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Background. Many young adults with cerebral palsy (CP) face limited participation in activities, including employment and independent living. Physical therapy during the transition period can help to support participation through promotion of self-care, ambulation, and functional mobility. Thus, ensuring appropriate access to physical therapy services for young people who can benefit from them before, during, and after transition is imperative. Objective. The objective of this study was to identify factors contributing to the utilization of physical therapy services for youth with CP both during and after secondary school. Design. The design was a deidentified secondary analysis of the National Longitudinal Transition Study 2 (NLTS2). Methods. Multivariate regression models were run to examine demographic and disability characteristics influencing utilization of physical therapy services for youth with CP both during and after secondary school. Results. The total weighted population sample included 35,290 young people with CP. When all youth were in secondary school, 59.4% of the youth utilized physical therapy services; however, once all youth were out of school, only 33.7% of them were reported to have utilized physical therapy since leaving secondary school. For young people with difficulties accessing general disability support services, demographic characteristics, including sex, race, income, and parent education status, influenced use of physical therapy services in addition to disability characteristics. Limitations. This population sample included only young people in special education with Individual Education Plans (IEPs) and may not generalize to young people with CP in general education settings. Conclusions. Frequency of physical therapy services decreases drastically once young adults with CP leave secondary school. Future work should examine this trend in more depth to identify therapy intervention strategies to optimize participation in young adult life for persons with CP., For many families of young people with developmental disabilities (DD) across Australia, Europe, and North America, adolescence is the beginning of the transition period from pediatric to adult health care [...]

Background. Physical therapy for youth with cerebral palsy (CP) who are ambulatory includes interventions to increase functional mobility and participation in physical activity (PA). Thus, reliable and valid measures are needed to document PA in youth with CP. Objective. The purpose of this study was to evaluate the inter-instrument reliability and concurrent validity of 3 accelerometer-based motion sensors with indirect calorimetry as the criterion for measuring PA intensity in youth with CP. Methods. Fifty-seven youth with CP (mean age=12.5 years, SD=33; 51% female; 49.1% with spastic hemiplegia) participated. Inclusion criteria were: aged 6 to 20 years, ambulatory, Gross Motor Function Classification System (GMFCS) levels I through III, able to follow directions, and able to complete the full PA protocol. Protocol activities included standardized activity trials with increasing PA intensity (resting, writing, household chores, active video games, and walking at 3 self-selected speeds), as measured by weight-relative oxygen uptake (in mL/kg/min). During each trial, participants wore bilateral accelerometers on the upper arms, waist/hip, and ankle and a portable indirect calorimeter. Intraclass coefficient correlations (ICCs) were calculated to evaluate inter-instrument reliability (left-to-right accelerometer placement). Spearman correlations were used to examine concurrent validity between accelerometer output (activity and step counts) and indirect calorimetry. Friedman analyses of variance with post hoc pair-wise analyses were conducted to examine the validity of accelerometers to discriminate PA intensity across activity trials. Results. All accelerometers exhibited excellent inter-instrument reliability (ICC =.94-.99) and good concurrent validity (rho=.70-.85). All accelerometers discriminated PA intensity across most activity trials. Limitations. This PA protocol consisted of controlled activity trials. Conclusions. Accelerometers provide valid and reliable measures of PA intensity among youth with CP., Cerebral palsy (CP) is the most common physical disability of childhood. (1-3) Although the neurologic insult associated with CP is nonprogressive, youth with CP are less physically active and spend [...]

Children with brain injuries or cerebral palsy (CP) comprise a large percentage of pediatric clients served by physical therapists. There is no consensus on what the basic parameters should be [...]

Background and Purpose. A nationwide survey was conducted to explore decision making among school-based physical therapists and to examine recommendations regarding the models, contexts, frequency, and intensity of physical therapy service delivery. Factors that the therapists considered important in making clinical decisions also were examined. Subjects and Methods. A survey instrument using a clinical case format was sent to all members of the American Physical Therapy Association's Section on Pediatrics who identified themselves as school-based therapists (N=1,154); 626 respondents, from all 50 states, completed the survey. Fore case descriptions were presented in the survey: 2 preschool girls with developmental delay (1 with and 1 without cognitive impairment) and a boy with cerebral palsy (at 6 and 12 years of age). Results. Individual direct services were recommended by 52% to 55% of the respondents for both 4-year-old girls and for the boy at 12 years of age; 92% of the respondents recommended them for the boy at 6 years of age. The most prevalent choice (48%-73%) for the context of service delivery (location or environment) was a combination of integrated and isolated contexts. For those respondents who selected direct services (individual or group, or both), the mean recommended monthly frequency for the boy at 6 years of age (5.8) was more than twice that for the boy at 12 years of age (2.4). The mean suggested direct frequency for the girl with cognitive impairment (4.5) was greater than that for the girl without cognitive impairment (4). The students' functional levels were considered very to extremely important in decision making by 87% to 90% of the respondents. Discussion and Conclusion. Survey responses were relatively consistent with current literature regarding school practice and principles of motor learning. Recommendations varied for each case, regarding the models, contexts, frequency, and intensity of physical therapy service delivery. Key Words: Clinical decision making, Pediatrics, Practice guidelines, School-based physical therapy., School-based physical therapists, as members of the Individualized Education Program (IEP) team, collaborate in decisions regarding the need for physical therapy services, including the models, contexts, frequency, and intensity of [...]

Medical records were reviewed to describe characteristics, report clinical and resource measures, and determine if differences exist between the diagnostic groups of prematurity and multiple congenital anomalies/neurologic conditions for initial admissions of 37 infants and toddlers to an inpatient pulmonary rehabilitation program. More than 75% of the children had a tracheostomy at admission and discharge. Forty-six percent of the sample was admitted requiting only oxygen, whereas 51% were discharged requiting only oxygen and not mechanical ventilation. Thirty percent of the children weaned to a less invasive mode of ventilation while just under half of the children were discharged home. Between-group comparisons indicated statistically significant differences for nutritional support at discharge (p ≤ = 0.05) and discharge disposition (p = 0.04). Complete weaning of oxygen or ventilator support during an initial inpatient pulmonary rehabilitation admission occurred less frequently than weaning to a less invasive mode of ventilation. This is an important consideration for referring children to rehabilitation programs, for clinical program improvement activities, and for setting realistic expectations for referral sources, patients and families, clinical staff, and payers. Further study is recommended using clinical data in program planning, in program improvements, and for setting outcome expectations for infants and toddlers dependent on pulmonary technology., Introduction A limited number of rehabilitation facilities admit children who are ventilator dependent. (1,2) Outcome reports in postintensive care pulmonary units for adults suggest reduction in morbidity may be directly [...]

Background and Purpose. Federal law mandates family-centered care as the service delivery model in early intervention programs for children from birth to 36 months of age. This study investigated the relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of physical therapists' family-centered behaviors during early intervention. Subjects and Methods. Twenty-five physical therapists and 75 mother-child dyads (3 from each therapist's caseload) participated. The mean chronological age for the children was 21.2 months (SD=7.3, range=6-35). Mothers participated in a structured interview using the Measures of Processes of Care (MPOC-56), and they completed the Parenting Stress Index-Short Form (PSI-SF) and a questionnaire. The Bayley-II Motor Scale was administered to the children. Therapists completed a modified version of the Measures of Processes of Care for Service Providers (MPOC-SP) and a questionnaire. Results. Scores for mothers on the MPOC-56 and for therapists on the MPOC-SP indicated strong positive perceptions and attitudes toward family-centered behaviors. Hierarchical multiple regression analyses indicated that parenting stress explained a considerable amount of the variance in mothers' perceptions of family-centered behaviors, whereas therapists' attitudes explained a considerable amount of the variance in mothers' perceptions of respectful and supportive care. Children's motor ability was inversely related to parenting stress. Discussion and Conclusion. Findings suggest that mothers perceive that physical therapists are using family-centered behaviors in early intervention. Findings from the questionnaires suggest that some early intervention policies may be barriers for therapists and prevent them from actualizing attitudes toward family-centered behaviors. [O'Neil ME, Palisano RJ, Westcott SL. Relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of therapists' behaviors during early intervention. Phys Ther. 2001;81:1412-1424.] Key Words: Early intervention, Family-centered care, Patient satisfaction, Physical therapy, Processes of health care, Service delivery models., The expanded role of the physical therapist in early intervention appears to reflect a shift from child-centered intervention to family-centered intervention.[1,2] Federal law (Individuals With Disabilities Education Act [IDEA], Public [...]