Let's talk Initial Assessments

Initial assessments are the cornerstone of effective therapy, for children and adults populations alike. It is the first opportunity to connect and help our big and little clients through exercise, however, assessments can be a minefield for practitioners. Which is most likely why it is one of the most frequently asked questions I get across my clinics and through my course community. As a practitioner with experience in both demographics and businesses catering to each, I’ve encountered and addressed many questions been a part of several conversations from new graduates and seasoned professionals alike. Drawing from my background and current practices, I wanted to explore and start the conversation on how assessments differ for adults and children and what our primary focus should be during these initial sessions.

Over the next few months, I will continue to unpack this topic sharing my experiences from my clinics and the research we are currently involved in to assess the impact of our Pilates program on Kindergarten aged children. I encourage others to join me in unpacking this topic and share learnings as we develop assessment protocols with attached normative data that are simple to use.

For now, let's start by looking at how paediatric assessments differ to assessments that we will all have had more training and experience with, in older populations. Let's unpack the key priorities in these assessments and how we can set ourselves up for a successful initial session.

Differences in Assessments: Adults vs. Children

Here are some differences and key points for assessments for both populations.

Adults:

1. Standardised Testing: Utilised often, and something you’ve likely practiced during your university studies. We can find reliable, simple to administer with normative data attached to assess how our client is tracking.

2. Education: A significant component, as adults can comprehend detailed explanations about their conditions and treatment plans.

3. Predictability: Adults generally present more predictably, and you engage with them at a similar cognitive level.

4. Information gathering: Is done directly with them sharing their history.

5. Setting: Often in a clinical setting that a clinician is comfortable and used to.  

Children:

1. Complex Testing: Often more intricate, with normative data being harder to come by.

2. Engagement: It is crucial we adopt creative ways to keep children interested and involved during the consult.

3. Observation: We need to lean more into observation with children through play-based activities to assess motor skills, preferences and behaviours.

4. Information gathering is more timely: Due to the reliance on caregivers and other health professionals gathering relevant information can be a lengthy process.

5. Setting: Can be in clinic, in home or early learning setting, settings that perhaps the clinician has not been in before.

Due to the distinct differences let's look at what the key focus is in those initial consultations.

Primary Focus During Initial Sessions

For Adults:

1. Building Rapport: Establish a connection to set up therapy.

2. Listening: Understand their concerns and difficulties thoroughly.

3. Education: Provide insights into their condition and the therapy process.

4. Align Expectations: Ensure both parties have a clear understanding of the therapy goals.

5. Motivational Interviewing: Encourage and motivate them towards their goals.

6. Standardised Testing: Apply appropriate tests and analyse normative data.

7. Intervention Prescription: Develop a tailored intervention plan.

8. Report Preparation: Collate the above information into a report to share with referring doctor and go through with client.

For Children:

With the Parent:

1. Building Rapport: Create a trusting relationship with both the parent and child.

2. Listening: Gain a deep understanding with the parent of the child’s key difficulties and the impact of those difficulties on both the child and the family.

3. Education: Inform parents about the therapy process, common outcomes of presentations and what to expect from sessions.

4. Expectation Alignment: Set realistic goals and expectations for the initial assessment and following therapy.

5. Motivational Interviewing: Engage parents in the therapeutic process and their involvement to get the best outcomes for the child.

With the Child:

1. Play-Based Activities: Use play to make the child comfortable and engaged.

2. Observation: Watch how the child navigates through obstacle courses and games, watch how a child interacts with others and you.

3. Functional Activities: Use relatable activities to assess balance, coordination, and other skills.

4. Relatable through imagination games: Use imagination games to engage and make any assessments relatable for children.

5. Standardised Testing: Where applicable, implement appropriate tests which may be spread across several sessions. We can also assess progress with non standardised assessments in and around their specific goals.

Key Takeaway: Connection is Crucial

Regardless of the demographic, building a strong connection is key to a successful assessment and following therapy. Connection and rapport ensures that they feel seen, understood and heard. It means that we adapt our protocol for that specific person not just blindly follow a procedure but to best help the client in front of us. When this is our priority we have a trusting relationship where people feel safe to try new things, show vulnerability and make appropriate change. So with that being said, while I am endeavouring to develop an evidence based, simple assessment protocol for children, flexibility is so important as client centered assessments are as important and client centered therapy.

It is important to note that as Accredited Exercise Physiologists, we can lean into our collaborating health professional partners for standardised testing. Standardised testing is imperative when it comes to diagnosis and assessment of progress. If we are not diagnosing or analysing to normative statistics though we can assess progress in the absence of standardised tests and normative data.

Prior Preparation prevents poor performance

Preparation is crucial, especially with children. If you have access to their sensory preferences, previous reports, and information on likes and dislikes, it can significantly enhance your confidence and effectiveness during the first session, not to mention the ablility to create an environment that is set up for connection. Confidence is not necessarily having all the answers; when we expect that of ourselves, the outcome is often the opposite. Rather we can gain confidence from being a curious problem solver, adapting our approach, asking questions, collaborating and using movement therapy to address various issues the individual is experiencing. Remember, you don’t need to know everything; you need to be inquisitive, communicative, and persistent. Layering evidence-based research and practice into your approach doesn’t need to be complex; it just needs to be effective.

What’s Next?

Given the frequency of questions about initial assessments, I’m thrilled to share some of our protocols over the coming months. What’s even more exciting is our ongoing research with the University of Queensland to test these protocols. I will continue to share my experience, research and protocols over the coming months.