Lessons Learned & Research to Guide Us in 2018
As M Street Pediatric Therapy kicks off the 2018 New Year, our therapists have compiled some of 2017’s best lessons learned. These advances will have the greatest impact on our practice and the lives of the children and families we work with.
#1 - Don’t “wait and see”
The top piece of advice from M Street Peds for both parents and clinicians is to NOT “wait and see.”
The lesson learned is that it’s important for parents and therapists to understand their critical role in early referrals, instead of prolonging a screening and diagnosis. So the next time you think to just “wait a few months to see....” DON’T and seek out the appropriate assessment or referral.
For example, cerebral palsy diagnosis’ have generally been made between 12-24 months, but now can be made before 6 months of age.(1) Obviously, the earlier diagnosis allows for earlier intervention and the advantage to increase support and functionality for the child.(1)
Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and early cognitive functioning.(1,3) These early referrals can also prevent secondary complications and enhance caregiver well-being.(1,2,3)
Additional examples of not “waiting to see” come from several studies of preterm babies born with low birth weight that show the importance of early diagnosis improving survival rates.(2)
Simple things like parents taking video clips of their child and sending them to a physical therapist for assessment could assist in detecting motor function deficits earlier.(4,5)
#2 - Quality of movement matters!
So often parents are looking for verbal signs or struggles with their children, but often it’s the physical movements that can be the clues to be aware of.
A 2017 study linked early motor abilities and language development in children. They found that children with smooth and fluent movements at three months of age equated to better expressive language skills as they got older.(6,7)
Another example from last year was studying the motor repertoire in 3-5 month old infants with Down syndrome and how that impacted their eventual motor abilities. The study found the rate of abnormal fidgety movements or extreme lack of movement was exceedingly high.(6)
The motor movement repertoire of infants with Down syndrome was less optimal than infants with normal neurological outcomes, but higher than infants who were later diagnosed with cerebral palsy.(6)
The lesson learned is that parents and therapists need to tune in to the quality of movement because it can foreshadow or predict future abilities.
#3 - Evaluate dosage and therapy recommendations
Therapists need to proactively assess how they recommend dosage and therapy for children with developmental conditions.
A study last year examined how infants and toddlers with cerebral palsy received lower doses of early intervention physical therapy compared to children who had developmental delays with multiple disorders.(8)
The findings were that the majority of infants who had identifiable medical risk factors that qualified them for early intervention were not enrolled in the program.(8) It pointed out how these less-easily seen children who have a disability and need physical therapy often are not getting their needs met because of the lack of recommended therapy.
Therefore, the lesson learned for parents and therapists is to reassess and consider the amount of therapy recommended for children and patients to make sure it’s allowing for the greatest potential benefit and progress possible.
#4 - Give it a try in 2018
The new year brings the chance to try new technologies and get trained in assessments that will advance your practice.
For Parents:
The CDC released a FREE Milestone tracker app. This app offers a milestone checklist for 2 months through 5 years of age. It also provides activities and tips for what to do if you become concerned.
Beginning with Babble – LEAP’s mobile app for parents and caregivers with children ages zero to 4.
For Clinicians:
Goal Attainment Scales have been shown to be highly accurate for assessing physical therapy intervention gains for infants born extremely preterm. They have a new iPhone app that was introduced at the AAPPT meeting last fall.
For children with cerebral palsy, the new Upsee device provides movement and lower extremity weight activities for children as an orthotic device. Every time the adult takes a step, so does the child because the Upsee sandals for both are attached.
Get trained in the most predictive tools for detecting risk of cerebral palsy – The Hammersmith Infant Neurological Exam & the Prechtl Qualitative Assessment of General Movements(1,5,6)
Advances in Diagnosis and Treatment. JAMA Pediatr. 2017 Sep 1;171(9):897-907., et al. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Adde L, Morgan C, Novak I
Nagara S, Kouwaki M, Togawa T, et at. Neurodevelopmental outcomes at 3 years old for infants with birth weights under 500 g. Pediatr Neonatol. 2017.
Spittle, Alicia J, Treyvaud, Karli, Lee, Katherine J, et al. The role of social risk in an early preventative care programme for infants born very preterm: a randomized controlled trial. Developmental Medicine & Child Neurology, October 2017.
Carter FA, Msall ME. Health Disparities and Child Development After Prematurity. Pediatr Ann. 2017 Oct 1;46(10):e360-e364
https://www.youtube.com/watch?v=WoaIEJzwqOo&feature=youtu.be
Herrero D, Einspieler C, Panvequio Aizawa CY, et al. The motor repertoire in 3- to 5-month old infants with Down syndrome. Res Dev Disabil. 2017. Aug;67:1-8
Salavati S, Einspieler C, Vagelli G The association between the early motor repertoire and language development in term children born after normal pregnancy. Early Hum Dev. 2017 Aug;111:30-35.
Kristi L. Atkins, Susanne W. Duvall,Jill K. Dolata, et al. Part C Early Intervention Enrollment in Low Birth Weight Infants At-Risk for Developmental Delays. Maternal and Child Health Journal. February 2017, Volume 21, Issue 2, pp 290–296