Effect of Trunk Support on Academic Engagement of Children With Severe Disability

Study Overview
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Brief Summary
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This study evaluates the effect of optimizing trunk support based on segmental principles of trunk control, on academic engagement of children in academic settings.

Detailed Description
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Head and trunk posture control are foundational skills, impacting vision, communication, swallowing, eating, reaching, and gait. Vision, communication and upper extremity skills are critical for participation in educational settings. From an academic point of view, participants with poor trunk stability have difficulties staying erect and keeping their head and trunk steady. This interferes with concentration, reduces ability and aptitude for learning and can lead to fatigue and reduced time on task. Examination of the effect of optimal trunk support may yield critical information regarding academic engagement in children with moderate to severe disability. The investigators propose to facilitate use of a segmental approach by physical and occupational therapists in educational settings. Activities will include identifying level of trunk control and applying segmental principles to adapt participant's positioning devices for optimal function.

Official Title
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Effect of Optimal Trunk Support on Academic Engagement of Children With Moderate to Severe Disability

Conditions
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Cerebral Palsy, Traumatic Brain Injury, Metabolic Disease, Hypotonia

Intervention / Treatment
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* Device: customized posture support


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Referral from physical, occupational or speech therapist working in Hartford Public School District or Connecticut Birth to Three, Segmental deficit in trunk control as measured by Segmental Assessment of Trunk Control parent or guardian consent that includes permission for video data collection and sharing of IEP (individualized education plan) or IFSP (individualized family support plan). Exclusion Criteria: pain that interferes with positioning, impending surgery that will result in extended absence from school

Ages Eligible for Study
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Minimum Age: 3 Months
Maximum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Single Subject Research Design
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Single Subject Design<br>The investigators will use a longitudinal design with baseline, immediate and post-intervention data collections. The intervention will include customized posture support in seated, standing or walking devices that will be used in the child's educational setting or home (for early intervention) to facilitate specific educational activities. | Device: customized posture support<br>* We will provide customized modifications for seated or standing or walking devices based on the child's segmental level of control<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Video Behavior Coding of time on task for selected IEP or IFSP goals. | Frequency and duration of 'on task' behavior will be coded for 2 or 3 of the child's existing education goals under two conditions, when child is in usual positioning equipment and in segmentally optimized equipment. Goals of interest reflect motor behaviors that promote task performance or interaction. These include 1) eye gaze (at people or objects), 2) reaching, 3) object manipulation, 4) head turning and 5) making choices (using eye gaze or reach). | On day 1 and one additional date at least 3 weeks later. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in vertical alignment of head | frequency and duration of upright 'head position' will be coded for 2 or 3 of the child's existing education goals under two conditions, when child is in usual positioning equipment and in segmentally optimized equipment. | On the day 1 and one additional date at least 3 weeks later. | 
| parent, teacher or aide device use record | frequency and duration of device use and comments about child and teachers response to using the device. | from day 1 to second session at least 3 weeks later) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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posture, trunk control, assistive device