Adaptive behavior and mastery motivation in children with physical disabilities.

BACKGROUND: Adaptive behavior consists of conceptual, social, and practical skills and describes the ability of individuals to manage environmental demands, interact with others, and engage in activities to meet ones needs. Mastery motivation is an intrinsic characteristic that enables persistence when attempting to master a skill. Children with physical disabilities often demonstrate less effective adaptive behaviors and lower mastery motivation than their peers without disabilities, which may subsequently impact development and participation in daily activities. Therefore, it may be beneficial for pediatric rehabilitation practitioners to focus intentionally on facilitating effective adaptive behaviors in children with physical disabilities as they aim to support child development and function. OBJECTIVE: This perspective paper highlights the importance of adaptive behavior for children with physical disabilities, discusses methods of assessment, and illustrates intervention principles and strategies to support the development of appropriate adaptive behaviors across childhood. Key intervention principles include: 1) engage children and address motivation; 2) collaborate with others; 3) support real-life meaningful experiences; 4) scaffold the just-right challenge; and 5) guide children in discovering solutions.

Child engagement in daily life measure V2: validation of psychometric properties for children with cerebral palsy.

PURPOSE: Measurement development is a reiterative process requiring refinements and revalidation. The purpose of this study was to examine structural validity and reliability of the Child Engagement in Daily Life Measure (Version 2) for parents of children with cerebral palsy (CP) across a broader age span. METHODS: Participants were 1054 parents of children with CP 1.5-11 years of age. Parents completed the Child Engagement in Daily Life measure that consists of the Participation in Family and Recreational Activities domain (11 items) and the Performance of Self-care Activities domain (18 items) as part of two longitudinal studies related to outcomes for children with CP. RESULTS: Rasch analysis indicated acceptable fit of items, stable item calibration, and logical ordering of items by difficulty for both frequency of participation in family and recreational activities and performance of self-care activities. Test-retest reliability was good to excellent: ICC = 0.78 for frequency of participation, ICC = 0.68 for enjoyment of participation, and ICC = 0.97 for self-care. CONCLUSIONS: Evidence supports reliability and validity of the Child Engagement in Daily Life Measure (Version 2) for parent-report of their children's participation in family and recreational activities and performance of self-care activities for children with CP 1.5-12 years of age.IMPLICATIONS FOR REHABILITATIONParticipation in family and recreational activities and performance of self-care activities of children with cerebral palsy can be assessed using the concise parent-report Child Engagement in Daily Life Measure V2.Knowledge of the continuum of difficulty of the frequency of participation in family and recreational activities and performance of self-care activities can assist practitioners in progressing service plans.Practitioners are encouraged to use the measure to guide discussions with parents and children on areas to focus services to support participation in family and recreational activities and performance of self-care activities.

Understanding Acceptability, Barriers, and Facilitators to Clinical Implementation of the on Track Developmental Monitoring System for Children with Cerebral Palsy: A Qualitative Study.

AIMS: On Track Developmental Monitoring System (DMS) is a novel series of tools to assist in shared-decision making, guide rehabilitation intervention based on functional ability levels, and promote episodic care service models. Further understanding of the acceptability, feasibility, and appropriateness of On Track DMS in clinical settings is critical. The purpose of this study was to understand clinician perspectives of the acceptability of On Track DMS and to identify potential implementation barriers and facilitators within pediatric physical therapist practice. METHODS: Three, day-long training workshops were conducted with 32 pediatric physical therapists across the US. Focus groups with 21 workshop participants were conducted following training. Results were audio recorded, transcribed verbatim, and coded into themes. RESULTS: Three themes emerged from the data: (1) Valuing the On Track Approach to Intervention; (2) Setting-Specific Needs and Challenges to Implementation; and (3) Training Material/Tool Strengths and Limitations. CONCLUSIONS: On Track DMS appears to have initial value and acceptability for pediatric physical therapists across practice settings. Perceived benefits include facilitation of data-driven practice and therapist/family collaboration to improve health outcomes for children with CP. Using this data to understand and assess barriers and facilitators to knowledge use are first steps in successfully implementing On Track DMS.

The SIT-PT Trial Protocol: A Dose-Matched Randomized Clinical Trial Comparing 2 Physical Therapist Interventions for Infants and Toddlers With Cerebral Palsy.

OBJECTIVE: Although early intervention for infants at risk for cerebral palsy is routinely recommended, the content of intervention is poorly described, varies widely, and has mixed supporting evidence. The purpose of this study was to compare efficacy of 2 interventions grounded in differing domains of the International Classification of Functioning, Disability and Health on developmental outcomes of infants with or at high risk of cerebral palsy. METHODS: Infants who meet inclusion criteria will be randomized into either Sitting Together and Reaching To Play or Movement, Orientation, Repetition, Exercise Physical Therapy groups. Both groups will receive intervention twice weekly for 3 months and follow-up at 3, 6, 9, and 12 months from baseline. The primary objectives compare changes over time and between groups in sitting, gross motor, and cognitive development. The setting is the infant's home unless the caregiver requests otherwise. One hundred and fifty infants between 8 and 24 months of age will be enrolled in 3 geographically, racially, and ethnically diverse sites: Los Angeles, California; Omaha, Nebraska; and Seattle, Washington. Enrolled infants will demonstrate motor delays, emerging sitting skills, and signs of neurologic impairment. Sitting Together and Reaching To Play targets activities including sitting, reaching, and motor-based problem solving to improve global development. In contrast, Movement, Orientation, Repetition, Exercise Physical Therapy focuses on strengthening and musculoskeletal alignment while encouraging repeated movement practice. Outcome measures include the Gross Motor Function Measure, Bayley Scales of Infant Development-IV, Assessment of Problem Solving in Play, and a Parent Child Interaction assessment. Enrolled children will maintain usual intervention services due to ethical concerns with intervention withdrawal. IMPACT: This will be the first study, to our knowledge, comparing efficacy of early physical therapy with dose-matched interventions and well-defined key principles. The outcomes will inform selection of key principle of intervention in this population.

Measuring Early Problem-Solving in Young Children with Motor Delays: A Validation Study.

AIM: There is a lack of evidence-based tools for measuring problem-solving in young children with motor delays. The purpose of this study was to evaluate the construct validity and responsiveness of the Assessment of Problem-Solving in Play. METHODS: 125 young children (10.72, SD 2.62 months) with mild, moderate, and severe motor delays were assessed with the Bayley Scales of Infant and Toddler Development, Third Edition Cognitive Scale and the Assessment of Problem-Solving in Play up to 4 times over 12 months. The baseline and change over time assessment scores were compared. RESULTS: The Assessment of Problem-Solving in Play was strongly, positively correlated with the Bayley Scales of Infant and Toddler Development, Third Edition Cognitive Scale raw scores at baseline (r=.83, p<.001) and for changes in scores across time (r=.64, p<.001). On average, participants demonstrated positive change in problem-solving scores across time. Participants with severe motor delay scored lower at baseline and changed less as compared to other participants. CONCLUSIONS: Results provide evidence for the construct validity and responsiveness of the Assessment of Problem-Solving in Play scores in quantifying problem-solving in young children with motor delays 7-27 months of age.

Information access and sharing among prosthetics and orthotics faculty in Ghana and the United States.

BACKGROUND: Information access is essential for quality healthcare provision and education. Despite technological advances, access to prosthetics and orthotics information in low- and middle-income countries is not ubiquitous. The current state of information access, availability, and exchange among prosthetics and orthotics faculty is unknown. OBJECTIVES: Describe information exchange networks and access at two prosthetics and orthotics programs in Ghana and the United States. STUDY DESIGN: Cross-sectional survey, social network analysis. METHODS: An online survey of faculty at two prosthetics and orthotics programs using REDCap. The survey included a social network analysis, demographics, and prosthetics and orthotics information resources and frequency of use. Descriptive statistics were calculated. RESULTS: Twenty-one faculty members completed the survey (84% response). Ghanaian faculty were on average younger (median Ghana: 27 years, United States: 43 years), had less teaching experience, and had less education than US faculty. Textbooks were the most commonly used resource at both programs. The Ghanaian network had more internal connections with few outside sources. The US network had fewer internal connections, relied heavily upon four key players, and had numerous outside contacts. CONCLUSION: Ghana and US faculty have two distinct information exchange networks. These networks identify key players and barriers to dissemination among faculty to promote successful knowledge translation of current scientific literature and technology development. Social network analysis may be a useful method to explore information sharing among prosthetics and orthotics faculty, and identify areas for further study.

Motor performance and sensory processing behaviors among children with fetal alcohol spectrum disorders compared to children with developmental coordination disorders.

BACKGROUND: Children with fetal alcohol spectrum disorders (FASD) and developmental coordination disorders (DCD) may show similar clinical sensory-motor symptoms. AIMS: This study aimed to compare motor skills and sensory processing behaviors between these two groups. METHODS AND PROCEDURES: In this retrospective analysis, we examined secondary data and used multivariate analysis of variance to compare the Movement Assessment Battery for Children-2 (MABC-2) and Sensory Processing Measure (SPM)-Home for 21 children with FASD and 21 with DCD without prenatal alcohol exposure, ages 5-13 years. OUTCOMES AND RESULTS: No significant group differences in mean total motor or subtest scores on the MABC-2 were detected, but a higher proportion of children with DCD had more severe motor delays. Both groups had sensory processing difficulties, but the children with FASD had significantly more sensory processing difficulties on the SPM total score and visual, touch, body awareness, and planning subscales. CONCLUSIONS AND IMPLICATIONS: The sensory processing symptoms in children with FASD distinguished the two groups. These group differences between children with FASD and DCD need corroboration in larger samples but haveimplications for differential diagnosis, clinical assessment, and targeted intervention.

Physical, occupational, and speech therapy for children with cerebral palsy.

AIM: To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP). METHOD: We conducted a prospective, longitudinal study involving 656 children with CP (mean age [SD] 6y [2y 8mo] at study entry; 1y 6mo-11y 11mo; 287 females, 369 males), and their parents. Children were assessed two to five times over 2 years by therapists using standardized measures of balance and walking endurance. Parents completed questionnaires on demographics, rehabilitation therapies, and their children's performance in self-care and participation in recreation. Therapists and parents collaboratively classified children's Gross Motor Function Classification System (GMFCS) levels. We created longitudinal graphs for each GMFCS level, depicting change across time using centiles. Using multinomial models, we analyzed the relationship between therapies (amount, focus, family-centeredness, and the extent therapies met children's needs) and whether change in balance, walking endurance, and participation was 'more than' and 'less than' the reference of 'as expected'. RESULTS: Children were more likely to progress 'more than expected' when participating in recreation when therapies were family-centered, met children's needs, and focused on structured play/recreation. A focus on health and well-being was positively associated with participation and self-care. The amount of therapy did not predict outcomes. INTERPRETATION: Therapy services that are family-centered, consider the needs of the child, and focus on structured play/recreational activities and health/well-being may enhance the development of children with CP. WHAT THIS PAPER ADDS: Family-centered rehabilitation therapies were positively associated with greater participation in family/recreation activities and walking endurance. Parental perception that rehabilitation therapies met children's needs was associated with greater participation in family/recreation activities. Structured play, recreational activities, and health/well-being are important for self-care and participation when planning rehabilitation therapy. The amount of rehabilitation therapy was not related to developmental outcomes.

Relationship of School-Based Physical Therapy Services to Student Goal Achievement.

PURPOSE: To explore the relationships of school-based physical therapy services to student goal achievement. METHODS: One hundred nine physical therapists and 296 students participated in a practice-based study. Therapists formatted goals using goal attainment scaling and evaluated goal achievement. Using the School-Physical Therapy Interventions for Pediatrics system, therapists documented services weekly for 20 weeks. Group comparisons and logistic regressions were conducted. RESULTS: For primary goals, no documented physical therapy services were associated with exceeding goal expectation. For posture/mobility goals, more minutes in self-care activities and services on behalf of the students were associated with exceeding goal expectation; use of cognitive and behavioral training interventions was associated with not exceeding goal expectation (P < .05). For recreation/fitness goals, greater use of functional strength and mobility for playground access and cognitive/behavioral interventions were associated with exceeding goal expectation (P < .05). CONCLUSION: A limited number of physical therapy services was associated with exceeding goal expectation.

Developmental Trajectories for the Early Clinical Assessment of Balance by Gross Motor Function Classification System Level for Children With Cerebral Palsy.

Background: Children with cerebral palsy (CP) characteristically present with impairments in balance. Currently, the pattern and timing of the development of balance ability have not been described for children with CP of varying Gross Motor Function Classification System (GMFCS) levels. Objective: The purpose of this study was to document longitudinal developmental trajectories in a measure of balance, the Early Clinical Assessment of Balance (ECAB) scores, along with age-specific reference percentiles and the amount of change typical over a 1-year period for children within different GMFCS levels. Design: The design was a longitudinal cohort study. Methods: Participants included 708 children with CP, aged 18 months through their 12th birthday, and their families. Children participated in 2 to 5 assessments using the GMFCS and ECAB. Results: Longitudinal trajectories describing the average change in the ECAB score with respect to age were created by fitting separate nonlinear mixed-effect models for children in each GMFCS level. Reference percentiles were constructed using quantile regression of ECAB data from the first visit (baseline) and 12-month and 24-month visits. Using these reference points, the amount of change in percentiles was calculated for all children by subtracting the baseline percentile score from the 12-month percentile score. Children whose percentile changes are within the 80% limits can usually be described as "developing as expected" for their age and GMFCS levels. Limitations: Limitations of this study included use of a convenience sample, a ceiling effect of the ECAB for some children in GMFCS levels I and II, and the use of both a 12-month and 24-month study protocol that impacted the number of children available for each assessment session. Conclusions: When used appropriately to monitor development and change over time for children with CP, the ECAB longitudinal trajectories, reference percentiles, and the associated change scores presented here should assist therapists and families in collaborative interaction to proactively plan services and interventions relative to balance ability.

Determinants of playfulness of young children with cerebral palsy.

PURPOSE: To identify child, family, and service determinants of playfulness of young children with cerebral palsy. METHODS: Participants were 429 children, 18-60 months. Children were divided into two groups, Gross Motor Function Classification System levels I-II and III-V. Therapists collected data on body functions and gross motor function; parents provided information about children's health conditions and adaptive behavior, family life, and services. One year after the beginning of the study, therapists assessed children's playfulness. Data were analyzed using structural equation modeling. RESULTS: Higher gross motor function was associated with higher playfulness for both groups. Greater impact of health conditions on daily life was associated with lower playfulness for children in levels I-II. More effective adaptive behavior was associated with higher playfulness, and higher parent perception of therapists' family-centeredness was associated with lower playfulness for children in levels III-V. CONCLUSION: Supporting gross motor function, health, and adaptive behavior may foster playfulness.

"Look, Your Muscles Are Firing!": A Qualitative Study of Clinician Perspectives on the Use of Surface Electromyography in Neurorehabilitation.

OBJECTIVE: To examine the perceived value, benefits, drawbacks, and ideas for technology development and implementation of surface electromyography recordings in neurologic rehabilitation practice from clinical stakeholder perspectives. DESIGN: A qualitative, phenomenological study was conducted. In-depth, semistructured interviews and focus groups were completed. Sessions included questions about clinician perspectives and demonstrations of surface electromyography systems to garner perceptions of specific system features. SETTING: The study was conducted at hospital systems in a large metropolitan area. PARTICIPANTS: Adult and pediatric physical therapists, occupational therapists, and physiatrists from inpatient, outpatient, and research settings (N=22) took part in the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Interviews and focus groups were audio-recorded, transcribed verbatim, then coded for analysis into themes. RESULTS: Four major themes emerged: (1) low-tech clinical practice and future directions for rehabilitation; (2) barriers to surface electromyography uptake and potential solutions; (3) benefits of surface electromyography for targeted populations; and (4) essential features of surface electromyography systems. CONCLUSIONS: Surface electromyography systems were not routinely utilized for assessment or intervention following neurologic injury. Despite recognition of potential clinical benefits of surface electromyography use, clinicians identified limited time and resources as key barriers to implementation. Perspectives on design and surface electromyography system features indicated the need for streamlined, intuitive, and clinically effective applications. Further research is needed to determine feasibility and clinical relevance of surface electromyography in rehabilitation intervention.

Description of the Services, Activities, and Interventions Within School-Based Physical Therapist Practices Across the United States.

Background: Students with disabilities receive school-based physical therapy services under the Individuals with Disabilities Education Improvement Act of 2004. Little research exists regarding therapy services in schools. Objective: This study explored the school-based services that students received and the activities and interventions that physical therapists implemented, and determined if services differed based on the student's functional gross motor ability and age. Design: This was a prospective observational cohort study using a practice-based evidence design. Methods: Data were collected by 109 physical therapists for 296 students, aged 5 to 12 years, receiving school-based physical therapy. Physical therapists completed the School-Physical Therapy Interventions for Pediatrics data form for 20 weeks during 1 school year. This evaluation included the type of service delivery, the amount of time spent on each student (consultation/documentation), minutes spent in activities, the specific interventions implemented, and the student's level of participation. The Gross Motor Function Classification System (GMFCS) was used to describe the students' functional ability. Results: Physical therapists provided an average of 26.7 min/wk (standard deviation [SD] = 15.1) of direct services and 13.1 min/wk (SD = 7.7) of services on behalf of the student. Primary activities were physical education/recreation (7.7 min/wk, SD = 8.2), mobility (6.7 min/wk, SD = 7.9), and sitting/standing/transitions (6.3 min/wk, SD = 8.1). Primary interventions were neuromuscular (32.5 counts per student, SD = 15.9), mobility (15.3 counts per student, SD = 14.65), and musculoskeletal (14.4 counts per student, SD = 10.3). Differences existed based on GMFCS but not student age. Limitations: Physical therapists reported School-Physical Therapy Interventions for Pediatrics data weekly, not necessarily after each therapy session. The GMFCS was used as a proxy of students' functional gross motor ability. Conclusions: Our description of services is provided to encourage physical therapists to reflect on the services they provide and to foster future examinations of service effectiveness.

Motor Planning and Gait Coordination Assessments for Children with Developmental Coordination Disorder.

AIMS: The purposes were to examine construct validity of the Motor Planning Maze Assessment (Maze) and three items from the Functional Gait Assessment (FGA) that were modified for children (pediatric modified FGA, pmFGA), by comparing performance of children with DCD and age matched peers with typical development (TD); the construct validity of total scores of the Dynamic Gait Index (DGI) and the FGA. METHODS: Twenty pairs of children with DCD and TD, age from 5 to 12 years, participated in this study. Children in both groups were tested on the Maze, pmFGA, DGI, and FGA. Paired t-tests and agreement tables were used to compare the motor performances between two groups. RESULTS: The DCD group showed higher summary scores in the Maze (p < 0.001) and demonstrated significantly fewer steps (p ≤ 0.001) while doing the pmFGA items than the TD group. However, the FGA quality scores demonstrated minimal differences between the two groups on all three items. Children with DCD showed significantly lower DGI and FGA total scores (p < 0.001) than the TD group. CONCLUSION: The Maze, DGI, and FGA tests are easily applied in clinical settings and can differentiate motor planning and gait coordination between children with DCD and with TD.

Stability of the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System.

AIM: To determine the stability of the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) over 1-year and 2-year intervals using a process for consensus classification between parents and therapists. METHOD: Participants were 664 children with cerebral palsy (CP), 18 months to 12 years of age, one of their parents, and 90 therapists. Consensus between parents and therapists on level of function was ≥92% for the GMFCS, MACS, and CFCS. A linearly weighted kappa coefficient of ≥0.75 was the criterion for stability. RESULTS: Kappa coefficients varied from 0.76 to 0.88 for the GMFCS, 0.59 to 0.73 for the MACS, and 0.57 to 0.77 for the CFCS. For children younger than 4 years of age, level of function did not change for 58.2% on the GMFCS, 30.3% on the MACS, and 39.3% on the CFCS. For children 4 years of age or older, level of function did not change for 72.3% on the GMFCS, 49.1% on the MACS, and 55% on the CFCS. INTERPRETATION: The findings support repeated classification of children over time. The kappa coefficients for the GMFCS are attributed to descriptions of levels for each age band. Consensus classification facilitates discussion between parents and professionals that has implications for shared decision-making. WHAT THIS PAPER ADDS: The findings support repeated classification of children over time. Stability was higher for the Gross Motor Function Classification System than the Manual Ability Classification System and Communication Function Classification System. The function of younger children was more likely to be reclassified. Percentage agreement between parents and therapists using consensus classification varied from 92% to 97%. The intraclass correlation coefficient overestimated stability compared with the weighted kappa coefficient.

School-based physical therapy services and student functional performance at school.

AIM: We explored relationships of school-based physical therapy to standardized outcomes of students receiving physical therapy. METHOD: Using a practice-based evidence research design, School Function Assessment (SFA) outcomes of 296 students with disabilities (mean age 7y 4mo [standard deviation 2y]; 166 males, 130 females), served by 109 physical therapists, were explored. After training, therapists completed 10 SFA scales on students at the beginning and end of the school year. Therapists collected detailed weekly data on services (activities, interventions, types, student participation) using the School-Physical Therapy Interventions for Pediatrics (S-PTIP) system. Stepwise linear regressions were used to investigate S-PTIP predictors of SFA outcomes. RESULTS: Predictors of SFA section outcomes varied in strength, with the coefficient of determination (R2 ) for each outcome ranging from 0.107 to 0.326. Services that correlated positively with the SFA outcomes included mobility, sensory, motor learning, aerobic/conditioning, functional strengthening, playground access interventions, and higher student participation during therapy (standardized ß=0.11-0.26). Services that correlated negatively with the SFA outcomes included providing services within student groups, within school activity, with students not in special education, during recreation activities, and with positioning, hands-on facilitation, sensory integration, orthoses, and equipment interventions (standardized ß=-0.14 to -0.22). INTERPRETATION: Consideration of outcomes is prudent to focus services. Overall results suggest we should emphasize active mobility practice by using motor learning interventions and engaging students within therapy sessions. WHAT THIS PAPER ADDS: No specific interventions predicted positively on all School Function Assessment (SFA) outcomes. Active movement practice seems related to overall better SFA outcomes. Active mobility practice improved SFA participation, mobility, recreation, and activities of daily living. Engaging students in therapy activities and interventions improved outcomes.

Response to Tendon Vibration Questions the Underlying Rationale of Proprioceptive Training.

CONTEXT: Proprioceptive training on compliant surfaces is used to rehabilitate and prevent ankle sprains. The ability to improve proprioceptive function via such training has been questioned. Achilles tendon vibration is used in motor-control research as a form of proprioceptive stimulus. Using measures of postural steadiness with nonlinear measures to elucidate control mechanisms, tendon vibration can be applied to investigate the underlying rationale of proprioceptive training. OBJECTIVE: To test whether the effect of vibration on young adults' postural control depended on the support surface. DESIGN: Descriptive laboratory study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Thirty healthy adults and 10 adults with chronic ankle instability (CAI; age range = 18-40 years). INTERVENTION(S): With eyes open, participants stood in bilateral stance on a rigid plate (floor), memory foam, and a Both Sides Up (BOSU) ball covering a force platform. We applied bilateral Achilles tendon vibration for the middle 20 seconds in a series of 60-second trials and analyzed participants' responses from previbration to vibration (pre-vib) and from vibration to postvibration (vib-post). MAIN OUTCOME MEASURE(S): We calculated anterior-posterior excursion of the center of pressure and complexity index derived from the area under multiscale entropy curves. RESULTS: The excursion response to vibration differed by surface, as indicated by a significant interaction of P < .001 for the healthy group at both time points and for the CAI group vib-post. Although both groups demonstrated increased excursion from pre-vib and from vib-post, a decrease was observed on the BOSU. The complexity response to vibration differed by surface for the healthy group (pre-vib, P < .001). The pattern for the CAI group was similar but not significant. Complexity changes vib-post were the same on all surfaces for both groups. CONCLUSIONS: Participants reacted less to ankle vibration when standing on the BOSU as compared with the floor, suggesting that proprioceptive training may not be occurring. Different balance-training paradigms to target proprioception, including tendon vibration, should be explored.

Interventions to improve gross motor performance in children with neurodevelopmental disorders: a meta-analysis.

BACKGROUND: Gross motor skills are fundamental to childhood development. The effectiveness of current physical therapy options for children with mild to moderate gross motor disorders is unknown. The aim of this study was to systematically review the literature to investigate the effectiveness of conservative interventions to improve gross motor performance in children with a range of neurodevelopmental disorders. METHODS: A systematic review with meta-analysis was conducted. MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, PEDro, Cochrane Collaboration, Google Scholar databases and clinical trial registries were searched. Published randomised controlled trials including children 3 to ≤18 years with (i) Developmental Coordination Disorder (DCD) or Cerebral Palsy (CP) (Gross Motor Function Classification System Level 1) or Developmental Delay or Minimal Acquired Brain Injury or Prematurity (<30 weeks gestational age) or Fetal Alcohol Spectrum Disorders; and (ii) receiving non-pharmacological or non-surgical interventions from a health professional and (iii) gross motor outcomes obtained using a standardised assessment tool. Meta-analysis was performed to determine the pooled effect of intervention on gross motor function. Methodological quality and strength of meta-analysis recommendations were evaluated using PEDro and the GRADE approach respectively. RESULTS: Of 2513 papers, 9 met inclusion criteria including children with CP (n = 2) or DCD (n = 7) receiving 11 different interventions. Only two of 9 trials showed an effect for treatment. Using the least conservative trial outcomes a large beneficial effect of intervention was shown (SMD:-0.8; 95% CI:-1.1 to -0.5) with "very low quality" GRADE ratings. Using the most conservative trial outcomes there is no treatment effect (SMD:-0.1; 95% CI:-0.3 to 0.2) with "low quality" GRADE ratings. Study limitations included the small number and poor quality of the available trials. CONCLUSION: Although we found that some interventions with a task-orientated framework can improve gross motor outcomes in children with DCD or CP, these findings are limited by the very low quality of the available evidence. High quality intervention trials are urgently needed.

Outcomes for Students Receiving School-Based Physical Therapy as Measured by the School Function Assessment.

PURPOSE: To describe School Function Assessment (SFA) outcomes after 6 months of school-based physical therapy and the effects of age and gross motor function on outcomes. METHODS: Within 28 states, 109 physical therapists and 296 of their students with disabilities, ages 5 to 12 years, participated. After training, therapists completed 10 SFA scales on students near the beginning and end of the school year. RESULTS: Criterion scores for many students remained stable (46%-59%) or improved (37%-51%) with the most students improving in Participation and Maintaining/Changing Positions. Students aged 5 to 7 years showed greater change than 8- to 12-year-olds on 5 scales. Students with higher gross motor function (Gross Motor Function Classification System levels I vs IV/V and II/III vs IV/V) showed greater change on 9 scales. CONCLUSIONS: Positive SFA change was recorded in students receiving school-based physical therapy; however, the SFA is less sensitive for older students and those with lower functional movement.