Alyssa LaForme Fiss

Participation-based therapy for children with physical disabilities

Purpose: Optimizing home and community participation of children with physical disabilities is an important outcome of rehabilitation. Method: A review of literature identified research and theory on participation of children with physical disabilities. The authors’ incorporated current knowledge to conceptualize the experience of optimal participation, formulate principles of participation-based physical and occupational therapy, and develop a five-step process for intervention. A case report was completed to illustrate application to practice. Results: Optimal participation involves the dynamic interaction of determinants (attributes of the child, family, and environment) and dimensions (physical, social, and self engagement) of participation. Real-life experiences enable children to learn new activities and develop skills that optimize their participation and self-determination. Interventions are: goal-oriented, family-centered, collaborative, strengths-based, ecological, and self-determined. A distinguishing feature of intervention is that the therapist’s primary role is to support the child and family to identify challenges to participation and solutions to challenges. The therapist is a consultant, collaborating with the child, family, and community providers to share information, educate, and instruct in ways that build child, family, and community capacity. Conclusion: The model may have utility for collaboration with families and community providers, determining goals for participation, and providing evidence-informed interventions. Implications for Rehabiliation Home and community participation of children with physical disabilities is an important outcome of rehabilitation. Optimal participation is conceptualized as the dynamic interaction of determinants (attributes of the child, family, and environment) and dimensions (physical, social, and self engagement) of participation. Participation-based physical and occupational therapy is based on the assumption that real-life experiences enable children to learn new activities and develop skills and that the empowerment of families enables them to advocate for the full inclusion and integration of their children in society. In participation-based therapy, the therapist is a consultant, collaborating with the child, family, and community providers to share information, educate, and instruct in ways that build child, family, and community capacity.

The Move & PLAY Study: An Example of Comprehensive Rehabilitation Outcomes Research

This perspective article provides an example of a study planned using guidelines for comprehensive rehabilitation outcomes research, an approach that is believed to give service providers meaningful evidence to support practice. This line of investigation has been guided by the World Health Organizations International Classification of Functioning, Disability and Health. The short title of a study under way is Move & PLAY (Movement and Participation in Life Activities of Young Children). The article briefly describes the conceptual model, provides guidelines on how indicators and measures are selected, alludes to the details of selected measures, and describes processes of preparing for data collection, including obtaining ethics approval, preparing data collection booklets, training assessors and interviewers, and sampling. The aim of this investigation is to gain a better understanding of the multiple child, family, and service factors associated with changes in mobility, self-care, and play of preschool children with cerebral palsy as a result of using this research method. Comprehensive rehabilitation outcomes research holds promise in providing evidence that supports the complexities of planning rehabilitation services with clients with chronic conditions, such as children with cerebral palsy.

Determinants of gross motor function of young children with cerebral palsy : A prospective cohort study

The aim of this study was to test a model of determinants of gross motor function of young children with cerebral palsy (CP).

Determinants of participation in family and recreational activities of young children with cerebral palsy

Abstract Purpose: To test a model of child, family and service determinants of participation in family and recreational activities for young children with cerebral palsy (CP). Methods: Participants were a convenience sample of 429 children (242 males) with CP, aged 18 to 60 months, representing all levels of the Gross Motor Function Classification System (GMFCS). Children were divided into two groups by GMFCS levels, levels I to II and levels III to V. Data on impairments and gross motor function were collected by therapists; parents provided information about children’s health conditions and adaptive behaviour. Seven months later, parents reported on family life and services received. One year after the beginning of the study, parents reported their children’s participation. Data from the two groups of children were analysed separately using structural equation modelling. Results: The model explained 35% and 40% of the variance of frequency of participation in family and recreation and 28% and 38% of enjoyment in participation, for the two groups of children, respectively. Children’s adaptive behaviour, family ecology, and number of community recreational programs were associated with the frequency of participation for both groups. Gross motor function was only associated with the frequency of participation for children in levels III–V. Adaptive behaviour was associated with enjoyment for both groups. The extent services met children’s needs was associated with enjoyment for children in levels I to II and family ecology was a determinant of enjoyment for children in levels III to V. Conclusion: Supporting children’s adaptive behaviour, family ecology, and access to community recreational programmes may foster participation in family and recreational activities for young children with CP. Implications for Rehabilitation Participation in family and recreational activities for young children with CP is complex and influenced by child, family and environmental factors. Practitioners are encouraged to support children’s adaptive behaviour and access to community programs and family relationships, involvement in community activities and expectations of their children. Optimizing gross motor function for children who have limitations in self-mobility may enhance their participation in family and recreational activities. For children with a good prognosis for walking, providing services perceived by parents to meet their children’s needs may enhance children’s enjoyment of participation.

Use of groups in pediatric physical therapy: survey of current practices.

Purpose: This nationwide survey study aimed to examine the use of groups in pediatric physical therapy, including characteristics, effectiveness, and financial considerations of group intervention. Methods: Questionnaires were mailed to 500 randomly selected members of the American Physical Therapy Association Section on Pediatrics. Respondents reported on the characteristics of children typically included in group intervention, types of activities used, effectiveness at meeting goals, billing methods, and documentation practices. Results and conclusions: The response rate was 285 (57%). Only 41.4% of respondents reported using groups. Characteristics of group intervention were variable among respondents, and considerable differences in billing practices and perceived effectiveness were noted. Commonly reported characteristics included use of small groups of young children with developmental delay and use of task specific developmental activities. Perceived benefits and limitations of group intervention were also reported. Implications for further research into the use of groups were explored.

Development and validity of the early clinical assessment of balance for young children with cerebral palsy.

Abstract Objectives: Validity of the Early Clinical Assessment of Balance (ECAB), to monitor postural stability in children with cerebral palsy (CP), was evaluated. Methods: 410 children with CP, 1.5 to 5 years old, participated. Physical therapists scored children on the Movement Assessment of Infants Automatic Reactions section and Pediatric Balance Scale. Through consensus, researchers selected items from both measures to create the ECAB. Content and construct validity were examined through item correlations, comparison of ECAB scores among motor ability, age and gender groups and correlations with the Gross Motor Function Measure 66 basal and ceiling (GMFM-66-B&C). Results: Internal consistency was high (Cronbach’s alpha = 0.92). ECAB differed significantly among motor ability, children <31 months old scored lower than older children, but there was no difference between boys and girls. ECAB and GMFM-66-B&C scores correlated strongly (r = 0.97). Conclusion: Validity of the ECAB was supported. Reliability and responsiveness need study.

Effect of sensorimotor groups on gross motor acquisition for young children with Down syndrome.

Purpose: To examine whether participation in sensorimotor groups and individual intervention resulted in greater improvements in motor skill acquisition than solely individual intervention for young children with Down syndrome. Methods: Ten children with Down syndrome, 13 to 29 months of age, participated. Children in both groups received individual intervention, and children in the intervention group participated in 10 weekly sensorimotor groups. All children were assessed at 3 points using the Gross Motor Function Measure and Goal Attainment Scaling. Results: Children in the intervention group demonstrated significant improvement compared with children in the control group at the p < 0.10 level in lying and rolling, crawling and kneeling, and total score domains of the Gross Motor Function Measure and in Goal Attainment Scaling. Conclusions: Participation in sensorimotor groups and individual intervention resulted in greater improvement in motor skill acquisition than solely individual intervention for young children with Down syndrome. Additional research to support these exploratory findings is needed.

Determinants of self-care participation of young children with cerebral palsy

Abstract Objective: To test a model of child, family and service determinants of self-care participation of children with cerebral palsy (CP), grouped by Gross Motor Function Classification System levels (I–II and III–V). Methods: Participants were a convenience sample of 429 children (242 males) with CP, aged 18–60 months. Data on impairments and gross motor function were collected by reliable therapists; parents provided information about childrens health conditions and adaptive behaviour. Seven months later parents reported on family life and services received. One year after study onset, parents documented childrens self-care participation. Data from two groups of children were analysed using structural equation modelling. Results: The model explained a significant proportion of the variance of self-care participation, with higher motor function, fewer health conditions and higher levels of adaptive behaviour being associated with greater self-care participation. Conclusion: Supporting childrens gross motor function, health and adaptive behaviour may optimize self-care participation.

Comparison of Family and Therapist Perceptions of Physical and Occupational Therapy Services Provided to Young Children with Cerebral Palsy

ABSTRACT The purpose of this study was to determine whether parents and therapists have similar perceptions of therapy services provided to young children with cerebral palsy (CP), reflecting collaboration and provision of family-centered care. Forty-six parents of young children with CP and 40 therapists providing services for those children participated. Parents and therapists independently completed the same Services Questionnaire, indicating their perceptions of the focus and extent of the childrens therapy services. For data analysis, answers to survey questions were combined into seven categories of items with a similar focus. The Spearman rho correlations and Wilcoxon signed-rank tests were used to explore relationships and differences between the ratings of parents and therapists. No significant correlations were found for the seven categories. Significant differences between ratings for five of the seven categories were identified, indicating parents and therapists differed in their ratings of the focus of therapy interventions. Based on the findings, suggestions for improvement in the provision of family-centered care are provided.

Description of Primary and Secondary Impairments in Young Children With Cerebral Palsy.

Purpose: We describe primary and secondary impairments in young children with cerebral palsy (CP); report differences in impairments on the basis of Gross Motor Function Classification System (GMFCS), age, and sex; and examine the extent that individual impairments account for the construct of primary and secondary impairments. Methods: Participants included 429 children with CP (242 [56%] male; 1½ to 5 years) representing all GMFCS levels. Reliable assessors collected primary and secondary impairment data using clinical measures. Analyses included descriptive statistics, comparisons among GMFCS, age, and sex, and factor analysis. Results: Young children with CP present with primary and secondary impairments. Significant differences in impairments occur among some GMFCS levels and age groups but not sex groups. Postural stability contributed most to primary impairments and strength to secondary impairments. Conclusion: Young children with CP across GMFCS levels may have already developed secondary impairments that should be addressed within therapy services.