Assessing the Need For and Effectiveness of a Presentation on Pediatric Equipment in Doctor of Physical Therapy Students
By: Brennan Ehlinger Visser, SPT
Background:
Surprisingly, there is a wide variety of experience and knowledge among pediatric physical therapists when it comes to equipment. Some clinicians consider this practice area as a huge component of what they do, while others decide to abstain from participating in the equipment decision-making process, leaving the entire process up to the equipment vendor. In order to obtain and maintain extensive equipment knowledge, physical therapists must be dedicated to researching and staying up to date with available products, discussing cases with other clinicians, and building their skills over time. Pediatric physical therapists report receiving very little instruction on pediatric-specific equipment while in physical therapy school, but instead have to rely on “on the job” learning and mentoring from more experienced therapists. The lack of curriculum content covering pediatric equipment may be due to lack of time, ever-changing durable medical equipment technology, and small focus on the PT licensure exam. My capstone aims to foster critical thinking skills and provide basic foundational knowledge to allow DPT students to participate in the adaptive equipment process while on their clinical rotations and be more prepared in the future as pediatric therapists.
Project Overview:
My interest in pediatric equipment began during my clinical rotation in school-based physical therapy, where I worked with students with various diagnoses and multiple equipment needs. This interest led me to complete my Critically Appraised Topic (CAT) on the available evidence regarding a very commonly used piece of pediatric equipment. My CAT, which can be accessed here, set out to answer the following clinical question: In a child with cerebral palsy, is an anterior walker more effective than a posterior walker in improving upright posture (measured by decreased hip and trunk flexion), gait parameters (such as cadence, walking velocity, stride and step length, single and double support/stance time) and energy efficiency (measured by oxygen consumption)? This search for evidence helped begin to lay the foundation for my capstone presentation.
To address the need I saw for additional educational content regarding pediatric adaptive equipment, for the first part of my capstone I created a Voicethread presentation. It was used as a supplemental resource in the PHYT701 Motor Development course taken by first year DPT students, as well as an optional resource for second and third year students in the program interested in pursuing pediatrics. The goal of the presentation is not to provide students with a long list of specific equipment currently available, as new equipment comes out on the market constantly, leading to accumulation of outdated information over time. The learning objectives for the presentation include introducing DPT students to the different categories of pediatric adaptive equipment and their indications for use, and how to choose certain aspects of equipment based upon patient presentation. The categories of pediatric equipment included in the presentation are standers (dynamic, prone, supine, sit-to-stand), walkers, pacers/gait trainers, adaptive seating (strollers, school chairs, floor sitters), and ADL-related equipment.
Before listening to the Voicethread, all participating students filled out a Pre-Test Assessment & Survey I. The Pre-Test Assessment included one case-based question requiring knowledge on the following: 1) existing pediatric equipment, 2) ability to determine which piece of equipment is appropriate, and 3) determine suitable features and accessories based on patient presentation. The aim of Survey I was to assess general comfort level and familiarity with pediatric equipment, as well as the students’ views on a physical therapist’s role in the equipment decision-making process. After listening to the Voicethread, all participating students filled out a Post-Test Assessment & Survey II. The Post-Test Assessment utilized the same format as the Pre-Test Assessment, but with a different case scenario, in order to show whether or not the information on the Voicethread was helpful for clinical decision-making on a patient case. The questions on Survey II aimed to evaluate if the student felt the presentation had any impact on their comfort level with equipment, as well as the overall effectiveness and usefulness of the presentation.
Project Products:
- The ~30 minute Voicethread on Pediatric Equipment can be accessed here, or if you prefer to download a PowerPoint version of the presentation to refer to later, you can do so here.
- Full list of references from the Voicethread: Capstone Presentation References
- Pre-Test Assessment & Survey I to be completed before the Voicethread.
- Post-Test Assessment & Survey II to be completed after the Voicethread.
- Here is the Answer Key which states the correct answers for the Pre- and Post-Test Assessment case-based questions, as well as provides an explanation for scoring.
- I also wrote an extensive qualitative report, discussing the results of the assessments and surveys, and their implications for DPT education. This report can be accessed here: Summary of Results
Results:
As for first year DPT students, even though 38% reported observation experience in various settings, only one DPT student out of thirty answered the pre-test question correctly. This shows that observation experience does not lead to an increase in actual pediatric equipment knowledge and decision-making ability. When describing rationale for equipment decisions, it was obvious that some of the first year students had good critical thinking skills, yet lacked the knowledge of pediatric equipment available or even just the appropriate terminology to use. Even further than knowing the available equipment to choose from, DPT1 students had very little knowledge regarding features and accessories. There was a dramatic improvement in the amount of DPT1 students that answered correctly on the Post-Test Assessment, with 73.3% giving an appropriate recommendation. A 70 percent increase in the amount of first year students answering correctly after listening to the Voicethread points to the effectiveness of this educational resource for those with very little, if any, clinical experience.
In contrast to the extremely low 3% of DPT1 students to correctly answer the pre-test question, 66.7% of DPT2 & DPT3 students correctly answered the pre-test question. Although DPT2 and DPT3 students did very well on the Pre-Test Assessment, there was still significant improvement after listening to the Voicethread, as 100% of these students answered the Post-Test Assessment correctly. This demonstrates the effectiveness of the Voicethread to not only teach foundational basic equipment knowledge to those with little clinical experience, it also shows its effectiveness in teaching information on areas that may have been missed on a pediatric clinical rotation.
Evaluation & Self-Assessment:
In addition to evaluating the effectiveness of the Voicethread by comparing results of the pre- and post-test assessments, a post-test survey was given to assess the participants’ perceptions of the presentation. The post-test survey asked if participants felt the presentation adequately addressed various considerations required to choose appropriate equipment for the pediatric population and if the information would be useful to reference later on, if they now have an understanding of what devices are available and for which type of patient they are appropriate, if they feel comfortable making decisions regarding a child’s adaptive equipment, and finally, if they felt it was an effective presentation. In addition, participants were given the opportunity to make comments or suggestions for improvement. All of this feedback can be found in my Summary of Results.
Throughout the process, I sought edits from my committee on all components of the capstone, asking for feedback on the PowerPoint presentation and Voicethread script, Pre- and Post-Test Assessments and Surveys, and the Answer Key early on, and more recently requested feedback on the qualitative report that summarized my findings. Because this presentation was designed for DPT students, instead of completing a health literacy assessment, I aimed to make changes to ensure it was more learner-friendly. To achieve this, I decreased the amount of text on each slide, allowing more room for images of equipment. I also made a PowerPoint version of the Voicethread available to students, to allow them to take notes during the presentation and keep for future reference. I was also able to incorporate a video of a child utilizing a piece of equipment. This patient video was particularly helpful because it corresponds to the case-based question in the Pre-Test Assessment, which allowed students to learn the correct answer and understand the critical thinking process behind that answer before having to complete another case-based question in the Post-Test Assessment.
Overall, I am extremely pleased with the final result, and proud of all the work I have done to get to this point. My initial goal was just to create a presentation on pediatric equipment for first year students in PHYT701, but I am glad that my committee members Dana McCarty and Laurie Ray pushed me to include a pre- and post-test assessment. I think adding this component, along with the surveys, shows the need for and effectiveness of my presentation and will allow my project to make an impact on future UNC DPT students interested in pursuing pediatrics.
Acknowledgements:
This project would not have come to fruition or been a success without the support and direction from several individuals. A huge thanks to my committee members Dana McCarty PT, DPT, PCS, C/NDT and Laurie Ray PT, MPT, PhD for pushing me outside of my comfort zone, for trusting me to provide supplemental educational content in the PHYT701 course, and for the endless knowledge and feedback they gave throughout the process that helped shape my project into what it is today. Thank you to Karen McCulloch, PT, PhD, NCS for your encouragement and feedback throughout the process. I also would like to thank my clinical instructors from my school-based clinical rotation, Janet Harbeck and Jen Wilkins, for fostering my interest in pediatrics and providing me with such strong foundational knowledge regarding pediatric equipment in the school setting. Finally, to my husband William, thank you for your unwavering support throughout this program; I would not have made it here without you!
4 Responses to “Assessing the Need For and Effectiveness of a Presentation on Pediatric Equipment in Doctor of Physical Therapy Students”
Jessie Risen
Brennan,
Congratulations on a job well done! You are spot on about your assessment about “learning on the job” as far as adaptive equipment goes. I must admit that my equipment knowledge and confidence has grown exponentially since I transitioned from outpatient pediatrics job (10yrs) to my current school based job in the school system (5years). I think your presentation would be a great reference tool maybe even for the licensed therapist who needs a little confidence or an equipment training boost when transitioning to a setting that requires more knowledge about a greater variety of pieces of equipment. I always felt that equipment was my weakness and it has taken a while for me to feel comfortable with it. I also never thought I would have my own tool box but I take it with me to every school I go!
I especially appreciate your input on the mobile stander. I personally have very little experience with this piece of equipment and just started treating a young child who has one of these. My point is, no matter how long you practice an updated resource like yours is informative and helpful.
I’m glad I finally got to meet you and put a face to your name. Great job! Congratulations again.
-Jessie
Brennan Visser
Jessie,
Thanks for reviewing my capstone! I completely agree that this could be a resource for the licensed therapist as well. When I was on my school-based rotation, I actually presented a much less in-depth version of my Voicethread as an inservice for the PTs and OTs of New Hanover County. It briefly went over the various categories of equipment and why they are used but did not go into nearly as much detail with features/accessories or evidence from the literature as my Voicethread did. I did this because although both of my CIs were very well-versed in pediatric equipment and taught me so much about that practice area, most of the other therapists in the county were not very involved (if at all) in the equipment decision-making process for their kiddos, leaving most of the decisions up to the equipment vendor. Because the presentation was brief (I only had 15 minutes), I referred them to a pediatric equipment resource guide I made that was quite extensive (41 pages), which detailed all of the current equipment options for standers (dynamic, prone, supine, sit to stand), gait trainers/pacers, walkers (anterior/posterior), positioning equipment, manual wheelchairs, beds, and adaptive bicycles/tricycles. This included features/accessories available, pricing, sizing, name brands, etc. I realize now that although that resource guide may be helpful now, it will soon become outdated as new equipment comes out on the market. However, it was very helpful for me to recognize what is out there and now it will be easier for me to keep up with any new devices that become available. Thanks again for all of your helpful insight on posts throughout the past two semesters. I have enjoyed learning from you and was very excited to finally meet you in person as well! Congrats on being done!! Brennan
Brennan Visser
Elizabeth,
Thank you for your kind words! I had originally intended for the presentation to be in person, but after finding out there was not enough time in the course schedule, a Voicethread was the most reasonable option. I think there are advantages and disadvantages to both types of presentations. With a Voicethread, students can watch in their own time and replay a slide again if they missed or didn’t understand something. But I agree, asking questions is much easier in a face-to-face presentation. Out of the devices discussed in my presentation, I actually worked with all of them during my school-based rotation. We used the Leckey Advance Bath Chair for a girl with spina bifida who needed a safer environment than a toilet for when she catheterized herself. That is how I was aware of that option for bathing equipment, but I had to do research to find others, since bathing is not a typical school day activity. Even though I gained experience assessing and writing LMNs for manual and power wheelchairs on my clinical rotation, I decided to forego including those because I think that would have caused my presentation to double in size. There are so many things to think about that I believe it should be a presentation on its own. I decided to include standers, walkers, pacers/gait trainers, and adaptive seating because those were pieces of equipment that I saw multiple times a day when working with students. I would have loved to include something about adaptive bicycles and tricycles, as I actually had the opportunity to manually put some of these together after my clinical instructors received a grant to order a few for the county. I think they are an awesome way to get these children active and participating like their peers. Thank you for taking the time to fill out the assessments, surveys, and listen to the Voicethread! I wouldn’t have been able to see the full impact of my work without you.
Best,
Brennan
Elizabeth Lynch
Brennan,
I thoroughly enjoyed reviewing your capstone and learned a lot from the practical information you shared. I believe that this project definitely helps to meet a need within the curriculum, particularly for those of us who plan to pursue pediatrics. You mentioned that many pediatric therapists have to rely on “on the job” learning in this area, so it’s encouraging to know that we can use your voicethread resource to be proactive in obtaining a general knowledge of pediatric equipment while still in school. Specifically, I benefitted a lot from the images you included, as I feel like equipment is often a challenging topic to grasp without seeing the devices being discussed. In addition, I appreciate that you included a full explanation of the pre-test answer within your voicethread. Hearing you talk through this process of choosing equipment for a specific patient really helped me to look at the full picture in a systematic way for the post-test question. Since all of the students watched this presentation on voicethread, I would be interested to know if/how the results of your survey would change if the lecture were delivered face-to-face during a class session. I know that I benefit greatly from being able to ask questions in the moment, and not having this ability is one of the drawbacks of voicethread. Personally, I would advocate for a small shift in the curriculum in order to create a 30-minute window for your lecture, but I’m also a bit biased by my pediatric interests.
Since the idea for this topic arose during your school-based rotation, I am interested to know which of the devices discussed in your presentation you encountered during this clinical experience. With the wide variety of pediatric equipment available, how did you determine which ones to focus on in your presentation? As I believe I noted in my post-test survey, I would love to see a similarly formatted presentation on manual and power pediatric wheelchairs as well! Thanks again for developing such a useful product that I will continue to utilize in my future practice.
Congratulations!
Elizabeth