Department of Physical TherapyPediatric Rehabilitation

2014-2015

Information compiled from:

Atinkson HA, Nixon-Cave, K. A tool for clinical reasoning and reflection using the International Classification of Functioning, Dis-ability and Health (ICF) framework and patient management model. Phys Ther 2011;91:416-430.

Epstein R, Siegel DJ, Silberman J. Self monitoring in clinical practice: A challenge for medical educators. J Con Ed Health Prof. 2008;28(1):5-13.

Escorpizo R, Stucki G, et al. Creating an interface between the International Classification of Functioning, Disability, and Health and physical therapist practice. Phys Ther. 2010;90:1053-63.

Guide to Physical Therapist Practice.American Physical Therapy Association, 2nd ed. Phys Ther 2001;81:9-746.

Kenyon LK. The hypothesis-oriented pediatric focused algorithm: A framework for clinical reasoning in pediatric physical therapist practice. Phys Ther. 2013;95(3):413-420. Permission granted via email 3.15.15

Palisano RJ. A collaborative model of service delivery for children with movement disorders: A framework for evidence based deci-sion-making. Phys Ther. 2006;86:1295-1305.

Schenkman M, Deutsch JE, Gill-Body KM. An integrated framework for decision-making in neurologic physical therapist practice. Phys Ther. 2006;86:1681-1702.

World Health Organization (WHO). (2007). International Classification of functioning, disability, and health-children and youth (ICF-CY). Geneva: World Health Organization.

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Step 1: Pre-Examination PlanningChild’s Name: Diagnosis:

Age:

Examination Component Plan

What is a typically developing child able to do at this age? • GM• FM• Cognitive• Social-Emotional• Expressive Language• Adaptive Skills

Given the diagnosis, define it & list (expected) im-pairments:

History/intake questions considered? (pregnancy, birth/Apgar, PMHx, PSHx, milestones, first noticed concerns, educational needs, temperament, etc.)

Based on the age, environment, and possible impair-ments, what is your choice of standardized test?

What GM/mobility concerns arise given the child’s environment: home, preschool, primary school, ju-nior high, high school?

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Pediatric Physical Therapy ExaminationChild’s Name: Date:

Diagnosis: Age:

History/Interview data:

Systems Review • Cardio-pulmonary • Integumentary• Musculoskeletal• Neuromuscular *

Standardized Tests used with Rationale?

Modified Ashworth Scale; Muscle Tone (quality, symmetry, distribution)

Functional Skills: positions & transitions• Supine sit• Rolling: log or segmental?• Sitting (ring, short, side-sit, prop?)• Quadruped (to/from sit, kneel)• Kneel (1/2 kneel)• Stand (plantigrade, hi/low guard)

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Muscle Strength /Functional Strength

Balance/postural control/protective reactions

ROM (if limited)

Quality of Movement• Blocks?• Pattern of weight bearing• Movement patterns; variety?• Use of compensatory strategies• Symmetry vs Asymmetry• Grading of movement• Motor planning • Sensory processing skills

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Observational Gait Assessment: (Sag. Plane)• Initial contact (heel rocker/ df)• Loading (heel rocker)• Mid Stance (tibia approaches vertical;

knee flexion wave; ankle rocker controls forward progression of body; eccentric tri-ceps surae)

• Terminal Stance (heel rise)

• Pre-Swing (unloading; pf; extends ground contact via gastroc to maximize the GRF for swing prep)

• Initial Swing (foot clearance; hemi-pelvis rotates in transverse plane extends stride length)

• Mid-Swing (foot clears; limb advances; ipsi-lateral pelvic drop; contra-lateral ec-centric glut med)

• Terminal Swing (deceleration; knee ext.)

Evaluation/Diagnosis/PrognosisWhat is the PT Diagnosis & Prognosis?

What are the Child’s Strengths?

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What are the physical ther-apy problem areas?

Impairments (systems) Functional Limitations Participation Restrictions

List Environmental Con-cerns:

Community/School Personal

Are referrals to other pro-fessionals indicated?

Develop a POC: Goal #1: Intervention Focus:

Goal #2:Intervention Focus:

Frequency & duration proposed:

Discharge Conditions:

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Planning a Pediatric Intervention EncounterChild’s Name: Date:Diagnosis: Age:

Intervention Component Plan

What specific motor activities are in-dicated for this specific child and family?

What environmental factors or set up will optimize intervention and meet the needs of this child?

Are there any basic safety issues, pre-cautions, or movements to minimize?

How can you build upon this child’s strengths to assist in achieving the goal(s)?

What specific motivational and play strategies are best to use with this child (personal factors)?

Education plan: What strategies will be best to help achieve therapeutic carryover for this specific child and optimize participation?

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Intervention Plan Child:____________________Date:______Functional Goal # ___:_________________________________

Intervention Details/Plan

What are the components of the task outlined in this goal? Circle elements missing for the child.

Does it require stability, mobility, strength (in what muscle groups) co-ordination, balance?

Is it a discrete or continuous task; an open or closed task?

What type of practice is best?Type of feedback: KP, KR, frequent, concurrent?

What are the demands of the envi-ronment?

Impairment Intervention Activity Motivational or Play Strategy

Incr. or Decr Challenge

Parent/Teacher/Team Teaching & Carryover (HEP)

1.

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2.

3.

Reflection & Self AssessmentWhat went well? Was your intervention skilled? Was your intervention effective?

What skill do you hypothesize the child will be able to do next ?

What will you do differently next time?

What communication strategies worked best?

Did the intervention you selected support or negate your hypothesis?

What is your assessment of this family’s knowl-edge and understanding of the child’s diagno-sis?

How might your personal biases/assumptions affect the interview, interactions with the child, goal setting or intervention planning?

What data might you have overlooked?

What inner experiences did you notice

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(thoughts & emotions) during this encounter?

What are you curious about regarding this en-counter?

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