Maria A Fragala-Pinkham

• PT, DPT, DSc
• Manager at Boston Children's Hospital

Purpose A health promotion and physical wellness (HPPW) life course approach for pediatric physical therapy (PT) is recommended to improve children’s health outcomes across the lifespan. Summary of Key Points A life course approach describes how a child’s individual responses to environmental factors influence health outcomes. Using HPPW strategie...

- Durable medical equipment (DME) policies require that the equipment be medically necessary; however, adaptive cycling equipment (bicycles and tricycles) are usually not deemed medically necessary. - Individuals with neurodevelopmental disabilities (NDD) are at high risk for secondary conditions, both physical and mental, that can be mitigated by...

Aims: Limited information is available on impairments, activity limitations and participation restrictions in youth with Hutchinson-Gilford progeria syndrome (HGPS), a rare genetic premature aging disease. The purposes were to: (1) describe range of motion (ROM), grip, pinch and quadriceps strength, functional balance, walking endurance, and gross...

There is a need for person-reported outcome measures for SMA. The PEDI-CAT is a caregiver-reported measure used to describe functional skill performance. Convergent validity of the PEDI-CAT with SMA phenotypes was established, and Rasch analysis of the full item bank revealed representation of abilities for SMA III and for daily activities for SMA...

Purpose To compare the effects of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy. Materials and Methods Twelve children with hemiplegic cerebral palsy and 12 typically developing children ages 5 to 12 years (GMFCS I–II) were evaluated with the Timed Up and Go (TUG) and Biodex Balan...

Purpose: The purpose of this study was to examine the psychometric properties of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) in children and youth with Spinal Muscular Atrophy (SMA). Methods: In this prospective cross-sectional study, caregivers of children and youth with SMA completed the PEDI-CAT Daily Ac...

Objective The purpose of this case report is to describe the challenges that COVID-19 presented for therapists in a pediatric hospital and the response to these challenges. Methods (Case Description) The case report setting is a physical therapy and occupational therapy department (department) of an academic pediatric medical center that provides...

Purpose To systematically examine the efficacy of lower extremity cycling interventions for youth with intellectual disability (ID). Methods Seven databases were searched from March 2000 to October 2019 for English-language articles on cycling interventions for youth with ID. The American Academy of Cerebral Palsy and Developmental Medicine guidel...

Participation in routine physical activity is important for health promotion and prevention of chronic health conditions. Sports and active recreation are activities that are carried out during leisure time and encourage movement and moderate to vigorous physical activity. Participating in sports and active recreation can be beneficial on several l...

Aim: To identify available judgment-based measures of ambulation with assistive devices for the purpose of examining item content and responses to aid in the expansion of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) Mobility Domain. Methods: PubMed and CINAHL databases were used to identify measures meeting the...

Objective: To evaluate the content validity of the PEDI-CAT Speedy Mobility domain through analysis of item and content area exposure, score range and scoring precision. Methods: Retrospective analysis of 3,364 items from assessments (n = 301) completed from 2013 to 2017. Content validity was appraised through analysis of item and content area expo...

Aim: The Pediatric Evaluation of Disability Inventory (PEDI) was revised to the PEDI-Computer Adaptive Test (PEDI-CAT). The PEDI has been used for over two decades to track function in youth, so it is important that follow-up data are not lost with this transition. The purpose of this study was to develop and validate equations for linking PEDI sco...

Background: Worldwide over a billion people live with a disability including 400,000 people in Ecuador. People with disabilities (PWD) face barriers to full participation in society. Barriers are generated by negative attitudes created through socio-cultural experiences. Awareness about disability can be facilitated through disability awareness tra...

Background Cerebral palsy (CP) is the most common physical disability among children (2.5 to 3.6 cases per 1000 live births). Inadequate physical activity (PA) is a major problem effecting the health and well-being of children with CP. Practical, yet accurate measures of PA are needed to evaluate the effectiveness of surgical and therapy-based inte...

Objective: The purpose of this study was to (1) investigate the construct validity and (2) test-retest reliability of the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) in children with cerebral palsy (CP). Design: A prospective convenience cross-sectional sample SETTING: Multidisciplinary CP clinic in a tertiar...

Objectives: Of all hospitalized children, those with medical complexity have the highest likelihood of hospital readmission. Post-acute hospital care could potentially help stabilize the health of these children. We examined the frequency of acute care hospital admissions after discharge home from a post-acute care hospital (PACH). Methods: A re...

Background: The PEDI-CAT is a new clinical assessment for children and youth from birth through 20 years of age. Objective: To determine the discriminant validity of the PEDI-CAT according to Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) in children with cerebral palsy (CP). Design: A prospe...

Purpose: To examine differences in physical therapy dosing frequency recommendations based on children's characteristics and to describe types of intervention recommended at postacute hospital admission. Methods: Demographic and clinical information, recommended physical therapy intervention frequency, and intervention types were collected for a...

Aims: To review the literature on the effects of aquatic intervention on gross motor skills for children with cerebral palsy (CP). Data sources: Six databases were searched from inception to January 2016. Review methods: Aquatic studies for children aged 1-21 years with any type or CP classification and at least one outcome measuring gross mot...

Purpose: To assess construct (convergent and divergent) validity of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) in a sample of children with complex medical conditions. Method: Demographics, clinical information, PEDI-CAT normative score, and the Post-Acute Acuity Rating for Children (PAARC) level were coll...

Purpose: Responsiveness of the PEDI-CAT Mobility, Daily Activities, and Social/Cognitive domains and Wheelchair subdomain was evaluated for youth admitted to a pediatric post-acute care hospital. Methods: Inpatients ages 2-21 years, with a length of stay of ≥ 5 days and with both admission and discharge scores were included. The difference betwe...

Purpose: We evaluated the suitability of a caregiver-reported functional measure, the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), for children and young adults with spinal muscular atrophy (SMA). Methods: PEDI-CAT Mobility and Daily Activities domain item banks were administered to 58 caregivers of children an...

VerbalCare is a mobile software platform for hospital patients and nursing staff to communicate in real-time. The purposes of this study were to (1) identify and evaluate icons for the VerbalCare tablet application and (2) examine use and satisfaction with this tablet application in a paediatric post-acute hospital. Hospital nursing staff were surv...

Purpose: To develop and test decision tree (DT) models to classify physical activity (PA) intensity from accelerometer output and Gross Motor Function Classification System (GMFCS) classification level in ambulatory youth with cerebral palsy (CP); and 2) compare the classification accuracy of the new DT models to that achieved by previously publis...

To analyze the clinimetric properties of maximal aerobic and anaerobic fitness measurement protocols in adults with cerebral palsy (CP). A systematic search through March 2015 of databases PubMed, Embase, SPORTDiscus and PsycINFO was performed with medical subject heading terms for 'cerebral palsy' combined with search terms adults or adolescents a...

Physical therapy (PT) for youth with cerebral palsy (CP) who are ambulatory includes interventions to increase functional mobility and participation in physical activity (PA). Reliable and valid measures are thus needed to document PA in youth with CP. To evaluate inter-instrument reliability and concurrent validity of three accelerometer-based mot...

While preliminary studies have established good psychometric foundation for the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) for a broad population of youth with disabilities, age-specific validation is warranted. The study objectives were to: 1) examine concurrent validity; 2) evaluate the ability to identify moto...

The purpose of this report is to discuss the scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities. Evidence is provided that supports integration of health promotion and fitness strategies in physical therapy clinical management. Physical therapists' roles in community-based adapted sports and fit...

This study evaluated the validity of the OMNI Walk/Run Rating of Perceived Exertion (OMNI-RPE) scores with heart rate and oxygen consumption (VO2 ) for children and adolescents with cerebral palsy (CP). Children and adolescents with CP, aged 6 to 18 years and Gross Motor Function Classification System (GMFCS) levels I to III completed a physical ac...

Purpose: The purposes of this study were to: 1) establish inter-instrument reliability between left and right hip accelerometer placement; 2) examine procedural reliability of a walking protocol used to measure physical activity (PA); and 3) confirm concurrent validity of accelerometers in measuring PA intensity as compared to the gold standard of...

Purpose: The primary purpose of this pilot study was to evaluate the effectiveness of a14-week aquatic exercise program on gross motor function and walking endurance in children with cerebral palsy (CP). The secondary purpose was to evaluate changes in functional strength, aerobic capacity and balance. Method: A prospective time series group des...

Purpose: Cerebral palsy (CP) is the most prevalent childhood physical disability. Youth with CP often have increased energy expenditure and decreased physical activity (PA) compared to peers without disabilities. Valid PA measures are important in the design and evaluation of health promotion programs. This study examined accelerometers to measure...

: To document physical therapist intervention activities and cardiorespiratory response for young children with chronic respiratory insufficiency. : Twelve children born prematurely, 6 to 30 months chronological age and admitted to inpatient pulmonary rehabilitation for oxygen and/or ventilation weaning, were included. During 3 intervention session...

OBJECTIVE: To systematically evaluate the level of evidence of the clinimetric properties of measures of aerobic and anaerobic capacity used for children with cerebral palsy (CP). DATA SOURCES: A systematic search of databases PubMed, Embase, SPORTDiscus and PsycINFO through April 2011 was performed. STUDY SELECTION: Two independent raters identifi...

To examine concurrent validity, item-specific reliability, and score distributions of the new Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) Mobility domain with the original PEDI Functional Skills (FS) Mobility Scale. Thirty-five parents of children with neurodevelopmental disabilities completed the PEDI-CAT on a co...

Background. Evidence suggests that children and youth with special health care needs (CYSHCN) have decreased physical activity compared to peers. This study describes weight status and physical activity in CYSHCN and identifies factors associated with physical activity and community resources to promote physical activity. Methods. Parents (n = 21)...

To examine the discriminant validity, test-retest reliability, administration time and acceptability of the pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT). A sample of 102 parents of children 3 through 20 years of age with (n = 50) and without (n = 52) disabilities was recruited for this prospective field study. A su...

This study tested in children with cerebral palsy (CP) whether motor habilitation resembles motor learning. Twelve children with hemiplegic CP ages 5 to 12 years with moderate to severe motor impairments underwent a 16-session robot-mediated planar therapy program to improve upper limb reach, with a focus on shoulder and elbow movements. Participan...

To examine the discriminant validity and scoring patterns of the PEDI-CAT Mobility item bank for children who use a walking aid or wheelchair. Parents whose children use a walking aid (n=35) or a wheelchair (n=31) completed the full PEDI-CAT Mobility item bank (105 items including 13 walking aid and 14 wheelchair items) on-line. An independent samp...

The aims of the study were to: (1) build new item banks for a revised version of the Pediatric Evaluation of Disability Inventory (PEDI) with four content domains: daily activities, mobility, social/cognitive, and responsibility; and (2) use post-hoc simulations based on the combined normative and disability calibration samples to assess the accura...

To evaluate the effectiveness of a 14-week aquatic exercise programme for children with autism spectrum disorders (ASD). Design: Non-randomized control trial. Twelve children participated in this pilot study with seven participants in the aquatic exercise group and five in the control group. The programme was held twice per week for 40 minutes per...

Although a number of research studies have examined the effects of robot-assisted movement therapy for adults with motor impairments following stroke, use of this technology for children with neurologically-based movement disorders is just beginning. Conventional rehabilitation methods are insufficient in meeting children's needs for intensive moto...

The Pediatric Evaluation of Disability Inventory (PEDI) is a useful clinical and research assessment, but it has limitations in content, age range, and efficiency. The purpose of this article is to describe the development of the item bank for a new computer adaptive testing version of the PEDI (PEDI-CAT). An expanded item set and response options...

Children with disabilities have lower physical activity levels and participate less in community-based sport and exercise programs than do children without disabilities. This in part is due to environmental barriers and lack of appropriate resources in these programs. Adaptive programs encouraging increased physical activity for children with disab...

The PEDI-CAT is a new computer adaptive test (CAT)version of the Pediatric Evaluation of Disability Inventory(PEDI). Additional PEDI-CAT items specific to post acute pediatric hospital care were recently developed using expert reviews and cognitive interviewing techniques.Expert reviews established face and construct validity,providing positive fee...

To assess the responsiveness, examine the scoring range and determine the efficiency of a multidimensional computer adaptive testing version of the Pediatric Evaluation of Disability Inventory (PEDI-MCAT) for children admitted to inpatient pulmonary rehabilitation. The PEDI-MCAT was completed by clinician report for 30 infants and children. Mean se...

The purpose of this article is to review the innovations, applications, and effect of the original Pediatric Evaluation of Disability Inventory (PEDI) published in 1992 and to describe planned revisions. During the past decade, the PEDI has helped to shift thinking from a developmental to a functional focus. Using the PEDI, researchers and clinicia...

The purpose of this study was to evaluate the effects of an aquatic aerobic exercise program for a child with cerebral palsy. A 5-year-old girl with spastic diplegia classified at level III on the Gross Motor Function Classification System participated in this single-subject A-B-A design study. The aquatic aerobic exercise intervention was carried...

To describe an adaptive ice skating programme designed by paediatric therapists. Twenty-two children, ages 5-12 years, with developmental disabilities participated in this once per week skating programme lasting 6 weeks. Ice skating instructors led the group lessons, while university student coaches provided individualized assistance to the childre...

To develop and field-test a physical performance measure (MPS-PPM) for individuals with Mucopolysaccharidosis I (MPS I), a rare genetic disorder. Motor performance and endurance items were developed based on literature review, clinician feedback, feasibility, and equipment and training needs. A standardized testing protocol and scoring rules were c...

The purpose of this study was to modify the Paediatric Evaluation of Disability Inventory (PEDI) to create a Pompe disease-specific disability instrument for use in clinical trials and natural history studies. PEDI item content was revised to include self-care and mobility items appropriate for children and youth with Pompe disease. Data were colle...

Contemporary clinical assessments of activity are needed across the age span for children with cerebral palsy (CP). Computerized adaptive testing (CAT) has the potential to efficiently administer items for children across wide age spans and functional levels. The objective of this study was to examine the psychometric properties of a new item bank...

The objective of this project was to develop computer-adaptive tests (CATs) using parent reports of physical function in children and adolescents with cerebral palsy (CP). The specific aims of this study were to (1) examine the psychometric properties of an item bank of lower-extremity and mobility skills for children with CP; (2) evaluate a CAT us...

The purposes of this study were to apply a bi-factor model for the determination of test dimensionality and a multidimensional CAT using computer simulations of real data for the assessment of a new global physical health measure for children with cerebral palsy (CP). Parent respondents of 306 children with cerebral palsy were recruited from four p...

The specific aims of this study were to (1) examine the psychometric properties (unidimensionality, differential item functioning, scale coverage) of an item bank of upper-extremity skills for children and adolescents with cerebral palsy (CP); (2) evaluate a simulated computer-adaptive test (CAT) using this item bank; (3) examine the concurrent val...

The purpose of this case series is to describe the implementation of an aquatic physical therapy (PT) program at a pediatric hospital and to document improvements in participants' abilities after PT intervention. Four patients with cerebral palsy, juvenile idiopathic arthritis, or Prader-Willi syndrome participated in aquatic and land-based PT inte...

Our aim was to examine the feasibility and effects of robotic therapy for children with cerebral palsy and upper limb hemiplegia. A single group within-subjects design was used. Twelve children aged 5-12 yrs with moderate to severe motor impairments participated in 1-hr robotic therapy sessions, 2 times per week for 8 wks. During each session, chil...

The effectiveness and safety of a group aquatic aerobic exercise program on cardiorespiratory endurance for children with disabilities was examined using an A-B study design. Sixteen children (11 males, five females) age range 6 to 11 years (mean age 9y 7mo [SD 1y 4mo]) participated in this twice-per-week program lasting 14 weeks. The children's di...

The combined effects of robotic therapy and botulinum toxin type A (BTX-A) on upper-limb movement and function were studied in an 8(1/2)-yr-old child with hemiplegic cerebral palsy. Robotic therapy comprising repetitive, goal-directed reaching tasks was administered two times per week for 8 wks. Clinical measures included the Modified Ashworth Scal...

To examine score agreement, validity, precision, and response burden of a prototype computer adaptive testing (CAT) version of the self-care and social function scales of the Pediatric Evaluation of Disability Inventory compared with the full-length version of these scales. Computer simulation analysis of cross-sectional and longitudinal retrospect...

The purpose of this study was to assess the content, format, and comprehension of test items and responses developed for use in a computer adaptive test (CAT) of physical function for children with cerebral palsy (CP). After training in cognitive interviewing techniques, investigators defined item intent and developed questions for each item. Paren...

The purposes of this paper are to: 1) present a conceptual framework that supports development of a computer adaptive test (CAT) outcome measure of physical functioning for children with cerebral palsy; 2) illustrate the development and refinement of an item bank for use in the CAT; and 3) describe the intended application of these newly developed...

The purpose of this article is to demonstrate: (1) the accuracy and (2) the reduction in amount of time and effort in assessing physical functioning (self-care and mobility domains) of children and adolescents using computer-adaptive testing (CAT). A CAT algorithm selects questions directly tailored to the child's ability level, based on previous r...

To describe and evaluate the nutrition counselling component of a fitness programme for children with disabilities. Twenty-eight children with disabilities, ages 6-14 years, participated in a 16-week comprehensive fitness programme consisting of twice weekly exercise sessions, nutrition counselling and physical activity promotion education sessions...

To compare the measurement efficiency and precision of a multidimensional computer adaptive testing (M-CAT) application to a unidimensional CAT (U-CAT) comparison using item bank data from 2 of the functional skills scales of the Pediatric Evaluation of Disability Inventory (PEDI). Using existing PEDI mobility and self-care item banks, we compared...

Objective: To examine the relative sensitivity to detect functional mobility changes with a full-length parent questionnaire compared with a computerized adaptive testing version of the questionnaire after a 16-week group fitness programme. Design: Prospective, pre- and posttest study with a 16-week group fitness intervention. Setting: Three commun...

The purpose of this article is threefold: (1) to describe the development, reliability, and validity of a revised physical performance measure for individuals with mucopolysaccharidosis type I (MPS I); (2) to standardize the test on a normal sample; and (3) to compare results from a selected sample of individuals with MPS I with age-based centiles....

The purpose of this article is threefold: (1) to describe the development, reliability, and validity of a revised physical performance measure for individuals with mucopolysaccharidosis type I (MPS I); (2) to standardize the test on a normal sample; and (3) to compare results from a selected sample of individuals with MPS I with age-based centiles....

Over the past decade, the methods and science used to describe changes in outcomes of physical therapy services have become more refined. Recently, emphasis has been placed not only on changes beyond expected measurement error, but also on the identification of changes that make a real difference in the lives of patients and families. This article...

This study examined the feasibility, safety, and effectiveness of a community-based group fitness program for children with disabilities. Twenty-eight children with neuromuscular and developmental disabilities, 6 to 14 years of age, participated. The 16-week community-based program, held twice weekly, consisted of strengthening, aerobic conditionin...

The purpose of this special report is to present recommendations for the clinical management of children with cerebral palsy, spastic diplegia when increased functional mobility is the identified outcome. These recommendations provide a framework that allows physical therapists to increase their accountability and promote effective interventions fo...

This case report describes a fitness program for children with disabilities and provides preliminary information about the safety and feasibility of the program. Nine children, 5 to 9 years of age with physical or other developmental disabilities, participated in a 14-week group exercise program held 2 times per week followed by a 12-week home exer...

To assess score agreement, validity, precision, and response burden of a prototype computerized adaptive testing (CAT) version of the Mobility Functional Skills Scale (Mob-CAT) of the Pediatric Evaluation of Disability Inventory (PEDI) as compared with the full 59-item version (Mob-59). Computer simulation analysis of cross-sectional and longitudin...

The purpose of this article is to demonstrate: (1) the accuracy and (2) the reduction in amount of time and effort in assessing physical functioning (self-care and mobility domains) of children and adolescents using computer-adaptive testing (CAT). A CAT algorithm selects questions directly tailored to the child's ability level, based on previous r...

To determine the effects of a home exercise program of combined aerobic and strength training on fitness with a 10.5-year-old girl with Down syndrome (DS). Measurements included cardiovascular variables, strength, body composition, flexibility, and skill. The subject participated in a home exercise program: 30 to 60 minutes of moderate- to high-int...

The purposes of this article are to describe the pathology, medical implications, and typical impairments of individuals with various lysosomal storage diseases (LSDs), summarize results of recent clinical trials on medical interventions relevant to physical therapy practice, report new advances in functional measurement, and suggest a framework fo...

We developed normative profiles of physical functioning (mobility and self-care) in infancy up through 14 years of age with an expanded version of the Pediatric Evaluation of Disability Inventory. Mobility and self-care reference curves were based on the original Pediatric Evaluation of Disability Inventory standardization data (n = 412) and data f...

This study describes the physical disability of 30 children and adolescents with Pompe disease (23 males, 7 females; mean age 7 years 7 months, SD 5 years 6 months; range 6 months to 22 years 1 month) using a disease-specific functional instrument. Data were collected by telephone interview with parents using a modified version of the Pediatric Eva...

The purpose of this pilot study was to investigate changes in passive range of motion (PROM) of children with severe limitations in self-mobility during periods of physical therapy intervention and naturally occurring periods of no intervention (school vacations). A multiple-case time-series design was used to monitor hip and knee PROM over a seven...

This study describes changes in physical therapy (PT) service delivery, intervention strategies, and anticipated goals after botulinum toxin A (BtA) injections for children with cerebral palsy and lower extremity spasticity. Subjects were six physical therapists who were the primary therapists for children who received BtA injections. A questionnai...

The purpose of this study was to describe self-care recovery of children and adolescents with acquired brain injury using six newly derived self-care functional classification levels, to examine the responsiveness of the levels, and to compare level changes with scaled score changes. Upon admission and discharge to inpatient rehabilitation, the Ped...

This article describes mobility recovery for children and youth with traumatic and non-traumatic brain injury during hospital-based rehabilitation. A retrospective, descriptive pre-test/post-test design was used. METHODS and One hundred and fifty-seven individuals with brain injury who were admitted for rehabilitation over a 5-year period were enro...

The purpose of this study was to describe self-care recovery of children and adolescents with acquired brain injury using six newly derived self-care functional classification levels, to examine the responsiveness of the levels, and to compare level changes with scaled score changes. Upon admission and discharge to inpatient rehabilitation, the Ped...