OACRS Best Practice - Physiotherapy Intervention in School for Ambulatory School Age Children with Developmental Delay

Last modified by Support on 2012/03/01 11:09

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Contact(s)/Date(s):

Audrey Zambon-Farrant, PT

ErinoakKids

azambon-farrant@erinoakkids.ca

(905) 315-6618

Goal:

  • To provide a framework for assessment and intervention
  • focus on client safety, mobility and integration
  • maximize participation in the school curriculum and school community

Definition:     

  • characterized by significantly sub average intelligence (C2,C3)14
  • mild to moderate gross motor delay
  • limitations in coordination, postural control, balance and endurance
  • typically able to walk independently (P1)14
  • conditions such as Down Syndrome and Global Developmental Delay would fit into this definition.
Measurement of Change (Assessment or Outcome Tools):

Assessment/Outcome tools used by Physiotherapists for children with Developmental Delay:

1. Outcome Tools:

  1. Observation: based on areas found in standardized assessments because the assessments themselves are not sensitive enough for the information that therapists want to measure or not appropriate for this population.
  2. Checklist developed by individual centres: function-oriented; modified from standardized assessments
  3. GOALS:
    • CCAC Outcome Evaluation Tool (OET)
    • Goal Attainment Scale (GAS)
    • Items from standardized assessments or observation formatted into OET, GAS which can be used to guide intervention and assess progress.

2. Assessments that contribute to above:

1.   Impairment Assessments:

  • Orthopaedic Concerns (orthotics, posture, tone and endurance)
  • Balance and Coordination
    • Paediatric Berg Balance Scale

2.  Functional/Activity Assessments/Tools:

  • GMFM (last 2 dimensions)
  • Movement ABC
  • School Functional Assessment
  • Peabody Developmental Scales or PDMS-2

3.  Environmental Assessments:

  • Observation
    • Gym participation
    • Access school environment(playground, bus, school trips)
    • Safety (stairs, playground)
Supporting Information:

1. Evidence Based Research:

  1. Literature search for school-based intervention was inconclusive for this population
  2. A review of the current literature was completed and revealed the following general themes for preschool intervention:
    • Children with developmental delay have greater success in their physiotherapy treatments when parental involvement is at its highest. 1,2,3,4,5, 6,7,8
    • Parents consider their child’s therapeutic programs as more beneficial when they are actively involved in the program. 1,2,6,8,9

2. Clinical Expertise

  1. Round table discussion with ErinoakKids School Age physiotherapists
  2. Consultation with Ann MacPhail, faculty of Health Sciences, University of Western Ontario, formerly of Thames Valley Treatment Centre, London, ON.
  3. Survey Monkey titled “ Best Practice Physiotherapy Guideline for Ambulatory, School Aged Children with Developmental Delay” sent to all Children Treatment Centres, fall 2007
  4. Round table discussion at OACRS conference 2007
  5. Additional questionnaire sent to CTCs with SHSS and follow-up clarification of certain questions

3. Family/Client Values

  1. Family input through review of goals and concerns: participation in family; school; community activities; safety and independence.
Intervention Protocols or Process Tools:

Therapists determine model and frequency of service each child receives. These decisions are influenced by CCAC guidelines and limitations

During times of transition, environmental or physical change there maybe a need for increased service

1. Models of service delivery:

  1. Infrequent but regular PT visits for consultation services. Discharge after discharge criteria met.
  2. Block treatment to address certain concerns, followed by consultation
  3. Refer to other disciplines/clinics/therapeutic, community programs

2. Frequency of visits/year:

  1. Primarily 1-4 visits sometimes up to 6 visits per year
  2. Variable and dependent upon
  • severity of physical limitations
  • safety concerns
  • change in physical status

May also depend upon:

  • parental/teacher/child concerns
  • age of child

3. Age of child:

  1. 4-5 years most commonly seen in Centre
  2. 6-9 years most commonly seen in school
  3. If there are safety issues the 4-5 age group would come on to school care earlier

4. Parental Contact:

  1. Telephone contact
  2. Face to face
  3. Items commonly discussed with parents:
    • assessment
    • exercise program
    • appropriate community programs
    • foot orthotics/appropriate footwear
    • adaptation of equipment (bikes, chairs)
    • community mobility devices
    • referral to Rec Therapist, orthopaedic/ medical clinic, Social Work/Family Support Services (FSS)
Discharge Criteria:

Discharge may be considered when one or more of the following conditions are present:

1. Current therapy goals have been achieved plus:

  1. Optimal level of functioning has been achieved given circumstances e.g. physical and developmental limitations
  2. Safety concerns have been addressed
  3. Recommendations have been provided related to community programs
  4. Referral to transitions coordinator

2. Situation is not amenable to intervention:

  1. motivation of family/child/school in achieving goals
  2. limited potential for actual change
  3. behavioural issues preventing progress

3. Minimal or no measurable change over a set period of time was achieved since the onset of intervention.

4. Parent, guardian or client declines further therapy

CCAC criteria may affect discharge planning.

Re-referral:     Does not occur often

 Reasons:

  1. Safety
  2. Equipment needs
  3. Integration/participation in gym

Checklist of goals     (see addendum 1)

Clinical pathway (see addendum 2)

Next Steps:

1. Dissemination of information to ErinoakKids school care physiotherapists

2. Send Guideline to OACRS BPC

3. Final presentation at OACRS conference 2008 as part of the Best Practise Working Group Presentation

References:

1 Iversen S et al. Intervention for 6-year-old children with motor coordination difficulties: Parental perspectives at follow-up in middle childhood. Advances in Physiotherapy 2005; 7: 67-76.

2 Chiarello L, Palisano R. Investigation of the Effects of a Model of Physical Therapy on Mother-Child Interactions and the Motor Behaviours of Children with Motor Delay. Physical Therapy 1998; 78(2).

3 Tetreault S, Parrot A, Trahan J. Home activity programs in families with children presenting with global developmental delays: evaluation and parental perceptions. International Journal of Rehabilitation Research. 2003; 26(3): 165-173.

4 Mahoney G, Robinson C, Perales F. Early Motor Intervention: The Need for New Treatment Paradigms. Infants and Young Children 2004; 17(4): 291-300.

5 Valvano J, Rapport MJ. Activity-focused Motor Interventions for Infants and Young Children with Neurological Conditions. Infants and Young Children 2006; 19(4): 292-307.

6 Iverson, M et al. Creating a Family-Centered Approach to Early Intervention Services: Perceptions of Parents and Professionals. Pediatric Physical Therapy. 2003; 15(1): 23-31.

7 Cameron E, Maehle V, Reid J. The Effects of an Early Physical Therapy Intervention for Very Preterm, Very Low Birth Weight Infants: A Randomized Controlled Clinical Trial. Pediatric Physical Therapy. 2005; 17(2): 107-119.

8 Wong SY et al. Effects of an Education Program on Family Participation in the Rehabilitation of Children with Developmental Disability.

9 Sayers L, Cowden J, Sherrill C. Parents perceptions of motor interventions for infants and toddlers with Down syndrome. Adapted Physical Activity Quarterly 2002; 19(2); 199-219.

10 Schreiber, J. Increased intensity of physical therapy for a child with gross motor developmental delay: a case report. Physical & Occupational Therapy in Pediatrics. 2004; 24(4): 63-78.

11 Montgomery, Patricia C. Predicting potential for ambulation in children with cerebral palsy. Pediatric Physical Therapy. 1998; 10(4).

12 Campbell S.K.: Physical Therapy for Children; W.B. Saunders Company, Toronto, (1994) p.459-488

13 Thames Valley Children Centre: A Physiotherapy Model of Service Delivery For Children with Developmental Delay Who Walk Independently at School; August 31, 2004

14 Client Groupings Model: Physical and Cognitive Descriptors; Erinoakkids, Mississauga, October 2008

Significant contributions to this project

Jayne Temple, PT (ErinoakKids)

Jacqui Rivers, PT (ErinoakKids)

Ann MacPhail, PT (Uof WO)

Joanne Assini, PT (TVCC)

Sada Hallman, PT, (ErinoakKids)

Brenda McNair, PT

Addendum 1

(Adapted from Thames Valley Children Centre’s “A Physiotherapy Model of Service For Children with Developmental Delay Who Walk Independently at School”) 13

PT Goals Checklist

(Percentages were calculated from the Survey Monkey of how common the goal is addressed by Physiotherapists across the Children’s Treatment Centres. Items without a percentage were taken from comments sent back in the Survey Monkey but not from the questions therefore a percentage could not be obtained.)


    • Primary Goals
    • Safe ambulation to all places within the school
    • Safe on playground equipment (home or school) 100%
    • Safe on stairs (89%)
    • Classroom gym participation 78%
    • Equipment needs 78%

    • Additional School Goals
    • Ride a bike/trike
    • Safety and mobility for school trips into the community (this may be achieved with specialized equipment). 56%
    • Successful transition from elementary school to high school 56%

    • Musculo-skeletal Related Goals
    • Client has been provided with an exercise program to address needs and prevent secondary impairments 89%
    • Appropriate footwear and orthotic inserts as required

    • Community Related Goals
    • Client and caregivers have been provided with information of appropriate Community programs and their physical benefits have been outlined 89%
    • Participation in community athletic program/recreational activities 56%

Other

Referral to other services ( e.g. nutritionist, behavioural program)

Addendum 2

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Created by Administrator on 2010/01/13 15:40