Pediatric Exam & Eval

List the 3 parts of the exam outline

1. Subjective & history

2. Exam: impairment-level testing

3. Exam: activity-level testing

What makes up the subjective portion?

• Reason for PT

• Duration of problem

• History of therapy

• Family/child goals & priorities

• Clinical observations

What do we look for in medical history?

• Birth history (gestational age, complications, NICU)

• Developmental history (milestones)

• Surgeries/hospitalizations

• Review of systems

What makes up social history?

• Childcare setting

• Home characteristics

• Family members in home

• Preferred activities

• Daily routine

What makes up the majority of pediatric PT?

Movement analysis!

What is important to know about our observations during evals?

They are subjective! May have different results from other clinicians

List some things we look for during observed movement analysis.

• symmetry

• speed

• amplitude

• alignment

• postural control

• coordination

• symptom provocation

What are common functional motor skills that should be seen in 2 year olds?

• Floor → stand transfers

• Sit → stand

• Sitting

• Standing

• Stairs

• Running

• Jumping & hopping

• SLS

• Walking

What are the purposes of using standardized outcome measures?

• ID risk of delays

• Determine eligibility for services

• Intervention planning

• Document change over time

• Determine efficacy of treatment over time

• Research purposes

What child characteristics must you consider when choosing an outcome measure?

• Age

• Diagnosis

• Current functional capability

• Cognitive & language ability

List external constraints for outcome measure selection

• time

• examiner experience & training

• space & equipment

• purchasing costs

• payor requirements or limitations (insurance)

Define age equivalent score

Mean chronological age represented by certain test score

Define criterion-referenced test

Scores interpreted on # of tasks performed correctly

Define norm-referenced test

Use norm values as standards for interpreting individual scores (peers)

Define percentile score

The # of children of same age who would be expected to score lower than the child you are testing (rank)

Define raw score

Total score for tasks performed correctly on test

Define standard & scaled score

Conversion of raw score to standardized score

Which type of outcome measure can ONLY be used to compare performance to a population?

Norm-referenced tests

What is the age range, target population, format, and cut off score of the AIMS?

• 0-18 months

• At risk infants of delay

• Norm-referenced

• <10th percentile

What areas of motor function are assessed through the AIMS?

• Achievement of motor milestones

• WB

• Posture

• Antigravity movement

What are some advantages of using the AIMS?

• Affordable

• Little training needed

• Observation based

• Quick

• Early detection of delays

What are some disadvantages of using the AIMS?

• Not as sensitive to deviations from norms

• Small change in raw score can lead to large change in percentile rank

What is the age range, target population, & format of the PDMS-3?

• 0 - 6 years old

• Young children

• Norm-referenced

What areas of motor function are assessed with the PDMS-3?

• Gross motor function

• Fine motor function

Describe the entry point & cut off of the PDMS-3.

• Basal level = 3 consecutive scores of 2 (start here)

• Ceiling level = 3 consecutive scores of 0 (stop here)

What are the 3 scores that can be given on the PDMS-3?

• 0 = can’t or won’t attempt skill

• 1 = does not fully meet criteria

• 2 = meets criteria for mastery

What are advantages of using the PDMS-3?

• Standardized

• Reliable

• Valid

• Broad age range

• Subtests scored separately

• 3-point scoring system (can see progress)

What are disadvantages of using the PDMS-3?

• Long administration time

• Less sensitive to quality of movement

• Expensive

• Needs online scoring system

What is the age range, target population, & format of the BOT-3?

• 4 years - 25 years

• School-aged children

• Norm-referenced

What ares of motor function are assessed with the BOT-3?

Higher level gross & fine motor skills

What are advantages of using the BOT-3?

• Good for school-aged children with higher motor ability

• Can use for up to 25 years & 11 months

• Can complete just one sub-section

What are disadvantages of using the BOT-3?

• Not useful for children with significant motor impairments/delays

• May not detect change in performance

• Age equivalents should be used cautiously

• Can be difficult for 4-5 year olds

What is the age range, target population, & format of the PEDI?

• 6 months - 7 years

• School-aged children

• Norm referenced OR criterion referenced

What areas of mobility are assessed with the PEDI?

• Self care

• Mobility

• Social function

• Functional skills

• Caregiver assistance

• Modifications

What are advantages of using the PEDI?

• Caregiver report

• Can be used for broad ranges of ages

• Useful for kids with disabilities

What are disadvantages of using the PEDI?

• Skills are lower level

• Expensive PEDI-CAT

• Norm-referenced only for up to 7 year olds

What is the age range, target population, & format School Function Assessment (SFA)?

• 6-12 years (K-6th)

• School-aged children

• Criterion-referenced

What areas of motor function are assessed with the SFA?

• Student performance of functional tasks that support participation in academic & social school-related activities

• Participation

• Task supports

• Activity performance

What are advantages of using the SFA?

• Measures meaningful functional change

• Separate scales for separate areas

• Assists with prioritizing needs, IEP development, documents progress

What is the big disadvantage of using the SFA?

Long time to administer & only in school

What is the age range, target population, & format of the GMFM?

• 5 months - 16 years

• GMFM 88 → CP & down syndrome

• GMFM 66 → CP

• Criterion-referenced

What areas of motor function are assessed with the GMFM?

• Lying & rolling

• Sitting

• Crawling & kneeling

• Standing

• Walking, running, & jumping

What are advantages of using the GMFM?

• Test booklets are free

• Manual is affordable

• Clinically useful for CP & down syndrome

• Can complete only dimensions needed

What are disadvantages of the GMFM?

• Long time to administer

• Only tests gross motor capacity

• GMFM 66 requires computer to interpret scores

What are 3 participation level outcome measures that can be used?

• Canadian Occupational Performance Measure

• Children’s Assessment of Participation & Enjoyment (CAPE)

• Pediatric Quality of Life Inventory (PedsQL)

What 3 components make up the evaluation?

• PT diagnosis

• Plan of care

• Prognosis

How do you make your plan of care?

Use exam findings to ID therapeutic interventions

What is typical frequency for plan of care for low, moderate, or high necessity?

• low = 1x/week

• moderate = 2x/week

• high = 3x/week

What factors help create the patient’s prognosis?

• Diagnosis

• Clinical experience

• Facilitators & barriers

• Predictive tools (GMFCS)