HIV encephalopathy with bilateral lower limb spasticity: upper limb motor function and level of activity and participation

The Relationship between Young Children's Graphomotor Skills and Their Environment: A Cross-Sectional Study

The current study aimed to examine the unique contribution of personal and environmental factors to explain graphomotor skills in typically developing preschoolers and first-year elementary school students. A convenience sample of 136 Israeli children aged three−seven years was recruited. Graphomotor skills were assessed using the Gilboa Functional Test (GIFT); personal and environmental factors were assessed using a demographic questionnaire and the Home Literacy Experiences Questionnaire (HLEQ). A hierarchical multiple linear regression analysis revealed that home literacy and educational approach accounted for 43.1% of the variance of graphomotor skills (R2 = 40.4, p < 0.000), each providing a unique contribution to the explained variance after controlling for age, gender, and spoken language. Generally, our results supported the bioecological model, with proximal factors (home literacy and educational approach) having a greater influence on child graphomotor skills than distal factors (parental socioeconomic and immigration status). By highlighting the role of environmental factors in graphomotor development, these results can be used as a conceptual framework for developing early intervention programs.

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.

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.

Participation Patterns of Preschool Children With Intellectual Developmental Disabilities

We aim to examine the pattern of participation of children with intellectual developmental disabilities (IDD) or global developmental delay (GDD) in comparison with typically developing preschoolers. In addition, to identify environmental and personal factors associated with their participation, 20 children with mild to moderate GDD or IDD, and 24 age- and gender-matched controls, aged 3 to 6 years, were assessed using the Assessment of Preschool Children's Participation and the Environmental Restriction Questionnaire. Significant differences were found between the groups, both for general scales of participation and for each activity area. For the IDD/GDD group, participation was significantly negatively correlated with environmental restrictions at home. For the control group, participation was correlated with demographic variables. Typically developing children participate at a higher frequency and in a more diverse range of activities compared with children with IDD/GDD. Associations between participation and contextual factors varied depending on the child's health condition.

Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy?

This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system.

WHAT THIS PAPER ADDS

The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.

Scaling up Pediatric HIV Testing by Incorporating Provider-Initiated HIV Testing Into all Child Health Services in Hurungwe District, Zimbabwe

BACKGROUND

Practical ways are needed to scale-up pediatric HIV testing in sub-Saharan Africa, where testing is usually limited to HIV-exposed children in maternal and child health clinics.

METHODS

We implemented an enhanced pediatric HIV testing program in 33 health facilities in Zimbabwe by integrating HIV testing into all pediatric health services. We collected individual data on children tested by having health care workers complete a program-specific child health booklet. We compared numbers of children tested before and during the program using routinely collected aggregate program data reported by health facilities.

RESULTS

A total of 12,556 children aged 0-5 years were recorded in child health booklets; 9431 (75.1%) had information on HIV testing, of whom 7326 (77.7%) were tested; 7167 had test results of whom 122 (1.7%) were HIV-infected. Among children seen in outpatient clinics, 82.1% were tested compared with 66.5% tested among children seen in maternal/child health clinics. Of the 122 HIV-infected children identified, 77 (63.1%) could be missed under existing pediatric testing guidelines. The number of HIV-infected children identified during the 6-month program increased by 55% compared with the prior 6-month period (RR = 1.55, 95% CI: 1.22 to 1.96). Factors independently associated with HIV infection included being malnourished (adjusted odds ratio [AOR] = 7.7, 95% CI: 2.1 to 28.6), being exposed to TB (AOR = 8.1, 95% CI: 2.0 to 32.2), and having an HIV-infected mother (AOR = 41.6, 95% CI: 15.9 to 108.8).

CONCLUSIONS

Integrating HIV testing into all pediatric health services is feasible and can assist in identifying HIV-infected children who could be missed in current testing guidelines.