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Barak S, Brezner A, Yissar T, Eisenstein E, Ackerman-Laufer S, Landa J. Gross motor proficiency deficits among children and adolescents post posterior fossa brain tumor removal vs. traumatic brain injury in the chronic phase of recovery: a cross-sectional study. Front Sports Act Living 2024; 6:1284421. [PMID: 38318486 PMCID: PMC10839087 DOI: 10.3389/fspor.2024.1284421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction Acquired brain injury (ABI) is a prevalent diagnosis in pediatric rehabilitation. Gross motor skills are often affected by ABI and limit the ability to participate in various physical activities. However, as ABI injury location is diverse, children and adolescents (youth) with localized ABI, such as ABI in the posterior fossa (ABI-PF) may present unique and different motor disabilities than youth with ABI on account of traumatic brain injury (TBI). Aims The aims of the study were: (1) to compare gross motor deficits in youth with TBI vs. ABI-PF; and (2) to compare two methods on scoring BOT2 to determine which is better for identifying motor deficits. Methods Participated in this study youth with TBI (N = 50) and ABI-PF (N = 30). Participants were tested on Bruininks-Oseretsky Test of Motor Proficiency-2nd Edition (BOT2) Upper-Limb Coordination, Balance, Strength, Running Speed and Agility, and Bilateral-Coordination subtests. Motor performance deficits were established using two-standard deviations (2SD) and age-equivalent methods. Between-group differences were assessed via independent t-tests and receiver operating characteristic curves (ROC). Results According to the 2SD method, motor deficits in the ABI-PF group ranged from 20% to 66.66%, whereas in the TBI group 8%-16%. According to the age-equivalent method, in the TBI and ABI-PF groups 40%-66.0% and 46.66%-76.66% of the youth presented motor deficits, respectively. Moreover, ROC analysis showed that motor performance deficits of both groups in all sub-scales except for Bilateral Coordination differed enough to result in medium area under the curve. Conclusions Motor deficits post-pediatric ABI are prevalent. In comparison to the TBI group, deficits are greater in the ABI-PF group. Moreover, compared to the 2SD method, the extent of motor deficiency is greater in the age-equivalent method. Therefore, using the later might provide a more valid classification of deficits in gross motor proficiency for youth post-ABI.
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Affiliation(s)
- Sharon Barak
- Department of Nursing, Faculty of Health Science, Ariel University, Ariel, Israel
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Tamar Yissar
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Etzyona Eisenstein
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Shirley Ackerman-Laufer
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Jana Landa
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Tanel MR, Gupta C, Wilson KE, Murphy J, Wright FV, Reed N. The Concussion Challenge Assessment: Development and reliability of a novel gross motor assessment tool for paediatric concussion. Front Sports Act Living 2022; 4:1027339. [PMID: 36589783 PMCID: PMC9795185 DOI: 10.3389/fspor.2022.1027339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Aims The aim of this study was to develop a gross motor performance clinical assessment tool, the Concussion Challenge Assessment (CCA), for paediatric concussion populations. Methods An expert panel evaluated tasks from the Acquired Brain Injury Challenge Assessment to determine relevant tasks for a paediatric concussion population. These tasks were administered to a convenience sample of 854 healthy youth. An analysis of the response options for each task, considering task difficulty, was performed. The test-retest reliability of each task was considered to finalise the tool. Results The Acquired Brain Injury Challenge Assessment was reduced to six tasks (three coordination, two speed and agility, and one strength) to create the CCA. Population-specific 4-point response options were generated, which, upon examination of task difficulty, were revised as 5-point response sets to better capture performance differences. The test-retest reliability results led to acceptance of all six: three performance tasks and three exertion tasks. Conclusion This development of the CCA is an important step in creating a gross motor performance assessment tool that can assist in the determination of when youth are able to safely return to activity following a concussion.
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Affiliation(s)
- Michelle R. Tanel
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Christopher Gupta
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Katherine E. Wilson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - James Murphy
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Correspondence: Nick Reed
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Ryan JL, Zhou C, Levac DE, Fehlings DL, Beal DS, Hung R, Wright FV. Gross motor change after inpatient rehabilitation for children with acquired brain injury: A 10-year retrospective review. Dev Med Child Neurol 2022. [PMID: 36404436 DOI: 10.1111/dmcn.15471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/16/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Jennifer L Ryan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Chuanlin Zhou
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Danielle E Levac
- School of Rehabilitation, University of Montreal, Montreal, Canada
| | - Darcy L Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Deryk S Beal
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Ryan Hung
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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Kelly G, Davis K, Wales L. The presence of high level physical difficulties in children and young people with severe acquired brain injuries who regain independent mobility. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Children and young people with acquired brain injuries take part in less physical activity than age-matched peers. A possible cause of this is reduced high level motor proficiency. This study aimed to determine whether children and young people who regain independent mobility following a severe acquired brain injury continue to experience high-level physical difficulties. Methods A retrospective review of routinely collected Bruininks-Oseretsky Test of Motor Proficiency 2 assessments was performed. Descriptive data analysis of motor proficiency results, both overall and within the different subsections, was conducted. Results Out of 26 participants (5–17 years) with severe traumatic and non-traumatic acquired brain injury, 22 scored below or well below average in overall motor composite score. The mean standard scores across all participants in three of the subsections were below average: manual coordination 35.9; body coordination 37.1; and strength and agility 37.9. The only subsection that produced scores within the average for participants' ages was fine motor control (mean 41.8). Conclusions Children and young people demonstrate reduced motor proficiency following acquired brain injury despite regaining functionally independent mobility. Those not participating in physical activities should be screened for high level motor difficulties that may impact on their participation.
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Affiliation(s)
- Gemma Kelly
- Research Physiotherapist, The Children's Trust, Tadworth, UK
| | - Kathy Davis
- Research Nurse, The Children's Trust, Tadworth, UK
| | - Lorna Wales
- Research Physiotherapist, The Children's Trust, Tadworth, UK
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Weightman MM, McCulloch KL, Radomski MV, Finkelstein M, Cecchini AS, Davidson LF, Heaton KJ, Smith LB, Scherer MR. Further Development of the Assessment of Military Multitasking Performance: Iterative Reliability Testing. PLoS One 2017; 12:e0169104. [PMID: 28056045 PMCID: PMC5215871 DOI: 10.1371/journal.pone.0169104] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/12/2016] [Indexed: 11/24/2022] Open
Abstract
The Assessment of Military Multitasking Performance (AMMP) is a battery of functional dual-tasks and multitasks based on military activities that target known sensorimotor, cognitive, and exertional vulnerabilities after concussion/mild traumatic brain injury (mTBI). The AMMP was developed to help address known limitations in post concussive return to duty assessment and decision making. Once validated, the AMMP is intended for use in combination with other metrics to inform duty-readiness decisions in Active Duty Service Members following concussion. This study used an iterative process of repeated interrater reliability testing and feasibility feedback to drive modifications to the 9 tasks of the original AMMP which resulted in a final version of 6 tasks with metrics that demonstrated clinically acceptable ICCs of > 0.92 (range of 0.92–1.0) for the 3 dual tasks and > 0.87 (range 0.87–1.0) for the metrics of the 3 multitasks. Three metrics involved in recording subject errors across 2 tasks did not achieve ICCs above 0.85 set apriori for multitasks (0.64) and above 0.90 set for dual-tasks (0.77 and 0.86) and were not used for further analysis. This iterative process involved 3 phases of testing with between 13 and 26 subjects, ages 18–42 years, tested in each phase from a combined cohort of healthy controls and Service Members with mTBI. Study findings support continued validation of this assessment tool to provide rehabilitation clinicians further return to duty assessment methods robust to ceiling effects with strong face validity to injured Warriors and their leaders.
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Affiliation(s)
- Margaret M. Weightman
- Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Karen L. McCulloch
- Division of Physical Therapy, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mary V. Radomski
- Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America
| | - Marsha Finkelstein
- Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America
| | - Amy S. Cecchini
- Courage Kenny Research Center, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America
- Defense and Veterans Brain Injury Center, Fort Bragg, North Carolina, United States of America
| | - Leslie F. Davidson
- Department of Clinical Research and Leadership, George Washington School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Kristin J. Heaton
- United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States of America
- Boston University School of Public Health, Department of Environmental Health, Boston, Massachusetts, United States of America
| | - Laurel B. Smith
- United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States of America
| | - Matthew R. Scherer
- Clinical and Rehabilitative Medicine Research Program, Medical Research Materiel Command, Ft Detrick, Maryland, United States of America
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Kissane AL, Eldridge BJ, Kelly S, Vidmar S, Galea MP, Williams GP. High-level mobility skills in children and adolescents with traumatic brain injury. Brain Inj 2015; 29:1711-6. [DOI: 10.3109/02699052.2015.1075174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wong RKY, McEwan J, Finlayson D, Chung S, Wan L, Salbach NM, Kirkwood G, Meschino C, Wright FV. Reliability and validity of the acquired brain injury challenge assessment (ABI-CA) in children. Brain Inj 2014; 28:1734-43. [DOI: 10.3109/02699052.2014.947620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Salbach NM, O'Brien K, Evans C, Yoshida K. Dissemination of student research in a canadian master of science in physical therapy programme. Physiother Can 2014; 65:154-7. [PMID: 24403678 DOI: 10.3138/ptc.2012-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the extent of presentation and publication, as well as time to publication, of student research completed as a component of a Master of Science in Physical Therapy (MScPT) degree at a Canadian university. METHOD The authors conducted a retrospective cross-sectional study of MScPT research projects completed between 2003 and 2009, each undertaken by a group of MScPT students who carried out protocol development, ethics submission, data collection, analysis, and manuscript and poster preparation under the supervision of research advisors. Research advisors were e-mailed a request for citations of presentations and publications. RESULTS Advisors from 102 of 113 research projects completed from 2003 through 2009 provided information, for a response rate of 90.3%. Of the 102 groups, 53.9% disseminated findings through publication or presentation, 33.3% presented at one or more conferences, and 30.4% published at least one peer-reviewed journal article. Median time to publication was 21 months. Almost half the journal articles (47%) were published in Physiotherapy Canada. CONCLUSIONS MScPT student research groups are disseminating their findings through publication or presentation at a moderate rate. Investigation of factors influencing dissemination is needed to develop strategies to facilitate knowledge transfer.
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Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Kelly O'Brien
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Cathy Evans
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Karen Yoshida
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
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McArthur C, Venkatesh S, Warren D, Pringle D, Doerr T, Salbach NM, Kirkwood G, Wright V. Further development of the response scales of the Acquired Brain Injury Challenge Assessment (ABI-CA). Brain Inj 2013; 27:1271-80. [PMID: 24020440 DOI: 10.3109/02699052.2013.809551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To revise the scaling of the response sets of the Acquired Brain Injury Challenge Assessment (ABI-CA) through expert input and determination of empirically based cut-points. RESEARCH DESIGN A measurement development study with a content validity focus. METHODS Response option wording was revised through consultation with six physiotherapists with paediatric ABI expertise. Twenty-nine typically-developing children performed the ABI-CA and empirically-based cut-points for item-specific response options were derived from their time/distance/repetition results (SD values) as benchmark values. Movement quality considerations (compensatory movements) were identified from expert consultation/ABI-CA video observation and built into revised response options. The revised ABI-CA was pilot-tested with four children with ABI, aged 7-15 years, for a feasibility check. RESULTS Nineteen of the 23 items' response scales were revised based on experts' feedback and empirically-based cut-points replaced the previous arbitrarily-determined cut-points. Compensatory movement considerations were re-defined in nine items. The mean score of the refined ABI-CA was 70.0% (SD = 18.5) with four children with ABI. CONCLUSION The new response options in the ABI-CA appeared suitable for testing high-functioning children with ABI and the mid-range mean score in this pilot sample indicates its potential to measure change. Recommendations are outlined for final ABI-CA amendments before large-scale validation.
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Affiliation(s)
- Caitlin McArthur
- Department of Physical Therapy, Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada
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Kamath T, Pfeifer M, Banerjee-Guenette P, Hunter T, Ito J, Salbach NM, Wright V, Levac D. Reliability of the motor learning strategy rating instrument for children and youth with acquired brain injury. Phys Occup Ther Pediatr 2012; 32:288-305. [PMID: 22574628 DOI: 10.3109/01942638.2012.672551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate reliability and feasibility of the Motor Learning Strategy Rating Instrument (MLSRI) in children with acquired brain injury (ABI). The MLSRI quantifies the extent to which motor learning strategies (MLS) are used within physiotherapy (PT) interventions. METHODS PT sessions conducted by ABI team physiotherapists with a convenience sample of children with ABI (4-18 years) were videotaped and independently scored later by two raters trained in MLSRI use. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) estimated intra- and inter-rater reliability. RESULTS Eighteen PT sessions were evaluated. Intra- and inter-rater reliability ICCs for total score were 0.86 (95% CI: 0.66-0.94) and 0.50 (95% CI: 0.08-0.78), respectively. MLSRI category ICCs were 0.56-0.86 (intra-rater) and 0.16-0.84 (inter-rater). CONCLUSIONS Intra-rater reliability of MSLRI total score was excellent. Moderate inter-rater reliability may partially be due to inconsistent item interpretation between raters. Revisions and further reliability testing are required before recommending the MLSRI for clinical and research use.
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Affiliation(s)
- Trishna Kamath
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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A colleague's plea. Pediatr Phys Ther 2010; 22:245. [PMID: 20699769 DOI: 10.1097/pep.0b013e3181eb645b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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