Τα νέα του Pediatric Physical Therapy Journal
Ενημερώθηκε: πριν από 1ημέρα 9 ώρες
Pediatric Physical Therapists' Use of the Congenital Muscular Torticollis Clinical Practice Guidelines: A Qualitative Implementation Study
Purpose: This study is a follow-up to the quantitative survey to examine the perceptions of pediatric physical therapists (PTs) on the application of the 2013 Congenital Muscular Torticollis Clinical Practice Guideline (CMT CPG). Method: Qualitative semi-structured telephone interviews were completed. Interview questions focused on how the guidelines influenced practice, facilitators and barriers to implementation, and knowledge translation activities. Results: Thirteen pediatric PTs from a variety of practice settings participated. Positive perceptions about the CMT CPG included the use of flow charts, synthesized literature in one place, and validation of examination and intervention approaches. Negative perceptions included its length and that approaches without published evidence were not addressed. Three major themes were identified: knowledge and evidence for practice, education of clinicians, and the CPG structure and components that influenced practice. Conclusions: The CMT CPG provided a number of benefits. Recommendations for future enhancement and development are provided.
Knowledge Translation Lecture: Providing Best Practice in Neonatal Intensive Care and Follow-up: A Clinician-Researcher Collaboration
Knowledge translation is the process by which we take new information that is evidence based and incorporate it into our practice. While we can each incorporate evidence into our practice, the collaboration between a researcher and a clinician can advance the implementation of evidence-based practice. We highlight the use of the Plan-Do-Study-Act cycle that includes a researcher and clinical partner on a journey of research question development, knowledge generation, clinical implementation, and policy change that advances the care to infants in the neonatal intensive care unit and in a developmental follow-up clinic. The team provides examples of implementation and highlights the clinical care differences following a decade of collaboration. Pediatric physical therapists have a responsibility to embrace and support knowledge translation to advance our profession and the care of infants, children, and families.
The Effects of Functional Progressive Strength and Power Training in Children With Unilateral Cerebral Palsy
Purpose: The purpose of this study was to investigate the effects of a novel functional strength and power-training program on gait and gross motor function in participants with unilateral cerebral palsy. Methods: This 12-week trial of functional strength and power training included 30 participants with cerebral palsy, randomly assigned to the experimental or comparison group. The primary outcomes, 1-minute walk test, muscle power, and the Gross Motor Function Measure, were assessed at baseline and 12 weeks after the intervention. Secondary outcomes included dynamic balance as measured by Timed Up and Go, muscle strength, and 1-repetition maximum measures. Results: Significantly greater improvements were seen in the experimental group for muscle power, Gross Motor Function Measure E score, and 1-minute walk test (P < .05), as well as for dynamic balance, 1-repetition maximum, and muscle strength. Conclusion: Functional strength training combined with plyometric exercises improved gait and gross motor function, dynamic balance, muscle strength, and power. Video Abstract: For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A254
Purpose: To investigate the relationships among the Infant Motor Profile (IMP), the Neuro-Sensory Motor Developmental Assessment (NSMDA), and the Alberta Infant Motor Scale (AIMS) in prematurely born infants. Methods: Sixty-one preterm infants with a birth weight under 2500 g were assessed by the IMP, the NSMDA, and the AIMS. Results: There was a significant correlation between the IMP total score and the AIMS percentile and between the IMP total score and the NSMDA functional levels. There were significant correlations between the AIMS percentile age and the NSMDA functional levels and between the AIMS total scores and the IMP total scores. In the infants with atypical development, the relationship was significant between the AIMS and the IMP; however, there was no relationship between the IMP and the NSMDA. Conclusions: The 3 movement analysis tests are related. The IMP was found to be consistent with other movement analysis tests.
Stretching and Progressive Resistance Exercise in Children With Cerebral Palsy: A Randomized Controlled Trial
Purpose: To evaluate the effect of stretching and progressive resistance exercise on range of motion and muscle strength in children with cerebral palsy. Methods: Thirty-seven children with spastic bilateral cerebral palsy and Gross Motor Function Classification System levels I to III were randomized to an intervention and a comparison group. The intervention included stretching of hamstrings and progressive resistance exercise, targeting the lower extremities for 16 weeks, followed by a 16-week maintenance program. Passive and active popliteal angle and muscle strength were evaluated at 0, 16, and 32 weeks. Results: After 16 weeks nonsignificant improvements were found in passive, active popliteal angle and quadriceps and hamstrings strength. Conclusion: A 16-week stretching and progressive resistance exercise program followed by a 16-week maintenance program showed nonsignificant improvements in passive, active popliteal angle and muscle strength for the intervention group.
An estimated 2.4 million children play baseball in 80 countries. The majority of these children have experienced pain with throwing. A key component to a successful rehabilitation after an upper extremity injury for a baseball player is an interval throwing program, which allows a youth athlete to increase the demands of throwing in a progressive and controlled manner. Numerous interval throwing programs are designed for baseball players of high school age and older, but few exist for the baseball player who is skeletally immature. Our interval throwing programs take into consideration various field dimensions, injury types, and position requirements for youth. Our goal is to create a guide for rehabilitation specialists and players to return to throwing as quickly and safely as possible.
Sitting Matters! Differences Between Sitters and Nonsitters at 6 Months' Adjusted Age in Infants At-Risk and Born Preterm
Purpose: Sitting delays in infants born preterm compound cognitive and language deficits. This retrospective study examines differences in prematurity-related risk and compares developmental outcomes between sitters and nonsitters at 6 months' adjusted age. Methods: A total of 105 graduates of the neonatal intensive care unit met inclusion criteria. Infant demographic and medical risk profiles and 6-month Bayley Scales of Infant Development-3rd edition (BSID-III) cognitive and language scores were retrieved. Infants who sat with hands free greater than 60 seconds were classified as “sitters.” Results: Sixty-nine percent of the sample were nonsitters and were born earlier, had lower birth weights, were chronologically older at follow-up, and spent more days with respiratory support. BSID-III scores were significantly higher in sitters but did not differ by gender, multiple birth, head ultrasound results, payment type, or race/ethnicity. Conclusion: Sitting abilities at 6 months' adjusted age are associated with prematurity risk factors. Cognitive and language scores differ significantly between sitters and nonsitters.
Physical Therapy Scoliosis-Specific Exercises May Reduce Curve Progression in Mild Adolescent Idiopathic Scoliosis Curves
Purpose: To evaluate the curve magnitude in participants with mild adolescent idiopathic scoliosis (AIS) at high risk of progression who received outpatient physical therapy scoliosis-specific exercises (PSSEs). Methods: Participants with AIS curves 12° to 20° and Risser grade 0 chose either the PSSE or the control group. The PSSE group was instructed in the Barcelona Scoliosis Physical Therapy School. The control group was observed. Cobb angles were measured by one observer masked to group type at baseline, 6-month follow-up, and 1-year follow-up. Results: Forty-nine participants were enrolled (26 exercise vs 23 controls). Thirty-three participants (19 exercise vs 14 controls) were seen at 1-year follow-up. At 1-year follow-up, the exercise group had smaller curves than controls (16.3° vs 21.6°, P = .04) and less curve progression (0° vs 5.6°, P = .02). Bracing was performed similarly between groups at 1-year follow-up (37% vs 43%). Conclusions: In this small prospective series, PSSE resulted in significantly less curve progression compared with controls.
Objective: The purpose of this study was to explore the practices physical therapists and occupational therapists use in early intervention (EI) for infants with or at risk for cerebral palsy (CP). Methods: A survey was disseminated nationally to EI providers using an online anonymous link. Results: Two hundred sixty-nine therapists completed at least 50% of the survey. Four percent of therapists use the General Movement Assessment to predict CP, 57% reported infants at risk for CP receive therapy once a week, 89% identified parents' goals as the most important factor in customizing the EI program, and 75% provide parents with home programs. However, 73% never or rarely use outcome measures to prioritize parents' goals; 31% provide parents with individualized home program and more than 60% never assess environmental enrichment. Conclusion: Therapists do not incorporate sufficient strategies for goal-oriented interventions, comprehensive parent education, and optimum environmental enrichment.
Purpose: Alternating hemiplegia of childhood (AHC) is a rare neurological disorder that can influence posture and movement during critical periods of motor development. There are no descriptions of physical therapy for children with AHC. The purpose of this case report is to present an example of physical therapy evaluation, intervention, and outcomes for a child with AHC. Summary of Key Points: Physical therapy services were provided over 9 sequential plans of care between 14 and 52 months of age. The child demonstrated improvements in motor control, walked independently at 16.5 months of age, and her Gross Motor Function Measure-88 score increased from 78% to 95% between 27 and 52 months of age. Conclusions and Recommendations for Clinical Practice: The importance in this case lies in the use of a multisystem approach to treatment, careful consideration of frequency of intervention, and discussion of the unique features of AHC.
Documenting Physical Therapy Dose for Individuals With Cerebral Palsy: A Quality Improvement Initiative
Purpose: To describe the quality improvement (QI) activities used to improve treatment dose documentation for individuals with cerebral palsy (CP) and to discuss insights gained from this project. Methods: Global and smart aims were established and interventions were tested from January 2017 through February 2018 using Plan-Do-Study-Act cycles. Performance was tracked overtime using run and control charts. Results: The QI initiative resulted in a sustainable increase in percentage of dose elements present in the electronic medical record from 78% to 94%. Key drivers of improvement included (1) knowledge and awareness of dose, (2) clinician buy-in, (3) effective engagement of child and parent, (4) therapist knowledge of evidence-based treatments, (5) transparent and reliable documentation system, and (6) audit and clinician feedback. Conclusions: QI methods provided the tools to improve workflow and increase dose documentation for individuals with CP.