Pediatric Physical Therapists Research Articles

Using a Co-design Approach to Create Tools to Facilitate Physical Activity in Children With Physical Disabilities.

Introduction: There is a lack of effective interventions available for Pediatric Physical Therapists (PPTs) to promote a physically active lifestyle in children with physical disabilities. Participatory design methods (co-design) may be helpful in generating insights and developing intervention prototypes for facilitating a physically active lifestyle in children with physical disabilities (6–12 years).Materials and methods: A multidisciplinary development team of designers, developers, and researchers engaged in a co-design process–together with parents, PPTs, and other relevant stakeholders (such as the Dutch Association of PPTs and care sports connectors). In this design process, the team developed prototypes for interventions during three co-creation sessions, four one-week design sprint, living-lab testing and two triangulation sessions. All available co-design data was structured and analyzed by three researchers independently resulting in themes for facilitating physical activity.Results: The data rendered two specific outcomes, (1) knowledge cards containing the insights collected during the co-design process, and (2) eleven intervention prototypes. Based on the generated insights, the following factors seem important when facilitating a physically active lifestyle: a) stimulating self-efficacy; b) stimulating autonomy; c) focusing on possibilities; d) focusing on the needs of the individual child; e) collaborating with stakeholders; f) connecting with a child's environment; and g) meaningful goal setting.Conclusion: This study shows how a co-design process can be successfully applied to generate insights and develop interventions in pediatric rehabilitation. The designed prototypes facilitate the incorporation of behavioral change techniques into pediatric rehabilitation and offer new opportunities to facilitate a physically active lifestyle in children with physical disabilities by PPTs. While promising, further studies should examine the feasibility and effectivity of these prototypes.

O09 Recurring brachial plexopathy- the zebra among the horses

O09 Recurring brachial plexopathy- the zebra among the horses

A Survey of Physical Therapists and Occupational Therapists to Explore Practice Patterns of Pediatric Telerehabilitation during COVID-19

<h3>Research Objectives</h3> To examine the current practice patterns including strengths and challenges faced by pediatric physical therapists (PTs) and occupational therapists (OTs) while delivering virtual care during the pandemic. <h3>Design</h3> Exploratory Survey Study. <h3>Setting</h3> Pediatric therapists working in different settings (i.e. inpatient, outpatient, early intervention, and school-based). <h3>Participants</h3> Pediatric PTs and OTs. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> An anonymous electronic survey distributed via Redcap Online Survey Software. The survey was developed and validated through cognitive interviewing of 3 therapists with clinical and/or research experience. It included components related to therapist demographics, specifications of telehealth sessions, and perceived quality of delivery. <h3>Results</h3> Preliminary data from 96 participants indicated an equivalent representation of PTs (51.2%) and OTs (49.7%), with 91.4% therapists reporting no prior experience with telerehabilitation. 74.5-78.6% reported average duration of 30-60 minutes for a virtual session and frequency of 1x/week. Maintaining child's interest and limited availability/willingness of caregivers to participate was identified as the most common challenge (70-74% of therapists), whereas, better assessment of home environment was identified as the most common strength (74% of therapists) of telerehabilitation. 59.6% therapists modified the assessments and 89.5% modified the intervention activities to make them conducive for the virtual environment. 57% of therapists felt they did not deliver equivalent care during virtual sessions compared to in-person sessions, and 40% reported lack of basic knowledge and resources required to conduct the sessions. Additionally, 50% lacked confidence in accurately assessing children virtually. <h3>Conclusions</h3> Our study provided the preliminary data on the current practice trends of virtual rehabilitation. Pediatric telerehabilitation is an evolving healthcare field with need of future research on operational guidelines and its effectiveness. <h3>Author(s) Disclosures</h3> All authors have no conflict of interest.

The diagnostic trajectory of developmental coordination disorder in the Netherlands: Experiences of mothers

BackgroundReceiving a diagnosis can have a major impact on the child and its family. Parental satisfaction concerning the diagnostic trajectory is important with regard to acceptance and coping with their child's problems. Our aim was to describe the diagnostic trajectory of developmental coordination disorder (DCD) in the Netherlands and identify factors that are related to parents' satisfaction.MethodMothers of 60 children with a DCD diagnosis completed an online survey concerning their experiences during and after the diagnostic trajectory of obtaining this diagnosis.ResultsForty percent of the mothers rated the diagnostic trajectory towards a DCD diagnosis as stressful and 47% rated the knowledgeability of the first professional they consulted (mostly a general practitioner, paediatric physical therapist, or youth health care physician) as having no or just superficial knowledge about DCD. Around 60% of the mothers described a lack of knowledge and support at their child's school after receiving the diagnosis. Notwithstanding this, the majority of the participating mothers was (very) satisfied with the diagnostic trajectory. Higher appreciation of both the manner of the diagnosing professional and the post‐diagnostic support provided were predictive of higher satisfaction.ConclusionsOur results underline the importance of improving the knowledgeability in primary schools and primary health care professionals with regard to DCD.

Neurodevelopmental Trajectories of Preterm Born Survivors of Twin–Twin Transfusion Syndrome: From Birth to 5 Years of Age

To investigate the neurodevelopmental outcome at age 2 and 5years in survivors of twin-twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery and born premature and/or small for gestational age. At 2 and 5years of age, standardized neurologic, motor, and cognitive assessments were performed by a neonatologist, a pediatric physical therapist, and a psychologist. Behavior was assessed using a validated questionnaire completed by parents. Neurodevelopmental assessment at both time points was available for 73 survivors of TTTS. Mild to moderate neurodevelopmental impairment (NDI) was detected in 34% of survivors (25 of 73) at 5years, compared with 25% (18 of 73) at 2years (P=.178). Severe NDI was observed in 12% (9 of 73) at 5years and in 3% (2 of 73) at 2years (P=.035). Mean cognitive score was lower at the 5-year follow-up (90.7±12.3 vs 95.6±13.1 at 2years; P=.001), and more children were diagnosed with mild cognitive impairment at 5years (29% vs 11% at 2years; P=.007). When comparing individual outcomes at both time points, 35% (25 of 71) moved from a normal outcome or mild to moderate impairment at 2years toward more severe impairment at 5years. A high rate of mild to moderate cognitive impairment and severe NDI at age 5years was not identified at age 2years. Our data highlight the importance of longitudinal follow-up of survivors of TTTS beyond age 2years and emphasize the precautions that should be taken when diagnosing an absence of impairment before school age.

Collaborative Goal-Setting Beliefs and Practices of Out-Patient Pediatric Physical Therapists Working in Saudi Arabia and the United States

Aims (1) identify and compare family-centered care (FCC) and collaborative goal-setting (CGS) beliefs and practices of out-patient pediatric physical therapists (PTs) in Saudi Arabia (SA) and the United States (US); (2) describe CGS approaches; and (3) determine the association between CGS practices and educational level, clinical experience, and FCC beliefs and practices. Methods 87 PTs completed an online survey. Results Ninety percent of PTs believed in FCC to a great extent. PTs in the US rated their organization’s family-centeredness and their own FCC application significantly higher than PTs in SA. PTs believed in CGS with parents (86%) and children (66%) to a great extent while 69% of PTs reported applying CGS with parents to a great extent compared to 39% with children. PTs in SA rated the importance of determining therapy goals by PTs significantly higher than PTs in the US. The most selected CGS strategy was asking about concerns and needs. Low to moderate significant positive associations were found between CGS practices and PTs belief of their organization’s family-centeredness and their own FCC application. Conclusion Similarities and differences were found between the two countries in FCC and CGS beliefs and practices. Organizational and individual FCC practices influence CGS practices.

Commentary on "Adoption of Telehealth by Pediatric Physical Therapists During COVID-19: A Survey Study".

Commentary on "Adoption of Telehealth by Pediatric Physical Therapists During COVID-19: A Survey Study".

Adoption of Telehealth by Pediatric Physical Therapists During COVID-19: A Survey Study.

To describe the characteristics of pediatric physical therapy telehealth practice during COVID-19. An anonymous, online survey was distributed to pediatric physical therapists (PTs) in the United States who transitioned to telehealth during COVID-19. Two hundred five respondents completed all quantitative questions. Ninety-six percent reported never providing telehealth previously and only 14.6% had formal training. More than 35% reported 76% to 100% of their caseload transitioned to telehealth. Most respondents perceived that telehealth was somewhat or very effective for caregivers (90.3%) and children (77.1%) and felt somewhat or very confident providing telehealth (73.2%). However, those practicing in school-based settings rated perceived effectiveness and confidence lower than PTs in other settings. Ultimately, 76.1% of respondents would consider providing telehealth in the future. The forced transition of pediatric PTs to the telehealth model during the COVID-19 pandemic resulted in positive experiences for many, supporting wider adoption in the future.

PHYSICAL THERAPISTS’ PERCEPTIONS OF ADOLESCENT IDIOPATHIC SCOLIOSIS TREATMENT

Background:Few studies have demonstrated the benefit of physical therapy in the treatment of adolescent idiopathic scoliosis (AIS), alone or in conjunction with bracing or surgery. To our knowledge, there is no consensus in pediatric physical therapists who treat AIS patients.Purpose:To identify the optimal physical therapy practices for AIS including; weekly frequency, session length, treatment duration, clinical interventions, therapeutic goal-setting, and outcome measures from pediatric physical therapists’ perspectives.Methods:A 40-question validated survey, The Analysis of the Schroth Method in Adjunct to Physical Therapy Services for Treatment of AIS, was distributed to pediatric physical therapists across the country via the Academy of Pediatric Physical Therapy electronic newsletter and via dissemination by the Injury Prevention Research Interest Group from Pediatric Research in Sport Medicine. REDCap was used to collect and organize responses. The responses were analyzed by a descriptive statistics using percentages (%).Results:Sixty-five responses were obtained. The majority of physical therapists, 78.5%, were Doctors of Physical Therapy (DPT), treating 1-5 AIS patients a week (69.2%), and 18.8% had Schroth certification. Preferred treatment frequency was twice a week (41.5%) for a duration of 60 minutes (53.8%), over the course of 3-5 months (44.6%). The top three common clinical interventions were; core and trunk stability enhancement (90.8%), abdominal strengthening (83.1%) and postural correction (80.0%). The three most common therapeutic goal-setting parameters were activity based (78.5%), quality of life measure based (56.9%), and therapy participation based (50.8%). Additionally, for outcome measures, patient reported outcome was the most common objective measurement (78.5%), followed by pain (63.1%), manual muscle testing (46.2%), range of motion (44.6%), cobb angle (27.7%), scoliometer readings (26.2%) and Adam’s forward bend test (10.8%). Therapists often monitored progress with completed surveys by patients. However, patients’ ability to return to activity was the most common marker of improvement (72.3%). Patient’s scoliosis was often being treated in another manner aside from PT (46.2%), and many patients had medical conditions in addition to scoliosis (52.3%).Conclusion:According to our data, pediatric physical therapists believe that patients with AIS can benefit from physical therapy treatments addressing core and trunk stability, abdominal strengthening, and postural correction. Ideal treatment sessions would occur twice a week for 60 minutes over a period of 3-5 months. Objective measurements can be monitored to ensure improvements in quality of life, pain, strength, range of motion and curvature of the patient’s spine.AcknowledgementsThe Injury Prevention Research Interest Group from Pediatric Research in Sports Medicine and Suzanne M. McCahan, PhD

Commentary on "Experiential Learning in Pediatric Physical Therapist Education: Faculty and Student Perceptions".

“How could I apply this information?” In their research, the authors identify that experiential learning (EL) with children in physical therapist education varies by program. Despite this, students and faculty agree that EL with children positively contributes to students' learning. Further, students value quality more than the quantity of EL with children. Pediatric physical therapy faculty may enhance students' perceived value of EL by clearly describing the goals of the EL activity and focus on direct interaction between students, children, and their families. A common barrier to EL is access to children with participation restrictions and their families. Faculty and local pediatric physical therapists must be proactive in developing partnerships to expand opportunities for meaningful EL with children. Cocreating a process to identify and recruit EL participants may decrease the administrative burden of implementing EL activities on campus and in the community. As faculty and clinicians work to improve EL opportunities for students, they may feel more equipped for an entry-level pediatrics position at graduation. “What should I be mindful about when applying this information?” There was small number of study participants compared with the total number of accredited Doctor of Physical Therapy (DPT) programs, as only 109 faculty and 20 students from 263 currently accredited DPT programs were included. Readers must also consider the potential bias of participants when generalizing the identified themes. Topics that were not covered in the article were how often clinicians from the community were involved with EL opportunities and their impact on quantity and quality of EL. This limits the understanding of the role of the clinician in EL. Questions remain about how the quantity or quality of EL influences students' decisions about pursuing a career in pediatric physical therapy at graduation. Chelsea Lasky-McFarlin, PT, DPT The University of North Carolina Health Care System, Chapel Hill, North Carolina Tricia Catalino, PT, DSc Hawai'i Pacific University, Honolulu, Hawaii

Commentary on "The Influence of Maternal Cognitions Upon Motor Development in Infants Born Preterm: A Scoping Review".

“How could I apply this information?” This scoping review affirms what we as physical therapists already know but sometimes forget that, in order to truly care for an infant, we must also care for the mother. Mothers of preterm infants may view their child as fragile long after they are critical, thus offering their infants less mature or varied toys and experiences. Focusing interventions with families understanding their infants' strengths perhaps more than the infant's challenges and scaffolding their learning builds confidence with mothers. This review highlights the maternal stress of having a preterm infant, and evidence presented in this scoping review validates that interventions should include working to understand and positively influence maternal cognition regarding her infant as we know this impacts infant development. Pediatric physical therapists are specialists in infant movement, yet this is never isolated and must be considered within the environment. Further research in this field could focus on intervention for mothers and infants, as certain neonatal intensive care unit (NICU) settings (private room vs open bay) or routines (the presence of support groups, frequency of therapy sessions) impact maternal cognition at hospital discharge. “What should I be mindful about when applying this information?” From a parent's perspective, this article provides useful information for parents of preemies. Having a preterm infant can feel like such a helpless time. Hearing “your child has an increased risk of developmental problems” can leave you fearful for the future and uncertain of what you can do for your child. This scoping review provides hope that parents can improve their child's development, in ways that intuitively make sense but aren't obvious in the NICU. It is encouraging that so many studies point toward this conclusion, but more research is certainly needed. This article can be helpful in collaborating with parents on things they can easily do in helping their child develop. Kara Boynewicz, PT, DPT Department of Physical Therapy, East Tennessee State University, Johnson City, Tennessee Karen Speropulos, PT Niswonger Children's Hospital, Johnson City, Tennessee Jen Hollinger Johnson City, Tennessee Shawn Hollinger, MD Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee

National Study of Excellence in Pediatric Physical Therapy Education: Design, Methods, and Results.

The purposes of this study were to identify and describe the attributes of excellence and innovation in professional pediatric physical therapy education and develop a conceptual framework identifying dimensions of excellence. A multimethod case study design based on a grounded theory framework was used. Data collection included review of artifacts and field interviews (individual and focus group). A constant-comparative method for within case and across case was used for data analysis to verify and revise coding schemes, identify categories and subcategories, revise emerging themes, and develop a conceptual framework. Based on results of a predetermined grading rubric, 6 of 17 self-nominated academic sites were selected representing diverse institution types (public/private, Carnegie classification, size) and geographic locations. Pedagogical approaches and method of content delivery varied among programs; all used the essential core competencies. The core pediatric faculty member(s) were Board Certified Clinical Specialists. A conceptual framework was developed based on 4 key dimensions: Culture of Excellence, Exemplary Pediatric Faculty, Pedagogy, and Child and Family as Teacher (CFT), and 16 related elements. CFT is a unique and nonnegotiable dimension of excellence in pediatric physical therapy education, highlighting the partnership between the learner, child, family, and pediatric faculty member. CFT intersects with the other dimensions and integrates their elements (ie, faculty characteristics, contributions from the child and family, use of instructional strategies) to effectively prepare future pediatric physical therapists. Based on the pervasiveness of this dimension in teaching and learning across all programs, this may be the signature pedagogy of pediatric physical therapy education. Results of this study are important to professional physical therapist education administrators, pediatric academic faculty, and clinical educators because they represent an understanding of the attributes of excellence. The model can serve as a guide for best practice in pediatric physical therapy education.

Pediatric Physical Therapy Telehealth and COVID-19: Factors, Facilitators, and Barriers Influencing Effectiveness-a Survey Study.

The purpose of this study was to identify the important factors, facilitators, and barriers for telehealth effectiveness as described by pediatric physical therapists, transitioning from in-person to telehealth during the COVID-19 pandemic. Pediatric physical therapists' responses to 3 open-ended questions and 1 multipart Likert Scale question from an anonymous survey were collected and analyzed using thematic analysis and descriptive statistics. Three overarching themes (Caregiver Engagement, Technology, and Resilience) were identified and accompanied by 3 subthemes (Personal Attributes, Equity, and COVID-Specific Considerations). Themes were supported by the Likert Scale question with Child/Caregiver Interaction, Internet Connection, and Family Factors identified as the most important factors related to telehealth effectiveness. High caregiver engagement and access to stable technology were most important for telehealth effectiveness. The telehealth service model met a need during the pandemic; however, emerging evidence suggests that it could be considered as an effective service delivery mode postpandemic.

Experiential Learning in Pediatric Physical Therapist Education: Faculty and Student Perceptions.

Faculty teaching pediatric content in accredited doctor of physical therapy programs was recruited; 106 responded. Students representing 20 participating programs were also invited to participate; 23 responded. Participants received an online questionnaire including closed- and open-ended questions regarding EL with children. Descriptive statistics were used to describe responses. Responses to open-ended questions were compiled and reviewed. Respondents reported an average of 12.4 hours of EL with children in required courses. Satisfaction with quality was stronger than with amount of EL. Several perceived barriers and facilitators were reported. Use of and satisfaction with EL with children in physical therapists' education vary. Continued research on this variation and potential effects to educational outcomes is needed.

P0689 / #1947: ENHANCING POSTGRADUATE SKILLS IN PAEDIATRIC CRITICAL CARE PHYSIOTHERAPY VIA SIMULATION-BASED EDUCATION: A COLLABORATIVE APPROACH

AIMS & OBJECTIVES: Cardiorespiratory physiotherapy within the paediatric critical care unit requires specialist knowledge and postgraduate training to ensure safety and clinical competency. Within the United Kingdom, simulationbased education (SBE) is primarily used for treatment skills and updates for cardiorespiratory on-call physiotherapists (Gough et al, 2013). The availability and accessibility of high-fidelity resources and specialist education is variable. A collaboration between Great Ormond Street Hospital and the Royal Brompton Hospital, London, was established with the aim of providing a comprehensive SBE course to paediatric physiotherapists nationally. There are currently no other paediatric SBE programmes within the region. METHODS: During May 2018, 2 courses were run with a combination of pre-simulation lectures, simulation scenarios and peer group discussion. Following an international peer review from Queensland Children's Hospital and anonymised candidate feedback (N=23), the course content was divided into 2 separate study days (October 2018 and May 2019). This allowed targeted, specific SBE to both a critical care group and a high dependency care group of paediatric physiotherapists. RESULTS: 15 candidates attended the SBE paediatric critical care (N=8) and high dependency care (N=7) courses. Of the 14 anonymised electronic feedback responses, 96.5% rated the 4 simulation scenarios as extremely useful or very useful. Feedback themes were collated to guide future course content. CONCLUSIONS: The targeted SBE programme for paediatric critical care physiotherapists demonstrated improved confidence in managing highly complex scenarios alongside an opportunity for shared peer learning and reflective practice. In the current COVID-19 pandemic, the course is being modified for teaching via a virtual platform.

Filling the gaps in knowledge translation: Physical therapy recommendations for individuals with spinal muscular atrophy compared to standard of care guidelines

This study describes the current landscape of physical therapy practice recommendations in the United States for children with spinal muscular atrophy (SMA) and their relationship to current SMA standard of care (SMA-SOC) guidelines. Pediatric physical therapists were surveyed to determine their knowledge of SMA-SOC guidelines, and the type, duration and frequency of intervention they recommend for children with SMA, as well as perceived barriers and facilitators to progress in physical therapy. Physical therapists recommend five key intervention areas for individuals with SMA; however discrepancies exist between the SOC recommended intervention parameters and respondents’ reported frequency and duration of recommendations. After individuals with SMA initiated disease modifying pharmacotherapies, a majority of physical therapist respondents recommended increases in both frequency and duration of interventions. Nearly all respondents reported that familiarity with SOC guidelines was beneficial to their practice. The primary facilitator to progress was parent/caregiver support, while the primary barrier was limited access to resources. Variation in practice exists regarding care for those with SMA, particularly in the areas of frequency and duration of specific interventions. These findings can guide educational initiatives, identify future research needs and further inform SMA-SOC and best-practice rehabilitation management.

Promoting Participation in Physical Activity in Children and Adolescents With Down Syndrome.

Physical therapists are experts in exercise and physical activity and are thus uniquely qualified to promote participation in children with Down syndrome. Instead of focusing on impairments or "correct" movement patterns, physical therapists are encouraged to allow the child and the child's environment to direct the treatment plan.

Embracing Our Role in the Prevention of Chronic Pain.

This perspective article advocates for pediatric physical therapists to increase their role and visibility in the primary and secondary prevention of chronic pain during 2 critical developmental periods: infancy and early adolescence. The opioid epidemic and the disabling aspects of chronic pain are adversely affecting children and their families. Health care disciplines are adopting measures that address risk factors for the development of chronic pain in children, including strategies to minimize acute procedural pain and parental education to reinforce healthy pain-coping behaviors. Pediatric physical therapists are uniquely positioned to develop and adopt strategies to aid in this effort. They routinely screen and evaluate children for developmental delays and work with children who are at increased risk for developing chronic pain as a sequela of their health condition or as a consequence of painful medical procedures.

Current Physical Therapy Practice in Norway for Children With Cerebral Palsy.

To investigate to what degree functional physical therapy approaches are implemented in Norway when promoting gross motor skill acquisition in children with cerebral palsy. It was a national survey about current practice among Norwegian pediatric physical therapists. The physical therapists chose between 5 predefined approaches developed through practice descriptions by a convenience sample of 55 physical therapists. The distribution of the main approaches were: functional training based on principles of motor learning, training of body functions and structures, manual stimulation of position and movements, addressing environmental factors, and conceptual methods. Working in the North and having more experience predicted less chance of using functional approaches. Most physical therapists frequently used other approaches as a supplement to the main approach, but not conceptual methods. Functional training based on principles of motor learning has become the method of choice in Norway.

Participation predictors for leisure-time physical activity intervention in children with cerebral palsy.

To determine the predictors of magnitude of change in response to a participation-focused leisure-time physical activity intervention in children with cerebral palsy (CP) using the ParticiPAte CP protocol. We included 33 children (16 males, 17 females) aged 8 to 12years (mean age=10y, SD=1y 6mo) with CP with pre/postintervention data from a wait-list randomized trial. The hypothesized linear predictors of change in primary outcomes (Canadian Occupational Performance Measure [COPM]-performance and COPM-satisfaction, Belief in Goal Self-Competence Scale (BiGSS), and minutes per day moderate-to-vigorous physical activity [MVPA]) were: age; Gross Motor Function Classification System level; comorbid autism spectrum disorder (ASD); Goal Attainment Scaling T score; Problems in Schools Questionnaire; Physical Activity Climate Questionnaire; Motives for Physical Activities Measure-Revised; and stage of behaviour change. Multivariable models were selected using the Bayesian information criterion. Overcoming barriers to participation, age, and comorbid ASD explained 49% of the variance in change in COPM-performance. Being motivated by interest and/or enjoyment and age explained 32% of the variance in change in COPM-satisfaction. Being motivated by physical activity competence or appearance (extrinsic motivation) explained 24% of the variance in change in BiGSS. Parental autonomy supportiveness, overcoming barriers to participation, appearance motivation, and baseline MVPA explained 59% of the variance in change in MVPA. These findings support a behaviour paradigm for conceptualizing physical activity in children with CP. Children who met their treatment goals showed a greater increase in physical activity participation. Children who were more intrinsically motivated by physical activity at baseline improved more. Being older and having a comorbid diagnosis of autism spectrum disorder were associated with an attenuated effect of the therapy.