Pediatric Physical Therapists Research Articles

International Delphi Recommendations for Pediatric Lower Limb Neurological Test Protocols for Muscle Strength, Reflexes, and Tactile Sensitivity.

To gain consensus from physical therapists on pediatric lower limb neurological tests of muscle strength, tactile sensitivity, and reflexes. A Delphi technique was used for 2 sequential questionnaire rounds to gain consensus from a panel of pediatric physical therapists (n = 28). Physical therapists rated their agreement to items from statements on pediatric lower limb neurological tests, their protocols, and interpretation using a 6-point Likert scale. Ninety percent of items gained consensus: 80% on pediatric lower limb neurological tests, 88% on test protocols, and 92% on test interpretation. Fifty-one percent of items had high agreement and high importance. There is variability in pediatric neurological tests used, their protocols, and interpretation. Identification of items with high agreement and importance is the first step to develop a standardized lower limb neurological assessment for pediatric clients of varying ages and diagnoses.

Perceptions of Pasifika caregivers on a Pacific community playgroup and implications for paediatric physiotherapists

Perceptions of Pasifika caregivers on a Pacific community playgroup and implications for paediatric physiotherapists

Reliability of Using a Smartphone Application to Objectify Skull Deformation

To establish intrarater and interrater reliability of photographs made in a newly developed smartphone app to determine the severity of infantile skull deformation by taking a cranial photograph of an infant's head. Using the app, 1 pediatric physical therapist and 2 pediatric physical therapy master students photographed heads of 30 infants aged up to 12 months receiving treatment for asymmetric or delayed motor development. Modified Cranial Vault Asymmetry Index and Cranial Index determined the severity of skull deformation. Intrarater reliability was excellent both for mCVAI and CI, with an ICC(3,1) = 0.97, and ICC(3,1) = 0.98, respectively. Interrater reliability with an ICC(2,1) = 0.97 for the mCVAI, and ICC(2,1) = 0.99 for the CI was excellent too. The reliability of the Skully Care App proved to be excellent when used by pediatric physical therapists.Supplemental Digital Content 1. Video Abstract available at: http://links.lww.com/PPT/A399 .

Commentary on "Pediatric Physical Therapists' Perceptions of Telehealth Continuation Post-pandemic: A Thematic Analysis of Open-Ended Survey Responses".

Commentary on "Pediatric Physical Therapists' Perceptions of Telehealth Continuation Post-pandemic: A Thematic Analysis of Open-Ended Survey Responses".

Pain Assessment and Management of Neurologic Impairments by Pediatric Physical Therapists; A Cross-Sectional Survey

Background: Physical therapists indicated the use of standardized pain assessment instruments like subjective measures, self-reported scales, behavioral and physiological measures to assess pain in children with neurological impairments. Indicators such as diminished attention, retreat, and changes in sleeping and feeding patterns were also reported along with facial expression, sobbing, and vocalizations. Therapists' perspectives on behavioral pain expressions may be significantly different from the perspectives of the children's parents or caregivers. Objective: To determine the methods of pain assessment and management for children with neurologic impairments used by pediatric physical therapists. Methods: A cross-sectional survey in which the data was collected from different public hospitals in Faisalabad, Pakistan. Convenient sampling was applied to recruit physiotherapists for this study and data was gathered through a structured questionnaire after taking their written informed consent. Results: Frequently used behaviors included facial expression, vocalizations, and irritability. Cues that were rarely used included changes in sleeping, withdrawal, eating behaviors, and decreased attention. Physiotherapists prefer to use pain interventions that were supported by research like praise and distraction as well as distress-producing potentially harmful measures such as reassurance and procedural talk. About 84% percent of the respondents used subjective measures to assess pain, 60% used self-report scales, and 32% used behavioral and physiological measures. The results regarding procedural explanation showed that 41.1% of physiotherapists had very often done procedural explanation and 58.9% had often done it. Conclusion: A well-structured practice pattern of pain assessment and treatment of neurologic deficits was observed among pediatric physical therapists. Praise, distraction, and procedural explanation were often used to ease discomfort and pain while doing physiotherapy treatment sessions. Overt signs such as vocalizations, weeping and facial expressions were used to measure pain more often than subtle markers such as lower attention, disengagement, and disturbed sleep and feeding habits.

Pediatric Physical Therapists' Perceptions of Telehealth Continuation Post-pandemic: A Thematic Analysis of Open-Ended Survey Responses.

To explore pediatric physical therapists' (PTs) perceptions about continuing telehealth services post-pandemic. Two open-ended questions from a larger survey were analyzed using a pragmatic application of thematic analysis. Two hundred two pediatric PTs in the United States responded. Themes included Telehealth During COVID-19, Benefits, Drawbacks , and Recommendations . Telehealth During COVID-19 acknowledged adopting and providing telehealth during a global pandemic was likely different than at other times. Benefits described perceived positive aspects of telehealth for children, families, and PTs, which support continuation of telehealth post-pandemic. Drawbacks described perceived negative aspects of telehealth for children, families, and PTs, which may dissuade continuation. Recommendations described respondents' recommendations for the continuation of telehealth. Ultimately respondents recommended a hybrid model of telehealth and in-person services going forward. A hybrid model of telehealth and in-person services may have the benefits of increasing access, flexibility, efficiency, communication, and home programming across pediatric practice settings.

Benefits and Challenges of Telerehabilitation Use By Pediatric Physiotherapists During the COVID-19 Pandemic In Western and Southern India: A Cross-Sectional Survey.

As the worldwide COVID-19 pandemic spread, many physiotherapists chose telerehabilitation (TR) to continue delivering therapy. This study was conducted to document the perceived benefits and challenges of TR faced by pediatric physiotherapists in western and southern India. Using the snowball method, electronic survey forms were distributed to 275 pediatric physiotherapists in Western and Southern India; 110 responses were available for analysis. A majority of respondents had experience with TR (n=83, 75.5%), while others had never used TR (n=27, 24.5%). TR was reported to be less effective than in-person therapy for treating children and adolescents during the COVID-19 pandemic. Therapists reported significant difficulties during TR sessions; these included assessing and modifying exercises for children. As the popularity of TR grows, pediatric physiotherapists will need to be aware of the benefits and challenges they will face during TR sessions. Most pediatric physiotherapists believed the interaction between parents and therapists is a requisite for optimal service delivery.

COVID-19 Lessons From The Field: Toward A Pediatric Physical Therapy Telehealth Framework.

Introduction:Telehealth is an established health service delivery method, yet little is known regarding pediatric physical therapy telehealth. We aimed to evaluate users' experiences and create a framework for effective delivery.Methods:A pediatric physical therapists' telehealth user survey was conducted.Results:Seventy-three respondents varied in years of experience and caseload. Most found telehealth easy to learn and use, and they believed the treatment they delivered was useful. Three main themes for successful treatments emerged and were organized into a framework for effective delivery: (1) caregivers' involvement; (2) therapist telehealth ‘toolbox’ (sub-divided into: treatment management tools, and therapist-caregivers' collaboration tools); and (3) telehealth client (child) characteristics.Conclusion:This study suggests a new framework for effective pediatric physical therapy telehealth delivery to support best practice, for use by administrators and therapists, and recommends directions for further research.

Commonly Used Outcome Measurement Tools in Pediatric Physical Therapy Telerehabilitation in the Philippines: A Quantitative Cross-Sectional Descriptive Study

Aim: The objective of the research is to identify the most common Outcome Measure Tools used in telerehabilitation by Filipino pediatric physical therapists. Methods: The research is a quantitative descriptive study with two phases. Phase I is the validation and pilot testing of an adapted questionnaire. A panel of three experts rated the questionnaire's items using a Likert scale; afterward, the content validity index was determined. In addition, pilot testing was done to determine the survey's average duration. Phase II is the questionnaire implementation using a Google Form. The study used frequencies and percentages to report participants' responses. Results: The final version of the adapted questionnaire had 23 items that were considered relevant. Of the 45 respondents, 51% used Outcome Measure Tools (OMT) during telerehabilitation. The most common OMT used in pediatric telerehabilitation is the Gross Motor Function Measure (GMFM) (100%), followed by the Pediatric Balance Scale (PBS) (30%), Goal Attainment Scale (GAS) (13%), and Test of Gross Motor Development - Second Edition (TGMD-2) (13%). The top enabler for OMT use in the telerehabilitation setting is the criterion of being easily understood by patients, clients, and caregivers (87%). Contrariwise, the main reason for the non-usage of OMTs is the difficulty for the stakeholders to complete OMTs independently (68%). Conclusion and Implications: The commonly used OMTs in telerehabilitation are the GMFM, PBS, GAS, and TGMD-2. The main reason for OMT use is the ease of understanding by the stakeholders.

Understanding Acceptability, Barriers, and Facilitators to Clinical Implementation of the on Track Developmental Monitoring System for Children with Cerebral Palsy: A Qualitative Study

Aims On Track Developmental Monitoring System (DMS) is a novel series of tools to assist in shared-decision making, guide rehabilitation intervention based on functional ability levels, and promote episodic care service models. Further understanding of the acceptability, feasibility, and appropriateness of On Track DMS in clinical settings is critical. The purpose of this study was to understand clinician perspectives of the acceptability of On Track DMS and to identify potential implementation barriers and facilitators within pediatric physical therapist practice. Methods Three, day-long training workshops were conducted with 32 pediatric physical therapists across the US. Focus groups with 21 workshop participants were conducted following training. Results were audio recorded, transcribed verbatim, and coded into themes. Results Three themes emerged from the data: (1) Valuing the On Track Approach to Intervention; (2) Setting-Specific Needs and Challenges to Implementation; and (3) Training Material/Tool Strengths and Limitations. Conclusions On Track DMS appears to have initial value and acceptability for pediatric physical therapists across practice settings. Perceived benefits include facilitation of data-driven practice and therapist/family collaboration to improve health outcomes for children with CP. Using this data to understand and assess barriers and facilitators to knowledge use are first steps in successfully implementing On Track DMS.

Tool Use for Early Detection of Cerebral Palsy: A Survey of Spanish Pediatric Physical Therapists.

The purpose of this study was to assess the use of diagnostic assessment tools in pediatric physical therapy practice in Spain. Best practice recommendations indicate the timely use of key assessment tools to reduce the age of diagnosis of cerebral palsy (CP). Pediatric physical therapists currently working in Spain in early intervention were recruited through targeted physical therapy entities. They were invited to complete the purpose-developed electronic survey, consisting of 45 multiple-choice questions, with 5 thematic blocks. Results from 140 anonymous respondents were analyzed. The average reported age when CP was suspected was 12.6 months. Most used the child's clinical history (88.1%), the Alberta Infant Motor Scale (41.3%), and Vojta Assessment Procedure (32.1%) to assess and detect CP. General Movements Assessment (25.7%) and Hammersmith Infant Neurological Examination (28.4%) were used infrequently. Currently, pediatric physical therapists in Spain rely on clinical history and outdated tools to identify children with CP.Digital Abstract available at: http://links.lww.com/PPT/A361 (English).Digital Abstract available at: http://links.lww.com/PPT/A362 (Spanish).

Commentary on "Tool Use for Early Detection of Cerebral Palsy: A Survey of Spanish Pediatric Physical Therapists".

Commentary on "Tool Use for Early Detection of Cerebral Palsy: A Survey of Spanish Pediatric Physical Therapists".

Role of Physiotherapy in Children’s Health

Children need the supervision of adults and also specialist facilitation, which is entirely different from those of adults. The child-centered health care approaches and their delivery modes are continuously in a changing phase. Health services provided to the children are remodeled according to their present and future needs.
 Pediatric physiotherapy is one of the developed domains of physiotherapy. Pediatric physiotherapists are specialists who work with individuals from being premature to adolescents, targeting the main goal of optimal physical development. They work with a holistic approach making certain that along with the highlighted health needs, the social, emotional and educational factors are also taken into consideration1. So, overall the role of a pediatric physiotherapist is not only to deliver the intervention but also to work as a consultant, trainer and educationist.
 Physiotherapy plays a vital role in guiding coordinated movements, posture education, specific therapeutic exercises and cardiorespiratory fitness by involving family and caregivers. Therapists can provide health care services in the hospital setting (out-patient or in-hospital clinics), community settings such as child development centers, in mainstream schools and in special schools. Treatments usually given to children are of a wide range such as motor learning, mobilization, massage, stretching, neurodevelopmental therapy and hydrotherapy.

Role of physiotherapist in the pediatric obesity: pooled experiences

Objectives: To study the problem of pediatric obesity and the engagement of Italian physiotherapists, laying the foundations for a future health education project of the Specialist Interest Group (GIS) PEDIATRIC PHYSIOTHERAPY AIFI.Methodology: Administration of an insight survey/questionnaire to the Pediatric GIS Group.Results: 95.7% of respondents have never taken part in projects dedicated to pediatric obesity. Three experiences emerged, but only two respondents became available for the interview. 94.4% of the operators considered useful the physiotherapist's contribution to the healthcare problem and 82.2% of them expressed a real interest in the subject.Conclusions: Physiotherapists should play an active role in planning interventions aimed at promoting and supporting correct lifestyles from early childhood to young adulthood, starting even sooner during the prenatal and perinatal periods. This study confirmed the awareness and feeling of Italian pediatric physiotherapists towards the issue: The bases are therefore laid for future involvement of pediatric GIS in educational projects for the prevention of pediatric obesity.

An Interdisciplinary Approach to Improve Head Tilt in Pediatric Torticollis Patients with the Use of Prism Glasses

Background: Infants with head tilts are most often diagnosed with torticollis and are referred to a pediatric physical therapist for evaluation and treatment. Determining if the head position is muscular or non-muscular when assessing these infants is key in making the appropriate referrals to other specialists and determining the best treatment approach. Most pediatric physical therapists treat patients with head tilts with manual therapy (i.e. massage, myofascial release, and passive/active range of motion). Many physical therapists only consider a visual etiology as a possibility after other treatment options have been exhausted and the head tilt persists. Although the incidence of torticollis has increased, based on the author’s experience, the number of cases of non-muscular etiology has also increased. There is a lack of current research on the use of prism glasses for treating head tilts in young children and infants carrying a diagnosis of torticollis, especially those presenting without any active/passive motion limitations. Traditionally, these patients undergo years of treatment without resolution of the head tilt. Case Report: A two-year-old patient initially presented with a diagnosis of torticollis with an intermittent and alternating head tilt for physical therapy. After several months of manual therapy, with little improvement in her head posture, the patient’s physical therapist referred her to a behavioral optometrist for a comprehensive vision examination and to pursue alternative treatment options. The optometric evaluation revealed ocular misalignment causing poor depth perception skills and prism glasses were prescribed full-time with the recommendation of continuing physical therapy for gross motor development. Conclusion: Prism glasses are an appropriate treatment consideration for some pediatric patients with persistent head tilts because they can provide immediate improvement in head position and depth perception. It is important to include optometrists in the multi-disciplinary team when working with patients with head tilts. Pediatric physical therapists would benefit from training on how to properly screen visual skills when evaluating children with head tilts. With such training, an appropriate optometric referral could be initiated early on in treatment.

Understanding the Lived Experience of Caring for a Child With Severe Cerebral Palsy: A Critical Step Toward Psychologically Informed Family-Centered Care.

The purpose of this study was to explore the lived experience of parents who care for children with cerebral palsy who function at a Gross Motor Function Classification System Level V, their beliefs about pain and non-pain-related emotional distress, and what it means to provide care and comfort. A phenomenological research design was used. Eleven participants were involved in this study. Pilot interviews informed the interview guide. Data were collected via participant journals and semi-structured interviews and analyzed using van Manen's framework for understanding experience. Trustworthiness criteria were met through a variety of strategies to ensure a rigorous research process. Four themes were revealed in this study: "life is hard, heavy with burden, worry, and love," "remarkable," "identity transformation and empowerment," and "living a life that is planned, forced with structure and without spontaneity." Caring for a child with lifelong needs is complex and requires a sensitive awareness of the contextual factors that impact daily decisions and routines. Understanding the lived experiences of parents who care for children with cerebral palsy Gross Motor Function Classification System Level V is necessary to provide psychologically informed, family-centered care. Comfort theory is presented as a framework for understanding what factors influence comfort and well-being. Understanding the complex nature of comfort for an individual can lead to greater understanding and empathy-driven care. These results will provide a foundation for future studies that aim to enhance pediatric physical therapist care through provider empathy and understanding. Caregiving parent experiences are impactful and play a large role in the life of children with developmental disabilities. Research exploring the lived experience of caregivers may enhance empathy-driven, psychologically informed, family-centered physical therapist care throughout the life course. If you are a parent who cares for a child with severe cerebral palsy, you have unique experiences that impact day-to-day activities and lifelong planning for your family and child.

Commonly Used Outcome Measurement Tools in Pediatric Physical Therapy Telerehabilitation in the Philippines: A Quantitative Cross-Sectional Descriptive Study.

With the COVID-19 pandemic, the adoption of telerehabilitation has rapidly increased to improve access and minimize cross-infection risk to patients. Nevertheless, Filipino pediatric physical therapists (PTs) must ensure that they conduct evidence-based procedures for specific tests and measures to determine patient outcomes. This investigation reported the most common pediatric outcome measurement tools (OMTs) used in telerehabilitation by Filipino pediatric PTs treating 0 to 21-year-olds in the Philippines. Validation and pilot testing of an adapted questionnaire on OMT usage was undertaken before dissemination via email and social media. Pediatric PTs reported that the commonly used OMTs in telerehabilitation are Gross Motor Function Measure (GMFM) (100%)—including both versions of GMFM-88 and GMFM-66 followed by Pediatric Balance Scale (PBS) (30%). These findings support the use of feasible OMTs in pediatric telerehabilitation due to their applicability in the online setting.

Functional Symmetry Observation Scale, Version 2: Development and Content Validation Using a Modified Delphi Method.

To describe the development of the Functional Symmetry Observation Scale (FSOS) Version 2 and its content validation. The FSOS Version 2 is an observational assessment that quantifies symmetry in spontaneous movement and posture in infants with congenital muscular torticollis, age birth to 18 months. Twenty expert pediatric physical therapists were identified through purposive sampling and invited to participate in a modified Delphi study. Survey data were collected on Qualtrics. Consensus was evaluated using median ratings and percent agreement on Likert Scale items. Thematic analysis was performed for open-ended question responses. Thirteen experts completed Round 1 and 2 surveys. In Round 1, consensus was achieved on all but 1 item. The scale was modified based on received feedback. In Round 2, consensus was achieved on all items (median rating of 4, agreement at 85%-100%). This study established the content validity of the FSOS Version 2.

Experiential Learning in Pediatric Physical Therapist Education: Challenges and Facilitators.

The purpose of this study was to conduct an in-depth investigation of physical therapist educators' challenges to and facilitators of the use of experiential learning (EL) with children. Although EL with children has been called an essential component of doctor of physical therapy (DPT) education, variability in the amount of EL used among DPT programs indicates that educators may experience different challenges and facilitators of the use of EL. Eighteen pediatric DPT educators participated in a semistructured interview. Researchers used thematic analysis to qualitatively analyze interview transcripts. Three themes emerged: (1) stakeholder considerations, (2) pedagogical considerations, and (3) logistical considerations. This research illustrates challenges and facilitators to the use of EL with children. How these challenges and facilitators are perceived by DPT educators has implications for faculty and program directors, particularly as they consider the use of EL with children in DPT programs nationally.

Commentary on "Experiential Learning in Pediatric Physical Therapist Education: Challenges and Facilitators".

“How could I apply this information?” This study provides context to how pediatric physical therapy faculty infuse experiential learning (EL) into didactic courses. It illuminates the barriers that exist that challenge the implementation of EL. Faculty can use the findings from this study to justify and advocate for resources (eg, time, semester course schedules, financial support, and teaching loads) needed for pediatric EL activities. Invested stakeholders were identified as a key success factor in EL. Faculty should identify engaged partners and maintain a longstanding relationship. Individual families, early intervention providers, daycares, pediatric outpatient clinics, pediatric hospitals, and public and private schools can support the implementation of EL activities. The findings from this study also provide clinicians with strategies to facilitate EL opportunities. Clinic administrators and managers can proactively identify staff willing to collaborate with academic faculty to develop and participate in EL. Clinicians work directly with children, families, and community partners, which positions clinicians as facilitators of reliable and consistent EL opportunities. Clinicians also need to be advocates within their own workplace for their participation in EL. “What should I be mindful about when applying this information?” The data collected for this study centered on faculty and did not include perspectives from other stakeholders. Further exploration of other stakeholders' perspectives beyond faculty could identify additional key factors that are needed to facilitate EL opportunities. Investigation of home and workplace facilitators and barriers experienced by other stakeholders outside the academic environment will provide guidance for faculty to address the needs of all stakeholders. Data were limited to faculty providing low or high EL opportunities and excluded faculty that provided no EL. Sampling those with the greatest barriers to EL may provide further insight into additional barriers to EL. Marisa Birkmeier, PT, DPT, PCS Department of Health, Human Function, and Rehabilitation, The George Washington University, Washington, District of Columbia Allison Elegbe, PT, MSPT, PCS Herndon, Virginia