An exploration of the relationship between grit, reflection-in-learning, and academic performance in entry-level doctor of physical therapy students.

INTRODUCTION: Recent literature in physical therapy education suggests learners' non-cognitive skills, such as grit and reflection, may be predictors of success. Little is known about the relationship of these constructs to each other or success during the first year of entry level physical therapist education. OBJECTIVE: The purpose of this study was to assess the relationship between Reflection-In- Learning Scale (RLS), grit, and grade point average (GPA) of entry-level physical therapy students during the first year of didactic instruction. METHODS: One hundred and fourteen entry-level doctor of physical therapy students enrolled in a private university completed the original 12-item Grit Scale (Grit 1) and the RLS (RLS 1) during the first term and again at the end of the third trimester (Grit 2 and RLS 2). RESULTS: The relationship between Grit 1 and RLS 1 demonstrated a fair, positive, significant correlation (r = .380, p < .001). No relationship was found between Grit 1 and GPA (r = .066, p = .485), or Grit 2 and GPA (r = .064, p = .500), or between RLS 1 and GPA (r = .017, p = .857), or RLS 2 and GPA (r = .171, p = .069). Fifty-three percent of students demonstrated a decrease in grit and 56% decreased RLS scores at the end of the first year of the program. CONCLUSION: The fair correlation between these variables indicates they may measure different constructs. Findings suggest that doctor of physical therapy programs should be cautious when using these non-cognitive factors in making admission decisions. Future research should explore changes in grit and RLS throughout the curricula and impact on student success.

Current Trends for Children With Spina Bifida: A Survey of Pediatric Physical Therapists.

PURPOSE: To describe contemporary physical therapy practice and management of children with spina bifida (SB) in the context of the International Classification of Functioning, Disability, and Health (ICF) framework. METHODS: A descriptive, cross-sectional electronic survey was sent to US pediatric physical therapy clinics and posted in the American Physical Therapy Association Pediatrics newsletter. Data were analyzed using content analysis. Codes were compared, refined, and condensed into categories. RESULTS: A total of 163 participants were included. Most assessments evaluated the ICF Activity component. Most frequently reported ICF components: impairments = decreased strength (17.9%), activity limitations = limited walking (22.5%), and participation restrictions = restricted socializing/playing with peers or siblings (22.6%). The most prevalent intervention was strength training. CONCLUSIONS: Physical therapists (PTs) in the United States are performing assessments and interventions supported by available evidence; however, knowledge translation and more research are needed to support best practices in PT management of children with SB.

Relationship between Movement Quality, Functional Ambulation Status, and Spatiotemporal Gait Parameters in Children with Myelomeningocele.

AIMS: We investigated relationships among the Pediatric Neuromuscular Recovery Scale (Peds NRS), modified Hoffer Scale, and spatiotemporal gait parameters in children with myelomeningocele (MMC). METHODS: 21 children with MMC, age 5.3 years (SD = 2.6), were assessed by three clinicians using the Peds NRS and modified Hoffer Scale. In eight children, gait parameters were also measured. RESULTS: The Peds NRS summary score demonstrated good correlation with modified Hoffer Scale score (r = -0.64, p = 0.002) that accounted for 41% of variation in summary score. Six Peds NRS seated/standing items exhibited good relationships with modified Hoffer Scale (r = -0.51 to -0.70, p ≤ 0.023), and the sit-to-stand item demonstrated an excellent relationship (r = -0.85, p < 0.001). Sit-to-stand and three standing/walking items exhibited excellent associations with cadence (Rs = 0.81 to 0.88, p ≤ 0.014), and swing and stance time (both Rs = -0.83 to -0.90, p ≤ 0.01). Two Peds NRS standing items and modified Hoffer Scale score demonstrated good correlations with velocity (Rs = 0.71, p = 0.047; Rs = -0.73, p = 0.04, respectively). CONCLUSIONS: Our findings suggest that children with MMC who exhibit greater movement quality and trunk control are likely to be functional ambulators with more optimal spatiotemporal gait parameters.

Interrater Reliability of the Pediatric Neuromuscular Recovery Scale for Spinal Cord Injury.

Background: In synergy with the mounting scientific evidence for the capacity of recovery after spinal cord injury (SCI) and training, new evidence-based therapies advancing neuromuscular recovery are emerging. There is a parallel need for outcome instruments that specifically address recovery. The Pediatric Neuromuscular Recovery Scale (Pediatric NRS) is one example with established content validity to assess neuromuscular capacity within task performance. Objective: The objective of this study was to determine interrater reliability of the Pediatric NRS to classify motor capacity in children after SCI. Methods: Pediatric physicians (3), occupational therapists (5), and physical therapists (6) received standardized training in scoring the scale, then rated video assessments of 32 children post SCI, 2-12 years of age, 78% non-ambulatory. Interrater reliability was analyzed using Kendall coefficient of concordance for individual Pediatric NRS items and overall score. Results: The interrater reliability coefficient was determined to be near 1 for the overall Pediatric NRS score (ICC = 0.966; 95% CI, 0.89-0.98). Twelve of 16 individual items exhibited high concordance coefficients (Kendall's W ≥ 0.8) and four items demonstrated concordance coefficients, < 0.8 and > 0.69. Interrater reliability was equivalent among groups defined by age and neurological level, but lower among non-ambulatory individuals. Conclusion: Strong interrater reliability was demonstrated by pediatric clinicians who scored children with SCI using the Pediatric NRS.

Activity-Based Therapy: From Basic Science to Clinical Application for Recovery After Spinal Cord Injury.

BACKGROUND AND PURPOSE: Collaboration between scientists and clinicians effectively accelerated translation of scientific evidence for activity-based therapies (ABTs) into rehabilitation. This article addresses the basic scientific findings of activity-dependent plasticity that led to locomotor training, an ABT, and its principles to advance recovery in adult and pediatric populations with spinal cord injury (SCI). Expansion to new therapies based on these common principles is highlighted, for example, epidural stimulation. The article also describes a recently developed measure, the Neuromuscular Recovery Scale (NRS), and its psychometric properties. SUMMARY OF KEY POINTS: Locomotor training has led to recovery of walking in some individuals with motor-incomplete SCI even years after injury. Recent studies resulted in individuals with motor-complete SCI regaining some voluntary movements and standing in the presence of epidural stimulation. The level of success for locomotor training and epidural stimulation appears dependent on spinal networks maintaining the appropriate central state of excitability for the desired task. As these new advances in restorative therapies required an outcome measure that measured performance without compensation, the NRS was developed. The NRS has strong psychometric properties in adults, and a pediatric version is under development. Application of locomotor training in children is still novel. Preliminary evidence suggests that locomotor training can improve trunk control and also foster participation in children with chronic SCI. RECOMMENDATIONS FOR CLINICAL PRACTICE: ABTs may effectively promote neuromuscular recovery and improve function and participation in adults and children post-SCI. Evaluation of outcomes with valid measures, such as the NRS, is necessary to document the ability to perform functional tasks and to assess progress as function improves.

Development and Initial Validation of the Pediatric Neuromuscular Recovery Scale.

PURPOSE: The Neuromuscular Recovery Scale (NRS) was developed to assess the capacity of adults' post-spinal cord injury (SCI) to perform functional tasks without compensation. Application of the NRS to children has been challenging. The purpose of this study was to develop and complete the initial validation of a pediatric version of the NRS. METHODS: First, the investigative team developed a draft Pediatric NRS. Next, a Delphi method was used to amend the draft by 12 pediatric experts. Finally, the revised Pediatric NRS was field-tested on a sample of children with SCI (n = 5) and without (n = 7). RESULTS: After the Delphi process and field testing, the Pediatric NRS consists of 13 items scored on a 12-point scale. All items, except 1, achieved 80% agreement by experts. CONCLUSIONS: This is the first step in development and validation of a pediatric SCI scale that evaluates neuromuscular capacity, in the context of pediatric function, without compensation.

The ABLE scale: the development and psychometric properties of an outcome measure for the spinal cord injury population.

BACKGROUND: A paucity of information exists on the psychometric properties of several balance outcome measures. With the exception of the Modified Functional Reach Test, none of these balance outcome measures were developed specifically for the population with spinal cord injury (SCI). A new balance assessment tool for people with SCI, the Activity-based Balance Level Evaluation (ABLE scale), was developed and tested. OBJECTIVE: The purposes of this study were: (1) to develop a scale capturing the wide spectrum of functional ability following SCI and (2) to assess the initial psychometric properties of the scale using a Rasch analysis. DESIGN: A methodological research design was used to test the initial psychometric properties of the ABLE scale. METHODS: The Delphi technique was used to establish the original 28-item ABLE scale. People with SCI at each of 4 centers (n=104) were evaluated using the ABLE scale. A Rasch analysis was conducted to test for targeting, item difficulty, item bias, and unidimensionality. An analysis of variance was completed to test for discriminant validity. RESULTS: The Rasch analysis revealed a scale with minimal floor and ceiling effects and a wide range of item difficulty capturing the large scope of functional capacity after SCI. Multiple redundancies of item difficulty were observed. Limitations All raters were experienced physical therapists, which may have skewed the results. The sample size of 104 participants precluded a principal component analysis. CONCLUSION: Development of an all-inclusive clinical instrument assessing balance in the SCI population was accomplished using the Delphi technique. Modifications of the ABLE scale based on the Rasch analysis yielded a 28-item scale with minimal floor or ceiling effects. Larger studies using the revised scale and factor analyses are necessary to establish unidimensionality and reduction of the total item number.