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Streamlining Progress Monitoring for Pediatric Physical Therapists

By Lisa Kathman

It’s progress monitoring time for your entire caseload. Your IEP (Individualized Education Plan) goals are written for measurement by data, and you pour through your notes trying to come up with something you wrote that can show progress. Not finding anything concrete, you grab the student to get more concise data. What did you do last time? There has to be a better way!

This is where criterion referenced tests (CRTs) and rubrics come to the rescue! Let’s take a kindergarten student who has a goal of navigating playground stairs safely and independently. There are two ways you can measure this, depending on the type of data you determine is most meaningful for this student.

Criterion Referenced Tests

Criterion referenced tests (CRTs) measure performance against a pass-fail criteria that determines whether or not a client can perform a particular skill. Teachers frequently use CRTs to evaluate whether students have learned an academic skill or met the expected standards. This form of measurement is an excellent way for physical therapists (or their assistants!) to collect baseline data and then retest a student’s performance using the same criteria each grading period to monitor progress. The consistency of using the same CRT to retest improves the accuracy of the data. They are best used for concrete skills where a simple “correct/incorrect” or “can do/can’t do” score applies.

 During your therapy sessions, you get to work on the foundational skills for the annual goal such as single limb strength, ankle balance reactions, and visual targeting, and your documentation will indicate where improvement is being seen from session to session. But when it is time to write a progress report, you will need to zoom out and report on progress as the annual goal is written in the IEP.

Here is an example of a CRT that can be used to test climbing playground stairs for a kindergarten student. The same set of tasks would be used each grading period to determine progress on the skill.

  1. Step up three steps with use of handrail on empty playground
  2. Step up three steps with stand by assistance on empty playground
  3. Step up three steps independently on an empty playground
  4. Climb up three steps with use of handrail during recess
  5. Climb up three steps independently during recess

Have the student complete each task, mark the task as correct or incorrect, and voila, you have your percentage score to put on the progress report!

Rubrics

Another effective way to measure progress on IEP goals is to use a rubric. Rubrics are a buzzword in education today. They list a set of criteria for mastery that can include both quantitative and qualitative data in a way that makes sense to teachers and parents. Criteria may include objective performance data on the skill, the level of cueing needed, and setting skill is used among other things, making it a more authentic measurement of the skill.

For the skill of stair climbing, you may have a row that breaks down the skill itself into a task hierarchy of easiest to most functional use of the skill. You may have a row that lists points for level and/or type of cueing needed. You can include a row that identifies if the student is holding anything, has a handrail available, etc. The beauty of a rubric is that it is completely customizable and meaningful for the student it is being used for.

Here is an example of a rubric that can be used to test climbing playground stairs for a kindergarten student. Each box is assigned one point, with a total number of possible points equaling 20 points.

 

1 2 3 4 5
Task analysis of skill development Walks over one object, stair height or lower Walks up a curb, stair height or lower Walks up one playground step Walks up two playground steps Walks up three playground steps
Visual and verbal cues Needs full modeling with visual cue markers for foot placement and verbal cues Uses visual cue markers for foot placement and verbal cues for foot placement Uses visual cue markers for foot placement and a single verbal cue for foot placement Uses visual cues for foot placement or verbal cues for foot placement No visual or verbal cues needed for foot placement
Physical cues Holds adult hand and railing going up stairs Holds adult hand and railing going down stairs Holds adult hand or railing going up stairs Holds adult hand or railing going down stairs Does not hold onto support going up stairs
Setting Empty playground with one adult standing near Empty playground with adult present, but not near Full playground during recess, stair area cleared of other students. Adult is near. Full playground during recess, stair area has other students. Adult near. Full playground during recess, no other students/adults near.

 

At baseline and at each grading period, the PT will use session data to determine where on the rubric the student is performing. When using a rubric, it is important to attach the rubric to the student’s IEP so it is clear how the goal is being measured. Otherwise, parents, teachers, or unfamiliar readers may interpret the rubric score as a ratio rather than a total number of points to achieve.

With criterion referenced tests and rubrics, there is no more guesswork about what to test or how to get the data to enter into your progress report. Who has time for that anyway?!

Lisa

Lisa Kathman
Lisa has been a speech-language pathologist since 1997. As an SLP, Lisa has worked exclusively with pediatrics in home health, clinics and in schools. She was formerly the lead SLP in the largest school district in Arizona, and is passionate about mentoring other SLPs, graduate students and clinical fellows. Lisa is the co-founder of SLP Toolkit (www.slptoolkit.com) and Bright Ideas Media (www.bethebrightest.com), an ASHA approved continuing education provider. Lisa currently serves as a member of the ASHA Continuing Education Board.

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