Concurrent Validity of the School Outcomes Measure and the School Function Assessment in Elementary Students.

PURPOSE: Examine the concurrent validity of the School Outcomes Measure (SOM) and the School Function Assessment (SFA) in students kindergarten through sixth grade. METHODS: Twenty-four school-based therapists completed the SOM and the SFA for 42 students, representing Gross Motor Function Classification System (GMFCS) levels I to V. RESULTS: Correlation coefficients between SOM Self-Care, Mobility, and Assuming Student's Role median total scores and the 21 SFA Activity Performance scale median criterion scores were statistically significant. There were significant correlation coefficients between SOM Expressing Learning and Behavior and SFA median criterion scores. The SOM differentiated between GMFCS groups for all physical tasks but not cognitive/behavioral tasks, and the SFA for half of the physical tasks. CONCLUSIONS: Overall, student performance on the SOM was consistent with participation on the SFA, which lends support to the preliminary validity of the SOM. The GMFCS analysis suggests that the SOM differentiates between the GMFCS levels for physical tasks.

School-Based Physical Therapy Services: Predicting the Gap Between Ideal and Actual Embedded Services.

PURPOSE: To ascertain the variables predicting the gap between ideal and actual practice in embedding school-based physical therapy services. METHODS: School-based physical therapists completed an online survey estimating ideal and actual practice of embedding physical therapy services. Predictive modeling was used to determine whether disability, interventions, goals, families, teachers, workload, billing, and/or contracts predicted the gap between estimated ideal and actual practice. RESULTS: Data from 410 participants revealed that severity of students' disability, billing, written contracts, and families' preferences predicted the gap between estimated ideal and actual services. Actual practice varied based on region, APTA membership, and Academy of Pediatric Physical Therapy membership. CONCLUSIONS: Our model predicts the gap between estimates of ideally and actually embedding school-based physical therapy services. While 4 variables predicted the gap, further research is needed to develop a predictive model of actual practice to inform school-based physical therapy practice.

Family Eating Behavior and Child Eating Patterns Differences Between Children With and Without Siblings.

OBJECTIVE: To examine the differences in family eating behaviors and child eating patterns in children with siblings (nonsingletons) and without siblings (singletons). METHODS: Cross-sectional analysis of mother-child dyads of 5-7-year-old children, (nonsingletons with a 2-to-4-year-old sibling) was conducted. Anthropometrics were measured. Mothers completed questionnaires and a child dietary log. Healthy Eating Index 2010 (HEI) score was calculated. Linear regression models adjusting for child age, child sex, maternal body mass index, and hours-away-from-home were conducted, with a revised P < .021. RESULTS: Sixty-eight mother-child dyads (27 singletons, 41 nonsingletons) participated. Singletons exhibited less healthy family eating behaviors (ß = -4.98, SE = 1.88, P = .003), and lower total HEI scores than did nonsingletons (average: ß = -8.91, SE =2.40, P = .001). On average, singletons had lower scores in 3 HEI components compared with nonsingletons (P < .021 for all). CONCLUSION: In this sample, singleton children exhibited less healthy eating behaviors. Additional investigation into parent-level differences is warranted.

Difference in Objectively Measured Physical Activity and Obesity in Children With and Without Siblings.

Background/Context: Children without siblings (singletons) have higher rates of obesity than do children with siblings (nonsingletons). Higher moderate to vigorous physical activity (PA) and less sedentary behavior (SB) are associated with lower childhood obesity. PURPOSE: To examine the difference in PA and SB between singleton and nonsingleton children. METHODS: Mothers of children ages 5.0-7.9 years old who were singletons or nonsingletons with a sibling between the ages of 2.0 and 4.9 years old were recruited. Height, weight, and waist circumference of the 5.0- to 7.9-year-old children were measured, and age and sex percentiles were calculated. Accelerometry measured SB and PA, including light PA, moderate to vigorous PA, and counts per minute. RESULTS: Fifty-six mother-child dyads (23 singletons and 33 nonsingletons) with an average child age of 5.7 (0.7) years participated. More singletons were classified as overweight or obese than were nonsingletons (49% vs 17%, P = .04). In adjusted linear models, singletons had less light PA per day (ß = -38.1, SE = 19.2, P = .001) and more SB (ß = 38.0, SE = 16.5, P = .02) than did nonsingletons, with no difference in moderate to vigorous PA or counts per minute. CONCLUSION: In this sample, singletons had higher obesity and lower light PA than did nonsingleton children. Investigation into differences in singleton/nonsingleton families, including family health behaviors, may help assess sibling influence in early behavior development.

Tribally Affiliated Child-Care Center Environment and Obesogenic Behaviors in Young Children.

BACKGROUND: Child-care centers are an integral part of life for many families with young children. American Indian children are at elevated health risk because of higher levels of obesity and associated health behaviors. OBJECTIVE: Our aim was to assess the child-care environment and children's physical activity (PA) and dietary intake in young children attending tribally affiliated child care. DESIGN: We conducted a cross-sectional study. PARTICIPANTS/SETTING: Participants were from 11 tribally affiliated child-care centers across Oklahoma and included 82 children aged 3 to 5 years old. MAIN OUTCOME MEASURES: Classroom observations were conducted using the Environmental and Policy Assessment Observation to measure PA and nutrition environments. Children wore an ActiGraph GT3X accelerometer and lunchtime plate waste was observed. STATISTICAL ANALYSES: Descriptive statistics, including mean±standard deviation and frequencies, were calculated for the children's behaviors and environment. RESULTS: The total environment score was 23.9±5.2 (maximum=43). The nutrition score was 12.5±3.1 (maximum=21). The PA score was 11.7±2.2 (maximum=22). The participants were 3.8±0.1 years old, 55% were male, 67% were American Indian, and 38% were overweight or obese. Accelerometers were worn for 5.9±1.7 hours, excluding naptime. Children accumulated 4.3±2.2 min/h of moderate to vigorous PA, 4,294±1,883 steps/day, and 12.1±3.7 steps/min. At lunch, children were served 510±241 kcal, and consumed 387±239 kcal. Lunches consisted of 47% carbohydrate, 20% protein, and 33% fat. Total number of F/V served was 2.9±1.9 and consumed was 2.3±1.8, while whole grains served and consumed were 0.3±0.4 and 0.2±0.4, respectively, and lean proteins served and consumed were 0.3±0.4 and 0.2±0.4, respectively. CONCLUSIONS: This study describes obesogenic aspects of the child-care environment and identifies areas for improvement. Children did not accumulate adequate PA or consume calories or fat excessively. Children consumed multiple F/V; however, more whole grains and lean proteins could be provided. Future research might investigate how the healthfulness of the child-care environment can be improved by counseling providers on nutrition and PA strategies to prevent obesity.

Obesogenic environments in tribally-affiliated childcare centers and corresponding obesity rates in preschool children.

BACKGROUND: Determine the relationship between obesogenic characteristics of childcare and child adiposity in tribally-affiliated centers in Oklahoma. METHODS: The two-day Environment and Policy Assessment and Observation (EPAO) included a total environment (TE), nutrition (N), and physical activity (PA) score and took place in 11 centers across Oklahoma. Eighty-two preschool children (3-5 years) participated. Child height and weight were measured and overweight status (≥ 85th percentile for age and sex) was determined. Regression models, fit using Generalized Estimating Equations methodology to account for clustering by center were used and adjusted for center characteristics. RESULTS: Participants were 3.8 (0.8) years old, 55% male, 67% American Indian (AI) and 38% overweight. A healthier TE and PA was associated with a reduced odds of overweight, which remained significant after adjusting for some center characteristics, but not all. A healthier TE, N, and PA was associated with lower BMI percentile, which remained significant after some center-level adjustments, but not all. Lower sedentary opportunity and sedentary time were no longer associated with reduced odds of overweight following adjustment. Lower opportunity for high sugar and high fat foods and minutes of active play were associated with reduced odds of overweight in some adjusted models. CONCLUSIONS: Collectively unadjusted and adjusted models demonstrate that some aspects of a healthier childcare center environment are associated with reduced odds of overweight and lower BMI percentile in preschool children attending tribally-affiliated childcare in Oklahoma. Future research should examine the association of childcare and health behaviors and further explore the role of potential confounders.

Knowledge Translation of the Gross Motor Function Classification System Among Pediatric Physical Therapists.

PURPOSE: To learn where pediatric physical therapists in the United States are in the process of knowledge translation of the Gross Motor Function Classification System (GMFCS). METHODS: Links to an online survey were distributed electronically. RESULTS: All 283 respondents reported hearing about the GMFCS, 95% agreed it was useful, 81% reported they were confident in their ability to use it, 77% reported they use it, and 42% reported they use it consistently. Therapists primarily used the GMFCS to predict gross motor function, set realistic goals, and anticipate need for assistive technology. The American Physical Therapy Association Section on Pediatrics members were more likely than nonmembers to agree the GMFCS is useful, they are able to use it, that they use it, and that they use it consistently. CONCLUSIONS: The majority of therapists responding use the GMFCS, but not consistently. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, available at http://links.lww.com/PPT/A91.

Concurrent validity of the School Outcomes Measure (SOM) and Pediatric Evaluation of Disability Inventory (PEDI) in preschool-age children.

AIMS: The purpose of this study was to examine the concurrent validity of the School Outcomes Measure (SOM) compared with the Pediatric Evaluation of Disability Inventory (PEDI) in preschool-age children. This study also examined the consistency of children's motor performance across the home and school settings. METHODS: Five school-based physical therapists collected data on 44 preschool-age children with physical or combined physical and cognitive disability. Correlation coefficients analyzed the strength of association between SOM and PEDI subscale scores, while participant group mean scores analyzed agreement between measures regarding level of motor performance. RESULTS: Correlations between homologous PEDI and SOM subscale scores varied from rs = .53 to rs = .92 supporting concurrent validity. With some exceptions, group mean SOM scores showed agreement with group mean PEDI scores when children were categorized by age, gross motor function level, or PEDI cutoff score (1 or 2 SD below the mean). CONCLUSIONS: The results partially support concurrent validity between the SOM and PEDI, and suggest that the children's motor performance was similar across home and school settings. The findings also suggest that as a minimal database the SOM can reliably assess motor performance in the school setting; the disadvantage is difficulty interpreting SOM scores.

Proximal and distal environmental correlates of adolescent obesity.

BACKGROUND: The purpose of this study was to determine how proximal (home) and distal (neighborhood) environmental characteristics interact to influence obesity in early and middle adolescents. METHODS: This was a descriptive, cross-sectional study using the 2007 National Survey of Children's Health (NCSH). Participants were 39,542 children ages 11 to 17 years. Logistic regressions were used to examine the relationship between adolescent obesity and environmental factors, the relative strength of these factors, and the influence of age and gender. RESULTS: Proximal environmental factors were stronger correlates of adolescent obesity than distal environmental factors. Sedentary behavior related to TV watching time at home was the strongest correlate of adolescent obesity overall (OR 1.13, 95% CI 1.11-1.15). Parks and playgrounds (OR 0.86, 95% CI 0.08-0.92), as well as recreation centers (OR 0.91, 95% CI 0.85-0.97) were significant distal environmental factor correlates. Girls and middle adolescents were at less risk for obesity than boys and early adolescents (OR 0.51, 95% CI 0.68-0.82; OR 0.75, 95% CI 0.68-0.96). CONCLUSION: The results of this study reveal the importance of proximal environmental characteristics on adolescent obesity relative to distal environmental characteristics. Obesity intervention strategies for adolescents should target sedentary behavior and opportunities for physical activity with a focus on early adolescents and boys.

Exercise using the Wii Fit plus with a child with primary Raynaud's disease and obesity: a case report.

The purpose of this case report was to describe the use of the Nintendo® Wii Fit Plus as an alternative exercise for an 11-year-old child with primary Raynaud's disease (PRD) and obesity who was not involved in organized sports and had limited outdoor physical activity and exercise. The Wii Fit Plus exercise parameters are described as well as outcomes measured at baseline, 12 weeks, and 24 weeks. Specifically, we evaluated changes in body mass index (BMI), cardiorespiratory fitness, and health related quality of life (HRQL). Following the 24-week exercise program, the child's BMI decreased, cardiorespiratory fitness increased, and HRQL increased and were comparable to values in healthy children. These findings suggest that the Wii Fit Plus may have been an effective exercise strategy for this child.

How did the television get in the child's bedroom? Analysis of family interviews.

OBJECTIVE: Although recent research has shown associations between a television in the bedroom of children (BTV) and obesity, medical and negative societal consequences, the family decision making process supporting or opposing BTV is not yet understood. A qualitative research approach elicited rich, decision making experiences of families. METHODS: Structured family interviews (n=21) in spring 2011 in Oklahoma City captured direct quotations about family beliefs and practices related to BTV. Systematic constant comparative methods of grounded theory guided identification of patterns and themes across families to develop a model of family decision making for BTV. RESULTS: Nine themes represented family decision making processes for BTV. Supporting themes included "I didn't even think about it" and "benefit to me." Opposing themes included: "watch a lot more TV and get less sleep," "bedroom door would probably be closed a lot," "everyone knows it rots your brain," and "what the heck are they watching." CONCLUSIONS: Development of a conceptual model represented the basis for decisions opposing BTV in child concerns for development and missed opportunities while decisions supporting BTV reflected its use as a parenting tool. The emerged model could be useful in guiding strategies to modify family routines and address active and passive parenting strategies that negatively affect child health.

An investigation of the family practicum experience. Family and student perspectives.

Professional occupational therapy (OT) and physical therapy (PT) programs traditionally instruct students using volunteers, including children who have disabilities. Presenting a child before a classroom of students may deprive the child of dignity and may limit students' understanding of the child's disability and the importance of family-centered service delivery. An alternative approach that respects the child's privacy and promotes dignity is student observation in the context of the child's daily living. The Family Practicum Intervention Plan assignment (FPIP), part of the professional Neuro Rehab course, was created to facilitate students' understanding of a child with a disability while maintaining child dignity and family-centered values. This descriptive study explored, through two online surveys, the experiences of the OT and PT students and the families of children who participated in the FPIP. Additionally, the study investigated the influences of this participation on students' perceptions of family life and views of childhood disability. Overall, students and families perceived this assignment to be a good learning experience because it allowed the student to work within a real-life scenario and it gave the families an expert "voice" in the education of OT and PT students. The positive comments provided by the families and students and the desire of families to recommend the FPIP experience to other families suggest the value of the learning assignment. When developing OT and PT professional pediatric coursework, instructors should include assignments that take place in the child's natural environment to offer meaningful learning that maintains the dignity of the child.

The role of occupational therapists and physical therapists in elementary school system early intervening services and response to intervention: a case report.

The Individuals with Disabilities Improvement Act and No Child Left Behind Act broadened the roles of occupational therapists (OTs) and physical therapists (PTs) to include therapist participation in early intervening services including response to intervention (RTI). This case report describes one school district's inclusion of OT and PT in the elementary school RTI program by identifying and implementing role responsibility and changing workloads for therapists. Therapist responsibilities included (a) administering a screening tool, (b) educating and supporting teachers and staff, (c) providing student resources and intervention strategies, and (d) referring students from RTI to special education and related services. Teachers responded positively using therapist-provided strategies and support. Limitations included an increased workload because of large numbers of students to screen and very few staff available for screening. Future research should include longitudinal studies that measure student responses to therapy intervention, teacher responses to collaboration, and the use of intervention strategies over time.

Treadmill training in a child with cerebral palsy: a case report.

This case report describes the use of treadmill training without body weight support to improve walking speed in a child with diplegic cerebral palsy. The child was a six-year-old girl with spastic diplegic cerebral palsy. She walked short distances independently using a posterior support walker but was unable to keep up with her peers walking long distances. Speed of walking 50 feet and speed of walking from her classroom to the cafeteria (458 feet) were timed pretreadmill, posttreadmill, and 3 weeks following treadmill intervention. The GMFM-88 was administered pre- and posttreadmill intervention. Following treadmill intervention, the child's speed of walking increased and she was able to walk to the cafeteria daily with her peers. Improvements in the percent of maximum total score of the GMFM-88 were also observed. The outcomes of this case suggest that the use of short-term, task-specific treadmill intervention might increase a child's walking speed enough to increase their participation in the school setting.

Item test-retest reliability and responsiveness of the School Outcomes Measure (SOM).

The School Outcomes Measure (SOM) is a minimal data set designed to measure outcomes of students who receive school-based occupational therapy and physical therapy. The purpose of this study was to determine item test-retest reliability and the responsiveness to change of the SOM. Thirty-two occupational therapists and physical therapists collected data on 73 students, age 3-21 years, stratified into two groups based on the Gross Motor Function Classification System: those with mild/moderate functional limitations (Levels I, II, III) and those with severe functional limitations (Levels IV, V). Weighted kappa statistics (0.68-1.0) indicate good to excellent item test-retest reliability. Repeated measures analysis of variance indicated that the SOM is responsive to change in children with mild/moderate functional limitations but is less responsive to change in children with severe functional limitations. The findings support the use of the SOM to measure outcomes for students with mild/moderate functional limitations as well as enabling program evaluation of therapy services provided in school settings. More research is needed to evaluate responsiveness in students with severe functional limitations.

Interrater reliability and content validity of a minimal data set to measure outcomes of students receiving school-based occupational therapy and physical therapy.

BACKGROUND AND PURPOSE: The 1997 Amendments of the Individuals with Disabilities Education Act increased the emphasis on accountability for outcomes of students with disabilities in the United States. The purpose of this study was to determine the content validity and estimate the interrater reliability of the School Outcomes Measure, a new minimal data set to measure groups of students' performance in the areas addressed by school-based therapy. METHOD: Forty-five occupational therapists and physical therapists working in Oklahoma's public schools participated in the content validity study. Eight occupational therapist-physical therapist pairs rated 17 students for the interrater reliability study. Therapists were recruited and data were collected by mail for both studies. RESULTS: Most validity study participants thought the tool was comprehensive and clear, and that they could complete the tool twice a year for their students. The weighted kappa statistic indicated that the therapists' agreement was substantial (.73) to almost perfect (.96) for 25 of the 28 student functional status items. DISCUSSION: The results support the content validity and interrater reliability of the items. This study was an initial step in development of the tool and further studies are needed in the validation process.