An analysis of interagency collaboration: Lessons learned from Colorado's early intervention program.

INTRODUCTION: The purpose of this study was to describe interagency collaboration in Part C Early Intervention (EI) programs. METHODS: Between 18 April and 9 May 2022, 48 EI service coordinators (SCs) from 14 programs in one state completed adapted versions of the Interagency Collaboration Activities Scale (IACAS) and Relational Coordination Survey (RCS). Assessing perceptions of shared structures (IACAS) and coordination quality (RCS), these combined measures summarized interagency collaboration with 11 organizations. Mean (SD) survey responses were estimated and ranked. RESULTS: Sample SCs represent a breadth of professional disciples and vary substantially in their current and desired collaborations. The quantity of SCs collaborating with organizations ranged from 0% to 98%. Nearly all (98%) reported collaborating with the school districts, few (15%) reported collaborating with insurance, and none reported collaborating with Supplemental Nutrition Assistance Program or Special Supplemental Nutrition Program for Women, Infants, and Children. The majority of SCs expressed desire to increase their collaborations with most of the listed organizations. The perceived quality of collaborations varied substantially at both individual and organizational levels. When comparing SC perceptions of shared structures and coordination quality, SCs reported more favourable collaborations with school districts (IACAS rank: first and RCS rank: first) and less favourable collaborations with insurance (IACAS rank: ninth and RCS rank: seventh). Some organizations rankings varied across both scales, including pediatric primary care (IACAS rank: third and RCS rank: eighth) and hospitals (IACAS rank: sixth and RCS rank: second). Overall, SCs reported low perceived existence of shared structures while coordination quality varied by organization. Opportunities for collaborative growth were identified. DISCUSSION: Despite its importance and required implementation in EI, perceptions of interagency collaboration varied substantially within and between EI programs. There is a suggested need to increase the quantity of SCs that collaborate and identified opportunities to increase the quality of collaborations that already exist.

Identifying Perspectives on Physical Therapist Residency Program Goals: Hallmarks of Success and Excellence.

OBJECTIVE: The purpose of this study was to describe common perspectives important to achieving excellence and success in physical therapist residency education programs. METHODS: Individuals with direct responsibility for creating and revising physical therapist residency program goals participated in a mixed-methods study using Q-methodology. They sorted 31 goal topics based on the level of importance for achieving excellence and success in physical therapist residency education. By-participant factor analysis identified dominant perspectives, which were interpreted based on emergent themes from the topics identified as the most important. Participants' rationale for selecting goal topics as the most important were extracted from the post-survey. RESULTS: Seventy-three individuals responded, representing 9 of the 11 clinical residency areas of practice. Three main perspectives emerged: resident behaviors, resident achievements, and program attributes. One shared perspective emerged across all 3 factors that emphasized the residents' ability to become self-regulated, lifelong learners who integrate learning into practice: preparation for future learning. CONCLUSIONS: Variability in weighting the importance of program goals associated with each perspective may include a program's organization and mission, individual beliefs and experiences related to program leadership, and resource availability. Although respondent emphasis placed importance of some items over others, the findings do not suggest that items ranked lower were unnecessary or unimportant in achieving program excellence. The relative importance of items was weighted differently based on the perspective of program leadership and the individual completing the sorting activity. IMPACT: The results of this study suggest that physical therapist residency programs should have at least 1 or 2 goals in each of the 3 distinct perspectives, as well as the 1 shared perspective identified in our findings. Some consistency in program goals based on the perspectives identified here may enable further research exploring excellence, value, and outcomes in physical therapist residency education.

Changing Practice: Clinical Application of Resistance Training Evidence for Children With Cerebral Palsy.

PURPOSE: Describe the development and application of a progressive resistance exercise (PRE) program for children with cerebral palsy (CP), which became a standard care model at an urban specialty hospital network. SUMMARY OF KEY POINTS: Muscle structure and performance have been shown to impact function and participation in children with CP. Use of PRE to achieve function and participation goals is supported by a growing body of evidence. A novel guideline, focused on individualized, goal-focused PRE dosing, professional development, program monitoring, and outcome measures use, facilitated application of a new clinical practice. CONCLUSIONS: Practice change was accomplished by translating evidence using a clinical guideline resulting in positive child function and participation outcomes. RECOMMENDATIONS FOR CLINICAL PRACTICE: This Special Communication provides an example of addressing goal-related muscle performance impairments in children with CP. Clinicians should consider updating long-standing physical therapy intervention strategies by incorporating goal-specific PRE into practice.

Collaborative Therapist-Patient Decision Making: A Power-Based Exercise Program for an Adolescent With CMT1A.

PURPOSE: The purpose of this case report is to describe an episode of care for an adolescent with Charcot Marie Tooth disease (CMT) using a power-based progressive resistance exercise (PRE) and balance program to improve performance of participant-defined goals with added description through the voice of the patient as "participant lived experience." SUMMARY OF KEY POINTS: Participant discussion demonstrates improvement of functional performance for an adolescent with CMT subtype 1A (CMT1A), a progressive neuromuscular disorder. Function and participation-specific movement observation, clinical evaluation, and resistance training fostered appropriate program design and intervention dosing. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE: A power-based progressive resistance exercise and balance program with design based on participant-defined goals was feasible, well tolerated, and successful for an adolescent with CMT1A. Inclusion of viewpoints of the "lived experience" provides deeper insight into patient perspective and clinical outcomes. Outcomes may improve when intervention is specifically dosed to participant goals and individual muscle performance requirements for targeted tasks.

An Assessment of Essential Anatomy Course Content in an Entry-Level Doctor of Physical Therapy Program.

Anatomical knowledge is the foundation of the educational curricula in most healthcare programs. The varying scopes of practice between healthcare professions require anatomy educators to determine what content is essential to cover in a finite time with learners. When possible, the anatomy educator bases this decision on clinical experiences; this is a more significant challenge for the non-clinician educator teaching in a health profession curriculum. Although studies have determined essential anatomy content in many healthcare professions, no study has been undertaken in physical therapist education. This study was designed to determine what anatomical concepts are considered essential in physical therapist education in one doctor of physical therapy program. Faculty (n = 28), recent graduates (n = 134), and clinical instructors (n = 247) of a doctor of physical therapy program were invited to respond to a survey focused on rating the essential nature of 46 learning objectives. Consensus for learning objectives was determined using Lawshe's content validity method. One hundred forty-seven respondents completed the survey (36% response rate). Respondents represented a diversity in years of experience, highest physical therapist degree earned, specialty training, and setting of physical therapist practice. Of the 46 learning objectives presented, 10 were most frequently rated essential, 20 as useful but not essential, and 16 as not necessary. These results offer guidance for anatomy instructors at other institutions to make an informed decision on what anatomical content to focus on in their anatomy courses in order to increase time dedicated toward mastery of essential core anatomical knowledge for physical therapist practice. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01574-1.

The How and the Why of Including Children: Experiential Learning in Teaching Physical Therapist Students.

PURPOSE: This study describes experiential learning (EL) activities with children and the rationale for using EL. Experiential learning with children in entry-level doctor of physical therapy (DPT) education has not been described. METHODS: Eighteen pediatric educators from accredited DPT programs participated in semistructured, in-depth interviews. Researchers analyzed written interview transcriptions using an iterative, consensus-building, thematic analysis approach. RESULTS: Educators described their EL activities. Educators' rationale for using EL grouped around 4 themes: (1) EL is valued by multiple stakeholders, (2) EL provides an additional learning modality, (3) EL introduces students to pediatric physical therapy, and (4) EL addresses standards and competencies for DPT education. CONCLUSIONS: This research provides a rich description of EL with children and rationale for integrating EL in DPT education. These findings may inform educators and program directors regarding the value of EL and the investment of resources to support EL in DPT education. SUPPLEMENTAL VIDEO ABSTRACT AVAILABLE: at: http://links.lww.com/PPT/A386.

Experiential Learning in Pediatric Physical Therapist Education: Challenges and Facilitators.

PURPOSE: The purpose of this study was to conduct an in-depth investigation of physical therapist educators' challenges to and facilitators of the use of experiential learning (EL) with children. Although EL with children has been called an essential component of doctor of physical therapy (DPT) education, variability in the amount of EL used among DPT programs indicates that educators may experience different challenges and facilitators of the use of EL. METHODS: Eighteen pediatric DPT educators participated in a semistructured interview. Researchers used thematic analysis to qualitatively analyze interview transcripts. RESULTS: Three themes emerged: (1) stakeholder considerations, (2) pedagogical considerations, and (3) logistical considerations. CONCLUSIONS: This research illustrates challenges and facilitators to the use of EL with children. How these challenges and facilitators are perceived by DPT educators has implications for faculty and program directors, particularly as they consider the use of EL with children in DPT programs nationally.

Changing the Paradigm of School-Based Physical Therapist Service Delivery: Using Evidence to Support Intensive Intervention.

PURPOSE: The purpose of this article is to highlight the paradigm shift away from the typical model of direct service delivery of consistent frequency and duration in the school setting to accommodate an intensive progressive resistive exercise intervention. School-based physical therapists describe how they applied an evidence-based intensive intervention with multiple students in an urban public school district. SUMMARY OF KEY POINTS: The school-based physical therapists had to modify the typical service delivery model and overcome other challenges to implement this intensive intervention approach. Substantial improvements in strength and functional activities were observed in multiple students and measured across several months. CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE: An intensive intervention model appears effective and feasible in the school setting. Evidence-based intervention approaches should be considered when the student could benefit. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A339.

Experiential Learning in Pediatric Physical Therapist Education: Faculty and Student Perceptions.

SUBJECTS: Faculty teaching pediatric content in accredited doctor of physical therapy programs was recruited; 106 responded. Students representing 20 participating programs were also invited to participate; 23 responded. METHODS: Participants received an online questionnaire including closed- and open-ended questions regarding EL with children. Descriptive statistics were used to describe responses. Responses to open-ended questions were compiled and reviewed. RESULTS: Respondents reported an average of 12.4 hours of EL with children in required courses. Satisfaction with quality was stronger than with amount of EL. Several perceived barriers and facilitators were reported. CONCLUSIONS: Use of and satisfaction with EL with children in physical therapists' education vary. Continued research on this variation and potential effects to educational outcomes is needed.

Quality of Life and Functional Mobility After Progressive Resistance Exercise in an Adolescent With a Liver Transplant.

PURPOSE: This case report describes physical therapy intervention using progressive resistance exercise (PRE) with the recipient of a liver transplant to improve physical fitness, quality of life, and functional mobility. SUMMARY OF KEY POINTS: Outpatient physical therapy intervention included 2 phases, 10 weeks each, focused on functional training and PRE-based power training and functional tasks. Secondary conditions included excessive weight gain, adjustment disorder, and intensive scarring. STATEMENT OF CONCLUSIONS: PRE-based power training appears to be effective in an adolescent with decreased strength and endurance following liver transplant. Improvements in 1 repetition maximum, functional mobility, aerobic/anaerobic fitness, patient-directed goals, and quality of life were measurable. RECOMMENDATIONS FOR CLINICAL PRACTICE: A PRE-based program may be useful in physical therapy with adolescents after liver transplant. Choice of musculature for training should be relevant to functional limitations and dosing of exercises must be sufficient for muscular hypertrophy.

Development of a Grading Rubric to Assess Learning in Pediatric Physical Therapy Education.

The purpose of this perspective article is to describe the development and potential use of a grading rubric to assess pediatric psychomotor and clinical reasoning skills in professional pediatric physical therapist students. Feedback from focus groups made up of pediatric physical therapy educators informed development of the rubric. In addition, preliminary reliability and feasibility of the rubric were evaluated using videotaped student performance on a related pediatric case. Pilot data suggest a range of reliability between slight and moderate across the components of the rubric. Both the case and the rubric are included as appendices, and recommendations are provided for implementation and for future research.

Functional Mobility Improved After Intensive Progressive Resistance Exercise in an Adolescent With Spina Bifida.

PURPOSE: To describe the use and effectiveness of a novel intensive progressive resistance exercise (PRE) approach to address the functional goals of a 14-year-old adolescent with a myelomeningocele. SUMMARY OF KEY POINTS: The child had lower extremity weakness, knee and hip flexion contractures, impaired somatosensation, and cardiopulmonary deconditioning, affecting gait mechanics and functional ambulation. An 8-week intensive PRE-based intervention was designed to improve walking in the home by targeting both power-generating and stabilizing lower extremity musculature. Secondary intervention focused on cardiopulmonary endurance training. CONCLUSIONS: The child demonstrated improvements in gait speed, walking endurance, and functional lower extremity strength. Knee contracture was moderately responsive to sustained stretching and positioning. WHAT THIS CASE ADDS TO EVIDENCE-BASED PRACTICE: This intensive PRE training approach had been effective for improving function among youth with cerebral palsy, and to our knowledge it had not yet been applied to youth with other neurological conditions.

Associations of Gross Motor Delay, Behavior, and Quality of Life in Young Children With Autism Spectrum Disorder.

Background: Young children with autism spectrum disorder (ASD) often have gross motor delays that may accentuate problem daytime behavior and health-related quality of life (QoL). Objective: The objective of this study was to describe the degree of gross motor delays in young children with ASD and associations of gross motor delays with problem daytime behavior and QoL. The primary hypothesis was that Gross motor delays significantly modifies the associations between internalizing or externalizing problem daytime behavior and QoL. Design: This study used a cross-sectional, retrospective analysis. Methods: Data from 3253 children who were 2 to 6 years old and who had ASD were obtained from the Autism Speaks Autism Treatment Network and analyzed using unadjusted and adjusted linear regression. Measures included the Vineland Adaptive Behavior Scales, 2nd edition, gross motor v-scale score (VABS-GM) (for Gross motor delays), the Child Behavior Checklist (CBCL) (for Problem daytime behavior), and the Pediatric Quality of Life Inventory (PedsQL) (for QoL). Results: The mean VABS-GM was 12.12 (SD = 2.2), representing performance at or below the 16th percentile. After adjustment for covariates, the internalizing CBCL t score decreased with increasing VABS-GM (ß = - 0.64 SE = 0.12). Total and subscale PedsQL scores increased with increasing VABS-GM (for total score: ß = 1.79 SE = 0.17; for subscale score: ß = 0.9-2.66 SE = 0.17-0.25). CBCL internalizing and externalizing t scores decreased with increasing PedsQL total score (ß = - 0.39 SE = 0.01; ß = - 0.36 SE = 0.01). The associations between CBCL internalizing or externalizing t scores and PedsQL were significantly modified by VABSGM (ß = - 0.026 SE = 0.005]; ß = - 0.019 SE = 0.007). Limitations: The study lacked ethnic and socioeconomic diversity. Measures were collected via parent report without accompanying clinical assessment. Conclusions: Cross motor delay was independently associated with Problem daytime behavior and QoL in children with ASD. Gross motor delay modified the association between Problem daytime behavior and QoL. Children with ASD and co-occurring internalizing Problem daytime behavior had greater Gross motor delays than children without internalizing Problem daytime behavior; therefore, these children may be most appropriate for early physical therapist evaluation.

Therapy Use for Children With Developmental Conditions: Analysis of Colorado Medicaid Data.

STUDY PURPOSE: To examine therapy use and spending for Medicaid-enrolled infants and toddlers with developmental conditions. METHODS: Sample infants and toddlers had a diagnosis (eg, cerebral palsy) or developmental delay (DD). Colorado Children's Medicaid administrative outpatient therapy claims (2006-2008) were used to estimate differences, by condition type and number of comorbid chronic conditions (CCCs), of any physical therapy (PT)/occupational therapy (OT) and Medicaid PT/OT spending. RESULTS: The sample included 20 959 children. Children with at least 2 CCCs had higher odds of PT/OT than children with no CCC. Children with DD had 12-fold higher odds of having any PT/OT compared with children with diagnosis. Children with a DD and 2 CCCs had the highest PT/OT spending. CONCLUSIONS: Medicaid PT/OT use and spending are higher for children with more CCCs and those with DD because children with DD receive more specialized PT/OT.