Helen Carey
Forum Replies Created
-
Posts
-
I agree with Jessica in terms of the best strategy for answering questions with the best response, even if you have a differing clinical opinion. I remember thinking…”that was a stupid question” several times. Also, in the absence of conclusive evidence comparing the different methods, we can’t really say that our answers are incorrect.
It is very likely that therapists will leave the test disagreeing with questions and answers, especially in areas where they have clinical expertise. Obviously, your goal is to pass the exam, so try not to get wrapped up in the quality of questions. Your knowledge and expertise makes you a more effective clinician, so try to focus on what you have learned in this journey and not get caught up in the questions themselves.
Thanks for bringing this information to our attention so we can relook at the evidence for future exams.
Hi Juliana,
Case-control studies should include two groups that are identical EXCEPT for their outcome/disease status (one group would be the group of interest and the other a control group). An example would be: comparing a group of children with cerebral palsy with a group of identical children (such as age and gender and PMH) without cerebral palsy to examine a specific characteristic such as parenting stress.Cohort studies should include two groups that are identical EXCEPT for their exposure status. An example would be: comparing two groups of children with cerebral palsy, but they are exposed to two different treatment strategies.
Hope this helps!
Helen and JessYes, household ambulation is an important consideration as we know short distances are much less demanding in terms of motor control and muscle strength. Individuals with MM and SCI often use different means of mobility for community vs household ambulation.
AD prescription should be based on motor function level, not lesion level, since lesion levels are not an exact science. It is possible for 2 children with MM with the same lesion level to have some differences in functional motor levels and, therefore, different orthotic and AD needs. We developed our study guides using multiple sources, not just Campbell. We tried to include evidence presented from these different sources.
Hope that helps!
HelenIn regards to the issue with L3 levels between MM and SCI. The study guide has L3-S1 as a general group, so it seems possible for a L3 lesion due to SCI to require a bit more support, however, it will really depend on the individual’s motor function and muscle strength. Our information comes from published sources and doesn’t always capture all possible clinical variability (including an incomplete SCI). I think a good strategy is to focus on information regarding motor function and muscle strength since clinically we use that information to determine orthoses and assistive devices, not lesion levels.
Helen
Hi Heidi,
I addressed a similar question last night in the forum that might also be helpful.1. The perceptual action system is related to motor control; an example is motor control strategies for meeting the essential requirements for steady-state gait (including the requirements for postural control and movement).
2. I am not sure about cognitive theory? There is a strong component of cognition in motor learning which is seen in most theories and approaches/strategies (included in the study guide).
3. Yes, dynamic systems theory is the same. My reference (Shumway-Cook & Woollacott uses both terms.Thanks!
HelenHi Marie,
If I have the question correct, it states that the infant was 1 month CCA. The purpose of the question was to focus on interpretation of the TIMP and it’s predictive validity. The TIMP is most predictive of motor delay when administered around 90 days CCA, therefore, a child’s score at that age would provide the most meaningful information for clinical-decision-making. Because the child is not delayed or demonstrating atypical movement patterns or motor signs at 1 mo CCA, a HEP and follow up would provide targeted education, a follow up plan, and appropriate utilization of insurance resources. In some regions, this child might not quality for weekly OP services just because of PMH and risk factors. Your reasoning for intensity of services is not incorrect, although some might say it is over-utilization of services since the child is so young and not demonstrating delays or motor deficits at this time. It might also be stressful on the family who likely just returned home from the NICU.Nice question!
HelenYes, best practice (recommendations from the American Academy of Pediatrics) says you should correct for infants born less than 37 weeks up to the chronological age of 2 (24 months).
Hi Christine,
In the motor control and motor learning handout, I separated the motor control theories and the motor learning theories. Honestly, I have trouble sorting them out as well! I tried to provide specific motor implications for each to highlight their importance relative to clinical practice. Dynamic systems theory is the same at systems theory- I just tried to be consistent with terms from my resources (primarily the Motor Control textbook by Shumway-Cook & Woollacott). You’ll find that there is some overlap in the motor control and motor learning theories.Family systems theory is related to family-centered care and is the view that individual and family functioning is an interactional and dynamic process. The transactional model of development is also related to family-centered care and emphasizes the reciprocal relationship between the child and and caregiving environment. The ecological model of human development is also related to family-centered care and is the role that the larger social systems have on the function of the family unit. (Effgen, 2nd Edition, p154). Yes, there is an ecological model of human development, an ecological theory of motor control, and an ecological theory of motor learning! While a bit frustrating to have 3 theories with a similar name, it kind of makes sense since the environment is such a critical factor in child/family functioning and motor control/learning. I think the best strategy will be to focus on the context of the test question to figure out what theories are related. In your study preparation, it will be a good idea to at least be able to categorize the theories into family-centered care, motor control, and motor learning.
In terms of motor control, there is currently more evidence to support the dynamic systems theory compared to the other theories, however, most still “exist.” Some theories are decades old and others are newer, but most continue to exist. The reflex theory seems to be one, however, that now has limited support. As therapists, having some knowledge about these theories helps us understand the evolution of our learning about motor control. Shumway-Cook & Woollacott feel that “…the actions of therapists are based on assumptions that are derived from theories. The specific practices related to examination and intervention used with the patient who has motor dyscontrol are determined by underlying assumptions about the nature and cause of movement. Thus, motor control theory is part of the theoretical basis for clinical practice.”
I hope that helps!
HelenHi Heidi,
This is really confusing topic for most of us, so I am hoping this explanation helps. First thing to remember is that anteversion and antetorsion are different. Antetorsion is twisting along the femur so that the head/neck is positioned more forward compared to the femoral condyles (I tend to imagine the head/neck in one plane and the femoral condyles in a different plane, with the ability of these planes to reorient based on the amount of torsion in the shaft). Anteversion is not a rotation of the bone, but rather how the femoral head (and, therefore, neck/shaft) is positioned in the acetabulum relative to a plane (I tend to imagine the head/neck/shaft moving as 1 unit). Individuals can have issues with either or both.In the infant, they have about 30 degrees of antetorsion, which would result in IR of the thigh. They also have about 60 degrees of anteversion, which would result in ER of the thigh. These 2 forces are in opposite directions, but don’t cancel each other out because the ER is about 30 degrees greater; so, the net result is about 30 of ER. Campbell’s 5th edition, pp 104-106 does a pretty good job of explaining this. Fig 5.7 shows the newborn hip- you can see that the thigh is ER because the femoral head sits in more of an anteriorly facing position (anteversion) compared to the other pictures.
I hope this helps!
HelenHi Heidi,
Jessica’s explanation in a previous response about variability in motor function in children with myelo also applies here. A parent in this situation will not understand the difference between walking for exercise or walking for function, therefore, we should interpret the question as the parent asking if their child will walk similar to their peers. Children with motor levels of L1-3 might ambulate for exercise or short distances in the home, but not without extensive support (orthoses and assistive device). This level of ambulation is often not functional or sustainable and children in these levels often abandon ambulation for more efficient w/c use. We wrote this question to help participants think about broader functional outcomes, not just specific motor levels. Remember, during tests like the PCS, you should always choose the best or most correct answer. Other answers may be partially correct, but not the best response.Hope that helps!
HelenHi Kellie,
This is a challenging concept that still confuses me as well! Below is a posting from last year that seemed to help (not sure if you could see it so I copied it below).SNout: When a test has a high sensitivity, a negative result rules out the diagnosis and positive result confirms the diagnosis.
SPin: When a test has a high specificity, a positive result tends to rule in the diagnosis and negative result rules out condition.
(I actually find these very confusing, so trying looking at it from the examples below):Sensitivity (true positive rate): Likelihood that someone with the condition will be positive on the diagnostic test; refers to the percentage of children who are correctly identified as meeting criteria for a condition; VALUABLE FOR CONFIRMING DX; 80% sensitivity is preferable.
Specificity (true negative rate): Likelihood that someone who does not have the condition will be negative on the diagnostic test; refers to the percentage of children without problems who are correctly identified as such; VALUABLE TO RULE OUT THE PRESENCE OF A CONDITION; 90% is preferable for a diagnostic test.**For the TIMP, Specificity is higher, indicating that it is a good measure for detecting large numbers of high risk infants who are not developing typically (rule out GM delay) and have delayed posture and motor development, which is it’s intended purpose. Sensitivity is much lower, so it is not as sensitive for identifying (or confirming) CP.
**The AIMS has been found to be more beneficial when administered at critical age ranges. While the 5th centile cut off value is best to identify the most delayed children (and those likely to have CP) (because of high specificity and relatively high sensitivity), the 10th centile cut off is best for identification of the greatest # of infants with abnormal motor development (because of high sensitivity).Sensitivity focuses on a specific condition (the example I gave is CP) whereas specificity focuses on ruling out the presence of a condition (the example I gave is GM delay). A child with poor gross motor skills will very likely score below average on the TIMP and be correctly identified as being delayed, however, we won’t be able to necessarily determine if the low performance is due to CP or another condition affecting GM development. A test with high sensitivity is best when your focus is identifying CP, not just GM delay.
There is always a “trade-off” between sensitivity and specificity: for a screening test in which early diagnosis is beneficial and when it is desirable to identify all those at risk for having a condition, high sensitivity is preferable to higher specificity.
Hi Ashley,
Here are a few potential resources. Hope they help!https://www.resna.org/Resources/Position-Papers-and-Service-Provision-Guidelines
https://cdn.ymaws.com/npiap.com/resource/resmgr/events/NPIAP_Permobil_WC_Seating_Po.pdf
https://www.ncbi.nlm.nih.gov/books/NBK559231/• Jones, et.al. Effects of Power Wheelchairs on the Development and Function of Young Children With Severe Motor Impairments. Pediatric Physical Therapy. 2012; 24:2, 131-139.
• Kenyon, et.al. Power Mobility Training Methods for Children: A Systematic Review. Pediatric Physical Therapy. 2018; 30:1, 2-8.
• Livingstone & Paleg. Practice Considerations for the introduction and use of power mobility for children. Developmental Medicine Child Neurology. 2014; 014 Mar;56(3):210-21.
