Toby Long

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.

The efficacy of GMFM-88 and GMFM-66 to detect changes in gross motor function in children with cerebral palsy (CP): a literature review

Abstract Aim: The purpose of this study was to review published research on the use of the Gross Motor Function Measure (GMFM-88) and (GMFM-66) as outcome measures to determine if these tools detect changes in gross motor function in children with cerebral palsy (CP) undergoing interventions. Methods: A comprehensive literature search was conducted using Medline and PubMed to identify studies published from January 2000 through January 2011 that reported the accuracy of GMFM-88 and GMFM-66 to measure changes over time in children with CP undergoing interventions. The keywords used for the search were “GMFM” and “CP”. Two of the authors (M.A. and S.B.) reviewed the titles and abstracts found in the databases. The methodological quality of the studies was assessed by using the Critical Review Form-Quantitative Studies. Results: Of 62 papers initially identified, 21 studies fulfilled the inclusion criteria. These articles consist of three longitudinal studies, six randomized controlled trials, four repeated measure design, six pre–post test design, a case series and one non-randomized prospective study. The included studies were generally of moderate to high methodological quality. The studies included children from a wide age range of 10u2009months to 16u2009years. According to the National Health and Medical Research Council, the study designs were level II, III-2, III-3 and IV. Conclusion: The review suggests that the GMFM-88 and GMFM-66 are useful as outcome measures to detect changes in gross motor function in children with CP undergoing interventions. Implications for Rehabilitation Accurate measurement of change in gross motor skill acquisition is important to determine effectiveness of intervention programs in children with cerebral palsy (CP). The Gross Motor Function Measure (GMFM-88 and GMFM-66) are common tools used by rehabilitation specialists to measure gross motor function in children with CP. The GMFM appears to be an effective outcome tool for measuring change in gross motor function according to a small number of randomized control studies utilizing participant populations of convenience.

Integrating Assistive Technology into an Outcome-Driven Model of Service Delivery.

Infants and toddlers with disabilities and special health care needs (SHCN) have complex habilitative and health care needs requiring multiple services throughout their lives. Providers of services to children underutilize assistive technology (AT) and AT services. This underutilization has a significant impact on how well and how easily the children are integrated in home, school, and community activities. The literature indicates that AT is appropriate when the device (a) is related to specific and clearly defined goals that are meaningful to the child and family; (b) takes into consideration practical constraints, such as the environment and funding resources; and (c) results in the child achieving desired outcomes. Using an outcome-driven model this article outlines a 10-step framework that can be used by service providers to guide them in determining the fit between the childs needs and AT and/or AT services. Components of the framework and critical information needed for decision-making at each step will be discussed. A family-centered, interdisciplinary team philosophy is promoted.

Pediatric Physical Therapists' Perceptions of Their Training in Assistive Technology

Background and Purpose: Availability of assistive technology (AT) and federal legislation promoting greater use of AT for children with disabilities have increased substantially. The purpose of this study was to determine the perceived adequacy of previous training in AT, specific training needs, preferred methods of training, and the confidence level of pediatric physical therapists in providing AT. Subjects and Methods: Three hundred eighty pediatric physical therapists responded to a survey questionnaire mailed to a random sample of members of the Section on Pediatrics of the American Physical Therapy Association. The survey was used to determine training needs of therapists in the area of AT, their confidence in delivering AT services, preferred methods of training, and challenges in becoming trained. Results: The therapists reported having less-than-adequate training in AT and a lack of confidence in delivering AT services. They also reported that they would like accessible and affordable training that focuses on funding technology and services, knowledge of specific devices, and assessment and evaluation methods. Discussion and Conclusion: The findings underscore the need to develop pre-service, in-service, and continuing education training opportunities in AT for providers working with children who have disabilities.

Blended Learning: Strengths, Challenges, and Lessons Learned in an Interprofessional Training Program

This field report outlines the goals of providing a blended learning model for an interdisciplinary training program for healthcare professionals who care for children with disabilities. The curriculum blended traditional face-to-face or on-site learning with integrated online interactive instruction. Credit earning and audited graduate level online coursework, community engagement experiences, and on-site training with maternal and child health community engagement opportunities were blended into a cohesive program. The training approach emphasized adult learning principles in different environmental contexts integrating multiple components of the Leadership Education in Neurodevelopmental and Related Disabilities Program. This paper describes the key principles adopted for this blended approach and the accomplishments, challenges, and lessons learned. The discussion offers examples from training content, material gathered through yearly program evaluation, as well as university course evaluations. The lessons learned consider the process and the implications for the role of blended learning in this type of training program with suggestions for future development and adoption by other programs.

Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities

Life course theory sets the framework for strong inclusion of family centered care (FCC) in quality medical homes of children with neurodevelopmental disabilities (CNDD). The purpose of this study was to explore the perceptions of families with their experiences of FCC in medical homes for CNDD. Using a structured questionnaire, the Family-Centered Care Self-Assessment Tool developed by Family Voices, this study surveyed 122 parents of CNDD in a large urban area during 2010–2012. Data collected information on FCC in the provision of primary health care services for CNDD and focused on family-provider partnerships, care setting practices and policies, and community services. Frequency analysis classified participants’ responses as strengths in the “most of the time” range, and weaknesses in the “never” range. Only 31xa0% of parents were satisfied with the primary health care their CNDD received. Based on an accepted definition of medical home services, 16xa0% of parents reported their CNDD had most aspects of a medical home, 64xa0% had some, and 20xa0% had none. Strengths in FCC were primarily evident in the family-provider partnership and care settings when focused on meeting the medical care needs of the child. Weaknesses in FCC were noted in meeting the needs of families, coordination, follow-up, and support with community resources. Improvements in key pediatric health care strategies for CNDD are recommended. CNDD and their families have multifaceted needs that require strong partnerships among parents, providers, and communities. Quality medical homes must include FCC and valued partnerships with diverse families and community-based providers.

Maternal Depression and Cognitive Features of 9-Year-Old Children Prenatally-Exposed to Cocaine

This study evaluated cocaine exposure and maternal characteristics as competing predictors of school-age cognitive, achievement, and language performance. One group of 47 exposed 9-year-old children were first studied in an earlier prenatal study. A non-exposed contrast group (n = 46) served as a reference. Maternal measures included: IQ, psychopathology, drugs, demographics, and environment. Child intelligence, language, and achievement scores were inversely related to maternal IQ and depression scores, with cocaine exposure significant secondary or tertiary predictors for many children. Verbal IQ scores of exposed children strongly reflected maternal depression (r = .54) but no such relationship was found among the non-exposed cohort (r = .00).

Early Intervention for Children with Autism Spectrum Disorders in China: A Family Perspective.

Autism spectrum disorders (ASD) were first reported in China in 1982. Since then, autism and other related disorders have been recognized by both the public and professionals. The importance of early intervention for children with ASD is becoming more accepted throughout China. A survey was designed to investigate the status of early intervention for children with ASD in China from a family system perspective. One hundred fifty-six parents of children with ASD from Shanghai, Beijing, and Shandong completed the survey. Results found that 93.2% (n = 141) of the children were identified with symptoms of ASD before age 3. There was a sizable delay between the time when symptoms were first identified and the families sought a diagnosis and the time when the diagnosis was made. Annual family income and age of the child when symptoms were first identified contributed to the delay in diagnosis. It was also found that more than half of the participants had positive beliefs related to ASD and more than 99% of the participants held positive attitudes toward early intervention. Almost 90% (89.7%) of the participants reported needing more financial support, and 100% indicated the need for appropriate services for their children with ASD. Family income level and maternal education level significantly influence family resources. Seventy-five percent of the families reported that intervention expenses and lack of social acceptance contributed to stress. Thirty percent of the participants reported that disagreements among family members about the child with ASD further contribute to the stress experienced. Implications of the findings are discussed in relationship to the evolving Chinese early intervention system of care.

Applying Contemporary Developmental and Movement Science Theories and Evidence to Early Intervention Practice.

Changes in early childhood science, theory, and best practices for improving outcomes of children with motor delay or dysfunction and their families have evolved rapidly since EI began. Changes in daily early intervention (EI) practice have been more elusive. Closing the gap between knowledge and practice requires EI providers to piece together information from a variety of knowledge streams including early childhood special education, pediatric rehabilitation, and cognitive psychology. The purpose of this article is to create a body of shared, evidence-based knowledge among providers responsible for addressing the needs of children with movement disorders and their families to effect changes in practice. This article discusses the evolution of EI practice models for children with motor concerns; examines related theories, interventions, and outcomes; and presents an alternative model based on contemporary evidence and grounded in dynamic systems theory. Researchers describe existing barriers to implementation of family-centered, support-based practices. Recommendations highlight the need for EI providers to collaborate with families to develop meaningful goals and to recognize and create opportunities for children to engage in high volumes of task-specific activity in a meaningful context. Continued research is required to verify effectiveness of this integrated model for improving child and family outcomes.

Promoting Professional Development for Physical Therapists in Early Intervention

Early intervention service providers are expected to form cohesive teams to build the capacity of a family to promote their childs development. Given the differences in personnel preparation across disciplines of service providers, the Early Childhood Personnel Center is creating integrated and comprehensive professional development models for those who provide services for young children with disabilities and their families. To help guide this process, it is important to identify interdisciplinary competencies as well as the unique knowledge and skills that each discipline contributes to the development and implementation of effective intervention plans. This article describes personnel preparation of pediatric physical therapists from entry level to ongoing professional development. Topics include licensure requirements, specialist certification, and early intervention competencies. This article explains the unique knowledge and skills that pediatric physical therapists offer to the team as movement specialists. It also highlights particular challenges to professional development faced by novice and experienced physical therapists who work in natural environments. Finally, recommendations for personnel development, including structured mentorship, interdisciplinary and team-based learning, and strategies for knowledge translation, are suggested.