PURPOSE: To investigate whether the adapted version of the Gross Motor Function Measure-88 (GMFM-88) for children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) results in higher scores. This is most likely to be a reflection of their gross motor function, however it may be the result of a better comprehension of the instruction of the adapted version.METHOD: The scores of the original and adapted GMFM-88 were compared in the same group of children (n=21 boys and n=16 girls), mean (SD) age 113 (30) months with CP and CVI, within a time span of two weeks. A paediatric physical therapist familiar with the child assessed both tests in random order. The GMFCS level, mental development and age at testing were also collected. The Wilcoxon signed-rank test was used to compare two different measurements (the original and adapted GMFM-88) on a single sample, (the same child with CP and CVI; p<0.05).RESULTS: The comparison between scores on the original and adapted GMFM-88 in all children with CP and CVI showed a positive difference in percentage score on at least one of the five dimensions and positive percentage scores for the two versions differed on all five dimensions for fourteen children. For six children a difference was seen in four dimensions and in 10 children difference was present in three dimensions (GMFM dimension A, B& C or C, D & E) (p<0.001).CONCLUSION: The adapted GMFM-88 provides a better estimate of gross motor function per se in children with CP and CVI that is not adversely impacted bytheir visual problems. On the basis of these findings, we recommend using the adapted GMFM-88 to measure gross motor functioning in children with CP and CVI.
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AIM: The objectives of this study were (i) to develop two cerebral visual impairment motor questionnaires (CVI-MQ's) for children with cerebral palsy (CP): one for children with Gross Motor Function Classification System (GMFCS) levels I, II and III and one for children with GMFCS levels IV and V; (ii) to describe their face validity and usability; and (iii) to determine their sensitivity and specificity.BACKGROUNDS: The initial versions of the two CVI-MQ's were developed based on literature. Subsequently, the Delphi method was used in two groups of experts, one familiar with CVI and one not familiar with CVI, in order to gain consensus about face validity and usability. The sensitivity and specificity of the CVI-MQ's were subsequently assessed in 82 children with CP with (n = 39) and without CVI (n = 43). With the receiver operating curve the cut-off scores were determined to detect possible presence or absence of CVI in children with CP.RESULTS: Both questionnaires showed very good face validity (percentage agreement above 96%) and good usability (percentage agreement 95%) for practical use. The CVI-MQ version for GMFCS levels I, II and III had a sensitivity of 1.00 and specificity of 0.96, with a cut-off score of 12 points or higher, and the version for GMFCS levels IV and V had a sensitivity of 0.97 and a specificity of 0.98, with a cut-off score of eight points or higher.CONCLUSION: The CVI-MQ is able to identify at-risk children with CP for the probability of having CVI.
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Abstract Aim: To determine whether the level of gross motor function and functional skills in children with cerebral palsy (CP) and cerebral visual impairment (CVI) as well as caregiver assistance are lower in comparison with the corresponding group of children experiencing CP without CVI. Method: Data aggregated from 23 children experiencing CP with CVI were compared with data from children with CP without CVI matched for Gross Motor Function Classifi cation System, mental development and age at testing. Scores for Gross Motor Function Measure-88 (GMFM-88) and the Pediatric Evaluation of Disability Inventory-NL (PEDI-NL) were employed to compare the level of gross motor function, functional skills and caregiver assistance between both groups. The Wilcoxon Signed Rank Test was utilized with a signifi cance level of p 0.05. Results: Children with CP with CVI, mean ( SD) age 6.4 1.5, scored signifi cantly lower than those with CP without CVI, mean age 6.3 1.6, on all GMFM-88 dimensions and the total score ( p 0.001) and on the PEDI-NL in the sections of Functional Skills and Caregiver Assistance as well as in those of domains self-care ( p 0.001), mobility ( p 0.001) and social functioning ( p 0.001). Concerning the modifi cations scale, the scores for children with CP and CVI were signifi cantly lower regarding mobility (no modifi cation , p 0.05), social functioning (no modifi cation, p 0.05) and social functioning (child-oriented, p 0.05). Conclusion: CVI contributes to diminished gross motor function and functional skills in children experiencing CP with CVI compared with children with CP without CVI. Children with CP and CVI also require increased support at the level of caregiver assistance. Specifi c interventions need to be developed for children experiencing CP with CVI in order to improve gross motor function, functional skills and caregiver assistance.
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PurposeThe aims of this study were to adapt the Paediatric Evaluation of Disability Inventory, Dutch version (PEDI-NL) for children with cerebral visual impairment (CVI) and cerebral palsy (CP) and determine test–retest and inter-respondent reliability.MethodThe Delphi method was used to gain consensus among twenty-one health experts familiar with CVI. Test–retest and inter-respondent reliability were assessed for parents and caregivers of 75 children (aged 50–144 months) with CP and CVI. The percentage identical scores of item scores were computed, as well as the interclass coefficients (ICC) and Cronbach's alphas of scale scores over the domains self-care, mobility, and social function.ResultsAll experts agreed on the adaptation of the PEDI-NL for children with CVI. On item score, for the Functional Skills scale, mean percentage identical scores variations for test–retest reliability were 73–79 with Caregiver Assistance scale 73–81, and for inter-respondent reliability 21–76 with Caregiver Assistance scale 40–43. For all scales over all domains ICCs exceeded 0.87. For the domains self-care, mobility, and social function, the Functional Skills scale and the Caregiver Assistance scale have Cronbach's alpha above 0.88.ConclusionThe adapted PEDI-NL for children with CP and CVI is reliable and comparable to the original PEDI-NL.
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PURPOSE: The aims of this study were to adapt the Gross Motor Function Measure-88 (GMFM-88) for children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) and to determine the test-retest and interobserver reliability of the adapted version.METHOD: Sixteen paediatric physical therapists familiar with CVI participated in the adaptation process. The Delphi method was used to gain consensus among a panel of experts. Seventy-seven children with CP and CVI (44 boys and 33 girls, aged between 50 and 144 months) participated in this study. To assess test-retest and interobserver reliability, the GMFM-88 was administered twice within three weeks (Mean=9 days, SD=6 days) by trained paediatric physical therapists, one of whom was familiar with the child and one who wasn't. Percentages of identical scores, Cronbach's alphas and intraclass correlation coefficients (ICC) were computed for each dimension level.RESULTS: All experts agreed on the proposed adaptations of the GMFM-88 for children with CP and CVI. Test-retest reliability ICCs for dimension scores were between 0.94 and 1.00, mean percentages of identical scores between 29 and 71, and interobserver reliability ICCs of the adapted GMFM-88 were 0.99-1.00 for dimension scores. Mean percentages of identical scores varied between 53 and 91. Test-retest and interobserver reliability of the GMFM-88-CVI for children with CP and CVI was excellent. Internal consistency of dimension scores lay between 0.97 and 1.00.CONCLUSION: The psychometric properties of the adapted GMFM-88 for children with CP and CVI are reliable and comparable to the original GMFM-88.
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The aim of this study was to test the inter- and intraobserver reliability of the Physician Rating Scale (PRS) and the Edinburgh Visual Gait Analysis Interval Testing (GAIT) scale for use in children with cerebral palsy (CP). Both assessment scales are quantitative observational scales, evaluating gait. The study involved 24 patients ages 3 to 10 years (mean age 6.7 years) with an abnormal gait caused by CP. They were all able to walk independently with or without walking aids. Of the children 15 had spastic diplegia and 9 had spastic hemiplegia. With a minimum time interval of 6 weeks, video recordings of the gait of these 24 patients were scored twice by three independent observers using the PRS and the GAIT scale. The study showed that both the GAIT scale and the PRS had excellent intraobserver reliability but poor interobserver reliability for children with CP. In the total scores of the GAIT scale and the PRS, the three observers showed systematic differences. Consequently, the authors recommend that longitudinal assessments of a patient should be done by one observer only.
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Background: To date, there is no evidence-based functional therapy programme available for children with both cerebral palsy (CP) and cerebral visual impairment (CVI). This study evaluates an individually targeted functional therapy programme adapted for these children experiencing difficulties with gross motor functioning and functional skills. Methods: Participants: Five children with CP and CVI, mean (SD) age 114 (52) months, participated in this study. Intervention: Participants were assigned to an 18-week functional therapy programme including nine weeks of individual functional therapy aimed at improving gross motor function followed by nine weeks of daily training of functional skills from the parents/caregivers. Analyses: The Related Samples Wilcoxon Signed Rank Test with a significance level of p<.05 was utilised to detect possible significant differences between the pre- and post-test. Results: According to the Goal Attainment Scaling (GAS), each child improved gross motor functioning. All the children also scored significantly higher in the section Functional Skills in the domains self-care and mobility as well as in the section Caregiver Assistance in the domain of self-care. Conclusion: This adapted individually functional therapy programme suggests improved gross motor functioning and functional skills in children with CP and CVI.
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Introduction: To determine if athletes with coordination impairment (CI) can continue playing wheelchair rugby (WR), while an evidence-based classification system, including impairment tests for CI is not yet available. This is a defensible practise if they show similar activity limitations as athletes with other eligible impairment types (OI) within the same sports class. Methods: Standardised activities were measured in 58 elite WR athletes; 14 with CI and 44 with OI. Wheelchair activities consisted of 20-meter sprint, 12-meter sprint with full stop, intermittent sprint (3-meter sprint, stop, 3-meter sprint, stop, 6-meter sprint with full stop), sprint-curve-slalom-curve, turn on the spot 180°, turn on the spot 90°, stop, turn 90°in the same direction, X-test (short circuit with sharp turns) without the ball. Ball activities consisted of maximal throwing distance, precision throwing short (25% of maximum throw) and long (75% of maximal throw) distance and X-test with the ball (pick-up the ball and dribble whilst pushing). Descriptive statistics were used and Spearman’s Rank correlation was assessed for athletes with CI and OI for each outcome measure. Differences between athletes with CI and OI were assessed using a Mann-Whitney U test. Results: Most activities showed a high correlation with the athlete class in both athletes with CI and athletes with OI. Furthermore, outcome measures of athletes with CI overlapped with athletes with OI in the same sports class for all activities. There was a trend for worse performance in athletes with CI in turn on the spot 90°, stop, turn 90°in the same direction, the short distance one handed precision throw (P 0.11)and in the X-test with the ball (P 0.10). Discussion: Despite the current lack of evidence based impairment tests for CI, it is a defensible practise to not exclude athletes with CI from WR with the current classification system. The trends for differences in performance that were found can support athletes and coaches in optimising performance of athletes with CI.
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The aim of this study was to gain insight into the visual functioning of children with profound intellectuual and multiple disabilities (PIMD). A mixed methods study was performed, determining cross-sectional quantitative ophthalmological/orthoptic data, and qualitative observational data with a standardized research protocol (SRP) of 73 children with PIMD. Descriptive statistics and correlations were used for analyses of the data. Using ophthalmological data, 90.4% of the participants were found visually impaired. Based on the visual acuity (VA) testing, 49.6% of the participants had an impaired VA (
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The aim of the present thesis was to contribute to the improvement of patient care communication across the integrated care setting of children with cerebral palsy. Hereto, we followed two subsequent phases: 1) obtaining a better understanding of the experienced quality of patient care communication across the integrated care setting of cerebral palsy in three Dutch care regions; and 2) investigating the feasibility and usability of an eHealth application to improve patient care communication in these care regions.
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