Feasibility of a Child-Friendly 2-Minute Walk Test: A Crossover Randomized Controlled Trial.

AIMS: Most studies that use the NIH Toolbox 2-Minute Walk Test with young children, modify the protocol, compromising the generalizability of outcomes. A standardizable protocol is needed. The purpose of this study was to compare the 2MWT performance of children ages 3-6 years on the standard NIH Toolbox protocol and on a modified protocol designed to support young children. METHODS: Cross-over randomized controlled trial. Fifteen typically developing children ages 3-6 years were randomly assigned to the performance order of the NIH toolbox 2MWT protocol and the Modified Accessibility Path (MAP) 2MWT protocol. Outcome variables and statistical analyses included test completion (McNemar test), distance walked (Wilcoxon signed-rank test), and accuracy (general estimating equation model with Poisson distribution). RESULTS: All children completed 2 min of walking with the MAP protocol. Only 40% of children completed the NIH Toolbox protocol, with 83% of these NIH completers bolstered by previous exposure to the MAP protocol. Collapsed across the order, children also had significantly fewer errors per lap with the MAP protocol (p < 0.0001), despite walking a significantly greater distance (p = 0.006). CONCLUSIONS: These findings lend preliminary support for standardized application of a 2MWT with young children when the protocol is designed to be child-friendly.

Is medical home care adequacy associated with educational service use in children and youth with autism spectrum disorder (ASD)?

BACKGROUND: The American Academy of Pediatrics (AAP) recommends medical home care for children and youth with autism spectrum disorder (ASD) for health needs. Children and youth with ASD also receive educational services for cognitive, social, and behavioral needs. We measured whether inadequate medical home care was significantly associated with current educational service use, controlling for sociodemographic factors. METHODS: We analyzed the 2016/2017 National Survey of Children's Health (NSCH) on 1,248 children and youth with ASD ages 1-17. Inadequate medical home care was operationalized as negative or missing responses to at least one medical home component. Educational service use was defined as current service use under individualized family service plans (IFSP) and individualized education programs (IEP). RESULTS: Inadequate medical home care was significantly associated with higher likelihood of current educational service use (aOR = 1.95, 95% CI [1.10, 3.44], p = 0.03). After adjustment, older children (aOR = 0.91, 95% CI [0.84, 0.99], p = 0.03), lower maternal health (aOR = 0.52, 95% CI [0.29, 0.94], p = 0.03), and children without other special health care factors (aOR = 0.38, 95% CI [0.17-0.85], p = 0.02) had significantly lower odds of current educational service use. CONCLUSIONS: Inadequate medical home care yielded higher odds of current educational service use. Child's age, maternal health, and lack of other special health care factors were associated with lower odds of current educational service use. Future research should examine medical home care defined in the NSCH and improving educational service use via medical home care.

Learning from Graduate and Undergraduate Public Health Virtual Internship Experiences with State Title V Agencies During COVID-19, Summer 2020.

BACKGROUND: Since summer 2014, the National MCH Workforce Development Center has placed students from MCH public health graduate (Centers of Excellence and Catalyst) and undergraduate (MCH Pipeline) programs, all funded by the Maternal and Child Health Bureau, in summer internships with state and territorial Title V agencies. In 2020, due to the COVID-19 pandemic the Title V MCH Internship Program was offered virtually. PARTICIPANTS AND METHODS: This manuscript includes quantitative and qualitative data from 2017 to 2020 generated by both Title V MCH Internship student interns (n = 76) and their preceptors (n = 40) with a focus on a comparison between the 2020 virtual year and the 2017-2019 years. RESULTS: Evaluation data from the 2017 to 2020 Title V MCH Internship Program from both students and preceptors revealed the implementation of a robust and successful internship program in which students increased their confidence in a variety of team, mentorship, and leadership skills while gaining direct exposure to the daily work of state Title V agencies. However, students and preceptors identified more challenges during 2020 compared to previous years. CONCLUSIONS: The COVID-19 Pandemic was both a disruption and a catalyst for change in education. While there were clearly some challenges with the pivot to a virtual Title V MCH Internship Program in summer 2020, students were able to participate in meaningful internship experiences. This success can be attributed to the ability of the internship sponsor to engage in best practices, including extensive planning and provision of ongoing support to the students. Going forward, it is recognized that virtual internships may facilitate access to agencies in distant locales, eliminating issues related to housing and transportation. When both virtual and in-person relationships are available, those responsible for internship programs, including the Title V MCH Internship, will need to weigh these type of benefits against the potential missed opportunities students may have when not able to participate in on-site experiences.

MCH Pipeline Training Program: Connecting with Academia to Build Capacity Through Mentoring.

INTRODUCTION: Efforts to recruit and retain diverse Maternal and Child Health (MCH) professionals are of paramount public health significance. Culturally congruent mentorship strategies are key to supporting a successful transition from undergraduate to graduate studies. METHODS: This mixed-method study evaluated a culturally congruent mentorship training used by one of the MCH Pipeline Training programs and described mentorship practices and lessons learned from the six MCH Pipeline programs. A retrospective pre-test post-test survey assessed mentorship competency skills following a mentoring workshop. All MCH Pipeline program leaders completed a questionnaire to elicit responses about mentoring training practices, mentor evaluation strategies, and lessons learned. RESULTS: Maternal and Child Health Pipeline Training Programs supported 1890 undergraduate scholars at universities and institutions nationally. Scholars at six MCH Pipeline Programs participated in MCH education and mentored experiential leadership opportunities in clinical practice, research, and public health education. Qualitative program-level mentor survey themes indicated the importance of creating a reflective space and building mentorship teams. Mean mentor self-assessed improvement in mentor competencies was 14.4 points, 95% CI [10.5, 18.3], p < .001 following completion of a mentoring training workshop implemented by one of the MCH Pipeline programs. DISCUSSION: The Health Resources and Services Administration's Maternal and Child Health Bureau recognized the need to support the development of the next generation of diverse MCH leaders. Pipeline programs that included mentoring workshops and building culturally congruent mentorship teams are two strategies to increase and retain diverse scholars in graduate school and leaders in the public health workforce.

Success of Maternal and Child Health Pipeline Training Programs: Alumni Survey Results.

INTRODUCTION: The Maternal and Child Health (MCH) Pipeline Training Program, promotes development of a diverse health workforce by training undergraduate students from underrepresented minorities. We aimed to evaluate the success of this program based on three domains: (1) demographic characteristics, (2) academic and career development, and (3) attitudes towards the field of MCH and the training programs among graduates. METHODS: Three domains of success were determined through a collaborative effort between current program directors and the funding agency project officers. The survey with questions related to the three domains was distributed via an online platform to graduates from seven sites (one former site and six current sites). Data were analyzed and presented utilizing descriptive statistics. RESULTS: The survey was distributed to 550 graduates, 162 responded (37% response rate). Demographically, 78% were female, 54% were Black/African American, 22% were Latinx and 83% did not report any disability. Eighty percent of respondents applied to graduate/professional schools, 67% received admission. Graduates often continued to work in MCH fields (70%). Majority felt confident and knowledgeable in the field (89%) and agreed the faculty were supportive at their training sites (90%). CONCLUSION: The study highlights successes in recruiting from underrepresented minorities, particularly Black/African Americans and first-time college goers in the family into the MCH Pipeline Training Programs. Programs were successful in furthering academic and career development for most trainees. Attitudes towards MCH and the training programs were overwhelmingly positive. Continued support of these programs is critical in addressing health disparities and achieving health equity.

HRSA-Funded MCH Pipeline Training Program: Advancing the MCH Pipeline and Workforce Through Research Collaborations.

PURPOSE: Presently, there are six undergraduate HRSA-funded MCH pipeline training programs (MCHPTP) in the nation and they have gained significant momentum since inception by recruiting, training and mentoring undergraduate students in a comprehensive MCH-focused approach. This article describes the outcomes from the 6 training programs; and primarily Baylor College of Medicine-Texas Southern University (BCM-TSU's) collaborative strategy focusing on the MCH research training and outcomes, which align with HRSA's MCH bureau's missions. DESCRIPTION: Each MCHPTP offers trainees interdisciplinary MCH research experiences through intra/inter-institutional collaborations and partnerships, but BCM-TSU's MCHPTP was the only one with the primary focus to be research. As a case study, the BCM-TSU Program developed an innovative research curriculum integrated with MCH Foundations Course that comprised 2 hour weekly meetings. Students were split into collaborative research groups of 4-5 students, with multidisciplinary peer-mentors, clinical fellows and MCH research faculty from institutions at the world-renowned Texas Medical Center. ASSESSMENT: Since the inception of the MCH mentorship programs, all six MCHPTPs have enrolled up to 1890 trainees and/or interns. BCM-TSU Program trainees are defined as undergraduate students in their 1st or 2nd year of college while research interns are upper classmen in their 3rd or 4th year of college. The case study showed that BCM-TSU Program trainees demonstrated outstanding accomplishments in the area of research through primary and co-authorships of 13 peer-reviewed journal publications by 78 trainees, over a period of 3 years, in addition to dozens of presentations at local, regional and national conferences. CONCLUSIONS: The research productivity of students in the six MCHPTPs is strongly indicative of the success of integrating MCH research mentoring into MCH didactic training. The development of a diverse and robust MCH mentorship program promotes and strengthens research activities in areas of high priority such as addressing health disparities in MCH morbidity and mortality in the U.S.

Success of Maternal and Child Health Pipeline Training Programs: Alumni Survey Results.

INTRODUCTION: The Maternal and Child Health (MCH) Pipeline Training Program, promotes development of a diverse health workforce by training undergraduate students from underrepresented minorities. We aimed to evaluate the success of this program based on three domains: (1) demographic characteristics, (2) academic and career development, and (3) attitudes towards the field of MCH and the training programs among graduates. METHODS: Three domains of success were determined through a collaborative effort between current program directors and the funding agency project officers. The survey with questions related to the three domains was distributed via an online platform to graduates from seven sites (one former site and six current sites). Data were analyzed and presented utilizing descriptive statistics. RESULTS: The survey was distributed to 550 graduates, 162 responded (37% response rate). Demographically, 78% were female, 54% were Black/African American, 22% were Latinx and 83% did not report any disability. Eighty percent of respondents applied to graduate/professional schools, 67% received admission. Graduates often continued to work in MCH fields (70%). Majority felt confident and knowledgeable in the field (89%) and agreed the faculty were supportive at their training sites (90%). CONCLUSION: The study highlights successes in recruiting from underrepresented minorities, particularly Black/African Americans and first-time college goers in the family into the MCH Pipeline Training Programs. Programs were successful in furthering academic and career development for most trainees. Attitudes towards MCH and the training programs were overwhelmingly positive. Continued support of these programs is critical in addressing health disparities and achieving health equity.

Educational Research Priorities for Pediatric Physical Therapy: A Consensus Study.

PURPOSE: This study engaged stakeholders internal and external to pediatric physical therapy education in a consensus exercise toward determining and refining priorities and considerations for educational research for pediatric physical therapy. METHODS: The Delphi method was used to survey 54 physical therapists from 5 stakeholder groups drawn from experts in the field of physical therapy education and from Academy of Pediatric Physical Therapy members invested in educational leadership, research, and/or pediatric physical therapy clinical and residency education. RESULTS: A 4-round survey process revealed 12 educational research priorities and 13 educational research considerations that reached 80% consensus, with clear and consistent top ranking of 4 of these priorities and 4 considerations across all stakeholder groups. DISCUSSION: As the Academy of Pediatric Physical Therapy continues to develop and advance its capacity and support for educational research, knowledge of these priorities and considerations might be used to guide an educational research agenda.

Experiential Learning With Children: An Essential Component of Professional Physical Therapy Education.

PURPOSE: The Section on Pediatrics of the American Physical Therapy Association has developed a number of resources to support and improve the consistency of professional pediatric physical therapy education, including a set of core competencies that all graduates must attain. The purpose of this article is to advocate for the inclusion of experiential learning activities with children, including children with participation restrictions, as a necessary component to achieve the core competencies. KEY POINTS: Experiential learning is a form of practice-based education that provides exposures and opportunities for students to explore the work, roles, and identities they will encounter as future professionals. Experiential learning is learning by doing, and occurs within a relevant setting. Six representative curricular exemplars are presented to provide readers with a variety of suggestions for development and integration of experiential learning. SUMMARY: Recommendations for future research are provided and 4 key recommendations are provided.

Essential competencies in entry-level pediatric physical therapy education.

BACKGROUND: The Section on Pediatrics (SoP) convened an Education Summit in July 2012 to examine, discuss, and respond to documented inconsistencies and challenges in teaching pediatric physical therapy (PT) content in entry-level professional education programs. Despite previous attempts by the SoP to provide guidance around teaching pediatric PT, variability continued to be extensive across programs. KEY POINTS: This article presents the core competencies developed out of the Summit to inform pediatric content in the entry-level PT curriculum. In addition, the core competencies were linked to teaching strategies, learning activities, assessment outcomes, and curricular structures. STATEMENT OF CONCLUSIONS: Consensus was reached on 5 core competencies that represent a knowledge base essential to all graduates of PT programs. In contrast to prior SoP documents, these competencies were specifically designed to focus on knowledge and skills unique to pediatric practice but essential for all graduates of accredited entry-level PT education programs. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/PPT/A50.

Infants with spina bifida: immediate responses to contextual and manual sensory augmentation during treadmill stepping.

PURPOSE: This study examined the effect of combined sensory enhancements and manual assistance on the immediate motor responsiveness of infants with spina bifida during treadmill trials. METHODS: Six infants with spina bifida, aged 4 to 9.5 months, with lesion levels ranging from L4 to S3 were tested in each of 3 randomly ordered sets of enhanced sensory conditions across 3 weekly visits to the laboratory. Sensory enhancements included visual flow, unloading, load, and friction, presented in single and combined applications, as well as a set of trials with manual assistance for stepping at 2 treadmill belt speeds. Dependent variables included step frequencies and overall infant activity. RESULTS: Friction+load was the most salient of the contextual sensory enhancements. Manual assistance at the slower speed was also effective at increasing infant stepping. CONCLUSIONS: Sensory enhancements that increase stance excursion and vertical clearance during swing need further study.

Muscle activation patterns in infants with myelomeningocele stepping on a treadmill.

PURPOSE: To characterize how infants with myelomeningocele (MMC) activate lower limb muscles over the first year of life, without practice, while stepping on a motorized treadmill. METHODS: Twelve infants with MMC were tested longitudinally at 1, 6, and 12 months. Electromyography was used to collect data from the tibialis anterior, lateral gastrocnemius, rectus femoris, biceps femoris. RESULTS: Across the first year, infants showed no electromyographic activity for approximately 50% of the stride cycle with poor rhythmicity and timing of muscles, when activated. Single muscle activation predominated; agonist-antagonist coactivation was low. Probability of individual muscle activity across the stride decreased with age. CONCLUSIONS: Infants with MMC show high variability in timing and duration of muscle activity, few complex combinations, and very little change over time.

Objectively assessed physical activity and sedentary behaviour does not differ between children and adolescents with and without a congenital heart defect: a pilot examination.

OBJECTIVES: To objectively evaluate and describe physical activity levels in children with a stable congenital heart defect and compare those levels with children who do not have a congenital heart defect. METHODS: We matched 21 pairs of children for gender and grade in school and gave them an accelerometer-based motion sensor to wear for 7 consecutive days. RESULTS: Physical activity levels did not differ between children with and without a congenital heart defect. During the 7 days of monitoring, children in this study spent most of their time in sedentary behaviours, that is, 6.7 hours of the 13 monitored hours, 54 minutes in moderate-intensity physical activity, and 12 minutes in vigorous-intensity physical activity. Less than one-fifth of all participants, with or without a congenital heart defect, accumulated sufficient physical activity to meet current physical activity recommendations for children and adolescents. CONCLUSION: Children with a stable congenital heart defect have activity behaviours that are similar to children without a congenital heart defect. Habitual physical activity in children with a congenital heart defect should be encouraged early on in life to develop strong physical activity habits that will hopefully follow them across their lifespan.

Effects of positioning on respiratory measures in individuals with cerebral palsy and severe scoliosis.

PURPOSE: To examine the effect of positioning on respiratory measurements in individuals with cerebral palsy and severe scoliosis. METHODS: Five individuals aged 17 to 37 years participated in an alternating treatment, single-subject design. Oxygen saturation, respiratory rate, heart rate, and chest wall excursion measurements were obtained in supine, sitting, and sidelying positions. RESULTS: Level of support for hypotheses varied on the basis of the respiratory measurement and participants' status. Respiratory rate appeared to be most sensitive to change in the positions. Severity of respiratory compromise and age may be associated with less tolerance for supine position versus sitting and sidelying positions. CONCLUSIONS: The use of therapeutic positioning in sitting and sidelying positions should be considered as a noninvasive intervention for a population with respiratory compromise. Further research with a larger sample is needed to empirically link specific positions with improved respiratory efficiency.

A description of professional pediatric physical therapy education.

PURPOSE: The purpose of this work was to reexamine the status of professional pediatric physical therapy education in the United States. METHODS: A task force designed a 16-item survey and contacted representatives from all professional physical therapy programs. RESULTS: Surveys were gathered from 151 programs for a return rate of 75%. Much variability exists across programs in total number of hours devoted to pediatrics (range, 35-210 hours). In addition, almost 60% of respondents indicated that the individual responsible for delivering the pediatric content will be retiring within the next 15 years. CONCLUSION: These results describe current pediatric professional education and provide numerous opportunities and challenges for the development of optimal professional pediatric education.

Treadmill training and overground gait: decision making for a toddler with spina bifida.

BACKGROUND AND PURPOSE: This case report describes a decision-making process that was used to progress a home-based intervention that coupled treadmill and walker stepping for a preambulatory toddler with spina bifida. CASE DESCRIPTION: The toddler in this report had an L4-L5 level lesion, and began this home-based intervention at 18 months of age when she was pulling to stand. INTERVENTION: The intervention included parameters for treadmill stepping that prepared this toddler for gait with orthotics and was progressed to overground walking with a walker using a decision-making algorithm based on data obtained from a parent log and coded video. OUTCOMES: This toddler progressed from not stepping at the start of the study to ambulating 150 m with a walker at age 23 months, after 18 weeks of this intervention. DISCUSSION AND CONCLUSION: The intervention and decision-making process used in this study were family centered and may be applicable to gait intervention with other populations.

Impact of enhanced sensory input on treadmill step frequency: infants born with myelomeningocele.

PURPOSE: To determine the effect of enhanced sensory input on the step frequency of infants with myelomeningocele (MMC) when supported on a motorized treadmill. METHODS: Twenty-seven infants aged 2 to 10 months with MMC lesions at, or caudal to, L1 participated. We supported infants upright on the treadmill for 2 sets of 6 trials, each 30 seconds long. Enhanced sensory inputs within each set were presented in random order and included baseline, visual flow, unloading, weights, Velcro, and friction. RESULTS: Overall friction and visual flow significantly increased step rate, particularly for the older subjects. Friction and Velcro increased stance-phase duration. Enhanced sensory input had minimal effect on leg activity when infants were not stepping. CONCLUSIONS: : Increased friction via Dycem and enhancing visual flow via a checkerboard pattern on the treadmill belt appear to be more effective than the traditional smooth black belt surface for eliciting stepping patterns in infants with MMC.

The measurement of body composition in children with spina bifida: Feasibility and preliminary findings.

PURPOSE: To assess the feasibility of obtaining and comparing various methods of height and body composition (BC) measurements in children with spina bifida (SB). METHODS: Fifteen children (7M/8F) with SB (4-18 years old) underwent weight, four height measurements (arm span, wall-mounted stadiometer, segmental and recumbent length) and five BC measurements: (BMI; BodPod®; DEXA; Bioelectrical Impedance Analysis; and skinfold). Data collectors, parents, and study participants evaluated procedures. The four heights as paired with the BC measurements were compared to the gold standard DEXA measurements. RESULTS: Procedures were successfully completed in 14 of 15 children. Skinfolds and segmental length had a midlevel ranking of comfort. While no measures substituted for the DEXA scan, preliminary findings suggest that an algorithm may estimate BC in this high-risk population. Currently, arm span used within BodPod® measurements provided the closest agreement with the DEXA scan. CONCLUSION: Study protocol was feasible and provided necessary information, including recommended modifications, for successful implementation of the planned subsequent study.

Infant visual attention and step responsiveness to optic flow during treadmill stepping.

This study examined infant treadmill stepping in two groups of pre-locomotor infants in response to terrestrial optic flow. The optic flow was provided via the treadmill belt for flow translation that was directionally consistent with the forward stepping of the infants. Twelve 2-5-month-old and twelve 7-10-month-old infants participated. Visual attention (duration and direction) and step responsiveness (frequency and step types) were coded from digital video, and visuomotor coupling was examined by temporally juxtaposing the visual attention and step data. Longer durations of visual attention to the patterned belt with increased step frequencies during periods of visual attention were observed, suggesting that the visuotactile calibration afforded by the patterned treadmill belt, increased visuomotor coupling and enhanced the frequency and complexity of stepping in prelocomotor infants. The findings are discussed with regard to sensorimotor experiences that enhance treadmill stepping in infants and that may have application to clinical populations.

Stepping responses of infants with myelomeningocele when supported on a motorized treadmill.

BACKGROUND AND PURPOSE: Infants with myelomeningocele (MMC) have difficulty with, and show delays in, acquiring functional skills, such as walking. This study examined whether infants with MMC will respond to treadmill practice by producing stepping patterns or at least motor activity during the first year after birth. This study also compared the stepping trajectories of infants with MMC across age with those of infants with typical development (TD) to analyze the characteristics of the development of stepping patterns in infants with MMC early in life. PARTICIPANTS: Twelve infants with MMC (lumbar and sacral lesions) and 12 infants with TD were the participants in this study. METHODS: The infants were tested on a treadmill at ages 1, 3, 6, 9, and 12 months, with no treadmill practice between test sessions. Infants were supported on the treadmill for twelve 20-second trials. A digital camera and behavior coding were used to determine step rate, interlimb stepping patterns, step parameters, and motor activity level. RESULTS: Treadmill practice elicited steps in infants with MMC (14.4 steps/minute during the year) but less so than in infants with TD (40.8 steps/minute). Responsiveness was affected by lesion level but varied markedly among infants. Interlimb stepping was less readily alternating, but step parameters were similar to those produced by their peers with TD. Finally, holding infants with MMC on a moving treadmill resulted in greater motor activity (17% during the year) than holding infants on a nonmoving treadmill. DISCUSSION AND CONCLUSION: Infants with MMC responded to the treadmill by stepping (but less so than infants with TD) and showing increased motor activity, but they demonstrated a different developmental trajectory. Future studies are needed to explore the impact of enhancing sensory input during treadmill practice to optimize responses in infants with MMC.