A B S T R A C T S
Abstracts of Platform and Poster
Presentations for the 2006
Combined Sections Meeting
Platform Presentations
EFFECTS OF AN INTENSIVE THERAPY PROTOCOL
ON CHILDREN WITH CEREBRAL PALSY
Carr, Panthea M,1; Kolobe, Thubi A.1; OConnell, Laurie2;
Williams, Sammy2
1
Rehabilitation Science, University of Oklahoma Health
Sciences Center, Oklahoma City, OK, USA
2
Easter Seals DuPage, Villa Park, IL, USA
Purpose/Hypothesis: The purpose of this pilot study was
to examine the effects of an intensive therapy protocol
that uses the TheraSuitTM on the gross motor perfor-
mance of children with cerebral palsy (CP).
Number of Subjects: Participants were 20 children with
CP. The mean age was 7 years with a range of 3-17. Chil-
dren were classified into Gross Motor Function Classifi-
cation System (GMFCS) levels.
Materials/Methods: A pre and posttest design with one
group was used. The children received therapy 4 hours a
day, 5 days a week for 3 weeks using primary equipment
of a TheraSuitTM and a universal exercise unit. The
GMFM was videotaped for each child. The outcome mea-
sures were the Gross Motor Function Measure (GMFM),
clinical judgment of change, and observation of postural
alignment, latency of response, and duration of move-
ment [quality of movement]. Rater reliability on the mea-
sures was determined before data collection. An investi-
gator who was unfamiliar with the children and blinded
to test order assessed the videotapes by scoring the
GMFM and a clinical observation checklist that assessed
quality of movement. Spearman rho correlation coeffi-
cients examined relationships among GMFM scores and
participant characteristics. Paired sample t tests assessed
changes in GMFM88, GMFM66, and quality of move-
ment. A repeated measure MANOVA examined changes
in pre and post GMFM88 and GMFM66 mean scores
based on GMFCS levels.
Results: The GMFM88 and GMFM Goal Total mean
scores increased following the intervention (t -3.566, P
0.002 and t -3.094, P 0.006, respectively), but the
GMFM66 mean scores and quality of movement mean
totals did not. The correlation coefficients between
Pediatric Physical Therapy
GMFM88 or GMFM66 scores and participant characteris-
tics were not statistically significant. The MANOVA
showed a significant main effect for the GMFM88 but not
the GMFM66. The interaction of test time and GMFCS
level was not statistically significant.
Conclusions: The results of this pilot study revealed a
discrepancy between the GMFM88 and GMFM66 in
terms of evaluating change. Because the GMFM66 elimi-
nates redundancy of items by ranking the items by diffi-
culty level, several of the items that contributed to the
higher posttest GMFM88 scores in this study were those
that have been omitted from the GMFM66. The absence
of a statistically significant mean change in the quality of
movement variables raises a question about the ability of
this intervention to effect change at an impairment level.
The small sample size is a limitation, but these findings
highlight concerns that need to be addressed in a larger
study.
Clinical Relevance: Many parents and professionals who
care for children with CP seek alternative treatments in
addition to or instead of conventional interventions for
the children. With little evidence to support these inter-
ventions, therapists decisions about whether or not to
recommend them to parents tend to be subjective. The
findings of this study, although preliminary, provide in-
formation for therapists to use while awaiting larger stud-
ies on the effectiveness of intensive TheraSuitTM interven-
tions for a child with CP.
KEYWORDS: TheraSuit, cerebral palsy, GMFM
QUALITY OF LIFE, STRENGTH AND FUNCTION
FOLLOWING AN INTENSIVE STRENGTHENING
PROGRAM IN A 17 YEAR OLD WITH CEREBRAL PALSY
DiIenno, Michael1; Atkinson, Heather1
1
Physical Therapy, Childrens Hospital of Philadelphia,
Philadelphia, PA, USA
Background & Purpose: Strength training children with
cerebral palsy has been shown to be an effective means of
improving strength and function. While many studies
have shown improvements in subjects strength and func-
tional ability, few have also examined the effect of
Abstracts for the 2006 Combined Sections Meeting 73
strength training on quality of life. The purpose of this
case study is to report the effect of strength training in a
17 year old female with cerebral palsy.
Case Description: The subject is a 17 year old female
with spastic quadriplegic CP who received Botox and
Phenol injections to her bilateral lower extremities.
She attended a day hospital rehabilitation program
where she received 1.5 hours of physical therapy and 1
hour of occupational therapy 5 days per week. The
subject participated in a 6 week therapy regimen
which focused on quadriceps and gluteal strengthening
3 days per week and general balance and gait training
on alternate days. Initial load for weight training was
calculated as 65% of her maximal isometric knee ex-
tension and hip extension peak torque as measured on
the Biodex System 3. Repetitions and/or exercise load
was increased as the subject demonstrated improve-
ment in ability to perform prescribed exercises. Iso-
metric peak torque, TUG, the 9 minute walk run, EEI,
GMFM, and the PedsQL were performed pre and post
physical therapy intervention.
Outcomes: Isometric peak torque for knee extension in-
creased 92% and hip extension 57%, 9 minute walk run
improved 1105 feet, EEI decreased from 4.7 to 0.99
beats/m, GMFM total increased 12% and standing do-
main increased 41%, TUG decreased 3.72 seconds,
PedsQL decreased 9 points
Discussion: Dramatic improvements were noted in glu-
teal and quadriceps strength following the 6 week
strength training program. Although items from the
GMFM were not specifically practiced, the subject
showed improvement in all areas, most significantly in
the domain of standing. Additionally, while endurance
training was not a focus of physical therapy, significant
change was made on the 9 minute walk run as well as
the EEI. Most notably, the subjects EEI improved to
within normal limits for healthy age-matched peers.
Items of improvement on the PedsQL included attitude
toward walking, participation in household chores,
feeling afraid and keeping up with and fitting in with
peers. Though the PedsQL has been shown as a reli-
able and valid measure of quality of life in pediatric
populations, there have been few comments in the lit-
erature associating a physical therapist prescribed
strengthening program with quality of life in children
with chronic health conditions such as cerebral palsy.
The dramatic improvements in strength, function, en-
durance, and energy expenditure seen in this subject
corresponded to an improvement in quality of life as
measured by the PedsQL. Further research is war-
ranted to examine this relationship. This case supports
the use of intensive strength training as a primary
physical therapy intervention to achieve patient and
family goals related to function and quality of life.
KEYWORDS: strength training, cerebral palsy, quality of
life
74 Abstracts for the 2006 Combined Sections Meeting
EFFECTS OF THE STANDING WALKING AND
SITTING HIP ORTHOSIS IN CHILDREN WITH
SPASTIC CEREBRAL PALSY: SURFACE
ELECTROMYOGRAPHIC EVIDENCE
Embrey, David G.1; Westcott, Sarah L.2
1
Childrens Therapy Unit, Good Samaritan, Puyallup, WA, USA
2
Physical Therapy, University of Puget Sound, Tacoma, WA, USA
Purpose/Hypothesis: The effects of the Standing, Walk-
ing and Sitting Hip (SWASH) orthosis on children with
cerebral palsy (CP) were examined by surface electro-
myography (SEMG) data from the hip adductor (ADD)
and abductor (ABD) muscles during standing, walking,
and sitting.
Number of Subjects: Ten children diagnosed with spastic
diplegia, age four to 10 years-old, comprised a sample of
convenience. Children were Levels I-IV on the Gross Mo-
tor Functional Classification System. Children with sur-
gery or tone reducing procedures within six months prior
to the study were excluded.
Materials/Methods: A repeated measures design was used
to test subjects with the SWASH (SW) and with no
SWASH (NS). The orthoses were fitted by a certified or-
thotist. Children wore the SWASH at home, during ther-
apy, or at school for at least one week prior to testing.
The SWASH was worn for a mean of 2.7 hours (sd
1.9)/day during the week prior to data collection. Sub-
jects were randomly assigned to be evaluated in the SW
or NS condition first. SEMG data were collected bilater-
ally while subjects were sitting and standing for 10 sec-
onds and while walking 20 feet. Comparisons of sitting
and standing data were made between the SW and NS
conditions for the middle five seconds. Walking trials
required a minimum of four steps at self-selected speeds.
SEMG data amplitudes were normalized to a percentage
of each childs maximum functional contraction (%MFC)
during standing, walking, or sitting. The MFC values
were the maximum integrated SEMG amplitude during a
10 ms window of rectified and smoothed (RMS 50) data.
Group %MFC integrated SEMG mean amplitudes were
compared between the two conditions (SW/NS) for the
two muscles (hip ADD and ABD) for the sitting, stand-
ing, and walking tasks. Group co-contraction index and
ratio (ABD to ADD) scores were compared between SW
and NS conditions for walking data. Individual walking
data were compared within subjects using point by point
%MFC integrated SEMG amplitudes. All comparisons
were completed using the Wilcoxin Sign Ranks test due
to skewed data distributions.
Results: No statistically significant differences were
found between the SW or NS conditions for any of the
tasks. When point by point integrated SEMG %MFC am-
plitudes were examined within subject and by muscle
during walking, data were significantly reduced or un-
changed in the SW condition in 80% of the trials for ABD
and 75% for the ADD.
Conclusions: The manufacturers claim that the SWASH
does not increase adductor tone appears to be valid based
Pediatric Physical Therapy
on SEMG data in this sample. The claim that the SWASH
may increase hip abductor tone is not supported.
Clinical Relevance: Because children in this sample do
not seem to show increased muscle activity in the ADD
when wearing the SWASH in standing, walking or sitting,
clinical concerns about increasing ADD muscle activity
seem unwarranted. Longitudinal studies with larger sam-
ples are recommended to determine how continued use
of the SWASH could impact muscle function.
KEYWORDS: cerebral palsy, hip orthosis, gait
EFFECTS OF PREFERRED SLEEP AND AWAKE
POSITIONS ON MOTOR MILESTONE
DEVELOPMENT OF VERY LOW BIRTHWEIGHT
INFANTS (VLBW) WITH AND WITHOUT WHITE
MATTER DISEASE (WMD)
Fetters, Linda1; Huang, Hsiang-han1
1 tinue to be promoted, but prone activities, particularly
Physical Therapy and Athletic Training, Boston University,
Boston, MA, USA 2Child Development Unit, Childrens
Hospital, Boston, MA, USA 3Pediatrics, Harvard Medical
School, Boston, MA, USA
Purpose/Hypothesis: The focus of our research was to
evaluate the association of preferred sleep and awake posi-
tioning on motor milestone acquisition of infants born pre-
maturely with VLBW and with/without WMD.
Number of Subjects: Participants were sixty-eight in-
fants: 30 premature infants born VLBW and WMD (PT-
WMD), 21 premature infants born VLBW without WMD
(PT) and 17 full term infants (FT). Testing and parent
interview took place in the Developmental Motor Control
laboratory at Boston University when infants were 1, 5
and 9 months of age. Parents signed consent forms prior
to participation in the study, in accordance with the poli-
cies of Boston University Institutional Review Board and
the respective hospital.
Materials/Methods: Motor milestone development was
recorded using the Alberta Infant Motor Scale (AIMS) a
58-item assessment of gross motor performance designed
for the identification and evaluation of motor develop-
ment of infants aged birth to 18 months of age. Reliability
between two testers for two, one-month old infants and
four, 5 month old infants was established with a Pearson
product moment correlation of 0.93 (one month) and
0.92 (5 months). Parents were interviewed by the first
author and asked their infants preferred position(s) for
sleep (then eat, then play). Multiple regression was used
to predict AIMS scores with group (PTWMD, PT, FT)
and different positions as the between-subject factors.
Alpha level was set at 0.05.
Results: At 1 month, the prone position for sleep was posi-
tively correlated with AIMS total scores (P 0.039). At 5
months, the prone position for sleep and play were posi-
tively correlated with AIMS total scores; PTWMD was nega-
tively correlated with AIMS total score (prone for sleep: P
0.004; prone for play: P 0.027; PTWMD: P 0.039). At 9
months, the prone position for sleep was positively corre-
Pediatric Physical Therapy
lated with AIMS total scores; sitting for play, PTWMD and
PT were negatively correlated with AIMS total score. (prone
for sleep: P 0.020; sitting for play: P 0.001; PTWMD: P
0.002; PT: P 0.001). However, group was negatively
correlated with AIMS total scores at 5 and 9 months (5
months: PTWMD: P 0.039; 9 months: PTWMD: P
0.002, PT: P 0.001). There was a significant difference for
infants who slept prone, with increased ability on the AIMS
total scores at 5 months (P 0.007, r2 0.143). At 9
months, infants who chose sitting positions for play or were
in the PTWMD group had decreased ability on the AIMS
total scores (sitting for play: P 0.005, PTWMD: P
0.017, r2 0.491).
Conclusions: Sleeping supine did not impact motor mile-
stone development contrary to what has been previously
reported. Prone sleep and play, however promoted im-
proved AIMS scores.
Clinical Relevance: Supine sleep positions should con-
for infants who are VLBW/WMD should be highly en-
couraged.
KEYWORDS: premature, white matter disease, motor
BONE MINERAL DENSITY IN CHILDREN WITH
SPINAL CORD INJURY
Johnston, Therese1; Lauer, Richard T.1; Smith, Brian T.1;
Maurer, Alan H.2; Betz, Randal R.1
1
Research, Shriners Hospitals for Children, Philadelphia, PA, USA
2
Temple University Medical Center, Philadelphia, PA, USA
Purpose/Hypothesis: To determine the bone mineral
density (BMD) of the hip and the knee in children with
spinal cord injury (SCI) and to compare the BMD of the
hip to published data for children with typical develop-
ment.
Number of Subjects: Nine boys and five girls (ages 5 to
13 years, mean age 9.1 2.5 years) with spastic motor
complete SCI (neurological levels C7 to T10) and no his-
tory of lower extremity fractures underwent BMD testing
of the left hip, distal femur, and proximal tibia via dual
energy X-ray absorptiometry (DEXA) as part of a pro-
spective study of the effects of a lower extremity func-
tional electrical stimulation training program in children
with SCI. Subjects were 5.1 2.1 years (1 to 8 years)
post injury when tested.
Materials/Methods: The baseline BMD values from the
intervention study were analyzed for each subject. BMD
at the hip was compared to age and sex matched pub-
lished normative values obtained using DEXA (Zanchetta
et al., Bone, 1995;16(4 Suppl):393S-399S) and Z-scores
were calculated. Normative values were not available for
the machine on which the testing was performed. There
are no published normative values available for compari-
son for BMD at the distal femur and proximal tibia.
Results: All subjects had decreased BMD as compared to
age and sex-matched norms. At the hip, BMD averaged
0.44 0.17 g/cm2 at the femoral neck (Z 1.88 0.97),
Abstracts for the 2006 Combined Sections Meeting 75
0.41 0.19 g/cm2 at the trochanter (Z 1.82 1.55),
and 0.44 0.17 g/cm2 at Wards triangle (Z 1.88 0.81). arm movement with specific spatiotemporal parame-
At the knee, BMD averaged 0.35 0.10 at the distal fe-
mur and 0.36 0.08 at the proximal tibia.
Conclusions: These pediatric subjects with SCI showed
reduced BMD at the hip as compared to their peers.
While norms are not available at the knee, the BMD val-
ues in this area were comparable to the values for BMD at
the hip, with both showing a marked decrease thus sug-
gesting an increased fracture risk in both of these areas.
Techniques such as magnetic resonance imaging and
quantitative computerized tomography may provide
more in-depth information regarding the specific compo-
nents of bone affected.
Clinical Relevance: As individuals with SCI spend most
of the day in a seated position, they may be at less risk
of fracture than the non-disabled population due to
decreased weight bearing on these joints. However,
children with SCI may be more at risk than adults with
SCI due to their higher activity level, lack of under-
standing of protecting their lower extremities, and a
desire for upright mobility. In addition, it is unknown
as to what BMD threshold constitutes an increased risk
for fractures in these children due to activity or how
age at injury and length of time since injury impact
BMD in a growing child. Protection strategies should
be taught early to children with SCI and interventions
need to be developed to improve BMD in this popula-
tion to prevent fractures that may lead to deformity in
the presence of growth.
KEYWORDS: spinal cord injury, bone density, pediatrics
EFFECTS OF REDUCED FREQUENCY FEEDBACK
ON MOTOR PERFORMANCE AND LEARNING IN
CHILDREN
Kantak, Shailesh S.1; Sullivan, Katherine J.1; Burtner,
Patricia A.2
1 ness can be enhanced by the appropriate use of feedback
Biokinesiology & Physical Therapy, University of Southern
California, Los Angeles, CA, USA
2 disability. Further work is needed to understand the gen-
Division of Occupational Therapy, University of New
Mexico, Albuquerque, NM, USA
Purpose/Hypothesis: Motor learning studies in young
adult and older populations demonstrate that reduced
frequency feedback is more effective in the learning of
motor tasks. However, it is unknown if these findings can
be applied to motor learning in children, given that chil-
dren have different information processing capabilities
than adults. The purpose of this study is to determine the
effect of different relative frequencies of knowledge of
results (KR) on skill acquisition in healthy children com-
pared to healthy young adults.
Number of Subjects: 10 healthy young adults (mean age:
26.7 yrs) and 6 typically developing healthy children
(mean age:11.2yrs) participated in the study. All the par-
ticipants were screened for visual perception and grip
strength.
76 Abstracts for the 2006 Combined Sections Meeting
Materials/Methods: Participants practiced a discrete
ters using a light-weight lever. Participants from each
group (adults and children) were randomly assigned to
either a 100% feedback group or 62% feedback group.
The 100% KR group received feedback about their per-
formance after every trial while in the 62% KR group,
the frequency of KR presentation was faded over trials.
Feedback included a root mean square error (RMSE)
and the participants actual movement trajectory su-
perimposed on the target waveform. All subjects prac-
ticed the task for 200 trials (four 50-trial blocks) on
day 1 and returned next day for a 10-trial retention
test. Performance was measured as the RMSE between
the target and the participants response.
Results: During the acquisition phase, adults per-
formed with significantly less error than the children
(P 0.029). Further, children who practiced the task
with reduced frequency of feedback had a significantly
higher error than the other three groups (P 0.04).
For the retention test, adults who practiced with 62%
KR (error score: 16.04 4 deg) performed as accu-
rately as those who practiced with 100% KR (14.42
4.6 deg). However, the children who received KR on
all trials (11.93 3.5 deg) performed with less error
on the retention test than those who received KR on
62% of the trials (17.41 2.4 deg). This difference
was not statistically significant (P 0.09); however
the effect size was 1.7, indicating a strong effect, con-
sidering the small sample size and preliminary analysis
at this point in this study.
Conclusions: During motor learning of a discrete task,
children use feedback in a manner that is different from
that used by adults. The results suggest that reduced
feedback frequency during practice is not as effective in
motor performance and learning in children as is typi-
cally reported in the adult motor learning literature.
Clinical Relevance: Training and intervention effective-
during motor skill learning in children with and without
eralizability of motor learning principles to children
learning motor tasks.
KEYWORDS: motor learning, psychomotor skill, practice
DIAGNOSTIC ACCURACY AND CONSISTENCY OF
THE ALBERTA INFANT MOTOR SCALE IN A
LONGITUDINAL SAMPLE
Kolobe, Thubi A.1; Bulanda, Michelle2
1
Rehabilitation Science, University of Oklahoma Health
Science Center, Oklahoma City, OK, USA
2
Physical Therapy, University of Illinois at Chicago,
Chicago, IL, USA
Purpose/Hypothesis: The purpose of this study was to
examine the diagnostic ability of the Alberta Infant
Motor Scale (AIMS) when used with infants during the
Pediatric Physical Therapy
first year of life. More specifically, the study examined
whether the cut-off points or diagnostic criteria for the
AIMS is consistent in correctly classifying infants at
various ages and stages of development.
Number of Subjects: Sixty-one children who were pre-
school age participated in a longitudinal validation study
of the AIMS. The children were from an original cohort
of 90 infants who were assessed on the AIMS at 3, 6, 9,
and 12 months adjusted age.
Materials/Methods: The Peabody Developmental Motor
Scale, 2nd Edition (PDMS-2) were used to assess the
childrens motor performance between the ages of 4-5
years old. Medical diagnoses confirmed the childrens
developmental status. Inter- and intra-tester reliabili-
ties were established among the testers on the
PDMS-2. The children were tested in their homes. We
used the Pearson product moment correlation coeffi-
cient and multiple regressions to assess the relation-
ship between the AIMS and PDMS-2. To determine the
diagnostic and predictive ability of the AIMS we calcu-
lated sensitivity, specificity and predictive values (di-
agnostic values) using the 5th and 10th percentile cut-
offs on the AIMS.
Results: Correlation coefficients between the AIMS
percentile scores at 3, 6, 9, 12 months and the three
subscales of the PDMS-2 were statistically significant.
The coefficient between the AIMS and the PDMS-2
gross motor quotient (GMQ) was low at three months
(r 0.29), but good at 6, 9, and 13 months (r 0.59,
0.60, and 0.65, respectively). The AIMS at 3 months
had the lowest diagnostic values, however these values
increased at 6, 9, and 12 months of age. Sensitivity and
positive predictive values ranged from 0.33 at 3
months to 0.82 at 12 months. The 5th percentile cut-
off correctly classified a higher number of children
with or without disabilities than the 10th percentile
cut-off.
Conclusions: The AIMS is more likely to correctly iden-
tify an infant with motor disabilities at 6, 9, and 12 than
at 3 months. The scores on the AIMS at 3 months mis-
classified approximately 60% of infants who were later
diagnosed with CP. The AIMS 5th percentile cut-off is
more likely to correctly classify children at 6, 9, and 12
months who will later be diagnosed with CP, than the
10th percentile cut-off.
Clinical Relevance: Physical therapists play a major role
in developmental surveillance of infants and young chil-
dren. Research findings about the instability of motor
development raise questions about the diagnostic accu-
racy of many of the widely used developmental and
screening tests that are based on cross-sectional data. The
results of this study provide information that therapists
can use at several ages during infants first year to base
their decisions about referral.
KEYWORDS: motor development, developmental tests,
AIMS
Pediatric Physical Therapy
THE INFLUENCE OF MATERNAL CHILDREARING
BELIEFS AND PRACTICES ON MOTOR OUTCOME
OF MEXICAN AMERICAN CHILDREN
Kolobe, Thubi A.1; Smith, Everett2; Ishi, Leticia1
1
Rehabilitation Science, University of Oklahoma Health
Science Center, Oklahoma City, OK, USA
2
Educational Psychology, University of Illinois at Chicago,
Chicago, IL, USA
Purpose/Hypothesis: This prospective longitudinal study
examined the contributions of parenting beliefs, chil-
drearing practices, and demographic factors to childrens
motor performance during the first 3 years of life.
Number of Subjects: Participants were 60 mother-infant
dyads from the Mexican-American population. The mean
age of the children and mothers at the beginning of the
study was 11.3 months and 27 years, respectively. Half of
the children were male and 20% were receiving early in-
tervention services.
Materials/Methods: A descriptive design was used with
repeated measures at 1, 2, and 3 years of age. We used
the Parent Behavior Checklist (PBC), Home Observation
for the Home Environment (HOME), and Nursing Child
Assessment -Teaching Scale (NCATS) to measure parent-
ing beliefs and childrearing practices. The motor subscale
of the Bayley Scales of Infant Development II (BSM-2)
and Peabody Developmental Motor Scales II (PDMS-2)
were used to measure motor performance. All interviews
(PBC), observations (HOME & NCATS), and develop-
mental testing (BMS-2 and PDMS-2), took place in the
childrens homes. Inter-rater and test-retest reliabilities
were established among the testers on all the scales. We
used the Pearson Product Moment Correlation Coeffi-
cients (Pearson r) and multiple regressions to examine
the nature of the relationship among the childrearing
factors and motor performance over time.
Results: None of the childrearing measures were corre-
lated with motor performance at 1 year of age. At age 2
and 3 years only parental expectation (PBC-E) and disci-
pline (PBC-D) scores were associated with motor perfor-
mance (coefficients ranged from 0.30 to 0.44). However,
the HOME, NCATS, and PBC-D at age 1 year were corre-
lated with motor performance at age 3 years (r 0.48,
0.56, and 0.31, respectively). These variables predicted
approximately 50% of the variance in the childrens motor
performance at age 3.
Conclusions: The results of this study suggest that early
parenting beliefs and childrearing practices are associated
with later motor performance. The relationship suggests
that early motor development and performance may be
less sensitive to parental childrearing beliefs and prac-
tices, such as the quality and quantity of stimulation in
the home and parent-child interaction styles, than later
performance. The findings may also suggest that some of
the beliefs and childrearing practices of the Mexican
American mothers during the first year of their childrens
lives may be supportive to early, but not later motor per-
formance.
Abstracts for the 2006 Combined Sections Meeting 77
Clinical Relevance: An assumption underlying early in-
tervention in childrens natural environments is that chil-
dren are dependent and susceptible to their caregiving
environments. The results of this study underscore the
need for physical therapists assessments and evaluations
to include childrearing beliefs and practices, and to be
prepared to provide intervention if needed.
KEYWORDS: childrearing, motor development, culture
RESPONSES TO A MODIFIED VISUAL CLIFF BY PRE-
WALKING INFANTS BORN PRETERM AND AT TERM
Lin, Yuan-Shan1; Reilly, Marie1; Mercer, Vicki1; Thorpe,
Deborah1; Goldman, Barbara2
1 cordingly. Use of fewer behavioral and motor strategies
Allied Health Sciences, The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
2 have perceived different affordances than infants born at
Frank P Graham Child Development Center, The
University of North Carolina at Chapel Hill, Chapel Hill,
NC, USA
Purpose/Hypothesis: Perceptual differences between in-
fants born preterm and at term were investigated. We
hypothesized that infants in both groups would require
more time to cross the deep surface (DS) than the normal
surface (NS) and the shallow surface (SS). We further
hypothesized that infants born preterm would differ from
those born at term in the number of successful trials,
crossing time, and behavioral responses.
Number of Subjects: Subjects were 16 infants born at
term (gestational age of 38 weeks or more) and 16 infants
born preterm (gestational age of 34 weeks or less). In-
fants in both groups had at least one month of prone lo-
comotor experience but were not walking independently.
Materials/Methods: The apparatus consisted of a wooden
platform (183.5 cm long 76.5 cm wide 10 cm high)
supported 108 cm above the floor with a removable cen-
tral section. The plywood in this central section could be
replaced with a sheet of plexiglass to create a modified
visual cliff.
In the normal surface (NS) condition, a sheet of
patterned material covered the wooden base of the plat-
form. In the shallow surface (SS) condition, the same
material was secured directly beneath a sheet of plexi-
glass in the central section of the platform. In the deep
surface (DS) condition, the fabric beneath the plexiglass
was removed and the infants could see the patterned ma-
terial on the ground and around all four sides of the cen-
tral section of the platform.
The investigator placed the infant in a (supported)
sitting position at the start end of the platform and the
infant was encouraged to cross the platform toward his/
her caregivers at the other end. Six trials were adminis-
tered for each infant with two trials for each surface con-
dition. Two infrared sensors connected to a millisecond
timer were used to measure the time required to cross the
platform. A success was defined as crossing the platform
within the 2-min period. The camcorder was used to cap-
ture the infants behavioral responses, including visual
78 Abstracts for the 2006 Combined Sections Meeting
attention, tactile exploration, motor strategies, and avoid-
ance behaviors.
Results: Both groups of infants spent significantly longer
time crossing the DS than the NS and SS.
Chi-square analysis indicated no significant differ-
ences between groups for successful trials. For crossing
time, duration of visual attention and tactile exploration,
analysis of variance demonstrated a significant surface
effect but no group effects. Group differences were noted
in behavioral responses. Infants born at term demon-
strated a greater number and variety of motor strategies
as well as more avoidance behaviors.
Conclusions: Both infants born at term and those born
preterm could perceive the visual cliff and respond ac-
by infants born preterm suggests that this group may
term.
Clinical Relevance: Early identification of perceptual
differences in children born prematurely may lead to in-
tervention strategies directed at preventing or reducing
later perceptual/learning problems in this population.
KEYWORDS: prematurity, perception-action, visual cliff
DEVELOPMENTAL GAINS IN CHILDREN
ATTENDING A CENTER-BASED VERSUS HOME-
BASED EARLY INTERVENTION PROGRAM: A
MULTIVARIATE COMPARISON
Maring, Joyce R.1
1
Program In Physical Therapy, The George Washington
University, Washington, DC, USA
Purpose/Hypothesis: The purpose of this study was to
compare the developmental gains in six domains of
development in children attending a home-based ver-
sus center-based early intervention program while con-
trolling for the developmental quotient (DQ) or initial
level of delay. The six domains of development includ-
ed: gross motor, fine motor, language, self-help, cogni-
tion and social.
Number of Subjects: The records of 134 children with
a variety of diagnoses contributing to developmental
delay were reviewed. Of the participants whose records
were reviewed, 86 children received center-based in-
tervention, 48 received home-based services, 37% were
girls, 63% were boys and 67% qualified for Medicaid.
Childrens ages ranged from three to 44 months. The
record was considered for inclusion if the child partici-
pated in the program for one continuous year and had
developmental scores based on the administration of
the Early Intervention Profile (EIP) for the year under
consideration.
Materials/Methods: Developmental gains were calculated
for one year using the scores from the EIP in each of the
domains described above. Controlling for variances in
DQ, A Multivariate Analysis of Covariance (MANCOVA)
Pediatric Physical Therapy
was performed to determine whether a significant differ-
ence existed between the mean gains in each develop-
mental domain for children attending the center-based
versus home-based program.
Results: The comparison of the two groups on the mean
developmental gains in the six domains while controlling
for the DQ was significant (Hotellings Trace 0.190;
P 0.001). A comparison of the groups on the covariate
DQ was also significant (Hotellings Trace 0.260; P
0.001) substantiating the need to control for initial delay
in the group comparisons. Children attending center-
based programs made more gains in gross motor, fine
motor, and language development. Children attending
home-based programs made more gains in self-help and
social development. No differences were noted in cogni-
tive development based on intervention site. The only
univariate comparison that was statistically significant
was the gross motor gains (F 7.686; P 0.006). Chil-
dren attending the center-based program made signifi-
cantly more gross motor gains than children participating
in the home-based program.
Conclusions: Developmental gains in the above domains
may be influenced by program site placement. In this
population, children made greater developmental gains in
gross motor, fine motor and language skills if attending a
center-based program and greater gains in self-help and
social skills if attending a home-based program.
Clinical Relevance: Intervention site appears to have a
variable influence on each domain of development. Site
decisions should be based on a family and teams assess-
ment of each childs relative strengths and needs.
KEYWORDS: early intervention, developmental gains,
intervention site
COMPARISON OF PARENT AND YOUTH REPORTS
OF HEALTH-RELATED QUALITY OF LIFE IN
CEREBRAL PALSY
ORourke, Deborah A.1; Bjornson, Kristie F.2; Engel, Joyce
M.3; Jensen, Mark P.3; McLaughlin, Jeff F.2
1 and youth scores were strongest for the more subjective
Physical Therapy, University of Vermont, Burlington, VT, USA
2 CHQ scales. Also, while some of the associations were
Genetics/Development, Childrens Hospital and Regional
Medical Center, Seattle, WA, USA
3 Clinical Relevance: Parent and youth reports of youth
Department of Rehabilitation Medicine, University of
Washington, Seattle, WA, USA
Purpose/Hypothesis: Cerebral palsy (CP) is associated
with reduced health related quality of life (HRQL) sec-
ondary to neuromuscular impairments, activity restric-
tions, and participation limitations. HRQL measures are
used to plan interventions and to evaluate treatment out-
comes. Usually, HRQL information for youths with CP is
obtained from parents. However, discrepancies between
youth self-reports and parent proxy reports are well doc-
umented. The purpose of this study was to further exam-
ine the agreement between parent proxy and self-reports
of HRQL in youths with CP. We hypothesized that agree-
ment between parents and youths would be greatest for
Pediatric Physical Therapy
scales measuring observable (behavioral) areas of func-
tioning and lowest for scales assessing subjective states.
When discrepancies were found, and based on the find-
ings from previous research, we hypothesized that par-
ents would rate HRQL lower than youths.
Number of Subjects: A convenience sample of 28 dyads
of youths with CP and their parents were recruited
through a tertiary care childrens hospital and public
postings. Participants were primarily male (n 19) with
a mean age of 14.1 years (range 8-20). Gross Motor
Function Classification System levels were I 8, II 6,
III 6, IV 4, and V 4 and the topography of CP was
spastic quadriplegia, (9) hemiplegia, (3) and diplegia, (16).
Materials/Methods: The Child Health Questionnaire Par-
ent Form (CHQ-PF-28) and Child Form (CHQ-CF-87)
were administered as part of an ongoing study of pain in
youth with disabilities. Parent and youth participants
independently completed one-time interviews in-person
or by telephone at home or at a university medical center.
Independent samples paired t tests were used to compare
parent and youth group mean subscale scores. Agreement
in scores between parent and child dyads was examined
across CHQ subscales using Pearson product moment
correlations.
Results: Parent and youth group mean scores differed
significantly for Physical Functioning (t -2.64, P
0.01), Role/Social-Physical (t -3.02, P 0.004), Men-
tal Health (t -2.30, P 0.03), Self Esteem (t -2.07, P
0.04), and Family Activities (t -2.17, P 0.04). In
each case, parent scores were lower than youth scores.
Correlations between scores for parent and child dyads
were strong for Bodily Pain (r 0.52, P 0.01), Mental
Health (r 0.65, P 0.001), and Self Esteem (r 0.62,
P 0.001). The coefficients for the remaining CHQ
scales were weak and most were positive.
Conclusions: Parent and youth perceptions of HRQL in
this group of children with CP were discordant in several
domains. As predicted, when differences were found,
parents scores were lower than youths scores. However,
contrary to prediction, the associations between parent
strong, the majority of associations were weak.
HRQL appear to differ in many ways, suggesting that a
thorough assessment of youth HRQL should include as-
sessments from both sources.
KEYWORDS: cerebral palsy, health-related quality of
life
PEDIATRIC CONSTRAINT INDUCED THERAPY FOR
MANAGEMENT OF IMPAIRED UPPER EXTREMITY
FUNCTION IN A YOUNG GIRL WITH CONGENITAL
HEMIPARESIS: A CASE REPORT
Ries, Julie D.1; Leonard, Rebecca1; Carter, Jennifer1; Cribb,
Gavin1; Gerhard, Duncan1; Johnson, Jeana1
1
Physical Therapy, Marymount University, Arlington, VA, USA
Abstracts for the 2006 Combined Sections Meeting 79
Background & Purpose: Constraint Induced Therapy
(CIT) for management of upper extremity functional lim-
itation in adults with hemiparesis is gaining favor in neu-
rological rehabilitation. Pediatric CIT (PCIT) and its vari-
ations are not as well studied. The purpose of this case
report is to describe the use of a protocol that integrated
intensive PCIT with other physical therapy interventions
for a child with hemiparesis.
Case Description: The child is a 28-month old girl who
experienced a prenatal right cerebral vascular accident
resulting in left hemiparesis and hypertonicity. Her medi-
cal history has been free of any major complications or
medical procedures. She demonstrates some delay of her
major motor milestones associated with her hemiparesis,
but her cognitive and language development are typical
for her age. Spontaneous use of her left upper extremity
is markedly impaired, in both quantity and quality of
movement; however, when her right upper extremity is
therapeutically constrained or a bimanual demand is
placed upon her, her capacity for left upper extremity use
becomes apparent. The PCIT protocol was initiated when
the childs right (unaffected) arm was casted from upper
arm to finger tips for three weeks. While wearing the
cast, she received intervention in the form of shaping and
random, massed practice of left upper extremity skills
integrated into play activities for five hours per day, five
days per week in her home. The intervention also in-
cluded home program instruction to parents for the dura-
tion of the treatment. A specific, written home program
was provided upon completion of the PCIT intervention
to facilitate carry-over of left upper extremity function.
Outcomes: Data were collected using the Peabody De-
velopmental Motor Scales 2-Fine Motor Scales
(PDMS2-FM), Quality of Upper Extremity Skills Test
(QUEST), and Pediatric Motor Activity Log (PMAL).
Baseline measurements (pre-tests) were recorded three
weeks before, and immediately prior to, cast applica-
tion. Post-tests were carried out immediately, three
weeks, and three months post intervention.
PDMS2-FM scores for the left upper extremity demon-
strated a 67% and 76% improvement in mean grasp
and visual motor integration scores respectively, while
right upper extremity scores remained stable. QUEST
Total Scores showed a 24% improvement from mean
pre- to mean post-test measures. PMAL scores showed
parental perception of improvement in quantity and
quality of left upper extremity function post interven-
tion. Improvement of left upper extremity function
over baseline function persisted at three week and
three month post tests.
Discussion: The child appeared to tolerate casting and
intensive therapy very well, and demonstrated im-
proved function of the left upper extremity post inter-
vention. Experimental studies are needed to determine
the effects of PCIT on functional outcomes in a larger
sample of children with hemiparesis.
KEYWORDS: hemiparesis, upper extremity, rehabilitation
80 Abstracts for the 2006 Combined Sections Meeting
ANKLE STRENGTHENING TO IMPROVE GAIT AND
FUNCTION IN CEREBRAL PALSYA PILOT STUDY
Ross, Sandy A.1; Engsberg, Jack R.1; Collins, David R.1
1
Human Performance Laboratory, Washington Univ, St.
Louis, MO, USA
Purpose/Hypothesis: The purpose of this investigation
was to determine if increases in ankle strength can im-
prove gait and function in persons with cerebral palsy
(CP). Despite recognizing that muscle weakness is a ma-
jor impairment in CP, many of the current treatments
(e.g. tendon lengthening, Botulinum toxin, orthotics)
purposely weaken or result in further weakening of the
muscles.
Number of Subjects: Twelve subjects (3 males; 9 fe-
males, age 10 3 years) with spastic diplegia CP and
Gross Motor Function Classification System (GMFCS)
levels; I n 5, II n 5, III n 2.
Materials/Methods: Subjects were randomly assigned to
one of four groups: 1) dorsiflexor (DF) group [n 3], 2)
plantarflexor (PF) group [n 4], 3) dorsi-plantarflexor
(DF/PF) group [n 2], and 4) control group [n 3]
undergoing no strength training program. Subjects in the
3 training groups participated in a 12-week, 3/week
progressive resistance strength training program on an
isokinetic dynamometer (concentric/eccentric @ 30 and
90o/s). Pre and post training, the subjects underwent
tests for plantarflexor spasticity, end range dorsiflexion,
ankle strength, GMFM66 (Gross Motor Function Mea-
sure), GMFM-wrj (walk, run, jump) and gait speed.
Paired t test and correlations were used to assess changes
and relationships (P 0.05).
Results: Results indicated no increase in spasticity or
decrease in end range dorsiflexion. There was a signifi-
cant increase in strength in the trained muscles (P
0.007). The strength increase was greater for the plantar-
flexors of PF group (0.46 Nm/kg) than for the dorsiflex-
ors of the DF group (0.20 Nm/kg). For the DF/PF group,
the strength increase of the dorsiflexors was not as much
as those of the DF group, whereas the strength increase
of the plantarflexors was slightly greater than those of the
PF group. The muscles that were not trained were un-
changed. GMFM66 results showed increases in the 3
training groups and a decrease for the control group (1.0,
1.8, 2.7 and 2.7 for the DF, PF, DF/PF, Control groups,
respectively). Results for the GMFM-wrj indicated larger
improvements than the GMFM66. There was a significant
increase in the GMFM-wrj for the training groups (P
0.041). Further, the correlation between change in
strength and change in GMFM-wrj was r 0.84 (P
0.001). Gait speed was increased for the PF group (8.0
cm/s) and for the DF/PF group (2.4 cm/s). The increase
in the PF group was primarily due to a 6.4 cm increase in
stride length. Speed was unchanged for the DF group
(1.1 cm/s) and for the control group (1.5 cm/s).
Conclusions: Results from this study seem to indicate
that increases in ankle strength are possible in individu-
als with CP. Function was improved for all of the
Pediatric Physical Therapy
strength training groups. Gait speed improved with
strengthening of the plantarflexors but not with isolated
dorsiflexor strength training.
Clinical Relevance: If the results hold true for a larger
investigation, strengthening rather than weakening the
plantarflexors, may improve gait and function in persons
with CP. Funding: NIH- Ankle Strengthening to Improve
Gait and Function in CP (R01 NS046434).
KEYWORDS: cerebral palsy, strength, ankle
ALTERNATIVE SEATING DEVICES FOR CHILDREN
WITH ADHD: EFFECTS ON CLASSROOM BEHAVIOR
Schilling, Denise L.1
1 in a natural setting. This study also demonstrates how
Physical Therapy Education, Suny Upstate Medical,
Syracuse, NY, USA
Purpose/Hypothesis: To investigate the effects of 3 seat-
ing options: chairs, therapy balls, & air cushions on the
in-seat behavior & word productivity of students with
ADHD. Social validity was assessed to evaluate teacher &
student perspectives regarding the intervention.
Number of Subjects: 2 teachers & 47 students from 2
fifth grade classrooms participated in this study. Target
study participants were 5 students with a diagnosis of
ADHD.
Materials/Methods: A single subject multiple treatments
withdrawal design was used that consisted of 9 phases
over 6 months. Phases included: 4 A phases (chairs), 2 B
phases (balls), 2 C phases(cushions), & 1 D phase
(choice). In-seat data were collected via momentary real
time sampling by 2 observers independently & simulta-
neously. Legible word productivity was defined as the
percentage difference between target students word pro-
duction & the class mean. Data were collected via a word
count performed on daily in-class assignments. Social
validity was examined via questionnaires completed by
teachers & students at the end of the third A phase & at
the conclusion of the study. Data were graphed & visu-
ally analyzed for differences between phases.
Results: Results indicate improvements in in-seat behav-
ior & word production during use of either one or both
of the dynamic seating devices. All 5 participants with a
diagnosis of ADHD demonstrated immediate improve-
ment in in-seat behavior when seated on 1 or both forms
of dynamic seating (ball or cushion). Word productivity
also increased during use of dynamic seating, as demon-
strated by all 5 participants with ADHD surpassing the
class mean on 1 or more assignments. Students with
ADHD not only reported a preference for the balls, but
indicated perceived improvements in attention, produc-
tivity and comfort. Of the 45 students without ADHD,
the majority preferred dynamic seating. Likewise, both
teachers preferred dynamic seating & requested contin-
ued access to both devices.
Conclusions: This study suggests that dynamic seating in
the classroom, increases in-seat behavior & word produc-
tivity for children with ADHD. However no one type of
Pediatric Physical Therapy
seating was found appropriate for all children either with
or without ADHD. For some forms of challenging behav-
ior, the use of dynamic seating appears proactive, serving
as a positive behavior support strategy to assist in creat-
ing an opportunity for learning.
Clinical Relevance: School-based therapists are seeing an
increasing number of children with ADHD, many of
whom have sensory-motor issues that impact school par-
ticipation & success. Though therapists often employ
sensory-based interventions outcome studies have not
been available to validate their effectiveness. Knowledge
from this study will advance the practice of school-based
therapy by providing data to support evidence based
practice & demonstrate how research can be conducted
therapists can use single subject research methods in
clinical practice to evaluate if and under what conditions
specific interventions are effective for individual children.
KEYWORDS: school based therapy, sensory based inter-
vention, dynamic seating
ENHANCING FUNCTION, FITNESS AND
PARTICIPATION IN ADOLESCENTS WITH
CEREBRAL PALSY
Thorpe, Deborah E.1; Niles, Amanda1; Richardson, Jennifer1;
Turner, Jennifer1; Tych, Mira1
1
Division of Physical Therapy, Center for Human Movement
Science, University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA
Purpose/Hypothesis: To describe the effects of an aquatic
exercise or treadmill training program on function, fit-
ness and quality of life (QOL) in adolescents with cere-
bral palsy who were trained in a community wellness
center.
Number of Subjects: A sample of 10 adolescents (6
males, 4 females) with cerebral palsy aged 12 to 19 years
(mean 14.2, S.D 2.6) were randomized into either a
treadmill or an aquatic exercise training group. All sub-
jects were independently ambulatory with or without an
assistive device and of normal cognition.
Materials/Methods: Subjects completed pre and post test-
ing on multiple impairment, function, fitness and QOL
measures. Parents/caregivers also completed surveys re-
garding the function and QOL of their child. Each subject
received one hour of personal training within their re-
spective intervention group, 3 times per week for 10
weeks. Subjects were taught to monitor their heart rates
using Polar heart rate monitors with the goal of exercis-
ing as much as possible within their target heart rate
(80% of maximum). One-way repeated measures analysis
of variance was used to compare pre and post interven-
tion.
Results: There were no significant changes in pain, fa-
tigue, timed chair rise, 360-degree turn, GMFM dimen-
sions D and E, energy expenditure, or bone mineral den-
sity following the 10 week intervention period. However,
Abstracts for the 2006 Combined Sections Meeting 81
distances in the 6-minute walk improved (P 0.056) an
average of 34 meters per minute and lean muscle mass
increased (P 0.02) an average of 1,406 grams. No sig-
nificant differences were detected between intervention
groups. There was a 0% attrition rate for both the tread-
mill and aquatic training groups with all but one subject
completing all 30 training sessions. Parental perceptions
of pain and fatigue were often greater than the childs and
parental perceptions of function were often less than the
childs. However, parental perceptions of function did
increase slightly post intervention.
Conclusions: Adolescents with CP can be educated on
the benefits of training at an intensity compatible with
improving fitness levels and can monitor their exercise
intensity using heart rate. Exposure of these adolescents
to a community fitness facility was not only beneficial to
the adolescents but also to the staff and membership of
the facility. More research is needed to determine the role
that motivation may play on life long physical activity in
this population.
Clinical Relevance: Persons with CP can exercise on land
and in water with minimal assistance at a training inten-
sity. Physical therapists must facilitate the transition from
the therapeutic setting to the community setting in order
to encourage beneficial, sustained fitness programs for
this population.
KEYWORDS: cerebral palsy, aquatic exercise, treadmill
training
PHYSICAL ACTIVITY, HEALTH, AND DIETARY
PATTERNS OF MIDDLE SCHOOL-AGED CHILDREN
Wrotniak, Brian H.1; Zimmer, Nicole1; Dingle, Kim1; Dingle,
Aimee1; Miller, Aaron1; Knoell, Andrew1; Weiss, Edward1
1
Physical Therapy, DYouville College, Buffalo, NY, USA
Purpose/Hypothesis: Understanding relationships be-
tween physical activity, health, and dietary patterns in
school children is important for developing evidenced-
based strategies for improving pediatric health. Despite
the importance of physical activity and proper nutrition,
many school children are not meeting recommendations.
The purpose of this study was to characterize the physi-
cal activity, health, and dietary patterns of middle school-
aged children and to examine associations between these
factors and childhood overweight.
Number of Subjects: Thirty-eight Middle School-aged
Children Participated In This Study.
Materials/Methods: Students completed a three-day pre-
vious day physical activity recall (PDPAR) and the USDA
five-step multiple-pass method 24-hour dietary recall.
Parents completed the Child Health Questionnaire
(CHQ) and a three-day PDPAR. Parent and child PDPAR
activities were assigned a metabolic equivalent (MET)
value based on reported intensity levels and using a phys-
ical activity compendium. Height and weight were mea-
sured for children and parents.
Results: Fifty-two percent of the children were over-
82 Abstracts for the 2006 Combined Sections Meeting
weight or at risk for overweight based on age and gen-
der-specific body mass index percentiles. Parent and
child percent overweight were positively related (r
0.38, P 0.02). For boys, percent overweight was nega-
tively related to general health (r 0.49, P 0.05),
while average MET level was positively related to general
health (r 0.74, P 0.01) and self esteem (r 0.77, P
0.01). Forty-two percent of the children did not meet
the current recommendation of 60 minutes or more of
moderate to vigorous physical activity daily. Children
who spent more time in sedentary activity, defined as a
MET level less than 2, were more likely to have poorer
general health (r 0.41, P 0.05). Parent and child
physical activity was positively related for girls (r 0.78,
P 0.01). Intake of fat and sodium for children ex-
ceeded recommendations, and fruits, vegetables, and cal-
cium consumption was inadequate. Parent and child in-
take of carbohydrates was positively associated for boys
(r 0.49, P 0.05), and children who were overweight
were more likely to have a greater percent of their diet
from protein.
Conclusions: The results of this study indicate that
school children may not be meeting guidelines for physi-
cal activity and healthy eating, which may be contribut-
ing to the high prevalence of overweight in school chil-
dren. Similarities in child and parent weight, physical
activity, and dietary patterns suggest a shared family en-
vironment in which parents and children mutually rein-
force health behaviors.
Clinical Relevance: This study provides information on
the physical activity, health, and diet of middle school-
aged children. The prevalence of overweight in this sam-
ple of school children is concerning. Strategies to address
this problem include reducing time spent in sedentary
activity, and promotion of physical activity and proper
nutrition. Similarities in parent and child overweight,
physical activity, and dietary patterns support including
parents in interventions targeting youth.
KEYWORDS: physical activity, overweight, school chil-
dren
Poster Presentations
THE EFFECT OF BODY WEIGHT SUPPORTED
TREADMILL TRAINING ON GAIT FUNCTION IN
CHILDREN WITH CEREBRAL PALSY
Accivatti, Cara1; Harro, Cathy C.2; Bothner, Krisanne E.3
1
Mary Free Bed Guild Pediatric Physical Therapy Fellow,
Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
2
Department of Physical Therapy, Grand Valley State
University, Grand Rapids, MI, USA
3
Motion Analysis Center, Mary Free Bed Rehabilitation
Hospital, Grand Rapids, MI, USA
Purpose/Hypothesis: Research has demonstrated that
Body Weight Supported Treadmill Training (BWSTT) is a
feasible treatment environment for children with cerebral
Pediatric Physical Therapy
palsy (CP) and may be beneficial for improving ambula-
tion skills. The purpose of this study was to examine the
effects of BWSTT using a systematic progression of tread-
mill speed and level of body weight support (BWS) on
gait function in children with cerebral palsy. The re-
searchers hypothesized that subjects would improve in
gait function following intensive BWSTT.
Number of Subjects: Six subjects with CP, four with
spastic diplegia and two with spastic tetraplegia, ages 7 to
11 years, participated in this study. All subjects were
classified as limited community ambulators, four used
assistive devices and four used orthotics for walking.
Materials/Methods: Subjects were assessed before and
after an eight-week control period during which they
received only school physical therapy services. Following
the control period subjects participated in eight weeks of
BWSTT, three times per week. During training, facilita-
tion was provided for weight shift and hip extension.
Subjects completed three 10-minute bouts of BWSTT
each session. A systematic progression of treadmill speed
was used during the intervention, with advancement of
speed based on ability to maintain a rhythmic gait pattern
for 60 seconds following facilitation for several minutes.
Level of BWS began at 30% and was decreased in 5% in-
crements when subjects reached a speed of 0.8 m/s (1.7
mph). Pre- and post-training dependent measures in-
cluded a computerized gait analysis to determine spatio-
temporal parameters, the Normalcy Index, the Energy
Expenditure Index, the six-minute walk test, and the Gil-
lette Functional Assessment Questionnaire.
Results: All subjects completed 8 weeks of training and
progressed in treadmill speed. Four subjects decreased
BWS during intervention (530%). No significant
changes were found in dependent measures during con-
trol period, supporting a stable baseline. Paired t test (P
0.01) revealed no significant group differences be-
tween pre-and post-training gait measures. However,
some individual subjects did show isolated gains in gait
measures following BWSTT. There was high variability
between subjects in response to BWSTT.
Conclusions: This study demonstrated methodology for
progression of BWSTT parameters in children with CP
where advancement of treadmill speed and decrease of
BWS were controlled by specific, measurable criteria.
Due to the small sample and high inter-subject variabil-
ity, no significant changes in gait measures were evident
for this sample.
Clinical Relevance: Children in this study tolerated in-
tensive BWSTT and were able to progress in treadmill
speed and level of BWS. Effectiveness of BWSTT on the
subjects gait function was variable. Further research is
needed to examine this systematic application of BWSTT
to determine which children with CP are ideal candi-
dates, in terms of level of severity and age at treatment,
and to examine immediate and long-term effects on gait
function.
KEYWORDS: body weight supported treadmill training,
gait function, cerebral palsy
Pediatric Physical Therapy
LOCOMOTOR TRAINING: RECOVERY OF WALKING
IN NON-AMBULATORY 4.5 YEAR OLD CHILD WITH
CHRONIC, CERVICAL SCI
Behrman, Andrea L1; Nair, Preeti M.1; Bowden, Mark G.2;
Fuller, Laura2; Herget, Ben1; Phadke, Chetan1; Senesac, Claudia1
1
University of Florida, Gainesville, FL, USA
2
Brain Rehabilitation Research Center, Malcom Randall VA
Medical Center, Gainesville, FL, USA
Purpose/Hypothesis: Though only 5% of all spinal cord
injuries (SCI) occur in the pediatric population, its ef-
fects are devastating and complicated by many unknowns
relative to the immature setting and requirements for
subsequent development. Evidence is promising for re-
covery of walking in adults post-SCI with locomotor
training (LT), however, greater gains may occur in chil-
dren. The purpose of this case study is to evaluate the
effect of LT, using recovery-based training emphasizing
intense practice of walking, on recovery of walking in a
non-ambulatory child post-SCI.
Number of Subjects: The 4.5-year-old participant was 16
months post C6 SCI due to a gunshot wound. He had
completed inpatient rehabilitation and was receiving PT/
OT. He was non-ambulatory; crawled on the floor using
only his arms; and was unable to stand, sit without arm
support, and transfer. He was able to roll, come to sit,
and propel a wheelchair. He stood only in standing de-
vices. His injury was ASIA C, motor level C8 with im-
paired sensation, and 32/50 upper and 12/50 lower ex-
tremity motor scores noting that lower limb movement
occurred only in gross synergistic extension.
Materials/Methods: The child trained 5 times/wk for
75 sessions including: 1) 20 30 minutes of actual step-
ping with trainers assisting on a treadmill approximating
age-specific walking speed/cadence with partial body
weight support (20 25% or less) and alternating stand
training bouts and 2) translation of skills from the tread-
mill to overground. He also received PT using motor
learning strategies for general mobility, postural control,
and standing 23/week. The mother attended the train-
ing and participated in weekly planning and goal setting.
Results: After 7 weeks of training, extensor and trunk
control improved, training was then focused on activat-
ing hip flexion for swing initiation. One week later, the
child took his first seven, independent steps overground
assisted only to move the posterior rollator walker. Re-
covery continued as he initiated steps, diminished mid-
line crossing, and gained independence. At completion,
the child walked 1600 2400 steps per day, at 0.3 m/s
self-selected gait speed, and 0.5 m/s fast speed using the
walker with inconsistent minimal assist to initiate steps.
At one month follow-up, he walked independently, initi-
ated every step, and walked at 0.37 m/s. Remaining defi-
cits included a lack of automatic postural responses, in-
ability to stand without support, and inability to isolate
lower limb movements.
Abstracts for the 2006 Combined Sections Meeting 83
Conclusions: Following intense LT, this 4.5-year-old, 16
months post-SCI, demonstrated remarkable gains from
non-ambulatory to independent ambulation.
Clinical Relevance: This study demonstrates the poten-
tial for significant recovery of function in children post-
SCI when provided intense recovery-based LT. Family
support was consistent throughout the training and criti-
cal for promoting a rewarding environment and follow
through in the home and community. Continued fol-
low-up will be necessary as growth and maturation ef-
fects may interact with function.
KEYWORDS: SCI, pediatrics, locomotor training
IMPACT VERSUS ACTIVE LOADING SPORTS AND
BONE MINERAL DENSITY IN ADOLESCENT
FEMALE ATHLETES
Bellew, James W.1; Gehrig, Laura M.1
1 sents a sport involving repetitive impact and skeletal
Physical Therapy, Louisiana State University Health
Sciences Center, Shreveport, LA, USA
Purpose/Hypothesis: Soccer, tennis, swimming, and
weight lifting are popular activities attracting children
even at very young ages. The inherent difference in the
amount and type of skeletal loading between these sports
is obvious. However, the extent to which the bony
stresses from each sport affects bone mineral density
(BMD) in adolescent females is not clear. The purpose of
this study was to examine lower extremity bone mineral
densities of adolescent female athletes involved in soccer,
tennis, swimming, or weight lifting to determine whether
the differences in bony stress inherent to each of these
sports are manifested in measures of BMD. Additionally,
this study sought to compare BMD values from each
sport group to normative values for adult females from
the World Health Organization (WHO).
Number of Subjects: Seventy-eight elite level female ath-
letes (12.82.3 years; 157.110.7 cm; 50.914.7 kg) were
examined. These subjects were further divided into 29
swimmers, 19 weight lifters, 14 tennis players, and 16
soccer players each training at least 10 months per year, 5
hours per week, and with at least 3 years in their respec-
tive sport.
Materials/Methods: Areal BMD (g/cm2) of the calcaneus
was measured in this single session design using a pe-
ripheral dual energy x-ray absorptiometry. Pearson corre-
lation was used to assess the association between BMD
and body mass index (BMI). Between-sport differences in
BMD were examined using analysis of co-variance with
BMI and age as covariates while comparison to normative
data from the WHO was performed using one-sample t
tests.
Results: BMD was significantly correlated to BMI over all
subjects (P 0.001), however, when examined by indi-
vidual sport, soccer was the only group that did not show
a significant correlation between BMI and BMD. Between-
sport comparison of BMD showed sport type was a signif-
icant factor (F 4.528, P 0.006) as BMD in the soccer
84 Abstracts for the 2006 Combined Sections Meeting
players was greater than the weight lifters (P 0.016)
and swimmers (P 0.001), but was not significantly dif-
ferent from the tennis players (P 0.172). Compared to
adult female values equivalent to WHO norms, soccer
was the only sport significantly greater than adult norms
(P 0.003) while the swimmers were significantly less
(P 0.001) and the weight lifters and tennis players
were not significantly different from the WHO norms for
adult women.
Conclusions: Adolescent female athletes involved in soc-
cer, a sport requiring repetitive weight bearing and vigor-
ous impact loading, had significantly greater BMD when
compared to female athletes involved in non-impact, ac-
tive loading sports of swimming and weight lifting and
density exceeding normative values for adult women.
Clinical Relevance: Maximizing bone accrual during ad-
olescent years of bone development may attenuate the
risk of age-related bone loss in later years. Soccer pre-
loading. These repetitive forces appear to have a signifi-
cant impact on the development of bone density in ado-
lescent female athletes.
KEYWORDS: osteoporosis, bone, exercise
INTENSIVE PHYSICAL THERAPY FOR TWO
CHILDREN WITH CEREBRAL PALSY
Braswell, Jennifer1; Benedict, Anna2; Chapman, Corinne2;
Steed, Lisa2; York, Sheree C.2
1
Physical Therapy, University of Alabama at Birmingham,
Birmingham, AL, USA
2
Physical Therapy, Childrens Health System, Birmingham,
AL, USA
Background & Purpose: Typically developing children
have the gross motor abilities to participate in intensive
exercise on a daily basis as they run and play. Although
children with cerebral palsy typically receive physical
therapy once or twice a week from infancy, they are
rarely engaged in daily intensive exercise which may
hinder functional gains. The purpose of this study is to
report the positive effects of an intensive physical therapy
program on the functional skills of 2 sisters with cerebral
palsy, ages 12 and 17.
Case Description: A retrospective chart review was done.
The intensive program consisted of 3 weeks of physical
therapy, 5 days/week, 4 hrs/day. Sessions consisted of
heat, massage, stretching, gait training with/without a
therasuit (suit with resistance cords), resistance training
& functional activities. Goals were determined at initial
evaluation. Objective data reported before and after the
program included GMFM, distance walked in 6 min, and
descriptive information concerning use of assistive de-
vices. Documentation was done each session. Parameters
(i.e. weights, resistance on suit, activities) were pro-
gressed as determined by the therapists.
Outcomes: Both subjects had good motivation, intact
cognition and were receiving physical therapy at home
1/week with minimal gains.
Pediatric Physical Therapy
Subject #1 was 17 yrs with spastic quadriplegic type of
CP. Primary means of mobility was a power wheelchair
with occasional use of bilateral quad canes for short dis-
tances. 5 specific goals were set to address ADL, transfers,
standing, gait w/quad canes and use of a manual wheel-
chair. GMFM scores were: sitting 88% (pre) 100% (post),
crawling & kneeling 69% (pre) 88% (post), standing 21%
(pre) 44% (post), walking 4% (pre) 6.5% (post). Distance
walked in 6 min increased from 162 to 230 feet using
bilateral quad canes. Following the program a power
wheelchair was no longer required and the subject was
motivated to begin a strengthening and treadmill walking
program at home.
Subject #2 was 12 yrs with spastic diplegia. She ambu-
lated independently but had a history of falls and inabil-
ity to ascend/descend stairs without the use of a rail.
Goals included higher level activities such as stair climb-
ing, lifting objects from the floor without falling, and sin-
gle leg stance activities. GMFM scores were: crawling &
kneeling 98% (pre) 100% (post), standing 92% (pre)
100% (post), walking 96% (pre) 100% (post). Distance
walked in 6 min increased from 1407 to 2090 feet. Fol-
lowing the program she no longer demonstrated toe-
walking, presented with less sway and was able to run up
and down stairs without the use of the rail. Her mother
reported that she was motivated to continue daily exer-
cise to maintain functional gains.
Discussion: These case reports suggest that a 3 week inten-
sive physical therapy program may benefit children with
cerebral palsy. Future studies should be done to test this
model using an ABA design, subjects with varying ages and
abilities, and objective outcomes such as gait parameters,
postural control measures and motion analysis.
KEYWORDS: cerebral palsy, intervention, intensive
OVERWEIGHT CHILDREN IN PRESCHOOL
CLASSROOMS: PREVALENCE, FUNCTIONAL
CHARACTERISTICS AND POSSIBLE ROLES FOR
PHYSICAL THERAPISTS
Bucher, Heather1; Hoban, Shannon1; Cojocaru, Corine1;
Nichols, Sarah1; Lovelace-Chandler, Venita.1
1 KEYWORDS: obesity, overweight, preschool
Physical Therapy, Chapman University, Orange, CA, USA
Purpose/Hypothesis: The purposes of this descriptive
study were to determine the prevalence of overweight in
preschool children in one school in Southern California, to
observe the spontaneous movements and activities of these
children, to describe the appropriateness of such move-
ments, and to suggest the possible roles of physical thera-
pists in working with such children.
Number of Subjects: The subjects consisted of 90 children
enrolled in preschool classes and ranging in age from four to
six years. All children were from families with low socioeco-
nomic status, and the vast majority of the children were
Hispanic.
Materials/Methods: The childrens height and weight
were measured by the school nurses, and the Body Mass
Pediatric Physical Therapy
Index (BMI) was calculated by the researchers. Children
with BMIs greater than the 85th percentile were observed
in daily school activities over several days. Observed data
on physical characteristics and functional movements
were compiled for the overweight children, and the re-
searchers were able to observe all children during class
activities.
Results: Almost 36% 32 of the preschool children had a
BMI above the 85th percentile, and 18% 16 were above the
95th percentile. The children between the 85th and 95th
percentiles did not exhibit noticeable differences from peers
in the amount or kinds of activities and movements. The
children with BMIs above the 95th percentile were observed
to behave differently from peers in the following areas: pos-
tural alignment, transitional movements, choice of activities,
amount of movement, cardiopulmonary signs, and psychos-
ocial behaviors. Children below the 95th percentile partici-
pated in numerous strenuous activities, while children
above the 95th percentile chose sedentary activities. The
overweight children exhibited flushed faces when participat-
ing in movement activities. They played alone more than
other children, and appeared to be either quieter or more
aggressive than peers. Genu valgum was noticeable in this
group, and many of the playground activities were accom-
plished only when these children modified postures (in-
creasing hip internal rotation to fit in the swing or the slide).
Conclusions: Preschool children with BMIs greater than
the 95th percentile demonstrated differences in the qual-
ity and quantity of movements from the children with
BMIs below the 95th percentile. Musculoskeletal changes
were obvious, and postural adaptations were required to
participate in common classroom and recess activities.
Some of the musculoskeletal changes may be severe
enough to result in a contraindication for some of the
typical activities of preschool children. The overweight
children exhibited flushed faces with movement activities
while peers did not. Quietness, aggressive behaviors, and
embarrassment were noted in the overweight children.
Clinical Relevance: Physical therapists need to be aware
of the postural and movement changes that may be
present in overweight preschool children and need to
participate in developing appropriate activities.
CLINICAL MEASUREMENT OF WALKING SPEED:
COMPARISON OF RELIABILITY USING THE TRUNK
VERSUS THE FOOT AS A MARKER USING SLOW
MOTION VIDEO AND A STOP WATCH
Carey, Jerline1; Carlson, Nichole2
1
Physical Therapy Dept, The College of St. Scholastica,
Duluth, MN, USA
2
Division of Biostatistics, Oregon Health and Science
University, Portland, OR, USA
Purpose/Hypothesis: When using the foot as the marker,
establishing reliable gait speed measurement has involved
averaging the findings using 6-10 passes on a known
Abstracts for the 2006 Combined Sections Meeting 85
walkway. Collecting and analyzing this large number of
passes is not practical for the clinical setting. The pur-
pose of this study was to compare reliability of velocity
measurement when using the trunk as a marker versus
the foot for crossing walkway lines. We hypothesized
that changing the marker from the foot to the trunk
would result in better reliability and allow for fewer mea-
surements to evaluate walking speed in a clinic setting.
Number of Subjects: Ten Normal, Healthy Females Aged
2236 Years Old
Materials/Methods: were timed and recorded walking 6
passes each for 5 conditions (2 self-selected speed, walk-
ing with head turning, carrying a light load, and talking).
A 14-foot walkway was used with acceleration and decel-
eration lanes and a marked 10 foot area in the center.
Walking speed data were collected using Expert Vision
Advanced High Resolution, OrthoTrak 4.1 Motion Analy-
sis, Inc using the Cleveland Clinic Marker Set. At the
same time, walking was recorded using a AG-180 Panaso-
nic VHS Movie Camera placed 17 feet from the walkway
center. Time was recorded in seconds and milliseconds
using a Sports Timer Stopwatch by playing the tape at its
slowest forward speed (3.3% of normal). The stopwatch
was depressed when either the foot or the trunk crossed
the start and finish lines depending on the measurement
being recorded (SMV).
Results: Intra-rater reliability was established with both
SMV measurement techniques by measuring the first trial
of each of the 5 conditions for 5 subjects for four differ-
ent times. Intra and inter-rater reliability was greater than
0.81 for all conditions. There were no significant differ-
ence in velocities between the SMV measurement tech-
nique and the Motion Analysis data. When comparing
the two markers, the standard deviation of the walking
speed measures of the 6 passes using the foot as the
marker ranged from 1.9 to 2.5 times the standard devia-
tion when using the trunk as the marker for the 5 condi-
tions. For all but the normal walking conditions, the
standard deviations were marginally or significantly
higher when using the foot as the marker (t test P
0.0014 0.10). Using random effects ANOVA, we calcu-
lated the intra-class correlation coefficients. The mea-
surement reliability when using the foot was adequate
and ranged from 0.45 to 0.65 for the five conditions, but
the walking speed reliability when using the trunk was
higher and excellent ranging from 0.84 0.92 for the five
conditions. The intra-class correlation remained similar
when only using the first 3 passes with the trunk as the
marker.
Conclusions: Our hypothesis that fewer measurements
are needed for reliable estimates of gait speed when using
the trunk as a marker was supported.
Clinical Relevance: Inexpensive reliable methods of mea-
suring gait speed which require fewer passes and less
data analysis are of practical importance.
KEYWORDS: gait, reliability, temporal distance
86 Abstracts for the 2006 Combined Sections Meeting
NORMATIVE VALUES OF THE PEDIATRIC
MULTIDIRECTIONAL REACH IN SITTING AND
STANDING IN CHILDREN 3-8 YEARS OLD
Chanin, Renee1; Sefecka, Ashley B.1; Grant-Beuttler, Marybeth1
1
Physical Therapy, University of Scranton, Scranton, PA, USA
Purpose/Hypothesis: The purpose of this study was to
establish normative values for the multidirectional pedi-
atric reach test in children ages 3-8 in both the seated
and standing position.
Number of Subjects: 69
Materials/Methods: Sixty-nine children between the
ages of 3 and 8 were recruited from two local daycares
and an elementary school. Reach trial values were re-
corded using a standard tape measure attached to a
wall aligned with the tip of the acromion. Each subject
performed a total of 4 reaching trials in the forward,
backward, and lateral directions. The above procedure
was repeated with the subject seated excluding the
backward reach trials. Each child was placed with the
arm fully extended at 90 degrees shoulder flexion. The
initial measurement for each trial was taken using the
fingertip of the third digit at the starting point and
then at the point where the participant could no longer
reach any farther without losing balance or taking a
step. Mean reach values were calculated within each
age group and gender.
Results: Inter-rater reliability was calculated on all 69
children ICC[2,1] 0.88. In addition, mean reach
values increased with age, were nearly equivalent be-
tween males and females in their respective age
groups, and forward reach values were greater in sit-
ting versus standing.
Conclusions: This data provides basic normative values
for the multidirectional reach test for children ages 3-8 in
both the sitting and standing positions. Further research
on normative values for the pediatric multidirectional
reach is necessary in order to develop a standardized
scale with which clinicians can refer to regularly.
Clinical Relevance: Development of a standardized scale
for the pediatric multidirectional reach test would pro-
vide clinicians with an objective measurement tool with
which to assess children and further extract conclusions
regarding balance, fall risk, and postural stability.
KEYWORDS: pediatric, multidirectional reach
THE USE OF THE 600 YARD WALK-RUN TEST TO
ASSESS WALKING ENDURANCE AND SPEED IN
CHILDREN WITH CEREBRAL PALSY
Chien, Frances1; DeMuth, Sharon1; Knutson, Loretta3;
Fowler, Eileen2
1
Department of Biokinesiology and Physical Therapy,
University of Southern California, Los Angeles, CA, USA
2
Department of Orthopedics, UCLA/Orthopaedic Hospital
Center for Cerebral Palsy, Los Angeles, CA, USA
3
Department of Physical Therapy, Southwest Missouri State
University, Springfield, MO, USA
Pediatric Physical Therapy
Purpose/Hypothesis: Reduced physical fitness in chil-
dren with cerebral palsy (CP) has received little atten-
tion. The 600 Yard Walk-Run Test is easy to perform
and has been used to measure walking endurance and
speed in children without disability. A correlation be-
tween this test and cardiorespiratory fitness in chil-
dren with cognitive disabilities has been demonstrated
(Fernhall et al., 1998). The Gross Motor Functional
Classification System (GMFCS) classifies the level of
assistance required for independent mobility in the
community (Palisano et al., 1997). This study exam-
ined: 1) the ability of children with CP to walk 600
yards and 2) differences in walking speeds between
GMFCS Levels I, II and III.
Number of Subjects: This study included 46 subjects
with the spastic diplegic form of CP (22 males, 24 fe-
males) aged seven to 17 years.
Materials/Methods: Subjects were categorized as GM-
FCS Level I, II or III. During the 600 Yard Walk-Run
Test, subjects used the assistive devices they required
for community ambulation. They walked and/or ran as
fast as they could without stopping until completing a
distance of 600 yards along a circular path. Subjects
were encouraged to walk or run at a pace sustainable
for the entire distance. They could slow down but if
they stopped for more than five seconds the examiner
ended the test. If the subject stopped walking prior to
600 yards, the distance completed and the time were
recorded. If the subject did not complete the distance
within 15 minutes, the test ended and the distance was
recorded. Statistical tests consisted of a One-way
ANOVA with Tukey HSD post hoc analyses to examine
the difference between GMFCS Level and walk-run
times obtained for subjects who were able to walk the
entire 600 yards.
Results: Of the 46 subjects tested, 13 were Level I, 10
were Level II, and 23 were Level III. Only five subjects
were unable to walk 600 yards in less than 15 minutes.
Of this subset, four were classified as GMFCS III and one
as II. Based on Tukey HSD, post-hoc analyses found sta-
tistically significant differences between all three GMFCS
Levels on walking times, P 0.05. Mean times for com-
pletion were 289.282.3 seconds (s), 412.064.2 s and
519.4136.1 s for GMFCS Levels I, II, and III, respectively.
As all subjects walked the same distance, lower times
indicate higher walking speeds.
Conclusions: The 600 Yard Walk-Run Test appears to be
an appropriate tool for assessment of walking speed and
endurance in children with CP. The majority of the chil-
dren completed the test. Those with less mobility impair-
ment, based on GMFCS classification, demonstrated
faster walking speeds.
Clinical Relevance: Children with CP exhibit decreased
cardiorespiratory fitness compared to non-disabled peers.
Tests of walking endurance and speed are important to
assess the need for intervention and monitor change in
children with CP.
Pediatric Physical Therapy
Funding For This Project Was Provided By The Founda-
tion For Physical Therapy As Part Of Ptclinresnet.
KEYWORDS: cerebral palsy, GMFCS, 600 Yard Walk-
Run Test
THE BRIEF ASSESSMENT OF MOTOR FUNCTION
(BAMF): CONTENT VALIDITY AND RELIABILITY OF
THE FINE MOTOR SCALE
Cintas, Holly M.1; Parks, Rebecca1; Chou, Maisie1;
Hildenbrand, Hanna1; Gerber, Lynn.1
1
Rehabilitation Medicine, National Institutes of Health,
Bethesda, MD, USA
Purpose/Hypothesis: The BAMF consists of 5 hierarchi-
cal 0-10 scales designed for rapid assessment of motor
performance, independent of age. BAMF items are struc-
tured to reliably assess demonstrated motor capability,
not impairment or disability. The Lower Extremity Scale
has been validated and published. Content validity is
completed for the two Oral Motor Scales: Articulation
and Deglutition, their reliability trials are in progress.
This abstract reports content validity and reliability de-
terminations for the Fine Motor Scale (FMS). A compan-
ion abstract for this meeting reports content validity and
reliability for the Upper Extremity Gross Motor Scale.
Number of Subjects: 28 Occupational Therapists partici-
pated as Expert Panel Members to evaluate the content of
the FMS. All have PhD, DSc or ScD degrees; 90% have
more than 25 years of experience. For reliability, a conve-
nience sample of ten children (ages 19 mo to 15 years; 3
males, 7 females) with a range of diagnoses including
Proteus, Sheldon-Freeman, Smith-Lemli-Opitz, and
Smith-Magenis syndromes, was selected to represent a
broad range of skill levels.
Materials/Methods: After agreeing to participate, Expert
Panel members were sent a questionnaire via email com-
posed of 6 standard questions for each of the 0-10 FMS
items. Response range was 1 Disagree to 4 Agree.
Completion of the questionnaire was necessary for inclu-
sion on the Expert Panel. Respondents were invited, not
required, to provide additional written comments on the
questionnaire. Means, medians and ranges were used to
describe central tendency and range of responses. For
reliability, 3 occupational and 2 physical therapists rated
the videotaped motor performances of 10 children whose
FMS scores ranged from 0-10. The Kappa Statistic was
used to evaluate reliability.
Results: Expert panel members agreed that all items
should be included (means 3.433.89, range 1 4, medi-
ans 4.00); all items are functionally relevant (means
2.933.82, ranges 1 4, medians 2.5 4), and all items are
easily discriminated (means 3.32 4.0; ranges 1 4, medi-
ans 4.00). Eighty-six written comments were used to
modify the content of the FMS in addition to the quanti-
tative data. Kappa values for interrater and intrarater reli-
ability were 0.978 and 1.00, respectively.
Conclusions: Twenty-eight experts in occupational ther-
apy provided quantitative and qualitative feedback to
Abstracts for the 2006 Combined Sections Meeting 87
establish content validity of the BAMF FMS. Kappa val-
ues for interrater and intrarater reliability indicate this is
a highly reliable instrument for baseline and screening
purposes when rapid motor performance assessment is
desired.
Clinical Relevance: Motor skill assessments normed to
nondisabled children are valuable for obtaining interven-
tion services. However, children with motor limitations
are only described by these scales according to their rela-
tive deficits, using numbers which do not indicate what
the child can actually do. The BAMF FMS was designed
for very rapid screening and longitudinal assessment of
childrens capability, in a format that links immediately
to a specific fine motor level.
KEYWORDS: fine motor skill, performance assessment
THE BRIEF ASSESSMENT OF MOTOR FUNCTION
(BAMF): CONTENT VALIDITY AND RELIABILITY OF
THE UPPER EXTREMITY GROSS MOTOR SCALE
Cintas, Holly M.1; Parks, Rebecca1; Dom, Sarah2; Gerber, Lynn1
1 assessment for this domain, in a format that describes
Rehabilitation Medicine Department, National Institutes of
Health, Bethesda, MD, USA
2 tions.
Occupational Therapy, Towson State University, Towson,
MD, USA
Purpose/Hypothesis: Modeled after the concept, but not
the structure of the Apgar Scale, the BAMF is a series of 5
hierarchical 0 10 scales designed for rapid, dichotomous
assessment of motor skill level, independent of age. The
Lower Extremity Gross Motor Scale is validated and pub-
lished. Content validity has been established for the two
Oral Motor Scales: Articulation and Deglutition; their
reliability trials are underway. This abstract reports con-
tent validity and reliability for the Upper Extremity Gross
Motor Scale (UEGMS). A companion abstract for this
meeting reports content validity and reliability for the
BAMF Fine Motor Scale.
Number of Subjects: An Expert Panel of 17 Physical
Therapists and 13 Occupational Therapists was selected
to evaluate content of the UEGMS on the basis of consent
to participate and completion of a standardized question-
naire. All have doctoral degrees (PhD 26, ScD 3, DPT 1)
and at least 20 years of experience. Reliability: 10 chil-
dren (ages 11 mo to 16 years; 7 females, 3 males; 3 Black,
2 Hispanic children) with a range of diagnoses, including
mucolipidosis, achondroplasia, and osteogenesis imper-
fecta participated in the reliability trials.
Materials/Methods: Expert Panel members were asked to
respond to a questionnaire, sent via email, consisting of
six standardized questions for each of the 0 10 BAMF
skill levels. Responses ranged from 1 Disagree to 4
Agree. Means and standard deviations were used to de-
scribe central tendency and variability for each item. Re-
spondents were also invited, but not required, to provide
additional written comments. Reliability: three occupa-
tional and two physical therapists rated videotaped per-
formances of ten children with BAMF scores from 0-10.
Reliability was evaluated using the Kappa Statistic.
88 Abstracts for the 2006 Combined Sections Meeting
Results: BAMF items 1,3, and 5 received the strongest
support for inclusion (means 3.633.79, s.d. 0.49 0.64).
Items 3, 5, and 9 had the most support for functional
relevance (means 3.523.75, s.d. 0.52.99). All BAMF
items were easily discriminated (means 3.313.78; s.d.
0.26 0.97). Several changes to the UEGMS were made
based on the quantitative data and in response to 117
written comments on the questionnaire. Kappa values
were 0.92 for interrater and 0.98 for intrarater reliability.
Conclusions: 30 occupational and physical therapists
provided valuable quantitative and written feedback to
refine the content of the BAMF UE GMS. Kappa reliabil-
ity values indicate this scale is reliable for rapid assess-
ment of upper extremity gross motor skill.
Clinical Relevance: Considerable emphasis is placed on
lower extremity strength and coordination to support
ambulation, but upper extremity strength and coordina-
tion are essential to learn to walk, and to support mobil-
ity for children who are unable to walk. The UEGMS pro-
vides rapid, reliable screening and longitudinal
children according to their capability, rather than limita-
KEYWORDS: BAMF, motor skill assessment, upper ex-
tremity gross motor
GRIP STRENGTH IN A POPULATION OF BOYS WITH
BARTH SYNDROME
Day, Jane A.1; Spencer, Carolyn T.2; Byrne, Barry2
1
Physical Therapy, University of Florida, Gainesville, FL, USA
2
Pediatric Cardiology, University of Florida, Gainesville, FL, USA
Purpose/Hypothesis: Barth Syndrome (BTHS) is an X-
linked disorder characterized by cardiomyopathy, neutro-
penia, growth delay, and skeletal myopathy. Mutations in
the taffazin gene at Xq28 are known to cause a severe
deficiency of cardiolipin in the mitochondrial membrane.
Although skeletal myopathy has been described as a fre-
quent feature of BTHS, it has not been fully character-
ized. Patients frequently demonstrate gross motor delay
in infancy. The purpose of this study was to use quantita-
tive measures (QMT) to evaluate skeletal myopathy in
this patient population. The hypothesis was that boys
with BTHS would have lower quantitative muscle
strength than healthy aged-matched boys.
Number of Subjects: Twenty boys with BTHS between
the ages of 7 and 23 were tested with 7 of the boys re-
tested at least 7 months later at a different age. (Total n 27)
Materials/Methods: Strength of hand grip (Jamar Hand
Dynamometer), elbow flexors, knee extensors (MicroFET
2 handheld dynamometer), and ankle dorsiflexors (Mi-
croFET 2 and IsoBex muscle strength analyzer) was eval-
uated. The same evaluator tested all subjects. The average
of 3 trials was used for comparison with normal pub-
lished data for grip strength. Comparison of the results
using the MicroFET 2 and IsoBex are pending normal
data for the age range for those devices.
Pediatric Physical Therapy
Results: Normal grip strength data using the Jamar Hand
Dynamometer has been published for children and adults
between the ages of 6 and 75. Results for our subjects
were: 21/26 right side and 14/27 left side were 2 SD
below the normal mean. A one-sample t test correlated
with age and strength was significant at P 0.0001 for
both left and right. There was a significant trend toward
normalization as age increased, measured by both regres-
sion analysis and conversion to Z score and regression
analysis, although normalcy was never achieved.
Conclusions: These preliminary results indicate that boys
with BTHS are significantly weaker then age-matched
normal boys when grip is measured quantitatively. QMT
data analysis in other muscle groups is pending further
collection of normal data.
Clinical Relevance: No documentation of QMT strength
for this patient population has been published to date.
KEYWORDS: pediatrics, QMT, cardiopulmonary
GROSS MOTOR DEVELOPMENT OF CHILDREN
WITH HURLER SYNDROME POST UMBILICAL CORD
BLOOD TRANSPLANT
Dusing, Stacey1; Thorpe, Deborah2; Poe, Michele3;
Rosenberg, Angela1; Mercer, Vicki2; Escolar, Maria1
1 receive UCBT may gain skills faster in some areas of gross
Program of the Study of Neurodevelopmental Function in
Rare Disorders, Center for Development and Learning,
University of North Carolina, Chapel Hill, NC, USA
2 needed on the benefits of physical therapy and the use of
Division of Physical Therapy, Center for Human Movement
Science, University of North Carolina, Chapel Hill, NC, USA
3 KEYWORDS: Hurler, umbilical cord blood, gross motor
Frank Porter Graham Child Development Center,
University of North Carolina, Chapel Hill, NC, USA
Purpose/Hypothesis: Hurler syndrome is the most severe
form of Mucopolysaccharidosis type I. Children with
Hurler syndrome typically reach their maximum func-
tional abilities by 2 years of age followed by a gradual
regression in skills until death between 5 and 10 years of
age. Umbilical Cord Blood Transplant (UCBT) has been
documented to increase survival and decrease somatic
features in children with Hurler syndrome. No publica-
tions have reported on changes in gross motor abilities of
children with Hurler syndrome post-UCBT. The purpose
of this study was to describe the longitudinal changes in
gross motor abilities of children diagnosed with Hurler
syndrome post-UCBT.
Number of Subjects: This study describes 21 children
diagnosed with Hurler syndrome who received an UCBT
at Duke University Medical Center and whose develop-
ment was assessed at the Program for the Study of Neuro-
developmental Function in Rare Disorders at the Univer-
sity of North Carolina at Chapel Hill between July 2002
and May 2005.
Materials/Methods: Gross motor skills were assessed us-
ing the Peabody Developmental Motor Scales, second
edition (PDMS-2). Mixed model regression analyses were
used to determine if the children were gaining gross mo-
tor skills and if they were gaining at the same rate as their
Pediatric Physical Therapy
typically developing peers. Multivariate modeling was
used to evaluate differences between subtests on the
PDMS-2.
Results: The 21 children were assessed 1 6 times each
(mean 2.6) for a total of 54 assessments. The children
ranged in age from 8 to 68 months (mean 38 months).
Most children gained skill on all of the three gross motor
subtests of the PDMS-2 that were assessed. Children
gained skills slower than their typically developing peers
on both the stationary and locomotor subtests. There was
a high degree of variability for rate gain on the object
manipulation subtest. Gains in gross motor skills post-
transplant were slightly slower than the rate of gross mo-
tor progression for typically developing children.
Conclusions: This sample of 21 children with Hurler
syndrome who received an UCBT gained new gross mo-
tor skills after transplant. The differences between rate of
gain on specific subtests may provide evidence of specific
areas of gross motor deficit for children with Hurler syn-
drome. The overall rate of gross motor gains was slower
than that of a typically developing population. This may
be related to both the gradual removal of accumulated
substrate within the body and gradual recovery from the
transplant process.
Clinical Relevance: Children with Hurler syndrome who
motor development than in others warranting detailed
monitoring of gross motor skills. Further research is
orthotic devices for this population.
COMPARISON OF MUSCULAR ACTIVITY OF THE
TRUNK AND LOWER EXTREMITY MUSCLES
DURING NORMAL AMBULATION VERSUS
HORSEBACK RIDING
Encheff, Jenna L.1
1
Kinesiology, University Of Toledo, Toledo, OH, USA
Purpose/Hypothesis: Hippotherapy has been used in the
treatment of persons with neurological disorders and has
been purported to help improve their ambulation. These
claims have been based on subjective reports from thera-
pists and also from the fact that the path the human pel-
vis takes while riding has been shown to be very similar
to the path the pelvis takes while ambulating. Several
objective studies have been done to determine the effects
of hippotherapy on several factors involved during gait
such as balance, posture, and pelvic movement, but no
objective studies have been done to compare muscular
activity while riding versus while ambulating. Our study
is devised to compare/contrast the muscular activity of
the lower extremity and trunk muscles while riding ver-
sus while ambulating to determine if the muscles are ac-
tive in similar amplitudes and patterns.
Number of Subjects: Subjects Included 7 Males And 1
Female Ranging In Age From 25 40 Years.
Abstracts for the 2006 Combined Sections Meeting 89
Materials/Methods: Surface EMG electrodes were placed
on eight muscles on the right side of each of the subjects
bodies that are known to be active during the gait cycle. The
first phase of the study involved monitoring the electrical
activity of the muscles as the subjects walked at a cadence of
104 steps per minute. The second phase involved monitor-
ing electrical activity of the muscles as each subject sat on a
horse being led by a volunteer ambulating at 112 steps per
minute. For each phase, data were collected for five seconds
during each of four trials. Data were collected and analyzed
using MyoVideo and MyoResearch software (Noraxon, Inc.,
Scottsdale, AZ) to allow comparisons in relative phases of
the human gait cycle including initial contact, midstance,
pre-swing, and mid-swing. EMG data were normalized to
the average EMG activity of each muscle across the human
gait cycle.
Results: EMG data examined quantitatively and qualita-
tively demonstrated that although all eight muscles ex-
amined were active in both ambulation and riding, the
level of activation during riding was much lower and in
general not in a correlating pattern to that displayed dur-
ing ambulation. Only three of the muscles examined dur-
ing riding displayed a phasic pattern of activity as is the
norm during ambulation; the rectus abdominus, the glu-
teus maximus, and the erector spinae.
Conclusions: Overall, the muscles involved during the
gait cycle, as examined here, do appear to be active dur-
ing horseback riding, although to a much lesser extent
and in general, do not demonstrate phasic activity.
Clinical Relevance: It may be an important to consider
these results when developing hippotherapy programs for
those who wish to improve ambulation skills. In regards to
lower extremity and trunk musculature, it may be of more
advantage to view horseback riding as a method to develop
muscle co-contraction, trunk stabilization, and coordination
rather than a means to develop trunk and lower extremity
muscular strength and lower extremity motor planning for gait.
KEYWORDS: hippotherapy, electromyography, gait
THE EFFECT OF INFANT EXERCISE EQUIPMENT
ON MOTOR MILESTONE ACHIEVEMENT
Fay, Deanne1; Hall, Melissa1; Murray, Melinda1; Saatdjian,
Annie1; Vohwinkel, Emily1
1 equipment and this moderate use appears to be an acceptable
Arizona School of Health Sciences, Mesa, AZ, USA
Purpose/Hypothesis: While the use of equipment with
infants is quite prevalent, evidence is inconclusive as to
the safety, benefits, or detrimental effects this equipment
has on infant motor development. The purpose of this
study was to determine current parental patterns of
walker, jumper, and exersaucer use and the developmen-
tal effects, if any, that occur secondary to this use.
Number of Subjects: Twenty-five healthy, typically de-
veloping infants were followed from the age of 0 3
months through the onset of independent walking.
Materials/Methods: Caregivers recorded daily infant use of
walkers, exersaucers, and jumpers, as well as the date of
90 Abstracts for the 2006 Combined Sections Meeting
attainment of twelve pre-determined motor milestones. Use
of the equipment was determined by the family, and was
not influenced by researchers. Fifteen families chose to use
this type of equipment while ten families opted not to. Mean
start and stop ages (in weeks) were calculated for the group
and then total equipment use for each subject was averaged
over this time span (ages 20 to 44 weeks). Additionally,
equipment use time was also calculated for each subjects
highest consecutive 12 weeks of use. Equipment use was
categorized as low equipment use (0 50 minutes), medium
use (51150 minutes), and high use (151 minutes and
above). Regression analyses for motor milestone attainment
for each group were conducted and 95% confidence inter-
vals were calculated for the slopes. Kruskal-Wallis tests were
completed on each milestone to test for differences between
the groups.
Results: Among parents who used equipment, 33% said
it was because the baby enjoyed it and 47% said it was
because it was safe for the baby and convenient for
them. This was supported by the finding that 90% of
the families with more than one child chose to use the
equipment. Of the 10 families who did not use equip-
ment, 70% had heard it was either unsafe or harmful
developmentally. Regression analyses of motor mile-
stone development showed no statistical difference in
slopes between the three groups. Additionally, no sig-
nificant differences were found between any groups for
individual motor milestones.
Conclusions: This study revealed a higher rate and dura-
tion of equipment use for infants among families with
more than one child. This confirms the participants
statements that equipment was used because it was a
convenient way to keep their child entertained. Although
equipment use varied markedly across the families, over-
all use was moderate in comparison to previous studies.
This moderate use of infant exercise equipment does not
appear to delay or accelerate infant motor development.
However, there was an observable trend for a lower slope
in the high use group for both overall and 12 consecutive
week regression analyses. This trend suggests the possi-
bility that higher use of infant exercise equipment may be
related to slower motor development.
Clinical Relevance: The results of this study support that
parents today are choosing moderate use of infant exercise
option for entertaining infants without causing motor delay.
KEYWORDS: infant equipment, motor development,
infant walkers
CLINICALLY RELEVANT OUTCOMES OF
IMMERSION IN A COMMUNITY SERVICE BASED
EXPERIENCE FOR PHYSICAL THERAPY STUDENTS
Ganley, Kathleen J.1; Mueller, Karen2
1
Bioengineering, Arizona State University, Tempe, AZ, USA
2
Physical Therapy Department, Northern Arizona
University, Flagstaff, AZ, USA
Pediatric Physical Therapy
Purpose/Hypothesis: The APTA has invited discussions
regarding potential benefits of community service
based education. The purpose of this study was to test
the hypothesis that physical therapy students, through
an intensive immersion in a camp for children with a
chronic illness, could impact their future clinical inter-
actions with children and their families.
Number of Subjects: 20 physical therapy students enter-
ing their final year of an entry-level DPT program volun-
teered for this program.
Materials/Methods: The students served as members of
an integrated health care support team, with 24-hour
supervisory duties, in a 7-day camp for children with
either severe hemophilia or musclular dystrophy. A
primary mission of the camp is to emphasize wellness
and foster self-esteem through inclusion, play, and
achievement in a safe and supportive environment.
Students were expected to: demonstrate kindness and
respect; model effective communication; facilitate partici-
pation, play, and creativity; support individuality and
independence; monitor childrens safety. Post-camp in-
terviews and questionnaires (5-point Likert scale) were
used to assess each students opinions regarding the im-
pact of the camp experience on their personal and profes-
sional development.
Results: Students clearly indicated that the personal
growth experienced through the camp exceeded the
professional growth. Nevertheless, each student re-
ported that their expectations for clinical interactions
with children and their families were positively af-
fected. Specifically, students reported increased feel-
ings of competence for setting function-related therapy
goals as well as in their ability to more effectively
teach, communicate, and play with children. Further-
more, each student acknowledged a greater awareness
of the impact of a chronic illness on the societal roles
of a child and his/her caregivers and a greater appreci-
ation for the importance of promoting self-manage-
ment, independence, and self-esteem.
Conclusions: Physical therapy students experienced
significant personal and professional growth through a
7-day intensive experience with children with chronic
illnesses that is likely to positively affect their future
clinical interactions. Academic programs can work to
facilitate such gains by increasing students awareness
of community serviced-based educational opportuni-
ties and by actively promoting their involvement.
Clinical Relevance: Community service based experi-
ences may supplement information presented in the
classroom and provide unique opportunities for physical
therapy students to develop essential core values-related
skills such as altruism, social responsibility, and excel-
lence, each of which may be viewed as essential to clini-
cal practice.
KEYWORDS: service learning, core values
Pediatric Physical Therapy
PARENTS KNOWLEDGE AND PERCEPTION ABOUT
CHILD DEVELOPMENT: EVIDENCE FROM A
PRACTICE-BASED SURVEY
Girolami, Gay1; Becker Manion, Amy1; Glusman, Mariana1;
Cartland, Jennifer2; Green McLone, Suzanne2; Kurkowski, Felicia1
1
Pathways Awareness Foundations Medical Round Table,
Chicago, IL, USA
2
Child Health Data Lab, Childrens Memorial Hospital
The Mary Ann and J. Milburn Smith Child Health Research
Center, Chicago, IL, USA
Purpose/Hypothesis: Parent reporting of their childs
motor skills and collaboration with a health care profes-
sional is a key factor in identifying movement delays at
an early age and initiating early intervention. This study
examines parents knowledge of early motor development
and their understanding of the importance of early inter-
vention. There is increasing evidence that early therapy
services have a positive effect on developmental out-
comes for young children with movement delays. Several
studies report developmental and functional benefits for
children receiving interventions.(Ketelaar M, Phys Ther
2001:81:1534 45, Brooks-Gunn J, McCarton C. Casey P
et al., JAMA 1994;272:1257 62)
Number of Subjects: 500 Parents were asked to complete
a survey while in the waiting rooms of pediatricians of-
fices and the physical therapy department of Childrens
Memorial Hospital.
Materials/Methods: Parents were surveyed about their
understanding of early child development, their prefer-
ences for obtaining resource information regarding the
general health of their child and for answers related to
concerns about their childrens motor skills.
Results: *About one quarter (23.9%) of the parents sur-
veyed reported that at some point they had been concerned
about one of their children having a movement delay; 6.4%
of the sample of parents surveyed reported having at least
one child diagnosed with a movement delay.
*Parents regard pediatricians and physician specialists as
the most reliable sources of general child health information
and identify them as the sources they would most often use if
they had a concern about their childrens motor skills.
*Less than half of all parents report that they would
talk to their childs pediatrician before 12 months if they
had concerns about their childs motor skills. For the
three months infant motor skills milestones, 80% of all
parents would talk to their childs pediatrician later than
what is recommended. Therefore, most parents would
not reach out at this critical time.
*For parents who did discuss concerns about their
childs motor skills with a pediatrician, the majority were
advised by their pediatrician to talk to a physician spe-
cialist or non-physician specialist right away; about 40%
were advised to wait and see or to get more information
before seeking additional medical care.
Abstracts for the 2006 Combined Sections Meeting 91
Conclusions: The majority of parents surveyed were un-
aware that earlier screening of movement delays is criti-
cal. Research supports family engagement in early ther-
apy for children with movement delays has an impact on
a greater range of developmental outcomes (Lekskulchai
and Cole, 2001).
Clinical Relevance: The results of this study suggest that
there are a number of ways to increase the early detection
of movement delays in children. Increasing parents fa-
miliarity with early childhood development will increase
the reporting of and thus detection of a possible move-
ment delay. More importantly, this knowledge would
empower early collaborative discussion of concerns with
the family pediatrician, which in turn would facilitate
early intervention.
KEYWORDS: pediatrics, child development, infant
ANKLE MOVEMENTS DURING SUPINE KICKING IN
RELATION TO GASTROCNEMIUS/SOLEUS LENGTH
IN INFANTS BORN PRETERM
Grant-Beuttler, Marybeth1; Reddien Wagner, Barbara1;
Miller, Debra P.1; Palisano, Robert J.2; Heriza, Carolyn B.3;
Shewokis, Patricia A.2; Roberge, James4; Karduna, Andrew5
1 to examine this relationship during later development.
Physical Therapy, University of Scranton, Scranton, PA, USA
2 KEYWORDS: preterm, kicking, motor development
Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
3
Physical Therapy, Rocky Mountain University of Health
Sciences Center, Provo, UT, USA
4
Educational Psychology, Temple University, Philadelphia,
PA, USA
5
Human Physiology, University of Oregon, Eugene, OR, USA
Purpose/Hypothesis: Systems theory suggests that differ-
ences in body subsystems may account for movement
differences. Passive extensibility differences in the gas-
trocnemius/soleus muscle tendon unit have been demon-
strated between infants born preterm and infants born
fullterm. Differences in active ankle movement during
function may be observed secondary to passive extensi-
bility at the ankle. The purpose of this study is to exam-
ine differences in ankle kinematics between infants born
preterm and infants born fullterm during supine kicking
and determine if correlations exist between muscle exten-
sibility and active ankle movement.
Number of Subjects: Twenty infants born between 38
and 42 weeks gestation were included in a fullterm
group. Twenty-two infants born between 26 and 36
weeks gestation and at low-risk for a disorder in motor
development were included in a preterm group.
Materials/Methods: Infants born fullterm and infants
born preterm were observed using motion analysis to
analyze ankle kinematics during supine kicking. Maxi-
mum plantarflexion and maximum dorsiflexion were
measured at newborn age, 6 weeks of age, and 12 weeks
of age (all ages were adjusted for infants born preterm).
In addition, observed total active ankle range was calcu-
lated by adding the absolute value of maximum plantar-
flexion and maximum dorsiflexion observed at each mea-
surement session.
92 Abstracts for the 2006 Combined Sections Meeting
Results: Two-way, mixed model ANOVAs indicate that
infants born preterm have significantly more maximum
plantarflexion (F(1,40) 28.12, P 0.001), and less
maximum dorsiflexion (F(1,40) 15.92, P 0.001)
than infants born fullterm. Maximum plantarflexion in-
creased with age in both groups from newborn to 12
weeks (F(2,39) 9.97, P 0.001). Measures of muscle
extensibility reported in previous research were corre-
lated with ankle kinematics for all infants at each age.
Simple and semi-part correlations suggest a small to large
effect size between passive muscle extensibility measures
and active ankle kinematics. The strongest relationship
was between taut tendon, relaxed muscle length and
maximum plantarflexion at 12 weeks of age (r 0.48)
with semi-part correlations explaining 26.8% of the vari-
ability in maximum plantarflexion at 12 weeks of age
while controlling for knee flexion.
Conclusions: Differences in ankle kinematics between
infants born fullterm and infants born preterm are the
same as those predicted based on differences in muscle
extensibility.
Clinical Relevance: Correlations suggest muscle extensi-
bility is related to ankle kinematics and support the need
RECENT TRENDS AND ATTITUDES AMONG
PARENTS/PRIMARY CAREGIVERS AND PHYSICIANS
TOWARD THE USE OF EXERSAUCERS
Hagen, Katherine A.3; Lundeen, Heather M.2; Speich, Susan
A.3; Mabey, Renee1; Mohr, Peg1
1
Physical Therapy, University of North Dakota, Grand
Forks, ND, USA
2
Pediatric Therapies, Medcenter One, Bismarck, ND, USA
3
Special Education, Moorhead Public Schools, Moorhead,
MN, USA
Purpose/Hypothesis: Exersaucers are widely used for
infants and recommended over walkers due to increased
safety. Research indicated that equipment use might af-
fect development. No information exists regarding par-
ents and physicians perspectives about exersaucer use.
The purpose of this study was: 1) to investigate the atti-
tudes of caregivers and physicians regarding exersaucer
use and rationale for use, and 2) to determine the target
audience for education regarding the use of exersaucers.
Number of Subjects: Fifty-seven caregivers of children
6 24 months, 67 family physicians (n 40) and pedia-
tricians (n 27) participated in the study.
Materials/Methods: A total of 130 caregivers and 239
physicians were recruited to complete a survey regarding
exersaucers. Caregiver surveys addressed demographics,
exersaucer use and rationale, and informational sources
regarding infant growth and development. Physician sur-
veys investigated recommendations, understanding of
developmental implications, and perspectives on caregiv-
ers rationale for exersaucer use.
Pediatric Physical Therapy
Results: Seventy-seven percent (77%) of caregiver re-
spondents used exersaucers at home, 64% at daycare, and
56% at home and at daycare. The mean age of exersaucer
use was 4.5 months to 9.5 months. Mean frequency and
duration of exersaucer use was similar across locations, 2
times daily, 1516 minutes each time. Respondents re-
ported using an exersaucer for entertainment, develop-
mental benefit, convenience, and safety. Physicians were
listed as one of three choices for seeking information on
growth and development of their infants by 82% of care-
givers. Nineteen percent (19%) of physician respondents
made recommendations, 7% were neutral, and 73% indi-
cated they did not make recommendations for exersaucer
use; 25% of these indicating unfamiliarity with exersau-
cers. Physicians reported receiving knowledge regarding
exersaucers from peers (15%) and journals (15%). No
information on exersaucers had been received by 49% of
physicians.
Conclusions: A majority of caregivers used exersaucers
and listed physicians as their primary source of informa-
tion on growth/development of their infants. Some physi-
cians were unaware of exersaucers and/or potential nega-
tive implications on development; a small percentage
offered parents advice on appropriate use.
Clinical Relevance: While 77% of caregivers surveyed
utilized exersaucers, research has indicated exersaucer
use may negatively affect development. Physicians serv-
ing as informational resources may be unfamiliar with
the implications of exersaucer use and offer limited rec-
ommendations regarding appropriate use of this equip-
ment. The authors conclude that parent and physician
education that offers information and alternative meth-
ods to achieve child safety/entertainment and parental
convenience would be beneficial in addressing these fac-
tors. Mechanisms for such education may include an in-
formational website, in-services, and written handouts
for physicians, parent groups, daycare staff, and early
intervention staff.
KEYWORDS: exersaucers, infant equipment prescrip-
tion, infant motor development
COMPARISONS OF PERFORMANCES ON THE
STANDARDIZED WALKING OBSTACLE COURSE
(SWOC) FOR CHILDREN WITH DOWN SYNDROME
AND TYPICAL DEVELOPMENT
Held, Sharon1; Barbour, Kristen1; Kott, Karen2
1
Physical Therapy, Daemen College, Amherst, NY, USA
2
Physical Therapy, Hampton University, Hampton, VA, USA
Purpose/Hypothesis: The purpose was to support the
construct validity of the Standardized Walking Obstacle
Course (SWOC) as a test of functional ambulation and
balance by examining standard data in children with and
without disabilities.
Number of Subjects: Children with Down syndrome
(DS) and typical development (n 16 pairs) were
matched for age (range 3.0 21.0 years; mean 10.0 years,
Pediatric Physical Therapy
8.0 months), gender (9 female pairs, 7 male pairs), and
body mass index (range 16.144.7 kg/m2; mean 22.8 kg/m2).
Materials/Methods: The SWOC is a 39.5 foot long and
36 inch wide angled path with chairs at each end, sur-
face changes (shag rug, very colorful mat), and obsta-
cles (large trash can, standard crutch). Children were
randomly assigned a start condition on the SWOC:
arms free, carrying a lunch tray with place setting, and
wearing shaded glasses walking for a total of six trials.
The time and number of steps to complete the course,
stumbles, and steps off the path were recorded. t tests
for paired samples were used to analyze for differences
between the groups for conditions on the SWOC
(time, number of steps, stumbles, steps off the path).
Descriptive statistics were used to examine condition
differences in the variables.
Results: The mean times, number of steps, stumbles
and steps off the path were significantly different be-
tween the performances of the children with DS and
their matched pairs (P 0.05) with the exception of
the number of stumbles counted while wearing the
glasses (P 0.33). The average increases in time and
number of steps were 38% and 24% respectively for
children with DS across all three conditions. Only 17%
of the children with DS had no steps off the path com-
pared to 75% of their peers in all three conditions.
Twenty percent of the children with DS had one or
more stumbles compared to 6% of their peers in all
three conditions.
Conclusions: Children with DS when matched for gen-
der, age, and size to typically developing peers per-
formed significantly slower and took significantly
more steps to complete all conditions of the SWOC.
These children with DS tended to step off the path 1 or
more times 83% of the time compared to 25% of the
time for their peers, but they were fairly steady 80% of
the time experiencing no stumbles compared to their
peers 94% and the number of stumbles while wearing
the glasses was not different for the groups.
Clinical Relevance: For this group of children, the
SWOC was able to distinguish those with DS from
those developing typically for functional ambulation
and balance.
KEYWORDS: functional testing, obstacle course, pediatrics
THE EFFECTS OF IMPOSING CONCURRENT
COGNITIVE TASKS ON AN UPRIGHT POSTURAL
CONTROL TRAINING PROGRAM ON FUNCTIONAL
BALANCE AND MOBILITY IN A SCHOOL-AGED
POPULATION
Huber, Kelly A.1; Franjoine, Mary Rose1; Mazzone,
Margaret A.1
1
Daemen College, Amherst, NY, USA
Purpose/Hypothesis: School-aged children receiving
physical therapy services to improve balance and func-
tional mobility often appear to show degradation of
Abstracts for the 2006 Combined Sections Meeting 93
performance in situations that include a secondary
task. Current research does not yet provide evidence as
to the effects of training children for upright func-
tional postural control under dual-task conditions. The
purpose of this study was to examine the effects of im-
posing concurrent cognitive tasks during an upright
postural control training program on functional bal-
ance and mobility as measured by changes on the Pedi-
atric Balance Scale (PBS) and pediatric Standardized
Walking Obstacle Course (SWOC) in children receiv-
ing school-based physical therapy services.
Number of Subjects: Three male subjects between 5
and 8 years old participated in this study. All subjects
were currently receiving school-based physical therapy
services 2/week for 30-minute sessions, presenting
with minimal impairment of gross motor function.
Materials/Methods: A single-subject A-B-C design with
direct replication included a baseline phase (A) where the
independent variable was not provided, followed by an
upright postural control intervention phase (B) for 14
consecutive sessions, and lastly a dual-task upright pos-
tural control intervention phase (C) for 14 consecutive
sessions. Phase B intervention included activities to ad-
dress timing and coordination, postural strength, trunk
rotation, static and dynamic balance, and obstacle negoti-
ation. Three concurrent cognitive tasks, visual identifica-
tion, auditory identification, and memorization of a
three-number sequence, were imposed on the upright
postural control training program to create dual-task in-
tervention in Phase C. Intervention was completed the
initial portion of physical therapy sessions, lasting ap-
proximately 20 minutes. Data were analyzed using Fried-
mans two-way analysis of variance by ranks, and the
Nemenyi post-hoc testing procedure.
Results: Marginal significance was found on the PBS
(Chi Square r 5.636, DF 2, P 0.0597), with
strong trends toward improved values after the train-
ing program was completed with concurrent cognitive
tasks. A significant difference was found in step counts
on the SWOC under a condition of carrying a tray (Chi
Square r 6.000, DF 2, P 0.0498). No other sig-
nificant differences were found on the SWOC.
Conclusions: This study preliminarily supports the use
of dual-task training to promote automaticity of bal-
ance skills in children presenting with minimal gross
motor functional limitations relating to upright activi-
ties, and suggests that postural control training for
functional mobility under dual-task conditions pro-
motes improved dual-task functional mobility perfor-
mance in a school-aged population.
Clinical Relevance: School-based physical therapists
need to consider dual-task performance to conduct
examinations and plan intervention. Task-specific
practice was integral to findings, and may have
considerable impact on effectiveness of clinical inter-
ventions.
KEYWORDS: dual-task, postural control, balance
94 Abstracts for the 2006 Combined Sections Meeting
DIFFERENCES IN SCORES BETWEEN CHILDREN
WITH SPINAL CORD INJURY AND THEIR PARENTS
USING THE PEDIATRIC QUALITY OF LIFE
INVENTORY
Johnston, Therese1; Lauer, Richard T.1; Smith, Brian T.1
1
Research, Shriners Hospitals for Children, Philadelphia, PA, USA
Purpose/Hypothesis: To compare scores on the Pediatric
Quality of Life Inventory (PedsQL) between children
with spinal cord injury (SCI) and their parents.
Number of Subjects: Nine boys and five girls (ages 5 to
13 years, mean age 9.1 2.5 years) with motor complete
SCI (neurological levels C7 to T10) and one parent (the
primary caregiver) per child completed the PedsQL as
part of a prospective study of the effects of a lower ex-
tremity functional electrical stimulation training program
in children with SCI. Subjects were 5.1 2.1 years (1 to
8 years) post injury when tested.
Materials/Methods: Each child and one parent completed
the age-appropriate version of the PedsQL. The PedsQL
is a modular instrument that measures health related
quality of life issues. The 23-item questionnaire provides
summary scores on total well-being, physical well-being,
and psychosocial well being. In addition, scales on emo-
tional, social, and school functioning can be derived. All
scores are based on a scale of 0 to 100%, with 100% rep-
resenting the greatest well-being. Children and parents
were instructed to complete the PedsQL without input
from each other. A Spanish version was provided for in-
dividuals with Spanish as the primary language. For the
younger children (5 to 7 years), one of the investigators
read the questions and possible answers to them and as-
sisted each child in circling his or her choice for each
question. The instructions for the test ask parents and
children to answer the questions based upon the past few
weeks or one month, depending on the age of the child.
Results: The scores for the children with SCI for the
overall test and for each component were higher than
those of their parents, indicating that the children felt
that they were functioning at a higher level than did their
parents. On average the children scored 8.4% 1.8%
(range 5.7% to 10.5%) higher than did their parents.
Conclusions: The results demonstrated that children
consistently scored quality of life higher than did parents,
suggesting that children may perceive fewer functional
limitations. This trend may also reflect the parents per-
spective of seeing more of the long-term picture and con-
cerns over the future prospects of the child, while the
child is more focused on the present situation. The test
does ask both to focus on the recent past; however par-
ents may have had more difficulty in doing this.
Clinical Relevance: One of the goals of pediatric rehabili-
tation is to help children who have sustained a SCI lead a
full and productive life. Understanding childrens per-
spectives on quality of life is important in understanding
how the injury and subsequent disability affects them. It
is likewise important to consider the perspective of the
parents, who are also impacted by the childs injury, as
Pediatric Physical Therapy
well as how their perspectives may differ from the per-
spectives of the children.
KEYWORDS: spinal cord injury, exercise testing, pediat-
rics
THE EFFECTS OF TRANSLATORIC JOINT
MOBILIZATION ON KNEE FLEXION
CONTRACTURES IN AN ADOLESCENT WITH
CEREBRAL PALSY: A CASE REPORT
Kondratek, Melodie1; Francis, Sarah1
1
Physical Therapy, Oakland University, Rochester, MI, USA
Background & Purpose: The purpose of this case report
is to examine the effects of translatoric joint mobilization
in combination with a stretching and strengthening pro-
gram to address bilateral knee flexion contractures in a
15 year old girl with Cerebral Palsy (CP). Knee flexion
contractures are a common secondary complication expe-
rienced by children with CP. Physical therapy (PT) inter-
vention frequently includes hamstring stretching, and
quadriceps strengthening. The use of translatoric joint
mobilization in addition to these common PT interven-
tions in a child with CP and bilateral knee flexion con-
tractures has not been addressed in the literature.
Case Description: The subject was referred to PT with a
diagnosis of bilateral knee flexion contractures. Medical
diagnoses included CP, Dandy Walker Syndrome and a
Congenital Heart Defect. The child was not considered to
be a candidate for bilateral soft tissue releases or a right
femoral derotation osteotomy (as recommended by her
orthopedic surgeon) due to her cardiac condition. Prior
PT intervention, including a home stretching and
strengthening program, was not successful in reducing
the existing knee flexion contractures. Initial goniometric
measurements for this course of PT intervention were as
follows: active right knee extension 30 degrees and pas-
sive 15 degrees; active left knee extension 20 degrees
and passive 15 degrees. Knee flexion and all hip move-
ments were within normal limits. Mild limitations in an-
kle inversion were present. Dorsal glide of the femur on
the tibia was limited by posterior knee joint capsular re-
striction. PT intervention occurred twice weekly for 12
weeks and included translatoric joint mobilization, ham-
string and posterior capsule stretching, quadriceps
strengthening and a home exercise program. The Kalten-
born translatoric joint mobilization techniques used were
Grade II to III: tibio-femoral traction, femur dorsal, fe-
mur dorsal-medial and femur dorsal-lateral.
Outcomes: After 12 weeks of PT intervention goniomet-
ric measurements were as follows: active right knee ex-
tension 15 degrees and passive 5 degrees; active left
knee extension 5 degrees and passive 0 degrees. The
childs gait pattern changed from shuffling her feet to
consistent heel strike bilaterally.
Discussion: Translatoric joint mobilization proved to be
a safe and effective addition to standard PT interventions
for knee flexion contractures for the child in this case
Pediatric Physical Therapy
report. The functional impact of improved knee exten-
sion was the childs ability to achieve consistent heel
strike bilaterally.
KEYWORDS: joint mobilization, knee flexion contrac-
tures, cerebral palsy
ADVANTAGES OF SUPRAMALLEOLAR ORTHOTICS
OVER ARTICULATING ANKLE-FOOT ORTHOTICS
IN THE GAIT AND GROSS MOTOR FUNCTION OF
CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL
PALSY
Kornhaber, Lillian1; Majsak, Michael J.2; Robinson, Alexis2
1
Childrens Evaluation and Rehabilitation Center/Rose F.
Kennedy University Center for Excellence in Developmental
Disabilities, Albert Einstein College of Medicine of Yeshiva
University, Bronx, NY, USA
2
Program in Physical Therapy/School of Public Health, New
York Medical College, Valhalla, NY, USA
Background & Purpose: Ankle-foot orthotics (AFOs) are
frequently prescribed for children with spastic diplegic
cerebral palsy (CP) to prevent uncontrolled plantarflex-
ion. However, AFOs may disrupt the gait and motor
skills of some children. Supramalleolar orthotics (SMOs)
are orthotics that control the alignment of the foot while
allowing free ankle motion. This case series study ana-
lyzed the gait and gross motor function of four children
with spastic diplegic CP who were tested in AFOs and
SMOs. We hypothesized that children with CP would
show: (1) a higher gait velocity, a greater stride length,
and a more symmetrical stride in SMOs; (2) a higher
level of gross motor function in SMOs in motor skills
requiring ankle mobility; and (3) a lower level of gross
motor function in SMOs in motor skills requiring ankle
stability.
Case Description: Four children with spastic diplegic CP
who ambulated with articulating AFOs were recruited
from the Childrens Evaluation and Rehabilitation Center
of the Albert Einstein College of Medicine of Yeshiva
University. One male, age 4, used a posture walker; one
male, age 14, used forearm crutches. Two females, ages 7
and 15, used no assistive devices. In the first of 3 weekly
sessions, children were tested in gait and gross motor
function wearing their AFOs. The GAITRite Portable
Walkway System was used to record the gait velocity,
cadence, stride length, and stride symmetry of children
for 3 trials of walking at a comfortable speed. Children
were allowed to use their assistive devices while ambulat-
ing. Gross motor function without the use of assistive
devices was then assessed using the Gross Motor Func-
tion Measure-66 (GMFM). In the second session, cus-
tom-made SMOs were fabricated for each child (see Cu-
sick, 1990). No testing occurred on this day. The
children were instructed to use the SMOs 34 hours a
day over the following week. In the last session, children
wore the SMOs while they were retested in gait and gross
motor function.
Abstracts for the 2006 Combined Sections Meeting 95
Outcomes: The two children who used assistive devices
for ambulation walked faster, had a greater stride length,
and had greater symmetry of stride in SMOs than in
AFOs. Changes were not noted for children who ambu-
lated without assistive devices. All children showed
higher scores on the GMFM in SMOs than in AFOs for
tasks that required ankle mobility. Younger children im-
proved their performance in mat mobility and stand-to-
sit. Older children improved in more difficult tasks such
as climbing stairs and jumping. Three children had lower
gross motor function scores for the stability task of stand-
ing on one foot, but did not score lower on other tasks
that required ankle stability.
Discussion: SMOs provide an advantage over AFOs in
gait and gross motor function for some children with
spastic diplegic CP. The use of orthotics needs to be indi-
vidualized, taking into account each childs specific im-
pairments and functional abilities, age, means of ambula-
tion, and priorities in daily motor tasks.
KEYWORDS: cerebral palsy, spastic diplegia, orthotics
USE OF GROUPS IN PEDIATRIC PHYSICAL
THERAPY
Laforme, Alyssa C.1; Effgen, Susan K.1
1
Rehabilitation Sciences, The University of Kentucky,
Lexington, KY, USA
Purpose/Hypothesis: This survey examined the use of
groups in pediatric physical therapy including character-
istics, effectiveness and financial considerations of group
intervention.
Number of Subjects: Subjects were 500 randomly se-
lected members of the APTA Section on Pediatrics from
across the nation. Response rate was 285 of 500 surveys
(57%).
Materials/Methods: After development of the survey and
field testing, the surveys were mailed to participants. Re-
sults were complied from the returned surveys and ana-
lyzed to determine trends using descriptive statistics.
Results: Of the respondents, 41.4% reported using
groups with the most prevalent use in school settings.
Most frequent reasons for not using groups were home
based services (24%) and dissimilar children (21%).
Groups were generally 2 to 4 children (71%) having gen-
eral developmental delay (56%) and were described as
therapeutic groups (66%) working to increase physical
abilities (55%) with a focus on developmental activities
(44%). Most frequently reported benefits included peer
modeling (59%) and time efficiency (69%). Most fre-
quently reported drawbacks were down time (42%) and
space constraints (31%). Parents were infrequently in-
cluded in group activities with only 15% reporting par-
ents were included always or frequently. Different group
versus individual billing rates were reported by 53%, and
41% stated billing was completed through insurance or
included in overall program costs. However, 20% of the
respondents were unsure of billing practices. Respon-
96 Abstracts for the 2006 Combined Sections Meeting
dents were divided regarding the effectiveness of group
intervention with 48% reporting groups were not to
somewhat effective and 52% reporting groups were
moderate to very effective at meeting goals. Only 17%
of the respondents reported group intervention was more
effective than individual intervention. Despite the vari-
ance in reported effectiveness, 90% of respondents stated
they would use groups at least occasionally in the future.
Conclusions: Various trends in group therapy were noted
in the survey results. However, perceived effectiveness
was not established. Forty-one percent of respondents
reported using groups and as many as 90% reported they
would continue to use groups. More research is needed
to assess the effectiveness and the most appropriate use
of group intervention.
Clinical Relevance: With large numbers of children
needing rehabilitation services, therapists are challenged
to find efficient and effective methods of intervention.
Group intervention is one method that could be used,
but little research is available on how therapists use
groups. This study presents information on the current
use of group intervention across the nation and its per-
ceived effectiveness in pediatric physical therapy.
KEYWORDS: pediatrics, groups
THE EFFECTS OF FOOT ORTHOSES ON GAIT IN
NEW WALKERS WITH DOWN SYNDROME
Looper, Julia E.1; Ulrich, Dale A.1
1
Division of Kinesiology, University of Michigan, Ann
Arbor, MI, USA
Purpose/Hypothesis: The purpose of the study was to
determine whether the use of prefabricated foot orthoses
influences gait quality in new walkers with Down syn-
drome (DS).
Number of Subjects: Nine
Materials/Methods: The subjects were new walkers with
DS who could take 8-10 steps independently with no
more than 3 months of independent walking experience.
They participated in 1 visit to the Motor Development
Laboratory at the University of Michigan. Foot size was
measured. The appropriate shoe (modified athletic shoe)
and prefabricated orthotic (Pattibobs, Cascade DAFO)
sizes were determined for the session. Researchers at-
tached 5 light reflecting markers bilaterally to the lower
extremities of each child to allow for capture of kine-
matic data using a PEAK Motus motion capture system.
A GAITRite mat collected spatial and temporal gait pa-
rameters as the child walked from one end to their guard-
ian at the other end. This was repeated 3 times each in a
barefoot, shoes only and orthoses condition. The order of
these conditions was randomly assigned.
Results: A oneway MANOVA was performed to deter-
mine if there were differences between the conditions for
step length (SL), step width (SW), and relative double
support time (RDS) (double support time/stance time).
No significant differences were found. Effect sizes were
Pediatric Physical Therapy
also calculated. Orthotic use had a small effect on SW, in
favor of orthoses, in both the orthoses and barefoot con-
ditions (effect size 0.35) and the shoes and orthoses
conditions (effect size 0.22). It also had a small effect
on RDS, in favor of barefoot or shoes, in the orthoses and
barefoot conditions (effect size 0.26) and between the
shoes and orthoses conditions (effect size 0.31). The
effect for SL was negligible.
Conclusions: Given the small sample size and large vari-
ability in our data, it was difficult to find statistically sig-
nificant results. The small treatment effects suggest that a
relatively small amount of support to the foot improves
SW, however, RDS increased with orthotic use. While
orthoses are thought of as a biomechanical intervention,
they may have an impact on the neuromuscular system.
This system may recognize a change in foot position but
not know how respond until after an adaptation period,
causing an initial decrease in performance. No adaptation
period was given, possibly causing neuromuscular vari-
ables like RDS to deteriorate but allowing for biome-
chanical variables such as SW to improve. Future studies
should include a larger sample size and an adaptation
period to determine if prefabricated foot orthoses im-
prove gait in new walkers with DS.
Clinical Relevance: The early use of orthoses may have
far reaching consequences. Toddlers with DS show liga-
mentous laxity and ankle instability. This leads to diffi-
culty with balancing in dynamic activities such as walk-
ing. Instability also makes emergence of advanced
locomotor skills difficult. Prefabricated orthoses are a
relatively inexpensive intervention that may lead to better
quality of gait, emergence of advanced skills, and in-
creased physical activity.
KEYWORDS: Down syndrome, orthoses
A COMPARATIVE STUDY OF THE
CHARACTERISTICS OF GAIT IN NORMAL FOUR
AND FIVE YEAR OLD CHILDREN AS MEASURED BY
THE GAITRITE SYSTEM
1 who participate in an in-service educational program
Maclay, Thomas ; Breed, Bridget1; Brown, Jessica1; Jantzi,
Kelli ; Chau, Connie1
1
1 have improved knowledge about osteoporosis and im-
Nazareth College, Rochester, NY, USA
Purpose/Hypothesis: The purpose of this study was to
investigate the characteristics of the typical gait patterns
in normal four and five year-old children.
Number of Subjects: 24
Materials/Methods: This study included 24 four and five
year-old normal children recruited on a voluntary basis
from Rochester, New York including day care centers and
schools. The height and leg length were measured. Gait
parameters including cadence, step length and stride
length and cycle time were collected using the GAITRite
System as the children walk at their usual speed. All chil-
dren walked at least 3 trials. Data was then pooled and
analyzed for significance between the two age groups
using SPSS 10 as well as to pre-established standardized
adult values using Microsoft Excel.
Pediatric Physical Therapy
Results: Cadence, cycle time, and stance and swing phase
percentages of gait were found to be similar between four
and five year-olds. Leg length, step length, and stride
length were significantly higher in five year-olds despite
comparable heights between the two groups. Also, vari-
ability in stance and swing phase is reduced in the five
year-old group. Velocity, swing, and stance percentages
of the gait cycle were found to be comparable to normal-
ized adult values in both four and five year-old children.
Cadence, step length, and stride length were not found to
have reached maturity by age five.
Conclusions: Our results suggest that step and stride
lengths are more dependent on leg length than height
and that gait continues to mature between the ages of
four and five. Many studies have grouped four and five
year-olds together when analyzing gait, however, since
our study revealed significant differences in certain gait
parameters, it is not advisable to group these ages to-
gether when analyzing aspects of gait that may still be
maturing.
Clinical Relevance: This study suggests a need for larger
scale studies to develop normative data for these age
groups. If normative data is established, clinicians will be
able to objectively identify atypical gait patterns seen in
children and will be able to intervene at an earlier age.
KEYWORDS: pediatrics, gait
EFFECTS OF AN EARLY INTERVENTION ON BONE
HEALTH: KNOWLEDGE, PERCEIVED EFFICACY OF
BEHAVIORS, AND BEHAVIORAL RISK FACTORS IN
ADOLESCENT FEMALES
Magee, Julie2; Stuberg, Wayne A.3
1
Physical Therapy, American International College,
Springfield, MA, USA
2
Physical Therapy, Rocky Mountain University of Health
Professions, Provo, UT, USA
3
Physical Therapy, Munroe-Meyer Institute, Omaha, NE, USA
Purpose/Hypothesis: To determine if adolescent girls
about osteoporosis and bone density development will
proved confidence in health behaviors for bone density
development as well as improved bone-health lifestyle
behaviors compared to adolescents who do not partici-
pate in an in-service educational program.
Number of Subjects: Eighty four girls (M 15.64 1.2
yrs) from two high schools in a northeastern city school
district participated.
Materials/Methods: Pretests on knowledge (2 subscales),
self-efficacy (2 subscales), calcium intake, and previous
day physical activity were collected in the treatment and
control groups. Two to three days after the initial testing,
an educational in-service program about osteoporosis and
osteoporosis prevention was presented to the treatment
group during a 50-minute class-time block. No educa-
tional in-service program was given to control group par-
ticipants. Approximately a week after the educational
Abstracts for the 2006 Combined Sections Meeting 97
in-service, the four test instruments were again given to
all students.
Results: 1) Significant differences were found for the
main effect of time (posttests compared to pretests) and
the main effect of group (treatment compared to control)
on all measures of the Osteoporosis Knowledge Test: to-
tal scores, exercise subscale scores, and calcium subscale
scores. 2) Scores for improved confidence for conducting
activities related to osteoporosis prevention were encour-
aging. While there were no main effects for group or time
of testing, there was a significant interaction of the two.
The treatment group showed significantly greater in-
creases for self-efficacy from pretest to posttest compared
to participant scores in the control group. 3) Although
time by group analyses were significant for the behavioral
tests, the results were difficult to interpret.
Conclusions: An osteoporosis educational in-service can
significantly improve overall knowledge in high school
girls as well as their confidence for exercising and cal-
cium consumption; however, an educational in-service
alone is not an adequate intervention to change exercise
or nutrition lifestyle behaviors.
Clinical Relevance: If this study confirms that an educa-
tional in-service is effective for modifying risk behaviors
in adolescents, this may prompt physical therapists and
other health professionals to conduct intervention strate-
gies within the scope of early intervention and treatment
for the prevention of osteoporosis in this population.
KEYWORDS: osteoporosis, bone density, self-efficacy
NORMATIVE VALUES FOR SENSORY
ORGANIZATION TEST WITH COMPUTERIZED
DYNAMIC POSTUROGRAPHY FOR CHILDREN AGES
5 TO 8
Maher, Catherine1; Brooks, Andrea1; Roney, Stephanie1
1 ing of the normal developing balance response in chil-
Department of Physical Therapy and Sport Sciences, Seton
Hall University, So. Orange, NJ, USA
Purpose/Hypothesis: Computerized dynamic postu-
rograpy (CPD) is tool that objectively quantifies and dif-
ferentiates sensory, motor and balance control impair-
ments. The Sensory Organization Test (SOT) is one of
the protocol for CPD that evaluates visual, somatosen-
sory and vestibular components of balance. The purpose
of this study was to collect normative data on perfor-
mance of SOT for children ages 5 to 8 and identify if dif-
ferences in exist between this group.
Number of Subjects: Subjects: 12 healthy children be-
tween the ages of 5 and 8 years old participated who met
the inclusion criteria; no known neuromuscular delays or
vestibular impairments, no uncorrected vision, able to
follow multistep commands
Materials/Methods: The subjects, ages 5 to 8 years old
performing the sensory organization test (SOT) protocol
using CDP (NeuroCom Smart Balance Master) . The
three trials of the six test conditions were randomly pre-
sented. Subjects performed the balance subtest (eight
98 Abstracts for the 2006 Combined Sections Meeting
items) of the Bruininks-Oseretsky Test of Motor Profi-
ciency. All subjects were tested twice between 7 to 10
days.
Results: Means and standard deviations for scores of SOT
conditions and BOTMP for each subject and age group
were computed using SPS for Windows 12.0. Two-Way
Repeated Measures of Variance was used to examine the
effect of sensory conditions and age on postural sway. An
alpha level of P 0.05 was used for significance. Test-
retest reliability was analyzed using an ICC of 0.75 or
higher indicate good reliability. The subjects scores on
the BOTMP demonstrated performance within their age
normed-scores. Subjects age 7-7.11 years old showed
consistency in their SOT scores, while the children under
6 years showed more variability in their scores (Equilib-
rium Score; Age Group 5 year old: mean 52.5, sd 13.7
Age Group 6 year old; mean 64.25, sd 17.0, Age Group 7
year old; mean 64.16, sd 19.35). The results demon-
strated significant difference between age groups perfor-
mance under Sensory Condition 1 (df 2, F 4.9, sig 0.02)
and Sensory Condition 2 (df 2, F7.3, sig 0.01). There was
a weak correlation between the raw score of balance
subtest (BOTMP) and SOT for condition 1 eyes open,
fixed support (Pearson r.65 and condition 2 eyes closed,
fixed support (Pearson r 0.59. Our data did not indicate
any significant differences between gender.
Conclusions: Computerized dynamic posturography is
tool that can be used to assess performance of balance in
the pediatric population. The determination of normative
values for children performance on the SOT using com-
puterized dynamic posturography demonstrates differ-
ence in equilibrium responses between children ages 5
and 7 years. There is only a weak correlation of BOTMP
subtest of balance for one leg stance and walking and
SOT using CPD.
Clinical Relevance: This study increases the understand-
dren under static and dynamic conditions during stan-
dardized test protocols. CPD can be a useful tool for
evaluating possible causes of balance impairments in the
pediatric population.
KEYWORDS: balance, SOT, computerized dynamic pos-
turography
STRESSORS FOR PARENTS OF CHILDREN WITH
DISABILITIES: UNDERSTANDING NEEDS AND
SOLUTIONS
Martin, Kathy S.1; Berry, Sarah1; Harkins, Heather1; Miller,
Jennifer1; Torma, Jennifer1
1
Krannert School of Physical Therapy, University of
Indianapolis, Indianapolis, IN, USA
Purpose: The purpose of this paper was to review the
literature and synthesize current thought on the psychos-
ocial issues facing parents of children with disabilities.
We explored parental perceived stress, parental reactions
and solutions to stress, and the role of physical therapists
Pediatric Physical Therapy
in assisting parents with the management of this stress
and maximization of their childs potential.
Description: We performed a literature review of 46 articles
published from 1990 to 2004 related to but not limited to
the following search terms: disabled and family relations
and child, child and disabled and parents, developmen- ceptions may allow health care providers to identify be-
tal disabilities and parents, and parents and coping and
disability. We found that published studies have estab-
lished that parents of a child with disabilities are under in-
creased stress when compared to parents of typically devel-
oping children. However, the study of coping in families of a
child with disabilities has been inconclusive, probably be-
cause of the uniqueness of each familys situation. Parents of
a child with disabilities undergo stress related to personal
issues, relationship issues and financial matters. We found
common ways in which parents react to these stressors and
solutions to those stressors that parents frequently utilize.
Physical therapists often play an active role in the lives of
parents of a child with disabilities and can be very helpful to
families as they deal with various stressors. Based on our
review, we recommend that physical therapists be informed
of available financial, legal and technological resources; be
willing and able to provide accurate diagnosis-related and
prognostic information for parents; be educated on various
cultural and religious traditions that may affect how parents
interact with their child with disabilities and with the physi-
cal therapist; and maintain frequent communication with
other team members. Most importantly, physical therapists
need to realize that each child is a member of an unique
family unit and that one solution to decrease stress may not
work with all families.
Summary Of Use: This paper is a literature synthesis and
meant to provide a review of current thought on parent
stressors and how physical therapists should respond to
them.
Importance To Members: This information is useful to
all pediatric physical therapists in that it summarizes cur-
rent literature dealing with many of the psychosocial is-
sues facing a family with a child with disabilities. Individ-
ual studies have been inconclusive in identifying how
families cope because of the uniqueness of each familys
situation. This paper summarizes major themes across
the literature and will make physical therapists more
aware of the issues families face. As a result, it will help
physical therapists be more effective in their interactions
with these patients and their families.
KEYWORDS: parents, stressors, coping
CAREGIVERS PERCEPTIONS OF FITNESS AND DIET
RELATED BEHAVIOR MODIFICATIONS COMMONLY
SUGGESTED BY HEALTHCARE PROFESSIONALS
FOR WEIGHT CONTROL IN PRESCHOOL CHILDREN
Mattoccia, Samantha1; Trabulsi, Jillian2
1 1
Physical Therapy, The Childrens Hospital of Philadelphia,
Philadelphia, PA, USA
2 2
Gastroenterology and Nutrition, The Childrens Hospital of
Philadelphia, Philadelphia, PA, USA
Pediatric Physical Therapy
Purpose/Hypothesis: The purpose of our project was to
explore caregiver perceptions of the physical fitness and
diet related behavior modifications that are commonly
suggested by health care providers for weight control in
preschool children. A better understanding of these per-
havior modifications that will be most effective.
Number of Subjects: Caregivers of 2-6 year old children
were recruited from the Primary Care Clinics and Early
to Learn workshops at The Childrens Hospital of Phila-
delphia. Data was collected via 4 focus groups and a total
of 8 caregivers participated. Seven of 8 caregivers were
female and all were African American.
Materials/Methods: The focus groups solicited caregiver
perceptions of 8 standard behavior modifications (4 fit-
ness and 4 diet). Focus groups were audiotaped and writ-
ten notes were taken. Responses and comments to each
behavior modification were listed and common themes
were identified.
Results: With respect to physical activity, half of all care-
givers stated that they tried to play with their child in-
doors for 30 minutes each day. The majority of caregiv-
ers felt that outdoor play such as a trip to the
playground twice per week was difficult to achieve due
to concerns about safety. While half of all caregivers had
tried to limit television and video game usage to 1 hour
per day, their reasons for doing so seemed to be related
to concerns about exposure to violence rather than the
sedentary nature of the activity. With respect to diet, half
of all caregivers stated they were successful in limiting
juice intake to 8 oz per day, and the remaining half felt
that this modification was not attainable. Most caregivers
reported providing healthier, low fat versions of foods
as well as limiting intake of junk food, however some
stated that this was difficult to maintain over time or
when the child ate outside the home.
Conclusions: Throughout the discussions it became clear
that caregivers had tried most of the common fitness and
nutrition behavior modifications and were looking for
new ones. Furthermore, these caregivers desired specific
regimens for indoor and outdoor physical activities as
well as daily meal plans/recipes rather than broadly stated
modifications.
Clinical Relevance: New approaches to the treatment and
prevention of this childhood epidemic are needed. Profes-
sionals need to continue to work together in interdiscipli-
nary care and research to solve this current pediatric issue.
KEYWORDS: obesity, preschool, behavior modification
ASSESSMENT OF TEACHERS KNOWLEDGE OF
BACKPACK USE IN ADOLESCENTS: A SURVEY
McGuire, Staci1; Wakefield, Jeremiah1; Krista, Rasner1; Hood,
Nathan1; Bursch, Gail1; Darr, Nancy S.1; Giordano, Pete2
School of Physical Therapy, Belmont University, Nashville,
TN, USA
Department of Psychology, Belmont University, Nashville,
TN, USA
Abstracts for the 2006 Combined Sections Meeting 99
Purpose/Hypothesis: There has been an increasing
amount of information in the literature regarding
backpack weight related to back pain in adolescents.
While parents and students have been researched in
this area, there has been no research conducted to de-
termine teachers knowledge of backpack safety and the
factors that may contribute to excessive backpack
loads such as: book loads, how the backpacks are
worn, and frequency of backpack use. Therefore, the
purpose of this study was to assess fifth through eighth
grade teachers knowledge of the recommended back-
pack weight through a survey, to verify if the teachers
have received any information regarding backpack
safety, and to determine the teachers observation of
how students carry their backpacks.
Number of Subjects: Subjects consisted of 151 fifth
through eighth grade teachers from three private
schools and two public schools in a large metropolitan
area in the Southeast. The schools were chosen by
proximity.
Materials/Methods: The study design was a survey that
consisted of questions pertaining to teachers perception
of safe backpack weight, the students backpack use, and
general knowledge of backpack safety. A pilot study was
conducted by distributing the survey to teachers from a
local middle school, not involved in the study, as well as
physical therapists in the metropolitan school system.
After making revisions to the survey, the principals of six
schools were asked to participate; all agreed and signed
an impact letter stating their agreement to participate in
the study. The investigators then set up appointments to
visit the six middle schools; however, one of the schools
chose not to participate at that time due to time con-
straints. The remaining five schools were visited during a
school faculty meeting, and the teachers were asked to
sign an informed consent and complete the survey if they
were willing to participate. Survey methods assured the
anonymity of responses.
Results: Results of the survey showed no major differ-
ences between public school teachers versus private
school teachers knowledge of backpack use in adoles-
cents. Thirty-nine percent of teachers knew the correct
recommended backpack weight/body weight percentage,
38% were not sure of the correct percentage, and 23%
answered incorrectly according to the APTA guidelines
for backpack safety. Fifty-eight percent of those surveyed
had never received any information regarding backpack
issues as it relates to back injuries or postural problems.
The teachers perceptions of how students carry their
backpacks were inconclusive.
Conclusions: The results of the survey showed several
important findings related to teachers knowledge of
backpack use in adolescents. The majority of teachers
stated that they had not received information on this
topic and that they are not aware of the recommended
backpack weight.
Clinical Relevance: There is a need for physical thera-
100 Abstracts for the 2006 Combined Sections Meeting
pists to provide education about backpack safety to
teachers in the community
KEYWORDS: backpack, teacher
PHARMACOLOGIC KNOWLEDGE AND USE
PATTERNS IN PEDIATRIC PHYSICAL THERAPY
Millar, Audrey L.1; Dent, Bonnie1; Ley, Rebekah1; Goddard, Kelly1
1
Physical Therapy, Andrews University, Berrien Springs, MI, USA
Purpose/Hypothesis: The purpose of our study was two-
fold: to determine the most common medications used by
pediatric clients and to record pediatric PTs perceived
level of education about pharmacology related to pediat-
ric physical therapy.
Number of Subjects: The survey sample included 200
members of the APTA pediatric section, with 5 medica-
tion questionnaires for each therapist to give to parents of
current clients. A sample of 20 client records were also
reviewed for medications.
Materials/Methods: The PT survey included sections for
demographic and education information, and closed-
ended questions regarding perception of education level
regarding pharmacological categories. Respondents were
asked to rate their knowledge of symptoms, side effects
and impact of the medication type on physical therapy.
The medication questionnaires and chart reviewed in-
cluded age, diagnosis and a list of all current medica-
tions.
Results: 14 PT questionnaires were returned, yielding a
response rate of 7%. Medication questionnaires were re-
ceived from 33 parents. Overall, 69% of the therapists
reported that they were not educated about the symp-
toms of overdose, while 23% had some education. 31%
reported no education regarding side effects, while 69%
had some education. In regards to impact of medication
on physical therapy interventions, 39% said they were
not educated and 54% had some education. The trend
was similar for the predetermined categories, with most
reporting that they were not well educated. We found a
significant association between the pediatric therapists
perceived level of education about pharmacology and the
respondents years of experience working with pediatric
patients. A list of over 70 different types of medications
taken by children receiving physical therapy was com-
piled from the client questionnaires and charts. The most
common types of medications were Other (this was pri-
marily over the counter medications; 33%), antiseizure
(29%), and gastroreflux (12%). The two most common
specific medications were Phenobarbitol and Baclofen.
The majority of the charts had no record of over-the-
counter medications.
Conclusions: We feel that the responses from the thera-
pists are consistent with the lack of specific pharmaco-
logic information presented in pediatric texts. While
many of the therapists had some education regarding
medication categories, there was a notable lack of confi-
dence in the education. Every client questionnaire re-
ported more than one type of medication and we believe
Pediatric Physical Therapy
that the number of over-the-counter medications identi-
fies an additional area that is not often covered in tradi-
tional pharmacology courses. In addition, over-the
counter medications should be a part of the normal his-
tory.
Clinical Relevance: Our findings reflect the need for
more comprehensive pediatric education regarding phar-
macology. This area needs to be significantly expanded in
physical therapy textbooks to include those medications
most commonly used by children receiving physical ther-
apy, addressing side-effects and potential interaction with
assessment and intervention.
KEYWORDS: pharmacology, education
IMPLICATIONS FOR PHYSICAL THERAPY FOR
SEVERELY OVERWEIGHT CHILDREN IN
PRESCHOOL CLASSROOMS: A CLINICAL CASE
REPORT
Nichols, Sarah1; Cojocaru, Corine1; Hoban, Shannon1;
Bucher, Heather1; Lovelace-Chandler, Venita1
1 KEYWORDS: overweight, obesity, pediatrics
Physical Therapy, Chapman University, Orange, CA, USA
Background & Purpose: he role of physical therapists in
the care of overweight children has been explored but
not clarified. The purpose of this case report was to ex-
amine the possible implications for physical therapy for
severely overweight preschool children using one child as
an example.
Case Description: The subject was a 5 year old girl en-
rolled in a preschool class for children from Hispanic
families with low socioeconomic status. The subjects
height and weight were measured by the school nurse,
and the Body Mass Index (BMI) was calculated by the
researchers. Her BMI was above the 95th percentile and
was the highest of 90 children enrolled in preschool. She
was observed in daily school activities over several days,
and data on her physical characteristics and functional
movements were compiled. All children were observed,
and researchers were able to grossly compare this child
with peers. No formal testing was conducted, but the
Denver II and Peabody Developmental Motor Scales, 2nd
Edition, Locomotion Scale were used for observational
assessment.
Outcomes: This childs behaviors and movements were
strikingly different from her peers in postural alignment,
transitional movements, activities chosen, amount of
movement, cardiopulmonary signs, and psychosocial be-
haviors. She chose only sedimentary activities in the
classroom and at recess. In transitioning from floor sit-
ting to standing, she used a strategy similar to a Gowers
sign. During gait, she demonstrated genu valgum, in-
creased hip flexion and decreased upper extremity swing
and trunk rotation. She was unable to achieve flight,
leaned forward to gain momentum when attempting to
run. In stair climbing, she used both upper extremities
for support and placed both feet on each step. She was
unable to hop on one foot, and achieved jumping on both
Pediatric Physical Therapy
feet with less height than peers. Her gross motor scores
on the two assessment instruments using only observa-
tion appeared to be approximately 18 months, indicating
developmental delay in gross motor skills. Her face be-
came flushed when participating in any movement activi-
ties, and she exhibited decreased endurance. She engaged
in play with fewer peers and often sought teacher ap-
proval for activities. She was the only child to experience
targeted teasing about being overweight.
Discussion: This severely obese child demonstrated dif-
ferences in her movements from all peers, even from less
overweight peers above the 95th percentile. Musculoskel-
etal changes were obvious, and postural adaptations were
required for common activities. The musculoskeletal
changes may be contraindications for the typical activi-
ties of preschool children. Physical therapists need to be
aware of the postural and movement changes that may be
present in severely overweight preschool children. These
children may demonstrate developmental delay and may
need individual intervention to gain the skills necessary
to participate in typical classroom activities.
THE KIDS FITNESS PROGRAM: COMMUNITY-BASED
INTERVENTION FOR CHILDREN WHO ARE
OVERWEIGHT
ONeil, Margaret E.1
1
Rehabilitation Sciences, Drexel University, Philadelphia,
PA, USA
Purpose/Hypothesis: The Kids Fitness Program (KFP)
was created in a Community Health Center to provide
support and resources to improve weight status, increase
physical activity levels and improve nutritional habits for
children who are overweight and living in an under-
served, urban area.
Number of Subjects: Four KFP cycles are completed to
date. Cycles are 10 14 weeks each with 10 15 children
participating in each cycle. Children are 9 13 years with
body mass indices (BMI) above the 85th percentile.
Materials/Methods: This is an after school program con-
ducted three days/week with: nutrition education, exer-
cise and recreation sessions. Exercise sessions use circuit
training (strength and cardio fitness stations). Recreation
sessions are in a church hall for sports and games. Par-
ents attend some sessions. Monthly Parent-Child Nights
consist of preparing and serving a healthy, family meal
and conducting a parent support group. Four KFP cycles
are completed to date. Child measures include: physical
activity level and nutrition habit (self report), BMI (cal-
culated using height & weight), percent body fat (bioel-
ectric impedence), functional strength (President Chal-
lenge), cardio fitness (one mile walk/run), and
satisfaction (self report). Parent measures include pro-
gram satisfaction. Quantitative and qualitative data analy-
ses were generated.
Results: There are no statistically significant findings on
Abstracts for the 2006 Combined Sections Meeting 101
child measures. Children increased exercise tolerance
with minimal training effects. Child trends indicate in-
creased upper body and abdominal strength and de-
creased percent body fat. Children report increased phys-
ical activity with little change in nutritional habits and
parents report satisfaction with the program.
Conclusions: Attendance and adherence were challeng-
ing for children and parents. There was a 38% attrition
rate between baseline and endpoint measures across cy-
cles. The KFP is well accepted and valued by participants
and Health Center staff despite difficulty for some in get-
ting to the center for the sessions. Program revisions are
indicated to increase participation in healthy activities for
improved child and family health outcomes.
Clinical Relevance: This study illustrates the important
role that physical therapists have in providing health and
prevention programs for children. Physical therapists are
well trained to provide services and to participate in out-
comes research to determine the effectiveness of the
health programs.
KEYWORDS: overweight, children, physical activity
THE IMPACT OF THE BACK TO SLEEP CAMPAIGN
ON GROSS MOTOR DEVELOPMENT
Oriel, Kathryn N.1; Frazier, Kevin2; Lebron, Melissa2;
Pinkerton, Christopher2; Townsley, Tara2
1 purpose of this study was to describe how often adoles-
Physical Therapy, Lebanon Valley College, Annville, PA, USA
2 cents with cerebral palsy perform activities by them-
University of Medicine and Dentistry of New Jersey and
Rutgers University, Stratford, NJ, USA
Purpose: Historically, parents were advised to place their
infants in the prone position to sleep. As a result, infants
were provided with an opportunity to develop the mus-
culature necessary for gross motor skills such as crawling
and creeping. Since the initiation of the Back to Sleep
campaign, these skills appear to be developing later dur-
ing the first year of life. Whether or not this apparent
delay in development has a long-term impact has yet to
be determined. The purposes of this project were: 1) to
examine, through a comprehensive review of the litera-
ture, if the Back to Sleep campaign has a negative impact
on gross motor development, and 2) to apply the results
of the review to physical therapy clinical practice.
Description: A search for literature on the Back to Sleep
campaign and its impact was performed from January
2004 to June 2004. The review was performed using the
following databases: Cinahl, Ovid, Medline, and Pubmed.
Keywords used in these searches were motor develop-
ment, Back to Sleep, infants, SIDS, prone position, supine
position, and motor milestones. Studies were reviewed if
they examined development in infants sleeping supine.
Based on the results of the studies examined, the physical
therapists role in the Back to Sleep campaign was deter-
mined.
Summary Of Use: Based on this review of the literature,
placing infants supine to sleep appeared to result in a
delay in the development of gross motor skills that are
102 Abstracts for the 2006 Combined Sections Meeting
typically acquired in the prone position during the first
year of life. Gross motor milestones such as rolling,
crawling, creeping, and pulling to stand all appeared to
be delayed in comparison to infants who slept prone.
However, although seemingly delayed in some gross mo-
tor milestones, infants who slept supine attained walking
in a similar time frame as their prone sleeping peers in
most instances. The delays found in the studies examined
appeared to be related to a lack of prone playtime.
Importance To Members: Based on available evidence
reviewed, the physical therapists role in the Back to Sleep
campaign should involve promotion of the prone posi-
tion during supervised playtime to decrease the incidence
of delayed motor milestone achievement.
KEYWORDS: back to sleep, infant development, prone
to play
PERFORMANCE OF ACTIVITIES BY ADOLESCENTS
WITH CEREBRAL PALSY
Palisano, Robert J.1; Copeland, Wendy P1; Galuppi, Barbara2
1
Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
2
CanChild Centre, McMaster University, Hamilton, ON, Canada
Purpose/Hypothesis: Knowledge of performance of activ-
ities in daily life by adolescents with cerebral palsy is im-
portant for transition planning to young adulthood. The
selves. The hypothesis was that performance differs based
on Gross Motor Function Classification System (GMFCS)
level.
Number of Subjects: 195 adolescents with cerebral palsy,
11-18 years of age. Subjects were selected from a popula-
tion based sample of children with cerebral palsy in On-
tario Canada who had participated in a study of gross
motor development.
Materials/Methods: The Activity Scale for Kids perfor-
mance version (ASKp) was self-completed by 154 adoles-
cents and by a parent of 41 adolescents. The ASKp in-
cludes 30 items on personal care, dressing, standing
skills, transfers, locomotion, and play/recreation. How
often each item was performed in the past week is rated
on a 5-point scale. Response options range from all of
the time to none of the time. The maximum score is
100. A therapist classified gross motor function using the
5-level GMFCS.
Results: A one-way ANOVA indicated a significant (P
0.001) difference in mean ASKp scores: 90.2 (level I),
64.6 (level II), 57.9 (level III), 25.0 (level IV), 10.4 (level
V). Post-hoc multiple comparisons indicated that ASKp
scores differed between GMFCS levels except for levels II
and III. Most adolescents in level I reported that in the
past week they performed each activity by themselves all
of the time. The majority of adolescents in levels II and
III reported that they performed personal care and dress-
ing activities by themselves all or most of the time; where
as the majority reported performing sports and manual
Pediatric Physical Therapy
activities sometimes, once in a while, or never. The ma-
jority of adolescents in levels IV and V reported that they
performed activities by themselves none of the time.
Conclusions: Performance of activities in daily life by
adolescents with cerebral palsy differed based on GMFCS
level. The finding that scores did not differ between ado-
lescents in levels II and III may reflect similarities in fine
motor abilities, which are not considered in the GMFCS.
Clinical Relevance: The results suggest that assistive
technology, environmental modifications, and opportu-
nity for participation in physical and sports activities are
considerations for increasing performance of activities of
adolescents with cerebral palsy, particularly adolescents
in levels IV and V.
KEYWORDS: cerebral palsy, activity, performance
OTOLITH AND CANAL HYPOFUNCTION IN A FIVE
YEAR OLD: EVALUATION AND TREATMENT
Rine, Rose M.1
1 child. Therapists must be prepared to provide this type of
Physical Therapy, University Of Miami School Of
Medicine, Miami, FL, USA
Background & Purpose: The purpose of this report is to
provide a case detailing vestibular testing, identification
of impairments, and overview of intervention for a child
with acquired canal and otolith vestibular hypofunction.
Case Description: A 5.5 year old male with primary com-
plaint of tilting right with falls was diagnosed with bilat-
eral middle ear infection with effusion and reduced hear-
ing on left. Following medical management to include
insertion of Eustachian tubes, he was referred for vestibu-
lar testing and intervention. Hx positive for: sx to correct
strabismus, MRIs negative; premature birth with mild R
hemiparesis successfully treated with intensive physical
therapy: independently ambulatory without deviation
and full use of both UEs. He is mainstreamed in kinder-
garten, but struggling due to the recent problems with
balance and ear infection. Parent concerns: falls out of
chair at school, difficulty with written work and reading.
Falling/leaning episodes reduced immediately after sx,
but returned.
Initial Evaluation: Motor development testing (PDMS II)
revealed significant delay- scored at 2nd percentile, due
to problems of balance and eye-hand & eye-foot coordi-
nation. Muscle tone and strength normal. Oculomotor
exam: negative OKN; saccadic movements on visual
tracking worse to the left. Head thrust positive to left,
mixed results on right. On DVA testing, score of 0.3 (3
lines difference). VEMP testing positive with absent re-
sponses on left. Posturography: complete LOB on condi-
tions 5 and 6; sway increased on conditions 3 and 4
(stepping to prevent a fall on 4).
Assessment: Findings are consistent with diminished
gross motor and oculomotor function consequent to, or
exacerbated by, canal and otolith hypofunction. Impair-
ments include: unilateral canal and otolith hypofunction
left, diminished sensory organization with diminished
Pediatric Physical Therapy
use of vision and somatosensation, oculomotor deficit.
Intervention: Included 1) short term modifications for
school to prevent falls and enhance performance, 2) exer-
cises to include oculomotor and somatosensory training,
balance training (both with therapist and home activi-
ties). Home program was carried out 4 weekly; PT in-
tervention twice weekly for 3 months.
Outcomes: Outcomes: Short term intervention - modified
seating, enlarged print materials, and aide were success-
ful in preventing falls & improving school performance
(i.e. reading and completing desk work).
DVA improved to within normal limits, as did visual
tracking (no corrective saccades). Scores on PDMS im-
proved to the 20th percentile; leaning is no longer ob-
served. Child is successfully participating in extramural
basketball program with peers.
Discussion: Discussion: Identification of acquired unilat-
eral vestibular hypofunction and appropriately directed
intervention significantly enhanced school performance,
activities of daily living and quality of life for this young
intervention for all children suspect of vestibular dys-
function.
KEYWORDS: vestibular hypofunction, pediatrics, inter-
vention
THE EFFECTIVENESS OF LONG SITTING ON
HAMSTRING MUSCLE STRETCHING IN YOUNG
CHILDREN WITH SPASTIC DIPLEGIA
Rowland, Phyllis O.1; Kolobe, Hlapang3
1
Therapy, Northwestern Illinois Association, Saint Charles,
IL, USA
2
Physical Therapy, University of Illinois at Chicago,
Chicago, IL, USA
3
Rehabilitation Sciences, University of Oklahoma,
Oklahoma City, OK, USA
Purpose/Hypothesis: To compare the effectiveness of
prolonged passive stretch and repetitive (static) stretch in
increasing hamstring extensibility in children with
spastic diplegia. We hypothesized that prolonged passive
stretch would be more effective than repetitive stretch in
improving popliteal angle (PA); step/stride length,
cadence and speed during gait; and gross motor skills.
Number of Subjects: Participants were 4 children, 3 girls
and 1 boy (mean age 4 yrs 7 months; range 4 yrs 2
5 yr 1 month). The children represented Levels IIV of
the GMFCS.
Materials/Methods: This study employed a single-subject
cross-over design with random assignment of
intervention phases. Two methods of stretch, repetitive
(Phase B) and prolonged (Phase C) were implemented
using an ABAC or ACAB stretching sequence with
baseline interspersed between the types of stretch. The
initial baseline was 4 6 weeks with the subsequent
phases each 4 weeks long for a total of 16 18 weeks.
Goniometry, pedograph and GMFM-66 were used to
gather data on the popliteal angle (PA), time/distance gait
Abstracts for the 2006 Combined Sections Meeting 103
parameters, and motor skills. PA was measured with a
stabilization apparatus using an electronic digital
inclinometer. Spatiotemporal gait parameters were
obtained from pedograph assessments. Data on all
outcome measures were collected weekly. The data were
analyzed using visual analysis with determination of
statistical significance.
Results: Both repetitive and prolonged stretch methods
were effective in increasing hamstring muscle
hypoextensibility. Improvement was observed in 11 of 14
PA measures. The pattern of change in gait measures and
GMFM-66 scores was not consistent among the children.
Three subjects with a GMFCS level of II or lower
demonstrated an increase in step and stride lengths and
GMFM-66 scores that was commensurate with their
improved PA measures. The subject with a GMFCS level
of 1 demonstrated an increase in gait speed and cadence
that corresponded with improved PA measures for one of
the interventions.
Conclusions: The results of this study suggest that the
use of prolonged passive and repetitive stretching
methods on a short-term basis does not result in
differences in their effect on muscle length and gait.
There is a suggestion that a critical value in PA may need
to be attained before improvements in impairment
translate to enhanced function in gait and gross motor
skills thereby supporting previous findings.
Clinical Relevance: Tight hamstrings are a common
limiting factor in postural and functional mobility of
children with cerebral palsy. Physical therapists need
evidence to guide them in selecting effective methods of
stretching. Although no differences were observed
between the two methods in the outcomes employed in
this study, the single-subject design provided details and
information that therapists can use in deciding which
stretching program to implement and why. The
limitation is that the results cannot be generalized.
KEYWORDS: stretching, hamstrings, spastic diplegia
MODIFIED CONSTRAINT INDUCED MOVEMENT
THERAPY FOR CHILD WITH HEMIPLEGIA
Senesac, Claudia1; Helsel, Patty V.2; Breton, Justin3
1
Physical Therapy, University of Florida, Gainesville, FL, USA
2
Rehabilitation, Shands Health Care, Gainesville, FL, USA
3 1
Occupational Therapy, Bridging the Gap, Gainesville, FL, USA
Background & Purpose: CIMT has been a popular inter-
vention under investigation in the adult stroke popula-
tion. This intervention improves upper extremity func-
tion by restraining the non-involved arm in a hemiplegic
patient and forcing the use of the involved arm in func-
tional tasks. The practice sessions are intense with 6
hours of intervention a day for 2 weeks. CIMT is begin-
ning to be used in the clinic with the pediatric popula-
tion. Determining an effective way to deliver the intensity
of practice prescribed by the experimental protocols is
challenging. The purpose of this case study is to describe
104 Abstracts for the 2006 Combined Sections Meeting
a modified delivery of CIMT (mCIMT) in a pediatric pa-
tient with hemiplegia and the resultant outcomes.
Case Description: The subject of this case study was 4.6
years old with a history of hemiplegia of early onset at 4
months of age. A long arm cast was placed on the non-
involved upper extremity with the elbow in 90 degrees of
flexion and the hand, wrist and fingers in neutral in-
cluded in the cast for a period of 26 days. The subject
received formal PT and OT totaling 6 sessions/week (ap-
proximately 45 minutes each). To increase the intensity
of practice PT students were trained to provide practice
sessions in the home 6 days/week, 2 hours/day (totaling
32 hours). The family provided approximately 2-4 hours
of practice/day by incorporating practice into their every-
day activities and meal times. The subject received an
average of 5.5 hours of structured practice a day for 26
days combined home and clinic.
Outcomes: Meaningful improvement was determined
by comparing changes to SEM. Improvements on subtest
8: Upper-Limb Speed and Dexterity of the Bruininks-
Oseretsky Test of Motor Proficiency were meaningful
(SEM 2) with a standard score of 5 at pretest to 11-
post intervention. Peabody Developmental Motor Scale;
Fine Motor section improved from a FM quotient of 94 to
106 with the standard score (SS) 18 at pretest and SS
22 at post-test. Extrinsic finger flexion strength im-
proved from 2 to 4 pounds and intrinsic pinch strength
improved from 1 to 4 pounds both measured with dyna-
mometer.
Discussion: This case study demonstrated a meaningful
change in fine motor function and strength for a child
with hemiplegia after mCIMT. A modified delivery of
CIMT may prove to be an effective way to provide the
intensity of practice to affect a functional change in
children with hemiplegia. Further investigation into
the delivery of intense practice interventions, interven-
tion protocols, and appropriate outcome measures to
document change are necessary in the pediatric popu-
lation.
KEYWORDS: mCIMT (modified CIMT), hemiplegia,
intensity
BODY-WEIGHT SUPPORT TREADMILL STEPPING IN
INFANTS WITH SPINA BIFIDA
Smith, Beth A.1; Moerchen, Victoria A.2; Ulrich, Beverly D.1
Division of Kinesiology, University of Michigan, Ann
Arbor, MI, USA
2
Department of Physical Therapy and Rehabilitation
Science, University of Maryland School of Medicine,
Baltimore, MD, USA
Purpose/Hypothesis: The goal of this study was to map
the developmental trajectory of the stepping responses
of babies born with spina bifida (SB) over the first
postnatal year when in a body-weight supported tread-
mill (BWST) context. Depending on the lesion level,
20% (high lumbar lesion) to 90% (sacral lesion) of in-
fants with SB learn to walk but at a mean age of 3 years
Pediatric Physical Therapy
(Backer, 2002; Swank & Dias, 1992). Adults with spi-
nal cord injuries receive early and aggressive physical
therapy; infants with SB typically start therapy 6-9
months after birth (14-17 months post lesion). This
delay is likely due to the difficulty in identifying devel-
opmental delays earlier than 6 months of age and the
lack of evidence for early intervention approaches with
this population. Previous studies involving infants
with Down syndrome show that BWST training leads
to earlier walking (Ulrich et al., 2001). Before thera-
peutic interventions can be designed and tested we
need to know if, how, and when infants with SB will
step on the treadmill.
Number of Subjects: 11 Infants Born With Sb And 7 In-
fants With Typical Development (TD) Participated.
Materials/Methods: Newborn stepping response (NSR)
and treadmill responses (treadmill) were elicited at 1, 3,
6, 9, and 12 months. NSR trials consisted of infants being
held under the arms in a semi-weightbearing position
and moved forward slowly along a firm surface. During
treadmill trials we also held infants under the arms in a
semi-weightbearing posture for 2 20s trials in the follow-
ing conditions: baseline (treadmill belt stationary), 0.08,
0.12, 0.16, 0.20, and 0.24 m/s. We collected the following
data: video, joint position, EMG, & anthropometrics. For
purposes of this presentation we will focus on stepping
responses only.
Results: Trained behavior coders watched videos
(60Hz) and identified steps taken (alternating, single,
parallel, double) during NSR and treadmill trials. Mean
total number of NSR steps taken by infants with TD
remained relatively constant at 4.5 across months
(though SD reduced). For infants with SB, mean de-
creased from 4.5 to 2.5 across months (SD also re-
duced). Mean number of treadmill steps taken by in-
fants with TD increased non-linearly from 90 steps at
month 1 to 160 steps at month 12. Infants with SB
showed a mean decrease from month 1 to 3 (60 to 40
steps), followed by a plateau before increasing between
9 and 12 months to 90 steps.
Conclusions: Infants with SB showed a similar re-
sponse to infants with TD during newborn stepping
trials at month 1. Over time, infants with SB decreased
stepping while infants with TD retained a low but
more stable response. Infants with SB stepped less on
the treadmill overall, compared to peers with TD. They
also showed a period of minimal progress over the first
9 months. Nevertheless, infants with SB did respond to
the BWST context over the first postnatal year, demon-
strating the potential value for this as part of an inter-
vention strategy.
Clinical Relevance: Infants with SB demonstrate a delay
as early as 3 months of age and BWST intervention has
the potential to promote earlier onset of gait in this popu-
lation.
KEYWORDS: spina bifida, infant stepping, treadmill
Pediatric Physical Therapy
A COMPARISON OF COPING STRATEGIES OF
ADOLESCENTS WITH AND WITHOUT PHYSICAL
DISABILITIES
Smith, Catherine R.1; Cook, Sherry1; Frost, Karen1; Jones,
Melissa1; Wright, Paige1
1
Physical Therapy, University of Tennessee at Chattanooga,
Chattanooga, TN, USA
Purpose/Hypothesis: This study compared the effective-
ness of coping strategies of adolescents with physical dis-
abilities (n 19) to their non-physically disabled peers
(n 17).
Number of Subjects: Packets containing survey instru-
ments were distributed to 111 adolescents aged 13 to 17
with and without physical disabilities. Thirty-six packets
were returned (32.4% response rate); groups were
matched for gender and age
Materials/Methods: Survey instruments included: a) the
Piers-Harris Children Self Concept Scale, 2nd edition
(Piers-Harris), b) the Coping Responses Inventory (CRI),
c) a demographics questionnaire, and d) mobility impair-
ment survey developed by the investigators. The CRI is a
48-item self report scale administered to children aged
1218 with a sixth grade level. The instrument measures
eight domains of coping responses to stressful life cir-
cumstances: logical analysis, positive reappraisal, seeking
guidance and support, problem solving, cognitive avoid-
ance, acceptance or resignation, seeking alternative re-
wards, and emotional discharge. The Piers-Harris is a 60
item self report scale administered to children aged 718
years that demonstrate a second grade reading and writ-
ing level. Total self esteem is measured within 6 subscales
including behavioral adjustment, intellectual and school
status, physical appearance and attributes, freedom from
anxiety, popularity, and happiness and satisfaction. Data
analysis was performed using the Statistical Package for
the Social Sciences (SPSS, 12.0). Due to small sample size
and nominal and ordinal data collected, non-parametric
statistical tests were used to determine significance. Con-
trol vs experimental group scores on the Piers Harris and
CRI were compared using the chi-square statistical test.
To determine the correlation between data sets, a Spear-
man-Rho Correlation Matrix was calculated.
Results: Data analysis revealed no significant differences
in the coping strategy subscale measures between the two
groups. Moderately high negative correlation existed be-
tween severity of mobility impairment and cognitive
avoidance (0.527) and emotional discharge (0.530)
with a moderately high positive correlation demonstrated
between level of involvement requiring assistance for
BADL and seeking guidance (0.684) and problem solving
(0.486). Additionally, a moderately high positive correla-
tion was found between self-esteem and the 8 domains of
the CRI.
Conclusions: Adolescents with and without physical dis-
abilities cope with life stressors continuously. Coping
strategies differ amongst all adolescents, and are affected
Abstracts for the 2006 Combined Sections Meeting 105
by individual circumstances and self esteem concept. Ad-
olescents with physical disabilities who tend to avoid
stressful situations also tend to express negative feelings
through behavioral attempts to reduce tension.
Clinical Relevance: It is important take into consider-
ation the individual coping strategies of the adolescent
when designing intervention plans in order to optimize
the benefit to be gained.
KEYWORDS: coping strategies, self-esteem, adolescent
COPING BEHAVIORS OF PARENTS OF SCHOOL
AGE/LATENCY AGE CHILDREN WITH DISABILITIES
Smith, Catherine R.1; Jackson, Laura1; Sharpe, Lindsey1
1 families are facing in order to help them develop effective
Physical Therapy, University of Tennessee at Chattanooga,
Chattanooga, TN, USA
Purpose/Hypothesis: This study identified the coping
behaviors parents use to adjust to raising a latent/school
age child with a disability. The differences in coping be-
haviors between mothers and fathers were investigated as
well as differences between single and married parents of
children with disabilities.
Number of Subjects: Approximately 250 survey packets
were distributed to program directors, physical thera-
pists, occupational therapists and parents. Twenty-five of
these surveys were returned. Participation was also solic-
ited by placing a link to an electronic version of the sur-
vey on support group websites. Five electronic surveys
were received bringing the total sample size to 30 (n
30).
Materials/Methods: Two instruments were used in this
study. The Family Crisis Oriented Personal Evaluation
Scales (FCOPES) identifies coping strategies utilized by
families in difficult or problematic situations. The Coping
Health Inventory for Parent (CHIP) measures the parents
appraisal of the coping behaviors they use to manage
raising a child with a serious of chronic illness. In addi-
tion to the survey instruments, a demographics page was
included to identify pertinent information regarding the
parent and child.
Results: When analyzing the data from the FCOPES,
spiritual support was found to be utilized most often fol-
lowed by passive appraisal, reframing, mobilizing family
to acquire and accept help, and acquiring social support.
Social support was found to be used significantly less
than other coping behaviors (P 0.05). The CHIP re-
vealed maintaining family integration, cooperation, and
an optimistic definition of the situation was the most
helpful coping behavior, followed by understanding the
medical situation through communication with other
parents and consultation with medical staff. Maintaining
social support, self-esteem and psychological stability
was found to be significantly less helpful than the other
subscales (P 0.05). No significant differences were
found between coping behaviors of mothers and fathers,
nor married and single parents.
Conclusions: This study revealed social support was used
106 Abstracts for the 2006 Combined Sections Meeting
less frequently and reported less helpful than the other
coping behaviors. This finding contradicts much of the
current literature which reports that social support is one
of the most commonly cited coping strategies for parents
of physically and/or intellectually disabled children. This
study has shown that parents are not utilizing social sup-
port services. It is unknown however, if this is because
the parents view social support as not helpful, they do
not have enough time to engage, or they are not aware
the available services.
Clinical Relevance: Physical therapists have more fre-
quent and prolonged contact with both the family and
the child than most healthcare professionals. It is perti-
nent for physical therapists to understand the stress these
coping behaviors and to be able to provide information
regarding available resources.
KEYWORDS: coping strategies, parents, school-aged
children
ESOPHAGEAL ATRESIA AND
TRACHEOESOPHAGEAL FISTULA: A REVIEW OF
CURRENT LITERATURE
Tamminga, Janna S.1
1
Krannert School of Physical Therapy, University of
Indianapolis, Indianapolis, IN, USA
Purpose: Occupational and physical therapists working
in pediatrics are likely to encounter children with esoph-
ageal atresia (EA), tracheoesophageal fistula (TEF), or a
combination of these two conditions. It has been esti-
mated that up to 70% of children with EA and/or TEF
have associated developmental anomalies or defects. Al-
though an abundance of medical information is readily
available regarding these conditions, no literature has
been found that provides a general overview of these con-
ditions as they relate to therapy, let alone any specific
information for occupational and physical therapists re-
garding implications for treatment interventions. With
that in mind, this review offers an overview of EA/TEF,
providing a knowledge base for the practicing pediatric
therapist while presenting specific care implications to
serve as a guide when treating young children with these
conditions.
Description: Esophageal atresia with or without tracheo-
esophageal fistula is the most common congenital malfor-
mation of the esophagus. There are six major classifica-
tion types, with the Gross system most commonly used.
The most common type of EA/TEF consists of a proximal
EA and a distal TEF (Gross Type C). These congenital
anomalies occur approximately during the third and
fourth weeks of embryonic development. Several diag-
nostic tools are used in the diagnosis and intervention of
EA/TEF, depending upon the type and severity of the
anomaly. Surgical intervention is typically required soon
after the infants birth. Medical complications of EA/TEF
include multiple system anomalies, the vertebral, anorec-
tal, cardiac, tracheal, esophageal, renal and limb
Pediatric Physical Therapy
(VACTERL) association, dysphagia, gastroesophageal
reflux, respiratory problems, tracheomalacia, diminished
pulmonary function, and recurrent TEF after initial re-
pair. The implications of EA/TEF as these anomalies re-
late to occupational and physical therapy impact the
methods used for feeding because of poor esophageal
motility and aspiration, positioning the child during feed-
ing and gross motor activities, as well as timing of ther-
apy sessions to reduce the incidence of gastroesophageal
reflux. In addition, pulmonary compromise, scoliosis and
other chest wall deformities may be addressed through
therapeutic intervention.
Summary Of Use: To provide information regarding im-
plications for treatment interventions for occupational
and physical therapists working with children with EA/
TEF. Referenced tables depicting incidence, diagnostics,
medical and surgical treatments, associated complica-
tions, and therapeutic interventions are also presented.
Importance To Members: As the survival rate continues
to rise for children born with various medical conditions,
a constant flow of information is needed in order to edu-
cate occupational and physical therapists working in the
pediatric setting. Information regarding diagnostics, com-
plications, surgical interventions and treatment implica-
tions is needed in order for the pediatric therapist to
maintain a current base of knowledge.
KEYWORDS: esophageal atresia, tracheoesophageal fis-
tula, physical therapy
NEUROCOGNITIVE SEQUELAE OF REPAIRED
CONGENITAL HEART DISEASE (CHD)
Townsend, Elise L.1; Lohr, Jamie L.2; Nelson, Charles A.3
1 tant. PTs play an important role in the rehabilitation and
Physical Therapy, MGH-Institute of Health Professions,
Boston, MA, USA
2 ing their neurodevelopmental potential. When employing
Pediatric Cardiology, University of Minnesota,
Minneapolis, MN, USA
3 derstanding of multiple domains of development, includ-
Harvard Medical School, Boston, MA, USA
Purpose/Hypothesis: Children with cyanotic CHDs are at
risk for neurological damage due to lack of oxygen sup-
ply to the brain early in post-natal development. Global
delays/deficits in cognitive development, measured by
intellectual assessment, have been reported. The neural
basis of these cognitive impairments remains unclear.
The purpose of this research was to characterize cogni-
tive development in children with repaired CHD from a
neuroscientific perspective and attempt to elucidate spe-
cific patterns of deficits. The hippocampus is a brain
structure that subserves declarative memory. This struc-
ture is particularly vulnerable to oxygen deprivation, a
common occurrence both prior to and as a result of sur-
gical repair of cyanotic CHD. Therefore, we hypothesized
that children with repaired cyanotic CHD would show
deficits in declarative memory with relative sparing of
other cognitive functions.
Number of Subjects: Subjects were 711 year-old chil-
dren with repaired cyanotic CHD (n 12) and age-
matched controls (n 12).
Pediatric Physical Therapy
Materials/Methods: The Cambridge Neuropsychological
Testing Automated Battery (CANTAB) and an intellectual
assessment (WISC-III) were used to measure specific and
global cognitive function, respectively. The CANTAB is a
computerized battery of non-verbal, visually presented,
cognitive tasks with specific neural correlates. Children
also underwent a brief neurological exam by a physical
therapist.
Results: Global cognitive function of the CHD group was
within normal ranges, though significantly impaired
compared to matched controls (P 0.05). These findings
are largely consistent with previous reports. Specific neu-
rocognitive testing revealed that performance of cyanotic
CHD and control groups on specific cognitive tasks did
not differ significantly. However, consistent trends sug-
gest that children with repaired cyanotic CHD show sub-
tle decrements in memory and executive functions. Mul-
tiple regressions will be performed to identify risk factors
that predict variance in cognitive development.
Conclusions: Children with cyanotic CHD demonstrate
subtle global cognitive deficits. They may also demon-
strate specific deficits in memory, both that subserved by
the hippocampus and that thought to rely on frontal lobe
areas. The extant literature suggests children with CHD
often demonstrate gross and/or fine motor delays/deficits.
Thus, our future studies of children with CHD aim to
examine both cognitive and motor abilities to relate the
development of these entwined neurological functions.
Clinical Relevance: Recent advances in cardiac surgery
have improved the survival of children with CHDs.
Therefore, the identification and amelioration of neuro-
developmental morbidity has become increasingly impor-
care of children with CHD and are dedicated to maximiz-
a dynamic systems approach, we realize that a better un-
ing movement and cognition, will improve our evalua-
tion and treatment abilities and, ideally, translate to
improved patient outcomes.
KEYWORDS: congenital heart disease, neurocognitive
development
POSTURAL CONTROL AND BALANCE TRAINING IN
A PEDIATRIC PATIENT STATUS-POST
MEDULLOBLASTOMA REMOVAL
Toy, Stephanie L.1; Senesac, Claudia1; Trombini, Andrea2
1
University of Florida, Gainesville, FL, USA
2
Pediatrics, Shands at Magnolia Parke, Gainesville, FL, USA
Background & Purpose: Medulloblastomas are cerebellar
brain tumors that are the second most common brain
tumor to occur in children in the United States today.1
Postural control and balance deficits are impairments
frequently present after brain tumor surgical removal.
The systems theory of neural control of posture and bal-
ance suggests the musculoskeletal and neural systems
Abstracts for the 2006 Combined Sections Meeting 107
work together to help maintain normal postural control
through interactions of the individual with the task and
the environment. 5The purpose of this case study is to
describe physical therapy interventions and outcomes
specifically focused on improving postural control in a
patient that is status-post medulloblastoma removal.
Case Description: The subject of this case study was a
12-year-old male, 19 months post-surgery with a diagno-
sis of medulloblastoma and posterior fossa syndrome.
This report provides a description of the physical therapy
evaluation and interventions associated with this sub-
jects postural control and balance deficits. Interventions
used included static and dynamic balance activities, such
as tandem stance on an airex mat with a throwing activity
and traversal of a 6-inch balance beam, to increase the
use of ankle and hip strategies. Outcomes were assessed
at weeks 1, 4, and 8 with the Pediatric Balance Scale and
the Bruininks-Oseretsky Test of Motor Proficiency.
Outcomes: On the Pediatric Balance Scale, the score in-
creased from 50/56 initially to 54/56 at final evaluation.
Meaningful improvements on the Bruininks-Oseretsky
Test of Motor Proficiency were noted: Subtest 2: Balance,
initial score of 5 with final score equal to 9 (SEM 3.7)
and Subtest 4: Strength, initial score of 4 and final score
of 8 (SEM 2.0).
Discussion: Little research has been conducted on the
outcomes of children receiving physical therapy follow-
ing medulloblastoma removal. This case study demon-
strated that outpatient physical therapy interventions
have the potential to positively influence balance in the
pediatric cerebellar tumor population.
KEYWORDS: medulloblastoma, postural control, balance
deficits
PRESCHOOLHIGH SCHOOL PARTNERSHIP TO
ENRICH DEVELOPMENT OF INFANTS AND YOUNG
CHILDREN WITH MOVEMENT DYSFUNCTION
Vanderlinden, Darl1; Conley, Dan2; Sharkey, Mary Ann3
1 straint in all early childhood education programs, this
Physical Therapy, Eastern Washington University,
Spokane, WA, USA
2 opment of children with movement dysfunction.
Physical Therapy, Riverside School District, Chatteroy, WA, USA
3 KEYWORDS: pediatrics, movement dysfunction, move-
Physical Therapy Assistant, Spokane Falls Community
College, Spokane, WA, USA
Purpose: The purpose of this presentation is to describe an
innovative Preschool - High School partnership program
designed to enrich the motor development of preschool
children with immature or atypical movement patterns.
Description: Because young children require many repe-
titions to learn new motor skills and because direct phys-
ical therapy intervention in public schools is typically
limited in frequency and duration, we developed a pro-
gram whereby high school students can enhance the de-
velopment of young children in a preschool classroom.
Using the Child Directed Functional Movement Facilita-
tion (CDFMF) model, high school students work with
children in the preschool classroom after receiving spe-
108 Abstracts for the 2006 Combined Sections Meeting
cial training from the physical therapist. The primary
goal of CDFMF is to take the fear of movement away
from the child, which allows the child to learn more ef-
fectively from the teacher in the classroom. High school
students participate up to 5 hours each week in the class-
room and earn college credit from a local community
college for their work in the program. Using the CDFMF
model, they are taught how to provide physical cues and
guidance to increase the number of repetitions of nor-
mal movement. For instance, the high school students
are taught how to assist a child into an active 1/2 side-
sitting position, rather than allowing the child to W-sit.
This encourages the child to activate the abdominal mus-
cles as well as to develop trunk extension and postural
reactions during classroom activities such as circle time.
With the physical guidance provided by the high school
students, children participate in many more repetitions of
transitional movement throughout the preschool session
than they would without the presence of the high school
students in the classroom. All children with atypical or
immature movement are provided direct physical therapy
intervention by the physical therapist in the classroom,
but in addition, experience increased movement repeti-
tions due to the participation of the high school students
in the classroom. As a result, the children participate more fully
in all of the preschool classroom experiences, including activi-
ties that enhance cognitive and language development.
Summary of Use: Through this innovative preschool-
high school partnership, children in a preschool class-
room have increased opportunities to move using appro-
priate movement patterns during child-directed activities.
By implementing this model, physical therapists have the
opportunity to increase the number of movement repeti-
tions for young children on their caseload who have im-
mature movement or atypical movement patterns.
Importance To Members: By using trained high school
students, physical therapists can extend their influence
on motor development and increase the number of move-
ment repetitions in young children. In times of fiscal con-
model will allow physical therapists to maximize devel-
ment repetition
EFFECTS OF MEASUREMENT METHOD AND
SUBJECT CHARACTERISTICS ON THE
FUNCTIONAL REACH TEST IN TYPICALLY
DEVELOPING CHILDREN
Volkman, Kathleen G.1; Stergiou, Nicholas2; Stuberg,
Wayne1; Blanke, Daniel2; Stoner, Julie A.3
1
Munroe-Meyer Institute, University of Nebraska Medical
Center, Omaha, NE, USA
2
Health, Physical Education and Recreation, University of
Nebraska at Omaha, Omaha, NE, USA
3
Preventive and Societal Medicine, University of Nebraska
Medical Center, Omaha, NE, USA
Pediatric Physical Therapy
Purpose/Hypothesis: The purpose was to examine the
effects of four measurement methods on the Functional
Reach Test (FRT) measure in children using two meth-
ods of reach and two methods of measurement: 1 arm
finger-to-finger or 1AFF (the traditional method), 2 arm
finger-to-finger or 2AFF (hands clasped together), 1 arm
toe-to-finger or 1ATF (measured from tip of toes), and 2
arm toe-to-finger or 2ATF. Effects of gender, age, height,
lower extremity strategy and base of support (BOS) were
also studied. It was hypothesized that the methods would
differ from each other and one-arm scores and toe-to-
finger scores would be greater. It was expected that
scores would increase with age and height, but affects of
gender, strategy and BOS were unclear.
Number of Subjects: 80 Typically Developing Children,
Half Male And Half Female, Aged 716 Years Were Tested.
Materials/Methods: Subjects stood on paper next to a
measuring stick positioned at shoulder height. Feet were
traced on paper for BOS calculation (length times width
of stance). A subject used the same self-selected lower
extremity strategy on all tests (either feet flat or heels
up). Three trials were measured with the greatest dis-
tance score used. Toe-to-finger scores were calculated
mathematically from the location of the toes at the 0
point of the measuring stick. Each child was tested using
each of the four measurement methods at two different
times.
Results: Repeated measures ANOVA with pair-wise test-
ing using Tukeys method showed that mean measures
from the four methods were significantly different, toe-
to-finger scores being greater than finger-to-finger scores
(P 0.001 for one-arm and two-arm methods). One-arm
scores were greater than two-arm scores when the toe-to-
finger method was used and did not differ when the fin-
ger-to-finger method was used (P 0.001 and P 0.9,
respectively). The effects of age, height and BOS on FRT
scores were significant (P 0.05) while gender and strat-
egy were not. FRT scores increased with age, height and
BOS. Mean reach scores increased with age (7 8 versus
1112 year olds) in 1ATF and 2ATF methods after ad-
justing for confounding effects of subject characteristics
(P 0.05, and P 0.02, respectively). Mean scores
tended to increase across height groups in each method
except between the two shortest groups. The mean scores
tended to increase with BOS in the 1ATF method only.
Conclusions: Measurement was affected by reach method
and subject characteristics of age, height, and BOS, espe-
cially for toe-to-finger methods. The three tallest height
groups significantly differed from each other in the toe-
to-finger methods, possibly making height groups more
useful than age groups when comparing FRT scores
across children.
Clinical Relevance: In the literature, age groups have
been used for normative data in children. These results
show height groups might be preferred for comparing
FRT scores across children rather than age or BOS groups
in toe-to-finger methods. Lower extremity strategy may
Pediatric Physical Therapy
not be important as long as the strategy is consistent dur-
ing testing.
KEYWORDS: functional reach, balance test, children
EXERCISE AND NUTRITION SCHOOL PROGRAM
FOR ADOLESCENTS CLASSIFIED AS AT RISK FOR
OR OVERWEIGHT
Wagner, Barbara R.1; Grant-Beuttler, Marybeth1; Borja,
Marianne2; OConnor, Colleen1; Strong, Megan1; Lemoncelli,
Marlee2; Kertesz, Matthew.2
1
PT, University of Scranton, Scranton, PA, USA
2
Nutrition and Dietetics, Marywood University, Scranton,
PA, USA
Purpose/Hypothesis: Pennsylvania Health Secretary re-
ported in February 2004 that 18% of 8th graders are
overweight with another 17% at risk of becoming over-
weight. According to the Center for Disease Control,
overweight status increases the risk for long-term and
short-term physical, social and emotional consequences.
This program was designed to decrease the effects of
overweight status for students in a local middle school.
Number of Subjects: Thirty four middle school students
volunteered to participate. Students ranged in age from
11 to 14 years with 96.3% above the 95th percentile on
the age growth charts.
Materials/Methods: Prior to and following intervention,
students participated in measures of body composition
using DEXA scans and skin fold, self-esteem, body im-
age, and, cardiovascular health/efficiency using a 12
minute walk and a 3 minute step test. Intervention
occurred during the school day and consisted of nutri-
tion education one time each week using Way to Go
Kids program and exercise twice each week over a 10
week period.
Results: Statistically significant improvements were ob-
served on DEXA scans with a decrease in body fat com-
position and an increase in lean body mass. Statistically
significant improvements in cardiovascular measures
were observed with a decrease in working heart rate dur-
ing the 12 minute walk and an increase in number of
steps performed in 3 minutes. Mean score improvements
were observed in self-esteem with the largest change in
Physical Appearance and Attributes subscale. Nutritional
measures also demonstrated decreases in mean calories,
protein, carbohydrates, fat, saturated fat, cholesterol, fi-
ber, % calories from fat, and % calories from saturated
fat. Changes in mean scores on self-esteem or nutritional
measures were not significant with low statistical power.
Conclusions: Improvements were noted in school chil-
dren classified as at risk or overweight following a 10
week nutrition and exercise school based program. Addi-
tional research is needed to determine the most effective
outcome measures and intervention strategies for a mid-
dle school based program with students at risk for or
overweight.
Clinical Relevance: Intervention in schools by physical
Abstracts for the 2006 Combined Sections Meeting 109
therapists and nutritionists may be effective in decreasing
physical, social, and emotional consequences in over-
weight and at risk middle school students.
KEYWORDS: exercise, overweight, adolescents
A TWO YEAR OLD WITH A BRACHIAL PLEXUS
INJURY TREATED WITH KINESEOTAPE AND
EXERCISE
Walsh, Sharon F.1
1
Physical Therapy, The University of Findlay, Findlay, OH, USA
2
Neurology, Rocky Mountain University of Health
Professions, Provo, UT, USA
Background & Purpose: Brachial plexus injuries are fre-
quently seen in the physical therapy department with
treatment most often beginning soon after birth. Many
treatments such as surgery, bracing, and E-stim meet
with very poor compliance. The purpose of this case
study will be to describe the treatment and subsequent
progress of a 2 year old child whose brachial plexus injury
was treated successfully with kineseotape and exercise.
Case Description: The subject was a 2 year old female
with a diagnosis of brachial plexus injury. She had been
treated by a previous therapist until 1 1/2 years of age
and was discontinued from therapy when she plateaued.
A followup at a large urban center was successful until
x-rays demonstrated severe inferior subluxation of the
humeral head and severe winging of the scapula. The
subject was fitted with a night time brace to stretch
shoulder internal rotators. E-stim was recommended.
Reconstructive surgery was also scheduled in six months.
At the initial physical therapy examination she was ob-
served to hold the involved shoulder in approximately 80
degrees of abduction, displayed significant asymmetry
between sides, used the arm only as an assist, and always
110 Abstracts for the 2006 Combined Sections Meeting
transferred objects to the noninvolved hand for manipu-
lation. Treatment at the outpatient clinic consisted of
discontinuing use of the night resting brace as it was im-
possible for the child to sleep, discontinuing E-stim as
not feasible for a child of her young age, beginning pa-
tient education, and initiating kinesotape to facilitate ro-
tator cuff and scapular stabilizer function. The parent
typically left the tape on for 23 days before reapplying,
with the average weekly wear time of 4 5 days/week.
Outcomes: After only 2 weeks of taping (4 visits), there
was significant progress. The deltoid muscle definition
was prominent. The subject typically held her shoulder
in approximately 20 degrees of abduction. Her shoulders
were level and her scapula was displaying less winging.
Tape was then added for scapular stabilizers. At the end
of 4 weeks of taping (6 visits), her involved arm was held
to her side similar to her uninvolved arm. She used the
involved arm to initiate activities, no longer transferred
objects to the uninvolved arm, and displayed increased
fine motor use with the involved hand. The subjects in-
volved arm also displayed a very stable scapula on the
thoracic spine with negligible asymmetry. Treatment
continued for 3 months. X-rays of the involved shoulder
displayed an intact shoulder with good position of the
humeral head in the socket.
Discussion: Treatment of shoulder dislocation began
quite late for this child, almost 2 years after her diagno-
sis. Many of the treatments suggested were inappropriate
for a child of her age. With the use of simple kinesotape
and parent education for follow through, weekly therapy
visits made a significant difference in the functional use
of the involved upper extremity. Research needs to follow
in this area so that unnecessary surgery and expensive
treatments for children of this age do not occur.
KEYWORDS: brachial plexus, kineseotape, children
Pediatric Physical Therapy