Responsiveness of the Seated Postural Control Measure and the Level of Sitting Scale in children with neuromotor disorders

Validity and reliability of the Sitting Assessment Scale in cerebral palsy

AIM

The aim of this study was to examine the validity and reliability of the Sitting Assessment Scale (SAS) in individuals with cerebral palsy (CP).

METHODS

The study included 34 individuals with a diagnosis of spastic CP. Individuals were evaluated with the Gross Motor Function Classification System and the Manual Ability Classification System. SAS and Trunk Control Measurement Scale (TCMS) were applied to the participants. The intraclass correlation coefficient (ICC) was calculated to determine the intraobserver and interobserver reliability of the scale scored by three different physiotherapists at two different time intervals. Internal consistency was calculated with Cronbach's ⍺ coefficient. The fit between SAS and TCMS for criterion-dependent validity was evaluated using Pearson Correlation Analysis.

RESULTS

According to the GMFCS level, 79.41% of the children were mildly (Level I-II), 14.71% were moderately affected (level III), and 5.88% were severely affected (level IV). Intra > observer and interobserver reliability values of SAS were extremely high (ICCinterrater > 0.923, ICCintrarater > 0.930). It was observed that the internal consistency of SAS had high values (Cronbach ⍺test > 0.822, Cronbach ⍺retest > 0.804). For the criterion-dependent reliability; positive medium correlations found between SAS with Total TCMS Static Sitting Balance (r = 0.579, p < 0.001), with TCMS Selective Movement Control (r = 0.597, p < 0.001), with TCMS Dynamic Reaching (r = 0.609, p < 0.001), and with TCMS Total (r = 0.619, p < 0.001).

CONCLUSION

SAS was found to have high validity and reliability in children with CP. In addition, the test-retest reliability of the scale was also high. SAS is a practical tool that can be used to assess sitting balance in children with CP.

Following 4 months of social distancing during COVID-19 Pandemic in Brazil did not change aspects of functioning in children and adolescents with developmental disabilities: A longitudinal study

The COVID-19 pandemic and its demands of social distancing have created challenges in the lives of children/adolescents with developmental disabilities and their families, which would change aspects of children's functioning. The objetive of this study was to evaluate changes in some components of functioning of children/adolescents with disabilities following 4 months of social distancing during a period of high contamination rate in the year 2020 in Brazil. Participated 81 mothers of children/adolescents with disabilities, 3-17 years, most of them (80%) diagnosed with Down syndrome, cerebral palsy and autism spectrum disorder. Remote assessments of functioning' aspects including IPAQ, YC-PEM/ PEM-C, Social Support Scale and PedsQL V.4.0. Wilcoxon tests compared the measures, with significance level <0.05. No significant changes in participant's functioning were identified. Social adjustments required to facing the pandemic during two points in time in the midst of the pandemic did not change the evaluated aspects of functioning in our sample of Brazilian.

Effectiveness and Evidence Level of Dance on Functioning of Children and Adolescents with Neuromotor Impairments: A Systematic Review

OBJECTIVES

The aim of this paper is to investigate the effects of dance therapy in children with neuromotor impairments (CNI), organizing the outcomes according to International Classification of Functioning Disability and Health (ICF) domains, and to investigate if there is adequate evidence of effectiveness to recommend dance as a therapy.

METHODS

Electronic searches were conducted in December 2021. We include studies assessing the effects of dance in CNI up to 18 years. Data extraction included studies' populations, intervention features, and main outcomes. We classified outcomes according to the ICF framework. We used the Cochrane collaboration's tool, modified by effective practice and organization of care (EPOC), to assess the methodological quality. The GRADE synthesized the body of evidence.

RESULTS

Twelve studies were included, with most of them addressing the body structure and function and activity components of ICF. Only three studies addressed components of participation, and four of personal factors. All these studies reported the positive effects of dance. Nevertheless, all of them presented high risk of bias. We found very low evidence level for improvement of body structure and function and activity components.

CONCLUSION

Dance therapy presents low evidence level for improvements of body structure and function and activity in CNI. Further studies with low risk of bias and larger samples are needed.

Quantification of the development of trunk control in healthy infants using inertial measurement units

Trunk motor control is essential for the proper functioning of the upper extremities and is an important predictor of gait capacity in children with delayed development. Early diagnosis and intervention could increase the trunk motor capabilities in later life, but current tools used to assess the level of trunk motor control are largely subjective and many lack the sensitivity to accurately monitor development and the effects of therapy. Inertial measurement units could yield an objective quantitative assessment that is inexpensive and easy-to-implement. We hypothesized that root mean square of jerk, a proxy for movement smoothness, could be used to distinguish age and thereby presumed motor development. We attached a sensor to the trunks of six young children with no known developmental deficits. Root mean square of jerk decreases with age, up to 24 months, and is correlated to a more established method, i.e., center-of-pressure velocity, as well as other standard inertial measurement unit outputs. This metric therefore shows potential as a method to differentiate trunk motor control levels.

Seated postural control measure: Italian translation and validation in children with cerebral palsy

BACKGROUND

Seating interventions are part of the postural management program recommended for children with Cerebral Palsy (CP) who are nonambulatory or have difficulty in walking. The lack of validated outcome measures for assessing seating interventions limits access to obtain valid and comparable data internationally.

OBJECTIVE

To translate the Seated Postural Control Measure (SPCM) into Italian and assess reliability and validity of the translated measure in a population of children with CP.

STUDY DESIGN

Cross-sectional and repeated measures study.

METHODS

The original version of the SPCM was translated and culturally adapted by a multidisciplinary team according to international guidelines. Internal consistency was examined with Cronbach's alpha. Both inter- and intrarater reliabilities were estimated using intraclass correlation coefficients with 95% confidence intervals. Intrarater reliability was estimated over a 1-week period. Convergent construct validity was investigated by comparing SPCM values with the Level of Sitting Scale, the Gross Motor Function Classification System, and the Manual Ability Classification System using Pearson's correlation coefficients.

RESULTS

The Italian version of the SPCM (IT-SPCM) was evaluated on 72 children with CP aged 4-18 years. Cronbach's alpha was 0.83, 0.95, and 0.93 for IT-SPCM alignment subscale, IT-SPCM functioning subscale, and total score, respectively. Reliability for IT-SPCM total score was high for both inter- and intrarater reliabilities (0.95 and 0.93). The IT-SPCM total score was moderately correlated with the Level of Sitting Scale (0.37), Gross Motor Function Classification System (-0.41), and Manual Ability Classification System (-0.56).

CONCLUSION

Preliminary evidence supports the reliability and validity of using IT-SPCM with a population of children with CP.

Psychometric properties of trunk impairment scale in children with spastic diplegia

The Trunk Impairment Scale (TIS) is a valid and reliable tool to assess trunk impairment in children with heterogeneous cerebral palsy. The purpose of this study was to determine the reliability and validity of the TIS in assessing children with spastic diplegic cerebral palsy. The sample was a total of 30 subjects (15 = boys, 15 = girls). All subjects underwent an assessment of the sitting component of the Gross Motor Function Measure-88 and TIS by rater 1. Rater one observed video recordings within 24 h and scored TIS for intra-rater reliability, while rater two did likewise after 48 h for inter-rater reliability. The mean and standard deviation of the TIS and sitting components of the Gross Motor Function Measure-88 were 15.66 ± 4.20 and 52.36 ± 6.26, respectively. We established intra-rater and inter-rater reliability of the TIS with Intra Class Correlation Coefficient 0.991 and 0.972, respectively. The concurrent validity of the TIS with the sitting component of the Gross Motor Function Measure-88 was good, with an r-value of 0.844 (p < 0.001). This study showed the excellent intra-rater and inter-rater reliability and high concurrent validity of the TIS in assessing children with spastic diplegic cerebral palsy.

Development and Content Validity of the Clinical Assessment of Body Alignment for Children With Cerebral Palsy

PURPOSE

The purpose of this study is to describe the development and content validity of the clinical assessment of body alignment (CABA) to measure body alignment in children with cerebral palsy.

METHODS

Content validity and clinical utility were examined through expert opinion of 283 pediatric physical therapists. Participants reviewed items as matching or not to the domain of body alignment. Clinical utility was evaluated on a 5-point scale. Means and standard deviation were calculated for each attribute. Fleiss' kappa examined interrater reliability of expert responses.

RESULTS

Percentage agreement was high for 19 items and good for 1 item. Clinicians' ratings showed overall fair to good agreement. Four clinical utility attributes had a net importance score of more than 90%, although interrater reliability was low.

CONCLUSION

Content validity of the CABA was supported. Construct validity, reliability, and responsiveness require further study. What this adds to the evidence: The CABA has potential to offer clinicians and researchers a clinically practical measure of postural alignment for children with cerebral palsy. Preliminary investigation of CABA shows good content validity. However, more studies to assess the assessments' psychometrics including construct validity, reliability, and responsiveness are required.

A study validating the Italian version of the Level of Sitting Scale in children with cerebral palsy

Objectives:

To assess measurement properties of the Italian version of the Level of Sitting Scale when classifying sitting ability of children with cerebral palsy.

Design:

Methodological study.

Setting:

Children’s hospital (inpatients and outpatients).

Subjects:

Children 18 years of age or younger with cerebral palsy.

Methods:

The original English version of the Level of Sitting Scale was translated and culturally adapted for the Italian culture following international guidelines. Examination of reliability and validity of the Italian Level of Sitting Scale was then undertaken. Inter-rater and one-week test–retest reliability were estimated using both intraclass correlation coefficients (ICCs) with 95% confidence intervals and Bland–Altman plots. Construct validity of the Italian Level of Sitting was evaluated using three approaches examining Pearson’s correlation coefficient ( r) and Mann–Whitney U test ( P-value < 0.05).

Main measures:

Italian Level of Sitting Scale and Gross Motor Function Classification System.

Results:

The Italian Level of Sitting Scale was administered to 109 subjects. Inter-rater reliability and one-week test–retest showed excellent value with ICCs of 0.99 for both. (1) The Pearson correlation coefficient comparing Italian Level of Sitting Scale with Gross Motor Function Classification System was −0.91 and (2) correlation with total amount of adaptive seating components was −0.90. Differences in sitting abilities and use/non-use of wheelchair were found. All reported a statistical significance of P < 0.01.

Conclusion:

Our findings provide evidence of reliability and validity when using the Italian Level of Sitting Scale to classify seated postural abilities in a sample of Italian children with cerebral palsy.

Effectiveness of Neuro-Developmental Treatment (Bobath Concept) on postural control and balance in Cerebral Palsied children

BACKGROUND AND OBJECTIVE

The aim of this study was to show the effects of an 8-week Neurodevelopmental Treatment based posture and balance training on postural control and balance in diparetic and hemiparetic Cerebral Palsied children (CPC).

METHODS

Fifteen CPC (aged 5-15 yrs) were recruited from Denizli Yağmur Çocukları Rehabilitation Centre. Gross Motor Function Classification System, Gross Motor Function Measure, 1-Min Walking Test, Modified Timed Up and Go Test, Paediatric Balance Scale, Functional Independence Measure for Children and Seated Postural Control Measure were used for assessment before and after treatment. An 8-week NDT based posture and balance training was applied to the CPC in one session (60-min) 2 days in a week.

RESULTS

After the treatment program, all participants showed statistically significant improvements in terms of gross motor function (p< 0.05). They also showed statistically significant improvements about balance abilities and independence in terms of daily living activities (p< 0.05). Seated Postural Control Measure scores increased after the treatment program (p< 0.05).

CONCLUSIONS

The results of this study indicate that an 8-week Neurodevelopmental Treatment based posture and balance training is an effective approach in order to improve functional motor level and functional independency by improving postural control and balance in diparetic and hemiparetic CPC.

Effects of neuromuscular electrical stimulation and Kinesio Taping applications in children with cerebral palsy on postural control and sitting balance

BACKGROUND

Neurodevelopmental treatment (NDT), neuromuscular electrical stimulation (NMES), and Kinesio Taping (KT) applications are separately used to improve postural control and sitting balance in children with cerebral palsy (CP).

OBJECTIVE

The aim of this study is to examine the combined effect of NDT, NMES and KT applications on postural control and sitting balance in children with CP.

METHODS

Forty five children, in 3 groups, between the ages 5-12 years were included in the study. Group 1 received NDT; group 2 received NDT + NMES; and the group 3 received NDT + NMES + KT for 6 weeks. Sitting function evaluated by the sitting section of the gross motor function measure (GMFM), and postural control assessed with the seated postural control measurement (SPCM).

RESULTS

Seating section of GMFM was improved significantly in all the groups; however, increases in the group 3 were higher than groups 1 and 2 (p= 0.001). While significant differences were observed in all groups in the SPCM posture (p< 0.001), function (p< 0.001), and the total scores (p< 0.001); the change in the third group was higher according to the comparison of the three groups within each other.

CONCLUSIONS

Implementation of the NMES, and KT additionally to NDT improve the sitting posture, postural control, seating function, and gross motor function in children with CP.

Association between gross motor function and postural control in sitting in children with Cerebral Palsy: a correlational study in Spain

Background

Cerebral palsy (CP) is one of the causes of physical disability in children. Sitting abilities can be described using the Level of Sitting Scale (LSS) and the Gross Motor Function Classification System (GMFCS). There is growing interest in the sitting posture of children with CP owing to a stable sitting position allows for the development of eye-hand coordination, functions of the upper extremities and functional skills. Besides, in recent years researchers have tried to develop a new terminology to classify the CP as performed by the Surveillance of Cerebral Palsy in Europe (SCPE), in order to improve the monitoring of the frequency of the PC, providing a framework for research and service planning. The aim of this study was to analyse the relationship between GMFCS and LSS. The second purpose was to describe how the SCPE relates to sitting abilities with the GMFCS and LSS.

Methods

The study involved 139 children with CP (range 3–18 years) from 24 educational centres. Age, gender, CP classification according to SCPE, GMFCS and LSS levels were recorded by an experienced physiotherapist.

Results

A significant inverse relationship between GMFCS and LSS score levels was found (r_s = −0.86, p = 0.00). 45.3 % of the children capable of leaning in any direction and of re-erecting the trunk (level VIII on the LSS) could walk without limitation (level I on the GMFCS). There were differences in the distribution of the GMFCS (χ²(4):50.78) and LSS (χ²(7): 37.15) levels and CP according to the distribution of the spasticity (p <0.01).

Conclusions

There was a negative correlation between both scales and a relation between sitting ability and the capacity to walk with or without technical devices. GMFCS and the LSS are useful tools for describing the functional abilities and limitations of children with CP, specially sitting and mobility. Classification based on the distribution of spasticity and the gross motor function provides clinical information on the prognosis and development of children with CP.

Clinimetric properties of sitting balance measures for children with cerebral palsy: a systematic review

Assessment of sitting balance in children and youth with cerebral palsy (CP) is critical in order to design appropriate interventions to enhance activities and participation. This systematic review synthesized research evidence on the reliability, validity, responsiveness to change, and clinical utility of sitting balance measures for children and youth with CP. A two-tiered search in August 2012 using nine peer-reviewed electronic databases yielded nine articles with relevant information on seven clinical measures. Four of seven clinical measures: the Pediatric Reach Test (PRT), Sitting Assessment for Children with Neuromotor Dysfunction (SACND), Segmental Assessment of Trunk Control (SATCo), and Trunk Control Measurement Scale (TCMS), demonstrate acceptable overall applicability (at least one study supporting clinical utility, reliability, and validity) and are thus recommended for use in practice. Ongoing research on responsiveness to change, however, is warranted to support validity for outcomes measurement.

Clinical tools to assess balance in children and adults with cerebral palsy: a systematic review

We aimed to review tools used to assess balance in clinical practice in children and adults with cerebral palsy (CP), to describe their content and measurement properties and to evaluate the quality of the studies that have examined these properties. CINAHL, Embase, and PubMed/MEDLINE were searched. The COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) was used to assess the 'quality of studies' and the Terwee criteria were used to assess the 'result of studies'. Twenty-two clinical balance tools were identified from 35 papers. The content and focus of the tools varied significantly. There was moderate or limited levels of evidence for most of the measurement properties of the tools; the strongest level of evidence was found for the Trunk Control Measurement Scale and the Level of Sitting Scale, in the category 'maintain balance', the Timed Up and Go and the Segmental Assessment of Trunk Control in the categories 'achieve balance' and 'restore balance' respectively. Information on responsiveness was scarce. Further studies providing better evidence for reliability and responsiveness for clinical balance tools are needed. In the meantime, results of studies evaluating effects of treatment of balance in individuals with CP should be interpreted with caution.

Clinical tools that measure sitting posture, seated postural control or functional abilities in children with motor impairments: a systematic review

OBJECTIVE

To identify and critically appraise clinical measurement tools used to assess sitting posture, seated postural control or functional abilities for children with motor impairment who are candidates for seating interventions.

DATA SOURCES

Searches were run in 15 electronic databases along with hand searching. The search included articles published in English to December 2011.

REVIEW METHODS

Key terms included: posture, sitting, sitting posture, seated posture, seated postural control, sitting position, seating, wheelchair(s), outcome and assess(ment). The PRISMA statement was followed with inclusion criteria set a priori. Two reviewers independently screened titles, reviewed abstracts and identified full-text articles that met criteria. Data extraction included tool description and clinical utility. Two quality-rating scales were used to evaluate conduct of the studies and psychometric properties of the tools.

RESULTS

Of the 497 titles found in the search, 29 full-text articles met the inclusion criteria and 19 tools were identified. Tools represented all components of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), with emphasis on body structure and function and activity components. Evidence supporting reliability and validity varied, with small sample sizes influencing quality ratings. Evidence of the tools' reliability was more prevalent than evidence of the tools' validity. Only four tools reported on responsiveness, an important consideration for evaluating change. Little information on clinical utility was provided.

CONCLUSION

Although a number of tools are available, evidence supporting their use for seating interventions is limited, as is the evidence supporting the strength of their measurement properties. Few tools address participation, environmental factors or the child's and family's perspective.

Validation of the relation between the type and amount of seating support provided and Level of Sitting Scale (LSS) scores for children with neuromotor disorders

OBJECTIVES

To assess the construct validity of the Level of Sitting Scale (LSS) by examining the relationship between LSS scores and the type and amount of seating supports.

METHODS

Secondary analysis of the data for 114 children ≤18 years, with neuromotor disorders who participated in a responsiveness study of the Seated Postural Control Measure.

RESULTS

A significant inverse relationship (Spearman rho = -0.42, p < 0.05) was found between LSS scores and amount of seating support provided. Statistically significant differences were also revealed between LSS levels of sitting ability (p < 0.004) and pelvic, thigh, trunk and head seating components and type of seating system, using Kruskal-Wallis test.

CONCLUSION

This study provides evidence of construct validity for the LSS in use as a discriminative measure of sitting ability in children with neuromotor disorders. Further validation is justified. Clinically intuitive associations between sitting ability and seating interventions were confirmed.