Assessing the impact of a knowledge translation intervention on physical therapists' self-efficacy and implementation of motor learning practice.

BACKGROUND: The application of motor learning (ML) principles and research in physical therapy can optimize patient outcomes. However, the translation of the accumulated knowledge in ML to clinical practice is limited. Knowledge translation interventions, which are designed to promote changes in clinical behaviors, have the potential to address this implementation gap. We developed, implemented, and evaluated a knowledge translation intervention for ML implementation that focuses on building clinical capacity among physical therapists for the systematic application of ML knowledge in clinical practice. METHODS: A total of 111 physical therapists underwent the intervention, which consisted of the following: (1) an interactive didactic 20-hour course; (2) an illustrated conceptual model of ML elements; and (3) a structured clinical-thinking form. Participants completed the Physical Therapists' Perceptions of Motor Learning (PTP-ML) questionnaire pre and post intervention. The PTP-ML was used to assess ML-related self-efficacy and implementation. Participants also provided post-intervention feedback. A sub-sample (n = 25) provided follow-up feedback more than a year after the completion of the intervention. Pre-post and post-follow-up changes in the PTP-ML scores were calculated. The information gathered from the open-ended items of the post-intervention feedback was analyzed to identify emerging themes. RESULTS: Comparing pre- and post-intervention scores, significant changes were found in the total questionnaire scores, self-efficacy subscale scores, reported implementation subscale scores (P < .0001), and general perceptions and work environment subscale score (P < .005). The mean changes in the total questionnaire and self-efficacy scores also significantly exceeded the Reliable Change Index. In the follow-up sample, these changes were maintained. Participants felt that the intervention helped them organize their knowledge in a structured manner and consciously link their practice elements to concepts in ML. Discussion of clinical cases was reported to be the most valuable educational method, and the illustrated conceptual model of ML elements was the least valued. Respondents also suggested support activities to maintain and enhance the learning experience, including on-site mentorship and hands-on experience. CONCLUSIONS: Findings support the positive effect of an educational tool, most prominently on physical therapists' ML self-efficacy. The addition of practical modeling or ongoing educational support may enhance intervention effects.

Bridging Motor Learning Principles with Physiotherapy Specific Scoliosis Exercises: a Perspective Article.

AIM: This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) include a growing number of approaches to scoliosis management and serve as an example of this integration. METHODS: Three quintessential patient cases (a young hypermobile adolescent, a post-pubescent teen, and an adult with childhood diagnosis of scoliosis) serve to contrast the clinical decision-making process for a PSSE plan of care when organized within a motor learning framework. CONCLUSIONS AND IMPLICATIONS: As intervention approaches evolve, aligning the unique terminologies from different schools of thought with motor learning constructs would provide a common language for clinicians, academics and researchers to facilitate comparison of approaches and organize intervention care plans. Linking a motor learning framework and terminology to PSSE may facilitate comparison of PSSE treatment approaches by clinicians, academics, and researchers, as well as advance the global quality of care for patients with scoliosis.

Testing a new active learning approach to advance motor learning knowledge and self-efficacy in physical therapy undergraduate education.

BACKGROUND: Motor learning (ML) science is foundational for physical therapy. However, multiple sources of evidence have indicated a science-practice gap. Clinicians report low self-efficacy with ML concepts and indicate that the lack of access to systematic training is a barrier for practical implementation. The general goal of this preliminary study was to describe the effects of a new educational intervention on physical therapy student's ML self-efficacy and knowledge. METHODS: Self-efficacy was assessed with the Physical Therapists' Perceptions of Motor Learning questionnaire. Data was acquired from third-semester students before their participation in the ML educational intervention. Reference self-efficacy data was also acquired from physical therapy professionals and first and last-semester students. The educational intervention for third-semester students was designed around an established framework to apply ML principles to rehabilitation. A direct experience, the "Learning by Doing" approach, in which students had to choose a motor skill to acquire over 10 weeks, provided the opportunity to apply ML theory to practice in a personally meaningful way. After the intervention self-efficacy was re-tested. ML knowledge was tested with an objective final exam. Content analysis of coursework material was used to determine how students comprehended ML theory and related it to their practical experience. The Kruskal-Wallis and Mann-Whitney U tests were used to compare self-efficacy scores between the four groups. Changes in self-efficacy after the educational intervention were analyzed with the Wilcoxon test. Spearman rank correlation analysis was used to test the association between self-efficacy and final exam grades. RESULTS: By the end of the intervention, students' self-efficacy had significantly increased (p < 0.03), was higher than that of senior students (p < 0.00) and experienced professionals (p < 0.00) and correlated with performance on an objective knowledge test (p < 0.03). Content analysis revealed that students learned to apply the elements of ML-based interventions present in the scientific literature to a real-life, structured ML program tailored to personal objectives. CONCLUSIONS: Positive improvements were observed after the intervention. These results need confirmation with a controlled study. Because self-efficacy mediates the clinical application of knowledge and skills, systematic, active training in ML may help reduce the science-practice gap.

Physical therapists' perspectives of the construct of motor learning, and their motor learning-based practice: a qualitative study.

Introduction: The perceptions and beliefs of physical therapists play an important role in their clinical behavior. These clinician-related aspects may contribute to the knowledge-action gap in the field of motor learning (ML). Accordingly, this study explored how a sample of physical therapists perceive ML in their practice.Methods: A qualitative phenomenological study was conducted. Twelve physical therapists with a wide range of work experience were purposefully selected. Data were collected through semi-structured interviews and analyzed using content analysis methodology. Themes and categories were identified.Results: We identified five key themes: 1) 'ML within the scope of PT' showed that participants perceived ML as a fundamental part of the profession; 2) 'Understanding of ML' showed that participants had difficulty understanding the field comprehensively; 3) 'Self-efficacy toward the topic of ML' revealed that participants had low self-efficacy about their knowledge of the topic; 4) 'Features of ML implementation' showed that physical therapists tended to implement ML intuitively; and 5) 'Barriers to implementation and ways to facilitate it' showed that lack of knowledge was perceived as a main barrier to implementation.Conclusions: Physical therapists' perceptions of and experiences with ML showed the complexity of the field and the lack of clarity regarding its theoretical content and clinical applications. There is a need to reinforce knowledge of ML among physical therapists at different levels of professional development and to promote self-efficacy toward its use, possibly by increasing ML knowledge and education while emphasizing its clinical context.

Two Cultural Models on Infant Motor Development: Middle Class Parents in Israel and the Netherlands.

Culture influences the way parents shape children's environment. Two studies examined cross-cultural differences in parental practices related to motor development in Israel and the Netherlands. In the first study, 198 Dutch and 206 Israeli parents of infants aged 1-7.5 months completed questionnaires measuring parental practices and beliefs regarding motor development. In the second study, 30 Dutch and 30 Israeli parents completed the same questionnaires when their children were 2 and 10 months old. While similarities were found across the cultures, Israeli parents practiced infant prone positioning more. Additionally, Dutch infants spent substantial more time in the playpen. Furthermore, beliefs stressing stimulation and stimulating practices (both more frequent within Israeli parents) predicted better prone skills, shown by the Israeli infants. Findings highlight the diversity of parental practices related to infant motor development.

From Motor Learning Theory to Practice: A Scoping Review of Conceptual Frameworks for Applying Knowledge in Motor Learning to Physical Therapist Practice.

BACKGROUND: The importance of motor learning knowledge for physical therapist practice is well known; however, its application is lacking. Conceptual frameworks that place motor learning knowledge within a clinical context are a potential mediator to overcome this gap. PURPOSE: This study aimed to conduct a scoping review of the literature to identify and describe the content of such conceptual frameworks in physical therapy/rehabilitation, including the approaches taken in their development and the "elements" or building blocks of motor learning-based interventions within each conceptual framework. DATA SOURCES: The data sources used were PubMed, CINAHL, and PsychInfo databases. STUDY SELECTION: Articles that were selected had a primary focus on motor learning and its application in physical therapy/rehabilitation and were published between 2000 and 2017. DATA EXTRACTION: Twelve of 62 relevant articles met the inclusion criteria. DATA SYNTHESIS: Papers attempted to translate theoretical knowledge into a coherent, clinically accessible conceptual framework via 3 main approaches: synthesizing selected motor learning elements into original new conceptual frameworks, mapping motor learning elements in current clinical practices, and assembling selected motor learning elements. The elements of motor learning that were common across papers included theoretical concepts (such as "meaningful goal setting" and "active involvement"); practice variables (including the type, frequency, and timing of feedback; the focus of instructions; task breakdown; and the amount, variability, and order of practice); and intervention strategies (task specific and mental practice). Psychological aspects related to self-efficacy and motivation were also considered integral. LIMITATIONS: Papers published before the year 2000 were excluded. CONCLUSION: The scoping review revealed that the presentation of motor learning elements in a coherent framework encompassed very diverse approaches and used different categorization systems. In addition, to fully grasp the complexity of clinical practice, motor learning should be coupled with other fields of knowledge.

Implementation of motor learning principles in physical therapy practice: Survey of physical therapists' perceptions and reported implementation.

INTRODUCTION: The field of motor learning (ML) plays a pivotal role in physical therapy (PT), and its implementation has been shown to improve intervention outcomes. The objective of this study was to assess physical therapists' ML-related self-efficacy, self-reported implementation, and environmental workplace factors. An additional aim was to report the psychometric properties of a questionnaire that was developed to assess the above-mentioned constructs. METHODS: An observational, cross-sectional survey was completed by 289 physical therapists (average age: 38.7 (9.7), with 11.3 (9.7) years of experience and 74% female). Construct validity, internal consistency, and test-retest reliability were tested. The main outcome measures were the scores of the three scales of the questionnaire, referring to self-efficacy in ML, implementation of ML principles, and workplace environment features. RESULTS: The questionnaire had sound psychometric qualities. Respondents perceived ML as an integral part of PT. ML-related self-efficacy and implementation of ML principles were moderate (2.95/5 (0.7) and 3.04/5(0.8), respectively). PT practice had a significant effect on ML-related self-efficacy (p = 0.035) and implementation (p = 0.0031). Respondents who had undergone ML training in their graduate program reported higher ML-related self-efficacy (p = 0.007). Respondents who had postgraduate training in ML reported significantly more extensive implementation (p = 0.024). Lack of knowledge and lack of time were perceived as the major barriers to implementation. CONCLUSIONS: Level of self-efficacy might be insufficient to support the systematic implementation of ML principles in practice. Addressing impeding individual- and organizational-level factors might facilitate ML self-efficacy and implementation. Postgraduate education facilitates ML implementation.

Training Physical Therapists in Early ASD Screening.

Physical therapists (PTs) are often one of the first professionals to evaluate children at risk. To examine the effect of an early screening training on pediatric PTs': (1) knowledge of autism spectrum disorder (ASD), (2) clinical self-efficacy, and (3) identification of markers. Twenty-six PTs participated in a 2-day "Early ASD Screening" workshop. The ASD Knowledge and Self-Efficacy Questionnaire, and video case study analysis were completed pre- and post-training. Changes following training were significant for ASD knowledge related to etiology and learning performance, early signs, risk factors, and clinical self-efficacy. Rating the videoed case study after the training, was significantly more accurate than it was before. Training PTs is important for enhancing early identification of ASD.

Cross-cultural differences in parental beliefs about infant motor development: A quantitative and qualitative report of middle-class Israeli and Dutch parents.

The present study explored cultural differences in parental beliefs about motor development across 2 Western cultures: Israel and the Netherlands. Can 2 cultural models be distinguished regarding infant motor development in Israel and the Netherlands or are parental beliefs about motor development similar across these cultures? Using a questionnaire containing closed and open questions, beliefs of 206 Israeli and 198 Dutch parents of first-born children between 2 and 7 months old were analyzed. Based on both quantitative and qualitative analyses, distinct cultural models were found showing that the Dutch attributed a bigger role to maturation and children's own pace than to stimulation. The Israeli parents found stimulation of motor development important and discussed active stimulation more elaborately. When discussing supportive activities, the Israeli parents mentioned specific activities, whereas the Dutch parents used more general, vague expressions about support. Moreover, the Israeli parents discussed the need for expert advice and advice from relatives and other parents more than the Dutch parents, who rely on their own observations, books, or websites more often. The cultural background was the strongest predictor of parental beliefs about motor development. Parental education, age, children's birth weight, gender, and having seen a physical therapist showed weaker relations with parental beliefs. Altogether, 2 distinguishing cultural models can be found, raising the question whether infant motor development can be approached similarly across Western cultures. Besides this implication for science, practitioners should also be aware of differences between cultures and between parents. (PsycINFO Database Record

Infant motor activity during sleep: Simultaneous use of two actigraphs comparing right and left legs.

Motor asymmetry during the first hours of sleep documented in adults found higher activity in the non-dominant limb. The stage of development at which such asymmetries first appear is unknown. Twenty healthy infants were followed from 7 to 12months of age, at 3-week intervals, comparing motor activity of the right and left legs during sleep using twin actigraphs (AMI). Hour-by-hour analysis of the first seven hours of nocturnal sleep found no consistent difference in activity levels between the right and left legs. Using the standard algorithm for infants, which provides an overall estimate of sleep quality, revealed discrepancies in night waking episodes (Right versus Left) in 33% of the nights. Results pertaining to leg movement suggest that motor asymmetry is not yet present during the first year of life. However, given the large discrepancies in the detection of night waking, further investigation of the developmental course of circadian motor asymmetry is warranted.

Actigraphic motor activity during sleep from infancy to adulthood.

A secondary analysis of longitudinal and cohort studies was carried out to quantitatively investigate the motor activity pattern, recorded through actigraphy, during the first six hours of nocturnal sleep. The first study was of longitudinal nature. Ten healthy participants (four females) were monitored three times, at baseline (T1) when they were infants (mean age 7.10 ± 0.32 months), at the first follow-up examination (T2) around 4 months later (mean age 11.20 ± 0.63 months) and at the second follow-up (T3) around three years later, when they were preschoolers (mean age 4.68 ± 0.14 years). At T1, T2 and T3 each participant wore the actigraph Basic Mini-Motionlogger (Ambulatory Monitoring, Inc., Ardsley, NY, USA) over at least two consecutive nycthemeral cycles, with the aim to measure the mean hourly motor activity count. Seven- and 11-month-old infants had a higher level of motor activity over the night compared to preschoolers. Furthermore, motor activity increased as the night progressed, with a pronounced increment at both T1 and T2, while at T3 such an increase was less marked. The second study was cross-sectional and aimed to explore the motor activity pattern, using actigraphy, during the first six hours of nocturnal sleep in multiple-age healthy groups, from infancy to adulthood. We assigned participants to eight groups according to age: 20 (five females) aged around 10 months old (mean age 10.65 ± 0.67 months); 13 (nine females) aged around 4 years (mean age 4.38 ± 0.51 years); 21 (10 females) aged around 10 years (mean age 9.67 ± 0.91 years); 21 (nine females) aged around 20 years (mean age 19.33 ± 2.44 years); 20 (10 females) aged around 30 years (mean age 29.80 ± 1.99 years); 20 (15 females) aged around 40 years (mean age 40.70 ± 1.26 years); 20 (11 females) aged around 50 years (mean age 50.15 ± 2.80 years) and 20 (nine females) aged around 60 years (mean age 59.25 ± 3.23 years). The participants aged between 10 and 60 years wore the actigraph Basic Mini-Motionlogger over seven consecutive nycthemeral cycles (infants and preschoolers wore the actigraph over at least two consecutive nycthemeral cycles), with the aim to measure the mean hourly motor activity count. The results indicated a significantly higher motor activity count in 10-month-old infants compared to all the remaining age groups. Moreover, the pattern of motor activity of 10-month-old infants was different from that of all other groups, with the highest motor activity counts from the second to the sixth hour of sleep. Considered as a whole, the results of both studies converge regarding the high motor activity detected among infants, which could be explained by the presence of a maturational process that has not yet been fully completed at this stage of life. In both studies, only the motor activity of infants was above the cutoff level established for normal adults, highlighting the need to establish a specific cutoff value for infants.

Asymmetrical motor behaviour as a window to early leg preference: a longitudinal study in infants 7-12 months of age.

This longitudinal study explored leg preference in infancy during half-kneel pulling-to-stand (PTS) and asymmetrical four-point kneeling, which is part of the typical motor repertoire of infants. The special characteristics of the half-kneel PTS as a discrete task, performed in a bilateral context provide the opportunity to explore leg preference during an asymmetrical behaviour. Twenty-seven infants were observed in their homes, every 3 weeks between the ages of 7-12 months. Leg preference was determined by the "lead-out" limb used as the infants pulled to stand from the half-kneeling position (half-kneel PTS). As a complementary measure, the leading leg during asymmetrical four-point kneeling and crawling ("asymmetrical four-point patterns") was used in the 10 infants who developed these patterns. The infants studied showed a general preference for using a leading leg during half-kneel PTS, which was mostly consistent over the study period. A strong correlation was found between leg preferences during half-kneel PTS and asymmetrical four-point patterns. The findings documented functional asymmetry in infant lower limbs during half-kneel PTS and asymmetrical four-point patterns, highlighting the importance of the tasks used to define leg preference.

Sleep disruption and motor development: Does pulling-to-stand impacts sleep-wake regulation?

During the second half of the 1st year, periods of increased sleep disruption have been documented alongside overall improvement in sleep-wake regulation. The objective of the present research was to test if pulling-to-stand (PTS), a milestone typically achieved during the latter part of the 1st year, co-occurs with a period of disrupted sleep. In a longitudinal design, 20 healthy infants were followed-up, from 7 to 11-12 months, at 3-week intervals. Each measurement consisted of filmed motor observations and sleep recordings (actigraphy), both conducted at home. It was found that among early achievers of PTS (by 8 months), the milestone was time-linked to a period of disrupted sleep. The results point to the significance of timing in the interplay between domains of development, and highlight the importance of considering both chronological and developmental metrics in studying changes in sleep-wake regulation.

Assessing motivation to move and its relationship to motor development in infancy.

Motivation to move has typically been a post hoc explanation for infants' discovery of new patterns of behavior. As a first step to studying motivation to move directly, we qualitatively assessed motivation to move and measured its relationship to motor development in infancy. We observed 27 infants longitudinally from ages 7 to 12 months. Every 3 weeks we assessed infants' motor motivation based on persistence, activity level, activity preference, and stimulus strength needed to elicit movement. We documented the onset of sitting, pulling-to-stand, crawling and cruising, as well as infants' overall motor development as measured with the Alberta Infant Motor Scale (AIMS). Motor motivation increased over the course of the study and we identified two distinct motivation profiles. Strongly motivated infants had earlier onsets for all four motor milestones than weakly motivated infants (all p-values <0.05). Infants' motivation to move score was positively correlated with their AIMS percentile at the same and subsequent sessions. These findings provide empirical evidence for a motivational cascade whereby motivation to move and motor development enjoy a reciprocal relationship. These findings have important clinical implications for children with motor delay, suggesting that evaluation of motivation could be included as part of the assessment procedure so that both treatment and expectations can be tailored appropriately.

Physical therapy for young children diagnosed with autism spectrum disorders-clinical frameworks model in an israeli setting.

Recent research findings suggest that many children with Autism Spectrum Disorders (ASD) demonstrate delayed and atypical motor achievements. It has now become clear that a more holistic, integrative and multi-disciplinary intervention is required to effectively address the motor-related impairments of this population. It is also crucial to ensure that this group of clients has access to early physical therapy (PT) interventions. Despite accumulating research on physical interventions, little is known about intervention model for implementation at a national level. This report introduces a model that uniquely illustrates implementation of PT services for a large number of children with ASD. The model has been operating for the past 2 years in one country (Israel), and includes an optional implementation model of PT practice settings for young children diagnosed with ASD. The Israeli setting offers a unique opportunity for implementing PT services for a multitude of children with ASD on a regular basis as an accepted/needed service. The initial outcomes of the present implementation suggest that an intensive PT intervention program might enhance therapeutic outcomes for this population, and contribute to our knowledge on the potential of PT for individuals with ASD.

Seasonal effect on infants' sleep regulation: a preliminary study in a Mediterranean climate.

Infants' sleep-wake rhythms are influenced by multiple factors, including developmental and contextual aspects, as well as circadian cycles. Empirical studies that address the seasonal impact on infants' sleep are scarce. The present study examined aspects of sleep schedule and quality, comparing summer and winter months in a Mediterranean climate. This report is based on a convenience sample of 34 healthy 7-mo-olds, an age in which sleep is well consolidated and regulated compared with the first few months of life. Sleep was measured with actigraphy, in the home context. It was found that compared with winter, in the summer months, sleep onset occurred at a later hour, and more motor activity during sleep was detected. Although the overall sleep quality, as defined by sleep efficiency score, was similar in the two seasons, in the summer, more active sleep was observed. The authors discuss the finding in terms of circadian rhythms, developmental characteristics, as well as possible environmental factors and family routines, and call for more studies, in different climates and geographical zones, and in different developmental periods.

Pulling to stand: common trajectories and individual differences in development.

This longitudinal study of 27 infants examined the development of pulling-to-stand (PTS). In general, infants began PTS using a two-leg strategy and transitioned to a half-kneel strategy. As a group, infants showed no preference for either strategy at the onset of PTS, switching between strategies until half-kneeling became the dominant pattern about 1 month after the onset of PTS. Examination of individual developmental trajectories revealed variability in age at PTS onset, time between PTS onset and half-kneel strategy onset, duration of the two-leg strategy as the dominant pattern, time until the half-kneel strategy became the dominant pattern, shape of the transition between strategies (gradual vs. abrupt), and timing of PTS relative to onset of other motor milestones. We discuss variation in developmental trajectory in terms of adaptive behavior during the acquisition of new skills and as a process shaped by infants' unique experiences prior to and during the acquisition period.