Physiotherapy For Children Research Articles

RELEVANCE OF COMPETENCE DEVELOPMENTAND ADVANCED TRAINING PROGRAMMES FOR PHYSICAL THERAPISTS WORKING IN PAEDIATRICS

Physical therapists in Ukraine complete six years of study (4 years of first (bachelor's) degree and 2 years of second (master's) degree) to obtain a speciality and diploma of physical therapist, which involves the acquisition of a number of professional competencies described in the relevant educational standards and curricula. These educational standards and the vast majority of educational programmes contain a minimum amount of paediatric physical therapy component. Therefore, additional training based on the competency-based approach in paediatrics is needed to enable physical therapists to provide effective, qualified services to children. The aim of the study is to substantiate the need to develop a list of competencies to improve the training of physical therapists in Ukraine who will specialise in paediatrics. Materials and methods. The study was conducted by questionnaire survey of physical therapists working in paediatrics from 1 to 14 September 2023. The questionnaire was developed to assess the need for advanced training programmes for physical therapists working in paediatrics, as well as to assess the areas of clinical activity and the level of competencies of specialists. Results. The survey involved 82 physical therapists working in paediatrics. Of the 82 physical therapists, 59 (71.9%) were representatives of public institutions, 13 - private, and 10 respondents did not indicate the type of institution. In 80.4% of physical therapists, the total length of service is equal to the length of service in paediatrics. Only 10.97% of the surveyed physical therapists agree with the statement that university education in Ukraine is sufficient to start an effective practice in paediatrics. 6.10% believe that there are sufficient opportunities for advanced training in paediatric physical therapy in Ukraine, while 21.95% disagree with this statement. The majority of respondents provide services on an outpatient basis, only 25.60% - in acute rehabilitation. Among the proposed areas of physical therapy in paediatrics, most physical therapists work with patients with musculoskeletal disorders (79.26%). The next area in terms of the number of physical therapists working in it is physical therapy in neurology (70.73%). Almost not covered areas in physical therapy for children were assistance in neonatal intensive care (only 8.53% of respondents work in this area) and assistance in intensive care units (only 12.19% gave an affirmative answer to the question about this area). Only 4.87% of respondents work with burns, 7.32% - with amputations, 24.4% - with cardiovascular and respiratory disorders. Few specialists are engaged in physical therapy for such complex conditions as Spina bifida (24.4%), spinal cord injury (21.95%) and traumatic brain injury (24.9%). In addition, 14.63% of the surveyed physical therapists indicated other areas of clinical activity. The total number of educational components in paediatric physical therapy is very low compared to the total number of all disciplines in educational and professional programmes. Conclusions. Practicing physical therapists believe that university education in Ukraine does not sufficiently develop professional competencies for work in paediatrics. It is advisable to form the competencies of a physical therapist in paediatrics, which would be the basis for improving university curricula, educational components and the development of postgraduate training programmes.

FAMILY-ORIENTED PHYSICAL THERAPY PROGRAM FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS

Family-centered physical therapy programs for children with autism involve the child, family members, and professionals working together. They aim to provide support, education, and resources that enable the family to understand and cope with the special needs associated with the rehabilitation of a child with autism. By involving the entire family in the therapy process, such programs help improve communication, enhance the quality of life for the entire family, help the child develop skills to participate in various activities with peers, strengthen family ties and provide a more holistic approach to child care. Aim. To substantiate the structure and program of family-oriented physical therapy for preschool children with autism spectrum disorders (ASD). Materials and methods. Analysis of literature sources, including clinical guidelines and recommendations, as well as scientific research on the rehabilitation of patients with autism spectrum disorders; systematic analysis and synthesis, methods of analogy, abstraction and generalization. The experience of rehabilitation and physical therapy of children with ASD, gained by the NGO Agape, which is engaged in the rehabilitation and habilitation of children with disabilities in Khmelnytskyi, was also taken into account. Results. A child's atypical development and disabilities affect the entire family. Caregivers and family members may develop feelings of vulnerability and guilt, or they may feel unable to care for their child. In addition, the patient-centered and biopsychosocial approach assumes that decisions about therapy are made by caregivers, as they are the best experts on their needs and abilities. There has also been a shift in emphasis from impairment of body structures and functions to the child's participation in family life and activities with the family, as well as from what the child cannot do to what the child can do. Supporting the child and family through this complex process of rehabilitation and physical therapy with this in mind, and recognizing the family's interests and values, is crucial and helps families feel stronger and more confident as they face daily challenges. Family-centered physical therapy takes all of these approaches into account. Family-centered physical therapy is a set of activities aimed at involving the family and the family environment in the child's physical therapy process to provide support, necessary skills and resources to both the patient and the family at each stage of therapy, ensuring the best possible results. All phases of physical therapy involve the child and family members in the evaluation, goal and objective setting, education, implementation of the planned intervention program, counseling and monitoring, and adjustment of the goal, objectives and physical therapy program. Conclusions. Family-centered service programs encourage therapists to move from focusing on an isolated impairment and the needs of the child alone to understanding disability within the social model of services and the context of the family and community. A family-centered physical therapy program for children with ASD involves close collaboration between physical therapists, the child, and parents and other family members. This ensures an individualized approach to therapy, increased effectiveness of the sessions, and improved quality of life for the child and the entire family. Active involvement of parents and providing them with the knowledge and skills to conduct sessions at home helps to achieve sustainable results in the child's development and strengthens family ties, increasing the overall level of satisfaction.

The Effect of Video-Based Action Observation Training and Live Action Observation Training on Motor Function, Activity Participation, and Secondary Outcome Measures in Children With Spastic Diparetic Cerebral Palsy: A Randomized Controlled Study.

This study aimed to investigate the effects of Video-Based Action Observation Training and Live Action Observation Training on motor function, activity participation, and secondary outcome measures in children with spastic diparetic cerebral palsy (CP). Thirty-nine children with spastic diparetic cerebral palsy, aged 5-14 years, with Gross Motor Function Classification System I-III, were distributed in equal numbers to any of the Video-Based Action Observation Training (conventional physiotherapy + Video-Based Action Observation Training), Live Action Observation Training (conventional physiotherapy + Live Action Observation Training), and control (conventional physiotherapy) groups through stratified randomization. For 8 weeks, action observation training groups received 20 minutes of conventional physiotherapy followed by 20 minutes of action observation training, and the control group received 40 minutes of conventional physiotherapy. Primary outcome measures were Gross Motor Function Measurement and Child and Adolescent Scale of Participation, secondary outcome measures were Pediatric Berg Balance Scale, timed-up-and-go test, five times sit-to-stand test (FTSST), Gillette Functional Assessment Questionnaire (GFAQ), and 1-minute walk test (1MWT). Improvements were observed in all other evaluation parameters of the groups except Gross Motor Function Measurement-lying and rolling (P = .066) in the Live Action Observation Training Group, and lying and rolling (P = .317) and crawling and kneeling (P = .063) motor subtests and Gillette Functional Assessment Questionnaire-walking scale (P = .513) in the control group. Comparisons of the increases in all other measurements between the groups, except for the dimensions of Gross Motor Function Measurement-lying and rolling (P = .172), were statistically significant (P < .05) and this difference was in favor of action observation training. It was found that 2 different AOTs applied in addition to conventional physiotherapy in children with spastic diparetic cerebral palsy were more effective on all outcomes than was conventional physiotherapy alone.

OPTIMAL Motor Teaching Strategies Employed in Physiotherapy for Children with Developmental Coordination Disorder: An Observational Study

Aims To describe the teaching strategies that physiotherapists currently employ in individual therapy sessions for children with DCD using the OPTIMAL theory for motor learning as a framework, focused on (1) autonomy (supporting autonomy vs. therapist-controlled), (2) expectancies (enhancing vs. lowering expectancies), and (3) attention (promoting an internal vs. an external focus of attention). Methods Eighteen physiotherapy sessions were videotaped and analyzed with Noldus The Observer XT using the OPTIMAL Strategies Observational Tool (OSOT). Relative duration (% of session time) and frequency were extracted for teaching strategies related to autonomy, expectancies, and attention. Results Physiotherapists mostly applied strategies to support autonomy and enhance expectancies in contrast to therapist-controlled strategies, and lowering expectancies. Strategies to promote either an internal or an external focus of attention were used to a similar extent. Furthermore, strategies were frequently combined; physiotherapists often employed more than one teaching strategy at a time. Conclusions The insight into current physiotherapy teaching practice that this study provides can help inform research and application regarding effective motor teaching for children with DCD. Follow up studies are needed to further investigate how child and task characteristics influence teaching strategy employment and to examine physiotherapists’ reasoning behind their choice of strategies.

Changes in Lower Extremity Passive Range of Motion and Muscle Strength After Selective Percutaneous Myofascial Lengthening and Functional Physiotherapy in Children With Cerebral Palsy

Changes in Lower Extremity Passive Range of Motion and Muscle Strength After Selective Percutaneous Myofascial Lengthening and Functional Physiotherapy in Children With Cerebral Palsy

The effectiveness of respiratory physiotherapy in children with severe respiratory problems: Literature review

Introduction: Respiratory physiotherapy is essential for children with severe respiratory problems. It aims to clear the bronchi, maintain spinal and thoracic mobility, and improve posture. It also helps restore respiratory functions by improving oxygen uptake and carbon dioxide elimination. Aim: This review aims to highlight the effectiveness of respiratory physiotherapy in children with severe respiratory problems, focusing on improving respiratory function and rehabilitation of problems and complications. Methodology: A literature search was conducted via Google Scholar and PubMed, using keywords such as "physical therapy treatment", "cystic fibrosis", and "children". Clinical studies and systematic reviews published in English were selected. Of the 248 initially identified studies, 14 were selected based on specific criteria. Results: The review showed that respiratory physiotherapy significantly improves respiratory function and reduces complications in children with severe respiratory problems and cystic fibrosis. Effective techniques include diaphragmatic breathing, active breathing cycle and PEP, FLUTTER and ACAPELLA devices. Consistency in treatment is critical for better clinical outcomes. Conclusions: Respiratory physiotherapy is vital in the treatment of children with severe respiratory problems, offering multiple benefits in improving respiratory function and reducing complications. Consistency in treatment and parental involvement are critical to the success of treatment.

Treatment with robot-assisted gait trainer Walkbot along with physiotherapy vs. isolated physiotherapy in children and adolescents with cerebral palsy. Experimental study

BackgroundImproving walking ability is a key objective in the treatment of children and adolescents with cerebral palsy, since it directly affects their activity and participation. In recent years, robotic technology has been implemented in gait treatment, which allows training of longer duration and repetition of the movement. To know the effectiveness of a treatment with the robotic-assisted gait trainer Walkbot combined with physiotherapy compared to the isolated physiotherapy treatment in children and adolescents with cerebral palsy, we carried out a clinical trial.Methods23 participants, were divided into two groups: experimental and control. During 5 weeks, both groups received their physiotherapy sessions scheduled, in addition experimental group received 4 sessions per week of 40 min of robot. An evaluation of the participants was carried out before the intervention, at the end of the intervention, and at follow-up (two months after the end of the intervention). Gait was assessed with the Gross Motor Function Measure-88 dimensions D and E, strength was measured with a hydraulic dynamometer, and range of motion was assessed using the goniometer. A mixed ANOVA was performed when the assumptions of normality and homoscedasticity were met, and a robust mixed ANOVA was performed when these assumptions were not met. Statistical significance was stipulated at p < 0.05. For the effect size, η2 was calculated.ResultsSignificant differences were found regarding the time x group interaction in the Gross Motor Function Measure-88 in dimension D [η2 = 0.016], in the flexion strength of the left [η2 = 0.128] and right [η2 = 0.142] hips, in the extension strength of the right hip [η2 = 0.035], in the abduction strength of the left hip [η2 = 0.179] and right [η2 = 0.196], in the flexion strength of the left knee [η2 = 0.222] and right [η2 = 0.147], and in the range of motion of left [η2 = 0.071] and right [η2 = 0.053] knee flexion.ConclusionsCompared to treatments without walking robot, physiotherapy treatment including Walkbot improves standing, muscle strength, and knee range of motion in children and adolescents with cerebral palsy.Trial registrationClinicalTrials.gov: NCT04329793. First posted: April 1, 2020.

Toma de decisiones para el manejo ambulatorio de la bronquiolitis según fisioterapeutas docentes de la Universidad del Gran Rosario

IntroductionClinical practice guidelines recommend against performing respiratory physiotherapy in children with bronchiolitis. It is unknown which interventions physiotherapists use in routine practice, and what factors influence their decisions. The aim was to characterize decision-making in outpatient management of bronchiolitis according to teaching physiotherapists from the University of Gran Rosario. Material and methodsA Delphi technique-based survey was conducted with physiotherapy teachers in 2 stages. The first stage involved a questionnaire with open-ended questions. The second stage was developed from the results of the first, consisting of closed-ended questions. A majority criterion was established among physiotherapists≥60%. ResultsA considerable variability was observed in the interventions considered for the management of bronchiolitis. Over 60% of professionals expressed full agreement that their interventions are based on their knowledge of basic sciences, scientific evidence, clinical evaluation, and academic training. Also, over 60% stated full agreement that the application of interventions depends on clinical aspects of the child, their socioeconomic context, and their family's commitment to treatment. ConclusionsThe clinical intervention process as informed by physiotherapists differs from clinical practice guidelines recommendations. Multiple factors seem to condition, according to the statements of consulted physiotherapists, decision-making in the outpatient management of bronchiolitis.

Effectiveness of physiotherapy in children with functional constipation.

The objective was to compare the immediate effects of pharmacological versus physiotherapy intervention versus a combination of physiotherapy and pharmacological treatment, as well as the quality of life and the recurrence of symptoms in children with functional constipation after 3months. A total of 69 children with functional constipation between the ages of 5 and 14years of either gender were assessed and randomly assigned to one of three groups: Group A, B, and C. Visual Analogue Scale, Bristol Stool Form Scale, frequency of defecation, PedsQL GI symptom scale, and PedsQL Generic Core Scale were used as outcome measures. Pharmacology was used to treat Group A, physiotherapy was used to treat Group B, and a combination of both was used to treat Group C. The study revealed statistically significant results on Visual Analogue Scale, Bristol Stool Form Scale, and frequency of defecation in all groups. However, no significant changes were observed on the PedsQL GI symptom scale and the Generic Core scale in Group A, whereas significant changes were observed in Groups B and C. In this study, we found that there were significant differences in the short- and long-term effects across all groups. More changes occurred in Group C than in Groups A and B.

Conservative therapy and physiotherapy in children with toe walking: a systematic review

Conservative therapy and physiotherapy in children with toe walking: a systematic review

Chest Physiotherapy to Manage Respiratory Rate In Patients with Bronchopneumonia: A Literature Review

Purpose: Knowing the application of chest physiotherapy techniques can manage respiratory rates in children with bronchopneumonia. Methods: This review uses the literature review method. Searches were conducted in PubMed, Garuda, and Google Scholar. The search strategy used keywords with "bronchopneumonia", "chest", "physiotherapy", "respiratory rate". Findings: There were eight articles reviewed in this literature review. Seven articles discussed the application of chest physiotherapy and one article discussed the combination of nebulization therapy and chest physiotherapy in bronchopneumonia or pneumonia patients in children. The overall results of this review show that the application of chest physiotherapy in airway clearance problems in children with bronchopneumonia or pneumonia is effective in removing sputum, diluting sputum, and stabilizing hemodynamic status. Conclusions: The application of chest physiotherapy in children with bronchopneumonia or pneumonia has been shown to stabilize hemodynamic status such as pulse frequency, respiratory rate frequency, oxygen saturation within normal limits, and can remove secretions, sputum, and reduce cough frequency.

Physiotherapy in Children With Cri Du Chat Syndrome: A Clinical Case

Physiotherapy in Children With Cri Du Chat Syndrome: A Clinical Case

Diagnosis and referrals to physical therapy among caregivers of children with genetic disorders: a qualitative inquiry

Purpose Genetic disorders are common in Saudi Arabia. Impaired motor development is one of the major characteristics associated with genetic disorders. Early identifications and referrals are key to receiving physical therapy. This study aims to explore caregivers of children with genetic disorders’ experience with early identification and referrals to physical therapy. Materials and methods An inductive qualitative design of 16 caregivers of children with genetic disorders was done to investigate the identification and referral process to physical therapy. A thematic analysis was used to analyze the data and multiple coders coded the data to increase the trustworthiness of the analysis. Results The analysis led to emergence of four main themes. Caregivers revealed their struggle with the detection process. They struggled with the vague information related to their children’s condition. They also expressed a desperate need for guidance to clarify the process for genetic testing, counseling, and rehabilitation. Although their overall experience with physical therapy was satisfactory, they encountered a number of issues related to scheduling appointments, delayed referrals, and unconfirmed diagnoses. Conclusion The results of this study could indicate that more efforts are required to expedite and elucidate the identification and referral of children with genetic disorders in Saudi Arabia. IMPLICATIONS FOR REHABILITATION The process of referring children with genetic disorders to physical therapy (PT) is not clearly understood by caregivers. Providing caregivers with information about the benefits of PT for children with genetic disorders is needed to encourage adherence to PT sessions and rehabilitation plan. Caregivers expressed the need for further education on the wide spectrum of genetic disorders. Caregivers experienced costly and lengthy genetic testing process that often lead to inconclusive results which could delay the referral process. Alternative solutions should be considered to provide these children with early access to rehabilitation services including PT. One of these solutions could be implementing regular screening and monitoring as well as parent education to aid in detecting delays and expedite the referral process.

Chest Physiotherapy Interventions for Children During SARS-COV-2 Pandemic.

Since the first case of Severe Acute Respiratory Syndrome Coronavirus-2/Coronavirus Disease 2019 (SARS-COV-2/COVID-19) was discovered in Wuhan, China, it spread to vast limits globally and became a public health disaster, affecting nearly all countries around the globe. Along with mainstream medical treatment, alternative medicine desperately was the need of the hour for youngsters to manage their symptoms while being self-quarantined and ultimately to improve their chances of survival and recovery from COVID-19. Since the beginning of SARS-COV-2, few studies address the clinical-functional presentation of viral infection and management with physiotherapy for children. Major online electronic databases PubMed, PEDro, and Google Scholar were researched to identify, organize and commission the current review. To create a search strategy, Medical Subject Headings and Descriptors of Science and Health were utilized. The authors looked for other studies by screening the references list of the potentially pertinent papers. These computerized searches turned up studies and those studies' bibliographies with pertinent citations were examined. Personal protective equipment was a crucial component for protection and contact precaution. Following hypoxia, effective oxygen therapy is administered right away. When necessary, under the right circumstances, nasal high-flow oxygen therapy, non-invasive ventilation, lung-protective breathing methods, and prone positioning can be used. Children with SARS-CoV-2/COVID-19 may benefit from physiotherapy interventions with a focus on ventilatory management, airway clearance procedures, early activities, and mobilization.

The effects of functional electrical stimulation cycling on gait parameters in diplegic cerebral palsy: a single-blind randomized controlled trial

Purpose To investigate the effects of functional electrical stimulation cycling (FES-C) training in addition to conventional physical therapy on gait, muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic diplegic cerebral palsy. Materials and methods Twenty children with diplegic cerebral palsy were randomly assigned to FES-C group (n = 10) or control group (n = 10). Subjects trained 3 days/week for 8 weeks. Control group received conventional physical therapy. The FES-C group additionally received FES-C training. The functional muscle test was used for muscle strength assessment. Vicon-3D system was used for gait analysis. Gross Motor Function Measure (GMFM-88) was used for motor function assessment and calorimeter was used for energy expenditure. Measurements were performed at the baseline, at the eight week and at the sixteenth week. Results Functional muscle strength, gross motor function, and energy expenditure improved more in the FES-C group after training and follow up (p < 0.05). There was no significant difference found between the changes in gait parameters of the two groups after treatment and follow up (p > 0.05). Pelvic tilt while walking decreased after training in the FES-C group (p < 0.05). Conclusions FES-C applied in addition to conventional physical therapy in children with diplegic cerebral palsy is more effective than conventional physical therapy for increasing functional muscle strength, improving gross motor function functions, and reducing energy expenditure. Highlights FES-C improves lower extremity functional muscle strength, gross motor function, and energy expenditure in ambulatory children with spastic dCP. The use of FES-C in combination with conventional physiotherapy methods may be beneficial in outpatients with spastic dCP.

The effects of complications and comorbidities on physical therapy duration in children with pneumonia

Introduction/Objective. Physical therapy aims to improve airway clearance, breathing, and enhance gas exchange. It is widely used as an additional therapy in children with pneumonia. The aim of this study was to assess the effects of complications and comorbidities on physical therapy duration in children with pneumonia. Methods. We conducted a retrospective descriptive study including 40 children with pneumonia admitted to a tertiary children?s hospital. Study participants were divided into two groups ? a group with and without complications and a group with and without comorbidities. All children received physical therapy one time daily five days a week plus standard treatment for pneumonia. Physical therapy procedures that were applied were chest physical therapy and kinesiotherapy. Results. Chest physical therapy (p &lt; 0.001) and kinesiotherapy (p = 0.024) were applied significantly longer in the group with complications versus those without complications. Chest physical therapy was applied significantly longer in the group with comorbidities versus the group without comorbidities (p &lt; 0.001), while there was no difference regarding duration of kinesiotherapy in the group with and without comorbidities (p = 0.239). Conclusion. Our results show that the presence of complications and/or comorbidities significantly prolongs the duration of chest physical therapy in children with pneumonia.

PHYSIOTHERAPY IN CHILDHOOD BLADDER AND BOWEL DYSFUNCTIONS: A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS

Background: Bladder and bowel dysfunctions include daytime urinary incontinence, enuresis, urgency as well as constipation and faecal incontinence. Bladder and bowel dysfunctions are common in children of all ages worldwide. Dysfunction of the pelvic floor muscles is a major suggested cause of the bladder and bowel dysfunctions. Therefore, physiotherapists as musculoskeletal specialists, using standard motor control interventions, might play a role. There are no systematic studies that support this assumption. Aims: To determine whether physiotherapy has beneficial effects on bladder and bowel dysfunctions in otherwise healthy children, aged 4-18 years compared to standard medical care or urotherapy. Secondary aims are to investigate whether physiotherapy have any effect at all on childhood bladder and bowel dysfunctions and if so, which type of physiotherapy is preferable. Methods: A systematic review of randomised controlled trials (physiotherapy versus physiotherapy or physiotherapy versus no intervention, standard medical care, urotherapy, sham-intervention) was undertaken. The primary outcome was the number of cured children from bladder and bowel dysfunctions at six and twelve months. The methodological quality was assessed using the Physiotherapy Evidence Database-scale. To grade and assess the quality of the evidence, the Grading of Recommendation, Assessment, Development and Evaluation-tool was used. Results: Sixteen out of 1728 retrieved publications were eligible for this review. Compared to standard medical care or urotherapy, in favour of physiotherapy, significantly more children were cured from faecal incontinence at 6 months, and from urinary incontinence, day and night, and urgency at 12 months. Significantly more children were cured at 6 and 12 months from all bladder dysfunctions and constipation when receiving physiotherapy. Making substantiated statements about aspects of physiotherapy intervention was impossible. Conclusion: Physiotherapy in children over four years seems to be justified in bladder and bowel dysfunctions, but firm evidence is lacking. Further research is required. Larger pragmatic studies must be executed. Studies should be more tailored to specific age groups, taken in account the natural attrition of symptoms and developmental differences. Methods should include a range of primary and secondary outcomes which are most suitable, including questionnaires of psychometric sufficient quality. Adverse events, or its absence, should be reported.

The Use of the 6MWT for Rehabilitation in Children with Cerebral Palsy: A Narrative Review.

Assessing and improving walking abilities is considered one of the most important functional goals of physical therapy in children with cerebral palsy. However, there is still a gap in knowledge regarding the efficacy of treatment targeting the walking capacity of children with CP, as well as their responsiveness to the treatment. The 6 min walk test (6MWT) is a reliable tool to measure this function in children with CP, although less has been known about its potential efficacy to assess changes in the walking abilities associated with interventions. The aim of the present narrative review is to increase the amount of knowledge regarding the use of the 6MWT as a reliable measure to evaluate the effect of interventions on walking capacity in children with CP.

Current Occupational Therapy and Physiotherapy Services for Children with Cerebral Palsy in India

Background: Cerebral palsy (CP) is a common cause of chronic childhood disability and constitutes a substantial portion of paediatric occupational therapy (OT) and physical therapy (PT) practices. An analysis of current rehabilitation practices is necessary to use more recent, evidence-based, and effective treatment modalities. This study intends to explore the current rehabilitation trends in assessing and planning interventions for children with CP in India and finding the focus and gaps in treatment. Objectives: To describe the focus of therapy practices in OT and PT for children with CP and better understand whether it is congruent with recommended practices. Study Design: A cross-sectional survey. Methods: An India-wide web-based survey on “Rehabilitation services for children with CP: A survey of what we do and how we individualize treatment for different children” (self-designed questionnaire) was completed by 50 occupational and 12 physical therapists to identify assessments and treatment interventions based on their clinical practice. Data were coded using the International Classification of Functioning, Disability, and Health (ICF) definitions for “body functions and structure,” “activity and participation,” and “environment.” Descriptive and quantitative statistics were used to identify the focus and gaps. Results: Both professions focused primarily on body structure and function assessment (OT: 28 [56%] and PT: 8 [66.7%]) when assessing and intervening. “Activity and participation” related assessment was focussed more by physiotherapists 4 (33.3%) than occupational therapists 15 (30%). Majority 44 (71.09%) of the therapists chose interventions that came under the ICF category: Activity and participation. While the percentage of therapists focussing on body structure and function and contextual factors interventions were 28 (45.02%) and 32 (52.27%), respectively. Attention, however, was mainly directed toward task-oriented activities such as activities of daily living and mobility 49 (79%). Participation in leisure or community-based activities received comparatively least attention 35 (56.5%). The environment received limited attention for assessments, although it was an important focus of intervention (environment modifications: 47 [75.8%]).OTs focused more on sensory components (U = 173.000, P = 0.019, 95% confidence interval [CI]: 0.017 to 0.022, mdn = 1.00) and, PTs focused more on gait (U = 192.000, P = 0.046, 95% CI: 0.0.039 to 0.047, mdn = 2.00) and trunk impairment (U = 129.000, P = 0.001, 95% CI: 0.0.000 to 0.001, mdn = 1.00). Conclusion: While body functions and structure are well-addressed, other ICF elements, specifically participation, are poorly integrated into practice. The emerging focus on the environment in therapy intervention, by modifying the context rather than changing aspects of the child, is consistent with current approaches and evidence. Knowledge translation implementation initiatives are recommended to bridge identified gaps.

Effects of Aquatic Physical Therapy in Children With Congenital Femoral Deficiency Who Underwent Bone Lengthening Using an External Fixator: A Case Report

Introduction and Objective: Congenital femoral deficiency (CFD) is a malformation that affects 0.2 persons per 10,000 live births. The orthopedic treatment proposed for this disease is bone lengthening using an external fixator (EF). During this treatment, reductions in the range of motion (ROM) of the knee, alterations in the gait speed (GS), and worse quality of life (QOL) commonly occur. Therefore, rehabilitation of patients with CFD receiving this treatment is essential. Aquatic physical therapy (APT) is an innovative approach for this population, however, there are no reports on the effects of APT in patients with CFD after bone lengthening. The objective of this study was to assess the influence of APT on the knee ROM, GS, and QOL of 2 children with CFD implanted with an EF. Case Description: Two children with right-sided CFD implanted with an EF were selected. They received an APT protocol focusing on balance, muscle activation, analgesia and mobility of the right knee, and gait. The right knee ROM, GS, and QOL were measured using right knee goniometry, a 10-m walk test before and after each session, and the Child Health Questionnaire–Parent Form 50 before and after the protocol. Results: An increase in the ROM of the right knee and an improvement in the QOL were observed after the protocol. Only one of the children had an increased GS. Conclusion: The APT protocol increased the knee ROM and improved QOL of the 2 children with CFD implanted with an EF.