Human Development and Implications for Clinical Practice
Recently, I had the privilege of participating in the Academy of Pediatric Physical Therapy Education Summit III. The over-arching goal of this Summit was to continue Academy efforts toward achieving excellence in pediatric physical therapy education. An important related objective was to critically review and update the Essential Core Competencies. Forty-five individuals came together at the APTA Headquarters in Alexandria, Virginia, to work on these and other related goals and objectives on June 5th and 6th, and the work continues.
One of my post-Summit tasks is to integrate recommendations from the group into any potential revisions to Core Competency, Human Development, and the related Entrustable Professional Activities (EPAs) identified in the 2014 article. This has me thinking a bit- why is it important that physical therapists know about Human Development? What is it about knowing this information that helps us to be as effective as possible at helping children and families be happy and well and achieve their long-term potential? The verbs in the EPAs from 2014 provide some guidance here- integrate into clinical decision making, analyze motor skill development, and apply knowledge about other domains as well. However, the challenge for all of us in clinical practice and in educating the next generation of physical therapists is to translate our understanding- our knowing- of the way that humans develop and refine motor skills, communication skills, psychosocial skills, and cognitive skills, into our interventions for children who may be struggling in one or more of these areas.
A recent article in Pediatric Physical Therapy by Inamdar et al. provides some ideas that we might use to navigate these challenges. The purpose of this systematic review was to quantify the efficacy of interventions based on contingency paradigms in infancy on feeding, motor, and cognitive outcomes. The theoretical underpinning of these interventions, which the authors define as contingency-paradigm-based interventions (CPBI), is our current best understanding of human development. The principles here include the cascading impacts of change in one domain of development on other domains; embodied cognition, where infant learning occurs as the infant identifies the relationship between their self-initiated actions and the effect on the environment; learner readiness for the task initially and for more demanding practice as skill improves; and frequency and variability in practice of tasks. The results of the review suggest that CPBI have potential for application to physical therapy practice starting in the NICU and through infancy in Early Intervention. I would also suggest that we regularly think about these principles in clinical practice, and that we help students and novice clinicians build their own knowledge and skill here by sharing specific cases and examples where these principles are put into practice.
At PT Learning For Practice, registration for a course related to all this is now open. Although part of the course is in-person here in Pittsburgh (On Saturday morning, August 19), if you’re interested please contact me about creating an online-only option if getting to Pittsburgh that day isn’t possible for you.
References
Rapport, Furze, Martin, Schreiber, Dannemiller, Dibasio, and Moerchen. Essential Competencies in Entry-Level Pediatric Physical Therapy Education. Pediatric Physical Therapy. 2014, 26: 7-18.
Inamdar, khurana, and Dusing. Effect of Motor Intervention for Infants and toddlers with cerebral palsy: A systematic review and meta-analysis. Pediatric Physical Therapy. 2022; 34: 146-161