Reliability of the Pediatric Evaluation of Disability Inventory (PEDI)

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.

Efficacy of integrating a semi-immersive virtual device in the HABIT-ILE intervention for children with unilateral cerebral palsy: a non-inferiority randomized controlled trial

BACKGROUND

The implementation of virtual devices can facilitate the role of therapists (e.g., patient motivation, intensity of practice) to improve the effectiveness of treatment for children with cerebral palsy. Among existing therapeutic devices, none has been specifically designed to promote the application of principles underlying evidence-based motor skill learning interventions. Consequently, evidence is lacking regarding the effectiveness of virtual-based sessions in motor function rehabilitation with respect to promoting the transfer of motor improvements into daily life activities. We tested the effectiveness of implementing a recently developed virtual device (REAtouch®), specifically designed to enable the application of therapeutic motor skill learning principles, during a Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention.

METHODS

Forty children with unilateral cerebral palsy (5-18 years; MACS I-III; GMFCS I-II) were randomly assigned to a control group or a "REAtouch®" experimental group for a 90-h HABIT-ILE day-camp intervention (two weeks). Children in the REAtouch® group spent nearly half of their one-on-one therapeutic time using the REAtouch®. Participants underwent three testing sessions: the week before (T1), after intervention (T2), and at three months follow-up (T3). The primary outcome was the Assisting Hand Assessment (T3-T1; blinded). Secondary outcomes measured uni-bimanual hand function, stereognosis, gait endurance, daily life abilities, and functional goals. Accelerometers and a manual report of daily activities served to document therapeutic dosage and treatment characteristics. We used one-way RMANOVA to compare the efficacies of the two interventions, and non-inferiority analyses to contrast changes in the "REAtouch®" group versus the "HABIT-ILE" control group.

RESULTS

We found significant improvements in both groups for most of the outcome measures (p < 0.05). There was significant non-inferiority of changes in the REAtouch® group for upper extremities motor function, functional goals attainment, and abilities in daily life activities (p < 0.05).

CONCLUSIONS

Use of the REAtouch® device during HABIT-ILE showed non-inferior efficacy compared to the conventional evidence-based HABIT-ILE intervention in children with unilateral cerebral palsy. This study demonstrates the feasibility of using this virtual device in a high dosage camp model, and establishes the possibility of applying the therapeutic principles of motor skill learning during specifically designed virtual-based sessions.

TRIAL REGISTRATION

Trial registration number: NCT03930836-Registration date on the International Clinical Trials Registry Platform (ICTRP): June 21th, 2018; Registration date on NIH Clinical Trials Registry: April 29th, 2019. First patient enrollment: July 3rd, 2018.

Use of Goal Attainment Scaling to Measure Educational and Rehabilitation Improvements in Children with Multiple Disabilities

With a focus on children with multiple disabilities (CMD), the purpose of this quality improvement project was to elevate educational measurement and practices involving CMD. Using the goal attainment scaling (GAS) methodology, this project was conducted within a public charter school, Pattison's Academy for Comprehensive Education (PACE), focusing on 31 CMD and measuring student improvement and program effectiveness. For 2010-2011 and 2011-2012, improvements were demonstrated for the majority of CMD by meeting or exceeding their goals. Goal attainment scaling was able to capture improvement in educational and rehabilitation goals in the majority of CMD. Goal attainment scaling can provide an indication of a program's effectiveness. The use of GAS in CMD has potential to maximize participation across the school setting where all children in the United States commonly develop and learn skills as well as find meaning.

Combining Unimanual and Bimanual Therapies for Children with Hemiparesis: Is There an Optimal Delivery Schedule?

Constraint-induced movement therapy (CIMT) and bimanual therapy (BT) are among the most effective hand therapies for children with unilateral cerebral palsy (uCP). Since they train different aspects of hand use, they likely have synergistic effects. The aim of this study was to examine the efficacy of different combinations of mCIMT and BT in an intensive occupational therapy program for children with uCP. Children (n = 35) participated in intensive modified CIMT (mCIMT) and BT, 6 weeks, 5 days/week, 6 h/day. During the first 2 weeks, children wore a mitt over the less-affected hand and engaged in functional and play activities with the affected hand. Starting in week 3, bimanual play and functional activities were added progressively, 1 hour/week. This intervention was compared to two different schedules of block interventions: (1) 3 weeks of mCIMT followed by 3 weeks of BT, and (2) 3 weeks of BT followed by 3 weeks of mCIMT. Hand function was tested before, after, and two months after therapy with the Assisting Hand Assessment (AHA), Pediatric Evaluation of Disability Inventory (PEDI), and Canadian Occupational Performance Measure (COPM). All three groups of children improved in functional independence (PEDI; p < 0.031), goal performance (COPM Performance; p < 0.0001) and satisfaction (COPM Satisfaction; p < 0.0001), which persisted two months post-intervention. All groups showed similar amounts of improvement, indicating that the delivery schedule for mCIMT and BT does not significantly impact the outcomes.

Association of activities of daily living and cognitive function with thickness of the upper extremity muscles in children and adults with cerebral palsy

PURPOSE

We examined the association of activities of daily living (ADL) and cognitive function with the upper extremity muscle thickness and upper extremity range of motion (ROM) and spasticity in children and adults with cerebral palsy (CP).

METHODS

The subjects were 20 children and adults with CP. The ADL performed using the upper extremities and cognitive function were assessed using the self-care domain of the Pediatric Evaluation of Disability Inventory (PEDI) and the full-scale intelligence quotient (FSIQ) of the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV), respectively. The WISC-IV was assessed in only seven of 20 subjects able to undergo evaluation. The thickness of the upper extremity muscles was measured using an ultrasound imaging device. Moreover, ROM and spasticity of the upper extremities were assessed using the Modified Ashworth Scale (MAS). Manual manipulation ability was also assessed using the Manual Ability Classification System (MACS).

RESULTS

Stepwise regression analysis revealed that the extensor digitorum muscle thickness and MACS level were significant and independent factors of self-care in the PEDI. Partial correlation analysis with MACS level and age as control variables showed that the FSIQ of the WISC-IV was significantly associated with the thickness of the anterior fibers of the deltoid and flexor digitorum superficialis muscles.

CONCLUSION

Reduced ADL performed using the upper extremities is associated with decreased extensor digitorum muscle thickness rather than ROM and spasticity of the upper extremities in children and adults with CP.

Hypoxic-Ischemic Encephalopathy: Changing Outcomes Across the Spectrum

Neonatal hypoxic-ischemic encephalopathy (HIE) is a leading cause of death and neurodevelopmental impairment in neonates. Therapeutic hypothermia (TH) is the only established effective therapy and randomized trials affirm that TH reduces death and disability in moderate-to-severe HIE. Traditionally, infants with mild HIE were excluded from these trials due to the perceived low risk for impairment. Recently, multiple studies suggest that infants with untreated mild HIE may be at significant risk of abnormal neurodevelopmental outcomes. This review will focus on the changing landscape of TH, the spectrum of HIE presentations and their neurodevelopmental outcomes.

andomised to early neuroprotection and neurorehabilitation: protocol for a follow-up study of participants from four randomised clinical trials

INTRODUCTION

School readiness includes cognitive, socio-emotional, language and physical growth and development domains which share strong associations with life-course opportunities. Children with cerebral palsy (CP) are at increased risk of poor school readiness compared with their typically developing peers. Recently, earlier diagnosis of CP has allowed interventions to commence sooner, harnessing neuroplasticity. First, we hypothesise that early referral to intervention for children at-risk of CP will lead to improved school readiness at 4-6 years relative to placebo or care as usual. Second, we hypothesise that receipt of early diagnosis and early intervention will lead to cost-savings in the form of reduced healthcare utilisation.

METHODS AND ANALYSIS

Infants identified as at-risk of CP ≤6 months corrected age (n=425) recruited to four randomised trials of neuroprotectants (n=1), early neurorehabilitation (n=2) or early parenting support (n=1) will be re-recruited to one overarching follow-up study at age 4-6 years 3 months. A comprehensive battery of standardised assessments and questionnaires will be administered to assess all domains of school readiness and associated risk factors. Participants will be compared with a historical control group of children (n=245) who were diagnosed with CP in their second year of life. Mixed-effects regression models will be used to compare school readiness outcomes between those referred for early intervention versus placebo/care-as-usual. We will also compare health-resource use associated with early diagnosis and intervention versus later diagnosis and intervention.

ETHICS AND DISSEMINATION

The Children's Health Queensland Hospital and Health Service, The University of Queensland, University of Sydney, Monash University and Curtin University Human Research Ethics Committees have approved this study. Informed consent will be sought from the parent or legal guardian of every child invited to participate. Results will be disseminated in peer-reviewed journals, scientific conferences and professional organisations, and to people with lived experience of CP and their families.

TRIAL REGISTRATION NUMBER

ACTRN12621001253897.

Association of gross motor function and activities of daily living with muscle mass of the trunk and lower extremity muscles, range of motion, and spasticity in children and adults with cerebral palsy

PURPOSE

We examined the association of gross motor function and activities of daily living (ADL) with muscle mass of the trunk and lower extremity muscles in children and adults with cerebral palsy (CP).

METHODS

The subjects were 32 children and adults with CP. Muscle thickness of the trunk and lower extremity muscles was measured using an ultrasound imaging device.

RESULTS

Stepwise regression analysis revealed that the thoracic erector spinae muscle thickness was a significant and independent factor of gross motor function. Stepwise regression analysis also showed that the thickness of the rectus abdominis and vastus lateralis muscles were significant and independent factors of ADL.

CONCLUSIONS

Our findings suggest that declined gross motor function is associated with decreased thoracic erector spinae muscle mass in children and adults with CP. The results also indicate that declined ADL is associated with decreased muscle mass of the rectus abdominis and vastus lateralis muscles.

Effect of Longitudinal Practice in Real and Virtual Environments on Motor Performance, Physical Activity and Enjoyment in People with Autism Spectrum Disorder: A Prospective Randomized Crossover Controlled Trial

(1) Background: People with ASD commonly present difficulty performing motor skills and a decline in physical activity (PA) level and low enjoyment of PA. We aimed to evaluate whether longitudinal practice of an activity in virtual and real environments improves motor performance and whether this improvement is transferred to a subsequent practice when changing the environment, promoting PA and providing enjoyment; (2) Methods: People with ASD, aged between 10 and 16 years, were included and distributed randomly into two opposite sequences. The participants performed a 10 session protocol, with five sessions practicing in each environment (virtual or real). Heart rate measurement was carried out and an enjoyment scale was applied; (3) Results: 22 participants concluded the protocol. Sequence A (virtual first) presented an improvement in accuracy and precision and transferred this when changing environment; they also had a greater change in heart rate reserve. The majority of participants reported "fun" and "great fun" levels for enjoyment; (4) Conclusions: The virtual reality activity presented a higher level of difficulty, with greater gains in terms of transference to the real environment. Considering PA, our task provided very light to light activity and the majority of participants enjoyed the task.

Comparison of the Upper and Lower Extremity and Trunk Muscle Masses between Children with Down Syndrome and Children with Typical Development

PURPOSE

Comparison of not only the upper and lower extremity but also trunk muscle masses measured by means of an ultrasound imaging device between children with Down syndrome (DS) and children with typical development (TD).

METHODS

The study included 35 children with TD (TD group) and 26 children with DS (DS group). The upper and lower extremity and trunk muscle thicknesses were measured using an ultrasound imaging device.

RESULTS

The thicknesses of the rectus abdominis, obliquus externus and internus abdominis, rectus femoris, and short head of the biceps femoris muscles were significantly lower in the DS group than in the TD group. The thicknesses of the other upper and lower extremity and trunk muscles did not differ significantly between the groups.

CONCLUSIONS

The results of this study demonstrated lower masses of trunk flexor and knee extensor and flexor muscles in children with DS compared to those in children with TD.

Rehabilitation Including Structured Active Play for Preschoolers With Cancer (RePlay)-Study Protocol for a Randomized Controlled Trial

BACKGROUND

Children diagnosed with cancer experience muscle weakness and impaired physical function caused by treatment and related immobility. The situation forces them into a negative cycle of diminished participation in physical and leisure activities and isolation from peers; inhibiting the natural development of social and gross motor skills. This manuscript presents a protocol for a study that explores the effects of using structured active play to maintain preschoolers' age specific gross motor function and social and personal skills while undertaking intensive cancer treatment.

METHODS

The study is a two-arm, superiority randomized controlled trial with an intervention and a control group designed to evaluate the effects of a structured active play intervention on gross motor function. Gross motor subtests of the Peabody Developmental Motor Scales, Second Edition (PDMS-2) are used for measurement; with the primary end-point at 6 months post-treatment initiation. Eighty-four preschool children (aged 1-5 years), newly diagnosed with cancer at the Copenhagen University Hospital are randomly assigned to either an intervention or control group, using a 1:1 allocation. The intervention group receives a combined in-hospital and home-based program that includes structured active play activities, while the control group receives standard care, including physiotherapy. During hospital admission, the intervention group undertakes 45-min structured active play group sessions three times weekly, conducted by exercise professionals. Parents receive training and supervision to facilitate daily individual sessions outside of group sessions. Secondary study outcomes target the children's overall function level in everyday life, general physical performance, and health-related quality of life. As well, children's and parents' experiences within the intervention are explored and the children's social and personal development is observed.

DISCUSSION

Limited evidence exists regarding the effectiveness of rehabilitation interventions, particularly those including active play, for preschoolers diagnosed with cancer. This manuscript reporting on a study protocol will enhance clarity and transparency in reporting and offer insights for others with interest in this same topic. Once completed, findings from this study could extend knowledge about the conduct and measurement of effectiveness in rehabilitation initiatives. If study findings suggest that the intervention is effective, structured active play may become a standard part of rehabilitation.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04672681. Registered December 17, 2020. https://clinicaltrials.gov/ct2/show/NCT04672681.

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.

Combined effect of hydrotherapy and transcranial direct-current stimulation on children with cerebral palsy: A protocol for a randomized controlled trial

BACKGROUND

Cerebral palsy (CP) is a neurodevelopmental disorder caused by a brain injury resulting in poor coordination and motor control deficits, which is one of the most common physical disabilities in children. CP brings a heavy burden on families and society and becomes a significant public health issue. In recent years, hydrotherapy, and transcranial direct current stimulation (tDCS) as a physical therapy for CP is developing rapidly. When hydrotherapy and tDCS are used to treat separately, it has positive therapeutic effect in children with CP. The development of new therapies in combination with physical rehabilitation approaches is critical to optimize functional outcomes. tDCS has attracted interest in this context, because of significant functional improvements have been demonstrated in individuals with brain injuries after a short period of cerebral stimulation. Since the onset of this work, tDCS has been used in combination with constraint-induced therapy, virtual reality therapy to potentiate the treatment effect. Up to now, there are no studies on the effect of a combined application of hydrotherapy and tDCS in children with CP. We will conduct a 2-arm parallel clinical trial to investigate the effect of a combined application of tDCS and hydrotherapy.

METHODS AND ANALYSIS

This study is an outcome assessor and data analyst-blinded, randomized, controlled superiority trial during the period from October 2021 to December 2023. CP patients meeting the inclusion criteria will be allocated in a 1:1 ratio into the treatment group (hydrotherapy plus tDCS), or the control group (treatment as usual). All participants will receive 30 sessions of treatment over 10 weeks. The primary outcomes will be the difference in the Gross Motor Function Assessment and Pediatric Balance Scale during rest and activity. The secondary outcomes will be the difference in adverse effects between the control and treatment groups.

CONCLUSIONS

This study aims to estimate the efficacy of a combined application of tDCS and hydrotherapy in patients with CP.

TRIAL REGISTRATION

This study protocol was registered in Chinese ClinicalTrials.gov, ID: ChiCTR2100047946.

Association of sagittal spinal alignment in the sitting position with the trunk and lower extremity muscle masses in children and adults with cerebral palsy: A pilot study

BACKGROUND

We examined the association of sagittal spinal alignment in the sitting position with the trunk and lower extremity muscle masses in children and adults with cerebral palsy (CP). We also compared muscle masses between children and adults with CP who could and could not sit without the support of their upper extremities.

METHODS

The subjects were 34 children and adults with CP. Sagittal spinal alignment in the sitting position, such as thoracic kyphosis, lumbar lordosis, and sacral anterior inclination angles were measured using a Spinal Mouse. The thicknesses of the trunk and lower extremity muscles were measured using an ultrasound imaging device. Furthermore, the subjects were classified into the sitting-possible group (n = 18), who could sit without the support of the upper extremities, or a sitting-impossible group (n = 16), who could not sit without the support of the upper extremities.

FINDINGS

Stepwise regression analysis revealed that the lumbar multifidus muscle thickness and body weight were significant and independent factors of the lumbar lordosis angle in the sitting position. The thicknesses of the thoracic erector spinae, gluteus maximus and minimus, long head of the biceps femoris, semitendinosus, and rectus femoris muscles were significantly lower in the sitting-impossible group than those in the sitting-possible group.

INTERPRETATION

Decreased lumbar lordosis angle in the sitting position was associated with decreased lumbar multifidus muscle mass in children and adults with CP. Furthermore, not only trunk extensor but also hip joint muscles may contribute to sitting without upper extremity support.

One-year follow-up of problem-based task training for a child presenting cerebellar ataxia after brainstem glioma surgery: A single-subject experimental study

BACKGROUND AND PURPOSE

For the rehabilitation of patients with cerebellar ataxia, task training aids in achieving functional benefits. This study aimed to investigate the effects of problem-based task training on balance and motor function in a child with cerebellar ataxia after brainstem glioma surgery.

METHODS

This study used a single-subject reversal design (A-B) with a 1-year follow-up. A 5-year old child with cerebellar ataxia due to a brain glioma completed problem-based task training, including a 10-step walk and return trial, walking while carrying an object, walking between parallel lines, and kicking a ball. Assessments were made using the Pediatric Balance Scale (PBS) and motor function tests (International Cooperative Ataxia Rating Scale (ICARS), Gross Motor Function Measure (GMFM), and Pediatric Evaluation of Disability Inventory (PEDI).

RESULTS

During the intervention phase, the PBS score showed clinically and statistically significant improvement compared to the baseline score. The ICARS and GMFM scores improved by 10.53% and 3.56%, respectively, after the intervention. Furthermore, in the PEDI score, functional skills and caregiver assistance in the mobility domain increased by 7.58% and 5.02%, respectively, after the intervention. The improvements in all parameters were maintained or increased at further follow-up phases.

CONCLUSION

These findings suggest that problem-based task training has a positive effect on balance and motor function in a child with cerebellar ataxia after brainstem glioma surgery.

Effects of Virtual Reality-Based Rehabilitation on Upper Extremity Function among Children with Cerebral Palsy

Background: Deterioration in upper extremity function has been a common problem among children with cerebral palsy (CP). The present study evaluated the effects of virtual reality (VR)-based rehabilitation combined with conventional occupational therapy (COT) on upper extremity function and caregiver assistance among children with CP. Methods: Medical records of 17 children with CP who regularly participated in a rehabilitation program at Samsung Changwon Hospital were retrospectively reviewed. Ten children received VR-based rehabilitation, which utilized RAPAEL Smart Kids and video games combined with COT. Seven children received COT alone, which was provided by a trained occupational therapist and focused on their upper extremities. Clinical outcomes were determined using the Quality of Upper Extremity Skills Test (QUEST) and Pediatric Evaluation of Disability Inventory (PEDI), which were administered before and 8 weeks after the first intervention session. Results: The smart glove (SG) group showed significant improvements in all QUEST domains and five PEDI domains (p < 0.05), whereas the COT group showed a significant change only in total QUEST scores. A comparison between both groups revealed that the SG group had significantly greater improvements in five QUEST domains and two PEDI domains (p < 0.05). Conclusions: Our results suggest that VR-based rehabilitation combined with COT may improve the upper extremity functions and decrease caregiver burden among children with CP.

Does well-functioning hand constraint induce stress in forced-use therapy for children with unilateral cerebral palsy?

This study investigated the stress induced by well-functioning hand constraint in forced-use therapy (FUT) for children with unilateral spastic cerebral palsy (CP).Seventeen children with unilateral spastic CP (mean age 5.8 years) received FUT: 4-week unaffected upper limb immobilization with a short-arm Scotchcast and were encouraged to incorporate it to their daily routines and plays. They were evaluated at pretreatment, immediate post-treatment, and 6 months post-treatment. The Korea-Child Behavior Checklist (K-CBCL) was used to assess the stress degree; box and block test (BBT), Erhardt Developmental Prehension Assessment (EDPA), Quality of Upper Extremity Skill Test (QUEST), and Pediatric Motor Activity Log (PMAL), upper limb function; and Pediatric Evaluation of Disability Inventory (PEDI), daily living activities.In the preschoolers, most scores of K-CBCL tended to increase after FUT; however, there was no significant change in all scale findings after FUT. In the school-aged children, most scores of K-CBCL tended to decrease after FUT; however, there was no significant change in all scale findings after FUT. The findings of the BBT, QUEST, PMAL how often and well subscales significantly improved post-treatment (P < .05).The 4-week FUT with well-functioning hand constraint significantly improved the UL function and did not induce emotional and behavioral problems in children with unilateral spastic CP.

An Assessment of the Movement and Function of Children with Specific Learning Disabilities: A Review of Five Standardised Assessment Tools

Various standardised assessment tools have been used to evaluate children with disabilities. However, assessment tools that provide information on the movement and function of children with specific learning disabilities (SLD) are still limited. This article provides a narrative review of the characteristics of five movement and/or function assessment tools. The strengths and limitations of the tools will be highlighted. Empirical studies on the assessment tools used are reviewed based on three criteria: (i) standardised tools; (ii) assessment of movement and/or function; (iii) applicability to children with SLD ranging from 4-17 years of age and widely used in practice. The following instruments have been included as they have been found to fulfil the criteria: (i) the Bruininks-Oseretsky test of motor proficiency-2 (BOT-2); (ii) the movement assessment battery for children-2 (MABC-2); (iii) the pediatric balance scale (PBS); (iv) the Vineland adaptive behaviour scale-II (VABS-II) and (v) the pediatric evaluation of disability inventory-computerised adaptive test (PEDI-CAT). The article presents the characteristics, strengths and limitations of five standardised assessment tools that are currently in use, which measure the movement and/or function of children with SLD. This article concludes with a discussion of recommendations for the best approaches to evaluating the movement and functional abilities of children with SLD.

Physical Therapy Intervention for a Child With Congenital Zika Virus Syndrome: A Case Report

No studies have described physical therapy treatment for children with congenital Zika virus syndrome. In this case report, the authors aimed to improve postural control, mobility, and social skills in a 17- to 18-month-old child with congenital Zika virus syndrome through a period of 6-week home-based, intensive physical therapy intervention. Outcome measures were the Posture and Postural Ability Scale, Pediatric Evaluation of Disability Inventory, and Caregiver Priorities and Child Health Index of Life With Disabilities. From pre- to postintervention, the child's Posture and Postural Ability Scale scores increased for level of postural ability in the prone position and postural alignment in all 4 positions (prone, supine, sitting, and standing). The authors saw an overall improvement in mobility and social skills from preintervention to follow-up 3 weeks after intervention. In conclusion, postural control, mobility, and social skills improved for a child with congenital Zika virus syndrome after physical therapy intervention, but future studies are required to confirm these findings.

Effect of Group-Task-Oriented Training on Gross and Fine Motor Function, and Activities of Daily Living in Children with Spastic Cerebral Palsy

Aims: To determine the effects of group-task-oriented training (group-TOT) on gross and fine motor function, activities of daily living (ADL) and social function of children with spastic cerebral palsy (CP).Methods: Eighteen children with spastic CP (4-7.5 years, gross motor function classification system level I-III) were randomly assigned to the Group-TOT (9 children received group-TOT for 1 hour, twice a week for 8 weeks) or the comparison group (9 children received individualized traditional physical and occupational therapy). The Gross Motor Function Measure (GMFM)-88, the Bruininks-Oseretsky Test of Motor Proficiency 2^nd edition (BOT-2), and the Pediatric Evaluation of Disability Inventory (PEDI) were administered before and after the intervention, and in the Group-TOT, 16 weeks after the intervention.Results: Children in the Group-TOT showed significant improvements in the GMFM-88 standing and walking/running/jumping subscales, the BOT-2 manual dexterity subscale, and the PEDI social function subscale (p < 0.05); changes were maintained 16 weeks after the intervention ended. In contrast, the comparison group improved in only the BOT-2 fine motor integration subscale (p < 0.05).Conclusions: The findings provide evidence of effectiveness of group-TOT in improving gross and fine motor function, and social function in children with CP.

Administration of the German Pediatric Evaluation of Disability Inventory (PEDI-G) Using the Mode of Observation in Children Undergoing Inpatient Rehabilitation: A Reliability and Validity Study

Aims: To investigate inter-rater reliability, concurrent validity, and feasibility of the German Pediatric Evaluation of Disability Inventory (PEDI-G) using the mode of observation in a Swiss inpatient rehabilitation setting with the Functional Independence Measure for Children (WeeFIM®) as criterion.Methods: Cross-sectional clinimetric study including 36 children and adolescents with median age 10.8 (quartiles 8.7, 13.0) years with neurological/neuro-orthopedic disorders. Data were collected by healthcare professionals through observation. Analyses were performed using intraclass correlation coefficients (ICC_2,1), standard error of measurement (SEM_Agreement), Bland-Altman plots, Cohen's Kappa κ, percentage agreement, and correlations.Results: Excellent inter-rater reliability (ICCs_2,1 ≥ 0.97), small SEMs and acceptable limits of agreement for the Functional Skills Scale (FSS) and Caregiver Assistance Scale (CAS) were found. No systematic differences between raters existed. Cohen's Kappa for inter-rater agreement of the Modifications Scale (MS) ranged from poor to strong (-0.06 ≤ κ ≤0.85). Excellent concurrent validity for FSS and CAS with the WeeFIM^® (ρ  ≥ 0.96), and excellent correlations of FSS and CAS with each other (ρ  ≥ 0.98) were identified.Conclusion: The German PEDI-G seems to be a reliable and valid, but time-consuming tool when applied in an inpatient setting using observation.

Psychometric properties of the German Version of the Pediatric Evaluation of Disability Inventory (PEDI-G): A factor analysis

BACKGROUND

Activities of daily living (ADL) are crucial for children because they enable them to participate in everyday life. For the evaluation of children`s ADL performance, health professionals such as occupational therapists use standardized ADL assessments. To implement assessments into practice it is important that the score generated from an assessment can be viewed as a unidimensional measure.

AIM

To investigate the factor structure of the German Pediatric Evaluation of Disability Inventory (PEDI-G) in a sample of typically developing children and children with an impairment.

MATERIAL AND METHODS

An exploratory factor analysis (EFA) with factor rotation was performed to assess the factor structure for the PEDI-G domains (self-care, mobility and social function) of the Functional Skills Scale and the Caregiver Assistance Scale.

RESULTS

262 children (118 (45%) girls and 144 (55%) boys) participated in this study. Their mean age (SD) was 4 years (SD 1.91). Results suggest that the PEDI domains of the Functional Skills Scale and the Caregivers Assistance Scale can be used as unidimensional measures to evaluate child`s ability to perform activities of daily living.

CONCLUSION

The results of this study support the use of the PEDI-G for research and practice in Austria, Germany and Switzerland.

Scoring, Clinical Utility, and Psychometric Properties of the In-Home Medication Management Performance Evaluation (HOME-Rx)

IMPORTANCE

Forty percent to 75% of community-dwelling older adults are not able to adhere to their medication routine. A medication management assessment can correctly identify the reasons for nonadherence and the barriers contributing to it.

OBJECTIVE

To further develop the HOME-Rx, an in-home medication management assessment, by modifying scoring metrics, improving clinical utility, and establishing psychometric properties.

DESIGN

In Phase 1, the scoring metrics were modified, and the clinical procedures were evaluated. In Phase 2, the psychometric properties were established.

SETTING

The homes of older adults.

PARTICIPANTS

Older adults who took three or more medications, managed their own medications, and lived in their own home were eligible. Older adults with cognitive impairment were ineligible.

OUTCOMES AND MEASURES

We assessed concurrent validity with the Performance Assessment for Self-Care Skills (PASS) and Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and established interrater reliability.

RESULTS

The PASS was positively correlated with the HOME-Rx Performance and Safety subscales; the MedMaIDE was negatively correlated with the HOME-Rx Performance subscale and positively correlated with the Barriers subscale. Interrater reliability was excellent (ICCs = .87-1.00).

CONCLUSIONS AND RELEVANCE

All relationships were as predicted: The HOME-Rx is a valid and reliable performance-based assessment that provides clinicians and researchers with a measure of older adults' actual medication management ability in the home using their medications. The results can potentially be used to guide treatment planning and improve medication management.

WHAT THIS ARTICLE ADDS

Occupational therapy practitioners can use the HOME-Rx to adequately determine performance problems, safety concerns, and environmental barriers and potentially to guide treatment planning and improve medication management for older adults.

Trunk control and functionality in children with spastic cerebral palsy

PURPOSE

To investigate the relationship between trunk control in sitting and functionality in children with spastic cerebral palsy (CP).

METHODS

Fifty-eight children with spastic CP were included in the study. Functional abilities were evaluated with the Gross Motor Function Measurement-88 (GMFM-88) and the Pediatric Evaluation of Disability Inventory Functional Skills domain (PEDI-FSD). Trunk control in sitting was tested with the Trunk Control Measurement Scale (TCMS) and the Trunk Impairment Scale (TIS). The scores of the TCMS and TIS were compared with GMFM-88 and PEDI-FSD with Spearman correlation analysis.

RESULTS

The total score of GMFM-88 was significantly correlated with the total score of TCMS (r_ho = 0.90, p < 0.01) and TIS (r_ho = 0.78, p < 0.01). The total score of PEDI-FSD was also significantly correlated with the total score of TCMS (r_ho = 0.76, p < 0.01) and TIS (r_ho = 0.72, p < 0.01).

CONCLUSIONS

The evaluation of trunk control can provide valuable information for functional abilities of children with spastic CP.

The long-term effects of conductive education courses in young children with cerebral palsy: a randomized controlled trial

PURPOSE

To assess the additional long-term effects of multiple conductive education (CE) courses followed by conventional practice on functional skills and quality of life in children with cerebral palsy (CP) compared to a 4-month CE-course delay including conventional practice.

METHODS

Twenty-one children with CP, 3-6 years and varied functional levels, were randomized to 3-week CE course(s) followed by conventional practice or 4 months on a waiting list, including conventional practice and followed by CE-courses. Outcomes were measured 8 and 12 months after baseline. A web-based log collected data on conventional practice.

RESULTS

We found no interaction between group assignment and time on functional skills and quality of life in children with CP at 8 and 12 months. Two thirds of the children in both groups performed a large amount of conventional practice.

CONCLUSIONS

No added long-term effects of CE courses were found. Larger controlled CE studies are needed.

Effects of a conductive education course in young children with cerebral palsy:A randomized controlled trial

PURPOSE

To evaluate the effects of a conductive education (CE) course followed by conventional practice, on gross motor function, other functional skills, quality of life, and parents' experiences of family-centered services in young children with cerebral palsy (CP).

METHODS

Twenty-one children with CP, 3-6 years old, were randomized to one 3-week CE course followed by conventional practice or conventional practice on a waiting list. Outcomes were measured 4 months after baseline. A web-based log collected data on the conventional practice.

RESULTS

No additional improvements in the children's outcome were found. However, parents in the CE group reported that they received more information than parents in the waiting list group (p = 0.01). Children in both groups performed high amount of conventional practice at home.

CONCLUSIONS

A 3-week CE course did not add any improvements in the children's functioning, possibly explained by the large amount of conventional practice reported of both groups.

Rehabilitation Management of the Patient With Duchenne Muscular Dystrophy

Steadily improving management of Duchenne muscular dystrophy (DMD) continues to lead to improved physical and functional status, allowing increasingly successful transitions to independence and self-actualization in adulthood. Rehabilitation principles remain key to overall management for individuals with DMD with increasing options for ever more successful management, reflecting a changing natural history based on the use of glucocorticoids, more consistent comprehensive care, and the emergence of disease-modifying treatments. Advances and expansion in assessment, cardiorespiratory management, preventive management of contracture and deformity, assistive technology, "smart" technology, and robotics with increased emphasis on function, participation, self-advocacy, and independence in decision-making should allow individuals with DMD to experience childhood and transition to adulthood with support that allows for increasing success in the achievement of individual goals and fulfillment across the life span.

The paediatric version of Wisconsin gait scale, adaptation for children with hemiplegic cerebral palsy: a prospective observational study

Background

In clinical practice there is a need for a specific scale enabling detailed and multifactorial assessment of gait in children with spastic hemiplegic cerebral palsy. The practical value of the present study is linked with the attempts to find a new, affordable, easy-to-use tool for gait assessment in children with spastic hemiplegic cerebral palsy. The objective of the study is to evaluate the Wisconsin Gait Scale (WGS) in terms of its inter- and intra-rater reliability in observational assessment of walking in children with hemiplegic cerebral palsy.

Methods

The study was conducted in a group of 34 patients with hemiplegic cerebral palsy. At the first stage, the original version of the ordinal WGS was used. The WGS, consisting of four subscales, evaluates fourteen gait parameters which can be observed during consecutive gait phases. At the second stage, a modification was introduced in the kinematics description of the knee and weight shift, in relation to the original scale. The same video recordings were rescored using the new, paediatric version of the WGS. Three independent examiners performed the assessment twice. Inter and intra-observer reliability of the modified WGS were determined.

Results

The findings show very high inter- and intra-observer reliability of the modified WGS. This was reflected by a lack of systematically oriented differences between the repeated measurements, very high value of Spearman’s rank correlation coefficient 0.9 ≤ |R| < 1, very high value of ICC > 0.9, and low value of CV < 2.5% for the specific physical therapists.

Conclusions

The new, ordinal, paediatric version of WGS, proposed by the authors, seems to be useful as an additional tool that can be used in qualitative observational gait assessment of children with spastic hemiplegic cerebral palsy. Practical dimension of the study lies in the fact that it proposes a simple, easy-to-use tool for a global gait assessment in children with spastic hemiplegic cerebral palsy. However, further research is needed to validate the modified WGS by comparing it to other observational scales and objective 3-dimensional spatiotemporal and kinematic gait parameters.

Trial registration

anzctr.org.au, ID: ACTRN12617000436370. Registered 24 March 2017.

Incidence and prognostic factors of ataxia in children with posterior fossa tumors

Background

There is minimal literature specific to motor outcomes in children with posterior fossa tumors (PFTs) despite ataxia being a significant problem in this group. This study aims to report children's physical outcomes following management of PFT and determine which factors affect severity of ataxia and functional limitations.

Methods

Forty-two children aged between 5 and 17 and between 1 and 4 years following surgery for PFT were assessed using the Scale for the Assessment and Rating of Ataxia (SARA), the Brief Ataxia Rating Scale (BARS), and the mobility Pediatric Evaluation of Disability Inventory (PEDI) subscale to determine prevalence and severity of ataxia and a measure of physical function. Analysis was undertaken comparing impact of tumor location, tumor histology, adjuvant treatment, age at diagnosis, presence of preoperative ataxia, and presence of cerebellar mutism syndrome (CMS) on ataxia and physical function scores.

Results

Seventy-one percent of children demonstrated a SARA and BARS score greater than 2. A total of 48% of children had a PEDI-m score greater than 90. There was no correlation between age at diagnosis or preoperative ataxia and assessment scores. There was a significant difference in SARA/BARS and PEDI-mobility scores depending on tumor histology, tumor location, and presence of CMS.

Conclusions

A high proportion of children (>1 year) following surgery for PFT continue to present with ataxia. Higher ataxia and lower physical function scores were demonstrated in children with medulloblastoma and midline tumors and those diagnosed with CMS. The high prevalence of ataxia demonstrates the need for further research regarding rehabilitation management in this population.

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

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

Modified Ride-On Cars and Young Children with Disabilities: Effects of Combining Mobility and Social Training

BACKGROUND

Research has shown that the use of power mobility devices is safe and beneficial for motor and cognitive development in children with motor disabilities; nevertheless, strong evidence of the benefits for social skill development is limited. This study aimed to examine the effects of combining ride-on car training with an adult-directed, social interaction program in a hospital-based environment on mobility and social functions in young children with motor disabilities.

METHODS

This study used a prospective, nonequivalent pretest-posttest control group design. Twenty-nine young children with motor disabilities, aged between 1 and 3 years, were recruited from local hospitals in Taiwan. The treatment group (n = 15) underwent 2-h ride-on car training sessions twice per week for a total of 9 weeks in the hospital environment. The control group (n = 14) underwent a 9-week home education program (mean: 200 min/week) focusing on mobility and social skills training. The Chinese version of the Pediatric Evaluation of Disability Inventory, Parenting Stress Index, and Goal Attainment Scaling were administered to all participants before and after the intervention, and at the end of the 9-week follow-up phase.

RESULTS

Mobility and social functions significantly improved in both groups after the 9-week intervention, but this improvement was not maintained at the follow-up phase. The treatment group showed significantly better improvement in social function, parenting stress levels, and goal achievement than the control group at posttest.

CONCLUSION

This two-group design study showed the benefits of combining a ride-on car use with a family-centered, structured, social interaction program for positive impacts on mobility, social function, and parenting stress levels. The combination of a modified ride-on car and a social training program has the potential to enhance socialization in young children with motor disabilities.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, identifier NCT02527499.

Including a Lower-Extremity Component during Hand-Arm Bimanual Intensive Training does not Attenuate Improvements of the Upper Extremities: A Retrospective Study of Randomized Trials

Hand-Arm Bimanual Intensive Therapy (HABIT) promotes hand function using intensive practice of bimanual functional and play tasks. This intervention has shown to be efficacious to improve upper-extremity (UE) function in children with unilateral spastic cerebral palsy (USCP). In addition to UE function deficits, lower-extremity (LE) function and UE-LE coordination are also impaired in children with USCP. Recently, a new intervention has been introduced in which the LE is simultaneously engaged during HABIT (Hand-Arm Bimanual Intensive Therapy Including Lower Extremities; HABIT-ILE). Positive effects of this therapy have been demonstrated for both the UE and LE function in children with USCP. However, it is unknown whether the addition of this constant LE component during a bimanual intensive therapy attenuates UE improvements observed in children with USCP. This retrospective study, based on multiple randomized protocols, aims to compare the UE function improvements in children with USCP after HABIT or HABIT-ILE. This study included 86 children with USCP who received 90 h of either HABIT (n = 42) or HABIT-ILE (n = 44) as participants in previous studies. Children were assessed before, after, and 4-6 months after intervention. Primary outcomes were the ABILHAND-Kids and the Assisting Hand Assessment. Secondary measures included the Jebsen-Taylor Test of Hand Function, the Pediatric Evaluation of Disability Inventory [(PEDI); only the self-care functional ability domain] and the Canadian Occupational Performance Measure (COPM). Data analysis was performed using two-way repeated-measures analysis of variance with repeated measures on test sessions. Both groups showed similar, significant improvements for all tests (test session effect p < 0.001; group × test session interaction p > 0.05) except the PEDI and COPM. Larger improvements on these tests were found for the HABIT-ILE group (test session effect p < 0.001; group × test session interaction p < 0.05). These larger improvements may be explained by the constant simultaneous UE-LE engagement observed during the HABIT-ILE intervention since many daily living activities included in the PEDI and the COPM goals involve the LE and, more specifically, UE-LE coordination. We conclude that UE improvements in children with USCP are not attenuated by simultaneous UE-LE engagement during intensive intervention. In addition, systematic LE engagement during bimanual intensive intervention (HABIT-ILE) leads to larger functional improvements in activities of daily living involving the LE.

Mini-MACS: development of the Manual Ability Classification System for children younger than 4 years of age with signs of cerebral palsy

AIM

To develop the Mini-Manual Ability Classification System (Mini-MACS) and to evaluate the extent to which its ratings are valid and reliable when children younger than 4 years are rated by their parents and therapists.

METHOD

The Mini-MACS was created by making adjustments to the MACS. The development involved a pilot project, consensus discussions within an expert group, and the creation of a test version of the Mini-MACS that was evaluated for content validity and interrater reliability. A convenience sample of 61 children with signs of cerebral palsy aged 12 to 51 months (mean age 30.2mo [SD 10.1]) were classified by one parent and two occupational therapists across a total of 64 assessments. Agreement between the parents' and therapists' ratings was evaluated using the intraclass correlation coefficient (ICC) and the percentage of agreement.

RESULTS

The first sentence of the five levels in the MACS was kept, but other descriptions within the Mini-MACS were adjusted to be more relevant for the younger age group. The ICC between parents and therapists was 0.90 (95% confidence interval [CI] 0.79-0.92), and for the two therapists it was 0.97 (95% CI 0.78-0.92). Most parents and therapists found the descriptions in the Mini-MACS suitable and easy to understand.

INTERPRETATION

The Mini-MACS seems applicable for children from 1 to 4 years of age.

Cross-cultural validity of the German version of the Pediatric Evaluation of Disability Inventory (PEDI-G)-a Rasch model application

AIM

The aim of this study was to evaluate the cross-cultural validity of the German version of the Pediatric Evaluation of Disability Inventory (PEDI-G) when used in Austria, Germany and Switzerland.

METHOD

A total of 118 girls and 144 boys participated in this study; 198 of the children (75.6%) had a developmental disability and 64 (24.4%) were without a known disability. The mean age was four years (range 11 months to 10 years and six months, SD 1.91). Item goodness of fit, differential item functioning (DIF) and differential test functioning (DTF) were evaluated by use of a Rasch model.

RESULTS

Twenty-four (11.6%) out of 206 items of the Functional Skills Scale and one (5%) out of 20 items of the Caregiver Assistance Scale demonstrated misfit according to the Rasch model. Thirty-four (16.5%) out of 206 items of the Functional Skills Scale and no item from the Caregiver Assistance Scale demonstrated DIF. Almost half (46%) of the items demonstrating misfit also demonstrated DIF, indicating an association between them. The DIF by country only demonstrated a minimal impact on the person measures of the PEDI-G.

INTERPRETATION

Even though some items did not meet the statistical and clinical criteria set, the PEDI-G can be used, on a preliminary basis as a valid tool to measure activities of daily living of children with and without a disability in these countries. Further larger studies are needed to evaluate more psychometric item properties of the PEDI-G in relation to context.

Does early communication mediate the relationship between motor ability and social function in children with cerebral palsy?

BACKGROUND

Children diagnosed with neurodevelopmental conditions such as cerebral palsy (CP) are at risk of experiencing restrictions in social activities negatively impacting their subsequent social functioning. Research has identified motor and communication ability as being unique determinants of social function capabilities in children with CP, to date, no research has investigated whether communication is a mediator of the relationship between motor ability and social functioning.

AIMS

To investigate whether early communication ability at 24 months corrected age (ca.) mediates the relationship between early motor ability at 24 months ca. and later social development at 60 months ca. in a cohort of children diagnosed with cerebral palsy (CP).

METHOD

A cohort of 71 children (43 male) diagnosed with CP (GMFCS I=24, 33.8%, II=9, 12.7%, III=12, 16.9%, IV=10, 14.1%, V=16, 22.5%) were assessed at 24 and 60 months ca. Assessments included the Gross Motor Function Measure (GMFM), the Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS-DP) Infant-Toddler Checklist and the Paediatric Evaluation of Disability Inventory (PEDI). A mediation model was examined using bootstrapping.

RESULTS

Early communication skills mediated the relationship between early motor abilities and later social functioning, b=0.24 (95% CI=0.08-0.43 and the mediation model was significant, F (2, 68)=32.77, p<0.001, R(2)=0.49.

CONCLUSIONS AND IMPLICATION

Early communication ability partially mediates the relationship between early motor ability and later social function in children with CP. This demonstrates the important role of early communication in ongoing social development. Early identification of communication delay and enriched language exposure is crucial in this population.

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.

Therapist-Designed Adaptive Riding in Children With Cerebral Palsy: Results of a Feasibility Study

BACKGROUND

It is debatable whether adaptive riding (AR) in children with cerebral palsy (CP) improves postural control and gross motor development.

OBJECTIVE

The study aim was to explore the feasibility of an extensive assessment protocol for a randomized controlled trial of therapist-designed adaptive riding (TDAR) in children with CP, with the goals of assessing the effect on child outcomes and evaluating working mechanisms of sitting postural control.

DESIGN

A pretest-posttest group design with 2 baseline measurements was used.

METHODS

Six children (1 girl, 5 boys; age range=6-12 years, median age=8 years 9 months) with bilateral spastic CP (Gross Motor Function Classification System level III) participated. Outcomes were evaluated 3 times (T0, T1, and T2) at 6-week intervals. T0 and T1 were baseline measurements; between T1 and T2, a TDAR intervention including an integrated program of postural challenge exercises (2 times per week for 1 hour) was applied. The complex protocol included the 88-item Gross Motor Function Measure (GMFM-88) and electromyographic (EMG) recording of postural muscle activity during reaching while sitting (EMG recording at T1 and T2 only).

RESULTS

The protocol was feasible. Median GMFM-88 scores changed from 64.4 at T0 to 66.7 at T1 and from 66.7 at T1 to 73.2 at T2. The change scores for all children exceeded the minimal clinically important difference of the GMFM-88. Five of 6 children showed a decrease in stereotyped top-down recruitment between T1 and T2.

LIMITATIONS

Study limitations included the lack of a control group, small sample size, and potential assessor bias for all but the EMG parameters.

CONCLUSIONS

The feasibility of the complex protocol was established. The data suggested that a 6-week TDAR intervention may improve gross motor function and may reduce stereotyped postural adjustments in children with CP. The limited results warrant replication in a well-powered randomized controlled trial.

Inter-Rater and Test-Retest Reliability of the German Pediatric Evaluation of Disability Inventory (PEDI-G)

ABSTRACT Activities of daily living (ADL) of children are widely assessed with the Pediatric Evaluation Disability Inventory (PEDI). This study examined test-retest and inter-rater reliability of the German PEDI (PEDI-G). During the adaptation of the PEDI nine items were added. In total, 117 parents of 53 children without and 64 children with a diagnosed physical disability from Austria, Germany, and Switzerland participated. Reliability was examined by intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable difference (SDD) for the Functional Skill Scale with and without added items and the Caregiver Assistance Scale. Cohen`s Kappa was used to calculate the reliability of the Modification Scale. All ICC's for test-retest and inter-rater reliability were above 0.75, indicating good to very good reliability. The SDD varied from 0.83-5.58 across PEDI domains and scales. For the Modification Scale, Cohen's weighted kappa varied from 0.25 to 1.00 indicating sufficient reliability for some but not all items. Our findings indicate that the Functional Skill Scale and the Caregiver Assistance Scale of the PEDI-G are reliable scales that can be used to evaluate ADLs of children with and without physical disability.

Charting the territory: symptoms and functional assessment in children with progressive, non-curable conditions

BACKGROUND

Children with progressive, non-curable genetic, metabolic, or neurological conditions require specialised care to enhance their quality of life. Prevention and relief of physical symptoms for these children needs to begin at diagnosis, yet, little is known about their patterns of symptoms and functional abilities.

AIM

To describe these children's symptoms, as well as how the children's condition affects them physically.

DESIGN

Cross-sectional, baseline results from an observational, longitudinal study, Charting the Territory, that followed 275 children and their families.

SETTING/PARTICIPANTS

Seven tertiary care children's hospitals in Canada, 2 in the USA. Families were eligible based on the child's condition. A total of 275 children from 258 families participated.

RESULTS

The 3 most common symptoms in these children were pain, sleep problems, and feeding difficulties; on average, they had 3.2 symptoms of concern. There was a pattern of under-reporting of children's symptoms for clinicians compared with parents. Regardless of use of associated medications, pain, feeding and constipation symptoms were often frequent and distressing. Children with a G/J tube had a higher total number of symptoms, and respiratory problems, pain, feeding difficulties and constipation were more likely to occur. They also tended to have frequent and distressing symptoms, and to need extensive mobility modifications which, in turn, were associated with higher numbers of symptoms.

CONCLUSIONS

These children experience multiple symptoms that have been previously documented individually, but not collectively. Effective interventions are needed to reduce their symptom burden. Future longitudinal analyses will examine which disease-modifying interventions improve, or do not improve, symptom burden.

School readiness of children with cerebral palsy

AIM

To examine school readiness in preschool-age children with cerebral palsy (CP) on three of five domains compared with reported norms of children with typical development (CTD).

METHOD

A representative population of 151 preschool-age children with CP (87 males, 64 females; 131 [87%] with spasticity, 17 [11%] dyskinesia, 3 [4%] hypotonia) were assessed at 48 or 60 months corrected age. Children were functioning in the following Gross Motor Function Classification System (GMFCS) levels: I, 74 (49%); II, 17 (11%); III, 14 (9%); IV, 26 (17%); V, 20 (13%). Children's motor performance, self-care, and social function were assessed using the Pediatric Evaluation of Disability Inventory (PEDI) and communication using the Communication and Symbolic Behaviour Scales Developmental Profile (CSBS-DP). Results were compared with a reference sample of CTD (PEDI CTD n=412; CSBS-DP CTD n=790). Linear regression was used to compare these data by functional severity.

RESULTS

Children with CP had significantly lower PEDI scores in all domains than CTD. Self-care scores ranged from 0.5 to more than 4SD below CTD, motor performance was 2 to >4SD below CTD, and social function between 0.5 and >4SD below CTD. Fifty-five per cent of children demonstrated significantly delayed communication skills. Non-ambulant children displayed significantly lower scores than ambulant children.

INTERPRETATION

Preschool-age children with CP perform significantly below their peers in three of five key readiness-to-learn skill areas including mobility, self-care, social function, and communication abilities. Broader emphasis needs to be placed on multimodal screening and intervention to prepare children with CP for school entry.

Mothers' experiences with the Pediatric Evaluation of Disability Inventory (PEDI)

Parents of a child with a disability are often asked about their child's functioning in daily activities. One way to gather this information is through parent-report functional questionnaires such as the Pediatric Evaluation of Disability Inventory (PEDI). The purpose of this study was to explore parental experiences associated with completion of the PEDI before and after a functional therapy intervention. Semi-structured interviews were conducted with 12 mothers of children with cerebral palsy (CP) or developmental delay (DD) who had completed the PEDI within a larger study. A content analysis approach was used to code and organize the data into five themes. PEDI completion was associated with increased parental awareness of developmental patterns, and greater insight into levels of assistance they give to their child. Parents described various challenges and concerns with the PEDI that have implications for test administration processes. The findings have potential to enable more sensitive and focused PEDI use.

Sensitivity to functional improvements of GMFM-88, GMFM-66, and PEDI mobility scores in young children with cerebral palsy

This study assessed the sensitivity to functional change of the total score on age- and severity-relevant dimensions (Goal Total score) of the Gross Motor Function Measure (GMFM)-88 compared with GMFM-88 Total, GMFM-66, and Pediatric Evaluation of Disability Inventory (PEDI) Mobility scores in children with cerebral palsy (CP). Correlations among the four parameters were calculated to assess how sensitivity may differ according to the severity of CP. 64 children with CP (M age = 43.8 mo., SD = 16.5, range = 21 to 84 mo.; 36 boys, 28 girls) were recruited. The GMFM and PEDI assessments were performed over an interval of 6 mo. The effect sizes for changes over time were large (0.88 to 1.26) for the selected GMFM-88 Goal Total scores. The minimally important differences of the GMFM-88 Goal Total scores were within the mean range of change, with CP severity categorized as GMFCS Levels I/II, Level III, and Levels IV/V. The selected GMFM-88 Goal Total scores showed from poor to good correlations with GMFM-88 Total, GMFM-66, and PEDI Mobility scores. The results indicated that age- and severity-relevant GMFM-88 Goal Total scores were the optimal parameter to detect meaningful change in children with CP for clinical and research use.

Upper limb robot-assisted therapy in cerebral palsy: a single-blind randomized controlled trial

BACKGROUND

Several pilot studies have evoked interest in robot-assisted therapy (RAT) in children with cerebral palsy (CP).

OBJECTIVE

To assess the effectiveness of RAT in children with CP through a single-blind randomized controlled trial.

PATIENTS AND METHODS

Sixteen children with CP were randomized into 2 groups. Eight children performed 5 conventional therapy sessions per week over 8 weeks (control group). Eight children completed 3 conventional therapy sessions and 2 robot-assisted sessions per week over 8 weeks (robotic group). For both groups, each therapy session lasted 45 minutes. Throughout each RAT session, the patient attempted to reach several targets consecutively with the REAPlan. The REAPlan is a distal effector robot that allows for displacements of the upper limb in the horizontal plane. A blinded assessment was performed before and after the intervention with respect to the International Classification of Functioning framework: body structure and function (upper limb kinematics, Box and Block test, Quality of Upper Extremity Skills Test, strength, and spasticity), activities (Abilhand-Kids, Pediatric Evaluation of Disability Inventory), and participation (Life Habits).

RESULTS

During each RAT session, patients performed 744 movements on average with the REAPlan. Among the variables assessed, the smoothness of movement (P < .01) and manual dexterity assessed by the Box and Block test (P = .04) improved significantly more in the robotic group than in the control group.

CONCLUSIONS

This single-blind randomized controlled trial provides the first evidence that RAT is effective in children with CP. Future studies should investigate the long-term effects of this therapy.

Physical therapy for a child with sudden-onset choreoathetosis: a case report

PURPOSE

This case report describes the physical therapy examination, intervention, and outcomes for a 5-year-old girl who developed choreoathetosis following mitral valve repair.

CASE DESCRIPTION

This child was admitted to an inpatient short-term rehabilitation program with marked choreoathetosis and dependence for all functional mobility. She received physical therapy twice a day for 5 weeks. Physical therapy intervention included therapeutic exercise emphasizing stabilization and closed chain exercises, aquatic therapy, and functional training to improve gross motor skills and mobility. Tests and measures included the Selective Control Assessment of the Lower Extremity, 66-item Gross Motor Function Measure, and Pediatric Evaluation of Disability Inventory.

OUTCOMES

At discharge, this child demonstrated improvements in her Selective Control Assessment of the Lower Extremity, Gross Motor Function Measure, and Pediatric Evaluation of Disability Inventory scores. She was independent in all functional mobility tasks.

SUMMARY

This case study describes physical therapy tests and measures, intervention, and positive outcomes for a child with sudden-onset choreoathetosis.

A systematic review of evaluation methods for neonatal brachial plexus palsy: a review

OBJECT

Neonatal brachial plexus palsy (NBPP) affects 0.4-2.6 newborns per 1000 live births in the US. Many infants recover spontaneously, but for those without spontaneous recovery, nerve and/or secondary musculoskeletal reconstruction can restore function to the affected arm. This condition not only manifests in a paretic/paralyzed arm, but also affects the overall health and psychosocial condition of the children and their parents. Currently, measurement instruments for NBPP focus primarily on physical ability, with limited information regarding the effect of the disablement on activities of daily living and the child's psychosocial well-being. It is also difficult to assess and compare overall treatment efficacy among medical (conservative) or surgical management strategies without consistent use of evaluation instruments. The purpose of this study is to review the reported measurement evaluation methods for NBPP in an attempt to provide recommendations for future measurement usage and development.

METHODS

The authors systematically reviewed the literature published between January 1980 and February 2012 using multiple databases to search the keywords "brachial plexus" and "obstetric" or "pediatrics" or "neonatal" or "congenital." Original articles with primary patient outcomes were included in the data summary. Four types of evaluation methods (classification, diagnostics, physical assessment, and functional outcome) were distinguished among treatment management groups. Descriptive statistics and 1-way ANOVA were applied to compare the data summaries among specific groups.

RESULTS

Of 2836 articles initially identified, 307 were included in the analysis, with 198 articles (9646 patients) reporting results after surgical treatment, 70 articles (4434 patients) reporting results after medical treatment, and 39 articles (4247 patients) reporting results after combined surgical and medical treatment. Among medical practitioners who treat NBPP, there was equivalence in usage of classification, diagnostic, and physical assessment tools (that focused on the Body Function and Structures measure of the International Classification of Functioning, Disability, and Health [ICF]). However, there was discordance in the functional outcome measures that focus on ICF levels of Activity and Participation. Of the 126 reported evaluation methods, only a few (the Active Movement Scale, Toronto Scale Score, Mallet Scale, Assisting Hand Assessment, and Pediatric Outcomes Data Collection Instrument) are specifically validated for evaluating the NBPP population.

CONCLUSIONS

In this review, the authors demonstrate disparities in the use of NBPP evaluation instruments in the current literature. Additionally, valid and reliable evaluation instruments specifically for the NBPP population are significantly lacking, manifesting in difficulties with evaluating the overall impact and effectiveness of clinical treatments in a consistent and comparative manner, extending across the various subspecialties that are involved in the treatment of patients with NBPP. The authors suggest that all ICF domains should be considered, and future efforts should include consideration of spontaneous (not practitioner-elicited) use of the affected arm in activities of daily living with attention to the psychosocial impact of the disablement.

Differences in function among children with sensory processing disorders, physical disabilities, and typical development

PURPOSE

To examine the capability and performance of children with sensory processing disorders (SPD) compared with children who are developing typically and those with physical disabilities (PD).

METHODS

Participants included parents/caregivers of 81 children ranging in age from 1 to 7.3 years; 57% were boys. The child's therapist interviewed the parents using the Pediatric Evaluation of Disability Inventory (PEDI) to measure functional performance.

RESULTS

Children with SPD demonstrated significant differences from children in the other groups in functional skills and caregiver assistance within 3 domains (self-care, mobility, social function).

CONCLUSIONS

The PEDI can be used to (1) identify functional delays in young children with SPD, which can affect participation in age-appropriate self-care, mobility, and social skills, and (2) determine appropriate referrals for early intervention.

Spinal muscular atrophy type III: trying to understand subtle functional change over time--a case report

Spinal muscular atrophy is a relatively stable chronic disease. Patients may gradually experience declines in muscle strength and motor function over time. However, functional progression is difficult to document, and the mechanism remains poorly understood. An 11-year-old girl was diagnosed at 19 months and took a few steps without assistance at 25 months. She was evaluated for 54 months in a prospective multicenter natural history study. Outcome measures were performed serially. From 6 to 7.5 years, motor function improved. From 7.5 to 11 years, motor function declined with increasing growth. Manual muscle testing scores minimally decreased. Motor unit number estimation studies gradually increased over 4.5 years. Compared to the published natural history of spinal muscular atrophy type III, our patient lost motor function over time. However, she walked with assistance 2 years longer than expected. Our report highlights possible precipitating factors that could affect the natural history of spinal muscular atrophy type III.

The conductive environment enhances gross motor function of girls with Rett syndrome. A pilot study

INTRODUCTION

Rett syndrome (RTT) is a neurological disorder usually associated with a mutation in the MECP2 gene. Conductive Education (CE) is an educational approach that has not yet been explored with regard to children with RTT.

OBJECTIVE

Assessing functional abilities of individuals with RTT due to CE intervention.

DESIGN

A single subject, AB design. method: This study assessed the functional skills of three girls with RTT aged 3-5 years before and during participation in a CE programme.

RESULTS

Gross motor function improvements were observed at the end of the intervention period. Gross motor skills declined slightly in all participants over the summer holidays but improved again a few months after recommencement of the educational year.

CONCLUSION

Replication of this study with more subjects is justified as is comparison with other educational methods. A home intervention programme should be constructed to prevent decline of skills over the summer vacation.