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

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

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

Interrater Reliability of the Pediatric Neuromuscular Recovery Scale in Children with Spina Bifida

Purpose: There is a paucity of outcome measures to assess the quality of functional mobility in children with spina bifida1. The Pediatric Neuromuscular Recovery Scale (Peds NRS) is a valid and reliable outcome measure that was developed to assess the motor capacity of children with spinal cord injury2-6. The purpose of this study was to examine the interrater reliability of the Pediatric Neuromuscular Recovery Scale (Peds NRS) to classify motor capacity in children with myelomeningocele (MMC) form of spina bifida. Subjects: Twenty-one children with MMC (1.4- 10 years of age; mean age of 5.3 years) were recruited from clinics and support groups within a 250-mile radius of Austin, TX. Four clinicians, two physical therapists (PTs) and two occupational therapists (OTs) served as the raters for the study. Raters had an average of 14 years of clinical practice and 11 years of pediatric practice. Methods: Each child with MMC was scored on the Peds NRS three times: two live testing sessions and one video recorded session. Every child was scored by two PTs and one OT. Interrater reliability was analyzed using intraclass correlation coefficients (ICC) for individual items and the summary score. Results: The Peds NRS summary score demonstrated good reliability (ICC = 0.89; 95% CI, .80-.95). For the sixteen individual items, reliability was excellent for items forward reach and grasp (right and left), static stand, and walking (ICC= .919-.969), good for supine to sit, sit inside base of support, sit outside base of support, in-hand manipulation (right), overhead reach (right and left), sit to stand, dynamic stand, and step retraining (ICC= .765-.890) and moderate for in-hand manipulation (left), stand adaptability, step adaptability (.511-.745). None of the items had poor reliability. The summary score had consistent reliability across age categories and groups defined by modified Hoffer level. There was no difference in the summary scores among all raters at F(2,60)= .220, p=.804. Conclusions: Pediatric clinicians were able to reliably administer and score the Peds NRS on children with MMC, representing a wide range of ages and functional levels. Clinical Relevance: This is the first investigation of the use of the Peds NRS in children with MMC. This study adds to the literature regarding the psychometric properties of the Peds NRS and supports the use of this outcome measure as an instrument to assess motor capacity in children with MMC

Development of a Physical Therapy Faculty Workload Measurement Tool

Counting credit hours is not an equitable way to measure faculty workload in physical therapy education considering online delivery with heavy workloads negatively impacting satisfaction, learning outcomes, and research productivity. The University of St. Augustine for Health Sciences (USAHS) is a graduate-level institution in the United States, with seven Doctor of Physical Therapy programs offered in four US locations. USAHS faculty workload includes 50% teaching, 20% scholarship, 30% a combination of service, administration, release, and discretionary time. The aim of this study was to develop a faculty workload measurement tool that quantifies productivity, was easy to use, and equitable. Two large faculty pilots were completed; data and open-ended responses were used to develop a final version of the workload measurement tool to be fully implemented in late 2018. The task force developed a workload measurement tool that appears to be accurate, transparent, and impartial. With the addition of directions and the self-calculating formulas, the form provides quick, consistent information to faculty and their supervisors regarding the division of workload between the four main areas of faculty time

Does ethnicity impact DPT students’ clinical readiness and performance? An exploratory study

The purpose of this study was to explore the influence of ethnicity on clinical readiness and performance among DPT students as determined by (1) clinical reasoning Physical Therapist Self-Efficacy (PTSE) score during clinical experiences(2) self-confidence rating treating patients, and (3) final APTA Clinical Performance Instrument (CPI) clinical reasoning and summative ratings by clinical instructors. A 28 question survey was administered to 211 second- and third-year students in a Doctor of Physical Therapy program at mid-term of their clinical experience. Survey scores, PTSE scores, and CPI scores were analyzed using a Kruskal-Wallis test for differences between groups. All ethnic groups demonstrated strong clinical readiness and performance during all clinical experience levels. Ethnic groups did not differ in clinical reasoning self-efficacy or confidence treating patients. Although the gap appears to be closing, there continues to be underrepresentation of ethnic groups in DPT academic programs

Clinical Reasoning Readiness and Confidence of DPT Students with PT Interventions Using Telehealth

Telehealth service-delivery content has an emerging footprint on entry-level physical therapy programs. This study evaluated clinical reasoning readiness and confidence in third-year DPT students during clinical experiences with and without telehealth. Students’ clinical reasoning readiness and confidence were determined using the Physical Therapist Self-Efficacy (PTSE) score, self-confidence rating treating patients, and final APTA Clinical Performance Instrument (CPI) clinical reasoning and summative ratings. DPT students providing PT interventions using telehealth reported lower clinical reasoning self-efficacy (PTSE) when compared to traditional service-delivery. Confidence treating using telehealth was greater at the initial visit compared to subsequent visits, suggesting a lack of student readiness for providing subsequent telehealth visits. Final CPI ratings did not differ between DPT students with and without telehealth

Self-Efficacy with Telehealth Examination: the Doctor of Physical Therapy Student Perspective

Introduction: The shift to telehealth exposed gaps in our understanding of how physical therapy students perceive patient assessment in a remote situation using the examination component of the patient/client management (PCM) model. The purpose of the study was to compare Doctor of Physical Therapy (DPT) students’ self-efficacy performing patient assessment using the examination component of the PCM model using telehealth compared with conventional examination. To achieve the purpose of this study, the Physical Therapist Self-Efficacy (PTSE) scale was used. More specifically, self-efficacy in clinical reasoning was measured using the following items: (1) PTSE total score (2) performance of tests and measures, (3) determining when to refer to another practitioner, and (4) screening for primary medical disease. Methods: A survey-based descriptive and exploratory repeated measures design was used, with surveys distributed to entry-level DPT students during their clinical experiences in the United States during the Fall 2020 semester. A convenience sample of 35 second- and third-year entry-level DPT students who reported provided both telehealth and traditional examinations during clinical experiences was used. Descriptive and inferential statistics were used to evaluate within group differences comparing student self-efficacy using telehealth and conventional examination. Results: Wilcoxon sign ranks revealed statistically significant differences in self-efficacy scores of students conducting patient assessment using telehealth compared to conventional examination. More specifically, scores for telehealth were lower (P \u3c 0.001) compared to conventional examination in PTSE total score, performance of tests and measures, determining when to refer to another practitioner, and medical screening for primary disease. Discussion: Doctor of Physical Therapy students’ self-efficacy was lower when providing telehealth across all PTSE questions pertaining to the examination component of the PCM model. Exploring telehealth content and sequence in entry-level physical therapy curriculum may help students feel more prepared to perform telehealth examination. Key words: Examination, Physical therapy, Self-efficacy, Students, Telehealth

Doctor of Physical Therapy students’ clinical reasoning readiness and confidence treating with telehealth: a United States survey

Purpose: Telehealth has an emerging footprint on entry-level physical therapy programs. Students’ readiness for clinical reasoning with virtual versus traditional face-to-face treatment remains unknown. The purpose of this study was to evaluate Doctor of Physical Therapy (DPT) students’ preparedness for clinical experiences with and without telehealth. Methods: A descriptive and exploratory cross-sectional survey was employed, with a voluntary convenience sample of 211 second- and third-year university DPT students during Fall 2020 clinical experiences. Descriptive and inferential statistics evaluated differences in DPT students’ (1) Physical Therapist Self-Efficacy (PTSE) scale scores, (2) confidence with treating initial and subsequent same-patient visits, and (3) final Clinical Performance Instrument (CPI) clinical reasoning and summative scores during clinical experiences with and without telehealth. Results: Telehealth availability was 40.3%, with 16.6% of DPT students reporting participation. Most students reported being comfortable (39.3%) or neutral (32.2%) using telehealth. DPT students’ confidence level using telehealth to treat was 74% on initial and 97% on subsequent same-patient visits. Mean PTSE scores were significantly lower during clinical experiences with telehealth (13.1) compared to traditional experiences (15.1) (PP Conclusion: While entry-level DPT programs continue to establish best practice for telehealth education, current trends in academic curriculum seem to prepare students’ clinical reasoning readiness for clinical experiences. The PTSE could be used to identify outlier students requiring additional mentoring during traditional and telehealth clinical experiences

Comparison of Flex vs. residential clinical education program outcomes: physical therapy students’ self-efficacy, confidence, and clinical competence

Purpose: Alternative flexible (Flex) path Doctor of Physical Therapy (DPT) programs may have an emerging footprint. The differences between Flex and traditional residential DPT program clinical experience outcomes remain unknown. The purpose of this study was to evaluate Flex and residential DPT students’ clinical reasoning self-efficacy, confidence with treating, and Clinical Performance Instrument (CPI) clinical reasoning and summative scores during clinical experiences. Methods: A descriptive and exploratory cross-sectional survey was used with a voluntary convenience sample of 211 university DPT students during Fall 2020 full-time clinical experiences. Descriptive and inferential statistics evaluated differences in Flex and residential DPT program students’ (1) Physical Therapist Self-Efficacy (PTSE) scale scores, (2) confidence with treating initial and subsequent same-patient visits, and (3) final CPI clinical reasoning and summative scores during clinical experiences. Results: Mean PTSE scores were significantly lower for Flex (x̄ = 14.2) compared to residential DPT students (x̄ = 15.2) (P \u3c 0.05). No significant student differences were found in (1) Flex (x̄ = 2.1) and residential (x̄ = 2.2) confidence with treating at the initial visit (P = 0.59), (2) Flex (x̄ = 2.8) and residential (x̄ = 3.0) confidence with treating subsequent same-patient visits (P = 0.15), and (3) Flex (x̄ = 15.8) and residential (x̄ = 16.5) CPI clinical reasoning (P = 0.17), and (4) Flex (x̄ = 16.1) and residential (x̄ = 16.7) CPI summative scores (P = 0.21). Conclusion: Clinical reasoning self-efficacy among Flex DPT students was lower, but there was no difference in CPI clinical reasoning or summative results between Flex and residential DPT students. In the university investigated, the Flex distance learning DPT program curriculum appeared effective in preparing students’ clinical reasoning readiness for the available full-time clinical experiences. We recommend academic institutions consider expanding Flex entry-level DPT program availability options because the outcomes were comparable. Additional flex entry programs may help address the underrepresentation of nontraditional students in entry-level DPT programs and societal demands for physical therapy services