Overview:
There is a major concern among school-based physical therapists (SBPTs) about whether use of a less restrictive assistive device (AD) would be beneficial or detrimental to a child with disability’s learning ability in the classroom. According to the Individuals with Disabilities Education Act (IDEA) – Part B, physical therapists in the school system are required to address education-related needs1. While in the outpatient setting physical therapists provide treatment deemed medically necessary, school based physical therapy is required to be educationally relevant. For this reason, many school-based therapists face the decision of whether to utilize a more or less supportive AD for their students. A less supportive AD will allow the child more physical activity and exertion, allow for more freedom of movement, and provide the student with an increased sense of autonomy. A more supportive AD may allow the child to achieve increased success in the classroom and experience heightened levels of self-worth.
Children with cerebral palsy (CP), traumatic brain injury, and mitochondrial disorders not only battle chronic fatigue, but also fatigue faster during exercise than their typically developing and able-bodied peers2,3,4. The energy expenditure index (EEI) and rate of perceived exertion (RPE) have been utilized in this population to determine cost of ambulation.5,6,7,8,9 However, no studies have investigated the use of EEI or RPE in determining fatigue levels in the classroom. The purpose of this literature review and prospective study design is to examine the relationship between the EEI, RPE, and fatigue in the classroom as well as begin the process of developing a standardized, inexpensive, and accessible way of determining need for more supportive AD in the school setting.
Statement of Need:
My capstone project aimed to examine the relationship between EEI, RPE, and fatigue in the classroom as well as begin the process of developing a standardized way of determining need for more supportive assistive device in the school setting. Currently there is no research investigating the relationship between these factors. It is critical that PTs assist children in receiving the best education possible, while also meeting their needs for movement and autonomy. Valid, reliable, and standardized methods of determining most appropriate assistive device for children in the classroom would not only decrease burden on therapists, but also allow students to reach their full potential both physically and mentally.
Products:
Products of my capstone include a literature review on the relationship between EEI, RPE and fatigue as well as a prospective study design (Literature Review and Study Design). The study design was formulated using current literature, and aims to assist in the development of a standardized method of determining most appropriate assistive device in the school setting. The literature review and study design will be sent out to the School-Based Physical Therapy SIG listserv and will also be posted to the APTA Section on Pediatrics website. Arrangements are currently being made to complete the outlined study design in the fall. Following completion of data collection and formal write-up, I plan on submitting results to a peer-reviewed journal for publication. My products are intended for an audience of school-based physical therapists, or other education personnel interested in learning more about use of proper assistive devices in the school setting.
Assessment of Materials:
To evaluate my products I utilized a checklist of components necessary for a literature review by Taylor10 titled “A Brief Guide to Writing a Literature Review”. Additionally, following completion of my review I used a resource by the University of Ontario11 that outlined appropriate use of tenses in literature reviews. To see a write-up of my self-assessment, you can view this document. Self-Assessment
In addition to self-assessment, I formulated a questionnaire about my products to send to committee members. You can find a blank copy of the document here. Assessment
My capstone project allowed me to investigate a topic I am very interested in, while also learning to complete literature reviews and design research studies. Plans are being made now to carry out the research study in the fall and I cannot wait to get started on data collection!
Additional Resources:
If you would like to see a complete reference list utilized for this project, feel free to click on the link provided. Full Reference List
Acknowledgements:
A huge thanks to Dana McCarty PT, DPT, PCS, C/NDT and Laurie Ray PT, MPT, PhD for their guidance and assistance on the completion of this project. Their expertise and knowledge on this issue were instrumental to the literature review and study design formation. I also greatly appreciate Janet Harbeck and Amy Woodcock, both PTs for New Hanover County Schools, for encouraging me to research this topic and motivating me to provide better care to students in the school system. I am grateful for all the knowledge, skills, and life advice given to me by the faculty of UNC Chapel Hill’s DPT program and can’t wait to see all the wonderful things my classmates of 2016 accomplish in the future!
Resources:
1. American Physical Therapy Association Section on Pediatrics. Providing Physical Therapy in Schools Under IDEA 2004. PDF. Copyright: 2009. Accessed: 3/10/2016.
https://pediatricapta.org/pdfs/IDEA%20Schools.pdf
2. Berrin SJ, Malcarne VL, Varni JW, Burwinkle TM, Sherman SA, Artavia K, Chambers HG. Pain, fatigue, and school functioning in children with cerebral palsy: A path-analytic model. Journal of
Pediatric Psychology 2007; 32(3): 330-337.
3. Cantor JB, Ashman T, Gordon W, Ginsberg A, Engmann C, Egan M, Spielman L, Dijkers M, Flanagan S. Fatigue after traumatic brain injury and its impact on participation and quality of life. Journal of Head Trauma Rehabilitation 2008; 23(1): 41-51.
4. Chaudhuri A, Behan PO. Fatigue in neurological disorders. The Lancet 2004; 363(9413): 978-988.
5. Rose J, Gamble JG, Lee J, Lee R, Haskell WL. The energy expenditure index: A method to quantitate and compare walking energy expenditure for children and adolescents. Journal of Pediatric Orthopaedics 1991; 11: 571-578.
6. Norman J, Bossman S, Gardner P, Moen C. Comparison of the energy expenditure index and oxygen consumption index during self-paced walking in children with spastic diplegia cerebral palsy and children without physical disabilities. Pediatric Physical Therapy 2004; 16(4): 206-211.
7. McDonald CM, Henricson EK, Abresch RT, Florence J, Eagle M, Gappmaier E, Glanzman AM, Spiegel R, Barth J, Elfring G, Reha A, Peltz SW. The 6-minute walk test and other clinical endpoints in Duchenne Muscular Dystrophy: Reliability, concurrent validity, and minimal clinically importance differences from a multicenter study. Muscle Nerve 2013; 48(3): 357-368.
8. Bartonek A, Saraste H. Factors influencing ambulation in myelomeningocele: A cross-sectional study. Developmental Medicine & Child Neurology 2007; 43(4): 253-260.
9. Groslambert A, Mahon AD. Perceived exertion: Influence of age and cognitive development. Sports Med 2006; 36(11): 911-928.
Picture can be found at: https://nothingtobefeared.files.wordpress.com/2011/10/wheelchair_child_12.jpg