The Head Control Scale: Responsiveness and Concurrent Validity With the Alberta Infant Motor Scale.

PURPOSE: The purpose of this study was to investigate the Head Control Scale's (HCS's) responsiveness and concurrent validity with the Alberta Infant Motor Scale (AIMS). METHODS: The HCS and the AIMS were administered to 50 infants and young children. Thirty children were reevaluated at hospital discharge or at 18 months of age. RESULTS: A statistically significant positive change was noted in mean score from the initial HCS assessment to the second assessment for total score and all position scores. Concurrent validity between HCS and AIMS total scores was excellent. CONCLUSION: Responsiveness to changes in head control and concurrent validity with the AIMS were established, supporting HCS use in clinical practice.

Renal fluid and acid/base balance during refeeding in restrictive eating disorders.

BACKGROUND AND OBJECTIVES: Fluid shifts have been ascribed to central diabetes insipidus in patients with anorexia nervosa hospitalized for refeeding. Recent data, however, suggest that vasopressin production is not dysregulated in this population. Our objective was to describe the trajectory of fluid imbalances in relationship to kidney function, electrolyte disturbances, and acid/base balance during refeeding. METHODS: A retrospective review of daily fluid balance and biochemical values was performed in 70 sequential unique patients admitted to University of California at Los Angeles Hospital Medical Stabilization Program for Eating Disorders from December 2018 to November 2020. RESULTS: Participants (2 males/68 females) were between 10 and 24 years of age and with a median body mass index of 16.1 (14.3, 18.1) kg/m2 . A severe negative fluid balance (>-900 ml/day) was observed in 80% of patients at some point during hospitalization. Serum sodium concentrations were normal on admission and remained stable during refeeding. Serum bicarbonate concentrations were 25 ± 1 mEq/dl on admission and increased above the normal range in 31% of patients. Metabolic alkalosis was inversely associated with the development of a negative fluid balance. Estimated glomerular filtration rate was impaired in 54% of patients, improved with refeeding, and was not associated with the development of a severe negative fluid balance or metabolic alkalosis. DISCUSSION: Chronic energy deprivation alters the physiology of renal fluid and bicarbonate handling in ways that are independent of vasopressin and glomerular filtration. Further studies are warranted to understand the renal adaptations that occur during energy restriction and subsequent refeeding. PUBLIC SIGNIFICANCE: Massive urinary fluid losses occur in patients with restrictive eating disorders hospitalized for refeeding. In addition, many patients have impaired renal bicarbonate excretion. These findings suggest that chronic energy deprivation impairs the kidney's ability to handle the shifts in fluid and acid/base balance that occur when appropriate oral nutrition is re-introduced.

Association of the COVID-19 Pandemic With Adolescent and Young Adult Eating Disorder Care Volume.

Importance: The COVID-19 pandemic has affected youth mental health. Increases in site-specific eating disorder (ED) care have been documented; however, multisite studies demonstrating national trends are lacking. Objective: To compare the number of adolescent/young adult patients seeking inpatient and outpatient ED care before and after onset of the COVID-19 pandemic. Design, Setting, and Participants: Using an observational case series design, changes in volume in inpatient and outpatient ED-related care across 15 member sites (14 geographically diverse hospital-based adolescent medicine programs and 1 nonhospital-based ED program) of the US National Eating Disorder Quality Improvement Collaborative was examined. Sites reported monthly volumes of patients seeking inpatient and outpatient ED care between January 2018 and December 2021. Patient volumes pre- and postpandemic onset were compared separately for inpatient and outpatient settings. Demographic data such as race and ethnicity were not collected because this study used monthly summary data. Exposures: Onset of the COVID-19 pandemic. Main Outcomes and Measures: Monthly number of patients seeking inpatient/outpatient ED-related care. Results: Aggregate total inpatient ED admissions were 81 in January 2018 and 109 in February 2020. Aggregate total new outpatient assessments were 195 in January 2018 and 254 in February 2020. Before the COVID-19 pandemic, the relative number of pooled inpatient ED admissions were increasing over time by 0.7% per month (95% CI, 0.2%-1.3%). After onset of the pandemic, there was a significant increase in admissions over time of 7.2% per month (95% CI, 4.8%-9.7%) through April 2021, then a decrease of 3.6% per month (95% CI, -6.0% to -1.1%) through December 2021. Prepandemic, pooled data showed relative outpatient ED assessment volume was stable over time, with an immediate 39.7% decline (95% CI, -50.4% to -26.7%) in April 2020. Subsequently, new assessments increased by 8.1% (95% CI, 5.3%-11.1%) per month through April 2021, then decreased by 1.5% per month (95% CI, -3.6% to 0.7%) through December 2021. The nonhospital-based ED program did not demonstrate a significant increase in the absolute number of admissions after onset of the pandemic but did see a significant increase of 8.2 (95% CI, 6.2-10.2) additional inquiries for care per month in the first year after onset of the pandemic. Conclusions and Relevance: In this study, there was a significant COVID-19 pandemic-related increase in both inpatient and outpatient volume of patients with EDs across sites, particularly in the first year of the pandemic. Given inadequate ED care availability prior to the pandemic, the increased postpandemic demand will likely outstrip available resources. Results highlight the need to address ED workforce and program capacity issues as well as improve ED prevention strategies.

Renal Function in Patients Hospitalized With Anorexia Nervosa Undergoing Refeeding: Findings From the Study of Refeeding to Optimize Inpatient Gains.

PURPOSE: Among complications of malnutrition secondary to anorexia nervosa (AN) or atypical anorexia nervosa (AAN), renal impairment remains poorly elucidated. Evaluating renal function in hospitalized pediatric patients with AN and AAN undergoing refeeding will yield important information to guide clinicians in screening and managing renal dysfunction in this population. METHODS: This is a secondary analysis of data from the Study of Refeeding to Optimize Inpatient Gains trial, a multicenter randomized clinical trial comparing higher calorie refeeding versus lower calorie refeeding in 120 adolescents and young adults hospitalized with medical instability secondary to AN or AAN. Baseline disease characteristics were obtained. Vital sign measurements, weight, electrolytes, and fluid status were evaluated daily to ascertain medical stability. Renal function on admission and throughout hospitalization was quantified using daily creatinine measurement and calculation of the estimated glomerular filtration rate (eGFR) using the modified Schwartz equation. Regression analysis and mixed linear models were utilized to evaluate factors associated with eGFR. RESULTS: Of the 111 participants who completed treatment protocol, 33% had a baseline eGFR less than 90, suggesting renal impairment. Patients who experienced more rapid weight loss and more severe bradycardia were more likely to have low admission eGFR. While eGFR improved during refeeding, eGFR change by day based on refeeding treatment assignment did not reach statistical significance (95% confidence interval, -1.61, 0.15]; p = .095). DISCUSSION: Renal impairment is evident on admission in a significant number of adolescents and young adults hospitalized with AN and AAN. We demonstrate that short-term medical refeeding yields improvement in renal function.

Inter- and Intra-rater Reliability of the Head Control Scale: Brief Report.

PURPOSE: To examine inter-rater and intra-rater reliability of the Head Control Scale (HCS). METHODS: Introduction of the HCS to eight physical therapists in a pediatric post-acute hospital was followed by use in a repeated-measures design across two trials to establish reliability of the raters. Therapists scored the HCS twice within 4 weeks, using videos of infants at both 2 and 6 months of age, one infant described as typically developing and one with atypical development. RESULTS: For the HCS overall score, reliability was excellent with an inter-rater reliability intraclass correlation coefficient ((ICC) (3,1) = 0.97 (95% confidence interval, 0.899-0.998) and intra-rater reliability ICC (3,1) range = 0.815-1.0. HCS position scores between and within raters ranged from slight to substantial agreement. CONCLUSION: In this small study of inter- and intra-rater reliability, HCS overall score demonstrated excellent reliability for all raters however, HCS position scores demonstrated some variability, especially for the prone position.

A content validity evaluation of the PEDI-CAT Speedy Mobility domain.

Objective: To evaluate the content validity of the PEDI-CAT Speedy Mobility domain through analysis of item and content area exposure, score range and scoring precision.Methods: Retrospective analysis of 3,364 items from assessments (n = 301) completed from 2013 to 2017. Content validity was appraised through analysis of item and content area exposure (item, content area, response frequency), score range (floor and ceiling effect) and scoring precision (person fit, score reliability, item information function).Results: Sixty-five of the 75 general mobility items from the PEDI-CAT Mobility domain item bank were exposed. "Stands up from the middle of the floor" (68%) was the most frequently exposed non-mandatory item. Almost half (49%) of all items were from the Basic Mobility and Transfers content area. Scaled scores ranged from 26.77 to 69.40 with a floor (scores ≤27; n = 51, 17%) but no ceiling effect. Person fit statistics were acceptable for 238 (79%), suggesting limited outliers. Score reliability was sufficient with 68% of scores above threshold (>0.9). Item information function plot indicated less discriminating items at the lower end of the score range.Conclusion: Content is adequately and reliably measuring the intended construct, but additional items at the lower end of the scale could improve score precision.

Central diabetes insipidus associated with refeeding in anorexia nervosa: A case report.

Anorexia nervosa (AN) has been associated with a multitude of hypothalamic pituitary abnormalities, although it is unknown which aberrations reflect disease causation and which are the consequences of severe malnutrition. Among these endocrinopathies, hypothalamic-posterior pituitary aberrations have been described, including disorders of osmoregulation. We report the case of an adolescent female with a history of severe AN, restricting subtype, treated aggressively with multiple hospitalizations. During hospitalization for severe weakness and lethargy, her course of medical stabilization was complicated by significant polyuria, ultimately diagnosed as central diabetes insipidus (DI). This is the first reported case, to our knowledge, of a severely malnourished adolescent with AN-restricting subtype developing central DI during the refeeding process for medical stabilization, thus adding to the small body of existing literature on disordered osmoregulation in this patient population. This case report raises the question as to whether the frequency of central DI during refeeding is greater than that previously recognized. Additional research should focus on how neuroendocrine dysregulation of water balance might impact the clinical course of AN and its treatment.

Physical Therapy Dosing: Frequency and Type of Intervention in Pediatric Postacute Hospital Care.

PURPOSE: To examine differences in physical therapy dosing frequency recommendations based on children's characteristics and to describe types of intervention recommended at postacute hospital admission. METHODS: Demographic and clinical information, recommended physical therapy intervention frequency, and intervention types were collected for all admissions from April 1, 2015, to March 1, 2016. Differences across 2 groups, children with recommendations for "less" (≤3x/wk) or "more" (≥4x/wk) frequent therapy, were examined. Types of interventions recommended were described and the measure of association between frequency and type was determined. RESULTS: Older children, those with higher admission functional scores, and children with less dependence on medical technology were recommended for "more." Therapeutic exercise was the most common intervention recommended. Greater physical therapy frequency was associated with Functional Training and Motor Function Training. CONCLUSION: Children's age, functional level, and technology dependence influence dosing recommendations. Interventions focused on function are associated with greater physical therapy frequency.

Construct validity of the pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT) in children with medical complexity.

PURPOSE: To assess construct (convergent and divergent) validity of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) in a sample of children with complex medical conditions. METHOD: Demographics, clinical information, PEDI-CAT normative score, and the Post-Acute Acuity Rating for Children (PAARC) level were collected for all post-acute hospital admissions (n = 110) from 1 April 2015 to 1 March 2016. Correlations between the PEDI-CAT Daily Activities, Mobility, and Social/Cognitive domain scores for the total sample and across three age groups (infant, preschool, and school-age) were calculated. Differences in mean PEDI-CAT scores for each domain across two groups, children with "Less Complexity," or "More Complexity" based on PAARC level were examined. RESULTS: All correlations for the total sample and age subgroups were statistically significant and trends across age groups were evident with the stronger associations between domains for the infant group. Significant differences were found between mean PEDI-CAT Daily Activities, Mobility, and Social/Cognitive normative scores across the two complexity groups with children in the "Less Complex" group having higher PEDI-CAT scores for all domains. CONCLUSION: This study provides evidence indicating the PEDI-CAT can be used with confidence in capturing and differentiating children's level of function in a post-acute care setting. Implications for Rehabilitation The PEDI-CAT is measure of function for children with a variety of conditions and can be used in any clinical setting. Convergent validity of the PEDI-CAT's Daily Activities, Mobility, and Social/Cognitive domains was significant and particularly strong for infants and young children with medical complexity. The PEDI-CAT was able to discriminate groups of children with differing levels of medical complexity admitted to a pediatric post-acute care hospital.

Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) and Alberta Infant Motor Scale (AIMS): Validity and Responsiveness.

BACKGROUND: Although preliminary studies have established a good psychometric foundation for the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) for a broad population of youth with disabilities, additional validation is warranted for young children. OBJECTIVE: The study objective was to (1) examine concurrent validity, (2) evaluate the ability to identify motor delay, and (3) assess responsiveness of the PEDI-CAT Mobility domain and the Alberta Infant Motor Scale (AIMS). METHODS: Fifty-three infants and young children (<18 months of age) admitted to a pediatric postacute care hospital and referred for a physical therapist examination were included. The PEDI-CAT Mobility domain and the AIMS were completed during the initial physical therapist examination, at 3-month intervals, and at discharge. A Spearman rank correlation coefficient was used to examine concurrent validity. A chi-square analysis of age percentile scores was used to examine the identification of motor delay. Mean score differences from initial assessment to final assessment were analyzed to evaluate responsiveness. RESULTS: A statistically significant, fair association (rs=.313) was found for the 2 assessments. There was no significant difference in motor delay identification between tests; however, the AIMS had a higher percentage of infants with scores at or below the fifth percentile. Participants showed significant changes from initial testing to final testing on the PEDI-CAT Mobility domain and the AIMS. LIMITATIONS: This study included only young patients (<18 months of age) in a pediatric postacute hospital; therefore, the generalizability is limited to this population. CONCLUSIONS: The PEDI-CAT Mobility domain is a valid measure for young children admitted to postacute care and is responsive to changes in motor skills. However, further item and standardization development is needed before the PEDI-CAT is used confidently to identify motor delay in children <18 months of age.

Cardiorespiratory response during physical therapist intervention for infants and young children with chronic respiratory insufficiency.

PURPOSE: To document physical therapist intervention activities and cardiorespiratory response for young children with chronic respiratory insufficiency. METHODS: Twelve children born prematurely, 6 to 30 months chronological age and admitted to inpatient pulmonary rehabilitation for oxygen and/or ventilation weaning, were included. During 3 intervention sessions, a second physical therapist recorded intervention activity and heart rate (HR), oxygen saturation (SaO2), and respiratory rate. Total time and median HR, SaO2, and respiratory rate for each activity were calculated. An analysis of variance was used to compare HR and SaO2 across activity based on intersession reliability. RESULTS: Sitting activities were most frequent and prone least frequent. Median cardiorespiratory measures were within reference standards for age. No adverse effects were seen during intervention and no significant difference was found in HR and SaO2 among intervention activities. CONCLUSION: Young children with chronic respiratory insufficiency are able to tolerate intervention with close monitoring by the physical therapist.

Pedagogical tools to develop clinical reasoning: physical therapy students' perspective.

Physical therapy students' perspective about the development of clinical decision making ability was solicited to determine: 1) if actual clinical and academic learning experiences are consistent with student preferences; and 2) if actual academic learning experiences differ according to subject matter. Program representatives contacted physical therapy students via email with an embedded link to an on-line survey during their final clinical education experiences. Open-ended and forced-choice items addressed reactions to learning experiences to develop clinical reasoning in academic and final clinical education experiences. Data were analyzed with frequency analysis, chi-square and correlations of survey items. Ninety-one respondents completed the survey, yielding a 13% response rate. The frequency of use of pedagogical tools was lower than the preferred use of the tools. Perceptions about clinical reasoning learning tools varied with course content. Course content corresponded to the type of pedagogical tool that students deemed essential for learning clinical reasoning. Participants appeared to experience and prefer more independence at the final clinical experience although they preferred considerable involvement by the clinical instructor.

Measuring physical function in children with airway support: a pilot study using computer adaptive testing.

OBJECTIVE: To assess the responsiveness, examine the scoring range and determine the efficiency of a multidimensional computer adaptive testing version of the Pediatric Evaluation of Disability Inventory (PEDI-MCAT) for children admitted to inpatient pulmonary rehabilitation. METHODS: The PEDI-MCAT was completed by clinician report for 30 infants and children. Mean self-care and mobility admission scores were compared with discharge scores for the total group and two diagnostic sub-groups (prematurity and congenital/neurological conditions). The scoring range of the mobility and self-care scales was examined to determine placement of the scores along the overall PEDI-MCAT scale. Efficiency was determined using an internal clock and average number of items required for score generation. RESULTS: Mean changes for the total group and both sub-groups were significant for both self-care and mobility, except for the prematurity group's mobility scores. Effect sizes were small-to-moderate. Scores for both groups were at the low end of the scoring ranges. Average time to complete the PEDI-MCAT was 1.57 minutes. Average number of items administered was nine for self-care and 11 for mobility. CONCLUSION: The PEDI-MCAT was responsive to change in physical function, although only low-ability items were needed. The PEDI-MCAT can potentially minimize clinician burden in inpatient settings.

Physical therapy students' self-reports of development of clinical reasoning: a preliminary study.

Reports of student perceptions about the efficacy of educational tools used by academic and clinical instructors to facilitate clinical reasoning are limited. Physical therapist students' (PTSs') perceptions of tools for developing clinical reasoning and problem-solving skills were surveyed to determine the effectiveness of various teaching methods and to identify factors associated with clinical reasoning development. The purposes of this descriptive investigation were to determine (1) if factors, such as learning mode, life experience, and curriculum, influence PTS' perception of their clinical reasoning mastery; (2) the relative roles of academic and clinical instructors and the value of their pedagogic tools in assisting PTS with clinical reasoning development; and (3) how PTS rate their degree of mastery of clinical reasoning as they progress through training. A survey was mailed to 17 physical therapy schools in New York and 2 in New Jersey; 156 PTS near graduation responded, yielding a 22% response rate. The survey instrument had 6 open-ended and 19 multiple-choice questions. Frequency analysis showed (1) PTS' opinion about how they would teach clinical reasoning varied with their preferred learning mode, (2) prior life experiences were associated with clinical reasoning for some individuals, (3) academic and clinical instructors contribute to development of clinical reasoning, (4) the best pedagogic tools involved case study presentations/ assignments using actual patients or videotapes, and (5) PTS gained confidence in their clinical reasoning ability while progressing through clinical education experiences. Results support inclusion of diverse pedagogic tools, such as case studies, and emphasizing a variety of learning modes to facilitate PTS' development of clinical reasoning.