Irene R. McEwen

Case studies: Why and how

Case studies have been advocated as a means to advance the development of the augmentative and alternative communication (AAC) field. However, many potential case studies may remain unwritten because those with experiences to share do not know how to assemble them into a case study. To help provide potential authors with the knowledge necessary to prepare a case study, some of the definitions and purposes of case studies will be reviewed. This will be followed by suggestions for case study content and how to increase the probability that a case study will be publishable. Finally, relations between case studies and single-subject research designs will be discussed, in an attempt to clarify some of the differences between them.

The Role of Occupational Therapists and Physical Therapists in Elementary School System Early Intervening Services and Response to Intervention: A Case Report

ABSTRACT The Individuals with Disabilities Improvement Act and No Child Left Behind Act broadened the roles of occupational therapists (OTs) and physical therapists (PTs) to include therapist participation in early intervening services including response to intervention (RTI). This case report describes one school districts inclusion of OT and PT in the elementary school RTI program by identifying and implementing role responsibility and changing workloads for therapists. Therapist responsibilities included (a) administering a screening tool, (b) educating and supporting teachers and staff, (c) providing student resources and intervention strategies, and (d) referring students from RTI to special education and related services. Teachers responded positively using therapist-provided strategies and support. Limitations included an increased workload because of large numbers of students to screen and very few staff available for screening. Future research should include longitudinal studies that measure student responses to therapy intervention, teacher responses to collaboration, and the use of intervention strategies over time.

Assessment of effects of position on communication board access by individuals with cerebral palsy

Individuals who are severely physically disabled by cerebral palsy are often placed in a variety of adaptive positioning devices for therapeutic and functional purposes. Observation and theory suggest that position can influence the ability of these individuals to access communication boards and other communication aids, but there is little empirical evidence to support such claims and there are few guidelines for assessment of positioning effects. This study demonstrates an objective method to assess the ability of individuals with cerebral palsy to access communication board locations, and it also begins to provide needed information about the differential effects of adaptive positioning devices on communication board access.

Parents' perceived benefits of physical therapists' direct intervention compared with parental instruction in early intervention.

Purpose: This study compared parents’ perceptions of benefits of a therapist’s direct intervention with intervention designed to teach parents to promote their children’s motor development. Methods: Twenty-two mothers and one father of children with disabilities watched four videotapes. Two videotapes showed a physical therapist helping a child learn to sit or walk while the mother watched; two showed a therapist instructing a mother while the mother interacted with the child. Parents then responded to a 12-item questionnaire. Results: Overall, participants rated the parent instruction approach as more beneficial, but more stressful, than direct intervention. Conclusions: Most results were inconsistent with previous reports that parents believed direct intervention was more beneficial than other approaches. The parents’ belief that direct intervention could be less stressful is consistent with previous studies. Research is needed to identify the most effective model that parents prefer to promote children’s motor development.

Item Test-Retest Reliability and Responsiveness of the School Outcomes Measure (SOM)

The School Outcomes Measure (SOM) is a minimal data set designed to measure outcomes of students who receive school-based occupational therapy and physical therapy. The purpose of this study was to determine item test-retest reliability and the responsiveness to change of the SOM. Thirty-two occupational therapists and physical therapists collected data on 73 students, age 3–21 years, stratified into two groups based on the Gross Motor Function Classification System: those with mild/moderate functional limitations (Levels I, II, III) and those with severe functional limitations (Levels IV, V). Weighted kappa statistics (0.68–1.0) indicate good to excellent item test-retest reliability. Repeated measures analysis of variance indicated that the SOM is responsive to change in children with mild/moderate functional limitations but is less responsive to change in children with severe functional limitations. The findings support the use of the SOM to measure outcomes for students with mild/moderate functional limitations as well as enabling program evaluation of therapy services provided in school settings. More research is needed to evaluate responsiveness in students with severe functional limitations.

Exercise using the Wii Fit plus with a child with primary Raynaud's disease and obesity: a case report.

ABSTRACT The purpose of this case report was to describe the use of the Nintendo® Wii Fit Plus as an alternative exercise for an 11-year-old child with primary Raynauds disease (PRD) and obesity who was not involved in organized sports and had limited outdoor physical activity and exercise. The Wii Fit Plus exercise parameters are described as well as outcomes measured at baseline, 12 weeks, and 24 weeks. Specifically, we evaluated changes in body mass index (BMI), cardiorespiratory fitness, and health related quality of life (HRQL). Following the 24-week exercise program, the childs BMI decreased, cardiorespiratory fitness increased, and HRQL increased and were comparable to values in healthy children. These findings suggest that the Wii Fit Plus may have been an effective exercise strategy for this child.

Care coordination for children with special health care needs and roles for physical therapists.

Purpose: The purpose of this article is to summarize the research on the possible benefits of care coordination for children with special health care needs and explore potential roles for physical therapists in care coordination, including roles as primary care coordinators, members of interprofessional teams, advocates, and researchers. Key points: The medical home model is described. Benefits of care coordination are reviewed. Potential roles for physical therapists in care coordination are outlined. The barriers to care coordination are reviewed and recommendations to reduce barriers and better prepare therapists for care coordination are offered. Conclusion: Therapists need to be aware of and adapt to change in care models to be the provider of choice.

Treadmill Training in a Child with Cerebral Palsy: A Case Report

This case report describes the use of treadmill training without body weight support to improve walking speed in a child with diplegic cerebral palsy. The child was a six-year-old girl with spastic diplegic cerebral palsy. She walked short distances independently using a posterior support walker but was unable to keep up with her peers walking long distances. Speed of walking 50 feet and speed of walking from her classroom to the cafeteria (458 feet) were timed pretreadmill, posttreadmill, and 3 weeks following treadmill intervention. The GMFM-88 was administered pre- and posttreadmill intervention. Following treadmill intervention, the childs speed of walking increased and she was able to walk to the cafeteria daily with her peers. Improvements in the percent of maximum total score of the GMFM-88 were also observed. The outcomes of this case suggest that the use of short-term, task-specific treadmill intervention might increase a childs walking speed enough to increase their participation in the school setting.

Lightweight and ultralight wheelchairs: propulsion and preferences of two young children with spina bifida.

Purpose: This study compared the influence of two wheelchair styles, an ultralight rigid frame and a lightweight folding frame, on preference and propulsion in young children with spina bifida. Procedure: Speed, distance, energy expenditure, and perceived exertion of two girls were studied in an A-B-A single subject design. Questionnaires were used after the three phases to obtain parent and child preference. Results: Visual inspection of the data favored the ultralight wheelchair for all variables, except the first child’s speed with classmates and perceived exertion. Parents and children indicated preference for the ultralight wheelchair on all questions but one by Child 1. Using two standard deviation band width (2SDBW) analyses, 12 of 16 comparisons between the phases differed significantly. 2SDBW comparison was not used in the other four phase comparisons because of autocorrelations. Conclusion: This study presents initial evidence supporting the use of ultralight rigid-framed wheelchairs by young children.

Retrospective Analysis of Predictors of Proficient Power Mobility in Young Children With Severe Motor Impairments

OBJECTIVES To determine if child characteristics, maternal education, intervention parameters, type of wheelchair control mechanism, or a combination of these variables were associated with proficient power mobility skills in children with severe motor impairments aged 14 to 30 months; and to determine if performance on the Wheelchair Skills Checklist (WSC) was associated with performance on the Powered Mobility Program (PMP). DESIGN Secondary data analyses on data collected from 2 previously completed randomized controlled trials (RCTs). SETTING Intervention and outcomes measurements took place in natural environments. PARTICIPANTS Participants included children who were assigned to the intervention groups in 2 RCTs (N=31). INTERVENTION Children practiced maneuvering individually customized power wheelchairs for 12 months in natural environments. MAIN OUTCOME MEASURES Proficiency was assessed using the WSC and the PMP. The Battelle Developmental Inventory and Merrill-Palmer-Revised were used to assess baseline cognition and motor skills. Baseline mobility was assessed using the Pediatric Evaluation of Disability Inventory. RESULTS Cognition, fine motor skills, and wheelchair control mechanism were associated with proficiency. Cognition, type of wheelchair control, and diagnosis all predicted proficiency while controlling for other covariates using multiple regression analysis. Agreement between the WSC and PMP was 94.7%. CONCLUSIONS Cognition, type of wheelchair control, and diagnosis might predict power mobility proficiency in young children with severe motor impairments. These factors however should not be used to determine whether a child has the opportunity to participate in a training program. Agreement between the WSC and PMP could help researchers and clinicians compare results across studies that use only one of these outcome measures.