Functional profiles of children with cerebral palsy in Jordan based on the association between gross motor function and manual ability

Functional classification systems in Brazilian children with cerebral palsy: Reliability and associations between functional levels

Children with Cerebral palsy (CP) present movement and posture disorders. The Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), Eating and Drinking Ability Classification System (EDACS), and Visual Function Classification System (VFCS) enhance the understanding of their performance. We verified inter-rater reliability and associations between the classification levels. Physical therapists classified 100 Brazilian children with CP (3-17 years) according to GMFCS, MACS, CFCS, EDACS, and VFCS. To evaluate inter-rater reliability (Intraclass Correlation Coefficient-ICC) two independent examiners concurrently assessed a subset of 60 participants. According to Spearman's correlation coefficients, there were associations between GMFCS/MACS (r = 0.81), GMFCS/CFCS (r = 0.70), MACS/CFCS (r = 0.73), GMFCS/VFCS (r = 0.61), MACS/VFCS (r = 0.61), CFCS/EDACS (r = 0.58), CFCS/VFCS (r = 0.50), and EDACS/VFCS (r = 0.45) (p < .05). The inter-rater reliability ranged from excellent (ICC = 0.93-0.99) to good (ICC = 0.89), p < .05. The classification systems are reliable, and the levels associated with each other in Brazilian children, especially the GMFCS, MACS, and CFCS.

Effectiveness of Virtual Reality for Upper Extremity Function and Motor Performance of Children With Cerebral Palsy: A Systematic Review

IMPORTANCE

Research on the functional and motor performance impact of virtual reality (VR) as an intervention tool for children with cerebral palsy (CP) is limited.

OBJECTIVE

To understand whether VR is an effective intervention to improve upper extremity (UE) function and motor performance of children diagnosed with CP.

DATA SOURCES

Databases used in the search were EBSCOhost, One Search, PubMed, Cloud Source, CINAHL, SPORTDiscus, and Google Scholar.

STUDY SELECTION AND DATA COLLECTION

Studies published from 2006 to 2021 were included if children had a diagnosis of CP and were age 21 yr or younger, VR was used as an intervention, and measures of UE function and motor performance were used.

FINDINGS

Twenty-one studies were included, and the results provided promising evidence for improvements in areas of UE function, motor performance, and fine motor skills when VR is used as an intervention. To yield noticeable UE improvements in children with CP, VR should be implemented for 30 to 60 min/session and for at least 360 min over more than 3 wk. Additional areas of improvement include gross motor skills, functional mobility, occupational performance, and intrinsic factors.

CONCLUSIONS AND RELEVANCE

The use of VR as an intervention for children with CP to improve UE function and motor performance is supported. More randomized controlled trials with larger sample sizes focusing on similar outcomes and intervention frequencies are needed to determine the most effective type of VR for use in clinical occupational therapy. Plain-Language Summary: This systematic review explains how virtual reality (VR) has been used as an intervention with children with cerebral palsy (CP). The review synthesizes the results of 21 research studies of children who had a diagnosis of CP and who were 21 years old or younger. The findings support using VR to improve upper extremity performance, motor performance, and fine motor skills. The findings also show that occupational therapy practitioners should use a VR intervention at a minimum frequency of 30 to 60 minutes per session and for at least 360 minutes over more than 3 weeks to yield noticeable improvements in upper extremity, motor performance, and fine motor skills for children with CP.

Reliability and validity of the Japanese version of the Visual Function Classification System for children with cerebral palsy

BACKGROUND

Children with cerebral palsy (CP) often experience visual dysfunction that affects motor function and activities of daily living, but no 'gold standard' classification of visual function has been established. In recent years, however, a valid and reliable Visual Function Classification System (VFCS) for children with CP has been developed.

AIMS

To examine the reliability and validity of the Japanese version of the VFCS in individuals with CP.

METHODS

The translation of the VFCS was performed according to international standards for the translation of measurements. We conducted questionnaires of professionals (three physicians, eight physical therapists, five occupational therapists, six speech-language-hearing therapists and a certified orthoptist) regarding the content validity of the Japanese version of the VFCS. For reliability and concurrent validity, 148 individuals with CP were classified twice by professionals using the Japanese version of the VFCS, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS) and Eating and Drinking Ability Classification System (EDACS), with several weeks between each evaluation.

RESULTS

The content validity of the Japanese version of the VFCS almost met the criteria set. The percentage of positive and neutral opinions given by the professionals with regard to the four items ranged from 74% to 92%. The intra-rater reliability was 0.86 (95% CI 0.75-0.96) by Cohen's kappa and 0.93 (95% CI 0.88-0.96) by intraclass correlation coefficient. The inter-rater reliability was 0.67 (95% CI 0.56-0.78) by Cohen's kappa and 0.79 (95% CI 0.69-0.86) by intraclass correlation coefficient. The Spearman correlation coefficients between the VFCS and the GMFCS, MACS, CFCS and EDACS were 0.783, 0.764, 0.738, 0.738 and 0.830, respectively. The concurrent validity was confirmed by the correlations observed with other classification systems.

CONCLUSIONS

The results indicated good reliability and validity for the Japanese version of the VFCS.

Children and adolescents with physical disabilities: describing characteristics and disability-related needs in the Kilimanjaro region, north-eastern Tanzania - a cross-sectional survey

OBJECTIVES

To describe the characteristics and disability-related needs of children and adolescents with physical disabilities in the Kilimanjaro region, North-Eastern Tanzania.

DESIGN

A cross-sectional community survey was conducted from November 2020 to June 2021. Trained research assistants interviewed primary children's carers using a questionnaire based on the International Classification of Functioning, Disability and Health-Children and Youth Framework. Data were analysed using IBM SPSS Statistics V.27. The Pearson χ2 test was used to examine differences between age, gender and self-reported needs. The independent t-test assessed difference in needs according to age and gender.

SETTING

Kilimanjaro region, Tanzania.

PARTICIPANTS

Children and adolescents, aged 2-18 years, with physical disabilities (n=212).

RESULTS

Almost 40% had severe speech (n=84) and joint mobility (n=79) impairments, and more than half (n=124) had severe or complete difficulties walking. In aspects of self-care (caring for body parts, toileting, dressing, eating and drinking), most had severe and complete difficulties. Almost 70% (n=135) of households were located near health facilities without rehabilitation services. About one-quarter (n=51) had never received rehabilitation services. More than 90% (n=196) needed assistive devices, and therapeutic exercises (n=193). Over three-quarters needed nutritional supplements (n=162).

CONCLUSION

Children and adolescents with physical disabilities in North-Eastern Tanzania have impaired speech and joint mobility, and difficulties in communication, self-care and walking. Rehabilitation services essential for addressing these impairments and activity limitations are either scarce or inaccessible. Action is needed to facilitate urban and rural access to rehabilitation services in order to improve the well-being of children and adolescents with physical disabilities.

KINEMATIC COMPARISON OF ORTHOPEDIC SHOES AND ANKLE-FOOT ORTHOSES IN CHILDREN WITH CEREBRAL PALSY

Introduction Cerebral palsy (CP) patients may have additional complications such as deformities of lower limbs which significantly change the gait pattern. Various treatments have been used to correct the walking gait and among them are orthotic devices. According to the data based on literature research the ankle-foot orthoses (AFOs) are the most widely used in clinical practice for CP patients. However, orthopedic shoes are more widely used in Russia and there is a lack of gait comparison research has been done up to date. Aim. Kinematic data comparison of walking gait between orthopedic shoes and AFOs in children with CP. Materials and methods. Eighteen CP children with GMFCS 2 and GMFCS 3 were recruited for this research. Three test comparisons were conducted for barefoot, orthopedic shoes, and AFOs walking for each children being tested. Twelve Miqus M5 Qualisys cameras were used for kinematic data collection with 100 Hz frequency. Visual3D (C-Motion), Clinical Gait PAF (Qualisys), Statistica 10, and Excel were used for data analysis. Results. The results demonstrated that wearing AFOs versus barefoot improved spatial-temporal parameters as well as ankle and knee joint kinematics without significant changes in hip joint angles for both GMFCS 2 and GMFCS 3 levels. As a result, the Gait Profile Score (GPS) showed significant improvement in AFOs as well. The use of orthopedic footwear in patients with gross motor function levels GMFCS 2 and GMFCS 3 led to improvement of ankle and knee joints kinematics when compared to barefoot walking. However, the group with GMFCS 2 demonstrated less improvement of the ankle and knee joint angles in orthopedic shoes but the GPS showed significantly better overall values when compared to GMFCS 3 group. Therefore, this study showed that orthopedic footwear and AFOs almost equally corrected the walking gait in GMFCS 2 group but AFOs were significantly better for GMFCS 3 group.

Psychometric evaluation and distribution of classification systems in children with cerebral palsy in Japan

PURPOSE

The study sought to examine the content validity, the intra- and inter-rater reliability, and concurrent validity of the Japanese versions of the Manual Ability Classification System, the Communication Function Classification System, and the Eating and Drinking Ability Classification System, and representation of the distribution of the levels of each classification systems in comparison to the Gross Motor Function Classification System levels for children with cerebral palsy.

METHODS

The Japanese versions were developed using the back-translation method. For content validity, professionals were asked to complete a questionnaire including items on the appropriateness of the translation, its validity, and distinctions among levels. For reliability, professionals used the three classification systems twice in children with cerebral palsy. For concurrent validity, relationships among the four classification systems were examined by correlation analyses.

RESULTS

Participants included twenty-one professionals and 290 children with cerebral palsy (mean age: 12 years two months, female: 132, male: 158). The content validity was generally good. For reliability, the lower limit of the 95% confidence interval for the intraclass correlation coefficients was greater than 0.89, and the correlation coefficients were high.

CONCLUSION

The results of this study showed good reliability and validity of the functional classification systems in Japan.

Relationship among four functional classification systems and parent interpredicted intelligence level in children with different clinical types of cerebral palsy

OBJECTIVE

To investigate the relationships between four functional classification systems in children with cerebral palsy (CP) and parent-interpredicted intelligence level, and the functional status in clinical types of CP.

METHODS

Two hundred and twenty-five children with CP ages between 2 and 18 (mean age 6.5 ± 4.4) years included using the Surveillance of CP in Europe (SCPE) database in Turkey. Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS) and Eating and Drinking Classification System (EDACS) levels were classified by clinical observation, and intelligence quotient (IQ) was determined by parent reports.

RESULTS

Correlations were found between all functional levels; the strongest were between GMFCS-MACS (r = 0.784, p < .001), CFCS-EDACS (r = 0.772, p < .001). Strong correlations were found for the IQ-CFCS (r = 0.762, p < .001) and IQ-EDACS (r = 0.634, p < .001). Correlations were stronger in children with bilateral CP and IQ level <70.

CONCLUSIONS

Taken together, these four classification systems and reported IQ levels can adequately describe overall functioning for children with CP. Our results can guide clinicians in the rehabilitation of children with CP.

Epidemiology of Cerebral Palsy among Children and Adolescents in Arabic-Speaking Countries: A Systematic Review and Meta-Analysis

BACKGROUND

Studies on cerebral palsy among children and adolescents in Arabic-speaking countries are scarce. In this systematic review, we aimed to describe the epidemiology of cerebral palsy among children and adolescents in Arabic-speaking countries in terms of prevalence, risk factors, motor types, and rehabilitation.

METHODS

Six key bibliographic databases were searched for relevant literature published to 17 July 2021. Titles and abstracts were screened for potential inclusion and two independent reviewers screened the full texts of potential articles following pre-defined inclusion/exclusion criteria. The included studies were evaluated independently by three reviewers. The risk of bias was assessed, and data were extracted and analysed.

RESULTS

A total of 32 studies from 7 countries met our inclusion criteria. The prevalence of cerebral palsy in Arabic-speaking countries was 1.8/1000 live births (95% CI: 1.2-2.5). Spastic cerebral palsy was the most common motor type, representing 59.8% (95% CI: 46.2-72.7) of pooled estimates. This included children with spastic quadriplegia, diplegia, and hemiplegia; 25.1% (95% CI: 18.2-32.8), 16.2% (95% CI: 11.4-23.3), and 10.4% (95% CI: 7.3-13.8), respectively. Consanguinity was high and represented 37.7% (95% CI: 29.3-46.6). Only one included study reported the types of rehabilitation received (e.g., physiotherapy and assistance devices).

CONCLUSIONS

This paper provides a summary of the epidemiology of cerebral palsy in Arabic-speaking countries and highlights areas for future research. There is still a substantial knowledge gap on the epidemiology of cerebral palsy in these regions. Countries in the Arab region should follow examples of countries that have successfully established cerebral palsy registries to generate evidence on epidemiology of cerebral palsy and opportunities for prevention.

Frequência de comorbidades em crianças com paralisia cerebral de diferentes níveis de função motora grossa

ResumoIntrodução: A paralisia cerebral (PC) é uma desordem predominantemente motora, no entanto, pode estar associada a outras disfunções, que também impactam a funcionalidade das crianças. Objetivo: Documentar a frequência das comorbidades em crianças com PC nos diferentes níveis do Sistema de Classificação da Função Motora Grossa (GMFCS). Métodos: Estudo observacional, descritivo, de corte transversal. Foram coletados dados de 70 crianças com diagnóstico de PC, que recebiam tratamento fisioterapêutico em Belo Horizonte e na região metropolitana, por meio de entrevistas, e realizada análise descritiva e quantitativa. Resultados: As comorbidades mais frequentes foram as limitações do uso das mãos e dos braços, deficiências de continência urinária e fecal, deficiências da voz e da fala, deficiências de comportamento limitação para andar e epilepsia. Um número maior de comorbidades foi encontrado em crianças com maior comprometimento da função motora grossa. Conclusão: Profissionais da saúde devem observar com atenção a ocorrência das comorbidades na PC, proporcionando intervenções para preveni-las ou tratá-las, melhorando a funcionalidade desses indivíduos.