Yvette Blanchard

The Influence of Concurrent Cognitive Tasks on Postural Sway in Children

Purpose: The purpose of this study was to examine the influence of concurrent tasks on postural sway in children. Methods: Nineteen fourth-grade students, while standing on a balance platform, were asked to stand still, count backward, and read second-grade level sentences. The AMTI Accusway System was used to calculate the length of center of pressure path (LCOP), sway range (SR), and variability (SV) in mediolateral (ML) and anteroposterior (AP) directions of sway. Results: Analysis of variance revealed a main effect of cognitive task condition for SR-AP, SR-ML, SV-AP, and SV-ML. Post hoc comparisons revealed lower values of those four dependent measures for the counting backward task than for the standing still task and lower SV-AP for the counting backward task than for the reading task. In addition, there was a trend toward greater LCOP when performing a concurrent cognitive task. Conclusions: The demands of concurrent cognitive tasks while standing affect postural sway in children. The findings of this study contribute to our understanding of postural control in children and may explain why improvements in postural skills attained in clinical settings may not transfer to improved performance in other settings.

Neonatal Physical Therapy. Part II: Practice Frameworks and Evidence-Based Practice Guidelines

Purpose: (1) To outline frameworks for neonatal physical therapy based on 3 theoretical models, (2) to describe emerging literature supporting neonatal physical therapy practice, and (3) to identify evidence-based practice recommendations. Key Points: Three models are presented as a framework for neonatal practice: (1) dynamic systems theory including synactive theory and the theory of neuronal group selection, (2) the International Classification of Functioning, Disability and Health, and (3) family-centered care. Literature is summarized to support neonatal physical therapists in the areas of examination, developmental care, intervention, and parent education. Practice recommendations are offered with levels of evidence identified. Conclusions: Neonatal physical therapy practice has a theoretical and evidence-based structure, and evidence is emerging for selected clinical procedures. Continued research to expand the science of neonatal physical therapy is critical to elevate the evidence and support practice recommendations.

Interrater Reliability of Early Intervention Providers Scoring the Alberta Infant Motor Scale

Purpose This study was designed to examine the interrater reliability of early intervention providers scoring of the Alberta Infant Motor Scale (AIMS) and to examine whether training on the AIMS would improve their interrater reliability. Methods Eight early intervention providers were randomly assigned to two groups. Participants in Group 1 scored the AIMS on seven videotapes of infants prior to receiving training and after training on another set of seven videotapes of infants. Participants in Group 2 scored the AIMS on all 14 videotapes of the infants after receiving training. Results Overall interrater reliability before and after training was high with intraclass correlation coefficients ranging from 0.98 to 0.99. Detailed examination of the results showed that training improved the reliability of the supine subscale in a subgroup of infants between the ages of five and seven months. Training also had an effect on the classification of infants as normal or abnormal in their motor development based on their percentile rankings. Conclusion The AIMS manual provides sufficient information to attain high interrater reliability without training, but revisions regarding scoring are strongly recommended.

Neonatal physical therapy. Part I: clinical competencies and neonatal intensive care unit clinical training models.

Purpose: To describe clinical training models, delineate clinical competencies, and outline a clinical decision-making algorithm for neonatal physical therapy. Key Points: In these updated practice guidelines, advanced clinical training models, including precepted practicum and residency or fellowship training, are presented to guide practitioners in organizing mentored, competency-based preparation for neonatal care. Clinical competencies in neonatal physical therapy are outlined with advanced clinical proficiencies and knowledge areas specific to each role. An algorithm for decision making on examination, evaluation, intervention, and re-examination processes provides a framework for clinical reasoning. Because of advanced-level competency requirements and the continuous examination, evaluation, and modification of procedures during each patient contact, the intensive care unit is a restricted practice area for physical therapist assistants, physical therapist generalists, and physical therapy students. Conclusions/Practice Implications: Accountable, ethical physical therapy for neonates requires advanced, competency-based training with a preceptor in the pediatric subspecialty of neonatology.

Therapeutic encounters with preterm infants: interaction, posture and movement.

Abstract Background and purpose: Physiotherapy is a common intervention for preterm infants with motor disorders. There is a limited knowledge on how individual and contextual actions influence what is created and achieved in clinical encounters between physiotherapists and infants born preterm. In this theoretical paper the aim is to open a discussion for clinicians in pediatrics to take into consideration that patient interaction might have a significant impact for the outcome. Through introducing theoretical principles based on the phenomenology of the body and enactive intersubjectivity the paper provides a framework for better understanding the contribution that the interactional components in physiotherapy with preterm infants may have. Conclusion: The elaboration shows how social interaction and intentional actions influence each other in therapy. Accordingly, a fundamental driving force for effective physiotherapy intervention in preterm infants may involve a dynamical process of embodied interaction with the generation of meaning between physiotherapist and infant. Clinical implications: Our elaboration suggests that a coordinated process of embodied interaction with preterm infants can enhance motor performance during therapeutic encounters.

Physical therapy with newborns and infants: applying concepts of phenomenology and synactive theory to guide interventions

Abstract Physical therapy involving newborns and young infants is a specialized area of practice reserved for therapists who have advanced training and the competence to help newborns, young infants and their families meet their goals. Beginning at birth, infants apply a significant amount of effort to actively participate in and shape their world. Infants make their intentions and requests for support known through their behaviors during social and physical therapy encounters. The therapeutic encounter viewed from the infant’s perspective has received limited attention in the physical therapy literature. The purpose of this article is to discuss concepts related to phenomenology and synactive theory that are relevant to physical therapy with newborns and young infants during the first few months of life after birth.

Commentary on "Use of a Midliner Positioning System for Prevention of Dolichocephaly in Preterm Infants"

Improving the Lives of Newborns. http://www.invictusgelshield.com/. Accessed March 1, 2016. 22. AliMed: Innovative Solutions. AliGel Head Positioner Donut, Neonatal. http://www.alimed.com/aligel-head-positioner-donuts.html. Accessed January 4, 2017. 23. Medline. Squishon Pillows by Respironics, Inc. http://www.medline. com/product/PILLOW-SQUISTION-2-GEL-FILLED/Z05-PF30704/. Accessed January 4, 2017. 24. Sundance Solutions: Therapeutic Positioning in the NICU. Tortoise: Neo—Small Utility Pillow. http://sundancesolutions.com/neonatal/. Accessed January 4, 2017. 25. Dandle-LION Medical. Gel-filled Pillows. http://www.dandlelion medical.com/products/gel-filled-pillows/. Accessed January 4, 2017. 26. The Shape Right System home page. http://www.shaperight.net. Accessed January 4, 2017. 27. American Academy of Pediatrics, Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics. 2008; 122(5):1119-1126. 28. Iyer KK, Roberts JA, Hellström-Westas L, et al. Early detection of preterm intraventricular hemorrhage from clinical electroencephalography. Crit Care Med. 2015;43(10):2219-2227. 29. Natarajan G, Pappas A, Shankaran S, et al. Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia: impact of the physiologic definition. Early Human Development. 2012;88:509-515. 30. Malcolm WF, Gantz M, Martin RJ, Goldstein RF, Goldberg RN, Cotton CM. Use of medications for gastroesophageal reflux at discharge among extremely low birth weight infants. Pediatrics. 2008;121:22. 31. Baum JD, Searls D. Head shape and size of newborn infants. Develop Med Child Neurol. 1971;13:572-575. 32. Schultz AA, Goodwin PA, Jesseman C, Toews HG, Lane M, Smith C. Evaluating the effectiveness of gel pillows for reducing bilateral head flattening in preterm infants: a randomized controlled pilot study. Appl Nurs Res. 2008;21(4):191-198. 33. Schwirian PM, Eesley T, Cuellar L. Use of water pillows in reducing head shape distortion in preterm infants. Res Nurs Health. 1986;9(3):203207. 34. Marsden DJ. Reduction of head flattening in preterm infants. Dev Med Child Neurol. 1980;22(4):507-509. 35. Cartilidge PT, Rutter N. Reduction of head flattening in preterm infants. Arch Dis Child. 1988;63(7):755-777. 36. Chan JS, Kelley ML, Khan J. The effects of a pressure relief mattress on postnatal head molding in very low birth weight infants. Neonatal Network. 1993;12(5):19-22. 37. Hemingway M, Oliver S. Bilateral head flattening in hospitalized premature infants. Online J Knowl Synth Nurs. 2000;7:3.

Shared Meanings of Success, Happiness, and Health Among Adults with Cerebral Palsy and Physiotherapists: Implications for Practice and Research

Abstract Purpose: To describe shared meanings of success, happiness, and health of adults with cerebral palsy and physiotherapists. Materials and methods: Ethnography employed open ended/semi-structured interviews and structured questionnaires (Satisfaction with Life Scale, Beck Depression Inventory-II®, Oxford Happiness Questionnaire, Life Habits Questionnaire, Medical Outcomes Study-Social Support Survey, and PROMIS® Pain Interference Scale). Content analysis of qualitative data and principal components analysis of questionnaire responses identified shared meanings. Results: Fourteen adults with cerebral palsy and 15 physiotherapists (median age 46) had similar levels of education. For both groups, social achievements, personal goals, employment, and supporting a family defined success. Adults with cerebral palsy more frequently identified tenacity and persistence as important for success. Both groups described happiness as spending time with loved ones, recreational activities, and having purpose in life. Adults with cerebral palsy identified the importance of self-acceptance for happiness. For both, health included self-care of mind/spirit, cardiovascular and musculoskeletal wellness, and physical fitness (the ability to perform physical tasks). Analysis of questionnaire responses identified shared meanings (eigenvalue 41, 95% explained variance). Conclusions: Adults with cerebral palsy and physiotherapists share similar experiences, behaviors, and feelings about success, happiness, and health. This knowledge may improve communication, enhance evidence-based practice, and foster services to support wellbeing. Implications for rehabilitation Cerebral palsy is a life-long condition, but we know little about social and physical outcomes for adults with cerebral palsy. Lack of understanding about meanings of success, happiness, and health may be a barrier for consumers accessing and for providers delivering evidence-based services. Physiotherapists and adults with cerebral palsy share similar meanings (feelings, experiences, beliefs, behaviors) of success, happiness, and health- or wellbeing. Knowledge of this common ground may result in improved communication between providers and consumers, and foster more relevant and meaningful services to support the wellbeing of adults with cerebral palsy.

Health, Wellness, and the Pursuit of Happiness: Common Ground for Adults with Cerebral Palsy and Modern Physical Therapists

Abstracts* of Platform Presentations at the 2014 Combined Sections Meetings* of Platform Presentations at the 2014 Combined Sections Meeting

Cultural Competence: A Lifelong Journey to Cultural Proficiency (Book Review)

This book on cultural competence and proficiency edited by Leavitt offers a contemporary look that the impact culture has on our lives as both physical therapists and citizens of the world. Written for the most part by physical therapists, the book addresses the complex issues of culture and disability and specifically addresses the development of cultural competence and cultural proficiency of physical therapists and other health care providers. The first four chapters set the background for understanding culture and the development of cultural proficiency. Chapter 1 describes a continuum of cultural competence and makes a clear distinction between the attainment of cultural competence and cultural proficiency. What Leavitt brings to this content is the link she makes with physical therapy generic abilities—such a “hot topic” in physical therapy education these days. Chapter 2 further explains culture and its influence on everyday life. Chapter 3 offers a historical perspective on cultural competence in healthcare and physical therapy practice. Chapter 4 on cultural diversity elaborates on acculturation, socioeconomic status, racism, comparative value orientations, religion, communication styles, and health beliefs and behaviors. These chapters are well written and loaded with current and useful information. The chapters are well sequenced and summarize a body of literature that is complex to understand. The next three chapters address more specifically the relationship between culture and health and disability. In Chapter 5, “Disability Across Cultures,” Leavitt and Roush introduce the emerging field of disability studies, a field of study that focuses on the sociocultural perspectives of disability rather than solely on biomedical factors to appreciate the lives of people living with disabilities. Chapter 6 addresses issues of racial and health disparities in health status, health care, and physical therapy. The role that physical therapists play in the resolution in these disparities is emphasized. Chapter 7 on poverty and health highlights the clear link between poverty and health; those who suffer the most are the poor, women, children, and people of color. The authors of this chapter, Reviere and Stackman, summarize this reality by stating that “[w]hen we refuse to see the problems of the poor, we cannot reduce health disparities or improve quality of life” for a large proportion of our fellow citizens in the United States or the world. This chapter provides the context for Chapter 8 on “Understanding Racism.” Chapter 9 on “Cross-Cultural Communication” by Masin provides theoretical and practical information on cross-cultural communication including a section on reflective thinking as a means to develop self-awareness and promote better practice in physical therapy and health care in general.