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

CHARACTERISTICS OF PHYSICAL THERAPIST-PARENT GOAL-SETTING INTERACTIONS IN OUTPATIENT PEDIATRIC PHYSICAL THERAPY AUTHORS:AlShubaily R, Chiarello LA, Alabdulkarim L, Palisano RJ, Bradt J PURPOSE/HYPOTHESIS: To describe and characterize physical therapist (PT)-parent interactions around the goal-setting process, and examine the relationships of the attributes of PTs and families to these interactions. NUMBER OF SUBJECTS: The cross-sectional observational study included 20 PT-child-parent triads from multiple health settings. MATERIALS AND METHODS: We observed and audio-recorded the first two physical therapy sessions for children with physical disabilities aged 0-8 years old. PT-parent interactions were described using the Pediatric Rehabilitation Intervention Measure of Engagement-Observation (PRIME-O). PT-parent interactions were characterized using the Collaborative Goal-Setting Assessment Tool (CGSAT). PTs self-assessed their family-centered care beliefs, communication skills, and expertise. Descriptive statistics were used to qualify and characterize PT-parent interactions around the goal-setting process. Spearman’s correlations examined associations between PTs’ family-centered care beliefs, communication skills, educational level, clinical experience, and expertise with PTs’ engagement and collaborative goal-setting interactions. Spearmen and point-biserial correlations analyzed associations between parents’ educational level, families’ income, and children’s prior rehabilitation services with PT-parent collaborative goal-setting interactions. RESULTS: Scores on the PRIME-O indicated that on average PT-parent engagement during the interactions occurred to a moderate extent. PTs performed 50% and parents performed 56% of interaction items in the CGSAT. On average, 72% of the items for the initial therapy interactions, 60% of the items for clarification of concerns, and 33% of the items for goal-setting on the CGSAT were observed. No significant associations were found between PTs’ and families’ attributes with PT-parent interactions. CONCLUSIONS: Lower percentage of observed interactions in the goal-setting process indicated sub-optimal PT-parent goal-setting collaboration. CLINICAL RELEVANCE: Knowledge of in-session PT-parent interactions is essential to foster a collaborative family-centered approach to goal-setting. Further efforts are needed to support parents’ engagement in goal-setting and potentially improve the family-centerdness of pediatric physical therapy. While PTs involved parents indirectly in the goal-setting process by seeking information about their concerns and needs, there is room to enhance the collaborative nature of the goal-setting process. PTs may need to explicitly explain to parents the importance of therapy goals, discuss with parents their potential role in co-creating these goals, and encourage their engagement in goal-setting. The CGSAT could serve as a valuable institutional quality improvement tool. It can help organizations evaluate the level of therapist-parent in-session collaboration and identify areas for improvement in promoting a family-centered approach to pediatric rehabilitation. IMPLEMENTING AND SUSTAINING INTENSIVE PHYSICAL THERAPY PROGRAMS: THEMATIC ANALYSIS OF OPEN-ENDED SURVEY QUESTIONS AUTHORS:Chole D, Hedgecock JB, Greve KR, Rubsam M, Hall JB PURPOSE/HYPOTHESIS: Intensive therapy programs appear in the research literature but program types, dosages, and evidence to support them vary. The purpose of this survey study was to gather information about current pediatric outpatient intensive therapy practices across the United States (US). NUMBER OF SUBJECTS: Participants included physical therapy providers providing intensive therapy in the US. Recruitment included advertisements through professional organizations, word of mouth, and social media. Sample size for open-ended questions varied from 29 to 50 depending on the question. MATERIALS AND METHODS: Data were collected via a REDCap survey accessed through a QR code. The survey consisted of 31 multiple choice and Likert scale questions and 4 open-ended questions and was based on the Knowledge Translation Action Cycle: 1.) What additional information would you like to provide about your experiences with factors in the implementation and sustainability of intensive therapy programs? (n = 29) 2.) What would your IDEAL version of an intensive therapy program look like? (n = 41) 3.) What resources/information are needed to advance our professional understanding of intensive therapy programs and optimal therapy dosage? (n = 36) 4.) How do you keep your intensive therapy programs at your organization up to date? (n = 50) Data analysis of open-ended questions included pragmatic thematic analysis. This abstract explores these qualitative results. RESULTS: Three overarching themes emerged from the 4 open-ended questions: 1.) Clinicians Value Intensive Programs; 2.) “Logistically Tough” – although clinicians value programs, the logistics of providing programs are difficult; and 3.) Programs require 3 “Fs” for Implementation and Sustainability – Funding, Flexibility, and Foundational knowledge. Two to five themes emerged for each individual question. In response to question 1 (Q1), participants described factors related to program Cost, Coordination, Doing, and Benefits. In response to Q2, participants described the Recipe (theoretical underpinnings), Ingredients (tangible aspects of day-to-day operations), and Finishing Touches (follow-up and nice to have extras not necessary for daily operations). In response to Q3, participants described Institutional Support (necessary support provided by the institution) and Knowledge Support (knowledge needed to provide programs). In response to Q4, participants described Research Evidence, Outside Education, In-house Training, Collaboration, and Program Evaluation. CONCLUSIONS: Clinicians across the US are providing varying types of intensive therapies and find value in these programs; however, implementing and sustaining programs can be challenging. Funding and administrative support for day-to-day operations along with research evidence to support decision making may be instrumental in implementation and sustainability. CLINICAL RELEVANCE: Pediatric physical therapists value intensive models of service delivery. An intentional implementation and sustainability framework such as the Knowledge Translation Action Cycle may facilitate successful development. WEARABLE TECHNOLOGY FOR OPTIMIZING POWER TRAINING FOR TRANSITION AGED PERSONS WITH CEREBRAL PALSY AUTHORS:Corr BB, Bemis K, Baker S, Nguyen U, Kurz M PURPOSE/HYPOTHESIS: There is a lack of evidence for interventions specifically designed to support individuals with cerebral palsy (CP) across the transition age. Previous studies implementing muscle power training appear to be beneficial, but have primarily focused on younger children with CP. These studies have lacked functional movement training, and rigor for ensuring adequate movement velocity or intensity is achieved.1−7 This project attempts to overcome these prior limitations by utilizing wearable technology (Push Band 2.0; PUSH Designs Solutions Inc. Toronto, Ontario, Canada) that provides the physical therapist and the person with CP with real time rep-to-rep feedback on their movement velocity while performing functional movements. We hypothesized that this high-tech treatment approach would result in improvements in the lower extremity muscle peak power, ability to perform transitions, stair negotiation and walking performance. NUMBER OF SUBJECTS: 10 transitioned aged persons with CP (Age = 18.38 ± 4.27 years; GMFCS I-III; Females = 7). MATERIALS AND METHODS: Participants completed 24 therapeutic power training sessions (3 days/week for 8 weeks) under the instruction of a physical therapist. Sessions included weighted functional movements such as sit-to-stand, step-ups, hip thrust and sled pushes. Training was performed at 40-80% of participants’ one-repetition maximum (1-RM) with focus on explosive concentric movements for every repetition. Visual feedback of the prescribed target velocity and actual power production was provided by the wearable sensor. Pre- and post-therapy outcomes included bilateral peak lower extremity muscular power, preferred walking speed, 5x sit-to-stand (5xSTS) and timed up/down stairs. RESULTS: There was a 19.41% change in lower extremity muscular peak power production (Pre = 448.64 ± 197.40 W, Post = 525.51 ± 212.07 W; p = .002), 11.92% improvement in preferred walking speed (Pre = 1.04 ± 0.26 m/s, Post = 1.16 ± 0.27 m/s; p = .014, 25.45% faster 5xSTS (Pre = 10.20 ± 5.21s, Post = 7.03 ± 2.27s; p = .002), and 24.58% faster stair negotiation (Pre = 22.46 ± 21.23s, Post = 15.08 ± 11.56s; p = .002). CONCLUSIONS: Therapeutic power training with visual feedback via a wearable device during functional movement patterns has the potential to result in improvements in the lower extremity muscular function and walking performance of transitioned aged persons with CP. CLINICAL RELEVANCE: Transition from adolescents to adulthood presents a critical window to promote meaningful motor changes and physical activity for functional mobility. Wearable technology used here might enhance the ability of physical therapist to optimize the therapeutic protocols for this critical window. EVOLUTION AND CHALLENGES OF SAFE SLEEP IN THE NICU: A THERAPIST PERSPECTIVE AUTHORS:Fernandez-Fernandez A, Lochak E, Norwood L PURPOSE/HYPOTHESIS: The American Association of Pediatrics (AAP) guidelines for safe infant sleep were last updated in 2022. The AAP recognizes great variability in when and how these are implemented in the neonatal intensive care unit (NICU), but studies on these inconsistencies have mostly focused on the perspectives of neonatal nurses. The purpose of this study was to better understand how are implementing safe sleep guidelines for from the of and has with the NUMBER OF SUBJECTS: or in MATERIALS AND METHODS: completed an survey about and safe sleep with multiple choice and open-ended questions to describe Data were analyzed to implementation and and the last 3 years RESULTS: in US and the two were and with of in level have or are a safe sleep described the AAP guidelines as There were significant in this for and the On average, protocols were at age. To using such as the Assessment Tool or their for in of during the were to of 50% of with a implementation concerns related to and and of there were to was as a significant by of a and of have on an is an around that would not be to care as and on used to be and with transition to safe sleep and for safe sleep at analysis of evidence the need for and as as CONCLUSIONS: to the safe sleep to implementation and for safe sleep CLINICAL RELEVANCE: This study for and implementation of safe sleep organizations have and there to be a need for while to the of the OF THE PEDIATRIC PURPOSE/HYPOTHESIS: The Pediatric is a of functional for children are on a scale a maximum of a years to the of the Pediatric 20 items with a maximum of The the items with and and can be in a of with and in relationships between children’s performance on the and are The purpose of this study was to examine clinical and relationships between the and NUMBER OF SUBJECTS: children (n = to in performance was during study and were for of MATERIALS AND METHODS: An of children’s was used for the and using to Data were by in and for and A multiple analysis was performed in the (n = to and could be used to The from the multiple analysis in the was used to in the (n = and were used in the to by them to during RESULTS: from 24 to = ± with and of children a and were ± and ± in and were of the = = p and were = p and not = p = The in and was was examined by between and in children years = p were in children years = p The in and was in children while in children years was CONCLUSIONS: This study provides clinicians with a to to CLINICAL RELEVANCE: the has used to examine functional in the using the when to enhance and across a THE CLINICAL PHYSICAL THERAPY K, K, PURPOSE/HYPOTHESIS: To current evidence on physical therapy interventions for to the to the NUMBER OF SUBJECTS: MATERIALS AND METHODS: to were for and that of of and of evidence was RESULTS: and 3 were Participants in the included children aged 4 to years with or at of of was concerns for 4 and for Two from the were included in to from the for children with or at of evidence from a of 3 studies that to and physical are care for motor moderate evidence from 1 study that training is training or for evidence from a of studies that is training for motor skills, evidence from 1 study that is for motor skills, to evidence from 1 study each that the interventions are care or for for and skills, or muscle power training for of and training for motor performance. from the 3 1 of studies with in the that can motor skills, and physical in children with 1 of studies with in the found a on in of for 1 1 of studies with moderate in the that although children and to the were with evidence CONCLUSIONS: Research to support and and interventions and evidence on physical and training as There is evidence on the of the and CLINICAL RELEVANCE: of the may be needed to evidence on THE CLINICAL PHYSICAL THERAPY K, PURPOSE/HYPOTHESIS: To current evidence on the of used in the physical therapy of to the to the NUMBER OF SUBJECTS: 29 MATERIALS AND METHODS: to were for studies that the of used in the of quality was using the for the of health RESULTS: 29 studies from children with or at for of were from studies with adequate or studies the of to for and the activity limitations of of the are for and and are for and of the are for and and are for and of with of motor performance were found in 8 of 10 of 4 was found in 4 the version of the not between children at of and children with development. of was found in of parents and was found for the and the studies the of to the motor of or change with of motor and motor of a and was found in but 1 study found for a of motor performance. of motor was found in 3 of and was found in of 3 of was found in 1 and 1 study change of CONCLUSIONS: Research to support the of to for and the activity limitations of and for the for 3 to Research to support the of and for of and motor CLINICAL RELEVANCE: of the may be needed to evidence on the of used in the of OF A FOR IN CEREBRAL PALSY PURPOSE/HYPOTHESIS: power is with function and walking and is muscle in children with cerebral palsy The purpose of this study was to the training of power training with training to training with training on peak and muscle We that improve muscle performance in children with CP to therapeutic NUMBER OF SUBJECTS: individuals with bilateral CP ± years; years; 20 GMFCS level = = = in this MATERIALS AND METHODS: Participants were using the GMFCS level, and to (n = or (n = participants 24 sessions The was lower extremity peak power during a power outcomes were peak and average power at and and and at were at and were analyzed using RESULTS: There were significant at for of the or A significant was observed for peak power at = ± W; ± and at = ± W; ± in of between in and were observed at = p = and = p = in of There were between for or at changes in and at at were observed for = CONCLUSIONS: Participants in in peak power and and to in to our there were velocity training between in the and outcomes across the significant in and at the speed was observed at the CLINICAL RELEVANCE: of this study provide potential therapeutic interventions muscle performance in children with CP. to rehabilitation therapies training and power training with training was in peak power as as and studies of the clinical settings. POWER TRAINING WITH TRAINING IN CEREBRAL PALSY PURPOSE/HYPOTHESIS: power is in children with cerebral palsy (CP) and is with functional walking We that power may be the walking The purpose of this study was to the of lower extremity Training with intensity Training on walking and walking performance in with CP. NUMBER OF SUBJECTS: individuals with bilateral CP ± years; years; 20 level = = = MATERIALS AND METHODS: In this participants were to power training with training (n = or training with training = participants 24 sessions outcomes were speed and walking outcomes were the and walking performance and outcomes were the Assessment and for were at and were analyzed using RESULTS: There were significant at for of the or There were between for of the walking outcomes for speed in of = in speed were observed for at = p = = p and = p = in were observed for at = p = = p = and = p = and for at = p = There were changes in the between in the were observed at in of = CONCLUSIONS: in speed were observed and at as to and were at and at were for the speed not improve with CLINICAL RELEVANCE: These that power training with based training is to an of training with training for speed and of and the improvements in speed were for and were by in walking changes in walking are in changes in walking performance in settings. OF AND INTENSIVE TRAINING IN WITH CEREBRAL PALSY PURPOSE/HYPOTHESIS: with cerebral palsy have their A training such as Intensive the of training intensity on of are the purpose of this study was to the of and intensive training on extremity using analysis in children with NUMBER OF SUBJECTS: children with = ± M = = level MATERIALS AND METHODS: In this children first performed a of training, included a of with training training children the intensive training, included a training in for training A was used to bilateral while children performed the that The outcomes were of with peak speed, and analysis was at and intensive was used to outcomes with time intensive and as RESULTS: There were significant of time for movement and speed analysis indicated time with intensive training = ± = ± intensive training = ± p = improvement in with intensive training = ± = ± intensive training = ± p = of the There was a significant time interaction for peak intensive training, peak speed in the = ± m/s, = ± m/s, intensive training = ± m/s, p = with significant change in the = ± m/s, = ± m/s, intensive training = ± m/s, p speed during There was significant time interaction for CONCLUSIONS: The intensive training in children with While the of training to changes in but the was not to improve the CLINICAL RELEVANCE: The intensity of training is a critical to improve the function in children with OF THE K, K, PURPOSE/HYPOTHESIS: The is a by to with muscular It has and 3 questions related to the current functional The is from = of The provides an of a of and how changes across an of This study the of the by to the as described in a quality improvement The administrative of the and in the of physical therapy was NUMBER OF SUBJECTS: with for between at 8 outpatient MATERIALS AND METHODS: completed the at and last were by a and a based on The of was at and last of the to was using by was using a analysis to of in an of care using and clinical RESULTS: The was collected on of during the On average the 3 to based on were and by average for are to = p to last = p in to to change in = p analysis was significant = p = and of at was a significant CONCLUSIONS: The was and the clinical for was In between the and was but across the of The change in and was of the ability to of found the of at was the significant CLINICAL RELEVANCE: This study the can be implemented in a clinical with administrative It has with of adequate for clinical of the in clinical care can provide a of of change in across an of care may help and quality improvement FOR R, PURPOSE/HYPOTHESIS: there has a of in the of walking on infant and their first experiences with about in infant and In this this by infant of We how was by for transitions, change in visual and NUMBER OF SUBJECTS: 29 MATERIALS AND METHODS: of a were at for during with of infant were and to or not the was by the infant not by the infant up by a This was the for the = of the of each infant the infant there was a change in visual and the infant an RESULTS: There was individual variability in of = = of were by a transition to a with the observed. of In of these = = of were by a change in the visual about by and a = were by of CONCLUSIONS: These that provides with to to areas in their and movements that support from to are with skills, and visual perspectives and for social interaction and CLINICAL RELEVANCE: that of understanding of the experiences that have with the of This information can be interventions to experiences that infant A ANALYSIS OF THE AND OF A, K, A, PURPOSE/HYPOTHESIS: The of in children changes across communication and at an can be of their and quality of children with may be through a for children under is to there has not of how communication and may for This project to describe how communication and emerged and during for children with of children = with disabilities and their MATERIALS AND METHODS: in using a consisted of two was by 3 research for and using a to were analyzed using statistics and qualitative analysis. was at RESULTS: used by children during were there were of and of and with across on average from to study = – to with for and individual changes were observed an in when in or in the with an used and to and during CONCLUSIONS: that a for was from a communication and of communication and This may that a of of may not be to or of using a Further research on and outcomes is CLINICAL RELEVANCE: communication and in children under this critical may provide to help the in for children in Clinicians training to the of children with AND IN WITH PURPOSE/HYPOTHESIS: with in and that It is that infant via or performance in there are studies of visual or in with to identify the the purpose of this study is to to visual in with The is with areas of function to NUMBER OF SUBJECTS: Two children with or using Three MATERIALS AND METHODS: and were used to has a of with an of The is Visual that an infant can an and to a = on the a with at each is to the and to and The in of the the infant The infant and their and to an for 3 target is for a of 8 time to target target velocity initial to and target Visual or to target and to target and and percentage RESULTS: There was a significant in target for with = = to = = = p = to to 50% to to to to and to target with to primarily at and to target with 33% CONCLUSIONS: The a time to may be to to the or target and were in the could be to initial to the or to or There was in to CLINICAL RELEVANCE: with are in up to may be to these to visual performance. OF AND A K, PURPOSE/HYPOTHESIS: is in with disabilities to role of pediatric physical therapists is to facilitate in valuable This the outcomes of in and for to better understand on factors at in The may depending on the program this improve to families for NUMBER OF SUBJECTS: A of studies with a were MATERIALS AND METHODS: A was to of and were for studies were with and disabilities 3 to years; interventions were that may or may not be and in Two first based on and by were by a was for of research and were RESULTS: A of were included across included and 24 were and were quality of and and and social skills, and primarily significant improvements in were in CONCLUSIONS: experiences for appear to of or program for with and disabilities have in the social This is the result of the of the with social outcomes found in programs that and outcomes in programs that with to first CLINICAL RELEVANCE: outcomes of for may depending on program understand the of these on the of to care and to promote not physical health in but social and health as

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