Purpose: Intrauterine constraint factors such as multiparity and breech presentation at birth have been associated with congenital muscular torticollis (CMT). The literature lacks evidence linking these factors to CMT severity. The purpose of this study is to determine how birth weight, length, presentation, sex, and delivery factors associate with CMT severity. A secondary purpose is to correlate severity with CMT direction and age at physical therapy evaluation. Methods: Researchers relied on a clinical outcome database of 1239 infants ≤6 months diagnosed with CMT to examine how birth weight, length, breech positioning, sex, multiparity, and delivery method relate to CMT severity. Results: Breech presentation was the only factor associated with torticollis severity. Infants with >30° of cervical tightness were more likely to be younger at evaluation and have a right torticollis. Conclusions: The increased likelihood of CMT severity with breech presentation at birth can guide pediatric physical therapists in prognostics.

Purpose: Cerebral palsy (CP) is a condition that often presents with altered muscle tone affecting function. The purpose of this case report is to describe the clinical application of transcutaneous electrical nerve stimulation (TENS) to manage the impact of muscle tone during gait in 2 children with CP. Summary of Key Points: Two children with CP, who are gait, received TENS to manage spasticity and dystonia. Gait was analyzed using a two-dimensional gait analysis with and without TENS. Results demonstrated medium and large minimally clinically important differences in velocity, cadence, and stride length with TENS. Conclusion: Using TENS parameters may be a modality to manage tone and improve gait for children with CP. A larger study is needed to determine the effects of TENS. Recommendations for Clinical Practice: Clinicians may use TENS on spastic or dystonic muscles as an intervention to improve gait for children with CP.

Purpose: This systematic review investigated the threshold dose of active lower limb training required to improve outcomes in children with cerebral palsy (CP) and to evaluate the reporting of motor learning strategies. Methods: Five databases were searched for randomized controlled trials on active lower limb training in children with CP. Independent assessors conducted study selection, data extraction, and risk of bias assessment. Clinically significant mean group changes established dose thresholds, while motor learning strategies were assessed based on 11 common strategies. Results: One hundred and one studies (3566 participants, mean age 8.8 years) met inclusion criteria. Threshold doses were 12 hours for walking speed, 7.5 hours for walking endurance, 23.33 hours for gross motor function, and 21 hours for goal performance. Motor learning strategy reporting was low. Most studies had a high risk of bias. Conclusions: These results provide preliminary guidance for optimizing therapy time to improve walking speed and endurance, gross motor function, and goal performance. More high-quality studies with detailed intervention reporting are needed.

No abstract available

Purpose: To explore the long-term impacts of an intensive physical therapy program, as perceived by caregivers and children. Methods: Semi-structured interviews were completed with 7 caregivers and 1 child. The data from these interviews were analyzed by an interdisciplinary coding team comprised of 3 physical therapists and 2 psychologists. Rapid qualitative inquiry (RQI) was used, which relies on intensive teamwork, iterative data analysis, and triangulation from multiple sources to get insiders’ perspectives. Results: Interviewees had positive experiences in the Intensity Program which they believed led to long-term and positive impacts in physical, psychological, and social functioning. Even though the program was challenging, and certain parts of it could be improved, interviewees were pleased with it. Conclusions: Interviewees perceived that the benefits of intensive physical therapy may persist for over a year following the completion of such a program. Perceived benefits of participating in an intensive program seem to outweigh the challenges.

Purpose: To assess the concurrent validity of 2 wearable sensors, GENEActiv (GA) and MonBaby (MB), for tracking tummy time in full-term and preterm infants at home. Methods: Nineteen full-term infants and 13 infants born preterm, aged 3 to 6 months, wore GA and MB sensors during caregivervideo-recorded active play at home over 3 days. Prone (tummy time) durations detected by each sensor were compared to video for validation. Results: Both GA and MB sensors demonstrated excellent (κ = 0.86) and substantial (κ = 0.78) second-by-second agreement with video, respectively, for tracking tummy time. For cumulative tummy time, the GA showed higher accuracy with video (GA =60 minutes, video =58 minutes, difference =2 minutes) compared to MB (MB =43 minutes, video =47 minutes, difference =4 minutes). No differences in accuracy were found between the 2 sensors. Conclusion: Wearable sensors can accurately track tummy time at home and can support adherence to movement guidelines in infants. Establishing caregiver feasibility is crucial for broader use.

Purpose: This case report describes the combined use of whole-body vibration (WBV), serial casting (SC), and physical therapy (PT) for a child with hemiplegic cerebral palsy (HCP). Summary of Key Points: A 3-year 10-month-old male with HCP was followed for 10 months. Treatment included 9 weeks of SC due to ankle plantarflexion contracture, hypertonicity, poor orthotic tolerance, and gait limitations. WBV was introduced during week 4 to address hypertonicity and poor tolerance of manual therapy. PT sessions included stretching, gait training, and strengthening exercises, integrating SC and WBV into a comprehensive intervention. Statement of Conclusion and Recommendations for Clinical Practice: This is the first report to explore combining WBV and SC within a PT program. WBV was safe and effective, potentially serving as a preparatory activity for SC. Improved orthotic wear tolerance, dorsiflexion range of motion, and gait efficiency suggest potential benefits of this multimodal approach, warranting further research. Video Abstract: Supplemental digital content available at http://links.lww.com/PPT/A657.

Purpose: The purpose of this study was to explore the experiences of pediatric physical therapists with the implementation and sustainability of pediatric intensive physical therapy (PT) programs in the United States. Methods: Data were collected from a 35-question survey consisting of multiple choice, Likert scale, and open-ended questions based on the Knowledge to Action Cycle Framework. Mixed methods were used in the data analysis of 2 quantitative questions relevant to implementing and sustaining pediatric intensive PT programs and 4 open-ended questions. Results: The sample size for quantitative questions was 80 and varied from 29 to 50 for open-ended questions depending on the question. Identified overarching themes included: Clinicians value intensive programs; “Logistically tough,” and Programs require 3 “Fs” for implementation and sustainability – Funding, Flexibility, and Foundational Knowledge. Conclusions: Pediatric physical therapists value intensive programs. Identified areas for support included formal training, improved research evidence, and institutional support.

Objective: To analyze and compare the effects of 2 aquatic exercise protocols on the gait of children with cerebral palsy (CP), aged 6 to 8 years. Methods: A randomized, controlled, and blind clinical trial, carried out with 16 children with CP classified to Gross Motor Function Classification System (GMFCS) II and III bilateral spastic, divided into a group of aquatic balance exercises group (BG) and a group of aquatic trunk exercises group (TG). The following assessments were completed before and after the intervention: 6-Minute Walk Test (6MWT), Trunk Control Measurement Scale, Pediatric Balance Scale, Timed Up and Go, Dynamic Gait Index, and Child Health Questionnaire—Parent form 50. Results: BG was superior to TG in 6MWT after the intervention. Improvement was observed in most outcomes in both groups. Conclusion: The protocols demonstrated positive effects on the outcomes analyzed, and BG performed better in the distance covered in 6MWT.

Purpose: To evaluate the potential of a task-specific training model to improve sitting through tailored trunk support and incrementally challenging reaching. Methods: A single-subject AB design with follow-up was conducted with a 20-month-old child with severe postural impairments due to 16p11.2 deletion syndrome and multiple comorbidities. Phase A included 6 baseline assessments during 2 weeks, followed by 15 intervention sessions (Phase B) during 5 weeks, and 4 post-intervention assessments during follow-up. Outcomes included the Segmental Assessment of Trunk Control (SATCo) and the Gross Motor Function Measure (GMFM) sitting dimension. Visual analysis, the 2 standard deviation band method, and C-statistics evaluated change. Results: SATCo and GMFM scores were stable during baseline but had significant trend changes from baseline to intervention and follow-up phases. Independent sitting skills emerged after the intervention. Conclusions: Task-specific training tailored to the child’s ability by systematically progressing trunk support and reaching practice may promote long-lasting sitting function.

Purpose: Intensive pediatric physical therapy (PT) programs are increasingly common yet lack a clear definition. This study aimed to examine current practice patterns of intensive pediatric PT in the United States. Methods: A survey was developed and administered using the FITT (frequency, intensity, time, type) model and Knowledge to Action Cycle for pediatric physical therapists providing intensive PT. Survey respondents included pediatric physical therapists providing intensive physical therapy in outpatient, non-acute settings. Data analysis used descriptive statistics and cluster analysis. Results: Eighty pediatric physical therapists reported intensive programs involved children aged 4-6 years with cerebral palsy (90%), neuromuscular (78%), and neuromotor (44%) disorders. Greatest dose often-always ranged from 2-5 visits per week, ≤60-120 minute sessions over 3-8 weeks. Top interventions included locomotor training (80%), task-specific training (78%), and progressive resistive exercise (76%). Two clusters were identified based on therapist organization and dose. Conclusions: This first study of intensive pediatric PT revealed marked variability, underscoring the need for a standardized definition to improve clinical care.

Purpose: This study analyzed evidence of the impact of physical therapy-directed early mobilization (EM) on hospital and pediatric intensive care (PICU) length of stay, and mechanical ventilation days. Methods: PubMed and CINAHL were searched through January 2023. Studies included non-neonates through 18 years who participated in an EM program led by a physical therapist. Effect sizes and risk ratios were analyzed. Evidence quality of studies was assessed. Results: Six high-quality studies met the inclusion criteria. There was a statistically significant effect in the between-group analysis on hospital length of stay, PICU length of stay and mechanical ventilation days. Conclusions: This systematic review and meta-analysis support implementing EM in PICUs to reduce hospital and PICU length of stay, and mechanical ventilation days. This evidence can inform wider adoption of physical therapy-directed EM in PICUs to benefit infants and improve quality healthcare.

Purpose: The aims of this study are to: (1) identify standardized pediatric outcome measures (OMs) currently taught in professional physical therapist (PT) education; (2) identify standardized pediatric OMs currently used in PT practice; and (3) compare similarities and differences in standardized pediatric OMs taught in professional PT education and those used in PT clinical practice. Methods: This study used an explanatory, sequential mixed methods design with quantitative data from a descriptive, cross-sectional electronic survey to inform 4 qualitative focus group interviews. Quantitative data were analyzed using a 2-proportion Z-test and descriptive statistics. Qualitative data were analyzed using direct content analysis. Results: Quantitative and qualitative data were integrated, revealing significant differences between standardized pediatric OMs taught in entry-level PT programs and those used in professional practice. Conclusions: Improved alignment of standardized pediatric OMs used by both faculty and clinicians could better equip learners for clinical practice.

Purpose: The aim of this article is to characterize parents’ use of containers and determine whether it relates to infants’ development or body mass index (BMI). Methods: A cross-section of parents with infants under 19 months completed a survey reporting their use of containers and infants’ height and weight; parents also completed the Ages and Stages Questionnaire (ASQ-3). Descriptive and correlation analyses were used to describe parents’ container use and evaluate whether container use was related to ASQ-3 scores or BMI. Results: Parents reportedly used containers for 5.15 hours daily. More time reported in containers overall was associated with poorer fine motor scores. Longer bouts in positional pillows were associated with poorer gross motor development. Conclusion: Providing enhanced fine motor opportunities may be important for families using containers more often. Reported container use was higher than professionals typically recommend, yet did not relate to obesity or delayed development in most domains, an important consideration when updating recommendations for parents.

Dynamic Movement Intervention (DMI) and Cuevas Medek Exercises (CME) are promoted as innovative neurorehabilitation methods for children with neurological disabilities, yet both rely on outdated reflex-hierarchical models rather than contemporary motor learning principles. A review of the literature reveals that CME, despite 5 decades of use, is supported only by a few case reports and 2 small, biased comparative studies. DMI, introduced in 2021, has no published empirical evidence beyond a single conference abstract. Thus, both interventions remain at Sackett Level 5—no evidence.

Purpose: To evaluate feasibility and effect of Enhanced Play Education (EPE) on development relative to Usual Play Education (UPE) for infants of varying abilities. EPE encouraged child-initiated movement, problem-solving with objects, and responsive communication; UPE reflected popular education. Methods: Participants were randomly assigned to the UPE or EPE group and received written, illustrated instructions to perform their play activities 15 minutes daily. Standardized developmental assessments occurred at baseline, after the 4-week intervention, and 1 and 2 months later. Results: Forty-nine infants (M = 3.5 months; 35 with typical development; 14 at risk of developmental delays) and 44 parents were enrolled. Both interventions were feasible. Infants with typical development had greater cognitive and supine gross motor improvements after EPE; infants at risk had greater gross motor improvements after EPE. Conclusion: Educating parents to engage in quality play activities may be an effective method to advance early motor and cognitive outcomes for young infants.

Purpose: This study evaluated the accuracy of the Activity Measure for Post-Acute Care “6-Clicks” Inpatient Basic Mobility Short Form (AM-PAC BMSF) in predicting discharge outcomes in a pediatric acute care setting and identifying a cutoff score for outpatient physical therapy referrals. Methods: A retrospective analysis included initial AM-PAC BMSF scores from 2014 children aged 4 to 17 years hospitalized for more than 72 hours. Receiver operating characteristic curve analysis assessed the tool’s sensitivity and specificity in predicting postdischarge physical therapy referrals. Results: Children referred to outpatient physical therapy had significantly lower initial AM-PAC BMSF scores. A raw score of 17 to 18 (49% impairment) was the optimal cutoff score for predicting outpatient physical therapy referrals. Conclusions: The AM-PAC BMSF, completed at the initial evaluation, can moderately predict the need for outpatient physical therapy following pediatric acute care discharge. A cutoff score of 18 may support more proactive and targeted discharge planning.

Purpose: To evaluate the effectiveness of hydrotherapy (HT) on pain and function in children with juvenile idiopathic arthritis (JIA). Methods: Eligible studies were randomized clinical trials published in English, which recruited children with JIA and had 2 groups with 1 receiving HT alone and the other receiving a comparison/control intervention. Risk of bias was assessed using the Cochrane Risk of Bias 2. Overall quality of evidence was assessed with the Grading of Recommendations Assessments, Development, and Evaluation. Meta-analyses were performed for outcomes when possible. Results: Meta-analyses comparing HT to standard care demonstrated statistically significant effects on pain and VO2max favoring HT. No significant differences were found for function (CHAQ), peak knee extensor torque, or 6-minute walk test. The overall level of evidence ranged from very low to moderate. Conclusions: Hydrotherapy improved VO2max and reduced pain in individuals with JIA compared to standard care.

Purpose: The aim of this article is to characterize parents’ use of containers and determine whether it relates to infants’ development or body mass index (BMI). Methods: A cross-section of parents with infants under 19 months completed a survey reporting their use of containers and infants’ height and weight; parents also completed the Ages and Stages Questionnaire (ASQ-3). Descriptive and correlation analyses were used to describe parents’ container use and evaluate whether container use was related to ASQ-3 scores or BMI. Results: Parents reportedly used containers for 5.15 hours daily. More time reported in containers overall was associated with poorer fine motor scores. Longer bouts in positional pillows were associated with poorer gross motor development. Conclusion: Providing enhanced fine motor opportunities may be important for families using containers more often. Reported container use was higher than professionals typically recommend, yet did not relate to obesity or delayed development in most domains, an important consideration when updating recommendations for parents.

Purpose: The purpose of this case series was to explore the feasibility and impact of a 3-week activities-based locomotor training (AB-LT) program on functional activities and neurophysiological adaptations in 5 children with cerebral palsy (CP). Methods: Children, aged 2–6 years who were classified as Gross Motor Function Classification Scale levels III or IV, participated in the intervention 5 days per week for 3 hours per day. The Gross Motor Function Measure-66 (GMFM-66) and functional near-infrared spectroscopy neuroimaging were performed pre- and post-intervention. Results: After AB-LT, increases in GMFM-66 scores were observed for Children 1 (Δ3.3), 2 (Δ5.6), 4 (Δ1.8), and 5 (Δ1.3), beyond expected natural progression. A reduction in total hemoglobin activation and increased neural demand was observed. Child 3 had minimal functional changes with no observed neurophysiological adaptations. Conclusions: The 3-week AB-LT regimen is a short duration, high-intensity program with the potential to benefit children with CP.