Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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#1 The issue at hand in this study is the opaque tray, the results, therefore, can be generalized. This is not a leap.
#2 These other variables were taken into account, that's why quantitative reseacher is conducted in a matched and randomized way. (APGAR scores, are not predictive of future development by the way, but that's another discussion --- yes, I know, not logical results, but this has been repeatedly demonstrated).
#3 You can't argue both points SJ. Either you want the research to be conducted in an inclusive or qualitative manner, or you don't, but you can't pick and choose from moment to moment as it suits your needs. At any rate, you missed my point. Children that are placed in baby walkers don't do as well as those that weren't in terms of mental and motor outcome measures. If the external variables of parental laziness played as large a role as you'd question, then there would be no difference between kids that were "opaque trayed," and "clear trayed." So while I understand your concern, and it's a valid one, the researchers, in a way, addressed it and dismissed it to my satisfaction as the only differing variable between the two subgroups of kids in walkers, was a clear or opaque tray. How do you propose that would be linked to any of the external variable concerns that you raised? Personally, I don't think it is.
As for "when the greatest delay is during the 6-9 months and may last for up to 10 months, well, geesh, it's pretty insignificant in the scheme of life, don't you think?" I'd have to give a mixed answer on that. Afterall, the entire early intervention system is based on that very "significance" of developmental stimulation despite the fact that most studies suggest that by 8 years of age, EI doesn't make much difference as to the functioning in the child --- except perhaps in the domain of communication. So, as a pediatric PT, I'll stay the heck out of that kind of philosophical discussion in open forum if you don't mind.
Many young kids do in fact have the little protruding bellies, they may not be running on thier tippy toes, but you'll note, upon close inspection, that their heel strike isn't quite normal either. Many will completely self-resolve, and others will "shadow resolve" meaning that they will compensate well enough for most people, even compotent PT's to miss the increased potential for painful syndromes down the pike.
As for the reliablity and accuracy of the study, I'm not sure that you and I use the terms the same way. It is accurate and valid in the sense the methods used were sound research protocols to answer the research question at the level that the authors intended. The results weren't under nor over stated in my opinion. As for reliablity, that term means generalizable, not just will the results be the same upon multiple subsequent testing. It's hard to day how reliable the study is because, to my knowledge, it's not yet been replicated. As I pointed out, 102 of the 109 subjects were white, and the point you made about kids from different cultures developing in slightly different patterns is a good one. (A GREAT reference would be Cohen, et al. Evaluation of the Peabody Developmental GM scales for Young children of African American and Hispanic Ethinic Bacgrounds. Ped Phys Ther 1999;11:191-197). Anyway, the study isn't particularly reliable in the sense that the results cannot and should not be generalized from a population of white infants, to a population of african american, hispanic, or asian children.
Drew
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