Pediatric Evaluation of Disability Inventory (PEDI) – BWSTT and CP
Pediatric Evaluation of Disability Index – Computer Adaptive Test (PEDI-CAT)
Type of Test: The Pediatric Evaluation of Disability Index – Computer Adaptive Test is a self-report measure used to assess a child’s ability across different functional parameters. Parents, caregivers, or healthcare individuals (ie. Physical therapists) fill out the PEDI-CAT assessing 5 different categories of their child’s functional abilities.
Target Population and Ages: The PEDI-CAT can be used on any pediatric patient of any age.
Cost:
· Windows – $89.00 for one-year license
· iPad – $399.00 for perpetual license
· Manual 1.4.0 for PEDI-CAT is included with either Windows of iPad purchase
Title of Article: A home-based body weight supported treadmill training program for children with cerebral palsy: A case series
Authors: Lisa K. Kenyon PT, DPT, PhD, PCS, Marci Westman PT, DPT, Ashley Hefferan PT, DPT, Peter McCrary PT, DPT and Barbara J. Baker PT, PhD, NCS
Kenyon LK, Westman M, Hefferan A, McCrary P, Baker BJ. A home-based body weight supported treadmill training program for children with cerebral palsy: A case series. Physiotherapy Theory and Practice. 33(7):576-585. doi:10.1080/09593985.2017.1325956
Purpose: The purpose of this article was to assess the use of at home body-weight support treadmill training in improving functional outcomes of pediatric patients diagnosed with cerebral palsy.
Study Population: This study focused on 3 participants of different ages and varying severity levels of CP and differing levels of mobility (based on Gross Motor Function Classification System levels). Participant one was 5 years, 11 months old. Participant two was 14 years, 10 months old. Participant three was 5 years, 6 months old.
Methods: Participants were selected based on inclusion criteria that included a diagnosis of cerebral palsy, ability to follow simple commands, parent goals of improving overall functional mobility, a treadmill already in the home, and parental agreement to carry out interventions during the testing period. The three participants were assessed using several functional measures, both pre-intervention and post-intervention.
Outcome Measures: Measures reported in this test pre-intervention and post-intervention included: GMFM-66, PEDI-CAT, FAQ and the 10-meter walk test. Participants were also assessed for their Gross Motor Function Classification level prior to testing and reassessed post-treadmill training intervention.
Interventions: Participants were given, fitted and instructed on use of the Wingman MultiSport Harness and Ceiling Mounting Kit for body weight support treadmill interventions. A home visit by a clinician was done to ensure proper use and understanding of the body weight support components. For the training interventions, parents were instructed to set the speed of walking to a comfortable pace that allowed for a consistent fluid motion, with proper gait mechanics during all phases of gait. Parents were instructed to use the BWSTT interventions 2-3 times per week, building up to a duration of 15-20 minutes each session, with speed set by guidelines introduced by the researchers. Participants 2 and 3 performed interventions for 8 weeks and participant 1 performed intervention for 12 weeks (secondary to increased time required for child to become comfortable with the intervention).
Results: At the conclusion of the study, each participant was noted (via family) to have improvements in regard to their functional abilities. Participant one showed no change on the PEDI-CAT. Participants two and three showed improvements of 1 point on the PEDI-CAT at the conclusion of the intervention period. Even though numerical data showed little change, each family noted significant improvements in function.
Strengths/Limitations: This article did a great job of looking at not only increasing activity and attempting to improve ambulation in children diagnosed with CP, but also implementing family involvement into the rehab process. The research was easy to read and understand. It offered a variety of tests and assessments to analyze different functional aspects of patients diagnosed with CP. The authors also implemented a method of testing that was easy to follow and offered potential continuations once the data collection process was concluded. A few limitations were noted while analyzing this study. The small sample size may not give us a full picture of if this intervention would be beneficial for those. Perhaps a larger sample size, larger age differentials, or a follow up after a set time period would allow for a more detailed inference to be made on whether or not BWSTT could be beneficial long term for patients diagnosed with CP.
Conclusions: Although significant improvements were noted via the family of each participant and the conclusion of BWSTT, no significant changes were noted on the PEDI-CAT outcome measure. Perhaps with more testing, longer intervention periods, or follow up measurements, we might see improvements across standard outcome measures like the PEDI-CAT in this patient population. Since function is the main focus of the PEDI-CAT, we would expect there to be a significant change at the conclusion of BWSTT, however this was not the case for this particular study.
4 responses to “Pediatric Evaluation of Disability Inventory (PEDI) – BWSTT and CP”
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Interesting article. Do you know if there were improvements on the 10-meter walk test? Is there anything in the intervention you think you would change in order to get better results, maybe even change the outcome measure? Because, it seems odd that parents are noticing results but no significant change in the outcome measures.
I agree that it is interesting that although the formal outcome measure did not show significant improvements, the parents were able to see improved functional abilities. In regards to the 10m walk test, both participants 2 and 3 were able to decrease total time to complete the 10m walk test and improve gait speed. Participant 2 was also able to decrease the amount of assistance needed while ambulating at the completion of BWSTT interventions.
Great conversation! Were the changes in 10m walk significant or meet MCIDs? I love using BWSTT as a means of increasing activity. Did they monitor HR or RR?
They did not monitor HR or RR during training. They used continuity of stepping patterns, as well as the child’s fatigue level to determine if a rest break was needed or if the session should be ended for the day. Since parents were administering all but the initial session, using the child’s stepping pattern and signs of fatigue was perhaps easier. In regards to the 10m walk test, no significant difference was noted across the 3 participants. Participant 2 improved the 10m walk test by 3 seconds and improve gait speed from 0.19 m/s to 0.2 m/s. Participant 3 improved the 10m walk test by 3 seconds and showed an improvement in gait speed from 0.45 ms to 0.52 m/s.