Sarah Westcott McCoy

Grounding Early Intervention: Physical Therapy Cannot Just Be About Motor Skills Anymore

This perspective article provides support for 4 interrelated tenets: grounded perceptual-motor experience within cultural and social contexts forms cognition; exploration through early behaviors, such as object interaction, sitting, and locomotion, broadly facilitates development; infants and children with limited exploration are at risk for global developmental impairments; and early interventions targeting exploratory behaviors may be feasible and effective at advancing a range of abilities across developmental domains and time. These tenets emphasize that through the promotion of early perceptual-motor behaviors, broader, more global developmental advancements can be facilitated and future delays can be minimized across domains for infants and children with special needs. Researchers, educators, and clinicians should build on these tenets to further demonstrate the effectiveness of targeted early interventions. The goals of these interventions should be not only to advance targeted perceptual-motor skills in the moment but also to more broadly advance future abilities and meet the early intervention goal of maximizing childrens learning potential.

Anticipatory postural adjustments in children with cerebral palsy and children with typical development.

Purpose: We sought to examine whether children with cerebral palsy (CP) demonstrate anticipatory postural adjustments (APAs) similar to those observed in children with typical development (TD). Methods: A sample of convenience of 14 children, seven with CP and seven with TD, participated in this study. The center of pressure (COP) was calculated from ground reaction force data collected from the AMTI (OR-6) force platform as the child reached forward while standing. Results: Posterior COP shift frequently was observed in both groups of children before arm movement. However, the children with CP showed greater variability and significantly shorter amplitude of the APA COP excursion as compared with those with TD. Conclusions: The control of APAs is problematic for some children with CP and, therefore, intervention designed to facilitate APAs may be beneficial for those children.

Amount and Focus of Physical Therapy and Occupational Therapy for Young Children with Cerebral Palsy

ABSTRACT The aims of this study were to describe physical therapy (PT) and occupational therapy (OT) services for a cohort of 399 children with cerebral palsy (CP), 2–6 years old, residing in the United States and Canada. Parents completed a services questionnaire by telephone interview. Therapists classified childrens Gross Motor Function Classification System (GMFCS) level. Mean minutes per month of PT and OT were greater for children receiving services in both an educational and clinic setting. Mean minutes per month of PT and OT were greater for children in levels IV–V than children in level I and greater for children in the United States than children in Canada. Parents reported that interventions focused a moderate to great extent on primary impairments, secondary impairments, activity, and structured play activities, a moderate extent on environmental modifications and equipment; and a moderate to small extent on self-care routines. The results support the importance of coordination of PT and OT services.

A Multivariate Model of Determinants of Change in Gross-Motor Abilities and Engagement in Self-Care and Play of Young Children with Cerebral Palsy.

ABSTRACT A multivariate model of determinants of change in gross-motor ability and engagement in self-care and play provides physical and occupational therapists a framework for decisions on interventions and supports for young children with cerebral palsy and their families. Aspects of the child, family ecology, and rehabilitation and community services may influence childrens activity and participation. Aspects of the child include primary and secondary impairments, associated and comorbid health conditions, and adaptive behaviors. Literature support for the model is reviewed. A clinical scenario illustrates the use of the model as a framework for practice. The model encourages therapists to broaden the focus of rehabilitation services for young children with CP to include not only development of motor abilities but also comprehensive interventions and supports to enhance participation in daily activities and routines. Therapists are encouraged to consider how child, family, and service factors interact when planning interventions and evaluating outcomes.

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).

Statistical Analysis of Clinical Prediction Rules for Rehabilitation Interventions: Current State of the Literature

Deriving clinical prediction rules (CPRs) to identify specific characteristics of patients who would likely respond to certain interventions has become a research priority in physical rehabilitation. Understanding the appropriate statistical principles and methods of analyses underlying the derivation of CPRs is important for future rehabilitation research and clinical applications. In this article, we aimed to provide an overview of statistical techniques used for the derivation of CPRs to predict success following physical therapy interventions and to generate recommendations for improvements in CPR derivation research and statistical analysis in rehabilitation. We have summarized the current state of CPR intervention-related research by reviewing 26 studies. A common technique was found in most studies and included univariate association of factors with treatment success, stepwise logistic regression to determine the most parsimonious set of predictors for success, and calculation of accuracy statistics (focusing on positive likelihood ratios). We identified several shortcomings related to inadequate ratio of events by number of predictors, lack of standardization regarding acceptable interobserver reliability of predictors, questionable handling of predictors including reliance on univariate analysis and early categorization, and not accounting for dependence and collinearity of predictors in multivariable model construction. Interpretation of the derived CPRs was found to be difficult due to lack of precision of estimates and paradoxical findings when a subset of the predictors yielded a larger positive likelihood ratio than did the full set of predictors. Finally, we make recommendations regarding how to strengthen the use of statistical principles and methods to create consistency across rehabilitation research for CPR derivations.

Investigation of the Dynamic Gait Index in Children: A Pilot Study

Purpose: We investigated the feasibility and construct validity of the Dynamic Gait Index (DGI) in children and explored interrater and test-retest reliability. Methods: DGI performance of 10 children with fetal alcohol spectrum disorder (FASD), aged 8 to 15 years, was compared with that of 10 age- and sex-matched children with typical development (TD). Interrater reliability was evaluated for 16 children (10 TD, 6 FASD); 11 children returned for a retest (5 TD, 6 FASD). Results: The DGI is simple for raters to learn and easy to administer in children. A Mann-Whitney U test identified a significant difference on the DGI total score between children with FASD and TD (P = .01). Interrater and test-retest reliability were promising but need to be further explored. Conclusions: The DGI was feasible and valid in a population of children aged 8 to 15 years with FASD and TD. Some modifications are suggested for administration of the DGI in children.

Reliability and Validity of the Standing Heel-Rise Test

ABSTRACT A standardized protocol for a pediatric heel-rise test was developed and reliability and validity are reported. Fifty-seven children developing typically (CDT) and 34 children with plantar flexion weakness performed three tests: unilateral heel rise, vertical jump, and force measurement using handheld dynamometry. Intraclass correlation coefficients (ICC) varied from 0.85–0.99 for reliability analyses in both participant groups. Construct validity analysis revealed a significant difference between groups (F = 44.57, p < .05) and age-related differences among CDT; 5- to 8-year olds (mean = 15.2, SD = 5.4) performed fewer repetitions compared to 9- to 12-year olds (mean = 27.7, SD = 11.7) (p < .05). Age explained 41% of the variance in the number of heel-rise repetitions. Correlations between the three tests (r = 0.56 to 0.66) provide evidence of convergent validity. The results indicate that the standardized protocol is both reliable and valid for use in 5- to 12-year-old children with and without plantar flexion weakness.

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.