Informing Clinical Practice Guidelines for Children and Youth With Down Syndrome: A Survey of Key Partners.

PURPOSE: The purpose of this work was to describe input from key partners to inform the scope and priorities for a clinical practice guideline (CPG) pertaining to physical therapy services provided to children and youth with Down syndrome (DS). METHODS: A 68-item survey was completed by interventionists and parents (n = 296) of children and youth with DS. RESULTS: The most prevalent physical therapy interventions currently being performed included tummy time, postural control activities, activity-based interventions, and play-based interventions. Key partners agreed on the importance of specific clinical outcomes, needing guidance on frequency and dosage of interventions, common barriers to physical therapy intervention, and needing information for discharge criteria in a future CPG. CONCLUSIONS: The results of this survey have given the CPG committee the necessary information to inform the CPG process for children and youth with DS.

Preliminary assessment of a standardized vision screening guideline in a pediatric inpatient rehabilitation unit.

PURPOSE: This study aimed to evaluate the impact of a standardized vision screen guideline on occupational therapy vision screens in a pediatric inpatient rehabilitation unit. METHODS: Charts of patients admitted to a pediatric inpatient rehabilitation before guideline implementation (n = 47) versus charts after implementation (n = 47) were randomly, retrospectively reviewed to explore differences in visual skills screened and use of standardized assessments. RESULTS: Significant improvements (p <  = 0.05) were found in the number of visual skills screened (p = 0.034), use of standardized assessments (p = 0.005), and screening of the specific visual skills of accommodative amplitude (p = 0.05), suppression (p = 0.015), and double vision (p <  0.001). CONCLUSION: Implementation of a standardized vision screen guideline improved the frequency of vision screens during occupational therapy evaluations in a pediatric inpatient rehabilitation unit. The use of standardized assessments may also improve the quality of vision screens by encouraging staff to complete more comprehensive vision screens, including screening more visual skills, and by prompting use of standardized assessments, which can improve accuracy of screening procedures.

Knowledge is power: Relationship between professional recommendations, maternal attitudes, and screen time exposure of infants.

PURPOSE: The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend infants avoid screen media exposure, yet most infants are regularly exposed. This study aimed to explore screen exposure, maternal attitudes regarding screen media effects, and pediatricians' recommendations to better understand widespread screen media use with infants younger than 18 months of age in hopes of informing mitigation efforts. DESIGN AND METHODS: Surveys consisting of 10 Likert-style questions were distributed real-time to a purposive sample of 193 mothers with infants 18 months of age or younger in Georgia, Pennsylvania, and New York. RESULTS: Seventy-nine percent of infants exceeded AAP/WHO guidelines and 61% of respondents couldn't recall receiving pediatrician recommendations regarding screen exposure for their infant. Mothers with higher levels of education were associated with an accurate reflection of the adverse effects of screen usage on infant development (ANOVA; F = 10.122; df = 3; p < .001). Accurate maternal attitudes regarding adverse effects on infants was associated with less daily screen exposure (Spearman correlation; r = -0.428; p < .001). CONCLUSIONS: Findings suggest that knowledge about adverse side effects of screen media usage with infants is associated with less daily exposure; and, that pediatricians may not routinely review guidelines for infants with their families, underscoring the importance of other methods of knowledge dissemination. PRACTICE IMPLICATIONS: Nurses, as trusted healthcare providers, can provide counseling on infant screen media usage creating an opportunity for augmented knowledge dissemination across maternal demographics potentially leading to less screen exposure in this vulnerable population.

A Qualitative Exploration of Exercise During Pregnancy.

OBJECTIVE: To explore the experience of women engaging in physical activity during pregnancy. DESIGN: This was the qualitative arm of the Starting Pregnancy With Robustness for Optimal Upward Trajectories (SPROUT) pilot project. Thematic analysis was used to realize patterns of meaning and significance from data on participants' experiences in engaging in physical activity during pregnancy. SETTING: One-on-one structured interviews via video conferencing. PARTICIPANTS: Eighteen women in the first trimester of their pregnancy were recruited from local obstetric practices and randomized into one of three exercise groups. All three groups of women were followed for their entire pregnancy and for 6 months postpartum. METHODS: Interviews were recorded and analyzed using thematic analysis. RESULTS: Six major themes important for clinical practice resulted from the analysis: Physical Activity During Pregnancy Is Desirous for Health Benefits, Activity Monitors Provide Motivation, Human Connection HelpsSupportPhysical Activity, More Guidance Is Needed on How to Be Physically Active During Pregnancy, A Supervised Physical Activity Program Is Preferred if Available and Flexible, and Participants Would Choose to Be Physically Active in Subsequent Pregnancies. CONCLUSION: Human interaction, education on physical activity guidelines, and exercise advice increased motivation, accountability, and confidence in the women. Using a tracking device such as an activity watch provided real-world feedback in addition to fostering motivation.

Relations among parent-reported physical activity and interoception in children.

BACKGROUND: Interoception is the sense of one's internal body and emotional state; it plays a critical role in guiding self-regulatory behaviors. Physical activity (PA) can support interoceptive processes, but limited research has examined the association in children. This study explored the relations among parent-reported PA and several interoceptive domains in children aged 3 - 10 years old. METHODS: Baseline data were analyzed from a cluster-randomized controlled study examining a yoga intervention (N = 122). Parents completed a questionnaire that included the Caregiver Questionnaire for Interoceptive Awareness, Second Edition (CQIA-2) and two measures of PA, the PROMIS Parent-Proxy Short Form (PROMIS-PA) and the adapted Burdette Proxy Report (aBPR-PA). Psychometrics of the CQIA-2 subscales were assessed and then used in subsequent analyses to examine the association between PA and interoceptive sensibility. RESULTS: Seventy percent of the surveys were completed by mothers (30% by fathers), and their children (56% female, Mage = 5.81 ± 1.7 years) were predominately white. Across all children, PA had a significant positive relationship with interoceptive domains related to emotion and physical energy (p < 0.01). Children who met the PROMIS-PA "good" cutoff had a clearer sense of emotion and physical energy (F(2,115) = 4.30, p = 0.016, R2 = 0.070), compared to children who did not. Children's age predicted interoceptive sensibility of illness and toileting needs (F(1,116) = 14.16, p < 0.001, R2 = 0.109). CONCLUSION: Children with higher PA levels were perceived to have better interoceptive sensibility of emotion and physical energy. Children's age was predictive of interoceptive domains representing the awareness of illness and toileting needs. Future work should consider incorporating direct measures of PA and child-reported interoceptive sensibility. A better understanding of their relationship will likely help guide the design of more effective interventions for health behavior development.

Promoting Participation in Physical Activity in Children and Adolescents With Down Syndrome.

Children with Down syndrome (DS) often have lower physical activity (PA) levels compared with their peers with typical development, and face challenges to being physically active such as medical comorbidities, access issues, and societal stigma. Physical therapists are experts in exercise prescription and PA and are thus uniquely qualified to successfully promote participation in children with DS, in spite of inherent challenges. Our perspective is that a shift in physical therapy service delivery is needed. We suggest that physical therapists change the focus of their interventions for children with DS from underlying impairments such as low tone or joint laxity or from developing motor skills in isolation and "correct" movement patterns. Instead, physical therapists should allow the PA preferences and the environmental contexts of the children and adolescents they are working with to direct the treatment plan. In this way, physical therapist intervention becomes more child centered by concentrating on developing the specific skills and strategies required for success in the child's preferred PA. In this article, we consider the role of pediatric physical therapists in the United States, as well as in low- and middle-income countries, in promoting and monitoring PA in children with DS from infancy through adolescence. Examples of physical therapist interventions such as tummy time, movement exploration, treadmill training, bicycle riding, and strength training are discussed, across infancy, childhood, and adolescence, with a focus on how to successfully promote lifelong participation in PA. LAY SUMMARY: Physical therapists are experts in exercise and physical activity and are thus uniquely qualified to promote participation in children with Down syndrome. Instead of focusing on impairments or "correct" movement patterns, physical therapists are encouraged to allow the child and the child's environment to direct the treatment plan.

Walking Performance, Physical Activity, and Validity of the Early Activity Scale for Endurance in Young Children with Cerebral Palsy.

AIMS: To describe the walking performance and physical activity of children with cerebral palsy (CP) by Gross Motor Function Classification System (GMFCS) level, age, sex, and geographical location; and, to examine the concurrent validity of the 4-item Early Activity Scale for Endurance (EASE) to walking performance and physical activity scores. METHODS: Seventy-nine children with CP participated. Parents completed the 4-item EASE. All children wore an Actigraph monitor (n = 79), and children in GMFCS levels I - III also wore a StepWatch monitor (n = 50), for seven days. RESULTS: Only GMFCS level yielded significant differences in average strides taken per day, in strides per day taken faster than 30 strides per minute, in average physical activity counts per minute, and in minutes per day spent in moderate to vigorous physical activity. The 4-item EASE findings were moderately correlated with average physical activity counts per minute (.61, p< .001) and minutes per day spent in moderate to vigorous physical activity (.62, p < .001). CONCLUSIONS: GMFCS level is predictive of both walking performance and physical activity in children with CP. The 4-item EASE may provide a quick and valid way to monitor physical activity in children with CP.

Longitudinal trajectories of physical activity and walking performance by gross motor function classification system level for children with cerebral palsy.

Purpose: This study aims to present developmental trajectories for physical activity (PA) and walking performance for children with cerebral palsy (CP).Materials and methods: Seventy-nine children with CP, 39 (49%) female, Gross Motor Functional Classification System levels I-V, and mean age 91.3 months (+/-27.7 SD) participated. Participants in levels I-V wore the Actigraph to capture PA and children in levels I-II also wore a StepWatch (SW) (n = 43) to measure walking performance. Trajectories for average PA counts/minute and number of minutes of moderate to vigorous PA were generated for levels I, II, and III/IV/V (aggregate). Single leg strides/day and average strides faster than 30 strides/min trajectories were generated for levels I-II.Results: Participants did not display plateaus in PA or walking performance based on functional level. Children in all levels showed a decrease in amount and intensity of PA from 3.0 to 12 years old, with participants in level I demonstrating the steepest decline. Children in level I decreased slightly, and level II increased slightly in both walking performance measures from 3.0 to 12 years old.Conclusions: Longitudinal curves demonstrate variations in PA and walking performance by functional level and provide prognostic information as to what changes may be anticipated for children with CP.Implications for rehabilitationLongitudinal developmental trajectories for physical activity and walking performance for children with cerebral palsy across functional levels are documented.Trajectories have potential to support collaborative intervention planning between therapists and families relative to physical activity and walking performance.

Meeting at the crossroads: collaboration between information technology departments and health sciences libraries.

OBJECTIVE: The purposes of this survey were to determine the nature and extent of collaboration between health sciences libraries and their information technology (IT) departments, to identify strengths and issues connected to this relationship, and to provide examples demonstrating exceptional collaborative success. METHODS: A fourteen-question survey was sent to a broad selection of health care and academic libraries through a variety of email discussion lists and was limited to one response per institution. Convenience sampling was used to collect the responses. RESULTS: An overwhelming majority of libraries described the relationship with their IT departments as good or excellent, and there were a variety of creative joint initiatives underway. Opportunities exist for continued and expanded library/IT collaboration. CONCLUSIONS: Good quality relationships between libraries and their IT departments are essential due to the interconnected nature of their services, and fortunately, this appears to be the norm at a variety of institutions. Mutual respect, open communication, realization of each department's mission, and responsiveness to each other's needs are part of what makes these relationships successful, which in turn leads to successful collaborative ventures that bode well for the future of both services.

Importance of Initiating a "Tummy Time" Intervention Early in Infants With Down Syndrome.

PURPOSE: This study compared differences in motor development in infants with Down syndrome beginning a tummy time intervention before 11 weeks of age and after 11 weeks of age. METHODS: Nineteen infants with Down syndrome participated in tummy time until they could independently transition in and out of sitting. Motor development was assessed monthly using the Bayley III Motor Scales and compared between the groups. RESULTS: A difference in motor development between early and late groups is apparent 1, 2, and 3 months following intervention initiation. CONCLUSION: Early implemented tummy time was effective in reducing motor delay in young infants with Down syndrome and is a prudent first step in intervention.

"You've got to settle down!": Mothers' perceptions of physical activity in their young children.

BACKGROUND: Mothers are important mediators of children's physical activity (PA) level and risk of obesity, however previous studies of maternal perceptions of child PA have been limited. Furthermore, it is unknown if maternal perceptions of child PA are predicted by family, mother and child characteristics. Therefore objectives of this study were to 1) evaluate maternal perceptions of PA in their children and 2) test associations of family, mother and child characteristics with these perceptions. METHODS: 278 low-income mothers of children (mean age 70.9 months) participated in an audio-taped semi-structured interview. Transcripts were systematically analyzed using the constant comparative method and themes were generated. A coding scheme to classify the themes appearing in each transcript was developed and reliably applied. Anthropometrics were measured. Demographics and questionnaires (the Confusion, Hubbub and Order Scale, The Parenting Scale, and the Child Behavior Questionnaire (CBQ)) were collected. Logistic regression models were used to test the associations of family, mother and child characteristics with each theme. RESULTS: In this sample of low-income United States mothers, two themes emerged: 1) Mothers perceive their children as already very active (87.8%, n = 244), predicted by the child being younger, the child not being overweight, and higher child CBQ Activity Level; and 2) Mothers view their children's high activity level as problematic (27.0%, n = 75), predicted by lower Parenting Laxness, the child being male and lower child CBQ Inhibitory Control. CONCLUSIONS: Low-income United States mothers have unique perceptions of PA in their children; these beliefs are associated with characteristics of the child and mother but not characteristics of the family. Further understanding of contributors to maternal perceptions of child PA may inform future childhood obesity interventions. The influence of these perceptions on physical activity outcomes in low-income children should be pursued in future research.

Use of visual and proprioceptive feedback to improve gait speed and spatiotemporal symmetry following chronic stroke: a case series.

BACKGROUND AND PURPOSE: Persistent deficits in gait speed and spatiotemporal symmetry are prevalent following stroke and can limit the achievement of community mobility goals. Rehabilitation can improve gait speed, but has shown limited ability to improve spatiotemporal symmetry. The incorporation of combined visual and proprioceptive feedback regarding spatiotemporal symmetry has the potential to be effective at improving gait. CASE DESCRIPTION: A 60-year-old man (18 months poststroke) and a 53-year-old woman (21 months poststroke) each participated in gait training to improve gait speed and spatiotemporal symmetry. Each patient performed 18 sessions (6 weeks) of combined treadmill-based gait training followed by overground practice. To assist with relearning spatiotemporal symmetry, treadmill-based training for both patients was augmented with continuous, real-time visual and proprioceptive feedback from an immersive virtual environment and a dual belt treadmill, respectively. OUTCOMES: Both patients improved gait speed (patient 1: 0.35 m/s improvement; patient 2: 0.26 m/s improvement) and spatiotemporal symmetry. Patient 1, who trained with step-length symmetry feedback, improved his step-length symmetry ratio, but not his stance-time symmetry ratio. Patient 2, who trained with stance-time symmetry feedback, improved her stance-time symmetry ratio. She had no step-length asymmetry before training. DISCUSSION: Both patients made improvements in gait speed and spatiotemporal symmetry that exceeded those reported in the literature. Further work is needed to ascertain the role of combined visual and proprioceptive feedback for improving gait speed and spatiotemporal symmetry after chronic stroke.