Pediatric Physical Therapy Interventions
PHT 5140C
Faculty
Anna Edwards, PT, MA, MBA, ACCE
[email protected]
or
Extension – 2402
Cornelia Lieb-Lundell, PT, DPT, MA, PCS
[email protected]
Additional Pediatric POINT LAB Instructors:
Jan Spain, PT
Cathy Courtney, PT
Luci Schmeiser, PT, DPT
Required Texts
Effgen, Susan K. (2013).
Meeting the physical therapy
needs of children
. Philadelphia: F.A. Davis.
Shumway-Cook A, Woollacott, M.H
.Motor Control
Translating Research into Clinical Practice, Fourth
Edition
. Philadelphia, PA: Lippincott Williams & Wilkins;
2011.
Child Development, Neuromuscular I and Neuromuscular III required textbooks and course note packets and references
.
Section on Pediatrics fact sheets as assigned
Pediatric Clinical Practice Guidelines
Additional References in the syllabus and course notes
Course Introduction Objectives
APTA Section on Pediatrics
Physical Therapy Across the Life Course
Development from Pediatrics to Geriatrics
Pediatric Diagnosis, Interventions & Settings
Conceptual Framework for Clinical Practice applied to
Pediatric Physical Therapy
Models of team interaction and models of service
delivery
Issues Influencing Pediatric Physical Therapy
Practice
Section on Pediatrics Vision:
The Section on Pediatrics American Physical Therapy Assoc. 1111 North Fairfax Street Alexandria, VA 22314 - www.pediatricapta.org
Transforming society by
optimizing movement
to improve the human
experience for all
children, adults with
developmental
disabilities, and their
families
A Vision to Transform Society
http://www.apta.org/PTinMotion/ 2014/3/Feature/APTAVision
/
Objectives to support SOP vision
: Pediatric physical therapists will engage in diagnosis, intervention, prevention, and advocacy.
Pediatric physical therapists will participate in the advancement of
evidence-based practice by identifying critical needs, utilizing currently available evidence, and producing and directing future data.
Pediatric physical therapists will provide expertise regarding movement dysfunction in individuals with developmental disabilities and other pediatric disorders.
Pediatric physical therapists and physical therapist assistants will participate in community-based activities that enhance
comprehensive and accessible services.
Pediatric physical therapists and physical therapist assistants will
promote health and fitness.
Pediatric physical therapists and physical therapist assistants will engage in life-long learning.
Physical Therapy across the Life Course
A Life Course Approach to Development
Katherine Sullivan, PT, PhD, FAHA and Reggie Harbourne, PT, PhD, PCS Development is a life long process related to the development, peak growth,
and declineof the muscular skeletal, neuromuscular, cardiovascular/pulmonary, and integumentary systems.
Development across the life stages (transitions)
Childhood, adolescence, young adult, middle adulthood, older adult, senior adult
Our focus in this course will be development in utero, infant, toddler, preschool, school age, adolescence/ teenage
Functional capacity changes over the life course Early life is linked to later life
Early motor experiences are linked to cognitive development
Sitting initiates a period of exploration and change in infant vocalization.
http://transitions.canchild.ca/en/OurResearch/bestpractices.asp
Diagnosis and Prognosis
Medical and Physical Therapy DX
Cerebral Palsy Developmental delay Down syndrome Torticollis Spina bifida Autism Aspberger’s syndrome Rett syndrome Hypotonia Down syndrome
Traumatic Brain Injuries
Epilepsy
Metabolic Disorders/Infant Diabetic Syndrome
Chromosomal Disorders Prader Willi Angleman syndrome Duchenne’s Muscular Dystrophy Club foot surgery
Congenital Hip Dysplasia Burns
Tetralogy of Fallot Global Developmental Delay
Aging with Developmental Disabilities
Life Transitions in Childhood
In Utero
Birth to home
Being away from
parents
Preschool Age 2-3
Elementary School
Middle School
High school
Infant
Toddler
Children 5-6
Children 10-12
Adolescence 13-18
http://health.discovery.com/tv/nicu/Pediatric Clinical Settings
NICU and Inpatient
Rehabilitation
Home Health
Pediatric Hospice
Early Intervention
Regular Education
Public Schools Special
Education
Private Schools
Outpatient Clinics
Pediatric Private Practice
Early Intervention Schools
(Ch 11)
Schools
(Ch 12)
Sports Setting for the
School Aged Child
(Ch 13)
Pediatric Acute Care
Hospital
(Ch 14) Neonatal ICU
(Ch 15) Rehabilitation Setting
(Ch 16) Chapters 11-16 in EffgenPediatric Development
Evaluation Includes:
Social Emotional Development
Gross Motor Development
Fine motor Development
Language Development
Resources:
Pathways Checklists (www.pathways.org)
Assure Baby’s Physical Development (class handout) Pathways Sensory Motor Checklists by age
Play and Social Skills (Social Emotional Development)
Coordination (Gross Motor Development)
Daily Activities (Fine Motor Development)
Pediatric Interventions
Frequency, Intensity, and Duration of Interventions
Tone management Balance & Coordination
Stretching & Strengthening
Joint mobilization
Movement and mobility
Kinesiotaping
Splinting and Serial Casting
Transfer training
Gait training
Standing Wheelchairs
Treadmill/Gait Lite
Body weight support training
NDT
(Adele) Suit Therapy
Theratogs Hip Huggers NMES TENS FES Botox Hippo therapy Conductive Education
Facilitation can take many forms, remember to
document what worked and the resultant
outcome in terms of motor and muscle activity
What Role Does the Family Play?
Parents and families have the primary (central)
role in their child’s development.
The pediatric physical therapist collaborates with the family to implement an individualized program for the child.
Families are supported through coordination of services, advocacy, and assistance to enhance the development of their child through:
Positioning during daily routines and activities, Adapting toys for play,
Expanding mobility options,
Easing transitions from early childhood to school and into adult life. Adapting to families choice of settings: home, child care centers,
preschools, schools and job sites.
Child and Family Centered Practice
“While I have worked many hours with professionals, my parents were the key people”. David, age 22 with cerebral palsy
Child and Family Centered Practice
Patient and Family Centered Practice
Applying principles of
Dignity and respect
Transparent access to information
Active participation
Collaboration between the patient, their
family and the therapist
Take into account personal context and
environmental context
Team-based Service Delivery
Models of Team Interaction
Unidisciplinary
Multidisciplinary
Interdisciplinary
Transdisciplinary
Collaborative
PT Models of PT
service delivery
Direct
Integrated
Consultative
Monitoring
Collaborative
Resources: SOP Fact Sheet Effgen pp. 23 -28
Conceptual Framework for Clinical
Practice
1.
Model of practice
2.
Model of function and disability
3.
Hypothesis-oriented clinical practice
4.Principles of motor control and motor
learning
5.
Evidence-based clinical practice
Constructs and Concepts That
Inform Physical Therapist Practice
Four major constructs and concepts
inform current physical therapist
practice:
The
International Classification of
Functioning, Disability and Health
(ICF)
and the biopsychosocial model
Evidence-based practice
Professional values
Quality assessment
Model of Practice
Using APTA’s Guide to Physical Therapist Practice
in Pediatric Settings
Practice Patterns
Child may have a PT diagnosis of one or more practice patterns 5B (impaired neuromotor development) 5C (non progressive CNS disorders-child) 4C (impaired muscle performance) 6B (deconditioning)
Model of Practice
Using APTA’s Guide to Physical Therapist Practice
in Pediatric Settings
Practice Patterns
Child may have a PT diagnosis of one or more practice patterns 5B (impaired neuromotor development) 5C (non progressive CNS disorders-child) 4C (impaired muscle performance) 6B (deconditioning)
Structure of the International Classification of Functioning, Disability and Health (ICF) model of functioning and disability.5.
© 2014 by American Physical Therapy Association
Interaction among the components of the International Classification of Functioning, Disability and Health (ICF) model of functioning and disability.5.
Principles of Physical Therapist
Patient and Client Management
Co-management
Consultation
Direction & Supervision
Referral
© 2014 by American Physical Therapy Association
Model of function and
disability ICF
ICF framework –
enablement perspective
Part 1: Functioning and disability
Body structure and function-impairments
Activity
Activity limitations are difficulties an individual may have in executing activities
Participation
Participation restrictions are problems an individual may experience in involvement in life situations
Part 2: Contextual Factors
Environmental Factors
Personal Factors
Table 1.1 p 6 EffgenActivities
Prone: Supine: Side lying: Sitting: Quadruped: Kneeling half kneeling
Standing:
Single leg stance:
Cruising:
Walking
Walking, stairs, varied surfaces
GMFM 5 Dimensions
Lying and Rolling
Sitting
Crawling and Kneeling
Standing
Walking, Running and
Jumping
Participation
Young Child
Family routines (household chores and errands)
Care giving routines (bathing, dressing, eating, grooming, bedtime) Family rituals and celebrations (holidays, birthdays, religious events) Outdoor activities (gardening, visits to park/zoo)
Play activities (physical play and play with toys)
Learning activities (listening to stories, looking at books/pictures)
CAPE Children's Assessment of Participation and Enjoyment
Participation
In school activities
Lunchtime activity among peers Use boy’s bathroom in Elementary school’ Age appropriate art activities in school classroom Play on playground ad interact with peers in neighborhood
For Life situations
Go with family in restaurant to celebrate an occasion Participate in shopping
www.who.int/classifications/terminology
ICF-CY
(WHO, 2007)
Confirms the importance of precise descriptions
of children's health status
Greater detail to encompass the body functions
and structures, activities, participation
ICF-CY is from birth to 18 years of age - infants,
toddlers, children and adolescents
ICF-CY was developed in a manner sensitive to
changes associated with growth and
development
http://apps.who.int/iris/bitstream/10665/43737/1/9789241547321_eng.pdf
ICF-CY
International Classification of
Functioning, Disability and Health Children and
Youth Version
Activities and Participation
for Mobility
Changing basic body
position
Maintaining a body position
Transferring oneself
Lifting and carrying objects
Moving objects with lower
extremities
Fine hand use
Hand and arm use
Walking
Moving around
Moving around in
different locations
Using Transportation
Driving
Effgen, Chapter 3 Table 3.5
Differences:
Codes for
Manual and lateral dominance Learning through
actions and playing Following routines Managing one’s own
behavior
Qualifiers for
Performance Capacity
Evidence Based Clinical Practice
SOP initiatives aimed at supporting the translation of evidence
based knowledge and information into clinical practice
1.Establishes the steps for intervention2.Examines the constituents of health and the effects of disease on the
individual
3.Provides a process for testing assumptions regarding the nature and
cause of motor control problems
4.Suggests essential elements to examine and treat
5.Emphasized the integration of research evidence, clinical expertise and patient characteristics in clinical practice
Evidence Based Clinical Practice
Translation from research to clinical application
Increased emphasis on EBP
Reimbursement issue
Development of the
Guide
Practice guidelines
APTA Clinical Research
Agenda
Legislative affairs
Access to Evidence
APTA.org Google Scholar PT research Development of
Residencies and
Fellowships
PhD programs in
rehabilitation sciences
Research preformed by
clinician in clinical setting
Revised APTA Clin
Research Agenda
Evidence Based Clinical Practice in
Pediatric Physical Therapy
How to implement EBP— translation into the clinic
:
1: Ask a clinical question 2: Find the best evidence 3: Critically appraise the
evidence
4: Integrate evidence with practice
5: Evaluate effectiveness
www.pediatricapta.org “EBP” is the integration of research findings, clinical expertise, individual professional opinion & values.
4 elements of good
evidence
(Law and McDermid (2008):
1. Awareness
2. Consultation
3. Judgment
4. Creativity
Developing Evidence Based Practice
through research Translation
“
It’s about integrating individual clinical expertise and the best external evidence” (David L. Sackett) Use of current best evidence in making decisions about the care of individual patients Physical therapists are positive
and indicate they are interested in learning or improving skills necessary to implement EBP
Jette Phys Ther 2003 83:786-805
Knowing which test to choose to use to diagnose and which intervention to deliver in order to limit or eliminate disability (or prevent disability)
PT’s note that they need to increase the use of evidence in their daily practice
Evidence to Practice
Algorithms
Written guidelines to stepwise evaluation and management strategies
Clinical practice guidelines
Systematically developed plans to assist in health care decision making for specific clinical circumstances
Clinical, critical, or care pathways
Predetermined protocols that define the critical steps in exam eval and providing interventions
Clinical prediction rules (CPR)
Clinical findings are groups to help with screening, diagnosing, or prognostications
Clinical Practice Guidelines (CPG’s)
What are CPGs?
Evidence based recommendations intended to optimize
patient care.
Informed by a systematic review of the literature
Include assessments of the benefits and harms of alternative care options
When coupled with clinical judgment and consideration for patient’s preferences
CPG’s reduce practice in variation
Improve diagnostic accuracy
Promote effective interventions
Discourage ineffective or potentially harmful practicies
Improve patient centered health outcomes
Clinical Reasoning in Pediatric
Physical Therapy Practice
Complex and Critical
Numerous patient specific variables that
influence care
Innate variability in the growth and
development of children
Identifying and considering contextual
variables
Directs a clinicians actions and decisions
What is Clinical Reasoning
The thinking and
decision-making of a health care
provider in clinical practice
Clinical reasoning
the
thinking or judgment behind
one’s action
Clinical decision making
is
the action on this process
Complex and Critical
Numerous patient specific
variables
that influence
care
Innate variability in the
growth and development of
children
Identifying and considering
contextual variables
Directs a clinicians actions and decisions
Clinical Reasoning
Critical aspects of
reflection
Mutual Decision
Mutual
decision-making
Patient context
Thought processes
vital in clinical
reasoning
Discipline specific
knowledge
Metacognition
Reflective self
awareness
Patient centered
focus
Development of
expertise
Clinical Reasoning as a
Developmental Process
Hypothetico-deductive
(deductive reasoning)
Hypothesis based
upon results of test
and measures,
followed by testing this
hypothesis
Pattern recognition
(inductive reasoning)
Retrieval of
information from well
structured
knowledge based
upon previous
clinical experience
Application of clinical
reasoning skills in the
classroom and in the clinic
Reflection-on-Action
Reflection-in-Action
Reflection-for-Action
Pediatric & Adult POINT Labs
Issues Influencing Practice
Pediatric Physical Therapy
Advocacy and Public Policy
Changing Health-Care Delivery System
Family Centered Care
Child Abuse and Neglect
Behavior Management
Cultural Practices
Natural Environment - What is it?
Early Intervention
Defining Educationally vs Medically based
Interventions
Essential Key Components for
Successful Teams
(Reflection Paper)
A shared framework of trust
Clearly defined roles and responsibilities
Respectful and empathetic open communication
Appreciation of diversity
Equal participation among all team members
Established common goals
Consensus decision making
Solution focused problem solving
Ongoing evaluation
THANK YOU
Thank you to the parents and children and
educational website sources who participated
in the development of this information and
graciously allowed the use of their pictures for
educational purposes.
Picture material is copyrighted and may not be used without the author’s permission.
