Lisa Rivard

Reference Curves for the Gross Motor Function Measure: Percentiles for Clinical Description and Tracking Over Time Among Children With Cerebral Palsy

Background and Purpose: Physical therapists frequently use the 66-item Gross Motor Function Measure (GMFM-66) with the Gross Motor Function Classification System (GMFCS) to examine gross motor function in children with cerebral palsy (CP). Until now, reference percentiles for this measure were not available. The aim of this study was to improve the clinical utility of this gross motor measure by developing cross-sectional reference percentiles for the GMFM-66 within levels of the GMFCS. Subjects and Methods: A total of 1,940 motor measurements from 650 children with CP were used to develop percentiles. These observations were taken from a subsample, stratified by age and GMFCS, of those in a longitudinal cohort study reported in 2002. A standard LMS (skewness-median-coefficient of variation) method was used to develop cross-sectional reference percentiles. Results: Reference curves were created for the GMFM-66 by age and GMFCS level, plotted at the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentiles. The variability of change in childrens percentiles over a 1-year interval also was investigated. Discussion and Conclusion. The reference percentiles extend the clinical utility of the GMFM-66 and GMFCS by providing for appropriate normative interpretation of GMFM-66 scores within GMFCS levels. When interpreting change in percentiles over time, therapists must carefully consider the large variability in change that is typical among children with CP. The use of percentiles should be supplemented by interpretation of the raw scores to understand change in function as well as relative standing.

Early identification and risk management of children with developmental coordination disorder.

Purpose The purpose of this study was to determine the motor control issues, motor learning differences, and secondary impairments of children with developmental coordination disorder (DCD) and to explore physical therapists’ contribution to their early management. Summary of Key Points DCD is a condition involving limitations in gross motor, postural, and/or fine motor performance that is not attributable to other neurological disorders. Manifestation is varied across children and depends, in part, on their level of anticipatory motor control, response to specific task demands, and ability to attend to feedback to obtain flexible, adaptive movement solutions. Children with DCD rely primarily on vision for feedback, frequently use “fixing” strategies, and exhibit limited motor repertoires. As a result of their movement problems, they tend to avoid physical activity and are prone to secondary impairments, including decreased strength and power. Clinical Implications and Recommendations Physical therapists can 1) use their keen observational skills to identify children with DCD earlier in life and 2) use their knowledge of the secondary impairments and movement difficulties to work with families to engage children in continuous movement activities to maintain strength and power and thus obtain the physical, social, and psychosocial benefits of physical activity.

Exploring Assessment Tools and the Target of Intervention for Children with Developmental Coordination Disorder

Purpose: We reviewed current practice for children with Developmental Coordination Disorder (DCD) using research evidence and the International Classification of Functioning, Disability and Health (ICF). Characteristics of children with DCD can be described at the levels of body function (impairments), whole body movements (activities) and involvement in life situations (participation). Summary of Key Points: Descriptive instruments measuring the extent of motor impairments or activity limitations can be used to: (1) identify children who might benefit from intervention; and (2) determine the optimal type of intervention and model of service delivery. Evaluative tools that measure activities or participation, but not primary impairments, should be used to determine change over time. Commonly used measures for describing children with DCD and evaluating outcomes are reviewed and discussed in the context of the ICF framework. Intervention approaches are then outlined for children with DCD that are targeted to the levels of ativity, participation, and prevention of secondary impairments. Conclusions: Outcomes of children with DCD will be optimized with the use of current research evidence and the appropriate ICF level guiding both assessment and intervention.

Best Practice Recommendations for the Development, Implementation, and Evaluation of Online Knowledge Translation Resources in Rehabilitation

The knowledge-to-practice gap in rehabilitation has spurred knowledge translation (KT) initiatives aimed at promoting clinician behavior change and improving patient care. Online KT resources for physical therapists and other rehabilitation clinicians are appealing because of their potential to reach large numbers of individuals through self-paced, self-directed learning. This article proposes best practice recommendations for developing online KT resources that are designed to translate evidence into practice. Four recommendations are proposed with specific steps in the development, implementation, and evaluation process: (1) develop evidence-based, user-centered content; (2) tailor content to online format; (3) evaluate impact; and (4) share results and disseminate knowledge. Based on KT evidence and instructional design principles, concrete examples are provided along with insights gained from experiences in creating and evaluating online KT resources for physical therapists. In proposing these recommendations, the next steps for research are suggested, and others are invited to contribute to the discussion.

Knowledge to Practice in Developmental Coordination Disorder: Utility of an Evidence-Based Online Module for Physical Therapists

ABSTRACT Aims: Developmental coordination disorder (DCD) is a chronic condition with potential negative health consequences. Therapists working with children with DCD need access to tailored, synthesized, evidence-based information; however a knowledge-to-practice gap exists. The aim of this study was to develop and evaluate the utility of an evidence-based online DCD module tailored to physical therapists’ (PTs) needs. Methods: Guided by the Knowledge to Action framework, we interviewed PTs working with children with DCD (n = 9) to identify their information needs. Their recommendations, along with synthesized DCD research evidence, informed module development. These PTs as well as others (n = 50) evaluated the modules usefulness. Results: The module incorporated important content areas including: (1) identification; (2) planning interventions and goals; (3) evidence-based practice; (4) management; and (5) resources. Case scenarios, clinical applications, interactive media, links to resources, and interactive learning opportunities were also embedded. PTs perceived the module to be comprehensive and useful and provided feedback to improve module navigation. Conclusions: Involving end-users throughout the development and evaluation of an online PT DCD module contributed to its relevance, applicability, and utility. It will be important to evaluate whether use of this module improves the quality of services provided by PTs.

Knowledge to Practice in Developmental Coordination Disorder: Impact of an Evidence-Based Online Module on Physical Therapists’ Self-Reported Knowledge, Skills, and Practice

ABSTRACT Aims: To evaluate the impact of an evidence-based online module on Developmental Coordination Disorder (DCD) on self-reported physical therapist (PT) knowledge, skills, and practice. Methods: Fifty PTs completed a questionnaire before and after the completion of the online module, with 41 PTs completing the same questionnaire 2 months later. The questionnaires included items rated using a 7-point Likert Scale and short open-ended questions. Results: There was a significant effect of Time for 17 out of 18 items on self-reported knowledge, and all 19 items for self-reported skills. Post-hoc analyses indicated that mean scores at Time 2 and Time 3 were higher than the mean scores at Time 1. Forty-six (92%) participants reported an increase in their confidence to provide evidence-based services. Forty-three (86%) participants indicated their intentions to modify their evaluative practices (e.g., involving children in goal setting) and their management of DCD (e.g., using the best practice principles, providing resources to families). At the 2-month follow-up, 19 (46%) participants had returned to the module to review information (e.g., video, resources) or to download handouts. Conclusions: The online DCD module appears to be an effective knowledge translation strategy to increase PTs’ self-reported knowledge and skills, and to support evidence-informed practice.

Developmental Coordination Disorder

“There is something wrong with my child”. What physician hasn’t heard these words at some point from a parent whose preschool or school-aged child seems to be developing well, may have achieved major motor and cognitive milestones on time … but where something is just not right? The concerns begin when parents notice their toddler sitting back and watching, while other children climb on play equipment or manipulate toys. Instead of supervising from a nearby bench, parents find themselves standing at the bottom of the ladder of the slide, ready to catch their child when he falls off. These same parents are still helping to put coats and boots on when the child is six, tying shoelaces at eight, cutting meat at ten and still encouraging pants with an elastic waist at age twelve instead of jeans. It is puzzling. These children are often of average or above-average intellectual ability, are well supported and stimulated in their home environment, walked on schedule, give good eye contact, interact well and look quite normal physically. Parents usually raise concerns with their primary health-care provider before their child enters school, but the issues are often vague (Missiuna, Moll, Law, King, & King, 2006). “He’s tired a lot”, “She gets frustrated easily”, “He doesn’t want to go out and play”, “Should she still be having toileting accidents in Grade 2?”, “She whines, and wants me to do everything for her”, “He falls all the time, and has lots of cuts and bruises”. These children usually achieve basic motor milestones like sitting or standing on time but are slow to learn new motor skills such as holding and using a spoon, fork, crayon, pencil, pair of scissors; doing up buttons, zippers, shoelaces; learning to go downstairs with alternating feet, to ride a bicycle, to turn a doorknob ... everyday motor skills that require coordination (Missiuna, Moll, King, King, & Law, 2006). Children with these motor challenges have developmental coordination disorder (DCD).