Jessica Lewis
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Hi Rachelle!
The question in the test and the 24 month prediction rule are two different things.
In general, we know that if a child with CP is able to sit independently by 24 months, this indicates that the child will be able to ambulate household distances at some point in the future. This information we don’t have is when this will happen in the future.
The exam question about what motor skill helps predict walking within 1 year of attainment is sit-to-stand. The ability of completing a sit to stand demonstrates that the child is gaining good strength and dynamic postural control. Once a child gets to this point, it can help guide a physical therapist’s decision making when it comes to goals and plan of care because they now know that the child will likely start walking within a year.
Does that make sense and help clarify the difference?
Jessica
I think this website gives some good information about the differences between these three items: https://www.ncbi.nlm.nih.gov/books/NBK557491/
Basically it’s a big messy family and they all play off of one another. Not confusing at all, right?!?
If this doesn’t help, shoot us another message and we can try helping in a different way!!
Jessica
Hello Therese!
The Academy of Pediatric Physical Therapy has two really good fact sheets on orthoses.
Foundations of Pediatric Orthotics: https://pediatricapta.org/includes/fact-sheets/pdfs/FactSheet_FoundationsofPediatricOrthotics_2009.pdf
and
Ankle-Foot Orthoses and Footwear for Children with Cerebral Palsy-Selecting Optimal Designs: https://pediatricapta.org/includes/fact-sheets/pdfs/Ankle-Foot%20Orthoses%20and%20Footwear%20for%20Children%20with%20Cerebral%20Palsy.pdf
I hope you find these helpful!!
Jessica
Hello Heidi!
My reference for this statement comes from the CanChild website and from an article by Linder-Lucht et al, 2007.
– CanChild: https://canchild.ca/en/resources/44-gross-motor-function-measure-gmfm
– Linder-Lucht M, et al. Validation of the Gross Motor Function Measure for use in children and adolescents with traumatic brain injuries. Pediatrics. 2007;120:e880-886.Jessica
Yes, similar line of thought…although some children with L4 lesions may get away with an AFO. It really all depends on level of strength, overall gait pattern, and sometimes age/size. Tricky lesion level 🙂
Hello Heidi!
L3 and L4 both innervate knee extensors, so you would expect a degree of quadriceps weakness if these are affected. Clinically, the “level of weakness” varies from person to person because “lesion levels” do not all act the same. There are some institutes that do not even provide lesion levels because of how much variability is seen from patient to patient. I think the overall take away message for L3 and L4 lesions is that the child might have knee extensor weakness and you should then understand what secondary impairments could occur because of this weakness and what orthoses or assistive devices may be needed.
Does this help answer your question?
Jessica
Hi Lindsay!
Sorry for the later than usual response. We don’t check the board as often in the “off season.”
The ABPTS website gives the following explanation about scoring (but I’m guessing you have already read this since you are specifically asking a question about a score of 500).
Reporting Examination Results
NBME scores the specialist certification examinations, and candidates are issued a report that specifies their score, the passing score on the examination, and an analysis of performance according to the major competency areas tested. Although the score is based on the actual number of questions answered correctly, it is a scaled score. ABPTS requires a scaled score of 500 to pass the examination.
-http://www.abpts.org/Certification/About/ExamScoring/Based on this explanation, I’m not sure that the score of 500 represents a specific percentage. It seems like it could change each year depending on the scaling of the scores. At least this is my understanding of how it works. If someone else has more information on this, please share!
Hi Jonathan!
Ideally, if the child was diagnosed early on with CP, he would have started hip surveillance every 6 months until the age of 2 years and then once a year after that. Since he is older and has not yet received hip x-rays, it is recommended that he now get x-rays completed every 6 months for 24 months to get a baseline and then once a year after that. So, in this case, the 24 month period starts now at the age of 4 years and then after 24 months (at the age of 6 years) he will start getting x-rays one time per month.
Here is a link to a nice visual depiction of this schedule: https://www.aacpdm.org/UserFiles/file/hip-surveillance-care-pathway.pdf
A lot of the info I have for therapy after SDR comes from an AACPDM presentation by Caroline Colvin and Molly Thomas in 2018. It’s title is “An Evidence-Based Review of Physical Therapy Intervention for Individuals Who Have Undergone a Selective Dorsal Rhizotomy” found here: https://www.aacpdm.org/UserFiles/file/handouts/am18/bsh/BRK4-An-Evidence-based-Review-of-Physical-Therapy-.pdf
Here is another article that I think is helpful that isn’t listed in their powerpoint presentation:
Effect of selective dorsal rhizotomy in the treatment of children with cerebral palsy – Engsberg et al 2006I think the downfall of a lot of the literature is that it never specifies what “intensive” therapy is. It only vaguely references it and never fully defines it. I think what we can gather from some of the literature coming out about dosing and PT, intensive would be at least 3-5 times per week or longer sessions less times per week.
At my hospital our guidelines are that the child will participate in therapy for 24-36 months after their SDR. 4-5x/week for 6 months post SDR, 2-3x/week from 6-12 months post SDR, and 1-2x/week 12-36 months post SDR. A lot of our patients also receive inpatient rehab immediately after the surgery for 2-3 weeks. Of course (unfortunately) insurance ultimately dictates if our children can actually do all of this.
Hello Sarah!
In this scenario, at one month corrected age the child score in the low average range on the TIMP. Since the infant is not showing any major delays, supporting the family with a home program on areas that the child might be needing more help in would be best in this scenario. In the clinic, if there are any other more concerning signs (ex. asymmetries, abnormal GMA score, etc.), more frequent therapy would definitely warrant increased frequency and a more urgent need for therapy. In this case, no other signs/symptoms were noted in the question, so HEP with scheduled follow-up would be the best plan.
In the case of the TIMP, it is still a good measure to determine if delays are present at any age. It is just most predictive of future motor delays at approximately 3 months corrected age.
The PEDI-CAT is both discriminative and evaluative. The normative standard score (provided as age percentiles and T scores) is discriminative. The scaled score is evaluative over time. However there is currently limited research at this time to interpret changes in scaled scores over time for the PEDI-CAT (vs the data we have available for the PEDI).
I was fortunate to have just completed a residency and that helped build those skills. The APTA also has a good resources about ethics and professionalism – https://www.apta.org/your-practice/ethics-and-professionalism
If you’re an APTA member, they have additional resources including a monthly publication about ethics and professionalism.
The APTA learning center also has a series of professionalism modules you can complete.I think the information listed in the DSP is pretty comprehensive and covers everything you will need to know. ABPTS states that there will not be any information on the test outside of what is listed in the DSP. There are some more difficult areas to really be able to study for and areas that we had more difficult generating questions about – for example workplace leadership and professional behaviors. Even though this is a small part of the test, those questions still haunt me because they were questions that are very difficult to know how to study for and I think is just something that you have to work out in your head pulling on your past leadership and professional behavior experiences.
DSP outline (if you haven’t already found this): http://www.abpts.org/Resources/ExamOutlines/Pediatrics/
Hi Sarah!
This is a great question but I do not have that data. I can check with Chrissy (the RKA founder) to see if she can pull that data. I can look into that over the next week and if it is available, I can let you know! We do know that last year we had a 96% pass rate for the exam. This is higher than the overall national average for the exam so we are confident that our materials do give you a boost when you are finally sitting to take the exam.
