Yasmin is a sixteen-year-old girl with athetoid cerebral palsy, GMFCS level IV. She is passionate about her studies and has already gone to check out a few colleges. She is thinking about living in a dorm. As her PT, are there measures that will help you learn about her current level of participation? You know about her activity capacity, but not as much about her current level of performance – and that is what will matter as she transitions to more independent living. After some thought, you decide to update the TRANSITION-Q for health management skills and the ACTIVLIM-CP for daily activities. Additionally, you are going to update Yasmin’s COPM to prioritize her individual goals.
I’ve recently discovered the world of performance and participation measures. They can begin to bridge the gap between physical therapy appointments and higher participation in daily life. Some measures are free and translated into many languages. Other measures assess global performance change after PT intensives, Botox, or surgery. Many of these are new to me, aside from the CHAQ, PEM-CY, COPM, and GAS. It is exciting to think of the potential and I look forward to trying them out in the months to come! Continue reading “Tests & Measures for Participation”
JoLee is a four-year-old girl with mixed spastic/dystonic cerebral palsy, GMFCS III. Her physical therapy progress report is due and you would like to use objective tests and measures that are appropriate for her age. After looking through this list, you decide on the ECAB for balance, the SATCo for trunk control, and the HAT for hypertonia/dystonia. Of course you will also do traditional range of motion testing and an Adam’s forward bend test. What’s unfamiliar on the list? The MPST for anaerobic performance looks interesting, but it isn’t valid for JoLee’s age.
Continue reading “Tests & Measures of Body Structures and Body Functions”
Devin likes to go fishing; it’s his favorite hobby. He is a five-year old boy with a diagnosis of bilateral cerebral palsy, GMFCS level 1. Devin perches at the river’s edge in a deep squat in order to catch a glimpse of the trout beneath him.
Deep squatting is useful for a variety of reasons, like getting close to the floor to see something clearly, or to rest without getting on knees or bottom. It requires adequate hip flexion range, ankle range, and postural control. It is a developmental milestone.
When I look at the drawing of Devin, I wonder why:
- Devin has an inverted foot position on right.
- His low back position shows excessive lumbar flexion during a deep squat.
- His pelvis is posteriorly tilted.
- He is stabilizing, or limiting his degrees of freedom, by bracing his right elbow on his right knee and resting his chin firmly on his left knee.
Continue reading “Case Study- Supporting one Boy’s Love for Fishing”
Michaela is a five-year-old girl who loves ballet. She has a diagnosis of diplegic cerebral palsy, GMFCS level III. What does this mean?
GMFCS Level III (Between 4th & 6th Birthday)
Children walk using a hand-held mobility device in most indoor settings. They may climb stairs holding onto a railing with supervision or assistance. Children use wheeled mobility when traveling long distances and may self-propel for shorter distances.
From the GMFCS E&R instruction guide
GMFCS-E&R Quick facts:
- Five-level classification system
- Based on the child’s self-initiated, regular movement
- For use with children with cerebral palsy only
- Used to classify children with CP from 1-18 years
- Not for use to classify infants under 1 year of age
- Not for use as an outcome measure
The Gross Motor Function Classification System (GMFCS) levels I-V are gross motor function categories for children with cerebral palsy. This post describes what GMFCS levels I through V mean, how they are used, and some of the controversy around them. Continue reading “Using the Gross Motor Function Classification System- Expanded & Revised Version (GMFCS-E&R)”
“Nate, stand up”. Nathan is five, has cerebral palsy and takes a while to prepare to move his body. Thirty seconds or more can pass between the request to move and getting a response. He is quiet, then there may be a quiver of movement. Sure enough, after some patience, up comes the leg and he rises to standing with only a little assistance. In the context of the classroom, this extra waiting time is surely difficult. Nathan either arrives late to an activity or his aide is lifting and initiating for him throughout the day and a behavioral expectation is set up.
Children with motor planning difficulty need extra time to initiate and carry out their movement. Many of us live in a world where time is scarce and we don’t feel that we have time to wait. On the other hand, starting with the end in mind is crucial and takes a lot of training, repetition and patience. What have you decided to do when faced with this dilemma?
Continue reading “Are You Helping a Child Move Before They are Ready? Thinking About Latency in the Context of Movement.”
Dana loves going to school and spending time with her classmates. She is a first grader with hemiplegic cerebral palsy (GMFCS level 1). Dana’s typical school day involves getting up and down from circle time, getting in and out of chairs at various stations, and moving to get supplies. As a PT coming into the classroom for the first time, you are pleased with the number of activities she joins. However, her teacher shares concern that Dana struggles to keep up with the movement pace of the classroom. How can you compare Dana’s classroom mobility to that of her peers? Is there a test with norms that you can use?
TFTS-N Quick Facts:
- 5-14 years
- Stand-alone test for children in school environments
- Walking at a natural pace
- Timing begins at “go,” not when movement is initiated
- Tape 3m apart on floor
- Face validity: activity of transitioning to/from floor and walking short distance.
The Timed Floor to Stand-Natural (TFTS-N) test measures time as a child transitions from floor sitting to standing, walks 3m at a natural pace, turns around, walks back to the starting point and then returns to floor sitting. The sitting position is tailor (criss-cross). Continue reading “How to Use the Timed Floor to Stand-Natural Test (TFTS-N)”
“Yesterday was a big day because Zahra sat all by herself! She is so happy! Of course, I had to put her in this position first. She can’t take her hands off her feet because she falls backwards. I keep her safe by putting soft pillows and blankets all around her and sitting with her while she plays.”
Zahra is five-months old and has attained the developmental milestone of sitting independently. Her parents are proud and it is easy to see that Zahara is proud too. What are the building blocks for independent sitting? Continue reading “5 Months: Sitting”
“My 6-month old daughter rocks on her belly and moves her arms all around. It looks like she is swimming on land! What is going on while she is playing like that?”
This swimming motion, common during the development of 5-6 month olds, is also known as pivot prone. The first time you might see something like this would be at about 3 months of age during a Landau reaction. This emerges at as a reflex/postural reaction, allowing the baby to use their back muscles to extend against gravity while held at the stomach. However, by 5-6 months of age, the baby has developed the strength and flexibility to play with it in a variety of ways during their tummy time. These new sensations and movement often keep interest in the activity and are a delight to watch. You might see a few seconds of swimming motion followed by a push into the floor or rocking back and forth. In these actions, the baby is strengthening their postural control system to balance flexion and extension in their core muscles. Simultaneously the gluteals are learning to becoming active and the hips are beginning to fully straighten. With practice, the thighs and arms begin to come off the ground simultaneously. Ideally, even though the back muscles are working, the abdominal muscles are still active and slowly lengthening in order to control the motion, and the core is fully engaged.
During pivot prone play, the baby is strengthening and discovering:
Continue reading “6 Months: Pivot Prone”
Have you ever wanted to try out a whole selection of adapted trikes? Try a new swimming experience? Enroll in a summer camp?
Participation is defined as anything that involves friends, family, future, fitness, fun, or function. There are many local activities that promote play, new friends, and new interests for children and young adults with disabilities. However, these opportunities are not always easy to find. Most suggestions on this list are based in Sonoma County, California. Some are further away, but could be a fun destination or a special side trip if you are in the mood for adventure! Additional suggestions are welcome.
Continue reading “Recreation for Children With Disabilities in Sonoma County (updated 2022)”
“Is my baby standing OK? It seems like he is up on his toes, and toe walking runs in my family”.
The answer to this question, of course, depends on how old the baby is and how long he or she has been on their feet. I teach in an infant mobility class every week and have the amazing opportunity to watch children pull to stand at the big drum in the middle of the room. How they love to pound on that drum! I love their joy and their success. However, as the class physical therapist, I’m also looking closely at how they are standing. Are they up on their tip toes and leaning into the drum, or are they standing with their hips a little behind their firmly planted feet? Continue reading “Nice Weight Through Your Heels, Little One”