Assessing Student Self-Perception of Confidence in the Evaluation and Treatment of the Neurologically Involved Across the Lifespan

PURPOSE AND HYPOTHESIS: The purpose of this study was to investigate student confidence in the evaluation and treatment of a person with a neurological condition through the use of Patient Oriented Integrated Neurological Treatment (POINT) labs. We hypothesized that POINT labs would significantly improve students\u27 confidence in evaluation and treatment this population. METHODS AND MATERIALS: As part of their curriculum, physical therapy students at the University of St. Augustine are required to participate in POINT labs during their Neuromuscular III and Pediatric PT classes. The POINT labs are divided into an adult and pediatric section, in which the students evaluate and treat each participant from both sections once a week for 4 weeks. The participants are volunteers from the community who have been diagnosed with a neurological condition. A survey pilot study was conducted during the Spring 2015 semester to assess students\u27 perception of confidence in the evaluation and treatment of this population. Forty eight physical therapy students participated in the pretest survey prior to the start of the first POINT lab. The survey contained 10 questions and took no more than 5 minutes to complete. The same survey was given to the students immediately upon completion of the fourth POINT lab. A paired sample t-test was used to analyze the difference between the pretest and posttest groups for each question on the survey. RESULTS AND CONCLUSION: There was a significant difference between the pretest and posttest for each of the 10 questions (p\u3c.0001). These findings are consistent with our hypothesis that the use of POINT labs significantly improve students\u27 confidence in evaluation and treatment of a person with a neurological condition. This study supports improving upon the traditional model of physical therapy education by bringing patients into the classroom

The Effects of Closed Kinetic Chain and Endurance Exercises on Reducing Pain in a Child with Ehlers-Danlos Syndrome: A Case Report

Background and Purpose: Ehlers-Danlos syndrome (EDS) is a connective tissue disorder characterized by joint laxity, chronic pain, and joint instability. Often, children with EDS exhibit polyarthralgia and fatigue as their main symptoms. Although physical therapy is a mainstay of treatment for individuals with EDS, evidence is lacking for specific exercises or treatment strategies for management of pain. The purpose of this case report is to describe the effectiveness of closed kinetic chain and endurance exercises on reducing pain in a child with EDS. Case Description: The child was a 9 year old girl diagnosed with EDS hypermobility type, and a 3 week history of bilateral ankle pain. Her pain was worse when running and participating in sports (basketball and softball). She had long-standing polyarthralgia that occurred “all the time”, accompanied by fatigue during activities that had worsened over the past 3 weeks. The child wore ankle stabilizing orthotics at all times, and pain had caused her to discontinue playing sports. The child and her mother were seeking conservative treatment in an attempt to reduce her chronic pain and improve overall function. Outcomes: Treatment focused on closed chain kinetic exercises. Initially, verbal feedback was given to obtain neutral range in weight-bearing joints in order to reduce microtrauma, facilitate proprioception, and recruit surrounding musculature for stability. After demonstrating proper form and reduced pain, the child was progressed to closed chain exercises within her full range of motion. The child\u27s fatigue was addressed through the use of a Lower Body Positive Pressure Treadmill to reduce the forces applied from normal walking. The fact that she had a history of polyarthralgia suggested tailoring her treatment plan according to her functional capabilities and limitations, mainly hypermobility with reduced proprioception. After 6 weeks, the child reported decreased pain on the Faces Pain Scale from 7 out of 10 at initial evaluation to 2 out of 10 at discharge. Her Lower Extremity Function Scale, which identifies functional impairments, increased from 42/80 (52.5%) to 53/80 (66.3%). During the fourth week of her episode of care, she began wearing her Ankle Stabilizing Braces only during sports or when walking long distances. The child also reported less pain overall and was able to return to playing basketball, softball, and other extracurricular activities. Discussion: These results support interventions utilizing progressive closed kinetic chain exercises into full hyperextension range for children with EDS to help to achieve functional outcomes. Since EDS is a chronic condition, longitudinal studies could help increase the reliability of these exercise programs by investigating musculoskeletal influences over time. Further research should contribute to developing evidence-based treatment strategies for this condition

The Impact of Body-Weight Supported Locomotor Training in a Toddler with GMFCS Level V Cerebral Palsy: A Case Study

BACKGROUND AND PURPOSE: Children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) level V present with decreased gross motor function and trunk control that impacts their functional activities and participation in family activities. Research indicates body-weight supported locomotor training (BWSLT) may improve motor control for children with neuromotor disabilities. The toddler years present a window of opportunity for developmental changes. The purpose of this case study was to explore the impact of a 6-week BWSLT intervention on postural control, gross motor function, and quality of life in a young child with cerebral palsy in GMFCS level V. CASE DESCRIPTION: A 3 year-old male child diagnosed with CP was recruited from a local pediatric home health agency. He presented with spasticity in all four extremities, gross motor delay, truncal ataxia, and decreased head control. The child was dependent for all functional mobility and activities of daily living. The child attended BWSLT sessions 3 times per week for 6 weeks. An experienced pediatric physical therapist and 3 assistants facilitated the gait cycle on the treadmill. Facilitation was decreased when the child demonstrated improved motor control. Throughout the 6 weeks, treadmill speed was systematically increased from 0.7mph to 1.8mph and body-weight support was systematically decreased from 50 to 33%. Total walking time varied between 11 and 26 minutes (in 3-5 minute bouts) and total standing time ranged from 4 to 13 minutes (in 2-5 minute bouts). The child attended 17 of the 18 sessions, missing 1 due to respiratory illness. OUTCOMES: At the initial assessment, the child received a total Gross Motor Function Measure (GMFM-66) score of 20.5, SE = 2.2, 95%CI [16.3, 24.8]. He scored 1/20 on the Segmental Assessment of Trunk Control (SATCo) and his total standardized score was 61.5 on the CPCHILD, an assessment of quality of life for children with CP in GMFCS levels IV and V. After 6-weeks of BWSLT, the child improved his GMFM-66 score by 30% to 26, SE = 2, 95%CI [22.1, 29.9]. He also showed a slight improvement in the SATCo, 2/20, and the CPCHILD, 61.91. His school physical therapist reported he was able to hold his head up more during the day and showed increased endurance with improved lower extremity control with walking in his gait trainer. DISCUSSION: The outcomes of this case study suggest that gross motor function and trunk control may improve through body-weight supported locomotor training in young children with severe CP. The 6 week time frame was chosen based on previous literature, but a longer time frame may have produced greater results. Future research is needed to determine if this type of intervention can improve function across a larger population of toddlers with CP in GMFCS levels V. Additionally, dosage requirements for this population should be explored

Caregiver perspectives on body-weight supported treadmill training as an intervention for young children with cerebral palsy

PURPOSE/HYPOTHESIS: Children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and V present with challenges that impact their functional activities and participation in family activities. The purpose of this study was to examine caregivers’ perspectives on body-weight supported treadmill training (BWSTT) as an intervention for their young children with CP. NUMBER OF SUBJECTS: Participants included 4 caregivers of children with CP in GMFCS levels IV (n = 2) and V (n = 2) who previously participated in 6 weeks of BWSTT. MATERIALS/METHODS: Three children diagnosed with CP in GMFCS levels IV and V between the ages of 2 to 3 years participated in 6 weeks of BWSTT, 3 times per week. The type of CP varied for each child: 1 had spastic diplegia, 1 had spastic triplegia and 1 had spastic quadriplegia. The caregivers of the children were asked to participate in face to face interviews after the intervention ended. Four caregivers (1 parent of each child, plus an additional parent of 1 of the children) participated in one-on-one semi-structured interviews using open-ended questions. Interviews were audio recorded and transcribed. Analysis of the interviews was conducted through open coding to identify categories by the principal investigator. A secondary investigator coded 50% of the transcripts to triangulate the coding for trustworthiness. The two investigators then discussed the codes and categories until an agreement was reached to identify the emergent themes and an overarching theme. RESULTS: The principal investigator and 3-4 research assistants were able to perform BWSTT with all 3 young children without adverse effects. Attendance varied between 16 to 18 sessions, with an average participation rate of 94%. Careful triangulation of the interview data led to the identification of 3 common themes and 1 overarching theme based on caregiver perceptions of the BWSTT program. The themes identified were: 1) Caregiving (support system, physical and emotional strain, routines), 2) Future outlook (optimism, facing challenges, fears/worries), and 3) Importance of therapies (traditional physical therapy, BWSTT intervention, and other therapies as more important than physical therapy). The overarching theme that emerged was: Acceptance of the journey. CONCLUSIONS: The caregivers reported that after the BWSTT intervention, their children improved in motivation to walk, and also with head and trunk control. Caregivers of the children all expressed the desire to continue the program and stated that they would participate again if given the chance. They also emphasized the importance of other therapies to address issues such as feeding and communication. CLINICAL RELEVANCE: Caregivers are likely to take time out of their busy schedules to pursue physical therapy treatments that they view as effective in improving their child’s gross motor function. Although physical therapy is perceived as vital to their child’s progress, it is a small part of the overall journey for these families

Trunk control and gross motor outcomes after body-weight supported treadmill training in young children with severe cerebral palsy: A case series

BACKGROUND AND PURPOSE: Children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and V present with decreased gross motor function and trunk control that impacts their functional activities and participation in family activities. Research indicates body-weight supported treadmill training (BWSTT) may improve motor control for children with neuromotor disabilities. The toddler years present a window of opportunity for developmental changes. The purpose of this case series was to explore the impact of a 6-week BWSTT intervention on postural control and gross motor function in 3 young children with cerebral palsy in GMFCS levels IV and V. CASE DESCRIPTION: Three children diagnosed with CP between the ages of 2 to 3 years participated in 6 weeks of BWSTT, 3 times per week. All children displayed decreased trunk control as measured by the Segmental Assessment of Trunk Control (SATCo) and decreased gross motor function as measured by the Gross Motor Function Measure (GMFM-66). One child was dependent for all mobility (GMFCS level V) and 2 children were able to belly crawl for short distances (GMFCS level IV). None of the children were able to walk without assistance. All 3 displayed spasticity in bilateral lower extremities. BWSTT consisted of an experienced pediatric physical therapist and 3 assistants facilitating the gait cycle on the treadmill. Facilitation was decreased when the child demonstrated improved motor control. Treadmill speed was systematically increased (average speed = 1.15mph) and body-weight support was systematically decreased (range: 50 to 33%). Total walking time averaged 20:04 minutes (in 2-10 minute bouts) and total standing time averaged 8:28 minutes (in 2-4 minute bouts). Average attendance was 94%. OUTCOMES: Final scores revealed that all 3 children improved gross motor function and trunk control. Child 1 improved his SATCo score from Level 0 to Level 1, indicating improved head control. His GMFM-66 score increased from 20.5 to 26. The other 2 children showed greater improvements in trunk control. Child 2’s SATCo score increased from Level 2 to Level 3 and his GMFM-66 score increased from 36.8 to 42.4. Child 3 improved on the SATCo from Level 2 to Level 4 and on the GMFM from 31.8 to 40.9. Parents of all 3 children reported increased motivation to walk during physical therapy sessions. DISCUSSION: The outcomes of this case series suggest that gross motor function and trunk control may improve through BWSTT in young children with severe CP. The 6 week time frame was chosen based on previous literature, but a longer time frame may have produced greater results. Parents of all 3 children expressed the desire to continue the intervention. Future research is needed to determine if this type of intervention can improve function across a larger population of toddlers with CP in GMFCS levels IV and V

Relationship between Movement Quality, Functional Ambulation Status, and Spatiotemporal Gait Parameters in Children with Myelomeningocele.

Aims: We investigated relationships among the Pediatric Neuromuscular Recovery Scale (Peds NRS), modified Hoffer Scale, and spatiotemporal gait parameters in children with myelomeningocele (MMC). Methods: 21 children with MMC, age 5.3 years (SD = 2.6), were assessed by three clinicians using the Peds NRS and modified Hoffer Scale. In eight children, gait parameters were also measured. Results: The Peds NRS summary score demonstrated good correlation with modified Hoffer Scale score (r = -0.64, p = 0.002) that accounted for 41% of variation in summary score. Six Peds NRS seated/standing items exhibited good relationships with modified Hoffer Scale (r = -0.51 to -0.70, p≤ 0.023), and the sit-to-stand item demonstrated an excellent relationship (r = -0.85, ps = 0.81 to 0.88, p≤ 0.014), and swing and stance time (both Rs = -0.83 to -0.90, p≤ 0.01). Two Peds NRS standing items and modified Hoffer Scale score demonstrated good correlations with velocity (Rs = 0.71, p= 0.047; Rs = -0.73, p= 0.04, respectively). Conclusions: Our findings suggest that children with MMC who exhibit greater movement quality and trunk control are likely to be functional ambulators with more optimal spatiotemporal gait parameters

Upsee Daisy! Gross Motor Outcomes after Dynamic Weight Bearing in Two Children with Truncal Hypotonia: A Case Series

PURPOSE: The purpose of this case series was to report the impact of a home-based dynamic standing program on postural control and gross motor activity in two children with truncal hypotonia. BACKGROUNDS/SIGNIFICANCE: Poor postural control associated with central hypotonia limits a child’s ability to interact with the environment, delaying attainment of developmental milestones such as sitting, crawling, standing and walking. Participation in social interactions with peers and caregivers may be restricted resulting in a decreased quality of life. Supported standing programs are commonly used to ameliorate impairments and optimize function in children with poor postural control. Increased social interactions, as well as reduced burden of care have all been associated with supported standing programs. The Upsee is an orthotic standing and walking device which is worn by the child and parent. As the adult stands, moves, and walks the child is encouraged to stand, move, and step. Functional tasks and participation activities are encouraged while the child is in the Upsee. There are no reports of the effectiveness of the Upsee as a dynamic standing program. Because of its simple design and ease of use, the Upsee can be readily added to a home program to increase standing and weight shifting in children. SUBJECTS: Child 1 was a 24-month-old boy born at 37 weeks gestation and diagnosed at birth with a rare form of chromosome 3 deletion and agenesis of the corpus callosum. His Gross Motor Function Classification System (GMFCS) classification was Level IV. Child 2 was a 21-month-old boy born at 39 weeks gestation. Prior to birth, his mother experienced decreased fetal movement. A cesarean section was performed and the baby was found to have a true umbilical cord knot, causing hypoxic ischemic encephalopathy. He was diagnosed with Cerebral Palsy (CP) at 12 months of age. His GMFCS classification was Level V. Both children displayed truncal hypotonicity with significant gross motor delays for their ages. They both had cognitive ability to follow simple commands, but no verbal communication skills. The children had excellent family support and parents of both children expressed an overall goal for improvement with functional independence. METHODS AND MATERIALS: Each child participated in 12 weeks of a home-based program that included upright dynamic weight bearing using the Upsee device. The harness system was adjusted by a physical therapist during the first assessment period to provide appropriate anatomical alignment and positioning for the children to bear weight through their lower extremities. The families were educated in the correct use of the device, and followed a protocol that included up to 30 minutes of weight bearing per day, 3 to 5 days a week. The parents were educated on dynamic weight bearing to facilitate muscle activation in the trunk and legs while using the Upsee. Families were asked to keep a journal of the amount of time spent in the device and activities performed by their child. ANALYSES: The Segmental Assessment of Trunk Control (SATCo) and the Gross Motor Function Measure (GMFM- 66) identified changes in gross motor function and trunk control. Pre- and post-intervention scores were compared. RESULTS: Final scores revealed that both children improved gross motor function, and Child 1 demonstrated improved trunk control in sitting. Child 1 improved his SATCo score from 11/20 to 20/20 and GMFM-66 score from 35 to 42. Child 2 initially scored 0/20 on the SATCo outcome measure, which did not change. His GMFM-66 score improved from 16 to 21. By the end of the study period, both children were able to take steps independently with a gait trainer. This new ability expanded opportunities for physical therapy goals and interventions for both children. CONCLUSIONS: Children with truncal hypotonia can participate in, and benefit from, a dynamic standing program using the Upsee. We speculate that this program may be effective in improving the gross motor abilities of children with severely impaired postural control. Of the two children, Child 1 demonstrated more improvement in gross motor function and trunk control. One possible reason for this is that Child 2 presented with increased extensor tone of his four extremities, which increased when he became excited or when attempting to focus on an activity at hand and constrained his movement activity. Also, Child 2 spent less time overall in the Upsee, never progressing beyond 15 minutes of weight bearing per session. Future research is needed to further explore the necessary dosage of an upright dynamic weight bearing program for children with impaired postural control. Studies with a more homogenous and larger sample are needed to conduct a randomized controlled trial design comparing the use of the Upsee to a traditional standing frame. Future studies should also aim to capture changes across the full ICF-CY model, including activities and participation. The findings from this case series support the use of the Upsee as a new home-based upright dynamic weight bearing program for children with impaired postural control

Trunk control and gross motor outcomes after body weight supported treadmill training in young children with severe cerebral palsy: a non-experimental case series

OBJECTIVE: To explore the impact of a body weight supported treadmill training (BWSTT) intervention on postural control and gross motor function in three young children with cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) levels IV or V. METHOD: Children (N = 3) between the ages of 2-3 years who were diagnosed with CP classified as GMFCS levels IV and V participated in BWSTT three times per week. The Segmental Assessment of Trunk Control (SATCo) and the gross motor function measure (GMFM-66) were assessed before and after the 6-week intervention. RESULTS: Final testing revealed that all participants improved on the SATCo and GMFM. CONCLUSION: BWSTT is a viable intervention that may improve trunk control and gross motor outcomes in young children with severe CP. Further research is needed to explore the impact of BWSTT for young children classified as GMFCS levels IV and V

WHAT IS THE PERCEIVED EFFECTIVENESS OF THE ON-CAMPUS SERVICES FOR STUDENTS WHO STRUGGLE WITH SUBSTANCE USE BASED ON THE PERSPECTIVES OF THE STAFF MEMBERS?

There is an increased risk in college aged students to engage in problematic substance use. The culture and perceived college experience endorse substance use, whether it is through alcohol, marijuana, or other related drugs. Students are susceptible to these behaviors that can later turn into addictions. Literature supports that this population benefits from the availability of on-campus support groups and services related to substance use. This study provides insight into the perceived effectiveness of campus-based services that are directed to assisting students with substance use. More specifically, this study explored the views of staff members that deliver these services in order to gain insight about how students benefit from accessing these resources. The data was gathered by conducting face-to-face interviews in which responses were audio recorded on an electronic device and later transcribed into transcripts. The transcripts were analyzed and coded for themes and concepts that surfaced throughout the participants’ responses. The results obtained demonstrate significant aspects of how services can impact the student’s struggles with substance use. Ultimately, this research builds on the need for this population to have campus-based services accessible and the importance of integrating social work practice to further assist them

Gross Motor Outcomes After Dynamic Weight-Bearing in 2 Children With Trunk Hypotonia: A Case Series

NTRODUCTION: Children with trunk hypotonia may have limited ability to maintain an upright weight-bearing position, resulting in decreased postural control and a delay in achieving gross motor milestones. PURPOSE: The purpose of this case series is to report the effect of a home-based dynamic standing program on postural control and gross motor activity in 2 children with trunk hypotonia. DESCRIPTIONS: Child 1 (aged 24 months, Gross Motor Function Classification Scale Level IV) and Child 2 (aged 21 months, Gross Motor Function Classification Scale Level V) participated in a standing program using the Upsee harness at home 3 days per week for 12 weeks. OUTCOMES: Both children improved their gross motor function, and Child 1 demonstrated improved trunk control in sitting. WHAT THIS CASE ADDS: The use of the Upsee harness was an effective intervention for these children with trunk hypotonia to achieve weight-bearing and improve gross motor abilities