Pilot study of reliability and validity of the Walking Index for Spinal Cord Injury II (WISCI-II) in children and adolescents with spinal cord injury

Use of the Physical Abilities and Mobility Scale (PAMS) in Children Receiving Inpatient Rehabilitation for Spinal Cord Related Paralysis

OBJECTIVES

To investigate the performance of the Physical Abilities and Mobility Scale (PAMS) in children receiving inpatient rehabilitation for paralysis related to spinal cord disease and injury (SCD/SCI).

METHODS

Participants were 146 children with paralysis related to SCD/SCI, aged 2-21, admitted between January 2010 and 2017 for inpatient rehabilitation at a single free-standing academically affiliated pediatric rehabilitation hospital. Retrospective chart review was performed to obtain admission and discharge scores on the PAMS and the functional independence measure for children (WeeFIM®), collected as part of clinical care. Internal consistency was evaluated using Cronbach's alpha. Inter-rater reliability was evaluated through overall agreement, Pearson correlations, and intraclass correlations. Construct validity was examined through exploratory factor analysis. Criterion validity was explored through correlations of PAMS overall and item scores with WeeFIM® total and subscale scores. Sensitivity to change was tested using paired t-tests examining differences between admission and discharge scores for each item and for the total score on the PAMS.

RESULTS

Internal consistency and inter-rater reliability were high (0.94 at admission and 0.95 at discharge). Total PAMS scores are highly correlated with total WeeFIM®, mobility, self-care, and cognitive subscores at admission and discharge. Correlations with the WeeFIM® ranged from low (cognitive) to strong (mobility). Total PAMS score and all individual items increased significantly between admission and discharge.

CONCLUSIONS

The PAMS is a useful measure capturing incremental and granular functional motor skills changes occurring during inpatient rehabilitation for children with spinal cord-related paralysis.

The effects of locomotor training in children with spinal cord injury: a systematic review

PURPOSE

Discuss the effectiveness of locomotor training (LT) in children following spinal cord injury (SCI). This intervention was assessed following an exhaustive search of the literature using the Preferred Reporting Items for Systematic Reviews and Meta- Analyses: The PRISMA Statement as a guideline.

METHOD

Six databases were searched including PubMed, PEDro, CINAHL, Cochrane, PsycINFO, and Web of Knowledge in January 2016 and November 2016, without date restrictions. Inclusion criteria were: studies in English and peer-reviewed and journal articles with a primary intervention of LT in children following SCI.

RESULTS

Twelve articles, reporting eleven studies, were included. A systematic review assessing locomotor training in children with SCI published in April 2016 was also included. Participants were ages 15 months to 18 years old. Forms of LT included body-weight supported treadmill or over ground training, functional electrical stimulation, robotics, and virtual reality. Protocols differed in set-up and delivery mode, with improvements seen in ambulation for all 41 participants following LT.

CONCLUSION

Children might benefit from LT to develop or restore ambulation following SCI. Age, completeness, and level of injury remain the most important prognostic factors to consider with this intervention. Additional benefits include improved bowel/ bladder management and control, bone density, cardiovascular endurance, and overall quality of life. Looking beyond the effects LT has just on ambulation is crucial because it can offer benefits to all children sustaining a SCI, even if restoration or development of walking is not the primary goal. Further rigorous research is required to determine the overall effectiveness of LT.

[The experience with the early rehabilitation of the children presenting with the vertebral cerebrospinal injury]

This article was designed to report the experience with the provision of early rehabilitation care to the children suffering from a spinal-cord injury (SCI) that was gained at the Clinical and Research Institute of Urgent Pediatric Surgery and Traumatology. The authors have developed and describe the combined multidisciplinary approach making it possible to promote the recovery of the children presenting with SCI at the first stage of the rehabilitative treatment. They distinguish three basic periods in the early rehabilitation of the children with this condition, defined the main goals of rehabilitation and the role of each specialist in their achievement. The results of the work provided the basis for the development of a stepwise approach for the extension of the rehabilitation measures and the solution of the tasks facing rehabilitation of the patients with vertebral cerebrospinal injuries. The correction of nutritive losses was found to be a most important component of the early stage of the rehabilitation process preceding the full-scale rehabilitative treatment. The role of various technical devices designed for the patients' re-education in functional motor activities, development and acquisition of the sustained self-service skills, enhancement of the patient's mobility, and improvement of his/her quality of life is discussed. The importance of the early beginning of the rehabilitation measures for the children suffering from a vertebral cerebrospinal injury has been confirmed.

Recommendations for the National Institute for Neurologic Disorders and Stroke spinal cord injury common data elements for children and youth with SCI

STUDY DESIGN

In 2014, the adult spinal cord injury (SCI) common data element (CDE) recommendations were made available. This project was a review of the adult SCI CDE for relevance to children and youth with SCI.

OBJECTIVES

The objective of this study was to review the National Institute of Neurologic Disorders and Stroke (NINDS) adult SCI CDEs for relevance to children and youth with SCI.

SETTING

International.

METHODS

The pediatric working group consisted of international members with varied fields of expertise related to pediatric SCI. The group convened biweekly meetings for 6 months in 2015. All of the adult SCI CDEs were reviewed, evaluated and modified/created for four age groups: 0-5 years, 6-12 years, 13-15 years and 16-18 years. Whenever possible, results of published research studies were used to guide recommendations. In the absence of empirical support, grey literature and international content expert consensus were garnered. Existing pediatric NINDS CDEs and new CDEs were developed in areas where adult recommendations were not appropriate. After internal working group review of domain recommendations, these pediatric CDEs were vetted during a public review from November through December 2015.

RESULTS

Version 1.0 of the pediatric SCI CDEs was posted in February 2016.

CONCLUSION

The pediatric SCI CDEs are incorporated directly into the NINDS SCI CDE sets and can be found at https://commondataelements.ninds.nih.gov.

Gait recovery in a girl with ischemic spinal cord stroke

BACKGROUND AND PURPOSE

This case report describes an aggressive, task-specific program for the recovery of gait in a girl with a spinal cord stroke.

CASE DESCRIPTION

The 11-year-old girl sustained a spinal cord stroke resulting in a T4 motor-incomplete lesion. Therapy was initiated 6 months after onset when she was not ambulating.

INTERVENTION

The focus of all interventions was on the restoration of gait. Locomotor treadmill training and over ground walking were the primary practice interventions. Walking was facilitated by orthoses, neuromuscular electrical stimulation, laser treatments, and strengthening. Treatment continued for 18 months.

OUTCOMES

At the conclusion of therapy, the client was able to walk independently in the community with a single ankle foot orthosis and reverse rolling walker.

DISCUSSION

The outcome was not anticipated for this client, given the type and level of her injury and the delay in starting gait training.