Perception-Action Approach Versus Standard Care for Infants With Congenital Muscular Torticollis: A Pilot Single-Blind Randomized Controlled Trial.

OBJECTIVE: The purposes of this pilot study were to compare short-term outcomes of the Perception-Action Approach (P-AA) and standard care based on 5 components of first-choice interventions listed in the congenital muscular torticollis (CMT) clinical practice guideline. Changes in postural alignment, symmetrical use of both sides of the body during movement and play, gross motor development, and behavior observed during therapy were considered. METHODS: Thirty-two participants were enrolled in a 2-group (P-AA and standard care) randomized, single-blind trial with pre-posttest measures. Participants were infants with CMT, age range 5 to 35 weeks at enrollment. Outcome measures administered at initial and final evaluations included still photography, arthrodial goniometry, Muscle Function Scale, Alberta Infant Motor Scale, and Functional Symmetry Observation Scale. Participants in both groups attended 3 intervention sessions. Their behavior exhibited during therapy was compared using the Therapy Behavior Scale Version 2.2. RESULTS: Data collection was interrupted by the COVID-19 pandemic lockdown. Twenty-four infants completed the study (10 in P-AA and 14 in the standard care group). There were no significant differences between the groups in performance at initial and final evaluations. Both groups improved on most outcome measures. The P-AA group made greater gains on the Functional Symmetry Observation Scale, and the Therapy Behavior Scale Version 2.2 scores were higher in the P-AA group; however, these results did not reach significance. CONCLUSION: Results suggest that similar short-term outcomes may be obtained in infants with CMT undergoing P-AA and standard care interventions. Definitive conclusions regarding the efficacy of the P-AA in infants with CMT cannot be made at this time. Nevertheless, the pilot findings provide valuable preliminary data for a future efficacy trial, which will require funding. IMPACT: This was the first randomized controlled trial to provide evidence for use of P-AA intervention in infants with CMT. LAY SUMMARY: Compared to standard treatment, the Perception-Action Approach (P-AA) provided similar short-term benefits to infants with congenital muscular torticollis. The P-AA group participants demonstrated higher symmetry and behavior scores, which needs to be confirmed in a larger future study.

Reliability of the Therapy Behavior Scale version 2.2 in infants with congenital muscular torticollis: A pilot study.

BACKGROUND: The Therapy Behavior Scale (TBS) is a standardized instrument that is used to evaluate behavior of infants and toddlers during physical, occupational, and developmental therapy sessions. The TBS can be applied in intervention comparison research to assess therapy-related behaviors exhibited by study participants. PURPOSE: The purpose of this pilot study was to establish the reliability of the TBS Version 2.2 prior to its use in a randomized clinical trial comparing two physical therapy (PT) interventions in infants with congenital muscular torticollis (CMT). METHODS: Three infants with right and 7 with left CMT, severity grades 1-3, 3 girls and 7 boys, age range 3-6 months, participated in this research. Examiners were 2 experienced pediatric physical therapists. To obtain the intrarater reliability estimates, each examiner conducted 2 PT sessions with 5 infants and scored their behavior "live," and then scored the video recordings of these 10 sessions at least 1 month later. To obtain the interrater reliability estimates, both examiners scored a total of 20 video recordings. RESULTS: Results indicated good intrarater reliability, with ICC (3,1) of 0.92, 95% CI = 0.81-0.99, and 0.95, 95% CI = 73-0.98, and moderate to good interrater reliability, with ICC (2,1) of 0.84, 95% CI = 0.48-0.96, and 0.91, 95% CI = 0.67-0.98. CONCLUSION: This study established the reliability of the TBS Version 2.2 for 2 examiners who subsequently used it in a RCT of 2 PT interventions. Further research is necessary to demonstrate the reliability of this instrument in a larger population of infants with CMT, and in infants and toddlers with other conditions.

Applying the Pit Crew Resuscitation Model to the Inpatient Care Setting.

The Pit Crew Resuscitation model for team performance was designed to facilitate emergency team performance. This article documents observations during model implementation to the in-hospital setting. Low-fidelity simulations were evaluated on medical-surgical nursing units. Six significant findings were obtained: finder confusion, first responder chaos, leaderless teams, equipment disorder, limited space, and disjointed integration. Recommendations were developed and tested. Research is needed to develop training methods for in-hospital application.

A community-based family intervention program to improve obesity in Hispanic families.

INTRODUCTION: The Waukesha County Division of Public Health and Waukesha Memorial Hospital developed a social-ecological approach to diminish the incidence of overweight and obesity in Hispanic families in Waukesha County. PROGRAM DESCRIPTION: A sample of Waukesha County children and their families participated in an 8-week program that promoted awareness of healthy food choices and the importance of physical activity. The program was selected, translated, and adapted for the Hispanic community. Weekly sessions included nutrition classes, physical activity, and a healthy meal for participating families. Biometric data were collected pre- and post-program, including blood pressure, cholesterol, glucose, weight, height, and waist measurement. A pre- and post-program knowledge test regarding nutrition, food labels, and physical activity was administered. RESULTS: A total of 47 Hispanic families participated throughout the course of the program. Biometric measures and tests of nutrition knowledge and attitudes of participants consistently showed improvements. In addition, changes occurred in the community system structure, which positively affected the built environment by improving access to parks, YMCA, and schools for family physical activity. CONCLUSION: The translated curriculum was successful in reducing cardiac and diabetes risk factors in Hispanic adults by increasing knowledge and positive attitudes about healthy behaviors.

Syndromic surveillance using regional emergency medicine internet.

STUDY OBJECTIVE: We demonstrate the feasibility and utility of emergency department (ED) syndromic surveillance using a regional emergency medicine Internet application to minimize impact on ED and public health staffing. METHODS: Regional (multi-ED) surveillance was established for 2 periods, one characterized by a high-profile national sports event and the other during an international disease outbreak. Counts of patient visits meeting syndrome criteria and total patient visits were reported daily on the secure regional emergency medicine Internet site and downloaded by public health staff. Trends were analyzed and displayed on the secure Web site. ED participants were surveyed about the acceptability and time cost of the project. RESULTS: In the first ("All Star Game") project, 8 departments reported daily counts for 4 weeks, covering more than 26,000 patient visits. In the second ("severe acute respiratory syndrome" [SARS]) project, an average of 11 departments in the same region reported daily data on febrile respiratory illnesses, travel, and contacts for 10 weeks. Experience with the first project allowed for rapid implementation of the second project during a 3-day period. In both instances, the surveillance efforts were undertaken without the need for extraordinary ED or public health staffing requirements. CONCLUSION: A regional emergency medicine Internet approach permitted rapid implementation of multisite syndromic surveillance without additional staff. Some problems were identified with the first project, related to clinician checklist completion and manual data tabulation and entry. The SARS project addressed these by simplifying data collection and restricting it to triage.