Diagnosis dialog for pediatric physical therapists: hypotonia, developmental coordination disorder, and pediatric obesity as examples.

PURPOSE: To clarify what diagnosis means for pediatric physical therapists, to provide several examples of human movement dysfunction syndromes, and to offer guidance for how pediatric physical therapists may continue this work in any clinical setting. KEY POINTS: The importance of diagnosis in pediatric physical therapy is presented along with examples of 3 different processes used to develop diagnostic labels. These processes included surveys to identify consensus opinion of clinicians, a literature review, and a combination of these 2. Hypotonia, developmental coordination disorder, and pediatric obesity are presented as examples. SUMMARY: The 3 diagnoses serve as a basis for ongoing dialogue, discussion, and development of diagnostic labels for human movement syndromes identified by pediatric physical therapists.

Single-subject design study of 2 types of supramalleolar orthoses for young children with down syndrome.

PURPOSE: This study examined the effects of 2 types of supramalleolar orthoses on gross motor skills of young children with Down syndrome. METHODS: Two children participated in this prospective single-subject, alternating treatment design with 3 conditions: baseline phase with shoes but without orthoses (A), first intervention phase (B1), and second intervention phase (B2). The Gross Motor Function Measure was used to collect data on motor skills. The 2-standard deviation band method was used for data analysis. RESULTS: Both children demonstrated improvement, using the SureStep compared to shoes only, and 1 child also improved with the DAFO #4. Both families chose to continue using the SureStep at the conclusion of the study. CONCLUSIONS: Orthoses for young children with Down syndrome continue to be the standard of care; however, research has yet to confirm the most effective type of orthosis or when developmentally to introduce orthoses.

Hippotherapy--an intervention to habilitate balance deficits in children with movement disorders: a clinical trial.

BACKGROUND: Clinical observations have suggested that hippotherapy may be an effective strategy for habilitating balance deficits in children with movement disorders. However, there is limited research to support this notion. OBJECTIVE: The purposes of this study were to assess the effectiveness of hippotherapy for the management of postural instability in children with mild to moderate balance problems and to determine whether there is a correlation between balance and function. DESIGN: A repeated-measures design for a cohort of children with documented balance deficits was used. METHODS: Sixteen children (9 boys and 7 girls) who were 5 to 16 years of age and had documented balance problems participated in this study. Intervention consisted of 45-minute hippotherapy sessions twice per week for 6 weeks. Two baseline assessments and 1 postintervention assessment of balance, as measured with the Pediatric Balance Scale (PBS), and of function, as measured with the Activities Scale for Kids-Performance (ASKp), were performed. RESULTS: With the Friedman analysis of variance, the PBS and the ASKp were found to be statistically significant across all measurements (P<.0001 for both measures). Post hoc analysis revealed a statistical difference between baseline and postintervention measures (P≤.017). This degree of difference resulted in large effect sizes for PBS (d=1.59) and ASKp (d=1.51) scores after hippotherapy. A Spearman rho correlation of .700 indicated a statistical association between PBS and ASKp postintervention scores (P=.003). There was no correlation between the change in PBS scores and the change in ASKp scores (r(s)=.13, P>.05). LIMITATIONS: Lack of a control group and the short duration between baseline assessments are study limitations. CONCLUSIONS: The findings suggest that hippotherapy may be a viable strategy for reducing balance deficits and improving the performance of daily life skills in children with mild to moderate balance problems.