APTA Pediatrics Research

Researcher Spotlight - August 2021

Web page MyCP.orgMary Gannotti is a pediatric physical therapist and Professor in the Doctor of Physical Therapy Program Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut, and Scientific Staff at Shriners Hospitals- Springfield, Massachusetts where she collaborates with community partners locally, nationally, and internationally to promote care for individuals with childhood onset disability. She received her professional physical therapy degree from the University of Connecticut while simultaneously earning a Master's degree in Applied Anthropology, focusing on community-based rehabilitation models in low resource countries. She completed a PhD in Medical Anthropology at the University of Connecticut and postdoctoral fellowships at Yale School of Medicine, Department of Pediatrics and Department of Epidemiology & Public Health. Dr. Gannotti has received research grants from the National Science Foundation, the National Institute on Disability and Rehabilitation Research, the Foundation for Physical Therapy, and the Academy of Pediatric Physical Therapy.

My friend Ian who has presented with me at CSM and SOPAC still working out 7 years later Dr. Gannotti has over 35 years of clinical experience in pediatrics and neurologic disability, working in outpatient clinics, short term and long-term care facilities, community programs, and tertiary care hospitals throughout North America, the Caribbean, and Mexico. Her work focuses on the influence of personal factors (values, temperament, beliefs) and the environment (supports and barriers) on intervention effectiveness. Her doctoral work focused on a description the influence of socio-cultural factors on the disability experience, highlighting children living in Puerto Rico.  Her work resulted in a Spanish translation of the Pediatric Evaluation Disability Inventory, which is widely used today. Her subsequent work described how cultural values shape parental-child-provider interactions among Hispanic and Korean families. Her work has more recently focused on issues of access and long-term outcomes. She has used large federal data bases to evaluate the interrelationships among of level of severity of disability and unmet needs for therapy for both children and adults. She worked with colleagues to conceptualize dosing therapy giving the complex interrelationship of the child, the family, and the environment, and identified gaps in knowledge about long term outcomes. She has completed outcome studies among adults with cerebral palsy and spina bifida about physical, social, and emotional wellbeing. She has evaluated long term outcomes of orthopedic surgery and the cost benefit to the consumer using consumer perspectives. She is on the Executive Committee of the Cerebral Palsy Research Network, which has an online space for individuals with cerebral palsy. Longitudinal data about pain and function are being collected.

Me a student coach and an athlete at
BFIT Power Based Program at Shriners Hospitals
for Children, SpringfieldDr. Gannotti utilizes her physical therapy students to enact inclusive, individualized exercise programs in the community. Her collaboration with Shriners has resulted in an extremely successful program which has been spread to other communities. She performs extensive community outreach and continuing education to translate research findings to multiple disciplines in local, national and international venues. She has authored over 50 peer-reviewed articles and chapters with a focus on providing clinical pearls families, individuals, and clinicians can use daily. Her collaborations across disciplines with epidemiologists, health service researchers, biomechanists, data scientists and engineers support her creative approach to improving access and outcomes across the life span.

My student coach and an athlete at BFIT Power Based Program

 

 

Researcher Spotlight - Dec 2020

Michele A. Lobo is a pediatric physical therapist and Associate Professor in the Doctor of Physical Therapy Program at the University of Delaware, where she directs the Super Suits FUNctional Fashion and Wearable Technology Program and co-directs the Move to Learn Innovation Lab. She received her MPT from The Medical College of Pennsylvania & Hahnemann University and her PhD in Biomechanics & Movement Science from the University of Delaware. She returned for her doctoral degree from full-time clinical work because she wanted to address the need for more evidence to guide pediatric practice. Her work has been funded by the Institute of Education Sciences, the National Science Foundation, the National Institutes of Health, and a number of foundations. Michele is a clinician at heart so her rule for her research group is that people can only propose and perform projects that have the potential to translate to practice – the team's interventions must be family-friendly and feasible; the devices and tools they create must be user-guided and accessible. That rule can be challenging at times, yet it drives results that are innovative, impactful, and extremely rewarding.

Michele's overarching research goal is to improve learning and quality of life for children with or at risk for disabilities. To this end, she leads research to better understand how learning and development happen for children of different abilities and how activity- and technology-based interventions can be used to advance learning and development and to maximize participation. Her amazing and diverse team members from rehabilitation, developmental psychology, engineering, and fashion and apparel studies truly enjoy working with and learning from one another. Most recently, the team has been working on a variety of innovative and impactful projects (https://www.ncbi.nlm.nih.gov/myncbi/1Dcv-F7vOpeQw/bibliography/public/).

• Rehabilitation Technology: Michele and her team developed a novel design model for rehabilitation technology, highlighting that device designers must consider the Functional, Expressive, Aesthetic, and Accessibility (FEA2) needs of end users. Michele and her team have demonstrated how the Playskin LiftTM, an affordable, do-it-yourself (DIY) exoskeletal garment they developed using this design model can improve function, activity, and participation for young children with arm movement impairments. The DIY manual for this product as well as others can be found on Michele's lab web site: https://sites.udel.edu/move2learn/how-todiy/. Michele and her team are now developing a version of this exoskeletal garment for older children, the Playskin AirTM, that allows users to control the level of support they receive in real time.

• Early Learning Processes & Assessment: Michele and her team have identified key early differences in learning and exploration in young children born preterm or with motor delays relative to those born full-term and without delays; these differences highlight areas early intervention providers should be targeting. Michele and her team also developed the Means-End Problem-Solving Assessment Tool (MEPSAT), to support clinicians in identifying and tracking early problem-solving abilities in children.
• Early Intervention: Michele and her team have been engaged in the Sitting Together And Reaching to Play (START-Play) multi-site study showing that motor interventions with a cognitive and social focus can still advance gross motor development – with added benefits for fine motor, problem-solving, and cognitive abilities in young children with significant motor delays. Michele and her team have also led the development of parent education interventions to advance motor and cognitive outcomes for children.
• Methodology: Michele and her team have worked to make single-case design methods more understandable and accessible for clinicians. These methods allow for experimental manipulations and hypothesis testing to be conducted even in cases where resources available for research are limited. These methods can be extremely useful to support research conducted in clinical settings.

Michele and her team have also worked closely with community members to develop clothing solutions for persons with disabilities. Most recently, they developed attractive, comfortable scarves for children with oral-motor impairments (see DIY instructions in the link above). The design work of Michele and her team has been highlighted in two major museum exhibitions and through an invited visit to the White House.

 

Researcher Spotlight - August 2020

Sandra Saavedra is an Associate Professor and Director of the Pediatric Balance Laboratory in the Department of Rehabilitation Sciences at University of Hartford in West Hartford, Connecticut. She received her master's degree in physical therapy from University of Southern California, her PhD in Human Physiology and Motor Control from the University of Oregon and postdoctoral training in Developmental Neuromotor Control at University of Michigan. Dr. Saavedra's doctoral and postdoctoral studies were funded through National Student Research Awards from the National Institutes of Health. She has received research grants from multiple sources including the National Science Foundation, the National Institutes of Health, and the Scoliosis Research Society.

Dr. Saavedra spent 22 years working clinically as a pediatric physical therapist before earning her PhD. Her clinical experience in hospitals, rehabilitation outpatient clinics, school-based and early intervention settings, and private practice fuels her dedication to clinically relevant research and commitment to translation of evidence into practice. Dr. Saavedra's research focuses on the emergence of upright control in infants with typical development and in infants and children with postural dysfunction.

Her research has three primary legs. First, she conducts neurophysiological studies aimed at understanding the sensory and motor mechanisms underlying the emergence of upright postural control. These studies rely on collaborations with engineers to assess and model changes in system dynamics as children gain trunk control. Methods employed in these studies include optical, magnetic and wearable sensor tracking of postural kinematics, electromyography, video behavior coding, eye tracking and sensory feedback modeling using controlled postural perturbations and an adjustable trunk support unit (Figure 1).

Second, Dr. Saavedra co-authored the refinement and publication of the Segmental Assessment of Trunk Control (SATCo, Figure 2) and presents nationally and internationally on the SATCo and the segmental approach to postural dysfunction. The SATCo is now included in the NINDS core data elements for cerebral palsy and spinal cord injury. Studies have demonstrated the reliability and validity of SATCo for typically developing infants, premature infants, children with spinal cord injury, Down syndrome, muscular dystrophy.

 

Researcher Spotlight - July 2020

Reggie Harbourne is a Board-certified Pediatric Clinical Specialist and Associate Professor in the Doctor of Physical Therapy Program at the Rangos School of Health Sciences, Duquesne University in Pittsburgh Pennsylvania, where she directs the Infant Development Lab. She received her professional physical therapy degree from Virginia Commonwealth University, her Masters degree from the University of North Carolina at Chapel Hill, and her PhD in Developmental Psychology from the University of Nebraska. Dr. Harbourne has received research grants from multiple sources including the US Department of Education, the National Science Foundation, the National Institutes of Health, the National Institute on Disability and Rehabilitation Research, the Pennsylvania Department of Health, and the Academy of Pediatric Physical Therapy.

Dr. Harbourne has over 40 years of clinical experience in pediatrics, with experience in clinics, school-based and early intervention physical therapy, and with her clinical specialist certification in pediatrics.  Her research focuses on studying the efficacy of different types of intervention for young children with early motor and cognitive delays. She currently leads the START-Play study (https://start-play.unl.edu/), a national multi-site comparison of interventions trial funded by U. S. Department of Education Institute of Education Sciences. Her research is translational, using multiple methods to examine the effects of intervention on young children including standardized testing, qualitative methods, behavioral coding, eye-tracking and motion analysis tools. Her specific interest is at the intersection of early movement and emerging cognition, and the inter-relationships of multiple factors on the trajectory of child development in children with neuromotor disabilities or delays. Recent research findings include the important advantage that advancing sitting postural control and early reaching brings to improvements in cognitive outcomes. Her research currently focuses on intervention embedded in natural settings, and the benefits of motor-based problem-solving on global developmental outcomes.

Dr. Harbourne also conducts extensive community outreach and continuing education to translate research findings to multiple disciplines in local, national and international venues. She has authored over 50 peer-reviewed articles and chapters with a focus on providing implementation science to advance development in children with movement disorders. Her collaborations across disciplines with occupational therapy, biomechanists, data scientists and engineers support her creative approach to investigating early motor development.

Researcher Spotlight - June 2020

Lisa Kenyon is a Board-certified Pediatric Clinical Specialist and Associate Professor in the Doctor of Physical Therapy Program at Grand Valley State University in Grand Rapids, Michigan. She received her professional physical therapy degree from the University of Vermont, a Master of Health Science from the University of Indianapolis, and her PhD and tDPT from Nova Southeastern University. Dr. Kenyon leads two interprofessional service and research projects, one focused on pediatric power mobility and the other on pediatric manual wheelchair skills. The Grand Valley Power Mobility Project provides power mobility training and use for individuals ages 6 months to 26 years who are not typically considered to be candidates for power mobility whereas the Grand Valley Wheeled Mobility Project provides manual wheelchair skills training to children as a way to increase their independence. The overall goals of Dr. Kenyon's research are to promote self-exploration, participation, and development through the use of self-initiated mobility.  Her research has been funded by the Academy of Pediatric Physical Therapists.

Dr. Kenyon's work employs quantitative, qualitative, and mixed research methodologies. Her clinical studies primarily have focused on the influence of power mobility intervention on children with severe disabilities and their families. Her qualitative studies seek to explore the perspectives of various stakeholders (children, parents, therapist, etc.) on the provision of power mobility and other assistive technologies. Her work also includes development of the Power Mobility Training Tool and exploring the validity of the Wheelchair Skills Test and Wheelchair Skills Test – Questionnaire in children with spina bifida. Collaboration with other researchers, both nationally and internationally, is a central aspect of Dr. Kenyon's work. Her current collaborative research projects include a grounded theory study of power mobility interventions for infants and children with multiple, severe disabilities and a mixed method project focused on health and participation outcomes in children who use wheelchairs. At present, Dr. Kenyon is laying the foundation for collaborative research projects; one focused on use of power mobility to increase participation in children with multiple, severe disabilities who are at the beginning stages of learning to use power mobility, another aimed at the use of on-time mobility practices to enhance development in infants and toddlers with disabilities, and a third pertaining to the use technology-enhanced power mobility interventions.

Dr. Kenyon has also completed several research projects related to both clinical education and pediatric curricular content in professional, entry-level physical therapist education programs. Her published clinical reasoning framework, the Hypothesis Oriented Pediatric Focused Algorithm (HOP-FA), is used in both pediatric clinical education and pediatric classroom-based courses throughout the United States. The HOP-FA has been translated into Mandarin and is used in various settings across Mainland China.

 

Researcher Spotlight - May 2020

Jill Heathcock is an Associate Professor and the Director of the Pediatric a>nd Rehabilitation Laboratory (PEARL lab) at The Ohio State University. She received her doctoral training in Biomechanics and Movement Science at the University of Delaware and complete a post-doctoral fellowship in Infant Development and Kinesiology at the University of Michigan. Her current research focuses on upper and lower extremity biomechanical analysis for assessment and diagnosis of motor impairments; and dosing for pediatric rehabilitation in infants and children with or at high risk of cerebral palsy. The overall goal of Dr. Heathcock's research is to promote optimal health, development, and functional independence for infants and children in order to improve lifelong health outcomes. Dr. Heathcock's research has been funded by the National Institutes of Health (NIH), Patient-Centered Outcomes Research Institute (PCORI), the American Heart Association (AHA), the Foundation for Physical Therapy Research, and the Academy of Pediatric Physical Therapists.

Dr. Heathcock's research seeks to understand optimal dosing parameters of pediatric physical therapy with a current emphasis on daily or intensive periodic rehabilitation programs. Dr. Heathcock and her collaborators have recently completed a three-year $1.9 million PCORI funded comparative effectiveness research study on high intensity periodic compared to usual weekly physical therapy for children with cerebral palsy 2-8 years of age and inclusive of all GMFCS levels. The study expanded on a collaborative clinical program at Nationwide Children's Hospital and was supported by a parent, patient, and community partner stakeholder panel. Research participants receive 40 hours of physical therapy from highly qualified physical therapists. Participants receive usual weekly therapy – 1 hour sessions, 1x/week for 40 weeks or high intensity periodic therapy – 2 hour sessions, 5x/week for two weeks with and 18 week break then repeated for a second bout.  Participants are evaluated before treatment, 1x/month during the 40 week treatment period and 9, 12, and 18 months after the baseline assessment to evaluate short-term and explore long-term effects. The purpose of this patient-centered study is to understand the dosing effectiveness of usual weekly, and high intense periodic therapy schedules for children 2-8 years of age with cerebral palsy. The primary outcome measures is gross motor function and the secondary outcome measures include change in goal attainment scaling, change in developmental functioning, change in child's functional performance, change in parent's perception of child's overall health, pain, and ability to take part in normal daily activities.  Since this study is a CER study there is some established efficacy for both groups, meaning that both groups are expected to benefit from the intervention. What is unknown is if patients benefit more from one schedule over the other and if there are certain patient characteristics like age or functional level that influence schedule-based improvements.

 

Currently, Dr. Heathcock is also PI on a funded 5-year $2.1 million NIH grant that looks at daily rehabilitation for young infants with severe motor skill delay; and Co-I on a funded 5-year $13 million dollar NIH StrokeNET grant that is the first phase III CIMT trial for infants with stroke (Drs. Sharon Ramey and Warren Lo (MPI) and Drs. Amy Darragh, Stephanie DeLuca, Craig Ramey (Co-Is)). The goal of this national study is to determine the effectiveness of 2 doses of CIMT for infants with perinatal arterial ischemic stroke and hemiparesis.

Researcher Spotlight - December 2019

Researcher Spotlight - May 2019

Thubi H.A. Kolobe, PT, PhD, FAPTA is a Professor and the Ann Taylor Chair for Pediatrics and Developmental Disabilities at the University of Oklahoma Health Sciences Center. She received her doctoral training in pediatric physical therapy at Hahnemann University (now Drexel University). Dr. Kolobe is also a co-developer of the Test of Infant Motor Performance (TIMP) for preterm infants, a norm-referenced test that is used worldwide. Her current research focuses on movement learning and skill acquisition in infants with or at risk for cerebral palsy. The overarching goal of Dr. Kolobe's research is to prevent developmental delays and reduce the significant functional limitations, cognitive and educational achievement gaps that are experienced by many infants with brain insult. Dr. Kolobe's research also seeks to understand neural correlates of infant motor learning. Although research suggests that interventions that produce sustained gains tend to also show changes in brain structure and functioning, the brain-behavior relationship during infant learning of complex motor skills is poorly understood. Dr. Kolobe's research has been funded by the National Institutes of Health (NIH), National Science Foundation (NSF), Foundation for Physical Therapy, Presbyterian Foundation, and the Section on Pediatrics of the APTA.

Dr. Kolobe and her collaborators have recently completed a five-year $1.2 million NSF funded study on prone locomotion in infants with and without CP. The study, which expanded on an earlier NIH funded validation study of the Self-Initiated Prone Progression Crawler (SIPPC) system, explored how infants with and without brain insult learn to use the SIPPC system to explore and crawl. A collection of robotics and sensor technology, the SIPPC system is not only a training device, but it also captures, promotes, and measures movement learning in very young infants in real time. Another unique feature of the system is that it rewards self-initiated movement effort, however subtle, and permits error learning, thus enabling researchers to test the effectiveness of two prominent approaches in motor learning; reinforcement and error-based learning. Reinforcement movement learning has gained prominence in the movement science literature and has shown the potential to accelerate movement learning in adults. The benefits for very young infants, particularly those brain insult such as with CP, are unknown. Indeed, very little is known about how infants with brain insult learn new motor skills.

Self-initiated prone locomotion occurs in typical infants as young as 6 months of age and is believed to be integrated with other systems essential for development, school readiness, and social interactions, such as vision, arousal, and perceptual-cognition, making it a pivotal target for intervention. Robotic and sensor technology like the SIPPC allows us to teach a skill before it emerges or fails, thus enabling us in real time to capture and study the evolution of learning strategies. For interventions to promote neuroplastic changes and skill acquisition in infants, integration of at least 5 things is important: task-specific training, novelty, high repetition, stretching performance boundaries, cognitive orientation, reward- and error-based feedback. Technology can provide all 5 at the same time.

Currently, Dr. Kolobe is also a Co-PI on a funded 4-year $1.6 million IES grant (Dr. Sandy Arnold (PI) and Dr. Everett Smith (Co-PI)). The goal of this national study is to validate the School Outcome Measure (SOM) for children with disabilities who are receiving school-based physical and occupation therapy services. When completed the SOM will be ready for use as an outcome measure in school settings.

Researcher Spotlight - December 2018

Noelle Moreau, PT, PhD is an Associate Professor of physical therapy at Louisiana State University Health Sciences Center in New Orleans. Dr. Moreau received her doctoral training in biomechanics at Louisiana State University and completed a postdoctoral fellowship in movement sciences at Washington University in St. Louis. Dr. Moreau's research focuses on the investigation of the neuromuscular mechanisms underlying abnormal muscle function and movement impairments in children with cerebral palsy. The overarching goal of Dr. Moreau's research is the development of effective rehabilitation strategies to address these impairments and improve activity, participation, and quality of life. Dr. Moreau's research has been funded through the National Institutes of Health (NIH), Thrasher Research Fund, Pedal-with-Pete Foundation, American Physical Therapy Association (APTA), and the Section on Pediatrics of the APTA.

Dr. Moreau was recently awarded a $2.5 million R01 grant from the NIH's National Institute of Child Health and Human Development for a clinical trial to investigate the effects of a novel, high intensity power training program on functional walking capacity, neuromuscular function, and community-based activity and participation in children and adolescents with cerebral palsy. Power Training combined with Interval Treadmill Training (PT3)  targets muscle power deficits specifically in order to drive changes in walking activity for children with cerebral palsy. Current rehabilitation practice utilizes motor learning principles related to specificity of practice, or task-specific training, for improving walking in those with neurological disorders, such as cerebral palsy.

However, this traditional singular approach fails to address the underlying muscular mechanisms responsible for the walking limitations and has not been shown to be more effective than other therapies in people with spinal cord injury, stroke, and cerebral palsy. The theoretical premise for PT3 is innovative in that it will address muscle power, a key ingredient that is missing from current clinical practice for children with cerebral palsy, and will combine it in a package of care with a task-specific training protocol that allows the participants to practice using muscle power generation during the functional task of walking. Another unique feature of this project is that mobile sensing technology will be used to directly measure walking activity and participation out in the community before and after the intervention. PT3 is an innovative departure from current rehabilitation practice with strong potential for improving mobility outcomes in ambulatory children with CP. Dr. Moreau at LSUHSC in New Orleans will partner with Dr. Kristie Bjornson at Seattle Children's Research Institute for this multi-site clinical trial.