A B S T R A C T S
Abstracts of Poster and Platform
Presentations for the 2004
Combined Sections Meeting
■ POSTER PRESENTATIONS
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CONSIDERATIONS IN PASSIVE STANDING
PROGRAMS FOR CLIENTS WHO ARE MEDICALLY
FRAGILE.
K.A. Aukland, Lombard, IL, G. Paleg, MD.
BACKGROUND & PURPOSE: Standing is a recom-
mended treatment method for persons unable to stand
independently for a variety of medical or physical rea-
sons, including increasing/maintaining bone density, im-
proving bowel/bladder function, maintaining PROM, and
improving postural control. Review of published data
reveals that there is no established optimum daily sched-
ule range to be used for training/maintaining endurance
for standing in a person who is medically fragile.
CASE DESCRIPTION: Subject: 20 year old female with
history of medical fragility following TBI, s/p (3.25 years)
R frontotemporal craniotomy, s/p L frontal craniotomy,
flaccid hypotonicity, tracheostomy, G-tube, diabetes in-
sipidus, panhypopituitarism, hypothalamic storms during
early rehabilitation, and autonomic dysregulation, in-
cluding temperature control impairment.
METHODS AND MATERIALS: Digital blood pressure
monitor (LifeSource UA 767), pulse oximeters (including
Datex Ohmeda 3800), and stander (Easy Stand 5000 Se-
ries) with adaptations. Data was recorded by Physical and
Occupational therapists. Parameters measured included
Start/End BP, Start/High/Low Pulse Rate and Start/High/
Low SpO2.
OUTCOMES: Analyses: Use of Microsoft Excel with Re-
gression Analysis – scatter charts with trend lines.
RESULTS: Hypertension and decreased start/low SpO2
were directly related to amount of time between standing
sessions. As exposure to interventions increased, inci-
dence of negative outcomes decreased.
DISCUSSION: Results suggested that negative outcomes
were most likely when there were 8 or more days be-
tween interventions, but increased hypertensive tenden-
cies were noted by the 3rd day of non-participation. Pre-
vious studies made recommendations on frequency of
intervention based on the desired benefits of the standing
program. When considering a person with medical fragil-
Pediatric Physical Therapy
ity, further attention to scheduling of the intervention
may be required to prevent undesirable sequelae second-
ary to cardiovascular and pulmonary stress, yet still pro-
vide adequate stress to increase/maintain endurance.
Caretakers need to be involved in assessing their ability
to be consistent with a standing schedule before accept-
ing a standing program. They require adequate training
on how to safely reinstitute standing when the schedule
is disrupted. To support consistency, choice of equip-
ment should fit caretakers needs as well as those of the
person receiving the intervention.
CONCURRENT VALIDITY OF THE ALBERTA
INFANT MOTOR SCALE (AIMS) AND THE PEABODY
DEVELOPMENTAL MOTOR SCALES II (PDMS II).
J. Bean, G. Breaux, E. Hymel, E. Kinler, D. Monti, B. Rome,
E. Schiro, L. Wilkerson, J. Eason, Physical Therapy,
LSUHSC, New Orleans, LA, P. Snyder, D. Philibert, Early
Intervention Institute, LSUHSC, New Orleans, LA.
PURPOSE/HYPOTHESIS: The purpose of this study was
to evaluate the concurrent score validity of two measures
commonly used to evaluate motor status, the Alberta In-
fant Motor Scales (AIMS) and the Peabody Developmen-
tal Gross Motor Scales (PDGMS II).
NUMBER OF SUBJECTS: Thirty-five predominantly Af-
rican American infants, (age range of 2 to 15 months) at
risk for motor delay were given the PDGMS II and AIMS.
Mean birth weight was 1512 643 g (mean SD); mean
chronological age (CA) of the sample was 35.4 17 weeks;
corrected chronological age (CCA) was 24.5 16.7 weeks.
MATERIALS/METHODS: Two students and one early
interventionist administered either the AIMS or PDGMS
II. Next, a second set of two student examiners and an
early interventionist administered the other test to the
same infant. Pearson product-moment correlation was
used to analyze the magnitudes of the relationship be-
tween scores on the PDGMS II subtests (reflex, locomo-
tion and stationary) and the AIMS scores and for rela-
tionships between the PDGMS II subtests and total AIMS
score based on CA and CCA of the children. Intraclass
correlation coefficients (ICC) were used to evaluate inter-
rater agreement and reliability of scores. The alpha level
was P ⬍ 0.05 for all analyses.
Pediatric Physical Therapy 49
RESULTS: Pearson product-moment correlations of
0.90 – 0.97 were obtained between the AIMS total score
and the three subtests of the PDGMS II. The ICC was
0.98 for the AIMS and ranged from 0.98 – 0.99 for the
three subtests of the PDGMS II. Pearson product-moment
correlations between the PDGMS II subtests and total
AIMS scores across CA and CCA were consistently high
and positive except for a -0.56 correlation between the
reflex scale of the PDGMS II and the AIMS in the CCA
group of 0 –3 months and the CCA of 6 –9 months.
CONCLUSIONS: Scores obtained on the PDGMS II and
the AIMS are likely to be similar when these assessments
are used to evaluate infants at risk for motor delays.
However, the comparison of reflex and total AIMS scores
across various age groups suggest that pediatric therapists
should not focus solely on reflexes when evaluating and
treating at-risk infants. CLINICAL RELEVANCE: The
practical advantages of the AIMS make it more appropri-
ate for use in a high-risk clinic environment. The AIMS
permits structured observation of motor behaviors with-
out direct handling of the infant and allows the infant to
move freely during the examination.
QUALITY OF LIFE OF TWO ADULTS WITH
DEVELOPMENTAL DISABILITIES: A
LONGITUDINAL CASE STUDY.
M. Bono, W. Brimicombe , S. Dacey, J. Gustafson, S.E.
Roush, K. Fresher-Samways, Physical Therapy Program,
University of Rhode Island, Kingston, RI.
PURPOSE/HYPOTHESIS: The purpose of this study was
to describe the changes in perceived quality of life (QOL)
for two community-based adults with developmental dis-
abilities (DD) over a two-year period.
NUMBER OF SUBJECTS: One male and one female vol-
unteered for the study.
MATERIALS/METHODS: Subjects were audio-taped
during two one-hour interviews which were conducted
two years apart. Data were analyzed using the NUD.IST
qualitative data analysis program.
RESULTS: Subjects John and Mary (pseudonyms) dis-
played many characteristics of growth and change over
the years. The most significant changes in John’s life in-
cluded: improved relationship with his service agency,
increased daily independence with newly-acquired
wheelchair, increased confidence and security with his
job, and a more serious, committed relationship with his
previous girlfriend (now fiancée). The most notable
changes in Mary’s life included: increased job responsibil-
ities, more opportunity for community involvement and
leadership, and growth away from a roommate relation-
ship and environment.
CONCLUSIONS: John and Mary generally participate in
and interact with others in the community at an age ap-
propriate level and derive a positive perceived QOL.
Their respective disabilities however, require them to
utilize outside agencies, family support, and assistive
technology to complete these age appropriate tasks.
50 Abstracts for the 2004 Combined Sections Meeting
CLINICAL RELEVANCE: This case study offers insight
into the lives of adults with developmental disabilities
who live and work in the community. It informs advo-
cates and policy makers in their efforts to improve the
quality of life of this group and suggests areas for future
research.
DIFFERENCES IN PERCEPTIONS BETWEEN
CAREGIVERS AND PHYSICAL/OCCUPATIONAL
THERAPISTS REGARDING THE IMPORTANCE,
KNOWLEDGE, AND CONFIDENCE IN CAREGIVING
ROLE TECHNIQUES TAUGHT DURING AN
INPATIENT REHABILITATION STAY.
J. Christenson, Physical therapy, The Children’s Hospital of
Philadelphia, Philadelphia, PA, K.G. Cunningham,
Occupational Therapy, The Children’s Hospital of
Philadelphia, Philadelphia, PA.
PURPOSE: The aim of this quality improvement project
was to:1 To measure the effectiveness of caregiver educa-
tion done on a pediatric inpatient rehabilitation unit by
PTs/OTs.2 To determine whether there needs to be modi-
fications to caregiver education on an inpatient rehabili-
tation unit.
DESCRIPTION: It was determined by a PT and an OT
that a PT’s main focus of caregiver education with pa-
tients with a lower extremity fixator is teaching on how
to assist the patient with ambulation with an assistive
device, going up and down stairs, and car transfers. OT’s
main focus of caregiver education is teaching on how to
assist the patient with upper and lower body dressing,
tub transfers, and toilet transfers. A questionnaire was
formulated to give to caregivers of patients with external
fixators and to the PTs/OTs treating these patients. The
questionnaire, distributed upon admission and at dis-
charge, consisted of 18 –20 Likert scale questions and 3
open ended questions to gather qualitative data. It was
distributed to one family upon admission and discharge,
and to the patient’s treating PT and OT upon admission
and discharge. The questionnaire asked caregivers about
the importance, perceived knowledge, and confidence in
assisting with the above tasks; the questionnaire then
asked the PT and OT to assess the caregivers on the im-
portance, perceived knowledge, and confidence in assist-
ing with the tasks.
SUMMARY OF USE: Upon admission, caregivers felt all
of the tasks to be taught to them were very important, yet
they only knew a small amount about them and were
somewhat confident in assisting their child with the
tasks. Upon discharge though, the caregivers felt they
knew a great deal about the tasks and were very confi-
dent in helping their child with them. The PT and OT
treating this child concurred, the family was very confi-
dent and able to independently and safely assist their
child with all tasks.
IMPORTANCE TO MEMBERS: Though further research
is needed to replicate these initial findings with multiple
subjects, results suggest that caregiver education may be
Pediatric Physical Therapy
associated with gains in caregiver knowledge and confi-
dence, both from the caregiver’s and PT’s/OT’s perspec-
tive. Also, further research can be done to determine if
there is carryover, of caregiving role techniques, in the
home environment.
EFFECTS OF BACKPACK WEIGHT ON THE GAIT OF
CHILDREN.
B. Connolly, L. Scruggs, S. Shipman, A. Sutton, S. Tomson,
Department of Physical Therapy, University of Tennessee
Health Science Center, Memphis, TN.
PURPOSE/HYPOTHESIS: Educators and health care pro-
fessionals are concerned about injuries due to a loss of
balance when a child wears a heavy backpack. Children
may increase their risks for falls and injuries when rush-
ing to get to class. This study was examined how increas-
ingly heavier backpack weights affect the gait of children.
NUMBER OF SUBJECTS: The sample included 17M and
15F (mean age ⫽ 11 yrs; mean weight ⫽ 94 lb., mean
height ⫽ 60 in.) from the 5th, 6th, and 7th grades at a
local school, who met inclusion and exclusion criteria
and whose parents returned the signed informed consent.
MATERIALS/METHODS: All students walked across the
GAITRite mat carrying 0%, 10%, 20%, and 30% of their
body weight (selected in random order) in the same
backpack. The children were asked to walk at their self-
selected velocity and cadence for all trials. In addition,
the children were asked to walk as if you are late for class
while carrying the 30% load (30% fast).
RESULTS: Using a MANOVA, significant difference was
found in double support time as analyzed by the GAI-
TRite system. Double support time increased when any
percentage of body weight was added to the backpack
when compared to the baseline of 0% bodyweight. A sig-
nificant difference was found at 10%. 20%, 30% , and
30% fast. A Newman-Keuls was used to further analyze
the data with no significant difference found between
10% and 20%, 20% and 30%, or 30% and 30% fast. The
velocity changed significantly between body weight per-
centages except for 0% and 10% and between 0% and
20%. At 0%, 10%, and 20% velocity of gait remained ap-
proximately the same, but significantly decreased when
30% was added. Further post hoc analyses found signifi-
cant differences between 10% and 20%, 10% and 30% ,
and 20% and 30%. No significant differences were found
when analyzing base of support.
CONCLUSIONS: Velocity and double support time
changed as a result of increasing backpack weights. Con-
trary to the expected outcome, base of support did not
change with added backpack weight.
CLINICAL RELEVANCE: Due to the decrease in velocity
caused by the added weight of the backpack, children
may compensate by trying to walk faster or even run if
they are late for class, thus increasing a risk for falling.
Furthermore, increased double support time may cause
an unstable gait which leads to a loss of balance. Clini-
cians, educators and parents can use this information in
Pediatric Physical Therapy
the prevention of falls due to improper weighting of the
backpack.
THE EFFECT OF YOGA POSTURES ON BALANCE,
COORDINATION AND FLEXIBILITY IN TYPICALLY
DEVELOPING CHILDREN.
B. Donahoe-Fillmore, M. Holdash, C. Moore, J. Robertson,
Andrews University, Dayton, OH.
PURPOSE/HYPOTHESIS: Yoga is being integrated into
pediatric physical therapy programs but currently no re-
search is available on the effects of yoga. The purpose of
this study was to document the effect of yoga postures on
flexibility, balance and coordination in typically develop-
ing children.
NUMBER OF SUBJECTS: Ten typically developing chil-
dren ages 5– 8 years were selected from a local after
school program to participate in this study. These chil-
dren had no known motor delays or orthopedic, neuro-
logical or metabolic disorders. Informed consent was ob-
tained from the parents of all participants.
MATERIALS/METHODS: The children were randomly
divided into two groups, which were similar in age. One
group was to participate in a 60-minute yoga session
once a week for twelve weeks while the other group con-
tinued with their typical schedule. Measurements were
collected on the balance, coordination and flexibility of
each child before and after the twelve-week program. Pre
and post-study measurements for each child were com-
pared in all areas. The mean value and percent change in
value for the experimental and control groups were
calculated.
RESULTS: The results showed that the yoga group im-
proved in three of the six measurement areas with im-
provements ranging from 1.2% in the sit and reach test to
14.3% in coordination. The control group improved in
four of the six measurement areas with improvements
ranging from 10.5% in the sit and reach test to 26.5% in
coordination. CONCLUSIONS: Although this study did
not provide evidence for the use of yoga with typically
developing children, it did demonstrate several limita-
tions we had not anticipated. The limitations were dis-
cussed in detail as well as design recommendations for
future studies in this area.
CLINICAL RELEVANCE: The identified limitations and
problem areas could help other researchers in developing
future studies to assess the effectiveness of yoga postures
in children.
THE PREVALENCE OF PELVIC ASYMMETRY AND
SACROILIAC JOINT DYSFUNCTION IN CHILDREN.
M. Drnach, M. Janovich, K. Capdeville, S. Gehring, Physical
Therapy, Wheeling Jesuit University, Wheeling, WV.
PURPOSE/HYPOTHESIS: This observational study was
done to assess the prevalence of pelvic asymmetry and
sacroiliac joint dysfunction in children.
Pediatric Physical Therapy 51
NUMBER OF SUBJECTS: Fifty-three children were re-
cruited from two private schools. Twenty-four females
and 29 males consented to be tested. The average age was
9.2 years with a range from 7 to 12 years. Excluded were
children who had a history of orthopedic surgery or had
a diagnosis of a neurological impairment.
MATERIALS/METHODS: Palpation of bony landmarks
including anterior superior iliac spine (ASIS), posterior
superior iliac spine (PSIS), and iliac crests were per-
formed in a standard format with the subject standing.
Visual evaluation of alignment was done by the exam-
iner, at eye level with the examiner s dominant eye. Com-
parison was made to determine if one side appeared
higher than the other. Leg length measurements were
taken from the ASIS to the medial malleolus, and umbili-
cus to medial malleolus with the subject in the supine
position. The threshold for a leg length discrepancy was
set at 2 cm or greater. The examination concluded with a
cluster of special tests to determine sacroiliac joint dys-
function: standing flexion, sitting PSIS palpation, prone
knee flexion and supine long sit test.
RESULTS: The data were analyzed using descriptive sta-
tistics (SPSS for Windows, version 9.0). Inter rater agree-
ment of the three examiners for the bony landmark pal-
pation was 92.5% and the inter rater agreement for the
cluster of the four special tests was 76.7%. Six out of 53
subjects (11.3%) exhibited pelvic asymmetry. These same
6 subjects had positive findings in the areas of bony land-
mark palpation and true leg length discrepancy of 2 cm
or greater on the same side. No subject had more than
one positive special test. Therefore, no subject met the
requirements for determining sacroiliac dysfunction as
suggested by Cibulka et al.
CONCLUSIONS: Eleven percent of children in this
study presented with a pelvic asymmetry with a concur-
rent true leg length discrepancy of 2 cm or greater on the
side of the pelvis that appeared higher upon visual exam-
ination. No subject demonstrated sacroiliac joint dys-
function as noted by a cluster of special tests.
CLINICAL RELEVANCE: This study contributes to the
understanding of the prevalence of pelvic asymmetry and
sacroiliac joint dysfunction in typically developing chil-
dren. The information is useful in the evaluation of clini-
cal findings in the orthopedic examination of a child.
A RETROSPECTIVE STUDY OF DISCREPANCY IN
GROSS AND FINE MOTOR SKILLS IN CHILDREN
DIAGNOSED WITH HURLER SYNDROME.
S. Dusing, A. Rosenberg, Allied Health Sciences, University
of North Carolina, Chapel Hill, NC, S. Piner, Dr. Carlton
Watkins Center, Mecklenburg County Children’s
Developmental Services, Charlotte, NC.
PURPOSE/HYPOTHESIS: Hurlers Syndrome(HS), the
most severe form of Mucoploysaccharidosis I results in a
buildup of glycosaminoglycans in tissue resulting in a
decline in function and death by 10 year of age. A prom-
ising treatment for children with HS is hematopoietic
52 Abstracts for the 2004 Combined Sections Meeting
stem cell transplantation (HSCT) using umbilical cord
blood. The purpose of this preliminary study was to de-
termine if children with HS have a discrepancy in their
fine and gross motor skills and if the discrepancy is in a
consistent direction, pre and post transplant.
NUMBER OF SUBJECTS: Eleven children with HS were
assessed using the Bayley (BSID-2).
MATERIALS/METHODS: Six physical and occupational
therapists categorized items in the BSID-2 motor scale as
measuring gross or fine motor skills as defined by
subtests of the Peabody Developmental Motor Scales, 2nd
edition (PDMS-2). Secondary data from pre and post
transplant subjects was reviewed with a proportion of
earned gross and fine motor items credited using criteria
similar to that used in the PDMS-2. Any fine/gross motor
discrepancy was recorded.
RESULTS: Of the five pre-transplant children, aged
16 –32 months, three had a discrepancy between their
gross and fine motor skills that was inconsistent in direc-
tion. Two children had similar fine and gross motor abili-
ties. Two of children assessed multiple times post trans-
plant had similar fine and gross motor abilities shortly
after transplant. However, both children had more ad-
vanced fine motor skills than gross motor skills by 10
months post-transplant, with increases on each sequen-
tial assessment. The child assessed once 6 months post-
transplant had more advanced fine motor skills than
gross motor skills.
CONCLUSIONS: Inconsistent presence and direction of
discrepancy was noted in children with HS pre-trans-
plant. Children assessed post-transplant had fine motor
skills more advanced than their gross motor skills by 10
months post-transplant and continued to gain new skills.
This suggests that children with HS may be gaining fine
motor skills at a faster rate than gross motor skills
post-transplant.
CLINICAL RELEVANCE: HSCT may prevent regression
of function in children with HS. Children in this prelimi-
nary study appear to be gaining fine motor skills faster
than gross motor skills. Clinicians working with this
population should assess motor abilities on standardized
assessments that have distinct gross and fine motor scales
and monitor children for emerging discrepancies in mo-
tor abilities.
UNMET NEED FOR THERAPY SERVICES AND
MOBILITY AIDS: DATA FROM THE NATIONAL
SURVEY OF CHILDREN WITH SPECIAL HEALTH
CARE NEEDS.
S. Dusing, Allied Health Sciences, University of North
Carolina, Chapel Hill, NC, M.L. Mayer, Cecil G. Sheps
Center for Health Services Research, University of North
Carolina, Chapel Hill, NC, A.C. Skinner, Health Policy and
Administration, University of North Carolina, Chapel Hill,
NC.
PURPOSE/HYPOTHESIS: Few studies have explored
children with special health care needs (CSHCN) access
Pediatric Physical Therapy
to therapy services and mobility aids. The purpose of this
study was to assess the prevalence of and identified fac-
tors associated with having an unmet need for therapy or
mobility aids in CSHCN.
NUMBER OF SUBJECTS: We used data from 38,866
respondents of the National Survey of CSHCN. MATERI-
ALS/METHODS: Bivariate and logit analyses were used
to assess differences in unmet need for therapy services
and mobility aids and the independent contribution of
various factors.
RESULTS: Nationally, 23.5% and 4.7% of CSHCN
needed therapy services or mobility aids, respectively. Of
those reporting a need, 11.1% reported they did not re-
ceive needed therapy services and 9.0% did not receive
needed mobility aids. Of those reporting an unmet need
for therapy services, 32% also had an unmet need for mo-
bility aids. In contrast, only 8.7% of children who re-
ceived all needed therapy services had an unmet need for
mobility aids (P ⬍ 0.01). Respondents reported several
reasons for having unmet needs for therapy services in-
cluding; cost, health plan coverage, transportation, and
scheduling. CSHCN residing in metropolitan statistical
areas (MSA) were more likely to have an unmet need for
therapy service than those residing in a non-MSA (aOR
1.74, P ⬍ 0.01). Compared to the least affected, children
whose abilities were most affected had greater risk of
having an unmet need for therapy services and mobility
aids (aOR 2.69, P ⬍ 0.01 and 4.65, P ⬍ 0.05, respec-
tively). Compared to continually insured CSHCN, those
who had been uninsured during the last 12 months were
more likely to have an unmet need for therapy services
and mobility aids (aOR 2.07 and 4.07, P ⬍ 0.01).
CONCLUSIONS: CSHCN whose abilities are most im-
paired or have limited insurance coverage have a higher
risk of unmet needs for therapy and mobility aids.
CSHCN who receive therapy have fewer unmet needs for
mobility aids than children who are not receiving all
needed therapy.
CLINICAL RELEVANCE: Therapists working with
CSHCN should work with insurance companies, families,
and community programs to improve access to therapy
services and mobility aids based on need rather than the
source of payment or the location of the child’s residence.
Therapists should continue to make referrals for and as-
sist children in obtaining mobility aids they would bene-
fit from.
RESTORATION OF WEIGHT BEARING AND
FUNCTION IN AN ADOLESCENT WITH REFLEX
SYMPATHETIC DYSTROPHY: A CASE REPORT.
L.G. Dyczek, V.K. Trost, H.K. Reelfs, Physical Therapy,
Munroe-Meyer Institute, Omaha, NE.
BACKGROUND & PURPOSE: The purpose of this re-
port is to present specific physical therapy treatment
strategies used in the management of reflex sympathetic
dystrophy (RSD) and the progress made toward restored
function in a fifteen year old girl.
Pediatric Physical Therapy
CASE DESCRIPTION: The subject was an active, typi-
cally developing young girl until being diagnosed with
RSD at age 11 years following injury to her left knee. Af-
ter recovery, she had reoccurrence of RSD at age 12
years, following injury to her right ankle. Despite inten-
sive physical therapy treatment and management pro-
grams at several national pain centers, the subject
showed increase in dysfunction and pain level in both
lower extremities. Time line for this case report begins at
age 14 years plus 8 months when subject was referred for
therapeutic exercise and desensitization. She had been
non-weight bearing on her lower extremities for approxi-
mately 1 year and required a wheelchair for mobility. She
rated her pain level at 10 throughout both legs, and had
contractures of her knees, ankles, and feet with dystonic
posturing and skin discoloration. A 16 month course of
intervention was used. Passive range of motion, joint mo-
bilization, contrast bath, electrical stimulation, and
weight bearing were implemented with the subject placed
under general anesthesia. Later, aquatic therapy,
strengthening and stretching exercises, gait training us-
ing partial weight support on a treadmill, and EMG
biofeedback were implemented. Right foot serial casting
and AFO wear were incorporated with gait training.
OUTCOMES: Objective measures of progress included
goniometric range of motion (passive and active), manual
muscle testing, weight bearing tolerance in pounds, wa-
termark footprints, and assessment of ambulation ability.
After 12 months of treatment, subject was participating
in swim team at her high school, and after 14 months
was walking without an assistive device.
DISCUSSION: The physical therapy management of this
subject, augmented by numerous specialists and profes-
sionals, developed into a dynamic team approach which
was essential to the excellent outcome attained. This
study outlines the management needed for return to nor-
mal function in an adolescent with RSD.
DETECTION OF GROSS MOTOR IMPAIRMENTS OR
DEVELOPMENTAL DELAY BY PHYSICAL
THERAPISTS AND DEVELOPMENTAL
INTERVENTIONISTS.
S.K. Effgen, A. Henning, A. Lee, D. Russell, Rehabilitation
Sciences, University of Kentucky, Lexington, KY.
PURPOSE/HYPOTHESIS: Early Intervention (EI) is pro-
vided to assist young children with disabilities. The abil-
ity to detect subtle gross motor impairments or delay is
difficult and if not detected these children would not re-
ceive EI including physical therapy, when intervention
can be most effective. Developmental interventionists
(DIs) frequently determine eligibility for EI. This study
compared the ability to detect subtle gross motor impair-
ments and developmental delay in a young child between
physical therapists (PTs) and DIs.
NUMBER OF SUBJECTS: There were 37 subjects (aver-
age age 38 years)who worked in EI: 11 PTs and 26
Pediatric Physical Therapy 53
DIs(10 with state training in assessment and 16 without
assessment training).
MATERIALS/METHODS: The subjects viewed a video-
taped evaluation of a 15-month-old child who exhibited
documented, but subtle motor impairments and develop-
mental delay. After the video, the subjects completed a
questionnaire that included questions from the Batelle
Developmental Inventory (BDI).
RESULTS: Descriptive statistics and Pearson Chi-Square
were used to analyze the data. Statistically significant dif-
ferences were noted between the responses of the PTs
and DIs. All PTs and trained DIs, but only 25% of the
untrained DIs indicated any developmental delay. 100%
of PTs, 40% of trained DIs, and only 25% of untrained
DIs indicated motor impairments. 86% of PTs and
trained DIs, but only 13% of untrained DIs believed the
child was eligible for EI. 100% of PTs and trained DIs,
but only 40% of the untrained DIs believed the child
should receive a physical therapy evaluation. No statisti-
cally significant differences were noted regarding the BDI
questions.
CONCLUSIONS: Differences in the ability to detect
gross motor impairments and developmental delay by
PTs and DIs were noted. Fortunately there no significant
differences between PTs and trained DIs who believed
the child was eligible for EI and warranted a physical
therapy evaluation.
CLINICAL RELEVANCE: The inability to recognize sub-
tle gross motor impairment and delay by the DIs not
trained in assessment supports the need for and success
of assessment training programs. Apparently, without
adequate training in assessment, many DIs would not
recommend EI or a physical therapy evaluation for chil-
dren with less obvious problems. The lack of differences
on the BDI points to the limitations of this common
measure.
GAIT INITIATION PROCESS IN CHILDREN WITH
DIPLEGIA AND TYPICALLY DEVELOPING
CHILDREN.
D.G. Embrey, Children’s Therapy Unit, Good Samaritan,
Puyallup, WA, X.C. Liu, B.R. Logan, Orthopedic Surgery,
Medical College of Wisconsin, Milwaukee, WI, G.S.
Kasman, Rehabilitation Medicine, Good Samaritan,
Puyallup, WA.
PURPOSE/HYPOTHESIS: The transition from quiet
standing to dynamic walking, called the gait initiation
process (GIP), was assessed in children nine to 15 years
of age.
NUMBER OF SUBJECTS: The GIP was examined in five
children with diplegia, and five typically developing chil-
dren. MATERIALS/METHODS: Kinematic, kinetic, and
timing data were determined during five phases: reaction,
preparation, execution, single limb support, and double
limb support. Kinematic data were analyzed for hip flex-
ion-extension, hip abduction-adduction, knee flexion-
extension, and ankle dorsiflexion-plantar flexion. SEMG
54 Abstracts for the 2004 Combined Sections Meeting
data were assessed bilaterally in the hip abductors, ab-
dominal obliques, plantar flexors, and dorsiflexors.
DATA ANALYSES: The mean values for kinematic, ki-
netic, and timing data were compared for the two groups
using two-sample t tests. SEMG data were assessed using
Nonparametric Mann-Whitney Wilcox rank tests to com-
pare the percentage activation in each phase. Probability
of less than 0.05 was considered significant.
RESULTS: At specific points in the GIP, children with
diplegia had significantly greater (P ⬍ 0.05) knee flexion,
ankle dorsiflexion, and hip flexion on their “stance leg,”
compared to typically developing children. Although
children with diplegia showed similar timing in most of
the phases, their “reaction time” was slower (P ⬍ 0.05)
than their typically developing peers. Late in the GIP, on
their “step leg,” children with diplegia, compared to their
peers, showed more (P ⬍ 0.05) tibialis anterior muscle
activity during the execution phase, and more (P ⬍ 0.05)
abdominal oblique muscle activity during the single limb
support phase.
CONCLUSIONS: These findings will help researchers
and clinicians understand key components of postural
control used by children with diplegia as they transition
from standing to walking.
CLINICAL RELEVANCE: Understanding the gait initia-
tion process for children with diplegia, will help thera-
pists refine their treatment strategies and orthotic recom-
mendations for improving this important functional skill.
THE PERFORMANCE OF SIX SCHOOL-AGE
CHILDREN WITH CEREBRAL PALSY ON THE
PEDIATRIC BALANCE SCALE (PBS): A THREE YEAR
STUDY OF CHANGES IN FUNCTIONAL BALANCE.
M. Franjoine, Physical Therapy, Daemen College, Amherst,
NY, B.L. Young, Natural Science, Daemen College, Amherst,
NY.
PURPOSE/HYPOTHESIS: To ascertain if the PBS is re-
sponsive to changes in functional balance. The PBS, a 14
item, criterion-referenced outcome measure, (0 - 4 scale,
max. score ⫽ 56) examines steady state and anticipatory
balance. Extremely high test-retest (ICC3,1 ⫽ 0.998) and
inter-rater (ICC3,1 ⫽ 0.997) reliability have been estab-
lished. Analysis of normative data for 285 typically devel-
oping children, ages 2–13 years, revealed that 74% of 5
year olds attained a 54 or better (mean ⫽ 54.4, SD ⫽
2.00, SEM ⫽ 0.30).
NUMBER OF SUBJECTS: Six children (2 male, 4 fe-
male), age 8 –14 years, participate in this 3-year study
(sample of convenience). Inclusion criteria were a diag-
nosis of cerebral palsy and the ability to stand hands-free
for a minimum of 4 seconds. All subjects were considered
to have community-based ambulation skills at the onset,
and utilized orthotics during ambulation. Ambulatory
aides were used by 4 subjects.
MATERIALS/METHODS: PBS was individually adminis-
tered per protocol, at 4-month intervals for 3 years (9
sessions per subject). The location of test administration
Pediatric Physical Therapy
varied, and was based on child/family convenience. The
PBS was administered and scored by a pediatric clinical
specialist, who was formally trained in test administra-
tion/scoring. Following completion of the PBS, the sub-
ject, parent(s), and community therapist(s) were asked to
independently rate their perception of the subject’s func-
tional balance utilizing a 5-point Likert scale with “1”
representing very poor balance (fearful of falling, limits
physical activity), and “5” representing excellent balance
(no fear of falling, no activity limitations). RESULTS:
Four of the 6 subjects demonstrated gains/losses in PBS
scores of 9 points or greater over the 3 year period. These
changes were positively correlated with a change in per-
ception reported on the Likert scale and validated by
“real life” changes reported by parents and therapists in-
cluding onset of seizures, orthopedic surgeries, and botox
injections. The remaining 2 subjects displayed limited
variability in their PBS scores and on the Likert scale.
CONCLUSIONS: Results suggest the PBS is sensitive to
changes in functional balance in children with mild-mod-
erate motor impairments.
CLINICAL RELEVANCE: The PBS may be valuable tool
as a functional balance outcome measure.
RANGE OF MOTION MEASUREMENT IN CEREBRAL
PALSY: A COMPARISON OF ASSESSMENT METHOD.
A.M. Glanzman, Physical Therapy, Children’s Seashore
House of The Children’s Hospital of Philadelphia,
Philadelphia, PA, A.E. Swenson, Physical Therapy, Drexel
University, Philadelphia, PA, H. Kim, Physical Medicine and
Rehabilitation, Children’s Seashore House of The Children’s
Hospital of Philadelphia, Philadelphia, PA.
PURPOSE/HYPOTHESIS: This study was designed to
compare intrarater reliability of passive range of motion
(PROM) in children with cerebral palsy.
NUMBER OF SUBJECTS: 50 children with cerebral
palsy were assessed.
MATERIALS/METHODS: PROM was taken by gonio-
metric measurement by one rater both with and without
a holder. 37 of those children were assessed by visual
estimation (VE). Measurements were taken of ankle dor-
siflexion, popliteal angle, hip abduction, hip extension by
Thomas Test (TT), and Staheli’s Test (ST) in a blinded
fashion to assess intrarater reliability of the three forms of
measurement. VE data was compared to goniometric
measurement since blind intrarater visual measurement
was not possible.
RESULTS: Intraclass correlations (3,1) were performed
to establish reliability for each measure. To compare the
ICCs, a Z statistic for the test for equal correlations was
used. All ICCs for one-person, two-person, and VE were
above 0.90 and in the excellent range. ICCs for one-per-
son ranged from 0.9439 to 0.9956; and for two-persons
from 0.9671 to 0.9971. When VE was compared with
two-person measurement, the ICC ranged from 0.9137 to
0.9988. Comparison of one-person vs two-person goni-
ometry showed no significant difference between the
Pediatric Physical Therapy
groups, with the exception of ST (P ⬍ 0.05) which was
more reliable with a holder. When TT was compared to
ST, TT was more reliable with one-person (P ⬍ 0.05),
but with two there was no difference between the meth-
ods. Comparison of two-person goniometry and VE
showed that two-person measurements were significantly
more reliable than VE in all measures except popliteal
angle, where there was no statistically significant differ-
ence, and abduction, where VE was more reliable (ICC ⫽
0.9988 vs ICC ⫽ 0.9896). Similarly, when compared with
VE, one-person goniometry was more reliable for dorsi-
flexion and hip extension by TT, but inferior for abduc-
tion. There was no statistically significant difference be-
tween VE and one-person goniometry for ST or popliteal
angle.
CONCLUSIONS: Goniometry provides a significant ad-
vantage in terms of reliability over VE in children with
cerebral palsy. However, the addition of a second assessor
to provide stabilization of the patient during measure-
ment did not improve measurement reliability, with the
exception of ST for hip extension where a holder im-
proved reliability.
CLINICAL RELEVANCE: Reliability is critical to assess-
ment of change. Understanding the impact of technique
in goniometry improves reliability.
SCHOOL-BASED BACKPACK HEALTH PROMOTION
PROGRAM: ONE YEAR FOLLOW-UP EVALUATION.
S.A. Goodgold, M.M. Blackman, Simmons College, Boston,
MA.
PURPOSE: Recent research has validated that school-
aged children are carrying exceedingly heavy backpack
loads that may cause injury. This abstract presents a fol-
low-up evaluation of a school-based backpack safety
program.
DESCRIPTION: A one year follow-up evaluation was
performed to assess the benefits of a backpack safety pro-
gram. Students included 226 eighth graders who were
taught backpack biomechanics, warning signs when the
backpack is too heavy, desirable backpack features, and
the proper way to wear and pack a backpack.
SUMMARY OF USE: This one year follow-up evaluation
examined students’ self-reported history of back prob-
lems, beliefs regarding injury, backpack use, opinions on
the value of the program, and support from adults. Re-
ported history of back injuries dropped from 27% last
year to 23% for girls and 13% for boys. Duration carrying
backpack was not associated with injury. Belief that you
could injure yourself from improper backpack use also
dropped from 85% girls and 58% boys to 63% girls and
55% boys. However, only 52% girls and 74% boys re-
ported using their backpack correctly. Although most
girls initially believed the program worthwhile (72%
girls; 46% boys), few students now think it of value (25%
girls; 35% boys). However, belief that the program was
worthwhile was associated with proper backpack use,
Pediatric Physical Therapy 55
and 91% of students who made changes last year in re-
sponse to the program continue to implement those be-
haviors. In addition, muscle fatigue was associated with
injury, difficulty using backpack, belief that the program
was worthwhile, and adult support. However, only 20%
of students felt that teachers help limit backpack weight,
and 47% reported that their parents encourage proper
backpack use.
IMPORTANCE TO MEMBERS: As physical therapists
assume leadership in school-based backpack safety pro-
grams, follow-up evaluation is essential in assessing ini-
tial outcomes as well as the maintenance of program ben-
efits. This evaluation supports gender differences as well
as differences between students who experience fatigue,
find backpack use difficult, think improper backpack use
can cause injury, and feel supported by adults. Therefore,
to enhance and sustain changes in beliefs and behaviors,
annual programming should be specifically tailored to
address these parameters and incorporate adult support.
EFFECTIVENESS OF SCHOOL-BASED HEALTH
PROMOTION PROGRAMS ON PARTICIPATION IN
PHYSICAL ACTIVITY.
S.A. Goodgold, W.M. Osborn, S.J. Soroka, Simmons College,
Milton, MA.
PURPOSE/HYPOTHESIS: Sedentary lifestyle, obesity,
type II diabetes, and high cholesterol are epidemic our
youth, and increasing physical activity has been identi-
fied as a public health priority. The purpose of this sys-
tematic review was to examine the effectiveness of
school-based health promotion programs to achieve that
goal.
NUMBER OF SUBJECTS: Twenty-one articles met inclu-
sion criteria. Research designs included two systematic
reviews, 14 random control trials (RCT), and 5 quasi-
experimental designs.
MATERIALS/METHODS: The search strategy included
11 electronic databases. Two independent investigators
first screened 1403 titles/abstracts, and then reviewed
167 full text articles. For each article, standardized forms
were employed for data extraction, validity assessment,
and potential for bias. Scotland’s National Health Service
criteria were used for scoring level of evidence and grad-
ing of the recommendations.
RESULTS: Both systematic reviews were well executed
(rated 1⫹⫹) but both reported insufficient evidence to
support the programs. Eight of the 14 RCTs had very low
to low/moderate risk of bias, and all 5 quasi-experimental
had high risk of bias. Most of the RCT and quasi-experi-
mental studies reported conflicting and incongruous re-
sults from multiple study arms. Only three reported sta-
tistically significant findings that were in favor of
intervention and also clinically meaningful. Each of these
included Center for Disease Control (CDC) guidelines of
incorporating school policies, health education, and per-
sonnel training.
CONCLUSIONS: Conflicting results across and within
56 Abstracts for the 2004 Combined Sections Meeting
studies reflect the difficulty in changing behavior pat-
terns. Programs tailored specifically to participants may
be beneficial since differential effects based on gender
and high-risk classification were found. Incorporation of
behavior change theory and use of the CDC guidelines
may also be beneficial when designing intervention
programs.
CLINICAL RELEVANCE: Schools are an ideal site for
physical therapists to assume a leadership role in promot-
ing increased participation in physical activity. This sys-
tematic review provides therapists with the best evidence
to help them plan and evaluate such health promotion
programs as well as directions for future research.
RATES OF LEARNING A COMPLEX MOTOR SKILL
USING A NOVEL PROTOCOL IN CHILDREN WITH
DEVELOPMENTAL COORDINATION DISORDER.
R.T. Harbourne, H. Reelfs, Munroe-Meyer, Physical
Therapy, Univ. of Nebraska Medical Center, Omaha, NE.
PURPOSE/HYPOTHESIS: The purpose of this study was
to determine whether a new protocol for teaching the
complex skill of bike riding would be successful for chil-
dren with DCD, and whether these children would have
varying rates of learning the skill.
NUMBER OF SUBJECTS: 4 subjects, 2 males and 2 fe-
males, ranging in age from 10 to 14. All subjects had a
history of difficulty learning motor tasks, and all had
tried to learn bicycle riding in the past with no success.
MATERIALS/METHODS: A program to break down the
task of riding a bike was developed, with approximately
35 sub-skills nested within the overall task of bike riding.
Subjects attended 1 hour group sessions weekly, which
were held in a large open gym area. Each session con-
sisted of practice on several of the sub-tasks, as well as
specific feedback to the children on force, speed and di-
rection parameters of movement required to accomplish
the given sub-task. Sub-tasks were charted as a percent of
the overall number of tasks to determine progress. Per-
cent of task achievement was charted against number of
practice sessions to describe the rate of progress for each
subject. Overall rate of learning was calculated by divid-
ing the percent of skill acquired during training by the
number of sessions needed to accomplish 100% of the
sub-skills.
RESULTS: All subjects were successful in learning the
task of riding a bike independently, achieving 100% of
the sub-skills. The average rate of learning varied be-
tween subjects, with a low of 18% per session and a high
of 54%. For comparison, one normal 5 year old subject
was engaged in the program and learned at the rate of
54% per session. CONCLUSIONS: Children with DCD
who have been unable to learn to ride a bike in a normal
setting were able to learn the skill using a novel protocol
which breaks down the skill of bike riding into 35 sub-
skills. The rate of learning the skill was variable in this
small group, which is supported by literature describing
the variability of performance in children with DCD.
Pediatric Physical Therapy
CLINICAL RELEVANCE: Physical therapists should be
engaged in teaching children with DCD complex skills
such as bike riding. Therapists can provide unique con-
tributions to the learning of complex tasks such as break-
ing down the skill into manageable sub-skills, and pro-
viding information to the learner regarding strategies of
movement that would lead to success.
ASSESSMENT OF MUSCLE STRENGTH AND THE
BONE MUSCLE UNIT OF THE TIBIA IN CHILDREN.
M. DiIenno, Physical Therapy, Children’s Hospital of
Philadelphia, Philadelphia, PA, K.M. Howard, R.M.
Herskovitz, B.S. Zemel, M.B. Leonard, Nutrition and
Growth Lab, Children’s Hospital of Philadelphia,
Philadelphia, PA.
PURPOSE/HYPOTHESIS: The purpose of this study was
to compare measures of muscle cross-sectional area and
muscle strength as they relate to bone mass and dimen-
sions in children and adolescents.
NUMBER OF SUBJECTS: 20 healthy controls, 38 pa-
tients with nephrotic syndrome, 19 patients with Crohn’s
disease, 5–20 years old (mean 12.0 3.7)
MATERIALS/METHODS: Peripheral quantitative com-
puted tomography (pQCT, Stratec XCT-2000) measures
of cortical bone dimensions and content were obtained in
the left tibia, 38% proximal to the growth plate. Muscle
cross-sectional area (CSA, cm2) was measured at the 66%
tibia site. Isometric muscle peak torque was measured at
10 of dorsiflexion, neutral, 10 and 20 of plantarflexion in
the left ankle using the Biodex System 3 Dynamometer
(Biodex, Shirley NY). The correlations between bone and
muscle measures were assessed with Pearson product-
moment estimates.
RESULTS: All 8 strength measures were significantly
correlated with muscle CSA on pQCT: R2 0.62, P ⬍
0.001. The correlation with muscle CSA was greatest for
dorsiflexion in 20 plantarflexion R2 ⫽ 0.81, P ⬍ 0.001.
Comparisons of bone and muscle measures demonstrated
that dorsiflexion in 20 of plantarflexion explained 87%
and 84% of the variability in cortical bone content and
cross-sectional area respectively. In contrast, muscle CSA
explained 82% and 75% on the variability in these bone
measures. The relationship between muscle strength and
muscle CSA relative to tibia length was compared across
the 3 groups; no differences were detected.
CONCLUSIONS: The correlations between measures of
isometric muscle strength and bone are greater than the
correlations between muscle CSA and bone. Future stud-
ies are needed in larger populations with derangements
in muscle mass and strength, such as glucocorticoid-in-
duced myopathy, edema, renal failure and neuropathies.
CLINICAL RELEVANCE: Strength measures may be
useful in determining the need for physical therapy inter-
vention in children with nephrotic syndrome and
Crohn’s disease. These strength measures may provide
additional insight into the impact of chronic diseases on
bone mineral accretion.
Pediatric Physical Therapy
BIMANUAL COORDINATION DURING A GOAL-
DIRECTED TASK IN CHILDREN WITH HEMIPLEGIC
CEREBRAL PALSY.
Y. Hung, J. Charles, A.M. Gordon, Biobehavioral Sciences,
Teachers College, Columbia University, New York, NY.
PURPOSE/HYPOTHESIS: The purpose of this investiga-
tion was to examine temporal synchronization and move-
ment overlap of the two hands under speed, hand, and
accuracy constraints in children with hemiplegic cerebral
palsy (CP) and to compare their performance to age-
matched typically developing children.
NUMBER OF SUBJECTS: Ten children with hemiplegic
CP (8 to 16 years of age) and ten age-matched typically
developing children participated in this study.
MATERIALS/METHODS: Children were asked to reach
forward and open a spring-loaded drawer with one hand
and then activate a light switch inside the drawer with
the contralateral hand while the 3-D kinematics were
recorded. The role of the two hands (which hand opens
the drawer), the type of drawer handle (knob versus
loop), light switch size (large versus small) and speed
(self-paced versus fast-as-possible) were varied. Repeated
measures ANOVAs with one between factor (2 groups)
and four within factors 2(hand) ⫻ 2(handle) ⫻ 2(switch)
⫻ 2(speed) were used on all measures. Post-hoc compar-
isons were carried out using the Tukey procedure.
RESULTS: The children with hemiplegic CP displayed
slower and more sequential movement of the two hands
compared to the typically developing children (P ⬍ 0.001
in all cases). They also showed less overlapping move-
ment of the two hands (group x hand, P ⫽ 0.003) but
better synchronization at task completion (group x hand,
P ⫽ 0.011) when their involved hand opened the drawer
than when the non-involved hand did so. The children
with hemiplegic CP demonstrated better synchronization
of the two hands at task completion for the small light
switch compared to the large one while using the knob
handle under self-paced speed (group x handle x switch
x speed, P ⫽ 0.049). In contrast, they performed better
with larger switch under the fast-as-possible speed (post-
hoc, P ⬍ 0.05). The fast-as-possible speed facilitated bet-
ter movement overlap and temporal synchronization for
both groups in all cases (P ⬍ 0.001).
CONCLUSIONS: Children with hemiplegic CP have im-
paired bimanual coordination. The degree of impairment
depended on the role of the hands, the task constraints,
and speed.
CLINICAL RELEVANCE: Therapist should vary these
constraints carefully to facilitate better performance.
USE OF CRANIOSACRAL THERAPY TO TREAT
INFANT POST-TRAUMATIC TORTICOLLI.
C. Johansson, Elon University, Elon, NC.
BACKGROUND & PURPOSE: To describe the use of
craniosacral therapy (CST) to improve ROM and posture
Pediatric Physical Therapy 57
in an infant with post-traumatic torticollis and C1–2
subluxation.
CASE DESCRIPTION: A typically developing 6-week-
old male experienced head and neck compression when
his car seat overturned during a MVA. At 4 months, he
was diagnosed with traumatic torticollis. At 9 months,
CT scan revealed C1–2 subluxation. Following spinal
manipulation under general anesthesia, he was placed in
a halo brace with a headband. Two weeks later, he began
PT. After 8 weeks in the halo, a repeat CT scan revealed
no subluxation improvement. After 2 1/2 months of tra-
ditional PT, the patient showed minimal improvement in
cervical ROM. At 16 months, his physician recommended
that, in the absence of significant improvement, a C1–2
fusion be performed after age 18 to 24 months. The child
was then referred to a PT skilled in CST. Examination
findings were consistent with the mechanism of injury.
The frontal bone was noted to be more anterior on the
left than the right, consistent with a lateral strain pattern
of the cranial base. Cranial vault palpation revealed lat-
eral spheno-basilar torsion. Dural tube assessment re-
vealed a pronounced abnormal torsion from the cranium
to the sacrum. Craniosacral therapy, including cranial
base mobilization, sacral decompression, dural tube re-
lease, occipito-atlas release, and still point induction, was
added to his treatment program 1–2 times a week, fol-
lowing CST guidelines for treatment of infants and small
children.
OUTCOMES: Posture and ROM improved markedly in
the first 4 weeks. Treatment continued weekly for 6 more
months with consistent, though less dramatic, progress.
Digital overlays of photographs allow comparative esti-
mates of improvement. At discharge, patient achieved
neutral head and neck posture in times of quiet standing
and AROM beyond neutral in inversion. Mild asymmetry
was still evident in stand-to-squat and in times of dy-
namic play. The child was discharged at nearly 24
months of age, with no imminent plans for additional CT
scans or surgical intervention, to a hippotherapy
program.
DISCUSSION: While considerable literature exists on
physical and surgical interventions for congenital torti-
collis, little is written on the treatment of traumatic torti-
collis in very young children. In this case, CST appeared
to be an effective intervention for improving cervical pos-
ture and ROM in an infant with post-traumatic torticollis.
PERFORMANCE ON THE STANDARDIZED
WALKING OBSTACLE COURSE (SWOC) FOR
MATCHED PAIRS OF CHILDREN WITH CEREBRAL
PALSY AND TYPICAL DEVELOPMENT.
K. Kott, Physical Therapy Education, SUNY Upstate
Medical University, Syracuse, NY, S. Held, M. Franjoine,
Physical Therapy, Daemen College, Amherst, NY B.
Engbretson, Health Science and Human Studies, SUNY
Upstate Medical University, Syracuse, NY.
PURPOSE/HYPOTHESIS: The purpose was to examine
58 Abstracts for the 2004 Combined Sections Meeting
the normative data on the Standardized Walking Obstacle
Course (SWOC), supporting its construct validity
(known groups) as a test of functional ambulation and
balance in children with and without disabilities.
NUMBER OF SUBJECTS: Children with cerebral palsy
(CP) and typical development (n ⫽ 17 pairs) were
matched for age (range 5–15 years; mean 8 years, 8
months), gender (9 female pairs, 8 male pairs), and body
mass index (range 14.66 –26.31 kg/m2; mean 18.14
kg/m2).
MATERIALS/METHODS: The SWOC is a 39.5 foot long
and 36 inch wide angled path with chairs at each end,
surface changes (shag rug, very colorful mat), and obsta-
cles (large trash can, standard crutch). Children were
randomly assigned a start condition on the SWOC: arms
free, carrying a lunch tray with place setting, and wearing
shaded glasses walking for a total of six trials. The time
and number of steps to complete the course, stumbles,
and steps off the path were recorded. ANOVA was used
to analyze the effects of group and condition on the
SWOC on time and number of steps. Chi-Square was
used to determine whether stumbles and steps off were
associated with both group and condition. RESULTS:
For time and number of steps, there were significant
main effects for group and condition (F 24.6, P ⬍
0.0001; F 73.9, P ⬍ 0.0001, respectively) and an interac-
tion effect (F 13.2, P ⬎ 0.0001). There were average in-
creases in time and number of steps (46% and 35%, re-
spectively) for children with CP across all three
conditions. Chi-Square Tests of Independence were sig-
nificant for steps off ( 2 42.5, P ⬍ 0.0001) and stumbles (
2 40.5, P ⬍ 0.0001). Only 10% of the children with CP
had no steps off compared to 71% of their peers. 57% of
the children with CP had one or more stumbles com-
pared to 100% of their peers with no stumbles.
CONCLUSIONS: There were highly significant differ-
ences on all measures of the SWOC between children
with CP and typical development. The interaction effect,
while highly significant, showed no differences in the
relative ranking of the groups for the different conditions
of the SWOC. Therefore, children with CP on all condi-
tions of the SWOC took longer, used more steps, and had
more stumbles and more steps off the path than their
peers.
CLINICAL RELEVANCE: For this group of children, the
SWOC was able to distinguish the children with CP from
those developing typically on functional gait and balance.
THE EFFECTS OF OBSERVATIONAL FEEDBACK ON
MOTOR LEARNING OF AN AIMED REACHING
TASK.
C.A. Larson, Program in Physical Therapy, Oakland
University, Rochester, MI, M.R. Surber, Total
Rehabilitation, Adrian, MI.
BACKGROUND & PURPOSE: Observational feedback
has a positive effect on motor learning, however, the best
means of delivering feedback is under debate. Thus, the
Pediatric Physical Therapy
purpose of this single-subject, case study was to compare
the subject’s performance of an aimed reaching task after
viewing a videotape of a model’s performance plus verbal
cues and after viewing a split-screen comparison of the
model’s and subject’s performance plus verbal cues.
CASE DESCRIPTION: The subject was a 13 year old,
left-hand-dominant, male diagnosed with cerebral palsy.
He had mild involvement of his upper extremities with
full range of motion, minimal to moderate flexor tone
and mild coordination impairments. The PTVision, vid-
eo-based, motion analysis system was utilized to provide
both the observational feedback and to record the out-
comes of the aimed reaching task performance. The task
was to reach to one of three circular targets located 10
inches at 45°, 90° or 135° angles from the start location.
Baseline measurements (phase A1) of trajectory curvilin-
earity, shoulder, elbow and wrist joint angles at mid- and
end-reach, and target accuracy were obtained. Three days
later, these same parameters were again recorded after
the subject watched a videotape of a model’s performance
(phase B) and then four days later, watched a split-screen
comparison of the model’s and subject’s performance
(phase C) of ten reaches to all three targets at normal and
slow speed while simultaneously receiving verbal cues to
sit in a more erect posture and utilize a “relaxed wrist
with smooth motion out toward the target”. Three days
later, baseline measurements were again recorded in or-
der to measure retention.
OUTCOMES: Viewing a split-screen comparison be-
tween the model’s and subject’s reaching performance
had the largest impact upon aimed reaching performance,
however, the effects were both beneficial (better wrist
extension, increased target accuracy) and detrimental
(more curved spatial trajectory, awkward ulnar devia-
tion). Also, the subject with cerebral palsy produced
more curvilinear spatial trajectories, more variable shoul-
der and wrist joint angles and more target errors as com-
pared to the model who had no
DISCUSSION: Directing a patient’s attention to intrinsic
factors (such as wrist movement) rather than to extrinsic
factors (such as target accuracy or straight line trajecto-
ries) may be detrimental to learning a motor task.
THE EFFECT OF BOTULINUM TOXIN TYPE A
COMBINED WITH PHYSICAL THERAPY ON GAIT IN
CHILDREN WITH IDIOPATHIC TOE WALKING.
S. Li, M. Bishop, C. Senesac, Physical Therapy, University
of Florida, Gainesville, FL; R. Woo, M. Horodyski,
Orthopedics, University of Florida, Gainesville, FL.
PURPOSE/HYPOTHESIS: The gait pattern of children
with idiopathic toe walking (ITW) is characterized by
initial contact with the forefoot or toes during walking.
This study examined the effects of Botulinum Toxin Type
A (BTA) combined with physical therapy treatment on
the gait of children with ITW.
NUMBER OF SUBJECTS: 12 children 3 to 7 years old
Pediatric Physical Therapy
with the diagnosis of idiopathic toe walking were re-
cruited for this study.
MATERIALS/METHODS: Physical Therapy intervention
was given to children with ITW three weeks after they
received BTA injection and continued until children ob-
tained normal gait pattern. The gait patterns and lower
leg muscle electromyographic (EMG) activity were mea-
sured before treatment and following treatment. Fol-
low-up times ranged from 12 to 30 months.
RESULTS: Pre-treatment video and EMG analysis
showed predominantly when the digitigrade or forefoot
contact patterns and gastrocnemius (GA) firing timing
occurring earlier than normal in the stance phase. The
average of GA onset time in ITW was about 80 ms before
foot contact. Tibialis anterior (TA) firing duration was
very brief and offset timing was earlier in the swing phase
than would be anticipated. Post-treatment, video and
EMG analysis showed an increase in the frequency of
heel strike at initial foot contact and EMG data paralleled
the change in initial contact patterns. The firing pattern
of TA and GA muscles improved to nearly similar firing
pattern in normal gait. After treatment, GA firing timing
was postponed to at least 50 ms after foot contact in the
stance phase, and TA offset schedule was extended to
sometime after foot contact.
CONCLUSIONS: Botulinum Toxin Type A treatment
normalized the ankle EMG pattern and gait pattern by
inhibiting GA muscle activities initially after injection
thus, allowing TA muscle to be re-educated through
physical therapy.
CLINICAL RELEVANCE: The short period of physical
therapy training suggested the high neuro-plasticity of
children’s neuron circuit in the motor area of cortex. A
new motor programming is likely built through motor
learning or experience of the normal gait task.
THE EFFECTS OF BALLET EXERCISES AND
STRETCHES ON RANGE OF MOTION, STRENGTH,
AND GAIT IN A CHILD WITH NEUROLOGICAL
DEFICITS.
J.R. Long, S.L. Bede, E. Galanti, B.R. Wagner, M. Grant-
Beuttler, University of Scranton, Scranton, PA.
PURPOSE/HYPOTHESIS: In countries outside of the
United States, Dance Movement Therapy (DMT) is used
as a therapeutic modality to treat children with a variety
of impairments. Prior research in DMT focuses on cogni-
tive and behavioral effects of the therapy. This study ex-
amines potential physical and functional benefits that
may result from treatment techniques based on DMT.
NUMBER OF SUBJECTS: The subject is a nine-year-old
male who sustained a traumatic brain injury when struck
by a vehicle at the age of two. He presents with right-
sided hemiplegia, marked hip retraction with genu recur-
vatum on his involved side and excessive internal rota-
tion of his uninvolved hip during gait.
MATERIALS/METHODS: A stretching and strengthening
program using ballet techniques was designed within the
Pediatric Physical Therapy 59
subject’s specific abilities. Intervention occurred twice a
week for 45-minute sessions over six weeks duration.
The program was continually modified as tasks became
unchallenging. Prior to the initial treatment, baseline
measurements were taken for hip extension strength and
range of motion (ROM), and a Pedograph gait analysis
was completed. The gait analysis included measurements
of step and stride lengths, base of support, foot angle, gait
speed, and cadence. After the completion of the interven-
tion, post-test data was acquired immediately following
the final treatment session.
RESULTS: Improvements were observed for 23 of the 24
variables analyzed. Most notably, hip extensor strength
and active ROM on the participant’s involved (right) side
increased 17.6% and 248.5%, respectively. The partici-
pant’s passive ROM also increased 52.6% on his involved
side. When wearing shoes and orthoses, his left foot an-
gle decreased from 21.33 internal rotation to 12.13 inter-
nal rotation.
CONCLUSIONS: Our results suggest using ballet exer-
cises and stretches as a therapeutic modality may result
in increased lower extremity strength and ROM and may
also assist in facilitating a more normal, symmetrical gait
in children with hemiplegia. Further research needs to be
conducted with a larger subject population comprised of
various ages and neurological deficits.
CLINICAL RELEVANCE: Using ballet as a therapeutic
modality may promote gains in strength and range of
motion as well as functional improvements while making
therapy sessions more interesting and exciting for the
patients. Ultimately, patients may prove to be more com-
pliant with a regimen they enjoy doing.
PT TRAINING IN ASSISTIVE TECHNOLOGY (AT/AT
SERVICES).
T.M. Long, Pediatrics, Georgetown University, Washington,
DC.
PURPOSE/HYPOTHESIS: To identify the training needs
of PTs in AT/AT services.
NUMBER OF SUBJECTS: 3402 surveys were mailed to
members of six organizations who provide AT services to
children with disabilities. 1031 surveys were returned a
30% response rate. 980 members of the Section on Pedi-
atrics were sampled. 373 surveys were returned a 38%
response rate.
MATERIALS/METHODS: Survey consisted of 19 closed,
multipart, open-ended questions divided into 3 sections:
Adequacy of Training; Access to Information; Confidence
in Providing AT and AT Services, and demographic
characteristics.
RESULTS: 75% of respondents have advanced academic
degrees, 64% have practiced for 11 or more years. They
provide service to children birth through 21, in a variety
of settings. 43.3% spend less than 10% of their time in
AT/AT services.
PTs reported less than adequate training in knowledge
about children with disabilities, pediatric service delivery
60 Abstracts for the 2004 Combined Sections Meeting
systems, working with families, collaborating with other
service providers, and legislation, regulation, and policy.
PTs report interest in training on devices, negotiating
skills, and funding. Less experienced respondents want
information on seating, positioning, and mobility devices.
The respondents rated person-to-person and group in-
struction as preferred methods of training. The respon-
dents report confidence in recognizing the benefit of AT,
working with low-tech devices, and assessment. Lowest
confidence levels for PTs were for identifying sources of
funding and working with high tech devices. PTs with
more job responsibilities related to AT/AT services rated
their training more adequate and are more confidant pro-
viding AT/AT services.
CONCLUSIONS: Section members report minimal job
responsibilities related to AT/AT services, have received
less than adequate training in AT/AT services, and low
confidence in providing AT/AT services. PTs who report
more job responsibilities related to AT/AT services also
report more adequate training and more confidence in
providing services. PTs are interested in being trained in
mobility, seating, positioning devices and funding sys-
tems. Mentoring, supervision or consultation on specific
cases are preferred training methods.
CLINICAL RELEVANCE: Children with disabilities in-
creasingly use AT to overcome functional limitations.
With increased training in device specific information,
clinical decision-making skills in relation to AT and ne-
gotiating skills PTs will be better able to provide this
needed service.
COMPARISON OF TWO SUPPORT WALKERS ON
THE GAIT AND MOBILITY OF A CHILD WITH
CEREBRAL PALSY: A CASE REPORT.
S.A. Low, Dept of PT, Cal State Univ, Northridge,
Northridge, CA.
BACKGROUND & PURPOSE: Support walkers are fre-
quently recommended by pediatric physical therapists for
children with CP to allow a form of self-initiated mobility
in the home or classroom setting. This case report de-
scribes the effects of two different support walkers on the
gait and mobility of a 12-year-old child with Cerebral
Palsy (CP) in the home or classroom setting.
CASE DESCRIPTION: Secondary to growth a twelve-
year old child with CP switched from using a posterior
support walker to an anterior support walker, which pro-
vided a noticeable improvement in the quality of gait and
mobility for the child. Gait temporal and spatial parame-
ters were compared using the GAITRite walkway system,
quality of gait was assessed using the Observational Gait
Scale and family and therapist preference were compared
using the two support walkers.
OUTCOMES: Overall the anterior support walker pro-
vided a better quality of gait including improved trunk,
hip, knee flexion and heel/foot contact during the phases
of gait. Improvements were also noted in single and dou-
ble limb stance time and foot progression angles using
Pediatric Physical Therapy
the anterior support walker. Family and therapist pre-
ferred the anterior support walker for ease of use and
improved mobility in the home and school settings.
DISCUSSION: Support walkers should be considered for
children with CP to improve gait and mobility as part of
their therapy program.
EFFECTS OF USING THE STRUTTER FUNCTIONAL
ORTHOSIS SYSTEM ON UPRIGHT MOBILITY IN AN
ADOLESCENT BOY WITH MYELODYSPLASIA.
J.A. Magee, D.M. Kenney, Physical Therapy, American
International College, Springfield, MA.
BACKGROUND & PURPOSE: The purpose of this case
report is to describe the progress of a child with L5 level
myelodysplasia before and after using a new ambulatory
assistive device, the Strutter Functional Orthosis.
CASE DESCRIPTION: A young boy with a diagnosis of
L5 level myelodysplasia was first seen at age 10 for hip
strengthening following bilateral femoral derotation os-
teotomies with internal fixation. This child was reported
to have started walking at 5 years of age with Lofstrand
crutches but did not use them regularly until after the hip
surgery, he would resort to a type of crawl is mother calls
“bear-hopping” (crawling on hands and feet), or propel
himself in a manual wheelchair. By age 11 he became
more proficient in walking but still preferentially used
the wheelchair for functional mobility complaining of
fatigue. He obtained the Strutter Functional Orthosis am-
bulatory device when he was 12 1/2 years old and found
that walking with them was easier than with his
Lofstrand crutches.
OUTCOMES: -This child has become a functional com-
munity ambulator since introduction of the Strutter
Functional Orthosis. -Footprint analysis found improved
step and stride lengths. Improved balance was demon-
strated using the functional reach test. Posture improved
with measured height gains with the Strutter compared
to the Lofstrands. FIM scores improved using the Strutter
particularly for toileting self-care, stairclimbing, and so-
cial interaction.
DISCUSSION: This child has become a functional com-
munity ambulator since introduction of the Strutter
Functional Orthosis. Gait has improved evidenced by the
footprint analysis and the child has a more upright pos-
ture as seen by change in height measurements, and still
photo images in stance. He now exclusively uses the
Strutter. At school he uses them to walk between classes
and for climbing stairs relegating his wheelchair to bath-
room trips, library, and the cafeteria.
THE EFFECTS OF GASTROESOPHAGEAL REFLUX
ON INFANT CAREGIVING PRACTICES AND
DEVELOPMENT.
M. Mandich, L.J. Freed, S.G. Holderman, L.M. McClelland,
T.A. Quinlan, Division of Physical Therapy, West Virginia
University, Morgantown, WV, S.K. Ritchie, S. Lynch,
Pediatric Physical Therapy
Department of Pediatrics, West Virginia University,
Morgantown, WV.
PURPOSE/HYPOTHESIS: The purpose of the present
study was to examine the relationship between position-
ing, gastroesophageal reflux disease (GERD) and motor
development in preterm infants.
NUMBER OF SUBJECTS: The subjects were 22 preterm
infants. Eligibility criteria were gestational age of less
than or equal to 37 weeks and an adjusted age of 2– 6
months.
MATERIALS/METHODS: A correlational design was
used to determine the relationship between study vari-
ables, including infant characteristics, parental report of
caregiving, health care provider assessment and motor
development as measure by the Alberta Infant Motor
Scale (AIMS). Data were analyzed descriptively as well as
by simple and multiple linear regression techniques.
RESULTS: Descriptive statistics showed the most fre-
quent sleeping position was supine; the most frequent
awake position was supported sitting. The swing was the
most frequently utilized piece of infant equipment. There
was a slight trend for total AIMS score to be negatively
impacted by presence of severe reflux. Results of the mul-
tiple linear regression showed: birth weight (⫹) and time
in bassinette (-) were significant predictors of AIMS total
score; awake position (-) and adjusted age (⫹) were sig-
nificant predictors of AIMS prone score; time in bassi-
nette (-) was a significant predictor of AIMS supine score;
birth weight (⫹), adjusted age (⫹), reflux now (⫹), re-
flux worst by physician (-) and sleep position (-) were
significant predictors of AIMS sitting score.
CONCLUSIONS: The study results confirm other reports
that infant caregiving practices impact motor develop-
ment in the first year, at least transiently. Fear of SIDS
and infant preference tended to be the most common
reason for positioning, rather than avoidance of spitting.
Presence of severe reflux was negatively correlated to
total AIMS score. The most common awake position was
supported sitting and the most common equipment was
the swing, crib and car seat. This confirmed that contem-
porary infant caregiving practices limit the amount of
time infants spend in prone. Further investigation of
these findings is warranted.
CLINICAL RELEVANCE: Physical therapists are often
consulted about infants at risk for developmental delay.
In recognizing the multiple systems that impact motor
development, including physiological and environmental,
therapists may better educate parents about positioning
and caregiving practices which facilitate normal motor
development.
COMPARISON OF GROSS MOTOR SUBTEST SCORES
OF THE PEABODY DEVELOPMENTAL MOTOR
SCALE-2 IN CHILDREN WITH DOWN SYNDROME.
J.R. Maring, K.J. Courcelle-Carter, Physical Therapy
Department, Florida International University, Miami, FL.
Pediatric Physical Therapy 61
PURPOSE/HYPOTHESIS: The purpose of this study was
to investigate whether children with Down Syndrome
(DS) demonstrate an equal level of gross motor (GM)
delay in the Peabody Developmental Motor Scale-2
(PDMS-2) subtests: Stationary, Locomotion, and Object
Manipulation. Previous research based on tests that do
not differentiate between GM skills suggest children with
DS, although delayed, achieve GM milestones in the same
sequence as typically developing children.
NUMBER OF SUBJECTS: Eighteen children in an Early
Intervention Center diagnosed with DS participated in
this study. There were 10 boys and 8 girls between the
ages of 10 – 44 months.
MATERIALS/METHODS: The PDMS-2 was administered
to all 18 children. The raw scores of each GM subtest
were converted to standard scores as stipulated by the
testing manual. A one-way repeated measures analysis of
variance (ANOVA) was performed to determine if there
was a significant difference in the mean scores within the
GM subtests of the PDMS-2.
RESULTS: There was a significant difference in the
means of the subtest scores in the children tested (Wilks’,
F ⫽ 58.14, P ⬍ 0.01). Children with DS had the most
delay in the Locomotion GM subtest area followed by
Object Manipulation and then Stationary.
Additionally, subsequent pairwise comparisons indicated
that the difference between each of the paired gross mo-
tor subtest scores was significant (P ⬍ 0.01).
CONCLUSIONS: The children diagnosed with DS in this
study demonstrated a significantly different level of delay
in the GM subtests of the PDMS-2. Children with DS
likely do not develop GM skills in the same pattern as
typically developing children.
CLINICAL RELEVANCE: Increased sophistication in
GM testing such as permitted by the PDMS-2 allows ther-
apists to identify relative areas of strengths or weak-
nesses. This allows therapists to plan specific exercises
and movement experiences to emphasize those skill areas
that are not in the child’s repertoire. It appears as though
children with DS would benefit from an emphasis on lo-
comotion skills during therapeutic intervention sessions.
LONG-TERM OUTCOMES OF RECTUS FEMORIS
TRANSFERS IN CHILDREN WITH CEREBRAL PALSY.
N.G. Moreau, Kinesiology, Louisiana State University,
Baton Rouge, LA, S.L. Tinsley, A. Cavell, K. Semones,
Physical Therapy, Louisiana State University Health
Sciences Center, Shreveport, LA.
PURPOSE/HYPOTHESIS: The purpose of this study was
to compare pre-, 1-year, and 3-year postoperative out-
comes of rectus femoris transfer in children with CP to
determine if 1-year postoperative outcomes persist as the
children develop.
NUMBER OF SUBJECTS: Twenty-four children (43
sides) with cerebral palsy were evaluated. All subjects
underwent rectus femoris transfers in conjunction with
other multi-level surgeries.
62 Abstracts for the 2004 Combined Sections Meeting
MATERIALS/METHODS: Subjects underwent preopera-
tive, 1, and 3-year post-operative gait analyses from
which the following variables were analyzed: peak knee
flexion in swing (PKFS), knee flexion swing range
(KFSR), and barefoot and braced walking velocity (m/s).
All subjects received 2–12 weeks of inpatient physical
therapy bid following surgery. A one-way repeated mea-
sures MANOVA was used to analyze changes in PKFS
and KFSR from pre-, 1, and 3-year gait analyses. A one-
way repeated measures ANOVA was used to analyze
changes in barefoot walking velocities. To identify differ-
ences in walking velocities between the two conditions
(barefoot and braced) and between the two times of anal-
ysis (1 and 3 years), a two-way repeated measures
ANOVA was utilized.
RESULTS: One year after surgery, PKFS and KFSR both
significantly increased and continued to increase over the
next two years. The initial decrease in barefoot velocity
seen 1-year post-operatively did not persist at 3-years
post but significantly improved. Three years after sur-
gery, both barefoot and braced walking velocities were
significantly greater than preoperative values. At both
one- and three-years after surgery, braced walking veloc-
ity was significantly greater than barefoot walking
velocity.
CONCLUSIONS: Our results indicate that the benefits of
rectus femoris transfers on PKFS and KFSR are main-
tained 3-years post-operatively. Although rectus transfers
may have a short-term effect on walking speed, velocity is
significantly improved over time both barefoot and
braced.
CLINICAL RELEVANCE: Research in this area will pro-
vide information on neurological adaptations and vis-
coelastic changes that occur in the muscles of children
with CP and aid in identifying the most appropriate post-
operative interventions.
THE EFFECTIVENESS OF TRANSITIONING A CHILD
FROM INPATIENT REHABILITATION BACK INTO
THE SCHOOL SETTING AFTER SUSTAINING A TBI.
L. Murphy, R. Karasick, Physical Therapy, Children’s
Hospital of Philadelphia, Philadelphia, PA.
PURPOSE/HYPOTHESIS: The purpose of this study was
to examine the discharge process involved in transition-
ing school-aged children who sustained a TBI and re-
ceived services at The Children’s Hospital of Philadelphia
(CHOP), better understand current practices related to
TBI services at The CHOP, and better understand school
personnel’s perception on CHOP’s transition services.
NUMBER OF SUBJECTS: 14 IEP team members work-
ing in the Philadelphia School District who have worked
with 1 child who sustained a TBI and received services at
The CHOP Materials/Methods: The researchers reviewed
10 cases of school-aged children who sustained a TBI and
attend school in the Philadelphia school district. A 15
Pediatric Physical Therapy
minute phone questionnaire was developed and was ad-
ministered to each team member. The child’s identity
remained unknown and confidential.
RESULTS: Descriptive Statistics were used in order to
assess current school reintegration issues. The results
indicated the participants have had limited experience
working with children who sustained a TBI. The partici-
pant’s perception of their knowledge base of TBI was also
rated low. The participants rated background information
about the child’s injury and consequences of the injury as
the most helpful. The majority of the participants viewed
the CHOP rehabilitation team’s knowledge of the capaci-
ties of their schools as somewhat knowledgeable.
CONCLUSIONS: This descriptive study examined the
effectiveness of transitioning a child from inpatient reha-
bilitation back into the school setting after sustaining a
TBI. The results formulated the following conclusions:
(1) There is limited knowledge and experience between
all disciplines (2), discharge summaries are missing po-
tential consequences of the injuries and effects on peer
relationships, and (3) need to develop a stronger and
more effective relationship between the school and the
hospital. Additional research is warranted in this area to
examine the school’s process and effectiveness of receiv-
ing and implementing our reports as well as to explore
existing school re-entry programs for children with TBI
used in area hospitals.
CLINICAL RELEVANCE: With the growing number of
children who sustain a TBI each year and receive rehabil-
itation services, it is imperative that the rehabilitation
team effectively transition these children to the school
system. The Schools and hospitals need to collaborate
with one another to help these children transition suc-
cessfully to the community.
DEVELOPMENT OF A DYNAMIC BACK EXTENSOR
ENDURANCE TEST IN CHILDREN AGES 6 –10: A
PILOT STUDY.
D.G. O’Connell, N. Adams, B. Patterson, E. Spencer, M.
Garrett, J.K. O’Connell, Physical Therapy, Hardin-Simmons
University, Abilene, TX.
PURPOSE/HYPOTHESIS: The purpose of this study was
threefold. First, to assess the relationship between dy-
namic endurance and isometric strength of back exten-
sors. Second, to test the reliability of the HSU Back Ex-
tensor Endurance Test. Third, to determine if endurance
scores differed by age and gender.
NUMBER OF SUBJECTS: One Hundred and Forty-Five,
6 –10 year olds (69 males, 76 females) from three rural
Midwest Texas public elementary schools participated in
the study.
MATERIALS/METHODS: Forty-two subjects performed
endurance and isometric tests. Isometric strength testing
involved sustaining three, 5-second maximum contrac-
tions of prone back extension against a calibrated station-
ary isometric dynamometer. The highest peak force value
was recorded for each of three trials. Subjects also per-
Pediatric Physical Therapy
formed back flexion/extensions (start prone–⬎45° flex-
ion) 20 times per minute for up to four minutes or until
two form corrections were made. Sixty-nine subjects
completed a test-retest of the endurance test within a ten
day period. Thirty-four additional subjects were tested
once for the back extensor endurance so that differences
could be assessed for age and gender.
ANALYSIS: Analysis was performed with SPSS 11.5 for
Windows with statistical significance set at P ⬍ 0.05
apriori. Pearson-Product Moment correlations were cal-
culated for isometric force vs endurance (reps) and for
test-retest reliability of the endurance test. One-Way
ANOVA’s were performed to test for differences in gen-
der and age in relation to endurance test scores. Descrip-
tive statistics were calculated for average weight, height,
gender and degree of inclination.
RESULTS: Static and dynamic endurance were not corre-
lated (r ⫽ 0.026, P ⫽ 0.868). Test retest reliability for the
HSU back extensor endurance test was moderate(r ⫽
0.55, P ⫽ 0.000). Back endurance did not differ by age (F
⫽ 0.236, P ⫽ 0.918) or by gender (F ⫽ 0.002, P ⫽
0.960).
CONCLUSIONS: This research supports evidence that
isometric strength is not correlated to endurance. The
HSU Back Extensor Endurance test was moderately reli-
able, however, no differences in the number of back repe-
titions was noted across the age span tested or by gender.
CLINICAL RELEVANCE: This was a first attempt at cre-
ating a dynamic back extensor test in grade-school chil-
dren, a generally agreed upon important but as of yet,
untested component of physical fitness.
EFFECT OF CALCANEAL EVERSION ON BALANCE
AND TEMPORAL SPATIAL CHARACTERISTICS OF
GAIT IN CHILDREN.
M.N. Orlin, R.J. Palisano, Programs in Rehabilitation
Sciences, Drexel University, Philadelphia, PA, M.R.
Pierrynowski, School of Rehabilitation Sciences, McMaster
University, Hamilton, CANADA. Sally Westcott, Lake
Washington School District, Redmond, WA, E.J. Gracely,
Family, Community and Preventive Medicine, Drexel
University, Philadelphia, PA.
PURPOSE/HYPOTHESIS: The purpose of this study was
to examine the effect of altered calcaneal eversion on
standing and walking balance and temporal spatial gait
characteristics in children with typical development.
NUMBER OF SUBJECTS: Forty-six subjects with typical
development ages 6 years to 10 years were tested. MATE-
RIALS/METHODS: Pronation wedges that everted the
heels by 5 and 10 were applied to all subjects. Velocity,
stride length and time in single limb support were mea-
sured during gait. Balance skills were measured by the
balance subtest of the Bruininks-Oseretsky Test of Motor
Proficiency. A within subject repeated measures design
was used to compare the variables between the no wedge
and the 5 and 10 conditions.
Pediatric Physical Therapy 63
RESULTS: Results indicated no condition effect for ve-
locity, stride length or time in single limb support. A con-
dition effect was found for balance skills (P ⬍ 0.001).
Total scores for balance skills were significantly lower (P
⫽ 0.002) in the 5 condition (M ⫽ 18.3, SD ⫽ 4.84) com-
pared to the no wedge condition (M ⫽ 20.1, SD ⫽ 4.48).
Balance scores were also significantly lower (P ⬍ 0.001)
in the 10 condition (M ⫽ 17.6, SD ⫽ 4.77) compared to
the no wedge condition. There was no difference between
the 5 and 10 conditions (P ⫽ 0.370).
CONCLUSIONS: The children appeared to adapt to the
wedges during walking but they experienced greater diffi-
culty adapting to the relatively novel and challenging
balance skills. This research indicates that the ability to
perform standing and walking balance skills with in-
creased eversion may depend upon the extent to which
the task is novel as well as its difficulty.
CLINICAL RELEVANCE: Research is needed to examine
the impact of increased eversion on function in children
with impairments. The presence of impairments may
make adaptation during walking and balance activities
with increased eversion more difficult.
COMPARISON OF PERCUTANEOUS AND SURFACE
FUNCTIONAL ELECTRICAL STIMULATION DURING
GAIT IN A CHILD WITH HEMIPLEGIC CEREBRAL
PALSY.
S. Pierce, R.T. Lauer, T.E. Johnston, B.T. Smith, J.J.
McCarthy, Research Department, Shriners Hospitals for
Children, Philadelphia, PA, M.N. Orlin, Programs in
Rehabilitation Sciences, Drexel University, Philadelphia, PA.
BACKGROUND & PURPOSE: Surface functional electri-
cal stimulation (S-FES) has been investigated as a treat-
ment intervention to improve gait in children with cere-
bral palsy (CP). However, our laboratory has used
percutaneous functional electrical stimulation (P-FES) as
an alternative method of applying stimulation. No com-
parisons between S-FES and P-FES in children with CP
have been made to our knowledge. The purpose of this
case report is to compare the immediate effects of S-FES
and P-FES of the tibialis anterior (TA) applied during
walking on gait in a child with hemiplegic CP.
CASE DESCRIPTION: A three dimensional gait analysis
was conducted while an eleven-year-old female with right
hemiplegia walked with S-FES, P-FES, and no stimula-
tion. The strength of the TA contractions induced by S-
FES and P-FES was compared to the maximal voluntary
contraction of the subject.
OUTCOMES: The results indicated that P-FES increased
dorsiflexion at initial contact, peak dorsiflexion in swing,
and mean dorsiflexion in swing by greater than eight de-
grees compared to walking without stimulation. The in-
crease in dorsiflexion with S-FES compared to no stimu-
lation was less then five degrees for dorsiflexion at initial
contact, peak dorsiflexion in swing, and mean dorsiflex-
ion in swing. Ankle absorption work was improved by
12% with P-FES and by 48% with S-FES compared to
64 Abstracts for the 2004 Combined Sections Meeting
walking without stimulation. The mean P-FES force of
the TA was 83% and the mean S-FES force was 31% of
the dorsiflexor maximal voluntary effort.
DISCUSSION: This case study suggests that the immedi-
ate effect of FES applied to the TA during gait in a child
with hemiplegic CP varied according to the type of stim-
ulation applied. Issues such as the strength of muscular
contraction, sensory feedback, and stimulation control
systems may contribute to the different effects found with
S-FES and P-FES. By investigating these variables, re-
searchers and clinicians may be able to improve interven-
tion protocols and determine the unique advantages of
P-FES and S-FES for children with CP.
DEVELOPMENT OF A PRESSURE REDUCING
MATTRESS FOR THE NICU.
J. Robison, D. Hodge, S. Lee, Rehab Services, Vanderbilt
Medical Center, Nashville, TN.
PURPOSE: Babies in the NICU are at risk for complica-
tions due to their fragile medical condition. There is an
increased incidence of poor head molding and pressure
sore development in this population. These problems can
be related to the lack of movement by the baby, equip-
ment that prevents movement, and long hospital stays.
Present mattresses are not adequate to provide good pres-
sure reduction.
DESCRIPTION: An interdisciplinary team of Clinical
Nurse Specialist, Wound Care Nurse and Physical Thera-
pist worked together to develop a better mattress for the
NICU population. The therapist works in the Wheel-
chair/Seating clinic and has pressure mapping equipment
that is used in that practice area. This pressure mapping
equipment gives objective computerized data that helped
this team of health care professionals design this mat-
tress. We collected data on a small (2.1 lb) baby and large
(7.1 lb) baby. Each baby was mapped on the standard
mattress, a pressure reducing foam mattress, and a foam
with gel overlay mattress. After the “best” initial reading
was determined we then left each baby on the “best” mat-
tress for 1 hour. This was done to look at long term pres-
sure relief and how the baby immersed into the mattress.
Summary of Use: Both babies showed poor pressure relief
on the standard mattress. The foam and gel overlay mat-
tress showed the best pressure relief. The 1 hour period
of time on the foam with gel overlay showed a greater
amount of pressure reduction and immersion of both
babies into the mattress.
IMPORTANCE TO MEMBERS: Taking care of babies in
the NICU is costly and labor intensive. It is important to
have the proper equipment in order to provide optimal
care. This project is an example of collaborative and
multi-disciplinary care. It mirrors projects where thera-
pists collaborate with other health care professionals to
provide the best outcome possible for the patient.
Pediatric Physical Therapy
THE EFFECTS OF AEROBIC EXERCISE ON
ENDURANCE, STRENGTH, FUNCTION AND SELF-
PERCEPTION IN ADOLESCENTS WITH SPASTIC
CEREBRAL PALSY.
K.A. Schlough, D. Nawoczenski, E. Arnold, E. Clarke, K.
Doyle, M. Vicari, Physical Therapy, Ithaca College, Ithaca,
NY.
PURPOSE/HYPOTHESIS: The purpose of this study was
to investigate the effects of aerobic exercise on endur-
ance, strength, function, and self-perception in ambula-
tory adolescents with spastic cerebral palsy while utiliz-
ing community resources and easily adapted testing
procedures.
NUMBER OF SUBJECTS: Participants were three adoles-
cents (mean age of 18.3 years) with varying classifica-
tions of spastic cerebral palsy who were able to ambulate
for at least 5 minutes.
MATERIALS/METHODS: A single system A1B1A2B2
design was used to study changes before, during and after
two different regimens of aerobic exercise. Data collec-
tion during the different phases included the energy ex-
penditure index (EEI), lower extremity muscle strength,
the Gross Motor Function Measure (GMFM) and the
Self-Perception Profile for College Students (SPPCS).
DATA ANALYSIS: A 2 standard deviation bandwidth
analysis was used to determine significance (P ⬍ 0.05).
Phases were graphed for visual analysis of slope, levels
and trends.
RESULTS: One participant showed a significant improve-
ment in the EEI, one had no change and another partici-
pant showed a significant deterioration. All participants
had a significant improvement in at least one of the com-
ponents of the EEI; resting heart rate (HR), walking HR,
velocity. Combined mean strength of quadriceps, ham-
strings, plantarflexor and dorsiflexor muscles increased
for all participants. GMFM and self-perception of appear-
ance improved for all participants. Two participants im-
proved the symmetry of muscle strength. The initial three
times weekly aerobic exercise intervention phase (B1)
showed some evidence of overtraining effects.
CONCLUSIONS: The use of aerobic exercise, while
maintaining the HR at appropriate levels, may aid in in-
creasing the strength of the lower extremity muscles, de-
crease the amount of energy required to ambulate, im-
prove gross motor function and improve self-perception
for some adolescents with spastic cerebral palsy.
CLINICAL RELEVANCE: Physical therapists might con-
sider fitness programs for adolescents with spastic cere-
bral palsy by familiarizing them with typical exercise
equipment at school or in the community. Life long fit-
ness habits formed at a young age begin with experience,
success and satisfaction derived from the benefits of a
good exercise program.
Pediatric Physical Therapy
A QUALITATIVE ANALYSIS OF ATTITUDES
TOWARDS DISABILITY BETWEEN HISPANIC AND
ANGLO-AMERICAN FAMILIES OF CHILDREN WITH
CHRONIC DISABILITIES.
E.M. Spearing, Physical Therapy, Children’s Seashore
House of the Children’s Hospital of Philadelphia,
Philadelphia, PA, J.D. Devine, Department of Foreign
Language, Graduate Program in Bilingual/Bicultural
Studies, LaSalle University, Philadelphia, PA.
PURPOSE/HYPOTHESIS: Today’s trend towards globili-
zation and a national health care initiative for family cen-
tered care creates a multi-cultural clientele for health care
providers. The purpose of this study is to examine the
similarities and differences in cultural attitudes towards
disability between Hispanic and Anglo-American caretak-
ers of children with chronic disability.
NUMBER OF SUBJECTS: Subjects included 10 Hispanic
and 10 Anglo-American primary caretakers of children
between the ages of 0 and 18 years with a chronic illness
who are currently under the care or consultation of a
physical therapist.
MATERIALS/METHODS: Subjects were interviewed in
their native language with a series of questions designed
to explore cultural beliefs and how these beliefs affect
their attitudes towards disability as well as the impact of
the disability on their family. Following transcription of
the interview, responses were then coded for each ques-
tion by category as follows: Name of Diagnosis, Name of
disability, Cause of disability, Effect of disability, Fears,
Problems for child, Problems for caretakers, Treatments
desired and Results desired. A cross comparison of
themes between and within groups were then performed
and discussed.
RESULTS: Some general similar themes between the
groups were 1) the prioritization of walking, and 2) the
lack of knowledge regarding their child’s disability. Dif-
ferences were also noted between the groups with respect
to 1) severity of disability, 2) expression of emotional
issues and 3) conceptualization of disability.
CONCLUSIONS: Although this study discusses similari-
ties and difference between two ethnic groups, it is im-
portant to realize that each person within a culture is an
individual and should not be characterized or stereotyped
on the basis of their cultural identity.
CLINICAL RELEVANCE: Sensitivity towards cultural
similarities and differences in attitudes towards disability
will serve to enhance patient-clinician care and improve
patient/family compliance.
GAIT TRAINING USING PARTIAL BODY WEIGHT
SUPPORT DURING OVER GROUND WALKING IN
INDIVIDUALS WITH DEVELOPMENTAL
DISABILITIES.
W.A. Stuberg, S.L. DeJong, M.L. Kelly, Physical Therapy,
Munroe-Meyer Institute, Omaha, NE, G.M. Ginsburg,
Pediatric Physical Therapy 65
Orthopaedic Surgery, University of Nebraska Medical
Center, Omaha, NE.
PURPOSE/HYPOTHESIS: This study evaluated the effect
of gait training using partial body weight support (PBWS)
during over ground walking in children and young adults
with developmental disabilities and severe/profound cog-
nitive impairment.
NUMBER OF SUBJECTS: Nine subjects were studied,
including 7 females and 2 males, age 9 to 21 yrs (16.3
5.1). Four were diagnosed with cerebral palsy (2 spastic
quadriplegia, 1 spastic diplegia, 1 ataxic quadriplegia),
two with Rett syndrome, two with chromosomal anoma-
lies, and one with history of traumatic brain injury. Seven
used walkers for short distance mobility, two used no
walking aid, but required one hand to be held for bal-
ance. Seven wore ankle foot orthoses, one wore foot or-
thoses and one wore none.
MATERIALS/METHODS: A gait training program was
administered by a physical therapist assistant twice
weekly for 12 weeks. Four subjects had 100% attendance,
three 96%, one 83%, and one 75%. Each session included
20 minutes of walking over ground in a long hallway.
Using a Biodex Unweighing System, PBWS of 40% of
body weight was provided at the beginning, and was de-
creased by 5% every two weeks. Verbal encouragement
was provided. One child required minimal facilitation to
elicit stepping. Others received no physical prompts. Dis-
tance walked was recorded and converted to average
speed for each session. Pre and post tests included sec-
tions D and E of the Gross Motor Function Measure
(GMFM), the Supported Walker Ambulation Perfor-
mance Scale (SWAPS) and the Physician Rating Scale
(PRS), each with the subject’s usual assistive device(s).
Paired t tests were used to analyze mean differences.
RESULTS: Average walking speed during the last four
sessions was significantly greater than during the first
four (59.9 ft/min pre vs 106.4 post, p 0.008). GMFM Sec-
tion E showed a small increase (14.7% pre vs 15.7% post,
p 0.03), with no change in Section D (20.5% pre vs 21.9%
post, p 0.07). SWAPS score improved marginally from
64.1 to 69.6 (p 0.055). PRS score showed no significant
change (11.1 pre vs 11.9 post, p 0.09).
CONCLUSIONS: Improvements in walking ability
(speed, distance walked in 20 minutes) were seen follow-
ing a 12 week program of PBWS gait training, with some
indication of improved function and quality of movement
(GMFM section E, SWAPS).
CLINICAL RELEVANCE: This study supports over
ground gait training with PBWS for individuals with de-
velopmental disabilities and severe/profound cognitive
impairment.
MOTOR CONTROL OF 7–10 YEAR OLD CHILDREN
WITH HISTORIES OF PRETERM BIRTH.
L.R. Svien, M.W. Hung, Physical Therapy, University of
South Dakota, Vermillion, SD.
66 Abstracts for the 2004 Combined Sections Meeting
PURPOSE/HYPOTHESIS: The purpose of this study was
to examine motor control, as measured on the Quick
Neurological Screening Test (QNST-II), 2nd Edition, of
pre-adolescents ages 7–10 years who were born 5–10
weeks preterm, low birth weight (LBW) and appropriate
for gestational age (AGA). Few studies have examined
motor control of children born preterm. It was hypothe-
sized that the children in the preterm group would dem-
onstrate deficiencies in motor control when compared to
fullterm peers matched for age, gender, race and body
mass index.
NUMBER OF SUBJECTS: Twenty-two children ages
7–10 years, who were born 5–10 weeks preterm, LBW
and AGA were recruited into the study and matched to
22 controls. This sample was based on an apriori power
analysis computation of 0.8 and a medium effect based
on Cohen’s tables.
MATERIALS/METHODS: The Quick Neurological
Screening Test-II was administered by an experience
physical therapist who was blind to subject group. The
following seven dimensions were analyzed: Eye Tracking,
Finger to Nose, Rapidly Reversing Repetitive Hand Move-
ment, Arm and Leg Extension, Tandem Walk, Skip, and
Stand on One Leg.
RESULTS: The children in the preterm group demon-
strated more deficiencies in motor control. Based on re-
sults of a paired sample t test, the differences reached
statistical significance (P ⫽ 0.006).
CONCLUSIONS: According to the National Center for
Vital Statistics, approximately 11% of all live births are
preterm, of which 9.8% are between 5–10 weeks early.
Therefore, the majority of children born preterm are in
this cohort. This study demonstrated that at school-age
children born preterm still demonstrated deficiencies in
motor control.
CLINICAL RELEVANCE: It is important that pediatric
physical therapists are aware of the motor control defi-
ciencies in children born preterm. These deficiencies may
impact the child’s self-esteem or participation in sports or
extracurricular physical activities.
THE EFFECTS OF BACKPACK WEIGHT ON THE
POSTURE OF 11–14 YEAR-OLD CHILDREN.
L. Tsoumas, K.A. Gilbert, J.S. LaCava, P.E. Ricard,
Department of Physical Therapy, Springfield College,
Springfield, MA.
PURPOSE/HYPOTHESIS: The purpose of this study was
to describe the daily backpack loads carried by 11–14
year old children and to determine if there was a relation-
ship between posture and load. The contribution of
weight from binders was examined also.
NUMBER OF SUBJECTS: The sample consisted of 37
students, 25 male and 12 female, across grades 6 – 8. The
means for subject age, height, and mass were, 12.38 years
(⫹/-.982), 152.25 cm (⫹/-9.58), and 48.98 kg (⫹/-13.13)
respectively. Subjects who did not use a backpack were
excluded.
Pediatric Physical Therapy
MATERIALS/METHODS: Subjects completed a demo-
graphic questionnaire and reported frequency and
method of backpack use, and perception of load carried.
Subject’s weights with and without backpacks and
heights were measured. Binders were weighed separately.
Each subject’s anatomical landmarks were highlighted
with self-adhesive colored circles. A digital camera, af-
fixed to a tripod and placed 3.8m from the wall marked
with a grid was used. Sample characteristics were ob-
tained using descriptive statistics. The backpack mass
was analyzed as a percentage of the subject’s mass
(%BPW). A Spearman rank correlation coefficient and
ANOVA were completed.
RESULTS: Backpack loads greater than 10% of body
weight were carried by 86.5% of the subjects while 40.5%
carried loads that were over 15% of body weight. Subjects
reported the backpack to be heavy 3.46 days of the week
(⫹/-1.22). The subject’s binders had a mean ratio of
binder to backpack and binder to student weight of
37.83% (⫹/-17.04) and 5.69% (⫹/-2.36), respectively. A
significant relationship (a ⫽ 0.05) was found when for-
ward lean was compared to %BPW. No significant rela-
tionships were found for %BPW and lateral spinal devia-
tion, between gender, grade, or age and the mass of the
backpack.
CONCLUSIONS: Significant numbers of subjects carried
backpack loads that were more than the recommended
10 –15% of body weight. Binders accounted for over half
the recommended load.
CLINICAL RELEVANCE: Middle schools need to con-
sider coordination of assignments across subject areas,
multiple volume textbooks, and recommendation of
wheeled backpacks to reduce the impact of the loads car-
ried by their students. Future studies should analyze pos-
tural changes over time and what middle school students
are expected to carry. Prevention of musculoskeletal con-
cerns at this age is important.
THE EFFECTS OF STRENGTH TRAINING THE
QUADRICEPS FEMORIS AND TRICEPS SURAE
MUSCLES USING PERCUTANEOUS ELECTRICAL
STIMULATION IN CHILDREN WITH SPASTIC
DIPLEGIC CEREBRAL PALSY: A PRELIMINARY
STUDY.
K.N. Yapsuga, K. Larson, Arcadia University, Glenside,
PA., S.C. Lee, M.K. Schaefer, Shriners Hospital for Children,
Philadelphia, PA, S.K. Stackhouse, University of Delaware,
Newark, DE.
PURPOSE/HYPOTHESIS: To describe changes in force
production, gross motor function and energy expenditure
in children with cerebral palsy (CP) after strength train-
ing with percutaneous electrical stimulation (ES).
NUMBER OF SUBJECTS: 3 children, ages 9 –14, with
spastic diplegic CP
MATERIALS/METHODS: Electrodes were implanted
bilaterally for the quadriceps femoris and triceps surae
muscles. Subjects underwent an isometric strength-train-
Pediatric Physical Therapy
ing program including 1 set of 15 contractions, 3 times
per week for 12 weeks. Each contraction was 15 s in du-
ration and was dosed to achieve at least 50% of their
maximum voluntary isometric contraction (MVIC).
MVIC testing with electrical burst superimposition test-
ing was performed to document force production and
voluntary muscle activation (VA). Energy expenditure
was assessed during 5 minutes of steady-state walking via
gas dilution method using a metabolic cart. Dimensions
D and E of the Gross Motor Function Measure
(GMFM66) were used to assess functional ability. All
measures were performed at baseline and following 12
weeks of training. VA was calculated as: 1-(Force Aug-
mentation from Stimulation/Force of Stimulation at Base-
line). The highest MVIC force and highest VA of all trials
for each subject were used to quantify MVIC force and
extent of muscle recruitment. GMFM scores were con-
verted to Gross Motor Ability Estimate (GMAE) scores.
For all variables, the percent changes from baseline to
after 12-weeks of training were determined for each indi-
vidual and then group means were calculated.
RESULTS: Following 12-weeks of training, MVIC forces
normalized to body weight increased by 30.3% and
23.4%; and VA increased by 26.0% and 4.2% for the
quadriceps femoris and triceps surae muscles, respec-
tively. Initial energy cost during steady state walking de-
creased by 7.3%. Initial GMAE scores were 70.3 and re-
mained essentially unchanged at 69.2 at the end of
training.
CONCLUSIONS: Isometric strength training with ES
appears to be effective at increasing force production in
children with CP.
CLINICAL RELEVANCE: Increases in force production
were partly attributable to improvements in muscle re-
cruitment and may have helped to reduce the energy cost
during steady state walking. Strength changes did not
appear to affect GMAE scores, however, subjects and
their families reported functional improvements at home
and school.
A CASE STUDY ON DIFFERENTIAL DIAGNOSIS OF
LOW BACK AND FLANK PAIN IN AN ADULT WITH
DEVELOPMENTAL DELAY.
J. Yee, Woods Services, Philadelphia, PA.
BACKGROUND & PURPOSE: The purpose of this
poster is to present a case involving a very common diag-
nosis, low back and flank pain, in an adult with develop-
mental disability whose communication skills are some-
what compromised. The use of differential diagnosis was
necessary in order to determine the true cause of the
back pain.
CASE DESCRIPTION: J is a 57 year old male with a his-
tory of mild mental retardation, seizure disorder, obesity,
osteoarthritis, hypertension, and cervical disc disease. J
presented in physical therapy with complains of low
Pediatric Physical Therapy 67
back, right flank, and right hip pain that J’s primary phy-
sician attributed to a minor fall 2 months prior to this PT
examination. J’s symptoms appeared inconsistent and not
dependent upon level of physical activity. It seemed
counterintuitive that a minor fall could cause the symp-
toms of which J complained. The location of the pain also
raised some concerns, as J had never before complained
of flank pain that was unrelieved with medication. The
physical therapist requested x-rays of J’s hip and spine
from the orthopedic surgeon serving as consultant to rule
out a more serious orthopedic or systemic issue. OUT-
COMES: AP pelvis and frog view x-rays of hips were re-
viewed by the orthopedist and PT, and the x-rays were
unremarkable. AP x-ray of J’s TLS spine showed a circu-
lar, 2 cm suspicious area that appeared on film to be
where J’s right kidney would be. Further imaging con-
firmed our suspicions that it was a kidney stone. After
68 Abstracts for the 2004 Combined Sections Meeting
appropriate treatment, J reported that the pain on his
right side had resolved.
DISCUSSION: J was a challenging case because he does
not always accurately communicate his symptoms due to
his mild limits in cognition. He also has comorbidities
that warrant a more cautious approach in treating and
assessing his complaints. These include his hypertension
and his seizure disorder and the multitude of medications
that he takes. It was the responsibility of the physical
therapist to try to interpret his meanings as closely as she
could. Fortunately in this case, J’s chief complaint of
flank pain and his clinical presentation was different
enough to warrant further examination, and the imaging
clearly showed a systemic cause of J’s symptoms. This
case illustrates the importance of the physical therapist s
role in the differential diagnosis and medical screening
process.
Pediatric Physical Therapy