hours and have not participated in any hands on care. Without discouraging and even discriminating against children, parents and educators need to be able advise individuals with developmental disabilities interested on the best careers and programs in health care. This should be based on the individual abilities, essential functions of the profession and curriculum of a given educational program.

A student's first full-time clinical experience typically does not occur until they have completed one and half to two years of schooling. There is quite a discrepancy between the classroom culture and clinical culture and it can be a rude awakening in terms of the actual physical and cognitive demands. For students with functional limitations this can be even more challenging. They not only must adapt in terms of culture but also in terms of physical accommodations. This may include accommodations for limitations in gross and fine motor abilities, communication and hearing deficits and other common impairments. Once they arrive in the clinic, adaptations must be altered to suit the setting and the needs of the patients. Further, once a student with functional limitations is in the clinic, they become enlightened to limitations they may not previously have been aware.

The integrated model of clinical education has the potential to make a significant impact on the successful matriculation of students with functional limitations. For example, being a student physical therapist with cerebral palsy presents challenges in terms of the associated neuromuscular impairments. An integrated clinical education can give students with physical limitations more time early on in their education to identify their limitations, develop communication skills about their limitations and possible accommodations. It also provides an opportunity for practice on how to respond to patients' observations and remarks about their physical limitations. Lastly, it gives students a venue to practice advocating for themselves. Students with functional limitations need to learn how to communicate and advocate about appropriate accommodations based on setting.

CLINICAL RELEVANCE: When choosing a career and program in the health sciences, individuals with disabilities should examine the essential functions of the profession, consult others with disabilities who practice in the field and choose an educational program that incorporates clinical practice early in the curriculum. Classroom and laboratory culture is much different than clinical culture and early exposure to the physical and cognitive demands of a profession may help one to successfully complete their program. A therapist can assist with analyzing these demands.

PHYSICAL THERAPIST MANAGEMENT OF A CHILD WITH COMPLEX REGIONAL PAIN SYNDROME COMPLICATED BY EXTENSIVE PSYCHOSOCIAL COMORBIDITIES

Troup R (University of Colorado Physical Therapy Program), Hernandez M (University of Colorado Physical Therapy Program and JFK Partners), Miller K (Children's Hospital Colorado)

BACKGROUND & PURPOSE: Complex Regional Pain Syndrome (CRPS) is hypothesized to be an exaggerated inflammatory response to trauma. Common symptoms include pain, allodynia, hyperalgesia, swelling, and skin changes of the affected limb. Approximately one-fourth of patients with CRPS meet the diagnostic criteria for a psychological disorder, which can exacerbate symptoms. Despite sufficient medical research on CRPS in the pediatric population, there is a lack of physical therapy management research. The purpose of this case report was to describe the physical therapist management of a 12-year old female with CRPS of the ankle directly complicated by extensive psychosocial comorbidities.

CASE DESCRIPTION: The patient presented non-weight bearing on her right lower extremity, with a score of 7/7 on the Budapest Criteria and a goal of returning to all desired school activities. Review of systems revealed psychosocial comorbidities of anxiety, signs of depression, and suicidal ideation. Early diagnosis and intervention contributed to a good functional prognosis. However, extensive psychosocial comorbidities were expected to negatively impact her recovery. Physical therapy intervention included pain neuroscience education, neuromuscular reeducation, strengthening, graded motor imagery, and functional activities. The patient also received concurrent psychological treatment.

OUTCOMES: Within 3 weeks of treatment, the patient was able to ambulate independently. Within 6 weeks, the patient tested at a 5/5 on all ankle manual muscle tests and had full ankle ROM in all directions. After 8 weeks, the patient scored a 0/7 on the Budapest Criteria, and thus no longer met the diagnostic criteria for CRPS. Most importantly, the patient was able to report a Patient Specific Functional Scale total score of 31/50, which was an improvement from her initial evaluation score of 5/50, indicating that treatment not only drastically reduced or eliminated her symptoms, but also allowed the patient to participate in activities that were meaningful to her.

DISCUSSION: This case report discussed specific intervention techniques for pediatric patients with a diagnosis of CRPS, including use of multidisciplinary management of extensive psychosocial comorbidities. It is crucial for physical therapy providers to screen for psychosocial comorbidities in patients with CRPS, as they often co-occur.

EFFECTIVENESS OF ROBOTIC-ASSISTED GAIT TRAINING AND AQUATIC PHYSICAL THERAPY IN A CHILD WITH LONG-CHAIN 3-HYDROXY-ACYL-COA DEHYDROGENASE DEFICIENCY: A CASE STUDY

Tucker PM, Severin L. Children's Health

BACKGROUND & PURPOSE: The purpose of this case study is to describe the outpatient rehabilitation program for a 16-year-old female with long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency, specific to physical therapy examination, treatment, and outcomes.

BACKGROUND: LCHAD is a rare autosomal recessive inborn error of fatty acid oxidation that prevents the body from converting long chain fatty acids to energy. Signs and symptoms of LCHAD deficiency typically appear during infancy or early childhood and can include feeding difficulties, lack of energy, hypoglycemia, hypotonia, hepatomegaly, and retinal abnormalities. Individuals with LCHAD deficiency experience a heightened risk for muscle pain, rhabdomyolysis, peripheral neuropathy, cardiomyopathy, breathing difficulties, coma, and sudden death. Literature review revealed a dearth of publications on the rehabilitation care for a person with LCHAD deficiency.

CASE DESCRIPTION: This teenager presented to Children's Health outpatient clinic with sudden onset muscle weakness and fatigue with resultant dependence for all mobility and self-care. Interventions focused on transfer training, activities of daily living (ADLs), core and lower extremity strengthening, energy conservation, balance, endurance, and gait training in body weight-supported environments on both land and in the pool. After four months of aquatic therapy, she transitioned to a combined aquatic therapy and land-based therapy program with body weight support (Andago), which was followed by four months in an intensive robotic-assisted gait program (Lokomat).

OUTCOMES: After 12 months of therapy, the patient demonstrated independence with transfers, ambulation up to 150 feet with a rolling walker, and stair navigation. Functional mobility, gross motor skills, and participation in ADLs significantly improved per the Gross Motor Function Measure (GMFM), Pediatric Evaluation of Disability Inventory (PEDI), Six Minute Walk Test (6MWT), and Timed Up and Go (TUG).

DISCUSSION: Due to the scarcity of published data describing physical therapy treatment of LCHAD, this report describes one individual's response to an outpatient rehabilitation program. Her rehabilitative course will hopefully add to future research to provide patients and families with expectations for their recovery and ultimate level of function.

ATHLETE COMPLIANCE AND PARENT-PERCEIVED EFFECTIVENESS OF A HEP FOR THE SPECIAL OLYMPICS ATHLETE

Vincent L, Ennis B. Bellarmine University

PURPOSE: A survey study was completed with parents of Special Olympics Kentucky athletes after completion of a fitness screening in order to assess athlete compliance, athlete perceived motivation and parent perceived effectiveness of the Funfitness program.

DESCRIPTION: FUNfitness is the athletic screening component of the Special Olympics Heathy Athletes Initiative which addresses the ongoing health needs of the athletes. FUNfitness provides athletes the opportunity to be screened for flexibility, functional strength and balance. During these screens Physical Therapy professionals and students work with athletes and coaches to improve optimal function in sports training and competition, reduce risk for injuries and recommend home exercise programs. Following screening at the state Special Olympics, participants were invited to complete a survey study to assess the perspective of the current program. Follow up surveys were sent at 4 and 8 weeks post-screening to assess compliance. The study determined that athlete compliance was significantly low both at four and eight weeks post screening, revealing that lack of time and interest led to decreased compliance levels and motivation, with parents perceiving that the athletes did not have enough repetition with the program for it to be effective. 80% of athletes' parents also reported that their child required at least minimal assistance in order to complete the program correctly.

SUMMARY OF USE: The FunFitness program allows for athletes and their caregivers to understand the athletes' abilities, assist with prevention of injuries and assess what athletes may require further care from a licensed physical therapist. Physical Therapists across the country should be aware of the current limitations with the program in order to advocate for improvements in programming in order to better serve this population.

IMPORTANCE TO MEMBERS: As a part of our professions core values of compassion, excellence and social responsibility we are called to serve this population by using our skills and the most current evidence to provide the highest level of care. As pediatric physical therapists we often assist with providing this program in order to improve functional mobility needed for athletics and to prevent declines in health. Based on the current research and this preliminary survey, the current program may not be optimal in meeting the needs of this population. In order to improve this program continued research should be conducted to determine the consistency of these findings as well as develop recommendations to improve compliance. For example, therapists could advocate to be a part of the Special Olympics coach training program to provide coaches with adequate exercise programs for maintaining and improving physical abilities while also preventing injuries. It may also be important to consider the variability in physical and intellectual abilities of the participants in the home activities provided.

ACTIVTY-BASED RESTORATIVE THERAPY WITH SACRAL WOUND: A CASE STUDY

Warwick-Arndt L, Farrell B, Martin R. Kennedy Krieger Institute

BACKGROUND & PURPOSE: Activity Based Restorative Therapy (ABRT) is a well-studied rehabilitation approach aimed at the restoration of function lost to neurological injury. By providing repeated, near-normal input, ABRT optimizes the nervous system for recovery and offsets the chronic complications, maintaining the physical integrity of the body. ABRT is more aggressive than traditional models of rehabilitation and may be limited by comorbidities. The purpose of this case study is to demonstrate the feasibility of ABRT with a patient with sacral wound and discuss practical modifications of associated interventions.

CASE DESCRIPTION: Patient is a 14-year old male with history of sudden onset bilateral lower extremity weakness, bilateral upper extremity weakness, urinary retention, respiratory distress and bradycardia. Patient was diagnosed with Transverse Myelitis and transferred to specialty inpatient rehabilitation one month later. At admission, patient was ventilator dependent, had right LE paralysis, emerging left LE movement, and bilateral UE paralysis. He had developed an unstageable sacral pressure wound and significant anxiety. Patient was unable to walk and did not participate in any of his ADLs. Patient remained in IRF for 12 weeks. He received 5 hours a day, 6 days a week of ABRT. At week 3 the wound underwent sharp debridement and a wound vac was placed at week 5. Modifications were made to ABRT interventions, including FES cycling, weight bearing, and massed practice of task specific functional skills. Prone and side lying positioning were employed during strengthening activities to decrease pressure on sacrum. FES, as part of the RT300 LE ergometer, was applied but the patients LE were not connected to the pedals. This allowed the patient to still benefit from the LE patterning and CNS excitation associated with LE ergometry, but avoid shear and friction over the wound. Patient participated in gait training, whole body vibration, and supported standing using modified techniques with emphasis on reducing or eliminating pressure to the wound. Pressure mapping technology was utilized early and continuously during the admission to guide progression of therapeutic interventions in the upright position.

OUTCOMES: Over the course of the admission, the wound fully healed. The medical team removed all related activity restrictions. The patient was weaned from the ventilator and decannulated. The patient also recovered strength and function from 0/5 in right LE and 2/5 in the left LE to 2/5 in right LE and 3-4/5 in the left LE. He returned to walking. His 6-Minute Walk Test scores improved from 0ft to 362.4ft. His 10-Meter Walk Test Score improved from unable to complete to 22.4sec. Patient was discharged home as a household ambulator.

DISCUSSION: This case demonstrates that ABRT is possible in a patient with an unstageable sacral wound. In this case aggressive therapy did not sacrifice wound healing and resulted in improvements in strength and functional skills. Further study is warranted to investigate optimal treatment intensities and conditions and elucidate the contribution of ABRT to wound healing.

UNDERSERVED AND OVERBURDENED: REHAB CANDIDATES IN A STATE WITHOUT ACCESS TO PEDIATRIC INPATIENT REHABILITATION

Welch SA (Vanderbilt University Medical Center), Marsden Camille (Monroe Carell Jr. Children's Hospital at Vanderbilt), Haring RS (Vanderbilt University Medical Center), Stark S (Vanderbilt University Medical Center)

PURPOSE: There is evidence that receiving inpatient rehabilitation (IPR) at pediatric-specific rehab facilities is associated with improved functional outcomes. Yet, there are many places in the US where patients do not have access to pediatric IPR. In the first part of this study, we aimed to characterize IPR candidates discharged from pediatric acute care at a large academic medical center in a state where no pediatric-specific rehabilitation facilities exist.

DESCRIPTION: This retrospective cohort study included IPR candidates aged 11 months - 20 years who discharged January 2017 - June 2018 from pediatric acute care at a large academic medical center. IPR candidates were children who had multidisciplinary rehab needs prior to discharge, e.g. at least two disciplines agreed on candidacy (PT, OT, SLP, or PM&R consult service). The Functional Status Scale (FSS) was scored from pre-illness baseline status and later at hospital discharge retrospectively by two independent examiners, with disagreements resolved by consultation with a third reviewer. Discharge-ready days were obtained retrospectively through documentation of the patients' medical readiness for rehab. Sixty-nine patients met inclusion criteria and had complete records on characteristics of interest. Within this cohort, 53.6% discharged to pediatric-specific IPR, 24.6% to home, and 21.7% to adult IPR. 60% of discharges to home occurred due to medical, social, and geographic barriers. Rehab candidates who discharged to pediatric IPR facilities were younger (p < 0.0001), had more discharge-ready days waiting for rehab (p=0.02), and traveled longer distances to get to IPR (p < 0.0001) than those discharged to adult IPR.

SUMMARY OF USE: Among pediatric rehab candidates at a large academic hospital in a State without pediatric IPR, significant barriers exist that prevent nearly half from receiving age-appropriate post-acute care. Many of these barriers reflect the distance required to travel to an appropriate facility. Children who do discharge to pediatric rehab facilities spend more discharge-ready days waiting for IPR. Extra hospital days have financial implications and pose risk for hospital-acquired illness. Within our cohort, the patients who discharged to pediatric specific rehab facilities also had more functional decline from baseline than those who discharged to adult rehab. Future work should explore the relationship between discharge-ready days and functional decline specific to this patient cohort further.

IMPORTANCE TO MEMBERS: To the authors' knowledge, this is the first study characterizing hospitalized pediatric IPR candidates in a State without a pediatric specific rehab facility. Findings suggest that hospitalized children with post-acute care IPR needs have significant functional decline reflective of morbidity and unfavorable functional outcomes. Access to high quality, age-appropriate post-acute care is of the utmost importance. Future work should explore tracking health outcomes and functional changes prospectively throughout the continuum of care, improving access to pediatric IPR, and exploring alternative post-acute care options.

THE PROFESSIONAL DEVELOPMENT PLAN FOR SCHOOL-BASED PHYSICAL THERAPISTS: DEVELOPMENT AND USE

Wynarczuk KD (Kean University), Barreca J (Saint Louis University), Foudriat BA (Northland Learning Center and College of St. Scholastica), George K (Seton Hall University), Lowe E (Total Education Solutions), Tavera M (School District of Superior)

PURPOSE: Pediatric physical therapists (PTs) who work in school settings have a unique set of competencies, rules, and standards to guide their practice. In order to provide effective services to children in schools, PTs need to understand the intersection of the Individuals with Disabilities Education Act (IDEA), state and local school-based physical therapy practice guidelines, and their own states practice act. Previous work by Effgen, Chiarello, and Milbourne (2007) outlined nine competency areas for school-based PTs in areas such as educational team collaboration; school-based examination, evaluation, and intervention; administrative issues, and research. Within these competency areas, school-based physical therapists need professional development to promote ongoing reflective practice, lifelong learning, and to meet the American Physical Therapy Associations core values. The purpose of this project was to develop a resource and tool for professional development of school-based physical therapists.

DESCRIPTION: The Professional Development Plan for School-Based Physical Therapists (PDP-SBPT) was developed between 2016 and 2018 by six experienced school-based physical therapists from across the United States. The PDP-SBPT identifies a skill-based pathway to become competent and successfully navigate the complexities of practice in providing physical therapy in educational environments. The PDP-SBPT is structured around the nine competency areas for physical therapists working in schools, as described by Effgen, Chiarello, and Milbourne (2007). For each competency area, the authors identified and listed relevant resources from professional organizations, peer-reviewed research, and selected texts. On the PDP-SBPT, therapists may self-rate their skills for each competency and related clinical skills, may identify relevant professional development opportunities and resources, and may record progress toward achievement of each competency and related clinical skill.

SUMMARY OF USE: It is intended that therapists may use the PDP-SBPT to: 1) assess their skills for each competency area, 2) identify available professional development opportunities and resources, 3) create a learning plan and 4) record progress toward development in each competency area.

IMPORTANCE TO MEMBERS: Physical therapists who work in educational environments are responsible for knowing and understanding the unique rules and standards that guide practice in that unique environment. This tool is intended to guide professional development of school-based physical therapists.

© 2019 Academy of Pediatric Physical Therapy of the American Physical Therapy Association