Kathy Martin

Measuring Walking: A Handbook of Clinical Gait Analysis

This book is part of the “Practical Guide” series by Mac Keith Press and was written with the primary aim of providing guidance on how to provide clinical gait analysis services. The author has more than 25 years of experience in this area in both the United Kingdom and Australia. The book is intended for clinical gait laboratory staff, clinical researchers, and clinicians who will use the data generated. Overall, the author fulfills his promise of providing guidelines in that the book not only reviews the state of the art and science of gait analysis, but he also offers pragmatic advice based on the his years of experience. The uniqueness of this book is that it fills a void by attempting to cross disciplines and focus on an outcome (instrumented gait analysis) instead of the skill set of one specific professional. The author consulted with several colleagues for some chapters, and these people are noted where appropriate. However, Dr. Baker wrote the entire book himself to “maintain a consistent narrative voice.” The book is well-written and logically organized, but does get a bit technical in places. Many chapters will be understood by physical therapists, but the chapters that go into more depth about biomechanics and physics may be more difficult for someone without a strong background in this area. This book presents a nice mix of the history of gait analysis, how it got to where it is today and where it may be going. For example, in Chapter 6 on electromyography, Dr. Baker acknowledges that this data is not as important as it used to be because newer technology provides kinematic data that is more meaningful. Throughout the book, he identifies new technology in development and how it may change clinical gait analysis in the future. The scope of this book is limited to gait laboratory services; however, for those who specialize in this field, covering the entire practice of clinical gait analysis in one book is quite ambitious. This book may be conceptualized as a “how to” manual for nearly everything relating to gait analysis laboratories, from basics of hiring the staff, setting up and maintaining the space, and preparing for the client appointment to the esoteric placement of markers and interpretation of data. In many places, Dr. Baker offers suggestions for even the most basic of tasks, such as what verbal instructions to give to the client before the testing. Because this book is covering new territory, it is an interesting mix of a synthesis of current knowledge and a compilation of “lessons learned” from experience. In

Hippotherapy—An Intervention to Habilitate Balance Deficits in Children With Movement Disorders: A Clinical Trial

Background Clinical observations have suggested that hippotherapy may be an effective strategy for habilitating balance deficits in children with movement disorders. However, there is limited research to support this notion. Objective The purposes of this study were to assess the effectiveness of hippotherapy for the management of postural instability in children with mild to moderate balance problems and to determine whether there is a correlation between balance and function. Design A repeated-measures design for a cohort of children with documented balance deficits was used. Methods Sixteen children (9 boys and 7 girls) who were 5 to 16 years of age and had documented balance problems participated in this study. Intervention consisted of 45-minute hippotherapy sessions twice per week for 6 weeks. Two baseline assessments and 1 postintervention assessment of balance, as measured with the Pediatric Balance Scale (PBS), and of function, as measured with the Activities Scale for Kids—Performance (ASKp), were performed. Results With the Friedman analysis of variance, the PBS and the ASKp were found to be statistically significant across all measurements (P<.0001 for both measures). Post hoc analysis revealed a statistical difference between baseline and postintervention measures (P≤.017). This degree of difference resulted in large effect sizes for PBS (d=1.59) and ASKp (d=1.51) scores after hippotherapy. A Spearman rho correlation of .700 indicated a statistical association between PBS and ASKp postintervention scores (P=.003). There was no correlation between the change in PBS scores and the change in ASKp scores (rs=.13, P>.05). Limitations Lack of a control group and the short duration between baseline assessments are study limitations. Conclusions The findings suggest that hippotherapy may be a viable strategy for reducing balance deficits and improving the performance of daily life skills in children with mild to moderate balance problems.

Effects of supramalleolar orthoses on postural stability in children with Down syndrome

This study explored the effects of a flexible supramalleolar orthosis (SMO), indicated to decrease pronation associated with hypotonia, on postural stability in children with Down syndrome. Seventeen children with Down syndrome (nine males, eight females; mean age 5 years 10 months, SD 17.2 months; range 3 years 6 months to 8 years) were tested three times in a 10‐week period (weeks 1,3, and 10) using the Standing and the Walking, Running, and Jumping dimensions of the Gross Motor Function Measure (GMFM), and the Balance subtest of the Bruininks‐Oseretsky Test of Motor Proficiency (BOTMP). Range of motion measurements were used to explore the influence of joint laxity. Significant improvement was found with SMOs compared with shoes only in the Standing dimension (p=0.001) and the Walking, Running, and Jumping dimension (p=0.0001) of the GMFM, both at the time of fitting (week 3) and after 7 weeks of wearing SMOs (week 10). For the BOTMP Balance subtest, significant improvement (p=0.027) was seen only at the end of the 7‐week study period. Amount of joint laxity did not influence response to orthotic intervention. This study showed that young children with Down syndrome showed immediate and longer‐term (after 7 weeks of use) improvement in postural stability with the use of flexible SMOs.

Characteristics of hypotonia in children: a consensus opinion of pediatric occupational and physical therapists.

Purpose: The term hypotonia is often used to describe children with reduced muscle tone, yet it remains abstract and undefined. The purpose of this study was to identify characteristics of children with hypotonia to begin the process of developing an operational definition of hypotonia. Methods: Three hundred physical and occupational therapists were systematically selected from the memberships of the Pediatric Section of the American Physical Therapy Association and the Developmental Delay Section of the American Occupational Therapy Association and asked to complete an open-ended survey exploring characteristics of strength, endurance, mobility, posture, and flexibility. Results: The response rate was 26.6%. Forty-six physical therapists and 34 occupational therapists participated. The criterion for consensus about a characteristic was being mentioned by at least 25% of respondents from each discipline. The consensus was that children with hypotonia have decreased strength, decreased activity tolerance, delayed motor skills development, rounded shoulder posture, with leaning onto supports, hypermobile joints, increased flexibility, and poor attention and motivation. Conclusion: An objective tool for defining and quantifying hypotonia does not exist. A preliminary characterization of children with hypotonia was established, but further research is needed to achieve objectivity and clarity.

Essential competencies in entry-level pediatric physical therapy education

Background: The Section on Pediatrics (SoP) convened an Education Summit in July 2012 to examine, discuss, and respond to documented inconsistencies and challenges in teaching pediatric physical therapy (PT) content in entry-level professional education programs. Despite previous attempts by the SoP to provide guidance around teaching pediatric PT, variability continued to be extensive across programs. Key Points: This article presents the core competencies developed out of the Summit to inform pediatric content in the entry-level PT curriculum. In addition, the core competencies were linked to teaching strategies, learning activities, assessment outcomes, and curricular structures. Statement of Conclusions: Consensus was reached on 5 core competencies that represent a knowledge base essential to all graduates of PT programs. In contrast to prior SoP documents, these competencies were specifically designed to focus on knowledge and skills unique to pediatric practice but essential for all graduates of accredited entry-level PT education programs. Video Abstract: For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/PPT/A50.

The relationship between body mass index and gross motor development in children aged 3 to 5 years.

Purpose: To investigate the relationship between obesity and gross motor development in children who are developing typically and determine whether body mass index (BMI) predicts difficulty in gross motor skills. Methods: BMIs were calculated and gross motor skills examined in 50 children who were healthy aged 3 to 5 years using the Peabody Developmental Motor Scales, 2nd edition (PDMS-2). Pearson chi-square statistic and stepwise linear hierarchical regression were used for analysis. Results: A total of 24% of the children were overweight/obese, whereas 76% were found not to be overweight/obese. Fifty-eight percent of the overweight/obese group scored below average on the PDMS-2 compared to 15% of the nonoverweight group. Association between BMI and gross motor quotients was identified with significance of less than 0.002. Regression results were nonsignificant with all 50 subjects, yet showed significance (P = 0.018) when an outlier was excluded. Conclusions: Children aged 3 to 5 years with high BMIs may have difficulty with their gross motor skills. Further research is needed.

Clinical characteristics of hypotonia: a survey of pediatric physical and occupational therapists.

Purpose: This study extended previous work on defining characteristics of children with hypotonia. Methods: A survey regarding previously identified characteristics of hypotonia, examination tools, interventions, and prognosis was sent to a random sample of 500 physical therapists and 500 occupational therapists. Results: A total of 268 surveys were returned, for a response rate of 26.8%. Characteristics most frequently observed in children with hypotonia included decreased strength, hypermobile joints, and increased flexibility. Observation was the most commonly cited assessment tool and 85% of those surveyed believe that characteristics of hypotonia improve with therapy. Conclusions: Despite agreement among physical and occupational therapists on characteristics of hypotonia and potential for improvement, clear clinical guidelines for the diagnosis and quantification of hypotonia have yet to be determined. Research is needed to develop an operational definition of hypotonia, develop valid tests and assess effectiveness of intervention.

Development and reliability of an observational gait analysis tool for children with Down syndrome.

Purpose: To develop an observational gait analysis tool for children with Down syndrome and to examine its reliability. Methods: Two physical therapists and 5 physical therapy students participated in this study. Sixty videos were examined to determine interrater reliability. Four months later, 15 of those 60 videos were reexamined twice (2 weeks apart) by the students for intrarater reliability. Intraclass correlation coefficients for interrater and intrarater reliability, percentage of agreement, and standard error of measurement were calculated. Results: Interrater reliability was 0.663, intrarater reliability was 0.616–0.877, standard error of measurement was 1.89, and absolute agreement was found for 35.56% of the trials. Conclusion: Good reliability was found, but further study is needed to determine validity and clinical relevance.

Experiential Learning With Children: An Essential Component of Professional Physical Therapy Education.

Purpose: The Section on Pediatrics of the American Physical Therapy Association has developed a number of resources to support and improve the consistency of professional pediatric physical therapy education, including a set of core competencies that all graduates must attain. The purpose of this article is to advocate for the inclusion of experiential learning activities with children, including children with participation restrictions, as a necessary component to achieve the core competencies. Key Points: Experiential learning is a form of practice-based education that provides exposures and opportunities for students to explore the work, roles, and identities they will encounter as future professionals. Experiential learning is learning by doing, and occurs within a relevant setting. Six representative curricular exemplars are presented to provide readers with a variety of suggestions for development and integration of experiential learning. Summary: Recommendations for future research are provided and 4 key recommendations are provided.

Efficacy of orthoses for children with hypotonia: a systematic review.

Purpose: The purpose of this systematic review of the literature was to determine the efficacy of orthoses for children with hypotonia and provide a concise summary of the state of the evidence in this area. Methods: Fifteen search terms were used to find articles addressing children with hypotonia, orthotic use, and physical therapy. Results: Ten articles met the inclusion criteria, but no level I evidence was found. Data were reported for body structure and activity components, but not participation outcomes. Current evidence suggests that foot orthoses and supramalleolar orthoses may benefit children with hypotonia; however, the evidence is low level. Conclusion: The evidence for efficacy of orthoses for children with hypotonia continues to have gaps with the following questions still unanswered: When is the optimal time to introduce orthoses? Are foot orthoses or supramalleolar orthoses more efficacious? Should orthoses be combined with physical therapy?