Research completed primarily by non-physical therapist healthcare professionals delineate assessment tools and psychosocial pain management techniques that hold promise for evaluating and reducing pain that occurs during PT procedures for children with CP.
Further research is needed to determine the feasibility of using behavioral pain assessment measures during physical therapy sessions. Physical therapist continuing education regarding nonpharmaceutical pain interventions is indicated.
This perspective article advocates for pediatric physical therapists to increase their role and visibility in the primary and secondary prevention of chronic pain during 2 critical developmental periods: infancy and early adolescence. The opioid epidemic and the disabling aspects of chronic pain are adversely affecting children and their families. Health care disciplines are adopting measures that address risk factors for the development of chronic pain in children, including strategies to minimize acute procedural pain and parental education to reinforce healthy pain-coping behaviors. Pediatric physical therapists are uniquely positioned to develop and adopt strategies to aid in this effort. They routinely screen and evaluate children for developmental delays and work with children who are at increased risk for developing chronic pain as a sequela of their health condition or as a consequence of painful medical procedures.
This chapter is divided into four sections. The first section provides an overview of the theoretical foundations that can be used as a framework for possible mechanisms of effect for physical therapy (PT) interventions and identification of PT interventions oriented towards maximizing participation of children with pain in valued roles and life activities. The second reviews the literature on active therapies as interventions for children with pain. The third section reviews the literature on passive therapies and safety and efficacy for manual therapy or therapeutic modalities for pain. The importance of the therapeutic relationship and pain education will also be discussed. The final section reviews the literature on procedural pain from a PT perspective and provides recommendations on procedural pain management. Although PT practice settings and the treatment needs of infants, children and adolescents with pain vary widely, this chapter provides a structure for development of a theoretical and evidence-based physical therapeutic approach for all children with pain.
Background and Purpose: Recent changes to the standards of accreditation implemented by the Commission on Accreditation in Physical Therapy Education require that a minimum 50% of all core faculty must hold an academic doctoral degree such as a PhD. Enforcement of these requirements will begin in 2020. Clearly, these changes will present challenges to the growing need for qualified faculty in physical therapist education programs. The purpose of this commentary is to provide a brief review of recent changes in the academic credentialing requirements for core faculty members and to offer our rationale for supporting these new standards. Reasons to Support the New Standards: The importance of maintaining the new requirements is supported by a recent decline in full-text scholarly products from core faculty across the profession, with faculty relying much more on presentation abstracts to meet accreditation requirements. The collective effect of decreased publication of full-length articles suggests that the generation of scholarly products in the field of physical therapy is at risk. In addition, a lack of scientific dissemination is likely to reduce the profession's ability to advance the profession through translational science. The minimum 50% core faculty with earned academic degrees standard also serves to aid in longevity and resultant stability of a core faculty through increased rates of successful promotion and tenure. Finally, recently published studies on methods of proposed excellence in physical therapist education suggest the need for continuing emphasis on physical therapist education in increased depth and breadth of foundation knowledge is needed to prepare graduates for a more complex health care environment. Faculty who possess terminal academic degrees in the field of physical therapy and foundational sciences are best prepared to take on this challenge. Summary: The practice of physical therapy is changing, and the education of entry-level students must adapt to keep current with those changes. We, as academic leaders in the profession, must insist on retaining, and possibly even strengthening, the requirement of a minimum 50% mix of terminally academic degreed faculty within our core faculty.
BACKGROUND: Neuro-Developmental Treatment (NDT) currently embraces evidence-based concepts of motor control, motor learning and neuroplasticity. However, most research has been performed on outdated models of NDT. OBJECTIVE: This case series examines the short- and long-term outcomes of a three-week intensive using contemporary NDT interventions. METHODS: Six children, 2–10 years old with neurologic disorders and Gross Motor Function Classification System (GMFCS) levels I-III participated in the intervention. The three-week intensive included 60 minutes of physical, occupational and speech therapy 3–5 times weekly. RESULTS: All children demonstrated Gross Motor Function Measure-66 gains of medium to large effect sizes. These gains were maintained or improved upon 3 months’ post conclusion of the intensive intervention. CONCLUSIONS: This study supports emerging research regarding the effectiveness of intensive intervention and further study of current NDT interventions.
Context: Care of patients in their own home following total knee arthroplasty is often preferred because of the potential for cost savings over inpatient rehabilitation options; however, no best practice guidelines have been established for the rehabilitation professional to attempt to control for best patient outcomes. Objective: To determine through analysis (regression) what rehabilitation factors that are controllable by the home health therapist are shown to be of aid in achieving positive patient outcomes following knee arthroplasty. Design: Retrospective chart review with multiple regression analyses. Setting: Combination of rural and metro home health care in the mid-Atlantic region of the United States. Subjects: A total of 141 records of patients who had undergone elective knee arthroplasty and who met the study criteria were reviewed. Main Outcome Measures: Outcome measures were change in scores or values between home health admission and discharge in the categories of Tinetti score, knee fl exion range of motion, and the ability to ambulate safely (OASIS 1860 ). Predictor variables examined included patient age, the presence of a rehabilitation stay prior to home health care, days from surgery to start of physical therapy care, frequency of physical therapist (PT) visits, total number of PT visits, frequency of pain that interferes with activity or movement at admission (OASIS 1242), and frequency of pain that interferes with activity or movement at discharge (OASIS 1242). Results: Change in knee fl exion was signifi cant ( R 2 ϭ 0.171, P ϭ .005) whereas that for the Tinetti score ( R 2 ϭ 0.237, P ϭ .064) and functional ambulation ( R 2 ϭ 0.112, P ϭ .079) approached signifi cance. Age ( r ϭ negative 0.241), frequency of pain that interfered with activity ( r ϭ negative 0.269), and total PT visits ( r ϭ 0.234) were signifi cant predictor variables. Conclusions: The only variable that made a signifi cant contribution to change in outcome (knee fl exion range of motion) is the total number of PT visits. More PT visits equated to improved knee fl exion. Tinetti scores and safety in ambulation were also improved. The relatively insignifi cant cost of a home health PT following knee arthroplasty appears to be a prudent intervention early in the rehabilitation scheme to improve functional outcomes and reduce the risk of other unwanted results.
Occupational therapists (OTs) and physical therapists (PTs) are rehabilitation therapists with distinct but complementary roles who contribute to pain assessment and management in young people either as solo providers, or as a critical component of the interdisciplinary treatment team. Pain in infants, children, and adolescents interferes with their ability to engage in essential interactions with caregivers, acquisition of developmental milestones, and with participation in activities related to self-care, leisure, play, school, and work. OTs and PTs use specific treatment strategies, such as positioning, splinting, adaptive equipment, exercise, manual therapy, electrophysical agents, education on energy conservation, joint protection strategies, and pain self-management training to facilitate participation in valued life activities and occupations. This chapter provides an overview of important theoretical frameworks for rehabilitation therapists, reviews evidence for OT and PT interventions, and describes a framework for planning procedural pain management for rehabilitation therapists when working with pediatric clients.
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