Responsiveness of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test in measuring functional outcomes for inpatient pediatric rehabilitation.

PURPOSE: Responsiveness of the PEDI-CAT Mobility, Daily Activities, and Social/Cognitive domains and Wheelchair subdomain was evaluated for youth admitted to a pediatric post-acute care hospital. METHODS: Inpatients ages 2-21 years, with a length of stay of ≥ 5 days and with both admission and discharge scores were included. The difference between mean admission and discharge PEDI-CAT scaled scores were analyzed using paired t-tests. Effect sizes, standard response means (SRMs), and minimal detectable change values were calculated. Score comparison between diagnostic subgroups (Traumatic Brain Injury, Neurological, Orthopedic, Medical) and age groups ( ≤ 5, > 5 but < 13, ≥ 13 years) were evaluated for the Mobility domain. RESULTS: Sample size differed by domain with 66 Mobility, 30 Daily Activities, 19 Social/Cognitive and 9 Wheelchair subdomain pairs. Significant differences were found for all domains when mean admission and discharge scaled scores were compared. Moderate to large effect sizes and SRMs were found for the Mobility and Daily Activities domains and Wheelchair subdomain. Small effect size but large SRM was found for the Social/Cognitive domain. The Mobility domain was also responsive to changes in all diagnostic and age groups. CONCLUSION: The PEDI-CAT was responsive to functional changes for youth discharged from an inpatient pediatric rehabilitation hospital.

Physical Therapy for a Child Poststroke With a Left Ventricular Assist Device.

PURPOSE: To describe physical therapy (PT) examination and intervention during rehabilitation for a child poststroke with an implanted left ventricular assist device (LVAD). KEY POINTS: A 10-year-old boy with a history of congenital heart disease awaiting heart transplant was admitted to a pediatric rehabilitation hospital with right hemiplegia, and an external, portable LVAD. This child participated in standard PT examination procedures and interventions with accommodations for the LVAD. Observation was used to evaluate exercise response because of inability to measure vital signs. At admission, impaired muscle tone, balance, and endurance contributed to limitations in functional mobility. By discharge, improvements were seen in all impairments and also in ambulation distance, speed, and independence. CONCLUSION: This child awaiting heart transplant with an LVAD was able to tolerate intensive individualized PT. With monitoring and adjustments to the plan of care, he demonstrated improvements in functional mobility.

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.

Aquatic aerobic exercise for children with cerebral palsy: a pilot intervention study.

PURPOSE: The primary purpose of this pilot study was to evaluate the effectiveness of a14-week aquatic exercise program on gross motor function and walking endurance in children with cerebral palsy (CP). The secondary purpose was to evaluate changes in functional strength, aerobic capacity and balance. METHOD: A prospective time series group design consisting of four measurement sessions (two baseline, one post intervention, and 1-month follow-up) was used. Eight ambulatory children ages 6-15 years with CP and classified at Gross Motor Function Classification System Level I or Level III participated in an aquatic aerobic exercise program. RESULTS: Significant improvements were observed for the primary outcomes of gross motor function and walking endurance. No significant differences between any of the secondary measures were observed, although all of the measures demonstrated trends of improvement after intervention. CONCLUSION: Ambulatory children with CP may improve their gross motor skills and walking endurance after an aquatic exercise program held twice per week for 14 weeks, utilizing moderate-to-vigorous exercise intensity and consisting of functional activities.

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.