Measuring family-centred practices of professionals in early intervention services in Taiwan.

BACKGROUND: Family-centred practices emphasize professional supports for forming partnerships with families in early intervention. The Measure of Processes of Care for Service Providers (MPOC-SP) measures the perceptions of paediatric service providers in supporting children and families. This study aimed to establish reliability of the Chinese version of the MPOC-SP (C-MPOC-SP) and to examine professional perceptions of family-centred practices in relation to professional discipline and years of experience. METHODS: A convenience sample of 94 physical therapists, occupational therapists, speech-language pathologists, social workers and early childhood educators completed the C-MPOC-SP. Thirty-seven professionals completed the measure a second time within 2-4 weeks for test-retest reliability. Internal consistency and test-retest reliability were examined by Cronbach's α and intra-class correlation coefficient. Comparisons were made across professional disciplines by multivariate analyses of variance followed by analyses of variance. Relationships between years of experience and ratings of family-centred practices were examined by Pearson's correlation coefficients (r). RESULTS: Cronbach's α for items on each of the four scales of the C-MPOC-SP ranged from 0.80 to 0.92, indicating adequate internal consistency. Intra-class correlation coefficient between the initial and repeat completion of the C-MPOC-SP for each scale ranged from 0.56 to 0.77, indicating adequate to excellent test-retest reliability. Mean ratings for the Communicating Specific Information were significantly higher for physical therapists, occupational therapists and speech-language pathologists than for social workers (P = 0.001). The C-MPOC-SP scores were positively correlated with years of experience for all four scales (r = 0.23-0.38; P < 0.05). CONCLUSIONS: This study established adequate internal consistency and adequate to excellent test-retest reliability of the C-MPOC-SP in measuring perceptions of family centeredness of early intervention service providers. Cross-discipline differences were found in communicating specific information about the child. Higher perceptions of family centeredness were associated with more years of experience. The results support the utility of the C-MPOC-SP in professional education and programme evaluation of early intervention services in Taiwan.

Family ecology of young children with cerebral palsy.

BACKGROUND: Family ecology in early childhood may influence children's activity and participation in daily life. The aim of this study was to describe family functioning, family expectations of their children, family support to their children, and supports for families of young children with cerebral palsy (CP) based on children's gross motor function level. METHODS: Participants were 398 children with CP (mean age = 44.9 months) and their parents residing in the USA and Canada. Parents completed four measures of family ecology, the Family Environment Scale (FES), Family Expectations of Child (FEC), Family Support to Child (FSC) and Family Support Scale (FSS). RESULTS: The median scores on the FES indicated average to high family functioning and the median score on the FSS indicated that families had helpful family supports. On average, parents reported high expectations of their children on the FEC and strong support to their children on the FSC. On the FES, higher levels of achievement orientation were reported by parents of children in Gross Motor Function Classification System (GMFCS) level II than parents of children in level I, and higher levels of control were reported by parents of children in level I than parents of children in level IV. On the FEC, parents of children with limited gross motor function (level V) reported lower expectations than parents of children at all other levels. CONCLUSIONS: Family ecology, including family strengths, expectations, interests, supports and resources, should be discussed when providing interventions and supports for young children with CP and their families.

Social participation of youths with cerebral palsy differed based on their self-perceived competence as a friend.

BACKGROUND: Social participation with friends fosters development of meaningful relationships, life skills and psychosocial well-being. Youths with cerebral palsy (CP) face challenges to establishing social relationships with friends. The aim of this study was to explore whether social participation with friends differs among youths with CP based on their self-perceived competence as a friend. METHODS: A total of 135 youths with CP, 13-21 years old (mean age 16 years, 50% were male), completed the measures Fulfillment in Social Roles and Children's Assessment of Participation and Enjoyment. Youths were assigned to high, middle and low groups defined by their self-perceived competence as a friend. Differences among the three groups in the number, total frequency and enjoyment of activities done with friends was examined by Kruskal-Wallis one-way analyses of variance. Post hoc analysis of significant effects was performed using a Mann-Whitney U-test or Kolmogorov-Smirnov test. RESULTS: The number (χ(2) = 17.07, d.f. = 2, P < 0.001) and total frequency (χ(2) = 18.35, d.f. = 2, P < 0.001) of activities done with friends differed based on youths' self-perceived competence as a friend. Youths with high self-perceived competence as a friend did the greatest number of activities and participated most often with friends. Youths with low self-perceived competence did the fewest activities and participated least often with friends. No differences were found in the enjoyment of activities done with friends among the three groups (χ(2) = 1.86, d.f. = 2, P > 0.05). CONCLUSIONS: For youths with CP, the number and frequency of activities done with friends differed based on self-perceived competence as a friend, but not enjoyment of activities. The results suggest a positive link between social participation and self-perceived competence. Healthcare providers have a role to support youths' efforts to engage with friends by enhancing community opportunities, developing and providing interventions in natural social environments and incorporating peer support into service delivery.

Profiles of family needs of children and youth with cerebral palsy.

BACKGROUND: To identify profiles of family needs of families of children and youth with cerebral palsy (CP), and determine whether profile membership is related to child, family and service characteristics. METHODS: Participants were mostly mothers (80%) of 579 children and youth with CP. A family member completed modified version of the Family Needs Survey and questionnaires about their child, family and services. Research assistants determined the Gross Motor Function Classification System levels. K-means cluster analysis identified profiles of needs. Cluster membership was analysed to examine differences in clusters based on selected characteristics. RESULTS: Four profiles of needs were identified: Low needs, Needs related to community and financial resources, Needs related to child health condition and High needs. Profile membership was differentiated based on child/youth gross motor function, adaptive behaviour, family relationships, family income, access and effort to co-ordinate services. CONCLUSION: Despite heterogeneity among individuals with CP and their families, four profiles of family needs were identified. In total, 51% of families had low needs suggesting that they are effectively managing their children's health conditions while 11% of families had high needs that may require high levels of services and supports. Service providers are encouraged to partner with families, provide anticipatory guidance and co-ordinate services.

Family needs of parents of children and youth with cerebral palsy.

BACKGROUND: Understanding the needs of families of children and youth with cerebral palsy (CP) is important for family-centred services. The aims of this study were to identify: (1) differences in the number and types of family needs expressed by parents based on the age and gross motor function level of their children with CP; (2) the most frequent family needs; and (3) needs that differ on gross motor function level. METHODS: A total of 501 parents (77.6% mothers) of children and youth with CP completed a modified version of a Family Needs Survey and a demographic questionnaire. Children's gross motor function level was classified using the Gross Motor Function Classification System. RESULTS: Total number of family needs differed based on gross motor function level (P < 0.001) but not age. Parents of children/youth who use wheeled mobility expressed the highest number of family needs, while parents of children/youth who walk without restrictions expressed the fewest needs. Family needs for Information (P= 0.001), Support (P= 0.001), Community Services (P < 0.001) and Finances (P < 0.001) differed based on children's gross motor function level. Over 50% of parents expressed family needs for information on current and future services, planning for the future, help in locating community activities and more personal time. Parents of children and youth who use wheeled mobility were more likely to express the need for help in paying for home modifications, equipment, services and locating sitters, respite care providers and community activities. CONCLUSIONS: The gross motor function of children/youth with CP has implications for collaboration with families to identify needs and co-ordinate services. Health professionals have a role to assist families with information needs and locating community services and leisure activities. Family needs for future planning suggest that health professionals should assist families to prepare for key periods in the lives of their children with CP.

Relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of therapists' behaviors during early intervention.

BACKGROUND AND PURPOSE: Federal law mandates family-centered care as the service delivery model in early intervention programs for children from birth to 36 months of age. This study investigated the relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of physical therapists' family-centered behaviors during early intervention. SUBJECTS AND METHODS: Twenty-five physical therapists and 75 mother-child dyads (3 from each therapist's caseload) participated. The mean chronological age for the children was 21.2 months (SD=7.3, range=6-35). Mothers participated in a structured interview using the Measures of Processes of Care (MPOC-56), and they completed the Parenting Stress Index-Short Form (PSI-SF) and a questionnaire. The Bayley-II Motor Scale was administered to the children. Therapists completed a modified version of the Measures of Processes of Care for Service Providers (MPOC-SP) and a questionnaire. RESULTS: Scores for mothers on the MPOC-56 and for therapists on the MPOC-SP indicated strong positive perceptions and attitudes toward family-centered behaviors. Hierarchical multiple regression analyses indicated that parenting stress explained a considerable amount of the variance in mothers' perceptions of family-centered behaviors, whereas therapists' attitudes explained a considerable amount of the variance in mothers' perceptions of respectful and supportive care. Children's motor ability was inversely related to parenting stress. DISCUSSION AND CONCLUSION: Findings suggest that mothers perceive that physical therapists are using family-centered behaviors in early intervention. Findings from the questionnaires suggest that some early intervention policies may be barriers for therapists and prevent them from actualizing attitudes toward family-centered behaviors.

Gross motor function of children with down syndrome: creation of motor growth curves.

OBJECTIVE: To create gross motor function growth curves for children with Down syndrome (DS) and to estimate the probability that motor functions are achieved by different ages. DESIGN: Nonlinear growth curve analysis by using a 2-parameter (rate, upper limit) model. SETTING: Early intervention programs, schools, and children's homes. PARTICIPANTS: One hundred twenty-one children with DS, ages 1 month to 6 years. MAIN OUTCOME MEASURES: Gross Motor Function Measure (GMFM) and severity of motor impairment. RESULTS: The curves for children with mild (n = 51) and moderate/severe (n = 70) impairment were characterized by a greater increase in GMFM scores during infancy and smaller increases as the children approached the predicted maximum score of 85.9 or 87.9. The estimated probability that a child would roll by 6 months was 51%; sit by 12 months, 78%; crawl by 18 months, 34%; walk by 24 months, 40%; and run, walk up stairs, and jump by 5 years, 45% to 52%. CONCLUSIONS: Children with DS require more time to learn movements as movement complexity increases. Impairment severity affected the rate but not the upper limit of motor function. The results have implications for counseling parents, making decisions about motor interventions, and anticipating the time frame for achievement of motor functions.

The effect of foot orthoses on standing foot posture and gait of young children with Down syndrome.

The purpose of this study was to determine if foot orthoses (FOs) immediately affected gait of children with Down Syndrome (DS) and excessively pronated feet. Subjects were 3--6 years old; 16 with DS and 10 without disabilities. Gait of children with DS wearing sneakers was compared with and without FOs and compared to gait of children without disabilities. Ankle moment, walking speed during stance phase, sneaker prints, center of pressure, and transverse plane foot angles were collected and compared. In standing, heel eversion was reduced when the children wore FOs (p=0.000). During gait the transverse plane foot angle decreased indicating more internal rotation with FOs (p=0.000). Trial-to-trial variability of pronation-supination index (p=0.0001), foot length contact (p=0.0001), transverse plane foot angle (p=0.0003), and walking speed (p=0.0001) all decreased with FO use. Trial-to-trial variability of normalized peak ankle moment (p=0.0001), and of phase of peak ankle moment (p=0.0001) increased when the children wore FOs.

Validation of a model of gross motor function for children with cerebral palsy.

BACKGROUND AND PURPOSE: Development of gross motor function in children with cerebral palsy (CP) has not been documented. The purposes of this study were to examine a model of gross motor function in children with CP and to apply the model to construct gross motor function curves for each of the 5 levels of the Gross Motor Function Classification System (GMFCS). SUBJECTS: A stratified sample of 586 children with CP, 1 to 12 years of age, who reside in Ontario, Canada, and are known to rehabilitation centers participated. METHODS: Subjects were classified using the GMFCS, and gross motor function was measured with the Gross Motor Function Measure (GMFM). Four models were examined to construct curves that described the nonlinear relationship between age and gross motor function. RESULTS: The model in which both the limit parameter (maximum GMFM score) and the rate parameter (rate at which the maximum GMFM score is approached) vary for each GMFCS level explained 83% of the variation in GMFM scores. The predicted maximum GMFM scores differed among the 5 curves (level I=96.8, level II=89.3, level III=61.3, level IV=36.1, and level V=12.9). The rate at which children at level II approached their maximum GMFM score was slower than the rates for levels I and III. The correlation between GMFCS levels and GMFM scores was (.91. Logistic regression, used to estimate the probability that children with CP are able to achieve gross motor milestones based on their GMFM total scores, suggests that distinctions between GMFCS levels are clinically meaningful. CONCLUSION AND DISCUSSION: Classification of children with CP based on functional abilities and limitations is predictive of gross motor function, whereas age alone is a poor predictor. Evaluation of gross motor function of children with CP by comparison with children of the same age and GMFCS level has implications for decision making and interpretation of intervention outcomes.

Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity.

BACKGROUND AND PURPOSE: This study examined the reliability, validity, and responsiveness to change of measurements obtained with a 66-item version of the Gross Motor Function Measure (GMFM-66) developed using Rasch analysis. SUBJECTS AND METHODS: The validity of measurements obtained with the GMFM-66 was assessed by examining the hierarchy of items and the GMFM-66 scores for different groups of children from a stratified random community-based sample of 537 children with cerebral palsy (CP). A subset of 228 children who had been reassessed at 12 months was used to test the hypothesis that children who are young (<5 years of age) and have "mild" CP will demonstrate greater change in GMFM-66 scores than children who are older ((5 years of age) and whose CP is more severe. Data from an additional 19 children with CP who were assessed twice, one week apart, were used to examine test-retest reliability. RESULTS: The overall changes in GMFM-66 scores over 12 months and a time ( severity ( age interaction supported our hypotheses. Test-retest reliability was high (intraclass correlation coefficient=.99). CONCLUSION AND DISCUSSION: This study demonstrated that the GMFM-66 has good psychometric properties. By providing a hierarchical structure and interval scaling, the GMFM-66 can provide a better understanding of motor development for children with CP than the 88 item GMFM and can improve the scoring and interpretation of data obtained with the GMFM.

A multivariate model of determinants of motor change for children with cerebral palsy.

The purpose of this article is to describe the development of a theory- and data-based model of determinants of motor change for children with cerebral palsy. The dimensions of human functioning proposed by the World Health Organization, general systems theory, theories of human ecology, and a philosophical approach incorporating family-centered care provide the conceptual framework for the model. The model focuses on relationships among child characteristics (eg, primary and secondary impairments, personality), family ecology (eg, dynamics of family function), and health care services (eg, availability, access, intervention options). Clarification of the complex multivariate and interactive relationships among the multiple child and family determinants, using statistical methods such as structural equation modeling, is necessary before determining how physical therapy intervention can optimize motor outcomes of children with cerebral palsy. We propose that the development and testing of multivariate models is also useful in physical therapy research and in the management of complex chronic conditions other than cerebral palsy. Testing of similar models could provide physical therapists with support for: (1) prognostic discussions with clients and their families, (2) establishment of realistic and attainable goals, and (3) interventions to enhance outcomes for individual clients with a variety of prognostic attributes.

Attitudes toward family-centered care and clinical decision making in early intervention among physical therapists.

Family-centered care is the mandated service delivery model in early intervention. The purpose of this study was to examine the attitudes of physical therapists toward family-centered care and to describe clinical decision making factors in determining frequency and duration of service. A convenience sample of 25 physical therapists working in early intervention participated in a mail survey. Therapists completed a modified version of the Measures of Processes of Care for Service Providers (MPOC-SP) and the Physical Therapist Questionnaire. Mean subscale scores on the modified version of the MPOC-SP varied from 6.04-6.43 on a seven-point scale with highest scores on the Respectful and Supportive Care subscale. Therapists' attitudes toward family-centered care correlated with attitudes toward direct intervention items (r = 0.43-0.66, p < 0.05). Child considerations were most important to therapists and administration considerations were least important when determining levels of service. Results suggest that therapists are sensitive to the needs of families and children and value parents as partners on the early intervention team. The relationship between therapists' family-centered care attitudes and intervention are consistent with a systems approach. Results on clinical decision making reflect the role of the physical therapist in early intervention and suggest a potential conflict with administrative policies when determining levels of service.

Comparison of two outcome measures for infants with cerebral palsy and infants with motor delays.

BACKGROUND AND PURPOSE: The purpose of this study was to compare the Gross Motor Function Measure (GMFM) and the Peabody Developmental Gross Motor Scale (PDMS-GM) as measures of change in infants with cerebr-al palsy (CP) and infants with motor delays. We hypothesized that mean change scores would be greater for the GMFM than for the PDMS-GM. SUBJECTS AND METHODS: Subjects were 42 infants with a mean adjusted age of 13.9 months (SD=6.1, range=4.2-24.2). Twenty-four infants had CP, and 18 infants had motor delays. The GMFM and the PDMS-GM were administered to the infants 3 times over a 6-month period. Raw scores were standardized for data analysis. Data were analyzed using a 3-factor repeated-measures analysis of variance. RESULTS: For the 6-month period, mean PDMS-GM age-equivalent scores increased 3.8 months and mean scaled scores increased 35 points for infants with motor delays compared with increased scores of 1.8 months and 13 points for infants with CP. Mean GMFM scores increased by 12.2% for infants with rmotor delays and by 4.2% for infants with CP. The diagnosis X time interaction was significant. Infants with motor delays had a greater change in motor development compared with the infants with CP. The hypothesis that the GMFM is more responsive to change than the PDMS-GM was not supported. CONCLUSION AND DISCUSSION: The findings suggest that the GMFM and the PDMS-GM are comparable in measuring change in infants with CP or motor delays. Implications for selection and use of either measure are discussed.

Performance following ability-focused physical therapy intervention in individuals with severely limited physical and cognitive abilities.

BACKGROUND AND PURPOSE: Do individuals with severely limited physical and cognitive abilities improve their gross motor abilities when given physical therapy intervention, and does improvement transfer to nontreatment settings? SUBJECTS: The subjects were 24 individuals (10 female, 14 male), aged 3 to 30 years (X = 20.1, SD = 8.1), who were nonambulatory and had limited adaptive behavior. METHODS: Change in gross motor ability during 18 weeks of twice-weekly therapy was measured using goal attainment scaling (GAS). Three gross motor goals were developed for each subject based on individual or caregiver needs, with one goal randomly selected as a control. Physical impairments were treated, and behavioral management principles, low-level communication approaches, high-repetition practice of goals, and a progressive reduction of both physical assistance and multisensory cues were used. An independent rater scored goal level from randomly ordered videotapes recorded during therapy and in recess and home settings. RESULTS: Mean GAS T scores were higher for treatment goals (X = 45.6, SD = 10.5) compared with control goals (X = 34.6, SD = 11.8). When the expected goal level (50) was met during therapy, mean GAS T scores in recess settings ( X = 35.9, SD = 11.5) and home settings (X = 42.2, SD = 12.2) were lower. At the conclusion of therapy, there were no differences in goal levels between treatment and control goals in both the recess and home settings. CONCLUSION AND DISCUSSION: The subjects demonstrated improvement of gross motor abilities practiced during therapy. Level of ability during therapy, however, did not consistently transfer to the recess of home settings. [Brown DA, Effgen SK, Palisano RJ. Performance following ability-focused physical therapy intervention in individuals with severely limited physical and cognitive abilities.

Investigation of the effects of a model of physical therapy on mother-child interactions and the motor behaviors of children with motor delay.

BACKGROUND AND PURPOSE: Physical therapists strive to promote children's motor function and the parents' abilities to interact with their children, thus aiming to positively influence the parent-child relationship. This study examined a model for provision of home-based physical therapy within the context of motor play on mother-child interactions and motor behaviors of children. SUBJECTS: The subjects were 38 mothers and their children with motor delay, aged 6 to 34 months (mean = 18.8, SD = 7.2), who were receiving center-based early intervention. METHOD: Children were ranked by motor development, using the Bayley Motor Scale, and assigned to either an experimental or control group. The experimental group received five home-based sessions of physical therapy. Conventional physical therapy strategies were incorporated into interactive play activities between mothers and their children. Both groups continued to receive their centered-based services. Mother-child interactions were videotaped before and after intervention and were analyzed using a modification of the response-class matrix. RESULTS: The mothers in the experimental group demonstrated an increase in appropriate holding of their children, whereas mothers in the control group demonstrated a decrease. The mothers in the experimental group became more directive, thus controlling their children's behavior, but they were not less positive or more negative when interacting with their children. CONCLUSION AND DISCUSSION: The integration of conventional physical therapy within the context of interactive play was well received and may promote generalization of motor skills during play without interfering with positive mother-child interactions.

Validity of the Peabody Developmental Gross Motor Scale as an evaluative measure of infants receiving physical therapy.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the validity of the Peabody Developmental Gross Motor Scale (PDMS-GM) as an evaluative measure of infants receiving physical therapy. SUBJECTS AND METHODS: Infants who attended an early intervention program (N = 124) were grouped by diagnosis: cerebral palsy, Down syndrome, hydrocephalus, preterm with developmental delay, full term with developmental delay, and other. The PDMS-GM was administered to each infant three times over a 6-month period by a therapist who did not provide treatment. RESULTS: Mean scaled scores and age-equivalent scores increased for each group. Individual change was examined using the reliable change index. The results indicated that the change in total raw score for 62% of the infants was greater than what could be attributed to measurement error. When minimal clinically important change was defined as 10 scaled score points, the index of responsiveness was equal to 0.5. This finding indicates that a sample size of 68 subjects per group would be needed when the PDMS-GM is used as an outcome measure in research. CONCLUSION AND DISCUSSION: The mean change scores for each group support the use of the PDMS-GM as an evaluative measure. For many infants, particularly infants with cerebral palsy, the PDMS-GM was not responsive to change over a 6-month period. The index of responsiveness suggests that the PDMS-GM should be used only as an outcome measure in large clinical trials. The PDMS-GM is not recommended for evaluating the direct effects of physical therapy but is recommended for providing a global measure of change in motor development as part of a multidimensional assessment.

Validity of goal attainment scaling in infants with motor delays.

BACKGROUND AND PURPOSE: The purpose of this study was to examine (1) content validity of goal attainment scaling (GAS), (2) the responsiveness of GAS compared with a behavioral objective, and (3) concurrent validity of GAS and the Peabody Developmental Gross Motor Scale. SUBJECTS AND METHODS: Two motor goals were developed for two consecutive 3-month periods for 21 infants with motor delays. The goals were put into behavioral objective and GAS formats and scored by independent examiners. Content validity was examined by having 10 physical therapists rate 10 randomly selected GAS-formatted goals on three dimensions: (1) the importance of the goal for motor development and function, (2) whether the expected progress was achievable, and (3) whether each of the four levels of change was clinically important. RESULTS: Between 77% and 88% of the therapists' ratings for each dimension met the criterion for content validity. The ratings did not differ significantly among the therapists for any of the three dimensions. Change that could not be measured with the behavioral objective format was measured with the GAS format for 61% of the goals, including 73% of the goals in which the behavioral objective was achieved. Correlations between GAS T-scores and Peabody gross motor age-equivalent change scores were not significant. CONCLUSION AND DISCUSSION: The results support content validity and the responsiveness of GAS, and provide evidence that GAS and the Peabody Scale measure different aspects of motor development. Goal attainment scaling is recommended for use in clinical practice and in treatment outcomes research.

Goal attainment scaling as a measure of change in infants with motor delays.

Goal attainment scaling (GAS) is an individualized criterion-referenced measure of change that has several unique features, compared with the behavioral objective, and five possible levels of attainment for each goal. The validity of GAS as a measure of motor change was investigated in 65 infants, 3 to 30 months of age, with motor delays. For each infant, two goals to be attained within a 6-month period of intervention were established. After the 6-month period, the mean GAS T-score of 55.4 was significantly higher than the expected mean of 50. This finding indicated that the infants' motor change exceeded the therapists' expectations. Neither the type nor the category of goal influenced the therapists' ability to select outcomes that the infants were capable of achieving. Because moderate and low correlations were found between GAS T-scores and Peabody gross motor and fine motor change scores, the two assessments appear to measure different aspects of motor development. Selected child, family, and program variables were examined as sources of bias in GAS T-scores. Motor delay was the only variable that biased GAS T-scores; infants who were less delayed had higher GAS T-scores. The results indicate that GAS was responsive to change in individualized motor goals and support the model of GAS as an idiosyncratic measure. The unique features of GAS offer advantages for measurement of motor change compared with the behavioral objective and norm-referenced developmental scales.

The effect of walking with an assistive device and using a wheelchair on school performance in students with myelomeningocele.

An alternating-condition, single-subject research design was used to examine the effect of ambulation on three measures of school performance in three students with myelomeningocele. The subjects, aged 9, 10, and 15 years, had a physiological cost index greater than 1.00 beats per meter when walking with crutches or a walker. Subjects propelled a wheelchair at school for 5 days, ambulated with crutches or a walker for 5 days, and propelled a wheelchair for an additional 5 days. Performance in reading fluency, visuomotor accuracy, and manual dexterity was assessed at the end of each school day. Results were graphed and analyzed using the two-standard-deviation band method. All subjects had significantly lower visuomotor accuracy scores during the assistive-device ambulation phase than during the wheelchair phases. Performance in manual dexterity during the assistive-device ambulation and wheelchair phases varied among the subjects. Reading fluency was not affected by method of mobility. The results suggest that the high energy cost of walking may have a negative effect on certain aspects of the subjects' school performance. [Franks CA, Palisano RJ, Darbee JC. The effect of walking with an assistive device and using a wheelchair on school performance in students with myelomeningocele.

Effects of a developmental physical therapy program on oxygen saturation and heart rate in preterm infants.

To evaluate the physiologic responses of 14 preterm infants to physical therapy, pulse oximetry was used to measure the percentage of arterial oxygen saturation (SaO2) and heart rate during baseline, intervention, and recovery phases. Treatment consisted of six one-minute activities that were equally divided between the side-lying and supported-sitting positions. The order of position and activities was randomly varied. A one-way analysis of variance for repeated measures revealed no significant changes in mean SaO2 as a function of the position or duration of intervention. Mean heart rate increased significantly as a result of intervention (p less than .0001), but there was no significant difference between the baseline and recovery phases. Further analysis indicated that the change in heart rate was not a function of duration of intervention. The results indicate that the preterm infants were able to tolerate the intervention without desaturation. The return of heart rate to baseline values during the recovery phase suggested a normal physiologic response to exercise. Despite some technical limitations, pulse oximetry is recommended to monitor preterm infants during physical therapy.