Susan K. Effgen

Updated competencies for physical therapists working in early intervention.

Purpose: The purpose of this project was to revisit the 1990 American Physical Therapy Association Section on Pediatrics policy statement and competencies for physical therapists in early intervention and update their content to reflect present practice, legislation, and terminology. Methods: A review of the literature and competencies for early intervention professionals was completed. Surveys of six focus groups of parents of children with disabilities were conducted to ascertain their perspectives of the knowledge and skills important for therapists. This information was integrated into a listing of competencies expected of physical therapists working in early intervention. The competencies were reviewed regionally and nationally by experts in the field and therapists practicing in early intervention. Results: Nine content areas with specific competencies were identified in which early intervention physical therapists should have expertise. The primary change in the content between the 1990 and 2005 competencies is the addition of service provision in natural environments. Conclusion: Physical therapists who work in early intervention require specific skills and knowledge to effectively serve infants, toddlers, and their families. Competencies are useful to guide professional development.

Use of groups in pediatric physical therapy: survey of current practices.

Purpose: This nationwide survey study aimed to examine the use of groups in pediatric physical therapy, including characteristics, effectiveness, and financial considerations of group intervention. Methods: Questionnaires were mailed to 500 randomly selected members of the American Physical Therapy Association Section on Pediatrics. Respondents reported on the characteristics of children typically included in group intervention, types of activities used, effectiveness at meeting goals, billing methods, and documentation practices. Results and conclusions: The response rate was 285 (57%). Only 41.4% of respondents reported using groups. Characteristics of group intervention were variable among respondents, and considerable differences in billing practices and perceived effectiveness were noted. Commonly reported characteristics included use of small groups of young children with developmental delay and use of task specific developmental activities. Perceived benefits and limitations of group intervention were also reported. Implications for further research into the use of groups were explored.

Effect of sensorimotor groups on gross motor acquisition for young children with Down syndrome.

Purpose: To examine whether participation in sensorimotor groups and individual intervention resulted in greater improvements in motor skill acquisition than solely individual intervention for young children with Down syndrome. Methods: Ten children with Down syndrome, 13 to 29 months of age, participated. Children in both groups received individual intervention, and children in the intervention group participated in 10 weekly sensorimotor groups. All children were assessed at 3 points using the Gross Motor Function Measure and Goal Attainment Scaling. Results: Children in the intervention group demonstrated significant improvement compared with children in the control group at the p < 0.10 level in lying and rolling, crawling and kneeling, and total score domains of the Gross Motor Function Measure and in Goal Attainment Scaling. Conclusions: Participation in sensorimotor groups and individual intervention resulted in greater improvement in motor skill acquisition than solely individual intervention for young children with Down syndrome. Additional research to support these exploratory findings is needed.

Physical therapists' participation in early childhood transitions.

Purpose: This study was designed to explore the role of physical therapists in the transition of young children with special needs from early intervention to preschool and from preschool to kindergarten. Methods: Questionnaires were mailed to 500 pediatric physical therapists throughout the United States. Respondents reported how they participated in transition planning, if they perceived they were participating fully in the transition process, what barriers limited their participation, where they obtained information about transitions, and special training they had received on transition planning. Results: The response rate was 41.6%. Differences in type and level of participation were noted across settings. Therapists commented on specific barriers to participation and identified working with the family and performing evaluations as the top strategies for participation. Only 16.6% of respondents reported receiving training on transition. Conclusions: The survey provided preliminary data regarding physical therapists involvement in early childhood transitions and suggests that further research is needed.

Physical Therapist Education for Service in Early Intervention

Initial professional preparation as a physical therapist includes little about the nature and needs of infants and young children in early intervention. Therefore, physical therapists must seek training through on-the-job training, continuing education, self-study, graduate degrees, certificates, an

Parent-Professional Partnership in Evaluation and Development of Individualized Family Service Plans

PL 99–457 and its reauthorization PL 102–119, the Individuals with Disabilities Education Amendments of 1991 have been instrumental in shifting the emphasis of early intervention programs from a child-centered to a family-centered approach. The child is to receive a multidisciplinary evaluation using observational and standardized instruments to determine eligibility for early intervention services. The physical therapist has the expertise necessary to evaluate physical development, including gross and fine motor and several areas of adaptive development in order to formulate functional outcomes. Parents are included in the evaluation process as interactive and collaborative members on the multidisciplinary team. Strengths and priorities of the family as related to enhancing development of the child are assessed. Major areas of strengths and needs of the family are identified which are translated into outcomes in the individualized family service plan. Family-centered intervention assists families in choosing their desired level of involvement in the intervention of their child. The individualized family service plan is based on the comprehensive evaluation of the child and family and outlines the services to be provided.

Occurrence of gross motor behaviors and attainment of motor objectives in children with cerebral palsy participating in conductive education

ABSTRACT This exploratory study investigated the frequency of occurrence of gross motor behaviors by nine children with cerebral palsy (CP) participating in an 11 -month conductive education (CE) program and the attainment of their gross motor objectives. The intervention team determined gross motor objectives for each child. Activities to achieve those objectives were fully integrated into the childs daily routines. Interval by interval recording was used to observe eight stability, seven mobility, and six transfer behaviors during four school days for each child. The interrater reliability using a kappa statistic was 0.73–0.93 for the observed behaviors. An independent evaluator determined that the children achieved 83% of their gross motor objectives for the first term and 89% for the second term of the year. Of the objectives initially not achieved, three related to stair climbing, an activity not observed being practiced. Stability behaviors, mainly sitting, occurred at substantially higher rates than all mobility and transfer behaviors. All stability and transfer objectives that were practiced were achieved. The children spent the majority of their day in sitting. While the children achieved the majority of their motor objectives, the limited active mobility seen in this and other preschools warrants further investigation.

Outcomes for Students Receiving School-Based Physical Therapy as Measured by the School Function Assessment.

Purpose: To describe School Function Assessment (SFA) outcomes after 6 months of school-based physical therapy and the effects of age and gross motor function on outcomes. Methods: Within 28 states, 109 physical therapists and 296 of their students with disabilities, ages 5 to 12 years, participated. After training, therapists completed 10 SFA scales on students near the beginning and end of the school year. Results: Criterion scores for many students remained stable (46%-59%) or improved (37%-51%) with the most students improving in Participation and Maintaining/Changing Positions. Students aged 5 to 7 years showed greater change than 8- to 12-year-olds on 5 scales. Students with higher gross motor function (Gross Motor Function Classification System levels I vs IV/V and II/III vs IV/V) showed greater change on 9 scales. Conclusions: Positive SFA change was recorded in students receiving school-based physical therapy; however, the SFA is less sensitive for older students and those with lower functional movement.

Occurrence of gross motor behaviors in integrated and segregated preschool classrooms.

The purpose of this pilot study was to determine incidences per hour of stability, mobility, and transfer behaviors of children with physical disabilities in segregated and integrated preschool classrooms. Ten children performing these behaviors in physical therapy participated in this study. Each childs gross motor and school activities were observed for an entire school day and recorded in 30-second intervals. The incidences per hour of gross motor behaviors did not differ significantly between the two types of preschools; however, incidences per hour differed significantly among the types of motor behaviors and the types of school activities. Stability behaviors consistently occurred at substantially higher rates than mobility and transfer behaviors. Nearly one third of the transfers and mobility behaviors did not involve the childs active participation. Mobility behaviors occurred at highest rates during transition and gross motor activity times. The childrens limited active movement is a serious concern. For motor skill learning to occur, children must participate actively. Stability activities occur more often during the preschool routine, whereas mobility and transfers occur significantly less often and likely will require additional practice.

The Americans with Disabilities Act of 1990: Implications for Pediatric Physical Therapists

The Americans with Disabilities Act of 1990 (ADA) is an important piece of civil rights legislation that can assist pediatric physical therapists in maximizing the opportunities afforded the children and adolescents they serve. The four sections of the ADA with particular relevance to children and adolescents with disabilities are: employment, public and private accommodations, transportation, and telecommunications. An overview of the regulations governing each of these areas and examples relevant to children and adolescents will be given. An understanding of the provisions of the ADA will assist a therapist in designing a treatment plan that will help prepare children and adolescents with disabilities for their transition into leading productive, fulfilling lives as adults. This plan should include functionally based approaches to treatment, child and family education, and advocacy training. Knowledge of the provisions of the ADA and the implications for children with disabilities will assist therapists in their efforts to optimize their clients independence.