Publications by authors named "Linda Fetters"

66 Publications

Motivating Selective Motor Control of Infants at High Risk of Cerebral Palsy Using an in-Home Kicking-Activated Mobile Task: A Pilot Study.

Phys Ther 2021 Dec 2. Epub 2021 Dec 2.

Division of Biokinesiology & Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1540 E. Alcazar St., CHP 155, Los Angeles, CA 90033, USA.

Objective: Decreased selective motor control limits gait function of children with spastic cerebral palsy (CP). Infants at high risk of CP demonstrate decreased selective motor control by 1 month of age. To motivate more selective hip-knee control, infants at high risk of CP participated in an in-home kicking-activated mobile task. The purpose of this study was to determine whether infants at high risk of CP and infants with typical development (TD) demonstrated increased selective hip-knee control during 2-minute intervals of the mobile task when they demonstrated learning of the association between their leg movement and mobile activation versus during 2-minute intervals when they did not demonstrate learning.

Methods: Participants in this cohort study included 10 infants at high risk of CP based on neuroimaging and 11 infants with TD at 3.5 to 4.5 months of age. Each infant participated in the in-home kicking-activated mobile task for 8 to 10 min/d, 5 d/wk, for 6 weeks. Over 80,000 kicks were extracted and classified for each infant as occurring during 2-minute intervals of the task when the infant demonstrated learning versus not learning, based on mobile activation time above baseline.

Results: Infants demonstrated kicks with more selective hip-knee control during 2-minute intervals of the mobile task when they demonstrated learning compared to when they did not demonstrate learning for 4 of 6 weeks in the cohort at high risk of CP and for 2 of 6 weeks in the cohort with TD.

Conclusions: Participation in the in-home kicking-activated mobile task may motivate more selective hip-knee control of infants at high risk of CP.

Impact: This study is a first step toward developing an intervention to promote selective hip-knee control of infants at high risk of CP, with the ultimate goal of optimizing future walking function.

Lay Summary: This study showed that playing with an in-home infant kicking-activated mobile may motivate infants at high risk of CP to produce more age-appropriate leg movements.
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http://dx.doi.org/10.1093/ptj/pzab265DOI Listing
December 2021

Infants born preterm and infants born full-term generate more selective leg joint movement during the scaffolded mobile task.

Infancy 2021 09 20;26(5):756-769. Epub 2021 Jul 20.

Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.

Infants born very preterm (PT), prior to 32 weeks gestation, are at increased risk of developing cerebral palsy. Children with spastic cerebral palsy have impaired selective leg joint movement, which contributes to lifelong walking limitations. We investigated whether infants born PT generated more selective hip-knee joint movement (e.g., hip flexes as knee extends) while participating in a scaffolded mobile task. Infants born PT and infants born full-term (FT) at 4 months corrected age participated in a scaffolded mobile task for 2-3 consecutive days. The scaffolded mobile task required infants to raise their legs vertically over a virtual threshold. Three threshold heights (low, middle, and high) were used to test whether the middle and high heights encourage infants to move their legs more selectively. Fifteen infants born FT learned the task and showed more selective hip-knee movement at each of the three threshold heights on the day that they learned, compared with their baseline spontaneous kicking. Thirteen infants born PT learned the task and showed more selective hip-knee movement on their learning day, but only when the middle and high thresholds were used. The results show that the scaffolded mobile task effectively encouraged infants to generate more selective hip-knee joint movement.
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http://dx.doi.org/10.1111/infa.12424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349863PMC
September 2021

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews.

JAMA Pediatr 2021 08;175(8):846-858

Orygen, Parkville, Victoria, Australia.

Importance: Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years.

Objective: To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support.

Evidence Review: The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument.

Findings: Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5).

Conclusions And Relevance: When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.
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http://dx.doi.org/10.1001/jamapediatrics.2021.0878DOI Listing
August 2021

A New Year!

Authors:
Linda Fetters

Pediatr Phys Ther 2021 01;33(1)

Jackson Hole, Wyoming.

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http://dx.doi.org/10.1097/PEP.0000000000000777DOI Listing
January 2021

Infants born full term and preterm increase the height of anti-gravity leg movements during a kick-activated mobile task using a scaffolded task environment.

Infancy 2021 01 10;26(1):168-183. Epub 2020 Dec 10.

Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA.

Prior research supports that infants born very preterm (PT), compared with full term (FT), have early differences in rate of learning and motor control that may hinder their ability to learn challenging motor tasks. Four-month-old infants born FT (n = 18) and PT (n = 18) participated in an infant kick-activated mobile task that was scaffolded to motivate progressively higher kicks. We found the FT group learned the association between their leg movements and mobile activation on the second day, but the PT group learned the association on the third day. Both groups of infants increased the height of their kicks on the day they learned the task, compared with their spontaneous kicking height. These findings suggest that infants born PT have the ability to learn challenging motor tasks, such as kicking high, when participating in a task environment that uses scaffolding.
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http://dx.doi.org/10.1111/infa.12379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310369PMC
January 2021

Leadership.

Authors:
Linda Fetters

Pediatr Phys Ther 2020 10;32(4):277

Freeport, Maine.

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http://dx.doi.org/10.1097/PEP.0000000000000755DOI Listing
October 2020

In-Home Kicking-Activated Mobile Task to Motivate Selective Motor Control of Infants at High Risk of Cerebral Palsy: A Feasibility Study.

Phys Ther 2020 12;100(12):2217-2226

Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California.

Objective: Children with spastic cerebral palsy (CP) have gait impairments resulting from decreased selective motor control, an inability to move the leg joints independently of one another, relying on excessive flexion or extension coupling across the 3 joints. Infants with white matter injury are at high risk of CP and have decreased selective motor control as early as 1 month corrected age. An in-home kicking-activated mobile task was developed to motivate more selective hip-knee control of infants at high risk of CP. The purposes of this study were to determine the feasibility of the in-home mobile task and to determine whether infants at high risk of CP and infants with typical development (TD) learn the association between their leg movements and mobile activation.

Methods: Ten infants at high risk of CP based on neuroimaging and 11 infants with TD participated in this cohort study at 3.5 to 4.5 months corrected age. Each infant participated in the in-home kicking-activated mobile task for 8 to 10 min/d, 5 d/wk, for 6 weeks. Learning was assessed weekly based on an increase in the time that the infant demonstrated the reinforced leg actions when interacting with the kicking-activated mobile compared with spontaneous kicking.

Results: With regard to feasibility, participation averaged 92% for infants at high risk of CP and 99% for infants with TD. With regard to learning, the group at high risk of CP demonstrated learning of the task for 2 of 6 weeks, whereas the group with TD demonstrated learning for all 6 weeks.

Conclusions: Infants at high risk of CP demonstrated learning of the kicking-activated mobile task but at a reduced amount compared with infants with TD. Further research is necessary to determine whether the kicking-activated mobile task has potential as an intervention to motivate more selective hip-knee control and improve walking outcomes of infants at high risk of CP.

Impact: This study investigated the feasibility of an in-home kicking-activated mobile task, a discovery learning task designed to motivate infants at high risk of CP to engage in the intensive task practice necessary to promote their learning abilities and selective motor control.

Lay Summary: CP is a lifelong disorder of movement caused by abnormal development or early damage to the brain. If an in-home infant kicking-activated mobile task could be used to motivate certain types of age-appropriate leg movements of infants who are at high risk of CP, the task could help improve walking outcomes, which eventually could contribute to improving children's ability to participate in daily life. This study showed that infants at high risk of CP did learn the infant kicking-activated mobile task but at a much reduced amount compared with infants who are developing typically; so, this is a first step in determining whether the task has potential to motivate more age-appropriate leg movements in infants at high risk of cerebral palsy.
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http://dx.doi.org/10.1093/ptj/pzaa174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720641PMC
December 2020

Extraordinary Times.

Authors:
Linda Fetters

Pediatr Phys Ther 2020 07;32(3):171

Jackson, WY.

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http://dx.doi.org/10.1097/PEP.0000000000000727DOI Listing
July 2020

Parents and Families: Our Partners.

Authors:
Linda Fetters

Pediatr Phys Ther 2020 01;32(1)

Freeport, Maine, USA.

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http://dx.doi.org/10.1097/PEP.0000000000000676DOI Listing
January 2020

Our Many Accomplishments.

Authors:
Linda Fetters

Pediatr Phys Ther 2019 10;31(4):307

Editor-in-Chief, Freeport, Maine.

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http://dx.doi.org/10.1097/PEP.0000000000000656DOI Listing
October 2019

Time for Recommendations.

Authors:
Linda Fetters

Pediatr Phys Ther 2019 07;31(3):233

Editor-in-Chief, Maine, USA.

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http://dx.doi.org/10.1097/PEP.0000000000000632DOI Listing
July 2019

Reflections: 2018.

Authors:
Linda Fetters

Pediatr Phys Ther 2019 04;31(2):131

Editor-in-Chief, Los Angeles, California.

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http://dx.doi.org/10.1097/PEP.0000000000000611DOI Listing
April 2019

A New Year!

Authors:
Linda Fetters

Pediatr Phys Ther 2019 01;31(1)

Editor-in-Chief, Freeport, Maine.

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http://dx.doi.org/10.1097/PEP.0000000000000578DOI Listing
January 2019

New CPG for Torticollis!

Authors:
Linda Fetters

Pediatr Phys Ther 2018 10;30(4):239

Editor-in-Chief, Freeport, Maine.

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http://dx.doi.org/10.1097/PEP.0000000000000547DOI Listing
October 2018

Highlights of the Issue.

Authors:
Linda Fetters

Pediatr Phys Ther 2018 07;30(3):163

Editor-in-Chief.

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http://dx.doi.org/10.1097/PEP.0000000000000529DOI Listing
July 2018

The effects of locomotor training in children with spinal cord injury: a systematic review.

Dev Neurorehabil 2019 May 19;22(4):272-287. Epub 2018 Jun 19.

b Norris Medical Library , University of Southern California , Los Angeles , CA , USA.

Purpose: Discuss the effectiveness of locomotor training (LT) in children following spinal cord injury (SCI). This intervention was assessed following an exhaustive search of the literature using the Preferred Reporting Items for Systematic Reviews and Meta- Analyses: The PRISMA Statement as a guideline.

Method: Six databases were searched including PubMed, PEDro, CINAHL, Cochrane, PsycINFO, and Web of Knowledge in January 2016 and November 2016, without date restrictions. Inclusion criteria were: studies in English and peer-reviewed and journal articles with a primary intervention of LT in children following SCI.

Results: Twelve articles, reporting eleven studies, were included. A systematic review assessing locomotor training in children with SCI published in April 2016 was also included. Participants were ages 15 months to 18 years old. Forms of LT included body-weight supported treadmill or over ground training, functional electrical stimulation, robotics, and virtual reality. Protocols differed in set-up and delivery mode, with improvements seen in ambulation for all 41 participants following LT.

Conclusion: Children might benefit from LT to develop or restore ambulation following SCI. Age, completeness, and level of injury remain the most important prognostic factors to consider with this intervention. Additional benefits include improved bowel/ bladder management and control, bone density, cardiovascular endurance, and overall quality of life. Looking beyond the effects LT has just on ambulation is crucial because it can offer benefits to all children sustaining a SCI, even if restoration or development of walking is not the primary goal. Further rigorous research is required to determine the overall effectiveness of LT.
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http://dx.doi.org/10.1080/17518423.2018.1487474DOI Listing
May 2019

Diversity.

Authors:
Linda Fetters

Pediatr Phys Ther 2018 04;30(2):73

Editor-in-Chief, Los Angeles, California.

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http://dx.doi.org/10.1097/PEP.0000000000000503DOI Listing
April 2018

Service to the Greater Good.

Authors:
Linda Fetters

Pediatr Phys Ther 2018 01;30(1)

Editor-in-Chief, Los Angeles, California.

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http://dx.doi.org/10.1097/PEP.0000000000000478DOI Listing
January 2018

We Need Evidence More Than Ever!

Authors:
Linda Fetters

Pediatr Phys Ther 2017 10;29(4):287

Editor-in-Chief, Los Angeles, California.

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http://dx.doi.org/10.1097/PEP.0000000000000462DOI Listing
October 2017

Infant intralimb coordination and torque production: Influence of prematurity.

Infant Behav Dev 2017 11 8;49:129-140. Epub 2017 Sep 8.

Division of Biokinesiology & Physical Therapy, Herman Ostrow School of Dentistry, Department of Pediatrics Keck School of Medicine, University of Southern California, 1540 E. Alcazar St., CHP 155, Los Angeles, CA 90033, USA. Electronic address:

The purpose of this study is to investigate changes in leg joint coordination, intersegmental dynamics, and their relation in infants born preterm (PT) during the first months of life. Kicking actions were analyzed of 11 infants born PT at 6 and 15-weeks corrected age (CA) using three-dimensional kinematics and kinetics; results were compared to the kicking actions of 10 infants born full-term (FT). Both groups changed from a predominately in-phase coordination at 6-weeks CA to a less in-phase coordination at 15-weeks CA, however, at 6-weeks CA, infants born PT demonstrated less in-phase coordination of their ankle joints with their hip and knee joints. Between groups and across ages, both groups demonstrated consistent net and partitioned joint torque profiles, however, at 6-weeks CA infants born PT demonstrated more complex patterns of torque components. In both groups, less in-phase hip-knee coordination was associated with reduced active knee muscle torque and increased passive knee torques, however, passive knee torques had a greater influence on the kicks of infants born PT at 6-weeks CA. At 6-weeks CA, infants born PT, compared to FT, generated kicks with less in-phase hip-knee coordination, hip excursion, hip angular velocity, and hip muscle torque impulse. By 15-weeks CA, differences resolved in all variables except hip muscle torque impulse. These results highlight a different trajectory of leg joint coordination and torque production for infants born PT compared to FT.
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http://dx.doi.org/10.1016/j.infbeh.2017.08.009DOI Listing
November 2017

Infant Discovery Learning and Lower Extremity Coordination: Influence of Prematurity.

Phys Occup Ther Pediatr 2018 05 8;38(2):210-225. Epub 2017 Sep 8.

c Division of Biokinesiology & Physical Therapy, Herman Ostrow School of Dentistry, Department of Pediatrics Keck School of Medicine , University of Southern California , Los Angeles , California , USA.

Aims: Preterm infants at increased risk for neurodevelopmental disabilities, including cerebral palsy, demonstrate reduced selective leg joint coordination. Full-term infants demonstrate more selective hip-knee coordination when specific leg actions are reinforced using an overhead infant mobile. The purpose of this pilot study was to determine the ability of preterm infants to: (1) perform and learn through discovery, the contingency between leg action and mobile activation, and (2) demonstrate more selective hip-knee coordination when leg actions are reinforced with mobile activation.

Methods: At both 3 and 4-months corrected age, ten infants born very preterm and with very low birth weight participated in 2 sessions of mobile reinforcement on consecutive days.

Results: The preterm group at 4-months, but not 3-months, learned the contingency between leg action and mobile activation. Preterm infants at 4-months were separated into those that learned (n = 6) and did not learn (n = 4) the contingency. As a group, preterm infants at 4-months who learned the contingency, did not demonstrate more selective hip-knee coordination when interacting with the mobile on Day 2 as compared to spontaneous kicking on Day 1.

Conclusions: Preterm infants, as compared to full-term infants, may have difficulty producing more selective hip-knee coordination during task-specific leg action.
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http://dx.doi.org/10.1080/01942638.2017.1357065DOI Listing
May 2018

Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment.

JAMA Pediatr 2017 09;171(9):897-907

Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia.

Importance: Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age.

Objectives: To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.

Evidence Review: This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument.

Findings: Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months' corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months' corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence.

Conclusions And Relevance: Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
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http://dx.doi.org/10.1001/jamapediatrics.2017.1689DOI Listing
September 2017

Global Reach.

Authors:
Linda Fetters

Pediatr Phys Ther 2017 07;29(3):191

Editor-in-Chief, Los Angeles, CA.

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http://dx.doi.org/10.1097/PEP.0000000000000441DOI Listing
July 2017

State of Our Profession Over the Decades.

Authors:
Linda Fetters

Pediatr Phys Ther 2017 07;29 Suppl 3:S1

Editor-in-Chief, Pediatric Physical Therapy, Los Angeles, California.

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http://dx.doi.org/10.1097/PEP.0000000000000434DOI Listing
July 2017

Let Your Voice Be Heard.

Authors:
Linda Fetters

Pediatr Phys Ther 2017 04;29(2):105

Editor-in-Chief, Los Angeles, CA.

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http://dx.doi.org/10.1097/PEP.0000000000000386DOI Listing
April 2017

Change and Continuity.

Authors:
Linda Fetters

Pediatr Phys Ther 2017 01;29(1)

Editor-in-Chief, Los Angeles, California.

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http://dx.doi.org/10.1097/PEP.0000000000000356DOI Listing
January 2017

Cross-cultural validity of standardized motor development screening and assessment tools: a systematic review.

Dev Med Child Neurol 2016 Dec 4;58(12):1213-1222. Epub 2016 Oct 4.

Division of Biokinesiology and Physical Therapy at the Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.

Aim: To investigate whether standardized motor development screening and assessment tools that are used to evaluate motor abilities of children aged 0 to 2 years are valid in cultures other than those in which the normative sample was established.

Method: This was a systematic review in which six databases were searched. Studies were selected based on inclusion/exclusion criteria and appraised for evidence level and quality. Study variables were extracted.

Results: Twenty-three studies representing six motor development screening and assessment tools in 16 cultural contexts met the inclusion criteria: Alberta Infant Motor Scale (n=7), Ages and Stages Questionnaire, 3rd edition (n=2), Bayley Scales of Infant and Toddler Development, 3rd edition (n=8), Denver Developmental Screening Test, 2nd edition (n=4), Harris Infant Neuromotor Test (n=1), and Peabody Developmental Motor Scales, 2nd edition (n=1). Thirteen studies found significant differences between the cultural context and normative sample. Two studies established reliability and/or validity of standardized motor development assessments in high-risk infants from different cultural contexts. Five studies established new population norms. Eight studies described the cross-cultural adaptation of a standardized motor development assessment.

Interpretation: Standardized motor development assessments have limited validity in cultures other than that in which the normative sample was established. Their use can result in under- or over-referral for services.
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http://dx.doi.org/10.1111/dmcn.13263DOI Listing
December 2016

The TIDieR Checklist Will Benefit the Physical Therapy Profession.

Pediatr Phys Ther 2016 ;28(4):366-7

Musculoskeletal Division The George Institute for Global Health Sydney Medical School, The University of Sydney Australia Centre for Research in Evidence Based Practice Faculty of Health Sciences and Medicine Bond University Queensland, Australia International Society of Physiotherapy Journal Editors Division of Biokinesiology and Physical Therapy University of Southern California Los Angeles, California.

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http://dx.doi.org/10.1097/PEP.0000000000000329DOI Listing
January 2016

Talking to Each Other.

Authors:
Linda Fetters

Pediatr Phys Ther 2016 ;28(4):365

Editor-in-Chief Freeport, Maine.

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http://dx.doi.org/10.1097/PEP.0000000000000328DOI Listing
January 2016

Our Fit in the World.

Authors:
Linda Fetters

Pediatr Phys Ther 2016 ;28(3):261

Editor-in-Chief, Sydney, Australia.

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http://dx.doi.org/10.1097/PEP.0000000000000294DOI Listing
January 2016
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