Postural Control Assessment of the Infant and Toddler: Increasing Outcome Measurement Tool Use

Postural Control Assessment of the Infant and Toddler: Increasing Outcome Measurement Tool Use

By: Jennifer Tompkins, PT

Background:

As I began the transitional Doctor of Physical Therapy program, I knew I wanted my Capstone Project to be directly related to my current clinical practice. A project that was of value to both myself and to the pediatric physical therapists who join the practice was essential to me. If you had asked me in 2004 as a new graduate of the Masters of Physical Therapy program at UNC, if I have the desire to start a private clinical practice, I would have given you a firm and resounding “No!”  However, 10-years later, I found myself with a great deal of pediatric clinical experience and a desire to work independently and provide community-based services to our littlest of patients. Four years after that great big leap, I found myself wanting to increase my evidence-based practice, ensure that myself and the PTs who work with me are providing the most up to date, effective, and compassionate care. I decided to return to UNC for the two-year transitional DPT program. A Critical Appraisal Topic I completed in our Evidence-Based Practice II class catapulted my project idea and inspired the products created here. The products designed will enhance understanding of the complex processes that are needed to develop postural control. Upright sitting is a milestone every parent waits for, but for some infants, this milestone is not met when expected. Pediatric physical therapists asses and treat countless children who struggle with this developmental milestone.  One way to improve our assessment of postural control is to utilize outcome measurement tool use.  Outcome measures can help identify impairments impacting the child’s postural control, track progress, and justify treatment.^1-5 I hope that this Capstone project serves as a resource that can be used for years to come.

 

Purpose and Statement of Need:

As a private practice owner, I often onboard and train physical therapists as they enter the world of in-home pediatric physical therapy. Both novice and experienced pediatric physical therapists often need refresher information on typical and atypical development. I find myself in the role of an educator. I regularly want to find ways to help increase knowledge around the complex process that leads to successful upright sitting and mobility. Early impairments in head righting, upper extremity reaching, and balance reactions in sitting can be clues to long term balance impairments.^1,6-9 Early intervention pediatric physical therapists rarely use outcome measurement tools to identify and track balance and postural deficits. The home or community environment can be challenging to perform outcome measures due to the changing nature of each setting, or lack of appropriate resources to complete a more formalized assessment.

The development of educational materials with an in-depth look at postural control and sitting balance development in infancy has been created to provide the necessary background information for therapists working with infants and toddlers. A descriptive and instructional guide on how to select the appropriate outcome measures, the research that supports their use, and guiding information on how to use the measure are included here on this Capstone website. This project will boost the pediatric physical therapists’ knowledge and comfort with understanding the complexities of postural control, improve our ability to pinpoint impairments, and track progress more accurately.

 

Product Overview:

1. A literature review: Postural Control- Literature Review

Title: Postural Control Development: Typical, Atypical, and At-Risk Infants and Toddlers

The literature review is intended to provide evidence-based support to increase detailed assessment of postural control in early infancy through the onset of walking.

2. A literature table is also offered here as a quick reference tool: Postural Control Dev. Literature Table

3.  A pocket guide: Outcome Measurement Tools ~Pocket Guide ~

Title: Assessing Infant Postural Control with Outcome Measures; Guide to successful use of the SATCo, ECAB, and the MFS

The pocket guide is intended to assist the pediatric physical therapist with the selection of an appropriate outcome measure to use with their patients. It can serve as a reference during testing and interpreting results.

4. CAT (Critical Appraisal Topic): Tompkins.J -CAT

Clinical Question: In children aged 6-months to 5-years with neurodevelopmental delays is the Segmental Assessment of Trunk Control (SATCo) or the Early Clinical Assessment of Balance (ECAB) better at detecting progress in postural control and balance in sitting for children receiving physical therapy services?

 

Evaluation:

Throughout the process of creating the products associated with this Capstone, my committee members provided ongoing feedback. The feedback was incorporated to strengthen the content, accessibility, and usefulness of the products. My advisor, Dr. Deborah Thorpe, PT, PhD, was especially encouraging and helpful, providing expert-level feedback that enhanced this project throughout the creation process. My committee members Dr. McCarty, PT, DPT, and Megan Hardisty, PT, MS, provided me excellent clinical feedback and tips on making the pocket guide more user friendly and were soundboards to ensure the correct level of health literacy. Megan Hardisty, PT, MS generously filled out an evaluation form that I created to assess the usefulness of the pocket guide. This valuable feedback will enhance the tool as it moves toward use as onboarding educational material for physical therapists new to providing early intervention services.

The evaluation form Pocket Guide Feedback Form will be given to all therapists who use the pocket guide to obtain their feedback and to help enhance the usability of the guide.

 

Self-Reflection:

Initially, I struggled with formulating an idea for this project and felt overwhelmed with the process of creating products with my name attached to them. After completing a CAT in our Evidence-Based Practice II class, I became more confident in my ability to review the literature available on a specific topic. I found myself inspired by the course content. As I struggled to solidify on my idea for this project, I was most definite that I wanted the project to address a need in my area of clinical practice, but also enhance my teaching capabilities. Completion of this project has increased my confidence in my ability to create and teach pediatric content that is meaningful to me, the patients and families I serve, and to therapists who might join me in early intervention clinical practice over the years. The project highlighted my strengths and weakness and provided me with an opportunity to push myself farther than I would have expected academically. I learned that, for me, writing requires significant time and effort with multiple returns to review the structures of my sentences and the flow of my thoughts. This project required self-discipline, rigorous research, and critical thinking, as well as creativity.  Not only am I proud of the materials I have created, but I feel more confident now than ever before in my knowledge base. This project has brought me pride and confidence and helped create a new goal of venturing into seeking out academic teaching opportunities.

 

Acknowledgments:

I want to thank first and foremost, my mother, Helen Tompkins, RN, for encouraging me to pursue my academic goals and assisting me with taking care of my daughter Bailey Tompkins over the past two years. Without her assistance and full-support, I would not have been able to complete this rigorous program. My daughter patiently understood that mommy had school work to do most nights, and every weekend and accompanied me to the library many times reading books while I read and worked on this project over the past 4-months.

I want to thank my advisor on this project, Dr. Deborah Thorpe, PT, Ph.D. for her encouragement, feedback, and suggestions, as well as her smart advice to do excellent work on fewer products than mediocre work on more products! I want to thank Dr. Dana McCarty, PT, DPT for her down to earth chats and feedback over the past few years, even before I entered the transitional DPT program. I would also like to thank Megan Hardisty, PT, MS, who is an evaluator for North Carolina’s Infant-Toddler Program at the Durham Children’s Developmental Service Agency. She has become a mentor and friend over the years and was willing to provide me valuable feedback (and many phone calls) over the past few years.  Most recently, she took time out of her busy professional and personal life to assess these products.

An additional thank you to Dr. Laurie Ray, PT, Ph.D. for working with me on a lecture this semester, and helped me through my first teaching experience. Although not directly related to this Capstone project, her advice and preparatory process for teaching also influenced me a great deal during the creation of this project.

Thank you to all of the professors, especially Dr. Karen McCulloch, PT, Ph.D., who has taught me in numerous classes over the years, and was encouraging to me before jumping into this program to complete my transitional DPT.

Lastly, thank you to the UNC Physical Therapy Division for taking a chance on me as a young person and admitting me to your Master’s Program in 2002 and then again accepting me into the transitional DPT program in 2018 (no longer that young person). I have achieved my academic goals because of your willingness to admit me as your student multiple times. Thank You!

~ Jennifer Tompkins, PT

 

 

Bibliography

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