3/15/2017. Being upright improves vision

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1 Part Three Easy to use Acceptable by the family Fun for the Kid Affordable/Accessable Dynamic Stimulates balance Allows for exploration and Independence Being upright improves vision 46 Football Fields/Day Over 14,000 steps a day (AdolpH, 2012) Phys Ther Mar;87(3): Ambulatory physical activity performance in youth with cerebral palsy and youth who are developing typically What Are They Really Doing? Dev Med Child Neurol Mar;50(3):166 Physical Activity Measurement in Cerebral Palsy Pediatr Phys Ther Fall;20(3):

2 Can we use Fitbit to monitor activity? $100 Fitbit.com GPS Current and average speed Distance Traveled Free app for your phone (uses flash from camera) Pulse oximeter on a lanyard ($49) Uses flash All babies 8.5 months old Randomly assigned to baby walker 15 min 2x/day or no walker Pairs were matched for chronological age and developmental age 2

3 Testing Procedure Infants with Spina Bifida Infants who are delayed in the onset of locomotion for neurological or orthopaedic reasons have also been shown to be delayed in the development of spatialcognitive skills. Cognitive deficits in older children and adults with motor disabilities might be attributable to a lack of locomotor experience or delays in locomotor experience, especially if sensitive periods are missed. The test was a two-position hiding task in which a toy was hidden only in one location, with a second hiding location serving as a distractor. Infants were tested monthly after recruitment until 2 months after the delayed onset of independent locomotion, which occurred at 8.5, 11.5, and 13.5 months-of-age in three of the infants and 10.5 months-of-age in the other four. Dramatic improvements on the task were noted following the onset of locomotion. Infants searched successfully for the hidden object on only 14% of trials before they were able to crawl, but improved to 64% correct search following the delayed onset of locomotion. 3

4 Kermoian and Campos (1988) argued that belly crawlers failed to profit from their locomotor experiences because belly crawling is so effortful and inefficient. Belly crawlers were thought to devote so much effort and attention to organizing forward progression that they were unable to deploy attention to the environment in the same way as the hands-andknees crawlers and infants in walkers. Consequently, the belly crawlers may not have noticed some of the important spatial transformations during crawling, such as occlusion and reappearance of objects that contribute to improved search performance Children who walked independently or directed the experimenter while being pushed in the wheelchair performed most successfully on the task. Control over decision making was the crucial determinant of spatial search performance, not the means by which locomotion was achieved. Child has to be able to move efficiently on their own if walker is too effortful use a gait trainer!!!! au/cp_research_news.html Weekly s of abstracts on CP Come from Utrecht 4

5 Children with Down Syndrome Normal Children Average Range Average Range Smiling 2 months 1½-4 months 1 month ½-3 months Rolling over 8 months 4-22 months 5 months 2-10 months Sitting alone 10 months 6-28 months 7 months 5-9 months Crawling 12 months 7-21 months 8 months 6-11 months Creeping 15 months 9-27 months 10 months 7-13 months Standing 20 months months 11 months 8-16 months Walking 24 months months 13 months 8-18 months Words 16 months 9-31 months 10 months 6-14 months Sentences 28 months months 21 months months (Pueschel, 1978) METHODS Randomized controlled study PT 2x/mo both groups Study group also received treadmill training 5 days a week x8 minutes SUBJECTS 30 infants with Down Syndrome could sit indep for 30 sec 5

6 MEASUREMENTS Age of child at onset of indep walking Standing Crawling Body part size RESULTS Experimental group walked earlier than the Control group From sitting to pull to stand 60 days earlier walk with help 73 days earlier walk independently 101days earlier ULRICH S CONCLUSIONS Not sure we have designed optimal treadmill procedures Has potential to impact beyond locomotor behavior CUTE LITTLE TREADMILL Sam Carlin Phone / Fax scarlin@voyager.net carlinscreations.com Oak Dr. Sturgis, Mi Is it safe???????? 6

7 Ariana at age 3 There is yellow light evidence for gait trainers Two new articles out this year Publish your case stories Get equipment funded Pick the right GMFCS level (check your work) Try GMFM with percentiles Know the evidence behind what you do Gait Trainers work and are used as part of evidence based practice patterns Our kids deserve to move Pick one kid and try 7

8 JOIN MY FACEBOOK GROUPS: 1. PEDIATRIC PT AND OT ARTICLE DISCUSSION GROUP AND 2. PRIME ENGINEERING 8