- Email: [email protected]
Sensorimotor training to affect balance, engagement, and learning for children with fetal alcohol spectrum disorders
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237
(reference lists of PFMT systematic reviews) was undertaken to identify English language publications reporting the use of a health behaviour theory to underpin the planning and/or delivery of a PFMT programme with the intent of promoting PFMT adherence. Results: From 13 studies that reported the use of health behaviour theory to promote or understand PFMT adherence five models were identified. These were: The Health Belief Model (4 studies); Theory of Planned Behaviour (one study); Social Cognitive Theory (SCT) (6 studies); the Transtheoretical Model and Self-regulatory model (used conjointly in two studies by the same author). Self-efficacy (a major component of SCT) was the most studied determinant of adherence and was found to be important in the prediction of adherence, and in the short and long term, behavioural changes required to undertake PFMT in peri-partum women and those with SUI (all ages). The Health Belief Model primarily focused on the person’s ability to assess the benefits and disadvantages of undertaking the exercises with studies again focussing on the peri-partum period with one recruiting women from primary care. The Theory of planned Behaviour describes the intention to behave in a certain way in order to overcome a perceived threat, e.g. intention to undertake PFM exercises pre and post-delivery to prevent UI. Other authors used the Transtheoretical Model and Self-regulatory model to assess and develop a health education programme and protocol checklist for undertaking PFM exercise for women with stress and or urge UI. Conclusion(s): This is the first review on the use of Behavioural Theories to support interventions to improve adherence to PFMT. Evidence is limited, but the findings would suggest that self-efficacy (SCT) is important in long and short term effectiveness. A better theoretically-based understanding of interventions to promote PFMT adherence needs to be developed. The work to date has primarily focussed on the peri-partum period but future work should focus on variables e.g. age, type of UI. Implications: Existing health behaviour theories show some promise in planning PFMT programme content and delivery. Clinicians should be encouraged to use skills to enhance self-efficacy for PFMT. In research more attention is needed in reporting the theoretical underpinning of interventions intended to promote adherence and developing robust measures of adherence. Keywords: Pelviic floor muscle training; Adherence; Behavioural therapies Funding acknowledgements: The International Continence Society provided a fund for the initial state of the art seminar attended by relevant experts. Ethics approval: Ethical approval was not required. http://dx.doi.org/10.1016/j.physio.2015.03.1827
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Research Report Platform Rapid 5 Presentation Number: RR-PLR5-2712 Sunday 3 May 2015 16:00 Room 324–326 SENSORIMOTOR TRAINING TO AFFECT BALANCE, ENGAGEMENT, AND LEARNING FOR CHILDREN WITH FETAL ALCOHOL SPECTRUM DISORDERS S.W. McCoy, L.-Y. Hsu, T. Jirikowic, R. Price, M. Ciol, D. Kartin University of Washington, Rehabilitation Medicine, Seattle, USA Background: Time, geography and costs pose challenges to completing individualized, intensive pediatric rehabilitation interventions. Virtual reality (VR), gaming and teletherapy technologies, as appropriate home delivery methods of intensive rehabilitation for children with disabilities, are now possible. There is, however, minimal evidence to support these interventions. Sensorimotor Training to Affect Balance, Engagement and Learning (STABEL) is a novel VR system designed to improve the ability to use specific sensory information during balance. STABEL combines VR goggles and a compliant standing surface to control the visual display and support surface during a game involving standing balance. With access to the Internet, therapists can monitor game play and adjust practice difficulty. Purpose: We examined the effects of STABEL on functional balance, motor abilities and sensory attention during standing balance in children with fetal alcohol spectrum disorder (FASD) who had motor coordination concerns. We expected that children would improve their balance ability after STABEL intervention. Methods: Twenty children with FASD, 7-14 year-old (13 in STABEL group; 7 in no treatment control group) participated. All children were tested pre- and post- STABEL or control conditions with three clinical assessments (1) Movement Assessment Battery for Children-2nd edition (MABC-2), a standardized test with three motor composite scores: manual dexterity, aiming and catching, and balance, (2) Pediatric Clinical Test of Sensory Interaction for Balance-2 (P-CTSIB-2), a test of standing balance under altered sensory conditions, and (3) Dynamic Gait Index (DGI), a test of gait under varied sensory conditions. The STABEL group was asked to complete 5 sessions (250 total minutes) in the lab or home over one month. Within STABEL sessions, children moved their bodies to drive a virtual plane through hoops while the visual background and stability of the surface were manipulated. Visual (black surround versus flowing stars) and support surface
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237
(firm versus compliant foam) conditions during the game were varied within each session. Children were asked to report their impressions of playing the game. Mixed repeated measure ANOVAs were used to compare scores pre to post and between STABEL and control groups. Results: Children in the STABEL group completed a mean of 205 minutes (SD = 32.5) of intervention. The majority of the STABEL group (11/13) reported that the intervention was very fun. There were significant interactions as follows: compared to the control group, children in the STABEL group showed increases in their MABC-2 Balance Composite scale scores (P = 0.04) and MABC-2 Total Motor Scores (P = 0.01) after STABEL training. Children in the STABEL group also showed better post-test P-CTSIB2 total scores (P = 0.07). However, there was no difference in DGI scores either between groups or pre-post sessions (P = 0.30). Conclusion(s): Children who received the STABEL found it acceptable and fun and demonstrated greater improvement in balance and motor skill than a control group. The DGI may not be sensitive enough to show change in these children. Implications: The STABEL intervention may be an appropriate intervention that can be employed in rural areas to improve motor ability. Further research within larger sample sizes of children with balance disorders is warranted. Keywords: Balance training; Virtual reality; Gaming Funding acknowledgements: The National Institute on Alcohol Abuse and Alcoholism, award number R21AA019579, funded this project. Ethics approval: The study was approved by the University of Washington Institutional Review Board for use of humans within research. http://dx.doi.org/10.1016/j.physio.2015.03.1828 Research Report Poster Presentation Number: RR-PO-17-10-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 RELATIONSHIP OF SCHOOL-BASED PHYSICAL THERAPY TO OUTCOMES FOR CHILDREN WITH DISABILITIES IN THE UNITED STATES S.W. McCoy 1 , S. Effgen 2 , L. Chiarello 3 , L. Jeffries 4 , H. Bush 2 1 University
of Washington, Rehabilitation Medicine, Seattle, USA; 2 University of Kentucky, Lexington, USA; 3 Drexel University, Philadelphia, USA; 4 University of Oklahoma Health Sciences Center, Oklahoma City, USA Background: Children receive physical therapy (PT) services within schools to support their educational programs in
the United States (US) and other countries. Minimal evidence supports school-based PT. Purpose: We examined relationships of school-based PT to individual change using Goal Attainment Scaling (GAS) and standardized change using the School Function Assessment (SFA). We hypothesized that service amount and type, activity focus, and interventions used would predict GAS and SFA outcomes. Knowing relationships between student outcomes and PT should influence practice, research, and professional development worldwide. Methods: Our prospective, multi-site observational study, PT related Child Outcomes in the Schools (PT COUNTS), of school-based PT was completed across 4 US regions, involving 111 physical therapists and a random sample of 296 of their 5 to 12 year-old students who received PT at least monthly. Diagnoses varied with 39% at Gross Motor Function Classification System (GMFCS) Level I, 39% Level II/III and 22% Level IV/V. Physical therapists tested students early in the 2012-2013 school year and again at year-end. After pre-testing, PT services were reported weekly for 6 months using the School-Physical Therapy Interventions for Pediatrics system including data on amount of PT, activities and interventions used, types of service delivery, and amount/type of service on behalf of the students (services without students present). Researchers categorized GAS goals (posture/mobility, self-care, recreation/fitness, academics) and physical therapists identified their primary goal. Primary goal GAS scores were dichotomized into scores ≥1 (n = 119) and < 1 (n = 105). SFA scores for the Participation, Travel, Maintaining/Changing Positions, Recreational Movement, and Manipulation with Movement sections were categorized into standardized change scores of <−5 (n = 9–14), −5 to 5 (n = 151–157), and >5 (n = 123–134). Group comparisons and logistic regression were used to examine relationships of services to outcomes. Results: Primary GAS goals were predominantly posture/mobility (58%). Comparison of GAS groups for the primary goals showed significant differences for recreation activities (p = 0.04) and service minutes on behalf of the student (p = 0.04). Regression analyses showed age, severity, and minutes on behalf of the student predicted higher GAS scores. Students who were younger and had lower GMFCS ratings showed greater change on SFA. Regression analysis revealed significant (p < 0.05) predictors of SFA as: more use of mobility assistance, motor learning, aerobic conditioning, ongoing assessment, balance, strengthening, mobility interventions such as hall/stairs/door training interventions, and higher engagement by students within therapy sessions. Conclusion(s): Age and functional level were related to both GAS and SFA outcomes. Students who improved the most on GAS received more recreation activity and services on behalf of the student (consultation, documentation). Students who improved most on the SFA had more time spent on active practice that facilitated mobility in the school environment and higher student engagement in therapy sessions.
(reference lists of PFMT systematic reviews) was undertaken to identify English language publications reporting the use of a health behaviour theory to underpin the planning and/or delivery of a PFMT programme with the intent of promoting PFMT adherence. Results: From 13 studies that reported the use of health behaviour theory to promote or understand PFMT adherence five models were identified. These were: The Health Belief Model (4 studies); Theory of Planned Behaviour (one study); Social Cognitive Theory (SCT) (6 studies); the Transtheoretical Model and Self-regulatory model (used conjointly in two studies by the same author). Self-efficacy (a major component of SCT) was the most studied determinant of adherence and was found to be important in the prediction of adherence, and in the short and long term, behavioural changes required to undertake PFMT in peri-partum women and those with SUI (all ages). The Health Belief Model primarily focused on the person’s ability to assess the benefits and disadvantages of undertaking the exercises with studies again focussing on the peri-partum period with one recruiting women from primary care. The Theory of planned Behaviour describes the intention to behave in a certain way in order to overcome a perceived threat, e.g. intention to undertake PFM exercises pre and post-delivery to prevent UI. Other authors used the Transtheoretical Model and Self-regulatory model to assess and develop a health education programme and protocol checklist for undertaking PFM exercise for women with stress and or urge UI. Conclusion(s): This is the first review on the use of Behavioural Theories to support interventions to improve adherence to PFMT. Evidence is limited, but the findings would suggest that self-efficacy (SCT) is important in long and short term effectiveness. A better theoretically-based understanding of interventions to promote PFMT adherence needs to be developed. The work to date has primarily focussed on the peri-partum period but future work should focus on variables e.g. age, type of UI. Implications: Existing health behaviour theories show some promise in planning PFMT programme content and delivery. Clinicians should be encouraged to use skills to enhance self-efficacy for PFMT. In research more attention is needed in reporting the theoretical underpinning of interventions intended to promote adherence and developing robust measures of adherence. Keywords: Pelviic floor muscle training; Adherence; Behavioural therapies Funding acknowledgements: The International Continence Society provided a fund for the initial state of the art seminar attended by relevant experts. Ethics approval: Ethical approval was not required. http://dx.doi.org/10.1016/j.physio.2015.03.1827
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Research Report Platform Rapid 5 Presentation Number: RR-PLR5-2712 Sunday 3 May 2015 16:00 Room 324–326 SENSORIMOTOR TRAINING TO AFFECT BALANCE, ENGAGEMENT, AND LEARNING FOR CHILDREN WITH FETAL ALCOHOL SPECTRUM DISORDERS S.W. McCoy, L.-Y. Hsu, T. Jirikowic, R. Price, M. Ciol, D. Kartin University of Washington, Rehabilitation Medicine, Seattle, USA Background: Time, geography and costs pose challenges to completing individualized, intensive pediatric rehabilitation interventions. Virtual reality (VR), gaming and teletherapy technologies, as appropriate home delivery methods of intensive rehabilitation for children with disabilities, are now possible. There is, however, minimal evidence to support these interventions. Sensorimotor Training to Affect Balance, Engagement and Learning (STABEL) is a novel VR system designed to improve the ability to use specific sensory information during balance. STABEL combines VR goggles and a compliant standing surface to control the visual display and support surface during a game involving standing balance. With access to the Internet, therapists can monitor game play and adjust practice difficulty. Purpose: We examined the effects of STABEL on functional balance, motor abilities and sensory attention during standing balance in children with fetal alcohol spectrum disorder (FASD) who had motor coordination concerns. We expected that children would improve their balance ability after STABEL intervention. Methods: Twenty children with FASD, 7-14 year-old (13 in STABEL group; 7 in no treatment control group) participated. All children were tested pre- and post- STABEL or control conditions with three clinical assessments (1) Movement Assessment Battery for Children-2nd edition (MABC-2), a standardized test with three motor composite scores: manual dexterity, aiming and catching, and balance, (2) Pediatric Clinical Test of Sensory Interaction for Balance-2 (P-CTSIB-2), a test of standing balance under altered sensory conditions, and (3) Dynamic Gait Index (DGI), a test of gait under varied sensory conditions. The STABEL group was asked to complete 5 sessions (250 total minutes) in the lab or home over one month. Within STABEL sessions, children moved their bodies to drive a virtual plane through hoops while the visual background and stability of the surface were manipulated. Visual (black surround versus flowing stars) and support surface
eS972
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237
(firm versus compliant foam) conditions during the game were varied within each session. Children were asked to report their impressions of playing the game. Mixed repeated measure ANOVAs were used to compare scores pre to post and between STABEL and control groups. Results: Children in the STABEL group completed a mean of 205 minutes (SD = 32.5) of intervention. The majority of the STABEL group (11/13) reported that the intervention was very fun. There were significant interactions as follows: compared to the control group, children in the STABEL group showed increases in their MABC-2 Balance Composite scale scores (P = 0.04) and MABC-2 Total Motor Scores (P = 0.01) after STABEL training. Children in the STABEL group also showed better post-test P-CTSIB2 total scores (P = 0.07). However, there was no difference in DGI scores either between groups or pre-post sessions (P = 0.30). Conclusion(s): Children who received the STABEL found it acceptable and fun and demonstrated greater improvement in balance and motor skill than a control group. The DGI may not be sensitive enough to show change in these children. Implications: The STABEL intervention may be an appropriate intervention that can be employed in rural areas to improve motor ability. Further research within larger sample sizes of children with balance disorders is warranted. Keywords: Balance training; Virtual reality; Gaming Funding acknowledgements: The National Institute on Alcohol Abuse and Alcoholism, award number R21AA019579, funded this project. Ethics approval: The study was approved by the University of Washington Institutional Review Board for use of humans within research. http://dx.doi.org/10.1016/j.physio.2015.03.1828 Research Report Poster Presentation Number: RR-PO-17-10-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 RELATIONSHIP OF SCHOOL-BASED PHYSICAL THERAPY TO OUTCOMES FOR CHILDREN WITH DISABILITIES IN THE UNITED STATES S.W. McCoy 1 , S. Effgen 2 , L. Chiarello 3 , L. Jeffries 4 , H. Bush 2 1 University
of Washington, Rehabilitation Medicine, Seattle, USA; 2 University of Kentucky, Lexington, USA; 3 Drexel University, Philadelphia, USA; 4 University of Oklahoma Health Sciences Center, Oklahoma City, USA Background: Children receive physical therapy (PT) services within schools to support their educational programs in
the United States (US) and other countries. Minimal evidence supports school-based PT. Purpose: We examined relationships of school-based PT to individual change using Goal Attainment Scaling (GAS) and standardized change using the School Function Assessment (SFA). We hypothesized that service amount and type, activity focus, and interventions used would predict GAS and SFA outcomes. Knowing relationships between student outcomes and PT should influence practice, research, and professional development worldwide. Methods: Our prospective, multi-site observational study, PT related Child Outcomes in the Schools (PT COUNTS), of school-based PT was completed across 4 US regions, involving 111 physical therapists and a random sample of 296 of their 5 to 12 year-old students who received PT at least monthly. Diagnoses varied with 39% at Gross Motor Function Classification System (GMFCS) Level I, 39% Level II/III and 22% Level IV/V. Physical therapists tested students early in the 2012-2013 school year and again at year-end. After pre-testing, PT services were reported weekly for 6 months using the School-Physical Therapy Interventions for Pediatrics system including data on amount of PT, activities and interventions used, types of service delivery, and amount/type of service on behalf of the students (services without students present). Researchers categorized GAS goals (posture/mobility, self-care, recreation/fitness, academics) and physical therapists identified their primary goal. Primary goal GAS scores were dichotomized into scores ≥1 (n = 119) and < 1 (n = 105). SFA scores for the Participation, Travel, Maintaining/Changing Positions, Recreational Movement, and Manipulation with Movement sections were categorized into standardized change scores of <−5 (n = 9–14), −5 to 5 (n = 151–157), and >5 (n = 123–134). Group comparisons and logistic regression were used to examine relationships of services to outcomes. Results: Primary GAS goals were predominantly posture/mobility (58%). Comparison of GAS groups for the primary goals showed significant differences for recreation activities (p = 0.04) and service minutes on behalf of the student (p = 0.04). Regression analyses showed age, severity, and minutes on behalf of the student predicted higher GAS scores. Students who were younger and had lower GMFCS ratings showed greater change on SFA. Regression analysis revealed significant (p < 0.05) predictors of SFA as: more use of mobility assistance, motor learning, aerobic conditioning, ongoing assessment, balance, strengthening, mobility interventions such as hall/stairs/door training interventions, and higher engagement by students within therapy sessions. Conclusion(s): Age and functional level were related to both GAS and SFA outcomes. Students who improved the most on GAS received more recreation activity and services on behalf of the student (consultation, documentation). Students who improved most on the SFA had more time spent on active practice that facilitated mobility in the school environment and higher student engagement in therapy sessions.