Perceptions of the caregiver-pediatric physical therapist relationship1.

PURPOSE: Collaboration between physical therapists and caregivers of children who receive physical therapy is integral to providing family-centered care. Successful collaboration depends upon the therapeutic relationship built within the caregiver-therapist dyad. However, the nature of these relationships is not well understood. The purpose of this study was to explore the caregiver-pediatric physical therapist relationship from the perspectives of the caregiver and pediatric physical therapist. METHODS: A qualitative multiple case study methodology was used; a caregiver and pediatric physical therapist represented a bounded case. Each caregiver and therapist engaged in separate, semi-structured, in-depth interviews. RESULTS: Through within- and cross-case coding, three themes were identified: physical therapist as a guide, the caregiver-pediatric physical therapist connection, and professional qualities and performance. CONCLUSION: These themes help to provide an understanding of the therapeutic relationships that can occur between caregivers and pediatric physical therapists, which can help support effective collaboration as part of providing family-centered care.

Utilization of the Pediatric Modified Dynamic Gait Index: Issues Related to Child Development.

Aims: This cross-sectional study investigated how typically developing children performed on a version of the Dynamic Gait Index, modified for children (Pediatric Modified DGI). Methods: Seventy-four typically developing children, ages 7-18 years, were evaluated using the Pediatric Modified DGI. Scores were analyzed in three age groups using descriptive statistics for age-related performance. The Kruskal-Wallis and Mann-Whitney U tests were used to evaluate group differences. Results: Children performed differently on the Pediatric Modified DGI between the three groups (Kruskal-Wallis H(2) = 18.819, p < .05). Mann-Whitney U post hoc testing identified significant differences between the 7 to 10 and the 15 to 18-year-old groups (U = 128.5, p = .000, r = -.54) and between the 11 to 14 and the 15 to 18-year-old groups (U = 139, p = .001, r = -.46). Pediatric modified DGI scores were notably different between the three age groups on three of the items: horizontal head turn, vertical head turn, and pivot turn. Conclusions: Children's age appears to impact performance on the pediatric modified DGI, which should be considered when using this tool to examine functional mobility. Future studies should explore functional mobility assessments that consider sensory system development.

Linking the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) to the International Classification of Function.

PURPOSE: The purpose of the current study was to examine how comprehensively the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) addresses Activity and Participation components of the International Classification of Functioning, Disability, and Health (ICF). METHODS: Two raters individually linked the 276 items of the PEDI-CAT to the ICF using ICF linking rules, the PEDI-CAT manual, and the ICF browser. Agreement between reviewers was evaluated, and reliability of the linking process was assessed using Cohen's κ. RESULTS: All 9 chapters of Activity and Participation were represented within the PEDI-CAT. The highest frequency of representation was in Mobility (43%) and Self-care (20%) chapters. Agreement between the 2 raters was strong (κ = 0.84). Two items were not definable in the ICF, and 3 linked to Body Function codes. CONCLUSIONS: The PEDI-CAT was strongly representative of the Activities and Participation component of the ICF. The linking process had substantial reliability.

Collaborating with Communities and Higher Education to Address the Health-care Needs of Individuals with Disabilities in Ecuador.

Individuals with disabilities experience inequities in access to health care, education, employment, and social inclusion. Causes for Change International (CCI), a non-governmental Organization (NGO), using a community-based rehabilitation approach has worked for 20 years to build self-sufficiency, improve health-care services, and education for women, children, and persons with disabilities in Ecuador. CCI initially addressed health; advocacy for individuals with disabilities; and promoted educational opportunities for children with disabilities, starting in one rural community. CCI's outreach has expanded through Ecuador's coastal provinces, Andean provinces, and Galapagos Islands. CCI also focused on local health-care workforce development, developing employment skills for individuals with disabilities and social inclusion for this population. CCI collaborated with local organizations, government, and universities to provide resources, managed by local leadership. Key program elements of the CCI approach include (1) develop trust between CCI, local communities, local agencies, and government; (2) empower local groups to assume leadership and sustain programs; (3) support communities and groups invested in developing self-sufficiency; and (4) strengthen collaborations and partnerships between local and international organizations, universities, and government agencies. Key lessons learned by CCI are to be supportive of cultural differences; understand that limited financial and material resources may limit the program development; recognize that it is difficult not to foster dependent relationships with communities and appreciate the importance of working with and within the host country's governmental systems. CCI is expanding its service base to other regions of Ecuador and is focusing on development of the Ecuadorian health-care workforce and social inclusion opportunities for individuals with disability. The efforts of a small NGO have helped build community self-sufficiency in meeting the health care and rehabilitation needs of all Ecuadorian citizens and a greater awareness of the abilities and potential contributions of individuals with disabilities.

Use of music during physical therapy intervention for an infant with Erb's palsy: a single-subject design.

Evidence supporting the use of music during pediatric physical therapy intervention is limited. The purpose of this single-subject design was to evaluate the effects of music on patient progress, the amount of crying during therapy, and parent satisfaction with physical therapy services. The subject was an infant girl with Erb's palsy who participated in this study from age 8 months to age 20 months. An A-B-A withdrawal single-subject design was used. The patient's progress was assessed by using the T.I.M.E. The amount of crying was documented in the Crying Log. A parent satisfaction questionnaire was administered three times over the course of the study. The subject's progress in the music intervention period increased on three of five primary subtests of the T.I.M.E. The amount of crying decreased and parent satisfaction increased when music was played during therapy. Music may be used by pediatric physical therapists to decrease the patient's crying, increase parent satisfaction, and possibly to increase the child's rate of progress. Further research conducted with a group of infants and toddlers may help generalize these findings to a wider patient population.

Evaluation of the primary subtests of toddler and infant motor evaluation: implications for clinical practice in pediatric physical therapy.

PURPOSE: The Toddler and Infant Motor Evaluation (T.I.M.E., The Psychological Corporation, San Antonio, Tex) is a norm-referenced, comprehensive qualitative assessment of the motor abilities of children between the ages of four months and 3.5 years. The purpose of this article is to describe the strengths and the limitations of the primary subtests of the T.I.M.E. on the basis of the previously published reviews, the authors' clinical experience, and two A-B-A single-subject studies. SUMMARY OF KEY POINTS: Five primary subtests of the T.I.M.E. and their possible modifications for the future use by pediatric clinicians are discussed. CONCLUSIONS: The T.I.M.E. is a family-friendly assessment tool that can be used by pediatric clinicians who work with infants and toddlers. Although it has high test-retest and interrater reliability, our use of the instrument in two case studies has revealed several structural and scoring problems. Physical therapists using the T.I.M.E. for research and in clinical practice should be aware of its strengths and limitations.