Retrospective Analysis of Predictors of Proficient Power Mobility in Young Children With Severe Motor Impairments.

OBJECTIVES: To determine if child characteristics, maternal education, intervention parameters, type of wheelchair control mechanism, or a combination of these variables were associated with proficient power mobility skills in children with severe motor impairments aged 14 to 30 months; and to determine if performance on the Wheelchair Skills Checklist (WSC) was associated with performance on the Powered Mobility Program (PMP). DESIGN: Secondary data analyses on data collected from 2 previously completed randomized controlled trials (RCTs). SETTING: Intervention and outcomes measurements took place in natural environments. PARTICIPANTS: Participants included children who were assigned to the intervention groups in 2 RCTs (N=31). INTERVENTION: Children practiced maneuvering individually customized power wheelchairs for 12 months in natural environments. MAIN OUTCOME MEASURES: Proficiency was assessed using the WSC and the PMP. The Battelle Developmental Inventory and Merrill-Palmer-Revised were used to assess baseline cognition and motor skills. Baseline mobility was assessed using the Pediatric Evaluation of Disability Inventory. RESULTS: Cognition, fine motor skills, and wheelchair control mechanism were associated with proficiency. Cognition, type of wheelchair control, and diagnosis all predicted proficiency while controlling for other covariates using multiple regression analysis. Agreement between the WSC and PMP was 94.7%. CONCLUSIONS: Cognition, type of wheelchair control, and diagnosis might predict power mobility proficiency in young children with severe motor impairments. These factors however should not be used to determine whether a child has the opportunity to participate in a training program. Agreement between the WSC and PMP could help researchers and clinicians compare results across studies that use only one of these outcome measures.

Concurrent validity of the School Outcomes Measure (SOM) and Pediatric Evaluation of Disability Inventory (PEDI) in preschool-age children.

AIMS: The purpose of this study was to examine the concurrent validity of the School Outcomes Measure (SOM) compared with the Pediatric Evaluation of Disability Inventory (PEDI) in preschool-age children. This study also examined the consistency of children's motor performance across the home and school settings. METHODS: Five school-based physical therapists collected data on 44 preschool-age children with physical or combined physical and cognitive disability. Correlation coefficients analyzed the strength of association between SOM and PEDI subscale scores, while participant group mean scores analyzed agreement between measures regarding level of motor performance. RESULTS: Correlations between homologous PEDI and SOM subscale scores varied from rs = .53 to rs = .92 supporting concurrent validity. With some exceptions, group mean SOM scores showed agreement with group mean PEDI scores when children were categorized by age, gross motor function level, or PEDI cutoff score (1 or 2 SD below the mean). CONCLUSIONS: The results partially support concurrent validity between the SOM and PEDI, and suggest that the children's motor performance was similar across home and school settings. The findings also suggest that as a minimal database the SOM can reliably assess motor performance in the school setting; the disadvantage is difficulty interpreting SOM scores.

Exercise using the Wii Fit plus with a child with primary Raynaud's disease and obesity: a case report.

The purpose of this case report was to describe the use of the Nintendo® Wii Fit Plus as an alternative exercise for an 11-year-old child with primary Raynaud's disease (PRD) and obesity who was not involved in organized sports and had limited outdoor physical activity and exercise. The Wii Fit Plus exercise parameters are described as well as outcomes measured at baseline, 12 weeks, and 24 weeks. Specifically, we evaluated changes in body mass index (BMI), cardiorespiratory fitness, and health related quality of life (HRQL). Following the 24-week exercise program, the child's BMI decreased, cardiorespiratory fitness increased, and HRQL increased and were comparable to values in healthy children. These findings suggest that the Wii Fit Plus may have been an effective exercise strategy for this child.

Effects of power wheelchairs on the development and function of young children with severe motor impairments.

PURPOSE: The purpose of this pilot randomized controlled study was to identify any effects of power wheelchairs on the development and function of young children with severe motor impairments. METHODS: Participants were 28 children with various diagnoses, aged 14 to 30 months when they entered the study. The Battelle Developmental Inventory (BDI), Pediatric Evaluation of Disability Inventory, and Early Coping Inventory were administered at entry and after 12 months. RESULTS: The on-protocol analysis comparing median change scores showed the experimental groups' BDI receptive communication scores, and their Pediatric Evaluation of Disability Inventory mobility functional skills, mobility caregiver assistance, and self-care caregiver scores improved significantly more than the control group's scores. An intention-to-treat analysis upheld the findings and revealed an additional difference between the groups' BDI total score. CONCLUSION: The results support use of power wheelchairs with children as young as age 14 months to enhance development and function, although additional research is needed.

Care coordination for children with special health care needs and roles for physical therapists.

PURPOSE: The purpose of this article is to summarize the research on the possible benefits of care coordination for children with special health care needs and explore potential roles for physical therapists in care coordination, including roles as primary care coordinators, members of interprofessional teams, advocates, and researchers. KEY POINTS: The medical home model is described. Benefits of care coordination are reviewed. Potential roles for physical therapists in care coordination are outlined. The barriers to care coordination are reviewed and recommendations to reduce barriers and better prepare therapists for care coordination are offered. CONCLUSION: Therapists need to be aware of and adapt to change in care models to be the provider of choice.

The role of occupational therapists and physical therapists in elementary school system early intervening services and response to intervention: a case report.

The Individuals with Disabilities Improvement Act and No Child Left Behind Act broadened the roles of occupational therapists (OTs) and physical therapists (PTs) to include therapist participation in early intervening services including response to intervention (RTI). This case report describes one school district's inclusion of OT and PT in the elementary school RTI program by identifying and implementing role responsibility and changing workloads for therapists. Therapist responsibilities included (a) administering a screening tool, (b) educating and supporting teachers and staff, (c) providing student resources and intervention strategies, and (d) referring students from RTI to special education and related services. Teachers responded positively using therapist-provided strategies and support. Limitations included an increased workload because of large numbers of students to screen and very few staff available for screening. Future research should include longitudinal studies that measure student responses to therapy intervention, teacher responses to collaboration, and the use of intervention strategies over time.

Treadmill training in a child with cerebral palsy: a case report.

This case report describes the use of treadmill training without body weight support to improve walking speed in a child with diplegic cerebral palsy. The child was a six-year-old girl with spastic diplegic cerebral palsy. She walked short distances independently using a posterior support walker but was unable to keep up with her peers walking long distances. Speed of walking 50 feet and speed of walking from her classroom to the cafeteria (458 feet) were timed pretreadmill, posttreadmill, and 3 weeks following treadmill intervention. The GMFM-88 was administered pre- and posttreadmill intervention. Following treadmill intervention, the child's speed of walking increased and she was able to walk to the cafeteria daily with her peers. Improvements in the percent of maximum total score of the GMFM-88 were also observed. The outcomes of this case suggest that the use of short-term, task-specific treadmill intervention might increase a child's walking speed enough to increase their participation in the school setting.

Item test-retest reliability and responsiveness of the School Outcomes Measure (SOM).

The School Outcomes Measure (SOM) is a minimal data set designed to measure outcomes of students who receive school-based occupational therapy and physical therapy. The purpose of this study was to determine item test-retest reliability and the responsiveness to change of the SOM. Thirty-two occupational therapists and physical therapists collected data on 73 students, age 3-21 years, stratified into two groups based on the Gross Motor Function Classification System: those with mild/moderate functional limitations (Levels I, II, III) and those with severe functional limitations (Levels IV, V). Weighted kappa statistics (0.68-1.0) indicate good to excellent item test-retest reliability. Repeated measures analysis of variance indicated that the SOM is responsive to change in children with mild/moderate functional limitations but is less responsive to change in children with severe functional limitations. The findings support the use of the SOM to measure outcomes for students with mild/moderate functional limitations as well as enabling program evaluation of therapy services provided in school settings. More research is needed to evaluate responsiveness in students with severe functional limitations.

Parents' perceived benefits of physical therapists' direct intervention compared with parental instruction in early intervention.

PURPOSE: This study compared parents' perceptions of benefits of a therapist's direct intervention with intervention designed to teach parents to promote their children's motor development. METHODS: Twenty-two mothers and one father of children with disabilities watched four videotapes. Two videotapes showed a physical therapist helping a child learn to sit or walk while the mother watched; two showed a therapist instructing a mother while the mother interacted with the child. Parents then responded to a 12-item questionnaire. RESULTS: Overall, participants rated the parent instruction approach as more beneficial, but more stressful, than direct intervention. CONCLUSIONS: Most results were inconsistent with previous reports that parents believed direct intervention was more beneficial than other approaches. The parents' belief that direct intervention could be less stressful is consistent with previous studies. Research is needed to identify the most effective model that parents prefer to promote children's motor development.

Lightweight and ultralight wheelchairs: propulsion and preferences of two young children with spina bifida.

PURPOSE: This study compared the influence of two wheelchair styles, an ultralight rigid frame and a lightweight folding frame, on preference and propulsion in young children with spina bifida. PROCEDURE: Speed, distance, energy expenditure, and perceived exertion of two girls were studied in an A-B-A single subject design. Questionnaires were used after the three phases to obtain parent and child preference. RESULTS: Visual inspection of the data favored the ultralight wheelchair for all variables, except the first child's speed with classmates and perceived exertion. Parents and children indicated preference for the ultralight wheelchair on all questions but one by Child 1. Using two standard deviation band width (2SDBW) analyses, 12 of 16 comparisons between the phases differed significantly. 2SDBW comparison was not used in the other four phase comparisons because of autocorrelations. CONCLUSION: This study presents initial evidence supporting the use of ultralight rigid-framed wheelchairs by young children.

Interrater reliability and content validity of a minimal data set to measure outcomes of students receiving school-based occupational therapy and physical therapy.

BACKGROUND AND PURPOSE: The 1997 Amendments of the Individuals with Disabilities Education Act increased the emphasis on accountability for outcomes of students with disabilities in the United States. The purpose of this study was to determine the content validity and estimate the interrater reliability of the School Outcomes Measure, a new minimal data set to measure groups of students' performance in the areas addressed by school-based therapy. METHOD: Forty-five occupational therapists and physical therapists working in Oklahoma's public schools participated in the content validity study. Eight occupational therapist-physical therapist pairs rated 17 students for the interrater reliability study. Therapists were recruited and data were collected by mail for both studies. RESULTS: Most validity study participants thought the tool was comprehensive and clear, and that they could complete the tool twice a year for their students. The weighted kappa statistic indicated that the therapists' agreement was substantial (.73) to almost perfect (.96) for 25 of the 28 student functional status items. DISCUSSION: The results support the content validity and interrater reliability of the items. This study was an initial step in development of the tool and further studies are needed in the validation process.

Use of power mobility for a young child with spinal muscular atrophy.

BACKGROUND AND PURPOSE: Young children with severe motor impairments, such as spinal muscular atrophy, are often unable to move around their environment independently; therefore, they may be at risk for delays in areas of development not directly related to their motor limitations. Power mobility is an intervention that provides young children a means of independent movement and enables them to independently explore their environment. CASE DESCRIPTION: The participant was a 20-month-old girl with type II spinal muscular atrophy. INTERVENTION: The authors provided the child with a power wheelchair and gave her mother and physical therapist general guidelines to encourage her use of the power wheelchair. OUTCOMES: Within 6 weeks after receiving the power wheelchair, the child operated the wheelchair independently. She showed developmental gains in all domains of the Battelle Developmental Inventory and the Pediatric Evaluation of Disability Inventory over 6 months. The authors conducted an interview with the child's mother before and after intervention. She reported that the child was more independent after receiving the power wheelchair. DISCUSSION: The power wheelchair may have been associated with the changes in the child's mobility and her developmental changes over 6 months.

Effect of passive range of motion exercises on lower-extremity goniometric measurements of adults with cerebral palsy: a single-subject design.

BACKGROUND AND PURPOSE: People with spastic cerebral palsy often receive passive stretching that is intended to maintain or increase joint passive range of motion (PROM) even though the effectiveness of these exercises has not been definitively demonstrated. The purpose of this study was to determine the effect of PROM exercises on 6 adults with spastic quadriplegia and contractures. PARTICIPANTS: Four men and 2 women (X =31 years of age, range=20-44 years) who lived in an institution for people with mental retardation participated in the study. METHODS: The authors used 2 multiple baseline designs. Three participants (group 1) received lower-extremity PROM exercises during phase A; PROM exercises were discontinued during phase B. Three participants (group 2) did not receive PROM exercises during phase A; PROM exercises were initiated during phase B. Data were analyzed using visual analysis and the C statistic. RESULTS: Results varied with the method of analysis; however, phase A and phase B measurements, overall, did not differ for either group. DISCUSSION AND CONCLUSION: This study demonstrated use of a single-subject design to measure the effect of PROM exercises on adults with cerebral palsy. The authors concluded that the PROM exercise protocol did not have an effect on the lower-extremity goniometric measurements of the participants.