Quantifying recovery after spinal cord injury (SCI) and other neurologic disorders in the clinic is a challenge, yet a timely need with advances in therapies targeting enhanced recovery post-SCI. While some measurement instruments specifically designed for SCI rehabilitation typically allow compensation, other measures such as manual muscle testing prohibit use of compensatory strategies during testing. The Neuromuscular Recovery Scale is innovative and unique in that performance is assessed based on a comparison to pre-injury performance criteria or how a task was performed one day prior to SCI and without use of compensation strategies. For instance, the ability to stand up from sitting is assessed without use of load-bearing on the arms and with usual, pre-injury limb and trunk kinematics for this task as the reference for comparison.
The Pediatric Neuromuscular Recovery Scale is a new assessment scale that assesses a child’s (age 1-12 years) neuromuscular capacity to perform 13 everyday tasks without behavioral compensation, physical assistance, or assistive device/orthotics. Thus, ‘how’ a task is performed is critical to the assessment and uniquely defines the tool compared to other pediatric assessment instruments. Ten tasks are assessed in a routine clinical setting and include supine-to-sit, sitting inside base-of-support, sitting outside base-of-support, object to mouth, in-hand manipulation, overhead reach, sit-to-stand, standing (static/dynamic), and walking; while three tasks are assessed on the treadmill to examine standing and stepping capacity in a controlled environment (e.g. body weight support, treadmill speed).
The Peds NRS was introduced at the SoPac 2015 conference in Pittsburgh and the first paper describing the scale will be published in Pediatric Physical Therapy by E. Ardolino. The scale was adapted from the Adult Neuromuscular Recovery Scale developed to examine recovery in adults with SCI with established validity, reliability, and responsiveness (Behrman et al. 2012, Basso et al. 2014, Behrman et al. 2015, Velozo et al. 2015, Tester et al. 2015). The Peds NRS was adapted and developed specifically for children with neurologic disorders with funding from the Craig H. Neilsen Foundation (Andrea Behrman: PI; co-investigators: MJ Mulcahey, Elizabeth Ardolino; Research Physical Therapists: S Trimble, L Argetsinger, M Bienkowski, and C Mullen). Pediatric PTs, OTs, and physicians contributed to the content-development and validation of the instrument.
This inaugural course consists of two parts: 1) on-line preparatory course (approximately 6 hours), 2) on-site course at SoPac 2016 (8 hours). The on-line course introduces the Pediatric Neuromuscular Recovery Scale, its items, and scoring method through a detailed manual of procedures and example videos of therapists conducting the Peds NRS with typically-developing children. The on-line course culminates with the participant viewing videotapes of patients (i.e. children with neurologic disorders) undergoing the Peds NRS evaluation and then practice scoring each item. Scoring outcomes are reviewed with detailed explanations. The on-line course must be fully completed prior to attending the on-site course. At SoPac 2016, attendees of the on-site course will practice conducting the scale with typically-developing children and children with neurologic disorders. The on-site course will focus solely on the first 10 scale items, though the treadmill items will be discussed.
Attendees who complete both on-line and on-site components are eligible to complete Peds NRS certification, either ‘over ground’ items alone or all 13 items (includes the treadmill items). Treadmill-based items require specific equipment and advanced manual skills for facilitating stepping/standing. Therapists having this skill set may select to seek certification for all 13 items. Certification entails 1) completion of the on-line course, 2) achievement of scoring reliability of the Peds NRS (on-line videos), and 3) submission of a video of the therapist conducting the scale (10 or 13 items) on a typically-developing child. Submission of the video is anticipated after completion of the on-site course. The manual for conducting and scoring the Peds NRS identifies key elements of the assessment for competency and standardization in conducting the assessment. The manual and a parallel checklist will be used to evaluate the competency for conducting the Peds NRS (video submission). Establishing competency is useful for therapists or staff working in clinical and research settings to establish consistent, standardized use of the Peds NRS within and across clinicians/raters for clinic or research purposes. Certification entails an additional fee specifically for video review.
Target Audience: Novice and intermediate level course open to licensed physical therapists, physical therapy assistants, occupational therapists, exercise physiologist, and rehab technicians.
Credits: 12 contact hours from the EIM Institute of Health Professions
Program Applicability: None.
Upon completion of the on-line and on-site course, the learner will be able to:
- Appropriately select the Peds NRS as a tool to assess children age 1-12 with neurologic disorders.
- Appropriately conduct the Pediatric Neuromuscular Recovery Scale items (over ground items) using standardized methods for children age 1-12 years and understand the role of the treadmill-based items.
- Reliably score a child’s neuromuscular capacity across functional tasks using the Pediatric Neuromuscular Recovery Scale.
- Use the Peds NRS to measure progress and guide clinical-decision making for rehabilitation and neuromuscular recovery of children with neurologic dysfunction.
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