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Lidbeck C, Bartonek Å, Ferrari A, Alboresi S, Örtqvist M. Signs of perceptual disorder during movement were reliably assessed in children with cerebral palsy in Sweden. Acta Paediatr 2024; 113:344-352. [PMID: 37874018 DOI: 10.1111/apa.17012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
AIM The aim of this Swedish study was to evaluate the assessment of clinical signs of perceptual disorder in children with cerebral palsy (CP). METHODS Three experienced raters assessed 56 videos of 19 children from 1 to 18 years of age with bilateral spastic CP, which were recorded by colleagues at an Italian hospital. Six signs were evaluated for inter-rater reliability and criterion validity. Clinical applicability was evaluated by assessing inter-rater reliability between 47 Swedish clinicians, who examined 15 of the videos during face-to-face and online education seminars. There were 41 physiotherapists, two occupational therapists and four doctors, with 1-37 years of clinical experience and a median of 10 years. RESULTS The experienced raters demonstrated moderate to almost perfect inter-rater reliability (kappa 0.54-0.81) and criterion validity (0.54-0.87) for startle reaction, upper limbs in startle position, averted eye gaze and eye blinking. The clinicians recognised these signs with at least moderate reliability (0.56-0.88). Grimacing and posture freezing were less reliable (0.22-0.35) and valid (0.09-0.50). CONCLUSION Four of the six signs of perceptual disorder were reliably recognised by experienced raters and by clinicians after education seminars. Extended education and larger study samples are needed to recognise all the signs.
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Affiliation(s)
- Cecilia Lidbeck
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Bartonek
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Adriano Ferrari
- Department of Neuroscience, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Alboresi
- Children Rehabilitation Unit of S. M. Nuova Hospital, AUSL-IRCCS, Reggio Emilia, Italy
| | - Maria Örtqvist
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Costi S, Mecugni D, Beccani L, Alboresi S, Bressi B, Paltrinieri S, Ferrari A, Pelosin E. Construct Validity of the Activities Scale for Kids Performance in Children with Cerebral Palsy: Brief Report. Dev Neurorehabil 2020; 23:474-477. [PMID: 32508188 DOI: 10.1080/17518423.2020.1764649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: This study collects evidence of construct convergent validity of the Activity Scale for Kids performance (ASKp), comparing its results with the 66-item Gross Motor Function Measure (GMFM-66) and with the Gross Motor Function Classification System (GMFCS) and testing the ASKp's ability to discriminate between individuals with different functional capabilities. Methods: This cross-sectional study involved 60 children with spastic cerebral palsy (CP) assessed with the GMFM-66 who self-administered the Italian version of the ASKp. Results: Children were 10.9 (±3) years old with GMFCS Level I-III. Moderate correlations were found between GMFM and ASKp scores (r = 0.577; p < .001), and between GMFCS levels and ASKp score (rs = -0.541, p < .001). The ASKp discriminated between children with different functional capabilities, determined by the GMFCS (F = 18.2, p < .001). Conclusions: ASKp is valid to assess physical functioning, a crucial domain in rehabilitation of children with spastic CP. Trial registration: ClinicalTrials.gov Identifier: NCT03325842.
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Affiliation(s)
- Stefania Costi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa , Genova, Italy.,Scientific Directorate, Azienda Unità Sanitaria Locale - IRCCS Di Reggio Emilia , Reggio Emilia, Italy.,Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia , Modena, Italy
| | - Daniela Mecugni
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia , Modena, Italy
| | - Laura Beccani
- Scientific Directorate, Azienda Unità Sanitaria Locale - IRCCS Di Reggio Emilia , Reggio Emilia, Italy
| | - Silvia Alboresi
- Scientific Directorate, Azienda Unità Sanitaria Locale - IRCCS Di Reggio Emilia , Reggio Emilia, Italy
| | - Barbara Bressi
- Scientific Directorate, Azienda Unità Sanitaria Locale - IRCCS Di Reggio Emilia , Reggio Emilia, Italy.,Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia , Modena, Italy
| | - Sara Paltrinieri
- Scientific Directorate, Azienda Unità Sanitaria Locale - IRCCS Di Reggio Emilia , Reggio Emilia, Italy
| | - Adriano Ferrari
- Scientific Directorate, Azienda Unità Sanitaria Locale - IRCCS Di Reggio Emilia , Reggio Emilia, Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa , Genova, Italy
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Alboresi S, Sghedoni A, Borelli G, Costi S, Beccani L, Neviani R, Ferrari A. Are perceptual disorder signs in diplegic cerebral palsied children stable over time? A retrospective cohort analysis. Minerva Pediatr 2019; 72:79-84. [PMID: 30994318 DOI: 10.23736/s0026-4946.18.05237-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A group of diplegic cerebral palsied (CP) children presents six precise signs that can be easily observed during clinical examinations, physiotherapy sessions and everyday activities. These signs are: startle reaction, upper limbs in startle position, averted-eye gaze, grimaces, eye blinking and posture freezing. METHODS In a population of 32 diplegic CP children (aged 1-8 years) perceptual signs were retrospectively identified through videos to verify their stability in the same child over time. RESULTS Startle reaction, upper limb in startle position and posture freezing were the most frequently observed signs and the easiest to recognize with the highest agreement in both observations (P<0.001). Eye signs (eye blinking and averted-eye gaze) were more difficult to detect in our recordings. CONCLUSIONS Signs of perceptual disorders were present in our sample of diplegic CP children from the second year of age and could still be observed after 1- to 3-year intervals, demonstrating they remain unaltered over time. Furthermore, if absent in the first observation, they did not appear later on. CP children with these perceptual signs could represent a new clinical entity, which we are currently describing and defining.
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Affiliation(s)
- Silvia Alboresi
- Department of Surgery, Dentistry, and Morphological Sciences with regard to Transplant Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy - silvia. .,Pediatric Rehabilitation Unit for Severe Developmental Disabilities (UDGEE), Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy - silvia.
| | - Alice Sghedoni
- Unit of Neuropsychiatry, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Borelli
- Pediatric Rehabilitation Unit for Severe Developmental Disabilities (UDGEE), Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Costi
- Department of Surgery, Dentistry, and Morphological Sciences with regard to Transplant Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Laura Beccani
- Pediatric Rehabilitation Unit for Severe Developmental Disabilities (UDGEE), Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rita Neviani
- Pediatric Rehabilitation Unit for Severe Developmental Disabilities (UDGEE), Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Adriano Ferrari
- Department of Surgery, Dentistry, and Morphological Sciences with regard to Transplant Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,Pediatric Rehabilitation Unit for Severe Developmental Disabilities (UDGEE), Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Cristella G, Filippi MC, Mori M, Alboresi S, Ferrari A. Evaluation of hand function in patients with unilateral cerebral palsy who underwent multilevel functional surgery: a retrospective observational study. Eur J Phys Rehabil Med 2018; 55:123-130. [PMID: 30156083 DOI: 10.23736/s1973-9087.18.04904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hemiplegia is the most common form of cerebral palsy. Upper limb is generally more affected than lower one. Indeed, hemiplegic children can spontaneously acquire standing and walking ability, while manipulation remains uncertain, with severe limitations in activity and participation, which define a child's functional status (International Classification of Functioning [ICF]). Several non-surgical tools are currently available to approach upper limb impairments. Studies regarding upper limb multilevel surgery in Hemiplegic Cerebral Palsy are relatively few and inhomogeneous. AIM The aim of this study is to propose a surgical approach based on upper limb functional level and manipulation strategy and establish whether multilevel surgery can improve segmental alignment, performance and capacity, that ICF defines as activities and participation qualifiers. DESIGN This study is an observational retrospective study. SETTING This study involves patients who referred to the Unit of Children Rehabilitation of S. Maria Nuova Institute for Research and Care, in Reggio Emilia (Italy), over a four-year period. POPULATION Children affected by hemiplegic cerebral palsy who underwent upper limb multilevel surgery. METHODS For each patient, we previously defined functional use of affected upper limb applying the House classification and the Ferrari one of manipulation pattern. Patients are divided into three groups: synergic hand (House 4, 5), imprisoned hand (House 3), excluded hand (House 0). We recorded goals achievement through Goal Attainment Scale and unimanual and bimanual abilities through Melbourne Assessment of Unilateral Upper Limb Function and through Assisting Hand Assessment respectively. RESULTS We recorded 16 upper limb multilevel surgical interventions in 13 children and report their results. CONCLUSIONS This study suggests that surgery can induce a segmental and/or aesthetic and/or a functional change depending on manipulation pattern. It also underlines the importance to analyze results in term of spontaneous manipulation abilities and daily use. CLINICAL REHABILITATION IMPACT This study provides a preliminary guide to plan surgery in relation to segmental deformities and overall manipulation pattern and describes their feasible improvement measures. It also suggests the most useful tools to record goal achievements in modifying manipulation function. Further controlled, randomized and prospective studies are required to support this idea.
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Affiliation(s)
- Giovanna Cristella
- Unit of Children Rehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy -
| | - Maria C Filippi
- Unit of Children Rehabilitation, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Maurizio Mori
- Unit of Children Rehabilitation, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Silvia Alboresi
- Unit of Children Rehabilitation, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Adriano Ferrari
- Unit of Children Rehabilitation, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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Ferrari A, Sghedoni A, Alboresi S, Pedroni E, Lombardi F. New definitions of 6 clinical signs of perceptual disorder in children with cerebral palsy: an observational study through reliability measures. Eur J Phys Rehabil Med 2014; 50:709-716. [PMID: 24896142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Recently authors have begun to emphasize the non-motor aspects of Cerebral Palsy and their influence on motor control and recovery prognosis. Much has been written about single clinical signs (i.e., startle reaction) but so far no definitions of the six perceptual signs presented in this study have appeared in literature. AIM This study defines 6 signs (startle reaction, upper limbs in startle position, frequent eye blinking, posture freezing, averted eye gaze, grimacing) suggestive of perceptual disorders in children with cerebral palsy and measures agreement on sign recognition among independent observers and consistency of opinions over time. DESIGN Observational study with both cross-sectional and prospective components. SETTING Fifty-six videos presented to observers in random order. Videos were taken from 19 children with a bilateral form of cerebral palsy referred to the Children Rehabilitation Unit in Reggio Emilia. PARTICIPANTS Thirty-five rehabilitation professionals from all over Italy: 9 doctors and 26 physiotherapists. METHODS Measure of agreement among 35 independent observers was compiled from a sample of 56 videos. Interobserver reliability was determined using the K index of Fleiss and reliability intra-observer was calculated by the Spearman correlation index between ranks (rho - ρ). Percentage of agreement between observers and Gold Standard was used as criterion validity. RESULTS Interobserver reliability was moderate for startle reaction, upper limb in startle position, adverted eye gaze and eye-blinking and fair for posture freezing and grimacing. Intraobserver reliability remained consistent over time. Criterion validity revealed very high agreement between independent observer evaluation and gold standard. CONCLUSIONS Semiotics of perceptual disorders can be used as a specific and sensitive instrument in order to identify a new class of patients within existing heterogeneous clinical types of bilateral cerebral palsy forms and could help clinicians in identifying functional prognosis. CLINICAL REHABILITATION IMPACT To provide clinicians with a definition of 6 clinical signs found in children with cerebral palsy in routine rehabilitation settings. Future research should explore the link between these signs and motor prognosis (i.e., time to independent walking).
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Affiliation(s)
- A Ferrari
- Department of Neuroscience University of Modena and Reggio Emilia -
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Ferrari A, Maoret AR, Muzzini S, Alboresi S, Lombardi F, Sgandurra G, Paolicelli PB, Sicola E, Cioni G. A randomized trial of upper limb botulimun toxin versus placebo injection, combined with physiotherapy, in children with hemiplegia. Res Dev Disabil 2014; 35:2505-2513. [PMID: 24995688 DOI: 10.1016/j.ridd.2014.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/01/2014] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
The main goal of this study was to investigate the efficacy of Botulinum Toxin A (BoNT-A), combined with an individualized intensive physiotherapy/orthoses treatment, in improving upper limb activity and competence in daily activity in children with hemiplegia, and to compare its effectiveness with that of non-pharmacological instruments. It was a Randomized Clinical Trial of 27 children with spastic hemiplegic cerebral palsy, outpatients of two high speciality Centres for child rehabilitation. Each child was assigned by simple randomization to experimental group (BoNT-A) or control group (placebo). Assisting Hand Assessment (AHA) was chosen as primary outcome measure; other measures were selected according to ICF dimensions. Participants were assessed at baseline (T0), at T1, T2, T3 (1-3-6 months after injection, respectively). Every patient was given a specific physiotherapeutic treatment, consisting of individualized goal directed exercises, task oriented activities, daily stretching manoeuvres, functional and/or static orthoses. BoNT-A group showed a significant increase of AHA raw scores at T2, compared to control group (T2-T0: p=.025) and functional goals achievement (GAS) was also slightly better in the same group (p=.033). Other measures indicated some improvement in both groups, without significant intergroup differences. Children with intermediate severity of hand function at House scale for upper limb impairment seem to have a better benefit from BoNT-A protocol. BoNT-A was effective in improving manipulation in the activity domain, in association with individualized goal-directed physiotherapy and orthoses; the combined treatment is recommended. The study brings more evidence for the efficacy of a combined treatment botulinum toxin injection-physiotherapy-orthoses, and it gives some suggestions for candidate selection and individualized treatment.
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Affiliation(s)
- Adriano Ferrari
- Department of Biomedical, Metabolic Sciences and Neuroscience, University of Modena and Reggio Emilia, 42123 Reggio Emilia, Italy; Children Rehabilitation Unit, IRCCS S. Maria Nuova Hospital, 42123 Reggio Emilia, Italy.
| | - Anna Rosa Maoret
- Children Rehabilitation Unit, IRCCS S. Maria Nuova Hospital, 42123 Reggio Emilia, Italy.
| | - Simonetta Muzzini
- Children Rehabilitation Unit, IRCCS S. Maria Nuova Hospital, 42123 Reggio Emilia, Italy.
| | - Silvia Alboresi
- Children Rehabilitation Unit, IRCCS S. Maria Nuova Hospital, 42123 Reggio Emilia, Italy.
| | - Francesco Lombardi
- Intensive Rehabilitation Unit, S. Sebastiano Hospital, 42015 Correggio (Reggio Emilia), Italy.
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone (Pisa), Italy.
| | - Paola Bruna Paolicelli
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone (Pisa), Italy.
| | - Elisa Sicola
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone (Pisa), Italy.
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone (Pisa), Italy; Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
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Pascale R, Perazza S, Borelli G, Bianchini E, Alboresi S, Paolicelli PB, Ferrari A, Cioni G. The term diplegia should be enhanced. Part III: inter-observer reliability of the new rehabilitation oriented classification. Eur J Phys Rehabil Med 2008; 44:213-220. [PMID: 18418341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM The aim of this study was to validate a recent classification of gait in children with the spastic diplegic form of cerebral palsy (CP) by checking the reliability of different scorers in assigning subject walking performance to one of the four specific patterns described in the classification. METHODS The gait patterns of 50 children and adolescents with CP (23 males, 27 females; age range 3-17 years) were selected among patients whose videos were stored in the archives of the Pisa and Reggio Emilia Hospitals. Only video recordings of gait with homogeneous features (duration of at least 90 s, simultaneous recordings on sagittal and frontal views, and other criteria) were taken for examination. The videos were blindly scored using an observational gait scale, at first by two of the authors of the classification system (defined as ''maximum experts''), then by ten expert observers, and finally by 206 professionals of rehabilitation after a one-day training on the classification. Cohen's kappa statistics (k) and intra class correlations (ICC) were calculated. RESULTS Kappa and ICC indicate an almost perfect agreement both between the two maximum experts and among the ten expert observers. Good results were also obtained in the group of one-day trained scorers. Only a few cases were assigned to the ''unclassified'' category. The profession of the observer (doctor or therapist) and previous knowledge of the classification had no significant influence on reliability scores. CONCLUSION The results suggest that the proposed classification can be reliably applied, even utilizing short video recordings, to arrange diplegic children into different patterns. Further studies are needed to validate the use of this classification system for clinical and research aims.
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Affiliation(s)
- R Pascale
- Division of Child Neurology and Psychiatry, University of Pisa, Pisa, Italy
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Ferrari A, Alboresi S, Muzzini S, Pascale R, Perazza S, Cioni G. The term diplegia should be enhanced. Part I: a new rehabilitation oriented classification of cerebral palsy. Eur J Phys Rehabil Med 2008; 44:195-201. [PMID: 18418339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The classification systems for cerebral palsy (CP) need to be continuously updated, according to specific aims and to significant changes observed over the years in the panorama of CP. A simplification of CP categories, abandoning the use of the term diplegia, has been recently suggested. Conversely, in this paper a new proposal for classification of CP is briefly presented, where special attention is given to diplegia which is suggested to be divided into four main clinical forms, according to the patterns of walking observable in these subjects. The proposed classification was applied to a large population of 213 subjects with diplegia, among 467 cases of CP admitted to two reference centres for this disorder. The relative incidence of the four forms is reported. The adopted classification criteria, based on a primary ability of professionals working in rehabilitation, i.e. observation capacity, makes this approach simple and easy to use at all levels of the rehabilitation services for CP.
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Affiliation(s)
- A Ferrari
- Department of Neuroscience, University of Modena and Reggio Emilia, Italy.
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