The Head Control Scale: Inter-Rater Reliability among Therapy Students

Research has demonstrated the Head Control Scale to have almost perfect inter-rater reliability when utilized by experienced clinicians. This study examines if further clinical experience or additional training is required to use the scale for assessment of head control in a reliable and effective manner. First and second year physical and occupational therapy students were shown five videotaped subjects of varying ages and abilities in four positions (supine, prone, supported sitting, and pull to sit). Students then utilized each subscale of the HCS to rate every subject on the rating scale in each of the positions. When utilizing the kappa coefficient statistic, the inter-rater reliability among student participants was "almost perfect" on each of the subscales. Thus, the Head Control Scale was found to be reliable with no significant difference in interrater reliability when used by clinicians or students suggesting that additional training or expertise is not required to reliably use this scale in clinical practice.

A Pilot Study of Idiopathic Toe Walking: Measures and Outcomes

This pilot study sought to determine the feasibility of quantifying sensory processing, postural control, motor skill development and participation in daily life in children with idiopathic toe walking (ITW) compared to children without ITW. A nonrandomized, prospective case-control design was employed. Twenty participants were recruited. Computerized weight bearing and postural control data was successfully collected. Differences were found in forefoot/rearfoot weight bearing, balance, sensory-motor abilities and parent reported participation challenges. Sensory processing results were inconclusive. Findings can inform standardized assessment and treatment of ITW.

Investigation of Sensory Modulation Dysfunction in Children in Congregate Foster Care

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

Youth who reside in congregate-care foster homes are at greater risk of developing physical, emotional, and behavioral problems. Many of these children could benefit from OT services but are not yet identified because of a lack of assessment. Data from this study suggest sensory modulation challenges are common in this population and may contribute to observed behavior problems. Critical information is provided to advocate for OT services in the foster care system.

Primary Author and Speaker: Amy Armstrong-Heimsoth

Additional Authors and Speakers: Sarah A. Schoen

Contributing Authors: Tessa Burt

The Head Control Scale: Interrater Reliability Among Therapy Students

Date Presented 04/13/21

This study assesses reliability and accuracy of the Head Control Scale (HCS) when used by inexperienced raters. Physical therapy and OT students used the HCS to rate five videotaped pediatric subjects. The kappa coefficient for interrater reliability among students was "almost perfect" (>.80). In one subscale, when comparing student raters with clinicians, there was strong agreement in grading between each group. The HCS may be consistently used by both new and experienced raters.

Primary Author and Speaker: Amy Armstrong-Heimsoth

Additional Authors and Speakers: Emily Mei Chun, Elizabeth Diane Hesse, Kelsey E. Ranneklev, and Camila E. Sanchez

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Toward a Defined Role for Occupational Therapy in Foster Care Transition Programming

Youth who age out of the foster care system and transition to adulthood face challenges that are exacerbated by a history of trauma, severed relationships, and instability of living and educational placements. A review of the literature demonstrates poor outcomes overall for this population. Occupational therapists are positioned to meet the needs that arise during this time; however, a review of emerging roles for occupational therapists is necessary to describe how occupational therapists can best fulfill gaps in current programming. Through a review of the literature and a preliminary mixed-methods study, this paper establishes a direction for the inclusion of occupational therapy for youth aging out of foster care using the Person Environment Occupation Performance (PEOP) model as a structure. Federal, state, and local organizations provide resources to assist transitioning foster youth. However, there is a lack of collaborative, individualized, and evidence-based approaches reporting good outcomes. Specific occupational therapy interventions are suggested to delineate our role with this high-risk population during transition to independent living: both novel interventions and additions to current evidence-based programming.

Creating Reliability and Fidelity in Measuring Head Control

Date Presented 04/05/19

Primary Author and Speaker: Amy Armstrong-Heimsoth

Additional Authors and Speakers: Ashley Sinnappan

Contributing Authors: Jodi Thomas, Roy St. Laurent

The Head Control Scale: Development, inter-rater reliability, and utility

PURPOSE

This study introduces a new scale for the assessment of head control called the Head Control Scale (HCS). The purpose of this study was to establish interrater reliability of the HCS and to determine its usefulness in a clinical setting.

METHODS

The HCS assesses head control in four positions (prone, supine, pull to sit, and supported sitting) on a 0-4 rating scale. The authors used both a focus group and pilot testing to refine the scale to its final version, which was then used to assess interrater reliability. Twenty-six therapists used the HCS to evaluate head control of five subjects of varying ages and abilities who were videotaped spending 30-40 seconds in each position. Participants also completed a post-rating survey.

RESULTS

Fleiss's weighted kappa coefficient is excellent for the prone (0.82), pull to sit (0.83), and sitting (0.88) positions as well as for the scale overall (kappa = 0.91). It can be described as fair to good for supine (kappa = 0.68).

CONCLUSIONS

The HCS has high interrater reliability and users report it to be a needed tool, applicable to clinical practice, and easy to use.

IMPLICATIONS

The results of this study indicate that the HCS has great potential for clinical use.

Knowledge of congenital cytomegalovirus (cCMV) among physical and occupational therapists in the United States

Congenital cytomegalovirus (cCMV) infections cause more children to have permanent disabilities than Down Syndrome, Fetal Alcohol Syndrome, Spina Bifida, and pediatric HIV/AIDS combined. The risk of infection during pregnancy can be significantly decreased using universal precautions, such as thorough handwashing and cleansing of surfaces and objects that have come into contact with infected body fluids. Children under 3 years of age are commonly asymptomatic excretors of CMV, with the highest viral loads present in saliva. Pediatric therapists have regular close contact with young children, and are thus likely at elevated occupational risk of acquiring CMV. Our objective was to evaluate therapist knowledge of cCMV and its transmission. We recruited American Occupational Therapy Association (AOTA) and American Physical Therapy Association (APTA) members via electronic newsletters and printed flyers from April to September 2015. Participants completed an online, anonymous 24-question survey using Survey Monkey. We compared responses between groups and previously published CMV awareness data using binomial tests of difference of proportions and multiple logistic regression. Our study identified both a low level of therapist awareness and poor demonstrated understanding of cCMV. Self-reported cCMV awareness amongst therapists was greater than awareness in the general population, and equivalent to awareness amongst health care professionals. Whereas 52% of participants self-reported awareness of cCMV, only 18% demonstrated understanding of the behavioral modes of CMV transmission. Fewer therapists reported awareness of cCMV than other, less prevalent conditions. Higher levels of health risk knowledge were associated with greater contact with children. Most participants reported learning about cCMV from the workplace. The knowledge gaps between self-reported awareness of cCMV and demonstrated understanding of modes of transmission described by our results emphasize the need for additional training of therapists. cCMV is preventable, and accurate knowledge of modes of transmission is crucial for the health of practitioners and clients.