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Waiserberg N, Horev T, Feder-Bubis P. "When everyone is responsible, no one takes responsibility": exploring pediatric physiotherapy services in Israel. Isr J Health Policy Res 2024; 13:10. [PMID: 38414047 PMCID: PMC10900823 DOI: 10.1186/s13584-024-00597-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND According to Israel's National Health Insurance Law (1994), the Ministry of Health is responsible for the provision of health services in the country including physiotherapy services; moreover, the Special Education Law (1988), stipulates that physiotherapy services for children with motor disabilities, as well as other allied health services, are provided by the Ministry of Education in educational settings. Thus, children with motor disabilities are entitled PT services under two different laws by two different ministries. METHOD To describe the physiotherapy services for children with motor disabilities and examine how policymakers view these services, we conducted a qualitative study including in-depth semi-structured interviews with 10 policymakers from the Ministry of Health and the Ministry of Education, and the national directors of physiotherapy services from three of the four health maintenance organizations in Israel. RESULTS Study results indicate that there is an array of physiotherapy services and providers. Despite the regulation of these services for children with motor disabilities, uncertainty and lack of knowledge were found about various issues. Therefore, the thematic analysis was structured around four descriptive questions: Where do the children receive physiotherapy? Who is eligible for physiotherapy treatment and who receives treatment? What interventions do children with motor disabilities receive? Who provides therapy for children with motor disabilities? CONCLUSIONS Policymakers are dubious regarding the provision of these services, questioning whether children with motor disabilities receive physiotherapy services according to their needs. In addition, the abundance of suppliers does not necessarily improve the quality of services provided to children with motor disabilities, which may ultimately harm their developmental potential.
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Affiliation(s)
- Nilly Waiserberg
- Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, David Ben Gurion Blvd 1, P.O.B. 653, Beer-Sheva, Israel.
- Department of Physical Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Chaim Levanon Street, P.O.B. 39040, Tel Aviv, Israel.
| | - Tuvia Horev
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, David Ben Gurion Blvd 1, P.O.B. 653, Beer-Sheva, Israel
| | - Paula Feder-Bubis
- Department of Health Policy and Management, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, David Ben Gurion Blvd 1, P.O.B. 653, Beer-Sheva, Israel
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McLean LJ, Paleg GS, Livingstone RW. Supported-standing interventions for children and young adults with non-ambulant cerebral palsy: A scoping review. Dev Med Child Neurol 2022; 65:754-772. [PMID: 36463377 DOI: 10.1111/dmcn.15435] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 12/07/2022]
Abstract
AIM To describe the evidence, outcomes, and lived experience of supported standing for children and young adults with cerebral palsy aged 25 years or younger, classified in Gross Motor Function Classification System levels IV and V. METHOD This scoping review included searches in eight electronic databases and manual searching from database inception to May 2020 and updated on 21st February 2022. Two of three reviewers independently screened titles and abstracts and extracted and appraised data. Methodological quality and risk of bias were appraised using tools appropriate to study type. Content analysis and frequency effect sizes were calculated for qualitative and descriptive evidence. RESULTS From 126 full-text references, 59 citations (one study was reported over two citations) were included: 16 systematic reviews, 17 intervention studies reporting over 18 citations, eight analytical cross-sectional studies, five descriptive cross-sectional/survey studies, five qualitative studies, and one mixed-methods study were identified, along with six clinical guidelines. Maintenance of bone mineral density and contracture prevention outcomes were supported by the most experimental studies and evidence syntheses, while evidence supporting other outcomes was primarily quasi-experimental or descriptive. Qualitative evidence suggests that programmes are influenced by attitudes, device, child, and environmental factors. INTERPRETATION Individualized assessment and prescription are essential to match personal and environmental needs. Although experimental evidence is limited due to many factors, lived-experience and cohort data suggest that successful integration of standing programmes into age-appropriate and meaningful activities may enhance function, participation, and overall health.
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Affiliation(s)
- Lynore J McLean
- Neuromotor Program, Sunny Hill Health Centre, Vancouver, BC, Canada
| | - Ginny S Paleg
- Montgomery County Infants and Toddlers Program, Silver Spring, MD, USA
| | - Roslyn W Livingstone
- Occupational Science and Occupational Therapy University of British Columbia, Vancouver, BC, Canada
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Kim M, Park C, Jeon H, Choi WJ, You SJH. Comparative effects of community-based family-child-centered care and conventional pediatric rehabilitation for cerebral palsy. NeuroRehabilitation 2021; 49:533-546. [PMID: 34776430 DOI: 10.3233/nre-210219] [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: 12/27/2022]
Abstract
BACKGROUND While the transdisciplinary-based rehabilitation provided ample evidence on improving impairment (body structure and functions) levels, the therapeutic effects on the international classification of functioning, disability, and health (ICF) domains are unknown in cerebral palsy (CP). OBJECTIVE To compare the effects of the community-based family-child-centered care (CFC) and conventional pediatric rehabilitation (CPR) on the physical, cognitive, sensory, and social integration domains in children and adolescents with CP. METHODS Twenty-six participants with CP (mean age = 9.37±5.24, 14 females) were assigned into either CPR or CFC groups. Clinical outcomes included gross motor function measure (GMFM-66), Pediatric Balance Scale (PBS), fine motor area of Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2), Functional Independence Measure (FIM) cognition area, Short Sensory Profile (sSP), COPM, Pediatrics Quality of Life (PedsQL) questionnaire, Short Falls Efficacy Scale (sFES), and Dynamic Postural Instability (DPI). An analysis of variance (ANOVA) and an analysis of covariance (ANCOVA) was conducted at P < 0.05. RESULTS ANOVA revealed the superior effects of CFC in GMFM-66, PBS, BOT-2, FIM, and PedsQL compared to CPR (P < 0.05). ANCOVA showed the superior effects of CFC in Z-axis of DPI than CPR (P < 0.05). CONCLUSIONS Our results provide novel, promising clinical evidence that CFC was more effective than CPR at improving impairment, activity, as well as participation levels in participants with CP.
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Affiliation(s)
- Mikyoung Kim
- Sports Movement Artificial Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Chanhee Park
- Sports Movement Artificial Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Hyeseon Jeon
- Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | | | - Sung Joshua Hyun You
- Sports Movement Artificial Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
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Liu Z, Dong S, Zhong S, Huang F, Zhang C, Zhou Y, Deng H. The effect of combined transcranial pulsed current stimulation and transcutaneous electrical nerve stimulation on lower limb spasticity in children with spastic cerebral palsy: a randomized and controlled clinical study. BMC Pediatr 2021; 21:141. [PMID: 33761932 PMCID: PMC7989146 DOI: 10.1186/s12887-021-02615-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In the current study, we applied a combination of non-invasive neuromodulation modalities concurrently with multiple stimulating electrodes. Specifically, we used transcranial pulsed current stimulation (tPCS) and transcutaneous electrical nerve stimulation (TENS) as a novel strategy for improving lower limb spasticity in children with spastic cerebral palsy (SCP) categorized on levels III-V of the Gross Motor Function Classification System (GMFCS) with minimal side effects. METHODS Sixty-three SCP children aged 2-12 years, who were classified on levels III-V of the GMFCS were randomly assigned to one of two groups, resulting in 32 children in the experimental group and 31 children in the control group. The experimental group underwent a combination therapy of tPCS (400 Hz, 1 mA cerebello-cerebral stimulation) and TENS (400 Hz, max 10 mA) for 30 min, followed by 30 min of physiotherapy five times per week for 12 weeks. The control group underwent physiotherapy only 30 mins per day five times per week for 12 weeks. In total, all groups underwent 60 treatment sessions. The primary outcome measures were the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS). Evaluations were performed 3 days before and after treatment. RESULTS We found a significant improvement in MAS and MTS scores of the lower limbs in the experimental group compared to the control group in the hip adductors (Left: p = 0.002; Right: p = 0.002), hamstrings (Left: p = 0.001; Right: p < 0.001, and gastrocnemius (Left: p = 0.001; Right: p = 0.000). Moreover, MTS scores of R1, R2 and R2-R1 in left and right hip adduction, knee joint, and ankle joint all showed significant improvements (p ≤ 0.05). Analysis of MAS and MTS scores compared to baseline scores showed significant improvements in the experimental group but declines in the control group. CONCLUSION These results are among the first to demonstrate that a combination of tPCS and TENS can significantly improve lower limb spasticity in SCP children classified on GMFCS levels III-V with minimal side effects, presenting a novel strategy for addressing spasticity challenges in children with severe SCP. TRIAL REGISTRATION ChiCTR.org, ChiCTR1800020283, Registration: 22 December 2018 (URL: http://www.chictr.org.cn/showproj.aspx?proj=33953 ).
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Affiliation(s)
- Zhenhuan Liu
- Department of Pediatric Rehabilitation, Nanhai Maternity and Children's Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, Foshan, Guangdong Province, China.
| | - Shangsheng Dong
- Department of Pediatric Rehabilitation, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong Province, China
| | - Sandra Zhong
- Guangzhou Yirui Charitable Foundation, Guangzhou, Guangdong Province, China
| | - Fang Huang
- Department of Pediatric Rehabilitation, Guangzhou City Social Welfare Institute Rehabilitation Hospital, Guangzhou, Guangdong Province, China
| | - Chuntao Zhang
- Department of Pediatric Rehabilitation, Nanhai Maternity and Children's Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Yuan Zhou
- Department of Pediatric Rehabilitation, Nanhai Maternity and Children's Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Haorong Deng
- Department of Pediatric Rehabilitation, Guangzhou City Social Welfare Institute Rehabilitation Hospital, Guangzhou, Guangdong Province, China
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Abstract
PURPOSE To explore the relationships of school-based physical therapy services to student goal achievement. METHODS One hundred nine physical therapists and 296 students participated in a practice-based study. Therapists formatted goals using goal attainment scaling and evaluated goal achievement. Using the School-Physical Therapy Interventions for Pediatrics system, therapists documented services weekly for 20 weeks. Group comparisons and logistic regressions were conducted. RESULTS For primary goals, no documented physical therapy services were associated with exceeding goal expectation. For posture/mobility goals, more minutes in self-care activities and services on behalf of the students were associated with exceeding goal expectation; use of cognitive and behavioral training interventions was associated with not exceeding goal expectation (P < .05). For recreation/fitness goals, greater use of functional strength and mobility for playground access and cognitive/behavioral interventions were associated with exceeding goal expectation (P < .05). CONCLUSION A limited number of physical therapy services was associated with exceeding goal expectation.
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Description of School-Based Physical Therapy Services and Outcomes for Students with Down Syndrome. J Autism Dev Disord 2019; 49:4019-4029. [PMID: 31209740 DOI: 10.1007/s10803-019-04109-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Students with Down syndrome (DS) receive school-based physical therapy (SBPT), however little data exists regarding services and outcomes. Using a prospective observational cohort study our aim was to explore SBPT activities and interventions, and students' goal achievement of 46 students with DS, tracked by 17 physical therapists (PTs). PTs provided on average 24.0 min/week direct service and 11.6 min/week services on behalf of the student. The most frequent activities employed were physical education/recreation, mobility, and sitting/standing/transitions. The most frequent interventions implemented were neuromuscular, mobility, and musculoskeletal. Although students individually met 69.5% of their primary outcome goals, their achievement could not be explained by total minutes of either direct and minutes on behalf of SBPT, nor minutes spent in most frequent activity.
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Jeffries LM, McCoy SW, Effgen SK, Chiarello LA, Villasante Tezanos AG. Description of the Services, Activities, and Interventions Within School-Based Physical Therapist Practices Across the United States. Phys Ther 2019; 99:98-108. [PMID: 30329119 PMCID: PMC6314330 DOI: 10.1093/ptj/pzy123] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 06/18/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Students with disabilities receive school-based physical therapy services under the Individuals with Disabilities Education Improvement Act of 2004. Little research exists regarding therapy services in schools. OBJECTIVE This study explored the school-based services that students received and the activities and interventions that physical therapists implemented, and determined if services differed based on the student's functional gross motor ability and age. DESIGN This was a prospective observational cohort study using a practice-based evidence design. METHODS Data were collected by 109 physical therapists for 296 students, aged 5 to 12 years, receiving school-based physical therapy. Physical therapists completed the School-Physical Therapy Interventions for Pediatrics data form for 20 weeks during 1 school year. This evaluation included the type of service delivery, the amount of time spent on each student (consultation/documentation), minutes spent in activities, the specific interventions implemented, and the student's level of participation. The Gross Motor Function Classification System (GMFCS) was used to describe the students' functional ability. RESULTS Physical therapists provided an average of 26.7 min/wk (standard deviation [SD] = 15.1) of direct services and 13.1 min/wk (SD = 7.7) of services on behalf of the student. Primary activities were physical education/recreation (7.7 min/wk, SD = 8.2), mobility (6.7 min/wk, SD = 7.9), and sitting/standing/transitions (6.3 min/wk, SD = 8.1). Primary interventions were neuromuscular (32.5 counts per student, SD = 15.9), mobility (15.3 counts per student, SD = 14.65), and musculoskeletal (14.4 counts per student, SD = 10.3). Differences existed based on GMFCS but not student age. LIMITATIONS Physical therapists reported School-Physical Therapy Interventions for Pediatrics data weekly, not necessarily after each therapy session. The GMFCS was used as a proxy of students' functional gross motor ability. CONCLUSIONS Our description of services is provided to encourage physical therapists to reflect on the services they provide and to foster future examinations of service effectiveness.
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Affiliation(s)
- Lynn M Jeffries
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences, 1200 N Stonewall, Room 3092, Oklahoma City, OK 73117 (USA),Address all correspondence to Dr Jeffries at:
| | - Sarah Westcott McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Susan K Effgen
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky
| | - Lisa A Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, Pennsylvania
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Mccoy SW, Effgen SK, Chiarello LA, Jeffries LM, Villasante Tezanos AG. School-based physical therapy services and student functional performance at school. Dev Med Child Neurol 2018; 60:1140-1148. [PMID: 29603734 DOI: 10.1111/dmcn.13748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2018] [Indexed: 11/27/2022]
Abstract
AIM We explored relationships of school-based physical therapy to standardized outcomes of students receiving physical therapy. METHOD Using a practice-based evidence research design, School Function Assessment (SFA) outcomes of 296 students with disabilities (mean age 7y 4mo [standard deviation 2y]; 166 males, 130 females), served by 109 physical therapists, were explored. After training, therapists completed 10 SFA scales on students at the beginning and end of the school year. Therapists collected detailed weekly data on services (activities, interventions, types, student participation) using the School-Physical Therapy Interventions for Pediatrics (S-PTIP) system. Stepwise linear regressions were used to investigate S-PTIP predictors of SFA outcomes. RESULTS Predictors of SFA section outcomes varied in strength, with the coefficient of determination (R2 ) for each outcome ranging from 0.107 to 0.326. Services that correlated positively with the SFA outcomes included mobility, sensory, motor learning, aerobic/conditioning, functional strengthening, playground access interventions, and higher student participation during therapy (standardized β=0.11-0.26). Services that correlated negatively with the SFA outcomes included providing services within student groups, within school activity, with students not in special education, during recreation activities, and with positioning, hands-on facilitation, sensory integration, orthoses, and equipment interventions (standardized β=-0.14 to -0.22). INTERPRETATION Consideration of outcomes is prudent to focus services. Overall results suggest we should emphasize active mobility practice by using motor learning interventions and engaging students within therapy sessions. WHAT THIS PAPER ADDS No specific interventions predicted positively on all School Function Assessment (SFA) outcomes. Active movement practice seems related to overall better SFA outcomes. Active mobility practice improved SFA participation, mobility, recreation, and activities of daily living. Engaging students in therapy activities and interventions improved outcomes.
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Affiliation(s)
- Sarah Westcott Mccoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Susan K Effgen
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Lisa A Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Lynn M Jeffries
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
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Determining Need for School-Based Physical Therapy Under IDEA: Commonalities Across Practice Guidelines. Pediatr Phys Ther 2017; 29:350-355. [PMID: 28953182 DOI: 10.1097/pep.0000000000000448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The Individuals with Disabilities Education Act (IDEA) includes physical therapy (PT) as a related service that may be provided to help students with disabilities benefit from their education. However, the IDEA does not provide specific guidance for the provision of school-based PT, resulting in variations in practice across the United States. The authors examined 22 state and local education agency guidelines available online to find commonalities related to the determination of a student's need for PT. RESULTS AND CONCLUSIONS Seven commonalities found: educational benefit, team decision, need for PT expertise, establishment of Individualized Education Program (IEP) goal before determining need for PT, distinction between medical and educational PT, the student's disability adversely affects education, and the student's potential for improvement. These commonalities are discussed in relation to current PT and special education literature. This article suggests applying these commonalities as procedural requirements and questions for discussion during an IEP team meeting.
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Robertson J, Baines S, Emerson E, Hatton C. Postural care for people with intellectual disabilities and severely impaired motor function: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 31 Suppl 1:11-28. [DOI: 10.1111/jar.12325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research; Division of Health Research; Faculty of Health and Medicine; Lancaster University; Lancaster UK
| | - Susannah Baines
- Centre for Disability Research; Division of Health Research; Faculty of Health and Medicine; Lancaster University; Lancaster UK
| | - Eric Emerson
- Centre for Disability Research; Division of Health Research; Faculty of Health and Medicine; Lancaster University; Lancaster UK
- Centre for Disability Research and Policy; University of Sydney; Lidcombe NSW Australia
| | - Chris Hatton
- Centre for Disability Research; Division of Health Research; Faculty of Health and Medicine; Lancaster University; Lancaster UK
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Effectiveness of Stretch Interventions for Children With Neuromuscular Disabilities: Evidence-Based Recommendations. Pediatr Phys Ther 2016; 28:262-75. [PMID: 27341572 DOI: 10.1097/pep.0000000000000269] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine whether casting, orthoses, stretching, or supported standing programs are effective in improving or maintaining body functions and structures, activity, or participation in children with neuromuscular disabilities. METHODS A systematic review was conducted using 6 electronic databases to identify Level 1 and 2 studies investigating stretch interventions for children aged 0 to 19 years with neuromuscular disabilities. Interventions were coded using the International Classification of Function and rated with Grading of Recommendation Assessment, Development and Evaluation, the Oxford Levels of Evidence, and the Evidence Alert Traffic Light System. RESULTS Sixteen studies evaluated the effectiveness of stretch interventions. Low-grade evidence supports casting temporarily increasing ankle range of motion, orthoses improving gait parameters while they are worn, and supported standing programs improving bone mineral density. CONCLUSION There is limited evidence suggesting stretch interventions benefit body functions and structures. There is inconclusive evidence to support or refute stretching interventions for preventing contractures or impacting a child's activity or participation. TRIAL REGISTRATION Prospero CRD42014013807.
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Outcomes for Students Receiving School-Based Physical Therapy as Measured by the School Function Assessment. Pediatr Phys Ther 2016; 28:371-8. [PMID: 27661224 DOI: 10.1097/pep.0000000000000279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe School Function Assessment (SFA) outcomes after 6 months of school-based physical therapy and the effects of age and gross motor function on outcomes. METHODS Within 28 states, 109 physical therapists and 296 of their students with disabilities, ages 5 to 12 years, participated. After training, therapists completed 10 SFA scales on students near the beginning and end of the school year. RESULTS Criterion scores for many students remained stable (46%-59%) or improved (37%-51%) with the most students improving in Participation and Maintaining/Changing Positions. Students aged 5 to 7 years showed greater change than 8- to 12-year-olds on 5 scales. Students with higher gross motor function (Gross Motor Function Classification System levels I vs IV/V and II/III vs IV/V) showed greater change on 9 scales. CONCLUSIONS Positive SFA change was recorded in students receiving school-based physical therapy; however, the SFA is less sensitive for older students and those with lower functional movement.
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Tustin K, Patel A. A Critical Evaluation of the Updated Evidence for Casting for Equinus Deformity in Children with Cerebral Palsy. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2015; 22. [DOI: 10.1002/pri.1646] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/15/2015] [Accepted: 06/12/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Kylee Tustin
- Complex Motor Disorders Service, Guy's and St Thomas' NHS Foundation Trust; Evelina London Children's Hospital; 6th Floor Sky, Westminster Bridge Road London SE1 7EH UK
| | - Anita Patel
- Paediatric Neurosciences, Guy's and St Thomas' NHS Foundation Trust; Evelina London Children's Hospital; 6th Floor Sky, Westminster Bridge Road London SE1 7EH UK
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Abstract
AIMS Surveys have reported that most school-based physical therapists perceive ideal practices are not commonly implemented in their settings. Our aim was to obtain a more in-depth understanding of these perceptions through open-ended inquiry. METHODS Qualitative data were derived from voluntary open-ended responses provided upon completion of a survey regarding school-based physical therapy practice. Of the survey's 561 participants, 250 provided open-ended commentaries that were analyzed using interpretive phenomenology. RESULTS Six qualitative themes emerged from the open-ended responses, including: In quest: Meeting students' school-based needs via physical therapy; Seeking relatedness: Finding working teams in the school system; Building understanding: Developing a voice/identity in the school context; Stretched beyond limits: Managing workloads; Networking: Coordinating services outside school to meet student needs; Defying definition: What does working in an educational model mean? CONCLUSIONS School-based physical therapists seek to meet educationally relevant physical therapy needs of students, ages 3 to 21 years. Successes appear woven of a multitude of factors such as therapist expertise, team dynamics, and district supports.
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Affiliation(s)
- Sheryl L Holt
- a 1 Physical Therapy Division, Wheeling Jesuit University , Wheeling, WV, USA
| | - Janice Kuperstein
- b 2 Division of Physical Therapy, University of Kentucky , Lexington, KY, USA
| | - Susan K Effgen
- c 3 Division of Physical Therapy, University of Kentucky , Lexington, KY, USA
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Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson SA, Goldsmith S. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol 2013; 55:885-910. [PMID: 23962350 DOI: 10.1111/dmcn.12246] [Citation(s) in RCA: 787] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2013] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP). METHOD This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health. RESULTS Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded 'do it' (green go); 58% (76 out of 131) 'probably do it' (yellow measure); 20% (26 out of 131) 'probably do not do it' (yellow measure); and 6% (8 out of 131) 'do not do it' (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red). INTERPRETATION Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, Sydney, Australia; University of Notre Dame Australia, Sydney, Australia
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Identification of a common language describing paediatric physiotherapy practice for children with additional support needs, to support communication with those outside the physiotherapy profession. Physiotherapy 2013; 99:84-91. [DOI: 10.1016/j.physio.2011.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 12/31/2011] [Indexed: 11/24/2022]
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