Jane K. Sweeney

Neonatal Physical Therapy. Part II: Practice Frameworks and Evidence-Based Practice Guidelines

Purpose: (1) To outline frameworks for neonatal physical therapy based on 3 theoretical models, (2) to describe emerging literature supporting neonatal physical therapy practice, and (3) to identify evidence-based practice recommendations. Key Points: Three models are presented as a framework for neonatal practice: (1) dynamic systems theory including synactive theory and the theory of neuronal group selection, (2) the International Classification of Functioning, Disability and Health, and (3) family-centered care. Literature is summarized to support neonatal physical therapists in the areas of examination, developmental care, intervention, and parent education. Practice recommendations are offered with levels of evidence identified. Conclusions: Neonatal physical therapy practice has a theoretical and evidence-based structure, and evidence is emerging for selected clinical procedures. Continued research to expand the science of neonatal physical therapy is critical to elevate the evidence and support practice recommendations.

Neonatal physical therapy. Part I: clinical competencies and neonatal intensive care unit clinical training models.

Purpose: To describe clinical training models, delineate clinical competencies, and outline a clinical decision-making algorithm for neonatal physical therapy. Key Points: In these updated practice guidelines, advanced clinical training models, including precepted practicum and residency or fellowship training, are presented to guide practitioners in organizing mentored, competency-based preparation for neonatal care. Clinical competencies in neonatal physical therapy are outlined with advanced clinical proficiencies and knowledge areas specific to each role. An algorithm for decision making on examination, evaluation, intervention, and re-examination processes provides a framework for clinical reasoning. Because of advanced-level competency requirements and the continuous examination, evaluation, and modification of procedures during each patient contact, the intensive care unit is a restricted practice area for physical therapist assistants, physical therapist generalists, and physical therapy students. Conclusions/Practice Implications: Accountable, ethical physical therapy for neonates requires advanced, competency-based training with a preceptor in the pediatric subspecialty of neonatology.

Motor Development and Self-Stimulatory Movement in Institutionalized Romanian Children

Two hundred sixty-seven children without neurological impairment were studied to determine the effect of orphanage placement on motor performance and occurrence of self-stimulatory movement. The children were identified from nine institutions in six cities across Romania. Two hundred thirty-six children had failure-to-thrive (FTT) syndrome and a comparison group of 31 children were not failing-to-thrive (NFTT). Children in both groups performed under the sixth total percentile rank in fine motor skills and under the fourth total percentile rank in gross motor skills on the Peabody Developmental Motor Scales. Considered “normal” by orphanage staff, the NFTT children showed profound motor delay despite higher scores in gross and fine motor subtests than the FTT group. Higher frequency of self-stimulatory movement found in FTT subjects included body body rocking (FTT 50%; NFTT 35%), wrist flapping (FTT 10%; NFTT 6%), and face guarding (FTT 16%; NFTT 10%). The occurrence of finger shadowing was similar between the two groups (FTT 18%; NFTT 19%). These results suggest that motor delay and self-stimulatory movement appeared related to orphanage placement, rather than to the presence of FTT. Physical therapists assessing adopted Romanian orphans can expect global motor delay and self-stimulatory movement, particularly rocking.

Effects of motor control intervention for children with idiopathic toe walking: a 5-case series.

PURPOSE To describe and evaluate the effects of motor control intervention in young children diagnosed with idiopathic toe walking. METHODS Five children received motor control intervention in a multiple-case series design using a nonconcurrent, variable baseline. Multiple gait measures were taken before and during the intervention phase. Pre- and posttreatment measures of gross motor development and ankle dorsiflexion range of motion were compared. RESULTS During the intervention phase, heel strike frequency showed an upward slope for 1 participant, slight upward trends for 3 participants, and no change for 1 participant. Parents indicated minimal gait change within the childrens regular environments. Gross motor skill scores increased but were not statistically significant. Passive ankle range of motion improved and was maintained (P = .002). CONCLUSIONS Presentation of children with idiopathic toe walking varies and refinement is needed for gait measures and assessment methods. Intervention improved ankle mobility, but additional components appear necessary to attain spontaneous heel-toe gait.

Pediatric Physical Therapy: Part I. Practice Scope, Scientific Basis, and Theoretical Foundation.

Widespread change has occurred in pediatric physical therapy and in the scientific and theoretical foundations of the specialty since the poliomyelitis epidemics in the 1890s. The focus in this first article of a two-part series is on the scope of clinical practice, scientific basis, and theoretical foundation of pediatric physical therapy. In the second article, methods of assessing and treating movement dysfunction and physical disability will be addressed, as well as analyses of efficacy studies.

Effects of a neurodevelopmental treatment-based trunk protocol for infants with posture and movement dysfunction.

Purpose: This study was used to evaluate the efficacy of a neurodevelopmental treatment (NDT)-based sequenced trunk activation protocol for change in gross motor function of infants aged 4 to 12 months with posture and movement dysfunction. Infants who received a dynamic co-activation trunk protocol were compared with a control group who received a parent-infant interaction and play protocol. Method: A repeated measures randomized block design was used. A masked reliable examiner assessed infants before, immediately after, and 3 weeks after intervention using the Gross Motor Function Measure (GMFM). Results: The NDT-based protocol group made significantly (P = 0.048) more progress than the control group from pretest to posttest. Conclusions: Cautious support was found for (1) sequenced, dynamic trunk co-activation intervention compared to generalized infant play; (2) high-frequency, short-term, task-specific intervention; and (3) direct service by NDT-trained pediatric therapists specializing in infant intervention.

Practice Guidelines for the Physical Therapist in the Neonatal Intensive Care Unit (NICU)

Neonatal physical therapy is an advanced practice, subspecialty area within pediatric physical therapy. Because of the structural, physiological, and behavioral vulnerabilities of neonates, pediatric physical therapists need postprofessional precepted training and experience before providing neonata

Identifying 4-month-old infants at risk in community screening.

Purpose: To validate a 2-step infant developmental screening protocol administered by nonphysician health professionals. Methods: The Parent Concerns Survey and the Meade Movement Checklist (MMCL) were administered during 5 community clinics. Infant scores at 4 months were compared with the Bayley Scales of Infant Development II and Movement Assessment of Infants at 6 months and to the Ages and Stages Questionnaires at 8 months. Results: Parents identified significantly more concerns on the Parent Concerns Survey (×2 = 6.43, p = 0.011) than parents not attending clinics. The correlation between infant MMCL scores at 4 months and Movement Assessment of Infants was r = 0.58 (p = 0.01) and r = −0.48 (p = 0.01) with Bayley Scales of Infant Development II scores at 6 months. The MMCL demonstrated 87.5% sensitivity, 91.4% specificity, and 70% positive predictive value. Conclusion: Combining parent concerns and observational screening effectively identified infants for further evaluation. This 2-step screening by nonphysician health professionals provides a valid, new perspective for screening young infants.

Guatemalan Caregivers’ Perceptions of Receiving and Using Wheelchairs Donated for Their Children

Purpose: The purpose of this qualitative study was to explore the experiences, perceptions, and needs of caregivers receiving wheelchairs donated for nonambulatory children in a less-resourced country. Methods: A phenomenological research design was used with purposeful sampling of 14 participants living in urban and rural areas of Guatemala. Data were collected primarily by interviews and supplemented with observations in natural settings, photographs, and record reviews. Results: Eight themes emerged uncovering the meaning and essence of caregivers’ experiences: value of the wheelchair, relief for caregivers, enhancement of child participation, wheelchair as a form of “therapy,” improvement of learning opportunities, challenges to inadequate disability awareness, impact of contextual barriers, and need for community-based supports. Conclusion: Caregivers in this sample perceived donated wheelchairs as beneficial to themselves and to their children. Support was found for the need to provide wheelchairs in collaboration with local services to support wheelchair use.

Student experiences in the neonatal intensive care unit: addendum to neonatal physical therapy competencies and clinical training models.

PURPOSE To describe the appropriate experience for entry-level physical therapist students in the neonatal intensive care unit (NICU). KEY POINTS Care for infants in the NICU represents a subspecialty within pediatric physical therapy delivered in a very complex environment. Recommendations for designing student educational experiences related to the NICU are provided. CONCLUSIONS/PRACTICE IMPLICATIONS Supervised observation is the appropriate level of NICU experience for physical therapy students. Observation in the NICU cannot be used to demonstrate entry-level clinical competency defined as managing 100% patient caseload in the setting. Additional closely supervised experiences with older, less fragile infants and children in neonatal follow-up clinics and pediatric wards can provide opportunities for entry-level physical therapist students interested in pediatrics to participate in examination and intervention with young children.