ABSTRACT
BACKGROUND: Idiopathic toe walking (ITW) is an exclusionary diagnosis resulting in a child walking on the balls of their feet. Preferred treatment options may be due to the severity of the toe or the health professional preference There are limited guidelines supporting consistent treatment recommendations for this condition. This research aimed to understand agreement between health professionals' knowledge of evidence for common treatment strategies for ITW and if health professionals supported these strategies being used in clinical practice. METHODS: An international online survey was opened to registered health professionals who treat children with ITW between July 2017 and March 2018. The survey had two components: (a) demographic variables and variables relating to knowledge of evidence about ITW treatments and (b) support for common treatment strategies. Additional data on strategy use, referrals, and preference were collected. Kappa statistics described intra-rater agreement between evidence knowledge and support. Multivariable regression analyses identified factors associated with the 10 most commonly preferred treatments. RESULTS: There were 908 international responses. Kappa agreement for paired correct responses determined a fair agreement for evidence support knowledge for four strategies including watch and wait (Kappa = 0.24), stretching (Kappa = 0.30), sensory integration strategies (Kappa = 0.40), and motor control strategies (Kappa = 0.24) and moderate responses for 13 others. No strategies had greater than moderate agreement between correct knowledge of evidence and strategy support. Profession, location, number of children seen in practice, and not correctly identifying the evidence factored into many of the most commonly used strategies for ITW (p < .05). CONCLUSIONS: The results from this study, which confirm a variety of interventions, are utilized in the management of ITW around the world. Furthermore, there remains a disconnection between paediatric health professionals' understanding of the evidence of common treatment strategies of ITW and a consensus for the treatment of this condition.
Subject(s)
Clinical Competence , Evidence-Based Practice , Gait/physiology , Pediatrics , Toes , Child , Child, Preschool , Female , Humans , Male , Orthopedic Procedures , Orthotic Devices , Physical Therapy Modalities , Practice Patterns, Physicians' , Surveys and QuestionnairesSubject(s)
Child, Institutionalized , Intellectual Disability/diagnosis , Intellectual Disability/history , Intellectual Disability/physiopathology , Pediatrics/history , Anthropometry , Attitude of Health Personnel , Birth Order , Body Height , Body Weight , Cephalometry , Child , Cultural Characteristics , Family Health , Growth , History, 20th Century , HumansSubject(s)
Developmental Disabilities/diagnosis , Pediatrics/history , Periodicals as Topic/history , Child , Child, Preschool , Developmental Disabilities/history , History, 20th Century , Humans , Infant , Infant, Newborn , Language Tests/history , Mass Screening/history , Neuropsychological Tests/history , Sensitivity and Specificity , United StatesABSTRACT
Toe walking has been associated with language disorders and autism. To better understand the association between persistent toe walking and sensory and motor variables in children with autism, the degree of toe walking was compared with an estimate of the severity of sensory integration dysfunction symptoms and the presence of residual components of the tonic labyrinthine in supine reflex pattern in 61 children younger than 37 months of age with newly diagnosed autism. There was no association between the presence of toe walking and sensory symptoms (P = .5298) or language age (P = .6142), but there was an association between toe walking and the presence of components of the tonic labyrinthine reflex (P = .04222). These preliminary results support the contribution of subtle motor deficits to the evolution of some behaviors associated with autism.
Subject(s)
Autistic Disorder/physiopathology , Gait , Movement Disorders/physiopathology , Walking , Autistic Disorder/complications , Child, Preschool , Female , Humans , Infant , Male , Movement Disorders/complications , Reflex , Severity of Illness Index , ToesABSTRACT
The hypothesis that the presence of macrocephaly might vary with the specific growth chart used was tested by using the Nellahus, CDC, and recent Rollins et al revision head circumference charts to plot the head circumferences of 253 children with neurodevelopmental disorders and with ages between 12 to 36 months; of these children, 59 had a diagnosis of autism spectrum disorder. The CDC and Rollins et al head circumference charts identified more cases of macrocephaly and fewer cases of microcephaly than did the older Nellhaus chart but did not significantly differ in their identification of macrocephaly in children with autism.
Subject(s)
Child Development Disorders, Pervasive/complications , Megalencephaly/complications , Microcephaly/complications , Cephalometry , Child Development Disorders, Pervasive/pathology , Child, Preschool , Female , Humans , Infant , Male , Megalencephaly/pathology , Microcephaly/pathology , Organ SizeSubject(s)
Brain Diseases/history , Brain Diseases/diagnosis , Child, Preschool , History, 20th Century , Humans , Infant , Infant, NewbornSubject(s)
Brain Injuries/diagnosis , Crying/physiology , Reaction Time , Brain Injuries/complications , Humans , Infant , Infant, Newborn , PediatricsSubject(s)
Child Development , Down Syndrome/physiopathology , Child, Preschool , Humans , Infant , Predictive Value of TestsABSTRACT
The records of 954 ambulatory children presenting for initial evaluation to a university developmental pediatrician were reviewed for the prevalence of persistent toe walking and associated tight heel cords. The incidence of persistent toe walking (20.1%) and tight heel cords (12.0%) were found to be higher in 324 children with an autistic spectrum disorder but lower (10.0%/3.0%) in 30 children with Asperger syndrome. These results confirm the previously reported high incidence of toe walking in children with autism and with language disorders and also raise the possibility of a secondary orthopedic deformity that can complicate long-term management of these patients.
Subject(s)
Autistic Disorder/complications , Movement Disorders/etiology , Toes , Walking/physiology , Chi-Square Distribution , Child , Child, Preschool , Female , Humans , MaleSubject(s)
Cerebral Palsy/classification , Algorithms , CD-ROM , Cerebral Palsy/epidemiology , Child, Preschool , Comorbidity , Humans , Neurologic Examination , PrevalenceSubject(s)
Celiac Disease/diagnosis , Paraparesis/etiology , Celiac Disease/complications , Female , Humans , InfantABSTRACT
Health and social outcomes in children who have cerebral palsy (CP) depend on several factors, including the severity of the CP, medical interventions, and the child's environment. One of the hallmarks of cerebral palsy is its variability. Several formal methods of classifying persons with CP, such as the Gross Motor Function Classification System, have been developed to standardize that variability. Children and adults with CP must contend with increased mortality as well as many secondary conditions that can affect activities and participation in society. Predicting outcomes for children with CP, establishing realistic goals, and determining the best interventions to improve functioning are facilitated by applying research results to individual decisions. Many more such studies are needed--especially those performed with large representative samples. In addition, the childhood factors that affect outcomes in adults with CP still need to be elucidated.
