Reliability of the peabody developmental gross motor scale in children with cerebral palsy

High-level motor skills assessment for ambulant children with cerebral palsy: a systematic review and decision tree

AIM

To examine the psychometric evidence for high-level motor skills assessment tools for ambulant, school-aged children with cerebral palsy (CP).

METHOD

We searched five databases for population (children with CP aged 5-18y in Gross Motor Function Classification System levels I and II), assessment focus (high-level motor skills), and psychometric evidence. We evaluated evidence strength using the number of studies, quality, and conduct according to COnsensus-based Standards for the selection of health status Measurement INstruments checklists.

RESULTS

Eleven assessments (39 studies) met the criteria. Seven high-level motor skills assessment items (Muscle Power Sprint Test, 10m Shuttle Run Test, 10×5m Sprint Test, vertical jump, standing broad jump, seated throw, and Timed Up and Down Stairs) had strong validity and responsiveness evidence. Jumping items and seated throw lacked reliability data. Four high-level motor skills assessment batteries (Functional Strength Measure in CP, Gross Motor Function Measure-Challenge, Peabody Developmental Motor Scale, and Test of Gross Motor Development, Second Edition) had moderate-to-strong validity and/or reliability evidence. Responsiveness data were only available for the Gross Motor Function Measure-Challenge battery. The decision tree was developed with five levels: clinical feasibility, relevance, tool design, clinical utility, and psychometric properties.

INTERPRETATION

High-level motor skills assessment tools have strong psychometric evidence for ambulant, school-aged children with CP. The decision tree can assist clinicians and researchers in identifying appropriate tools to measure high-level motor skills.

WHAT THIS PAPER ADDS

An evidence-based decision tree guides the selection of appropriate high-level motor skills assessment tools. Seven high-level motor skills assessment items have strong psychometric evidence and clinical utility for ambulant children with cerebral palsy. Four high-level motor skills assessment batteries with recreation and mobility items have emerging psychometric evidence in this population.

The Relationship Between Gait, Gross Motor Function, and Parental Perceived Outcome in Children With Clubfeet

BACKGROUND

Assessment of children treated nonoperatively for idiopathic clubfoot, has primarily focused on the kinematic and kinetic results measured with gait analysis (GA). Excellent results in ankle motion and push-off power during gait have been reported at age 5; however, the assessment of gross motor function, has not been evaluated. The purpose of this study was to look at the relationship between gait measures, Peabody Developmental Motor Scales and parent-perception of their child's outcome [measured with the Pediatric Outcomes Data Collection Instrument (PODCI)].

METHODS

A total of 81 children with idiopathic clubfoot were seen for both GA and Peabody testing. Children who initially underwent the Ponseti technique (n=29), the French Physical Therapy method (PT) (n=23), and a group of children initially treated nonoperatively, but who required surgical intervention before GA at 5 years of age (n=29) were enrolled. Pearson's correlation coefficient was used to establish significant relationships between gait variables, Peabody, and PODCI scores.

RESULTS

Gait data showed that the Ponseti treated feet had significantly greater ankle power than feet treated surgically (P=0.0075). The Peabody results showed that the PT feet had higher stationary (P=0.0332) and overall gross motor quotient percent (GMQ%) scores (P=0.0092) than the surgical feet. No differences were found in PODCI scores. Ankle power was weakly correlated to the GMQ% (r=0.29; P=0.0102); however, the GMQ% showed a strong correlation to the parent report of Global Functioning Scale on the PODCI (r=0.48; P=0.0005).

CONCLUSIONS

Minimal gait disturbances do not interfere with function or parental assessment of abilities and satisfaction at 5-year follow-up in children with idiopathic clubfeet. Nonoperative correction of clubfeet should be the goal when possible, as the Peabody scores show better function as early as 5 years of age when surgery is not required.

Motor development of infants with positional plagiocephaly

Concurrent with recommendations to place infants to sleep in supine, there has been a dramatic increase in the number of infants with positional plagiocephaly (PP). Recent evidence suggests that infants who have decreased exposure to prone position may have a higher incidence of PP and may be at risk for a delay in the acquisition of certain motor skills. The purpose of this study was to compare motor development between infants with PP and matched peers without PP. We also examined differences in infant positioning practices when asleep and awake between the two groups. Twenty-seven infants with PP, 3 to 8 months of age, were matched by age, gender, and race to infants without PP. Motor performance was evaluated using the Alberta Infant Motor Scale (AIMS) and the Peabody Developmental Motor Scales (PDMS). Parents completed a diary that recorded infant positioning over a 3-day period. Mean AIMS percentile score for infants with PP was 31.1 +/- 21.6 as compared with 42.7 +/- 20.2 in infants without PP (p = .06). Better performance on the AIMS was positively correlated with the amount of time in prone position when awake, for both groups of children (PP r = .52, no PP r = .44, p < .05). Therapists should be aware of a risk of a motor delay when evaluating infants with PP. It is also important for parents to be informed about the importance of supervised prone playtime to enhance the development of early motor skills.

Actual vs. best practices for young children with cerebral palsy: a survey of paediatric occupational therapists and physical therapists in Quebec, Canada

RATIONALE

Cerebral palsy (CP) constitutes a substantial portion of paediatric rehabilitation, yet little is known regarding actual occupational therapy (OT) and physical therapy (PT) practices. This study describes OT and PT practices for young children with CP in Quebec, Canada.

METHODS

This was a cross-sectional survey. All eligible, consenting paediatric occupational therapists (OTs) and physical therapists (PTs) were interviewed using a structured telephone interview based on vignettes of two typical children with CP at two age points--18 months and 4 years. Reported practices were grouped according to the International Classification of Functioning, Disability and Health (ICF).

RESULTS

91.9% of PTs (n=62; 83.8% participation rate) and 67.1% of OTs (n=85; 91.4% participation rate) reported using at least one standardized paediatric assessment. OT and PT interventions focused primarily on impairments and primary function (such as gait function and activities of daily living). Both professions gave little attention to interventions related to play and recreation/leisure. Clinicians reported the need for more training and education specific to CP and to the use of research findings in clinical practice.

CONCLUSION

Wide variations and gaps were identified in clinicians' responses suggesting the need for a basic standard of OT and PT management as well as strategies to encourage knowledge dissemination regarding current best practice.