Research Agenda for Physical Therapy From the American Physical Therapy Association.

Research agendas play an important role in directing scholarly inquiry in a field. The Research Agenda for Physical Therapy From the American Physical Therapy Association (APTA) outlines research priorities that are vital to advancing physical therapist practice and the profession. The development of the research agenda included multiple iterative steps and feedback from stakeholders. A research agenda subgroup (n = 6) of the APTA Scientific and Practice Affairs Committee (SPAC), with APTA staff support, gathered information on existing research agendas, developed draft priority descriptions, and gathered feedback via surveys. The subgroup first conducted an environmental scan of the research agendas in the physical therapy and rehabilitation fields. To gather information about research priorities, APTA's Technology and Organizational Performance department distributed a survey to 3 samples. APTA staff organized the feedback, and SPAC edited and synthesized a draft agenda. This draft was sent out in survey form to the original samples and to members of the APTA Academy of Research. Concurrently, a repeat environmental scan was conducted. A final draft of the research agenda was sent for final review to a smaller cohort (n = 95) that included content experts in each of the main categories of the agenda as identified by the APTA Academy of Research. The SPAC research agenda subgroup reviewed and incorporated the information into the final draft. The final research agenda includes priorities in topical areas (population health, mechanistic research, clinical research, education/professional development research, health services research, and workforce development) identified as key in the evolution of our profession. IMPACT: The Research Agenda for Physical Therapy From APTA identifies research priorities within the profession vital to advancing the practice and profession of physical therapy. The research agenda has 6 key areas of focus: population health research, mechanistic research, clinical research, education and professional development research, health services research, and workforce research. Researchers, funding agencies, and public policy makers can use the research agenda to concentrate research efforts around these areas.

Understanding Acceptability, Barriers, and Facilitators to Clinical Implementation of the on Track Developmental Monitoring System for Children with Cerebral Palsy: A Qualitative Study.

AIMS: On Track Developmental Monitoring System (DMS) is a novel series of tools to assist in shared-decision making, guide rehabilitation intervention based on functional ability levels, and promote episodic care service models. Further understanding of the acceptability, feasibility, and appropriateness of On Track DMS in clinical settings is critical. The purpose of this study was to understand clinician perspectives of the acceptability of On Track DMS and to identify potential implementation barriers and facilitators within pediatric physical therapist practice. METHODS: Three, day-long training workshops were conducted with 32 pediatric physical therapists across the US. Focus groups with 21 workshop participants were conducted following training. Results were audio recorded, transcribed verbatim, and coded into themes. RESULTS: Three themes emerged from the data: (1) Valuing the On Track Approach to Intervention; (2) Setting-Specific Needs and Challenges to Implementation; and (3) Training Material/Tool Strengths and Limitations. CONCLUSIONS: On Track DMS appears to have initial value and acceptability for pediatric physical therapists across practice settings. Perceived benefits include facilitation of data-driven practice and therapist/family collaboration to improve health outcomes for children with CP. Using this data to understand and assess barriers and facilitators to knowledge use are first steps in successfully implementing On Track DMS.

Applications of Biomechanical Foot Models to Evaluate Dance Movements Using Three-Dimensional Motion Capture: A Review of the Literature.

Dance movement requires excessive, repetitive range of motion (ROM) at the foot-ankle complex, possibly contributing to the high rate of injury among dancers. However, we know little about foot biomechanics during dance movements. Researchers are using three-dimensional (3D) motion capture systems to study the in vivo kinematics of joint segments more frequently in dance-medicine research, warranting a literature review and quality assessment evaluation. The purpose of this literature review was to identify and evaluate studies that used 3D motion capture to analyze in vivo biomechanics of the foot and ankle for a cohort of dancers during dance-specific movement. Three databases (PubMed, Ovid MEDLINE, CINAHL) were accessed along with hand searches of dance-specific journals to identify relevant articles through March 2020. Using specific selection criteria, 25 studies were identified. Fifteen studies used single-segment biomechanical foot models originally created to study gait, four used a novel two-segment model, and six utilized a multi-seg- ment foot model. Nine of the studies referenced common and frequently published gait marker sets and four used a dance-specific biomechanical model with purposefully designed foot segments to analyze the dancers' foot and ankle. Description of the biomechanical models varied, reducing the reproducibility of the models and protocols. Investigators concluded that there is little evidence that the extreme total, segmental, and inter-segmental foot and ankle ROM exerted by dancers are being evaluated during dance-specific movements using 3D motion capture. Findings suggest that 3D motion capture is a robust measurement tool that has the capability to assist researchers in evaluating the in vivo, inter-segmental motion of the foot and ankle to potentially discover many of the remaining significant factors predisposing dancers to injury. The literature review synthesis is presented with recommendations for consideration when evaluating results from studies that utilized a 3D biomechanical foot model to evaluate dance-specific movement.

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.

Regional Differences in School-Based Physical Therapy Practice for Students Who Made Progress on 2 Outcome Measures.

PURPOSE: This study examined whether regional differences exist in the provision of school-based physical therapy services for students who achieved positive progress and explored relationships between student outcomes and school-based physical therapy. METHODS: Physical therapists developed student goals using Goal Attainment Scaling (GAS) and administered the School Function Assessment (SFA). Therapists documented activities, interventions, and type of service delivery provided weekly. Students were assigned to regions for analysis. RESULTS: Student GAS goal attainment and progress on the SFA did not vary significantly among regions. The dosage of school-based physical therapy services, interventions, and activities varied. CONCLUSIONS: There were regional differences that did not impact goal achievement. Further research is needed to identify the most efficient and effective interventions and dosage to support student outcomes.

Efficacy of Lower Extremity Cycling Interventions for Youth with Intellectual Disabilities: A Systematic Review.

PURPOSE: To systematically examine the efficacy of lower extremity cycling interventions for youth with intellectual disability (ID). METHODS: Seven databases were searched from March 2000 to October 2019 for English-language articles on cycling interventions for youth with ID. The American Academy of Cerebral Palsy and Developmental Medicine guidelines were used for assigning levels of evidence and grading study quality. RESULTS: Eight articles met inclusion criteria. Children and young adults, 7-26 years (n = 229), with diagnoses of Down syndrome, autism spectrum disorder, or unspecified ID participated in the studies. Moderate evidence (one level II single subject design study) suggests that a specific cycling intervention can improve two-wheeled cycling skills in youth with ID. Weak evidence (level II group studies) supports stationary cycling for short-term improvements in cognitive skills and two-wheeled riding intervention for increasing physical activity one-year after intervention. CONCLUSIONS: Moderate to weak evidence exists to support two-wheeled cycling instructional programs or stationary cycling interventions for children and young adults with intellectual disabilities. Therapists can use this information when discussing cycling interventions for individuals with ID. Further research is needed to inform therapists in clinical decision-making related to dosing cycling interventions.

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.

Longitudinal Change in Common Impairments in Children With Cerebral Palsy From Age 1.5 to 11 Years.

PURPOSE: This project aimed to determine whether change occurs over time for impairments of balance, range of motion, endurance, and strength of children with cerebral palsy, by Gross Motor Function Classification System (GMFCS) levels. METHODS: Measurements were completed in 77 children at 2 sessions (T1, T2) on average 5.8 years apart. Mean ages were 2.9 years (SD = 0.9) and 8.7 years (SD = 1.1) at T1 and T2, respectively. RESULTS: There were significant differences from T1 to T2 for some children (GMFCS levels I, II, and III/IV: balance increased; GMFCS levels I and II: strength increased; and GMFCS levels III/IV and V: range of motion decreased). Endurance scores were not different and did not change. CONCLUSIONS: Longitudinal changes in most impairments occurred in children with cerebral palsy. Monitoring and targeted interventions should support each child's development.

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.

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.

Developmental Trajectories and Reference Percentiles for Range of Motion, Endurance, and Muscle Strength of Children With Cerebral Palsy.

BACKGROUND: Children with cerebral palsy (CP) frequently present with secondary impairments in spinal alignment and extremity range of motion, endurance for activity, and muscle strength. Creation of developmental trajectories for these impairments will help guide clinical decision-making. OBJECTIVE: For children in each level of the Gross Motor Function Classification System (GMFCS) this study aimed to: (1) create longitudinal developmental trajectories for range of motion (Spinal Alignment and Range of Motion Measures [SAROMM]), endurance (Early Activity Scale for Endurance [EASE]), and functional strength (Functional Strength Assessment [FSA]); and (2) develop age-specific reference percentiles and amount of change typical over 1 year for these outcomes. DESIGN: This study used a longitudinal cohort design. METHODS: Participants comprised 708 children with CP across GMFCS levels, aged 18 months up to the 12th birthday, and their families. In 2 to 5 assessments every 6 months over 2 years, trained therapists performed the SAROMM and FSA, and parents completed the EASE questionnaire. For children in each GMFCS level, longitudinal trajectories using linear and nonlinear mixed-effects models from all visits, and reference percentiles using quantile regression from the first, 12-month, and 24-month visits were created for each measure. RESULTS: Longitudinal trajectories and percentile graphs for SAROMM, FSA, and EASE were primarily linear, with different performance scores among GMFCS levels. There was much variability in both longitudinal trajectories and percentiles within GMFCS levels. LIMITATIONS: Limitations included a convenience sample and varying numbers of participants assessed at each visit. CONCLUSIONS: The longitudinal trajectories and percentile graphs have application for monitoring how children with CP are performing and changing over time compared with other children with CP. The resources presented allow therapists and families to collaboratively make decisions about intervention activities targeted to children's unique needs.

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.

Longitudinal trajectories and reference centiles for the impact of health conditions on daily activities of children with cerebral palsy.

AIM: First, to describe the impact of health conditions on daily activities over time in children with cerebral palsy (CP) and to create age-specific reference centiles. Second, to determine the amount of change typical over a 1-year period, across Gross Motor Function Classification System (GMFCS) levels. METHOD: A prospective, cohort design, with five assessments over 2 years, involved 708 children with a confirmed diagnosis of CP participating in the On Track Study (396 males, 312 females; mean age 6y [SD 2y 7mo]; range 18mo-12y at first assessment; 32.1% in GMFCS level I, 22.7% in GMFCS level II, 11.2% in GMFCS level III, 18.2% in GMFCS level IV, 15.7% in GMFCS level V). The impact of health conditions on daily activities was assessed using the Child Health Conditions Questionnaire. Data were analyzed using mixed-effects models and quantile regression. RESULTS: Linear longitudinal trajectories describe the relatively stable impact of health conditions over time for each functional level for children aged 2 years to 12 years, with the lowest scores (least impact) in GMFCS level I and the highest scores (highest impact) in GMFCS level V. Centiles were created for children in each GMFCS level. A system to interpret the magnitude of change over time in centiles was developed. INTERPRETATION: Longitudinal trajectories of co-occurring health conditions assist with understanding children's prognoses. Centiles assist in understanding a child's experience relative to children in similar GMFCS levels. Guidelines are provided to determine if children are progressing 'as expected', 'better than expected' or 'more poorly than expected' in regard to the impact of health conditions on daily activities. WHAT THIS PAPER ADDS: For children with cerebral palsy, the mean impact of health conditions on daily activities is relatively stable. Significant intraindividual and interindividual variability for the impact of health conditions exists, which complicates prognosis. Centiles enable interpretation of the impact of health conditions relative to Gross Motor Function Classification System level.

TRAYECTORIAS LONGITUDINALES Y CENTILES DE REFERENCIA PARA EL IMPACTO DE LAS CONDICIONES DE SALUD EN LAS ACTIVIDADES DIARIAS DE LOS NIÑOS CON PARÁLISIS CEREBRAL: OBJETIVO: Primero, describir el impacto de las condiciones de salud en las actividades diarias a lo largo del tiempo en niños con parálisis cerebral (PC) y crear centiles de referencia específicos de la edad. Segundo, para determinar la cantidad de cambio típica en un período de 1 año, a través de los niveles del Sistema de Clasificación de la Función Motora Bruta (GMFCS). MÉTODO: Un diseño de cohorte prospectivo, con cinco evaluaciones durante 2 años, involucró a 708 niños con un diagnóstico confirmado de PC que participó en el estudio On Track (396 varones, 312 mujeres; edad media 6 años de edad [SD 2 años 7 meses]; rango 18 meses-12 años a primera evaluación: 32,1% en GMFCS nivel I, 22,7% en GMFCS nivel II, 11,2% en GMFCS nivel III, 18,2% en GMFCS nivel IV, 15,7% en GMFCS nivel V). El impacto de las condiciones de salud en las actividades diarias se evaluó utilizando el Cuestionario de Condiciones de Salud Infantil. Los datos se analizaron utilizando modelos de efectos mixtos y regresión por cuantiles. RESULTADOS: Las trayectorias longitudinales lineales describen el impacto relativamente estable de las condiciones de salud a lo largo del tiempo para cada nivel funcional para niños de 2 años a 12 años, con las puntuaciones más bajas (menor impacto) en el nivel I de GMFCS y las puntuaciones más altas (mayor impacto) en el nivel de GMFCS V. Centiles fueron creados para los niños en cada nivel de GMFCS. Se desarrolló un sistema para interpretar la magnitud del cambio en el tiempo en centiles. INTERPRETACIÓN: Las trayectorias longitudinales de las condiciones de salud concurrentes ayudan a comprender los pronósticos de los niños. Los centiles ayudan a comprender la experiencia de un niño en relación con los niños en niveles similares de GMFCS. Se proporcionan pautas para determinar si los niños progresan "como se espera", "mejor de lo esperado" o "peor de lo esperado" en relación con el impacto de las condiciones de salud en las actividades diarias.

TRAJETÓRIAS LONGITUDINAIS E CENTIS DE REFERÊNCIA PARA O IMPACTO DAS CONDIÇÕES DE SAÚDE NAS ATIVIDADES DIÁRIAS DE CRIANÇAS COM PARALISIA CEREBRAL: OBJETIVO: Primeiro, descrever o impacto das condições de saúde nas atividades diárias ao longo do tempo em crianças com paralisia cerebral (PC) e criar centis de referência idade-específicos. Segundo, determinar a quantidade de mudança típica em um ano, nos diversos níveis do Sistema de Classificação da Função Motora Grossa (GMFCS). MÉTODO: Um desenho prospectivo de coorte, com cinco avaliações em 2 anos, envolveu 708 crianças com diagnóstico confirmado de PC que participavam do Estudo On Track (396 do sexo masculino, 312 do sexo feminino; méida de idade 6a [DP 2a 7m]; variação 18m-12a na primeira avaliação; 32,1% no nível GMFCS I, 22,7% no nível GMFCS II, 11,2% no nível GMFCS III, 18,2% no nível GMFCS IV, 15,7% no nível GMFCS V). O impacto das condições de saúde nas atividades diárias foi avaliado usando o Questionário das condições de saúde da criança. Os dados foram analisados usando modelos de efeitos mistos e regressão quantil. RESULTADOS: Trajetórias lineares longitudinais descrevem o impacto relativamente estável das condições de saúde ao longo do tempo para cada nível funcional para crianças com idades de 2 a 12 anos, com os menores escores (menor impacto) no nível GMFCS I e maiores escores (maior impacto) no nível GMFCS V. Centis foram criados para crianças em cada nível GMFCS. Um sistema para interpretar a magnitude da mudança ao longo do tempo em centis foi criado. INTERPRETAÇÃO: Trajetórias longitudinais de condições de saúde co-ocorrentes ajudam a entender o prognóstico da criança. Os centis ajudam a compreender a experiência da criança com relação a crianças em níveis GMFCS similares. Diretrizes são oferecidas para determinar se crianças estão progredindo "como esperado", "melhor do que o esperado"ou "pior do que o esperado" com relação ao impacto das condições de saúde nas atividades diárias.

Modified Ride-on Cars as Early Mobility for Children with Mobility Limitations: A Scoping Review.

Aim: This study aims to systematically examine and map current available evidence describing the benefits of modified ride-on car use for young children with mobility limitations and identify potential applications to occupational and physical therapy practice while illuminating gaps in knowledge to be explored in future research. Methods: An electronic database search, manual search of bibliographies, contact with existing networks and organizations were used to identify all relevant literature. Studies addressing modified ride-on toy use by children ≤6 years old with identified mobility delays were included. Data were extracted and analyzed independently by the investigators using a standardized process. Results: Thirteen case studies and one case controlled study involving children ≤6 years old with a variety of diagnoses were included in the review. Studies were at the activities and participation levels and focused on mobility, interpersonal interactions and relationships, communication, and Community, Social, and Civic Life. Conclusion: Findings support the use of modified ride-on cars as a form of early mobility to encourage the development of social-emotional and mobility skills in young children with mobility limitations. Future research with valid, reliable outcome measures that address changes in developmental levels across domains is indicated.

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.

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.

Exercise using the Wii Fit plus with a child with primary Raynaud's disease and obesity: a case report.

The purpose of this case report was to describe the use of the Nintendo® Wii Fit Plus as an alternative exercise for an 11-year-old child with primary Raynaud's disease (PRD) and obesity who was not involved in organized sports and had limited outdoor physical activity and exercise. The Wii Fit Plus exercise parameters are described as well as outcomes measured at baseline, 12 weeks, and 24 weeks. Specifically, we evaluated changes in body mass index (BMI), cardiorespiratory fitness, and health related quality of life (HRQL). Following the 24-week exercise program, the child's BMI decreased, cardiorespiratory fitness increased, and HRQL increased and were comparable to values in healthy children. These findings suggest that the Wii Fit Plus may have been an effective exercise strategy for this child.

The role of occupational therapists and physical therapists in elementary school system early intervening services and response to intervention: a case report.

The Individuals with Disabilities Improvement Act and No Child Left Behind Act broadened the roles of occupational therapists (OTs) and physical therapists (PTs) to include therapist participation in early intervening services including response to intervention (RTI). This case report describes one school district's inclusion of OT and PT in the elementary school RTI program by identifying and implementing role responsibility and changing workloads for therapists. Therapist responsibilities included (a) administering a screening tool, (b) educating and supporting teachers and staff, (c) providing student resources and intervention strategies, and (d) referring students from RTI to special education and related services. Teachers responded positively using therapist-provided strategies and support. Limitations included an increased workload because of large numbers of students to screen and very few staff available for screening. Future research should include longitudinal studies that measure student responses to therapy intervention, teacher responses to collaboration, and the use of intervention strategies over time.