Pediatric Physical Therapists Research Articles

Health Promotion and Physical Wellness in Pediatric Physical Therapy.

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. 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. 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. Supplemental digital content available at https://www.dropbox.com/scl/fi/3g468hj1rpxrrivbeses0/HPPW-Video-Abstract_1080.mp4?rlkey=4p1i8z1gynroz064zpx3alijz&st=8u0gqemz&dl=0.

Practices of Physical Therapists Who Assist People With Cerebral Palsy in Brazil: A National Survey.

To describe the practices of pediatric physical therapists (PTs) working with children and adolescents with cerebral palsy (CP) in Brazil. PTs working with children and adolescents with CP were invited to participate via social media and email campaigns to complete an online survey containing 46 questions. In total, 373 PTs participated. Most PTs reported searching in scientific databases (96.8%) and on social media (71%). The main barrier to information reported was limited access to full-text articles (44%). Among the PTs, 58.4% and 84% reported using the International Classification of Functioning, Disability and Health (ICF) and family centered practice models, respectively. Regarding tools and interventions, there was little focus on the domains of contextual factors and participation. This survey points to some important advances. However, strategies are still needed to promote knowledge translation and evidence-based practices among pediatric PTs in Brazil.

Integrating Heart Rate Monitoring Into a Camp for Children With Neuromotor Disorders: A Case Series.

This case series investigated the implementation fidelity, feasibility, and effectiveness of integrating continuous heart rate monitoring with visual feedback into an established, intensive physical therapy camp for children with neuromotor disorders. The provision of continuous visual feedback through color-coded, individually calculated heart rate zones was a feasible and effective intervention, encouraging pediatric gait camp participants to exercise at intensities that produced aerobic and functional gains. The use of technology facilitated participation with peers, an outcome equally as important as their endurance and functional improvements. Pediatric physical therapists play a crucial role in enhancing the well-being and physical fitness of children with disabilities. Encouraging regular exercise in a social environment fosters enjoyable, inclusive experiences while promoting overall health. It is important for clinicians in various pediatric rehabilitation settings to establish programs that offer such opportunities for children with neuromotor disorders.

The Impact of Parent-Based Support Programs on Neurodevelopmental Prognosis: Second-Year Results from a Newly Established Neurodevelopmental Follow-Up Unit in a Tertiary Hospital.

This study aims to assess the neurodevelopmental progress of high-risk infants 2 years post implementation of the Neurodevelopmental Follow-Up Unit (NFU) program at our hospital and explore implementation challenges for insights. Infants were assessed using the Hammersmith Infant Neurological Examination (HINE), The Alberta Infant Motor Scale (AIMS), and Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). A multidisciplinary team provided comprehensive parent education covering neurologic cues, postural advice, and developmental instructions in accordance with the children's assessment findings. In addition, a pediatric physical therapist provided motor development training emphasizing age-appropriate milestones and functional independence, while child development specialists addressed delays identified through BSID-III assessments. A total of 121 high-risk babies were enrolled during a 2-year period. Results revealed that 9 infants exhibited suboptimal HINE scores at 3-4 months, with only 2 maintaining suboptimal scores at 12-15 months. Similarly, 2 infants with suboptimal AIMS scores at 3-4 months reached normal values at 12-15 months. Comparable improvements were observed in BSID-III scores. While no correlation between HINE and AIMS scores was found at the 3-4-month mark, a significant correlation emerged between AIMS and HINE scores at 6-9 months (r = 0.643, P < .001) and 12-15 months (r = 0.820, P < .001). Encouraging early family education alongside regular monitoring of high-risk newborns appears to have a positive impact on their motor and cognitive development. Consideration of clinical recommendations, such as tailored interventions and periodic assessments, may contribute to optimizing developmental outcomes.

Virtual reality current use, facilitators and barriers to implementation in paediatric physiotherapy: cross-sectional online survey of UK paediatric physiotherapists

Background The literature is scarce about virtual reality (VR) use and its integration into clinical practice. Given the growing interest toward using VR in healthcare in the UK, the aims of this survey were to explore its current use by paediatric physiotherapists in clinical practice in the UK, identify the facilitators and barriers to VR implementation in clinical practice and investigate the factors that will enhance intentions to use it in the future. Methods An online survey using Assessing Determinants of Prospective Take-Up of Virtual Reality (ADOPT-VR2) was distributed to UK paediatric physiotherapists through the Association of Paediatric Chartered Physiotherapists. Descriptive statistics and regression analysis were conducted. Results Out of 128 responses, 81 UK-based paediatric physiotherapists completed the survey. The therapists worked in the National Health Service, in the private sector and education. Most of the respondents reported not using VR in clinical practice (n = 75; 93%). Only 7% of respondents reported using VR in clinical practice. Attitudes toward VR, compatibility, and the peer influence constructs of ADOPT-VR2 all significantly predicted the behavioural intention to use VR (R2 = 0.612, p = <0.001). Conclusions This study shows that the current use of VR is limited. The findings from this study suggest that multiple factors need to be reconciled to enhance VR implementation. Specifically, therapists need to be provided with time, appropriate training, and financial and technical support. Stakeholders may also need to consider developing practical manuals to ensure therapists are implementing VR consistently and correctly.

The implementation of EMI-Heart, a family-tailored early motor intervention in infants with complex congenital heart disease, in practice: a feasibility RCT

BackgroundChildren with congenital heart disease (CHD) who undergo open-heart surgery are at risk of developmental impairment, including motor delay, which contributes to parental concerns. Additionally, parents experience prolonged stress associated with their child’s disease. There is a lack of early motor interventions in infants with CHD accounting for parental burdens. We developed a family-tailored early motor intervention (EMI-Heart), aiming to promote motor development in infants with CHD and family well-being. The primary aim was to evaluate the feasibility of the study design and the intervention. The secondary aim was to evaluate differences between the intervention and the control group in motor outcomes and family well-being at baseline (3–5 months), post-treatment (6–8 months), and at follow-up (12 months).MethodIn this single-centre feasibility randomized control trial (RCT), infants with CHD after open-heart surgery without genetic or major neurological comorbidities were randomly allocated to EMI-Heart or the control group (standard of care). EMI-Heart’s key elements promote postural functional activities and encourage parental sensitivity to infants’ motor and behaviour cues. Infants assigned to EMI-Heart received nine sessions of early motor intervention at home, in the hospital, and online for a duration of 3 months by a paediatric physiotherapist. We performed descriptive statistics for feasibility and secondary outcomes.ResultsThe recruitment rate was 59% (10/17), all participating families completed the study (10/10), and the intervention duration was 3.9 months (± 0.54), including nine intervention sessions per family. Median acceptability to parents was 3.9 (1 = not agree–4 = totally agree, Likert scale). The paediatric physiotherapist considered the intervention as feasible. The comparison of motor outcomes did not show differences between groups. However, we detected improved reliable change scores in family well-being outcomes for families of the intervention group compared to the controls.ConclusionsOur research indicates that EMI-Heart is a feasible intervention for infants with CHD after open-heart surgery. The intervention was highly acceptable both to parents and to the paediatric physiotherapist. Online treatment sessions offer a valuable alternative to home and hospital visits. This feasibility RCT provides a foundation for a future full trial.Trial registrationClinicalTrials.gov, NCTT04666857. Registered 23.11.2020.

Developing Cerebral Palsy Screening of Functional Abilities in School (CPS –FAS)

Objective: This study aimed to determine the psychometric property of a newly developed functional abilities screening tool for children with cerebral palsy (CP) in special education units. Materials and Methods: This study was designed as a cross-sectional study. The tool for cerebral palsy screening of functional abilities in school (CPS-FAS) was established by surveying 28 pediatric physical therapists and holding focus group discussions with them. The CPS-FAS tool was used to evaluate content validity, reliability, and discriminative ability with 30 school-age children with CP at levels 1-3 of the Gross Motor Function Classification System (GMFCS). Results: The CPS-FAS generation process established 21 activity-problem screening items for children with CP, which had good content validity (index of item-objective congruence (IOC) = 1), good internal consistency (α = 0.92), and showed significant differences between GMFCS levels 1 and 3 (p &gt; 0.001) and GMFCS levels 2 and 3 (p &gt; 0.001). Conclusion: The CPS-FAS tool can be applied to school-age children with CP in a special education unit to screen such children for activity problems that affect school living without environmental obstruction and language barriers, and it only takes a short time (10-15 minutes) to complete.

Checks and balances: a meta-analysis on the known-groups validity of functional postural control tests in children.

Pediatric physical therapists commonly treat children with postural control deficits. Ideally, pediatric functional postural control tests should therefore be able to identify postural control deficits in children with various disorders. Despite a plethora of available tests, evidence for their validity - especially known-groups - remains scarce. This review aims to determine the known-group validity of available functional postural control tests to differentiate various pediatric pathological groups of different ages from their typically developing (TD) peers. PubMed, Web of Science and Scopus were systematically searched (last update: February 2023; PROSPERO: CRD42023408982). Forty case-control studies with a pathological pediatric sample (N.=1331) and TD peers (N.=1889) were included and selected for data-extraction and -analysis. Risk of bias was assessed using the SIGN checklist and level of evidence was scored using GRADE. Random-effect meta-analyses were performed to estimate pooled standardized mean differences (SMD) for the various test types and subclassified based on pathology and/or age. When compared with TD peers, children with underlying pathologies performed significantly worse on pediatric functional postural control test batteries (SMD=-2.21), the Timed Up and Go Test and variants (SMD=2.30), the One Leg Stance test and variants (SMD=-2.14), while the Reach tests showed a smaller difference (SMD=-1.19). Subclassification within the meta-analyses showed that pathology was an influencing factor for the test batteries and the one leg stance test and variants. Age was an influencing factor for the reach tests. None of the included functional postural control tests exceeded a low level of evidence. Pediatric functional postural control tests that assess multiple aspects of postural control (such as test batteries) seem to offer higher known-groups validity than single-task tests (e.g. reach tests). The underlying pathology has a larger impact on the validity of these tests than age. There remains an overall low level of evidence for the known-groups validity of pediatric functional postural control tests indicating the need for research with more homogenous groups and norm reference data.

Inclusion, Participation, Belonging = Surviving, Thriving, Flourishing.

To share my perspectives on how pediatric physical therapists support children with disabilities and their families to maximize their potential to flourish. Best practice supports the inclusion of people with disabilities in all aspects of society. Policy statements from governmental agencies, research universities, advocacy, and non-governmental organizations all support inclusion. The concept of belonging and how pediatric physical therapists can promote belonging is less familiar to pediatric physical therapists than inclusion and participation. Essential elements necessary to bring about a sense of belonging in young children will be presented, leading to a discussion on the role of the pediatric physical therapist and key implications for the early childhood system of care. Pediatric physical therapists support children with disabilities and their families to maximize the potential of every child. I propose that to do this, we must focus our interventions to promote a child's active participation in community life and build programs and relationships that promote belonging. Interventions for children with disabilities will be successful by focusing on the outcomes that promote inclusion, participation, and belonging.

Understanding Pediatric Physical Therapists' Experiences With Middle Eastern Patients and Arabic Interpreters: A Qualitative Study.

The purpose of this study was to explore pediatric physical therapists' (PTs') experiences including successes, challenges, and barriers with cross-cultural communication with Arabic-speaking Middle Eastern children and their families who require interpreter services. Eight PTs consented to participate in qualitative dyadic interviews. Transcription and interviews were conducted virtually in Microsoft Teams. Quality criteria included member checking for validity and trustworthiness and bracketing to minimize investigator bias. Inductive thematic analysis was used to identify meaning units and major themes. The 6 themes that emerged were: fostering therapeutic relationships, practicing culturally sensitive care, communicating intentionally, experiencing successes, recognizing challenges, and tailoring a physical therapy plan of care. Representative quotations support each theme. Therapists perceive their experiences with Arabic-speaking children, families, and interpreters positively despite challenges related to cultural and language barriers. In sharing their experiences, therapists demonstrated self-reflection, openness to learning, and desire to build strong therapeutic alliances.

Commentary on "Understanding Pediatric Physical Therapists' Experiences with Middle Eastern Patients and Arabic Interpreters: A Qualitative Study".

Commentary on "Understanding Pediatric Physical Therapists' Experiences with Middle Eastern Patients and Arabic Interpreters: A Qualitative Study".

Commentary on "Current Trends for Children with Spina Bifida: A Survey of Pediatric Physical Therapists".

Commentary on "Current Trends for Children with Spina Bifida: A Survey of Pediatric Physical Therapists".

Exploring needs and requirements for a prototype device measuring physical activity in pediatric physical therapy: A qualitative study.

To analyze needs and requirements of Pediatric Physical Therapists (PPTs), parents, children and adolescents with and without developmental disabilities in the future use of an activity monitor prototype (AM-p) in everyday clinical practice. Qualitative exploratory study with a thematic analysis approach, based on Braun and Clarke's six steps. Codes derived from the analysis and central themes were collated, based on Fleuren et al.'s groupings of determinants. We interviewed 25 PPTs, 12 parents, and 12 children and adolescents. Within four groupings of determinants, we found nine themes: 1) development of information materials; 2) application: output visualization and ease of use; 3) design; 4) relevance and acceptance; 5) shared decision-making; 6) compatibility in daily living; 7) finances, 8) time, and 9) legislation and regulations. End-users have similar basic needs, with individual fine-tuning to be addressed during further development of the AM-p. A child-friendly design, information material, and an easy-to-use application to read and interpret results, need to be developed. Efficient training for PPTs is important for the use of the AM-p and analysis of results. Communication between PPTs and children as well as parents enhances shared decision-making. We recommend involving diverse end-users to enable maximum customization of the AM-p.

Current Trends for Children With Spina Bifida: A Survey of Pediatric Physical Therapists.

To describe contemporary physical therapy practice and management of children with spina bifida (SB) in the context of the International Classification of Functioning, Disability, and Health (ICF) framework. A descriptive, cross-sectional electronic survey was sent to US pediatric physical therapy clinics and posted in the American Physical Therapy Association Pediatrics newsletter. Data were analyzed using content analysis. Codes were compared, refined, and condensed into categories. A total of 163 participants were included. Most assessments evaluated the ICF Activity component. Most frequently reported ICF components: impairments=decreased strength (17.9%), activity limitations=limited walking (22.5%), and participation restrictions=restricted socializing/playing with peers or siblings (22.6%). The most prevalent intervention was strength training. Physical therapists (PTs) in the United States are performing assessments and interventions supported by available evidence; however, knowledge translation and more research are needed to support best practices in PT management of children with SB.

Exploration of Potential Determinants of Implementation of a Clinical Practice Guide to Enhance Physical Activity Participation of Children with Developmental Coordination Disorder

Purpose: This project explored the potential determinants (barriers and facilitators) of implementing a recently developed clinical practice guide (CPG) for the promotion and enhancement of the physical activity participation of children with developmental coordination disorder (DCD) prior to its release for clinical use. Methods: The validated Clinician Guideline Determinants Questionnaire was used to explore the potential determinants reported by nine physiotherapists who provide services to children with DCD. Results: There was 100% agreement with the CPG content. All participants also agreed that following the CPG recommendations would improve care delivery and patient outcomes. Potential barriers of implementation were related to several factors, such as guideline factors (e.g., a lot of information, need for a visual summary), individual health professional factors (e.g., need for CPG training and experience), professional interactions (e.g., need to create community and school partnerships), and incentives and resources (e.g., need for dedicated time). Facilitators were having the above-mentioned needs met. Conclusion: Successful implementation of this CPG by pediatric physiotherapists may require: (1) that certain CPG and educational resources be put in place; (2) support to develop community and school partnerships, and (3) support from managers.

Early Detection and Intervention for Children with High Risk of Cerebral Palsy: A Survey of Physical Therapists and Occupational Therapists in Brazil

Aims The purpose of this study was to assess the current clinical practice of physiotherapists and occupational therapists on early detection and early intervention for children with cerebral palsy (CP) in Brazil. Methods This was a cross-sectional study. A purpose-developed electronic survey was disseminated across the country to physiotherapists and occupational therapists working with young children with or at risk of CP. Results A total of 205 anonymous respondents were included. Most participants (64.4%) agree that the diagnosis of CP can be made before 6 months of age. General Movements Assessment (26.8%) and Hammersmith Infant Neurological Examination (37.1%) were used infrequently. Infants at risk for CP receive therapy twice a week or more by 58.5% of therapists, 93.2% identified parents’ goals as the most important factor in customizing the early intervention program. The most frequent intervention strategies for this age group were active stimulation of the child (n = 182), family training (n = 161), strategies to optimize the environment (n = 143), and neurodevelopmental treatment/Bobath (n = 99). Conclusions Currently, pediatric physiotherapists and occupational therapists in Brazil do not fully incorporate best practice tools for early identification of children with CP, nor sufficient best evidence-based interventions.

P087 Role of a physiotherapy independent prescriber in a Paediatric Rheumatology setting

Abstract Background/Aims To assess the benefit of having a Physiotherapy Independent Prescriber (PIP) within a Paediatric Rheumatology service at University Hospitals Southampton (UHS). Legislative change in the UK in 2013 enabled physiotherapists to independently prescribe certain drugs that assist in patient management. Independent prescribing by physiotherapists is a relatively contemporary development in role change and purpose. The clients seen by the paediatric rheumatology physiotherapists within our service frequently require medication prescription as part of their review and management. Having the ability to independently prescribe reduces the need for additional medical or nursing input, so improving efficiency and patient experience within the clinic. Methods In our Paediatric Rheumatology service within UHS, our PIP is able to assess and manage the repeat prescriptions for routine follow-up patients with Juvenile Idiopathic Arthritis (JIA), plus alter medication prescriptions in response to clinical findings. The medications the PIP can change/prescribe include Methotrexate, Oral steroids, Non-steroidal anti-inflammatory drugs, Folic Acid and proton-pump inhibitors. This facilitates a greater number of patients to be seen as they do not require appointments with multiple professionals at routine reviews. A satisfaction questionnaire was completed by patients who accessed this service over a 6-month period. Results Over a six-month period of 25 morning clinics, a total of 23 satisfaction questionnaires were completed by those who had medication prescribed by the PIP. Of these, 100% were satisfied with the service they received and the outcome of the appointment. In particular, highest scores were given for communication by the therapist and having knowledge and understanding of medications prescribed. Conclusion Having a PIP in our Paediatric Rheumatology Clinic is well-received by service users and improved patient-experience by limiting the need for multiple appointments and reducing time spent in clinic. Disclosure E. Bhullar: None.

Does UK Entry-Level Physiotherapy Education Prepare Graduates for a Future in Pediatric Clinical Practice? A Mixed-Methods Study

Aims Identify the perceptions and experiences of how UK entry-level programs educationally prepared pediatric physiotherapists for their first clinical role. Review the extent programs taught essential, recommended, and additional content as per the International Organisation of Physical Therapists in Pediatrics (IOPTP). Methods Mixed methods design involving qualified UK pediatric physiotherapists. Forty-two physiotherapists completed an online questionnaire and nine (21%) completed a follow-up semi-structured interview. Results All 42 respondents felt they were “Not Well” (median 2, IQR 1.75–2.75) prepared for clinical practice. Not enough curricula emphasis was given to pediatric content (100%), with 31% (n = 13, CI 95% 19–46) reporting no pediatric content throughout their program. Only 15 (36%, 23–51) respondents experienced a pediatric placement. Themes from the follow-up interviews were (1) UK programs are adult focused; (2) placements are the only meaningful opportunity to develop competency; (3) programs lacked non-clinical content; and (4) experiencing pediatric patients was overwhelming due poor preparation. The majority of the IOPTP curriculum guidance is not embedded within UK curriculums. Conclusions Respondents reported they were not well prepared for pediatric clinical practice. Some entry-level programs did not include any pediatric teaching throughout the entirety of the course.

Trauma-Informed Care in Pediatric Physical Therapy as a Standard Precaution: The Time Is Here.

In this special communication, an overview of the research on trauma, resilience, and action items for the pediatric physical therapist (PT) is addressed. The experiences of early childhood, positive and negative, impact overall development and well-being throughout the lifespan. Childhood trauma can include exposure to abuse, neglect, violence, racism, or medical procedures. These adverse childhood experiences are associated with poor physical and mental health outcomes that can extend into adulthood and can appear in the pediatric rehabilitative realm as caregivers who become labeled noncompliant. Trauma is common and impacts all children; however, some populations, such as children with disabilities, have greater risk for experiencing adversity. An individual's trauma history is not always visible, necessitating a standard approach. Pediatric PTs must take an intentional approach to address the detrimental effects of trauma on those we serve. Many organizations recommend adopting trauma-informed care as the standard of care for all populations.

The effect of novel Head and Trunk Control Rehabilitation (HATCoRe) device in children with cerebral palsy: Single-Subject multiple baseline protocol

ObjectiveHead and trunk control is essential for enhancing engagement and participation by improving visual integration, respiration, oromotor skill, arm control, and self-care. Our study protocol aims to investigate the effect of novel Head And Trunk Control Rehabilitation (HATCoRe) device on promoting head and trunk control in children with Cerebral Palsy (CP). MethodThis single subject multiple baseline design trial will include six children with CP aged two to 10 years, exhibiting delayed head and trunk control, having Gross Motor Function Classification System level IV and V will be enrolled. Participants will be randomly assigned to 4-, 6-, or 8-weeks baseline phases followed by 16-week intervention phase with HATCoRe device, for 30–45 min thrice weekly; and follow-up phase of 9 weeks. The study will span for 29 to 33 weeks. An experienced pediatric physiotherapist, blinded to the baseline duration, will assess the outcome measures through 15 to 19 observations. Structured visual analysis will be used supplemented with the celeration line approach to detect statistically significant change. ImpactHATCoRe device can enable health-care professionals to objectively measure head movement trajectories in children with CP. If proven effective, clinicians may utilize this device to create interactive and child engaging sessions.