Development of a clinical measure of postural control for assessment of adaptive seating in children with neuromotor disabilities

Lessons learned from a pediatric powered mobility lending program

PURPOSE

To evaluate children's characteristics and impact of a powered wheelchair lending program including comparisons of diagnostic sub-groups, and validation of a predictive model of powered mobility proficiency.

METHODS AND MATERIALS

This retrospective study included 172 children who participated in the ALYN powered mobility lending program from 3/2009-7/2022. Demographics and functional levels were measured via questionnaires; driving proficiency was evaluated when the wheelchair was returned, and parents and children were interviewed following their participation in the program.

RESULTS

Two diagnostic groups were identified: cerebral palsy (CP) (n = 136, median = 9.75 yrs) and other neuromuscular diseases (NMD) (n = 30, median = 5.83 yrs). They differed significantly in the age they commenced PM training, the male/female ratio, walking ability and access mode. Fifty-seven percent of the participants with CP achieved powered mobility proficiency, a rate that was significantly lower than the 73% proficiency found for the NMD group. Four significant predictors were identified: communication, manual wheelchair operation, access mode and go-stop upon request. They predicted proficiency in approximately 80% of cases. Overall feedback from the parents and children indicated that their personal and family's quality of life improved as a result of their child's ability to use a powered wheelchair.

CONCLUSIONS

A lending program provides children with opportunities to improve mobility skills in an appropriate powered wheelchair. Children who can communicate verbally, propel a manual wheelchair, use a joystick and go-stop upon request are significantly more likely to become proficient drivers; however, many who were unable to complete these tasks also improved and even became proficient drivers.

Physiotherapy-assisted overground exoskeleton use: mixed methods feasibility study protocol quantifying the user experience, as well as functional, neural, and muscular outcomes in children with mobility impairments

Background

Early phase research suggests that physiotherapy paired with use of robotic walking aids provides a novel opportunity for children with severe mobility challenges to experience active walking. The Trexo Plus is a pediatric lower limb exoskeleton mounted on a wheeled walker frame, and is adjustable to fit a child's positional and gait requirements. It guides and powers the child's leg movements in a way that is individualized to their movement potential and upright support needs, and can provide progressive challenges for walking within a physiotherapy-based motor learning treatment paradigm.

Methods

This protocol outlines a single group mixed-methods study that assesses the feasibility of physiotherapy-assisted overground Trexo use in school and outpatient settings during a 6-week physiotherapy block. Children ages 3-6 years (n = 10; cerebral palsy or related disorder, Gross Motor Function Classification System level IV) will be recruited by circle of care invitations to participate. Study indicators/outcomes will focus on evaluation of: (i) clinical feasibility, safety, and acceptability of intervention; (ii) pre-post intervention motor/functional outcomes; (iii) pre-post intervention brain structure characterization and resting state brain connectivity; (iv) muscle activity characterization during Trexo-assisted gait and natural assisted gait; (v) heart rate during Trexo-assisted gait and natural assisted gait; and (vi) user experience and perceptions of physiotherapists, children, and parents.

Discussion

This will be the first study to investigate feasibility indicators, outcomes, and experiences of Trexo-based physiotherapy in a school and outpatient context with children who have mobility challenges. It will explore the possibility of experience-dependent neuroplasticity in the context of gait rehabilitation, as well as associated functional and muscular outcomes. Finally, the study will address important questions about clinical utility and future adoption of the device from the physiotherapists' perspective, comfort and engagement from the children's perspective, and the impressions of parents about the value of introducing this technology as an early intervention.

Clinical trial registration

https://clinicaltrials.gov, identifier NCT05463211.

Supported standing and stepping device use in young children with cerebral palsy, gross motor function classification system III, IV and V: A descriptive study

This study described and compared use of supported-standing and stepping devices by young children with cerebral palsy, Gross-Motor Function Classification System (GMFCS) levels III-V following power mobility introduction. Data was collected at two time-points, 5-6 months apart, for 42 participants, aged 18-80 months, using the Home Use of Technology for CHildren (HUTCH). Supported-standing and stepping device choice and time in each device remained stable over 6 months. Associations between device use and three functional classifications were examined. Children with more impaired motor, postural and manual abilities were more likely to use a supine stander rather than a prone/upright stander or no stander. Children at GMFCS V tended to use hands-free stepping devices, while support-arms stepping devices were more common for children at GMFCS IV. Only children at GMFCS III used convertible stepping devices. Using power mobility, standers and supported-stepping devices was feasible and 19/34 classified at GMFCS IV/V used all three devices over 6 months. A key finding was that introduction of power mobility did not reduce use of supported-stepping devices at any GMFCS level. Use of multiple upright positioning and mobility devices may assist children with limited mobility to be actively engaged and participate in daily life.

Cultural adaptation and validation in Italian of the Seated Postural Control Measure for Adults 2.0

OBJECTIVE

The aim of this study was to assess the cultural adaptation and validation in Italian of the Seated Postural Control Measure for Adults 2.0 (SPCMA 2.0).

METHODS

The original scale was translated and culturally adapted from French to Italian using the "Translation and Cultural Adaptation of Patient Reported Outcomes Measures-Principles of Good Practice" guidelines. Its internal consistency and test-retest reliability were examined. Its concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Wheelchair use Confidence Scale and Wheelchair Skills Test 4.2.

RESULTS

Fifty-nine people were evaluated and re-evaluated after 48 h. Most of the items and subscale totals were stable in the 2 evaluations as they reported an intraclass correlation coefficient value of >0.77. The test-retest analysis of the dynamic evaluation was performed on the same patients 48 h apart. The analysis for construct validity showed statistically significant correlations with Wheelchair use Confidence Scale and Wheelchair Skills Test 4.2.

CONCLUSIONS

Seated Postural Control Measure for Adults 2.0 is one of the few tools that allow researchers to perform a quantitative and standardized posture assessment in a cost-effective and time-saving way. Furthermore, it has been demonstrated that it is an easy-to-administer scale and requires readily available tools. The limitations of this study highlighted above and the need to use quantitative and qualitative tools in clinical practice imply the need to conduct future studies.

Is functional mobility associated with quality of sitting in cerebral palsy? A cross-sectional study

Objectives

A group of neuromuscular system anomalies associated with non-progressive issues in the developing fetal or newborn brain are known as cerebral palsy (CP). These abnormalities are typified by poor posture and motor development, which limits the execution of functional activities. Consequently, to achieve the same goals as peers who are typically developing, children with CP employ a variety of compensatory postures and techniques. Given that both sitting and mobility are essential for functioning, assessing each skill alone and in relation to the other is necessary. This study aims to determine if a child's functional mobility affects their sitting ability.

Materials and Methods

Twenty CP (Gross Motor Function Classification System [GMFCS] levels I and II) children, aged 6-12, were enrolled in the research. The level of sitting scale (LSS) and the modified timed up and go (mTUG) test were utilized to evaluate sitting and functional mobility, respectively.

Results

The quality of sitting was shown to have a substantial effect on functional mobility, as a significant difference in mTUG durations was established between LSS levels (P < 0.001) and persisted when analyzed within the same GMFCS level (P = 0.007).

Conclusion

The importance of trunk control in functional mobility can be inferred from the link between sitting quality and mobility. To improve children with CP's functional mobility, this evidence may be utilized to design a well-informed and specific intervention program incorporating trunk control.

Standing power wheelchairs and their use by children and youth with mobility limitations: an interrupted time series

Standing power wheelchairs (PWSDs) expand positioning and mobility options for individuals with motor impairments. Although more available, little is known about how PWSDs are used in everyday life.

PURPOSE

to describe children's use of PWSDs in the first three months post-wheelchair delivery and the impacts on satisfaction with participation in daily life.

MATERIALS AND METHODS

An interrupted time series of purposefully sampled children aged 5-18 years who were receiving a PWSD. The Wheelchair Outcome Measure for Young People (WhOM-YP) documented satisfaction with patient-reported meaningful participation outcomes. Data loggers objectively measured wheelchair mobility outcomes including distance travelled, bouts of mobility, and duration. Data were measured over two sessions pre-wheelchair-delivery and at one week, one month and three months post-wheelchair-delivery.

RESULTS

Six children aged 7-18 years participated, four diagnosed with cerebral palsy, two with spina bifida. Analyses of individual data illustrated positive change in overall WhOM-YP satisfaction scores after PWSD provision though change varied across time, as did, distance, bouts of mobility and duration of use. Participants identified 14 in-home and 16 out-of-home unique participation outcomes, although several commonalities existed.

CONCLUSION

PWSDs hold promise for increasing children's satisfaction with participation in daily life, in addition to possibly increasing mobility outcomes. IMPLICATIONS FOR REHABILITATIONFor children with mobility limitations, PWSDs may promote participation in daily life and increased mobility.Data logger technology provides valuable information about children's PWSD use and how this varies over time.Benefits and challenges exist with implementing PWSD and data logger technologies.When implementing PWSD use, it is critical to consider context, training and support needs of clients and caregivers.

Pediatric powered mobility training: powered wheelchair versus simulator-based practice

METHOD

Participants included 30 children and adolescents (23 males, 13 females) with cerebral palsy and other neuromuscular diseases, aged 6-18. Data were collected and compared at baseline and after 12 weeks of home-based practice via a powered wheelchair or a simulator. Powered mobility ability was determined by the Powered Mobility Program (PMP), the Israel Ministry of Health's Powered Mobility Proficiency Test (PM-PT) and the Assessment of Learning Powered Mobility (ALP).

RESULTS

All participants practiced for the required amount of time and both groups reported a similar user experience. Both groups achieved significant improvement following the practice period as assessed by the PMP and PM-PT assessments, with no significant differences between them. A significant improvement was found in the ALP assessment outcomes for the powered wheelchair group only.

CONCLUSIONS

This is the first study, to our knowledge, that compares two different wheelchair training methods. Simulator-based practice is an effective training option for powered mobility for children with physical disabilities aged 6-18 years old, demonstrating that it is possible to provide driving skill practice opportunities safe, controlled environments.

The clinical effectiveness of custom-contoured seating for wheelchair users with neuromuscular disorders: a scoping review

Despite its widespread use, the clinical effectiveness of custom-contoured wheelchair seating for individuals with neuromuscular disorders remains unclear. A scoping review was conducted using PubMed, Scopus, and Web of Knowledge databases in November 2021 and updated April 2022. A total of 17 full text articles were included. Discussion themes were grouped based on three outcomes of interest: (1) posture and musculoskeletal deformity, (2) quantitative measures of body structures and functions, and (3) qualitative perceptions, opinions, and quality of life indicators. This review highlighted the lack of literature exploring the impact of custom-contoured seating on cardiopulmonary function, pressure injury management, and upper limb function; although, there was no indication that risk is increased compared to alternative seating and it performed well in terms of perceived user satisfaction, comfort, and function. The findings also demonstrated immediate benefits to postural alignment, although, the longitudinal effect on progression of musculoskeletal deformity compared to alternative seating is more ambiguous. This review aimed to scope the evidence-base for custom-contoured seating for wheelchair users with neuromuscular disorders to synthesize information from the existing literature, inform current practice, and identify knowledge gaps for further experimental investigation.

Turkish validity and reliability of the level of sitting scale in children with cerebral palsy

BACKGROUND

The Level of Sitting Scale (LSS) is a valid and reliable classification index that categorizes sitting ability. The aim of this study is to establish the Turkish validity and reliability of the LSS in children with cerebral palsy (CP).

METHODS

In total, 165 children (75 girls and 90 boys) between the ages of 4 and 18 years who were diagnosed with CP were included in the study. All children were evaluated by two independent physiotherapists for the interrater reliability analysis of the LSS and were reevaluated 1 week later by the same physiotherapist for the intrarater reliability analysis. The Gross Motor Function Classification System (GMFCS) was used for validity analysis.

RESULTS

The intrarater reliability analyses of the LSS showed an intraclass correlation coefficient of 0.999 (ICC 95% CI [0.999-1]),and the interrater reliability analyses showed an intraclass correlation coefficient of 0.998 (ICC 95% CI [0.998-0.999]). A statistically significant, negative, and strong correlation was found between the GMFCS and the LSS (p < 0.001, r = -0.770).

DISCUSSION

The Turkish version of the LSS in children with CP is a valid and reliable scale. The Turkish LSS can be used by researchersand clinicians in research and to determine the sitting level of children with CP.

Deep brain stimulation effect in genetic dyskinetic cerebral palsy: The case of ADCY5- related disease

BACKGROUND

Cerebral Palsy (CP) represents a frequent cause of disability in childhood. Early in life, genetic disorders may present with motor dysfunction and diagnosed as CP. Establishing the primary, genetic etiology allows more accurate prognosis, genetic counselling, and planning for symptomatic interventions in homogeneous etiological groups. Deep brain stimulation (DBS) is recommended in refractory movement disorders, including isolated pediatric dystonias. For dystonia evolving in more complex associations in genetic CP, the effect of DBS is still understudied and currently only sporadically described.

OBJECTIVES

To report the effect of DBS applied to the globus pallidus pars interna (GPi) in children with complex movement disorders caused by pathogenic ADCY5 variants, diagnosed as dyskinetic CP previous to genetic diagnostic.

METHODS

We conducted a retrospective study on evolution of treatment with DBS in ADCY5-related disease. A standardized proforma including the different type of movement disorders and associated neurological signs was completed at each follow-up time, based on video recordings, as well as functional assessments used in children with CP.

RESULTS

Four children (mean of age, 13 ± 2.9 years) received GPi-DBS. The same de novo pathogenic missense variant (c.1252C > T, p.R418W) was identified in three out of four and a splice site variant (c.2088 + 2G > T) in one subject. Developmental delay and overlapping features including axial hypotonia, chorea, dystonic attacks, myoclonus, and cranial dyskinesia were present. The median age at DBS was 9 years and follow-up with DBS, 2.6 years. We identified a pattern of clinical response with early suppression of dystonic attacks, followed by improvement of myoclonus and facial dyskinesia. Effect on chorea was delayed and more limited. Two patients gained notable functional benefit related to sitting, standing, gait, use of upper limbs and speech.

CONCLUSION

ADCY5-related disease may benefit from GPi-DBS. The most significant clinical response relates to the early and sustained benefit on dystonic attacks and a variable but still positive response on the other hyperkinetic features. Genetic etiology of CP will contribute to further elucidate genotype-phenotype correlations and to refine DBS indication as network-related symptomatic interventions.

The Psychometric Properties of the Trunk Impairment Scale in Children with Cerebral Palsy

The Trunk Impairment Scale (TIS) measures static and dynamic seated trunk control in children with cerebral palsy (CP) who have postural control problems. Studies have investigated the reliability and validity of the TIS. However, the fitness and difficulty of the scale items have not been investigated. This study used Rasch analysis to test the construct validity of TIS for children with CP. TIS data were collected from 60 children with CP and analyzed for person and item fit, item difficulty, rating scale suitability, and separation reliability. Principal component analyses of residuals revealed that TIS had unidimensionality. Five misfit items (static sitting balance (SSB) items 2 and 3, dynamic sitting balance (DSB) items 4 and 5, and coordination (COO) item 3) were identified. DSB8 is the most difficult item, followed by DSB3 and COO4. On the other hand, the SSB3 item was found to be a relatively easy item. The rating scales demonstrated that out of the three subscales, SSB, DSB, and COO, only the SSB subscale did not meet the appropriate criteria. We demonstrated that statistical item analysis with the Rasch model could provide valuable information related to psychometric properties.

Paralytic dislocation of the hip in children

Despite the progress made in the past decades, hip disorders are one of the most common orthopedic problems in the context of paralysis. The etiology can be congenital (malformation such as myelomeningoceles, genetic neuromuscular disorders) or acquired (cerebral palsy, post-traumatic). In these conditions, the orthopedic deformities are minimal at birth. They can develop as the child grows, at different ages, depending on the etiology, severity of the neuromuscular disorder and functional potential. Hip subluxation and dislocation can compromise standing and walking capacities, but also the quality of the seated position and the personal care. Daily life activities and participation are restricted and influence the disabled person's quality of life. Paralytic dislocation of the hip is the orthopedic deformity that has be biggest impact on day-to-day life, general health and the overall orthopedic result in adulthood. Neuro-orthopedic care is challenging. However, there are basic principles that one must know to ensure good long-term quality of life in patients suffering from paralytic dislocations of the hip. When planning the treatment strategy, it is essential to take into consideration the day-to-day life and to integrate the patient's experiences and needs, along with those of their caretakers. The objective of this review is to outline the differences in paralytic dislocations of the hip of diverse etiology, to present evaluation principles useful in daily clinical practice and to help practitioners in choosing a treatment strategy.

Prevalence of the need for adaptive seating systems among children with cerebral palsy in Egypt

BACKGROUND

An adaptive seating system is a basic rehabilitation need for children and youth with cerebral palsy (CP) as it supports the structure and function of the musculoskeletal system and can positively affect their activities and participation. Despite the importance of adaptive seating systems, there is limited access to such systems in low-income countries.

OBJECTIVES

To determine the percentage of children and youth between 4 and 18 years of age with CP in Egypt whose activity level and sitting ability suggest the need for an adaptive seating system.

STUDY DESIGN

Observational cross-sectional study.

METHODS

One hundred ninety-three participants were included after fulfilling the criteria of the Surveillance of Cerebral Palsy of Europe. Their level of activity was assessed by a physical therapist using the Gross Motor Function Classification System (GMFCS), and their sitting ability was evaluated using the Level of Sitting Scale (LSS). Participants were considered to require an adaptive seating system if they scored GMFCS level IV or V and LSS level 1-5 concurrently.

RESULTS

Approximately 44% of the study participants were classified as GMFCS level IV or V and LSS level 1-5, suggesting that they were in need of an adaptive seating system.

CONCLUSIONS

There is a large percentage of children and youth with CP in Egypt who need an adaptive seating system to be integrated into their rehabilitation.

Effects of modified pilates on trunk, postural control, gait and balance in children with cerebral palsy: a single-blinded randomized controlled study

OBJECTIVE

This study aimed to determine the effects of modified pilates exercises (MPE) and neurodevelopmental therapy (NDT) on trunk, postural control, gait, and balance in children with cerebral palsy (CP).

METHODS

18 children with CP between gross motor function classification system (GMFCS) I and III were randomized into two groups as study (Group A, MPE) and control (Group B, NDT). Physiotherapy (PT) took place 2 days a week for 8 weeks. Trunk control measurement scale (TCMS), seated postural control measurement (SPCM), pediatric reach test (PRT), pediatric berg balance measurement (PBBM), 6 minute walking test (6MWT), observational gait scale (OGS), core stability performance measurements, and muscle strength tests were performed.

RESULTS

Mean age of group A (n = 9) was 9 ± 1.58 years, and group B (n = 9) was 10 ± 2.73 years. Significant differences were found in the SPCM posture (p = 0.000), TCMS (p = 0.004), OGS right (p = 0.019) and left (p = 0.001) scores, abdominal fatigue test (AFT) (p = 0.014), modified side bridge (MSBT) test (right p = 0.04, left p = 0.031), pressure biofeedback unit test (PBU) (p = 0.024), and sit-ups test (SUT) (p = 0.011) in favor of group A. According to the initial measurements of the percentage changes of the tests, significantly difference was found in PBBMR (p = 0.001), PBBML (p = 0.000), SPCM posture (0.001), TCMS (0.000), MBSTET (0.000), MSBT left (p = 0.034), AFT (p = 0.002), PBU (p = 0.015), SUT (p = 0.000), MPUT (p = 0.018), and OGS right (p = 0.029) in favor of group A.

CONCLUSION

The results revealed that MPEs in children with CP positively affects trunk, postural control, gait, and balance compared to NDT. It is concluded that MPE can be used as an alternative treatment approach in children with CP. TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION/STUDY START DATE/URL OF THE RECORD: NCT04035954/ 24/07/2019/ August 1, 2019/ https://clinicaltrials.gov/ct2/show/NCT04035954 .

Seated postural control measure: Italian translation and validation in children with cerebral palsy

BACKGROUND

Seating interventions are part of the postural management program recommended for children with Cerebral Palsy (CP) who are nonambulatory or have difficulty in walking. The lack of validated outcome measures for assessing seating interventions limits access to obtain valid and comparable data internationally.

OBJECTIVE

To translate the Seated Postural Control Measure (SPCM) into Italian and assess reliability and validity of the translated measure in a population of children with CP.

STUDY DESIGN

Cross-sectional and repeated measures study.

METHODS

The original version of the SPCM was translated and culturally adapted by a multidisciplinary team according to international guidelines. Internal consistency was examined with Cronbach's alpha. Both inter- and intrarater reliabilities were estimated using intraclass correlation coefficients with 95% confidence intervals. Intrarater reliability was estimated over a 1-week period. Convergent construct validity was investigated by comparing SPCM values with the Level of Sitting Scale, the Gross Motor Function Classification System, and the Manual Ability Classification System using Pearson's correlation coefficients.

RESULTS

The Italian version of the SPCM (IT-SPCM) was evaluated on 72 children with CP aged 4-18 years. Cronbach's alpha was 0.83, 0.95, and 0.93 for IT-SPCM alignment subscale, IT-SPCM functioning subscale, and total score, respectively. Reliability for IT-SPCM total score was high for both inter- and intrarater reliabilities (0.95 and 0.93). The IT-SPCM total score was moderately correlated with the Level of Sitting Scale (0.37), Gross Motor Function Classification System (-0.41), and Manual Ability Classification System (-0.56).

CONCLUSION

Preliminary evidence supports the reliability and validity of using IT-SPCM with a population of children with CP.

Exploring young children’s activity and participation change following 6 months’ power mobility experience

Introduction

This pre-post study explored the effect of children’s 6 months’ experience in one of four early power mobility devices.

Method

Satisfaction with parent-selected goal achievement was measured using the wheelchair outcome measure for young people and compared with the assessment of learning powered mobility use, as well as device expectation fulfilment ratings.

Results

Forty-six children with mobility limitations, aged 13–68 months (mean 40.40; SD 15.60) participated. The most common condition was cerebral palsy ( n = 33; 71.74%). The Wilcoxon signed rank test measured the positive change in goal achievement ( z = 4.90; P<0.001; r = 0.51). Fair to good statistically significant Spearman’s correlations were observed between power mobility skill and goal achievement, as well as parent and therapist device expectation scores ( rs = 0.48, 0.46 and 0.66, respectively; P<0.001). Parent and therapist ratings did not differ significantly. No statistically significant associations were found between goal achievement and child (age, diagnosis, abilities) or environmental factors (device, access method, loan length).

Conclusion

Children at all phases of power mobility skill, using various devices and access methods, can demonstrate activity and participation change following power mobility experience. This study adds validity evidence supporting the use of the wheelchair outcome measure for young people with young children by parent-proxy rating.

Exploring change in young children's power mobility skill following several months' experience

PURPOSE

To measure and compare progression in children's power mobility skill among process and task-based measures following a loan of one of four early power mobility devices. Additionally, to explore different power mobility learner groups and skill development trajectories.

METHODS

In this pre-post study, children were purposefully sampled and power mobility skill was measured from video taken pre-post several months' experience (mean 192.40; SD 42.79 days) using the Assessment of Learning Powered mobility use (ALP) and two task-based measures. Associations among power mobility skill measures were examined. Child and environmental factors influencing ALP phase at loan-end were explored.

RESULTS

Forty-six children aged 13 - 68 months (mean 40.40; SD 15.60) participated, with cerebral palsy being the most common condition (n = 33; 71.74%). ALP change scores ranged from -2 to +4 ALP phases (median 1.0). Wilcoxon signed rank test was significant for pre-post differences with a large effect size (z = 5.50, p < 0.001; r = 0.57). End-of-loan Spearman correlations between ALP and two task-based paediatric measures were excellent (r_s = 0.92). Kruskal-Wallis test revealed significant effect of device, access method, diagnostic group and communication abilities on loan-end ALP phase.

CONCLUSION

Positive change was demonstrated with most children (n = 39; 84.78%) changing at least one ALP phase during the study. Positive change was seen with children at all phases of tool-use, using all devices and access methods. Process and task-based measures were highly correlated, but differed in application for different learner groups. Different trajectories of skill development may be associated with different child profiles and access abilities.IMPLICATIONS FOR REHABILITATIONChildren at all phases of tool-use can demonstrate positive change in power mobility skill using different devices and switch as well as joystick access methodsThe Assessment of Learning Powered mobility use (ALP) is useful for assessing tool-use and learning process skills for young children across the power mobility skill continuum.Task-based measures may also be helpful for guiding training and recording progress; The Power Mobility Training Tool (PMTT) is most useful for children exploring cause-effect and direction (ALP Phases 1-5), while the Power Mobility Program (PMP) is most useful for functional learners and those progressing from exploring direction to functional use (ALP Phases 5-8).Access method may influence power mobility learning trajectory and training.

Beginning power mobility: parent and therapist perspectives

PURPOSE

To explore parent and therapist experiences of early power mobility following participation in a Power Mobility Day - a 60-90 min play-based session where children with mobility limitations (<6 years of age) experienced four different early power mobility devices.

METHOD

Participants were purposefully selected from parents and therapists who took part in Power Mobility Days as part of a larger cross-sectional study. One semi-structured interview with each participant was conducted via telephone. Interviews were audio-recorded, transcribed, and analyzed using a content analysis approach.

RESULTS

Of 35 adults approached, 11 parents and 11 occupational or physical therapists completed interviews averaging 20 min (range 10-45 min), one week to three months after the session. Participants were parents or therapists of children aged 12 to 48 months of age with a variety of neuromotor diagnoses from different areas of the province. The overarching theme Empowering Children and Families to Explore was developed from themes: Earlier Experiences; A Novel Introduction; and Moving Forward.

CONCLUSION

Power Mobility Days provided a welcoming and inclusive child- and family-led introduction to power mobility. This novel approach may help change both therapists' and families' perception of child potential and perspectives on power mobility as an intervention.IMPLICATIONS FOR REHABILITATION:Exploratory sessions can provide a novel introduction to power mobility interventions.Child enjoyment has a reciprocal impact on family engagement with early power mobility.Experiential child- and family-led learning can increase awareness of power mobility options and possibilities.

Beginning power mobility: An exploration of factors associated with child use of early power mobility devices and parent device preference

Objectives

Describe and compare young children's use of four early power mobility devices and examine associations between child and environmental factors that may influence power mobility use and parent device preference.

Design

Cross-sectional observational study.

Methods

Power Mobility Days introduced four devices: Wizzybug, Bugzi, Tiger Cub, and a switch-adapted ride-on toy car in a single 60-90 min, play-based session.

Results

A convenience sample of 74 children, aged 9-68 months (mean: 32.45, SD: 14.08) with mobility limitations, and their parents participated. Children had a range of motor, postural and communication profiles, with cerebral palsy being the most common condition (n = 55; 73.33%). Assessment of Learning Powered mobility use phase achieved ranged from 1 to 6; mean: 2.34; median: 2. For children who tried all four devices (n = 51), Friedman test (χ²: 8.27, p = 0.04) suggests Assessment of Learning Powered mobility use phase differs across devices. Of 73 parents who identified a device preference, 43 (59%) chose Wizzybug. Regression analyses suggest that access method and communication function may influence children's power mobility use, while age, access and postural support requirements may influence parent device choice.

Discussion

Parent impressions of an early power mobility device may be influenced by many factors, yet be less influenced by child performance.

Psychometric Properties of Segmental Assessment of Trunk Control in Infants and Toddlers With Down Syndrome

PURPOSE

This study investigated infants and toddlers with Down syndrome (DS) to determine: reliability of the Segmental Assessment of Trunk Control (SATCo), concurrent validity of the SATCo with the Gross Motor Function Measure (GMFM), and whether age and SATCo score predict GMFM score.

METHODS

Eighteen infants and toddlers with DS were tested on the SATCo by 2 physical therapist (PT) raters. One PT rater administered the GMFM. After 2 weeks, PT raters rescored their recorded SATCo sessions. A third PT rater also scored the SATCo videos.

RESULTS

Interrater reliability of the SATCo was moderate to good and intrarater reliability was good to excellent. The SATCo and the GMFM had good to excellent significant correlations. Age and SATCo score were significant predictors of the GMFM.

CONCLUSIONS

Trunk control appears to play a central role in gross motor function of infants and toddlers with DS. The SATCo has good psychometric properties in this population.

WHAT THIS ADDS TO THE EVIDENCE

This study contributes to the literature on the psychometric properties of the SATCo and supports its use to measure trunk control in infants and toddlers with DS between the ages of 6 and 24 months.

Development and Content Validity of the Clinical Assessment of Body Alignment for Children With Cerebral Palsy

PURPOSE

The purpose of this study is to describe the development and content validity of the clinical assessment of body alignment (CABA) to measure body alignment in children with cerebral palsy.

METHODS

Content validity and clinical utility were examined through expert opinion of 283 pediatric physical therapists. Participants reviewed items as matching or not to the domain of body alignment. Clinical utility was evaluated on a 5-point scale. Means and standard deviation were calculated for each attribute. Fleiss' kappa examined interrater reliability of expert responses.

RESULTS

Percentage agreement was high for 19 items and good for 1 item. Clinicians' ratings showed overall fair to good agreement. Four clinical utility attributes had a net importance score of more than 90%, although interrater reliability was low.

CONCLUSION

Content validity of the CABA was supported. Construct validity, reliability, and responsiveness require further study. What this adds to the evidence: The CABA has potential to offer clinicians and researchers a clinically practical measure of postural alignment for children with cerebral palsy. Preliminary investigation of CABA shows good content validity. However, more studies to assess the assessments' psychometrics including construct validity, reliability, and responsiveness are required.

Evaluation Tools for Assistive Technologies: A Scoping Review

OBJECTIVE

Assistive technologies (ATs) support independence and well-being in people with cognitive, perceptual, and physical limitations. Given the increasing availability and diversity of ATs, evaluating the usefulness of current and emerging ATs is crucial for informed comparison. We aimed to chart the landscape and development of AT evaluation tools (ETs; ATETs) across disparate fields in order to improve the process of AT evaluation and development.

DATA SOURCES

We performed a scoping review of ATETs through database searching of MEDLINE, Embase, CINAHL, HaPI, PsycINFO, Cochrane Reviews, and Compendex as well as citation mining.

STUDY SELECTION

Articles explicitly referencing ATETs were retained for screening. We included ETs if they were designed to specifically evaluate ATs.

DATA EXTRACTION

We extracted 5 attributes of ATETs: AT category, construct evaluated, conceptual frameworks, type of end user input used for ATET development, and presence of validity testing.

DATA SYNTHESIS

From screening 23,434 records, we included 159 ATETs. Specificity of tools ranged from single to general ATs across 40 AT categories. Satisfaction, functional performance, and usage were the most common constructs of 103 identified. We identified 34 conceptual frameworks across 53 ETs. Finally, 36% incorporated end user input and 80% showed validation testing.

CONCLUSIONS

We characterized a wide range of AT categories with diverse approaches to their evaluation based on varied conceptual frameworks. Combining these frameworks in future ATETs may provide more holistic views of AT usefulness. ATET selection may be improved with guidelines for conceptually reconciling results of disparate ATETs. Future ATET development may benefit from more integrated approaches to end user engagement.

Inter-intra observer reliability and validity of the Turkish version of Trunk Control Measurement Scale in children with cerebral palsy

Objective

The aim of this study was to demonstrate the inter and intra rater reliability and validity of the Turkish version of the Trunk Control Measurement Scale (TCMS) for children with CP.

Methods

Fifty children (21 girls and 29 boys; mean age 6.6 ± 2.3 years) with spastic, dyskinetic and ataxic types of CP were participated in the study. Children with Level I–II and III according to Gross Motor Function Classification System (GMFCS) were included into the study. All children were evaluated separately by two physiotherapists for interrater reliability and they re-evaluated for intra rater reliability. Gross Motor Function Measurement total score and B part were used for construct validity.

Results

The intraclass correlation coefficient (ICC) value of the inter-rater reliability for the Turkish TCMS was 95% CI (0.823–886), and the intra-rater reliability was 95% CI (0.986–0.992). The Spearman rank correlation coefficient between the Turkish TCMS and the Gross Motor Function Measure total score r: 0.827; p < 0.05 Part B was r: 0.863; p < 0.05.

Conclusion

The results of the study support that the Turkish TCMS has a high inter and intra rater reliability and validity similar to the original version. Thus, the Turkish TCMS appears to be a suitable evaluation tool to assess the qualitative performance of trunk control and sitting balance for children with CP and it gives opportunity to use clinically and research purposes.

Level of Evidence

Level III, Diagnostic Study.

Effects of adjustments to wheelchair seat to back support angle on head, neck, and shoulder postures in subjects with cerebral palsy

A wheelchair is usually a source of mobility for people with moderate to severe cerebral palsy, who are unable to walk. They spend long periods of time sitting in their wheelchair, which can affect their head and neck alignment. Opening the seat to back support angle of the wheelchair can modify realignment of body segments and improve posture. Aims: To examine the effect of seat to back support angle adjustments on head, neck, and shoulder postural alignment in people with cerebral palsy. Methods: Nine participants with cerebral palsy who use a wheelchair for mobility sat in a research wheelchair. Sagittal head angle (SHA), cervical angle (CVA), and shoulder angle (SA) from photographs were examined using the Coach's Eye device during three different seat to back support angles of the wheelchair (90°, 100°, 110°). Results: There were significant differences in mean SHA and CVA among the different seat to back support angles (p < .001). However, there was no significant difference in mean SA. Conclusion: Head (SHA) and (CVA) alignment was closest to neutral posture with seat to back support angles set at 110°. Thus, adjusting the wheelchair back support to a 110º would provide the most appropriate sagittal head and cervical angle for this population.

A study validating the Italian version of the Level of Sitting Scale in children with cerebral palsy

Objectives:

To assess measurement properties of the Italian version of the Level of Sitting Scale when classifying sitting ability of children with cerebral palsy.

Design:

Methodological study.

Setting:

Children’s hospital (inpatients and outpatients).

Subjects:

Children 18 years of age or younger with cerebral palsy.

Methods:

The original English version of the Level of Sitting Scale was translated and culturally adapted for the Italian culture following international guidelines. Examination of reliability and validity of the Italian Level of Sitting Scale was then undertaken. Inter-rater and one-week test–retest reliability were estimated using both intraclass correlation coefficients (ICCs) with 95% confidence intervals and Bland–Altman plots. Construct validity of the Italian Level of Sitting was evaluated using three approaches examining Pearson’s correlation coefficient ( r) and Mann–Whitney U test ( P-value < 0.05).

Main measures:

Italian Level of Sitting Scale and Gross Motor Function Classification System.

Results:

The Italian Level of Sitting Scale was administered to 109 subjects. Inter-rater reliability and one-week test–retest showed excellent value with ICCs of 0.99 for both. (1) The Pearson correlation coefficient comparing Italian Level of Sitting Scale with Gross Motor Function Classification System was −0.91 and (2) correlation with total amount of adaptive seating components was −0.90. Differences in sitting abilities and use/non-use of wheelchair were found. All reported a statistical significance of P < 0.01.

Conclusion:

Our findings provide evidence of reliability and validity when using the Italian Level of Sitting Scale to classify seated postural abilities in a sample of Italian children with cerebral palsy.

The effect of spinal bracing on sitting function in children with neuromuscular scoliosis

BACKGROUND:

Scoliosis is common in children with neuromuscular deficits. It is often associated with an asymmetric sitting position and with poor balance. Many children with neuromuscular scoliosis spend most of their day sitting.

OBJECTIVES:

To describe how sitting function is affected by treatment with a modified custom-moulded Boston brace in children with neuromuscular scoliosis.

STUDY DESIGN:

Retrospective review of medical records.

METHODS:

A review of medical records from children fitted with scoliosis braces, including analysis of sitting, using a pressure-mapping system.

RESULTS:

A total of 106 children with a median age of 11.3 (1.7-17.7) years were included. The most frequent diagnoses were cerebral palsy ( n = 33) and myelomeningocele ( n = 17). Around 56 children could sit without support and 24 children were independent walkers. The Cobb angle was between 19° and 126°. Sitting function as noted in medical records improved in 73/105 children and deteriorated in five. The pressure mapping showed that symmetry was improved in 44/86 children, while three deteriorated. Stability improved in 20/40 children and seven decreased.

CONCLUSION:

Bracing had a positive effect on sitting function in children with neuromuscular scoliosis.

CLINICAL RELEVANCE

Bracing can reduce the need for support in sitting. Children with severe scoliosis can get a better sitting function with a brace. Sitting analysis with pressure mapping can identify sitting problems needing correction of the brace and adaptations of the chair.

A Multidisciplinary Approach to Equipment Use in Pediatric Patient Mobilization

Research has shown that patients who are mechanically ventilated or immobile for greater than 7 days are at increased risk for deconditioning and muscle atrophy. Immobility impacts length of stay as well as patients' ability to return to their prior level of function. As part of the safe patient-handling initiative created at Michigan Medicine, a special team of nurses and therapists was assembled to adapt an adult mobility framework for the pediatric population. The pediatric mobility model determines each patient's specific mobility "phase" based on detailed criteria. Clinical staff can then implement strategies aimed at preventing deconditioning and hospital-acquired weakness. At C.S. Mott Children's Hospital, a multidisciplinary team is available to support this pediatric mobility model. Specific equipment utilized during the different phases of mobility has been reviewed and discussed in this article.

Effects of different seating equipment on postural control and upper extremity function in children with cerebral palsy

BACKGROUND

Adaptive seating supports for cerebral palsy are recommended to develop and maintain optimum posture, and functional use of upper extremities.

OBJECTIVES

To compare the effectiveness of different seating adaptations regarding postural alignment and related functions and to investigate the effects of these seating adaptations on different motor levels.

STUDY DESIGN

Prospective study.

METHODS

A total of 20 children with spastic cerebral palsy (Gross Motor Function Classification System 3-5) were included. Postural control and function (Seated Postural Control Measure, Sitting Assessment Scale) were measured in three different systems: standard chair, adjustable seating system and custom-made orthosis.

RESULTS

In results of all participants ungrouped, there was a significant difference in most parameters of both measurement tools in favor of custom-made orthosis and adjustable seating system when compared to standard chair ( p < 0.0017). There was a difference among interventions in most of the Seated Postural Control Measure results in Level 4 when subjects were grouped according to Gross Motor Function Classification System levels. A difference was observed between standard chair and adjustable seating system in foot control, arm control, and total Sitting Assessment Scale scores; and between standard chair and custom-made orthosis in trunk control, arm control, and total Sitting Assessment Scale score in Level 4. There was no difference in adjustable seating system and custom-made orthosis in Sitting Assessment Scale in this group of children ( p < 0.017).

CONCLUSION

Although custom-made orthosis fabrication is time consuming, it is still recommended since it is custom made, easy to use, and low-cost. On the other hand, the adjustable seating system can be modified according to a patient's height and weight. Clinical relevance It was found that Gross Motor Function Classification System Level 4 children benefitted most from the seating support systems. It was presented that standard chair is sufficient in providing postural alignment. Both custom-made orthosis and adjustable seating system have pros and cons and the best solution for each will be dependent on a number of factors.

The International Classification of Functioning, Disability and Health provides a Model for Adaptive Seating Interventions for Children with Cerebral Palsy

Children with severe types of cerebral palsy use adaptive seating systems to encourage function and assist in delaying the development of deformity. These systems are often assessed for and provided by occupational therapists. However, there has been no unifying policy or theoretical basis on which these systems are provided and research evidence is lacking, with studies tending to be small and non-controlled.

The International Classification of Functioning, Disability and Health (World Health Organisation 2001a,b) aims to establish a common language for clinical practice as well as research, while bringing together the opposing social and medical models of health care delivery. This paper suggests that the ICF model is an ideal theoretical basis for adaptive seating system assessment and provision, given that these systems often conflict between the medical model of reducing or delaying impairment of body functions and structures and the social model of children and families accessing life and environmental situations through mobility and seating equipment.

The paper considers all the domains of the ICF with regard to the current literature. It concludes that using the model in the context of providing adaptive seating gives occupational therapists both a powerful tool for communicating with children and families as well as managers and a basis for evaluating practice.

Association between gross motor function and postural control in sitting in children with Cerebral Palsy: a correlational study in Spain

Background

Cerebral palsy (CP) is one of the causes of physical disability in children. Sitting abilities can be described using the Level of Sitting Scale (LSS) and the Gross Motor Function Classification System (GMFCS). There is growing interest in the sitting posture of children with CP owing to a stable sitting position allows for the development of eye-hand coordination, functions of the upper extremities and functional skills. Besides, in recent years researchers have tried to develop a new terminology to classify the CP as performed by the Surveillance of Cerebral Palsy in Europe (SCPE), in order to improve the monitoring of the frequency of the PC, providing a framework for research and service planning. The aim of this study was to analyse the relationship between GMFCS and LSS. The second purpose was to describe how the SCPE relates to sitting abilities with the GMFCS and LSS.

Methods

The study involved 139 children with CP (range 3–18 years) from 24 educational centres. Age, gender, CP classification according to SCPE, GMFCS and LSS levels were recorded by an experienced physiotherapist.

Results

A significant inverse relationship between GMFCS and LSS score levels was found (r_s = −0.86, p = 0.00). 45.3 % of the children capable of leaning in any direction and of re-erecting the trunk (level VIII on the LSS) could walk without limitation (level I on the GMFCS). There were differences in the distribution of the GMFCS (χ²(4):50.78) and LSS (χ²(7): 37.15) levels and CP according to the distribution of the spasticity (p <0.01).

Conclusions

There was a negative correlation between both scales and a relation between sitting ability and the capacity to walk with or without technical devices. GMFCS and the LSS are useful tools for describing the functional abilities and limitations of children with CP, specially sitting and mobility. Classification based on the distribution of spasticity and the gross motor function provides clinical information on the prognosis and development of children with CP.

Segmental Contributions to Trunk Control in Children With Moderate-to-Severe Cerebral Palsy

OBJECTIVE

To examine postural constraints in children with moderate-to-severe cerebral palsy (CP) using a segmental approach.

DESIGN

Quasi-experimental repeated-measures study; case series.

SETTING

Motor control research laboratory.

PARTICIPANTS

Children (N=15; age range, 4-16y) with moderate (Gross Motor Function Classification System [GMFCS] IV; n=8; 4 boys) or severe (GMFCS V) (n=7; 4 boys) CP.

INTERVENTIONS

Each child participated in 3 data collection sessions. During each session, we evaluated postural control for sitting using kinematics and clinical assessments.

MAIN OUTCOME MEASURES

Kinematic data were used to document head alignment and stabilization with external support at 4 levels (axillae, midrib, waist, hip). Two clinical assessments, the Segmental Assessment of Trunk Control and behavioral assessment for stage of trunk control, were also used to compare results for children with CP to previous longitudinal data from typically developing (TD) infants (3-9mo of age).

RESULTS

Children with GMFCS V had difficulty aligning and stabilizing their head along the medial-lateral and anterior-posterior axes. External support improved postural control for children with GMFCS V but not for those classified as GMFCS IV, who had opposite responses to support compared with TD infants.

CONCLUSIONS

Children with GMFCS V have limited trunk control but respond to support similarly to young TD infants, suggesting delayed postural control. Response to external support for children with GMFCS IV suggests a unique strategy for trunk control not observed in typical infants. Overall a segmental approach offers new insights into development of trunk control in children with moderate-to-severe CP.

Clinimetric properties of sitting balance measures for children with cerebral palsy: a systematic review

Assessment of sitting balance in children and youth with cerebral palsy (CP) is critical in order to design appropriate interventions to enhance activities and participation. This systematic review synthesized research evidence on the reliability, validity, responsiveness to change, and clinical utility of sitting balance measures for children and youth with CP. A two-tiered search in August 2012 using nine peer-reviewed electronic databases yielded nine articles with relevant information on seven clinical measures. Four of seven clinical measures: the Pediatric Reach Test (PRT), Sitting Assessment for Children with Neuromotor Dysfunction (SACND), Segmental Assessment of Trunk Control (SATCo), and Trunk Control Measurement Scale (TCMS), demonstrate acceptable overall applicability (at least one study supporting clinical utility, reliability, and validity) and are thus recommended for use in practice. Ongoing research on responsiveness to change, however, is warranted to support validity for outcomes measurement.

Reliability and validity of the Korean version of the trunk control measurement scale (TCMS-K) for children with cerebral palsy

The Trunk Control Measurement Scale (TCMS) was developed by Lieve Heyrman in 2011 to evaluate the clinical features of impaired trunk control ability in patients with cerebral palsy (CP). This study aimed to demonstrate the reliability and validity of the Korean version of the Trunk Control Measurement Scale (TCMS-K) for children with CP. Fifty children with spastic CP (mean age 9.08±3.75) participated in the study. They were classified using the Gross Motor Function Classification System and the Manual Ability Classification System. The intraclass correlation coefficient (ICC) value of the inter-rater reliability for the TCMS-K was .987-.998, and the intra-rater reliability was .947-.996. The Spearman rank correlation coefficient between the TCMS-K and the Gross Motor Function Measure-B dimension was .860. The results of the study support that the TCMS-K has a high reliability and validity, which is similar to the original version. Thus, the TCMS-K is a suitable evaluation tool to assess the qualitative performance of trunk control and sitting balance for children with CP, and we expect that it will be a very useful tool for clinicians and researchers.

Clinical tools to assess balance in children and adults with cerebral palsy: a systematic review

We aimed to review tools used to assess balance in clinical practice in children and adults with cerebral palsy (CP), to describe their content and measurement properties and to evaluate the quality of the studies that have examined these properties. CINAHL, Embase, and PubMed/MEDLINE were searched. The COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) was used to assess the 'quality of studies' and the Terwee criteria were used to assess the 'result of studies'. Twenty-two clinical balance tools were identified from 35 papers. The content and focus of the tools varied significantly. There was moderate or limited levels of evidence for most of the measurement properties of the tools; the strongest level of evidence was found for the Trunk Control Measurement Scale and the Level of Sitting Scale, in the category 'maintain balance', the Timed Up and Go and the Segmental Assessment of Trunk Control in the categories 'achieve balance' and 'restore balance' respectively. Information on responsiveness was scarce. Further studies providing better evidence for reliability and responsiveness for clinical balance tools are needed. In the meantime, results of studies evaluating effects of treatment of balance in individuals with CP should be interpreted with caution.

Clinical tools that measure sitting posture, seated postural control or functional abilities in children with motor impairments: a systematic review

OBJECTIVE

To identify and critically appraise clinical measurement tools used to assess sitting posture, seated postural control or functional abilities for children with motor impairment who are candidates for seating interventions.

DATA SOURCES

Searches were run in 15 electronic databases along with hand searching. The search included articles published in English to December 2011.

REVIEW METHODS

Key terms included: posture, sitting, sitting posture, seated posture, seated postural control, sitting position, seating, wheelchair(s), outcome and assess(ment). The PRISMA statement was followed with inclusion criteria set a priori. Two reviewers independently screened titles, reviewed abstracts and identified full-text articles that met criteria. Data extraction included tool description and clinical utility. Two quality-rating scales were used to evaluate conduct of the studies and psychometric properties of the tools.

RESULTS

Of the 497 titles found in the search, 29 full-text articles met the inclusion criteria and 19 tools were identified. Tools represented all components of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), with emphasis on body structure and function and activity components. Evidence supporting reliability and validity varied, with small sample sizes influencing quality ratings. Evidence of the tools' reliability was more prevalent than evidence of the tools' validity. Only four tools reported on responsiveness, an important consideration for evaluating change. Little information on clinical utility was provided.

CONCLUSION

Although a number of tools are available, evidence supporting their use for seating interventions is limited, as is the evidence supporting the strength of their measurement properties. Few tools address participation, environmental factors or the child's and family's perspective.

Clinical characteristics of impaired trunk control in children with spastic cerebral palsy

This study aimed to identify clinical characteristics of impaired trunk control in hundred children with spastic CP (mean age 11.4 ± 2.1 years, range 8-15 years). Assessment of trunk control was performed with the Trunk Control Measurement Scale (TCMS). Trunk control was clearly impaired, indicated by a median total TCMS score of 38.5 out of 58 (66%). Median subscale scores were 18 out of 20 (90%) for the subscale static sitting balance, 16 out of 28 (57%) for the subscale selective movement control and 6 out of 10 (60%) for the subscale dynamic reaching. Total TCMS and subscale scores differed significantly between topographies and severity of motor impairment according to the Gross Motor Function Classification System (GMFCS). Children with hemiplegia obtained the highest scores, followed by children with diplegia and children with quadriplegia obtained the lowest scores. TCMS scores significantly decreased with increasing GMFCS level. In conclusion, trunk control is impaired in children with CP to a various extent, depending on the topography and severity of the motor impairment. The findings of this study also provide specific clues for treatment interventions targeting trunk control to improve their functional abilities.

Validation of the relation between the type and amount of seating support provided and Level of Sitting Scale (LSS) scores for children with neuromotor disorders

OBJECTIVES

To assess the construct validity of the Level of Sitting Scale (LSS) by examining the relationship between LSS scores and the type and amount of seating supports.

METHODS

Secondary analysis of the data for 114 children ≤18 years, with neuromotor disorders who participated in a responsiveness study of the Seated Postural Control Measure.

RESULTS

A significant inverse relationship (Spearman rho = -0.42, p < 0.05) was found between LSS scores and amount of seating support provided. Statistically significant differences were also revealed between LSS levels of sitting ability (p < 0.004) and pelvic, thigh, trunk and head seating components and type of seating system, using Kruskal-Wallis test.

CONCLUSION

This study provides evidence of construct validity for the LSS in use as a discriminative measure of sitting ability in children with neuromotor disorders. Further validation is justified. Clinically intuitive associations between sitting ability and seating interventions were confirmed.

A clinical tool to measure trunk control in children with cerebral palsy: the Trunk Control Measurement Scale

In this study the psychometric properties of the Trunk Control Measurement Scale (TCMS) in children with cerebral palsy (CP) were examined. Twenty-six children with spastic CP (mean age 11 years 3 months, range 8-15 years; Gross Motor Function Classification System level I n = 11, level II n = 5, level III n = 10) were included in this study. To determine the discriminant ability of the TCMS, 30 typically developing (TD) children (mean age 10 years 6 months, range 8-15 years) were also included. For inter-rater reliability, two testers scored all children simultaneously. To determine test-retest reliability, participants were reassessed on a second test occasion. For construct validity, the Gross Motor Function Measure (GMFM) was administered. Intraclass correlation coefficients (ICC) ranged from 0.91 to 0.99 for inter-rater and test-retest reliability. Kappa and weighted kappa values ranged for all but one item from 0.45 to 1. The standard error of measurement was 2.9% and 3.4%, and the smallest detectable difference for repeated measurements was 8% and 9.43% between raters and test-retest, respectively. Cronbach's alpha coefficients ranged from 0.82 to 0.94. Spearman rank correlation with the GMFM was 0.88 and increasing coefficients were found from dimension B to E. Subscale and total TCMS scores showed significant differences between children with CP and TD children (p < 0.0001). The results support the reliability and validity of the TCMS in children with spastic CP. The scale gives insight into the strengths and weaknesses of the child's trunk performance and therefore can have valuable clinical use.

Intra- and inter-observer reliability of the Trunk Impairment Scale for children with cerebral palsy

Standardized scales to evaluate qualities of trunk movements in children with dysfunction are sparse. An examination of the reliability of scales that may be useful in the clinic is important. The aim of this study was to examine the reliability of the Trunk Impairment Scale (TIS) for children with cerebral palsy (CP). Standardized scales are useful for treatment planning and evaluation. This was an intra- and inter-observer reliability study. Video recordings of 25 children, 20 with CP and 5 with no motor impairment, in the age group 5-12 years of age, were analyzed by three observers on two occasions. Intraclass correlation coefficients (ICC [1,1] and [3,1]) with 95% confidence intervals, standard error of measurement, kappa values and percent agreement, and Bland-Altman Plots were calculated. The relative reliability (intra- and inter-observer reliability) was very high for the total score and subscale score of the TIS: ICC [1,1] and [3,1] varied between .94 and 1.00. Kappa values for the items ranged from .45 to 1.00. The absolute reliability values for the parameters are reported. The Bland-Altman analysis showed consistency of scores. This study indicates that TIS is a reliable measure of trunk control for children, 5-12 years of age, with CP.

Refinement, reliability, and validity of the segmental assessment of trunk control

PURPOSE

The Segmental Assessment of Trunk Control (SATCo) provides a systematic method of assessing discrete levels of trunk control in children with motor disabilities. This study refined the assessment method and examined reliability and validity of the SATCo.

METHODS

After refining guidelines, 102 video recordings of the SATCo were made of 8 infants with typical development followed longitudinally from 3 to 9 months of age and 24 children with neuromotor disability with a mean age of 10 years 4 months. Eight researchers independently scored recordings.

RESULTS

Intraclass correlation coefficient values for interrater reliability were more than 0.84 and 0.98 across all data sets and all aspects of control. Tests of concurrent validity with the Alberta Infant Motor Scales resulted in coefficients ranging from 0.86 to 0.88.

CONCLUSION

The SATCo is a reliable and valid measure allowing clinicians greater specificity in assessing trunk control.

Longitudinal study evaluating a seating system using a sacral pad and kneeblock for children with cerebral palsy

PURPOSE

Adaptive seating systems using sacral pads and kneeblocks are commonly used throughout the UK with children with complex motor disorders to improve their posture and stability in sitting. We sought to evaluate how effective these systems are for a group of children with cerebral palsy.

METHOD

A six-visit trial was performed to examine whether this combination controls pelvic and hip positioning. Twenty-three children with cerebral palsy aged 7 - 14 years participated (11 females and 12 males). The kneeblocks (active intervention) were removed for a period in the middle of the trial. Force exerted through the kneeblock, pressure exerted on the sacral pad and postural alignment was measured for change.

RESULTS

Statistically significant differences before and after kneeblock removal were found for force at the kneeblock, but no difference was found in pressure at the sacral pad. No statistically significant correlations between force and pressure or posture were found.

CONCLUSION

The results indicate that seating systems using a sacral pad and kneeblock may not improve overall posture but may improve hip position in children with cerebral palsy.

Reliability of the seated postural control measure for adult wheelchair users

PURPOSE

To evaluate the test-retest and interrater reliability of the Seated Postural Control Measure for Adults 1.0 (SPCMA 1.0).

METHOD

The participants were evaluated first by two raters and then, 3 weeks later, by one rater. Section 1 (one item, seven-point scale) evaluates the adult's overall ability to control its posture in a sitting position. Sections 2 and 3 (22 items each, scored on a seven-point scale), evaluate the adult's postural alignment in a static position and the changes in postural alignment induced by a dynamic activity.

RESULTS

For the test-retest reliability, the intraclass correlation coefficient (ICC) of section 1 was excellent (0.95) and moderate to good for sections 2 and 3 (0.60 - 0.62) and their subsections (0.47 - 0.78). For interrater reliability, the three sections had good to excellent ICCs (0.68 - 0.93) and their subsections had moderate to good ICCs (0.41 - 0.69). A large range was observed in Kappa coefficients (test-retest and interrater reliability) for the item analysis of the sections 2 and 3, due to a lack of variability in some items.

CONCLUSIONS

The results confirm that the SPCMA is reliable as a whole. Suitable information has been obtained for the development of the SPCMA 2.0 and, although further psychometric testing is needed, the latter should improve clinical evaluation of seated postural control in adult wheelchair users.