Victoria A. Moerchen

Stepping responses of infants with myelomeningocele when supported on a motorized treadmill.

Background and Purpose: Infants with myelomeningocele (MMC) have difficulty with, and show delays in, acquiring functional skills, such as walking. This study examined whether infants with MMC will respond to treadmill practice by producing stepping patterns or at least motor activity during the first year after birth. This study also compared the stepping trajectories of infants with MMC across age with those of infants with typical development (TD) to analyze the characteristics of the development of stepping patterns in infants with MMC early in life. Participants: Twelve infants with MMC (lumbar and sacral lesions) and 12 infants with TD were the participants in this study. Methods: The infants were tested on a treadmill at ages 1, 3, 6, 9, and 12 months, with no treadmill practice between test sessions. Infants were supported on the treadmill for twelve 20-second trials. A digital camera and behavior coding were used to determine step rate, interlimb stepping patterns, step parameters, and motor activity level. Results: Treadmill practice elicited steps in infants with MMC (14.4 steps/minute during the year) but less so than in infants with TD (40.8 steps/minute). Responsiveness was affected by lesion level but varied markedly among infants. Interlimb stepping was less readily alternating, but step parameters were similar to those produced by their peers with TD. Finally, holding infants with MMC on a moving treadmill resulted in greater motor activity (17% during the year) than holding infants on a nonmoving treadmill. Discussion and Conclusion: Infants with MMC responded to the treadmill by stepping (but less so than infants with TD) and showing increased motor activity, but they demonstrated a different developmental trajectory. Future studies are needed to explore the impact of enhancing sensory input during treadmill practice to optimize responses in infants with MMC.

Essential competencies in entry-level pediatric physical therapy education

Background: The Section on Pediatrics (SoP) convened an Education Summit in July 2012 to examine, discuss, and respond to documented inconsistencies and challenges in teaching pediatric physical therapy (PT) content in entry-level professional education programs. Despite previous attempts by the SoP to provide guidance around teaching pediatric PT, variability continued to be extensive across programs. Key Points: This article presents the core competencies developed out of the Summit to inform pediatric content in the entry-level PT curriculum. In addition, the core competencies were linked to teaching strategies, learning activities, assessment outcomes, and curricular structures. Statement of Conclusions: Consensus was reached on 5 core competencies that represent a knowledge base essential to all graduates of PT programs. In contrast to prior SoP documents, these competencies were specifically designed to focus on knowledge and skills unique to pediatric practice but essential for all graduates of accredited entry-level PT education programs. Video Abstract: For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/PPT/A50.

Impact of Enhanced Sensory Input on Treadmill Step Frequency: Infants Born With Myelomeningocele

Purpose: To determine the effect of enhanced sensory input on the step frequency of infants with myelomeningocele (MMC) when supported on a motorized treadmill. Methods: Twenty-seven infants aged 2 to 10 months with MMC lesions at, or caudal to, L1 participated. We supported infants upright on the treadmill for 2 sets of 6 trials, each 30 seconds long. Enhanced sensory inputs within each set were presented in random order and included baseline, visual flow, unloading, weights, Velcro, and friction. Results: Overall friction and visual flow significantly increased step rate, particularly for the older subjects. Friction and Velcro increased stance-phase duration. Enhanced sensory input had minimal effect on leg activity when infants were not stepping. Conclusions: Increased friction via Dycem and enhancing visual flow via a checkerboard pattern on the treadmill belt appear to be more effective than the traditional smooth black belt surface for eliciting stepping patterns in infants with MMC.

A description of professional pediatric physical therapy education.

Purpose: The purpose of this work was to reexamine the status of professional pediatric physical therapy education in the United States. Methods: A task force designed a 16-item survey and contacted representatives from all professional physical therapy programs. Results: Surveys were gathered from 151 programs for a return rate of 75%. Much variability exists across programs in total number of hours devoted to pediatrics (range, 35-210 hours). In addition, almost 60% of respondents indicated that the individual responsible for delivering the pediatric content will be retiring within the next 15 years. Conclusion: These results describe current pediatric professional education and provide numerous opportunities and challenges for the development of optimal professional pediatric education.

Objectively assessed physical activity and sedentary behaviour does not differ between children and adolescents with and without a congenital heart defect: a pilot examination

OBJECTIVES To objectively evaluate and describe physical activity levels in children with a stable congenital heart defect and compare those levels with children who do not have a congenital heart defect. METHODS We matched 21 pairs of children for gender and grade in school and gave them an accelerometer-based motion sensor to wear for 7 consecutive days. RESULTS Physical activity levels did not differ between children with and without a congenital heart defect. During the 7 days of monitoring, children in this study spent most of their time in sedentary behaviours, that is, 6.7 hours of the 13 monitored hours, 54 minutes in moderate-intensity physical activity, and 12 minutes in vigorous-intensity physical activity. Less than one-fifth of all participants, with or without a congenital heart defect, accumulated sufficient physical activity to meet current physical activity recommendations for children and adolescents. CONCLUSION Children with a stable congenital heart defect have activity behaviours that are similar to children without a congenital heart defect. Habitual physical activity in children with a congenital heart defect should be encouraged early on in life to develop strong physical activity habits that will hopefully follow them across their lifespan.

Treadmill training and overground gait: decision making for a toddler with spina bifida.

Background and Purpose: This case report describes a decision-making process that was used to progress a home-based intervention that coupled treadmill and walker stepping for a preambulatory toddler with spina bifida. Case description: The toddler in this report had an L4-L5 level lesion, and began this home-based intervention at 18 months of age when she was pulling to stand. Intervention: The intervention included parameters for treadmill stepping that prepared this toddler for gait with orthotics and was progressed to overground walking with a walker using a decision-making algorithm based on data obtained from a parent log and coded video. Outcomes: This toddler progressed from not stepping at the start of the study to ambulating 150 m with a walker at age 23 months, after 18 weeks of this intervention. Discussion and conclusion: The intervention and decision-making process used in this study were family centered and may be applicable to gait intervention with other populations.

Effect of airway control by glottal structures on postural stability

Maintenance of upright posture involves complex neuromotor processes that include control of thoracic and abdominal pressures. Control of airflow by glottal structures is a primary determinant of thoracic pressure and may have a role in control of postural stability. This study aimed to investigate the effect of modulation of airway control on upright postural stability during postural perturbations. Standing balance was gently perturbed in the sagittal plane during 7 breathing/voicing tasks that ranged from completely closed (breath-hold), to partially opened (voicing) or completely open (sigh) glottal conditions in 11 healthy adults. Dependent measures were peak amplitude of displacement of the thorax and center of pressure (CoP). When the glottis was completely open during sigh, thoracic displacement in response to the perturbation was greater than in all other conditions, regardless of direction of perturbation (post hoc, all P < 0.002). The absolute amplitude of CoP displacement was greater with backward perturbation (main effect, Direction P = 0.001) and was greater at both extremes of glottal modulation (glottis closed and completely open) than when the glottis was partially opened during counting out loud (post hoc, all P < 0.04). These results show that airway modulation affects postural control during upright perturbations. The thorax was more stable when the glottis was engaged than when it was required to remain open, whereas control of CoP displacement appeared more optimal during the natural dynamic mid-range airway modulation of voicing. These data suggest that glottal control influences balance, and that glottal control strategies may be an important consideration for patients with breathing and/or balance disorders.

Infant visual attention and step responsiveness to optic flow during treadmill stepping.

This study examined infant treadmill stepping in two groups of pre-locomotor infants in response to terrestrial optic flow. The optic flow was provided via the treadmill belt for flow translation that was directionally consistent with the forward stepping of the infants. Twelve 2-5-month-old and twelve 7-10-month-old infants participated. Visual attention (duration and direction) and step responsiveness (frequency and step types) were coded from digital video, and visuomotor coupling was examined by temporally juxtaposing the visual attention and step data. Longer durations of visual attention to the patterned belt with increased step frequencies during periods of visual attention were observed, suggesting that the visuotactile calibration afforded by the patterned treadmill belt, increased visuomotor coupling and enhanced the frequency and complexity of stepping in prelocomotor infants. The findings are discussed with regard to sensorimotor experiences that enhance treadmill stepping in infants and that may have application to clinical populations.

Experiential Learning With Children: An Essential Component of Professional Physical Therapy Education.

Purpose: The Section on Pediatrics of the American Physical Therapy Association has developed a number of resources to support and improve the consistency of professional pediatric physical therapy education, including a set of core competencies that all graduates must attain. The purpose of this article is to advocate for the inclusion of experiential learning activities with children, including children with participation restrictions, as a necessary component to achieve the core competencies. Key Points: Experiential learning is a form of practice-based education that provides exposures and opportunities for students to explore the work, roles, and identities they will encounter as future professionals. Experiential learning is learning by doing, and occurs within a relevant setting. Six representative curricular exemplars are presented to provide readers with a variety of suggestions for development and integration of experiential learning. Summary: Recommendations for future research are provided and 4 key recommendations are provided.

Infants with spina bifida: immediate responses to contextual and manual sensory augmentation during treadmill stepping.

Purpose: This study examined the effect of combined sensory enhancements and manual assistance on the immediate motor responsiveness of infants with spina bifida during treadmill trials. Methods: Six infants with spina bifida, aged 4 to 9.5 months, with lesion levels ranging from L4 to S3 were tested in each of 3 randomly ordered sets of enhanced sensory conditions across 3 weekly visits to the laboratory. Sensory enhancements included visual flow, unloading, load, and friction, presented in single and combined applications, as well as a set of trials with manual assistance for stepping at 2 treadmill belt speeds. Dependent variables included step frequencies and overall infant activity. Results: Friction+load was the most salient of the contextual sensory enhancements. Manual assistance at the slower speed was also effective at increasing infant stepping. Conclusions: Sensory enhancements that increase stance excursion and vertical clearance during swing need further study.