Abstracts of the APTA Academy of Pediatric Physical Therapy Platform Presentations at the Combined Sections Meeting

SPATIOTEMPORAL KINEMATIC PARAMETERS REFLECT SPASTICITY LEVEL DURING REACHING IN CHILDREN WITH HEMIPLEGIC CEREBRAL PALSY Aboelnasr E, Hegazy FA, Salem Y PURPOSE/HYPOTHESIS: Three-dimensional kinematic analysis of reaching is considered the gold standard in the evaluation of upper limb motor performance. Previous literature highlighted the differences in reaching pattern between children with cerebral palsy and typically developing children. However, identifying the spatiotemporal parameters that best quantify upper limb motor performance and investigating the relationship between these parameters and the level of spasticity are still challenging. This study aimed to investigate the relationship between the level of spasticity and spatiotemporal parameters and detect which parameter is the most influenced by spasticity level. MATERIALS AND METHODS: Forty children with hemiplegic cerebral palsy participated in this correlational study. Participants were asked to reach forward, at a self-selected pace, toward one target at a normalized distance under one level of accuracy. An optoelectronic system captured 3-dimensional spatiotemporal parameters during forward reaching. Spatiotemporal parameters describing movement time, velocity, strategy and smoothness were analyzed. Spearman rank correlation coefficient was used to investigate the strength of the relationship between the level of spasticity measured by the modified Ashworth scale (MAS) and the studied spatiotemporal parameters (P˂0.05). RESULTS: The level of spasticity measured by MAS was significantly correlated with normalized jerk score (NJS), number of movement units (NMU) and peak velocity (PV) respectively (r=0.7-0.8). The measure of movement smoothness (NJS) presented the most spatiotemporal parameter influenced by the level of spasticity. CONCLUSIONS: Normalized Jerk Score can be used as a good indicator to quantify the impact of spasticity on reaching performance and to evaluate the effectiveness of treatment protocol on motor recovery in children with hemiplegic cerebral palsy. CLINICAL RELEVANCE: Kinematic analysis of upper limb functional tasks can provide valuable information on several aspects of motor control that could potentially help in assessing rehabilitation strategies for children with CP. This study confirms that 3D kinematic measure for movement smoothness could be used as an important index to evaluate the effects of treatment on motor recovery and analyze the interference of spasticity on control of reaching in children with hemiplegic CP, which is valuable for clinical practitioners and researchers as well. SHORT TERM OUTCOMES FROM A CLINICAL TRIAL OF SPEEDI INTERVENTION FOR NEONATES AND YOUNG INFANTS Dusing SC, Burnsed J, Thacker LR, Stevenson R, Harper AD, Brown SE, Molinini R, Kane AE, Inamdar K, Spence CM, Shall MS PURPOSE/HYPOTHESIS: Transition from the neonatal intensive care unit (NICU) to home poses a significant challenge for enrollment in Early Intervention (EI) services. Moreover, once enrolled in EI, a “wait and see” approach often limits direct services until an infant shows developmental delays followed by low intensity intervention. This 3 group clinical trial aimed to compare the efficacy of usual care with Supporting Play Exploration and Early Development Intervention when delivered either starting in the NICU (SPEEDI_Early) or at 3-4 months of age (SPEEDI_Late). Essential components of SPEEDI include: reading cues, promoting postural control, self directed movements and early cognitive skills. MATERIALS AND METHODS: A sample of 83 infants born very preterm, less than 32 weeks, were enrolled from one of 3 NICUs in the same state. The sample was 31% Black, 58% white, and 4% Hispanic, and 49% of parents had a college education. Infants were randomized to one of 3 groups; 27 in Usual Care (UC), 27 in SPEEDI_Early, and 29 in SPEEDI_Late group. The SPEEDI_Early group started intervention following a baseline assessment, while medically stable, but still requiring intensive care. The SPEEDI_Late group started intervention about 15 weeks post baseline, about the same time as community based early intervention typically begins. Short term outcomes were assessed at baseline (34-42 weeks gestational age), 15 weeks post baseline and 30 weeks post baseline using the Test of Infant Motor Performance (TIMP) and Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley). Sub analysis of outcomes based on group are reported. RESULTS: Change on the TIMP raw scores from baseline to Visit 2 did not differ between those who has completed intervention and those who had not. However, a moderate effect size favored the SPEEDI_Early group over the SPEEDI_Late group (= 1.41, p = 0.23, cohen d=0.42). At Visit 3 infants who received SPEEDI (Early or Late) did not differ from the UC group on any domains of the Bayley. However, comparing infants who received SPEEDI_Early to SPEEDI_Late revealed a greater improvement in the cognitive scaled scores on the Bayley (Median=10 (4-14) versus 8 (1-12) respectively, p=0.01, d=0.90). There was no statistical difference between the 2 SPEEDI groups in the fine motor, gross motor, receptive or expressive communication scaled scores. However effect sizes ranged from 0.27 to 0.65. CONCLUSIONS: SPEEDI is an early dyadic intervention that is designed to support parents and infants developing a relationship that facilitates the infant's development. While the short term outcomes on the TIMP and Bayley did not differ when combining the 2 SPEEDI groups, gains in cognitive skills in the SPEED_Early group support the use of SPEEDI while the infant is in the NICU. CLINICAL RELEVANCE: Providing therapists and hospitals the resources to implement this intervention may improve infant outcomes at NICU discharge. DIRECT-ACCESS PHYSIOTHERAPY IN THE PEDIATRIC EMERGENCY DEPARTMENT FACILITATES RECOVERY AFTER PEDIATRIC CONCUSSION Gagnon I, Janta E, Turner M, Plotnick LH, Friedman D, Beaulieu C, Osseiran L, Hahn M, Greenstone I, Brody D PURPOSE/HYPOTHESIS: Concussions are common in children and proactive management is essential to optimize recovery. Because of competing priorities related to higher acuity conditions, it is sometimes difficult for Pediatric Emergency Physicians (PED-MD) to deliver personalized education to children, potentially leading to poor recall of instructions and less adherence to recommendations. Direct-access physical therapists present in the pediatric emergency department (PED-PT) could improve both the assessment and management of pediatric patients with concussions. The purpose of this study was to determine the impact of being seen by a PED-PT for evaluation and intervention compared to being seen by the PED-MD alone on post-concussion symptoms 1-month post-injury. MATERIALS AND METHODS: 72 children (14.05±2.44 years; 58% girls) followed by the Montreal Children's Hospital Concussion Clinic (MCHCC), who were diagnosed with a concussion in the PED, were recruited in this quasi-experimental study, with 12 receiving the PED-PT intervention and 60 receiving care from the PED-MD alone, based on the day and time of presentation to the PED. PED-PTs were present in the PED for 12 hours per week and all other periods were covered by the PED-MD alone. The PED-PT completed a patient history of clinical signs and symptoms, prior health conditions, and physical examination using the SCAT5 and other pertinent tests. They then proceeded with their recommendations for management, consisting education on recovery as well as early return to activity. After the PED episode of care, clinicians could refer children to the MCHCC if they met specific criteria or provide them with instructions for self-management with the possibility of self-referral to the MCHCC if recovery failed to progress in the initial week post-injury. The primary outcome was the severity of post-concussion symptoms 1-month post-injury, as measured by the Post-Concussion Symptom Inventory, a developmentally appropriate symptom-reporting measure. Secondary outcomes included the duration of episode of care in the MCHCC as well as time to referral to MCHCC. RESULTS: Children in both groups were similar relative to age, pre-injury risk factors, initial symptoms of their concussion and time since injury at presentation to the PED (p>0.05). Those children who had been evaluated and received intervention from the PED-PT had significantly less symptoms at 1 month than those managed by the PED-MD alone (p=0.002; 95%CI 2.70-11.86), had a shorter episode of care in the MCHCC (p=0.04; 95%CI 4.08-27.01), and had been referred to the MCHCC earlier (p<0.001; 3.61-11.74). CONCLUSIONS: Children who benefited from PED-PT when presenting to the PED with a suspected concussion had less symptoms 1-month post-injury than those who were seen with the traditional model of being seen by a PED-MD alone. In addition, they were referred earlier to specialized care in the multi-disciplinary MCHCC and were cleared to return to pre-injury activities earlier. CLINICAL RELEVANCE: Pediatric Physical Therapists, in a direct access practice model, can contribute to optimize recovery in children post-concussions in the PED. HAND ARM BIMANUAL INTENSIVE THERAPY IMPROVES REAL-WORLD PERFORMANCE AND SPATIOTEMPORAL CHARACTERISTICS IN CHILDREN WITH HEMIPLEGIA Gardas S, Willson JD, Lysaght C, Holland H, Surkar SM PURPOSE/HYPOTHESIS: Hand-arm bimanual intensive therapy (HABIT) improves bimanual coordination in children with unilateral cerebral palsy (UCP).2 However, HABIT outcomes are typically assessed using standard measures like Assisting Hand Assessment, which primarily assesses capacity, which is what a child does in the clinic.3 HABIT effects on bimanual performance in real-world environments (performance) is not well understood. Accelerometers objectively quantify upper extremity (UE) movements outside the clinic.4 Furthermore, standard assessments lack precision in measuring movement accuracy and fluency during bimanual tasks. To address this, we used 3-dimensional motion analysis (3DMA) to capture spatiotemporal UE characteristics during a robust bimanual task like cup stacking.5 Therefore, this study aimed to investigate whether HABIT improves real-world performance and spatiotemporal UE characteristics in children with UCP. MATERIALS AND METHODS: Number of Subjects: Twenty-five children with UCP (mean age=11.2±3.6 yrs; 18M, 7F) at MACS levels I-III participated in the study. HABIT comprised structured bimanual practice in a play context, delivered for 6 h/day over 5 consecutive days. UE performance gains were quantified by having children wear ActiGraph GT9X Link accelerometers on both wrists for 3 and and were assessed to determine the of the UE in of and Spatiotemporal parameters during cup an bimanual were evaluated using parameters included peak velocity, task and movement was and were used to analyze UE performance and motion analysis RESULTS: significant gains were in performance from to from to a greater of the UE during activities in of hours and from to and from to higher and in movements of the Spatiotemporal outcomes with time task time and movement time and bimanual CONCLUSIONS: HABIT bimanual performance and the use of UE in children with UCP. Furthermore, HABIT improves and coordination as by CLINICAL RELEVANCE: The of rehabilitation is to UE in that can be objectively measured with HABIT in real-world performance and precision of tasks requiring bimanual AND OF FOR FROM Inamdar Thacker LR, J, Dusing PURPOSE/HYPOTHESIS: time or is for gross motor and of in The and been in for play in However, their in the real-world is not aimed to the and of and for play at MATERIALS AND METHODS: infants infants were born term = and infants were born age = parents received the and were on their and a of 3 at parents their infant's play while the was using to and while the The of the was assessed by comparing them to correlation and model analysis was used to determine with a of considered was evaluated by and a was at RESULTS: the and had a correlation with for time The difference between the and for time was not significant (mean of while the a significant difference (mean of The of both and the were between and to or with having the compared to for CONCLUSIONS: The for and accuracy in real-world play in both and The higher precision and for measuring play at the to and However, the related to the or their from the CLINICAL RELEVANCE: The is for clinical measuring in play an intervention. can objectively adherence to play recommendations at home if and This study the of in real-world them in clinical OF AND IN CHILDREN WITH J, M, D, PURPOSE/HYPOTHESIS: Children with to a of which can However, these during are not assessed or in children with is that is a task that Therefore, we that children tasks present significant with from The purpose of the study was to determine the effects of and on and with in children with MATERIALS AND METHODS: children with index and children were during at self-selected and was for all was measured using an scale no A Friedman was used to compare the differences and in children with and A was for post to determine the difference between A was used to compare the differences between groups and for A Spearman correlation was used to determine the relationship between during and in children with RESULTS: was the in followed by and in children with and in children with and were not significantly in with p = or p Children with significantly less peak during compared to children p The during was significantly correlated with p but not during p or p CONCLUSIONS: the peak in children with compared to children The of during was with in children with CLINICAL RELEVANCE: is that clinicians during physical to in children with during and the with may to for WITH THE OF WITH CEREBRAL PALSY M, S, M, PURPOSE/HYPOTHESIS: has that are that are with the of with cerebral palsy Furthermore, we revealed that the of these be with the of the from that can in the of the the we seen be to assessed the between the and the seen in with CP. OF participated in this were with = yrs; MACS and as = MATERIALS AND METHODS: a protocol on a with a The was used for and of the the of the and The was for the of the of the with and the of the Participants completed clinical assessments of and RESULTS: The with had performance on the and tests. for the and had greater for the with Participants that on the to for the and Furthermore, with to for the and CONCLUSIONS: in the of the and be to the acuity seen in with CP. CLINICAL RELEVANCE: The in with been to the that the developmental effects on the which the level Physical therapy that the intensive practice use the OF IN A PEDIATRIC TRIAL S, PURPOSE/HYPOTHESIS: measures the to which an intervention is as it was the to the of Change for treatment of treatment for clinical in rehabilitation has The purpose of this is to the of treatment in a pediatric physical therapy trial of a based protocol in children with cerebral palsy and and child that impact treatment MATERIALS AND METHODS: A of for was as of a clinical trial comparing and based in children with cerebral palsy. The treatment was for this study, using the of motor intervention. are on a scale for a score of completed on of motor of treatment was with for by 6 A model with effect and forward were used to of in pediatric of a pediatric and Pediatric and child Motor child child age, and treatment that impact treatment and levels were groups, or and I-III or and by RESULTS: treatment was pediatric was 2 therapists had completed There was no difference in treatment by pediatric child age child treatment group or group and these were not included in the However, was a for treatment for children in levels to be than children in level CONCLUSIONS: motor can be with for children with cerebral palsy of child child age, or level. However, is to are in children in levels CLINICAL RELEVANCE: pediatric physical therapists can deliver motor intervention to children with cerebral of pediatric be that motor intervention may be for children in compared to levels OF INTERVENTION AND Molinini R, S, S, Shall Dusing PURPOSE/HYPOTHESIS: The relationship and early both on in children with motor The purpose of this analysis was to investigate the effect of of early physical therapy intervention Usual Care Early and the of the relationship as on in children with significant motor MATERIALS AND METHODS: Number of children and their primary Participants with significant motor were randomized to months of or Participants were assessed to 5 over 12 but and months post intervention are included in this outcomes the fine motor, gross motor, receptive and expressive of the Bayley Scales of Infant and Toddler Development, was quantified by the on play quantified the difference in of in children in or in and children in in was by score at the from the RESULTS: Children in in at the post intervention had significantly greater in Bayley fine motor p gross motor p and receptive p than children in in at the post intervention There were no differences in between children in in children in at the had significantly greater in Bayley fine motor p receptive p and expressive p compared to children in in at the CONCLUSIONS: that the of physical therapy intervention and are important in with children in in having the most developmental CLINICAL RELEVANCE: that in children receiving it is important to both the of intervention received as well as with children with motor and their to developmental activities as well as to support the Providing parents with education on to the in which can their development. IN INFANTS WITH PURPOSE/HYPOTHESIS: The of cognitive in typically developing infants and infants with However, infants with delays in and cognitive scores. is that delays in may play a in in the This purpose is to cognitive performance in infants with and compare in a The is be a significant cognitive in infants with in a compared to a of no intervention. MATERIALS AND METHODS: Number of Subjects: 6 infants with months 3 and 3 infants had level and a infants with age 30 and upper limb or use of a of no intervention and at during until of 8 were in the use of the and they 5 per 2 per Infant Motor Bayley of Infant Development and the task The is a with that are covered with a the is in a and trial it is in the an a in one of the A is when the infant a on the has measures and measures with of time, and RESULTS: infants the and 2 infants 12 weeks 6 to age at and in the compared to significant in = with post a significant in the intervention A significant was between time and significant differences between and upper CONCLUSIONS: There were significant gains in and the of motor skills in and group. There were differences in between the upper and CLINICAL RELEVANCE: Infants with from which may cognitive performance. cognitive but gains at a OUTCOMES AND A S, C, E, S, K, PURPOSE/HYPOTHESIS: The system is is based on age, of motion postural of a and was not correlated with of The purpose of this study was to determine treatment outcomes and if a which infants based on age and infants at age of initial evaluation and is correlated with the of treatment compared to the MATERIALS AND METHODS: Number of Subjects: were on infants with and age months age, and post and and and of number of and whether they were The is based on age in months and difference Early Early Early RESULTS: infants were with while infants presented with Infants had a significant to post improvement for and of treatment = and number of = of infants of infants rank of treatment and number of had significant with the for all infants = p = = p = and those who were = p = = p of treatment and number of were not significantly correlated with the system for all infants = p = = p = and those who were = p = = p = CONCLUSIONS: Infants for had significant to post in and The was less infants and was correlated with of treatment and number of compared to the CLINICAL RELEVANCE: Physical therapy treatment is in infants with infants with less had shorter treatment The was based on and correlated with of treatment compared to the WITH THERAPY IN WITH CEREBRAL PALSY M, PURPOSE/HYPOTHESIS: with cerebral palsy with greater to they on over other for that with their receiving as While the of is related to their baseline it is not whether those with greater greater improvement with This study whether with to intervention. that with greater in and greater with intervention. MATERIALS AND METHODS: This is a analysis of a randomized trial with or hemiplegic with Motor levels age 8 and typically developing or age on a in a that A intervention was to the and of the and an by primary outcome measure was the of in to the correlated the improvement in the while receiving the intervention with their performance on at the and and using and analysis using all as and the improvement with as the RESULTS: significant and between improvement with and performance on for the group and for and and and moderate to for group and for and and to the correlation between was that it of or in any model, that performance on any of the of which one it was to the improvement with intervention. CONCLUSIONS: There is a relationship between and to with with being to CLINICAL RELEVANCE: This study is an initial in identifying as for outcomes and patient of to in with cerebral palsy. INTENSIVE IN WITH PURPOSE/HYPOTHESIS: is an of pediatric and and is as an in the and that control in the study of with on the of could detect a in intensive treatment in the that with This study the to which in by the of in and that improve MATERIALS AND METHODS: Number of Subjects: was to at and completed a 3rd study 5 of to evaluate was to the and compared to on control and tests. and control are as a in at the relative to the higher scores under the during the greater and less and evaluated characteristics and in correlation coefficient RESULTS: at of (mean to at improvement = = Participants less and greater during the between and difference = = control were at and at and did not differ significantly between and as = = = CONCLUSIONS: This is the study to using in with that with significant in and that may be and in with CLINICAL RELEVANCE: that is and to rehabilitation in with may provide a and which the effectiveness of specific rehabilitation delivered can be as BIMANUAL AND BIMANUAL IN CHILDREN WITH CEREBRAL PALSY Surkar Willson JD, Gardas S, K, Brown C, PURPOSE/HYPOTHESIS: Children with unilateral cerebral palsy in bimanual coordination that the to improve bimanual coordination higher and effect is a to an when with upper extremity the of is a in which of on the or from The effects of from to and to and severity of prior when with motor in the of study were to determine the effects of on bimanual and bimanual coordination in children with UCP. MATERIALS AND METHODS: OF This randomized trial of children with MACS levels I-III yrs; was on the to and with using a standard of 5 of 5 of and 5 of or was with bimanual cup for 5 consecutive and assessments included bimanual time to of cup primary and bimanual coordination as movement time, and peak assessed with 3D motion analysis while children an bimanual cup A model with group as between and time as evaluated the in the RESULTS: There was a significant group time effect groups in bimanual with practice the group a significant in bimanual to compared to the group score = was no significant group time limb group greater in the movement and and peak during bimanual coordination CONCLUSIONS: bimanual with bimanual and to bimanual coordination in children with UCP. CLINICAL RELEVANCE: can be as a to the effects of rehabilitation Pediatric

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