Comparing Levels of Mastery Motivation in Children with Cerebral Palsy (CP) and Typically Developing Children

Introduction

The present study aimed to compare motivation in school-age children with CP and typically developing children.

Material and Methods

229 parents of children with cerebral palsy and 212 parents of typically developing children participated in the present cross sectional study and completed demographic and DMQ18 forms. The rest of information was measured by an occupational therapist. Average age was equal to 127.12±24.56 months for children with cerebral palsy (CP) and 128.08±15.90 for typically developing children. Independent t-test used to compare two groups; and Pearson correlation coefficient by SPSS software applied to study correlation with other factors.

Results

There were differences between DMQ subscales of CP and typically developing groups in terms of all subscales (P<0.05). The lowest motivation scores of subscales obtained in gross motor persistence (2.4870±.81047) and cognitive-oriented persistence (2.8529±.84223) in children with CP. Motivation was correlated with Gross Motor function Classification System (r= -0.831, P<0.001), Manual ability classification system (r=-0.782, P<0.001) and cognitive impairment (r=-0.161, P<0.05).

Conclusion

Children with CP had lower mastery motivation than typically developing children. Rehabilitation efforts should take to enhance motivation, so that children felt empowered to do tasks or practices.

Mastery Motivation in Children with Cerebral Palsy (CP) Based on Parental Report: Validity and Reliability of Dimensions of Mastery Questionnaire in Persian

Introduction:

The present study aimed to investigate validity and reliability of Persian Dimensions of Mastery Questionnaire (DMQ18) in children with cerebral palsy.

Material and Methods:

The original version was carried out through back translation into Persian, and then the construct validity was assessed by confirmatory factor analysis; and reliability was evaluated through Cronbach’s alpha (n=230). Intra-class correlation coefficient (ICC) was used for test retest reliability (n=32).

Results:

230 parents (155 (67.4%) mothers and 75 (32.6%) fathers) of children and adolescents with CP with an average age of 126.99±24.59 months participated in the present research. Non-questions excluded from the confirmatory factor analysis, and thus all questions remained. Internal consistency reliability and total score were acceptable in all domains (higher than 0.70) except for negative reactions, sadness/shame (Cronbach’s alpha of 0.414). Intra-class correlation coefficient of all domains and total score were significant (p<0.001).

Conclusion:

DMQ18 (parental report) was valid and reliable for children with cerebral palsy. It also provided valuable information about different aspects of motivation in CP children according to their parents’ opinion, and thus it can be used in clinical interventions.

Attention demands of postural control in non-specific chronic low back pain subjects with low and high pain-related anxiety

Impaired postural control in chronic low back pain (CLBP) has been attributed to deficits in sensory and motor functions. However, it is not known if pain-related anxiety affects motor and cognitive function of postural control. The aim of this study was to compare the interactive effects of postural and cognitive function in CLBP patients with high and low pain-related anxiety and healthy subjects. Thirty-eight patients with nonspecific CLBP (19 with low and 19 with high pain-related anxiety levels) and 20 asymptomatic subjects participated. Postural control was assessed by center of pressure (COP) parameters including mean total sway velocity, area, anterior-posterior (A-P), and medial-lateral (Med-Lat) range. Postural task was assessed during four conditions (eyes open with and without ankle vibration-eyes closed with and without ankle vibrations). Participants performed the postural task with or without auditory Stroop task. Average reaction time and error ratio of auditory Stroop test were calculated as measures of the cognitive task performance. Significantly reduced sway area was observed in CLBP patients with high pain-related anxiety and control subjects during the dual-task condition as compared with the single task. In addition, A-P range was significantly reduced in CLBP patients with high pain-related anxiety during dual tasking when eyes were closed with ankle vibration. In addition, only the CLBP subjects with high pain-related anxiety showed significantly longer reaction times by increasing the difficulty of standing postural task. Pain-related anxiety may influence the postural cognitive interactions in CLBP patients. Furthermore, it may be considered as a contributing factor for postural strategies adopted by CLBP patients.

Reliability and Validity of the European Child Environment Questionnaire (ECEQ) in Children and Adolescents with Cerebral Palsy: Persian Version

The aim of this study was to assess the reliability and validity of the Persian version of the European Child Environment Questionnaire (ECEQ) in the Iranian context. In total, 332 parents (20.2% fathers and 79.8% mothers) of children and adolescents with cerebral palsy (CP) with an average age of 12.33 years (min 7.08 to max 18.08) from three provinces in Iran participated in the study. The original version of the questionnaire was translated and back-translated. Confirmatory construct validity was assessed by factor analysis and reliability was evaluated by Cronbach’s alpha (N = 332) and after two weeks’ test–retest reliability (n = 51) using an intraclass correlation coefficient (ICC). Eleven questions were dropped as they did not fit well into domains in the Persian version (p > 0.05). Cronbach’s alpha and intraclass correlation coefficient in all domains and overall were acceptable (higher than 0.70) and significant (p > 0.05). The Persian version of the ECEQ is suitable for assessing the needs and availability of environmental factors and is reliable and valid for children with CP, as reported by their parents.

Normal values of abdominal muscles thickness in healthy children using ultrasonography

Abdominal muscles are one of the important elements to support the lumbar spine. Evaluation of muscle thickness using ultrasonography (US) is considered to be a source of information from muscles characteristics. The purpose of this study was to demonstrate normal reference data of abdominal muscles thickness and subcutaneous fat in adolescents using US. A random sample of 160 healthy adolescents (80 boys and 80 girls) at the age range of 15-18 years was recruited. Three abdominal muscles including Transversus Abdominis (TA), Internal Oblique (IO), External Oblique (EO) and subcutaneous fat (SF) were bilaterally measured using US. The range of normal values for TA muscle thickness was between 2.31 and 2.57 mm, for IO muscle thickness was between 4.02 and 5.15 mm and for EO muscle thickness was between 2.81 and 3.17 mm. The normal patterns of abdominal muscles were found as IO > EO > TA at both sides. Boys were taller, heavier with greater body mass index (BMI) and had larger abdominal muscles thickness than girls. A weak negative correlation was found between age and muscles size [r = (-0.06) - (-0.23), p < .05], but a significant positive correlation was found between BMI and muscle size (r = 0.21-0.68, p < .05). It seems that abdominal muscles thickness in adolescents followed the same pattern of muscle size in adults. BMI appeared to be the best predictor of muscle thickness. However, further studies are recommended to support the findings of the present study.

Comparative Study of Abdominal Muscle Thickness on Ultrasonography in Healthy Adolescents and Patients With Low Back Pain

OBJECTIVES

Low back pain (LBP) is a common musculoskeletal disorder among different age groups, including adolescents. The purpose of this study was to compare the abdominal muscle thickness between healthy adolescents and those with LBP.

METHODS

One hundred sixty healthy high school adolescents and 80 high school adolescents with LBP participated in the study. All participants were asked to complete a demographic questionnaire and also a visual analog scale and the Oswestry Disability Questionnaire to evaluate the pain intensity and functional disability. Then abdominal muscle thickness was examined with ultrasonography.

RESULTS

The healthy high adolescents included 80 boys and 80 girls, and the adolescents with LBP included 40 boys and 40 girls. The results showed a significant difference between healthy adolescents and those with LBP in terms of abdominal muscle thickness (P < .05). Patients with LBP had smaller abdominal muscles compared with healthy adolescents. No significant difference was found between the groups in terms of the subcutaneous fat dimension (P > .05).

CONCLUSIONS

The thickness of abdominal muscles was lower in adolescents with LBP. Future studies with a larger sample and a wider age range are recommended to support the results of this study.

Ultrasound imaging transducer motion during standing postural tasks with and without using transducer fixator

BACKGROUND

Changes in the orientation of ultrasound (US) transducer relative to the body surface during dynamic standing tests can affect US measurements.

OBJECTIVE

The purpose of the study was to evaluate ultrasound imaging transducer motion while measuring the lateral abdominal muscle thickness during standing tasks with and without using transducer fixator (TF).

DESIGN

Cross-sectional experimental study.

METHODS

A digital optical motion analysis system was used to assess the motions of US transducer during double-leg stance in different levels of platform stability of Biodex Balance System (BBS) (static, levels 6 and 3) with and without using TF in 45 healthy individuals. In addition, lateral abdominal muscle thickness was evaluated by US imaging.

RESULTS

The results indicated that the amount of angular and linear transducer motions during static and dynamic standing tasks significantly decreased by the use of TF as compared to the conditions without TF (P < 0.001, effect size> 0.84).

CONCLUSION

TF can significantly control US transducer motions within acceptable threshold limits during standing postural task. This may improve the clinical application of US imaging.

Effects of vision and cognitive load on static postural control in subjects with and without patellofemoral pain syndrome

OBJECTIVE

To compare the effects of vision and cognitive load on static postural control in subjects with and without patellofemoral pain syndrome (PFPS).

METHODS

Twenty-eight PFPS patients and 28 controls participated in the study. Postural control was assessed in isolation as well as with visual manipulation and cognitive loading on symptomatic limb. The outcome measures of postural control were quantified in terms of area, anterior-posterior (AP), medial-lateral (ML), and mean velocity (MV) of the displacements of center of pressure (COP). In addition, cognitive performance (auditory Stroop task) was measured in the forms of average reaction time and error ratio in baseline (sitting) and different postural conditions.

RESULTS

PFPS subjects showed greater increases in area (p = 0.01), AP (p = 0.01), and ML (p = 0.05) displacements of COP in the blindfolded tasks as compared to control group. However, cognitive load did not differently affect postural control in the two groups. Although PFPS and control group had similar reaction times in the sitting position (p = 0.29), PFPS subjects had longer reaction times than healthy subjects in dual task conditions (p = 0.04).

CONCLUSION

Visual inputs seem to be essential for discriminating postural control between PFPS and healthy individuals. PFPS patients biased toward decreasing cognitive performance more than healthy subjects when they perform the single leg stance and cognitive task concurrently.

Reliability of the Upper Trapezius Muscle and Fascia Thickness and Strain Ratio Measures by Ultrasonography and Sonoelastography in Participants With Myofascial Pain Syndrome

Objective

The purpose of this study was to assess the intra- and interexaminer reliability of the upper trapezius muscle and fascia thickness measured by ultrasonography imaging and strain ratio by sonoelastography in participants with myofascial pain syndrome.

Methods

Thirty-two upper trapezius muscles were assessed. Two examiners measured the upper trapezius thickness and strain ratio 3 times by ultrasonography and sonoelastography independently in the test session. The retest session was completed 6 to 8 days later.

Results

A total of 87.5% of participants had trigger points on the right side, and 22.5% had trigger points on the left side. For the test session, the average upper trapezius thickness, fascia thickness, and strain ratio measured by first and second examiners were 11.86 mm and 11.56 mm, 1.23 mm and 1.25 mm, and 0.94 and 0.99, respectively. For the retest session, the previously mentioned parameters obtained by first and second examiners were 11.76 mm and 11.39 mm, 1.27 mm and 1.29 mm, and 0.96 and 0.99, respectively. The intraclass correlation coefficients indicated good to excellent reliability for both within-intraexaminer (0.78-0.96) and between-intraexaminer (0.75-0.98) measurements. Also, the intraclass correlation coefficients and standard errors of measurement of interexaminer reliability ranged between 0.88 to 0.93 and 0.05 to 0.44 for both muscle and fascia thickness and 0.70 to 0.75 and 0.04 to 0.20 for strain ratio of upper trapezius, respectively.

Conclusion

Upper trapezius thickness measurements by ultrasonography and strain ratio by sonoelastography are reliable methods in participants with myofascial pain syndrome.

Translation, cross-cultural adaptation and validation of the Persian version of COOP/WONCA charts in Persian-speaking Iranians with multiple sclerosis

PURPOSE

Translation, cross-culturally adaptation and validation of a Persian version of COOP/WONCA charts in Persian-speaking Iranians with multiple sclerosis (MS).

METHOD

The Persian version of COOP/WONCA charts was developed after a standard forward translation, synthesis and backward translation. A total of 197 subjects with MS participated in this study. They were asked to complete the COOP/WONCA charts and Short-Form 36 Health Survey (SF-36). The COOP/WONCA charts were re-administered to 50 patients, 4 weeks after the first session. Expanded Disability Status Scale (EDSS) was also scored for each subject by the referring physician. Construct validity was assessed by testing linear relationship between corresponding domains of the COOP/WONCA charts, the SF-36 and the EDSS. Test-retest reliability was examined using interclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) values.

RESULTS

Related domains of COOP/WONCA charts and SF-36 demonstrated strong linear relationships with Spearman's coefficients ranging from -0.51 to -0.75 (p< 0.05). Physical fitness and daily activity charts also demonstrated strong relationships with the EDSS by Spearman's coefficients of 0.65 and 0.50, respectively (p< 0.05). The ICC values for most of COOP/WONCA charts domains were acceptable (>0.70) except for feelings and quality-of-life domains that were 0.50 and 0.51, respectively.

CONCLUSIONS

The Persian version of the COOP/WONCA charts was shown to be psychometrically appropriate to evaluate the functional level and quality of life in Persian-speaking Iranians with MS. Implications for rehabilitation COOP/WONCA charts are now available in Persian and demonstrate good psychometric properties. COOP/WONCA charts demonstrate excellent reliability and construct validity in a Persian-speaking Iranian population with MS. Minimal detectable change in COOP/WONCA is now available in MS to guide within and between group analyses. Knowledge on a wide variety of physical, mental and emotional parameters as well as the status of patients' symptoms, daily activities and quality of life helps rehabilitation clinicians and service providers plan preventive and remedial interventions more effectively.

A structural equation model of the relation between socioeconomic status, physical activity level, independence and health status in older Iranian people

BACKGROUND AND AIM

Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling.

METHODS

Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit.

RESULTS

The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (β=0.13, p=0.059) but it was a predictor of HS either through affecting PA (β=0.31, p<0.001) or I (β=0.57, p<0.001).

CONCLUSION

Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.

Development and face validity of a cerebral visual impairment motor questionnaire for children with cerebral palsy

AIM

The objectives of this study were (i) to develop two cerebral visual impairment motor questionnaires (CVI-MQ's) for children with cerebral palsy (CP): one for children with Gross Motor Function Classification System (GMFCS) levels I, II and III and one for children with GMFCS levels IV and V; (ii) to describe their face validity and usability; and (iii) to determine their sensitivity and specificity.

BACKGROUNDS

The initial versions of the two CVI-MQ's were developed based on literature. Subsequently, the Delphi method was used in two groups of experts, one familiar with CVI and one not familiar with CVI, in order to gain consensus about face validity and usability. The sensitivity and specificity of the CVI-MQ's were subsequently assessed in 82 children with CP with (n = 39) and without CVI (n = 43). With the receiver operating curve the cut-off scores were determined to detect possible presence or absence of CVI in children with CP.

RESULTS

Both questionnaires showed very good face validity (percentage agreement above 96%) and good usability (percentage agreement 95%) for practical use. The CVI-MQ version for GMFCS levels I, II and III had a sensitivity of 1.00 and specificity of 0.96, with a cut-off score of 12 points or higher, and the version for GMFCS levels IV and V had a sensitivity of 0.97 and a specificity of 0.98, with a cut-off score of eight points or higher.

CONCLUSION

The CVI-MQ is able to identify at-risk children with CP for the probability of having CVI.

Gross motor function in children with spastic Cerebral Palsy and Cerebral Visual Impairment: A comparison between outcomes of the original and the Cerebral Visual Impairment adapted Gross Motor Function Measure-88 (GMFM-88-CVI)

PURPOSE

To investigate whether the adapted version of the Gross Motor Function Measure-88 (GMFM-88) for children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) results in higher scores. This is most likely to be a reflection of their gross motor function, however it may be the result of a better comprehension of the instruction of the adapted version.

METHOD

The scores of the original and adapted GMFM-88 were compared in the same group of children (n=21 boys and n=16 girls), mean (SD) age 113 (30) months with CP and CVI, within a time span of two weeks. A paediatric physical therapist familiar with the child assessed both tests in random order. The GMFCS level, mental development and age at testing were also collected. The Wilcoxon signed-rank test was used to compare two different measurements (the original and adapted GMFM-88) on a single sample, (the same child with CP and CVI; p<0.05).

RESULTS

The comparison between scores on the original and adapted GMFM-88 in all children with CP and CVI showed a positive difference in percentage score on at least one of the five dimensions and positive percentage scores for the two versions differed on all five dimensions for fourteen children. For six children a difference was seen in four dimensions and in 10 children difference was present in three dimensions (GMFM dimension A, B& C or C, D & E) (p<0.001).

CONCLUSION

The adapted GMFM-88 provides a better estimate of gross motor function per se in children with CP and CVI that is not adversely impacted bytheir visual problems. On the basis of these findings, we recommend using the adapted GMFM-88 to measure gross motor functioning in children with CP and CVI.

Intratester and intertester reliability of the movement system impairment-based classification for patients with knee pain

BACKGROUND

The methods to standardize the test items used for classification of patients with knee pain based on the movement system impairment (MSI) approach have been established. To our knowledge, no study has concentrated on establishing reliability for proposed classification for knee pain problems.

OBJECTIVE

The aim of the study was to assess intra- and intertester reliability of the knee MSI classification in patients with knee pain.

DESIGN

A cross-sectional methodological study.

SETTING

Rasul Akram Hospital.

PARTICIPANTS

Ninety-six subjects with knee pain aged 18-65 years.

METHODS

In order to examine intertester reliability, all three testers assessed the symptoms, signs and the MSI diagnosis of subjects with knee pain simultaneously. In order to assess intratester reliability, the procedure was exactly repeated after a one-week intersession period. Kappa values and percentages of agreement were calculated to analyze the reliability level.

RESULTS

The kappa values for intra- and intertester reliability of the symptom items ranged from 0.83 to 1.00 and 0.00 to 0.83, respectively. For the sign items, the kappa values ranged from 0.18 to 1.00 and 0.00 to 0.82, respectively. Finally, the kappa values of intra- and intertester reliability for patients' classification judgments ranged from 0.66 to 0.71, and 0.48 to 0.58, respectively.

CONCLUSION

The results of the present study indicate that intertester reliability for the symptoms, signs and classification judgments of patients with knee pain based on the MSI approach seemed generally acceptable. However, for intratester reliability, lower levels of the system were observed, probably due to different pain levels or pain behavior between test and retest sessions.

Construct validity of center of rotation in differentiating of lumbar segmental instability patients

PURPOSE

Lumbar Segmental Instability (LSI) is a subgroup of nonspecific Low Back Pain (NSLBP) without any accepted diagnostic tool as a gold standard. Some authors emphasize on quality measure such as centre of rotation (COR) but construct validity of this measure had not been approved. Therefore the purpose of the present study was to evaluate Concurrent and Convergent validity of COR in differentiating LSI.

METHODS

A total of 66 volunteered males participated in three groups named control, NSLBP and LSI groups based on clinical examination. Patients were diagnosed as LSI according to screening criteria adopted by Hicks et al. Study variables included CORs of lumbar segments in sagittal plane. Three x-rays were taken in neutral, flexion and extension positions. The variables were calculated using CARA software. The ANOVA and Tukey test were utilized in statistic analysis.

RESULTS

ANOVA results demonstrated mean differences between three groups for COR of L4 motion segment in y axis (p= 0/008) and L5 motion segment in y axis (p= 0/005) were significant. Tukey test showed significant difference for COR of L4 motion segment in y axis between LSI and healthy groups (p= 0/038) and between LSI and NSLBP groups (p= 0/009). For COR of L5 motion segment in y axis, tukey test demonstrated mean difference between LSI and healthy groups (p= 0/028) and between LSI and NSLBP groups (p= 0/007) were significant. Tukey test did't show any significant difference between NSLBP and healthy groups for COR of L4 (p= 0/852) and L5 (p= 0/871) motion segments in y-axis.

CONCLUSIONS

The COR has ability to differentiate patients with signs and symptoms of LSI from other NSLBP and healthy subjects based on the present study results. However, more researches are needed to develop and support results of this study.

Adaptation, reliability and validity testing of a Persian version of the Health Assessment Questionnaire-Disability Index in Iranian patients with rheumatoid arthritis

OBJECTIVE

The aim of the present study was to culturally adapt and evaluate reliability and validity of Health Assessment Questionnaire-Disability Index (HAQ-DI) in Iranian patients with rheumatoid arthritis (RA).

SUBJECTS

234 patients with RA for validation study, Eighty-six participants for reliability study.

METHODS

Test-retest relative reliability and internal consistency of Persian version of HAQ-DI were examined by intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. Additionally, HAQ-DI construct validity (Spearman's correlation) was examined using Persian version of Short-Form 36 Health survey (SF-36), activity and severity parameters.

RESULTS

Persian version of HAQ-DI total score showed excellent test-retest reliability (ICC = 0.98) and internal consistency (Cronbach's alpha = 0.95). Spearman's correlations between the total PHAQ-DI score and activity and severity parameters were above 0.55. Correlation between PHAQ-DI and SF-36 Physical Health were higher as compared with SF-36 Mental Health.

CONCLUSION

Persian version of HAQ-DI is a reliable and valid culturally-adapted instrument in order to measure functional limitations in Iranian people with RA.

Validation of the movement system impairment-based classification in patients with knee pain

BACKGROUND

Categorizing patients with knee pain problems based on pathoanatomical sources has not proved to be the most effective method for directing physical therapy interventions. Movement system impairment (MSI) classification system may be an alternative in the assessment, diagnosis, and management of patients with knee pain. No previous study has been conducted to validate the proposed system in these patients.

OBJECTIVE

To assess construct validity of the MSI classification system in patients with knee pain.

DESIGN

A cross-sectional methodological study.

SETTING

Rasul Akram Hospital.

PARTICIPANTS

One hundred eighty subjects with knee pain aged 18-65 years.

METHODS

The MSI classification recognizes seven categories of knee pain problems based on the findings from the symptoms and signs assessment. Three physical therapists examined subjects with knee pain. A principal component analysis (PCA) was used to derive proposed categories. Eigenvalues and a scree plot were also used to determine the factor retention.

RESULTS

Four factors related to three proposed categories were extracted from the PCA. Two factors were related to tibiofemoral rotation (TFR) category. The other two factors were related to proposed categories patellar lateral glide (PLG) and tibiofemoral hypomobility (TFHypo).

CONCLUSION

The results provided evidence for the construct validity of three (TFR, PLG, and TFHypo) of the seven categories proposed by MSI classification. In addition TFR was subcategorized into two groups which were named as tibial lateral rotation (TLR) and femoral adduction/medial rotation (FAdd/MR) in the present study.