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Kumar DS, Bodt BA, Galloway JC. Real-world environmental enrichment rehabilitation paradigm in people with severe traumatic brain injury: a pilot feasibility study. Brain Inj 2024; 38:742-749. [PMID: 38695288 DOI: 10.1080/02699052.2024.2347551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/22/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND The use of Environmental Enrichment (EE) has been widely studied in animal models. However, the application of the same in humans is limited to rehabilitation settings. OBJECTIVE To investigate the feasibility of a community-based EE paradigm in adults with brain injury. METHODS Six individuals diagnosed with traumatic brain injury enrolled in the study. The Go Baby Go Café instrumented with a body weight harness system, provided physical and social enrichment as participants performed functional tasks for 2 hours, three times a week, for 2 months. Feasibility and safety outcomes were recorded throughout sessions. Clinical measures including 10-meter walk, timed up and go, jebsen hand function, 6-minute walk, and trail making tests were obtained pre and post intervention. RESULTS All participants completed the study. The attendance was 100% and adherence was 87%. Positive changes in clinical measures were statistically significant for the timed up and go (p = 0.0175), TUG-cognitive (p = 0.0064), 10-meter walk (p = 0.0428), six-minute walk (p = 0.0196), TMT-A (p = 0.034). Changes in JHFT were not significant (p = 0.0506), with one subject recording values counter to the trend. CONCLUSION The Café was a comprehensive EE-based intervention that was feasible, safe, and has the potential to enhance motor and cognitive function in individuals with brain injury.
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Affiliation(s)
- Devina S Kumar
- Burke Neurological Institute, White Plains, New York, USA
| | | | - James C Galloway
- University of Delaware, Newark, Delaware, USA
- Baylor University, Waco, Texas, USA
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Abuatiq RA, Hoffman ME, LaForme Fiss A, Looper J, Feldner HA. Exploring the Efficacy of a Dynamic Harness System on Gross Motor Development and Motivation for Infants With Down Syndrome: A Pilot Study. Pediatr Phys Ther 2024:00001577-990000000-00099. [PMID: 39073058 DOI: 10.1097/pep.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
PURPOSE To explore the benefits of a Partial Body Weight Support (PBWS) harness system within a play enriched environment on gross motor development and mastery motivation of infants with Down Syndrome (DS). METHODS A randomized crossover study with 17 pre-walking infants with DS in two conditions-play with or without the harness engaged-each for 3×/week over 3 weeks with a 1-week washout. Assessments took place at baseline, crossover, and completion. RESULTS Statistically and clinically significant changes were evident on the Gross Motor Function Measure-88; however, there were no significant changes in parent-reported mastery motivation. CONCLUSION The combination of PBWS harness system support and high frequency-facilitated play within an enriched play environment positively affected gross motor development. The intervention did not impact mastery motivation skills, and the direct impact of the harness remains unclear.
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Affiliation(s)
- Reham A Abuatiq
- Department of Rehabilitation Medicine (Ms Abuatiq and Dr Feldner), University of Washington; Department of Mechanical Engineering (Ms Hoffman), University of Washington, Seattle, Washington State; School of Physical Therapy (Dr LaForme Fiss), Texas Woman's University, Dallas, Texas; Physical Therapy Department (Dr Looper), University of Puget Sound, Tacoma, Washington State
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Sabet A, Galloway JC. Harnessing Mobility: A Medically Complex Child's Home Program Utilizing an In-Home Body Weight Support System. Pediatr Phys Ther 2024; 36:347-352. [PMID: 39023763 DOI: 10.1097/pep.0000000000001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
PURPOSE To describe a home program for a child with medical complexity using an over-ground body weight support (BWS) system. SUMMARY OF KEY POINTS Children with medical complexity often use home programs due to challenges with regular therapy attendance. In this case, effective home program components including child centered design, family leadership, and best practice principles were prioritized around the PUMA (portable mobility aid for children). This BWS system was to be used for 1 hour per day to support mobility and active play. STATEMENT OF CONCLUSIONS The CMC and family demonstrated high adherence, using over-ground BWS 87% of the 135 days it was accessible with an average daily usage of 59 min spread across 1-3 bouts per day. The average daily fun index during usage was 7/10. RECOMMENDATIONS FOR CLINICAL PRACTICE This home program demonstrated over-ground BWS technology as a feasible, fun platform for functional mobility and socialization in a child with significant medical and physical limitations.
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Affiliation(s)
- Andrina Sabet
- Go Baby Go, Mobility Matters, LLC, Cleveland, Ohio (Ms Sabet); Go Baby Go, University of Delaware, Newark, Delaware Physical Therapy, Baylor University, Waco, Texas (Dr Galloway)
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Iammarino MA, Alfano LN, Reash NF, Sabo B, Conroy S, Noritz G, Wendland M, Lowes LP. Feasibility and utility of in-home body weight support harness system use in young children treated for spinal muscular atrophy: A single-arm prospective cohort study. PLoS One 2024; 19:e0300244. [PMID: 38502672 PMCID: PMC10950233 DOI: 10.1371/journal.pone.0300244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
PURPOSE This single-arm prospective cohort study aimed to evaluate the feasibility and utility of in-home body weight support harness system (BWSS) use in children treated for spinal muscular atrophy (SMA). METHODS Individuals with 2 or 3 copies of SMN2 who received pharmacotherapeutic treatment, had head control, and weight <50lbs were enrolled. Families were provided a BWSS and documented use. Motor outcome assessments were completed at baseline, month 3 and month 6. Families provided feedback in an end of study survey. RESULTS All 32 participants (2.9 (SD 1.9) yrs), improved or remained stable on all outcomes. Average reported frequency of use was 4.1(2.3) hrs/week. Controlling for other covariates, frequency of use explained over 70% of the variability in change scores. Family feedback was overwhelmingly positive. CONCLUSION Use of in-home BWSS is a safe, feasible and useful option to increase exercise dosage after treatment in SMA and may help optimize motor abilities. TRIAL REGISTRATION Study registered with: Clinicaltrials.gov Clinicaltrials.gov identifier: NCT05715749.
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Affiliation(s)
- Megan A. Iammarino
- Center for Gene Therapy, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Lindsay N. Alfano
- Center for Gene Therapy, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, United States of America
| | - Natalie F. Reash
- Center for Gene Therapy, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Brenna Sabo
- Center for Gene Therapy, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Sara Conroy
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- Biostatistics Resource at Nationwide Children’s Hospital, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- School of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Madalynn Wendland
- Doctor of Physical Therapy Program, Cleveland State University, Cleveland, Ohio, United States of America
| | - Linda P. Lowes
- Center for Gene Therapy, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, United States of America
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Subramaniam S, Wang E, Bhatt T. A survey to assess perspectives of people with chronic stroke about customized safety harnesses for dance-based exergaming in home settings. PM R 2023; 15:1249-1257. [PMID: 36459574 DOI: 10.1002/pmrj.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Early dance-based exergaming (DBExG) trials in people with chronic stroke (PwCS) have shown promising results, but there remains a lack of knowledge if PwCS are interested in receiving such training in their homes and the applicability of a fall-protection safety harness in the home environment. OBJECTIVE To survey people with chronic stroke to understand the perspectives and preferences of various customized safety harnesses for home-based harness assisted dance-based exergaming rehabilitation. METHODS Participants were included in this survey study if they had a stroke, lived in the community, and understood English. Participants completed a study-specific safety harness survey via mail, in-person, or online. Descriptive statistics were used to characterize the sample and survey responses. RESULTS One hundred two survey responses were returned. The majority of participants voted for a door mountable harness (51%), side-release style buckle (58%), and preferred to receive a manual to explain how to use the harness (51%). Seventy-eight percent of the participants required permission to install or use a harness system in their homes. More than half of the participants preferred exhibiting independence by strapping the harness themselves (68%), along with choosing to live independently (the ability to live in one's own home and community safely, independently, comfortably, and able also perform their activities of daily living, regardless of physical ability level) (89%). CONCLUSIONS PwCS opted to use ShA-DBExG in their homes. The current survey serves as a guideline to develop, customize, and prescribe home-based ShA-DBExG rehabilitation.
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Affiliation(s)
- Savitha Subramaniam
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Edward Wang
- Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
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Helmi A, Wang TH, Logan SW, Fitter NT. Harnessing the Power of Movement: A Body-Weight Support System & Assistive Robot Case Study. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941223 DOI: 10.1109/icorr58425.2023.10304811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Young children with motor disabilities face extra obstacles to engaging in movement and initiating social interaction. A body-weight support harness system (BWSS) allows a child to take steps, explore the environment, and interact with people and objects, but further research is needed to understand how this type of system can help children with motor disabilities. Assistive robots have the potential to keep a child engaged and motivated during physical therapy sessions with a BWSS. We conducted a case study over three and a half months to understand if the BWSS alone and if the BWSS with an assistive robot could promote child movement and engagement. Our results show that the child tended to increase their amount of movement over each session with the BWSS. The assistive robots used in this study also tended to keep the child engaged. The products of this work can benefit clinicians and researchers interested in early mobility intervention technologies, as well as roboticists working in the child mobility domain.
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Kumar DS, Galloway JC. Feasibility of a home-based environmental enrichment paradigm to enhance purposeful activities in adults with traumatic brain injury: a case series. Disabil Rehabil 2021; 44:3559-3565. [PMID: 33417505 DOI: 10.1080/09638288.2020.1868583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the feasibility, safety, and functional recovery of an Environmental Enrichment (EE) inspired paradigm for enhancing daily activities in people with traumatic brain injury. METHODS Two TBI-Caregiver dyads participated in the six-month study. A preinstalled harness provided the support structure that enabled the family to perform task-specific functional and cognitive goals. The pre- and post-intervention evaluations included the safety, feasibility, and clinical outcomes such as the 10-m walk test, the Timed Up and Go test, the Jebsen Hand Function test, the Six-Minute Walk test, and the Trail Making Test. The Actigraph GT9X recorded the Caregiver-TBI step count during days spent in harness and out of harness. RESULTS The study was feasible, safe, and both TBI subjects improved in functional outcomes. Analysis of Actigraph GT9X yielded mixed results. CONCLUSION A partnership with caregivers and adults with TBI to design an EE-focused community program could improve functional activities in real life. To optimize this intervention, caregivers will likely need an alternate approach to record time spent in the harness.IMPLICATIONS FOR REHABILITATIONThe complexities of the real world encourage meaningful activities and participation.Autonomy in everyday activities is an important long-term objective for adults with brain injury.Community-tailored harnesses designed to prevent falls encourages physical activity and social interaction.
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Affiliation(s)
- Devina S Kumar
- Department of Physical Therapy, Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - James C Galloway
- Department of Physical Therapy, Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
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In-Home Mobility Training With a Portable Body Weight Support System of an Infant With Down Syndrome. Pediatr Phys Ther 2020; 32:E76-E82. [PMID: 32991571 DOI: 10.1097/pep.0000000000000752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report on the feasibility of an open-area, portable body weight support system (PBWSS) for in-home use and overground mobility training in an infant with Down syndrome. SUMMARY OF KEY POINTS The family used the PBWSS on average 4 days/week and for a mean duration of 27.9 minutes/day. Within sessions, the infant's mobility in the open area was greater with PBWSS assistance. The infant's mobility increased whereas variable trends were noted in the infant's motor, language, and cognitive development. CONCLUSIONS The long-term and frequent use of the PBWSS by this family provided opportunities to practice on emerging motor skills and exploratory actions that may have had a positive effect on her mobility and overall development. RECOMMENDATION FOR CLINICAL PRACTICE High-dose, body weight-supported training on emerging motor skills is feasible in the infants' natural environments. Future studies using a large sample will quantify the effects.
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Exploring the Unmet Need for Technology to Promote Motor Ability in Children Younger Than 5 Years of Age: A Systematic Review. Arch Rehabil Res Clin Transl 2020; 2:100051. [PMID: 33543078 PMCID: PMC7853335 DOI: 10.1016/j.arrct.2020.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To (1) identify types of technology that promote motor ability in children younger than 5 years of age, (2) report on the type of support these devices provide, and (3) evaluate their potential for use in the community (outside of the laboratory or clinic). Data Sources A literature search of PubMed was conducted in February 2019 using specific terms, including child, rehabilitation, movement, and instrumentation. Study Selection The search yielded 451 peer-reviewed articles, which were screened by multiple reviewers. Articles that described the use of devices for the purpose of motor rehabilitation and/or assistance (regardless of device type or body part targeted) in the age range of 0-5 years were eligible for inclusion. Data Extraction In conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, final stage data extraction consisted of full text readings where each article was reviewed twice by 3 independent reviewers. Data Synthesis About half of the devices available (46%) for children younger than 5 years of age are orthotics and corrective casting devices. There are more facilitative (ie, power mobility devices) than inhibitive (ie, casting) technologies being used. Approximately 60% of the devices are designed for use by a single body part. Walking is the most common motor skill addressed. Although most of the devices were used to some degree outside of the laboratory or clinic, most of the devices available are considered investigative and are not available for commercial purchase. Conclusions Many types of pediatric devices to assist movement exist, but the current scope of employed devices is limited. There is a need for developing technology that allows for, if not supports, high-dosage, early, and variable motor practice that can take place in community settings.
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Kokkoni E, Mavroudi E, Zehfroosh A, Galloway JC, Vidal R, Heinz J, Tanner HG. GEARing smart environments for pediatric motor rehabilitation. J Neuroeng Rehabil 2020; 17:16. [PMID: 32041623 PMCID: PMC7011606 DOI: 10.1186/s12984-020-0647-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/20/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There is a lack of early (infant) mobility rehabilitation approaches that incorporate natural and complex environments and have the potential to concurrently advance motor, cognitive, and social development. The Grounded Early Adaptive Rehabilitation (GEAR) system is a pediatric learning environment designed to provide motor interventions that are grounded in social theory and can be applied in early life. Within a perceptively complex and behaviorally natural setting, GEAR utilizes novel body-weight support technology and socially-assistive robots to both ease and encourage mobility in young children through play-based, child-robot interaction. This methodology article reports on the development and integration of the different system components and presents preliminary evidence on the feasibility of the system. METHODS GEAR consists of the physical and cyber components. The physical component includes the playground equipment to enrich the environment, an open-area body weight support (BWS) device to assist children by partially counter-acting gravity, two mobile robots to engage children into motor activity through social interaction, and a synchronized camera network to monitor the sessions. The cyber component consists of the interface to collect human movement and video data, the algorithms to identify the children's actions from the video stream, and the behavioral models for the child-robot interaction that suggest the most appropriate robot action in support of given motor training goals for the child. The feasibility of both components was assessed via preliminary testing. Three very young children (with and without Down syndrome) used the system in eight sessions within a 4-week period. RESULTS All subjects completed the 8-session protocol, participated in all tasks involving the selected objects of the enriched environment, used the BWS device and interacted with the robots in all eight sessions. Action classification algorithms to identify early child behaviors in a complex naturalistic setting were tested and validated using the video data. Decision making algorithms specific to the type of interactions seen in the GEAR system were developed to be used for robot automation. CONCLUSIONS Preliminary results from this study support the feasibility of both the physical and cyber components of the GEAR system and demonstrate its potential for use in future studies to assess the effects on the co-development of the motor, cognitive, and social systems of very young children with mobility challenges.
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Affiliation(s)
- Elena Kokkoni
- Department of Bioengineering, University of California, Riverside, CA 92521 USA
- Department of Mechanical Engineering, University of Delaware, Newark, DE 19716 USA
| | - Effrosyni Mavroudi
- Department of Biomedical Engineering and Mathematical Institute for Data Science, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Ashkan Zehfroosh
- Department of Mechanical Engineering, University of Delaware, Newark, DE 19716 USA
| | - James C. Galloway
- Department of Physical Therapy and Biomechanics and Movement Science Program, University of Delaware, Newark, DE 19713 USA
| | - Renè Vidal
- Department of Biomedical Engineering and Mathematical Institute for Data Science, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Jeffrey Heinz
- Department of Linguistics and Institute of Advanced Computational Science, Stony Brook University, Stony Brook, NY 11794 USA
| | - Herbert G. Tanner
- Department of Mechanical Engineering, University of Delaware, Newark, DE 19716 USA
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Kokkoni E, Galloway JC. User-centred assistive technology assessment of a portable open-area body weight support system for in-home use. Disabil Rehabil Assist Technol 2019; 16:505-512. [PMID: 31809205 DOI: 10.1080/17483107.2019.1683236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Current paediatric technology lacks mobility devices that support early, high-dose and variable movement that can be managed by professionals and parents outside of the lab or clinic. Parent acceptability of the technology is a critical piece to the continued use of devices by their infants. The purpose of this study was to determine the level of feasibility of an in-home application of a novel portable body weight support system (PBWSS), designed for community use. METHOD Sixteen typically and atypically developing infants used the system for four sessions at the home and lab. Parents assisted with the in-home system setup and completed a questionnaire on their: (a) infant's behavioural change, (b) infant's enjoyment, (c) own satisfaction, need and predicted use of the device, and (d) recommendations for future modifications. RESULTS Parents and their infants successfully used the device during a wide range of activities. Parents noted positive changes in their infants' behaviour including their infants initiating certain behaviours for the first time. Parents quickly learned to setup and use the device and were satisfied with its current structure. Future modifications included increasing the wearable harness comfort. CONCLUSION Infant performance and parent perceptions support the development of devices that place body-weight supported activity in real-world environments to promote high-dose, enriched experiences for young infants with mobility challenges.Implications for rehabilitationAssistive technology that can support multiple aspects of mobility in developing infants is limited.The in-home application of open-area body weight support systems has the potential to support early, enriched, high-dose mobility.Users of this technology, infants and their parents, were meaningfully involved throughout the assessment process.Preliminary findings support that: (1) this device was successfully implemented in these homes, (2) parents and infants enjoyed using the device, (3) parents noted positive changes in their infant's behavior, and (4) parents perceived the device to be safe and easy to use.Future studies can now determine the optimal use of this device with a range of pediatric populations.
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Affiliation(s)
- Elena Kokkoni
- Department of Bioengineering, University of California, Riverside, CA, USA.,Department of Physical Therapy, Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - James Cole Galloway
- Department of Physical Therapy, Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
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Rahlin M, Barnett J, Becker E, Fregosi CM. Development Through the Lens of a Perception-Action-Cognition Connection: Recognizing the Need for a Paradigm Shift in Clinical Reasoning. Phys Ther 2019; 99:748-760. [PMID: 30810752 DOI: 10.1093/ptj/pzz026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 12/02/2018] [Indexed: 11/14/2022]
Abstract
Clinical assessment of movement and posture guides the decision-making process in designing interventions for infants and children with movement disorders. Clinical reasoning is influenced by the therapist's understanding of developmental processes. The views of development grounded in perception-action, dynamic systems, and neuronal group selection theories are well recognized in current literature and supported by a large body of research. Based on the available evidence, intervention must be task-specific, repetitive, and highly salient to the child. Furthermore, it must honor spontaneous exploration and active problem-solving, enhance the child's ability to perceive environmental affordances, and target optimal variability and adaptability of movement and posture. However, a neuromaturational approach to developmental assessment and intervention that relies on "teaching" motor milestones and emphasizes the importance of correcting movement patterns in infants and children developing atypically is still prevalent in the clinic. This perspective paper will: (1) examine evidence in support of a paradigm shift from neuromaturational views toward bringing the concepts of grounded cognition, variability, complexity, and adaptability to the forefront of clinical reasoning; and (2) introduce the Perception-Action Approach as a method of assessment and intervention that may serve as an agent of such a shift by augmenting knowledge translation for the clinician.
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Affiliation(s)
- Mary Rahlin
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064 (USA)
| | - Joyce Barnett
- Ability Occupational Therapy Services, LLC, Anchorage, Alaska
| | - Elaine Becker
- Department of Physical Therapy, New York University, New York City, New York. Dr Becker is a Board-Certified Clinical Specialist in Pediatric Physical Therapy
| | - Charlene M Fregosi
- Outpatient Therapies and Audiology, Tucson Medical Center, Tucson, Arizona. Ms Fregosi is a Board-Certified Clinical Specialist in Pediatric Physical Therapy
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