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Peters BC, Gabriels R, Schmid AA, Lassell RKF, Pan Z, Hoffman A, Hepburn S. Occupational Therapy Using Zones of Regulation™ Concepts: A Feasibility Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:597-609. [PMID: 38659367 DOI: 10.1177/15394492241246549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
There is a lack of peer-reviewed research on occupational therapy using Zones of Regulation™ concepts for autistic youth. The purpose of this article is to describe the feasibility of a newly-developed occupational therapy intervention using Zones of Regulation™ concepts (OT-ZOR) for autistic youth. Specifically, we aimed to evaluate: (a) participant recruitment, retention, and attendance; (b) intervention fidelity, safety, and assessment completion; (c) intervention acceptability; and (d) preliminary participant outcomes. A single-arm feasibility study was completed with outcome measures before and after 10 weeks of OT-ZOR. Fourteen autistic youth ages 6 to 13 completed the study. Youth attended 94% of OT-ZOR sessions. Providers achieved 97% fidelity to the intervention. Occupational therapists and caregivers expressed overall satisfaction with the OT-ZOR intervention. Youth demonstrated significant decreases in irritability, hyperactivity, emotional reactivity, and dysphoria. OT-ZOR is feasible to implement, acceptable to providers and caregivers, and may improve self-regulation in autistic youth.
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Fernandes ACN, Félix TM. Evaluation of functioning and associated factors in children and adolescents with osteogenesis imperfecta. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2024; 43:e2023193. [PMID: 39258640 PMCID: PMC11385739 DOI: 10.1590/1984-0462/2025/43/2023193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/29/2024] [Indexed: 09/12/2024]
Abstract
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.
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Affiliation(s)
| | - Têmis Maria Félix
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
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Palomo-Carrión R, López-Muñoz P, Longo E, Romay-Barrero H, Ródenas-Martínez M, Plasencia-Robledo M, de Andrés-Beltrán B, Coello-Villalón M, Díaz-López C, Pacheco-da-Costa S. AMEsobreRuedas Early Powered Mobility in Children with Spinal Muscular Atrophy Type I: Protocol of a Randomized Controlled Trial. J Clin Med 2024; 13:4875. [PMID: 39201015 PMCID: PMC11355458 DOI: 10.3390/jcm13164875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/06/2024] [Accepted: 08/16/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Young children with spinal muscular atrophy type 1 (SMA1) have limited independent mobility and participation that may lead to cognitive development delays. Implementing early powered mobility in interventions may help them to learn self-initiated movement, play, and having fun to participate in natural settings. The aim of this study is to evaluate the effectiveness of an early power mobility intervention for increasing participation, functional ability, and quality of life in young children with SMA1. Methods: AMEsobreRuedas is a randomized waiting list controlled clinical trial. A sample of 24 children (10 months-5 years old, with SMA1) will be randomly allocated to two groups. The experimental group will perform a family-centered intervention with powered mobility for 16 weeks in their natural environment: a 12-week-structured program three times a week; and a 4-week follow-up with free use of the powered mobility device. The control group (waiting list) will keep their routine and will receive the same intervention after the experimental group. Five assessments will be carried out at baseline and weeks 4, 8, 12, and 16. Primary outcomes are participation (YC-PEM); functional ability (PEDI-CAT); and quality of life (PedsQL-Neuromuscular module). Results: It is expected that this study will provide further knowledge about the positive impact of powered mobility for the analyzed variables. Moreover, family engagement in the intervention and establishment of functional goals may help to add valuable information about real needs in future research. Conclusions: Early powered mobility could increase the opportunities for children with SMA1 to learn to move independently and participate in their natural environment.
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Affiliation(s)
- Rocío Palomo-Carrión
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Avda. Carlos III, s/n, 45071 Toledo, Spain; (R.P.-C.); (H.R.-B.)
| | - Purificación López-Muñoz
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Avda. Carlos III, s/n, 45071 Toledo, Spain; (R.P.-C.); (H.R.-B.)
| | - Egmar Longo
- Department of Physical Therapy, Federal University of Paraiba, João Pessoa 58051-900, Brazil;
| | - Helena Romay-Barrero
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Avda. Carlos III, s/n, 45071 Toledo, Spain; (R.P.-C.); (H.R.-B.)
| | | | | | - Beatriz de Andrés-Beltrán
- Department of Physical Therapy, Centro RIE (Rehabilitación Infantil Especializada), 28050 Madrid, Spain;
| | - María Coello-Villalón
- Hemichild-Research-Unit, Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, 45071 Toledo, Spain;
| | - Cristina Díaz-López
- Asociación de Padres de Niños con Dificultades en el Desarrollo—APANDID, 45500 Toledo, Spain;
| | - Soraya Pacheco-da-Costa
- Neuromusculoskeletal Physical Therapy in Stages of Life Research Group (FINEMEV), Physical Therapy Degree, Department of Nursing and Physical Therapy, Faculty of Medicine and Health Sciences, Universidad de Alcalá, Autovía A2, km 33.200, Alcalá de Henares, 28805 Madrid, Spain;
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Polfuss M, Smith K, Hopson B, Moosreiner A, Huang CC, Ravelli MN, Ding D, Huang Z, Rocque BG, White-Traut R, Van Speybroeck A, Sawin KJ. Body Composition and Energy Expenditure in Youth With Spina Bifida: Protocol for a Multisite, Cross-Sectional Study. JMIR Res Protoc 2024; 13:e52779. [PMID: 38954458 PMCID: PMC11252625 DOI: 10.2196/52779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Obesity prevalence in youth with spina bifida is higher than in their typically developing peers. Obesity is associated with lifelong medical, psychological, and economic burdens. Successful prevention or treatment of obesity in individuals with spina bifida is compromised by (1) the lack of valid and reliable methods to identify body fat in a clinical setting and (2) limited data on energy expenditure that are necessary to provide daily caloric recommendations. OBJECTIVE The objectives of this study will be to develop 2 algorithms for use in youth with spina bifida in a clinical setting, one to model body fat and one to predict total daily energy expenditure. In addition, physical activity and dietary intake will be described for the sample. METHODS This multisite, prospective, national clinical study will enroll 232 youth with myelomeningocele aged 5 to 18 years (stratified by age and mobility). Participants will be enrolled for 1 week. Data obtained include 4 measures of body composition, up to 5 height measures, a ramped activity protocol, and a nutrition and physical activity screener. Participants will wear an accelerometer for the week. On the final study day, 2 samples of urine or saliva, which complete the doubly labeled water protocol, will be obtained. The analysis will include descriptive statistics, Bland-Altman plots, concordance correlation, and regression analysis. RESULTS The study received extramural federal funding in July 2019. Data collection was initiated in March 2020. As of April 2024, a total of 143 (female participants: n=76, 53.1%; male participants: n=67, 46.9%) out of 232 participants have been enrolled. Data collection is expected to continue throughout 2024. A no-cost extension until November 2025 will be requested for data analysis and dissemination of findings. CONCLUSIONS This study furthers previous pilot work that confirmed the acceptability and feasibility of obtaining alternate height, body composition, and energy expenditure measures. The findings from this study will enhance screening, prevention, and treatment of abnormal weight status by facilitating the accurate identification of youths' weight status category and recommendations of daily caloric needs for this population that is at higher risk of obesity. Furthermore, the findings have the potential to impact outcomes for youth diagnosed with disabilities other than spina bifida who experience similar challenges related to alterations in body composition or fat distribution or measurement challenges secondary to mobility issues or musculoskeletal problems. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52779.
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Affiliation(s)
- Michele Polfuss
- School of Nursing, College of Health Professions and Sciences, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, United States
| | - Kathryn Smith
- Department of Pediatrics, USC Keck School of Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, United States
| | - Betsy Hopson
- Department of Mediciine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrea Moosreiner
- Clinical and Translational Science Institute, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Chiang-Ching Huang
- Zilber College of Public Health, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
| | - Michele N Ravelli
- Biotechnology Center, University of Wisconsin - Madison, Madison, WI, United States
| | - Dan Ding
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zijian Huang
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rosemary White-Traut
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, United States
- College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Alexander Van Speybroeck
- Division of General Pediatrics, USC Keck School of Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, United States
| | - Kathleen J Sawin
- School of Nursing, College of Health Professions and Sciences, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, United States
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Castilho JDS, Barbosa RMF, Ayupe KMA, Defilipo ÉC, Chagas PSDC. 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. Physiother Can 2024; 76:104-108. [PMID: 38465305 PMCID: PMC10919367 DOI: 10.3138/ptc-2021-0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 03/12/2024]
Abstract
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.
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Affiliation(s)
- Julia de Souza Castilho
- From the:Faculty of Physical Therapy, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | | | | | - Érica Cesário Defilipo
- Department of Physical Therapy, Universidade Federal de Juiz de Fora - campus Governador Valadares, Governador Valadares, Minas Gerais, Brazil
| | - Paula Silva de Carvalho Chagas
- Department of Physical Therapy of the Old, the Adult and Maternal-Infant, Faculty of Physical Therapy, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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Conroy S, Evans T, Butler-Moburg D, Beuttler R, Robinson J, Huebert M, O Mahony E, Grant-Beuttler M. Clinical application and feasibility of utilizing the PEDI-CAT to assess activity and participation among children receiving physical therapy incorporating hippotherapy. Physiother Theory Pract 2023; 39:2300-2313. [PMID: 35594061 DOI: 10.1080/09593985.2022.2072250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hippotherapy (HPOT) is a physical therapy (PT) treatment tool using equine movement to improve mobility for children with movement impairments. Although research suggests HPOT improves body structure and function, there is limited evidence regarding its impact on activity and participation outcomes in a clinical setting. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) may be useful in HPOT settings to highlight changes in activity and participation. PURPOSE 1) Evaluate the PEDI-CAT's sensitivity to changes in activity and participation among children receiving PT using HPOT; 2) determine feasibility of administering the PEDI-CAT in a HPOT setting; and 3) examine how PEDI-CAT scores influence clinical decision-making. METHODS Participants (N = 34) were children who attended weekly PT using HPOT for 6 months. The PEDI-CAT was completed for all participants by a parent or caregiver at initial treatment (T1) and 6 months later (T2). A linear mixed effects model was used to evaluate changes in scores over time. Team meetings occurred monthly to discuss how PEDI-CAT scores impacted treatment. RESULTS There were significant improvements across 3 PEDI-CAT domains between T1 and T2 for all children with small effect sizes and nonsignificant changes noted within two diagnostic subgroups with small-to-medium effect sizes. The PEDI-CAT was completed by all participants without interrupting treatment flow. PEDI-CAT score reports enriched therapist-client conversations increasing shared decision-making. CONCLUSION PTs who treat children using HPOT may feasibly use the PEDI-CAT to assess changes in activity level outcomes and to assist clinical decision-making.
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Affiliation(s)
- Susan Conroy
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
| | - Trish Evans
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
| | - Dana Butler-Moburg
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
| | | | - Janelle Robinson
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
| | - Matt Huebert
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
| | - Erin O Mahony
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
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Davis TJ, Salazar R, Beenders S, Boehme A, LaMarca NM, Bain JM. A Prospective, Longitudinal Study of Caregiver-Reported Adaptive Skills and Function of Individuals with HNRNPH2-related Neurodevelopmental Disorder. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2023; 8:445-456. [PMID: 39220267 PMCID: PMC11358239 DOI: 10.1007/s41252-023-00346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 09/04/2024]
Abstract
Objectives This study presents a cohort of individuals in a natural history study with de novo pathogenic missense variants in HNRNPH2 causative of HNRNPH2-related neurodevelopmental disorder (NDD) to describe individuals' adaptive functional abilities. Methods We measured adaptive function using the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) and the Vineland Adaptive Behavior Scale (VABS-III). Results were compared using inferential statistics and regression analysis. Results Sixty-seven individuals carried known pathogenic or likely pathogenic variants in HNRNPH2. Thirty-five participants (2.89-42.04 years, 83% female) and caregivers completed PEDI-CAT assessments with 25 of these participants completing the VABS-III. Sixteen, three and two participants completed a follow-up PEDI-CAT assessment at one, two and three years respectively. Individuals had mean normative scores less than age-matched peers across all domains on both PEDI-CAT and VABS-III measures, with 91% participants < 5th percentile on both the PEDI- CAT and VABS-III. Verbal and ambulatory participants had significantly higher PEDI-CAT scores across all domains, using both raw and normative data. There was no significant change in PEDI-CAT scores over 3 years. Conclusions Overall scores, both raw and normative, are low across all individuals with HNRNPH2-related NDD using both the PEDI-CAT and VABS-III. PEDI-CAT normative scores do not likely represent the clinical variability, but raw scores may be able to capture functional variability. In a small sample, longitudinal data from the PEDI-CAT domain scores demonstrate stability in performance at 3 years.Trial Registration: ClinicalTrials.gov NCT03492060.
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Affiliation(s)
- Thomas J. Davis
- Department of Neurology, Columbia University Irving Medical Center and NewYork Presbyterian Morgan Stanley Children’s Hospital, New York, NY USA
| | - Rachel Salazar
- Department of Neurology, Columbia University Irving Medical Center and NewYork Presbyterian Morgan Stanley Children’s Hospital, New York, NY USA
- Department of Interprofessional Health Sciences and Health Administration, Seton Hall University, Nutley, NJ United States
| | - Sarah Beenders
- Department of Neurology, Columbia University Irving Medical Center and NewYork Presbyterian Morgan Stanley Children’s Hospital, New York, NY USA
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, PA Philadelphia, United States
| | - Amelia Boehme
- Department of Neurology, Columbia University Irving Medical Center and NewYork Presbyterian Morgan Stanley Children’s Hospital, New York, NY USA
| | - Nicole M. LaMarca
- Department of Neurology, Columbia University Irving Medical Center and NewYork Presbyterian Morgan Stanley Children’s Hospital, New York, NY USA
| | - Jennifer M. Bain
- Department of Neurology, Columbia University Irving Medical Center and NewYork Presbyterian Morgan Stanley Children’s Hospital, New York, NY USA
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Polfuss M, Bandini LG, Ravelli MN, Huang Z, Moosreiner A, Schoeller DA, Huang CC, Ding D, Berry C, Marston E, Hussain A, Shriver TC, Sawin KJ. Energy expenditure and weight-related behaviors in youth with Down syndrome: a protocol. Front Pediatr 2023; 11:1151797. [PMID: 37547107 PMCID: PMC10397728 DOI: 10.3389/fped.2023.1151797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background The consequences of obesity are ominous, yet healthcare professionals are not adequately preventing or treating obesity in youth with Down syndrome (DS). Total daily energy expenditure (TDEE) is the energy expended in 24 h through physical activity and life-sustaining physiologic processes. An individual's TDEE is essential for determining the daily caloric intake needed to maintain or change body weight. Successful prevention and treatment of obesity in youth with DS is severely compromised by the lack of data on TDEE and information on weight-related behaviors for this high-risk population. This manuscript describes the protocol for the federally funded study that is in process to determine daily energy expenditure in a large cohort of children with DS. Methods This observational cross-sectional study will include a national sample of 230 youth with DS, stratified by age (5-11 and 12-18 years of age) and sex. Doubly Labeled Water analysis will provide the criterion body fat%, fat-free mass, and TDEE. To increase accessibility and decrease the burden on participants, the entire study, including obtaining consent and data collection, is conducted virtually within the participant's home environment on weekdays and weekends. The study team supervises all data collection via a video conferencing platform, e.g., Zoom. This study will (1) examine and determine average TDEE based on age and sex, (2) develop a prediction equation based on measured TDEE to predict energy requirements with a best-fit model based on fat-free mass, sex, age, and height and/or weight, and (3) use 24-hour dietary recalls, a nutrition and physical activity screener, wearable devices, and sleep questionnaire to describe the patterns and quality of dietary intake, sleep, and physical activity status in youth with DS. Discussion The lack of accurate information on energy expenditure and weight-related behaviors in youth with DS significantly impedes the successful prevention and treatment of obesity for this vulnerable population. The findings of this study will provide a further understanding of weight-related behaviors as obesity risk factors, currently not well understood for this population. This study will advance the science of weight management in individuals with disabilities and shift clinical practice paradigms.
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Affiliation(s)
- Michele Polfuss
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, United States
| | - Linda G Bandini
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Michele N Ravelli
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Zijian Huang
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea Moosreiner
- Clinical and Translational Science Institute of Southeast Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Dale A Schoeller
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Chiang-Ching Huang
- Zilber School of Public Health, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
| | - Dan Ding
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cristen Berry
- Pediatric Translational Research Unit, Children's Wisconsin, Milwaukee, WI, United States
| | - Emma Marston
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
| | - Azeem Hussain
- Zilber School of Public Health, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
| | - Timothy C Shriver
- Isotope Ratio Mass Spectrometry Laboratory, Biotechnology Center, University of Wisconsin, Madison, WI, United States
| | - Kathleen J Sawin
- College of Nursing, University of Wisconsin - Milwaukee, Milwaukee, WI, United States
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, United States
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Thornton CB, Kolehmainen N, Nazarpour K. Using unsupervised machine learning to quantify physical activity from accelerometry in a diverse and rapidly changing population. PLOS DIGITAL HEALTH 2023; 2:e0000220. [PMID: 37018183 PMCID: PMC10075441 DOI: 10.1371/journal.pdig.0000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/23/2023] [Indexed: 04/06/2023]
Abstract
Accelerometers are widely used to measure physical activity behaviour, including in children. The traditional method for processing acceleration data uses cut points to define physical activity intensity, relying on calibration studies that relate the magnitude of acceleration to energy expenditure. However, these relationships do not generalise across diverse populations and hence they must be parametrised for each subpopulation (e.g., age groups) which is costly and makes studies across diverse populations and over time difficult. A data-driven approach that allows physical activity intensity states to emerge from the data, without relying on parameters derived from external populations, offers a new perspective on this problem and potentially improved results. We applied an unsupervised machine learning approach, namely a hidden semi-Markov model, to segment and cluster the raw accelerometer data recorded (using a waist-worn ActiGraph GT3X+) from 279 children (9-38 months old) with a diverse range of developmental abilities (measured using the Paediatric Evaluation of Disability Inventory-Computer Adaptive Testing measure). We benchmarked this analysis with the cut points approach, calculated using thresholds from the literature which had been validated using the same device and for a population which most closely matched ours. Time spent active as measured by this unsupervised approach correlated more strongly with PEDI-CAT measures of the child's mobility (R2: 0.51 vs 0.39), social-cognitive capacity (R2: 0.32 vs 0.20), responsibility (R2: 0.21 vs 0.13), daily activity (R2: 0.35 vs 0.24), and age (R2: 0.15 vs 0.1) than that measured using the cut points approach. Unsupervised machine learning offers the potential to provide a more sensitive, appropriate, and cost-effective approach to quantifying physical activity behaviour in diverse populations, compared to the current cut points approach. This, in turn, supports research that is more inclusive of diverse or rapidly changing populations.
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Affiliation(s)
- Christopher B. Thornton
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
| | - Niina Kolehmainen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- Great North Children’s Hospital, Newcastle upon Tyne NHS Hospitals Trust, Unite Kingdom
| | - Kianoush Nazarpour
- Institute for Adaptive and Neural Computation, School of Informatics, The University of Edinburgh, United Kingdom
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Benfer K, Boyd RN, Roe Y, Fagan R, Luke C, Mick-Ramsamy L, Whittingham K, Novak I, Bosanquet M, McNamara L, Khandaker G, Fogarty L, Cadet-James Y, Ruben A, Comans T, Smith A, Ware RS. Study protocol: peer delivered early intervention (Learning through Everyday Activities with Parents for Infants at risk of Cerebral Palsy: LEAP-CP) for First Nation Australian infants at high risk of cerebral palsy - an RCT study. BMJ Open 2023; 13:e059531. [PMID: 36914182 PMCID: PMC10016288 DOI: 10.1136/bmjopen-2021-059531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 02/03/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common childhood physical disability with rates approximately 50% higher in First Nations Australian children. This study aims to evaluate a culturally-adapted parent-delivered early intervention programme for First Nations Australian infants at high risk of CP (Learning through Everyday Activities with Parents for infants with CP; LEAP-CP). METHODS AND ANALYSIS This study is a randomised assessor masked controlled trial. Infants with birth/postnatal risk factors will be eligible for screening. Infants at high risk of CP ('absent fidgety' on General Movements Assessment, and/or 'suboptimal score' on the Hammersmith Infant Neurological Examination) aged 12-52 weeks corrected age will be recruited. Infants and their caregivers will be randomised to receive LEAP-CP (intervention) or health advice (comparator). LEAP-CP is a culturally-adapted programme of 30 home visits delivered by a peer trainer (First Nations Community Health Worker); and includes goal-directed active motor/cognitive strategies, CP learning games and caregiver educational modules. The control arm receives a monthly health advice visit, based on the Key Family Practices, WHO. All infants continue to receive standard (mainstream) Care as Usual. Dual child primary outcomes are Peabody Developmental Motor Scales-2 (PDMS-2) and Bayley Scales of Infant Development-III. The primary caregiver outcome is the Depression, Anxiety and Stress Scale. Secondary outcomes include function, goal attainment, vision, nutritional status and emotional availability. SAMPLE SIZE total of 86 children (43/group) will enable an effect size of 0.65 on the PDMS-2 to be detected (80% power, α=0.05; 10% attrition). ETHICS AND DISSEMINATION Ethics approval through Queensland ethics committees and Aboriginal Controlled Community Health Organisation Research Governance Groups, with families providing written informed consent. Findings will be disseminated with guidance from the Participatory Action Research, in collaboration with First Nations communities; peer-reviewed journal publications and national/international conference presentations. TRIAL REGISTRATION NUMBER ACTRN12619000969167p.
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Affiliation(s)
- Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Yvette Roe
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queensland, Australia
| | - Ruth Fagan
- Research, Gurriny Yealamucka Health Service, Yarrabah, Queensland, Australia
| | - Carly Luke
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Leeann Mick-Ramsamy
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Iona Novak
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Margot Bosanquet
- Department of Health and Wellbeing, Townsville Hospital and Health Service, Queensland Health, Townsville, Queensland, Australia
| | - Lynda McNamara
- Physiotherapy Department, Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, Queensland, Australia
| | - Gulam Khandaker
- Public Health Unit, Central Queensland Hospital and Health Service, Queensland Health, Rockhampton, Queensland, Australia
| | - Lucy Fogarty
- Department of Physiotherapy, Townsville Hospital and Health Service, Queensland Health, Townsville, Queensland, Australia
| | - Yvonne Cadet-James
- Research, Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Alan Ruben
- Child, Youth, and Family Health, Cape and Torres Strait Hospital and Health Service, Cairns, Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Smith
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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de Koning L, Warnink-Kavelaars J, van Rossum M, Limmen S, Van der Looven R, Muiño-Mosquera L, van der Hulst A, Oosterlaan J, Rombaut L, Engelbert R. Physical activity and physical fitness in children with heritable connective tissue disorders. Front Pediatr 2023; 11:1057070. [PMID: 37009265 PMCID: PMC10065825 DOI: 10.3389/fped.2023.1057070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/21/2023] [Indexed: 04/04/2023] Open
Abstract
Objectives Health problems in patients with heritable connective tissue disorders (HCTD) are diverse and complex and might lead to lower physical activity (PA) and physical fitness (PF). This study aimed to investigate the PA and PF of children with heritable connective tissue disorders (HCTD). Methods PA was assessed using an accelerometer-based activity monitor (ActivPAL) and the mobility subscale of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT). PF was measured in terms of cardiovascular endurance using the Fitkids Treadmill Test (FTT); maximal hand grip strength, using hand grip dynamometry (HGD) as an indicator of muscle strength; and motor proficiency, using the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOTMP-2). Results A total of 56 children, with a median age of 11.6 (interquartile range [IQR], 8.8-15.8) years, diagnosed with Marfan syndrome (MFS), n = 37, Loeys-Dietz syndrome (LDS), n = 6, and genetically confirmed Ehlers-Danlos (EDS) syndromes, n = 13 (including classical EDS n = 10, vascular EDS n = 1, dermatosparaxis EDS n = 1, arthrochalasia EDS n = 1), participated. Regarding PA, children with HCTD were active for 4.5 (IQR 3.5-5.2) hours/day, spent 9.2 (IQR 7.6-10.4) hours/day sedentary, slept 11.2 (IQR 9.5-11.5) hours/day, and performed 8,351.7 (IQR 6,456.9-1,0484.6) steps/day. They scored below average (mean (standard deviation [SD]) z-score -1.4 (1.6)) on the PEDI-CAT mobility subscale. Regarding PF, children with HCTD scored well below average on the FFT (mean (SD) z-score -3.3 (3.2)) and below average on the HGD (mean (SD) z-score -1.1 (1.2)) compared to normative data. Contradictory, the BOTMP-2 score was classified as average (mean (SD) z-score.02 (.98)). Moderate positive correlations were found between PA and PF (r(39) = .378, p < .001). Moderately sized negative correlations were found between pain intensity and fatigue and time spent actively (r(35) = .408, p < .001 and r(24) = .395 p < .001, respectively). Conclusion This study is the first to demonstrate reduced PA and PF in children with HCTD. PF was moderately positively correlated with PA and negatively correlated with pain intensity and fatigue. Reduced cardiovascular endurance, muscle strength, and deconditioning, combined with disorder-specific cardiovascular and musculoskeletal features, are hypothesized to be causal. Identifying the limitations in PA and PF provides a starting point for tailor-made interventions.
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Affiliation(s)
- Lisanne de Koning
- Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Correspondence: Lisanne de Koning
| | - Jessica Warnink-Kavelaars
- Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, Netherlands
| | - Marion van Rossum
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Selina Limmen
- Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
| | - Ruth Van der Looven
- Department of Physical and Rehabilitation Medicine, Child Rehabilitation, Ghent University Hospital, Ghent, Belgium
| | - Laura Muiño-Mosquera
- Department of Pediatrics, Division of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
| | - Annelies van der Hulst
- Department of Pediatric Cardiology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Lies Rombaut
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
| | - Raoul Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, Netherlands
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Hayden-Evans M, Milbourn B, D’Arcy E, Chamberlain A, Afsharnejad B, Evans K, Whitehouse AJO, Bölte S, Girdler S. An Evaluation of the Overall Utility of Measures of Functioning Suitable for School-Aged Children on the Autism Spectrum: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14114. [PMID: 36360993 PMCID: PMC9659140 DOI: 10.3390/ijerph192114114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
A diagnosis of an autism spectrum condition (autism) provides limited information regarding an individual's level of functioning, information key in determining support and funding needs. Using the framework introduced by Arksey and O'Malley, this scoping review aimed to identify measures of functioning suitable for school-aged children on the autism spectrum and evaluate their overall utility, including content validity against the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets for Autism. The overall utility of the 13 included tools was determined using the Outcome Measures Rating Form (OMRF), with the Adaptive Behavior Assessment System (ABAS-3) receiving the highest overall utility rating. Content validity of the tools in relation to the ICF and ICF Core Sets for Autism varied, with few assessment tools including any items linking to Environmental Factors of the ICF. The ABAS-3 had the greatest total number of codes linking to the Comprehensive ICF Core Set for Autism while the Vineland Adaptive Behavior Scales (Vineland-3) had the greatest number of unique codes linking to both the Comprehensive ICF Core Set for Autism and the Brief ICF Core Set for Autism (6-16 years). Measuring functioning of school-aged children on the spectrum can be challenging, however, it is important to accurately capture their abilities to ensure equitable and individualised access to funding and supports.
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Affiliation(s)
- Maya Hayden-Evans
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
| | - Benjamin Milbourn
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
| | - Emily D’Arcy
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
| | - Angela Chamberlain
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
| | - Bahareh Afsharnejad
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
| | - Kiah Evans
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
- School of Allied Health, University of Western Australia, Perth 6009, Australia
| | - Andrew J. O. Whitehouse
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
- School of Psychological Science, University of Western Australia, Perth 6009, Australia
| | - Sven Bölte
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 104 31 Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, 104 31 Stockholm, Sweden
| | - Sonya Girdler
- Curtin Autism Research Group, School of Allied Health, Curtin University, Perth 6102, Australia
- Autism CRC, Long Pocket, Brisbane 4850, Australia
- School of Allied Health, University of Western Australia, Perth 6009, Australia
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 104 31 Stockholm, Sweden
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Moraes JMD, Costa MADD, Rodrigues ISDO, Fontes DE, Camargos ACR. 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. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/22008629042022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
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.
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Moraes JMD, Costa MADD, Rodrigues ISDO, Fontes DE, Camargos ACR. Comparison between speedy and content-balanced versions of the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) in children with cerebral palsy. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/22008629042022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
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.
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Forsyth RJ, Roberts L, Henderson R, Wales L. Rehabilitation after paediatric acquired brain injury: Longitudinal change in content and effect on recovery. Dev Med Child Neurol 2022; 64:1168-1175. [PMID: 35262182 PMCID: PMC9544058 DOI: 10.1111/dmcn.15199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/19/2023]
Abstract
AIM To describe cross-sectional and longitudinal variation in neurorehabilitation content provided to young people after severe paediatric acquired brain injury (pABI) and to relate this to observed functional recovery. METHOD This was an observational study in a cohort of admissions to a residential neurorehabilitation centre. Recovery was described using the Pediatric Evaluation of Disability - Computer Adaptive Testing instrument. Rehabilitation content was measured using the recently described Paediatric Rehabilitation Ingredients Measure (PRISM) and examined using multidimensional scaling. RESULTS The PRISM reveals wide variation in rehabilitation content between and during admissions primarily reflecting proportions of child active practice, child emotional support, and other management of body structure and function. Rehabilitation content is predicted by pre-admission recovery, suggesting therapist decisions in designing rehabilitation programmes are shaped by their initial expectations of recovery. However, significant correlations persist between plausibly-related aspects of delivered therapy and observed post-admission recovery after adjusting for such effects. INTERPRETATION The PRISM approach to the analysis of rehabilitation content shows promise in that it demonstrates significant correlations between plausibly-related aspects of delivered therapy and observed recovery that have been hard to identify with other approaches. However, rigorous, causal analysis will be required to truly understand the contributions of rehabilitation to recovery after pABI. WHAT THIS PAPER ADDS Rehabilitation content varies widely between, and during, admissions for neurorehabilitation after paediatric acquire brain injury. Strong correlations are seen between plausibly-related aspects of rehabilitation content and observed recovery, though careful interpretation is necessary.
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Affiliation(s)
- Rob J. Forsyth
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
- The Children’s TrustHarrison Research CentreTadworthUK
| | - Liz Roberts
- The Children’s TrustHarrison Research CentreTadworthUK
| | - Rob Henderson
- School of Mathematics, Statistics and PhysicsNewcastle UniversityNewcastle upon TyneUK
| | - Lorna Wales
- The Children’s TrustHarrison Research CentreTadworthUK
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Smeitink J, van Maanen R, de Boer L, Ruiterkamp G, Renkema H. A randomised placebo-controlled, double-blind phase II study to explore the safety, efficacy, and pharmacokinetics of sonlicromanol in children with genetically confirmed mitochondrial disease and motor symptoms ("KHENERGYC"). BMC Neurol 2022; 22:158. [PMID: 35477351 PMCID: PMC9044835 DOI: 10.1186/s12883-022-02685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Methods The KHENERGYC trial will be a phase II, randomised, double-blinded, placebo-controlled (DBPC), parallel-group study in the paediatric population (birth up to and including 17 years). The study will be recruiting 24 patients suffering from motor symptoms due to genetically confirmed PMD. The trial will be divided into two phases. The first phase of the study will be an adaptive pharmacokinetic (PK) study with four days of treatment, while the second phase will include randomisation of the participants and evaluating the efficacy and safety of sonlicromanol over 6 months. Discussion Effective novel therapies for treating PMDs in children are an unmet need. This study will assess the pharmacokinetics, efficacy, and safety of sonlicromanol in children with genetically confirmed PMDs, suffering from motor symptoms. Trial registration clinicaltrials.gov: NCT04846036, registered April 15, 2021. European Union Clinical Trial Register (EUDRACT number: 2020–003124-16), registered October 20, 2020. CCMO registration: NL75221.091.20, registered on October 7, 2020.
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Affiliation(s)
- Jan Smeitink
- Khondrion BV, Transistorweg 5C, M Building, 6534, AT, Nijmegen, The Netherlands.
| | - Rob van Maanen
- Khondrion BV, Transistorweg 5C, M Building, 6534, AT, Nijmegen, The Netherlands
| | - Lonneke de Boer
- Radboud Center for Mitochondrial Medicine, Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - Gerrit Ruiterkamp
- Khondrion BV, Transistorweg 5C, M Building, 6534, AT, Nijmegen, The Netherlands
| | - Herma Renkema
- Khondrion BV, Transistorweg 5C, M Building, 6534, AT, Nijmegen, The Netherlands
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Luke CR, Benfer K, Mick-Ramsamy L, Ware RS, Reid N, Bos AF, Bosanquet M, Boyd RN. Early detection of Australian Aboriginal and Torres Strait Islander infants at high risk of adverse neurodevelopmental outcomes at 12 months corrected age: LEAP-CP prospective cohort study protocol. BMJ Open 2022; 12:e053646. [PMID: 34996793 PMCID: PMC8744123 DOI: 10.1136/bmjopen-2021-053646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Neurodevelopmental disorders (NDD), including cerebral palsy (CP), autism spectrum disorder (ASD) and foetal alcohol spectrum disorder (FASD), are characterised by impaired development of the early central nervous system, impacting cognitive and/or physical function. Early detection of NDD enables infants to be fast-tracked to early intervention services, optimising outcomes. Aboriginal and Torres Strait Islander infants may experience early life factors increasing their risk of neurodevelopmental vulnerability, which persist into later childhood, further compounding the health inequities experienced by First Nations peoples in Australia. The LEAP-CP prospective cohort study will investigate the efficacy of early screening programmes, implemented in Queensland, Australia to earlier identify Aboriginal and Torres Strait Islander infants who are 'at risk' of adverse neurodevelopmental outcomes (NDO) or NDD. Diagnostic accuracy and feasibility of early detection tools for identifying infants 'at risk' of a later diagnosis of adverse NDO or NDD will be determined. METHODS AND ANALYSIS Aboriginal and/or Torres Strait Islander infants born in Queensland, Australia (birth years 2020-2022) will be invited to participate. Infants aged <9 months corrected age (CA) will undergo screening using the (1) General Movements Assessment (GMA); (2) Hammersmith Infant Neurological Examination (HINE); (3) Rapid Neurodevelopmental Assessment (RNDA) and (4) Ages and Stages Questionnaire-Aboriginal adaptation (ASQ-TRAK). Developmental outcomes at 12 months CA will be determined for: (1) neurological (HINE); (2) motor (Peabody Developmental Motor Scales 2); (3) cognitive and communication (Bayley Scales of Infant Development III); (4) functional capabilities (Paediatric Evaluation of Disability Inventory-Computer Adaptive Test) and (5) behaviour (Infant Toddler Social and Emotional Assessment). Infants will be classified as typically developing or 'at risk' of an adverse NDO and/or specific NDD based on symptomology using developmental and diagnostic outcomes for (1) CP (2) ASD and (3) FASD. The effects of perinatal, social and environmental factors, caregiver mental health and clinical neuroimaging on NDOs will be investigated. ETHICS AND DISSEMINATION Ethics approval has been granted by appropriate Queensland ethics committees; Far North Queensland Health Research Ethics Committee (HREC/2019/QCH/50533 (Sep ver 2)-1370), the Townsville HHS Human Research Ethics Committee (HREC/QTHS/56008), the University of Queensland Medical Research Ethics Committee (2020000185/HREC/2019/QCH/50533) and the Children's Health Queensland HHS Human Research Ethics Committee (HREC/20/QCHQ/63906) with governance and support from local First Nations communities. Findings from this study will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12619000969167.
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Affiliation(s)
- Carly R Luke
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Leeann Mick-Ramsamy
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Arend F Bos
- Department of Neonatology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Margot Bosanquet
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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Santos JC, Barreto NMPV, Silva LR. Desenvolvimento neuropsicomotor e habilidades funcionais em pré-escolares com doenças hepáticas. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35138.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Resumo Introdução Crianças com doenças hepáticas crônicas são expostas a fatores de risco biológicos e/ou ambientais que podem comprometer suas aquisições neuromotoras e o desenvolvimento de suas habilidades funcionais. Objetivo Descrever o desenvolvimento neuropsicomotor (DNPM) e habilidades funcionais de crianças com doenças hepáticas crônicas. Métodos Estudo seccional, descritivo e exploratório realizado com crianças de até 6 anos, que foram selecionadas em um hospital de referência do estado da Bahia, Brasil, no período de novembro de 2019 a março de 2020. Foram consideradas elegíveis para o estudo crianças em atendimento ambulatorial, com diagnóstico clínico, laboratorial e histológico compatíveis com doença hepática crônica. O instrumento de avaliação do desenvolvimento neuropsicomotor foi o Denver II. As habilidades funcionais foram obtidas pela aplicação do Inventário de Avaliação Pediátrica de Incapacidade Testagem Computadorizada Adaptativa (PEDI-CAT) aos pais ou cuidadores principais, versão rápida (Speedy-CAT). Resultados Das 34 crianças com hepatopatias crônicas, 52,9% eram do sexo feminino, com idade entre 4 e 6 anos (64%). Os resultados do teste de Denver II demonstraram que 68,7% (22/32) da amostra apresentaram risco para DNPM. No PEDI-CAT, os escores das crianças hepatopatas com risco para DNPM foram de 60,7 ± 9,1 nos domínios atividade diária, 57,6 ± 11,8 em mobilidade e 48,3 ± 6,2 em social/cognitivo. Conclusão Crianças com hepatopatias crônicas apresentam risco para DNPM, apesar de não possuírem comprometimento de suas habilidades funcionais quando avaliadas pelo PEDI-CAT.
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Ong C, Lee JH, Yang L, Wong JJM, Leow MKS, Puthucheary ZA. A Cross-Sectional Study of the Clinical Metrics of Functional Status Tools in Pediatric Critical Illness. Pediatr Crit Care Med 2021; 22:879-888. [PMID: 33813552 DOI: 10.1097/pcc.0000000000002722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the clinical metrics of functional assessments in pediatric critical illness survivors. DESIGN Cross-sectional observational study. SETTING PICU follow-up clinic. PATIENTS Forty-four PICU survivors 6-12 months post PICU stay, and 52 healthy controls 0-18 years old. INTERVENTIONS Nil. MEASUREMENTS AND MAIN RESULTS Function was assessed using the Pediatric Quality of Life Inventory 4.0 generic scales and infant scales, the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test, and the Functional Status Scale. Muscle strength was assessed by hand grip strength in children greater than or equal to 6 years. Clinical metrics assessed included floor and ceiling effects, known-group, and convergent validity. Floor and ceiling effects were present if the participants achieving the worst or best scores exceeded 15%, respectively. Known-group validity was assessed by comparing scores between those with and without complex chronic conditions and abnormal versus good baseline function. Convergent validity was assessed using partial correlation between two tools. Functional Status Scale and Pediatric Quality of Life Inventory physical domain scores showed significant ceiling effects in PICU survivors (69.2% and 15.4%, respectively, achieved the highest possible score). Functional scores were not significantly different between children with or without complex chronic conditions or children with good versus abnormal baseline function. In healthy children, Pediatric Quality of Life Inventory physical correlated moderately with hand grip strength (partial r = 0.66; p < 0.001), whereas Pediatric Quality of Life Inventory psychosocial correlated moderately with Pediatric Evaluation of Disability Inventory-Computer Adaptive Test social/cognitive score (partial r = 0.53; p < 0.001). In PICU survivors, only Pediatric Quality of Life Inventory physical and Pediatric Evaluation of Disability Inventory-Computer Adaptive Test mobility scores were correlated (partial r = 0.55; p < 0.001). CONCLUSIONS PICU functional assessment tools have varying clinical metrics. Considering ceiling effects, Pediatric Evaluation of Disability Inventory-Computer Adaptive Test may be more suitable in survivors than Functional Status Scale. Differences in scores between children with or without complex chronic conditions, and with or without baseline functional impairment, were not observed. Functional assessments likely require a combination of tools to measure the spectrum of pediatric critical illness and recovery.
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Affiliation(s)
- Chengsi Ong
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Liying Yang
- Department of Physiotherapy, KK Women's and Children's Hospital, Singapore
| | - Judith J M Wong
- Children's Intensive Care Unit, KK Women's Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Zudin A Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Adult Critical Care Unit, Royal London Hospital, London, United Kingdom
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20
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Scott K, Lewis J, Pan X, Heathcock J. Parent-Reported PEDI-CAT Mobility and Gross Motor Function in Infants With Cerebral Palsy. Pediatr Phys Ther 2021; 33:156-161. [PMID: 34086623 PMCID: PMC8217157 DOI: 10.1097/pep.0000000000000801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study is to determine the relationship between the Pediatric Evaluation of Disability Index-Computer Adapted Test (PEDI-CAT), a parent-reported outcome measure, and therapist-administered measures of motor function for infants with cerebral palsy (CP) with moderate to severe motor impairments. METHODS A prospective, cohort study included 54 infants, ages 6 to 24 months, with CP or high risk of CP, Gross Motor Function Classification System (GMFCS) levels III to V. Measures included the Gross Motor Function Measure (GMFM) and the mobility domain of the PEDI-CAT (PEDI-mob). RESULTS A significant correlation was found between PEDI-mob and GMFM scores. Significant differences were found in PEDI-mob scores as a function of GMFCS level. CONCLUSIONS The PEDI-mob adds value to motor evaluations of infants with CP. Parents can accurately contribute information about daily motor performance for goal setting and treatment planning. The PEDI-mob offers a practical solution when longer assessments cannot be completed.
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Affiliation(s)
- Kimberley Scott
- The Ohio State University (Drs Scott, Pan, and Heathcock), Columbus, Ohio; Nationwide Children's Hospital (Dr Lewis), Columbus, Ohio
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21
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Camden C, Zwicker JG, Morin M, Schuster T, Couture M, Poder TG, Maltais DB, Battista MC, Baillargeon JP, Goyette M, Pratte G, Hurtubise K, Phoenix M, Nguyen T, Berbari J, Tousignant M. Web-based early intervention for children with motor difficulties aged 3–8 years old using multimodal rehabilitation (WECARE): protocol of a patient-centred pragmatic randomised trial of paediatric telerehabilitation to support families. BMJ Open 2021. [PMCID: PMC8039274 DOI: 10.1136/bmjopen-2020-046561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Mild motor difficulties in children are underdiagnosed despite being highly prevalent, leaving such children often underserved and at higher risk for secondary consequences such as cardiovascular disease and anxiety. Evidence suggests that early patient-oriented interventions, coaching parents and providing children with early stimulation should be provided, even in the absence of a diagnosis. Such interventions may be effectively delivered via telerehabilitation. Methods and analysis A family-centred, pragmatic randomised controlled trial will be carried out to evaluate the real-world effectiveness of a Web-based Early intervention for Children using multimodAl REhabilitation (WECARE). Families of children with motor difficulties, 3–8 years of age, living in Quebec, Canada, and receiving no public rehabilitation services (n=118) will be asked to determine up to 12 performance goals, evaluated using the Canadian Occupational Performance Measure (COPM, the primary outcome). Families will be randomised to receive either usual care or the WECARE intervention. The WECARE intervention will be delivered for 1 year via a web-based platform. Families will have access to videoconferences with an assigned rehabilitation therapist using a collaborative coaching approach, a private chat function, a forum open to all intervention arm participants and online resources pertaining to child development. Participants will be asked to re-evaluate the child’s COPM performance goals every 3 months up to 1 year post allocation. The COPM results will be analysed using a mixed Poisson regression model. Secondary outcomes include measures of the child’s functional ability, parental knowledge and skills and health-related quality of life, as well as qualitative outcomes pertaining to parental satisfaction and service delivery trajectories. Investigators and quantitative data analysts will be blinded to group allocation. Ethics and dissemination The CIUSSS de l’Estrie—CHUS ethics committee approved this trial (2020-3429). Study results will be communicated via peer-reviewed journal publications, conference presentations and stakeholder-specific knowledge transfer activities. Trial registration number NCT04254302.
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Affiliation(s)
- Chantal Camden
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Jill G Zwicker
- Occupational Science & Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Melanie Morin
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Melanie Couture
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Thomas G Poder
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Montreal, Québec, Canada
| | - Desiree B Maltais
- Département de réadaptation, Universite Laval, Québec City, Québec, Canada
| | - Marie-Claude Battista
- Department of Medicine, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Quebec, Canada
| | - Jean-Patrice Baillargeon
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
- Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Quebec, Canada
| | - Mathieu Goyette
- Département de sexologie, Université du Québec à Montréal, Montreal, Québec, Canada
| | - Gabrielle Pratte
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
| | - Karen Hurtubise
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Tram Nguyen
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jade Berbari
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, CIUSSS de l'Estrie—CHUS, Sherbrooke, Québec, Canada
| | - Michel Tousignant
- École de réadaptation, Universite de Sherbrooke Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Québec, Canada
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Krempley T, Schmidt EK. Assessing Activity of Daily Living Task Performance Among Autistic Adults. AUTISM IN ADULTHOOD 2021; 3:37-51. [PMID: 36601263 PMCID: PMC8992889 DOI: 10.1089/aut.2020.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Activities of daily living (ADLs) are activities that people engage in on a routine basis, such as brushing their teeth, preparing a meal, and caring for their child. Independence with ADLs is associated with better outcomes in independent living, education, employment, relationships, and mental health. Therefore, this perspective piece includes a review of the literature and assessment databases to identify and summarize ADL assessments for Autistic adults. These assessments were compared and analyzed using the neurodiversity paradigm. Specifically, we compared assessments using predetermined priorities the authors identified: (1) assessment type, (2) inclusivity, and (3) performance factors. We identified five unique norm-referenced measures, four performance-based measures, and a variety of checklists, surveys, questionnaires, and/or interviews used to assess ADL performance among Autistic adults. The authors present their perspectives regarding the challenges with the current assessments, including the high-frequency use of norm-referenced assessments, lack of inclusivity, and failure to consider performance factors (e.g., sensory, motor, and emotional), and the paucity of assessments designed specifically for Autistic adults older than 30 years. In response to these challenges, we recommend researchers partner with Autistic adults to develop a new assessment tool. If researchers or clinicians are using existing measures, we recommend that they utilize self-report over proxy-report and include methods to improve the accessibility of the assessment. We also recommend that clinicians and researchers offer breaks, comfort objects, or sensory modifications during the assessment to decrease anxiety; and ask follow-up questions to understand whether environment or emotional health are impacting one's ADL performance. Lay summary Why is this topic important?: Activity of daily living (ADL) assessments are used to determine what Autistics can and cannot do in their day-to-day life, what services they may be eligible for, and to monitor gains. However, we struggled to find an assessment that was useful and relevant from an Autistic point-of-view.What is the purpose of this article?: The purpose of this article was to review and evaluate current ADL assessments usefulness for Autistics and provide recommendations for improving the ADL assessment process.What is the perspective of the authors?: The first author is an Autistic social worker and the second author is an occupational therapist and postdoctoral fellow. The authors' perspective is based in the neurodiversity paradigm and social model of disability, which centers on respecting and acknowledging differences in the brain and their effects on Autistics' lives. We believe in strengths-based approaches versus deficit-based models.What did you find about this topic?: We found 17 measurement tools, some that compared Autistic ADL performance with neurotypical performance, a few that were observation-based meaning the researcher or clinician watched the Autistic person complete the ADLs, and many forms or guides that asked questions about ADL performance. Only six measures allowed Autistic people to respond to the questions themselves, whereas the rest of the measures had someone else respond for them. These measures did not include questions about how sensory differences (e.g., feeling upset by the feeling of jeans or the taste of minty toothpaste) or feeling sad or nervous may also impact ADL performance.What do the authors recommend?: We recommend that researchers partner with Autistic adults to make new ADL assessments. If researchers or clinicians are using previously made ADL assessments, we recommend that they use self-report and adapt the materials to make it easier to understand (e.g., using pictures). We also recommend that researchers and clinicians ask Autistics what they need or want to make the assessment easier and more comfortable for them. Finally, researchers and clinicians should ask follow-up questions about sensory differences and whether someone is feeling sad or nervous to know how this impacts their ability to do their ADL tasks.How will these recommendations help autistic adults now or in the future?: These recommendations will help Autistic adults be more involved in the evaluation process, which will make the assessments more trustworthy and relevant to Autistics. This also could help more Autistic people get services and supports that are useful to them. Finally, this may help researchers when monitoring if these supports or services actually work.
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Affiliation(s)
- Tema Krempley
- Nisonger Center, The Ohio State University, Columbus, Ohio, USA
| | - Elizabeth K. Schmidt
- Sargent College, Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
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23
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Hildenbrand H, Wickstrom J, Parks R, Zampieri C, Nguyen TT, Thurm A, Jenkins K, Alter KE, Matsubara J, Hammond D, Soldatos A, Porter FD, Dang Do AN. Characterizing upper limb function in the context of activities of daily living in CLN3 disease. Am J Med Genet A 2021; 185:1399-1413. [PMID: 33559393 DOI: 10.1002/ajmg.a.62114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 11/06/2022]
Abstract
In CLN3 disease, impairments in motor function are frequently reported to have later onset compared to visual and cognitive decline, but upper limb motor function has yet to be explored in this population. In a cohort of 22 individuals with CLN3, we used a novel application of multiple measures to (1) characterize motor function, particularly of the upper limbs, in activities of daily living (ADLs), and (2) explore associations between motor function and age as well as visual ability, disease severity, and cognitive function, as evaluated by the Unified Batten Disease Rating Scale (UBDRS), a validated CLN3 disease measure. ADLs that required coordination, speed, and fine motor control were particularly challenging for children with CLN3 based on item-level performance across direct assessments (Jebsen-Taylor Hand Function Test [JTHFT] and MyoSet Tools) and caregiver reports (Pediatric Evaluation of Disability Inventory-Computer Adaptive Testing [PEDI-CAT] and Patient-Reported Outcomes Measurement Information System [PROMIS] Pediatric Upper Extremity). Poorer visual ability, disease severity, and cognitive function were associated with worse performance on these measures, whereas age had limited impact. These findings support the need for children with CLN3 to receive skilled clinical evaluation and treatment tailored to their individual needs, particularly in the context of ADLs, as their symptom profile progresses.
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Affiliation(s)
- Hanna Hildenbrand
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jordan Wickstrom
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Rebecca Parks
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Cris Zampieri
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Thuy-Tien Nguyen
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, National Institutes of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Kisha Jenkins
- Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Katharine E Alter
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jesse Matsubara
- Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Dylan Hammond
- Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Ariane Soldatos
- Pediatric Neurology Consultation Service, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Forbes D Porter
- Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - An N Dang Do
- Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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24
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Fragala-Pinkham M, Pasternak A, McDermott MP, Mirek E, Glanzman AM, Montes J, Dunaway Young S, Salazar R, Quigley J, Riley SO, Chiriboga CA, Finkel RS, Tennekoon G, Martens WB, De Vivo DC, Darras BT. Psychometric properties of the PEDI-CAT for children and youth with spinal muscular atrophy. J Pediatr Rehabil Med 2021; 14:451-461. [PMID: 34275913 DOI: 10.3233/prm-190664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the psychometric properties of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) in children and youth with Spinal Muscular Atrophy (SMA). METHODS In this prospective cross-sectional study, caregivers of children and youth with SMA completed the PEDI-CAT Daily Activities and Mobility domains. A subset of caregivers completed a questionnaire about the measure. RESULTS Mean ranks of scaled scores for Daily Activities (n = 96) and Mobility (n = 95) domains were significantly different across the three SMA types and across the three motor classifications. Normative scores indicated that 85 participants (89.5%) had limitations in Mobility and 51 in Daily Activities (53.1%). Floor effects were observed in≤10.4% of the sample for Daily Activities and Mobility. On average, caregivers completed the Mobility domain in 5.4 minutes and the Daily Activities domain in 3.3 minutes. Most caregivers reported that they provided meaningful information (92.1%), were willing to use the PEDI-CAT format again (79%), and suggested adding content including power wheelchair mobility items. CONCLUSION Convergent validity was demonstrated for the Daily Activities and Mobility domains. Normative scores detected limitations in Mobility and Daily Activity performance for most participants with SMA. The PEDI-CATwas feasible to administer and caregivers expressed willingness to complete the PEDI-CAT in the future.
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Affiliation(s)
- Maria Fragala-Pinkham
- Research Center, Franciscan Children's Hospital, Brighton, MA, USA.,Department of Physical Therapy and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA
| | - Amy Pasternak
- Department of Physical Therapy and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Elizabeth Mirek
- Department of Physical Therapy and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Allan M Glanzman
- Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacqueline Montes
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sally Dunaway Young
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel Salazar
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Janet Quigley
- Department of Physical Therapy and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan O Riley
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Claudia A Chiriboga
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Richard S Finkel
- Center for Experimental Neurotherapeutics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gihan Tennekoon
- Departments of Neurology, Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William B Martens
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Darryl C De Vivo
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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25
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Kao YC, Orsmond GI, Cohn ES, Coster WJ. Variables Associated With Shift of Responsibility for Daily Tasks From Parents to Children With and Without Disabilities. Am J Occup Ther 2020; 74:7406205070p1-7406205070p10. [PMID: 33275567 PMCID: PMC7717646 DOI: 10.5014/ajot.2020.036764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IMPORTANCE No study has directly investigated which variables are associated with the shift of responsibility for managing daily tasks from parent to child in the transition to adulthood. OBJECTIVE To examine characteristics associated with responsibility for managing daily life tasks in youth with and without disabilities. DESIGN A secondary data analysis of parent-report data on typically developing (TD) youth and youth with disabilities. SETTING An online panel that has regularly participated in online surveys. PARTICIPANTS A nationally representative sample of 2,205 TD U.S. children and youth, ages 0 to 20 yr, 11 mo (about 100 children per age year) and a sample of 617 children and youth with disabilities, ages 0 to 20 yr, 11 mo. OUTCOMES AND MEASURES The dependent variable was the Responsibility domain scaled score (from the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test), which reflects the extent to which responsibility for daily tasks has shifted from parent to youth. RESULTS Youth with higher levels of responsibility were older in age, reported to be more focused, and youngest in birth order (TD, R 2 = .79; disability, R 2 = .35). Youth with developmental delay, intellectual disability, autism spectrum disorder, or orthopedic or movement impairments had assumed less responsibility. CONCLUSIONS AND RELEVANCE Other personal characteristics in addition to disability may have important influences on parents' decision making as they prepare their children to manage daily life tasks. WHAT THIS ARTICLE ADDS Clinicians who work with adolescents in the process of transition to adulthood need to consider the potential influence of the personal characteristics, such as birth order and child temperament, on preparation for adulthood.
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Affiliation(s)
- Ying-Chia Kao
- Ying-Chia Kao, ScD, OTR, is Assistant Professor, Department of Occupational Therapy, Asia University, Taichung, Taiwan;
| | - Gael I Orsmond
- Gael I. Orsmond, PhD, is Professor, Department of Occupational Therapy, Boston University, Boston, MA
| | - Ellen S Cohn
- Ellen S. Cohn, ScD, OTR, FAOTA, is Clinical Professor, Department of Occupational Therapy, Boston University, Boston, MA
| | - Wendy J Coster
- Wendy J. Coster, PhD, OTR, FAOTA, is Professor, Department of Occupational Therapy, Boston University, Boston, MA
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26
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Colman J, Casto SC, Wisner E, Stanek JR, Auletta JJ. Improving Occupational Performance in Pediatric Hematopoietic Cell Transplant Recipients. Am J Occup Ther 2020; 74:7405205020p1-7405205020p11. [PMID: 32804620 DOI: 10.5014/ajot.2020.040543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE There is a critical gap in the literature regarding the efficacy of occupational therapy interventions for pediatric hematopoietic cell transplantation (HCT) patients. OBJECTIVE To demonstrate that occupational therapy 4-5×/wk during inpatient hospitalization positively affects strength, coordination, and independence in activities of daily living (ADLs) of pediatric patients during HCT. DESIGN Retrospective study. SETTING Inpatient bone marrow transplant unit at a children's hospital. PARTICIPANTS Thirty-two pediatric patients admitted for HCT. OUTCOMES AND MEASURES Patients were seen by an occupational therapist as part of an interdisciplinary program. Interventions included play and leisure engagement, upper extremity therapeutic exercises, fine motor activities, and ADL training. Strength, coordination, and daily living skills data were documented prospectively and analyzed retrospectively to compare differences between patients seen by occupational therapy at high versus low frequency. RESULTS For grip strength (dynamometer), fine motor dexterity (the 9-Hole Peg Test), and independence in ADLs (an ADL functional measure and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test Daily Activities), the high-frequency group had a significantly smaller decrease in performance from time of admission at pretransplant (baseline) to peak decline after transplant. Grip strength and ADL scores for the high-frequency group returned to baseline at time of discharge more readily than for the low-frequency group. CONCLUSIONS AND RELEVANCE Participation in occupational therapy 4-5×/wk had positive effects on strength, coordination, and independence in ADLs for patients undergoing HCT. WHAT THIS ARTICLE ADDS This article provides evidence that occupational therapists are an important part of the interdisciplinary team treating pediatric bone marrow transplant patients. It also demonstrates that occupational therapy interventions delivered at a high frequency can have a positive impact on upper extremity strength and independence in ADLs.
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Affiliation(s)
- Julia Colman
- Julia Colman, OTD, OTR/L, is Occupational Therapist, Clinical Therapy Services, Nationwide Children's Hospital, Columbus, OH;
| | - Shelley Coleman Casto
- Shelley Coleman Casto, MS, OTR/L, is Occupational Therapy Clinical Lead, Clinical Therapy Services, Nationwide Children's Hospital, Columbus, OH
| | - Eliscia Wisner
- Eliscia Wisner, MOT, OTR/L, is Occupational Therapist, Clinical Therapy Services, Nationwide Children's Hospital, Columbus, OH
| | - Joseph R Stanek
- Joseph R. Stanek, MS, is Biostatistician, Hematology/Oncology/Blood and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, OH
| | - Jeffery J Auletta
- Jeffery J. Auletta, MD, is Director, Blood and Marrow Transplant Program, Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus OH; Director, Host Defense Program, Infectious Diseases, Nationwide Children's Hospital, Columbus, OH; and Member, Leukemia Research Program, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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27
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Baharudin NS, Harun D, Kadar M. An Assessment of the Movement and Function of Children with Specific Learning Disabilities: A Review of Five Standardised Assessment Tools. Malays J Med Sci 2020; 27:21-36. [PMID: 32788838 PMCID: PMC7409574 DOI: 10.21315/mjms2020.27.2.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 12/23/2019] [Indexed: 10/26/2022] Open
Abstract
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.
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Affiliation(s)
- Nur Sakinah Baharudin
- Occupational Therapy Programme, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Dzalani Harun
- Occupational Therapy Programme, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Masne Kadar
- Occupational Therapy Programme, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Inthachom R, Prasertsukdee S, Ryan SE, Kaewkungwal J, Limpaninlachat S. Evaluation of the multidimensional effects of adaptive seating interventions for young children with non-ambulatory cerebral palsy. Disabil Rehabil Assist Technol 2020; 16:780-788. [PMID: 32096423 DOI: 10.1080/17483107.2020.1731613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the short-term effectiveness of the first adaptive seating system received by children with non-ambulatory cerebral palsy (CP) who are classified as level IV or V according to the Gross Motor Function Classification System. MATERIALS AND METHODS A trained clinical assessor examined 20 children with non-ambulatory CP (mean age: 4.5 years) for their trunk control ability in static, active, and reactive tasks using the Segmental Assessment of Trunk Control. Their primary caregivers were also interviewed about their child's activity and participation using the Paediatric Evaluation of Disability Inventory Computer - Adaptive Test in daily activity and social/cognitive domains and Family Impact of Assistive Technology Scale for Adaptive Seating in child and family functioning domains. Data for each measure were collected 3 times: at baseline (pre-intervention) and then 6 weeks and 3 months after children received their first adaptive seating system. RESULTS AND CONCLUSION The static and active trunk control scores between baseline and 6 weeks, and baseline and 3 months significantly improved. Daily activity scaled scores significantly improved between baseline and 3 months, and 6 weeks and 3 months. Significant, large gains in child and family functioning overall were detected between baseline and 6 weeks, and baseline and 3 months. These findings provide emerging evidence of multidimensional effects associated with the introduction of a first adaptive seating system into the lives of young children with non-ambulatory CPIMPLICATIONS FOR REHABILITATIONThe introduction of an adaptive seating system into the wheelchair of children with non-ambulatory cerebral palsy may be associated with short-term gains in body function, activities, participation and aspects of the child's environment.
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Affiliation(s)
- Rumrada Inthachom
- Faculty of Physical Therapy, Mahidol University, Nakhonpathom, Thailand
| | | | - Stephen E Ryan
- Bloorview Research Institute, Holland Bloorview Kids, Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Shenhod E, Benzeev B, Sarouk I, Heimer G, Nissenkorn A. Functional parameter measurements in children with ataxia telangiectasia. Dev Med Child Neurol 2020; 62:207-213. [PMID: 31468510 DOI: 10.1111/dmcn.14334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2019] [Indexed: 12/17/2022]
Abstract
AIM To collect preliminary functional data on ataxia telangiectasia and create a disease specific scale: the Ataxia Telangiectasia Functional Scale (ATFS). METHOD Retrospective information on patients with ataxia telangiectasia referred to the Assistive Technology Unit was included. Functional mobility scales (the Gross Motor Function Classification System [GMFCS] and the Functional Mobility Scale [FMS]-5, FMS-50, FMS-500) and activities of daily living [ADL] parameters were recorded. We created a 51-point ATFS, that consisted of three ambulation items adapted for ataxia telangiectasia in the frame of FMS (home, school, outdoors), five ADL items, and one schooling item. RESULTS Twenty-seven participants (17 males, 10 females; mean age 10y 8mo [SD 5y 1mo], range 1y 9mo-25y 6mo), were enrolled; 168 measurements were recorded. Patients walked at a mean age of 1 year 4 months (SD 5y 4mo) and lost ambulatory capacity at 8 years 8 months (SD 2y 1mo). GMFCS level and FMS-5, FMS-50, FMS-500 assessments correlated with age (Spearman's correlations r=0.555, -0.617, -0.639, -0.662 respectively, p<0.01 for all), but plateaued after 12 years of age. ATFS mean score was 37.46 (SD 7.88) and increased with age (Spearman's correlation r=0.585, p<0.01). The scale showed three stages of disease progression. INTERPRETATION In this pilot study we show longitudinal functional data of ambulation and ADL skills in ataxia telangiectasia, and created a framework for a functional scale. This functional scale closely approximated disease course, but further validation is required. WHAT THIS PAPER ADDS The Gross Motor Function Classification System and the Functional Mobility Scale are ill-suited for ataxia telangiectasia assessments. Three functional mobility scales (home, school, outdoors) suited to ataxia telangiectasia were created. The Ataxia Telangiectasia Functional Scale (ATFS) combines mobility and items of activities of daily living. The ATFS closely approximates the three-stage progression of the disorder.
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Affiliation(s)
- Efrat Shenhod
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bruria Benzeev
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Pediatric Neurology Unit, Sheba Medical Center, Sackler Faculty of Medicine, Safra Children's Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Sarouk
- The National AT Center, Chaim Sheba Medical Center, Tel HaShomer, Israel.,The Pediatric Pulmonology Unit, Chaim Sheba Medical Center, Edmond and Lilly Safra Children Hospital, Tel HaShomer, Israel
| | - Gali Heimer
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Pediatric Neurology Unit, Sheba Medical Center, Sackler Faculty of Medicine, Safra Children's Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Andreea Nissenkorn
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Pediatric Neurology Unit, Sheba Medical Center, Sackler Faculty of Medicine, Safra Children's Hospital, Tel Aviv University, Tel Aviv, Israel.,The Service for Rare Disorders, Chaim Sheba Medical Center, Edmond and Lilly Safra Children Hospital, Tel HaShomer, Israel
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Lewis J, Scott K, Pan X, Heathcock J. The Relationship between Parent-reported PEDI-CAT Mobility and Gross Motor Function in Children with Cerebral Palsy: Brief Report. Dev Neurorehabil 2020; 23:140-144. [PMID: 31726912 DOI: 10.1080/17518423.2019.1687601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The PEDI-CAT mobility domain (PEDI-mob) is a parent-reported measure of mobility for children up to 21 years of age. The purpose of this research is to investigate the relationship between the PEDI-mob and Gross Motor Function Measure (GMFM)-66 and Gross Motor Function Classification Scale (GMFCS) levels.Methods: Fifty-seven children (N = 57), ages 2-8.8 years participated. PEDI-mob and GMFM were administered and GMFCS was confirmed during the same session. A Pearson correlation coefficient was calculated for PEDI-mob and GMFM-66 scores to evaluate the association between these two measures. An ANOVA was used to analyze PEDI-mob across GMFCS levels.Results: Large, statistically significant correlation was found between PEDI-mob and GMFM-66 scores (r = 0.894, p-value<0.001). Differences in PEDI-mob scores were found across GMFCS levels (p-value <0.001), where patients with higher GMFCS levels had lower PEDI-mob scores.Conclusion: These results support a strong relationship between parent-reported and clinically measured motor function.
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Fragala-Pinkham MA, Miller PE, M Dumas H, Shore BJ. Development and Validation of Equations to Link Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Scores to PEDI-Computer Adaptive Test Scores for Youth with Cerebral Palsy. Phys Occup Ther Pediatr 2020; 40:106-120. [PMID: 31203687 DOI: 10.1080/01942638.2019.1628160] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: The Pediatric Evaluation of Disability Inventory (PEDI) was revised to the PEDI-Computer Adaptive Test (PEDI-CAT). The PEDI has been used for over two decades to track function in youth, so it is important that follow-up data are not lost with this transition. The purpose of this study was to develop and validate equations for linking PEDI scores to PEDI-CAT scores.Methods: Caregivers of 101 youth 6.1 to 19.8 years of age with cerebral palsy (CP) and classified at Gross Motor Classification System (GMFCS) Levels I-V completed the PEDI and PEDI-CAT. Scaled score data from this sample were used to develop and validate linking equations using least squares regression and bootstrap cross-validation techniques. Next, equations were tested in an independent sample of 35 children with developmental disabilities.Results: The equations to predict PEDI-CAT scores exhibited excellent model fit. PEDI Self-care, Mobility, and Social Function explained 92%, 84%, and 85% of the variation in PEDI-CAT Daily Activities, Mobility, and Social/Cognitive domains, respectively. No differences were detected between actual and predicted PEDI-CAT scores across all domains and by GMFCS level for the equation development sample and for an equation validation independent sample.Conclusions: The model fit was excellent; however, equations should be used cautiously when evaluating changes in function for individual children with ceiling level PEDI scores. Valid score prediction equations for youth with CP will assist with transitioning from the PEDI to the PEDI-CAT.
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Affiliation(s)
- Maria A Fragala-Pinkham
- Medical Rehabilitation Research Center, Franciscan Children's Hospital, Brighton, Massachusetts, USA
| | - Patricia E Miller
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Helene M Dumas
- Medical Rehabilitation Research Center, Franciscan Children's Hospital, Brighton, Massachusetts, USA
| | - Benjamin J Shore
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Richardson ZS, Scully EA, Dooling-Litfin JK, Murphy NJ, Rigau B, Khetani MA, McManus BM. Early Intervention Service Intensity and Change in Children's Functional Capabilities. Arch Phys Med Rehabil 2019; 101:815-821. [PMID: 31778660 DOI: 10.1016/j.apmr.2019.10.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/08/2019] [Accepted: 10/13/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To estimate correlates of early intervention (EI) service dosage and gains in children's functional capabilities from EI entry and discharge. DESIGN Retrospective cohort study. SETTING Secondary analyses of a subset of data (N=1005) collected from an EI administrative database on children discharged from a large, urban EI program between October 1, 2014 and September 30, 2016. PARTICIPANTS Children who were EI eligible due to developmental delay, had received an EI care plan and at least 1 billable EI service, and had outcomes data at EI entry and exit (N=1005). Measured child characteristics included age (49.0% 12-24mo; n=492), sex (36.0% female; n=362), number of developmental delays (76.1% had 1 developmental delay; n=765), and number of EI services received (78.5% received multiple; n=789). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Outcomes were EI service intensity (hours per month) and change in functional capabilities as measured via the state-mandated Child Outcomes Summary (COS). Adjusted quantile median regression estimated EI intensity. Adjusted linear regression estimated change in function for social-emotional, cognitive, and adaptive domains of the COS. Measures of children's developmental delay severity, age at EI entry, race and ethnicity, sex, and language. RESULTS Children older than 24 months old experienced significantly higher EI service intensity (b=0.40; 95% confidence interval, 0.18-0.63). Child age and EI service intensity were significantly linked to gains in social and cognitive COS score changes from EI entry to exit. CONCLUSIONS Older children receive a higher intensity of EI services. EI service intensity and age were linked with positive changes in functional gains.
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Affiliation(s)
- Zachary S Richardson
- Department of Health Systems, Management and Policy, University of Colorado at Denver, Denver, Colorado
| | | | | | - Natalie J Murphy
- Department of Physical Medicine and Rehabilitation, University of Colorado at Denver, Denver, Colorado
| | - Briana Rigau
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois
| | - Mary A Khetani
- Departments of Occupational Therapy and Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois.
| | - Beth M McManus
- Department of Health Systems, Management and Policy, University of Colorado at Denver, Denver, Colorado
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The Need for a Developmentally Based Measure of Social Communication Skills. J Am Acad Child Adolesc Psychiatry 2019; 58:555-560. [PMID: 31130206 PMCID: PMC6599636 DOI: 10.1016/j.jaac.2018.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/04/2018] [Accepted: 02/15/2019] [Indexed: 12/14/2022]
Abstract
The ability to demonstrate and quantify changes in social communication skills has been hindered by a lack of existing measures with appropriate standardization and psychometric properties. Such a measure would be helpful for research in many populations but would be particularly crucial for detecting incremental changes in youth with neurodevelopmental disorders who might gain skills but still lag substantially behind same-age peers. Although study designs and statistical methods are under development to try to account for slow and/or nonlinear, but potentially meaningful, improvements,1 there is a dearth of measures designed to capture growth and loss of social communication skills. This opinion piece outlines the argument for such a measure and the primary issues to consider in its development.
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Shore BJ, Allar BG, Miller PE, Matheney TH, Snyder BD, Fragala-Pinkham M. Measuring the Reliability and Construct Validity of the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI-CAT) in Children With Cerebral Palsy. Arch Phys Med Rehabil 2019; 100:45-51. [DOI: 10.1016/j.apmr.2018.07.427] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/28/2018] [Accepted: 07/03/2018] [Indexed: 12/26/2022]
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Bos N, Engel MF, van Rijswijk NJ, Verheijden JMA, Coster W, Moed R, Ketelaar M. Translation and cross-cultural adaptation of the PEDI-CAT: Dutch version. J Pediatr Rehabil Med 2019; 12:57-64. [PMID: 30883373 DOI: 10.3233/prm-180544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Nynke Bos
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands
| | - Madelon F Engel
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Nina J van Rijswijk
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Physiotherapy, Hogeschool Utrecht, Utrecht, The Netherlands
| | | | - Wendy Coster
- Department of Occupational Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | | | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Mulligan SE. Initial Studies of Validity of the Children's Occupational Performance Questionnaire. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2018; 39:135-142. [PMID: 30403156 DOI: 10.1177/1539449218808276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies of validity of a new caregiver report measure, the Children's Occupational Performance Questionnaire (COPQ) designed to address children's performance in the domains of personal and instrumental activities of daily living (IADLs), social participation, play/leisure, and education/work are presented. I examined criterion-related and discriminant validity of the COPQ. Criterion-related validity was addressed by correlating children's COPQ scores with those from the Vineland Adaptive Behavior Scale (VABS-II). Quasi-experimental methods were used to compare COPQ scores from a heterogeneous group of children with disabilities with those from neurotypical children matched by age. COPQ scores correlated highly with scores from the VABS-II including social interaction, communication, daily living skills, and motor skills. Capacity of the COPQ to discriminate between children with and without disabilities varied dependent on age, and the occupational domain being considered. Preliminary support for the validity of COPQ as a measure of occupational performance for children was provided. Further study of the tool's psychometrics and with larger samples is needed.
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Paradis J, Arnould C, Thonnard JL, Houx L, Pons-Becmeur C, Renders A, Brochard S, Bleyenheuft Y. Responsiveness of the ACTIVLIM-CP questionnaire: measuring global activity performance in children with cerebral palsy. Dev Med Child Neurol 2018; 60:1178-1185. [PMID: 29869417 DOI: 10.1111/dmcn.13927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 11/29/2022]
Abstract
AIM To investigate the responsiveness of the ACTIVLIM-CP questionnaire after two evidence-based interventions for children with cerebral palsy (CP). METHOD Seventy-five children with CP either participated in an intensive motor-skill learning intervention (hand-arm bimanual intensive therapy including lower extremities [HABIT-ILE], n=47) or received botulinum neurotoxin-A (BoNT-A) injection(s) into lower extremities combined with conventional physical therapy (n=28). All children were assessed three times: at baseline (T0 ; before HABIT-ILE/the day of BoNT-A injection), at T1 (last day of HABIT-ILE/6wks after BoNT-A injection), and at follow-up (T2 ; 3-4mo after the beginning of intervention). Parents completed ACTIVLIM-CP and three other activity questionnaires. Responsiveness was analysed using group (based on intervention), subgroup (based on gross motor function level), and individual approaches. RESULTS For the HABIT-ILE group, significant improvements in ACTIVLIM-CP were observed for the T0 -T1 period (p<0.001) but not for the T1 -T2 period. No significant changes were found in the BoNT-A group during assessments (p=0.84). In the subgroup analysis for the HABIT-ILE group (T0 -T1 ), greater changes were demonstrated for children in Gross Motor Function Classification System levels III and IV (p<0.001, effect size=1.36). The individual approach was congruent with the group approach. INTERPRETATION ACTIVLIM-CP demonstrated high responsiveness after HABIT-ILE, showing that this scale may be used to investigate global activity performance in clinical trials focusing on improving daily life activities. WHAT THIS PAPER ADDS Good responsiveness of ACTIVLIM-CP questionnaire during intensive motor-skill learning intervention. Higher responsiveness for children in Gross Motor Function Classification System (GMFCS) levels III and IV versus I and II after intensive intervention. ACTIVLIM-CP is useful to identify children improving their performance after botulinum neurotoxin-A injection.
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Affiliation(s)
- Julie Paradis
- Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
| | - Carlyne Arnould
- Physical and Occupational Therapy Department, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Charleroi, Belgium
| | - Jean-Louis Thonnard
- Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
| | - Laëtitia Houx
- Physical and Rehabilitation Medicine Department, CHRU de Brest, Brest, France.,Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
| | - Christelle Pons-Becmeur
- Physical and Rehabilitation Medicine Department, CHRU de Brest, Brest, France.,Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
| | - Anne Renders
- Cliniques Universitaires Saint-Luc, Physical and Rehabilitation Medicine Department, Université catholique de Louvain, Brussels, Belgium
| | - Sylvain Brochard
- Physical and Rehabilitation Medicine Department, CHRU de Brest, Brest, France.,Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
| | - Yannick Bleyenheuft
- Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
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Khetani MA, Albrecht EC, Jarvis JM, Pogorzelski D, Cheng E, Choong K. Determinants of change in home participation among critically ill children. Dev Med Child Neurol 2018; 60:793-800. [PMID: 29574916 DOI: 10.1111/dmcn.13731] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 11/30/2022]
Abstract
AIM To estimate changes in home participation among critically ill children in the first 6 months after discharge from a pediatric intensive care unit (PICU), and to explore the effect of child, service, and environmental factors on change in home participation. METHOD This was a prospective bi-center, longitudinal cohort study. Caregivers of 180 children, aged 1 to 17 years, who were admitted into the PICU for at least 48 hours were included. Patient-reported outcomes were used to capture caregivers' perspectives of their child's participation and environmental supports for participation in home activities. Data were collected at enrollment, and 3 and 6 months after discharge. RESULTS There were no significant changes in home participation frequency or involvement, but involvement rates across time were moderated by functional status. Age significantly predicted participation frequency. Pre-PICU functional status and capabilities were significant predictors of participation frequency and involvement, and home environmental support significantly predicted home involvement. INTERPRETATION Results suggest relatively stable participation trajectories in the 6 months after PICU admission. Children with abnormal baseline function experienced a greater increase in home involvement after PICU. Rehabilitation interventions targeting functional capabilities and home environment may be viable approaches during the early phase of recovery. Environmental interventions may be more time-efficient after PICU stay and merit further study. WHAT THIS PAPER ADDS Children's pre-pediatric intensive care unit (PICU) functional status and capabilities impact their participation after critical illness. Children's trajectories of home involvement may differ over time based on their pre-PICU functional status. Caregiver perceptions of environmental support impact a child's home involvement after discharge from a PICU.
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Affiliation(s)
- Mary A Khetani
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Jessica M Jarvis
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - David Pogorzelski
- Department of Pediatrics, Critical Care, Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Emmy Cheng
- Department of Pediatrics, Critical Care, Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Karen Choong
- Department of Pediatrics, Critical Care, Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Technology-based functional assessment in early childhood intervention: a pilot study. Pilot Feasibility Stud 2018; 4:65. [PMID: 29588860 PMCID: PMC5863479 DOI: 10.1186/s40814-018-0260-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Electronic patient-reported outcomes (e-PROs) may provide valid and feasible options for obtaining family input on their child’s functioning for care planning and outcome monitoring, but they have not been adopted into early intervention (EI). The purpose of this pilot study was to evaluate the feasibility of implementing technology-based functional assessment into EI practice and to examine child, family, service, and environmental correlates of caregiver-reported child functioning in the home. Methods In a cross-sectional design, eight individual EI providers participated in a 90-min technology-based functional assessment training to recruit participants and a 60-min semi-structured focus group post data collection. Participants completed the Young Children’s Participation and Environment Measure (YC-PEM) home section online and Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) via iPad. Participants’ EI service use data were obtained from administrative records. Results A total of 37 caregivers of children between 6 and 35 months old (mean age = 19.4, SD = 7.7) enrolled, a rate of 44% (37/84) in 2.5 months. Providers suggested expanding staff training, gathering data during scheduled evaluations, and providing caregivers and providers with access to assessment summaries. Caregivers wanted their child’s participation to change in 56% of home activities. Lower caregiver education and higher EI intensity were related to less child involvement in home activities. Conclusions Implementing technology-based functional assessment is feasible with modifications, and these data can be useful for highlighting child, family, and EI service correlates of caregiver-reported child functioning that merit further study. Feasibility results informed protocol modifications related to EI provider training, timing of data collection, and management of EI service use data extraction, as preparation for a subsequent scale-up study that is underway.
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Rodday AM, Graham RJ, Weidner RA, Rothrock NE, Dewalt DA, Parsons SK. Leveraging pediatric PROMIS item banks to assess physical functioning in children at risk for severe functional loss. J Patient Rep Outcomes 2017; 1:10. [PMID: 29757321 PMCID: PMC5934938 DOI: 10.1186/s41687-017-0011-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 09/04/2017] [Indexed: 01/22/2023] Open
Abstract
Background Pediatric neuromuscular illnesses often result in decreased health-related quality of life (HRQL), notably in physical functioning. Generic HRQL measures have been developed for use in general populations, but may not adequately assess patients with severe functional loss. To address this measurement gap, we created two custom parent-proxy physical functioning short forms for use among children at risk for low levels of functioning, using pediatric Patient Reported Outcomes Measurement Information System (PROMIS) item banks for Upper Extremity and Mobility. Methods Two custom short forms from PROMIS Upper Extremity (13 items) and Mobility (13 items) parent-proxy item banks were created and administered to parents of children (ages 5 - 22 years) enrolled in an integrated care program for management of chronic respiratory insufficiency, largely due to neuromuscular illnesses. Standardized PROMIS T-scores have a mean of 50 (SD = 10); higher scores indicate better functioning. Physicians rated clinical severity. Single proxy-rated items on mental and physical health from the Child Health Rating Inventories (CHRIs) global health scale were completed by parents. Psychometric properties, including known groups comparisons, were explored. Results Fifty-seven parents completed the parent-proxy custom PROMIS short forms. The mean Upper Extremity T-score was 21 (SD = 13); the mean Mobility T-score was 22 (SD = 11). Some participants scored at the measurement floor; two items on assistive devices did not perform well in this sample and were excluded from the Mobility T-score. Known groups comparisons showed that those with lower clinical severity had better median Upper Extremity (22 vs. 14, p < 0.001) and Mobility (28 vs. 16, p = 0.004) function than those with worse clinical severity. Both Upper Extremity and Mobility T-scores were higher in the subgroups defined by better physical and mental health, as measured by the CHRIs. Conclusions Upper Extremity and Mobility T-scores were nearly three standard deviations below the PROMIS pediatric calibration population mean. Preliminary psychometrics demonstrated the potential to more accurately measure lower physical functioning using items from PROMIS item banks. However, some participants scored at the measurement floor despite targeting items at the lower end of the scale. Further short form refinement, enrichment of the item banks, and larger-scale field testing are needed.
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Affiliation(s)
- Angie Mae Rodday
- 1Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, 800 Washington St, Box 345, Boston, MA 02111 USA
| | - Robert J Graham
- 2Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Department of Anesthesia, Harvard Medical School, 300 Longwood Avenue, Bader 629, Boston, MA 02115 USA
| | - Ruth Ann Weidner
- 3Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 345, Boston, MA 02111 USA
| | - Nan E Rothrock
- 4Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine625, North Michigan Avenue, Suite 2700, Chicago, IL 60611 USA
| | - Darren A Dewalt
- 5Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, 5041 Old Clinic Building, CB 7110, Chapel Hill, NC 27599 USA
| | - Susan K Parsons
- 6Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, 800 Washington St, Box 345, Boston, MA 02111 USA
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Shore BJ, Allar BG, Miller PE, Matheney TH, Snyder BD, Fragala-Pinkham MA. Evaluating the Discriminant Validity of the Pediatric Evaluation of Disability Inventory: Computer Adaptive Test in Children With Cerebral Palsy. Phys Ther 2017; 97:669-676. [PMID: 28379484 DOI: 10.1093/ptj/pzx033] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 03/16/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) is a new clinical assessment for children and youth from birth through 20 years of age. OBJECTIVE To determine the discriminant validity of the PEDI-CAT according to the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) in children with cerebral palsy (CP). DESIGN A prospective convenience cross-sectional sample of 101 school-age children with CP was stratified by GMFCS level. METHODS Participants were excluded if they underwent recent surgery (<6 months). Receiver operating characteristics curve analysis was used to quantify the discriminant validity of the PEDI-CAT domains to distinguish the level of independence in fine and gross motor function. General linear modeling was used to assess discriminant ability across all GMFCS and MACS levels. RESULTS Mean age was 11 years, 11 months (SD 3.7). Mobility and Daily Activities domains exhibited excellent discriminant validity distinguishing between ambulatory and nonambulatory participants [area under the curve (AUC) = 0.98 and 0.97, respectively] and the Daily Activities domain exhibited excellent discriminant validity distinguishing between independent and dependent hand function (AUC = 0.93). All PEDI-CAT domains were able to discriminate between ambulatory (GMFCS levels I-III) or nonambulatory (GMFCS levels IV-V) as well as manually independent (MACS levels I-II) or manually dependent functional levels (MACS levels III-V) ( P < .001). LIMITATIONS Our convenience cross-sectional sample included school-age children with primarily Caucasian, middle-income parents and may not be representative of other cultural, socioeconomic backgrounds. Not all participants had a MACS level assigned, however, no differences were found in PEDI-CAT scores between those with and without MACS scores. CONCLUSIONS These results demonstrate that the PEDI-CAT is a valid outcome instrument for measuring functional abilities in children with CP, able to differentiate across fine and gross motor functional levels.
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Affiliation(s)
- Benjamin J Shore
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Hunnewell 221, 300 Longwood Ave, Boston MA 02115 (USA)
| | | | | | | | - Brian D Snyder
- Department of Orthopedic Surgery, Boston Children's Hospital
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Mann TN, Donald KA, Laughton B, Lamberts RP, Langerak NG. HIV encephalopathy with bilateral lower limb spasticity: upper limb motor function and level of activity and participation. Dev Med Child Neurol 2017; 59:412-419. [PMID: 27573542 DOI: 10.1111/dmcn.13236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/30/2022]
Abstract
AIM To describe upper limb motor function and level of activity and participation in children with HIV encephalopathy (HIVE) and bilateral lower limb (BLL) spasticity. METHOD Thirty ambulant children with HIVE and BLL spasticity and 20 typically developing children, between 5 years and 12 years, were recruited. Upper limb motor function was assessed using the Purdue Pegboard and level of activity and participation using the Computer-Adapted Pediatric Evaluation of Disabilities Inventory (PEDI-CAT). RESULTS The HIVE group comprised 14 males and 16 females (mean age [SD] 8y 8mo [2y 2mo], Gross Motor Function Classification System (GMFCS) level I [n=10], II [n=11], and III [n=9]) and the typically developing group comprised 11 males and 9 females (mean age 8y 8mo [2y 3mo]). The HIVE group had lower scores than the typically developing group for all pegboard tasks and three of the four PEDI-CAT domains (p≤0.001). However, individual outcome scores varied substantially within each GMFCS level. INTERPRETATION Children with HIVE and BLL spasticity may have significantly poorer upper limb motor performance and lower levels of activity and participation than typically developing children. These findings suggest that an assessment of upper limb motor function should form part of optimal care for this population.
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Affiliation(s)
- Theresa N Mann
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa.,Division of Orthopedic Surgery, Department of Surgical Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Kirsten A Donald
- Division of Developmental Pediatrics, Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Children's Infectious Diseases Clinical Research Unit, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Robert P Lamberts
- Division of Orthopedic Surgery, Department of Surgical Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Nelleke G Langerak
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
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Albrecht EC, Khetani MA. Environmental impact on young children's participation in home-based activities. Dev Med Child Neurol 2017; 59:388-394. [PMID: 27988938 PMCID: PMC5334138 DOI: 10.1111/dmcn.13360] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 12/03/2022]
Abstract
AIM To test the effect of child, family, and environmental factors on young children's participation in home-based activities. METHOD Caregivers of young children were recruited using convenience and snowball sampling. Participants were 395 caregivers of children (222 males, 173 females) aged from 1 month to 5 years and 11 months. Demographic items and the home section of the Young Children's Participation and Environment Measure were administered online, followed by completion of the daily activities, mobility, and social/cognitive domains of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test by telephone interview. RESULTS A structural equation model fitted the data well (comparative fit index=0.91) and explained 31.2% of the variance in perceived environmental support and 42.5% of the variance in home involvement. Functional limitations and performance had an indirect effect on young children's participation through their effect on perceived environmental support. Specifically, fewer functional limitations and higher task performance were associated with greater environmental support, which in turn predicted higher levels of home involvement. INTERPRETATION Results suggest the importance of a young child's functional abilities and task performance on caregiver perceptions of environmental support at home, and the impact of environmental support on a child's participation in home-based activities during the early childhood period. Results warrant replication with more diverse samples to evaluate model generalizability.
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Affiliation(s)
- Erin C Albrecht
- Department of Human Development and Family StudiesColorado State UniversityFort CollinsCOUSA
| | - Mary A Khetani
- Department of Occupational TherapyUniversity of Illinois at ChicagoChicagoILUSA
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Dumas HM, Fragala-Pinkham MA, Rosen EL, Folmar E. Physical Therapy Dosing: Frequency and Type of Intervention in Pediatric Postacute Hospital Care. Pediatr Phys Ther 2017; 29:47-53. [PMID: 27984468 DOI: 10.1097/pep.0000000000000339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine differences in physical therapy dosing frequency recommendations based on children's characteristics and to describe types of intervention recommended at postacute hospital admission. METHODS Demographic and clinical information, recommended physical therapy intervention frequency, and intervention types were collected for all admissions from April 1, 2015, to March 1, 2016. Differences across 2 groups, children with recommendations for "less" (≤3x/wk) or "more" (≥4x/wk) frequent therapy, were examined. Types of interventions recommended were described and the measure of association between frequency and type was determined. RESULTS Older children, those with higher admission functional scores, and children with less dependence on medical technology were recommended for "more." Therapeutic exercise was the most common intervention recommended. Greater physical therapy frequency was associated with Functional Training and Motor Function Training. CONCLUSION Children's age, functional level, and technology dependence influence dosing recommendations. Interventions focused on function are associated with greater physical therapy frequency.
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Affiliation(s)
- Helene M Dumas
- Research Center (Drs Dumas and Fragala-Pinkham) and Physical Therapy Department (Dr Rosen), Franciscan Hospital for Children, Boston, Massachusetts; and College of Professional Studies, Northeastern University, Boston, Massachusetts (Dr Folmar)
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45
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Mancini MC, Coster WJ, Amaral MF, Avelar BS, Freitas R, Sampaio RF. New version of the Pediatric Evaluation of Disability Inventory (PEDI-CAT): translation, cultural adaptation to Brazil and analyses of psychometric properties. Braz J Phys Ther 2016; 20:561-570. [PMID: 27333475 PMCID: PMC5176194 DOI: 10.1590/bjpt-rbf.2014.0166] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/08/2016] [Accepted: 02/23/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), developed with innovative measurement methodologies, evaluates functioning of children and youth, from 0 to 21 years, with different health conditions. It is a revision of an earlier instrument (PEDI) that has been used in national and international clinical practice and research. It was felt to be necessary to make this new version (PEDI-CAT) available in Brazil. OBJECTIVES Translate and culturally adapt the PEDI-CAT to the Brazilian-Portuguese language and test its psychometric properties. METHOD This methodological study was developed through the following stages: (1) translation, (2) synthesis, (3) back-translation, (4) revision by an expert committee, (5) testing of the pre-final version, and (6) evaluation of the psychometric properties. The 276 translated PEDI-CAT items were divided into three age groups (0-7, 8-14, and 15-21 years). RESULTS The PEDI-CAT translation followed all six stages. The adaptations incorporated cultural and socioeconomic class specificities. The PEDI-CAT/Brazil showed good indices of inter-examiner (intraclass correlation coefficient-ICC=0.83-0.89) and test-retest (ICC=0.96-0.97) reliability, good internal consistency (0.99) and small standard error of measurement in all three age groups (0.12-0.17). Factor analyses grouped the items from the three functional skills domains into one factor, and items from the responsibility scale into three factors, supporting the adequacy of these factor solutions to the conceptual structure of the instrument and the developmental model. CONCLUSION The PEDI-CAT/Brazil is a theoretically consistent, culturally appropriate, and reliable instrument. Its availability in Brazil will contribute to the evaluation and measurement of functional outcomes from clinical interventions, longitudinal follow-up, and rehabilitation research.
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Affiliation(s)
- Marisa C. Mancini
- Programa de Pós-graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Wendy J. Coster
- Department of Occupational Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, USA
| | - Maíra F. Amaral
- Programa de Pós-graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
- Departamento de Terapia Ocupacional de Lagarto, Universidade Federal de Sergipe (UFS), Lagarto, SE, Brazil
| | - Bruna S. Avelar
- Programa de Pós-graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Raphael Freitas
- Programa de Pós-graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Rosana F. Sampaio
- Programa de Pós-graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Pasternak A, Sideridis G, Fragala-Pinkham M, Glanzman AM, Montes J, Dunaway S, Salazar R, Quigley J, Pandya S, O'Riley S, Greenwood J, Chiriboga C, Finkel R, Tennekoon G, Martens WB, McDermott MP, Fournier HS, Madabusi L, Harrington T, Cruz RE, LaMarca NM, Videon NM, Vivo DCD, Darras BT. Rasch analysis of the Pediatric Evaluation of Disability Inventory-computer adaptive test (PEDI-CAT) item bank for children and young adults with spinal muscular atrophy. Muscle Nerve 2016; 54:1097-1107. [DOI: 10.1002/mus.25164] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Amy Pasternak
- Department of Physical Therapy and Occupational Therapy Services, 300 Longwood Avenue; Boston Children's Hospital; Boston Massachusetts USA
| | - Georgios Sideridis
- Clinical Research Center, Department of Medicine and Division of Developmental Medicine, Boston Children's Hospital; Harvard Medical School; Boston Massachusetts USA
| | - Maria Fragala-Pinkham
- Research Center for Children with Special Health Care Needs; Franciscan Hospital for Children; Brighton Massachusetts USA
| | - Allan M. Glanzman
- Department of Physical Therapy; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania USA
| | - Jacqueline Montes
- Department of Rehabilitation and Regenerative Medicine; Columbia University Medical Center; New York New York USA
- Department of Neurology; Columbia University Medical Center; New York New York USA
| | - Sally Dunaway
- Department of Rehabilitation and Regenerative Medicine; Columbia University Medical Center; New York New York USA
- Department of Neurology; Columbia University Medical Center; New York New York USA
| | - Rachel Salazar
- Department of Neurology; Columbia University Medical Center; New York New York USA
| | - Janet Quigley
- Department of Physical Therapy and Occupational Therapy Services, 300 Longwood Avenue; Boston Children's Hospital; Boston Massachusetts USA
| | - Shree Pandya
- Department of Neurology; University of Rochester; Rochester New York USA
| | - Susan O'Riley
- Department of Physical and Occupational Therapy; Massachusetts General Hospital; Boston Massachusetts USA
| | - Jonathan Greenwood
- Department of Physical Therapy and Occupational Therapy Services, 300 Longwood Avenue; Boston Children's Hospital; Boston Massachusetts USA
| | - Claudia Chiriboga
- Department of Neurology; Columbia University Medical Center; New York New York USA
| | - Richard Finkel
- Department of Pediatrics; Nemours Children's Hospital; Orlando Florida USA
| | - Gihan Tennekoon
- Department of Neurology; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania USA
- Department of Pediatrics; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania USA
| | - William B. Martens
- Department of Neurology; University of Rochester; Rochester New York USA
| | - Michael P. McDermott
- Department of Neurology; University of Rochester; Rochester New York USA
- Department of Biostatistics and Computational Biology; University of Rochester; New York USA
| | - Heather Szelag Fournier
- Department of Neurology, Boston Children's Hospital; Harvard Medical School; Boston Massachusetts USA
| | - Lavanya Madabusi
- Department of Neurology, Boston Children's Hospital; Harvard Medical School; Boston Massachusetts USA
| | - Timothy Harrington
- Department of Neurology, Boston Children's Hospital; Harvard Medical School; Boston Massachusetts USA
| | - Rosangel E. Cruz
- Department of Neurology; Columbia University Medical Center; New York New York USA
| | - Nicole M. LaMarca
- Department of Neurology; Columbia University Medical Center; New York New York USA
| | - Nancy M. Videon
- Department of Neurology; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania USA
- Department of Pediatrics; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania USA
| | - Darryl C. De Vivo
- Department of Neurology; Columbia University Medical Center; New York New York USA
| | - Basil T. Darras
- Department of Neurology, Boston Children's Hospital; Harvard Medical School; Boston Massachusetts USA
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Dumas HM, Fragala-Pinkham MA, Rosen EL, O’Brien JE. Construct validity of the pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT) in children with medical complexity. Disabil Rehabil 2016; 39:2446-2451. [DOI: 10.1080/09638288.2016.1226406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Helene M. Dumas
- Research Center, Franciscan Hospital for Children, Boston, MA, USA
| | - Maria A. Fragala-Pinkham
- Research Center, Franciscan Hospital for Children, Boston, MA, USA
- Physical Therapy Department, Franciscan Hospital for Children, Boston, MA, USA
| | - Elaine L. Rosen
- Physical Therapy Department, Franciscan Hospital for Children, Boston, MA, USA
| | - Jane E. O’Brien
- Research Center, Franciscan Hospital for Children, Boston, MA, USA
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Fragala-Pinkham MA, Dumas HM, Lombard KA, O'Brien JE. Responsiveness of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test in measuring functional outcomes for inpatient pediatric rehabilitation. J Pediatr Rehabil Med 2016; 9:215-22. [PMID: 27612081 DOI: 10.3233/prm-160382] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Responsiveness of the PEDI-CAT Mobility, Daily Activities, and Social/Cognitive domains and Wheelchair subdomain was evaluated for youth admitted to a pediatric post-acute care hospital. METHODS Inpatients ages 2-21 years, with a length of stay of ≥ 5 days and with both admission and discharge scores were included. The difference between mean admission and discharge PEDI-CAT scaled scores were analyzed using paired t-tests. Effect sizes, standard response means (SRMs), and minimal detectable change values were calculated. Score comparison between diagnostic subgroups (Traumatic Brain Injury, Neurological, Orthopedic, Medical) and age groups ( ≤ 5, > 5 but < 13, ≥ 13 years) were evaluated for the Mobility domain. RESULTS Sample size differed by domain with 66 Mobility, 30 Daily Activities, 19 Social/Cognitive and 9 Wheelchair subdomain pairs. Significant differences were found for all domains when mean admission and discharge scaled scores were compared. Moderate to large effect sizes and SRMs were found for the Mobility and Daily Activities domains and Wheelchair subdomain. Small effect size but large SRM was found for the Social/Cognitive domain. The Mobility domain was also responsive to changes in all diagnostic and age groups. CONCLUSION The PEDI-CAT was responsive to functional changes for youth discharged from an inpatient pediatric rehabilitation hospital.
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Affiliation(s)
| | - Helene M Dumas
- Research Center, Franciscan Hospital for Children, Brighton, MA, USA
| | - Kelly A Lombard
- Research Center, Franciscan Hospital for Children, Brighton, MA, USA.,Physical Therapy Department, Boston Children's Hospital, Boston, MA, USA
| | - Jane E O'Brien
- Research Center, Franciscan Hospital for Children, Brighton, MA, USA
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KRAMER JESSICAM, LILJENQUIST KENDRA, COSTER WENDYJ. Validity, reliability, and usability of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test for autism spectrum disorders. Dev Med Child Neurol 2016; 58:255-61. [PMID: 26104112 PMCID: PMC4688240 DOI: 10.1111/dmcn.12837] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2015] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to explore the test-retest reliability of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test for autism spectrum disorders (PEDI-CAT [ASD]), the concurrent validity of this test with the Vineland Adaptive Behavior Scales (VABS-II), and parents' perceptions of usability. METHOD A convenience sample of participants (n=39) was recruited nationally through disability organizations. Parents of young people aged 10 to 18 years (mean age 14y 10mo, SD 2y 8mo; 34 males, five females) who reported a diagnosis of autism were eligible to participate. Parents completed the VABS-II questionnaire once and the PEDI-CAT (ASD) twice (n=29) no more than 3 weeks apart (mean 12d) using computer-simulated administration. Parents also answered questions about the usability of these instruments. We examined score reliability using intraclass correlation coefficients (ICCs) and we explored the relationship between instruments using Spearman's rank correlation coefficients. Parent responses were grouped by common content; content categories were triangulated by an additional reviewer. RESULTS Intraclass correlation coefficients indicate excellent reliability for all PEDI-CAT (ASD) domain scores (ICC ≥ 0.86). PEDI-CAT (ASD) and VABS-II domain scores correlated as expected or stronger than expected (0.57-0.81). Parents reported that the computer-based PEDI-CAT (ASD) was easy to use and included fewer irrelevant questions than the VABS-II instrument. INTERPRETATION These findings suggest that the PEDI-CAT (ASD) is a reliable assessment that parents can easily use. The PEDI-CAT (ASD) operationalizes the International Classification of Function, Disability and Health for Children and Youth constructs of 'activity' and 'participation', and this preliminary research suggests that the instrument's constructs are related to those of VABS-II.
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Affiliation(s)
- JESSICA M KRAMER
- Department of Occupational Therapy, Boston University, Boston, MA
| | | | - WENDY J COSTER
- Department of Occupational Therapy, Boston University, Boston, MA
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Abstract
PURPOSE To describe physical therapy (PT) examination and intervention during rehabilitation for a child poststroke with an implanted left ventricular assist device (LVAD). KEY POINTS A 10-year-old boy with a history of congenital heart disease awaiting heart transplant was admitted to a pediatric rehabilitation hospital with right hemiplegia, and an external, portable LVAD. This child participated in standard PT examination procedures and interventions with accommodations for the LVAD. Observation was used to evaluate exercise response because of inability to measure vital signs. At admission, impaired muscle tone, balance, and endurance contributed to limitations in functional mobility. By discharge, improvements were seen in all impairments and also in ambulation distance, speed, and independence. CONCLUSION This child awaiting heart transplant with an LVAD was able to tolerate intensive individualized PT. With monitoring and adjustments to the plan of care, he demonstrated improvements in functional mobility.
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