Gait Device Choice for Children with Spastic Diplegia Cerebral Palsy or Lumbar Level Spina Bifida

Thank you for taking the time to view my Capstone. I appreciate any feedback, questions or comments.

Mae Langford, SPT

Background

This project is based on a recent experience working with pediatric patients in the field. Professionals have said, typically children are given posterior walkers while adults are given anterior walkers. This generic concept of assistive device prescription is largely based on research completed on children with various cerebral palsy diagnoses. Similar bodies of research have not been developed for the many other diagnoses seen in the pediatric physical therapy practice. If the goal of assistive device use with the pediatric population is to improve access to their environment and decrease energy expenditure, then the appropriate device is likely to change based on the individual. This is particularly important as children transition from a smaller preschool or home environment to a larger elementary school environment.

Project Purpose and Products

The goal of the project is two-fold. The first is to describe various assistive devices available for the pediatric population, from walkers to gait trainers, and their benefits, drawbacks and indications. This includes possible modifications available for the model and cost of the devices. The goal of the second portion of the project is to apply this information on devices to two pediatric populations who often benefit from their use, children diagnosed with spastic diplegia cerebral palsy and children diagnosed with lumbar level spina bifida. Two presentations were created to supplement course content in the Neuromuscular Assessment and Intervention courses in the UNC at Chapel Hill Doctorate of Physical Therapy program, one on gait device choice for children with spastic cerebral palsy and one on gait device choice for children with lumbar level spina bifida. Case studies were developed under each diagnosis to allow for practice applying gait device choices to patients with various levels of involvement.  

This project is designed for students in the entry level DPT program. While information about assistive devices is currently in the program curriculum, the information on gait trainers and walkers is primarily focused on the adult population. Within courses on development, pictures of pediatric gait trainers are displayed but there is little opportunity for students to think about and practice choosing a device for a child to address ambulation. These skills are important for the student planning to enter into the field of pediatrics but students who plan to go into other areas of practice can also utilize the concepts of gait device choice for their future patient populations.

Project Development

Completing my Critically Appraised Topic in Evidence Based Practice II helped to prepare me to create this project. My research focused on gait devices for children with lumbar-sacral level spina bifida. In working through that project, it became very clear that information on this topic is limited. Much more information is available regarding children with spastic diplegia CP. This prompted me to expand my topic to include that population. My evidence table was subsequently expanded to include information on gait in children with spastic diplegia cerebral palsy. To better develop my understanding of the various devices available, I worked with Kris Ledford, a seating and mobility specialist at Numotion in Cary, NC. I also worked with Cathy Howes, a pediatric physical therapist with a special interest in children with spina bifida and Melissa Scales, a school-based physical therapist in the Durham Public School System to improve my understanding of device choice for children and develop case studies for practice.

Evaluation

The project was developed to present to students in their second year of physical therapy school at UNC at Chapel Hill. Subsequently, this information has not yet been presented. I plan to present this information in person or over a voicethread to students in the fall semester of 2015 and the spring semester of 2016, schedule permitting. To assess the success of my presentations when they occur, I created a feedback form for the presentation on cerebral palsy and the presentation on spina bifida. In working with Cathy Howes who has presented to the second year students on cerebral palsy and spina bifida, and discussing the content of my presentation with Karen McCulloch who has taught the Neuromuscular Assessment and Intervention courses for many years, I feel confident these presentations will add useful content to the course material.

Self Evaluation

Creating this project has been a great learning experience for me. In working to develop course content for future physical therapy students, I greatly expanded my own understanding of the process and nuances of choosing gait devices for children. I also learned a lot about the diagnoses of spastic cerebral palsy and lumbar level spina bifida and how much variety there can be between children with the same diagnoses. Developing this project helped me learn to think critically about what the literature says and how that translates into living, dynamic patients who must interact with their environments. In working with a school-system physical therapist, an outpatient pediatric physical therapist and seating and mobility specialist, I developed relationships with area professionals and learned from their clinical experience. Working with those professionals, I was also able to get a diverse take on mobility devices for children.

The most difficult part of developing the project was creating presentations that are learner friendly and will be useful to future students. I hoped to limit my use of bullet points and allow for lots of time for class interaction. When it became clear my presentations may have to be delivered over voicethread, I felt a more traditional, bullet-point heavy presentation would be better able to convey the information. If I am able to give the presentations in person, I will plan to pause between slides to allow for class discussion and will use the bullet-point lists to briefly ensure all topics are covered. In this way, I hope my presentations will be more learner friendly. I feel confident the case studies will allow for learner interaction that should help with carry-over into clinical practice.

Finally, I learned a lot about the world of pediatric therapy by working to create case studies. Sickness, weather and school calendars do not always follow the deadlines I have set for myself. Coordinating between various settings, therapists and patients helped me practice patience and flexibility when things do not quite go my way. This project has helped to improve my ability to be adaptable, a skill necessary when working with children. This skill should serve me well in my future profession.

Acknowledgements

I would like to thank my committee members, Cathy Howes and Melissa Scales for working with me to develop these capstone materials. I would also like to thank my capstone advisor, Karen McCulloch who helped me create a project idea and scope appropriate for supporting the education of students in the physical therapy program at UNC at Chapel Hill.

Capstone References

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