Timed motor test for wheelchair users: initial development and application in children with spinal cord injury

Development of a wheelchair mobility skills test for children and adolescents: combining evidence with clinical expertise

Background

Wheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. Currently, there is no outcome measure available for the evaluation of WMS in children. Several wheelchair mobility outcome measures have been developed for adults, but none of these have been validated in children. Therefore the objective of this study is to develop a WMS outcome measure for children using the current knowledge from literature in combination with the clinical expertise of health care professionals, children and their parents.

Methods

Mixed methods approach. Phase 1: Item identification of WMS items through a systematic review using the ‘COnsensus-based Standards for the selection of health Measurement Instruments’ (COSMIN) recommendations. Phase 2: Item selection and validation of relevant WMS items for children, using a focus group and interviews with children using a manual wheelchair, their parents and health care professionals. Phase 3: Feasibility of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST) through pilot testing.

Results

Phase 1: Data analysis and synthesis of nine WMS related outcome measures showed there is no widely used outcome measure with levels of evidence across all measurement properties. However, four outcome measures showed some levels of evidence on reliability and validity for adults. Twenty-two WMS items with the best clinimetric properties were selected for further analysis in phase 2. Phase 2: Fifteen items were deemed as relevant for children, one item needed adaptation and six items were considered not relevant for assessing WMS in children. Phase 3: Two health care professionals administered the UP-WMST in eight children. The instructions of the UP-WMST were clear, but the scoring method of the height difference items needed adaptation. The outdoor items for rolling over soft surface and the side slope item were excluded in the final version of the UP-WMST due to logistic reasons.

Conclusions

The newly developed 15 item UP-WMST is a validated outcome measure which is easy to administer in children using a manual wheelchair. More research regarding reliability, construct validity and responsiveness is warranted before the UP-WMST can be used in practice.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-017-0809-9) contains supplementary material, which is available to authorized users.

Clinical efficacy of the vertebral wedge osteotomy for the fusionless treatment of paralytic scoliosis

STUDY DESIGN

Pre-post intervention study using outcome measure design.

OBJECTIVE

To evaluate the clinical efficacy and functional impact of a fusionless treatment for paralytic scoliosis at 2-year follow-up.

SUMMARY OF BACKGROUND DATA

It has been shown that 67% of pediatric patients with progressive paralytic scoliosis require spinal fusion to correct the curve. However, maintenance of spinal flexibility, motion, and potential growth is desirable.

METHODS

Fourteen patients with scoliosis secondary to spinal cord injury or myelodysplasia underwent a fusionless vertebral wedge osteotomy. Thirteen patients were available for minimum 2-year follow-up, using standard scoliosis radiographs. The functional impact of the procedure was evaluated using the Pediatric Outcomes Data Collection Instrument (PODCI), the Functional Independence Measure (FIM), and the Canadian Occupational Performance Measure (COPM).

RESULTS

At a minimum 2-year follow-up, 10 patients of 13 (77%) had improvement of greater than 5 degrees in their coronal Cobb angle. Two (15%) patients' curves measured the same (+/-5 degrees). One patient's curve had worsened by 12 degrees as compared to the preoperative Cobb angle. The overall average correction of the 13 patients was 56.1%. Two patients required fusion with an average delay to fusion of 30 months. At current follow-up, range of motion across the treated levels averaged 43 degrees (range 8 degrees to 103 degrees). The FIM showed no changes pre to post, and the PODCI scores showed some increases at 2-year follow-up. Clinical and statistical improvement in performance and satisfaction scores was seen pre to post on the Canadian Occupational Performance Measure.

CONCLUSION

Vertebral wedge osteotomy is potentially an effective treatment option for paralytic scoliosis. At 2-year follow-up, there was no loss of function as measured by the PODCI and FIM, and there was improvement in the COPM. Cobb angle measurements were either improved or maintained in 12 of 13 patients. Although 2 patients required fusion, they had an average of 2.5 years of subsequent growth before surgery.

Effect of thoracolumbosacral orthoses on reachable workspace volumes in children with spinal cord injury

BACKGROUND/OBJECTIVE

Wheelchair users often use trunk motion to facilitate or augment their upper extremity reach. Children with spinal cord injury (SCI) are often prescribed thoracic lumbar sacral orthoses (TLSO) to delay or prevent spinal curve progression. The impact of wearing a TLSO while reaching has not been studied. Therefore, the purpose of this study was to see the quantitative effect of the TLSO on reachable workspace volumes and reach of children with SCI.

METHODS

Twenty children with SCI aged 5 to 18 years participated in the present study. Three-dimensional upper extremity motion analysis was used to assess the reachable workspace patterns of children reaching for targets at varying heights. Volumes in and out of TLSO and kinematic ranges of reach were statistically analyzed using paired Student's t tests with a P value set at 0.05.

RESULTS

Reachable workspace volumes were significantly greater for the non-TLSO condition compared with the TLSO condition (112,836 vs. 80,711 cm3; P = 0.0002; a decrement of 28%). Anterior posterior and medial lateral ranges of reach were statistically greater in the non-TLSO condition (P = 0.002, P = 0.01). Nondominant hand medial lateral reaches were statistically greater in the non-TLSO condition (P = 0.003). Dominant hand anterior posterior reaches were greater in the non-TLSO condition (P = 0.009).

CONCLUSIONS

Results suggest the reachable workspace of children with SCI is lessened with the use of a TLSO. This may be an important negative factor for brace compliance in children with SCI. The TLSO interferes with their ability to reach; therefore, children may prefer not to wear the orthosis.

Impact of prophylactic thoracolumbosacral orthosis bracing on functional activities and activities of daily living in the pediatric spinal cord injury population

BACKGROUND/OBJECTIVE

The purpose of this study is to assess the impact of a thoracolumbosacral orthosis (TLSO) on children with spinal cord injuries (SCI) in terms of functional independence and time requirements for performance of functional activities and to ascertain the children's preference for TLSO use.

METHODS

Fourteen subjects with thoracic SCI, ages 6 to 14 years, were studied. All subjects had previously been prescribed and were using a TLSO to prevent the progression of scoliosis. Functional activities included in the Functional Independence Measure and 6 additional wheelchair and transfer skills were scored by level of assistance required. The timed motor test (TMT) included 6 activities involving dressing, transfers, and wheelchair propulsion. Subjects completed the activities of the functional activities scale (FAS) and TMT while wearing a TLSO and without a TLSO. Subjects were asked their preference for wearing or not wearing the TLSO during each of the activities.

RESULTS

For the TMT, subjects were slower with a TLSO when donning a shirt or pants, with even and uneven transfers and hallway propulsion (P < 0.05). The majority of subjects preferred not wearing the TLSO during the TMT activities. Lower functional activity scores were recorded while wearing a TLSO for upper-extremity dressing (P < 0.05), lower-extremity dressing, bladder management, transferring to bed, and reaching for objects on the floor. Subjects preferred not wearing a TLSO for the following activities: lower-extremity dressing, bladder management, reaching for an object on the floor, and transfer from a supine to a sitting position.

CONCLUSIONS

Wearing a TLSO adversely affected independence level and time requirements for selected functional activities. Subjects preferred not wearing a TLSO while performing the activities. Activities that required hip flexion, such as donning pants or transitioning from a supine to a sitting position were restricted by the TLSO. Future studies with larger sample sizes should explore the relationships between functioning with a TLSO as related to a patient's age, level of injury, and TLSO design.