Objective: To evaluate the effect of early immobilization and proper handling techniques in infants with Obstetric Brachial Plexus Injury (OBPI) in the first 2 weeks of life. Method: Six 1-day-old infants (2 males and 4 females) with OBPI were included. The assessments were done at baseline, post-intervention, and 3-month follow-up, which involved a physical exam, Narakas classification, Active Movement Scale, and gross and fine motor skills evaluation. Result: All infants had upper Erb’s palsy. They had statistically significant improvement in the Active Movement Scale scores post-intervention with a large effect size. These improvements were maintained at follow-up. All infants achieved age-appropriate gross and fine motor skills with the affected upper limb at 3 months of age. Conclusion: Early conservative physical therapy management had a statistically significant effect on enhancing spontaneous recovery and preventing further nerve injury in OBPI infants.

Purpose: A health promotion and physical wellness (HPPW) life course approach for pediatric physical therapy (PT) is recommended to improve children’s health outcomes across the lifespan. Summary of Key Points: A life course approach describes how a child’s individual responses to environmental factors influence health outcomes. Using HPPW strategies, pediatric physical therapists can identify health risks and promote positive outcomes. Outcome measures and intervention recommendations are outlined to assist therapists in integrating HPPW strategies to ensure a longitudinal plan of care and optimal health outcomes for children. Conclusions and Recommendations for Clinical Practice: A child’s health trajectory begins in the prenatal period and is influenced by individual and environmental factors. Pediatric PT uses child- and family-centered approaches and environmental assessments to design plans of care that address child and family HPPW goals. Incorporating HPPW strategies into pediatric PT facilitates positive health and physical wellness across a child’s lifespan. See the video abstract for insights from the authors. Video Abstract: Supplemental digital content available at https://www.dropbox.com/scl/fi/3g468hj1rpxrrivbeses0/HPPW-Video-Abstract_1080.mp4?rlkey=4p1i8z1gynroz064zpx3alijz&st=8u0gqemz&dl=0.

Purpose: The aim of this study was to describe existing GoBabyGo (GBG) programs with physical or occupational therapist (PT or OT) involvement and identify eligibility criteria and evaluation processes of organizations that build modified ride-on cars (MROCs). Methods: Forty-four PTs and OTs completed a survey including descriptive information about GBG programs, barriers and facilitators, and functional aspects of the programs such as inclusion and exclusion criteria, outcome measure use, and follow-up practices. Results: Findings demonstrated the heterogeneous nature of GBG programs. GBG programs most commonly serve 2 to-5-year-olds with cerebral palsy, spina bifida, and chromosomal abnormalities. Outcome measure use and follow-up was minimal, and successful MROC use definitions varied from independent driving to passive use. Conclusions: Clinicians can use this information to help improve existing GBG programs and start new chapters as well as make appropriate referrals for clients who may benefit from a MROC.

Purpose: To characterize physical therapy (PT) dose for children with cerebral palsy (CP) after multi-level surgery (MLS) and examine variation by ambulatory status and surgical burden. Methods: PT dose (Frequency, Intensity, Time, Type) data were extracted from electronic records of children with CP who received outpatient PT the year after MLS. Results: Seventeen children, mean 9 years, female (n=10), ambulatory (n=10), and high surgical burden (n=12) were included. In the year after surgery, 345 visits occurred. Intensity across visits was above average. Time was greatest for pre-functional activities, gait, and transitions/transfers. Types most often delivered were neuromuscular, musculoskeletal, and education/training. Ambulatory children received significantly more visits, higher intensity, and time in pre-functional activities and gait than non-ambulatory children. No differences in type by ambulatory status and PT dose by surgical burden were found. Conclusion: PT dose varied the first year after MLS indicating the need for guidelines by ambulatory status. Video Abstract: Supplemental Digital Content available at: http://links.lww.com/PPT/A516

Purpose: To develop a fidelity tool to support the implementation of clinical practice guidelines to improve physical function for children and young people with cerebral palsy. Methods: Fidelity tool development followed a 5-step process: the pilot study, using a mixed-methods action research approach, and including focus groups, questionnaires, and field notes. Results: A 21-item fidelity tool representing the core components of the clinical practice guidelines was developed, including subsections of goal setting, intervention, and elements seen throughout therapeutic intervention. Clinicians and supervisors reported this tool as acceptable and feasible, especially when used as a self-reflection tool. Conclusions: A fidelity tool has been developed that clinicians, supervisors and organizations can use to reflect on current practice and plan for changes to align practice with guidelines to improve function in children with cerebral palsy.

Purpose: Evaluate the content and variability of infant motor milestone education provided to parents in popular sources. Methods: Sources were screened for inclusion, and their motor milestone content was coded. Descriptive and inferential analyses were performed. Results: Content from 241 websites, applications, and books was evaluated; 6984 motor milestones were extracted, representing 146 unique milestone codes across 14 categories. Books and applications had more milestone content than websites. There was variability in the milestones mentioned and their associated ages across the sources and relative to the American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC) content. Several frequently mentioned milestones were behaviors that facilitate early learning. Conclusions: There is variability among sources in the motor milestones they provide to parents of infants. The AAP and CDC content likely has some influence on the broader content available, but there is substantial deviation from the information they provide.

Purpose: To create a multicriteria index with clinical factors associated with abnormal general movements (GMs) trajectories during a stay in the neonatal intensive care unit. Methods: A longitudinal study assessed abnormal GMs trajectories in preterm infants in the neonatal intensive care unit. The multicriteria index included clinical factors such as intraventricular hemorrhage, respiratory support, gestational age, patent ductus arteriosus, and infection based on multi-attribute utility theory. Results: A total of 52 preterm newborns, 57.7% male, were evaluated. The multicriteria index correlated with abnormal GMs trajectories and explained 26.5% of the variance in these trajectories. Conclusion: The developed multicriteria index, with the inclusion of combined clinical factors, allowed the identification of part of the abnormal trajectories of GMs in preterm infants. The multicriteria analysis can help clinicians to identify infants who have a greater chance of poor developmental trajectories before hospital discharge.

Purpose: To examine the intrarater and interrater reliability and construct validity of the Functional Symmetry Observation Scale, Version 2 (FSOS-V2) in infants with congenital muscular torticollis (CMT). Methods: The FSOS-V2 is a video-based measure of postural and movement symmetry in infants with CMT. Four examiners scored 50 participants’ videos twice. Scores obtained by the same rater and across 4 raters were compared to examine intrarater and interrater reliability, respectively. Participants’ habitual head deviation from midline in supine photographs was measured using a protractor. Relationship between the head tilt angles and FSOS-V2 scores was examined to assess construct validity. Results: Fifty infants with CMT, age range 1 to 16 months, participated. Results indicated moderate to good intrarater and poor to moderate interrater reliability. The FSOS-V2 construct validity was supported. Conclusion: The FSOS-V2 can be used by the same therapist repeatedly to make clinical decisions. Further research will strengthen its psychometric properties.

Purpose: To explore the benefits of a Partial Body Weight Support (PBWS) harness system within a play enriched environment on gross motor development and mastery motivation of infants with Down Syndrome (DS). Methods: A randomized crossover study with 17 pre-walking infants with DS in two conditions—play with or without the harness engaged—each for 3×/week over 3 weeks with a 1-week washout. Assessments took place at baseline, crossover, and completion. Results: Statistically and clinically significant changes were evident on the Gross Motor Function Measure-88; however, there were no significant changes in parent-reported mastery motivation. Conclusion: The combination of PBWS harness system support and high frequency-facilitated play within an enriched play environment positively affected gross motor development. The intervention did not impact mastery motivation skills, and the direct impact of the harness remains unclear.

Purpose: This study investigated the psychometric properties of a 4-second interval scoring modification of the Assessment of Problem-Solving in Play (ie, Assessment of Problem-Solving in Play 4-second interval scoring [APSP-4]). Methods: A total of 95 children (3-48 months) with or at high risk for neuromotor delay were assessed with the APSP-4 and Bayley Scales of Infant and Toddler Development-III (Bayley). APSP-4 and Bayley cognitive raw scores were compared by age (construct validity) and over time (responsiveness). Twenty percent of videos were scored twice for intra- and interrater reliability. Results: The APSP-4 demonstrated excellent interrater (intraclass correlations [ICCs] ≥ 0.96) and intrarater (ICCs ≥ 0.99) reliability and performed similar to Bayley cognitive raw scores at different ages (rs > 0.5), and over time (r = 0.81). The motor delay had similar effects on APSP-4 and Bayley scores. Conclusions: Results support the validity and reliability evidence of the APSP-4 for use over time in tracking problem-solving skills in young children aged 3 to 48 months. Future research investigating clinical implementation of the APSP-4 is needed.

Purpose: To evaluate the effectiveness of therapeutic physical exercise (TPE) interventions on the physical functioning, psychosocial well-being, and quality of life (QoL) of children undergoing treatment for cancer. Method: Systematic review: databases were searched in April 2023. Selection criteria: children (<18 years old) undergoing treatment for cancer or a malignant neoplasm, randomized controlled trial design, utilization of TPE, and including physical and psychosocial outcomes. Internal validity was measured with Physiotherapy Evidence Database scale. Results: Seven randomized controlled trials were included. Most studies showed that strength, fatigue, and QoL improved after the intervention. Cardiorespiratory capacity through 6-minute walk test and physical activity levels were better in the experimental groups. No changes were noted in other variables. Conclusions: This review supports the importance of a TPE program during cancer treatment, with the aim of maintaining physical capacities and counteracting physical inactivity.

Background: Congenital muscular torticollis (CMT) is a postural condition evident shortly after birth. The 2013 CMT Clinical Practice Guideline (2013 CMT CPG) set standards for the identification, referral, and physical therapy management of infants with CMT, and its implementation resulted in improved clinical outcomes. It was updated in 2018 to reflect current evidence and 7 resources were developed to support implementation. Purpose: This 2024 CMT CPG is intended as a reference document to guide physical therapists, families, health care professionals, educators, and researchers to improve clinical outcomes and health services for children with CMT, as well as to inform the need for continued research. Results/Conclusions: The 2024 CMT CPG addresses: education for prevention, screening, examination and evaluation including recommended outcome measures, consultation with and referral to other health care providers, classification and prognosis, first-choice and evidence-informed supplemental interventions, discontinuation from direct intervention, reassessment and discharge, implementation and compliance recommendations, and research recommendations.

Purpose: Containers (eg, strollers, bouncers) are an important part of infants’ environment but may negatively impact infant development and health. This study evaluated movement and play opportunities, constraints, and manufacturers’ developmental claims for infant containers. Methods: Containers were identified through Amazon.com. A content analysis of identified products was conducted to identify movement and visual-manual play opportunities, constraints, and developmental claims. Results: Content was analyzed for 460 containers. Containers varied in their movement and play opportunities; however, most did not incorporate toys and restricted trunk movement, self-directed locomotion, and independent head and trunk control. Containers, especially those with built-in toys, often had claims related to gross motor, sensory, and fine motor development. Conclusion: These findings demonstrate the variability of movement and play opportunities observed across and within categories of infant containers. General recommendations about container use may be less effective than more specific education to parents about selecting and implementing containers.

No abstract available

Purpose: The purpose of this Special Communication is to describe the processes of Education Summit III, sponsored by the Academy of Pediatric Physical Therapy, with an emphasis on the review, update, and integration of contemporary language and the Competency-Based Education framework into a revision of the Essential Core Competencies (ECCs). Summary of Key Points: The Academy of Pediatric Physical Therapy has consistently supported pediatric professional education, including sponsoring 3 Education Summits in 2012, 2016, and 2023. The most recent summit focused on a revision of the ECCs and the development of materials to support their implementation. Recommendations for Practice: These revised domains of competence and associated competencies will support and guide pediatric physical therapy education for professional students. Educators are encouraged to use their creativity and resources to integrate these into teaching and learning activities.

Purpose: Containers (eg, strollers, bouncers) are an important part of infants’ environment but may negatively impact infant development and health. This study evaluated movement and play opportunities, constraints, and manufacturers’ developmental claims for infant containers. Methods: Containers were identified through Amazon.com. A content analysis of identified products was conducted to identify movement and visual-manual play opportunities, constraints, and developmental claims. Results: Content was analyzed for 460 containers. Containers varied in their movement and play opportunities; however, most did not incorporate toys and restricted trunk movement, self-directed locomotion, and independent head and trunk control. Containers, especially those with built-in toys, often had claims related to gross motor, sensory, and fine motor development. Conclusion: These findings demonstrate the variability of movement and play opportunities observed across and within categories of infant containers. General recommendations about container use may be less effective than more specific education to parents about selecting and implementing containers.