Commentary on “Inpatient Physical Therapy After Orthopedic Lower Extremity Surgery in Children With Cerebral Palsy” : Pediatric Physical Therapy

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Commentary on “Inpatient Physical Therapy After Orthopedic Lower Extremity Surgery in Children With Cerebral Palsy”

Lennon, Nancy PT, DPT, MS; Virgil, Brittany PT, DPT

Author Information
Pediatric Physical Therapy 35(1):p 65, January 2023. | DOI: 10.1097/PEP.0000000000000982
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This article is an encouraging early step in much-needed work to describe physical therapy (PT) care and examine outcomes after orthopedic surgery in youth with cerebral palsy (CP).

“How should I apply this information?”

Acute postoperative PT service is less frequent for technology-dependent youth; family capability to manage care likely explains the less frequent services. Parents and therapists should be mindful of this potential bias and consider what acute postoperative PT can offer youth at Gross Motor Function Classification System levels IV and V. Acute physical therapists can highlight surgical expectations and connect these to functional goals, using tools such as the Caregiver Priorities and Child Health Index of Life with Disabilities.1 Therapists caring for youth with CP after surgery should seek opportunities to partner with orthopedic surgeons to advocate for postoperative PT care pathways and gather data on clinical practice and functional surgical outcomes.

“What should I be mindful about when applying this information?”

The authors provide a detailed list of lower extremity surgical procedures as well as broad regional categories. While useful statistically, it is less clinically meaningful. To deliver optimal care, physical therapists working in this area should have detailed knowledge of surgical principles and methods. There is risk in failing to recognize individualized goals. We are encouraged by the distinction of high and low surgical burden, which, as the authors note, is associated with functional recovery and guides expectations for progress and informs therapy dose.2

What this article lacks, as the authors highlight, is intervention detail. Pediatric physical therapists in acute settings educate and prepare families for discharge. While this fills an essential need, we encourage physical therapists to adopt a long view and support families in goal setting for the days, weeks, and months following orthopedic surgery using tools such as the Gait Outcomes Assessment List.3

We commend the authors and encourage investigation into interventions and dosing in post-acute settings to create evidence establishing surgical therapy best care for youth with CP.

Nancy Lennon, PT, DPT, MS
Department of Orthopedics
Brittany Virgil, PT, DPT
Department of Therapy and Rehabilitation Services
Nemours Children's Health
Delaware Valley, Wilmington, Delaware

REFERENCES

1. Narayanan UG, Fehlings D, Weir S, Knights S, Kiran S, Campbell K. Initial development and validation of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Dev Med Child Neurol. 2006;48(10):804–812.
2. Church C, Biermann I, Lennon N, et al. The impact of preoperative factors and surgical burden on postoperative recovery of walking activity in children with cerebral palsy. Dev Med Child Neurol. 2022;64(10):1289–1296.
3. Thomason P, Tan A, Donnan A, Rodda J, Graham HK, Narayanan U. The Gait Outcomes Assessment List (GOA): validation of a new assessment of gait function for children with cerebral palsy. Dev Med Child Neurol. 2018;60(6):618–623.
© 2023 Academy of Pediatric Physical Therapy of the American Physical Therapy Association