The engagement of children and youth with disabilities, and their parents, in rehabilitation interventions is critical to the success of these therapies. A fully engaged client is actively invested in the intervention session. He or she is receptive to what is happening, shares thoughts and experiences and shows enthusiasm. She/he is also actively involved in a physical and behavioral sense. Client engagement has long been considered to enhance goal attainment and increase the cost-effectiveness of services; however, there are no measures of client engagement that have been created or validated for use in pediatric rehabilitation. Accordingly, research on the best ways of fostering engagement and its predictive value with respect to outcomes and costs has been hampered. Our comprehensive research program will (a) ascertain from children, youth, parents, and service providers the nature of child/youth/parent engagement in pediatric rehabilitation interventions, (b) result in reliable and valid measures of the engagement of children/youth and parents that will apply to any type of pediatric rehabilitation intervention, and then (c) examine the predictive utility of these measures with respect to child/youth outcomes. This practice-based research will inform and potentially change service providers’ views and practice with respect to understanding, measuring, and optimizing client engagement. Through use of engagement principles in the design and delivery of interventions, it has the potential to increase client satisfaction, enhance outcomes, and reduce service costs. Canadian Institutes of Health Research. The study is funded by the Canadian Institutes of Health Research and is being conducted through collaboration among: Holland Bloorview Kids’ Rehabilitation Hospital and Research Institute, Drexel University, University of Queensland, and George Washington University. Children’s hospitals, rehabilitation centers, and early intervention programs are partnering with our research team to assist with recruitment of participants and data collection.

• PRIME

The aims of this pilot study were to establish the feasibility, acceptability, and preliminary support for the effectiveness of participation-based outpatient pediatric rehabilitation using collaboration through smartphone technology to promote community recreational participation for children with physical disabilities. Six children with disabilities (4-10 years of age), their mothers, physical therapists, and 3 community recreational program leaders participated in the study. Therapists collaborated with mothers and children on an ecological assessment and development of an intervention plan focused on attaining a community recreational goal. Children received outpatient therapy services over a period of 2-4 months. During therapy, parents, children, and therapists viewed videos of the children participating in the community activity and collaboratively discussed and practiced strategies to optimize children’s participation. Three therapists collaborated with the community leaders and visited the community program. Fidelity of the intervention protocol varied across the cases. Outcome data was gathered for five cases. Improvements were documented in children’s physical performance and children had expected or higher than expected goal achievement. Children reported enjoying and learning “a lot” to “really a lot” from their community participation. Parents’ capacity for enabling participation was high pre-and post-intervention. Therapists, mothers, and community leaders provided positive feedback on the therapy approach. Participation-based physical therapy can be adapted for outpatient services and shows promise for positive outcomes in achieving community recreational goals. This approach is valued by therapists, mothers, children, and community leaders. However, further study is needed to determine what supports are needed to enable therapists to successfully implement the approach and how to fully engage parents and community leaders.

These three multisite projects contributed to our understanding of participation of children with cerebral palsy (CP) in home and community activities. The objective of the cross-sectional Children’ Activity and Participation Study (CAPS) was to identify the determinants of participation in leisure and recreational activities for children and youth with CP (2-21 years of age). Over 700 children and youth and their families participated in the study. The study was funded by Shriners Hospital for Children. The objective of the longitudinal Movement and Participation in Life Activities of Young Children (Move and PLAY) study was to identify the determinants of gross motor function, self-care performance, participation in daily life, and playfulness of young children with CP. Over 400 children with CP, 18 months-6 years of age, and their families participated in the study. The study was funded by the Canadian Institutes of Health Research (CIHR) and the US National Institute of Disability and Rehabilitation Research. Findings from both studies highlighted the role of children’s attributes, including adaptive behavior, and family ecology on children’s participation. The objective of the On Track study was to create longitudinal trajectories and reference percentile curves for body functions, health, self-care performance, and participation in family and recreational activities for children with CP, 18 months to 12 years of age. Over 600 children with CP and their families participated in the study. The purpose of the curves is to enable families of children with CP and health care providers to: 1) monitor a child’s development (developmental surveillance), 2) anticipate a child’s future strengths and needs (prognosis), and 3) proactively plan efficient services and supports to optimize a child’s health, function, education, social participation, and prevention of secondary impairments. This study was funded by CIHR and PCORI.

• Move and Play
• On Track

PT COUNTS: Relationships of school-based physical therapy with student outcomes

 

Physical therapy as a related service in schools contributes to the educational programming of students in the least restricted environment, enhancing students’ successful participation in school and community activities leading to further education, employment, and independence. PT COUNTS was a multisite, observational study involving over 100 physical therapists and 300 students, 5-12 years of age. The objective of the study was to examine the relationships among physical therapy services (delivery approaches, activities, and interventions) with student outcomes. Higher student outcomes on the School Function Assessment were associated with more mobility, motor learning, and playground access interventions and when students had higher engagement within the therapy session. More physical therapy service minutes in self-care activities and services on behalf of the students were associated with exceeding posture/mobility individualized goal expectations. Greater use of functional strength, mobility for playground access, and cognitive / behavioral interventions was associated with exceeding recreation / fitness individualized goal expectations. The findings from this study provide support for key physical therapy interventions associated with enhanced student outcomes. This study was funded by the U.S. Department of Education, Institute of Education Sciences and conducted through a collaboration among: University of Kentucky, Drexel University, University of Washington, and University of Oklahoma Health Sciences Center. Numerous schools and school systems have partnered with our research team to assist with subject recruitment and data collection.

• PT COUNTS