Helen Carey
Forum Replies Created
-
Posts
-
Hi 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.Also, we suspect that there will be questions specific to practice and feedback, as these are areas with a lot of pediatric research and have the most clinical applicability.
Hi Sarah,
We feel that knowing specific prosthetic components might be unnecessary as the technology changes so quickly and is usually the expertise of the prosthetist. We feel that preparation should include an understanding of limb deficiencies (congenital and acquired) and best practice for the introduction of prostheses based on developmental readiness. We suspect that questions are going to focus on functional training using prostheses, such as identifying gait deviations and problem-solving appropriate interventions to address specific functional problems.In terms of orthoses, we suggest understanding the function of each type of device: what motions are intended to be controlled and what motions are free to move. Orthotic questions are most likely to be directly related to clinical problems, like the example you give, where you need to determine the most appropriate device to address a specific issue.
Consider focusing on the most common conditions seen clinically. Although Campbell doesn’t have a chapter on genetics, Effgen’s 2nd edition does. They list these as the most common: Angelman, Crid-du-chat, Klinefelter, Prader-Willi, Trisomy 13 and 18 and 21, Turner syndrome, achondroplasia, cystic fibrosis, Duchenne muscular dystrophy, Fragile X, hemophilia, Neurofibromatosis, Lesch-Nyhan syndrome, OI, PKU, Rett, SMA, and tuberous sclerosis. It would be important to understand how children are affected across the ICF for each of these; this includes overall outcomes and prognosis. Keep in mind that there have been significant advances in SMA and DMD in the past few years, which may not be reflected in the exam.
Sheila,
I agree that the numerous theories can be confusing. We used Shumway-Cook and Woollacott, 5th edition, as they are the gold standard for motor learning and control. We feel that the test will have more questions on newer theories, however, some knowledge of the basic premises of older theories would be important. Campbell’s text has some nice sections on application- that is probably the most valuable part of that text.r squared, or the coefficient of determination, reflects the magnitude of an association between variables and is most appropriate when comparing the magnitude of different correlations. A higher value of Pearson’s r indicates a stronger relationship between the variables. To determine the coefficient of determination, this r value is squared.
Example: if you have independent variables of age and GMFCS level and a dependent variable of TUG test time, you could have an r squared value for age vs TUG test time association (hypothetically .017) and a different r squared value for GMFCS level vs TUG test time association (hypothetically .068). The r squared value for the GMFCS level vs TUG test time association (.068) is a much greater magnitude than the r squared value for age vs TUG test time association (.017), therefore, GMFCS level could be said to explain 4 times as much of the variance than age. To interpret this clinically, we could say that a child’s GMFCS level has a greater magnitude of association with TUG test times compared to age.(r should be in italics, however, the forum post box won’t let me change the font).
Hi Kasey,
Campbell, 4th Edition, has a chapter on the burn unit. Effgen, 2nd Edition, has a chapter on the integumentary system, including burns. These are our primary sources.Helen
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.
My brain wants to switch the concepts since I tend to think of “specificity” as identifying a specific condition (being “specific” about a condition), when it is actually the opposite.
Hope this helps!
HelenHi Kasey,
Sorry for the confusion. We used a different resource when writing this question, however, this is a good example of some differences in interpretation for levels of evidence. A non-randomized cohort design is sometimes considered a lower quality level II, however, for the purposes of this question, it is a higher level than the others (so is the correct answer). There is a cohort (not single subjects) and at least 2 groups, since the design is non-randomized (group assignment is not randomized). This makes for a stronger design than a case series as there is a comparison group.Literature reviews are merely summaries of what is published on the topic; a systematic review or a meta-analysis, however, are stronger designs if they analyze and interpret data from multiple studies.
Case studies are usually level V, unless they have been grouped and analyzed as a series.
A multiple baseline design is a single subject research design where the subject serves as it’s own control. The researcher measures the baseline status of a trait of interest (such as walking speed), then applies a treatment before measuring that trait again. A stronger design will repeat this process and have multiple measurements along a continuum of intervention and no intervention periods. The term “multiple baselines” refers to the multiple measurements of the trait taken along the course of the study. If the exact design is used across 3 or more subjects and the data is analyzed collectively, the strength of the study increases.
Hope this helps!
HelenHi Kasey,
These concepts have rattled me for years! a. is the correct answer for this question: “The assessment has a high success rate of identifying gross motor delays but may also suggest that there is a gross motor delay when there is not really a delay present.”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).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 Kasey,
Below is the link to the guidelines. The link is also included in our reference list. We included this information because is it the most concise (and user friendly) resource for hip surveillance. There is a substantial body of literature on hip surveillance, however, this resource will be the most efficient review for exam purposes.https://www.aacpdm.org/publications/care-pathways/hip-surveillance
Helen
Hi Carole,
The correct answer for this question is (I am not sure which letter it correlates with as I only have the master exam):
“Practice lateral weight shifts in standing with as few manual cues as possible, advance toward single limb balance activities without support, and then ascension of a single step”We rewrote this question back in November, after an inquiry, to improve clarity and the detail of the response. Let us know if this response does not sufficiently address your question. The application of motor learning principles during PT practice is often inconsistent and not well linked with the literature so we decided to include multiple questions related to motor learning to provide a thorough review.
thanks,
Helen
