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My colleagues and I are currently reviewing the assessment methods for the kinder screening program around the Castlemaine area. The current form involves basic gait analysis, footware assessment, pain presence (yes/no), skin/nail abnormalities, structural deformity and proprioception/co-ordination.
The aim is a get them to walk back and forward a few times and post a "letter" at the top of the walkway. A letter is then sent to the parents requesting consent before hand and a follow up, and if anything unusual is noted a request for further podiatric assessment is advised.
I was just wanting to know what do other pods look for? what sort of forms do you use? what methods do you have of assessing? anything else you'd like to add, please feel free to add one or two cents in...anything would be appreciated. It is difficult sometimes to say the least to get the kids to walk "normally" and manage 18+ 4-5 year olds at the same time and try to analyse their gait, and attempt to pick up something that may have an impact on their quality of life. :S
This is timely, "hot off the press": Flexible flatfoot and related factors in primary school children: a report of a screening study. Rheumatol Int. 2006 May 3;
Quote:
The aim of this study was to analyze the longitudinal arch morphology and related factors in primary school children. Five hundred and seventy-nine primary school children were enrolled in the study. Generalized joint laxity, foot progression angle, frontal hindfoot alignment, and longitudinal arch height in dynamic position were evaluated. The footprints were recorded by Harris and Beath footprint mat and arch index of Staheli was calculated. The mean age was 9.23 +/- 1.66 years. Four hundred and fifty-six children (82.8%) were evaluated as normal and mild flexible flatfoot, and 95 children (17.2%) were evaluated as moderate and severe flexible flatfoot. The mean arch indices of the feet was 0.74 +/- 0.25. The percentage of flexible flatfoot in hypermobile and non-hypermobile children was found 27.6 and 13.4%, respectively. There was a statistically significant difference in dynamic arch evaluation between hypermobile and non-hypermobile children. There was a significant negative correlation between arch index and age, and a significant negative correlation between hypermobility score and age. Our study confirms that the flexible flatfoot and the hypermobility are developmental profiles
I guess the two other factors I would look for are symptoms of pain or discomfort, and footwear. Both are very tricky, as the first requires enough time for the child to trust you and share the information with you (as well as actually understand the question); and the second is a bit of a snapshot approach. However, I believe that evidence of footwear deformation can be valuable in gait analysis of young children; and issues about style and fit are important (although there really is no hard evidence to support this).
I have only just read this post and had a few ideas for you..... We do 3 and a half year screenings with maternal child health nurses, speech pathologists and occupational therapists. I find the best way to interact with the kids is to play games with them using balls and other equipment, that way you get a truer picture of their gait if they are just running around after toys and not concentrating on walking. I think you should also include major miletsones, not just gait analysis, within your assessment, that is, jumping, hopping, running, walking and running on tip-toes, climbing on equipment (particularly stairs). Sometimes getting an adult they're familiar with to join in can make them feel more comfortable and willing to participate. Hope this helps. Cheers
I am also reviewing our old paediatric screening program and will be introducing a new one in 2007. The key paediatric person I would speak to who has numerous assessment forms works in the Casey Muncipality. I can pass her details onto you if you would like and you could contact her. They have a very developed program.
Musculoskeletal screening examination (pGALS) for school-age children based on the adult GALS screen. Arthritis Rheum. 2006 Sep 29;55(5):709-716
Foster HE, Kay LJ, Friswell M, Coady D, Myers A
Quote:
OBJECTIVE: To develop and validate a musculoskeletal screening examination applicable to school-age children based on the adult Gait, Arms, Legs, Spine (GALS) screen.
METHODS: Adult GALS was tested in consecutive school-age children attending pediatric rheumatology clinics and was compared with an examination conducted, on the same day, by a pediatric rheumatologist who classified children as having abnormal or normal joints. Adult GALS was tested for validity compared with the pediatric rheumatologist's assessment and deficiencies in adult GALS were identified. Experts proposed amendments to adult GALS, achieving consensus by modified Delphi techniques. The resultant pediatric screening tool (pGALS) was tested (methodology identical to the testing of adult GALS) in an additional group of children.
RESULTS: Adult GALS was tested in 50 children (median age 11 years, range 4-16), of whom 37 (74%) had juvenile idiopathic arthritis. Adult GALS missed important abnormalities in 18% of children, mostly at the ankle, foot, and temporomandibular joints. The pGALS was tested in 65 children (median age 13 years, range 5-17 years) and demonstrated excellent sensitivity (97-100%) and specificity (98-100%) at all joints, with high acceptability scored by child and parent/guardian. The median time to perform pGALS was 2 minutes (range 1.5-3 minutes).
CONCLUSION: The pGALS musculoskeletal screening tool has excellent validity, is quick to perform, and is acceptable to school-age children and parents/guardians. We propose that pGALS be incorporated into undergraduate and postgraduate medical training to improve pediatric musculoskeletal clinical skills and facilitate diagnosis and referral to specialists.
I think you need to consider what are you looking at in 5 minutes within a kinder setting. I have had long chats with Sheridan/her student (I think) about the old kinder screening program we set up in Casey and have since ditched.
When looking at a public health/health promotion initative, you will have more effect if you change the setting that the child functions in. It will be more cost effective in the long term and easier for the child. Train up your maternal child health nurses/kinder teachers to be more on the ball and then intergrate yourself with a pead team that when they present to your service they will recieve a more comprehensive assessment with a physio, Pod and Ot.
With this approach we have maintained our referral rate and in some cases increased and found that the majority of kids are more appropriate for referral and treatment. All this therefore means more treating time and less sitting in a kinder surrounded by 30 4 year olds wanting to show you their lovely legs.
Paediatric Preschool Screenings
Paediatric Screening Program- Doncaster
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