Historical based vs more recent based approach to PT
Historical- Impairment based
Recent- Function based, like motor learning and task specific training
How many standard deviations below the mean for the child to be eligible for therapy interventions
1.5 or below
How many standard deviation below the mean is significant (clinical range)
4 Fundamental questions to Drive Evaluation and how to answer them
- WHO is your client?
- HOW can I best help this child/family?
- WHY is child presenting with performance/activity deficits/difficulty?
- WHAT information do I need to gather to figure this out?
WHO is your client?
Always the kiddo (and family)!
Not the BOE or El Agency
HOW can I best help this child/family?
Think about a GOAL: What is the most important thing to do for the child now
WHAT information do I need to gather to figure this (deficits) out?
The parent might know it all along. You can do FOMs for the child
Norm referenced Assessment: Purpose
To measure performance against average performance of a normative sample: compare child’s performance to same age peers
Criterion referenced Assessment: Purpose
To compare performance to specific standard or external criterion. Like serial testing: performance at different points of time. Ex: Can the child transition from floor to stance, only care i the child stand from squatting, sitting, and other positions.
What does standardization of assessment require (4)
Directions for administering and scoring, specific materials and equipment, testing conditions (instructions, number of trials ) given, interpretation guidelines given.
Without standardization, we cannot assume… and make sure you are…
Psychometric soundness: Reliability and validity
Three types of reliability
Inter-rater ( different observers to assess the same test) , test-restest (same test on the same sample of different point in time), intra-rater (single rater making multiple tests)
Construct validity: What it asks
Does this test measure what it purports to measure
Concurrent validity: What it asks
Does this test relate well to others that assess similar content
Predictive validity: What it asks
Do the results on this test predict future performance
Discriminative purpose of assessment
Used for discrimination or placement (how many STD below the mean is this baby compared to its same aged peers)
Evaluative purpose of assessment
Used for program planning
Items may be used for developing objectives
(How is this baby go from sit to stand. Is the child symmetrical in their movement)
Predictive purpose of assessment
Provides info on what is expected in the future
Screening purpose of assessment
To see if the child is normal or is at risk/needs more attention
Number obtained from test
Compares score to standardized sample
The percentage of standardized sample whose score is at or below a certain score
Age equivalent scores
Raw scores used to get age equivalent score
Ex: If mean score for 3 yr old is 80, then any child (no matter age) who gets a raw # of 80 is said to have an average score for a child of that age
Scores which are given mean and standard deviation in respect to the normal curve
Confidence Intervals (CI)
The boundaries of scores we can say with x% certainty that the true score lies.
Confidence interval calculation
+/- 2SD score + 2*SD in each direction
Purpose of a parent interview
Get some info before you meet the child! (so the child will not hear about the negative stuff about the condition)
Pediatric Quality of life (PQOL)
How is the child functioning at home, choose a survey most relevant to that child. It gives you an objective to see what is going on with the child.
Purpose of an ICF model
Structure the peds eval, reminds you to treat the whole person instead of the condition.
What do developmental assessments help us with
Quantify the extent of developmental delay or limits of function parents are concerned about.
Developmental assessments is appropriate for (2) but still doesn’t answer the…
Age ranges and patient presentations/diagnoses and purposes
Gait analysis: What it provides opportunity for and helps us with?
For movement analysis!
Plan for body functions and structures assessments!
Does does Body functions and structures provide?
Tell parent something he/she doesn’t know
Ask and answer “why”
Why is important for PT to build knowledge base in body functions and structures?
Really good ped clinicians need to know good knowledge in ortho and neuro
List of personal factors (6)
- Age ( super important. If u see a 14 yr old, u know u can no longer fix torsion)
- BMI (if system is weak and u are overweight, muscles become weaker)
- Tolerance to Testing
Environmental factors includes:
Environmental demands vs environmental supports (adaptive equipment, adaptive van, orthotics, family resources, supportive teacher, culture, opportunities for practice
Environmental factors: Parents’ role in clinical decision making
- Prefer active role- collaborative vs autonomous or paternalistic
- Prior experience like hospitalizations or similar situation
- Emotions beliefs and values, guilt, value of not giving up, social acceptability of tx
- They desire INFO from provider but need to couple with decision making support
- They filter info
Parents’ creation of micro-environment
Patients promote child to move. But if a baby is born with a disorder, parents are overprotective of their child and do not provide opportunities for child to explore. So as PT, u can tell parent “it’s okay, let him fall”
What do you want to know during a eval?
What is the kiddo/family’s main concern?
What do you really think is going on?
In most settings, more than one session can complete eval info, but which setting you need to move faster
Early intervention/Committee on Preschool Special Education
What to combine to create clinical reasoning for your client’s needs
Standardized tests/metrics and what you know
Risk of templates and what is the alternative
Risk of rigidity and looking at template vs at the patient
Consider flexible techniques like IFC model! even excel spreadsheet handout