Tuesday, September 8, 2015

Physical Therapy Evaluation



Allie recently had a new physical therapy evaluation and she's making so much progress!  Here it is:

Gross Motor Skills:

  •  Jumping:
  Jumping jacks x5 with cues for foot and arm position. Attempted scissor kicks. Able to complete with handheld support
  • Biking: Able to complete the tricycle outdoors with no tape on her feet and only minimal assist to start and steer
  • Swing: Able to complete the playground swing (sling seat) without assist and with pumping today:

Objective Measures:
 
The Peabody Developmental Motor Scales - 2nd Edition Standardized Test

The Peabody Developmental Motor Scales, Second Edition (PDMS-2) was utilized to assess Allison's overall motor skill development.

Stationary (posture, strength, balance, etc.)
Now: 75th percentile
December 2014: 63rd percentile
August 2014: 25th percentile

Locomotion (running, jumping, climbing, etc.)
Now: 63rd percentile
December 2014: 37th percentile
August 2014: 25th percentile

Object Manipulation  
Now: 50th percentile
December 2014: 25th percentile
August 2014: 25th percentile

Gross Motor Skills


Stationary Skills

On the Peabody Developmental Motor Scales (PDMS-2) subtest of Stationary skills, Allison's scores placed her in the 75th percentile for her chronological age. This subtest measures a child's ability to sustain control of her body within its center of gravity and retain equilibrium. Allie has improved in this area from a raw score of 50 and percentile of 63%. She was able to stand on her LLE [Left Lower Extremity; her left leg] for 10 seconds and her RLE [Right Lower Extremity; her right leg] for 4-5 seconds. She can stand on her tip toes for 8 seconds without moving. She is also able to imitate movements with her arms. Allie completed 7 sit ups in 30 seconds. She was not able to complete a push up on her knees.

Locomotion Skills
On the PDMS-2 subtest of Locomotion Skills, Allison scored with the 63rd percentile for her chronological age. This subtest measures a child's ability to move, including running, hopping and jumping forward. In December Allie scored a raw score of 152 and was in the 37th percentile. She is now able to:

  • Stairs: Allie is able to complete a reciprocal pattern ascending and descending without the rail. She is not confident descending but can complete this technique when asked.
  • Jumping: Allie is able to jump down from an 18" surface and land on two feet with symmetry. She is able to jump forward 30.5 inches and over a 6 and 9 inch hurdle (no hesitation today). She can jump on her L foot forward 10 inches. She attempted to jump on her R LE but was unable to leave the ground. This is a huge improvement that she is attempting to jump on the RLE without assist. She requires assistance to hop on her L and R foot forward. She can complete a turning jump and a lateral jump
  •  Running: Allie is able to run 45 feet in 5.59 seconds. She demonstrates decreased arm swing on the R. She is able to stop within two steps when asked. Running 10 feet forward and back Allie was able to complete this in 4.88 seconds.
  • Balance: Allie was able to walk on her tip toes across the room and on a line. She is able to walk on a balance beam forwards and is progressing with a heel toe pattern. She can walk on the beam backwards as well without heels touching toes.
  •  Other: Allie can complete a forward roll. She is able to gallop. Skipping is progressing but not coordinated and smooth.

Object Manipulation
On the PDMS-2 subtest of Object Manipulation, Allison scored within the 50th percentile for her chronological age. This subtest measures a child's ability to coordinate arm and leg movements in order to manipulate balls (catching, throwing, kicking). Allie has progressed from a raw score of 33 and the 25th percentile in December. She is able to kick a ball across the room and in the air. She is able to throw a ball over and underhand across the room. She is able to catch an 8" ball 2/3 reps hugging the ball to her body. She can hit a target from 5 feet away 2/3 reps throwing underhand and 3/3 reps overhand throwing. From 12 feet away she hit the target 1/3 times overhand. Allie can bounce a ball and hit the wall one time. She can catch a tennis ball with her hands 1/3 reps. She could catch a bounced ball 1/3 reps.

Shuttle run: This test measures how fast a child can run 30 feet, pick up a block, return to starting line and repeat. (120 feet total).
Current: 23.33 seconds (8-18-15) [Average time for a 5-6 year old is 15.1 seconds]

Timed floor to stand:
This test measures the time it takes for the child to get up from the floor (from seated in a crossed-leg position), walk as quickly as possible for 3 meters, turn around, walk back to starting line, and return to sitting on the floor.
Current: 6.81 seconds (8-18-15) [Average time for a 5-6 year old is 7.5 seconds with a standard deviation of 1.5 seconds]

EVALUATION
Allie has improved greatly on the Peabody since December especially with jumping, single limb stance and ball skills. She is much more stable with attempts to stand on her RLE alone. Continue to work on hopping, skipping and higher level balance activities.

Goals: Patient will continue to work on the following short term goals next session:


  1. Allison will gain >5 degrees of R ankle DF to help prevent tripping and optimize gait pattern. Time Frame: 2 months. Goal Progressing

  2. Allison will be able to perform single limb stance on each LE x3-5 seconds demonstrating improved balance. Time Frame: 2 months. Goal Met on 10/14/14

  3. Allison will be able to step onto uneven surfaces without falling 3/5 reps demonstrating improved balance. Time Frame: 2 months. Goal Met on 10/14/14

  4. Allison will be able to jump over a 6" hurdle with a two foot take off and symmetrical landing. Time Frame: 2 months. Goal Met on 01/13/15

  5. Allie will perform single limb stance x20 seconds BLE without additional support for balance or grounding. Time Frame: 3 months. Goal Progressing: Progressing on both LE, working on endurance with the LLE. Able to stand on the RLE for 4-5 seconds. Working for more stability. 8-18-15
  6. Allison will be able to hop on one leg 10 reps each without support. Time Frame: 5 months. Goal Progressing: Currently about to complete several hops on the L with assist and on the R with assist. 8-18-15
  7. Allie will be able to walk across a 4.5" balance beam in tandem with a 3 second pause without stepping off. Time Frame: 4 months. Goal Progressing: Able to walk across and is starting to attempt tandem 8-18-15

Patient will continue to work on the following long term goals:


  1.  Allison will ride a tricycle without LE stabilization x10 feet. Time Frame: 4 months. : Goal met- Allie is able to ride a tricycle without LE support now.

  2.  Allison will be able to consistently complete a reciprocal pattern ascending and descending the steps with one rail or less. Time Frame: 4 months. Goal Progressing: Allie has improved with the stairs. Working on consistency and confidence descending the stairs 8-18-15
  3.  Allison will be able to catch a >5" ball with 2 hands 3/5 reps. Time Frame: 4 months. Goal met 10/14/14
  4. Allie will be able to gallop with a smooth pattern x15 feet. Time Frame: 2 months. Goal met 8-18-15
5. : Allie will walk with a consistent heel strike or heel contact without catching her toes >75% of the time. Time Frame: 3 months. Goal Progressing

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