New version of the Pediatric Evaluation of Disability Inventory (PEDI-CAT): translation, cultural adaptation to Brazil and analyses of psychometric properties

The goal-oriented collaborative approach with postural management strategies intervention via telehealth for children with non-ambulant cerebral palsy: Feasibility randomized clinical trial protocol

INTRODUCTION

Children with non-ambulant Cerebral Palsy (CP), have limitations in terms of self-mobility and require the use of assistive technology with extensive adaptations. However, purchasing assistive technology equipment is expensive and difficult to access in low- and middle-income countries, like Brazil. Guidelines recommend a postural management program to children with CP and emphasize the need for high doses of practice to achieve functional goals. Furthermore, collaborative practices are recommended, with active parental participation in the intervention.

AIMS

This study describes a protocol for assessing the feasibility of a future randomized clinical trial using a goal-oriented collaborative approach with postural management strategies via telehealth for non-ambulant children with CP.

METHODS

Eighteen children (1-5 years) with CP and their families will be randomized into two groups for 12 weeks: (A) goal-oriented collaborative approach with postural management strategies intervention via telehealth associated with conventional physical therapy or (B) conventional physical therapy. Feasibility measures will be verified, and outcomes will include parents' perceptions of performance and satisfaction, gross motor function, postural control, goal achievement and participation at home, preschool, and community.

IMPLICATIONS

The findings will inform the planning and preparation of a future randomized clinical trial of interventions for non-ambulant CP children via telehealth.

e-EARLY TOGETHER Intervention for Infants at High Risk of Cerebral Palsy: Randomized Controlled Trial Protocol

PURPOSE

The purpose of this study is to evaluate the effectiveness of an early intervention program, e-EARLY TOGETHER, that combines goal-oriented training, parental coaching, environmental enrichment in a telehealth approach in a low- and middle-income country.

METHODS

Protocol for a randomized controlled clinical trial to evaluate the effectiveness of e-EARLY TOGETHER intervention compared to standard guidelines on outcomes related to development and performance in infants at high risk of cerebral palsy.

DISCUSSION

This protocol will inform and enrich clinical practice related to early intervention in low- and middle-income countries. It is expected that the data obtained will contribute to the implementation of effective early intervention programs with positive and lasting results for the child, their family, and the community.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials: RBR-7WWJRQ3, registered May 10, 2023; WHO Trial Registration UTN Code U-1111-1286-4639.

Family-professional collaborative intervention via telehealth with an infant with Down syndrome and visual impairment: a case report

BACKGROUND

Collaborative interventions, involving partnerships between professionals and families, make it possible to actively engage families in the rehabilitation process. However, no study was found that used a physiotherapy intervention via telehealth for infants with Down syndrome (DS).

OBJECTIVE

Describe the case report of a family-professional collaborative intervention via telehealth for an infant with Down syndrome and visual impairment during the COVID-19 pandemic.

CASE DESCRIPTION

A male infant five months old participated in a collaborative intervention for a period of eight weeks. Three goals were set with the family, and a goal-oriented home program, involving visual stimulation strategies, was organized.

OUTCOMES

Two goals were achieved. The family scored changes in performance and satisfaction with the infant's performance according to the adapted Canadian Occupational Performance Measure. Improvement of motor skills was verified by Alberta Infant Motor Scale and changes in mobility and daily activities performance were measured by the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test.

CONCLUSION

The use of family-professional collaborative intervention via telehealth during the COVID-19 pandemic shows promising results for achieving the goals established by the family collaboratively with the physical therapists.

Go Zika Go: feasibility study with modified motorized ride-on cars for the mobility of children with Congenital Zika Syndrome (CZS)

PURPOSE

To explore the feasibility of an intervention using modified ride-on cars in terms of acceptability and potential changes in goal attainment, mobility, social function, and participation of children with Congenital Zika Syndrome (CZS).

MATERIALS AND METHODS

A pre- and post-intervention feasibility study was conducted with children with CZS, levels IV and V of the Gross Motor Function Classification System (GMFCS). The intervention consisted of 12 weeks of training (3 times a week for 40 min per session) and 4 weeks of follow-up. The primary outcomes included adherence, satisfaction, and learning in mobility. Secondary outcomes encompassed goal attainment, mobility, social/cognitive function, and participation. Descriptive statistics were performed. To explore potential individual changes with the intervention, Wilcoxon test was used to analyze Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) data and Young Children's Participation and Environment Measure (YC-PEM)/Participation and Environment Measure for Children and Youth (PEM-CY), along with standard error measurements of the PEDI-CAT domains.

RESULTS

Four children participated (median age 4.75 years; two females: three at level V on the GMFCS). Adherence was 75% of the total intervention time, and family members reported being satisfied or very satisfied. Children showed gains in learning the use of the modified ride-on cars and an increase in goal attainment after the intervention. Individual changes were observed in the PEDI-CAT domains (mobility and social/cognitive), but there were no significant changes in participation outcomes.

CONCLUSIONS

Children with CZS at GMFCS levels IV and V can learn to use motorized ride-on cars, attainment goals, and experience satisfaction.

Relato Familiar da Motricidade Grossa: Refinamento e avaliação das propriedades psicométricas

Objetivo

Refinar o Relato Familiar da Motricidade Grossa (GM‐FR) utilizando a contribuição dos pais e avaliar as suas propriedades psicométricas.

Método

Neste estudo metodológico, 12 pais de crianças e adolescentes com paralisia cerebral (PC), com idade entre 2 e 18 anos, classificados em todos os níveis do Sistema de Classificação da Função Motora Grossa (GMFCS), foram entrevistados sobre sua experiência na conclusão do GM‐FR (validade de conteúdo). O feedback dos pais foi usado para refinar o instrumento que foi então preenchida por 146 famílias para avaliar a consistência interna, e a validade discriminativa e concorrente. 46 pais completaram o GM‐FR novamente, 7 a 30 dias depois, para avaliar a confiabilidade teste‐reteste.

Resultados

A pontuação do GM‐FR, as imagens, as descrições e o número total de itens foram revisados com base no feedback dos pais. O GM‐FR versão 2.0 demonstrou alta consistência interna (α de Cronbach = 0,99), ausência de efeitos piso/teto e excelente confiabilidade teste‐reteste (coeficiente de correlação intraclasse = 0,99). Os escores do GM‐FR discriminaram entre os níveis do GMFCS (p < 0,05) e foram fortemente correlacionados negativamente com o nível do GMFCS (r = −0,92; p < 0,001). Os escores do GM‐FR correlacionaram‐se de forma positiva e forte com o Gross Motor Function Measure‐66 (r = 0,94; p < 0,001) e com o domínio de mobilidade do Pediatric Evaluation of Disability Inventory – Computer Adaptive Test (r = 0,93; p < 0,001).

Interpretação

A participação ativa das famílias no desenvolvimento do GM‐FR facilitou a criação de um instrumento amigável à família. Este estudo fornece fortes evidências de confiabilidade e validade para apoiar o uso do GM‐FR na prática clínica e em pesquisas para avaliar o desempenho motor grosso de crianças e adolescentes com PC.

Evaluation of functioning and associated factors in children and adolescents with osteogenesis imperfecta

OBJECTIVE

The aim of this study was to evaluate the functioning and associated factors in children and adolescents with osteogenesis imperfecta (OI).

METHODS

This is a cross-sectional study conducted on 30 children and adolescents with OI. Medical records, use of bisphosphonates, socioeconomic status, handgrip strength, balance, joint hypermobility, ambulatory level, and the Pediatric Evaluation of Disability Inventory-Computer Adaptative Test (PEDI-CAT) scores were assessed. Data is presented as mean and standard deviation and Student's t-test or Mann-Whitney U test. Categorical data is presented as frequency and analyzed using Fisher's exact test. Within-group analyses were conducted using ANCOVA or Wilcoxon signed-rank test. Correlations used Kendall's Tau-b test.

RESULTS

The participants involved in this study were 6-18 years old. The sample was separated into two groups according to disease severity. The moderate/severe OI group (n=10) presented a lower height and muscular strength than the mild group (n=20). Muscle weakness was observed in all participants with OI when compared with the normal population. No differences were observed between the groups in the PEDI-CAT scores except for the mobility domain. There were correlations between the PEDI-CAT mobility domain and the number of fractures, OI type, weight, and balance; there was also a correlation between the PEDI-CAT daily activities, mobility, responsibility, and social/cognitive domains.

CONCLUSIONS

The findings suggest that children with moderate/severe forms of OI can achieve the same function levels as children with mild OI. Fractures can have a major influence on the functional level, and treatment should focus on the prevention and rehabilitation of these events when they occur.

Effect of botulinum toxin type a combined with physical therapy on functional capacity in children with spastic cerebral palsy: a randomized controlled clinical trial

OBJECTIVE

Investigate the effects of botulinum toxin type A (BoNT-A) combined with physical therapy on functional capacity in children with spastic cerebral palsy (CP).

METHODS

Twenty-four children with spastic CP were treated with either BoNT-A and physical therapy or physical therapy alone.

RESULTS

Significant differences (p < 0.05) were found after 30 days of treatment for the Berg Scale, Timed Up and Go (TUG) test, Ashworth Scale and Pediatric Evaluation of Disability Inventory (PEDI) and after three months for the Berg Scale, TUG test and PEDI. No significant differences (p > 0.05) were found in the control group.

DISCUSSION

BoNT-A combined with physical therapy leads to significant improvements in spasticity and functionality in children with CP within a period of three months from the onset of treatment.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Reliability and Acceptability to Caregivers of Telehealth Administration of the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) for Brazilian Youth with Down Syndrome

Purpose

To estimate test-retest reliability of the two versions of the PEDI-CAT administered via telehealth to caregivers of Brazilian young people with DS, to compare scores on the two versions, and to determine caregiver acceptance of telehealth administration of the assessment.

Method

A methodological study approved by the research ethics committee. Data collection was performed online, with a mean duration of 45.0 minutes for the content-balanced version of the PEDI-CAT and 17.5 minutes for the speedy version.

Results

In total, 28 caregivers of individuals with DS up to age 21 years participated (mean = 5.9 years; SD = 4.9 years). Intra-class correlation coefficients for the four domains of the PEDI-CAT content-balanced version and four domains of the PEDI-CAT speedy version ranged from 0.77 to 0.97. There was a statistical difference between the versions in the scores of the social-cognitive domain (p < 0.05). A mean of 105 items (SD = 21) was administered in the content-balanced version and a mean of 51 items (SD = 8) in the speedy version. All the caregivers found the method of administration of the PEDI-CAT acceptable.

Conclusions

This study demonstrated that either version of the Brazilian version of the PEDI-CAT can be used by telehealth in clinical practice to assess children, adolescents, and young adults with DS.

Association between participation at home and functional skills in children and adolescents with Down syndrome: A cross-sectional study

BACKGROUND

According to a biopsychosocial approach to health and disability, participation at home and functional skills are important components of the functioning. Therefore, knowledge about interactions between these components allows for targeting specific interventions.

OBJECTIVE

This study investigated whether participation opportunities (frequency and involvement) for children/adolescents with Down syndrome (DS) in a realistic environment at their own home are associated with the functional skills related to the domains of Daily Activities, Mobility, Social/Cognitive and Responsibility.

METHODS

This was an observational study. Forty-eight children/adolescents with DS participated (mean age: 10.73 ± 3.43; n = 27 females). Participants were evaluated using the Participation and Environment Measure for Children and Youth (PEM-CY) home environment setting (raw frequency and engagement scores) and Pediatric Evaluation of Disability Inventory speedy version (PEDI-CAT-SV) (continuous score).

RESULTS

Significant and positive correlations were found between the frequency of participation at home with Daily Activities (ro = 0.320), Social/Cognitive (ro = 0.423) and Responsibility (ro = 0.455). For involvement, significant and positive correlations were found with Daily Activities (ro = 0.297), Social/Cognitive (ro = 0.380) and Responsibility (ro = 0.380). For the PEDI-CAT-SV Mobility, no significant correlation was found.

CONCLUSIONS

Higher frequency and involvement of participation at home are associated with greater functional skills assessed, except for Mobility. This study provided pioneering insights about the relationships between the level of home participation and functional skills in DS, generating evidence that could guide approaches to participation-focused intervention.

Sports Stars Brazil in children with autism spectrum disorder: A feasibility randomized controlled trial protocol

BACKGROUND

Autism Spectrum Disorder (ASD) children have lower levels of participation in recreational and sporting activities when compared to their peers. Participation has been defined based on the Family of Participation-Related Constructs (fPRC) which defines participation as including both attendance and involvement, with sense of self, preferences and activity competence related to a child's participation. Modified sports interventions such as Sports Stars can act on physical literacy and some of the fPRCs components. This study aims to assess the feasibility of the Sports Stars Brazil intervention for children with ASD.

METHODS

This study will be conducted with 36 participants with ASD aged 6 to 12 years old following the CONSORT for pilot and feasibility recommendation. Participants will be randomly allocated into two groups. Intervention group will receive eight, weekly Sports Stars sessions. Each session will include of sports-focused gross motor activity training, confidence building, sports-education and teamwork development. Study assessments will occur at baseline, immediately post-intervention and 20-weeks post-randomization. First, we will assess process feasibility measures: recruitment, assessment completion, adherence, adverse events and satisfaction. Second, we will investigate the scientific feasibility of the intervention by estimating the effect size and variance at the level of achievement sports-related activity and physical activity participation goals (Goal Attainment Scaling), activity competence (Ignite Challenge, Test of Gross Motor Development-second edition, Physical Literacy Profile Questionnaire, Pediatric Disability Assessment Inventory-Computer Adaptive Test-PEDI-CAT-mobility, 10×5 Sprint Test and Muscle Power Sprint Test), sense of self (PEDI-CAT-responsibility), and overall participation at home, school and community, (Participation and Environment Measure for children and young people, PEM-CY).

DISCUSSION

The results of this feasibility study will inform which components are critical to planning and preparing a future RCT study, aiming to ensure that the RCT will be feasible, rigorous and justifiable.

TRIAL REGISTRATION

The trial was registered with the Brazilian Registry of Clinical Trials database (ID: RBR-9d5kyq4) on June 15, 2022.

Cross-cultural adaptation, reliability and validation of the Gillette Functional Assessment Questionnaire (FAQ) into Brazilian Portuguese in patients with cerebral palsy

BACKGROUND

The purpose of this study was to translate, cross-culturally adapt and validate the Gillette Functional Assessment Questionnaire (FAQ) into Brazilian Portuguese.

METHODS

The translation and cross-cultural adaptation was carried out in accordance with international recommendations. The FAQ was applied to a sample of 102 patients diagnosed with cerebral palsy (CP). Construct validity was assessed using Spearman's correlation coefficient (rho), and the FAQ score was correlated with the Functional Mobility Scale (FMS) and Gross Motor Function Classification Scale (GMFCS). A subsample of 50 patients was used to assess reliability using intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable difference (MDD). Ceiling and floor effects were also evaluated.

RESULTS

The Brazilian version of the FAQ showed excellent test-retest reliability by the assessment of the physiotherapist (ICC = 0.99) and respondent (ICC = 0.97), as well as excellent inter-examiner reliability (ICC = 0.94). The SEM was 0.23 (physiotherapist), 0.47 (respondent) and 0.64 (inter-examiner), while the MDD was 0.64 (physiotherapist), 1.29 (respondent) and 1.76 (inter-examiner). The classification of gross motor function showed a high correlation with the FAQ applied by the physiotherapist (rho = -0.89) and by the respondent (rho = -0.87). The FMS-5 m was highly correlated with the FAQ applied by the physiotherapist and the respondent (rho = 0.88 and rho = 0.87, respectively). The FMS-50 and FMS-500 presented very high correlation with the FAQ applied by the physiotherapist (rho = 0.91 for both) and high correlation with the FAQ applied by the respondent (rho = 0.89 and rho = 0.88, respectively). The Brazilian version of the FAQ did not present the ceiling and floor effects.

CONCLUSION

The FAQ presented adequate psychometric properties in patients with CP, indicating that it is possible to use it as a measure of functional gait mobility in Brazil.

Upper limb manual training for children with cerebral palsy: A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVE

There are different upper limb manual training protocols, namely constraint-induced movement therapy, modified constraint-induced movement therapy, hand-arm bimanual intensive training, hand-arm bimanual intensive training including lower extremity, action observation training, and mirror therapy, available for improving functional outcomes in children with cerebral palsy. However, the effect and priority of these strategies remain unclear.

DATA SOURCES

We searched the PubMed, Cochrane Library, and Embase databases for relevant articles from inception to October 12, 2022.

REVIEW METHODS

To assess the effect and priority of different strategies of upper limb manual training protocols through a systematic review and network meta-analysis of randomized controlled trials.

RESULTS

We included 22 randomized controlled trials in this network meta-analysis. The ranking probability and standard mean differences with 95% credible intervals of the comparison between placebo and other forms of upper limb manual training were as follows: mirror therapy = 2.83 (1.78, 3.88), hand-arm bimanual intensive training including the lower extremity = 0.53 (0.09, 0.96), constraint-induced movement therapy = 0.44 (0.18, 0.71), hand-arm bimanual intensive training = 0.41 (0.15, 0.67), modified constraint-induced movement therapy = 0.39 (0.03, 0.74), and action observation training = 0.18 ( - 0.29, 0.65). No significant inconsistency was noted between the results of direct and indirect comparisons.

CONCLUSION

We suggest that mirror therapy could be the upper limb manual training protocol of choice for improving functional outcomes in patients with cerebral palsy.

Trunk Control Measurement Scale (TCMS): Psychometric Properties of Cross-Cultural Adaptation and Validation of the Spanish Version

The aim of this study was to develop a Spanish Version of the Trunk Measurement Scale (TCMS-S) to analyze its validity and reliability and determine the Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) in children with Cerebral Palsy (CP). Participants were assessed twice 7-15 days apart with the TCMS-S and once with the Gross Motor Function Measurement-88 (GMFM-88), Pediatric Disability Inventory-Computer Adaptive Test (PEDI-CAT), Cerebral Palsy Quality of Life (CPQoL), and Gross Motor Classification System (GMFCS). Internal consistency was evaluated using Cronbach's alpha, and the intraclass correlation (ICC) and kappa coefficients were used to investigate the agreement between the assessments. Finally, 96 participants with CP were included. The TCMS-S showed excellent internal consistency (Cronbach's alpha = 0.95 [0.93 to 0.96]); was highly correlated with the GMFM-88 (rho = 0.816) and the "mobility" subscale of the PEDI-CAT (rho = 0.760); showed a moderate correlation with the "feeling about functioning" CPQoL subscale (rho = 0.576); and differentiated between the GMFCS levels. Excellent test-retest agreement was found for the total and subscale scores (ICC ≥ 0.94 [0.89 to 0.97). For the total TCMS-S score, an SEM of 1.86 and an MDC of 5.15 were found. The TCMS-S is a valid and reliable tool for assessing trunk control in children with CP.

Is Mobility Sufficient to Understand Community Participation of Adolescents and Young Adults With Cerebral Palsy? The Mediating and Moderating Roles of Contextual Factors

OBJECTIVE

To explore whether self-determination and family socioeconomic status (SES) mediate and/or moderate the relationship between mobility and community participation of adolescents and young adults with cerebral palsy (CP).

DESIGN

Survey.

SETTING

Online platform.

PARTICIPANTS

Of 55 eligible adolescents/young adults with CP, 50 agreed to participate and 2 were excluded. The final convenience sample included 48 individuals (N=48), aged 15-32 years, levels I-IV of the Gross Motor Function Classification System and I-II of the Communication Function Classification System.

MAIN OUTCOME MEASURES

The Temple University Community Participation Measure documented the amount, breadth, and insufficiency/sufficiency ratios of participation across 26 community settings. The ARC Self-determination Scale and the Mobility Scale of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) measured individuals' self-determination (ie, autonomy, psychological empowerment, self-realization) and mobility skills, respectively. The Brazilian Economic Classification Criteria-2021 assessed family SES.

RESULTS

Analyses of mediating/moderating effects revealed that the influence of individuals' mobility skills on their breadth of community participation was mediated by autonomy. Family SES moderated the indirect effect of mobility on community participation breadth through autonomy. When the model was adjusted for participants' age, individuals with higher SES reported greater breadth in community participation than those from moderate and lower SES for all mobility levels. However, the magnitude of the differences among individuals of different SES levels diminished as mobility increased.

CONCLUSIONS

The mobility skills of youths with CP influence their community participation through autonomy. To foster greater engagement of these individuals in the community, rehabilitation professionals should focus not only on improvement of mobility skills but also on the promotion of self-determined behaviors, especially autonomy.

The Pictorial Interview of Children's Metacognition and Executive Functions (PIC-ME): Cultural Adaptation for Ultra-Orthodox Jewish Populations

Introduction

Executive functions (EFs) are strongly linked to attention deficit hyperactivity disorder (ADHD). The pictorial interview of children's metacognition and executive functions (PIC-ME) assesses children's self-perceptions regarding their EF. This study is aimed at describing the cultural adaptation of the PIC-ME to the ultra-Orthodox (UO) Jewish population in Israel.

Method

In the first of three stages, 30 occupational therapists, who were experienced in working with children with ADHD from the UO population, completed a questionnaire about the suitability of PIC-ME for the UO community. In the second stage, six therapists participated in a focus group to discuss the recommendations and the adaptations made following the first stage. In the third stage, 20 UO children aged 5-10 participated in the tool validation process.

Results

First stage: most of the items of the original tool were found to be appropriate in representing the EFs of UO children and did not need to be adapted. No significant differences were found between the boys' and girls' versions regarding the tool's adaptability. However, most of the therapists suggested that the pictures in both versions needed adaptations. Second stage: additional recommendations led to the development of a final adapted version. Third stage: over 70 percent agreement was found among UO children regarding the clarity of the adapted pictures. No significant differences were found between boys and girls or between age groups.

Conclusions

This study presented wide agreement on the necessity for cultural adaptation of the PIC-ME to the UO population and described the adaptation process. Based on its face validity, the UO version may be a useful tool to assess the self-perception of EF among UO children. Further studies are needed to assess its psychometric properties and its usefulness as an outcome measure. The study findings may contribute to the cultural adaptation of other tools for culturally distinct populations.

Functional status of individuals with osteogenesis imperfecta: data from a reference center

OBJECTIVE

To evaluate the functional status of individuals with Osteogenesis Imperfecta (OI) followed up at a reference center in the state of Bahia.

MATERIALS AND METHODS

This is an observational, cross-sectional, descriptive study, which evaluated individuals with OI, based on a non-probabilistic sampling. To assess motor function, the Motor Function Measure (MFM) score was used, in addition to the measurement of muscle strength using the Medical Research Council (MRC) score. Functional performance was measured using the Pediatric Assessment of Disability Inventory, Computerized Adaptive Testing (PEDI-CAT).

RESULTS

Thirty-one individuals aged between two and 18 years old were evaluated. The overall score of MFM was 74.2%, and the lowest score was found in participants with type III OI (56.3%). The median of the MRC index was 80. The mobility domain was the most affected in the PEDI-CAT evaluation, with a mean T score of 23.9, (14.2 in type III OI).

CONCLUSIONS

Among the evaluated individuals, functional alterations were identified, reduced global gross motor functionality and muscle strength, impacting the mobility domain, with the most relevant findings in individuals with type III OI.

Efficacy of early interventions with active parent implementation in low-and-Middle income countries for young children with cerebral palsy to improve child development and parent mental health outcomes: a systematic review

PURPOSE

To determine the efficacy of interventions with active parent implementation for young children with cerebral palsy (CP) to improve child and parent outcomes in low-middle income countries (LMICs).

METHODS

Five databases were systematically searched. Randomised or comparison studies evaluating interventions with the training of the parent and/or home practice components to implement with their child with CP (<60 months of age) were included. The modified Downs and Black scale assessed methodological quality. Data were pooled to calculate mean differences and 95% confidence intervals (95% CI).

RESULTS

Searches yielded 189 unique articles. 11 studies from ten papers of moderate to high quality were included. Parent-implemented general developmental interventions had a small negative effect on gross motor function compared to interventionist-implemented therapy. Parent-implemented upper limb training compared to interventionist-implemented neurodevelopmental therapy had a small positive effect on bimanual hand function. Parent-implemented functional feeding training had a large significant effect on chewing function compared to parent-implemented oral motor exercises. Parent-implemented interventions targeting general child development and feeding had mixed effects on parent stress outcomes.

CONCLUSIONS

Parent-implemented interventions in LMICs are promising to improve child bimanual hand and chewing function. Further research evaluating the efficacy of parent-implemented interventions to improve parent mental health is needed.Implications for Rehabilitation:Intensive motor training-based interventions with active parent implementation were effective to improve child gross motor, bimanual hand, and chewing function in young children with CP compared to passive, generic interventionist-implemented or health education interventions.Interventions with active parent implementation had mixed results to improve parent mental health, however, this was frequently not assessed. A consistent level of support and training provided to parents may be required to have a positive effect on parent stress.To further understand the feasibility of early interventions with active parent implementation in LMICs, data on adherence to home practice dose and session attendance and a qualitative understanding of contextual and child factors influencing parent implementation is needed.

Comparação entre as versões rápida e conteúdo-balanceada do Inventário de Avaliação Pediátrica de Incapacidade - Testagem Computadorizada Adaptativa (PEDI-CAT) em crianças com paralisia cerebral

RESUMO O objetivo deste estudo foi comparar as versões rápida e conteúdo-balanceada do Inventário de Avaliação Pediátrica de Incapacidade - Testagem Computadorizada Adaptativa (PEDI-CAT) em seus quatro domínios. Para tanto, foi realizado um estudo observacional transversal com crianças com paralisia cerebral (PC). As duas versões do PEDI-CAT foram aplicadas em cada criança com um intervalo de sete dias, no formato remoto, por meio de entrevistas com os responsáveis. Foi utilizada a correlação de Pearson para verificar a associação entre os escores contínuos das duas versões do PEDI-CAT. Participaram do estudo 11 crianças com PC, entre 2 e 12 anos de idade. Foi verificada forte associação significativa entre valores médios do escore contínuo da versão rápida e conteúdo-balanceada em todos os domínios (p<0,0001). Duas crianças (18,2%) foram classificadas de forma diferente em relação ao escore normativo no domínio social-cognitivo. As versões do PEDI-CAT mostraram resultados concordantes em relação ao escore contínuo quando aplicadas em crianças com PC. No entanto, é necessário ter cautela na interpretação do escore normativo dependendo da versão utilizada no domínio social-cognitivo.

Comparison between speedy and content-balanced versions of the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) in children with cerebral palsy

ABSTRACT This study aimed to compare the speedy and content-balanced versions of the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) in its four domains. A cross-sectional observational study was conducted with children with cerebral palsy (CP). The two versions of PEDI-CAT were administered to each child with a 7-days interval, remotely, in interview format with caregivers. Pearson’s correlation was used to evaluate the association among scaled scores in the two versions of PEDI-CAT. In total, 11 children with CP, aged 2 to 12 years, participated in the study. A strong significant association between mean values of the scaled score of the speedy and content-balanced versions in all domains (p<0.0001) was observed. Two children (18.2%) were classified differently regarding normative standard score in the Social/Cognitive domain. Both versions of PEDI-CAT showed concordant results in relation to the scaled score when applied to children with CP. However, one must cautiously interpret the normative standard score depending on the version used in the Social/Cognitive domain.

Functioning of Children and Adolescents with Cancer

The aim of the current study was to evaluate the functioning of children and adolescents diagnosed with cancer. This was a cross-sectional, observational study, with children and adolescents diagnosed with cancer, from 2 to 18 years of age, of both sexes, invited to participate in the city of Juiz de Fora, Minas Gerais, Brazil. The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) questionnaire was applied to the caregivers to assess the functioning of the participants, in four domains: daily activities, mobility, social/cognitive, and responsibility. In total, 33 children and adolescents participated, of both sexes, with a mean age of 9.23 years. The results showed that in the mobility category, participants older than 8 years presented worse functioning (OR = 22.000, 95% CI = 3.415-141.733, p = 0.0001). Children older than 8 years of age and adolescents with different types of cancer showed a higher chance of presenting lower mobility than their normal peers of the same age and compared with children under 8 years of age. Understanding the impact of childhood cancer is important for the physiotherapist to determine treatment strategies for this population who live with dysfunctions left by the cancer treatment.

Cross-cultural adaptation of the Battelle Development Inventory, 2nd Edition for Brazil

Abstract The Battelle Developmental Inventory, 2nd Edition is a standardized inventory for evaluating the child development from birthto seven years, 11 months old. The objective of this article is to describe the process of cross-cultural adaptation of the Battelle Developmental Inventory, 2nd Edition Protocolto Portuguese-Brazil. This methodological study was conducted in three steps: 1) Pre-condition; 2) Test development; and 3) Evaluation of content validity. Adjustments were performed in the formulation of some items, as well as in the stimuli for structured application of the Brazilian version of Battelle Developmental Inventory, 2nd Edition. Compared to the original version, the Brazilian version showed good semantic, idiomatic, experiential, conceptual, and operational equivalences, as well as excellent content validity indexes. This adapted version of the Battelle Developmental Inventory, 2nd Edition for Brazil can be considered aviableinstrument for the usewith a Brazilian infant and child population.

Sleep quality, functional skills, and communication in preschool-aged children with autism spectrum disorder

AIM

This study aimed to correlate sleep quality, the performance of functional skills (mobility, self-care, and social function), communication, independence, and severity of ASD in children with ASD.

METHOD

58 children between 3 and 5 years and 11 months old were investigated. The Childhood Autism Rating Scale was applied to determine the severity of autism; the Sleep Disturbance Scale for Children was used to investigate sleep quality, and the Pediatric Evaluation of Disability Inventory to investigate functional abilities and independence of the children.

RESULTS

68.9 % of the children showed indicative of sleep disorders. There was no correlation between the different sleep disorders and communication. Sleep disorders showed a negative correlation with functional performance and a positive correlation with ASD severity.

INTERPRETATION

The current study offers an exploration between sleep and functional skills in children with ASD. These findings provide important clinical implications in the diagnosis and intervention process of children with ASD and also stimulate reflections on the importance in minimize the impact of sleep disorders and functional abilities on the quality of life of these individuals and their families.

Functional Motor Skills in Children Who Underwent Fetal Myelomeningocele Repair: Does Anatomic Level Matter?

BACKGROUND

In this study, we evaluated children who underwent prenatal myelomeningocele (MMC) repair to investigate the influence of the anatomical level of the lesion on functional motor skills and congenital orthopedic malformations.

METHODS

This cross-sectional study evaluated children who underwent prenatal correction. The anatomical level of the lesion was classified by observing the magnetic resonance of the spine. The sensory/motor assessment was performed by physical examination to classify the status of ambulation, functional level, and functional performance according to chronological age using the Pediatric Evaluation of Disability Inventory (PEDI-CAT) scale.

RESULTS

One hundred cases were evaluated; for 60%, lesions were located in the upper lumbar region and for 40%, they were located in the lower lumbar and sacral regions. The functionality, measured by the PEDI-CAT scale, showed a normal average according to age (mean 50), with 71% of children being community ambulators. Congenital orthopedic malformations were also unrelated to the injury levels, except for knee dislocation in relation to upper lumbar injury. At the functional level, we observed that for the majority, the levels of function of at least 2 vertebrae were below the anatomical level.

CONCLUSIONS

There were no differences in functional motor skills, walking pattern, or congenital orthopedic malformation when compared with the anatomical level of injury in patients who underwent prenatal repair of MMC, except for congenital knee dislocation.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Go Zika Go: A Feasibility Protocol of a Modified Ride-on Car Intervention for Children with Congenital Zika Syndrome in Brazil

Children with congenital Zika syndrome (CZS) present severe motor disability and can benefit from early powered mobility. The Go Zika Go project uses modified ride-on toy cars, which may advance the body functions, activities, and participation of children. This paper describes the study protocol aiming to assess the feasibility of a modified ride-on car intervention for children with CZS in Brazil. A mixed-methods design with a multiple 1-week baseline, 3-month intervention, and 1-month follow-up will be implemented. Modified ride-on car training sessions will be conducted three times a week at the participants’ home or in the clinic. The primary outcome will be a narrative description of study feasibility (photovoice method, focus groups, parent feasibility questionnaire and assessment of learning powered mobility). Secondary outcomes will be switch activation, driving sessions journal, social-cognitive interactions, mobility (pediatric evaluation of disability inventory computer adaptive test), goal attainment scaling (GAS), and participation (young children’s participation and environment measure). Go Zika Go is expected to be viable and to improve function, activity, and participation of children with CZS, providing a low-cost, evidence-based rehabilitation option that will be relevant to early child development in a global perspective.

Priority Outcomes in Critically Ill Children: A Patient and Parent Perspective

BACKGROUND

Outcomes in pediatric critical care research are typically selected by the researcher.

OBJECTIVES

(1) To identify outcomes prioritized by patients and their families following a critical illness and (2) to determine the overlap between patient-centered and researcher-selected study outcomes.

METHODS

An exploratory descriptive qualitative study nested within a longitudinal cohort study conducted in 2 pediatric intensive care units (PICUs). Participants were purposively sampled from the primary cohort to ensure adequate demographic representation. Qualitative descriptive approaches based on naturalistic observation were used to collect data and analyze results. Data were coded by using the International Classification of Functioning, Disability, and Health Children and Youth (ICF-CY) framework.

RESULTS

Twenty-one participants were interviewed a mean of 5.1 months after PICU discharge. Outcomes fell into 2 categories: patient-centered and family-centered. In the former, diagnosis, survival, and prognosis were key priorities during the acute critical illness. Once survival appears possible, functioning (physical, cognitive, and emotional), and factors that influence recovery (ie, rehabilitation, environment, and quality of life) are prioritized. Family-centered outcomes consisted of parents' psychosocial functioning and experience of care. Patient-centered outcomes were covered well by the selected study measures of functioning, but not by the clinical outcome measures.

CONCLUSION

Functioning and quality of life are key patient-centered outcomes during recovery from critical illness. These are not well captured by end points typically used in PICU studies. These results justify the importance of patient- and family-centered outcomes in PICU research and a need to determine how these outcomes can be comprehensively measured.

Study protocol: functioning curves and trajectories for children and adolescents with cerebral palsy in Brazil - PartiCipa Brazil

Background

Gross motor development curves for children with Cerebral Palsy (CP), grouped by Gross Motor Function Classification System (GMFCS) levels, help health care professionals and parents to understand children’s motor function prognosis. Although these curves are widely used in Brazil to guide clinical decision-making, they were developed with Canadian children with CP. Little is known about how these patterns evolve in children and adolescents with CP in low-income countries like Brazil. The PARTICIPA BRAZIL aims to: (i) to identify and draw a profile of functioning and disability of Brazilian children and adolescents with CP by classifying them, for descriptive purposes, with all five valid and reliable functional classifications systems (gross motor function, manual ability, communication function, visual and eating and drinking abilities); (ii) to create longitudinal trajectories capturing the mobility capacity of Brazilian children and adolescents with CP for each level of the GMFCS; (iii) to document longitudinal trajectories in the performance of activities and participation of Brazilian children and adolescents with CP across two functional classification systems: GMFCS and MACS (Manual Abilities Classification System); (iv) to document longitudinal trajectories of neuromusculoskeletal and movement-related functions and exercise tolerance functions of Brazilian children and adolescents with CP for each level of the GMFCS; and (v) to explore interrelationships among all ICF framework components and the five functional classification systems in Brazilian children and adolescents with CP.

Methods

We propose a multi-center, longitudinal, prospective cohort study with 750 Brazilian children and adolescents with CP from across the country. Participants will be classified according to five functional classification systems. Contextual factors, activity and participation, and body functions will be evaluated longitudinally and prospectively for four years. Nonlinear mixed-effects models for each of the five GMFCS and MACS levels will be created using test scores over time to create prognosis curves. To explore the interrelationships among ICF components, a multiple linear regression will be performed.

Discussion

The findings from this study will describe the level and nature of activities and levels of participation of children and youth with CP in Brazil. This will support evidence-based public policies to improve care to this population from childhood to adulthood, based on their prognosis.

Adaptive Skills in FXS: A Review of the Literature and Evaluation of the PEDI-Computer Adaptive Test (PEDI-CAT) to Measure Adaptive Skills

As adaptive skills (AS) are dynamic and may indicate the success of an intervention, they are a common domain measured in clinical trials. Typical interview tools for measuring AS are time-consuming, and questionnaire measures often lead to inconsistent information. The present study was designed to evaluate the feasibility, validity and test-retest performance of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) in Fragile X syndrome (FXS). The PEDI-CAT is administered via tablet and uses the item response theory to efficiently determine the items administered. The PEDI-CAT was administered to 42 individuals with FXS (27 males; 15 females) aged 1.6-50.9 years (M = 14.9; SD = 11.2), followed by the Vineland-3 (VABS-3) interview for comparison. Administration was efficient (M = 21.7 min; SD = 9.5; range 8-45 min; mode = 19). Males and females did not significantly differ on the PEDI-CAT domains, except for daily activities (t(40) = -2.22, p = 0.037). Floor effects were significant for both measures, although the PEDI-CAT showed more floor effects in the mobility (35.7%) and social-cognitive (50%) domains. PEDI-CAT daily activities, mobility, social-cognitive and responsibility domains were all significantly correlated with most of the VABS-3 domains (all rho > 0.5; p < 0.01). Test-rest of the PEDI-CAT was comparable to the VABS-3. Results suggest that the PEDI-CAT is efficient, and minimal training is needed to administer it; however, it lacks specificity and shares a high rate of floor effects with the VABS-3.

Systematic Review of the Main Motor Scales for Clinical Assessment of Individuals with down Syndrome

Objective: The aim of the present review was to identify the motor scales currently used to assess individuals with Down Syndrome (DS).Method: PubMed, WOS and BVS databases were systematically searched to identify the most relevant published studies that used motor scales in the evaluation of individuals with DS.Results: Of the 99 studies that met the eligibility criteria in this process, 20 experimental and observational studies were found to fully meet the eligibility criteria.Conclusion: We identified several motor scales including the Alberta Infant Motor Scale (AIMS), Test of Infant Motor Performance (TIMP), BAYLEY, Peabody Gross Motor Scale (PGMS-PDMS-GM), Gross Motor Function Measure (GMFM), Movement Assessment Battery for Children (MABC) and Pediatric Evaluation of Disability Inventory (PEDI).

Sistematização de instrumentos de avaliação para os dois primeiros anos de vida de bebês típicos ou em risco conforme o modelo da CIF

RESUMO O objetivo deste trabalho foi identificar instrumentos de avaliação do desenvolvimento neuropsicomotor (DNPM) de crianças de 0 a 2 anos, de baixo custo, que possam ser usados no contexto de creche e/ou ambiente clínico em programas de intervenção precoce, sistematizando esses instrumentos conforme o modelo biopsicossocial da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Foram selecionados instrumentos de avaliação do DNPM com tradução ou adaptação para o Brasil. Para isso os domínios da CIF foram escolhidos triangulando o checklist da própria CIF-CJ, core set de estimulação precoce e a última versão da CIF, para busca na literatura de instrumentos de avaliação. A sistematização das categorias selecionadas da CIF foi realizada por dois fisioterapeutas, e um terceiro para itens discordantes. As escalas que responderam aos critérios foram: Alberta Infant Motor Scale (AIMS), Teste de Triagem de Denver II, Inventário Pediátrico sobre Qualidade de Vida (PedSQl®), Affordance in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) e vínculo mãe-bebê. Mesmo com essas escalas, verificou-se a necessidade de um questionário de anamnese complementar para o responsável, dados da Caderneta de Saúde da Criança e de um questionário socioeconômico da Associação Brasileira de Empresas de Pesquisa para o Brasil (ABEP). Essa sistematização está disponível no apêndice, e procura facilitar o olhar ampliado do fisioterapeuta ou profissional da educação com abrangência biopsicossocial dos bebês, além de possibilitar a identificação de riscos de forma precoce e subsidiar ações de promoção e intervenção em diferentes contextos.

Functional skills and caregiver assistance of Brazilian children and adolescents with Down syndrome

BACKGROUND

Research into the evolution of the functional performance of children and adolescents with DS enables parents and professionals involved in their follow-up to promote their development.

OBJECTIVE

To evaluate the functional abilities of children and adolescents with Down syndrome and the assistance offered by their parents/caregivers.

METHOD

A cross-sectional study, with 100 children and adolescents with DS whom parents or caregivers were interviewed to complete the Paediatric Evaluation of Disability Inventory (PEDI). Linear regression analyses were performed with the software MedCalc version 16.8.4 and GraphPad Prism version 6.07.

RESULTS

Children and adolescents with DS need more time to acquire skills of self-care, mobility and social function. Their parents were able to better identify the difficulties before the children reached 8-years of age.

CONCLUSION

Parents can identify the difficulties of their children when they are younger and offer more assistance, but this does not happen when the children are of elementary school age. This suggests that they need professional support that is not restricted to the guidelines and the schools.

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

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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