The purpose of this clinical reasoning theater is to:

Provide students and PT programs with access to content modules called clinical reasoning theaters to facilitate the learner’s clinical reasoning process when working with children and their families. This would include video footage of children with special needs and their families, clinicians, and academic faculty dialoguing in movement analysis and determining appropriate tests and measures, interventions, and family education. Video guides for clinicians and faculty would be provided as well as assignments and assessment guides for student learning.

Potential clinical reasoning theaters:

• CMT (birth – 2 years, out-patient setting)
• ITW (1- 6 years, out-patient setting)
• Brain injury (in-patient setting)
• SCI/Myelomeningocele (in-patient or out-patient setting)
• DCD (5- 18 years, school-based setting)
• CP (out-patient or school)
• Peds Oncology (in-patient)
• ASD (6-18 years, school)
• Low tone/ DD (birth – 3 years, out-patient setting)
• CF or Cardiac issues (in-patient)
• MD/SMA (out-patient)

Rehabilitation strategies vary greatly due to differences in the dosing of interventions. These courses will explore the state of the science in dosing as it relates to children, with a focus on children with CP or brain injury. The speakers will place an emphasis on treatment strategies with established criteria for dosing and the use of a theoretical path model to guide treatment decisions and future clinical research related to dosing. Plasticity and recovery outcomes will guide the clinical utility of providing targeted interventions and applying the best available evidence.

There are 2 courses in this bundle:

1. Dosing and Rehabilitation: Balance and Vestibular Related Impairments (LMS-823)
2. Dosing and Rehabilitation: Upper Extremity and High Intensity Programs in Infancy (LMS-824)

The purpose of this clinical reasoning theater is to:

Provide students and PT programs with access to content modules called clinical reasoning theaters to facilitate the learner’s clinical reasoning process when working with children and their families. This would include video footage of children with special needs and their families, clinicians, and academic faculty dialoguing in movement analysis and determining appropriate tests and measures, interventions, and family education. Video guides for clinicians and faculty would be provided as well as assignments and assessment guides for student learning.

Potential clinical reasoning theaters:

• CMT (birth – 2 years, out-patient setting)
• ITW (1- 6 years, out-patient setting)
• Brain injury (in-patient setting)
• SCI/Myelomeningocele (in-patient or out-patient setting)
• DCD (5- 18 years, school-based setting)
• CP (out-patient or school)
• Peds Oncology (in-patient)
• ASD (6-18 years, school)
• Low tone/ DD (birth – 3 years, out-patient setting)
• CF or Cardiac issues (in-patient)
• MD/SMA (out-patient)

Course Instructions:

Timeline:

• Asynchronous lecture materials and resident assignment information will be available beginning on January 3, 2021. Participants will receive a link to access materials through the APTA Learning Center.
• Synchronous Meeting: Sunday February 21, 2021; 5p,-7pm EST. Zoom link will be provided to all participants.

Confidentiality Agreement:

• All registered participants are required to sign a confidentiality agreement, which requires participants to not distribute course material.
• Confidentiality agreements will be sent to your program. They should be signed by each participant and returned to Elena Bradley at bradleye@kennedykrieger.org.

Asynchronous Content:

• Participants should view the narrated lecture prior to the synchronous session on 2/21/21.
• All recorded video lectures can be found in the APTA Learning Center. The entire presentation has been divided into sections to create smaller files and also allow participants to pace their review in smaller sections.
• A handout is included with all of the slides from the presentation videos. Please respect Intellectual Property rules and do not distribute this handout. It is intended to be used only by your residency program.

Resident Assignment:

• Residents should review all 3 case examples provided in the APTA Learning Center and answer the corresponding questions prior to the synchronous session on 2/21/21.
• During the synchronous session on 2/21/21, residents will be separated into breakout rooms to discuss answers to 1 of the cases. Come prepared to participate in the discussion and then to share with the larger group.

Synchronous Session:

• The synchronous session is Sunday February 21, 2021; 5pm-7pm EST
• The platform is Zoom, so be sure to leave yourself some additional set up time if you need to download the free software.
• Stacey Caviston will be the meeting host.
• Please plan to have your video on during the entire session to facilitate interaction and discussion.
• Stacey Caviston will start with a brief overview of the asynchronous content, discuss a few important points, and answer any questions that residents have.
• Residents will be separated into breakout rooms to discuss answers to 1 of the cases. The course instructor will rotate between breakout rooms to answer questions and to help facilitate discussion.
• All participants will then come back together for a larger discussion of each of the 3 cases. Each group will present answers to their case, and residents and faculty from other groups are encouraged to add to the discussion.

Knowledge Translation Reflection:

• After the completion of the synchronous session, complete a Knowledge Translation Plan (see worksheet in APTA Learning Center) and discuss with your residency mentor(s).

Course Instructor: Stacey DiBiaso Caviston, PT, DPT, PCS

A PPT Journal course (Beyond the Read) - in Partnership with The Academy of Pediatric Physical Therapy.

This particular article, published in the April 2016 issue of the Journal of Pediatric Physical Therapy, details a randomized control trial conducted to assess the impact of a swimming intervention for children with cerebral palsy who were ambulatory (Gross Motor Classification System Levels I, II, and III).

A PPT Journal course (Beyond the Read) – in Partnership with The Academy of Pediatric Physical Therapy

This article, published in the April 2017 Pediatric Physical Therapy Journal, explores the utility of home videos taken by parents for using the AIMS to assess gross motor function compared to live observations.

This case report published in the PPT Journal (Beyond the Read) investigates the effect of an 8 week creative dance instruction on measures of postural control and balance in an 11 year old with spastic triplegic CP GMFCS Level II with recommendations for clinical practice and future studies.

This article, published in the March 2021 issue of the PPT Journal (Beyond the Read), used a retrospective cohort design to characterize the type of physical therapy intervention delivered in routine clinical care in a large sample of children with cerebral palsy. Comparative analyses were utilized to determine the effects of gross motor functional level, age, and medical diagnosis on attainment of outcomes.

This course was built in partnership with The Academy of Pediatric Physical Therapy.

This course will focus on the validation of clinical outcome tools for children with vestibular hypofunction and dosing of interventions to improve postural control and gaze stability in children with broad balance impairments and/or vestibular hypofunction. Intense interventions for children with cerebral palsy; oculomotor and vestibular function for individuals with concussion will be discussed.

This course was built in partnership with The Academy of Pediatric Physical Therapy.

This course will focus on the validation of clinical outcome tools for children with vestibular hypofunction and dosing of interventions to improve postural control and gaze stability in children with broad balance impairments and/or vestibular hypofunction. Intense interventions for children with cerebral palsy; oculomotor and vestibular function for individuals with concussion will be discussed.

This course was built in partnership with The Academy of Pediatric Physical Therapy.

Just like taking prescription medication requires a certain dose, exercise prescription for pediatric physical therapy may be enhanced by understanding appropriate components of dose. This course explores the role of early spontaneous to purposeful movements with a focus on the emergence of reaching to identify specific therapeutic targets in infants with risk factors for cerebral palsy such as neonatal stroke. Important techniques for behavioral and kinematic analysis are discussed. The dosing parameters of a parent-delivered home-based intervention program focusing on reach and grasp using principles of motor learning is presented for infants at risk for cerebral palsy. Using a path model for dosing, CIMT, bimanual training, and high intensity interventions are presented as options for dosing comparisons in infants and toddlers with cerebral palsy.

A PPT Journal course (Beyond the Read) – in Partnership with The Academy of Pediatric Physical Therapy

This article, published in Winter 2016 issue of the Pediatric Physical Therapy journal, is a single-subject, alternating design which compared the effect of two different playground environments on the documented physical activity of 5 children with ambulatory cerebral palsy over three sessions. Descriptive and objective comparative measures were used to document increased PA in 4 of 5 participants on the ADA-compliant playground. Other influencing factors are also discussed.

A PPT Journal course (Beyond the Read) – in Partnership with The Academy of Pediatric Physical Therapy.

This article, published in the January 2018 PPT journal, analyzes the impact of a modified ride-on car for 3 young children with significant motor disabilities on their self-directed mobility, visual attention, and perceived enjoyment while gathering info about the relationship of the location of driving experiences, training time, and other characteristics of ride-on car use.

Meet our Authors

Samuel W. Logan, PhD Dr. Logan joined the College of Public Health and Human Sciences at Oregon State University in 2014. He completed a two-year Post Doctoral Fellowship within the Pediatric Mobility Lab and Design Studio under the direction of Dr. Cole Galloway at the University of Delaware. His research agenda focuses on the self-directed mobility in the overall development of children who experience delays in mobility.

Karen Gage Bensley, PT, DPT, MS is a pediatric clinician, APPT board certified specialist in pediatric physical therapy (since 1994). She has provided pediatric services in private practice, early intervention, acute and outpatient settings (current), state neuromotor clinics, and school systems. She is core faculty on the NH-ME LEND (Leadership Education in Neurodevelopment Disabilities) grant, and has been adjunct faculty for the pediatric content courses at the entry-level DPT program at the University of New England. She currently is part of a pediatric rehab team in a community hospital in addition to her teaching & leadership activities. Dr. Bensley is active in state & regional APTA activities, currently serving as APPT Region IV Director.

This course is designed in partnership with the Academy of Pediatric Physical Therapy to educate participants in the importance of and necessity for an Annual Pediatric Physical Therapy Checkup as well as practical strategies for implementation into the framework of an existing practice. Therapist will learn how an Annual Pediatric Physical Therapy Checkup will improve their ability to enhance their patient’s wellbeing through a practical and preventative approach. Therapists will gain tangible strategies to advocate for their pediatric patients through a proactive approach focused on wellness.

Meet our Presenters

Cindy Miles, PT, PhD. PCS, CNDT established her pediatric private practice in 1981 after serving the pediatric population since 1977. Dr. Miles is a graduate of the University of Pittsburgh, School of Health Related Professionals, East Stroudsburg University with a Master of Education in exercise physiology and Rocky Mountain University of Health Professions with a PhD in Pediatric Science. Presently, she serves as President of the Academy of Pediatric Physical Therapy (APPT) and as Chair and Meeting Planner of the APPT Annual Conference. Dr. Miles presents nationally on pediatric private practice and reimbursement as well as nationally and internationally on Torticollis and Plagiocephaly, and Fitness for All Abilities. She has published in peer review journals and books on topics related to pediatric physical therapy.www.cindymiles.com or www.traintotriumph.com

Kellie S. Gossman PT, DPT, PCS is an Assistant Professor with the Division of Physical Therapy Education at the University of Nebraska Medical Center (UNMC) in Kearney, NE. Gossman received her Doctor of Physical Therapy in 2012 from UNMC and became a Board Certified Clinical Specialist in Pediatric Physical Therapy in 2018. Her clinical specialties include pediatrics, chronic health conditions, seating and mobility, lymphedema, women’s health and cancer rehabilitation.

Katherine Smith PT, DPT, PCS is an Assistant Professor of Kinesiology in the School of Health Science at Charleston Southern University in Charleston South Carolina. Smith earned her Master of Physical Therapy in 2002 from American International College in Springfield Massachusetts and her Doctorate of Physical Therapy in 2017 from the University of St. Augustine. Smith became a Board Certified Clinical Specialist in Pediatric Physical Therapy in 2014. Her clinical specialties include pediatrics and orthopedic physical therapy.

Rehabilitation strategies vary greatly due to differences in the dosing of interventions. These courses will explore the state of the science in dosing as it relates to children, with a focus on children with CP or brain injury. The speakers will place an emphasis on treatment strategies with established criteria for dosing and the use of a theoretical path model to guide treatment decisions and future clinical research related to dosing. Plasticity and recovery outcomes will guide the clinical utility of providing targeted interventions and applying the best available evidence.

There are 2 courses in this bundle:

1. Dosing and Rehabilitation: Balance and Vestibular Related Impairments (LMS-823)
2. Dosing and Rehabilitation: Upper Extremity and High Intensity Programs in Infancy (LMS-824)

This article, published in the Fall 2016 issue of the PPT Journal (Beyond the Read), used a prospective, multisite, longitudinal observational design to describe individualized outcomes of students receiving school-based physical therapy from 4 regions of the United States. Comparative analyses were utilized to determine the effects of gross motor functional level, age, and medical diagnosis on attainment of outcomes.

This course was built in partnership with The Academy of Pediatric Physical Therapy.

This session will explore the application of the ICF framework and dynamic systems theory to working with a student with a severe cognitive and physical disability. Current research findings will be applied to the domains of the ICF as they impact the school-based PT practice setting and student programming. A brief review of the International Classification of Function and the dynamic systems theory will be included. The shared research evidence of this course will focus on the detrimental outcomes of inactivity and immobility, as well as current findings in motor learning with task-oriented, participation-based intervention. Programming for functional motor skills development, based on a participatory framework, and suitable under IDEA, will be discussed. The rationale for physical therapy assessment and intervention will be interwoven throughout.

Meet our Presenters:

Susan (Sue) Cecere, PT, MHS, is the physical therapy instructional specialist for Prince George’s County Public Schools, a large, culturally diverse district in the Washington, DC, metropolitan area. A graduate of the University of Delaware physical therapy program, she also has a master’s degree in health science from Towson University and holds an administrative certificate in educational leadership from McDaniel College. Cecere has worked in school-based practice since 1994, both as a service provider and as a program administrator. For 10 years she was co-chair of the Maryland State Steering Committee for Occupational and Physical Therapy School-Based Programs, a Maryland State Department of Education subcommittee. She is a coauthor of Occupational and Physical Therapy Early Intervention and School-Based Services in Maryland: A Guide to Practice and several fact sheets for the Academy of Pediatric Physical Therapy. Cecere is a former vice president of the academy and an active member of the School-Based Physical Therapy Special Interest Group. Together with the American Speech-Language-Hearing Association and American Occupational Therapy Association, she wrote a joint document on workload and presented on the topic through a webinar for the IDEA Partnership.

Lori Potts, PT, works in private practice with Esopus Medical PC in pediatrics and orthopedics. She graduated from the physical therapy program of the Upstate Medical University College of Health Professions in Syracuse, New York. Potts is a certified MOVE International trainer, participating in MOVE training and education, and implementing MOVE principles with patients in physical therapist practice. Since 2005, Potts has been working with Rifton, consulting for product design and providing physical therapy resources for consumer and client education. She is a regular contributor to the Rifton Adaptive Mobility and Positioning blog and conducts equipment-related workshops throughout the United States, and in Canada, England, Germany, and Russia. She is a member of the APTA Academy of Pediatric Physical Therapy.

This article, published in the Jan 2017 PPT Journal (Beyond the Read), examines changes in motor functioning and activity performance and their longitudinal (1 year) relationships among youths with cerebral palsy, aged 9-16 years, stratified by GMFCS levels.

Meet the Authors

Chia-Hsieh Chang is director and associated professor of the Department of Pediatric Orthopedics, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan. He had fellowship training in duPont Hospital for Children, Delaware, USA in 2000 and has served for children's bone and joint disorders for 20 years. His research interests are gait disorders, hip displacement, and motor function in children and adolescent with cerebral palsy.

Ai-Wen Hwang, PhD, PT is Associate Professor at Graduate Institute of Early Intervention, Chang Gung University, Tao-Yuan, Taiwan. She has served at the child developmental center and child assessment center in Taiwan over 15 years. She is also one of the members of Task Force of Disability Eligibility System in Taiwan. Her research interests are early intervention, child environment and participation related research, ICF/ICF-CY, developing developmental screening test and measures, and the disability evaluation system in Taiwan.

Mats Granlund is full professor of psychology and disability science at Jönköping University and guest professor of Special Education at Oslo University. His main research area in the last 15 years is every day functioning, operationalized as participation, of children and youth in need of special support. In this area he has a long-standing collaboration with researchers from Taiwan, Australia, USA, Canada and South Africa. Mats has published extensively in this area. Current two main strands of research are the evaluation and further development of the ICF-CY classification and investigating two dimensions of participation being there, and engagement while being there. Activity competence with the components capacity, capability and performance is studied as a factor strongly influencing participation.

Karen Gage Bensley, PT, DPT, MS, PCS is a pediatric clinician, board certified specialist in pediatric physical therapy (since 1994). She has provided pediatric services in private practice, early intervention, acute and outpatient settings (current), state neuromotor clinics, and school systems. She is core faculty on the NH-ME LEND (Leadership Education in Neurodevelopment Disabilities) grant, and has been adjunct faculty for the pediatric content courses at the entry-level DPT program at the University of New England. She currently is part of a pediatric rehab team in a community hospital in addition to her teaching & leadership activities. Dr. Bensley is active in state & regional APTA activities.

A PPT Journal course (Beyond the Read) in Partnership with The Academy of Pediatric Physical Therapy.

This article, published in the July 2017 Pediatric Physical Therapy Journal, examines the differences of PT/OT service use and spending in children with developmental diagnoses (DX) and developmental delays (DD) that were enrolled in Colorado Medicaid.

This article, published in the April 2016 issue of the PPT Journal (Beyond the Read), provides normative reference data on school-age children using the timed floor to stand natural (TFTS-N). The TFTS-N focuses is a standardized test that was adapted from the timed floor to stand test and measures the time needed to complete the functional task of transitioning from sitting on the floor, walking a short distance at a natural pace, and returning to sitting on the floor.