Paleg G, Pool D, Hidalgo-Robles Á
… +3 more, Frumberg D, Livingstone R, Damiano D
Pediatr Phys Ther
· 2026 Jan · PMID 40982705
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Dynamic Movement Intervention (DMI) and Cuevas Medek Exercises (CME) are promoted as innovative neurorehabilitation methods for children with neurological disabilities, yet both rely on outdated reflex-hierarchical model...Dynamic Movement Intervention (DMI) and Cuevas Medek Exercises (CME) are promoted as innovative neurorehabilitation methods for children with neurological disabilities, yet both rely on outdated reflex-hierarchical models rather than contemporary motor learning principles. A review of the literature reveals that CME, despite 5 decades of use, is supported only by a few case reports and 2 small, biased comparative studies. DMI, introduced in 2021, has no published empirical evidence beyond a single conference abstract. Thus, both interventions remain at Sackett Level 5-no evidence. The ethical implications are substantial. Families often pay thousands for intensive, noncovered therapies that may displace meaningful participation in education and social life. Therapists have a professional responsibility to avoid legitimizing unproven practices and to prioritize interventions supported by robust evidence. Pediatric rehabilitation should shift toward child-led, functional, and task-specific approaches grounded in modern motor learning science, with professional bodies and insurers withholding endorsement of nonevidence-based methods.
PURPOSE: The purpose of this case series was to explore the feasibility and impact of a 3-week activities-based locomotor training (AB-LT) program on functional activities and neurophysiological adaptations in 5 children...PURPOSE: The purpose of this case series was to explore the feasibility and impact of a 3-week activities-based locomotor training (AB-LT) program on functional activities and neurophysiological adaptations in 5 children with cerebral palsy (CP). METHODS: Children, aged 2-6 years who were classified as Gross Motor Function Classification Scale levels III or IV, participated in the intervention 5 days per week for 3 hours per day. The Gross Motor Function Measure-66 (GMFM-66) and functional near-infrared spectroscopy neuroimaging were performed pre- and post-intervention. RESULTS: After AB-LT, increases in GMFM-66 scores were observed for Children 1 (Δ3.3), 2 (Δ5.6), 4 (Δ1.8), and 5 (Δ1.3), beyond expected natural progression. A reduction in total hemoglobin activation and increased neural demand was observed. Child 3 had minimal functional changes with no observed neurophysiological adaptations. CONCLUSIONS: The 3-week AB-LT regimen is a short duration, high-intensity program with the potential to benefit children with CP.
PURPOSE: In accordance with the International Society of Scoliosis Orthopedics and Rehabilitation Treatment (SOSORT), conservative management, including exercise therapy, should be the first step to treat adolescent idio...PURPOSE: In accordance with the International Society of Scoliosis Orthopedics and Rehabilitation Treatment (SOSORT), conservative management, including exercise therapy, should be the first step to treat adolescent idiopathic scoliosis (AIS). For moderate scoliosis, bracing is often indicated in conjunction with exercise therapy to reduce curve progression. Surgical intervention is typically reserved for severe cases (Cobb angle > 45°-50°). While previous research has examined Physical therapy students' knowledge of AIS, limited research has focused on the knowledge and practices of practicing physical therapists. This study aimed to address this gap by assessing Brazilian physical therapists' knowledge and management of AIS. METHODS: This is a cross-sectional study, and we used an internet-based survey with questions about knowledge and management of AIS. We analyzed the responses in relation to the best available evidence on this topic. We recruited Brazilian registered physical therapists from different regions in Brazil. Participants' demographics and survey responses were analyzed using descriptive and inferential statistics. RESULTS: A total of 65 Brazilian physical therapists from the 5 regions of the country participated in the study. Physical therapists with specific training to treat scoliosis (STTS) were more assertive compared to physical therapists without STTS in indicating brace in AIS with angles between 26° and 45° ( P = .008) and in not indicating surgical evaluation between 26° and 46° Cobb angle ( P = .002). CONCLUSION: Brazilian physical therapists generally possess a good understanding of evidence-based AIS treatment approaches, aligning with SOSORT recommendations. Physical therapists with STTS demonstrated superior knowledge and practice patterns, suggesting that STTS is essential for optimal AIS management.
PURPOSE: The aim of this article is to characterize parents' use of containers and determine whether it relates to infants' development or body mass index (BMI). METHODS: A cross-section of parents with infants under 19 ...PURPOSE: The aim of this article is to characterize parents' use of containers and determine whether it relates to infants' development or body mass index (BMI). METHODS: A cross-section of parents with infants under 19 months completed a survey reporting their use of containers and infants' height and weight; parents also completed the Ages and Stages Questionnaire (ASQ-3). Descriptive and correlation analyses were used to describe parents' container use and evaluate whether container use was related to ASQ-3 scores or BMI. RESULTS: Parents reportedly used containers for 5.15 hours daily. More time reported in containers overall was associated with poorer fine motor scores. Longer bouts in positional pillows were associated with poorer gross motor development. CONCLUSION: Providing enhanced fine motor opportunities may be important for families using containers more often. Reported container use was higher than professionals typically recommend, yet did not relate to obesity or delayed development in most domains, an important consideration when updating recommendations for parents.
PURPOSE: To evaluate feasibility and effect of Enhanced Play Education (EPE) on development relative to Usual Play Education (UPE) for infants of varying abilities. EPE encouraged child-initiated movement, problem-solvin...PURPOSE: To evaluate feasibility and effect of Enhanced Play Education (EPE) on development relative to Usual Play Education (UPE) for infants of varying abilities. EPE encouraged child-initiated movement, problem-solving with objects, and responsive communication; UPE reflected popular education. METHODS: Participants were randomly assigned to the UPE or EPE group and received written, illustrated instructions to perform their play activities 15 minutes daily. Standardized developmental assessments occurred at baseline, after the 4-week intervention, and 1 and 2 months later. RESULTS: Forty-nine infants (M = 3.5 months; 35 with typical development; 14 at risk of developmental delays) and 44 parents were enrolled. Both interventions were feasible. Infants with typical development had greater cognitive and supine gross motor improvements after EPE; infants at risk had greater gross motor improvements after EPE. CONCLUSION: Educating parents to engage in quality play activities may be an effective method to advance early motor and cognitive outcomes for young infants.
PURPOSE: This study evaluated the accuracy of the Activity Measure for Post-Acute Care "6-Clicks" Inpatient Basic Mobility Short Form (AM-PAC BMSF) in predicting discharge outcomes in a pediatric acute care setting and i...PURPOSE: This study evaluated the accuracy of the Activity Measure for Post-Acute Care "6-Clicks" Inpatient Basic Mobility Short Form (AM-PAC BMSF) in predicting discharge outcomes in a pediatric acute care setting and identifying a cutoff score for outpatient physical therapy referrals. METHODS: A retrospective analysis included initial AM-PAC BMSF scores from 2014 children aged 4 to 17 years hospitalized for more than 72 hours. Receiver operating characteristic curve analysis assessed the tool's sensitivity and specificity in predicting postdischarge physical therapy referrals. RESULTS: Children referred to outpatient physical therapy had significantly lower initial AM-PAC BMSF scores. A raw score of 17 to 18 (49% impairment) was the optimal cutoff score for predicting outpatient physical therapy referrals. CONCLUSIONS: The AM-PAC BMSF, completed at the initial evaluation, can moderately predict the need for outpatient physical therapy following pediatric acute care discharge. A cutoff score of 18 may support more proactive and targeted discharge planning.
PURPOSE: To evaluate the effectiveness of hydrotherapy (HT) on pain and function in children with juvenile idiopathic arthritis (JIA). METHODS: Eligible studies were randomized clinical trials published in English, which...PURPOSE: To evaluate the effectiveness of hydrotherapy (HT) on pain and function in children with juvenile idiopathic arthritis (JIA). METHODS: Eligible studies were randomized clinical trials published in English, which recruited children with JIA and had 2 groups with 1 receiving HT alone and the other receiving a comparison/control intervention. Risk of bias was assessed using the Cochrane Risk of Bias 2. Overall quality of evidence was assessed with the Grading of Recommendations Assessments, Development, and Evaluation. Meta-analyses were performed for outcomes when possible. RESULTS: Meta-analyses comparing HT to standard care demonstrated statistically significant effects on pain and VO 2 max favoring HT. No significant differences were found for function (CHAQ), peak knee extensor torque, or 6-minute walk test. The overall level of evidence ranged from very low to moderate. CONCLUSIONS: Hydrotherapy improved VO 2 max and reduced pain in individuals with JIA compared to standard care.
PURPOSE: To introduce a clinical reasoning tool that helps clinicians and families collaboratively identify intervention components in pediatric rehabilitation. KEY POINTS: This special communication presents the F-words...PURPOSE: To introduce a clinical reasoning tool that helps clinicians and families collaboratively identify intervention components in pediatric rehabilitation. KEY POINTS: This special communication presents the F-words Lens Tool, designed to integrate the F-words for Child Development framework with the Rehabilitation Treatment Specification System to enhance clinical reasoning in pediatric rehabilitation. The tool supports families and clinicians in selecting and evaluating intervention components based on the child's goals. RECOMMENDATIONS: Clinicians should use the F-words Lens Tool to ensure interventions align with the child's functional goals and actively involve families in the clinical reasoning process.
PURPOSE: To determine the level of burnout and investigate the relationship between effort-reward imbalance and burnout among early intervention (EI) physical therapists. METHOD: Study participants included EI physical t...PURPOSE: To determine the level of burnout and investigate the relationship between effort-reward imbalance and burnout among early intervention (EI) physical therapists. METHOD: Study participants included EI physical therapists from 1 state within the United States. Participants completed an online survey that included demographic questions, the Oldenburg Burnout Inventory, and the Effort-Reward Imbalance Scale. Linear regression examined the relationship between effort-reward imbalance and burnout. RESULTS: A total of 127 participants were included. Effort, reward, and overcommitment explained 49% ( R2 = .490) of the variance in exhaustion ( F4,118 = 28.38; P < .001) and 29.7% of the variance in disengagement ( F4,118 = 12.48; P < .001) components of burnout. CONCLUSION: Physical therapists practicing in EI report high levels of emotional exhaustion, disengagement, and burnout. The results suggest that strategies to manage job demands, rewards, and overcommitment may help EI organizations decrease burnout among EI physical therapists.
PURPOSE: Determine the safety and effectiveness of hybrid serial casting (fiberglass and soft casting tape) to increase ankle dorsiflexion passive range of motion (ADF PROM) in children with idiopathic toe walking (ITW)....PURPOSE: Determine the safety and effectiveness of hybrid serial casting (fiberglass and soft casting tape) to increase ankle dorsiflexion passive range of motion (ADF PROM) in children with idiopathic toe walking (ITW). METHODS: A retrospective cohort study of 65 children with ITW undergoing ankle hybrid serial casting was completed. Casts were applied weekly until age-based ADF PROM was achieved. RESULTS: Children were casted an average of 3.8 weeks on the left leg and 3.1 weeks on the right. ADF PROM significantly improved from -0.3° (SD: 7.1) to 18.0° (SD: 5.6) on the left and 0.2° (SD: 8.7) to 18.4° (SD: 5.3) on the right. 5.0% of casts were removed early. Skin irritation caused a 1-week pause in casting in 6.2% of children. CONCLUSION: Hybrid serial casting may be a safe and effective method to improve ADF PROM for ITW and offers the advantage of removal without a cast saw.
PURPOSE: Low back and neck pain are increasing worldwide, even in children. However, Italy lacks validated tools for the assessment of children and adolescents with spine disorders. The Young Spine Questionnaire (YSQ) se...PURPOSE: Low back and neck pain are increasing worldwide, even in children. However, Italy lacks validated tools for the assessment of children and adolescents with spine disorders. The Young Spine Questionnaire (YSQ) seems to be an appropriate option. The aim of this study was to translate, adapt, and validate the YSQ to develop an Italian version of it. METHODS: One hundred thirty-three participants were recruited in the area of Trieste, aged between 9 and 12 years old. The YSQ and the KIDSCREEN-10 were assessed with regard to their reliability, test-retest reliability from 3 to 4 days, and construct validity. RESULTS: The mean age of the sample was 10.25 (±1.5), with a slight prevalence of females (62.7%). The internal consistency was high, with an alpha score ranging from 0.62 to 0.92 and a total score of 0.82. The test-retest showed good reproducibility. The total score of the YSQ showed a Spearman correlation coefficient of 0.87. For the dimensions and the items of the questionnaire, the scores ranged from 0.52 to 0.79. Construct validity showed a strong correlation between the questionnaires, with a score of 0.61. CONCLUSIONS: The YSQ seems to be a valid and reliable questionnaire to assess spinal pain in Italian children. According to the results of the psychometric proprieties, the use of this questionnaire is recommended.
Hoogveld LPG, van der Wees PJ, Akkermans RP
… +1 more, Janssen AJWM
Pediatr Phys Ther
· 2026 Jan · PMID 40924904
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PURPOSE: To investigate the responsiveness of the patient-reported outcome measure pediatric physical therapy (PROM-ppt), a questionnaire used to also stimulate shared decision making in Dutch pediatric physical therapy...PURPOSE: To investigate the responsiveness of the patient-reported outcome measure pediatric physical therapy (PROM-ppt), a questionnaire used to also stimulate shared decision making in Dutch pediatric physical therapy practices. METHODS: Children completed the PROM-ppt at intake and 3 months after intervention or post-intervention. Reported problems were categorized as motor or pain related goals for intervention. Responsiveness was examined to test the a priori hypotheses and area under the curve (AUC). The Global Perceived Effect scale was used for comparison. RESULTS: Overall, the hypotheses were confirmed in 60% of the cases with adequate AUCs. In children with motor problems, 80% of the hypotheses were matched, with adequate AUCs. In children with pain related problems, 40% of the hypotheses were matched, with inadequate AUCs. CONCLUSION: The PROM-ppt had moderate responsiveness in the pediatric population, good responsiveness in children with interventions for motor problems, and poor responsiveness to pain related problems.
PURPOSE: This case report describes the combined use of whole-body vibration (WBV), serial casting (SC), and physical therapy (PT) for a child with hemiplegic cerebral palsy (HCP). SUMMARY OF KEY POINTS: A 3-year 10-mont...PURPOSE: This case report describes the combined use of whole-body vibration (WBV), serial casting (SC), and physical therapy (PT) for a child with hemiplegic cerebral palsy (HCP). SUMMARY OF KEY POINTS: A 3-year 10-month-old male with HCP was followed for 10 months. Treatment included 9 weeks of SC due to ankle plantarflexion contracture, hypertonicity, poor orthotic tolerance, and gait limitations. WBV was introduced during week 4 to address hypertonicity and poor tolerance of manual therapy. PT sessions included stretching, gait training, and strengthening exercises, integrating SC and WBV into a comprehensive intervention. STATEMENT OF CONCLUSION AND RECOMMENDATIONS FOR CLINICAL PRACTICE: This is the first report to explore combining WBV and SC within a PT program. WBV was safe and effective, potentially serving as a preparatory activity for SC. Improved orthotic wear tolerance, dorsiflexion range of motion, and gait efficiency suggest potential benefits of this multimodal approach, warranting further research. UNLABELLED: Video Abstract: Supplemental digital content available at http://links.lww.com/PPT/A657 .
PURPOSE: Intensive pediatric physical therapy (PT) programs are increasingly common yet lack a clear definition. This study aimed to examine current practice patterns of intensive pediatric PT in the United States. METHO...PURPOSE: Intensive pediatric physical therapy (PT) programs are increasingly common yet lack a clear definition. This study aimed to examine current practice patterns of intensive pediatric PT in the United States. METHODS: A survey was developed and administered using the FITT (frequency, intensity, time, type) model and Knowledge to Action Cycle for pediatric physical therapists providing intensive PT. Survey respondents included pediatric physical therapists providing intensive physical therapy in outpatient, non-acute settings. Data analysis used descriptive statistics and cluster analysis. RESULTS: Eighty pediatric physical therapists reported intensive programs involved children aged 4-6 years with cerebral palsy (90%), neuromuscular (78%), and neuromotor (44%) disorders. Greatest dose often-always ranged from 2-5 visits per week, ≤60-120 minute sessions over 3-8 weeks. Top interventions included locomotor training (80%), task-specific training (78%), and progressive resistive exercise (76%). Two clusters were identified based on therapist organization and dose. CONCLUSIONS: This first study of intensive pediatric PT revealed marked variability, underscoring the need for a standardized definition to improve clinical care.
Pediatr Phys Ther
· 2025 Oct · PMID 40845311
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PURPOSE: To assess the concurrent validity of 2 wearable sensors, GENEActiv (GA) and MonBaby (MB), for tracking tummy time in full-term and preterm infants at home. METHODS: Nineteen full-term infants and 13 infants born...PURPOSE: To assess the concurrent validity of 2 wearable sensors, GENEActiv (GA) and MonBaby (MB), for tracking tummy time in full-term and preterm infants at home. METHODS: Nineteen full-term infants and 13 infants born preterm, aged 3 to 6 months, wore GA and MB sensors during caregivervideo-recorded active play at home over 3 days. Prone (tummy time) durations detected by each sensor were compared to video for validation. RESULTS: Both GA and MB sensors demonstrated excellent (κ = 0.86) and substantial (κ = 0.78) second-by-second agreement with video, respectively, for tracking tummy time. For cumulative tummy time, the GA showed higher accuracy with video (GA =60 minutes, video =58 minutes, difference =2 minutes) compared to MB (MB =43 minutes, video =47 minutes, difference =4 minutes). No differences in accuracy were found between the 2 sensors. CONCLUSION: Wearable sensors can accurately track tummy time at home and can support adherence to movement guidelines in infants. Establishing caregiver feasibility is crucial for broader use.
OBJECTIVE: The aim of the study is to compare the effects of telerehabilitation-based individual and group exercise, with routine treatment on exercise capacity,muscle strength,lung function,lower extremity explosive str...OBJECTIVE: The aim of the study is to compare the effects of telerehabilitation-based individual and group exercise, with routine treatment on exercise capacity,muscle strength,lung function,lower extremity explosive strength,balance,quality of life,and change in clinical status in people with cystic fibrosis (CF). METHOD: Eligible participants aged 8 to 18 years will be randomly allocated into 3 groups;a telerehabilitation-based indiviual or group exercise,and a control group. Exercise capacity,muscle and handgrip strength,spirometry measurements,lower extremity explosive strength,balance, quality of life will be assessed. Adherence rate to exercise programs will be calculated. Change in clinical status for all groups, motivation and enjoyment in the intervention groups will be assessed. DISCUSSION: Telerehabilitation-based exercise programs can minimize barriers to undertaking exercise in CF. If the current research demonstrates similar effects between group and individual telerehabilitation sessions,and better results compared with routine treatment,physical therapists can integrate group tele-exercises into CF centres. This approach may not only save time, but also enhances participant adherence to exercise programs, producing many overall benefits.
PURPOSE: This case report presents the successful management of an adolescent with headache, dizziness, vertigo, and unsteadiness using the International Classification of Headache Disorders, 3rd edition (ICHD-3) and Int...PURPOSE: This case report presents the successful management of an adolescent with headache, dizziness, vertigo, and unsteadiness using the International Classification of Headache Disorders, 3rd edition (ICHD-3) and International Classification of Vestibular Disorders (ICVD) diagnostic criteria to screen for vestibular migraine of childhood (VMC) and rule out other conditions with similar symptoms. The physical therapist (PT) (1) used the diagnostic criteria from the ICHD-3 and the ICVD to determine the etiology, (2) taught protective lifestyle behaviors to reduce migraine symptoms, and (3) modified 2 physical therapy clinical practice guidelines to direct treatment. KEY POINTS: The intervention prioritized adopting protective lifestyle behaviors to manage migraine symptoms before introducing exercises targeting vestibular and exertional intolerance symptoms. CONCLUSION AND RECOMMENDATIONS FOR CLINICAL PRACTICE: The diagnostic criteria helped inform the PT that the symptoms were consistent with VMC, which guided the intervention. Protective lifestyle behaviors and physical therapy strategies proved effective with symptom management.
PURPOSE: To explore the long-term impacts of an intensive physical therapy program, as perceived by caregivers and children. METHODS: Semi-structured interviews were completed with 7 caregivers and 1 child. The data from...PURPOSE: To explore the long-term impacts of an intensive physical therapy program, as perceived by caregivers and children. METHODS: Semi-structured interviews were completed with 7 caregivers and 1 child. The data from these interviews were analyzed by an interdisciplinary coding team comprised of 3 physical therapists and 2 psychologists. Rapid qualitative inquiry (RQI) was used, which relies on intensive teamwork, iterative data analysis, and triangulation from multiple sources to get insiders' perspectives. RESULTS: Interviewees had positive experiences in the Intensity Program which they believed led to long-term and positive impacts in physical, psychological, and social functioning. Even though the program was challenging, and certain parts of it could be improved, interviewees were pleased with it. CONCLUSIONS: Interviewees perceived that the benefits of intensive physical therapy may persist for over a year following the completion of such a program. Perceived benefits of participating in an intensive program seem to outweigh the challenges.
PURPOSE: This study analyzed evidence of the impact of physical therapy-directed early mobilization (EM) on hospital and pediatric intensive care (PICU) length of stay, and mechanical ventilation days. METHODS: PubMed an...PURPOSE: This study analyzed evidence of the impact of physical therapy-directed early mobilization (EM) on hospital and pediatric intensive care (PICU) length of stay, and mechanical ventilation days. METHODS: PubMed and CINAHL were searched through January 2023. Studies included non-neonates through 18 years who participated in an EM program led by a physical therapist. Effect sizes and risk ratios were analyzed. Evidence quality of studies was assessed. RESULTS: Six high-quality studies met the inclusion criteria. There was a statistically significant effect in the between-group analysis on hospital length of stay, PICU length of stay and mechanical ventilation days. CONCLUSIONS: This systematic review and meta-analysis support implementing EM in PICUs to reduce hospital and PICU length of stay, and mechanical ventilation days. This evidence can inform wider adoption of physical therapy-directed EM in PICUs to benefit infants and improve quality healthcare.
PURPOSE: The purpose of this study was to explore the experiences of pediatric physical therapists with the implementation and sustainability of pediatric intensive physical therapy (PT) programs in the United States. ME...PURPOSE: The purpose of this study was to explore the experiences of pediatric physical therapists with the implementation and sustainability of pediatric intensive physical therapy (PT) programs in the United States. METHODS: Data were collected from a 35-question survey consisting of multiple choice, Likert scale, and open-ended questions based on the Knowledge to Action Cycle Framework. Mixed methods were used in the data analysis of 2 quantitative questions relevant to implementing and sustaining pediatric intensive PT programs and 4 open-ended questions. RESULTS: The sample size for quantitative questions was 80 and varied from 29 to 50 for open-ended questions depending on the question. IDENTIFIED OVERARCHING THEMES INCLUDED: Clinicians value intensive programs; "Logistically tough," and Programs require 3 "Fs" for implementation and sustainability - Funding, Flexibility, and Foundational Knowledge. CONCLUSIONS: Pediatric physical therapists value intensive programs. Identified areas for support included formal training, improved research evidence, and institutional support.