Progressing Pediatric Practice: the 5 P's and Beyond

Walking is a primary goal of parents when learning of possible developmental delays in infants at risk for movement disorders due to prematurity, neurological insults surrounding birth, or genetic anomalies. Early limitations in motor abilities and walking impact perceptual-motor and cognitive development and present potential barriers to participation in physical, recreational, and social activities (Harbourne & Berger, 2019; Begnoche, 2016). Novak and colleagues identified goal-directed training, strength training, treadmill training, and mobility training interventions in the motor skills category to improve motor outcomes in children with CP (Novak, 2020). A 2021 International Clinical Practice Guideline identified child-initiated movement, targeted motor training activities, task and context-specific exercises, and intensity of practice to optimize functional motor outcomes in infants 0-2 years with or at high risk for CP (Morgan, 2021). However, limited research is available to guide clinical reasoning regarding interventions to attain independent walking during critical periods of neuroplasticity.

This session will review the evolution of theoretical models and current evidence supporting pediatric physical therapy practice, explore the focus of rehabilitation through application of prediction, prevention, plasticity, participation, and personalization, the 5 P’s from the IV STEP conference (Kimberley, 2017), and propose an evidence-based intervention to scaffold child-initiated movement to accomplish motor goals. The aim of the intervention is to optimize plasticity through child-initiated, caregiver-scaffolded activities to promote foundational motor abilities leading to independent walking. Case descriptions with photo and video vignettes will illustrate intervention strategies.