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PROCEEDINGS
22-24 September 2003
Perth, Australia
5th National Paediatric Physiotherapy Conference Introduction
The 5th National Paediatric Physiotherapy Conference presented by theAustralian Physiotherapy Association Paediatric Special Group was held inPerth 22–24 September 2003.
The Conference theme Minding your P’s and Q’s in Paediatrics: Promotion,Prevention and Quality was chosen to reflect the diverse issues and challengesfaced by the physiotherapy profession, the children and families we meet, andthe education of our future paediatric therapists.
Promotion expresses the idea of promoting not only our profession and thespecialisation into paediatrics, but also encompasses strategies allowingpaediatric populations and families to make healthy choices. The diversity thatthis theme brought to the conference was reflected in the many healthpromotional strategies devised by speakers and the context in which they areapplied in child health and development issues.
Prevention suggests that, in professional practice, we seek to assure thatchildren have the opportunity to fulfil potentials for healthy and productivelives unhampered by disease or disability. In pursuit of this goalphysiotherapists employ best clinical practice and clinical research to maintainthe health of children. The conference focused attention on the urgency ofprevention, and on promising approaches to tackle key challenges faced byphysiotherapists and the children and families we see.
Quality refers to quality of clinical practice and of the education of ourcurrent and future physiotherapists. The conference explored the meaning ofbest practice and the issues faced when trying to implement and measure bestpractice. It examined issues such as developing and testing resources to assistphysiotherapists identify and apply quality practice in physiotherapyinterventions and in physiotherapy education.
Our keynote speaker was Dr Toby Long, co-author of Handbook of PaediatricPhysical Therapy and Associate Professor at Georgetown UniversityDepartment of Paediatrics, Washington DC.
This conference has grown from event to event, with the last two conferencesattracting over 250 delegates. This year we targeted our Asia-Pacificneighbours to further develop it from a successful national event to anattraction for our international colleagues. Registrations exceededexpectations with a good representation of international delegates. Furthersuccess of the conference was demonstrated by the tremendous response tothe call for papers, with over 60 abstracts being submitted for consideration.
The quality and diversity of topics presented was a credit to our paediatricphysiotherapy profession.
Noula Gibson
2003 Paediatric Physiotherapy Conference Convenor
Australian Physiotherapy Association
5th National Paediatric Physiotherapy Conference Contents
BURNS YR, O’CALLAGHAN M, MCDONNELL B
KINGSTON SC, JENSEN LM and BLACKMORE MA
The effects of an exercise program on the Is there a relationship between motor development at cardiorespiratory fitness and muscle strength of 1 year and movement and cognition at 4 years of age? FARBOTKO K, WILSON C, WATTER P and
KIRKEGARD A, WATTER P, RODGER S, ZIVIANI J,
Physiotherapy management of cystic fibrosis: has there Relationship between the movement assessment battery for children and the physiotherapy neurodevelopmentalassessment for children with developmental coordination GEDDES CD and BERTONE N
Adherence to physiotherapy home programme in cysticfibrosis MAHONY K, HUNT A, DALEY D and SIMS S
Inter-tester reliability of manual muscle testing and GIBSON N, VALENTINE JP, GUBBAY AJ, PEARCE A,
dynamometry in children with spina bifida Preliminary results of using Botulinum Toxin A in RAGHAVENDRA P, SMITH J, HARRISON T,
the treatment of upper limb spasticity in children Childhood physiotherapy experiences of adults with cerebral palsy: implications for today’s children with GIBSON S and RAGHAVENDRA P
Intensive physiotherapy intervention for children with cerebral palsy: functional outcomes and parents’ SCHEINBERG AM, HALL K, CLARK K and
Study of the effectiveness of oral baclofen in JOHNSTON LM, BURNS YR and BRAUER SG
A school-based physiotherapy intervention program for postural stability to improve motor coordination for SHIRCORE L, LOVE S, GIBSON N and PRICE C
children with DCD: a randomised controlled trial Application and standardisation of the Modified Tardieu Scale to measure spasticity in children with JOHNSTON LM, BURNS YR, BRAUER SG and
Increments of challenge: effects of increasing task SIMON S, ALISON J, DWYER G and FOLLET J
accuracy and attentional demands on postural muscle Validation of the Perceived Exertion Scale for 5th National Paediatric Physiotherapy Conference Is there a relationship between motor
significant changes were identified in use of flutter (p = development at 1 year and movement and
0.15) and exercise (p = 0.76). No significant differences cognition at 4 years of age?
were found in population biographics or occurrence ofconcomitant factors that may influence patient management.
Burns YR,1 O’Callaghan M,2 McDonnell B1
Poor chart design and inadequate recording of data were found to be significant problems. Contributing factors may 1The University of Queensland 2Mater Miseracordiae Hospital, Brisbane include excessively detailed or complex charts, inadequatetherapist time, inadequate training and ambiguous A multidisciplinary, longitudinal study of 132 children who instructions in chart recording. Such factors should be were less than 1000 gm at birth involved regular motor and addressed to optimise safe and efficient patient management.
cognitive assessments at specified ages corrected for thenumber of weeks preterm. This study explored possiblerelationships between motor and cognitive development at Adherence to physiotherapy home programme in
one and four years of age. The Neuro-Sensory and Motor cystic fibrosis
Developmental Assessment (NSMDA) was used to assessmovement at both ages while cognitive function was tested Geddes CD and Bertone N
using the Griffith Mental Developmental Scale at one year and the McCarthy Scales of Children’s Abilities at four Young people with cystic fibrosis (CF) must self-manage years of age. All assessors were blind to previous medical many components of their lung disease in order to reduce history and test results. A significant association was found the number of respiratory exacerbations and maintain their between the classification of movement as normal or with quality of life (QOL). Chest physiotherapy to remove lower minimal, mild or moderate/severe problems at one and four airway secretions is a major aspect of self-management in years (p < 0.001) and with cognitive performance of the CF. The aim of this quality project was to determine children at the same ages. Although a relationship between barriers and implement some methods to increase motor development at one and four years (p < 0.001) was adherence for patients of Southern Health. The first stage evident, the relationship between movement at one year was to send out questionnaires to people with CF who fit and cognitive outcome at 4 years was particularly strong (p into the specified age range (15–25 yrs) in order to gather < 0.001). This relationship between movement and feedback on methods that may assist to increase adherence.
cognitive performance was not affected by gender, The second stage was to develop a tool for increasing peri/neonatal factors, cerebral palsy or social factors. The adherence within this population. The thematic analysis of strong association found in this study between the NSMDA the questionnaires suggested the provision of easily grades and General Quotient at twelve months and four accessible information would be beneficial to years implies a link between movement and performance physiotherapy adherence. The suggested use of computer- that is not specifically related to the child’s ability/inability based technology was well received. An information to physically perform the test. These findings have resource was developed in the form of an interactive CD- implications for assessment of movement in children born ROM that will be distributed to all CF patients of Southern extremely preterm. In the future it is important to replicate Health, as well as a website that can be accessed from the the study in a population of children born at term.
CD-ROM or independently. The final stage will be toimplement the tool and assess its effect on adherence and Physiotherapy management of cystic fibrosis: Has
QOL. This will be undertaken in a future project.
there been a shift from traditional practice?
Preliminary results of using Botulinum Toxin A in
Farbotko K,1 Wilson C,2 Watter P3 and MacDonald J4
the treatment of upper limb spasticity in children
1Princess Alexandra Hospital, Brisbane 2Royal Children's Hospital, Brisbane 3,4School of Health and Rehabilitation Sciences, University of with cerebral palsy
Gibson N, Valentine JP, Gubbay AJ, Pearce A, Love SC
Clinicians suggest movement away from traditional physiotherapy treatment practices in cystic fibrosis (CF) Departments of Paediatric Rehabilitation and Physiotherapy, Princess towards newer and more independent means of secretion removal. A retrospective audit study was conducted, aimingto detect and explore possible changes in patient It is recognised that management of spasticity in children management in two one-year periods (1998 and 2000). All with cerebral palsy (CP) is important. It has been hospitalised children with CF with pulmonary manifestation demonstrated that Botulinum Toxin A (BTX-A) injections at the Brisbane Royal Children's Hospital (RCH) who into the lower limb reduce spasticity and improve function satisfied set criteria were included (n = 249). Relative in children with CP. More recently interest has emerged in frequency of each of six treatment modalities used at RCH the effect of BTX-A injections on the functional ability of were examined at two times, revealing some degree of the upper limb in the child with CP. This study aims to change in practice. Repeated measures ANOVA and t-tests establish the effects on function, of BTX-A treatment of revealed a significant decrease in frequency of use of upper limb spasticity in the child with spastic hemiplegic postural drainage with head down tilt (p = 0.00), and CP. A matched pair, randomised, single blind controlled autogenic drainage (p = 0.00) between 1998 and 2000. A intervention trial is being conducted. Presently, 8 matched significant increase in frequency of use of modified postural pairs between three and seven years of age are enrolled.
drainage without head-down tilt (p = 0.00) and positive Subjects randomised to the treatment group receive BTX- expiratory pressure devices (p = 0.00) was found. No A injection into the upper limb. Children in both groups 5th National Paediatric Physiotherapy Conference receive BTX-A injections into the lower limb. Outcomes A school-based physiotherapy intervention
have been measured at one month; three months and six program for postural stability to improve motor
months post injection. Preliminary results of four matched coordination for children with DCD:
pairs are available. Response to injection has been A randomised controlled trial
confirmed in the upper limb of the treatment subjects by areduction in spasticity measures, with little change in the Johnston LM,1,2 Burns YR1 and Brauer SG1,3
control subjects. There is a trend for the intrapair difference 1The University of Queensland 2Mater Children’s Hospital 3 Princess of proportional change of the functional measures (Quality of Upper Extremity Skills Test: QUEST) to be higher in the Aim: This study investigated whether a school-based,
treatment subjects by up to 2 times than the control group physiotherapy intervention program to improve subjects. The intrapair differences continue to increase in postural muscle function would improve motor the four matched pairs, even when the local effect of the coordination in children with developmental coordination BTX-A has started to decrease. These preliminary results disorder (DCD). Method: One hundred and ten children
suggest that BTX-A injections to the upper limb may aged eight to ten years, 50 with and 60 without DCD were improve function in children with spastic hemiplegic CP.
accepted into the study. Presence or absence of DCD wasdetermined by the Movement ABC Test (present if ≤ 15th Intensive physiotherapy intervention for children
percentile). Children were assigned randomly to with cerebral palsy: functional outcomes and
intervention or non-intervention groups. Intervention parents’ perceptions of outcomes
involved a graded program of activities promotingactivation of postural muscles of the trunk, and shoulder Gibson S and Raghavendra P
and hip girdles. Programs were delivered at school for 30 The Crippled Children’s Association of South Australia Inc., Adelaide minutes, twice per week, over eight weeks. Children notreceiving intervention carried out regular daily activities The aim of this study was to investigate changes in motor and did not receive other therapy intervention. Assessment, skill acquisition following intensive physiotherapy intervention and randomisation were conducted by separate intervention in children with cerebral palsy. An intervention investigators to ensure blinding to other study aspects.
study with a parallel group design was used. Sixteen children Differences between groups and assessment phases were with mild to moderate cerebral palsy classified at Level II or evaluated by t-test procedures. Results: No significant
III on the Gross Motor Function Classification System differences were seen for children without DCD. Children (GMFCS) and aged between four and seven years were with DCD who received treatment improved in total matched on GMFCS levels and randomly assigned to two impairment (p = 0.001) and balance scores (p = 0.011).
groups. Group A received Model 1 and Model 3 with a six- Manual dexterity scores also approached significance in week period of ‘no intervention’ following Model 3. Group this group (p = 0.084). Ball skills were improved for B received Model 1 and Model 2 with an eight-week period children with DCD in both intervention and non- of ‘no intervention’ following Model 2. Model I was defined intervention groups (p = 0.035). When children with DCD as Conventional Intensive Physiotherapy Intervention (10 who received intervention were stratified by initial hours over 10 weeks); Model 2 was Intensive Holiday Movement ABC scores, significant changes were Physiotherapy Program (21 hours over two weeks); and maintained for children scoring between the 0–5th but not Model 3 was an Intensive Block of Physiotherapy (21 hours percentiles. Conclusion:
over four weeks). Muscle strength (Nicholas Hand held physiotherapy to improve postural muscle function Myometer) and gross motor function (Gross Motor Function contributes to improvements in motor coordination for Measure) were recorded on six occasions. The Canadian Occupational Performance Measure (COPM) wasadministered to parents on five occasions. Using the COPM,short-term goals were set and incorporated into the Increments of challenge: effects of increasing task
participants’ physiotherapy programs. There was no accuracy and attentional demands on postural
significant difference in rate of motor skill acquisition muscle timing and upper-limb motion
between Models 1 and 2 for Group B and Models 1 and 3 forGroup A. Changes in muscle strength and gross motor Johnston LM,1,2 Burns YR,1 Brauer SG1,3 and
function were unremarkable, and did not match parents’ perception of change in their child’s functional skills as 1The University of Queensland 2Mater Children’s Hospital 3Princess indicated by COPM scores. This study emphasises the importance of goal setting, and that changes in gross motor Aim: This study investigated whether increased task
function, as perceived by parents, were related to the goals accuracy and cognitive demands affected postural muscle set, rather than to the intensity of intervention.
timing or upper-limb motion in children with typical motor
development. Method: Thirty-two children aged eight to
ten years participated. Typical motor development was
confirmed by the Movement ABC Test. Relative latencies
of trunk and shoulder muscles, and upper-limb reaction
time (RT), movement time (MT) and hand trajectory were
measured during three tasks of increasing difficulty in
standing. The baseline task was a non-goal-directed rapid-
arm-raise to 90 degrees flexion (RAR). Next, accuracy
demands were increased during a goal-directed-point
(GDP) to a 2 cm endpoint target at 90 degrees flexion.
5th National Paediatric Physiotherapy Conference Finally, attentional demands were increased with the GDP Relationship between the movement assessment
performed under dual-task (DT) conditions (GDP/DT).
battery for children and the physiotherapy
The secondary task was a cognitive, visual spatial neurodevelopmental assessment for children with
discrimination (VSD) task where children responded developmental co-ordination disorder
verbally as to whether a series of computerised spatialimages were the same or different. The VSD was also Kirkegard A, Watter P, Rodger S, Ziviani J, Ozane A and
completed under single-task conditions. Eight repeated measures for each variable were compared between tasks The University of Queensland, Brisbane using a linear mixed model. Results: Increased accuracy
Coordination difficulties in children require (RAR versus GDP) resulted in earlier muscle timing and comprehensive assessment to identify both functional RT, but lengthened MT. Increased attentional demands difficulties and underlying deficits for treatment planning.
(GDP versus GDP/DT) resulted in delayed muscle timing, The Movement Assessment Battery for Children (MABC) lengthened RT and MT and increased hand trajectory. VSD is increasingly being accepted as the ‘gold standard’ for response timing was slower under dual-task compared to children suspected of developmental coordination disorder single-task conditions. Response accuracy was not (DCD). While the MABC assesses functional performance, affected. Conclusion: Increasing task accuracy and
identification of the child’s neurodevelopmental profile is cognitive load alters postural muscle activity and upper- also required for treatment planning. This study limb motion in children with typical motor development.
investigated the neurosensorimotor profile using the Cognitive response time is also slowed during simultaneous Physiotherapy Neurodevelopmental Assessment (PNA) for 30 children aged four to seven years diagnosed by theMABC with DCD. Additionally, relationships between and The effects of an exercise program on the
within the two assessment tools were compared to examine cardiorespiratory fitness and muscle strength of
the clinical use of the MABC in assessment and treatment adolescents with cognitive impairments
planning. Findings revealed that each child experienced awide variety of neurosensorimotor deficits, confirming Kingston SC,1 Jensen LM1 and Blackmore MA2
DCD heterogeneity, and that in most cases the child’s 1Curtin University of Technology, Perth 2Therapy Focus Inc., Perth functional MABC scores were unable to indicate thepattern or severity of their underlying deficits and The aim of this study was to implement a school-based functional abilities as assessed by the PNA. Therefore the circuit exercise program to increase the physical activity of child’s MABC percentile ranking, in accordance with its adolescents with cognitive impairments and to evaluate screening purpose, cannot be used to infer the extent of the program’s effectiveness in increasing their their difficulties and hence is unable to provide sufficient cardiorespiratory fitness and muscle strength. The study detail to plan specific physiotherapy treatment. As current was a multiple-baseline-across subjects design involving treatment approaches focus on both underlying deficits and three adolescents with severe cognitive impairment. The functional difficulties, the inability of the MABC to exercise program consisted of 6–8 weeks of aerobic provide detailed information in either of these areas limits exercise and upper limb strength training using gymnasium the role of the MABC in planning intervention. This study equipment. The dependent variables were: time taken to therefore confirms the validity of the MABC as a screening complete the walk/run test, resting heart rate, submaximal tool for children suspected of experiencing motor heart rate and the amount of weight lifted. Testing was difficulties and suggests that its use should not be extended conducted approximately six times during the baseline phase, weekly during the exercise program and once atfollow-up. The students’ level of independence, motivation,cooperation and time-on-task during exercise was also Inter-tester reliability of manual muscle testing
recorded. Data was analysed using visual analysis, the C- and dynamometry in children with spina bifida
statistic and the two-standard deviation band. The studentswere capable of performing the exercise program with Mahony K,1 Hunt A,1 Daley D2 and Sims S2
moderate to low levels of prompting. Results indicated a 1The University of Sydney 2Sydney Children’s Hospital, Randwick significant improvement (p < 0.05) in cardiorespiratory The aims of this study were to establish the degree of fitness for two of the students, and significant increases (p confidence that is possible from two strength measures and < 0.05) in strength for all students on 85% of the strength the role of clinician experience in using these methods, by exercises. Findings of this study demonstrate that comparing the inter-tester reliability of manual muscle adolescents with severe cognitive impairment are capable testing (MMT) and dynamometry as a strength assessment of participating in a school-based exercise program and tool for children with spina bifida. Two experienced and making significant gains in their physical fitness. Exercise one novice tester used both MMT and dynamometry to test programs for these students need to be individualised to the strength of three lower limb muscles in ten male and ten ensure they cater for differences in motivation and physical female children with spina bifida (n = 20) who attended the ability. Special consideration also needs to be given to the Spina Bifida Clinic at Sydney Children’s Hospital, Randwick. Inter-class correlation coefficients (ICC)between the strength measures of each muscle and betweeneach combination of experienced and novice testers werecalculated from three trials of dynamometry, and 1 trial ofMMT for the iliopsoas, quadriceps and gluteus medius onthe right leg of all subjects. Children were tested by allthree testers on the one day. The order of testers was 5th National Paediatric Physiotherapy Conference random and the testers were blinded to each other’s results.
spasticity was impacting on function were enrolled from In this study dynamometry was found to be a more reliable the Physical Disability Clinic at a tertiary paediatric strength measure than MMT for iliopsoas and quadriceps hospital. All children had spastic quadriplegia (Gross (p < 0.05). There was no significant difference in inter- Motor Function Classification System Level IV or V). The tester reliability when measuring the strength of gluteus study used a double-blind, randomised, controlled cross- medius using either method (p > 0.05). Tester experience over design with two groups: children who received oral was found to have no effect on inter-tester reliability for baclofen followed by oral placebo, and children who either method of strength assessment (p > 0.05). These received oral placebo followed by oral baclofen. A 2-week results suggest that dynamometry should be recommended washout period was used between drug arms. Assessment as a strength assessment tool for children with spina bifida tools included the Goal Attainment Scale (GAS), Gross as limited training produces excellent inter-tester Motor Function Measure (GMFM), Pediatric Evaluation of Disability Inventory (PEDI), Modified Tardieu Scale(MTS) and a parent questionnaire. Seventeen children wereenrolled and 15 completed the study. Mean age of Childhood physiotherapy experiences of adults
participants was 7 years. Children scored significantly with cerebral palsy: Implications for today’s
better on the Goal Attainment Scale with baclofen children with cerebral palsy
compared to placebo (p = 0.04). There was no significant Raghavendra P,1 Smith J,2 Harrison T,3 Donnelly P4
difference between baclofen and placebo for the GMFM, PEDI, MTS, or number of reported side effects. This studydemonstrates that oral baclofen has an effect beyond 1 2 4Crippled Children’s Association of SA Inc. Adelaide 3H C Harrison placebo in improving goal-oriented tasks, such as transfers, Consultants, Adelaide 5Independent Living Centre, Adelaide in children with spastic quadriplegic CP. Realistic and The aim of the project was to investigate how an agency clearly defined treatment goals should be set prior to using providing long-term support for children with cerebral this medication in clinical practice.
palsy can best prepare them for adulthood. Adults, who hadreceived services from the Crippled Children’s Associationof SA Inc. (CCA) as children, were asked how Application and standardisation of the Modified
physiotherapy, occupational therapy, speech pathology and Tardieu Scale to measure spasticity in children
social work/psychology services had prepared them for with cerebral palsy
adult life. They were also asked what they thought of the Shircore L,1 Love S,1,2 Gibson N2 and Price C1
services they had received, what else they might have 1School of Physiotherapy, Curtin University of Technology, Western needed, and what suggestions they would like to make Australia 2Departments of Physiotherapy and Paediatric Rehabilitation, regarding CCA’s services now and for the future. The Princess Margaret Hospital for Children/Women’s and Children’s Health project used a ‘participatory research’ paradigm in which people with disabilities and researchers worked together ateach stage of the project. Fifteen people with cerebral palsy The emerging standard to measure spasticity in paediatric between the ages of 20 and 35 years who had received practice is the Modified Tardieu Scale (MTS). Treatment services from CCA as children, participated in the study.
decisions to manage spasticity in children with cerebral Ten of them were individually interviewed and 5 palsy (CP) are largely based on the R1 and R2 measures of participated in focus groups. All data was transcribed the MTS. There is currently no evidence to suggest that the verbatim and cross-checked with the participants i.e.
order in which R1 and R2 are measured is of any ‘member check’. Inductive analysis of the data included consequence. The purpose of this two-part study was to displaying the data in tables, developing codes, and assess the need to standardise the application of the MTS identifying patterns, themes, and categories of responses.
in order to make recommendations about how it should be Of all the therapies, physiotherapy was remembered in the used in the paediatric clinical setting. The first clinical greatest detail. The participants spoke very highly of the study was conducted to establish whether the magnitude of quality of the physiotherapy service they had received. The R1 varied if it was taken before or after the R2 measure.
recommendations relating to physiotherapy focused on the Sequential R1, R2, R1 measures were recorded using an importance of long-term mobility and maintaining fitness.
electrogoniometer in 60 hamstring muscle groups ofchildren with CP. Using a survey, the second studyidentified differences in the application of the MTS among Study of the effectiveness of oral baclofen in
physiotherapists working in the field of paediatrics across children with spasticity
Australia. RANOVA analysis revealed a statistically Scheinberg AM,1 Hall K,2 Clark K1 and O’Flaherty S1
significant difference in the magnitude of R1 measures 1Department of Rehabilitation, The Children’s Hospital at Westmead, taken before and after the R2 measure (p < 0.001). Survey Sydney 2Puketiro Centre, Porirua, New Zealand results (n = 178) identified that whilst the MTS was beingused in every state and facility, only 47% of respondents Oral baclofen has been available for many years as a were familiar with the MTS. The survey also highlighted treatment option for children with spasticity. However wide variability in the application of the MTS with 53% concerns have been raised in clinical practice that it measuring R1 first and 36% measuring R2 first. A provides few benefits and is associated with undesirable standardised method of applying the MTS is required. It is side effects. This study aimed to assess the effectiveness of proposed that taking the R2 measure before attempting to oral baclofen in reducing spasticity, improving function measure R1 aids in eliminating the non-neural components and/or reducing the amount of caregiver assistance contributing to the hypertonic muscle, thereby yielding a required in children with generalised spastic cerebral palsy more accurate R1 measure of spasticity.
(CP). Children aged between 1 and 15 years with CP whose 5th National Paediatric Physiotherapy Conference Validation of the Perceived Exertion Scale for
Children (PES-C) in young children
Simon S,1,2 Alison J,1,3 Dwyer G1and Follet J4
1The University of Sydney, Sydney 2Armidale Hospital, Armidale 3Royal Prince Alfred Hospital, Sydney 4The Children’s Hospital The aim of this study was to establish the validity andreliability of the recently devised Perceived Exertion Scalefor Children (PES-C) in healthy male and female childrenaged 6–7 years, and to examine whether children in this agegroup prefer to utilise pictures, words or numbers to ratetheir perception of exertion. Twenty-three subjects (12boys) performed an incremental exercise test, the ModifiedShuttle Test (MST) to exhaustion. Heart rate (HR: beats ?min-1) and PES-C score were recorded at rest and at one-minute intervals during the exercise test. Subjects weretested on two occasions (T1, T2) 1–2 weeks apart, toascertain reliability of this tool. A significant correlationbetween HR and PES-C score was found for most subjects,and for the group there was a mean correlation between HRand PES-C score for T1 (r = 0.79) and for T2 (r = 0.86).
Intraclass Correlation Coefficient (ICC) Reliabilityanalysis revealed that the PES-C has fair to good test-retestreliability (r = 0.67). Furthermore, examination of thepreferred component of the scale indicated that manysubjects utilised the pictures to rate their perceivedexertion. This study demonstrated that the PES-C is validand reliable for use in children as young as 6–7 years andcan, therefore, be applied in the clinical setting withconfidence that it is a reliable and valid tool to measureperceived exertion in this age group. This study alsodemonstrated that pictures are utilised by this age group toreport levels of perceived exertion.
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