Parents' Perspectives on the Application of Home Activities in Early Intervention.

Aims: This study explored parents' successes, challenges, and recommendations in relation to the application of home activities in early intervention.Methods: An electronic survey was prepared with Qualtrics software and distributed to parents of children with motor delays. Three open-ended questions were included at the end of the survey. Participants were the child's primary caregiver or guardian and their child must be currently receiving early intervention services or have received early intervention services from a physical or an occupational therapist in the United States in the past 5 years. Two coders used content analysis to analyze parents' responses to open-ended questions.Results: A total of 252 participants responded to at least one of the open-ended questions that were included in the survey. Responses were grouped into codes and categories that lead to the emergence of four themes. The themes indicated parent-reported challenges, successes, and recommendations in relation to team collaboration, individualization of activities, developmental gains, and parental support.Conclusions: The results of this study suggest that more focus should be directed toward parent-therapist partnership, multidisciplinary collaboration, and personalization of activities in early intervention. Parents-reported experiences and recommendation could assist early intervention personnel in advancing services provided for children with motor delays.

Regional Differences in School-Based Physical Therapy: Examination of Therapist and Student Characteristics, Service Delivery, Activities, Interventions, and Outcomes.

AimsThe aim of this study was to examine regional differences in school-based physical therapy practice focusing on the attributes of the school-based physical therapists and students; service delivery approaches, activities, and interventions; and student outcomes. Recognition of regional practices may decrease unnecessary variations, and assist with therapist clinical decision making and efforts to implement evidence-informed practice.MethodsA secondary data analysis of the PT COUNTS data was performed to compare physical therapist and student attributes; service delivery, activities, and interventions; and student outcomes across the Northeast, Southeast, Central, and Northwest regions of the United States.ResultsDifferences in the physical therapist and student characteristics, service delivery, activities, and interventions existed across the regions. There were no regional differences in outcomes when controlling for student functional level.ConclusionRegional differences in school-based practices may be expected and indicative of the influence of contextual factors including state and local policies and procedures that shape school-based service delivery and the characteristics of the therapists and students. Regional differences in practices may not have been of sufficient clinical magnitude to alter outcomes. Physical therapists can use the findings to reflect upon their individual decision making and practices.

Participation-Based Student Goals in School-Based Physical Therapy Practice: Influence on Service Delivery and Outcomes.

Aims: Legislation, perspectives, and guidelines support the use of goals that address student participation in school. The purpose of this study was to determine if students with participation-based goals receive school-based physical therapy services differently and demonstrate better outcomes than students with non-participation-based goals.Methods: Secondary data analysis. School-based physical therapists (n = 109) provided services to students (n = 294) over 20 weeks. The physical therapists determined a primary goal for each student and classified this goal based on if it was (n = 181) or was not (n = 113) performed and measured within a school activity or routine (participation-based versus non-participation-based). The physical therapists documented the proportion of services provided within a school activity, on behalf of the student, and consisting of activity-focused functional activities. They also measured goal attainment and assessed participation via the School Function Assessment at the beginning and end of the study.Results: Students with participation-based goals received a significantly greater proportion of services within a school activity than those with non-participation-based goals (p < 0.001). There was no significant difference for the remaining service variables, nor for the outcome variables.Conclusions: Use of participation-based goals may promote school-based physical therapy service delivery within a school activity, thus supporting best practice.

Parental Adherence to Home Activities in Early Intervention for Young Children With Delayed Motor Development.

OBJECTIVE: The purpose of this study was to investigate the relationship between characteristics of home activities and coaching practices with the adherence of parents of children with motor delays to home activities provided by physical therapists and occupational therapists in early intervention. METHODS: An online survey study was developed and distributed to physical therapists and occupational therapists across the United States. A survey flier was posted online in parent support groups, physical and occupational therapy groups, newsletters, and organizations supporting parents of children with disabilities. RESULTS: A total of 720 respondents participated in the survey, and 446 participants from 49 states met the inclusion criteria and were included in the analysis. Parents indicated that physical therapists and occupational therapists applied the 5 coaching practices (joint planning, observation, practice, reflection, and feedback). However, parents (63%) reported more time was needed on coaching. Parents stated that therapists' modeling the activities was the most helpful teaching technique that enhanced their adherence to home activities. Coaching practices, appropriateness of the home activities to daily routines and home environment, provision of home activities enjoyed by the child, and parent self-efficacy were all significantly associated with adherence to home activities. CONCLUSIONS: Parents' adherence to home activities is affected not only by the type of coaching used by the therapists but also by the characteristics of the home activities provided for young children with delayed motor development. IMPACT: The results of this study provide additional evidence supporting individualization of home activities to promote parents' continuous provision of learning opportunities to promote their children's development. There was also support of the therapists' use of the 5 coaching practices in early intervention to support the parent's application of home activities when the therapists are not present. LAY SUMMARY: This study explored the use of home activities from the parents' perspective and provided valuable recommendations to therapists to improve parents' adherence to the recommended home activities in early intervention.

School-Based Physical Therapy Services: Predicting the Gap Between Ideal and Actual Embedded Services.

PURPOSE: To ascertain the variables predicting the gap between ideal and actual practice in embedding school-based physical therapy services. METHODS: School-based physical therapists completed an online survey estimating ideal and actual practice of embedding physical therapy services. Predictive modeling was used to determine whether disability, interventions, goals, families, teachers, workload, billing, and/or contracts predicted the gap between estimated ideal and actual practice. RESULTS: Data from 410 participants revealed that severity of students' disability, billing, written contracts, and families' preferences predicted the gap between estimated ideal and actual services. Actual practice varied based on region, APTA membership, and Academy of Pediatric Physical Therapy membership. CONCLUSIONS: Our model predicts the gap between estimates of ideally and actually embedding school-based physical therapy services. While 4 variables predicted the gap, further research is needed to develop a predictive model of actual practice to inform school-based physical therapy practice.

Challenges Faced by Therapists Providing Services for Infants With or at Risk for Cerebral Palsy.

OBJECTIVE: The purpose of this study was to identify the challenges physical therapists (PTs) and occupational therapists (OTs) have in providing early intervention (EI) for infants with or at risk for cerebral palsy. METHODS: Therapists' responses to an open-ended question were collected via survey that was distributed to EI providers and analyzed using content analysis. RESULTS: The primary self-reported barriers to PT/OT EI services had 5 themes: (1) inadequate communication and collaboration, (2) challenges in coordination with family, (3) policy limitations, (4) meeting the child's individual medical needs, and (5) unequal access to resources. CONCLUSION: Respondents reported that barriers are complex and exist at the individual, family, team, and societal levels. Further research is needed to explore barriers and solutions at each of these levels, from meeting a child's individual medical needs to improving interprofessional communication to increasing equitable access to resources.

Relationship of School-Based Physical Therapy Services to Student Goal Achievement.

PURPOSE: To explore the relationships of school-based physical therapy services to student goal achievement. METHODS: One hundred nine physical therapists and 296 students participated in a practice-based study. Therapists formatted goals using goal attainment scaling and evaluated goal achievement. Using the School-Physical Therapy Interventions for Pediatrics system, therapists documented services weekly for 20 weeks. Group comparisons and logistic regressions were conducted. RESULTS: For primary goals, no documented physical therapy services were associated with exceeding goal expectation. For posture/mobility goals, more minutes in self-care activities and services on behalf of the students were associated with exceeding goal expectation; use of cognitive and behavioral training interventions was associated with not exceeding goal expectation (P < .05). For recreation/fitness goals, greater use of functional strength and mobility for playground access and cognitive/behavioral interventions were associated with exceeding goal expectation (P < .05). CONCLUSION: A limited number of physical therapy services was associated with exceeding goal expectation.

Early Intervention Therapy Services for Infants With or at Risk for Cerebral Palsy.

OBJECTIVE: The purpose of this study was to explore the practices physical therapists and occupational therapists use in early intervention (EI) for infants with or at risk for cerebral palsy (CP). METHODS: A survey was disseminated nationally to EI providers using an online anonymous link. RESULTS: Two hundred sixty-nine therapists completed at least 50% of the survey. Four percent of therapists use the General Movement Assessment to predict CP, 57% reported infants at risk for CP receive therapy once a week, 89% identified parents' goals as the most important factor in customizing the EI program, and 75% provide parents with home programs. However, 73% never or rarely use outcome measures to prioritize parents' goals; 31% provide parents with individualized home program and more than 60% never assess environmental enrichment. CONCLUSION: Therapists do not incorporate sufficient strategies for goal-oriented interventions, comprehensive parent education, and optimum environmental enrichment.

Description of School-Based Physical Therapy Services and Outcomes for Students with Down Syndrome.

Students with Down syndrome (DS) receive school-based physical therapy (SBPT), however little data exists regarding services and outcomes. Using a prospective observational cohort study our aim was to explore SBPT activities and interventions, and students' goal achievement of 46 students with DS, tracked by 17 physical therapists (PTs). PTs provided on average 24.0 min/week direct service and 11.6 min/week services on behalf of the student. The most frequent activities employed were physical education/recreation, mobility, and sitting/standing/transitions. The most frequent interventions implemented were neuromuscular, mobility, and musculoskeletal. Although students individually met 69.5% of their primary outcome goals, their achievement could not be explained by total minutes of either direct and minutes on behalf of SBPT, nor minutes spent in most frequent activity.

School-Based Physical Therapists' Experiences and Perceptions of How Student Goals Influence Services and Outcomes.

Aims: Individualized goals are the foundation for physical therapy services and outcomes. This research describes school-based physical therapists' (PTs) experiences and perceptions of how student goals impact services and outcomes. Methods: Twenty school-based PTs participated in one of five semi-structured focus groups on goal development and use. Therapists were recruited from 113 therapists who participated in a study of school-based physical therapy outcomes. Two researchers conducted thematic analysis of written transcriptions of audio recordings to identify qualitative themes; a third researcher reviewed the analysis. Results: Four themes emerged related to how goals impact services: (1) the nature of services, (2) intervention strategies, (3) teaming, and (4) flexibility of services. Three themes emerged related to how goals impact outcomes: (1) natural linkages among goals, services, and outcomes; (2) goals impact teaming to achieve outcomes; and (3) specifics of the goal matter. Therapists also reported a range of student and environmental factors that impact services and outcomes. Conclusions: Therapists perceive that goals influence services and outcomes in complex ways, especially due to the flexibility and individualization needed in school-based practice. This study helps school-based PTs understand and reflect on how individualized goals influence services and optimize student outcomes.

Description of the Services, Activities, and Interventions Within School-Based Physical Therapist Practices Across the United States.

Background: Students with disabilities receive school-based physical therapy services under the Individuals with Disabilities Education Improvement Act of 2004. Little research exists regarding therapy services in schools. Objective: This study explored the school-based services that students received and the activities and interventions that physical therapists implemented, and determined if services differed based on the student's functional gross motor ability and age. Design: This was a prospective observational cohort study using a practice-based evidence design. Methods: Data were collected by 109 physical therapists for 296 students, aged 5 to 12 years, receiving school-based physical therapy. Physical therapists completed the School-Physical Therapy Interventions for Pediatrics data form for 20 weeks during 1 school year. This evaluation included the type of service delivery, the amount of time spent on each student (consultation/documentation), minutes spent in activities, the specific interventions implemented, and the student's level of participation. The Gross Motor Function Classification System (GMFCS) was used to describe the students' functional ability. Results: Physical therapists provided an average of 26.7 min/wk (standard deviation [SD] = 15.1) of direct services and 13.1 min/wk (SD = 7.7) of services on behalf of the student. Primary activities were physical education/recreation (7.7 min/wk, SD = 8.2), mobility (6.7 min/wk, SD = 7.9), and sitting/standing/transitions (6.3 min/wk, SD = 8.1). Primary interventions were neuromuscular (32.5 counts per student, SD = 15.9), mobility (15.3 counts per student, SD = 14.65), and musculoskeletal (14.4 counts per student, SD = 10.3). Differences existed based on GMFCS but not student age. Limitations: Physical therapists reported School-Physical Therapy Interventions for Pediatrics data weekly, not necessarily after each therapy session. The GMFCS was used as a proxy of students' functional gross motor ability. Conclusions: Our description of services is provided to encourage physical therapists to reflect on the services they provide and to foster future examinations of service effectiveness.

School-based physical therapy services and student functional performance at school.

AIM: We explored relationships of school-based physical therapy to standardized outcomes of students receiving physical therapy. METHOD: Using a practice-based evidence research design, School Function Assessment (SFA) outcomes of 296 students with disabilities (mean age 7y 4mo [standard deviation 2y]; 166 males, 130 females), served by 109 physical therapists, were explored. After training, therapists completed 10 SFA scales on students at the beginning and end of the school year. Therapists collected detailed weekly data on services (activities, interventions, types, student participation) using the School-Physical Therapy Interventions for Pediatrics (S-PTIP) system. Stepwise linear regressions were used to investigate S-PTIP predictors of SFA outcomes. RESULTS: Predictors of SFA section outcomes varied in strength, with the coefficient of determination (R2 ) for each outcome ranging from 0.107 to 0.326. Services that correlated positively with the SFA outcomes included mobility, sensory, motor learning, aerobic/conditioning, functional strengthening, playground access interventions, and higher student participation during therapy (standardized ß=0.11-0.26). Services that correlated negatively with the SFA outcomes included providing services within student groups, within school activity, with students not in special education, during recreation activities, and with positioning, hands-on facilitation, sensory integration, orthoses, and equipment interventions (standardized ß=-0.14 to -0.22). INTERPRETATION: Consideration of outcomes is prudent to focus services. Overall results suggest we should emphasize active mobility practice by using motor learning interventions and engaging students within therapy sessions. WHAT THIS PAPER ADDS: No specific interventions predicted positively on all School Function Assessment (SFA) outcomes. Active movement practice seems related to overall better SFA outcomes. Active mobility practice improved SFA participation, mobility, recreation, and activities of daily living. Engaging students in therapy activities and interventions improved outcomes.

Outcomes for Students Receiving School-Based Physical Therapy as Measured by the School Function Assessment.

PURPOSE: To describe School Function Assessment (SFA) outcomes after 6 months of school-based physical therapy and the effects of age and gross motor function on outcomes. METHODS: Within 28 states, 109 physical therapists and 296 of their students with disabilities, ages 5 to 12 years, participated. After training, therapists completed 10 SFA scales on students near the beginning and end of the school year. RESULTS: Criterion scores for many students remained stable (46%-59%) or improved (37%-51%) with the most students improving in Participation and Maintaining/Changing Positions. Students aged 5 to 7 years showed greater change than 8- to 12-year-olds on 5 scales. Students with higher gross motor function (Gross Motor Function Classification System levels I vs IV/V and II/III vs IV/V) showed greater change on 9 scales. CONCLUSIONS: Positive SFA change was recorded in students receiving school-based physical therapy; however, the SFA is less sensitive for older students and those with lower functional movement.

Student Outcomes of School-Based Physical Therapy as Measured by Goal Attainment Scaling.

PURPOSE: The main purposes were to describe individualized outcomes of students receiving school-based physical therapy and determine if goal attainment differed by gross motor ability and age. METHODS: One hundred nine physical therapists and 296 students participated. At the beginning of the school year, therapists translated students' Individualized Education Program goals into subgoals using Goal Attainment Scaling and determined students' Gross Motor Functional Classification System level. Researchers categorized goals (posture/mobility, recreation/fitness, self-care, or academics), and therapists identified students' primary goal. At the end of the school year, therapists scored the goals. Descriptive statistics and 2-way analyses of variance were conducted. RESULTS: Students exceeded their expected goal level for primary goals and goals categorized as posture/mobility, recreation/fitness, and self-care and made progress on academic goals. No differences were found by gross motor ability. Younger students had higher goal attainment for primary and recreation goals. CONCLUSION: Students achieve individualized outcomes addressed by school-based physical therapy.

Physical Therapy-Related Child Outcomes in School: An Example of Practice-Based Evidence Methodology.

PURPOSE: To describe the use of practice-based evidence research methodology in a prospective, multisite observational study to investigate changes in students' participation in school activity, self-care, posture/mobility, recreation/fitness, and academic outcomes, and the relationships of these changes to characteristics of school-based physical therapy. METHODS: One hundred nine physical therapists completed the training and data collection and 296 students, 5 to 12 years of age (mean age = 7.3 years) had 6 months of complete data. Therapists completed individualized (Goal Attainment Scaling) and standardized (School Function Assessment) outcome measures for students at the beginning and end of the school year and during the year collected weekly data on services to and on behalf of the students. SUMMARY: This research design enabled the investigation of complex research questions related to school-based practice. The findings of this study, to be reported later, should influence school-based therapy by providing guidance related to what activities, interventions, and services influence student outcomes.

Physical Therapists' Perceptions of School-Based Practices.

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? CONCLUSIONS: School-based physical therapists seek to meet educationally relevant physical therapy needs of students, ages 3 to 21 years. Successes appear woven of a multitude of factors such as therapist expertise, team dynamics, and district supports.

Nationwide survey of school-based physical therapy practice.

PURPOSE: The Individuals with Disabilities Education Improvement Act and related literature have implications for school-based physical therapy. This study examined therapists' reports of their actual practice, compared with literature-based recommendations for "ideal" practice, and explored their conceptions of ideal practice. METHODS: Participation in an online survey was requested of school-based physical therapists. Analysis of the results compared the therapists' reports of their actual practice with their views about ideal practice. RESULTS: Among the 561 respondents, there was general agreement that actual practice was always or usually consistent with the literature. However, poor agreement was found between their reported actual practice and their opinions of ideal practice. The majority of service delivery was direct intervention. Ninety percent believed they were "adequately" meeting their students' needs. CONCLUSIONS: Actual reported practice generally met literature descriptions of ideal practice but not to the extent the respondents thought ideal.

Factors influencing physical therapists' involvement in preschool transitions.

BACKGROUND: Families and children receiving early intervention services benefit from service provider involvement during the transition to preschool special education services. OBJECTIVES: This study sought to determine the factors that physical therapists working in early intervention services and/or preschools identified as supportive of their involvement, and associated with their perceived involvement, in transition planning for young children with disabilities moving from early intervention to preschool services. DESIGN: A cross-sectional survey was used. METHODS: A survey was mailed to a random sample of 600 members of the American Physical Therapy Association's Section on Pediatrics. Physical therapists working with children transitioning out of early intervention and into preschool participated. Data from physical therapists providing services in preschools were included in this study. RESULTS: The response rate was 56.3%. The highest- and lowest-ranked facilitators of transition planning were: "Staff at my preschool program value my participation in transition planning activities" (highest ranked) (X=5.02, SD=1.36, n=142) and "I am encouraged to participate in transition planning activities by the early intervention service coordinator" (lowest ranked) (X=1.91, SD=3.50, n=143). Multivariate regression models demonstrated that physical therapists' perceived value and expertise in providing transition planning services were significantly associated with collaboration with professionals from early intervention programs (F(1,129)=207) and support of families during the transition process (F(1,134)=48). CONCLUSIONS: Physical therapists who identified implementing practices that supported communication, collaboration, and strong, positive relationships between early intervention and preschool programs had greater involvement in the transition planning process.