Writing patient-centered functional goals.

Motor learning research, health care policies, reimbursement practices, and the standards of accrediting bodies all support writing patient-centered functional goals of physical therapy. This article defines patient-centered functional goals within the context of the Guide to Physical Therapist Practice and provides a rationale for incorporating functional goals into physical therapy for patients in all areas of practice. The article also describes how physical therapists can collaborate with patients to identify functional goals that are meaningful to them and describes a 5-step process for writing functional goals that are measurable.

Effects of testing context on ball skill performance in 5-year-old children with and without developmental delay.

BACKGROUND AND PURPOSE: Physical therapists often test ball-playing skills of children with disabilities using standardized testing, which may not predict performance of ball skills in games with peers. This type of testing is used by physical therapists to determine whether children have delays in ball-handling skills. The purpose of this study was to compare ball skill performance of children with and without developmental delay in a one-to-one testing situation and in a structured game with peers. SUBJECTS: Five-year-old children with developmental delay (n=20) and 5-year-old children without disabilities (n=20) participated in the study. METHODS: We used the Peabody Developmental Motor Scales receipt and propulsion scale to test children one-to-one with a therapist and during a structured game with peers. RESULTS: Subjects without developmental delay performed better than subjects with developmental delay under both testing conditions. Children with developmental delay performed better in the one-to-one testing condition than in the game with peers. The performance of children without developmental delay did not differ under the 2 conditions. Boys performed better than girls. CONCLUSION AND DISCUSSION: Physical therapists should consider the potential effect of environment on the ball-handling skills of children with disabilities.

Assistive positioning as a control parameter of social-communicative interactions between students with profound multiple disabilities and classroom staff.

This study examined the effects of assistive positioning on social-communicative interactions between 10 students, 6 to 12 years of age, with profound multiple disabilities, and their classroom staff. Interactions were videotaped in the students' classrooms when each student was positioned using a wheelchair, a sidelyer, and a mat on the floor. Data were analyzed by repeated-measures analysis of variance. During unstructured interactions, adults initiated communication at higher rates when students were positioned in their wheelchairs. During structured interactions, when students were given standardized opportunities for interaction, students functioning at lower levels of communication development were more communicative when they were supine on a mat than when in their wheelchairs or a sidelyer. In dynamic systems terms, position served as a control parameter of both adult and student communicative behaviors, which should be considered when recommending use of assistive positioning equipment for students with severe disabilities.

Assessment of the reliability of pediatric screening: a tool for occupational or physical therapists.

This study was conducted to determine interrater and test-retest reliability characteristics of the instrument, Pediatric Screening: A Tool for Occupational and Physical Therapists. This protocol was developed by two public school therapists to be used as a decision-making mechanism for systematically assessing the students' relative need for therapy services. The subjects were 75 children, aged 3 to 16 years, with various types and degrees of disability. Each was scored on the screening tool by three different school therapists within one week to determine interrater reliability. Each of the therapists also tested two or three of the children again several weeks later to determine test-retest reliability. Analysis of interrater reliability using the Spearman-Brown prediction formula showed total scores on the screening tool to be reliable at the .90 level. Test-retest reliability measurements using the Pearson product-moment correlation coefficients showed that total scores were highly correlated (r = .96; p less than .001). These measures indicated that the Pediatric Screening tool is a highly reliable instrument in terms of scoring between therapists and by individual therapists across time.