Showing papers in "Physical & Occupational Therapy in Pediatrics in 2015"

Efficacy of constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy in an educational setting.

Abstract: We examined the efficacy of modified constraint-induced movement therapy (CIMT) and hand-arm bimanual intensive therapy (HABIT) in a special education preschool/kindergarten in Israel. Twelve children (1.5-7 years) with congenital hemiplegic cerebral palsy were randomized to receive modified CIMT (n = 6) or HABIT (n = 6). Occupational and physical therapists administered usual and customary care for 8 weeks; children then crossed over to receive CIMT or HABIT 2 hr/day, 6 days/week for 8 weeks from their occupational therapist. The Assisting Hand Assessment and Quality of Upper Extremity Skills Test were administered 2 months prior to the intervention, immediately before, immediately after intervention, and 6 months after the first baseline assessment. Both groups demonstrated no change during baseline and comparable improvement following CIMT and HABIT (p < .001), which was maintained at 6-month follow-up. Results suggest that modified CIMT and HABIT provided in school-based settings can lead to improvements in quality of bimanual skill and movement patterns.

Effectiveness of a Summer Camp Intervention for Children with Developmental Coordination Disorder

Abstract: Background: Developmental coordination disorder (DCD) significantly affects a child's motor abilities and negatively impacts their self-efficacy and participation in physical activity. Using a task-specific approach and cognitive strategies in a group setting, we designed a summer camp intervention for children with DCD. Aims: Our purpose was to examine the effectiveness of the summer camp in meeting child-chosen functional motor goals and increasing self-efficacy and participation. Methods: This mixed methods study examined performance and satisfaction of child-chosen goals, self-efficacy, and participation of 11 children before and after the camp. Survey and interview data from three children and nine parents were collected to supplement quantitative findings. Results: Statistically significant improvement in performance and satisfaction of child-chosen goals was noted. While no measureable changes in self-efficacy and participation were observed, parents and children reported positive benefits ...

Assessing Sensory Processing Problems in Children With and Without Attention Deficit Hyperactivity Disorder

Abstract: Aims: This exploratory study investigated whether children with attention-deficit/hyperactivity disorder (ADHD) are at greater risk than children with- out ADHD for problems with sensory processing and if certain sensory systems are more closely associated with the core symptoms of ADHD, specifically inattention and hyperactivity/impulsivity. Methods: The sample included 20 children with ADHD and 27 children without ADHD, ages 5 to 10 years. Assessments included the Sensory Pro- cessing Measure-Home Form and the Conners 3rd edition-Parent Short Form. Results: After controlling for age, children with ADHD exhibited more sensory processing prob- lems on all scales of the Sensory Processing Measure with small to medium effect sizes observed (η 2 = .27 to .61). For children with ADHD, the Social Participation (r = .50) and Planning and Ideas (r = .73) subtests of the Sensory Processing Measure were sig- nificantly associated with hyperactivity/impulsivity, but not with inattention on the sub- tests of the Conners Parent Short Form. Conclusion: The results suggest the importance of assessing sensory processing issues in children with ADHD to guide in the interven- tion process.

Psychometric Properties of the Canadian Little Developmental Coordination Disorder Questionnaire for Preschool Children

Abstract: Aims: Test the psychometric properties and cut-off scores for the Canadian Little Developmental Coordination Disorder Questionnaire (Little DCDQ), which screens for coordination difficulties in children aged 3 to 4 years. Methods: Parents of children with typical development (n = 108) and children at risk for motor problems (n = 245) completed the questionnaire. A subgroup (n = 119) of children was tested with the Movement Assessment Battery for Children-2 (MABC-2) and the Beery–Buktenica Developmental Test of visual-motor integration (VMI) to determine motor impairment (MI). Results: Test-retest reliability (r = 0.956, p < .001) and internal consistency (Cronbach's alpha = 0.94) were high. Construct validity was supported by a factor analysis and significant difference in scores of children who were typically developing and were at risk. Concurrent validity was evaluated for the children who received standardized motor testing, with significant difference between children with and without MI. Dis...

Effect of Cognitive Intervention on Children with ADHD

Abstract: Although not considered a diagnostic criterion in DSM-IV, motor difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD) are commonly reported. Prevalence of co-morbidity of ADHD and Developmental Coordination Disorder is as high as 50%. Cognitive Orientation to daily Occupational Performance (CO-OP) is a problem-solving approach originally developed for children with Developmental Coordination Disorder. In this approach, therapists support children to use cognitive strategies in a process of guided discovery to solve occupational performance problems. A single case experimental design (multiple baselines) was used to examine the influence of a 12-week intervention using CO-OP with six children with ADHD. Outcome measures included the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling and the Bruininks-Oseretsky Test of Motor Proficiency and Performance (BOTMP). The results of this study demonstrated improvements in both goals and motor performance in the participants due to the intervention. These results provide some support for the use of CO-OP with children with ADHD. Further research into the application of CO-OP with children with ADHD is warranted based on these preliminary positive findings regarding the efficacy of this intervention to address motor-based performance difficulties.

Adaptation and Extension of the European Recommendations (EACD) on Developmental Coordination Disorder (DCD) for the UK context.

Abstract: Background: Developmental Coordination Disorder (DCD) affects the learning and performance of everyday motor skills. It commonly co-occurs with other developmental disorders and a range of associated psycho-social impairments. Recent evidence-based guidelines on diagnosis, assessment, and intervention provide valuable information for practitioners. However these are directed primarily at German-speaking countries and focus on work with children. Aim: The aim of this project was to consider the application of these guidelines in the UK and to extend them for use with adults with DCD. Methods: Individuals with DCD, parents, and professionals from a wide range of disciplines were invited to two workshops to discuss and debate the guidelines, to adapt them for the UK and produce dissemination materials. Results: A working definition of DCD was agreed, minor revisions were made to the guidelines to reflect the UK context, an extension for adults was compiled and a series of leaflets was produced to dis...

Holistic Needs of University Students with Invisible Disabilities: A Qualitative Study

Abstract: Aim: To inform rehabilitation professionals’ role in supporting transition to higher education through identification and description of disability related needs experienced by university students. Methods: Participants were recruited from a large research-intensive university in the southeastern United States and included 13 students eligible for university disability services, 9 university personnel, and 1 parent of a university student with a disability. Disabilities of study participants were invisible; all but one chose to disclose diagnostic information. Data from 15 individual interviews and 2 focus groups were analyzed for themes. Results: The Navigating Parallel Demands theme elucidates the ways disability related needs extended beyond the classroom to areas of health and wellness, social, and daily living. Navigation in Context describes personal and environmental circumstances surrounding processes used to meet a broad-range of demands. Conclusion: University participation requires stud...

Children's perspective on their right to participate in decision-making according to the United Nations Convention on the Rights of the Child article 12

Abstract: Aims: According to the United Nations Convention on the Rights of the Child article 12, children have a right to express their views. However, knowledge on how children with a disability perceive t...

Using Posturography to Examine the Immediate Effects of Vestibular Therapy for Children with Autism Spectrum Disorders: A Feasibility Study

Abstract: Aims: The primary objective of this study was to determine the feasibility of using posturography to monitor acute changes in postural control induced by a Sensory Integration (SI) therapy intervention. A secondary objective was to identify which posturography outcome parameters, tests conditions and data analysis methods might be most useful in identifying post-intervention changes. Methods: Five children with Autism Spectrum Disorder (ASD) and five children with typical development (TD) participated in a 10 min vestibular swing activity and had their postural stability evaluated pre- and post-intervention under four different sensory testing conditions. Sway ranges, mean sway velocity, sway root mean square (RMS), and sample entropy were calculated from center of pressure (COP) data. Results: All five children with ASD demonstrated decreased mean sway velocity in the eyes open/flat plate condition post-intervention with an average decrease of 5.87 ± 2.69 mm/s. Four of the five children with ASD ...

Health Promotion in a Low-income Primary School: Children with and Without DCD Benefit, but Differently

Abstract: Poor motor performance and reduced physical fitness are characteristic of children with Developmental Coordination Disorder (DCD). These features have also been identified more frequently among children living in low socio-economic circumstances. Aims: To evaluate the outcomes of a nine-week health promotion program (HPP) on the motor performance and fitness levels of children (6–10 years) with and without DCD attending a low-income primary school. Methods: The HPP was designed and implemented by undergraduate physiotherapy students using guidelines from the World Health Organization School Health Initiative and their physiotherapy curriculum. Children with DCD (n = 22) and a control group without DCD (n = 19) participated in the evaluation. Motor skill, functional strength, aerobic capacity, and anaerobic power were measured at baseline and after nine weeks. Results: Both groups of children improved on all measures at the conclusion of the HPP. Children with DCD showed greater improvement than th...

Community Fitness Programs: What Is Available for Children and Youth with Motor Disabilities and What Do Parents Want?

Abstract: Background: Physical activity is recognized as a rehabilitation approach for individuals with motor disabilities. Objectives: To determine whether community fitness programs were accommodating children and youth with motor disabilities, and to understand family perspectives on important outcomes related to fitness programs. Design: Telephone survey and qualitative interviews. Participants and settings: Representatives of 61 fitness programs/facilities and 13 parents of children with motor disabilities. Methods: Telephone survey (facilities) and qualitative interviews (parents). Results: 24.6% of programs reported lack of wheelchair accessibility. Only 9.8% of programs and facilities required their staff to have training to support individuals with disabilities. Parents discussed barriers, including lack of staff support and challenges with finding information about community programs. Parents focused on the social benefits of fitness programs. Conclusions/significance: Additional efforts toward re...

Use of the Child Engagement in Daily Life and Ease of Caregiving for Children to Evaluate Change in Young Children with Cerebral Palsy

Abstract: Aims: Participation in family and recreational activities, self-care, and parent ease of caregiving are important outcomes for young children with cerebral palsy (CP). The aim of this study was to examine use of the Child Engagement in Daily Life and the Ease of Caregiving for Children to measure change over time. Methods: A convenience sample of 387 parents of young children with CP (18 months to 5 years of age) completed the measures twice, a mean of 12.7 months apart. Results: For the Child Engagement in Daily Life, parents of children in Gross Motor Function Classification System level I and levels II–III reported more change for the Self-care domain (medium effect) than the Family and Recreational Activities domain (small effect) and the Ease of Caregiving for Children (small effect). The change reported by parents of children in levels IV–V on all three measures was less than the criterion for a small effect. Minimal detectable change for each measure varied from 12.1 to 14.1, out of a total...

Decisional Support Algorithm for Collaborative Care Planning using the Participation and Environment Measure for Children and Youth (PEM-CY): A Mixed Methods Study

Abstract: Aims: The purpose of this study was to explore the utility of the Participation and Environment Measure for Children and Youth (PEM-CY) for collaborative care planning with parents of children with disabilities. Methods: An explanatory sequential mixed methods approach was employed to examine how community-based service providers interpret and apply PEM-CY case results to set goals and formulate care plans with parents. We used two distinct, interactive phases that included collection and summary of PEM-CY data in Phase One (quantitative) and sequential collection and analysis of interview data during Phase Two (qualitative). Twenty-three parents of children with disabilities (mean age = 10.7 years) completed the PEM-CY community section during Phase One (quan). Four PEM-CY case reports were used with seven providers who were interviewed during Phase Two (QUAL). Results: Providers identified a four-step decisional support algorithm for leveraging PEM-CY case results in care planning: (1) parent ra...

"You gotta try it all": Parents' Experiences with Robotic Gait Training for their Children with Cerebral Palsy.

Abstract: Aims: Innovative robotic technologies hold strong promise for improving walking abilities of children with cerebral palsy (CP), but may create expectations for parents pursuing the “newest thing” in treatment. The aim of this qualitative study was to explore parents’ values about walking in relation to their experiences with robotic gait training for their children. Methods: Semi-structured interviews were conducted with parents of five ambulatory children with CP participating in a randomized trial investigating robotic gait training effectiveness. Results: Parents valued walking, especially “correct” walking, as a key component of their children's present and future well-being. They continually sought the “next best thing” in therapy and viewed the robotic gait trainer as a potentially revolutionary technology despite mixed experiences. Conclusions: The results can help inform rehabilitation therapists’ knowledge of parents’ values and perspectives, and guide effective collaborations toward meet...

Knowledge to Practice in Developmental Coordination Disorder: Impact of an Evidence-Based Online Module on Physical Therapists’ Self-Reported Knowledge, Skills, and Practice

Abstract: Aims: To evaluate the impact of an evidence-based online module on Developmental Coordination Disorder (DCD) on self-reported physical therapist (PT) knowledge, skills, and practice. Methods: Fifty PTs completed a questionnaire before and after the completion of the online module, with 41 PTs completing the same questionnaire 2 months later. The questionnaires included items rated using a 7-point Likert Scale and short open-ended questions. Results: There was a significant effect of Time for 17 out of 18 items on self-reported knowledge, and all 19 items for self-reported skills. Post-hoc analyses indicated that mean scores at Time 2 and Time 3 were higher than the mean scores at Time 1. Forty-six (92%) participants reported an increase in their confidence to provide evidence-based services. Forty-three (86%) participants indicated their intentions to modify their evaluative practices (e.g., involving children in goal setting) and their management of DCD (e.g., using the best practice principles, ...

Knowledge to Practice in Developmental Coordination Disorder: Utility of an Evidence-Based Online Module for Physical Therapists

Abstract: Aims: Developmental coordination disorder (DCD) is a chronic condition with potential negative health consequences. Therapists working with children with DCD need access to tailored, synthesized, evidence-based information; however a knowledge-to-practice gap exists. The aim of this study was to develop and evaluate the utility of an evidence-based online DCD module tailored to physical therapists’ (PTs) needs. Methods: Guided by the Knowledge to Action framework, we interviewed PTs working with children with DCD (n = 9) to identify their information needs. Their recommendations, along with synthesized DCD research evidence, informed module development. These PTs as well as others (n = 50) evaluated the module's usefulness. Results: The module incorporated important content areas including: (1) identification; (2) planning interventions and goals; (3) evidence-based practice; (4) management; and (5) resources. Case scenarios, clinical applications, interactive media, links to resources, and intera...

Balancing Hope and Realism in Family-Centered Care: Physical Therapists’ Dilemmas in Negotiating Walking Goals with Parents of Children with Cerebral Palsy

Abstract: The aims of this study were to explore physical therapists' beliefs about the value of walking for children with cerebral palsy (CP), how these beliefs inform therapy choices, and to describe how physical therapists engage families in decision-making regarding walking goals. Eight physical therapists who had experience working with children with CP each participated in a qualitative, one-to-one interview exploring their walking-related values, beliefs, and decision-making practices. The physical therapists' accounts demonstrated that they balanced their beliefs and professional expertise with families' goals in order to preserve families' hopes and maintain rapport, while also ensuring evidence-based and efficacious treatment plans were implemented. Participants experienced internal conflict when attempting to balance the principles of family-centered care with their personal beliefs and expertise. Further research will augment these findings and contribute to ongoing debates regarding rehabilitation best practices and family-centered care.

A Case Review: Reframing School-Based Practices Using a Critical Perspective

Abstract: It is well established in the literature that school-based practice is fraught with challenges such as acquisition of appropriate and sufficient resources, communication barriers among professionals, parental burden, and redundancies and gaps in services. The purpose of this perspective paper is to reframe potentially problematic school-based practices using a critical social science perspective, suggesting a vision and strategies for therapists working in the context of school-based practice. We illustrate our approach with a case example. To reframe school-based practices, we begin with Jill's case, exploring it through a critical lens to identify potential issues and opportunities for change. We then trace these findings to our larger dataset from an ongoing program of research to ensure relevance to the broader context of school-based practice. Reframing of three school-based practice issues is discussed from: (a) advocacy by proxy to collaborative dialogue, (b) governing texts to guiding texts, and (c) playing the "right" part to having a voice. Although this is a perspective paper based on a case exemplar, we posit how we may reframe and rethink school-based practices in pediatric rehabilitation. We suggest that only with a genuine shift in our professional values will we see the enactment of collaborative practice in school-based settings.

Complementary, Alternative, and Mainstream Service use Among Families with Young Children with Multiple Disabilities: Family Costs to Access Choices

Abstract: Families raising a young child with multiple disabilities are charged with significant responsibilities such as learning about their child's condition and navigating mainstream and alternative services. Aim: Describe service choices, costs, out of pocket expenses, and the impact on families. Methods: Survey design using a custom questionnaire was used to collect extensive retrospective and current data. Purposive sampling (N = 29) occurred from one early intervention facility specialized in servicing children with cerebral palsy (CP) and, or multiple disabilities in Australia. Descriptive statistics were used for analysis of data. Results: Twenty-three (79%) families reported caring for a child with CP. Twenty-three families reported using at least one complementary/alternative intervention. Out-of-pocket amounts were reported including: chiropractic services (10 families); naturopathy (9 families); point percussion therapy (7 families), and Chinese medicine (6 families). Expenses resulted in fami...

Determinants of Developmental Gain in Daily Activities in Young Children with Cerebral Palsy.

Abstract: The aim of this study was to examine which child and family characteristics at the child's age of 2 years are determinants of development of self-care and mobility activities over a period of 2 years in young children with cerebral palsy (CP). Longitudinal data of 92 children, representing all levels of the Gross Motor Function Classification System (GMFCS), were analyzed. Children's self-care and mobility activities were assessed with the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory. Development of self-care and mobility activities was related to several child determinants but no family determinants. GMFCS, type of CP, intellectual capacity, and epilepsy were related to the development of self-care and mobility activities, while manual ability and spasticity were related to development of mobility activities. Multivariate analysis indicated that GMFCS and intellectual capacity were the strongest determinants of development of self-care activities, and GMFCS was the ...

Physical Therapists’ Perceptions of School-Based Practices

Abstract: Aims: Surveys have reported that most school-based physical therapists perceive ideal practices are not commonly implemented in their settings. Our aim was to obtain a more in-depth understanding of these perceptions through open-ended inquiry. Methods: Qualitative data were derived from voluntary open-ended responses provided upon completion of a survey regarding school-based physical therapy practice. Of the survey's 561 participants, 250 provided open-ended commentaries that were analyzed using interpretive phenomenology. Results: Six qualitative themes emerged from the open-ended responses, including: In quest: Meeting students’ school-based needs via physical therapy; Seeking relatedness: Finding working teams in the school system; Building understanding: Developing a voice/identity in the school context; Stretched beyond limits: Managing workloads; Networking: Coordinating services outside school to meet student needs; Defying definition: What does working in an educational model mean? Concl...

Inter-Rater and Test-Retest Reliability of the German Pediatric Evaluation of Disability Inventory (PEDI-G).

Abstract: Activities of daily living (ADL) of children are widely assessed with the Pediatric Evaluation Disability Inventory (PEDI). This study examined test-retest and inter-rater reliability of the German PEDI (PEDI-G). During the adaptation of the PEDI nine items were added. In total, 117 parents of 53 children without and 64 chil- dren with a diagnosed physical disability from Austria, Germany, and Switzerland par- ticipated. Reliability was examined by intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable difference (SDD) for the Func- tional Skill Scale with and without added items and the Caregiver Assistance Scale. Co- hen's Kappa was used to calculate the reliability of the Modification Scale. All ICC's for test-retest and inter-rater reliability were above 0.75, indicating good to very good reliability. The SDD varied from 0.83-5.58 across PEDI domains and scales. For the Modification Scale, Cohen's weighted kappa varied from 0.25 to 1.00 indicating suffi- cient reliability for some but not all items. Our findings indicate that the Functional Skill Scale and the Caregiver Assistance Scale of the PEDI-G are reliable scales that can be used to evaluate ADLs of children with and without physical disability.

European-French Cross-Cultural Adaptation of the Developmental Coordination Disorder Questionnaire and Pretest in French-Speaking Switzerland.

Abstract: The Developmental Coordination Disorder Questionnaire (DCDQ’07) is a Canadian-English instrument recommended for screening children aged 5 to 15 years who are at risk for developmental coordination disorder. While a Canadian-French version of the DCDQ’07 presently exists, a European-French version does not. Aims. To produce a cross-cultural adaptation of the DCDQ’07 for use in areas of Europe where French is spoken and to test its cultural relevance in French-speaking Switzerland. Methods. Cross-cultural adaptation was done using established guidelines. Cultural relevance was analyzed with cognitive interviews of thirteen parents of children aged 5.0 to 14.6 years (mean age: 8.5 years, SD = 3.4), using think-aloud and probing techniques. Results. Cultural and linguistic differences were noted between the European-French, the Canadian-French, and the original versions of the DCDQ’07. Despite correct translation and expert committee review, cognitive interviews revealed that certain items of the Eu...

Ten Conferences on Developmental Coordination Disorder (DCD): A Brief Commentary on 20 Years of Research

Abstract: Awareness and understanding of Developmental Coordination Disorder (DCD) has increased steadily over the last two decades. A series of international conferences, begun in 1995, has offered a forum ...

A comparative ICF-CY-based analysis and cultural piloting of the assessment of preschool children's participation (APCP).

Abstract: Aims: The aim of this study was to assess and compare the content and measurement construct of a new measure, the Assessment of Preschool Children's Participation (APCP), with other participation measures that have previously been linked to the ICF-CY, and pilot the APCP item relevance in a Norwegian context. Methods: All meaningful concepts in the APCP were linked to the ICF-CY and compared with the links of eight other preschool measures. The analysis of measurement construct was based on the attending/doing and involvement/engagement dimensions of participation. The pilot study was a survey among 36 parents of typically developing children. Results: Like most measures, the APCP has a relatively high content intensity on recreation and play, but differs by excluding self-care activities and including some learning activities. All instruments use objective indicators to measure participation. The APCP was not among the few that assessed subjective aspects of participation. The APCP items were fou...

Fostering Ambulation for a Preschool Child with Rett Syndrome: A Case Report.

Abstract: Children with Rett Syndrome (RS) have neuromotor impairments that impact their mobility. Poor hand function among children with RS limits the selection of an assistive device for ambulation. Purpose: The purpose of this case report is to describe the process of selecting an assistive device for a child with RS to promote ambulation. Method: This single subject case reports on a 5-year-old girl with RS at a suburban mid-western early childhood special education setting. Results: The child in this case was able to walk the farthest distances with a metal toy shopping cart and then with an anterior facing four-wheeled walker. Conclusion: The outcome suggests that physical therapists and health professionals caring for young children with RS consider using a metal toy shopping cart to establish and practice ambulation prior to selection of a longer term, adjustable anterior facing walker like the one in this case report.

A Service Delivery Model for Children with DCD Based on Principles of Best Practice

Abstract: Aims. In this perspective article, we propose the Apollo model as an ex- ample of an innovative interdisciplinary, community-based service delivery model for children with Developmental Coordination Disorder (DCD) characterized by the use of graduated levels of intensity and evidence-based interventions that focus on func- tion and participation. Methods. We describe the context that led to the creation of the Apollo model, describe the approach to service delivery and the services offered. Results. The Apollo model has 5 components: first contact, service delivery coordina- tion, community-, group-, and individual-interventions. This model guided the devel- opment of a streamlined set of services offered to children with DCD, including early- intake to share educational information with families, community interventions, inter- disciplinary and occupational therapy groups, and individual interventions. Following implementation of the Apollo model, wait-times decreased and the number of chil- dren receiving services increased, without compromising service quality. Conclusions. Lessons learned are shared to facilitate development of other practice models to sup- port children with DCD.

Electrical Stimulation Following Botulinum Toxin A in Children With Spastic Diplegia: A Within-Participant Randomized Pilot Study

Abstract: Aims: To determine whether electrical stimulation (ES) following botulinum toxin A (BoNT/A) injection increases passive extensibility of the hamstring muscles in children with spastic diplegia. Methods: Six children undergoing bilateral BoNT/A injections to the hamstrings participated in this within-participant single blind randomized controlled trial. One leg of each child was randomised to the experimental condition and the other to the control condition. The experimental leg received daily stretch and ES to the hamstrings for 12 weeks, while the control leg received only daily stretch. The primary outcome was passive hamstring extensibility reflected by popliteal angle measured with a standardised torque. Secondary outcomes were two goniometric measures of popliteal angle using the Modified Tardieu Scale (R1 and R2), and parents' perceptions of treatment effectiveness. Outcomes were measured at baseline, 4 weeks, 12 weeks and 6 months. Results: The mean between-group difference (95% CI) at 4 we...

Concurrent validity of the School Outcomes Measure (SOM) and Pediatric Evaluation of Disability Inventory (PEDI) in preschool-age children.

Abstract: Aims: The purpose of this study was to examine the concurrent validity of the School Outcomes Measure (SOM) compared with the Pediatric Evaluation of Disability Inventory (PEDI) in preschool-age children. This study also examined the consistency of children's motor performance across the home and school settings. Methods: Five school-based physical therapists collected data on 44 preschool-age children with physical or combined physical and cognitive disability. Correlation coefficients analyzed the strength of association between SOM and PEDI subscale scores, while participant group mean scores analyzed agreement between measures regarding level of motor performance. Results: Correlations between homologous PEDI and SOM subscale scores varied from rs = .53 to rs = .92 supporting concurrent validity. With some exceptions, group mean SOM scores showed agreement with group mean PEDI scores when children were categorized by age, gross motor function level, or PEDI cutoff score (1 or 2 SD below the me...

The "5Rs of Reorganization": A Case Report on Service Delivery Reorganization within a Pediatric Rehabilitation Organization.

Abstract: Aims: Pediatric rehabilitation centers constantly reorganize services to accommodate changes in funding, client needs, evidence-based practices, accountability requirements, theoretical models, and values. However, there are few service delivery models or descriptions of how organizations plan for change to guide organizations through this complex task. Methods: This case report presents the “5Rs of Reorganization,” a novel process for planning service delivery reorganization projects in pediatric rehabilitation centers. The 5Rs include: 1. Recognize the need for change, 2. Reallocate resources for project management, 3. Review the reality of clients, service delivery, and the community, 4. Reconstruct reality, and 5. Report results. Results: The implementation and outcomes of the “5Rs of Reorganization” process are described for one pediatric rehabilitation center to illustrate how use of this process led to effective service delivery reorganization planning. The resulting multi-component customi...