Use of Goal Attainment Scaling to Measure Educational and Rehabilitation Improvements in Children with Multiple Disabilities.

With a focus on children with multiple disabilities (CMD), the purpose of this quality improvement project was to elevate educational measurement and practices involving CMD. Using the goal attainment scaling (GAS) methodology, this project was conducted within a public charter school, Pattison's Academy for Comprehensive Education (PACE), focusing on 31 CMD and measuring student improvement and program effectiveness. For 2010-2011 and 2011-2012, improvements were demonstrated for the majority of CMD by meeting or exceeding their goals. Goal attainment scaling was able to capture improvement in educational and rehabilitation goals in the majority of CMD. Goal attainment scaling can provide an indication of a program's effectiveness. The use of GAS in CMD has potential to maximize participation across the school setting where all children in the United States commonly develop and learn skills as well as find meaning.

Neuromotor Rehabilitation Interventions After Pediatric Stroke: A Focused Review.

Pediatric stroke is a condition that often results in life-long motor, cognitive, or sensory deficits for children. The purpose of this focused review is to compile the most recent literature on pediatric stroke neuromotor interventions and summarize evidence for use by rehabilitation providers and researchers. Terms including stroke, pediatric, and neuromotor were searched with appropriate MeSH terms. Information was collected regarding interventions conducted and outcome measures used for each article. Interventions and outcome measures were organized based on ICF components (Body Structure and Function, Activity, Participation, and Environmental Factors). 16 articles were included after full-text screens. From these 16 articles, a large majority of them included some form of neuromodulation as a part of intervention. Results identified a potentially problematic gap between domains addressed by interventions and measured by outcomes, with a need to include more expansive outcome measures in research studies. There are several areas of potential growth in pediatric stroke literature. Research studies should be precise when describing included samples. As interventions for pediatric stroke shift toward neuromodulation and other neurologic treatments, there is a need for well-defined populations, both clinically in the community as well as in research studies. There is also a need for US guidelines for rehabilitation after pediatric stroke. Overall, the trend in the literature seems to suggest that combining some form of neuromodulatory technique with existing recommended rehabilitation technique (ex: CIMT) may promote overall recovery for children after stroke, though further research is needed.

Goal Attainment Scaling Made Easy With an App: GOALed.

Pediatric physical therapists use Goal Attainment Scaling (GAS) in a variety of clinical settings to objectively measure change in individual-, patient- and family-centered goals. Creating, recording, storing, scoring, and interpreting GAS goals have been manually completed. Recently developed GOALed, a GAS app, provides an improved, streamlined approach. The purpose of this special communication is to introduce the GOALed app and demonstrate its use with a case example.

The effect of supported physical activity on parental-reported sleep qualities and pain severity in children with medical complexity.

PURPOSE: To study the impact of a 5-week supported physical activity (PA) intervention on parental report of sleep qualities, sleep duration, and pain severity in children with medical complexity (CMC). METHODS: Twenty-nine CMC participated in 180 minutes of daily supported PA on weekdays over 5 weeks. A pre- and post-test design was used to collect sleep qualities (Children's Sleep Habits Questionnaire) and pain severity (Faces Pain Scale- Revised) as reported by parents. Using a repeated measures design, weekly sleep diaries captured sleep duration. RESULTS: Children with medical complexity experienced no adverse effects, including pain, with the supported PA intervention. Significant improvements in sleep problems, sleep duration, and pain severity (P< 0.05) were demonstrated. CONCLUSION: Short-term supported PA did not interfere with sleep or pain in CMC, and in fact, seems to have enhanced parental report of sleep qualities, sleep duration, and pain severity. Supported PA appears safe for CMC and healthcare professionals should explore methods to expand opportunities for supported PA participation.

Implementing school based telehealth for children with medical complexity.

PURPOSE: This quality improvement project aimed to improve parental experiences with healthcare delivery and collaborative health care offered at a school serving children with medical complexity (CMC) by implementing telehealth services. METHODS: Parents of students at an urban public charter school for CMC were surveyed before and after telehealth was implemented at the school for two months, and again one year later, using the Measure of Processes of Care (MPOC-20). RESULTS: Parental scores on the MPOC-20 were generally high both before and after the implementation of telehealth. There were no significant differences in the scores. Anecdotally, parent satisfaction with telehealth services was high. A review of the utilization of school-based telehealth during the 2015-2016 school year among 13 schools, including this unique school for CMC, revealed that the odds of having a telehealth visit at the school for CMC vs the other 12 schools was 23.8 (p value < 0.001; CL:11.2 to 50.6). CONCLUSION: Parental experiences with healthcare delivery were high both before and after the implementation of telehealth at an urban public charter school for CMC. Utilization of telehealth at the school for CMC was significantly higher than that of children enrolled in the program at 12 other schools. Further research is needed to evaluate parental experiences with school-based telehealth services.

The effect of supported physical activity on parental-reported health-related quality of life in children with medical complexity.

PURPOSE: To investigate the impact of a 5-week supported physical activity (PA) intervention on parental report of health-related quality of life (HRQL) in children with medical complexity (CMC). METHODS: Twenty-nine CMC participated in 180 minutes of supported PA daily. A pre- and post-test design was used to assess HRQL total and domain scores as reported by parents. The relationship between supported PA duration and HRQL was also examined. RESULTS: Children with medical complexity experienced no adverse effects with the supported PA intervention. Significant improvements in HRQL scores (P < 0.05) were demonstrated. A 5- to 8-point HRQL improvement occurred when CMC engaged in an average of 40 minutes of PA daily. CONCLUSION: Short-term, supported PA enhanced parental report of HRQL in children with medical complexity. Supported PA appears safe for CMC and rehabilitation therapists should explore methods to expand opportunities for participation.

Gait characteristics of children with hemiplegic cerebral palsy before and after modified constraint-induced movement therapy.

This investigation assessed selected gait parameters of children with hemiparesis before and after participation in a modified constraint-induced movement therapy program (mCIMT). Recent advances in the understanding of the relationship between mCIMT and cortical reorganization supports the use of upper-extremity mCIMT to treat lower extremity deficits. However, the effects of mCIMT on the gait patterns of children with hemiparesis remain unclear. Twelve preschool children participated in a mCIMT program for 5 consecutive days, 6 h each day. Pre- and post-intervention data, on the temporal-spatial aspects of gait, were collected with the GAITRite walkway. Data were analyzed using a repeated measures generalized linear model. Base of support decreased significantly (p < 0.001) following treatment and improvements were noted in most other gait descriptors. The results of this study suggest that mCIMT can increase stability and improve the overall gait pattern. This study provides a new dimension in the effects of pediatric mCIMT programs and could begin to shift the focus of this intervention to remediation of lower extremity deficits. Additional studies with a longitudinal follow-up focus to determine the long-term effects of mCIMT on walking balance and stability would be beneficial.