Development of an Electronic Version of The Children's Self-Perceptions of Adequacy in and Predilection for Physical Activity (CSAPPA) Scale.

PURPOSE: To develop an electronic version of the Children's Self-Perceptions of Adequacy in and Predilection for Physical Activity (eCSAPPA), which would allow individual administration to children younger than nine years of age. METHODS: Fifty-four, four-nine-year-old children completed the eCSAPPA and the Test of Gross Motor Development-2 (TGMD-2). Parental measures of physical activity, and body mass index were obtained. Twenty-one participants additionally completed the paper version of the CSAPPA. RESULTS: All children successfully completed the eCSAPPA with interclass correlation coefficients of .76 for Adequacy and .86 for Total Score. Correlations and linear predictive equations for eCSAPPA revealed the TGMD-2's Locomotor subtest, age, and parent's activity rating explained 28-30% of the variability in Total and Adequacy eCSAPPA scores. Predilection and Enjoyment of Physical Education (PE) scores were less stable, with the TGMD-2's Locomotor subtest and age predicting 17% of the Predilection score and the TGMD-2's Object Control subtest demonstrating 17% of Enjoyment of PE. CONCLUSION: Children ages four-nine years can feasibly complete the electronic version of the CSAPPA and results hint that self-efficacy may be more plastic in younger children. The eCSAPPA is a promising instrument allowing the exploration of young children's development of adequacy and predilection toward physical activity as well as enjoyment of PE.

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.

Strength training for a child with suspected developmental coordination disorder.

BACKGROUND: Children with developmental coordination disorder (DCD) demonstrate difficulty with feedforward motor control and use varied compensatory strategies. PURPOSE: To examine gross motor function changes following strength training in a child with motor control difficulties. CASE DESCRIPTION: A girl aged 6 years 11 months, with apraxia and hypotonia, and demonstrating motor delays consistent with DCD. INTERVENTION: Twenty-four strength training sessions were completed using a universal exercise unit. OUTCOMES: Postintervention scores significantly improved on the Bruininks-Oseretsky test of motor proficiency, second edition, and the Canadian occupational performance measure scores and raised the developmental coordination disorder questionnaire, revised 2007, scores above the range where DCD is suspected. Nonsignificant changes in strength were observed. DISCUSSION: Improved function and significant gains in manual coordination were observed following blocked practice of isolated, simple joint movements during strength training. Improved motor skills may be because of effective use of feedforward control and improved stabilization. Strength training does not rehearse skills using momentum, explaining nonsignificant changes in locomotor or locomotion areas.

Assessing sensory processing differences in children with idiopathic toe walking: A pilot study.

Idiopathic toe-walking (ITW) refers to persistent walking without heel contact for unknown reasons. An underexplored area is the relationship of sensory processing to ITW. This study presents methods to assess sensory differences in individuals with ITW and summarizes results from a pilot testing of the measures. This pilot study included nine children and one young adult with ITW. Ten age-matched controls were recruited to provide a comparison group when norms were not available in the literature. The measures included in this study were as follows: sensory questionnaires; electrodermal activity response to sensory stimuli; monofilaments; biothesiometer; gait on different surfaces; NeuroCom® SMART Balance Master® Sensory Organization Test and Adaptation Test; and ankle position matching. All study procedures were completed in about 3 hours. Children as young as 4 years were able to complete the measures. We observed overall differences in sensory processing, specifically, higher Sensory Processing Measure scores (p = .011), higher resting electrodermal activity (p = .012), increases in heel-toe walking on novel surfaces (p = .034), and more falls with balance perturbation (p = .007) in individuals with ITW. A subset of individuals also showed tactile hyposensitivity (5 out of 10 in the ITW group) and poor equilibrium scores in the Sensory Organization Test (4 out of 9 in the ITW group, 1 unable to complete the test). Our results confirmed the heterogeneity in the etiology of ITW. We propose that further testing in sensory modulation, tactile processing, and vestibular processing is needed to fully explore the impact of sensory processing on children with ITW.

Dense & Attention Convolutional Neural Networks for Toe Walking Recognition.

Idiopathic toe walking (ITW) is a gait disorder where children's initial contacts show limited or no heel touch during the gait cycle. Toe walking can lead to poor balance, increased risk of falling or tripping, leg pain, and stunted growth in children. Early detection and identification can facilitate targeted interventions for children diagnosed with ITW. This study proposes a new one-dimensional (1D) Dense & Attention convolutional network architecture, which is termed as the DANet, to detect idiopathic toe walking. The dense block is integrated into the network to maximize information transfer and avoid missed features. Further, the attention modules are incorporated into the network to highlight useful features while suppressing unwanted noises. Also, the Focal Loss function is enhanced to alleviate the imbalance sample issue. The proposed approach outperforms other methods and obtains a superior performance. It achieves a test recall of 88.91% for recognizing idiopathic toe walking on the local dataset collected from real-world experimental scenarios. To ensure the scalability and generalizability of the proposed approach, the algorithm is further validated through the publicly available datasets, and the proposed approach achieves an average precision, recall, and F1-Score of 89.34%, 91.50%, and 92.04%, respectively. Experimental results present a competitive performance and demonstrate the validity and feasibility of the proposed approach.

Clinical application and feasibility of utilizing the PEDI-CAT to assess activity and participation among children receiving physical therapy incorporating hippotherapy.

BACKGROUND: Hippotherapy (HPOT) is a physical therapy (PT) treatment tool using equine movement to improve mobility for children with movement impairments. Although research suggests HPOT improves body structure and function, there is limited evidence regarding its impact on activity and participation outcomes in a clinical setting. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) may be useful in HPOT settings to highlight changes in activity and participation. PURPOSE: 1) Evaluate the PEDI-CAT's sensitivity to changes in activity and participation among children receiving PT using HPOT; 2) determine feasibility of administering the PEDI-CAT in a HPOT setting; and 3) examine how PEDI-CAT scores influence clinical decision-making. METHODS: Participants (N = 34) were children who attended weekly PT using HPOT for 6 months. The PEDI-CAT was completed for all participants by a parent or caregiver at initial treatment (T1) and 6 months later (T2). A linear mixed effects model was used to evaluate changes in scores over time. Team meetings occurred monthly to discuss how PEDI-CAT scores impacted treatment. RESULTS: There were significant improvements across 3 PEDI-CAT domains between T1 and T2 for all children with small effect sizes and nonsignificant changes noted within two diagnostic subgroups with small-to-medium effect sizes. The PEDI-CAT was completed by all participants without interrupting treatment flow. PEDI-CAT score reports enriched therapist-client conversations increasing shared decision-making. CONCLUSION: PTs who treat children using HPOT may feasibly use the PEDI-CAT to assess changes in activity level outcomes and to assist clinical decision-making.

Lifelong Fitness in Ambulatory Children and Adolescents with Cerebral Palsy II: Influencing the Trajectory.

Physical activity of at least moderate intensity in all children contributes to higher levels of physical and psychological health. While essential, children with cerebral palsy (CP) often lack the physical capacity, resources, and knowledge to engage in physical activity at a sufficient intensity to optimize health and well-being. Low levels of physical activity place them at risk for declining fitness and health, contributing to a sedentary lifestyle. From this perspective, we describe a framework to foster a lifelong trajectory of fitness in ambulatory children with CP (GMFCS I-III) as they progress into adolescence and adulthood, implemented in conjunction with a training program to augment bone and muscle health. First, we recommend that altering the fitness trajectory of children with CP will require the use of methods to drive behavioral change prior to adolescence. Second, to promote behavior change, we suggest embedding lifestyle intervention into fitness programming while including meaningful activities and peer socialization to foster self-directed habit formation. If the inclusion of lifestyle intervention to drive behavior change is embedded into fitness programs and found to be effective, it may guide the delivery of targeted programming and community implementation. Participation in comprehensive programming could alter the long-term trajectory of musculoskeletal health while fostering strong self-efficacy in persons with CP.

Lifelong Fitness in Ambulatory Children and Adolescents with Cerebral Palsy I: Key Ingredients for Bone and Muscle Health.

Physical activity of a sufficient amount and intensity is essential to health and the prevention of a sedentary lifestyle in all children as they transition into adolescence and adulthood. While fostering a fit lifestyle in all children can be challenging, it may be even more so for those with cerebral palsy (CP). Evidence suggests that bone and muscle health can improve with targeted exercise programs for children with CP. Yet, it is not clear how musculoskeletal improvements are sustained into adulthood. In this perspective, we introduce key ingredients and guidelines to promote bone and muscle health in ambulatory children with CP (GMFCS I-III), which could lay the foundation for sustained fitness and musculoskeletal health as they transition from childhood to adolescence and adulthood. First, one must consider crucial characteristics of the skeletal and muscular systems as well as key factors to augment bone and muscle integrity. Second, to build a better foundation, we must consider critical time periods and essential ingredients for programming. Finally, to foster the sustainability of a fit lifestyle, we must encourage commitment and self-initiated action while ensuring the attainment of skill acquisition and function. Thus, the overall objective of this perspective paper is to guide exercise programming and community implementation to truly alter lifelong fitness in persons with CP.

Alumni perspectives on interprofessional experiential learning and interprofessional collaborative practice in health care settings.

INTRODUCTION: Interprofessional collaborative practice (ICP) is essential for optimizing patient outcomes in health care settings. Experiential learning (EL) is a method of modeling ICP to students during their education. No studies have evaluated the lasting impact of EL on self-reported clinical practice after students graduate. The aims of this study are to (a) examine what opportunities for ICP are available for alumni in current health care settings and (b) explore the early career impact of interprofessional EL on self-reported current clinical practice. METHODS: This study utilized a mixed-methods design using descriptive statistics and a phenomenological approach. Participants included Doctor of Physical Therapy (DPT) and Master of Arts in Marriage and Family Therapy (MAMFT) alumni who previously participated as graduate students in Balanced Families (BF), an interprofessional EL program. Sixty-four alumni were contacted through e-mail, of which 17 (27%) agreed to be interviewed. RESULTS: Quantitative data were analyzed utilizing descriptive statistics to describe demographics and summarize Likert scale responses. Qualitative data were analyzed using an interpretative phenomenological analysis approach. Five major themes were reflected in the transcripts: (a) The impact of interprofessional experiential learning on future clinical practice, (b) The value of holistic approaches, (c) The collaboration in holistic care, (d) The interconnected health care system and family system, and (e) The development of empathy for patients and their families. DISCUSSION: Interprofessional EL positively impacted DPT and MAMFT alumni, improving interprofessional communication skills and leading to more holistic approaches to care. Study outcomes support continued implementation of interprofessional EL in health care graduate study programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

WEARABLE SENSOR-BASED GAIT CLASSIFICATION IN IDIOPATHIC TOE WALKING ADOLESCENTS.

Idiopathic toe walking on the balls of the feet is commonly found in children. Many toddlers who are just beginning to walk show signs of toe walking, but when toe walking persists after two years of age, the child's risk of falling increases as well as the risk of other developmental delays. Idiopathic toe-walking is estimated to occur in 7 to 24% of children. In order to address the problem of toe walking and assess improvements due to intervention, one needs to identify heel-toe gait versus toe-toe gait in natural environments of idiopathic toe walkers. The aim of this study was to investigate if learning algorithms utilizing triaxial accelerometers and gyroscopes from wearable sensors could detect and differentiate heel-toe gait versus toe-toe gait. In this study, 5 adolescents (13± 5 years) patients with idiopathic toe walking characteristics wore inertial sensor at L5 - S1 joint. New interventions can be designed for idiopathic toe walking population, but currently, it is a challenge to quantify the efficiency of toe-walking intervention. In recent times, with the advancement of machine learning classification methods and powerful computing, longitudinal data from wearable sensors can be used to accurately classify gait abnormalities. The aim of this study was to investigate machine learning methods to classify toe-toe walking versus heel-toe walking using data from a single inertial sensor. We found that k-means clustering was successful in differentiating toe walking with that of typical walking signals. We found that some of the linear variability based features such as standard deviation, Root Mean Square (RMS), and kurtosis contained most of the variability among the data and could therefore distinguish toe-toe gait versus heeltoe gait through clustering. The k-means cluster provided an 82% accuracy score with a specificity of 83% and sensitivity of 86%. We further utilized Recurrent Convolution Neural Network (RNN) such as Long Short-Term Memory (LSTM). The LSTM model was another classification method that was used to distinguish between toe-toe gait and heel-toe gait. Wearable sensors integrated with machine and deep learning algorithms have the capability to transform current on-going therapy methods and monitor patients longitudinally for their improvement in gait. These novel learning-based techniques could successfully classify toe walking gait and help in estimating the efficacy of the treatment in idiopathic toe walking adolescents.

CUSTOMIZED WEARABLE SENSOR-BASED INSOLES FOR GAIT RE-TRAINING IN IDIOPATHIC TOE WALKERS.

Idiopathic toe walking is associated with lack of heel strike during the initial contact phase of a gait cycle. Idiopathic toe walking affects 5-12% of healthy children in the US. In the case of idiopathic toe walkers: typically, a child can heel-toe walk, but habitually walk on their toes. A corrective intervention is needed during the early age of a child. In this pilot study, we developed a wearable insole with tactile corrective feedback. A total of five subjects (13±4 years) participated in this study. A customized insole was designed with two pressure sensors, inertial measurement units, a vibration tactor and on-board data storage SD card. A vibration biofeedback was provided to the participants if three consecutive toe-toe strikes were found while walking. We found that the average proportion of heel to toe strikes was 0%,66%,64%,53% and 67 % among participants. We also found median time of return to habitual walk of toe-toe gait was 13 seconds. All analysis was conducted on a walking data ranging from 2 to 20 hours of walking. All five subjects reported that the customized insoles were helpful and motivated them for a corrective gait. This novel research with wearable sensors will help physical therapists to utilize innovative intervention methods for gait training in idiopathic toe walkers.

A Six Week Therapeutic Ballet Intervention Improved Gait and Inhibitory Control in Children With Cerebral Palsy-A Pilot Study.

Children with cerebral palsy (CP) have motor impairments that make it challenging for them to participate in standard physical activity (PA) interventions. There is a need to evaluate adapted PA interventions for this population. Dance can promote coordination, posture, muscle strength, motor learning, and executive functioning. This pilot study evaluated the feasibility and the effects of a new therapeutic ballet intervention specifically designed for children with CP. Methods: Eight children with CP (9-14 y/o; 75% female) participated in a 6-week therapeutic ballet intervention. Outcomes were measured in multiple domains, including body composition (DXA), muscle strength (hand-grip dynamometer), habitual physical activity, gait and selective motor control functions, and executive functioning. Follow-up assessments of habitual physical activity, gait, and executive functioning were completed 4 to 5 weeks post-intervention. Results: Five of the eight participants were overfat or obese based on DXA percentage of body fat. All participants were below the 50th percentile for their age and gender for bone density. Four participants showed a trend to improve hand-grip strength in one hand only, while one improved in both hands. There were significant improvements in gait across time points (pre, post, and follow-up), specifically in time of ambulation (X pre = 4.36, X post = 4.22, X follow-up = 3.72, d = 0.056, p = 0.02), and in step length (cm) on the right: X pre = 48.29, X post = 50.77, X follow-up = 52.11, d = 0.22, p = 0.027, and left stride: X pre = 96.29, X post = 102.20, X follow-up = 104.20, d = 0.30, p = 0.027, indicating gait changes in bilateral lower extremities. There was improvement in inhibitory control (d = 0.78; 95% Confidence Limit = ±0.71, p < 0.05) with large individual responses primarily among those above the mean at baseline. Conclusions: Therapeutic ballet may prove to be a useful intervention to promote physiological and cognitive functions in children with CP. Results demonstrated feasibility of the physical, physiological, and cognitive assessments and suggested improvements in participants' gait and inhibitory control with large individual responses. Modifications to personalize the intervention may be needed to optimize positive outcomes. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03681171.

Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis.

CONTEXT:: Low back pain is common in golfers. The risk factors for golf-related low back pain are unclear but may include individual demographic, anthropometric, and practice factors as well as movement characteristics of the golf swing. OBJECTIVE:: The aims of this systematic review were to summarize and synthesize evidence for factors associated with low back pain in recreational and professional golfers. DATA SOURCES:: A systematic literature search was conducted using the PubMed, CINAHL, and SPORTDiscus electronic databases through September 2017. STUDY SELECTION:: Studies were included if they quantified demographic, anthropometric, biomechanical, or practice variables in individuals with and without golf-related low back pain. STUDY DESIGN:: Systematic review and meta-analysis. LEVEL OF EVIDENCE:: Level 3. DATA EXTRACTION:: Studies were independently reviewed for inclusion by 2 authors, and the following data were extracted: characterization of low back pain, participant demographics, anthropometrics, biomechanics, strength/flexibility, and practice characteristics. The methodological quality of studies was appraised by 3 authors using a previously published checklist. Where possible, individual and pooled effect sizes of select variables of interest were calculated for differences between golfers with and without pain. RESULTS:: The search retrieved 73 articles, 19 of which met the inclusion criteria (12 case-control studies, 5 cross-sectional studies, and 2 prospective longitudinal studies). Methodological quality scores ranged from 12.5% to 100.0%. Pooled analyses demonstrated a significant association between increased age and body mass and golf-related low back pain in cross-sectional/case-control studies. Prospective data indicated that previous history of back pain predicts future episodes of pain. CONCLUSION:: Individual demographic and anthropometric characteristics may be associated with low back pain, but this does not support a relationship between swing characteristics and the development of golf-related pain. Additional high-quality prospective studies are needed to clarify risk factors for back pain in golfers.

Case report: a modified constraint-induced therapy (mCIT) program for the upper extremity of a person with chronic stroke.

The purpose of this case report was to assess the effect of a reduced intensity protocol for daily modified constraint-induced therapy (mCIT) without use of a restraint on the function of the upper extremity (UE) in an individual with a chronic stroke. A 57 year-old patient one year following a stroke participated in a two-hour mCITprogram for ten weekdays over a period of two weeks. During this period, voluntary use of the involved extremity was encouraged for 90% of waking hours at home without use of a restraint. Examination was conducted before and after intervention, and at a one month follow-up visit. Outcome measures included: the Wolf Motor Function Test (WMFT), the Motor Activity Log (MAL), and motion analysis of a reach and grasp task using Charnwood's CODA mpx 30. The patient improved or remained the same in functional upper extremity tasks on both the WMFT and MAL. The data from the motion analysis showed that grasp time and maximum pinch angle improved for bilateral UEs. Reaching profile graphed over time had fewer changes in velocity and fewer periods of acceleration and deceleration post-intervention. This reduced intensity program shows promise as an effective, feasible, and patient-preferred application of mCIT in a clinical setting.

Development of Fetal Movement between 26 and 36-Weeks' Gestation in Response to Vibro-Acoustic Stimulation.

BACKGROUND: Ultrasound observation of fetal movement has documented general trends in motor development and fetal age when motor response to stimulation is observed. Evaluation of fetal movement quality, in addition to specific motor activity, may improve documentation of motor development and highlight specific motor responses to stimulation. AIM: The aim of this investigation was to assess fetal movement at 26 and 36-weeks gestation during three conditions (baseline, immediate response to vibro-acoustic stimulation (VAS), and post-response). DESIGN: A prospective, longitudinal design was utilized. SUBJECTS: Twelve normally developing fetuses, eight females and four males, were examined with continuous ultrasound imaging. OUTCOME MEASURES: The fetal neurobehavioral coding system (FENS) was used to evaluate the quality of motor activity during 10-s epochs over the three conditions. RESULTS: Seventy-five percent of the fetuses at the 26-week assessment and 100% of the fetuses at the 36-week assessment responded with movement immediately following stimulation. Significant differences in head, fetal breathing, general, limb, and mouthing movements were detected between the 26 and 36-week assessments. Movement differences between conditions were detected in head, fetal breathing, limb, and mouthing movements. CONCLUSION: Smoother and more complex movement was observed with fetal maturation. Following VAS stimulation, an immediate increase of large, jerky movements suggests instability in fetal capabilities. Fetal movement quality changes over gestation may reflect sensorimotor synaptogenesis in the central nervous system, while observation of immature movement patterns following VAS stimulation may reflect movement pattern instability.

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.

Muscle tendon unit comparisons between infants born preterm and infants born full term: a pilot study.

PURPOSE: This study assessed differences in measures of the muscle tendon unit between infants born preterm and infants born full-term. METHODS: Twenty infants born between 26 and 36 weeks of gestation comprised the preterm group and 21 infants born between 38 and 42 weeks of gestation comprised the full-term group. Gastrocnemius-soleus measurements were obtained with a taut tendon and relaxed muscle belly (Ao), and with a taut tendon and elongated muscle belly (Amax). Muscle extensibility measurements were obtained with a goniometer. Ao to Amax was the difference between Ao and Amax measurements. RESULTS: Statistically significant differences were found for both measures of muscle extensibility, but not for the difference between these measures. The preterm group demonstrated measures of Ao and Amax in more extended ankle positions. CONCLUSION: Muscle length differences are present between infants born full-term and infants born preterm. These differences are most likely due to differences in tendon length.