Thubi H. A. Kolobe

Promotion of Physical Fitness and Prevention of Secondary Conditions for Children With Cerebral Palsy: Section on Pediatrics Research Summit Proceedings

Inadequate physical fitness is a major problem affecting the function and health of children with cerebral palsy (CP). Lack of optimal physical activity may contribute to the development of secondary conditions associated with CP such as chronic pain, fatigue, and osteoporosis. The purpose of this article is to highlight the content and recommendations of a Pediatrics Research Summit developed to foster collaborative research in this area. Two components of physical fitness—muscle strength and cardiorespiratory fitness—were emphasized. Although there is evidence to support the use of physical fitness interventions, there are many gaps in our current knowledge. Additional research of higher quality and rigor is needed in order to make definitive recommendations regarding the mode, intensity, frequency, and duration of exercise. Outcome measurements have focused on the body functions and structures level of the International Classification of Functioning, Disability and Health (ICF), and much less is known about effects at the activities and participation levels. Additionally, the influence of nutritional and growth factors on physical fitness has not been studied in this population, in which poor growth and skeletal fragility have been identified as serious health issues. Current intervention protocols and outcome measurements were critically evaluated, and recommendations were made for future research.

Validity of the Test of Infant Motor Performance for prediction of 6‐, 9‐ and 12‐month scores on the Alberta Infant Motor Scale

The Test of Infant Motor Performance (TIMP) is a test of functional movement in infants from 32 weeks’post‐conceptional age to 4 months postterm. The purpose of this study was to assess in 96 infants (44 females, 52 males) with varying risk, the relation between measures on the TIMP at 7, 30,60, and 90 days after term age and percentile ranks (PR) on the Alberta Infant Motor Scale (AIMS). Correlation between scores on the TIMP and the AIMS was highest for TIMP tests at 90 days and AIMS testing at 6 months (r=0.67,p=0.0001), but all comparisons were statistically significant except those between the TIMP at 7 days and AIMS PR at 9 months. In a multiple regression analysis combining a perinatal risk score and 7‐day TIMP measures to predict 12‐month AIMS PR, risk, but not TIMP, predicted outcome (21% of variance explained). At older ages TIMP measures made increasing contributions to prediction of 12‐month AIMS PR (30% of variance explained by 90‐day TIMP). The best TIMP score to maximize specificity and correctly identify 84% of the infants above versus below the 10th PR at 6 months was a cut‐off point of 1 SD below the mean. The same cut‐off point correctly identified 88% of the infants at 12 months. A cut‐off of‐0.5 SD, however, maximized sensitivity at 92%. A negative test result, i.e. score above ‐0.5 SD at 3 months, carried only a 2% probability of a poor 12‐month outcome. We conclude that TIMP scores significantly predict AIMS PR 6 to 12 months later, but the TIMP at 3 months of age has the greatest degree of validity for predicting motor performance on the AIMS at 12 months and can be used clinically to identify infants likely to benefit from intervention.

Concurrent Validity of the Test of Infant Motor Performance with the Alberta Infant Motor Scale

The purposes of this study were 1) to assess the relationship (concurrent validity) of scores at three months of age on a new scale, the Test of Infant Motor Performance (TIMP), with those on the Alberta Infant Motor Scale (AIMS) at the same age and 2) to determine the sensitivity and specificity of TIMP scores for classifying infants as above or below the 10th percentile on the AIMS (ie, agreement between the tests on low-scoring vs high-scoring infants). Ninety pairs of tests were performed on infants (n = 90) from nine to 18 weeks of age; 90% of the tests were completed within three days of each other. Eleven raters tested infants; 53% of the two tests on a given infant were conducted by different raters. The Pearson product moment correlation coefficient was used to assess the relationship between TIMP and AIMS raw scores or percentile ranks. The correlation between raw scores on the TIMP and the AIMS was 0.64 (p < 0.0001) and that between the TIMP raw scores and the AIMS percentile ranks was 0.60 (p < 0.0001). An analysis of the sensitivity and specificity of various TIMP cutoff scores for comparison with AIMS scores above and below the 10th percentile revealed that the best TIMP score that identified 80% of the infants correctly was a cutoff of −0.50 standard deviation below the mean. Chance-corrected agreement (kappa coefficient) between the two tests was 0.41. We conclude that TIMP items have much in common with those of the AIMS at three months of age and that both tests identify a similar group of infants as having low motor performance. Combined with the fact that the TIMP is sensitive to change with age and is relevant to daily life interactions, these results provide support for the validity of the TIMP as a tool for assessing motor performance in infants.

A Path Model for Evaluating Dosing Parameters for Children With Cerebral Palsy

Dosing of pediatric rehabilitation services for children with cerebral palsy (CP) has been identified as a national priority. Establishing dosing parameters for pediatric physical therapy interventions is critical for informing clinical decision making, health policy, and guidelines for reimbursement. The purpose of this perspective article is to describe a path model for evaluating dosing parameters of interventions for children with CP. The model is intended for dose-related and effectiveness studies of pediatric physical therapy interventions. The premise of the model is: Intervention type (focus on body structures, activity, or the environment) acts on a child first through the family, then through the dose (frequency, intensity, time), to yield structural and behavioral changes. As a result, these changes are linked to improvements in functional independence. Community factors affect dose as well as functional independence (performance and capacity), influencing the relationships between type of intervention and intervention responses. The constructs of family characteristics; child characteristics (eg, age, level of severity, comorbidities, readiness to change, preferences); plastic changes in bone, muscle, and brain; motor skill acquisition; and community access warrant consideration from researchers who are designing intervention studies. Multiple knowledge gaps are identified, and a framework is provided for conceptualizing dosing parameters for children with CP.

Research Summit III Proceedings on Dosing in Children With an Injured Brain or Cerebral Palsy: Executive Summary

Children with brain injuries or cerebral palsy (CP) comprise a large percentage of pediatric clients served by physical therapists. There is no consensus on what the basic parameters should be for different treatment protocols. A very important parameter of intervention that is pivotal for treatment efficacy is dosing. Dosing decisions are complex. To date, the minimum doses for changing structure and function, activity, and participation in children with various disabilities are unknown. This article describes the process and outcomes of a research summit with the goals of: (1) fostering a critical debate that would result in recommendations for the development of large-scale, second-generation research proposals to address thresholds for effective dosing of interventions for children with brain injuries or CP and (2) enhancing the research capacity of pediatric physical therapists through collaborative research networks. The summit brought together an interdisciplinary cadre of researchers (physical therapists, basic and clinical scientists), representatives from funding agencies, and consumers to an intensive 2.5-day think tank. The summit targeted questions of treatment dosage related to 3 areas: practice and neuroplasticity, structure-behavior connections, and clinical trial design. The consensus was that the intervention must demonstrate some evidence of effectiveness before optimal dosing can be investigated. Constraint-induced movement therapy (CIMT) is used as an example of an intervention that has demonstrated effectiveness and that requires dosing-related research. Summit results, including factors that merit special consideration and recommendations for future dose-related studies, are highlighted. Physical therapy is an important service for children with physical disabilities, particularly those with an injured brain resulting in neuromotor impairments and functional limitations.1 These children typically have multiple health complications that often result in complex functional limitations and require extensive health care, education, and vocational training. The costs of interventions result in substantial financial and social challenges for families and society.2 …

Working with Families of Children with Disabilities

Public law 99–457 requires professionals providing early intervention services to expand their practice to support families caring for children with disabilities. Family-centered early intervention has created the need for physical therapists to review their roles and intervention strategies in working with children with disabilities and their families. Effective family-centered early intervention, in part, depends on the therapists understanding of issues surrounding families caring for children with disabilities and the therapists ability to effectively collaborate with families in developing therapy options which are meaningful to families. This article provides an overview of factors which may impact on the familys capability to meet the needs of the child with disabilities. Ways in which physical therapists can expand their roles to enhance the familys capacity to care for the child are also outlined.

Families' Experiences and Occupations Following the Diagnosis of Autism

The unrelenting and persistent behaviors often demonstrated by children with autism, together with the uncertainty surrounding diagnosis and intervention options, pose a significant threat to the occupations of the family system. The purpose of this study was to explicate the experiences of living everyday life following the diagnosis of autism. Seven families were interviewed and using grounded theory methodology the research team investigated family experiences following a diagnosis of autism. Results informed the development of the preliminary Family Experience and Occupation Following the Diagnosis of Autism Model that explicitly framed family experience, the element of family occupation, and factors that mediate both experiences and occupation. By looking at family occupations from the time of diagnosis of a child, this work transcends the individual. It captures the co-constructed interplay of doing as families organize and seek ways to maintain everyday family functions.

A structural equation model of environmental correlates of adolescent obesity for age and gender groups

The relationships between environmental correlates of adolescent obesity are complex and not yet well defined by current research, especially when considering age and gender.

Relationships Among Family Participation, Team Support, and Intensity of Early Intervention Services

ABSTRACT Aims: In America, children with disabilities and their families may receive early intervention (EI) services under the Individuals with Disabilities Education Improvement Act (IDEA). The IDEA mandates that decisions on service delivery are based on the needs of the child and family. It is unclear how decisions on intensity of services are made in EI. The purpose of this study was to determine whether parent participation and team support are determinants of the recommendation for intensity of service at the initial Individualized Family Service Planning (IFSP) meeting. Methods: The participants were 63 parents of children 2–33 months of age and 74 professionals. The first author observed all IFSP meetings and completed the Parent Participation Measure. Following the meeting, parents completed a demographic form, the Ages and Stages Questionnaire, and the Family Needs Survey. The recommended intensity of service was recorded. Results and Conclusions: Parent participation and team support were not significant determinants of intensity of EI service after controlling for child development and family needs (R2 = 0.145, p = .14). The recommended intensity of service was 240 min per month for 57% of the families suggesting that factors other than parent participation and team support influenced the decision on intensity of service.

Characterization of infant mu rhythm immediately before crawling: A high-resolution EEG study

Abstract Crawling is an important milestone in infant motor development. However, infants with developmental motor disorders can exhibit delays, or even miss, in the acquisition of crawling skill. And little information is available from the neurodevelopmental domain about the changes in brain function with intervention. The mu rhythm can potentially play a substantial role in understanding human motor development at early ages in infants, as it has in adults. Studies about the mu rhythm in infants were in coarse temporal resolution with longitudinal samples taken months or years apart. Details about the infant mu rhythm at a fine age resolution has not been fully revealed, which leads to contradictory evidence about its formulation and developmental changes of its spectral origins and, therefore, impedes the full understanding of motor brain development before crawling skill acquisition. The present study aims to expand knowledge about the infant mu rhythm and its spatio‐spectral pattern shifts along maturation immediately before crawling. With high‐density EEG data recorded on a weekly basis and simultaneous characterization of spatio‐spectral patterns of the mu rhythm, subtle developmental changes in its spectral peak, frequency range, and scalp topography are revealed. This mu rhythm further indicates a significant correlation to the crawling onset while powers from other frequency bands do not show such correlations. These details of developmental changes about the mu rhythm provide an insight of rapid changes in the human motor cortex in the first year of life. Our results are consistent with previous findings about the peak frequency shifting of the mu rhythm and further depict detailed developmental curves of its frequency ranges and spatial topographies. The infant mu rhythm could potentially be used to assess motor brain deficiencies at early ages and to evaluate intervention effectiveness in children with neuromotor disorders. HighlightsData driven methods reveal developmental changes of mu rhythm in 5–7 month infants.Infant mu rhythm is suggested to formulate around 6 months at about 6 Hz.Its developmental features are also observed in its frequency peak and band shifts.It shows maturation at multiple central areas, resembling somatotopic organization.Power of infant mu rhythm indicates a significant correlation to the crawling onset.