Ankle Movements During Supine Kicking in Infants Born Preterm.

BACKGROUND: Knowledge of musculoskeletal factors that influence supine kicking of infants born preterm has implications for early intervention. HYPOTHESES: Differences exist between infants born preterm and full-term in ankle kinematics during supine kicking, which are attributable to passive measures of the gastrocnemius/soleus (g/s) muscle tendon unit (MTU). SUBJECTS: Twenty infants born full-term and 22 born preterm were measured at term, 6 weeks, and 12 weeks of age. OUTCOME MEASURES: Ankle kinematics during supine kicking and g/s MTU length. RESULTS: Infants born preterm demonstrated less dorsiflexion, more plantar flexion, and more total ankle range during supine kicking. Gestational age explained 69% to 85% of the variability in MTU length from term to 12 weeks of age. MTU lengths explained 0% to 42% of the variance in ankle kinematics. CONCLUSIONS: Passive measures of the g/s MTU may inform clinicians about ankle kinematics in newborns to 12-week infants during supine kicking.

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.

Student experiences in the neonatal intensive care unit: addendum to neonatal physical therapy competencies and clinical training models.

PURPOSE: To describe the appropriate experience for entry-level physical therapist students in the neonatal intensive care unit (NICU). KEY POINTS: Care for infants in the NICU represents a subspecialty within pediatric physical therapy delivered in a very complex environment. Recommendations for designing student educational experiences related to the NICU are provided. CONCLUSIONS/PRACTICE IMPLICATIONS: Supervised observation is the appropriate level of NICU experience for physical therapy students. Observation in the NICU cannot be used to demonstrate entry-level clinical competency defined as managing 100% patient caseload in the setting. Additional closely supervised experiences with older, less fragile infants and children in neonatal follow-up clinics and pediatric wards can provide opportunities for entry-level physical therapist students interested in pediatrics to participate in examination and intervention with young children.

Neonatal physical therapy. Part II: Practice frameworks and evidence-based practice guidelines.

PURPOSE: (1) To outline frameworks for neonatal physical therapy based on 3 theoretical models, (2) to describe emerging literature supporting neonatal physical therapy practice, and (3) to identify evidence-based practice recommendations. KEY POINTS: Three models are presented as a framework for neonatal practice: (1) dynamic systems theory including synactive theory and the theory of neuronal group selection, (2) the International Classification of Functioning, Disability and Health, and (3) family-centered care. Literature is summarized to support neonatal physical therapists in the areas of examination, developmental care, intervention, and parent education. Practice recommendations are offered with levels of evidence identified. CONCLUSIONS: Neonatal physical therapy practice has a theoretical and evidence-based structure, and evidence is emerging for selected clinical procedures. Continued research to expand the science of neonatal physical therapy is critical to elevate the evidence and support practice recommendations.

Neonatal physical therapy. Part I: clinical competencies and neonatal intensive care unit clinical training models.

PURPOSE: To describe clinical training models, delineate clinical competencies, and outline a clinical decision-making algorithm for neonatal physical therapy. KEY POINTS: In these updated practice guidelines, advanced clinical training models, including precepted practicum and residency or fellowship training, are presented to guide practitioners in organizing mentored, competency-based preparation for neonatal care. Clinical competencies in neonatal physical therapy are outlined with advanced clinical proficiencies and knowledge areas specific to each role. An algorithm for decision making on examination, evaluation, intervention, and re-examination processes provides a framework for clinical reasoning. Because of advanced-level competency requirements and the continuous examination, evaluation, and modification of procedures during each patient contact, the intensive care unit is a restricted practice area for physical therapist assistants, physical therapist generalists, and physical therapy students. CONCLUSIONS/PRACTICE IMPLICATIONS: Accountable, ethical physical therapy for neonates requires advanced, competency-based training with a preceptor in the pediatric subspecialty of neonatology.

Gastrocnemius-soleus muscle tendon unit changes over the first 12 weeks of adjusted age in infants born preterm.

BACKGROUND AND PURPOSE: Differences in the gastrocnemius-soleus muscle and tendon have been documented shortly after birth in infants born preterm compared with infants born at term. Knowledge of muscle tendon unit lengths at term age to 12 weeks of age in infants born preterm may be useful in understanding motor development. PARTICIPANTS AND METHOD: Gastrocnemius-soleus muscle tendon unit lengths were compared at term age, at 6 weeks of age, and at 12 weeks of age (preterm adjusted age) in 20 infants born full term and 22 infants born preterm. RESULTS: Significant differences were found between the 2 groups on taut tendon, relaxed muscle length (A(O)); taut tendon, stretched muscle length (A(Max)); and muscle stretch (A(O) to A(Max)). Infants born preterm demonstrated measures of A(O) and A(Max) in positions of greater plantar flexion compared with infants born full term. Significant differences in measurements of A(O) were found between term age and 12 weeks of age, indicating that the tendon lengthens during this period for both groups. DISCUSSION AND CONCLUSION: These results provide knowledge of musculoskeletal development of the gastrocnemius-soleus muscle and tendon. Differences in musculoskeletal measurements are consistent with uterine confinement in the last weeks of full-term gestation. These findings have implications when examining the musculoskeletal system in infants born preterm who are demonstrating functional changes.

Single-subject research design: recommendations for levels of evidence and quality rating.

The aim of this article is to present a set of evidence levels, accompanied by 14 quality or rigor questions, to foster a critical review of published single-subject research articles. In developing these guidelines, we reviewed levels of evidence and quality/rigor criteria that are in wide use for group research designs, e.g. randomized controlled trials, such as those developed by the Treatment Outcomes Committee of the American Academy for Cerebral Palsy and Developmental Medicine. We also reviewed methodological articles on how to conduct and critically evaluate single-subject research designs (SSRDs). We then subjected the quality questions to interrater agreement testing and refined them until acceptable agreement was reached. We recommend that these guidelines be implemented by clinical researchers who plan to conduct single-subject research or who incorporate SSRD studies into systematic reviews, and by clinicians who aim to practise evidence-based medicine and who wish to critically review pediatric single-subject research.

Treadmill training for an infant born preterm with a grade III intraventricular hemorrhage.

BACKGROUND AND PURPOSE: Research has documented the feasibility and benefit of treadmill training in children with cerebral palsy and Down syndrome. The purposes of this case report are: (1) to determine the feasibility of treadmill training in an infant at high risk for neuromotor dysfunction and (2) to describe the child's treadmill stepping patterns following treadmill training. CASE DESCRIPTION: The male infant, who had a grade III intraventricular hemorrhage following premature birth, began physical therapy and treadmill training at 51/4 months corrected age. Treadmill training was conducted 3 times weekly and videotaped weekly. Videotape analysis determined number of steps, step type, and foot position. OUTCOMES: Except for foot position, trends in treadmill stepping were similar to those of studies with infants not at high risk for neuromotor disabilities. DISCUSSION: This case report shows that treadmill training is feasible for an infant at high risk for neuromotor disabilities and may be associated with more mature stepping characteristics. Future research should evaluate optimum treadmill training parameters and long-term developmental outcomes.