Lessons from use of the Pediatric Evaluation of Disability Inventory: where do we go from here?

Effect of Muscle Strength on Functionality after Shoulder Tendon Transfer in Brachial Plexus Birth Injury: Is There a Relationship between Them?

BACKGROUND/OBJECTIVES

Secondary problems in BPBI occur due to decreased muscle strength in the upper extremities. Comprehensive assessment methods are necessary to understand structural problems and to plan appropriate interventions in children with BPBI. We investigated the relationship between distal muscle strength, range of motion (ROM), and functionality by comparing distal muscle strength on the affected and unaffected sides in patients with BPBI who underwent shoulder tendon transfer.

METHODS

A total of 25 children with BPBI, 13 (52%) girls and 12 (48%) boys, aged 4-7 years (mean age: 5.98 ± 1.27 years), who had undergone shoulder tendon transfer surgery at least one year prior to the study were included. The muscle strength of the elbow, forearm, and wrist were assessed using the MicroFET®2 Digital Hand Dynamometer. The ROM of the elbow, forearm, and wrist were measured using the universal goniometer. The Pediatric Evaluation of Disability Inventory (PEDI) was used for functionality assessment.

RESULTS

The strength of the elbow flexor-extensor, forearm pronator-supinator, and wrist extensor muscles on the affected side was greater than on the unaffected side in all children (p < 0.001). No correlation was found between muscle strength, ROM, and functionality in the affected extremity (p > 0.005).

CONCLUSIONS

Although children with BPBI have good shoulder function after shoulder tendon transfer, structural problems in the distal joints may affect their functionality during daily life. Distal joint strengthening and ROM exercises, as well as bimanual functional activities, should be included in the rehabilitation programs of children with BPBI after shoulder tendon transfer.

A Scoping Review of Intervention Implementation for Self-Care Skills among Children with Developmental Delay

Difficulties with self-care skills are frequently observed in children with developmental delays. Given the scarcity of robust evidence backing self-care interventions for this group, this scoping review is designed to aggregate existing literature on the implementation of such interventions. Therefore, this scoping review aims to collate literature on the nature of self-care intervention implementation to increase understanding of the current practice and inform future research directions. This scoping review endeavoured to explore the body of literature concerning the existence of self-care interventions and their implementation strategies in children who have developmental delays. Relevant studies were identified by searching through the following databases: Web of Science (W0S), Scopus, ASEAN Citation Index (ACI), CINAHL EBSCO and PubMed. Six types of interventions using various approaches were identified. Occupational therapists mainly manage intervention providers with multidisciplinary co-facilitator and parents' involvement. Whilst session information varied, some evidence suggests that at least 30 min per session, minimum once per week up to twice per week, ranging from 10 to 23 sessions, may be sufficient. Intervention plans should be tailored to each child's unique needs, taking into account the variety of available interventions. Collaboration among occupational therapists, parents, educators and health professionals in home programmes enhances self-care intervention outcomes. These results are set to inform future research and practice, paving the way for enhanced support and improved outcomes for children with developmental delays.

A Review of Developmental Scales in Pediatric Practice: Recent Guidelines

Imitation, fine motor abilities, eye-to-hand coordination, perception, gross motor abilities, mental abilities, and verbal cognitive abilities are assessed on the developmental scale. The behavioral scale also assesses social interaction, emotional expression, activity, curiosity, sensory reactivity, and language. The current developmental scales in pediatrics are discussed in this paper. These scales have evolved. International scales for Indian children are difficult to administer due to cultural differences in self-care and gender roles. If parental awareness and demand are raised, postnatal growth interventions for psychosocial development will benefit infants in developing nations. Routine screening involves identifying an appropriate opportunity, acquisition, tool selection, administration, interpreting data, scoring, counseling, and training.

The impact of a biocellulose-based repair of fetal open spina bifida on the need to untether the cord: is it time to unify techniques for prenatal repair?

OBJECTIVE

To report the need for cord untethering after prenatal repair of open spina bifida using a unique biocellulose-based technique performed at a later gestational age.

METHODS

An observational cohort study was conducted to determine the incidence of tethered cord syndrome. Between May 2013 and May 2022, we performed 172 procedures using the percutaneous fetoscopic approach in fetuses at 26-28 weeks of gestation. After placode dissection, a biocellulose patch was placed to cover the placode, a myofascial flap (when possible) was dissected, and the skin was closed. Owing to death or loss to follow-up, 23 cases were excluded. Cord tethering syndrome was defined as symptoms of medullary stretching, and the infants were evaluated and operated on by local neurosurgeons after an magnetic resonance imaging examination. Infants over 30-month had ambulation and neurodevelopment evaluations (PEDI scale).

RESULTS

Among 172 cases operated at a median gestational age of 26.7 weeks and delivered at 33.2 weeks, 149 cases were available for postnatal follow-up, and cord untethering was needed in 4.4% of cases (6/136; excluding 13 cases younger than 12 months). Cerebrospinal fluid diversion and bladder catheterization were needed in 38% and 36% of cases, respectively. Of the 78 cases evaluated at 30 months, 49% were ambulating independently, and 94% had normal social function.

CONCLUSION

The biocellulose-based technique was associated with a low rate of cord tethering, wich may be attributed to the lack of the duramater suture during prenatal repair, the formation of a neoduramater and/or later gestational age of surgery.

A study on the effectiveness of training in the operation of an electric mobility aid in severely mentally and physically handicapped children

Hideshima Y, Asami T, Ichiba M, Matsuo K, Murata T. A study on the effectiveness of training in the operation of an electric mobility aid in severely mentally and physically handicapped children. Jpn J Compr Rehabil Sci 2024; 15: 8-16.

Purpose

We examined whether operation training for children with severe mental and physical disabilities using recently developed electric mobility aids improves their skills in operating such aids and their daily activities. By doing so, we aimed to clarify the effectiveness of electric mobility aid operation training for children with severe mental and physical disabilities.

Method

Operation training and normal training using an electric mobility aid were conducted for 42 school-aged children with severe mental and physical disabilities, aged 8-18 years old. The trainee children were randomly assigned to two groups: 21 to the intervention group to receive operation training and 21 to the control group to receive general training. The intervention lasted 20 minutes/training session, with three sessions/week over a period of eight weeks. The Powered Mobility Program (PMP) and Pediatric Evaluation of Disability Inventory (PEDI) were used for pre- and post-intervention assessments, and SPSS was used for two-way analysis of variance (ANOVA).

Results

PMP scaled scores significantly increased (p = 0.001) in both groups, but there was no interaction effect. The PEDI scaled scores did not significantly increase in either of the two groups.

Discussion

The effects of the intervention and use of the electric mobility aid on the operating skills of children with severe mental and physical disabilities were explicitly demonstrated. Future long-term studies are required to clarify the effects of training in the operation of electric mobility aids on the subsequent development of severely physically and mentally handicapped children.

The Effects of Family Functioning on Gross Motor Function, Activity, and Participation in Children with Cerebral Palsy

Objectives

The present study aimed to investigate whether family functioning (FF) could impact gross motor function, activity, and participation in children with cerebral palsy (CP).

Materials & Methods

Sixty-seven children with spastic diplegic CP who were admitted to the Special Education and Rehabilitation Clinic were included in the study. The guidelines of the American Academy of Neurology were followed for the diagnosis of spastic diplegia. The type of home where the family lives, the family's average income, the child's age, gender, and number of siblings, and the age and educational level of the child's primary caregiver were recorded. The gross motor function capacity of children with CP was assessed with the Gross Motor Function Classification System (GMFCS). The Pediatric Evaluation of Disability Inventory (PEDI) was used to evaluate activity and participation performance.

Results

The children living in detached houses had statistically higher PEDI mobility levels than those living in apartments (p < 0.05). PEDI's social function and self-care levels were higher in 12 to 18-year-old children with two siblings (p < 0.05). The age and educational status of the primary caregiver were found to have an important impact on the PEDI scores. According to the results, social function and self-care levels were higher in children whose primary caregivers were 30 to 65 years old and had high levels of education above high school (p < 0.05 The effects of family income and gender on PEDI scores were statistically non-significant (p˃ 0.05). Variables related to family functioning had no statistically significant effect on GMFCS scores (p˃ 0.05).

Conclusion

These factors can enable healthcare providers to collaborate with the families to develop more comprehensive intervention plans emphasizing family strengths and supporting their needs.

Assessment Scales in Cerebral Palsy: A Comprehensive Review of Tools and Applications

Cerebral palsy (CP) is a complex neurological condition characterized by motor dysfunction affecting millions worldwide. This comprehensive review delves into the critical role of assessment in managing CP. Beginning with exploring its definition and background, we elucidate the diverse objectives of CP assessment, ranging from diagnosis and goal setting to research and epidemiology. We examine standard assessment scales and tools, discuss the challenges inherent in CP assessment, and highlight emerging trends, including integrating technology, personalized medicine, and neuroimaging. The applications of CP assessment in clinical diagnosis, treatment planning, research, and education are underscored. Recommendations for the future encompass standardization, interdisciplinary collaboration, research priorities, and professional training. In conclusion, we emphasize the importance of assessment as a compass guiding the care of individuals with CP, issuing a call to action for improved assessment practices to shape a brighter future for those affected by this condition.

The Extensor Indicis Proprius Transposition for the Ulnar Collateral Ligament Stabilization in Thumb Hypoplasia Grades II-IIIa

Congenital upper extremity deformities are rare, the reported incidence is from 0.15% to 0.2%. The thumb is very important for a hand's functionality, as it provides up to 50% of its total performance. Proper pinch grip formation at the age of 12 to 16 months is part of normal development; however, no functional development can affect a child's psychoemotional development. Well-described techniques such as third or fourth superficial flexor transposition can be found in the literature. There is a paucity of studies on using the extensor indicis proprius (EIP) transposition for stabilization of the ulnar collateral ligament for the first metacarpophalangeal joint (MCPJ). Techniques for the usage of EIP tendon for the reconstruction of absent extensor pollicis longus tendon are more commonly practiced as they create abduction and extension for the thumb hypoplasia grade II-IIIa. We performed EIP transposition with subperiosteally fixation for the ulnar collateral ligament stabilization for thumb hypoplasia patients with a mean age of 38 months (11 to 128) and grade II (n=9), grade IIIa (n=4), and grade IIIb (n=1). Long-term follow-up (2 to 10 y) for the esthetical and functional study was performed. Patients and parents are satisfied with functional and esthetic outcomes. We believe that the EIP tendon transposition can be an alternative method for thumb hypoplasia patients grade II-IIIa reconstruction.

Real-time myoelectric control of wrist/hand motion in Duchenne muscular dystrophy: A case study

Introduction: Duchenne muscular dystrophy (DMD) is a genetic disorder that induces progressive muscular degeneration. Currently, the increase in DMD individuals' life expectancy is not being matched by an increase in quality of life. The functioning of the hand and wrist is central for performing daily activities and for providing a higher degree of independence. Active exoskeletons can assist this functioning but require the accurate decoding of the users' motor intention. These methods have, however, never been systematically analyzed in the context of DMD. Methods: This case study evaluated direct control (DC) and pattern recognition (PR), combined with an admittance model. This enabled customization of myoelectric controllers to one DMD individual and to a control population of ten healthy participants during a target-reaching task in 1- and 2- degrees of freedom (DOF). We quantified real-time myocontrol performance using target reaching times and compared the differences between the healthy individuals and the DMD individual. Results and Discussion: Our findings suggest that despite the muscle tissue degeneration, the myocontrol performance of the DMD individual was comparable to that of the healthy individuals in both DOFs and with both control approaches. It was also evident that PR control performed better for the 2-DOF tasks for both DMD and healthy participants, while DC performed better for the 1-DOF tasks. The insights gained from this study can lead to further developments for the intuitive multi-DOF myoelectric control of active hand exoskeletons for individuals with DMD.

Short-term multidisciplinary family-centered workshop for preschool children with global developmental delays

BACKGROUND

Children with developmental delays have a great impact on their families. Educating families on how to interact with their children is an important task. Therefore, we assessed the short-term effectiveness of the workshop for children with global developmental delays.

METHODS

In total, 101 children aged 18-36 months with global developmental delays, all with language delay along with other developmental delays, and their parents participated in six 2-h family-centered workshop sessions for six weeks. Measures were taken before and after the workshop, including the Mandarin-Chinese Communicative Developmental Inventory, Peabody Developmental Motor Scales, Emotional Competency Rating Scales, Pediatric Outcomes Data Collection Instrument, Pediatric Evaluation of Disability Inventory, Pediatric Daily Occupation Scale, Pediatric Quality of Life Inventory (PedsQL), Caregiver Strain Index, and PedsQL-Family Impact Module.

RESULTS

Significant improvements with a small or intermediate effect size in emotions, upper extremity and physical functioning and global functioning, daily occupation performance in sensorimotor, communication, cognitive autonomy, and psychosocial domains, and parental quality of life and family impact were noted with high workshop satisfaction.

CONCLUSION

Short-term family-centered workshop is effective for children with global developmental delays. However, due to the lack of follow-up after the intervention, it should be careful in inferring the developmental gain effect.

IMPACT

The effectiveness of short-term family-centered workshops on children with global developmental delays remains uncertain. Short-term family-centered workshops improved the children's emotions, physical functional performance, and occupational performance in daily life. The short-term family-centered workshop is practical and effective for children with global developmental delays. Further long-term, large-scale, prospective, randomized trials are warranted to confirm these results.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT05418933.

Gross motor change after inpatient rehabilitation for children with acquired brain injury: A 10-year retrospective review

AIM

To estimate gross motor change in inpatient school-aged children with subacute acquired brain injury (ABI), identify factors associated with gross motor change, and describe inpatient physiotherapy focus.

METHOD

This retrospective chart review involved inpatient children (5-18 years) with subacute ABI who had either two Gross Motor Function Measure (GMFM-88) assessments or one GMFM-88 with another pre/post gross motor outcome measure. Outcome change scores and Goal Attainment Scaling (GAS) T scores were calculated. Regression analyses examined factors predicting gross motor change. GAS goal areas were analysed to determine physiotherapy focus.

RESULTS

Of the 546 charts screened, 266 (118 female) met study criteria. The GMFM-88 was generally administered first, followed by other measures. GMFM-88 (n = 202), Community Balance and Mobility Scale (n = 89), and Six-Minute Walk Test (6MWT) (n = 98) mean change scores were 18.03% (SD 19.34), 17.85% (SD 10.77), and 142.3 m (SD 101.8) respectively. The mean GAS T score was 55.06 (SD 11.50). Lower baseline scores and increased time between assessments were most predictive of greater GMFM-88 change (r ≥ 0.40). Twenty-five percent of GAS goals were ambulation-based.

INTERPRETATION

Appropriate outcome measure selection is integral to detecting gross motor change in pediatric inpatient ABI rehabilitation. Mean change score estimates can be used to compare standard inpatient rehabilitation with new treatment approaches.

Effect of task-oriented training on gross motor function, balance and activities of daily living in children with cerebral palsy: A systematic review and meta-analysis

BACKGROUND

To systematically evaluate task-oriented training (TOT) on the improvement of gross motor function, balance and activities of daily living in children with cerebral palsy (CP).

METHODS

A number of randomized controlled trials (RCTs) of TOT in children with CP were searched from Pubmed, Cochrane Library, Web of Science, EmBase, China National Knowledge Infrastructure, Chinese Biology Medicine, Chinese Scientific Journals Database and Wanfang data from the establishment of database to March 2022. The methodological quality of the included studies was evaluated, and meta-analysis was performed by RevMan5.4 software.

RESULTS

A total of 16 studies were included in the systematic review (n = 893). Meta-analysis showed that the gross motor function measure (GMFM) (MD = 11.05, 95%CI [8.26, 13.83], P < .00001), dimension D (MD = 3.05, 95%CI [1.58, 4.53], P < .0001) of the GMFM, dimension E (MD = 7.36, 95%CI [5.88, 8.84], P < .00001) of the GMFM, the Berg Balance Scale (BBS) (MD = 6.23, 95%CI [3.31, 9.15], P < .0001), the pediatric evaluation of disability inventory (PEDI) mobile function (MD = 6.44, 95%CI [3.85, 9.02], P < .00001) score improved significantly in the TOT group compared with the control group.

CONCLUSIONS

Current evidence shows that TOT could effectively improve gross motor function, balance and activities of daily living in children with CP. Due to the limitations of the number and quality of the included studies, the above conclusions need to be verified by more high-quality studies.

Using the Assessment of Motor and Process Skills and the Pediatric Evaluation of Disability Inventory to Assess Self-Care Performance Among Preschool Children With Autism Spectrum Disorder

IMPORTANCE

Caregiver rating scales often give an unclear picture of the actual self-care performance of preschool children with autism spectrum disorder (ASD).

OBJECTIVE

To assess self-care performance among preschool children with ASD using two standardized instruments.

DESIGN

Cross-sectional study.

SETTING

Clinics, hospitals, and early intervention centers in Tainan, Taiwan.

PARTICIPANTS

Sixty children with ASD (ages 48-71 mo). Outcomes and Measures: The Standard Version of the Childhood Autism Rating Scale-Second Edition, the Assessment of Motor and Process Skills (AMPS), and the Chinese version of the Pediatric Evaluation of Disability Inventory (PEDI-C).

RESULTS

About 53.3% of children with ASD scored below 1.5 logits for AMPS motor skills and below 1 logit for AMPS process skills, indicating difficulties performing activities of daily living tasks. The average PEDI-C self-care normative standard scores were moderately low (between -1 and -2 SDs), indicating poor self-care performance. The correlations between the two measures were also low (rs = .27-.44). Overall, the results for 36 children were consistent with AMPS and PEDI-C scores; however, those for 24 children (40.0%) were discrepant.

CONCLUSIONS AND RELEVANCE

These findings have implications for how preschool children with ASD perform their self-care activities and suggest that more than half of preschool children with ASD have a need for occupational therapy interventions that target self-care skills. Occupational therapy practitioners can work with preschool children with ASD and their families to help them improve their self-care performance. What This Article Adds: Many children with ASD need occupational therapy interventions that target self-care skills. Both the AMPS and the PEDI-C provide valuable information from different perspectives on the self-care performance of preschool children with ASD.

Assessment of Manual Abilities Using the Box and Block Test in Children with Bilateral Cerebral Palsy

Objective

The aim of this study was to determine the correlation between manual dexterity evaluated with the Box and Block Test (BBT) and the performance of daily activities in children with bilateral cerebral palsy (CP).

Methods

The BBT was applied to 162 children with cerebral palsy of bilateral distribution aged 6 to 13 years. The level of performance was evaluated according to the Manual Ability Classification System (MACS), Gross Motor Function Classification System (GMFCS), and Pediatric Evaluation of Disability Inventory (PEDI) in the domains of self-care, mobility, and social function. Correlations between the findings of the BBT and the PEDI were determined, and additionally, some specific toileting tasks of the PEDI were evaluated.

Results

The results of the BBT were lower in the lowest functional levels of the MACS (p ≤ 0.001). The BBT showed a strong correlation with the domains' self-care (r = 0.8), mobility (r = 0.7), and social function (r = 0.6) of the PEDI. The BBT was different between children who were able and children who were not able to perform the toileting tasks that were evaluated. A lower capacity in the BBT obtained in children with functional status GMFCS III, IV, and V was associated with poor performance in toileting tasks evaluated in the PEDI.

Conclusion

The results of the BBT are correlated with the activities of daily living of children with bilateral CP. The data obtained from this test is used to predict the performance of daily activities of these patients in settings such as school and home and helps to identify contextual factors that influence the level of independence in children with bilateral CP.

Evaluation of test-retest reliability and concurrent validity of the Italian version of the pediatric evaluation of disability inventory in children with down syndrome: A cross-sectional study

PURPOSE

Down Syndrome (DS) is a common genetic disorder caused by trisomy 21. Due to cognitive challenges associated with DS, individuals often experience difficulty performing activities of daily living (ADLs), at levels that can range from mild to significant. This study aimed to measure psychometric properties of the Italian version of the Pediatric Evaluation of Disability Inventory (PEDI-I) in the DS population.

METHODS

The PEDI-I was administered to children with DS. The internal consistency was examined using Cronbach's Alpha. Test-retest reliability was demonstrated by intraclass correlation coefficient (ICC) and Bland-Altman plots. The concurrent validity was evaluated with the Italian version of the Barthel Index.

RESULTS

The PEDI-I was administered to 54 children with DS. Cronbach's Alpha showed statistically significant values (0.899 -0.986). The ICC confirmed the reproducibility of the scale with a range of (0.988 -1), while Bland-Altman plots showed a smallest detectable change of (0.18-1.63). The Pearson Correlation Coefficient with the Barthel Index showed statistically significant values for all PEDI-I subscales (range 0.75-0.95).

CONCLUSION

The study provides evidence of good test-retest reliability and convergent validity when used in children with DS. Other psychometric proprieties need to be investigated in future studies.

Assessment of everyday functioning in visually impaired children from a developing country1

PURPOSE

To assess the functional capabilities and performance in children with visual impairment who live in a developing country.

METHODS

This was a case-control study, including binocular and monocular visually impaired children and non-visually disabled controls aged between 4 and 12 years. All participants underwent a basic ophthalmic exam and caregivers answered the Pediatric Evaluation of Disability Inventory (PEDI). The results were compared among the groups with ANOVA.

RESULTS

The sample included 35 children with visual disability (21 binocular and 14 monocular) and 23 age-matched controls. The groups did not differ in age, gender, and ethnicity. For the functional skills scale, binocular impaired children had lower scores than children from the monocular group and controls in all three domains - self-care (59.6±33.0, P < 0.001), mobility (38.5±26.6, P < 0.001), and social function (61.0±28.2, P < 0.001). For the caregiver assistance scale, children from the binocular group presented lower scores in the self-care (64.7±29.6, P = 0.002), mobility (50.6±36.3, P < 0.001), and social function (65.9±33.4, P = 0.008) domains as compared to monocular and controls. Children with monocular visual disability presented very similar scores to controls (all P > 0.05).

CONCLUSION

Children with binocular visual impairment presented some degree of difficulty with everyday functioning whereas monocular visual impairment did not cause any limitation in function.

Factors for changes in self-care and mobility capabilities in young children with cerebral palsy involved in regular outpatient rehabilitation care

Background

Assessing prognosis of self-care and mobility capabilities in children with cerebral palsy (CP) is important for goal setting, treatment guidance and meaningful professional-caregiver conversations.

Aims

Identifying factors associated with changes in self-care and mobility capabilities in regular outpatient multidisciplinary paediatric CP rehabilitation care.

Methods and procedures

Routinely monitored longitudinal data, assessed with the Paediatric Evaluation of Disability Inventory (PEDI-Functional-Skills-Scale, FSS 0–100) was retrospectively analysed. We determined contributions of age, gross-motor function, bimanual-arm function, intellectual function, education type, epilepsy, visual function, and psychiatric comorbidity to self-care and mobility capability changes (linear-mixed-models).

Outcomes and results

For 90 children (53 boys), in all Gross-Motor-Function-Classification-System (GMFCS) levels, 272 PEDI's were completed. Mean PEDI–FSS–scores at first measurement (median age: 3,2 years) for self-care and mobility were 46.3 and 42.4, and mean final FSS-scores respectively were 55.1 and 53.1 (median age: 6,5 years). Self-care capability change was significantly associated with age (2.81, p < 0.001), GMFCS levels III-V (-9.12 to -46.66, p < 0.01), and intellectual impairment (-6.39, p < 0.01). Mobility capability change was significantly associated with age (3.25, p < 0.001) and GMFCS levels II-V (-6.58 to -47.12, p < 0.01).

Conclusions and implications

Most important prognostic factor for self-care and mobility capabilities is GMFCS level, plus intellectual impairment for self-care. Maximum capability levels are reached at different ages, which is important for individual goal setting and managing expectations.

•

Capabilities of children with CP improve modestly over time in outpatient rehabilitation.

•

Children with more severe CP reach maximum mobility and self-care levels at an earlier age.

•

After this maintaining capabilities is more realistic than improvement.

•

Important prognostic factors are GMFCS level and intellectual impairment.

•

Routine monitoring can aid goal setting and expectation management in communication with families.

A-GAS: A Probabilistic Approach for Generating Automated Gait Assessment Score for Cerebral Palsy Children

Gait disorders in children with cerebral palsy (CP) affect their mental, physical, economic, and social lives. Gait assessment is one of the essential steps of gait management. It has been widely used for clinical decision making and evaluation of different treatment outcomes. However, most of the present methods of gait assessment are subjective, less sensitive to small pathological changes, time-taking and need a great effort of an expert. This work proposes an automated, comprehensive gait assessment score (A-GAS) for gait disorders in CP. Kinematic data of 356 CP and 41 typically developing subjects is used to validate the performance of A-GAS. For the computation of A-GAS, instance abnormality index (AII) and abnormality index (AI) are calculated. AII quantifies gait abnormality of a gait cycle instance, while AI quantifies gait abnormality of a joint angle profile during walking. AII is calculated for all gait cycle instances by performing probabilistic and statistical analyses. Abnormality index (AI) is a weighted sum of AII, computed for each joint angle profile. A-GAS is a weighted sum of AI, calculated for a lower limb. Moreover, a graphical representation of the gait assessment report, including AII, AI, and A-GAS is generated for providing a better depiction of the assessment score. Furthermore, the work compares A-GAS with a present rating-based gait assessment scores to understand fundamental differences. Finally, A-GAS's performance is verified for a high-cost multi-camera set-up using nine joint angle profiles and a low-cost single camera set-up using three joint angle profiles. Results show no significant differences in performance of A-GAS for both the set-ups. Therefore, A-GAS for both the set-ups can be used interchangeably.

Bayesian Hierarchical Multidimensional Item Response Modeling of Small Sample, Sparse Data for Personalized Developmental Surveillance

Developmental surveillance tools are used to closely monitor the early development of infants and young children. This study provides a novel implementation of a multidimensional item response model, using Bayesian hierarchical priors, to construct developmental profiles for a small sample of children (N = 115) with sparse data collected through an online developmental surveillance tool. The surveillance tool records 348 developmental milestones measured from birth to three years of age, within six functional domains: auditory, hands, movement, speech, tactile, and vision. The profiles were constructed in three steps: (1) the multidimensional item response model, embedded in the Bayesian hierarchical framework, was implemented in order to measure both the latent abilities of the children and attributes of the milestones, while retaining the correlation structure among the latent developmental domains; (2) subsequent hierarchical clustering of the multidimensional ability estimates enabled identification of subgroups of children; and (3) information from the posterior distributions of the item response model parameters and the results of the clustering were used to construct a personalized profile of development for each child. These individual profiles support early identification of, and personalized early interventions for, children with developmental delay.

Relevant factors of self-care in children and adolescents with spastic cerebral palsy

Objective

Manual ability is considered one of the factors that can predict functional independence in activities of daily living. For evaluating personal tasks such as self-care, the Pediatric Evaluation of Disability Inventory (PEDI) comprises/introduces/offers a set of useful measures that assist in enhancing the capability for self-care among children and adolescents with cerebral palsy (CP). The aim of this study was to investigate the relevant factors of self-care capability and performance in children and adolescents with spastic CP.

Methods

This was a cross-sectional study. Seventy-six children and adolescents with spastic CP (between 5 and 18 years of age), representing levels I to IV of the Gross Motor Function Classification System-Expanded & Revised version (GMFCS), were analyzed. Multiple linear regression analysis with forward stepwise selection was conducted to examine which determinants were related to self-care capability and performance. Independent variables were age, CP type, GMFCS, Manual Ability Classification System, Box and Block Test, and grip strength in the dominant and non-dominant hands. Dependent variables were scores for the PEDI Functional Skills Scale and the PEDI Caregiver Assistance Scale.

Results

Results of the multiple regression analysis showed that the PEDI Functional Skills scale scores were correlated with the Box and Block Test in the dominant hand and GMFCS (Adjusted R² = 0.69). The PEDI Caregiver Assistance Scale scores were correlated with the Box and Block Test in the dominant hand, GMFCS, and age (adjusted R² = 0.71).

Conclusion

When considering self-care of children and adolescents with spastic CP, it is necessary to consider the evaluation of upper limb dysfunction in addition to GMFCS.

Functioning of young patients with cerebral palsy: Rasch analysis of the pediatric evaluation of disability inventory computer adaptive test daily activity and mobility

BACKGROUND

People with cerebral palsy experience limitations in performing activities of daily living. Rehabilitation practitioners seek valid instruments to measure changes in the performance of those activities. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) is a new tool to assess functioning in children and youth with various health conditions. Its validity needs to be evaluated in a way that is consistent with the theoretical model on which it was based. We aimed to evaluate the fit of daily activity and mobility items and children with CP to the Rasch model and to compare the performance in daily activities and mobility of older children, adolescents, and young adults with CP based on manual function and gross motor function limitations.

METHODS

Eighty-three parents of children and youth of 8-20 years old (mean age: 11.6) with different severity levels of cerebral palsy participated in this study. Ninety-one items of the PEDI-CAT Daily Activities and Mobility domains were analyzed through Rasch analysis to evaluate relative item difficulty and participant ability. Participants were described according to the Manual Ability (MACS) (level I: 21.7%; II: 32.5%; III: 24.1%; IV: 7.2% and V: 3.6%) and the Gross Motor Function (GMFCS) (level I: 37.3%; II: 26.5%; III: 6%; IV: 18.1%; and V: 7.2%) classification systems levels.

RESULTS

Our data fit the Rasch Model. Parents had difficulty distinguishing some PEDI-CAT response categories. Participants from MACS and GMFCS levels IV and V showed lower ability to perform relatively more difficult items. There was a floor effect in both domains. Only 7.7% of the items presented differential item functioning when individuals with mild MACS and GMFCS levels (I, II) and moderate level (III) and individuals with moderate (III) and severe levels (IV, V) were compared.

CONCLUSIONS

PEDI-CAT daily activities and mobility domains are valid to evaluate children, adolescents and youth with CP of different severities, but the addition of items to these domains is recommended in order to address their floor effect.

Validation of the fine motor subtest of the Bayley-III with children with sickle cell disease using Rasch analysis

BACKGROUND

Children with sickle cell disease (SCD) are at risk for fine motor (FM) delays; however, screening for FM impairments is not common among young children with SCD. The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) is the most commonly used performance-based developmental assessment. We aim to determine if the FM subtest of the Bayley-III is structured hierarchically in accordance with development and comprehensively evaluates FM development in children with SCD.

METHODS

Bayley-III assessments were completed between October 2009 and December 2013. The Bayley-III FM screening test, a shorter and more rapid method of assessing for FM impairments, was not directly administered to participants. Screening test scores were calculated from full Bayley-III scores.

RESULTS

Rasch analysis was performed using WINSTEPS. Sixty children with SCD were included in the final Rasch model. The Rasch-generated Wright map, which jointly positions items and persons on the same latent trait, illustrated that the FM items were slightly skewed towards more challenging items, indicating more difficult items may be overrepresented. High item separation values were reported (17.4), and item outfit statistics were less than 1.7. More than one third of items demonstrated overfit, indicating possible item redundancy. The FM subtest and the screening test, a shorter and faster method of assessing skills, were highly correlated (r = 0.993, p < 0.001).

CONCLUSION

The Bayley-III FM subtest is structured hierarchically, aligning with motor development, and comprehensively evaluates FM development in children with SCD. The test could be improved by reordering items, removing overfitting items and modifying screening test items to capture all ranges of development. The screening test is comprehensive and has high potential clinical utility among children with SCD.

Characterization of Forearm Muscle Activation in Duchenne Muscular Dystrophy via High-Density Electromyography: A Case Study on the Implications for Myoelectric Control

Duchenne muscular dystrophy (DMD) is a genetic disorder that results in progressive muscular degeneration. Although medical advances increased their life expectancy, DMD individuals are still highly dependent on caregivers. Hand/wrist function is central for providing independence, and robotic exoskeletons are good candidates for effectively compensating for deteriorating functionality. Robotic hand exoskeletons require the accurate decoding of motor intention typically via surface electromyography (sEMG). Traditional low-density sEMG was used in the past to explore the muscular activations of individuals with DMD; however, it cannot provide high spatial resolution. This study characterized, for the first time, the forearm high-density (HD) electromyograms of three individuals with DMD while performing seven hand/wrist-related tasks and compared them to eight healthy individuals (all data available online). We looked into the spatial distribution of HD-sEMG patterns by using principal component analysis (PCA) and also assessed the repeatability and the amplitude distributions of muscle activity. Additionally, we used a machine learning approach to assess DMD individuals' potentials for myocontrol. Our analysis showed that although participants with DMD were able to repeat similar HD-sEMG patterns across gestures (similarly to healthy participants), a fewer number of electrodes was activated during their gestures compared to the healthy participants. Additionally, participants with DMD activated their muscles close to maximal contraction level (0.63 ± 0.23), whereas healthy participants had lower normalized activations (0.26 ± 0.2). Lastly, participants with DMD showed on average fewer PCs (3), explaining 90% of the complete gesture space than the healthy (5). However, the ability of the DMD participants to produce repeatable HD-sEMG patterns was unexpectedly comparable to that of healthy participants, and the same holds true for their offline myocontrol performance, disproving our hypothesis and suggesting a clear potential for the myocontrol of wearable exoskeletons. Our findings present evidence for the first time on how DMD leads to progressive alterations in hand/wrist motor control in DMD individuals compared to healthy. The better understanding of these alterations can lead to further developments for the intuitive and robust myoelectric control of active hand exoskeletons for individuals with DMD.

Are the American normative standard scores applicable to the German version of the Pediatric Evaluation of Disability Inventory (PEDI-G)?

BACKGROUND

The Pediatric Evaluation of Disability Inventory (PEDI) is an assessment to evaluate children's performance in activities of daily living.

AIMS

The study investigated if the normative standard scores of the PEDI are applicable to the German version of the PEDI (PEDI-G) in Germany, Austria and Switzerland, and whether there are differences in the applicability of the PEDI-G between the three countries.

MATERIALS AND METHODS

75 children with normal development (35 girls, 40 boys) from Germany (n = 17), Austria (n = 16), and Switzerland (n = 42) aged between 0.9 month and 7.3 years (SD = 2.03) participated in the study. Descriptive statistics, independent samples t-tests, univariate analyses of variance (ANOVA) and post hoc Tukey tests were applied.

RESULTS

No significant differences were identified. However, the German-speaking sample showed higher scores for the domain social function in both scales and in the Caregiver Assistance Scale self-care. Lower scores were identified in the Functional Skills Scale mobility.

CONCLUSIONS AND SIGNIFICANCE

The results support that the normative standard scores of the PEDI are applicable to the PEDI-G and for Austria, Germany and Switzerland, as no significant differences between the countries were identified. However, the generalizability of the results is limited due to sample size and recruitment procedures.

Evaluation of the multidimensional effects of adaptive seating interventions for young children with non-ambulatory cerebral palsy

PURPOSE

To investigate the short-term effectiveness of the first adaptive seating system received by children with non-ambulatory cerebral palsy (CP) who are classified as level IV or V according to the Gross Motor Function Classification System.

MATERIALS AND METHODS

A trained clinical assessor examined 20 children with non-ambulatory CP (mean age: 4.5 years) for their trunk control ability in static, active, and reactive tasks using the Segmental Assessment of Trunk Control. Their primary caregivers were also interviewed about their child's activity and participation using the Paediatric Evaluation of Disability Inventory Computer - Adaptive Test in daily activity and social/cognitive domains and Family Impact of Assistive Technology Scale for Adaptive Seating in child and family functioning domains. Data for each measure were collected 3 times: at baseline (pre-intervention) and then 6 weeks and 3 months after children received their first adaptive seating system.

RESULTS AND CONCLUSION

The static and active trunk control scores between baseline and 6 weeks, and baseline and 3 months significantly improved. Daily activity scaled scores significantly improved between baseline and 3 months, and 6 weeks and 3 months. Significant, large gains in child and family functioning overall were detected between baseline and 6 weeks, and baseline and 3 months. These findings provide emerging evidence of multidimensional effects associated with the introduction of a first adaptive seating system into the lives of young children with non-ambulatory CPIMPLICATIONS FOR REHABILITATIONThe introduction of an adaptive seating system into the wheelchair of children with non-ambulatory cerebral palsy may be associated with short-term gains in body function, activities, participation and aspects of the child's environment.

Comparison of gait characteristics between clinical and daily life settings in children with cerebral palsy

Gait assessments in standardized settings, as part of the clinical follow-up of children with cerebral palsy (CP), may not represent gait in daily life. This study aimed at comparing gait characteristics in laboratory and real life settings on the basis of multiple parameters in children with CP and with typical development (TD). Fifteen children with CP and 14 with TD wore 5 inertial sensors (chest, thighs and shanks) during in-laboratory gait assessments and during 3 days of daily life. Sixteen parameters belonging to 8 distinct domains were computed from the angular velocities and/or accelerations. Each parameter measured in the laboratory was compared to the same parameter measured in daily life for walking bouts defined by a travelled distance similar to the laboratory, using Wilcoxon paired tests and Spearman’s correlations. Most gait characteristics differed between both environments in both groups. Numerous high correlations were found between laboratory and daily life gait parameters for the CP group, whereas fewer correlations were found in the TD group. These results demonstrated that children with CP perform better in clinical settings. Such quantitative evidence may enhance clinicians’ understanding of the gap between capacity and performance in children with CP and improve their decision-making.

Development and Validation of Equations to Link Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Scores to PEDI-Computer Adaptive Test Scores for Youth with Cerebral Palsy

Aim: The Pediatric Evaluation of Disability Inventory (PEDI) was revised to the PEDI-Computer Adaptive Test (PEDI-CAT). The PEDI has been used for over two decades to track function in youth, so it is important that follow-up data are not lost with this transition. The purpose of this study was to develop and validate equations for linking PEDI scores to PEDI-CAT scores.Methods: Caregivers of 101 youth 6.1 to 19.8 years of age with cerebral palsy (CP) and classified at Gross Motor Classification System (GMFCS) Levels I-V completed the PEDI and PEDI-CAT. Scaled score data from this sample were used to develop and validate linking equations using least squares regression and bootstrap cross-validation techniques. Next, equations were tested in an independent sample of 35 children with developmental disabilities.Results: The equations to predict PEDI-CAT scores exhibited excellent model fit. PEDI Self-care, Mobility, and Social Function explained 92%, 84%, and 85% of the variation in PEDI-CAT Daily Activities, Mobility, and Social/Cognitive domains, respectively. No differences were detected between actual and predicted PEDI-CAT scores across all domains and by GMFCS level for the equation development sample and for an equation validation independent sample.Conclusions: The model fit was excellent; however, equations should be used cautiously when evaluating changes in function for individual children with ceiling level PEDI scores. Valid score prediction equations for youth with CP will assist with transitioning from the PEDI to the PEDI-CAT.

A Case Study With Symbihand: An sEMG-Controlled Electrohydraulic Hand Orthosis for Individuals With Duchenne Muscular Dystrophy

With recent improvements in healthcare, individuals with Duchenne muscular dystrophy (DMD) have prolonged life expectancy, and it is therefore vital to preserve their independence. Hand function plays a central role in maintaining independence in daily living. This requires sufficient grip force and the ability to modulate it with no substantially added effort. Individuals with DMD have low residual grip force and its modulation is challenging and fatiguing. To assist their hand function, we developed a novel dynamic hand orthosis called SymbiHand, where the user's hand motor intention is decoded by means of surface electromyography, enabling the control of an electrohydraulic pump for actuation. Mechanical work is transported using hydraulic transmission and flexible structures to redirect interaction forces, enhancing comfort by minimizing shear forces. This paper outlines SymbiHand's design and control, and a case study with an individual with DMD. Results show that SymbiHand increased the participant's maximum grasping force from 2.4 to 8 N. During a grasping force-tracking task, muscular activation was decreased by more than 40% without compromising task performance. These results suggest that SymbiHand has the potential to decrease muscular activation and increase grasping force for individuals with DMD, adding to the hand a total mass of no more than 241 g. Changes in mass distributions and an active thumb support are necessary for improved usability, in addition to larger-scale studies for generalizing its assistive potential.

Factors Associated With Gains in Performance During Rehabilitation After Pediatric Brain Injury: Growth Curve Analysis

OBJECTIVE

Predicting recovery of functional performance within pediatric rehabilitation after brain injury is important for health professionals and families, but information regarding factors associated with change in functional skills ("what the child can do") and functional independence ("what the child does") is limited. The aim of the study was to examine change in functional skills and independence over time in children with moderate-severe brain injury during prolonged inpatient rehabilitation.

DESIGN

This study used a retrospective cohort design. Longitudinal data from 139 children (age 1.6-20.6 yrs), hospitalized for 115.4 ± 72 days, were examined. Growth curve analysis was used to examine factors associated with change in the Pediatric Evaluation of Disability Inventory (functional skills and caregiver assistance, ie, functional independence) in mobility and self-care. Typical estimates for change per hospitalization day were obtained.

RESULTS

Traumatic brain injury and older age at injury, but not sex, were associated with faster recovery. Length of stay was associated with rate of change in functional skills but not in functional independence, suggesting that improvement in functional independence during rehabilitation may be associated with other factors.

CONCLUSIONS

Identifying the factors associated with individual profiles of functional improvement can provide valuable information for clinicians and decision-makers to optimize performance after prolonged inpatient rehabilitation.

Randomised controlled pilot feasibility trial of an early intervention programme for young infants with neurodevelopmental impairment in Uganda: a study protocol

INTRODUCTION

Early intervention programmes (EIPs) for infants with neurodevelopmental impairment have been poorly studied especially in low-income settings. We aim to evaluate the feasibility and acceptability of a group participatory EIP, the 'ABAaNA EIP', for young children with neurodevelopmental impairment in Uganda.

METHODS AND ANALYSIS

We will conduct a pilot feasibility, single-blinded, randomised controlled trial comparing the EIP with standard care across two study sites (one urban, one rural) in central Uganda. Eligible infants (n=126, age 6-11 completed months) with neurodevelopmental impairment (defined as a developmental quotient <70 on Griffiths Scales of Mental Development, and, or Hammersmith Infant Neurological Examination score <60) will be recruited and randomised to the intervention or standard care arm. Intervention arm families will receive the 10-modular, peer-facilitated, participatory, community-based programme over 6 months. Recruited families will be followed up at 6 and 12 months after recruitment, and assessors will be blinded to the trial allocation. The primary hypothesis is that the ABAaNA EIP is feasible and acceptable when compared with standard care. Primary outcomes of interest are feasibility (number recruited and randomised at baseline) and acceptability (protocol violation of arm allocation and number of sessions attended) and family and child quality of life. Guided by the study aim, the qualitative data analysis will use a data-led thematic framework approach. The findings will inform scalability and sustainability of the programme.

ETHICS AND DISSEMINATION

The trial protocol has been approved by the relevant Ugandan and UK ethics committees. Recruited families will give written informed consent and we will follow international codes for ethics and good clinical practice. Dissemination will be through peer-reviewed publications, conference presentations and public engagement.

TRIAL REGISTRATION NUMBER

ISRCTN44380971; protocol version 3.0, 19th February 2018.

Methods for Congenital Thumb Hypoplasia Reconstruction. A Review of the Outcomes for Ten Years of Surgical Treatment

BACKGROUND AND OBJECTIVES

Congenital thumb hypoplasia is a rare deformity of upper extremity. The incidence for thumb hypoplasia grade II-V is 1:10,000 newborns per year in Latvia. A technique for extensor indicis proprius (EIP) tendon transfer with subperiosteal fixation was developed and used for thumb hypoplasia grades II and IIIa. Pollicization or second-toe-to-hand transplantation with metatarsophalangeal (MTP) joint arthrodesis was used for the reconstruction of hypoplasia grade IIIb-V. The aim of this retrospective cohort study is to evaluate the outcomes for reconstruction techniques used in one surgical center during a ten-year period by one surgeon to evaluate functional and aesthetical outcomes for new techniques.

MATERIALS AND METHODS

In total, 21 patients were operated on during 2007-2017, and 18 of these patients were involved in this study. Long-term follow-up was completed to evaluate the functions and aesthetics of the hands.

RESULTS

disabilities of the arm, shoulder and hand (DASH) was 9.35 (8-10.7) for the second-toe-to-hand with MTP joint arthrodesis transplantation method for pollicization method 19.8 (6-26.7), and for the EIP tendon transposition, 14.54 (0.9-56.3).

CONCLUSIONS

The postoperative functional parameters of congenital hand hypoplasia patients, regardless of the surgical method, are worse than the functional results of healthy patients. The use of the second-toe-to-hand with MTP joint arthrodesis transplantation method provides patients with congenital hand IIIb-V hypoplasia a stable and functional first finger formation. The functional results are comparable to the clinical results of the pollicization method while ensuring the creation of a five-digit hand.

A content validity evaluation of the PEDI-CAT Speedy Mobility domain

Objective: To evaluate the content validity of the PEDI-CAT Speedy Mobility domain through analysis of item and content area exposure, score range and scoring precision.Methods: Retrospective analysis of 3,364 items from assessments (n = 301) completed from 2013 to 2017. Content validity was appraised through analysis of item and content area exposure (item, content area, response frequency), score range (floor and ceiling effect) and scoring precision (person fit, score reliability, item information function).Results: Sixty-five of the 75 general mobility items from the PEDI-CAT Mobility domain item bank were exposed. "Stands up from the middle of the floor" (68%) was the most frequently exposed non-mandatory item. Almost half (49%) of all items were from the Basic Mobility and Transfers content area. Scaled scores ranged from 26.77 to 69.40 with a floor (scores ≤27; n = 51, 17%) but no ceiling effect. Person fit statistics were acceptable for 238 (79%), suggesting limited outliers. Score reliability was sufficient with 68% of scores above threshold (>0.9). Item information function plot indicated less discriminating items at the lower end of the score range.Conclusion: Content is adequately and reliably measuring the intended construct, but additional items at the lower end of the scale could improve score precision.

Normative values and discriminative ability across functional levels of ACTIVLIM-CP, a measure of global activity performance for children with cerebral palsy

Purpose: This study aims to provide normative values of a global activity performance questionnaire (ACTIVLIM-CP) and investigate its ability to discriminate children with cerebral palsy of various functional levels.Methods: Parents of 503 typically developing children aged 2-18 years old (mean age ± standard deviation (SD): 9.56 ± 4.62 years) and 285 children with cerebral palsy aged 2-18 years old (mean age ± SD: 10.08 ± 4.09 years) answered ACTIVLIM-CP. To provide normative values, influence of typically developing children's characteristics on ACTIVLIM-CP measures was investigated with a multiple linear regression. A Kruskal-Wallis test and Dunn's post-hoc tests were performed to investigate age differences in ACTIVLIM-CP measures. Discriminative ability of ACTIVLIM-CP was investigated using a one-way analysis of variance and post-hoc tests between children with cerebral palsy who differed in manual and gross motor functional levels.Results: In typically developing children, age was the strongest predictor, explaining 74% of the variance of ACTIVLIM-CP measures (β = 0.86, t = 38.21, p < 0.001). ACTIVLIM-CP measure increased with age until 17-18 years old where all children reached the maximal value, although 50% of the children at 12 years old already reached the maximal measure. Normative values were developed for each age bracket. In addition, ACTIVLIM-CP was able to discriminate children with CP's performance measures across most manual ability and gross motor functional levels.Conclusions: Normative values developed in this study with a representative sample of typically developing children allow clinicians to appraise the functional delay of children with cerebral palsy from the normal development of global activity performance. The good discriminative ability of ACTIVLIM-CP support its precision, construct validity, and clinical relevance to describe global activity limitations in children with cerebral palsy with manual ability levels and gross motor function levels II-V.Implications for rehabilitationNormative data of ACTIVLIM-CP developed with a representative sample of typically developing children can be used with children with CP to differentiate the age effect from the disruption caused by cerebral palsy.ACTIVLIM-CP showed the ability to discriminate across children with cerebral palsy having different manual and gross motor function, highlighting its precision, construct validity, and its clinical relevance to describe limitations in children with manual ability levels and gross motor function levels II-V.ACTIVLIM-CP covers a wide age range, is a cost-effective, easy and freely-available assessment of global activity performance in activities of daily living for clinicians.

Translation and cross-cultural adaptation of the PEDI-CAT: Dutch version

PURPOSE

The PEDI-CAT measures daily functioning of children and youth, aged 1 to 21 years, with a variety of physical, cognitive and/or behavioral disabilities. In order to use an instrument in another culture or language, translation and cross-cultural validation are important, particularly for end-users. This study describes the process of translation and cross-cultural adaptation of the Dutch version of the PEDI-CAT.

METHODS

End-users were involved in all steps. First, the PEDI-CAT items were reviewed to determine whether the items were relevant and acceptable in the Dutch culture. Then, the PEDI-CAT was translated into Dutch using specific guidelines. Finally, the wording of the Dutch items and response options were reviewed and tested with 22 parents of children and adolescents with and without disabilities.

RESULTS

All 267 items and response options of the original PEDI-CAT were assessed as relevant and translated into Dutch. A selection of 175 items was tested with Think Aloud interviews which revealed that the translation of 46 items could be improved.

CONCLUSION

The role of end-users in the process of translation and cross-cultural adaptation was crucial. This collaborative process resulted in a Dutch version of the PEDI-CAT that has been optimally adapted to the Dutch language and culture.

The Ugandan version of the Pediatric Evaluation of Disability Inventory (PEDI-UG). Part II: Psychometric properties

BACKGROUND

The Pediatric Evaluation of Disability Inventory (PEDI) has been recommended as a gold standard in paediatric rehabilitation. A Ugandan version of PEDI (PEDI-UG) has been developed by culturally adapting and translating the original PEDI. The aim of this study was to investigate the psychometric properties of the PEDI-UG in Ugandan children by testing the instrument's rating scale functioning, internal structure, and test-retest reliability.

METHODS

Two hundred forty-nine Ugandan children (125 girls) aged 6 months to 7.5 years (Mean = 3.4, SD = 1.9) with typical development were tested using the PEDI-UG. Forty-nine children were tested twice to assess test-retest reliability. Validity was investigated by Rasch analysis and reliability by intraclass correlation coefficient.

RESULTS

The PEDI-UG domains showed good unidimensionality based on principal component analysis of residuals. Most activities (95%) showed acceptable fit to the Rasch model. Six misfit items were deleted from the Functional Skills scales and one from the Caregiver Assistance scales. The category steps on the Caregiver Assistance scales' rating scale were reversed but functioned well when changed from a 6-point to 4-point rating scale. The reliability was excellent; intraclass correlation coefficient was 0.87-0.92 for the domains of the Functional Skills scales and 0.86-0.88 for the domains of the Caregiver Assistance scales.

CONCLUSION

The PEDI-UG has good to excellent psychometric properties and provides a valid measure of the functional performance of typically developing children from the age of 6 months to 7.5 years in Uganda. Further analysis of all items, including misfit and deleted items, in children with functional disability is recommended.

Community-based parent-delivered early detection and intervention programme for infants at high risk of cerebral palsy in a low-resource country (Learning through Everyday Activities with Parents (LEAP-CP): protocol for a randomised controlled trial

INTRODUCTION

Cerebral palsy (CP) is the most common childhood physical disability, with 80% estimated to be in low-middle-income countries. This study aims to (1) determine the accuracy of General Movements (GMs)/Hammersmith Infant Neurological Examination (HINE) for detecting CP at 18 months corrected age (CA); (2) determine the effectiveness of a community-based parent-delivered early intervention for infants at high risk of CP in West Bengal, India (Learning through Everyday Activities with Parents for infants with CP; LEAP-CP).

METHODS

This study comprises two substudies: (1) a study of the predictive validity of the GMs and HINE for detecting CP; (2) randomised, double-blinded controlled trial of a novel intervention delivered through peer trainers (Community Disability Workers, CDW) compared with health advice (15 fortnightly visits). 142 infants at high risk of CP ('absent fidgety' GMs; 'high risk score' on HINE) aged 12-40 weeks CA will be recruited to the intervention substudy, with infants randomised based on a computer-generated sequence. Researchers will be masked to group allocation, and caregivers and CDWs naïve to intervention status. Visits will include therapeutic modules (goal-directed active motor/cognitive strategies and LEAP-CP games) and parent education. Health advice is based on the Integrated Management of Childhood Illness, WHO. Infants will be evaluated at baseline, post intervention and 18 months CA. The primary hypothesis is that infants receiving LEAP-CP will have greater scaled scores on the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (mobility domain) at 18 months compared with health advice. Secondary outcomes include infant functional motor, cognitive, visual and communication development; infant growth; maternal mental health.

ETHICS AND DISSEMINATION

This study is approved through appropriate Australian and Indian ethics committees (see in text) with families providing written informed consent. Findings from this trial will be disseminated through peer-reviewed journal publications and conference presentations.

TRIAL REGISTRATION NUMBER

12616000653460p; Pre-results.

The development and evaluation of content validity of the Zambia Spina Bifida Functional Measure: Preliminary studies

BACKGROUND

Very little is known on outcome measures for children with spina bifida (SB) in Zambia. If rehabilitation professionals managing children with SB in Zambia and other parts of sub-Saharan Africa are to instigate measuring outcomes routinely, a tool has to be made available. The main objective of this study was to develop an appropriate and culturally sensitive instrument for evaluating the impact of the interventions on children with SB in Zambia.

METHODS

A mixed design method was used for the study. Domains were identified retrospectively and confirmation was done through a systematic review study. Items were generated through semi-structured interviews and focus group discussions. Qualitative data were downloaded, translated into English, transcribed verbatim and presented. These were then placed into categories of the main domains of care deductively through the process of manifest content analysis. Descriptive statistics, alpha coefficient and index of content validity were calculated using SPSS.

RESULTS

Self-care, mobility and social function were identified as main domains, while participation and communication were sub-domains. A total of 100 statements were generated and 78 items were selected deductively. An alpha coefficient of 0.98 was computed and experts judged the items.

CONCLUSIONS

The new functional measure with an acceptable level of content validity titled Zambia Spina Bifida Functional Measure (ZSBFM) was developed. It was designed to evaluate effectiveness of interventions given to children with SB from the age of 6 months to 5 years. Psychometric properties of reliability and construct validity were tested and are reported in another study.

Lumbosacral Dorsal Rhizotomy for Spastic Cerebral Palsy: A Health Technology Assessment

BACKGROUND

Cerebral palsy, a spectrum of neuromuscular conditions caused by abnormal brain development or early damage to the brain, is the most common cause of childhood physical disability. Lumbosacral dorsal rhizotomy is a neurosurgical procedure that permanently decreases spasticity and is always followed by physical therapy. The objectives of this health technology assessment were to evaluate the clinical effectiveness, safety, cost effectiveness, and family perspectives of dorsal rhizotomy.

METHODS

We performed a systematic literature search until December 2015 with auto-alerts until December 2016. Search strategies were developed by medical librarians, and a single reviewer reviewed the abstracts. The health technology assessment included a clinical review based on functional outcomes, safety, and treatment satisfaction; an economic study reviewing cost-effective literature; a budget impact analysis; and interviews with families evaluating the intervention.

RESULTS

Eighty-four studies (1 meta-analysis, 5 randomized controlled studies [RCTs], 75 observational pre-post studies, and 3 case reports) were reviewed. A meta-analysis of RCTs involving dorsal rhizotomy and physical therapy versus physical therapy confirmed reduced lower-limb spasticity and increased gross motor function (4.5%, P = .002). Observational studies reported statistically significant improvements in gross motor function over 2 years or less (12 studies, GRADE moderate) and over more than 2 years (10 studies, GRADE moderate) as well as improvements in functional independence in the short term (10 studies, GRADE moderate) and long term (4 studies, GRADE low). Major operative complications, were infrequently reported (4 studies). Bony abnormalities and instabilities monitored radiologically in the spine (15 studies) and hip (8 studies) involved minimal or clinically insignificant changes after surgery. No studies evaluated the cost effectiveness of dorsal rhizotomy. The budget impact of funding dorsal rhizotomy for treatment of Ontario children with cerebral palsy was $1.3 million per year. Families reported perceived improvements in their children and expressed satisfaction with treatment. Ontario families reported inadequate medical information on benefits or risk to make an informed decision, enormous financial burdens, and lack rehabilitation support after surgery.

CONCLUSIONS

Lumbrosacral dorsal rhizotomy and physical therapy effectively reduces lower-limb spasticity in children with spastic cerebral palsy and significantly improves their gross motor function and functional independence. Major peri-operative complications were infrequently reported. Families reported perceived improvements with dorsal rhizotomy, and surgery and post-operative rehabilitation were intensive and demanding.

Evaluating the Discriminant Validity of the Pediatric Evaluation of Disability Inventory: Computer Adaptive Test in Children With Cerebral Palsy

BACKGROUND

The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) is a new clinical assessment for children and youth from birth through 20 years of age.

OBJECTIVE

To determine the discriminant validity of the PEDI-CAT according to the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) in children with cerebral palsy (CP).

DESIGN

A prospective convenience cross-sectional sample of 101 school-age children with CP was stratified by GMFCS level.

METHODS

Participants were excluded if they underwent recent surgery (<6 months). Receiver operating characteristics curve analysis was used to quantify the discriminant validity of the PEDI-CAT domains to distinguish the level of independence in fine and gross motor function. General linear modeling was used to assess discriminant ability across all GMFCS and MACS levels.

RESULTS

Mean age was 11 years, 11 months (SD 3.7). Mobility and Daily Activities domains exhibited excellent discriminant validity distinguishing between ambulatory and nonambulatory participants [area under the curve (AUC) = 0.98 and 0.97, respectively] and the Daily Activities domain exhibited excellent discriminant validity distinguishing between independent and dependent hand function (AUC = 0.93). All PEDI-CAT domains were able to discriminate between ambulatory (GMFCS levels I-III) or nonambulatory (GMFCS levels IV-V) as well as manually independent (MACS levels I-II) or manually dependent functional levels (MACS levels III-V) ( P < .001).

LIMITATIONS

Our convenience cross-sectional sample included school-age children with primarily Caucasian, middle-income parents and may not be representative of other cultural, socioeconomic backgrounds. Not all participants had a MACS level assigned, however, no differences were found in PEDI-CAT scores between those with and without MACS scores.

CONCLUSIONS

These results demonstrate that the PEDI-CAT is a valid outcome instrument for measuring functional abilities in children with CP, able to differentiate across fine and gross motor functional levels.

Responsiveness of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test in measuring functional outcomes for inpatient pediatric rehabilitation

PURPOSE

Responsiveness of the PEDI-CAT Mobility, Daily Activities, and Social/Cognitive domains and Wheelchair subdomain was evaluated for youth admitted to a pediatric post-acute care hospital.

METHODS

Inpatients ages 2-21 years, with a length of stay of ≥ 5 days and with both admission and discharge scores were included. The difference between mean admission and discharge PEDI-CAT scaled scores were analyzed using paired t-tests. Effect sizes, standard response means (SRMs), and minimal detectable change values were calculated. Score comparison between diagnostic subgroups (Traumatic Brain Injury, Neurological, Orthopedic, Medical) and age groups ( ≤ 5, > 5 but < 13, ≥ 13 years) were evaluated for the Mobility domain.

RESULTS

Sample size differed by domain with 66 Mobility, 30 Daily Activities, 19 Social/Cognitive and 9 Wheelchair subdomain pairs. Significant differences were found for all domains when mean admission and discharge scaled scores were compared. Moderate to large effect sizes and SRMs were found for the Mobility and Daily Activities domains and Wheelchair subdomain. Small effect size but large SRM was found for the Social/Cognitive domain. The Mobility domain was also responsive to changes in all diagnostic and age groups.

CONCLUSION

The PEDI-CAT was responsive to functional changes for youth discharged from an inpatient pediatric rehabilitation hospital.

The quality of life in boys with Duchenne muscular dystrophy

We conducted a study to evaluate the quality of life in boys with Duchenne muscular dystrophy aged 8-18 years, compared with that in matched healthy controls. A total of 85 boys with Duchenne muscular dystrophy aged 8-18 years and 136 age, sex and living place matched healthy controls were included in this study. Patients and one of their parents separately completed the 27-item Persian version of KIDSCREEN questionnaire (child and adolescent version and parent version). From the children's perspective, the quality of life in patients was found to be lower in two subclasses: "physical activities and health" (p < 0.001) and "friends" (p = 0.005). Parental estimation of their sick child's quality of life was significantly lower than children's own assessment in two subclasses: "physical activities and health" (p < 0.001) and "general mood and feelings" (p < 0.001). Our results indicate that boys with Duchenne muscular dystrophy have quite a satisfactory quality of life. A happier and more hopeful life can be promoted through increasing social support and improving the parental knowledge regarding their child's more positive life perspective.

Validity, reliability, and usability of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test for autism spectrum disorders

AIM

This study aimed to explore the test-retest reliability of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test for autism spectrum disorders (PEDI-CAT [ASD]), the concurrent validity of this test with the Vineland Adaptive Behavior Scales (VABS-II), and parents' perceptions of usability.

METHOD

A convenience sample of participants (n=39) was recruited nationally through disability organizations. Parents of young people aged 10 to 18 years (mean age 14y 10mo, SD 2y 8mo; 34 males, five females) who reported a diagnosis of autism were eligible to participate. Parents completed the VABS-II questionnaire once and the PEDI-CAT (ASD) twice (n=29) no more than 3 weeks apart (mean 12d) using computer-simulated administration. Parents also answered questions about the usability of these instruments. We examined score reliability using intraclass correlation coefficients (ICCs) and we explored the relationship between instruments using Spearman's rank correlation coefficients. Parent responses were grouped by common content; content categories were triangulated by an additional reviewer.

RESULTS

Intraclass correlation coefficients indicate excellent reliability for all PEDI-CAT (ASD) domain scores (ICC ≥ 0.86). PEDI-CAT (ASD) and VABS-II domain scores correlated as expected or stronger than expected (0.57-0.81). Parents reported that the computer-based PEDI-CAT (ASD) was easy to use and included fewer irrelevant questions than the VABS-II instrument.

INTERPRETATION

These findings suggest that the PEDI-CAT (ASD) is a reliable assessment that parents can easily use. The PEDI-CAT (ASD) operationalizes the International Classification of Function, Disability and Health for Children and Youth constructs of 'activity' and 'participation', and this preliminary research suggests that the instrument's constructs are related to those of VABS-II.

Normative Scores for the Pediatric Evaluation of Disability Inventory in Norway

AIM

The aim of this study was to develop clinically useful normative scores for the Pediatric Evaluation of Disability Inventory (PEDI) for children in Norway, and provide information on the relative difficulty level of individual test items.

METHODS

Using PEDI protocols from 224 Norwegian children without disability, we computed and scrutinized the normative scores for their representativeness, and compared them with scores from 313 children in the original US PEDI sample. Item functioning was compared using Rasch model-based differential item functioning (DIF) analyses and comparisons of item mastery.

RESULTS

The normative scores yielded consistent and regular results. The mean scores for each age group in the Norwegian sample were lower than in their US counterparts, and age mean plots ran parallel. However, this difference may be misleading for clinical use, as item comparisons revealed differences in both higher and lower directions between the samples for about a third of all items. Estimates of relative item difficulty for children in Norway were developed.

CONCLUSIONS

Identifying potential differences when using an instrument in another culture is important to avoid a risk of over- or underestimating a child's capability. In addition, item response patterns are required to make national normative scores clinically useful.

Intrathecal baclofen for treating spasticity in children with cerebral palsy

BACKGROUND

Cerebral palsy is a disorder of movement and posture arising from a non-progressive lesion in the developing brain. Spasticity, a disorder of increased muscle tone, is the most common motor difficulty and is associated with activity limitation to varying degrees in mobility and self care.Oral baclofen, a gamma-aminobutyric acid (GABA) agonist, has been used in oral form to treat spasticity for some time, but it has a variable effect on spasticity and the dose is limited by the unwanted effect of excessive sedation. Intrathecal baclofen produces higher local concentrations in cerebrospinal fluid at a fraction of the equivalent oral dose and avoids this excessive sedation.

OBJECTIVES

To determine whether intrathecal baclofen is an effective treatment for spasticity in children with cerebral palsy.

SEARCH METHODS

We searched the CENTRAL, MEDLINE, EMBASE and CINAHL databases, handsearched recent conference proceedings, and communicated with researchers in the field and pharmaceutical and drug delivery system companies.

SELECTION CRITERIA

We included studies which compared the effect of intrathecal baclofen treatment on spasticity, gross motor function or other areas of function with controls.

DATA COLLECTION AND ANALYSIS

Two authors selected studies, two authors extracted data and two authors assessed the methodological quality of included studies.

MAIN RESULTS

Six studies met the inclusion criteria. The data obtained were unsuitable for the conduct of a meta-analysis; we have completed a qualitative summary.All studies were found to have high or unclear risk of bias in some aspects of their methodology.Five of the six studies reported data collected in the randomised controlled phase of the study. A sixth study did not report sufficient results to determine the effect of intrathecal baclofen versus placebo. Of these five studies, four were conducted using lumbar puncture or other short-term means of delivering intrathecal baclofen. One study assessed the effectiveness of implantable intrathecal baclofen pumps over six months.The four short-term studies demonstrated that intrathecal baclofen therapy reduces spasticity in children with cerebral palsy. However, two of these studies utilised inappropriate techniques for statistical analysis of results. The single longer-term study demonstrated minimal reduction in spasticity with the use of intrathecal baclofen therapy.One of the short-term studies and the longer term study showed improvement in comfort and ease of care. The longer term study found a small improvement in gross motor function and also in some domains of health-related quality of life.Some caution is required in interpreting the findings of the all the studies in the review due to methodological issues. In particular, there was a high risk of bias in the methodology of the longer term study due to the lack of placebo use in the control group and the absence of blinding to the intervention after randomisation for both participants and investigators.

AUTHORS' CONCLUSIONS

There is some limited short-term evidence that intrathecal baclofen is an effective therapy for reducing spasticity in children with cerebral palsy. The effect of intrathecal baclofen on long-term spasticity outcomes is less certain.The validity of the evidence for the effectiveness of intrathecal baclofen in treating spasticity in children with cerebral palsy from the studies in the review is constrained by the small sample sizes of the studies and methodological issues in some studies.Spasticity is a impairment in the domain of body structure and function. Consideration must also be given to the broader context in determining whether intrathecal baclofen therapy is effective. The aim of therapy may be, for example, to improve gross motor function, to increase participation at a social role level, to improve comfort, to improve the ease of care by others or to improve the overall quality of life of the individual. Intrathecal baclofen may improve gross motor function in children with cerebral palsy, but more reliable evidence is needed to determine this.There is some evidence that intrathecal baclofen improves ease of care and the comfort and quality of life of the individuals receiving it, but again small sample sizes and methodological issues in the studies mean that these results should be interpreted with caution.Further evidence of the effectiveness of intrathecal baclofen for treating spasticity, increasing gross motor function and improving comfort, ease of care and quality of life is needed from other investigators in order to validate these results.The short duration of the controlled studies included in this review did not allow for the exploration of questions regarding whether the subsequent need for orthopaedic surgery in children receiving intrathecal baclofen therapy is altered, or the safety and the economic implications of intrathecal baclofen treatment when long-term therapy is administered via an implanted device. Controlled studies are not the most appropriate study design to address these questions, cohort studies may be more appropriate.

Functional recovery following critical illness in children: the "wee-cover" pilot study

OBJECTIVE

To determine the feasibility of conducting a longitudinal prospective study to evaluate functional recovery and predictors of impaired functional recovery in critically ill children.

DESIGN

Prospective pilot study.

SETTING

Single-center PICU at McMaster Children's Hospital, Hamilton, Canada.

PATIENTS

Children aged 12 months to 17 years, with at least one organ dysfunction, limited mobility or bed rest during the first 48 hours of PICU admission, and a minimum 48-hour PICU length of stay, were eligible. Patients transferred from a neonatal ICU prior to ever being discharged home, already mobilizing well or at baseline functional status at time of screening, with an English language barrier, and prior enrollment into this study, were excluded.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The primary outcome was feasibility, as defined by the ability to screen, enroll eligible patients, and execute the study procedures and measurements on participants. Secondary outcomes included functional status at baseline, 3 and 6 months, PICU morbidity, and mortality. Functional status was measured using the Pediatric Evaluation of Disability Inventory and the Participation and Environment Measure for Children and Youth. Thirty-three patients were enrolled between October 2012 and April 2013. Consent rate was 85%, and follow-up rates were 93% at 3 months and 71% at 6 months. We were able to execute the study procedures and measurements, demonstrating feasibility of conducting a future longitudinal study. Functional status deteriorated following critical illness. Recovery appears to be influenced by baseline health or functional status and severity of illness.

CONCLUSION

Longitudinal research is needed to understand how children recover after a critical illness. Our results suggest factors that may influence the recovery trajectory and were used to inform the methodology, outcomes of interest, and appropriate sample size of a larger multicenter study evaluating functional recovery in this population.